1 Tex. Admin. Code § 353.1504 - Use of Telecommunications in Service Coordination
(a) STAR+PLUS.
(1) Managed care organizations (MCOs) must
ensure all level 1 and 2 members receive at least one in-person service
coordination visit per year.
(2) An
in-person assessment satisfies the annual in-person service coordination visit
requirement for level 1 and 2 members.
(3) MCOs may offer level 1 and 2 members in
STAR+PLUS a choice of audio-visual communication for service coordination in
place of an in-person visit if no assessment is occurring.
(A) When an MCO conducts service coordination
using audio-visual communication, verbal consent must be obtained and
documented, and a HIPAA-compliant audio-visual communication product must be
used.
(B) If verbal consent for
audio-visual communication is not received, the MCO must use in-person
communication.
(C) The MCO must
inform members who utilize audio-visual communication for service coordination
that the member's services will be subject to the following:
(i) the MCO must monitor services for fraud,
waste, and abuse;
(ii) the MCO must
determine whether additional social services or supports are needed;
and
(iii) the MCO must ensure that
verbal consent to use telecommunications is documented in writing.
(4) During a declared
state of disaster, HHSC may issue direction to MCOs regarding whether service
coordination required to be conducted using face-to-face communication may be
conducted through audio-only communication.
(5) MCOs may offer level 3 members in
STAR+PLUS a choice of in-person, audio-visual, or audio-only communication for
service coordination.
(6) Nursing
facility residents must have at least one in-person service coordination visit
per year for service planning purposes.
(7) STAR+PLUS MCOs must conduct nursing
facility discharge planning visits in-person, including when a member is
transitioning to the STAR+PLUS HCBS Program. The in-person nursing facility
discharge planning visit may satisfy the requirement for the in-person
STAR+PLUS HCBS initial assessment when a nursing facility member is
transitioning to the STAR+PLUS HCBS Program. The requirement to conduct the
in-person STAR+PLUS HCBS initial assessment is satisfied during the in-person
nursing facility discharge planning visit if the MCO:
(A) uses the member's valid Minimum Data Set
(MDS) assessment to gather the information necessary to complete the STAR+PLUS
HCBS individual service plan; or
(B) conducts a Medical Necessity and Level of
Care assessment if the member does not have a valid MDS or in lieu of the
member's valid MDS to gather the information necessary to complete the
STAR+PLUS HCBS individual service plan.
(8) MCOs must provide service coordination in
accordance with §
353.609 of this chapter (relating
to Service Coordination).
(b) STAR Kids.
(1) MCOs must ensure all members receive at
least one in-person service coordination visit per year.
(2) An in-person assessment using the
HHSC-developed STAR Kids assessment tool satisfies the annual in-person service
coordination visit requirement.
(3)
MCOs may offer STAR Kids members a choice of audio-visual communication for
service coordination in place of in-person service coordination visits if no
assessment is occurring.
(A) When an MCO
conducts service coordination using audio-visual communication, verbal consent
must be obtained and documented, and a HIPAA-compliant audio-visual
communication product must be used.
(B) If verbal consent for audio-visual
communication is not received, the MCO must use in-person
communication.
(C) The MCO must
inform members who utilize audio-visual communication for service coordination
that the member's services will be subject to the following:
(i) the MCO must monitor services for fraud,
waste, and abuse;
(ii) the MCO must
determine whether additional social services or supports are needed;
and
(iii) the MCO must ensure that
verbal consent to use telecommunications is documented in writing.
(4) During a declared
state of disaster, HHSC may issue direction to MCOs regarding whether service
coordination required to be conducted using face-to-face communication may be
conducted through audio-only communication.
(5) STAR Kids MCOs must provide service
coordination in accordance with §
353.1205 of this chapter (relating
to Service Coordination).
(c) STAR Health.
(1) The MCO must ensure all members receive
at least one in-person service coordination visit per year.
(2) The MCO must ensure that the service
coordinator for a Medically Dependent Children Program member continues to make
required contacts with the member and the member's medical consenter to ensure
the member's needs are met.
(3) The
MCO may offer members or the member's medical consenter a choice of using
audio-visual or telephonic communication to conduct a service coordination
visit in place of conducting the visit in-person if an assessment is not
conducted during the visit.
(A) When an MCO
conducts service coordination using audio-visual communication, verbal consent
must be obtained and documented, and a HIPAA-compliant audio-visual
communication product must be used.
(B) The MCO must inform members who utilize
audio-visual or telephonic communication for service coordination that the
member's services will be subject to the following:
(i) the MCO must monitor services for fraud,
waste, and abuse;
(ii) the MCO must
determine whether additional social services or supports are needed;
and
(iii) the MCO must ensure that
verbal consent to use telecommunications is documented in writing.
(C) During a declared state of
disaster, HHSC may issue direction to the MCO regarding whether service
coordination required to be conducted using face-to-face communication may be
conducted through audio-only communication.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(a) STAR+PLUS .
(1) Managed care organizations (MCOs) must ensure all level 1 and 2 members receive at least one in-person service coordination visit per year.
(2) An in-person assessment satisfies the annual in-person service coordination visit requirement for level 1 and 2 members.
(3) MCOs may offer level 1 and 2 members in STAR+PLUS a choice of audio-visual communication for service coordination in place of an in-person visit if no assessment is occurring.
(A) When an MCO conducts service coordination using audio-visual communication, verbal consent must be obtained and documented, and a HIPAA -compliant audio-visual communication product must be used.
(B) If verbal consent for audio-visual communication is not received, the MCO must use in-person communication.
(C) The MCO must inform members who utilize audio-visual communication for service coordination that the member 's services will be subject to the following:
(i) The MCO must monitor services for fraud, waste, and abuse.
(ii) The MCO must determine whether additional social services or supports are needed.
(iii) The MCO must ensure that verbal consent to use telecommunications is documented in writing.
(4) During a declared state of disaster , HHSC may issue direction to MCOs regarding whether service coordination required to be conducted using face-to-face communication may be conducted through audio-only communication.
(5) MCOs may offer level 3 members in STAR+PLUS a choice of in-person, audio-visual , or audio-only communication for service coordination .
(6) Nursing facility residents must have at least one in-person service coordination visit per year for service planning purposes.
(7) STAR+PLUS MCOs must conduct nursing facility discharge planning visits in-person, including when a member is transitioning to the STAR+PLUS HCBS Program. The in-person nursing facility discharge planning visit may satisfy the requirement for the in-person STAR+PLUS HCBS initial assessment when a nursing facility member is transitioning to the STAR+PLUS HCBS Program. The requirement to conduct the in-person STAR+PLUS HCBS initial assessment is satisfied during the in-person nursing facility discharge planning visit if the MCO:
(A) uses the member 's valid Minimum Data Set (MDS) assessment to gather the information necessary to complete the STAR+PLUS HCBS individual service plan; or
(B) conducts a Medical Necessity and Level of Care assessment if the member does not have a valid MDS or in lieu of the member 's valid MDS to gather the information necessary to complete the STAR+PLUS HCBS individual service plan.
(8) MCOs must provide service coordination in accordance with § 353.609 of this chapter (relating to Service Coordination ).
(b) STAR Kids .
(1) MCOs must ensure all members receive at least one in-person service coordination visit per year.
(2) An in-person assessment using the HHSC -developed STAR Kids assessment tool satisfies the annual in-person service coordination visit requirement.
(3) MCOs may offer STAR Kids members a choice of audio-visual communication for service coordination in place of in-person service coordination visits if no assessment is occurring.
(A) When an MCO conducts service coordination using audio-visual communication, verbal consent must be obtained and documented, and a HIPAA -compliant audio-visual communication product must be used.
(B) If verbal consent for audio-visual communication is not received, the MCO must use in-person communication.
(C) The MCO must inform members who utilize audio-visual communication for service coordination that the member 's services will be subject to the following:
(i) The MCO must monitor services for fraud, waste, and abuse.
(ii) The MCO must determine whether additional social services or supports are needed.
(iii) The MCO must ensure that verbal consent to use telecommunications is documented in writing.
(4) During a declared state of disaster , HHSC may issue direction to MCOs regarding whether service coordination required to be conducted using face-to-face communication may be conducted through audio-only communication.
(5) STAR Kids MCOs must provide service coordination in accordance with § 353.1205 of this chapter (relating to Service Coordination ).
(c) STAR Health .
(1) The MCO must ensure that the service manager for a Medically Dependent Children Program member continues to make required contacts with the member and their medical consenter to ensure the member 's needs are met.
(2) The MCO may offer members or their medical consenter a choice of using audio-visual or telephonic communication to conduct a service management visit in place of conducting the visit in-person if an assessment is not conducted during the visit.
(A) When an MCO conducts service management using audio-visual communication, verbal consent must be obtained and documented, and a HIPAA -compliant audio-visual communication product must be used.
(B) The MCO must inform members who utilize audio-visual or telephonic communication for service management that the member 's services will be subject to the following:
(i) The MCO must monitor services for fraud, waste, and abuse.
(ii) The MCO must determine whether additional social services or supports are needed.
(iii) The MCO must ensure that verbal consent to use telecommunications is documented in writing.