4100.1 Community First Choice

Revision 22-3; Effective Sept. 9, 2022 

Community First Choice (CFC) is available to all STAR Kids members who meet an institutional level of care (LOC) for a hospital, nursing facility (NF), intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID), or an institution for mental disease. CFC services include personal care services (CFC-PCS), Emergency Response Services (CFC-ERS), support management, and habilitation (CFC-HAB). 

The managed care organization (MCO) must ensure the member receives at least one waiver service per month to maintain CFC eligibility. 

CFC-PCS provides help with activities of daily living (ADLs), instrumental activities of daily living (IADLs) through hands-on assistance, supervision, cueing or both, to include nurse-delegated tasks. Members may not be authorized for State Plan PCS and CFC-PCS at the same time. 

CFC-HAB provides assistance with acquisition, maintenance, and enhancement of skills necessary for the member to accomplish ADLS, IADLs and health-related tasks. 

CFC-ERS provides assistance for members who live alone, are alone for large parts of the day, or have no regular caregiver for extended periods of time and who would otherwise require extensive routine supervision. This service connects a member to an emergency response services (ERS) provider who notifies local authorities, like paramedics of a member's emergency. 

CFC support management provides voluntary training on how to select, manage and dismiss attendants. 

Refer to the STAR Kids Handbook (SKH) for more information about CFC services. 

4100.2 Personal Care Services

Revision 22-3; Effective Sept. 9, 2022 

Personal Care Services (PCS) is a benefit under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program (CCP), known in Texas as the Texas Health Steps Comprehensive Care Program (THSteps-CCP).

PCS provides help with activities of daily living (ADLs), instrumental activities of daily living (IADLs) and health-related tasks through hands-on assistance, supervision, or cueing, including nurse-delegated tasks. 

A member may not be authorized to receive both PCS and Community First Choice (CFC) services at the same time. 

Refer to the STAR Kids Handbook (SKH) for more information about PCS. 

4100.3 Private Duty Nursing

Revision 22-3; Effective Sept. 9, 2022

Private duty nursing (PDN) is a benefit under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program (CCP), known in Texas as the Texas Health Steps Comprehensive Care Program (THSteps-CCP).

PDN is nursing services for members who:

• meet medical necessity (MN) criteria outlined in the STAR Kids Screening and Assessment Instrument (SK-SAI); and
• require individualized, continuous skilled care beyond the level of skilled nursing visits provided under Texas Medicaid home health services. 

Refer to the STAR Kids Handbook (SKH) for more information about PDN. 

4100.4 Prescribed Pediatric Extended Care Centers

Revision 22-3; Effective Sept. 9, 2022 

Prescribed Pediatric Extended Care Center (PPECC) services is a benefit under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program (CCP), known in Texas as the Texas Health Steps Comprehensive Care Program (THSteps-CCP). 

PPECC is a facility that provides nonresidential basic services, including medical, nursing, psychosocial, therapeutic, and developmental services to medically dependent or technologically dependent members under 21 years for up to 12 hours per day. 

Refer to the STAR Kids Handbook (SKH) for more information about PPECC. 

4100.5 Day Activity and Health Services

Revision 22-3; Effective Sept. 9, 2022 

Day activity health services (DAHS) for members 18 through 20. DAHS includes nursing and personal care services, therapy extension services, nutrition services, transportation services and other supportive services.

Refer to the STAR Kids Handbook (SKH) for more information about DAHS.

Revision 22-3; Effective Sept. 9, 2022 

The Medically Dependent Children Program (MDCP) is a 1915(c)-waiver program for eligible members. It prevents placement in long-term care facilities who are medically dependent and under 21 years old. Only members who are assessed as meeting medical necessity (MN) for Medically Dependent Children Program (MDCP) and who have a slot in MDCP are eligible for MDCP services.

The applicant or member’s managed care organization (MCO) uses the STAR Kids Screening and Assessment Instrument (SK-SAI) to assess for MN for MDCP. Receipt of MDCP services does not impact a member's eligibility for other long-term services and supports (LTSS) available in STAR Kids. Refer to Appendix XIX, Mutually Exclusive Services, to determine if two services may be received simultaneously by an applicant or member.

MDCP services include respite, flexible family support services (FFSS), minor home modifications, adaptive aids, transition assistance services (TAS), supported employment (SE), employment assistance (EA) and financial management services (FMS).

4200.1 Medically Dependent Children Program Respite

Revision 22-3; Effective Sept. 9, 2022 

Respite services are direct care services needed because of a member's disability that provides a primary caregiver temporary relief from caregiving activities when the primary caregiver would usually perform such activities.

Refer to the STAR Kids Handbook (SKH) for more information about respite services.

4200.2 Flexible Family Support Services

Revision 22-3; Effective Sept. 9, 2022 

Flexible family support services (FFSS) are direct care services needed because of a member's disability that help a member participate in childcare, post-secondary education, employment, independent living, or support a member's move to an independent living situation. 

Refer to the STAR Kids Handbook (SKH) for more information about flexible family support services.

4200.3 Adaptive Aids

Revision 22-3; Effective Sept. 9, 2022

Adaptive aids are devices necessary to treat, rehabilitate, prevent, or compensate for conditions resulting in disability or loss of function and enable members to:

• perform activities of daily living (ADL); or
• control the environment in which they live.

Adaptive aids are available through the Medically Dependent Children Program (MDCP), if:

• determined medically necessary; and
• only after exhausting all Medicaid state plan services and other third-party resources.

After any applicable benefits are exhausted, adaptive aids covered through MDCP include but are not limited to:

• van lifts;
• vehicle modifications;
• jump seats;
• tumble form chairs;
• feeder seats;
• medically appropriate strollers;
• barrier-free lifts;
• stair lifts;
• environmental control units;
• alarm systems;
• support rails;
• electrical work related to use of authorized adaptive aids;
• installation of authorized adaptive aids; and
• repairs to adaptive aids. 

Refer to the STAR Kids Handbook (SKH) for more information about adaptive aids.

4200.4 Minor Home Modifications

Revision 22-3; Effective Sept. 9, 2022

A minor home modification (MHM) is a physical modification to a member’s residence necessary to prevent institutionalization or support de-institutionalization. Minor home modifications are necessary to ensure the health, welfare, and safety of the member or to enable the member to function with greater independence in their home. 

Refer to the STAR Kids Handbook (SKH) for more information about minor home modifications.

4200.5 Transition Assistance Services

Revision 22-3; Effective Sept. 9, 2022

Transition assistance services (TAS) are a one-time service provided to a Medicaid-eligible resident of a nursing facility (NF) located in Texas to assist the resident in moving from the NF into the community to receive Medically Dependent Children Program (MDCP) services.

Refer to the STAR Kids Handbook (SKH) for more information about TAS.

4200.6 Employment Assistance

Revision 22-3; Effective Sept. 9, 2022 

Employment assistance (EA) helps a member locate paid employment in the community. EA services include:

• identifying a member’s employment preferences, job skills, and requirements for a work setting and work conditions;
• locating prospective employers offering employment compatible with a member’s identified preferences, skills, and requirements; and
• contacting a prospective employer on behalf of a member and negotiating the member’s employment.

Refer to the STAR Kids Handbook (SKH) for more information about EA. 

4200.7 Supported Employment

Revision 22-3; Effective Sept. 9, 2022 

Supported employment (SE) helps to sustain paid, competitive employment to a member who, because of a disability, requires intensive, ongoing support to be self-employed, work from home, or perform in a work setting where members without disabilities are employed. SE services include:

• assistance provided to a member to sustain competitive employment and who, because of a disability, requires intensive, ongoing support to be self-employed, work from home or perform in a work setting at which individuals without disabilities are employed;
• employment adaptations, supervision and training related to a member’s assessed need; and
• ensuring members earn at least minimum wage, if not self-employed.

Refer to the STAR Kids Handbook (SKH) for more information about SE.

4200.8 Financial Management Services (FMS)

Revision 22-3; Effective Sept. 9, 2022 

Financial management services (FMS) are available to members who choose the Consumer Directed Services (CDS) option. FMS helps members with managing funds related to the services elected for self-direction. The service includes initial orientation and ongoing training about responsibilities of being an employer and adhering to legal requirements for employers. 

Refer to the STAR Kids Handbook (SKH) for more information about FMS.