Acknowledgments

The author would like to acknowledge the assistance of Brant Fries and Mary James for their reviews of the manuscript and unfailingly helpful advice. John Hirdes’ insightful comments were also appreciated. Earlier work by the dedicated members of the Texas A&M University PCAF project team built the foundation on which this research rests.


Continue Reading

Footnotes

ACADEMIC EDITOR: Jim Nuovo, Former Editor in Chief

PEER REVIEW: Three peer reviewers contributed to the peer review report. Reviewers’ reports totaled 1598 words, excluding any confidential comments to the academic editor.

FUNDING: Author discloses no external funding sources.

COMPETING INTERESTS: CDP is a member of interRAi, which holds the copyright to the PEDS HC. InterRAI is a not-for-profit organization, and PEDS HC is available to providers, researchers and governmental agencies at no cost. Information on the PEDS HC can be obtained through a query to [email protected]ni.

Paper subject to independent expert blind peer review. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE)

Author Contributions

Responsible for all aspects of this article: CDP.

REFERENCES

1. Casey MC. In whose hands are we placing children’s health: an examination of “medical necessity” for Medicaid’s EPSDT provision. J Contemp Health Law Policy. 2012;29:89–116. [PubMed]

2. EPSDT Services. [Accessed November 13, 2015]. Available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html.

3. Miller TR, Elliott TR, McMaughan DM, et al. Personal Care Services provided to children with special health care needs (CSHCN) and their subsequent physician services. Disabil Health J. 2013;6:317–324.[PubMed]

4. Phillips CD, Patnaik A, Dyer J, et al. Children and Medicaid Personal Care Services, 2009. College Station, TX: Texas A&M University Health Science Center, School of Public Health; 2010.

5. EPSDT Payment. [Accessed November 13, 2015]. Available at http://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/financing-and-reimbursement.html.

6. Texas Star Kids Program [Accessed August 18, 2015]. Available athttp://www.hhsc.state.tx.us/medicaid/managed-care/mmc/star-kids.shtml.

7. Phillips CD. Case-mix adjustment. In: Mullner R, editor. Encyclopedia of Health Services Research, Volume One. Thousand Oaks, CA: Sage Publications; 2009. pp. 129–132.

8. Phillips CD, Dyer J, Vanousek V, et al. Providing appropriate services to individuals in the community: a preliminary case-mix model for allocating personal care services. J Health Hum Serv Adm. 2008;30:379–401. [PubMed]

9. Fetter RB, Brand DA. In: DRGs: Their Design and Development. Gamache D, editor. Ann Arbor: Health Administration Press; 1991.

10. Fries BE, Schneider DP, Foley WJ, et al. Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III) Med Care. 1994;32:668–685. [PubMed]

11. Bjorkgren M, Fries BE, Shugarman L. A RUG-III case-mix system for home care. Can J Aging.2000;19(suppl 2):1040126.

12. Costa AP, Poss JW, McKillop I. Contemplating case-mix: a primer on case mix classification and management. Healthc Manage Forum. 2015;28:12–15. [PubMed]

13. Texas Medically Dependent Children Program Available at https://www.dads.state.tx.us/services/faqs-fact/mdcp.html. Updated June 3, 2015.

14. Payment Rates for Medically Dependent Children Program. Available athttps://www.hhsc.state.tx.us/rad/long-term-svcs/downloads/2010-mdcp-rates.pdf. Dated September, 2009.

15. Washington State Long-Term Care Services. Available at http://apps.leg.wa.gov/WAC/default.aspx?cite=388-106. Updated September 30, 2015.

16. Washington State Payment Classifications for In-Home Care. [Accessed August 18, 2015]. Available athttp://app.leg.wa.gov/WAC/default.aspx?cite=388-106-0125.

17. Hawes C, Morris JN, Phillips CD, et al. Development of the resident assessment instrument in the USA. Age Ageing. 1997;26(suppl 2):19–25. [PubMed]

18. Medicare Home Care Assessments [Accessed October 29, 2015]. Available athttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Home-HealthQualityInits/Home-Health-Quality-Reporting-Requirements.html.

19. Disability Rights Texas [Accessed August 21, 2015]. Available athttps://www.disabilityrightstx.org/files/changestotexasmedicaidthataffectbeneficiariesundertheageof21.pdf.

20. interRAI 2015. Available at www.interrai.org [Information on the interRAI organization is available on the website. Any questions concerning the organization, its instruments, or its activities should be sent via email to [email protected]]

21. Phillips CD, Hawes C, Morris JN, et al. interRAI Pediatric Home Care (PEDS HC) Assessment Form and User’s Manual, Version 92. Washington, DC: interRAI; 2014.

22. Phillips CD, Hawes C. The interRAI Pediatric Home Care (PEDS HC) assessment: evaluating the long-term community-based services and supports for children facing special healthcare challenges. Health Serv Insights. 2015;8:17–24. [PMC free article] [PubMed]

23. Fournier CJ, Davis MJ, Patnaik A, et al. Modeling caregivers’ perceptions of children’s need for formal care: physical function, intellectual disability, and behavior. Disabil Health J. 2010;3:213–221. [PubMed]

24. Elliott TR, Phillips CD, Patnaik A, et al. Medicaid personal care services and caregivers’ reports of children’s health: the dynamics of a relationship. HSR. 2011;46:1803–1821. [PMC free article] [PubMed]

25. Patnaik A, Elliott TR, Moudouni DM, et al. Severity of children’s intellectual disabilities and Medicaid Personal Care Services. Rehabil Psychol. 2011;4:383–390. [PubMed]

26. Adepoju L, Zhang Y, Phillips CD. Modeling the determinants of Medicaid home care payments for children with special health care needs: a structural equation model approach. Disabil Health J.2014;7:426–432. [PubMed]

27. Phillips CD, Patnaik A, Moudouni DK, et al. Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study using supplemented interRAI items. BMC Health Serv Res. 2012;12:19. [PMC free article] [PubMed]

28. Phillips CD, Patnaik A, Dyer JA, et al. Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community. Disabil Rehabil.2011;33:2013–2022. [PubMed]

29. Kass GV. An exploratory technique for investigating large quantities of categorical data. J Royal Statist Soc Series C. 1980;29:119–127.

30. Poss JW, Hirdes JP, Fries BE, et al. Validation of resource utilization groups version III for home care (RUG-III/HC): evidence from a Canadian home care jurisdiction. Med Care. 2008;46:380–387. [PubMed]

31. Leininger LJ, Saloner B, Wherry LR. Predicting high-cost pediatric patients: derivation and validation of a population-based model. Med Care. 2015;43:729–735. [PubMed]

Source: Health Services Insights
Originally published December 28, 2015.