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Report
Evaluation of Managed Care Organization Services for Adults with Serious Mental Illness in STAR+PLUS: As Required by 2020-21 General Appropriations Act, House Bill 1, 86th Legislature Regular Session, 2019 (Article II, Health and Human Services Commission, Rider 33) Health and Human Services Commission
Texas Health and Human Services
11/2020
Abstract
The 2020-21 General Appropriations Act, House Bill 1, 86th Legislature, Regular Session, 2019 (Article II, Health and Human Services Commission [HHSC], Rider 33) requires HHSC to evaluate variation in service delivery to individuals with serious mental illness (SMI) by managed care organization (MCO). Rider 33 also requires HHSC to identify performance measures to better hold MCOs accountable for outcomes and spending for individuals with SMI, evaluate the delivery of services, and develop recommendations to improve quality of care.
STAR+PLUS serves adults with disabilities and individuals who are 65 years or older. For the report, Medicaid STAR+PLUS members were evaluated. Dually enrolled members were not included because data was not available.
Claim-based performance metrics were evaluated to develop the report. The claimbased data, which include managed care encounter data, have several strengths including clinical validity, a representative population, and access. However, like any data set, there are limitations. The claims are based on the record of care received. Furthermore, the data provide no detail on the severity or longevity of the diagnosed condition, which may impact behavioral health (BH) outcomes. Readers should consider these limitations when drawing any conclusions from the findings.
Details
- Title
- Evaluation of Managed Care Organization Services for Adults with Serious Mental Illness in STAR+PLUS
- Resource Type
- Report
- Contributors
- Karishma S Chhabria (Contributor) - University of West Florida, Usha Kundu, MD College of Health
- Publisher
- Texas Health and Human Services; Texas, United States
- Format
- pdf
- Number of pages
- 45
- Identifiers
- 99380467295506600
- Academic Unit
- Public Health; Usha Kundu, MD College of Health
- Language
- English