3-2018

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Transition topics should be appropriate to the member’s individual needs as documented in the individual service plan (ISP). The following is a non-exhaustive list of topics that may be appropriate to discuss during each age range.

Transition Activities at Ages 15-16

  • The member's knowledge of his or her health care needs, including the disease process and progression specific to the member’s active diagnosis.
  • Health and wellness education to assist the member with self-management.
  • Alternative caregiver identified and a written back-up plan in place in the event the primary caregiver is unable to care for the member.
  • Promote independence and social skills by discussing available programs, such as camps.
  • If there is a transition plan (school) in place for the member with an Individualized Education Program (IEP). If no transition plan is in place, urge the member to reach out to the school to have a transition plan developed. If desired by the member or legally authorized representative (LAR), coordinate with the member's school and IEP to ensure consistency of goals and include any 504 plans, if applicable.
  • What age the member will no longer receive educational services and begin career planning, such as:
    • Coordination with the Texas Workforce Commission (TWC) to help identify future employment and employment training opportunities; and
    • Explore opportunities for higher education, such as college or technical school.
  • Provide information and referrals to community organizations that are important to the health and wellbeing of the member. These organizations include, but are not limited to:
    • State/federal agencies (e.g., those agencies with jurisdiction over aging, public health, substance abuse, mental health, intellectual or developmental disabilities, rehabilitation, income support, nutritional assistance, family support agencies, etc.). For members with progressive vision loss, a referral is made to explore services offered through the Texas School for the Blind and Visually Impaired;
    • Social service agencies (e.g., area agencies on aging, residential support agencies, independent living centers, supported employment agencies, etc.);
    • City and county agencies (e.g., welfare departments, housing programs, etc.);
    • Civic and religious organizations; and
    • Consumer groups, advocates, and councils (e.g., legal aid offices, consumer/family support groups, permanency planning, etc.).
  • This topic is only for individuals who receive private duty nursing (PDN) and/or Medically Dependent Children Program (MDCP) services.
    • Children's services, such as PDN and MDCP, are not available to adults. For individuals receiving PDN, the STAR+PLUS Home and Community Based Services (HCBS) program or an intellectual or developmental disability (IDD) waiver will need to cover medically necessary nursing services that are not intermittent or part-time at age 21, which may not be the same level of nursing they receive through STAR Kids. To be eligible for the STAR+PLUS HCBS program or an IDD waiver, the individual's health and safety must be ensured under the cost limit for the waiver program.
  • Guardianship, which should be discussed at least annually.

Transition Activities at Age 17

  • Goals and ways for the member to begin managing his or her own medical care, such as the member making and keeping his or her own medical appointments, ordering supplies, etc.
  • Alternative caregiver identified and a written back-up plan in the event the primary caregiver is unable to care for the member.
  • Discuss transportation options.
  • Assist the member with looking for a primary care provider (PCP), specialists, as necessary, and a dentist.
  • Discuss current and possible future community living options. Coordinate visits with potential providers or facilities, if applicable.
  • Verify eligibility for Supplemental Security Income (SSI) with the member, authorized representative (AR) or the LAR. If the member does not have SSI, refer the member to the Social Security Administration (SSA).
  • Services available through STAR Kids at age 18, such as Day Activity and Health Services (DAHS).
  • This topic is only for individuals who receive PDN and/or MDCP services.
    • Children's services, such as PDN and MDCP, are not available to adults. For individuals receiving PDN, STAR+PLUS HCBS program or an IDD waiver will need to cover medically necessary nursing services that are not intermittent or part-time at age 21, which may not be the same level of nursing they receive through STAR Kids. To be eligible for the STAR+PLUS HCBS program or an IDD waiver, the individual's health and safety must be ensured under the cost limit for the waiver program.
  • Provide information and referrals to community organizations that are important to the health and wellbeing of members. These organizations include but are not limited to:
    • State/federal agencies (e.g., those agencies with jurisdiction over aging, public health, substance abuse, mental health, intellectual or developmental disabilities, rehabilitation, income support, nutritional assistance, family support agencies, etc.). For members with progressive vision loss, a referral is made to explore services offered through Texas School for the Blind and Visually Impaired;
    • Social service agencies (e.g., area agencies on aging, residential support agencies, independent living centers, supported employment agencies, etc.);
    • City and county agencies (e.g., welfare departments, housing programs, etc.);
    • Civic and religious organizations; and
    • Consumer groups, advocates, and councils (e.g., legal aid offices, consumer/family support groups, permanency planning, etc.).
  • Discuss guardianship and provide contact information.

Transition Activities at Ages 18-19

  • Verify eligibility for Supplemental Security Income (SSI) with the member, authorized representative (AR) or the LAR the month of the member's 18th birthday. If the member does not have SSI, refer the member to the Social Security Administration (SSA).
  • Assist the member with looking for a PCP, specialists, as necessary, and a dentist.
  • This topic is only for individuals who receive PDN and/or MDCP services.
    • Children's services, such as PDN and MDCP, are not available to adults. For individuals receiving PDN, STAR+PLUS HCBS program or an IDD waiver will need to cover medically necessary nursing services that are not intermittent or part-time at age 21, which may not be the same level of nursing they receive through STAR Kids. To be eligible for the STAR+PLUS HCBS program or an IDD waiver, the individual's health and safety must be ensured under the cost limit for the waiver program.
  • Provide information and referrals to community organizations that are important to the health and wellbeing of members. These organizations include but are not limited to:       
    • State/federal agencies (e.g., those agencies with jurisdiction over aging, public health, substance abuse, mental health, intellectual or developmental disabilities, rehabilitation, income support, nutritional assistance, family support agencies, etc.) For members with progressive vision loss, a referral is made to explore services offered through Texas School for the Blind and Visually Impaired;
    • Social service agencies (e.g., area agencies on aging, residential support agencies, independent living centers, supported employment agencies, etc.);
    • City and county agencies (e.g., welfare departments, housing programs, etc.);
    • Civic and religious organizations; and
    • Consumer groups, advocates, and councils (e.g., legal aid offices, consumer/family support groups, permanency planning, etc.).
  • Discuss current and possible future community living options. Coordinate visits with potential providers or facilities, if applicable.
  • Assess the member's needs for adaptive aids, new equipment due to growth and development and minor home modifications, as necessary.
  • Discuss guardianship and provide contact information.

Transition Activities at Age 20

  • STAR Kids eligibility will terminate on the last day of the month in which the individual’s 21st birthday occurs and the individual will need to receive services through programs serving adults.
  • Individuals who meet STAR+PLUS enrollment criteria will transition to the STAR+PLUS program the first of the month following their individual’s 21st birthday.
  • STAR+PLUS HCBS program may be an option available to the individual at age 21. The managed care organization (MCO) must also present an overview of the array of services available in STAR+PLUS HCBS program.
  • Assist the member with looking for an adult PCP, specialists as necessary, and a dentist.
  • Provide information and referrals to community organizations that are important to the health and wellbeing of members. These organizations include but are not limited to:
    • State/federal agencies (e.g., those agencies with jurisdiction over aging, public health, substance abuse, mental health, intellectual or developmental disabilities, rehabilitation, income support, nutritional assistance, family support agencies, etc.). For members with progressive vision loss, a referral is made to explore services offered through Texas School for the Blind and Visually Impaired;
    • Social service agencies (e.g., area agencies on aging, residential support agencies, independent living centers, supported employment agencies, etc.);
    • City and county agencies (e.g., welfare departments, housing programs, etc.);
    • Civic and religious organizations; and
    • Consumer groups, advocates, and councils (e.g., legal aid offices, consumer/family support groups, permanency planning, etc.).
  • Discuss current and possible future community living options. Coordinate visits with potential providers or facilities, if applicable.
  • Assess the member's needs for adaptive aids, new equipment due to growth and development, and minor home modifications, as necessary.
  • Discuss guardianship and provide contact information.
  • Discuss the STAR+PLUS enrollment process below with individuals not receiving PDN and/or MDCP services.
    • MAXIMUS will reach out to the individual 30 days prior to the individual's 21st birthday and provide the member with STAR+PLUS enrollment packets (containing the STAR+PLUS MCO list). The member will be given 15 days to make an MCO selection. If the member has not made a selection after 15 days, MAXIMUS will select an MCO for the member, as outlined in 1 Texas Administrative Code §353.403(3), Enrollment and Disenrollment.
  • Discuss the STAR+PLUS enrollment process below with individuals receiving PDN and/or MDCP services.
    • Children's services, such as PDN and MDCP, are not available to adults. Individuals receiving PDN, STAR+PLUS HCBS or an IDD waiver will need to cover medically necessary nursing services that are not intermittent or part-time at age 21, which may not be the same level of nursing they receive through STAR Kids. To be eligible for STAR+PLUS HCBS program or an IDD waiver, the individual's health and safety must be ensured under the cost limit for the waiver program.
    • The STAR+PLUS HCBS program enrollment process that will begin no later than nine months prior to the individual’s 21st birthday.
    • PSU staff will send a STAR+PLUS HCBS program enrollment packet containing the STAR+PLUS MCO list and a comparison chart to the individual nine months prior to the individual’s 21st birthday.
    • The importance of choosing an MCO six months before the 21st birthday in order to avoid being assigned an MCO or having a gap in services.
    • The STAR+PLUS HCBS program has a cost limit based on a medical assessment, the Medical Necessity/Level of Care (MN/LOC) Assessment. The limit is 202 percent of the member's Resource Utilization Group (RUG). The assessment results in the cost limit for the annual individual service plan (ISP).
    • To be eligible for the STAR+PLUS HCBS program, an ISP must be developed within the cost limit that will meet the individual's needs and ensure health and safety.
    • If an ISP cannot be developed within the cost limit that ensures the health and safety, the STAR+PLUS HCBS program will be denied.
    • The ISP considers all resources available to meet the member's needs, including community supports, other programs, and what the member's informal support system can provide to meet the member's needs.
    • The STAR+PLUS HCBS program assessment process will begin six months before the individual's 21st birthday. PSU staff will contact the member to begin the assessment process and find out which STAR+PLUS MCO has been selected. If an MCO has not been selected, then 30 days is allowed for a selection. After 30 days, an MCO is selected for the member.
    • After the STAR+PLUS MCO is selected, the MCO will contact the member to begin the assessment for services and assist the member/available supports in identifying and developing additional resources and community supports to help meet the individual's needs.

 

Shared Appendix 19

This appendix appears in the following handbooks:

STAR Kids Handbook (SKH): Appendix VI
STAR Kids Program Support Unit Operational Procedures Handbook (SKOPH): Appendix VI
STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH): Appendix XXXVII