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Inside the January 2019 STAR Kids Managed Care Advisory Committee Meeting

By Heather Kennedy posted Jan 21,2019 05:35 PM

  

Dear Members,

Last week, I attended the STAR Kids Managed Care Advisory Committee meeting at HHSC. Here were the key points of discussion:

Proposed Changes to the SK-SAI

As described in HHSC’s recent report on STAR Kids, researchers at Texas A&M University (TAMU) have made recommendations for improvement to the STAR Kids Screening and Assessment Instrument (SK-SAI). HHSC’s goals for these changes are: to optimize the tool using the current version as the foundation and create an updated version (3.0), making the “triggers” within the tool and the wording of the questions more effective at identifying client needs for services.  Clinical and policy staff created additional goals based on feedback from the STAR Kids Advisory Committee and the results of the TAMU report, including improving data integrity, field validations intended to reduce redundant entries, and improving the overall quality of the data to make queries and reports more accurate, reducing the need for MCOs to enter so many corrections into the system. The SK-SAI is lengthy and the Commission’s plan is to reduce the length without losing the effectiveness of the tool, developing a more person-centered plan via the SK-SAI while reducing assessor error potential. A summary of proposed changes to the SK-SAI will be provided to the Advisory Committee for review, with an opportunity for stakeholder feedback and comments.

Results in the Quarterly Therapy Access Monitoring Report

HHSC staff provided the committee with an overview of the Quarterly Therapy Access Monitoring Report, which was also commented on by TAHC&H member providers during the public comment portion of the meeting.  Of note was the disturbing finding that only 4 of 19 managed care organizations (MCOs) provided waiting list data for these services to HHSC for this report, and most of this data (86%) came from a single provider in Houston. HHSC staff agreed that these results are thus not likely to be complete or generalizable across the state’s client population. Staff is working on gathering additional data on this topic.

Also of considerable concern was the overall trend in the data showing that therapy utilization for all types has decreased, but a trend unique to STAR Kids was especially concerning: a decrease was observed from June to Sept 2017 coinciding with the end of the continuity of care period for kids transferred into managed care from traditional (FFS) Medicaid.

HHSC has asked the MCOs for prior authorization data on these services in an attempt to try to understand this decrease, and will report back to the Advisory Committee on this issue after further analysis is completed.

State staff acknowledged that home health agency therapy provider numbers have not rebounded, remaining flat since ACA re-enrollment activities began. The data shows a 20% decrease in the number of active therapy providers from SFY 2016 to SFY 2017. MCOs reported 17% contract terminations with no additional explanation of the reasons for the terminations, reporting only 2% were due to reduced reimbursement rates. 

HHSC staff acknowledged that the effect of the rate cuts to reimbursement for therapy assistants will not be apparent until April 2019, due to the 8 month lag required to collect enough claims data for analysis.

The Commission’s next report on therapy access is due in March 2019.

Remarks on the SK-SAIs for MDCP Kids

Committee members expressed concerns about the increase in MDCP waiver eligibility denial rates since the transition of the program recipients to managed care. One member made a recommendation that the state return to using the Medical Necessity and Level of Care assessment (MNLOC) for these clients, making the ISP an actionable, living document, with assessments modified to better suit clients with complex needs that change quickly in response to interventions (or just change quickly, in general). One committee member stated that she feels the state should consider offering MDCP children access to another waiver.

Concerns about MCOs making decisions contrary to the recommendations of pediatricians were raised, and committee members directed staff to work on ways to improve notification to families of appeal processes and their rights when services are denied.

HHSC staff estimates that there are between 12,000 - 18,000 people currently on the MDCP interest list but note that only a small number of these people will qualify for the waiver once they are assessed.

The Committee will meet again on April 17, 2019. TAHC&H staff will continue to follow these issues, providing updates to you as we have more information. Please send any questions you may have on these notes to heather@tahch.org.

Thank you!

 

 

 

 

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