Healthcare Model for Children in Foster Care: Draft RFP HHSC Public Meeting March 9, 2006

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Healthcare Model for Children in Foster Care
Draft RFPHHSC Public MeetingMarch 9, 2006
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Healthcare Delivery Model for Children in Foster
Care

• Background
• In FY 2005, Texas Medicaid served 25,000 children
  per month in foster care.
• SB 6 directs HHSC to develop a new statewide
  model.
• A contracted managed care organization will
  provide and coordinate services.

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Foster Care Population in Texas

• Current Trends
• High risk population with greater need for care
  coordination.
• Average total monthly healthcare cost for foster
  children is 5 times higher than for TANF
  non-foster children.
• Cost of behavioral health care is 40 times higher
  for foster children than for TANF non-foster
  children.

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Average Monthly Cost Per Child for SFY 2004
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Healthcare Delivery Model for Children in Foster
Care

• Goals for the Model
• Expedited enrollment for immediate access to
  Medicaid benefits
• Health care coordinated through single point of
  contact
• Enhanced access to services
• Improved healthcare outcomes

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Development of the Foster Care Health Services
Procurement

• Interagency Workgroup (HHSC, DSHS, DFPS) formed
  in Spring 2005 to design the healthcare model
• HHSC hired Navigant Consulting to develop an RFP
  to procure services
• Draft RFP released March 1, 2006

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Program Components

• Service Delivery Through a Medicaid Managed Care
  Model
• Provides a Medical Home through a Primary Care
  Provider (PCP) or PCP Team
• Promotes coordination of physical and behavioral
  health, with some long-term care
• Promotes preventive care
• Improves access through a defined network of
  providers
• All PCPs in network must be certified Texas
  Health Steps Providers

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Program Components (cont.)

• Improved access to health history and medical
  records via electronic Health Passport.
• 7-day, 24-hour Nurse Hotline and Behavioral
  Health Hotline for caregivers and caseworkers.
• Medical advisory committees to monitor
  provider/network performance.

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Foster Care Health Services Procurement

• Capitated, full-risk model, to include
• Physical and behavioral healthcare
• Pharmacy
• Dental services
• Mental health rehabilitative services
• Attendant care (long-term service)
• Service Coordination
• Health Passport
• Hotlines for physical and behavioral health and
  provider assistance

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Foster Care Health Services Procurement

• HHSC will contract with one Managed Care
  Organization (MCO)
• Bidder must be HMO or Exclusive Provider Plan
  (EPP) licensed statewide
• Value-based purchasing approach
• Opportunity for significant traditional providers
  to participate in MCO network

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Service CoordinationTiered Approach

• Tier 1 Medical Home
• Available to all children
• Includes PCP or PCP Team
• Preventive and primary care
• Referrals

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Service CoordinationTiered Approach

• Tier 2 Enhanced Service Coordination
• Assistance in accessing appointments
• Information sharing among providers
• Referrals
• Coordination with DFPS to provide health
  information for court hearings
• Assistance with outreach to caregivers and
  providers re Texas Health Steps visits

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Service CoordinationTiered Approach

• Tier 3 Service Management
• Clinical coordination for children with special
  needs
• Service manager assists in developing
  comprehensive treatment plan
• Service manager monitors treatment progress

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Health Passport

• Web-based electronic medical record
• Allows for improved information sharing and
  coordination of medical services
• Provides DFPS with up-to-date medical information
  on children in conservatorship
• Provides user-specific access to records
• Requires strict security provisions and privacy
  compliance
• MCO will develop passport with input from HHSC
  and DFPS

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Timeline

• 3/1/06 Draft RFP released
• 3/22/06 Draft RFP public comment ends
• 5/19/06 Final RFP released
• May 2006 Bidder Conference
• 7/21/06 Bidder proposals due
• 9/4/06 Anticipated Contract Award
• 11/3/06 Anticipated Contract Signing
• 11/11/06 5/4/07 Transition and Readiness
  Review
• 6/1/07 Enrollment begins
• 7/1/07 Commencement of services

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Additional Information

• Draft RFP located at
• http//www.hhsc.state.tx.us/Contract/529060293/rfp
  _home.html
• Comments may be sent to
• gwen.edwards_at_hhsc.state.tx.us
• (Please use Comment Form provided on website.)