(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.
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