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 Updated algorithm and weights Maintenance of Effort Questions 2

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

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

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

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

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

UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestone Domains 12

UPDATED PAS FOR CHILDREN UNDER 6 Developmental Milestones 13

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

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

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

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

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

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

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

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

Updating the PAS for Children Under 6

Updating the PAS for Children Under 6

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