Dear Members,
On January 22, TAHC&H staff attended the quarterly meeting of the HHSC STAR Kids Stakeholder Workgroup. The group discussed many of the same issues raised during the STAR Kids Managed Care Advisory Committee meeting earlier this month, including:
HHSC’s Pay for Quality Initiative
HHSC’s Denbigh Shelton presented the Commission’s proposed Pay for Quality Program measures for the STAR Kids program, explaining that 3% of the MCO’s capitation will be at risk for recoupment if these requirements are not met.
One workgroup participant and MDCP mom noted that the sample of people (300 STAR Kids members per MCO) asked to respond to these quality surveys about the MCO’s performance is too small to be representative of the MDCP population within STAR Kids. This parent stated that HHSC should survey 300 of the 5600 MDCP members in STAR Kids to get a true picture of the quality with which these members are being served.
Another parent and advocate participating in the workgroup expressed concerns that these proposed measures are not appropriate for medically fragile children in STAR Kids, and may be more suitable for other STAR Kids members. The state agrees that they have noticed gaps in the standardized measures, and that there are not always ideal measures for children with very complex conditions. One provider and TAHC&H member on the call questioned why the group is even considering measures that don’t address these kids’ needs, planning to implement the measures when they won’t give valid information on medically fragile kids. HHSC argues that these measures are suitable for use with the overall STAR Kids population, and while they acknowledge that there are gaps related to the medically fragile population, they are working to address those with better measures if possible.
STAR Kids will be added to this program in CY 2020, and MCOs will be held accountable using a set of quality measures HHSC has selected from several based on state and federal criteria. HHSC would like stakeholder feedback on these measures by Jan 31, 2019. Please send your comments to Phyllis Matthews at Phyllis.Matthews02@hhsc.state.tx.us referencing SK Stakeholder Workgroup P4Q Input in your email subject line.
Preferred Provider Agreements
Some of the workgroup members expressed concerns that preferred provider agreements may result in exclusionary arrangements that would keep members from seeking care from other providers. One member who runs a weekly advocacy call with parents and providers reported that several providers in their area have quit serving STAR Kids member due to non-payment of their claims, and many parents on this call say that the first question they ask when they call a therapist looking for care for their children is, “Do you still see STAR Kids?”
Access to Care, Therapy Wait Lists
One of the workgroup members advised that HHSC should review the SK-SAI data for the numbers as to who qualifies for services in comparison to how many children are actually receiving services to gain a more accurate understanding of current access to care issues.
Provider therapy wait lists are a serious issue; one parent of an MDCP child in STAR Kids reported that some providers won’t even keep a waiting list because they feel it reflects badly upon them. Accurate numbers of kids waiting for therapy aren’t reflected as a result of this.
Access to therapy continues to be an ongoing concern, as indicated in the HHSC Quarterly Therapy Access Report issued in December 2018. 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. State staff is working on gathering additional data on this topic.
Also of considerable concern was the trend in the utilization data showing that therapy utilization for all types has decreased, but uniquely in STAR Kids a decrease was observed from June to Sept 2017 coinciding with the end of the continuity of care period for kids transferred into SK from FFS.
HHSC has asked the MCOs for PA data on these services in an attempt to try to understand this decrease, as well.
The state will issue its next report in March 2019. Phyllis Matthews will provide updates to the workgroup as they become available, prior to the next report in March. HHSC has asked for provider feedback on these topics; please send your comments to Phyllis Matthews at Phyllis.Matthews02@hhsc.state.tx.us referencing SK Stakeholder Workgroup Therapy Access in the subject line of your message.
Workgroup Feedback Requested
Jonathan Wilman, Dennis Hosley, and Kristen Robison have offered to work together to collect feedback on all topics of concern from this workgroup as requested by Phyllis, with the agreement that HHSC will facilitate a meeting with their leadership to address each of the unresolved issues on the workgroup’s agenda.
If you have concerns related to STAR Kids that you wish to share with the workgroup, please post them in response to this article, send them to heather@tahch.org, or email them directly to Jonathan, Dennis or Kristen. To sign up to participate in the workgroup in person or by conference call, contact Phyllis Matthews at Phyllis.Matthews02@hhsc.state.tx.us.
Thank you.