(a) Information technology, including HIPAA-compliant
text or email, may supplement audio-visual communication 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) Where HHSC contractually requires face-to-face
service coordination, the MCOs may conduct these visits in-person
or using audio-visual means. Audio-visual may not be used if an assessment
is being conducted during the service coordination visit, 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 the member's
LAR what verbal consent means, and what the member or member's LAR
is consenting to.
(1) The verbal consent for audio-visual communication
in place of an in-person visit applies only to that visit.
(2) Verbal consent must be obtained for each service
coordination visit conducted using audio-visual communication in place
of an in-person visit.
(i) When telephonic 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 assessments 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 a governor
declared disaster, may an MCO deny a member's request for an in-person
visit.
(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.
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