1 Tex. Admin. Code § 353.1506 - Additional Requirements for Assessments and Service Coordination in STAR Health
(a) Information
technology, including HIPAA-compliant text or email, may supplement
audio-visual or in-person assessments, but may not be used as the sole means of
conducting an assessment or service coordination visit.
(b) When a managed care organization (MCO)
conducts an assessment or service coordination visit using telecommunications,
the MCO must:
(1) monitor the health care
services provided to the recipient for evidence of fraud, waste, and
abuse;
(2) determine whether
additional social services or supports are needed;
(3) document verbal consent to use
telecommunications; and
(4) adhere
to HIPAA, including the use of a HIPAA-compliant audio-visual communication
product.
(c) HHSC may,
on a case-by-case basis, require an MCO to discontinue telecommunications for
the delivery of service coordination or assessments if HHSC determines that the
discontinuation is in the best interest of the member.
(d) An MCO may conduct additional in-person
visits with members, as determined by the MCO.
(e) MCOs must have a means to document verbal
consent to the use of telecommunications for the delivery of assessments or
service coordination.
(f)
Audio-visual may not be used if an initial or annual assessment for the
Medically Dependent Children Program or functionally necessary covered services
is being conducted, unless HHSC issues direction allowing audio-visual
assessments during a declared state of disaster.
(g) MCOs may not leave blank fields in
assessment tools, including tools to evaluate home and community-based service
needs, nursing needs, and functional needs. Audio-visual is not an appropriate
means of assessing a member if it results in blank fields.
(h) MCOs must explain to the member or
medical consenter what verbal consent means, and what the member or medical
consenter is consenting to.
(1) The verbal
consent for an audio-visual in place of an in-person visit applies only to that
visit.
(2) Verbal consent must be
obtained for each audio-visual service coordination visit conducted in place of
an in-person visit.
(i)
When telephonic screenings or service coordination visits are authorized by
contract, these visits may continue to be provided by telephonic
communication.
(j) An MCO must
honor a member's request to receive service coordination or assessment in
person. Only when HHSC issues direction to MCOs during a declared state of
disaster that service coordination or assessments must be conducted using
audio-visual or audio-only communication due to the specific nature of the
disaster, may an MCO deny a member's request for in-person contact.
(k) MCOs may use discretion on how to
document verbal consent in a HIPAA-compliant manner. However, MCOs must be able
to produce the documentation of verbal consent for audit and compliance
purposes.
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) Information technology , including HIPAA -compliant text or email, may supplement audio-visual or in-person assessments , but may not be used as the sole means of conducting an assessment or service management visit.
(b) When a managed care organization (MCO) conducts an assessment or service management visit using telecommunications , the MCO must:
(1) monitor the health care services provided to the recipient for evidence of fraud, waste, and abuse;
(2) determine whether additional social services or supports are needed;
(3) document verbal consent to use telecommunications ; and
(4) adhere to HIPAA , including the use of a HIPAA -compliant audio-visual communication product.
(c) HHSC may, on a case-by-case basis, require an MCO to discontinue telecommunications for the delivery of service management or assessments if HHSC determines that the discontinuation is in the best interest of the member .
(d) An MCO may conduct additional in-person visits with members, as determined by the MCO.
(e) MCOs must have a means to document verbal consent to the use of telecommunications for the delivery of assessments or service management .
(f) Audio-visual may not be used if an initial or annual assessment for the Medically Dependent Children Program or functionally necessary covered services is being conducted, unless HHSC issues direction allowing audio-visual assessments during a declared state of disaster .
(g) MCOs may not leave blank fields in assessment tools, including tools to evaluate home and community-based service needs, nursing needs, and functional needs. Audio-visual is not an appropriate means of assessing a member if it results in blank fields.
(h) MCOs must explain to the member or medical consenter what verbal consent means, and what the member or medical consenter is consenting to.
(1) The verbal consent for an audio-visual in place of an in-person visit applies only to that visit.
(2) Verbal consent must be obtained for each audio-visual service coordination visit conducted in place of an in-person visit.
(i) When telephonic screenings or service management visits are authorized by contract, these visits may continue to be provided by telephonic communication.
(j) An MCO must honor a member 's request to receive service management or assessment in person. Only when HHSC issues direction to MCOs during a declared state of disaster that service management or assessments must be conducted using audio-visual or audio-only communication due to the specific nature of a governor declared disaster, may an MCO deny a member 's request for in-person contact.
(k) MCOs may use their discretion on how to document verbal consent in a HIPAA -compliant manner. However, MCOs must be able to produce the documentation of verbal consent for audit and compliance purposes.