Texas House Committees on Appropriations Subcommittee on Article II and General Investigating & Ethics
SUMMARY – During the 85th Legislative Interim, in June 2018, the Texas House Committees on Appropriations Subcommittee on Article II and General Investigating & Ethics met to hear testimony. President and CEO Andy Keller, PhD, was invited testimony and presented on “Improving Managed Care for People with Mental Illness”.
During testimony, Dr. Keller provided background on 85(R) SB 1 – HHSC Rider 45a which laid out the following:
- Required HHSC to improve efforts to better serve individuals with serious mental illness.
- Required HHSC to develop performance metrics to better hold managed care companies accountable for care of enrollees with serious mental illness.
– Metrics include industry standard performance measures for integrated care, chronic illness, inpatient and emergency department diversion, post-discharge linkage to care, and medication adherence.
- Report to the Legislative Budget Board and Governor is due no later than November 1, 2018.
In response to Rider 45a, MMHPI reviewed performance measures for individuals with serious mental illness (SMI).
- Reviewed the STAR+PLUS Medicaid program in Texas.
- Reviewed leading states’ Medicaid managed care programs.
- Focused on data typically collected, particularly Healthcare Effectiveness Data and Information Set (HEDIS) measures.
– HEDIS consists of 81 measures across five domains of care and are used by more than 90 percent of America’s health plans to measure performance, including Texas.
During testimony, Dr. Keller made the following recommendations:
- Ten performance measures for the SMI population in STAR+PLUS, based on national best practices.
- ANSA data with Medicaid Managed Care Organizations (MCOs).
- Adding value-based purchasing requirements for members with severe mental illness (SMI).
- Adding SMI measures to the Pay for Quality (P4Q) program.
- Enforcing network equity.
- The State move away from fee-for-service utilization management requirements for MCOs.
At the conclusion of testimony, Dr. Keller also made recommendations for addressing gaps in pediatric networks and leveraging primary care to better address mental health care for children.