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Updating the PAS for Children Under 6

Updating the PAS for Children Under 6. Public Hearing The Pacific Health Policy Group October 12, 2010. UPDATED PAS FOR CHILDREN UNDER 6 Topics. Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones

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Updating the PAS for Children Under 6

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  1. Updating the PAS for Children Under 6 Public Hearing The Pacific Health Policy Group October 12, 2010

  2. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 2

  3. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 3

  4. UPDATED PAS FOR CHILDREN UNDER 6 Background • AHCCCS uses a comprehensive pre-admission screen (PAS) and score to determine eligibility for the ALTCS program • AHCCCS was an early adopter of objective, score-based clinical eligibility criteria (becoming the national norm) • Instruments should be updated periodically to reflect latest research • PAS for children under age 6 last updated in 1995 • Research on measuring childhood development has continued in the intervening years 4

  5. UPDATED PAS FOR CHILDREN UNDER 6 Objectives • Ensure that the PAS continues to properly identify children who meet the standard for eligibility (which is not changing): Immediate risk of institutionalization in an ICF/MR (regardless of actual service setting) • Incorporate latest research in measurement of age-appropriate developmental milestones • Replace adult-oriented independent living skill, communication and behavior items with age-appropriate developmental milestones • Update measurement of Autism Spectrum Disorder-related behaviors and developmental issues 5

  6. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 6

  7. UPDATED PAS FOR CHILDREN UNDER 6 Development Steps • Expert panel convened, including independent developmental pediatricians, PHPG consultants and senior AHCCCS assessors and managers • Research conducted on nationally-recognized and validated studies and instruments (e.g., Ages & Stages, Vineland-II, ICAP, CDC Guidelines, MCHAT) • Developmental section revised and significantly expanded • Pilot study data collected over five months (770 cases) • Statistical analysis performed to construct new scoring algorithm, with age-specific weights • Preliminary algorithm reviewed by experts to ensure clinical soundness 7

  8. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 8

  9. UPDATED PAS FOR CHILDREN UNDER 6 What is Changing? • A single PAS for all children under age 6 • Greater use of developmental milestones (with new milestones added at more frequent age intervals) • New variables that recognize behaviors or developmental delays related to ASD are being recognized through the scoring algorithm • Use of age-appropriate developmental milestones in place of adult-oriented variables • Updated weights for variables carried over from the previous PAS instruments 9

  10. UPDATED PAS FOR CHILDREN UNDER 6 What is Staying the Same? • The PAS assessment process • Medical section of PAS (scoring and weights have been updated) • 40 point threshold for eligibility • Use of physician review • Eligibility standard: Immediate risk of institutionalization in an ICF/MR (regardless of actual service setting) 10

  11. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 11

  12. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestone Domains 12

  13. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 13

  14. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 14

  15. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 15

  16. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 16

  17. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 17

  18. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 18

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  20. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 20

  21. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 21

  22. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 22

  23. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 23

  24. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 24

  25. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 25

  26. UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 26

  27. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 27

  28. UPDATED PAS FOR CHILDREN UNDER 6 Algorithm & Weights – Developmental Milestones 28

  29. UPDATED PAS FOR CHILDREN UNDER 6 Algorithm & Weights – Medical *See next slides for definitions 29

  30. UPDATED PAS FOR CHILDREN UNDER 6 Algorithm & Weights – Detailed Criteria Autism + MCHAT-Related – 18 months & Older • Diagnosis of Autism, PDD or Autism-like behaviors • Fails at least six of the following MCHAT-related milestones: • Does your child respond to their name when you call? • If you point at a toy across the room, does your child look at it? • Does your child ever use their index finger to point, to indicate interest in something? • Does your child ever bring objects over to you? • Does your child ever imitate you? For example, you make a face – will your child imitate it? • Does your child take an interest in other children? • Does your child like being hugged or cuddled? • Does your child look at you when you talk to them? (Milestone introduced at 24 months) • Note: Milestones also are scored individually and count toward 40-point threshold 30

  31. UPDATED PAS FOR CHILDREN UNDER 6 Algorithm & Weights – Detailed Criteria Autism + Behaviors – 30 to 35 Months • Diagnosis of Autism, PDD or Autism-like behaviors • Exhibits at least three of the following behaviors: • Does your child sleep at least 8 hours in a 24-hour period? (“No” response indicates presence of behavior) • Does your child do things over and over and can’t seem to stop? (Examples are rocking, hand flapping or spinning) • Does your child destroy or damage things on purpose? • Does your child hurt themselves on purpose? • Note: Milestones also are scored individually and count toward 40-point threshold 31

  32. UPDATED PAS FOR CHILDREN UNDER 6 Algorithm & Weights – Detailed Criteria Autism + Behaviors – 36 Months & Older • Diagnosis of Autism, PDD or Autism-like behaviors • Exhibits at least six of the following behaviors: • Does your child sleep at least 8 hours in a 24-hour period? • Does your child do things over and over and can’t seem to stop? • Does your child destroy or damage things on purpose? • Does your child hurt themselves on purpose? • Does your child cry, scream or have tantrums that last for 30 minutes or longer? • Does your child act physically aggressive? (For example, hits, kicks, bites etc.) • Does your child have eating difficulties? (For example, eats too fast or too slowly, hoards food, overeats, refuses to eat etc.) • Does your child sometimes stare at nothing or wander with no purpose? • Note: Milestones also are scored and count toward 40-point threshold 32

  33. UPDATED PAS FOR CHILDREN UNDER 6 Algorithm & Weights – Services/Treatments * Capped at 1.0 or 1.5 points **Past year; capped at 2.0 points 33

  34. UPDATED PAS FOR CHILDREN UNDER 6 Topics Background and objectives Updated PAS development steps What’s changing and what isn’t Updated developmental milestones Updated algorithm and weights Maintenance of Effort Questions 34

  35. UPDATED PAS FOR CHILDREN UNDER 6 Maintenance of Effort • AHCCCS’ intent is to maintain the existing eligibility standard, as defined in federal law • Individual customer outcomes can vary between the current PAS and revised draft tool • Pilot study results were analyzed to identify any program level impact. Findings for the updated PAS: • Increase in eligibility by score for younger children, particularly under 12 months of age • Decrease in eligibility by score for children 36 – 47 months • Slight increase in eligibility by score for children 48 months and older • The increase in eligibility for younger children will offset the effect to the 36-month old group over time 35

  36. UPDATED PAS FOR CHILDREN UNDER 6 Maintenance of Effort • The impact at the program level on eligibility and financial impact should be neutral • PHPG projected expenditures in year 1 would be 0.17 percent lower than would have occurred under the current PAS. Allowing for margin-of-error, this could mean a slight drop, increase or no change • Note: There will not be any program-wide reassessment of currently-eligible customers using the revised tool • Currently-eligible customers will not be reassessed using the revised tool unless they otherwise would have been reassessed using the current tool 36

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