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Below is the HillCo client report from the June 2 STAR KIDS Advisory Council Meeting.

Recommendations from The Children’s Policy Council   

  • Created in the 76th Legislative Session
  • Reports every 2 years to the Legislature
  • Recommendations for draft RFP:
    • Service Coordination
      • Help navigate the Medicaid system
      • Provide support system for families
      • Correlated caseloads with level of service coordination needed
      • Form service coordination teams
    • Patient Centered Health Home
    • Medical transition from child to adult services
      • Transition plan
    • Private insurance coordination
    • Outreach and education
    • Adequate provider network
      • Full range of services available
      • Continuity of care
      • Directory of all medical specialists in network for parents
    • Development of a standardized comprehensive assessment tool
      • For all ages, based on strengths
      • Family input team approach
      • Gather, analyze and store data
    • Streamline the PA process
    • Oversight and accountability
      • Contract compliance and monitoring
      • Believes that it should be don’t externally, not by the MCOs or HHSC
  • Gary Jessee – it would be helpful to know what the MCO standards already are for the group
    • Single case agreements are a last resort, MCO goal is to have a provider with open panels
    • Many protections for families regarding out of network providers
    • Prior authorization is the one topic HHSC hears the most about – there is hope in creating a standard PA form but does not know if all MCOs will have a standard PA process at the end of the day
    • MCOs have very limited timeframes in approving a procedure
    • There is a desire that has been expressed to have an independent assessor and service coordinator
      • As we craft the STAR KIDS, we will focus on making it as comprehensive as possible so that at the end of the day, who does the assessment might not be as important as you think

 
General discussion

  • Need to create more incentive a to have a service coordination approach for behavioral health and physical health in the medical home
  • Would like to see every big city in the state have a comprehensive care clinic
  • Seems like areas of Texas are siloed and are not talking together
  • Gary Jessee – if a system is already working for a family it doesn’t make sense to change it – the MCOs will be interested in looking at all aspects of care, and one size won’t fit all
    • Need to be clear on how capitation works, and how the MCO’s work to continue an open dialogue in the group to debunk myths and clarify operating procedures
  • Maybe there are some federal funds that can be utilized to expand medical homes and comprehensive care?

 
Discussion on STAR KID Screening and Assessment

  • HHSC vision:
    • Dr. Phillips and a team from A&M developed the Personal Care Assessment Form (PCAF) that HHSC currently uses is in the audience and will be meeting with HHSC over the next few days
    • Assessment instrument – the one screening that all STAR KIDS will receive
    • Assessment Process – the whole universe of screenings that the patients might receive
    • Intake telephonic screening for new members to determine which children need the most immediate assessment
    • RN will visit the home and conduct the first module of the assessment instrument – holistic overview
    • Determine needs for nursing or personal care services
    • Behavioral health, DME and therapy needs will be referred to the MCO and they will use a separate assessment instrument
  • Want to ensure equity for all STAR KIDS members across the state
  • A range of hours for individual client’s needs will result from the entire assessment instrument
  • The assessment will be electronic with the ability to prepopulate where appropriate
  • Structured timeframes for MCOs to finish patient assessments
  • Hoping to look at MCO trends and all patients across the state to identify any gaps in care
  • In future meetings HHSC wants to be able to provide the group a draft assessment document but right now they are in the brainstorming phase – hope to have a draft of the first module by the next meeting

 
Member feedback

  • Want full access to the assessments the MCOs do for transparency reasons
  • How will you hold MCOs accountable for providing services needed as per the results of the assessments?
  • It would be great to have all communication from HHSC be electronic
  • Would like the assessment to include more than “yes or no” answers
  • Care Management Society of America have tools for complex care – encourage HHSC and A&M to look at them first
  • No member will be screened out, right?
    • No
  • The age of the child and their comfort level should be taken into account during the assessment
  • Is there detail about the initial telephonic assessment?
    • Historical data will be very important

 
The next meeting of the STAR KIDS Advisory Council will be September 10, 2014.