Just the FAQs Ma’am… Q and A related to the Policy Council for Children and Families.

18th Oct 2017

The Policy Council for Children and Families met recently and several questions were addressed.  The most substantive issues and questions are addressed through the following FAQs.

Q: Where are services for the people with visual impairment now provided?

A: The Health and Human Services Commission provides the following:

The Texas Workforce Commission provides the following services:

Q: Did the transition of services to Texas Workforce Commission and HHSC reduce services to visually impaired children? 

A: This is a complicated question.  With the transition of services for visually impaired children to HHSC and to Texas Workforce Commission, some services that had been provided in the past fell through the cracks.  TWC had stated that their focus was for rehabilitation for employment and as such some of the social services did not fit their model.  The federal regulations specify the transition to adulthood services required and that they have to be the same for all disabilities.  There has to be one designated state unit with one unified age. They now provide transition services at age 14 and up as other states are doing.  The services for under 14 are “served up” by the Blind Children’s Program.  A couple of (summer) camps that had been provided to visually impaired children did not occur this past summer.  The Workforce Commission stated that they still serve blind children aged 10-13 and that the Camps are continuing but there were transition issues that occurred this year that will not occur in the future.  TWC stated that there are camps still being funded, however the agency does not provide services focused on social skills and independent living which has been the focus of some camps in the past.

Q: What is the position of families and advocates on the camps?

A: There are serious impacts from not continuing funding for specialty camps.  Because the specialty camps rent space at existing camps, specialty camping opportunities are being lost for a long time because the slots at the camp get lost.   Advocates also state that in order for children and youth to benefit from vocational training and services they first have to be taught personal and social skills. 

Q: What is the status of rider 178, Senate Bill 1, 84th Legislature.

A:  Rider 178 states “Included in the amounts appropriated above in Strategy D.1.5, Children’s Blindness Services, is $600,000 in General Revenue in each fiscal year of the 2018-19 biennium for the purpose of providing Blind Children’s Vocational Discovery and Development Program services for children 10 to 13 years of age.” The agency stated they received earmarked money and they are looking at the age range for the services to be provided.  They are also looking at the case management tools for that age range and are beginning the planning process on this. With regard to communication they are engaged with targeted stakeholder groups and there is a plan for the services provided under this rider that is under development that will be communicated.

Q: Under STAR Kids, what is happening regarding preferred provider arrangements?

A: Preferred provider arrangements are generally defined in state law as a contract between an insurer and health care provider to provide services to patients at discounted fees. The agreement stipulates the health care services available and the parties’ obligations. It also contains charging and reimbursement policies and states whether the contract extends to an existing network.  Many health plans develop preferred provider arrangements in order to be able to economize and save costs from using several different providers.   The STAR Kids program is allowing preferred provider arrangements specifically in durable medical equipment. 

Q: What do stakeholder say about these arrangements?

A: Many stakeholder feel that these arrangements limit choice.  They state that many providers have specialized equipment that is not available through a preferred provider (specialty communication devices and wheel chairs were cited as examples). For independent providers, there can be an uneven playing field with preferred arrangements and becomes evident in the prior authorization of services.

Q: Are families required to use the preferred provider?

A:  No, there is a process for going outside the preferred provider, however stakeholders claim that this process is complex and burdensome.

Q: Is there an update on the denial of services to children served through the Medically Dependent Services Program?

A:  Currently as high as 12 percent of children formerly served under MDCP are being denied service by health plans following a re-assessment.  A request had been made to extend the period for review of denials so that children will not lose service.  HHSC is not going to extend the medical necessity denials but they will take steps to allow continued services.  The way they will protect families is to call every person denied and let them know about their fair hearings rights.  Extensions may be provided on a case by case basis.  This will happen through the end of November.  State staff are being used, not contract staff.  Clinical staff will also be doing additional desk reviews of denied cases.  The agency is also working with Texas A&M on research on the assessment tool that is being used and will make recommendations.  They are having ongoing calls with TMHP and MCOs.  This is all happening at a time when Medicaid is undergoing significant change of personnel.

For more details on these topics, please see the Texas Insight Report from October 2, 2017: Policy Council for Children and Families.

Thomas Valentine

Texas Insight