The Texas Health and Human Services Commission (HHSC) recently announced a two-year pilot program that will carve the coverage of long-term services and supports (LTSS) for individuals with intellectual and developmental disabilities, traumatic brain injuries, and similar functional needs into Medicaid managed care. Individuals will be eligible for the STAR+PLUS Pilot Program (SP3) if they are not already enrolled in a waiver program, and if they meet other eligibility requirements.
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In a statement for State of Reform, HHSC said:
“Through the SP3 evaluation, HHSC strives to understand the experiences and outcomes for SP3 participants, family members, and providers to inform future planning for the IDD system redesign … SP3 will benefit Texans by providing home and community-based services (HCBS) to eligible STAR+PLUS Medicaid members not already receiving HCBS.”
SP3 services will include adaptive aids, cognitive rehabilitation therapy, dental services, home-delivered meals, individualized skills and socialization, nursing, personal assistance services/habilitation, respite services, employment assistance and supported employment, physical, speech, and occupational therapies, and transportation services.
According to HHSC, SP3 will also include new services—such as remote monitoring, housing supports, and enhanced behavioral health services—that are not currently available in other Medicaid waiver programs.
Several indicators will be in place to measure the program’s quality performance, including the National Core Indicators and Consumer Assessment of Healthcare Providers and Systems measures.
“In addition to that, HHSC contracted with the External Quality Review Organization (EQRO) to create evaluation design and performance measures. The EQRO is in the early phase of developing the evaluation plan and HHSC anticipates having a finalized plan in the Spring.”
HHSC has currently identified three possible managed care service areas for SP3 pilot operation: Bexar County, MRSA Northeast, and Tarrant County. HHSC said:
“To determine where to implement the SP3 pilot, HHSC is using factors such as number of eligible pilot participants and potential providers, and geographic representation of urban, suburban, and rural areas … The final SP3 managed care service area will be determined by the proposals received as part of the STAR+PLUS request for proposal.”
The agency said the pilot program would also have implications for payment models.
“The pilot program will also inform future transitions of 1915(c) waiver programs from a fee-for-service delivery model to a managed care service delivery model.”