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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

Updating the PAS for Children Under 6

Public Hearing

The Pacific Health Policy Group

October 12, 2010

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestone Domains

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Developmental Milestones

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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

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UPDATED PAS FOR CHILDREN UNDER 6

Algorithm & Weights – Developmental Milestones

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UPDATED PAS FOR CHILDREN UNDER 6

Algorithm & Weights – Medical

*See next slides for definitions

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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

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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

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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

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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

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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

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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

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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

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