|Mary Durheim, Chair
Andrew D. Crim, Vice Chair
Beth Stalvey, MPH, PhD, Executive Director
|6201 E. Oltorf, Suite 600
Austin, TX 78741-7509
|Phone: (512) 437-5432
Toll Free: (800) 262-0334
Fax: (512) 437-5434
House Human Services Committee
Written Testimony House Bill 4543
April 30, 2019
Thank you for the opportunity to provide comments on House Bill 4543, relating to system redesign for Medicaid benefits for persons with intellectual or developmental disabilities (IDD).
The Texas Council for Developmental Disabilities (TCDD) is established by state and federal law and is governed by 27 board members, appointed by the Governor, 60% of whom are individuals with developmental disabilities or family members of individuals with disabilities. TCDD’s purpose in law is to encourage policy change so that people with disabilities have opportunities to be fully included in their communities and exercise control over their own lives.
House Bill 4543 would provide additional time to test the effects of delivering long term services and supports to an IDD population through the use of a managed care program delivery model. Since a number of serious problems with existing managed care services in Texas have yet to be effectively addressed, this delay will help to better ensure that a model designed to serve individuals with IDD is functioning adequately with respect to the satisfaction of both recipients of services and providers.
Examples of ongoing problems which must be resolved before long term services and supports are transitioned to a managed care model of service delivery include:
- Insufficient safeguards and enforcement established in the Texas Health and Human Services Commission’s (HHSC’s) contracts with and monitoring of managed care organizations (MCOs);
- Unresolved or poorly resolved (and recurring) provider disputes, complaints, and other issues with managed care organizations;
- The lack of ready availability of documents relating to, and medical records of, recipients of services as needed by ad litem attorneys and others;
- Lack of clear procedures for recipients to complain or dispute a decision, and lack of HHSC enforcement of MCO participation in those procedures;
- Inadequate response to recipient complaints related to reduction or denial of services, including failure to provide in-person hearings or third-party arbitration informed by clinicians specifically qualified to make such determinations;
- Lack of a statewide policy on MCO preauthorization of services, pharmaceuticals, and supplies, such as durable medical equipment, with subsequent confusion and delays that can affect the health and well-being of recipients;
- Ongoing issues with network adequacy, resulting in delays in accessing services, as reflected in directories of service providers that are inaccurate and not updated on an ongoing basis, and inability to successfully recruit qualified clinicians and other providers;
- Lack of easily accessible, current, and validated information concerning MCO policies, such as clinical criteria for prior authorization;
- Lack of comprehensive and accessible data regarding number of recipients, services provided, and outcomes; and
- Failure to appropriately involve individuals and others, such as parents or legally authorized representatives, in needs assessments and decision-making related to services and care.
These examples are by no means comprehensive. Until these very basic elements of providing adequate services and care under a managed care model are put into place by HHSC, any expansion of the managed care model of service delivery should be reconsidered and delayed.
Please contact me if I can provide additional information or be of further assistance.
Linda Logan, MPAff
Public Policy Specialist
Texas Council for Developmental Disabilities