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Home -- Announcements
Action Alert from The Arc of Texas: HHSC to Hold Public Hearings Relating to Managed Care Pilot to Serve Persons with Intellectual and Developmental Disabilities.
Background:
The Texas Legislature has authorized the Texas Health and Human Services Commission (HHSC) to conduct a study for the purpose of planning a pilot program to deliver long-term care services for people with intellectual and developmental disabilities through a managed care model. It is the expectation of some leaders in state government that services can be delivered more appropriately and cost-effectively using a managed care approach.
Services to be included in the pilot would include, at least, community-based ICF-MR programs and Medicaid Waiver services; although unfortunately, as of yet, not services offered by State Supported Living Centers (state schools). A consulting firm, Health Management Associates, has been engaged to plan this pilot program. The firm has developed three possible alternatives for the proposed managed care pilot.
The models are presented on the Texas Health and Human Services website: www.hhsc.state.tx.us. The consultant's report can be accessed on the front page of the website under "Meetings Planning for Options on Pilot"
The Arc of Texas has reviewed the models. Each of the three presents a different approach to managing long-term care services.
Option #1 does not dramatically change the current configuration of the service delivery system. It is referred to as the Non-Capitated Enhanced Management model and includes services for both children and adults. Local authorities (MRA's) and community service providers continue to form the infrastructure of the system. In the pilot area the MRA would directly manage program waiting lists and available waiver slots allocated to the area, would coordinate ICF-MR to HCS conversions, and would promote lower cost service models. The report does not delineate exactly how those enhanced roles and expectations would be defined nor how the new arrangement could impact the current balance between authority and provider roles.
Option #2, the Fully-Capitated, Non-Integrated, Managed Long-Term Care pilot, would be mandatory for adults with the status of children's services to be determined later. It could be managed via any entity that meets defined administrative and organizational requirements including a local MRA with managed care experience, an MRA in partnership with a Managed Care Organization, a qualified non-profit entity, a qualified for-profit entity, or other organization able to bear financial risk under Texas law. This pilot would consolidate ICF-MR and community-based waiver services under a new waiver authority but would not include acute care or behavioral health care services. In the fully capitated service model, the managed care entity assumes the risk of providing services to a population defined under contract with the state. If the total cost of serving the target population exceeds the contract amount set by the state, the managed care entity is responsible for funding the remaining services required under the contract. If the cost of serving the defined population is less than the contracted cost, the entity keeps the excess as "profit". Current ICF-MR and waiver services providers could continue to offer services under this model. The Managed Care entity determines provider payment rates and requirements through contract negotiations with individual long-term care service providers. The Managed Care entity would have broad authority to manage and redesign services for consumers in the model.
Option#3, the Fully-Capitated, Integrated, Managed Long-Term Care Managed Care pilot program. This model would be mandatory for adults, with the status of children yet to be determined. Like Option #2, it uses a risk-based capitation model. It differs from Option #2 in that it integrates acute medical care services and behavioral health care services into one plan with long-term care services for the population of people with intellectual and developmental disabilities. It could, but does not necessarily have to, resemble the current Star+Plus program now available in some areas of the state to populations with other kinds of disabilities. Like Option #2, the Managed Care entity will negotiate for rates and programs with a network of service providers. Since all acute care services would be provided via a new managed care entity with an as yet unidentified network of acute care service providers, some individuals could have to switch from their current physician or other providers to other providers within the network.
The descriptions of the models leave many unanswered questions. It is difficult to ascertain the impact each would have on the lives and interests of people with intellectual and developmental disabilities and their families.
The Arc of Texas will be taking every opportunity to learn more about these options and will provide further comment to state officials in coming months. We will keep you apprised of developments as they occur.
Hearings:
The Health and Human Services Commission will hold a series of public hearings over the next week or so to receive public comment on these three Managed Care Options. A list of the dates, times, and sites of those hearings are:
Public Meeting Schedule
The following meetings will provide a review of options for a managed care pilot:
Fort Worth: Wednesday, June 23, 3 p.m., Fort Worth Botanical Gardens, 3220 Botanic Garden Boulevard, 817-871-7686
El Paso: Friday, June 25, 11 a.m., El Paso Marriott, 1600 Airway Blvd., 915-779-3300
Longview: Monday, June 28, 5 p.m., Holiday Inn Express Longview North, 300 Tuttle Circle, 903-663-6464
Austin: Tuesday, June 29, 3 p.m., Austin City Hall, 301 W. Second St., 512-974-2668
At this point The Arc of Texas has not taken a formal position on any of these options and is seeking additional information before doing so. However, there are some principles that must be present in whatever model is finally chosen for the pilot.
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