| (a) STAR+PLUS.
(1) STAR+PLUS managed care organizations (MCOs) must
conduct initial assessments and annual reassessments using HHSC-developed
tools for STAR+PLUS HCBS Program eligibility in-person.
(2) STAR+PLUS MCOs must conduct all initial and annual
assessments using HHSC-developed tools for functionally necessary
covered services such as personal assistance services, Community First
Choice services, and day activity and health services, in -person.
(3) Change in condition assessments that require or
potentially require a change in the Resource Utilization Group (RUG)
level must be conducted in-person.
(4) MCOs may offer to STAR+PLUS members a choice of
audio-visual communication in place of in-person change in condition
assessments, as long as the assessment does not require or potentially
require a change in the RUG level.
(A) When an MCO conducts a change in condition assessment
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 change in condition assessments 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.
(5) A STAR+PLUS MCO may not conduct an initial assessment,
annual reassessment, or change in condition assessment without the
in-person presence of the member.
(6) During a declared state of disaster, HHSC may issue
direction to STAR+PLUS MCOs regarding whether initial, annual renewal,
or change in condition assessments may be conducted through audio-visual
or audio-only communication for STAR+PLUS members who reside in the
area subject to the declared state of disaster.
(7) STAR+PLUS MCOs must adhere to §353.1153 of
this chapter (relating to STAR+PLUS Home and Community Based Services
(HCBS) Program) for STAR+PLUS assessments and service planning, and §353.1(c)
of this chapter (relating to Purpose) regarding compliance with all
terms of the contract with HHSC.
(8) For limited circumstances, STAR+PLUS MCOs may submit,
in a manner and format prescribed by HHSC, an exceptions policy for
required in-person assessments for approval by HHSC. The policy must
be developed by the MCO's clinical staff, such as the Chief Medical
Director or the Director's designee.
(b) STAR Kids.
(1) The STAR Kids MCO must administer the initial assessment
and annual reassessments using the HHSC-developed STAR Kids assessment
tool in-person.
(2) Change in condition assessments that require or
potentially require a change in the RUG level must be conducted in-person.
(3) MCOs may offer STAR Kids members a choice of audio-visual
communication in place of in-person change in condition assessments,
as long as the assessment does not require or potentially require
a change in the RUG level.
(A) When an MCO conducts a change in condition assessment
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 change in condition assessments 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) A STAR Kids MCO may not conduct an assessment without
the in-person presence of the member.
(5) During a declared state of disaster, HHSC may issue
direction to STAR Kids MCOs regarding whether initial, annual renewal,
or change in condition assessments may be conducted through audio-visual
or audio-only communication for STAR Kids members who reside in the
area subject to the declared state of disaster.
(6) STAR Kids MCOs must adhere to §353.1155 of
this chapter (relating to Medically Dependent Children Program) for
assessments and service planning, and §353.1(c) of this chapter
regarding compliance with all terms of the contract with HHSC.
(7) For limited circumstances, STAR Kids MCOs may submit,
in a manner and format prescribed by HHSC, an exceptions policy for
required in-person assessments for approval by HHSC. The policy must
be developed by the MCO's clinical staff, such as the Chief Medical
Director or the Director's designee.
(c) STAR Health.
(1) The STAR Health MCO must administer the HHSC-developed
assessment tool for initial Medically Dependent Children Program (MDCP)
eligibility and annual reassessments in -person.
(2) The STAR Health MCO must conduct all initial and
annual reassessments using HHSC-developed tools for functionally necessary
covered services such as personal assistance services, personal care
services, and Community First Choice services, in -person.
(3) Change in condition assessments that require or
potentially require a change in the RUG level must be conducted in-person.
(4) MCOs may offer STAR Health members a choice of
audio-visual communication in place of in-person change in condition
assessments, as long as the assessment does not require or potentially
require a change in the RUG level.
(A) When an MCO conducts a change in condition assessment
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 change in condition assessments 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.
(5) A STAR Health MCO may not conduct an assessment
without the in-person presence of the member.
(6) During a declared state of disaster, HHSC may issue
direction to STAR Health MCOs regarding whether initial, annual renewal,
or change in condition assessments may be conducted through audio-visual
or audio-only communication for STAR Health members who reside in
the area subject to the declared state of disaster.
(7) A STAR Health MCO must adhere to §353.1155
of this chapter for MDCP assessments and service planning, and §353.1(c)
of this chapter regarding compliance with all terms of the contract
with HHSC.
(8) For limited circumstances, a STAR Health MCO may
submit, in a manner and format prescribed by HHSC, an exceptions policy
for required in-person assessments for approval by HHSC. The policy
must be developed by the MCO's clinical staff, such as the Chief Medical
Director or the Director's designee.
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