SB 7 requires the transfer of the Medicaid long term services and supports for people with intellectual and developmental disabilities (IDD) into a single managed care system by 2020. This includes HCS, CLASS, DBMD and TxHmL waivers and the ICF/IID program, but not State Supported Living Centers.
Acute Medical Services: Medicaid acute care services would be provided through a capitated managed care program [STAR, STAR Kids, or STAR+PLUS] operated by a Managed Care Organization (MCO -generally operated by large insurance companies).
Medically Dependent Children’s Program (MDCP): MDPC would be eliminated. MDCP would be replaced by a mandatory STAR Kids capitated managed care program for children. As written, SB 7 does not clearly state that all services currently available in MDCP would be provided in the new program, however, legislative staff have clearly stated that the intent is that all services would be available.
Texas Home Living (TxHmL): TxHmL would be transferred to the managed care system first – no later than Sept. 1, 2017. HHSC would be required to determine whether to cease operating the TxHmL waiver because all of the waiver’s services are provided via managed care as an entitlement, whether to continue operating the TxHmL waiver to provide those services that are not included in managed care, or eliminate a portion of the services currently available to people receiving services from the TxHmL waiver.
Residential Changes to Reduce Costs: SB 7 would require prior authorization before a person could receive services in a group home in order to restrict access to only those that cannot be served in a less restrictive setting. SB 7 would also require the development of housing options, including the most restrictive settings, to reduce the cost of residential services.
Voluntary Transition to Managed Care – HCS, CLASS and DBMD waiver participants would not be required to transition to managed care. Persons receiving waiver services may choose to remain in their waiver program or transition to managed care. However, participants who choose to transition from their waiver program to managed care will not be permitted to transfer back to their previous waiver program.
The Commission would decide whether to continue to operate the waivers and the ICF/IID program for the purpose of providing supplemental services not available in managed care (Star+Plus) or for only those who choose to remain in a waiver program.
Pilot Capitated Managed Care Strategies for Persons with Intellectual and Developmental (IDD): DADS may test capitated, managed care strategies with a private provider by Sept. 1, 2016 for no longer than two years. The pilots would coordinate services provided through community ICFs and Medicaid waiver programs, and integrate long term services and supports with acute care services. A waiver program recipient’s pilot participation would be voluntary.
Community First Choice: A basic attendant and habilitation service for 11,902 people with IDD would be administered by managed care organizations. Cost projections indicate that wages for those that provide habilitation services would be about 25% less than current HCS habilitation wages. IDD Local Authorities would coordinate the new CFC service, but would not provide the CFC service. Current CLASS, HCS and TxHmL providers would be eligible to provide the new IDD service.
Comprehensive Assessment: SB 7 would require DADS to implement a comprehensive assessment and resource allocation process that would provide a uniform mechanism to provide recommendations relating to type, intensity and duration for appropriate and available services based on each person’s functional needs.