Dear Members,
The latest report on the transition of the Medically Dependent Children Program (MDCP) waiver recipients into the STAR Kids program has been released by the Health and Human Services Commission (HHSC). The purpose of this annual report is to evaluate the effect of moving these clients into a capitated managed care arrangement. STAR Kids was implemented statewide in November 2016 to serve Medicaid clients with disabilities aged 20 and younger as a result of S.B. 7, 83rd Legislature, Regular Session 2013, which directed HHSC to implement cost-savings measures for the provision of services while improving the quality of service delivery. HHSC transitioned MDCP waiver recipients into the STAR Kids program in 2017.
In STAR Kids, managed care organizations (MCOs) complete the STAR Kids Screening and Assessment Instrument (SK-SAI) to assess the service needs of these clients following a determination of medical necessity done by the Texas Medicaid and Healthcare Partnership (TMHP); prior to their transition to managed care, assessments for services and determinations of medical necessity were performed by Department of Aging and Disability Services (DADS) nurses/case workers using the Medical Necessity and Level of Care (MN/LOC) assessment.
HHSC notes that this difference in assessment tools makes a comparison of current MDCP STAR Kids program data to historical DADS data difficult, suggesting it may be too soon to tell whether the transition of these clients into managed care has yet achieved the results intended by HHSC and S.B. 7.
Of particular interest in this report:
- Denial of medical necessity for MDCP recipients increased from 3.1% in fiscal year (FY) 2016 to 14.3% in FY 2017, falling to 8.3% by FY 2018. HHSC cites differences in past and present methodology between DADS and the STAR Kids program in calculating these rates, also noting some effect of having extended ISPs for MDCP members during their initial transition into managed care.
- Recommendations by Texas A & M University (TAMU) that the SK-SAI could be revised to improve its functionality as a tool for evaluating the needs of STAR Kids/MDCP clients. HHSC is currently evaluating the recommendations made by TAMU, which are described in the TAMU Optimizing the STAR Kids Screening and Assessment Instrument Final Report, and include:
- clarification of Community First Choice items,
- updating training materials on the SK-SAI,
- improving communication about the SK-SAI through public outreach and additional health plan training, and
- improved service coordination opportunities via discussions of the SK-SAI with care givers prior to assessment/reassessment of the client.
- HHSC has noted a decrease in utilization of therapy services among STAR Kids clients in FY 2017, which they believe coincides with the end of continuity of care provisions for children moved into the program from traditional Medicaid, though they indicate that utilization rates for these services stabilized between September 2017 and March 2018.
HHSC is currently working with their External Quality Review Organization to evaluate the post-implementation quality data for the STAR Kids program; a final report on these measures will be given in May 2019.
Thank you,