The Texas Department of Aging and Disability Services held a stakeholder meeting on Wednesday, March 6 on Senate Bill 7 (SB 7). At least 250 people showed up to ask questions and learn more about the proposal to transition the acute and long term services and supports system for people with intellectual and developmental disabilities (IDD) to a managed care model. The bill was reported favorably in a unanimous vote by the Senate Health and Human Services Committee despite substantial opposition from the IDD community.
This was not a typical stakeholder forum. Health and Human Services Commission (HHSC) Deputy Commissioner Chris Traylor, Department of Aging and Disability Services Commissioner Jon Weizenbaum, HHSC Deputy Director Gary Jessee and Senate staff fielded questions for the better part of five hours. Stakeholders were given nearly unlimited time to ask questions while Deputy Commissioner Traylor moderated responses and discussion from agency and senate staff.
The discussion was emotional and complex. What follows is a summary of some of the issues that were raised as TCDD staff understood them.
Star+Plus 2060 Assessment
The current Star+Plus Medicaid program is an entitlement for all Social Security Supplemental Security Income (SSI) eligible adults that meet medical necessity criteria, but many people with intellectual and developmental disabilities enrolled in the program indicate they are not receiving necessary services. Families expressed concerns that the current assessment form (the “2060”) does not accurately reflect an individual’s true needs. They also claim that the current 2060 assessment instrument lacks inter-rater reliability, meaning that the same assessment yields different results depending on who administers the assessment. The strengths-based IDD culture may put people at a disadvantage when the receipt of services is based on the documentation of deficits.
Agency staff indicated that the current 2060 assessment tool is based on a medical model. Although the 2060 is not envisioned to be the tool that will determine eligibility for scope and duration of the habilitation service that would be provided to the 12,000 newly eligible people under the Community First Choice option, it is not yet known what tool would be used. NOTE: This is not the assessment that is referenced in SB 7 in relation to long term services and supports.
Families fear that the services their loved ones receive today will not be available five years down the road. Senate and agency staff said the plan is to, hopefully, add services that are currently available in the waivers to the Star+Plus managed care entitlement system so people don’t have to wait on a list for those services – as long as they qualify based on need and SSI income eligibility criteria. They also indicated that the language is broad throughout the bill because they didn’t want to be too prescriptive. As a result, the bill doesn’t indicate the intent to maintain services in the current service array either by adding those services to Star+Plus or continuing those services in a waiver.
Families expressed concerns about continued access to their doctors and multiple specialists in the new managed care system, especially because of the reluctance of these highly sought after professionals to deal with the administrative complexities of managed care.
State staff explained that managed care providers are required to ensure that they have adequate provider networks. “Network adequacy” refers to a health plan’s ability to meet the medical needs of its enrollees by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all other health care services for which benefits are included under the terms of the health care contract. In the event that a physician or specialist declines to participate in the new managed care system, the managed care organizations could contract with the specialist to provide care for a single person.
State staff stated that there are problems, such as provider shortages throughout healthcare in general and especially in Medicaid. Families with children with complex needs indicate that Medicaid is critical to the health and well-being of their children and they are reluctant to give up the security provided by the current system. They fear losing medical professionals that will not follow them to the managed care system.
SB 7 would require parents to pay a premium for long term services and support provided to a child. Under federal law a co-pay cannot be charged for institutional services (such as state supported living centers, nursing homes or community ICF group homes). As currently drafted, SB 7 would thus expect a co-pay from parents for only services in community based waivers and other community long term services programs. Families stated that it would be unfair to have premiums for parents whose children use community-based long term services and supports unless premiums are also applied to institutional services.
SB 7 is a work in progress. Senate staff indicated that stakeholder input would be considered by the bill’s author. It is not clear how much the bill will change prior to it being considered by the full Senate, but the author indicated during the February 27 committee hearing that she would be open to accepting floor amendments.
TCDD will provide updates regarding this important issue as it progresses through the legislative process.