The Pediatric Personal Care Allocation Model for Home Care (PCAM): A Personal Care Case-Mix Model for Children Facing
1Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA.
Insights
A new Pediatric Personal Care Allocation Model (PCAM) was developed to standardize Personal Care Services (PCS) for children with special health care needs. This model aims for equitable service distribution based on functional challenges.
Area of Science:
- Healthcare policy
- Pediatric health services research
- Health economics
Background:
- State Medicaid programs offer Personal Care Services (PCS) to children with special health care challenges.
- PCS aim to address functional impairments in children and youth (C/Y).
- Existing PCS allocation shows significant variability based on assessor judgment.
Purpose of the Study:
- To develop a case-mix model for uniform and equitable distribution of PCS.
- To reduce variability in PCS allocation among C/Y.
Main Methods:
- A sample of 2708 C/Y aged 4–20 receiving PCS in Texas in 2008 was analyzed.
- A case-mix model was developed based on authorized PCS hours.
Main Results:
- The Pediatric Personal Care Allocation Model (PCAM) was created, categorizing recipients into 33 groups.
- The PCAM accounts for 27% of the variance in PCS hour allocation.
Conclusions:
- PCAM implementation can guide equitable PCS allocation for C/Y with similar functional needs.
- Adoption of a case-mix model is a foundational step toward a prospective payment system for PCS.
Background:
State Medicaid programs in the United States provide services to children with special health care challenges through the Early Prevention, Screening, Diagnostic, and Treatment program. One element of the services provided is Medicaid Personal Care Services (PCS), which are intended to correct or ameliorate any functional impairments faced by a child or youth (C/Y) in the community. Previous research indicates that considerable variation in the allocation of PCS depends on the assessor. A case-mix model is developed that might make the distribution of such services more uniform and equitable.
Data:
The sample in this research includes 2708 C/Y aged 4 to 20 who were receiving PCS in Texas in 2008.
Results:
A case-mix model was developed that groups sample members into 33 categories based on the number of hours of PCS authorized by an assessor. The Pediatric Personal Care Allocation Model (PCAM) explains 27% of the variance in the allocation of PCS hours.
Discussion:
The implementation of the PCAM should provide guidance to assist in ensuring that C/Y facing similar functional challenges receive similar levels of PCS. However, implementation of any case-mix model is only a first step in moving to a prospective payment system for PCS.
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