| (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.
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