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Section 1000, Overview and Eligibility
- 1100 Legal Basis and Values
- 1200 STAR Kids Services and Service Delivery Options
- 1300 Service Coordination
- 1310 Service Coordination Requirements
- 1320 Service Coordination and Programs Serving Members with IDD
- 1330 Service Coordination and the Youth Empowerment Services Program
- 1340 Service Coordinators and HCBS - Adult Mental Health
- 1350 Service Coordinators and the Section 811 Project Rental Assistance Program
- 1400 Medically Dependent Children Program
- 1500 Medically Dependent Children Program Eligibility
- 1600 Disclosure of Information
- 1610 Confidential Nature of a Case Record
- 1611 Establishing Identity for Contact Outside the Interview Process
- 1612 Custody of Records
- 1613 Disposal of Record
- 1614 When and What Information May Be Disclosed
- 1615 Confidential Nature of Medical Information — Health Insurance Portability and Accountability Act
- 1616 Privacy Notice
- 1617 Member Authorization
- 1618 Minimum Necessary Information Release
- 1619 Legally Authorized Representatives and Authorized Representatives
- 1620 Correcting Information
- 1630 Communication with the Managed Care Organization
- 1640 Alternate Means of Communication
- 1610 Confidential Nature of a Case Record
- 1700 Member Rights and Responsibilities
- 1800 Notifications
Section 2000, Medically Dependent Children Program Intake and Initial Application
- 2010 Initial Requests for Medically Dependent Children Program
- 2020 Individual Who Receives STAR Health
- 2030 Managed Care Organization Coordination
- 2100 Money Follows the Person
- 2110 Traditional Money Follows the Person
- 2120 MFP Limited NF Stay Option for a Medically Fragile Individual
- 2130 Physician Determination of Medical Fragility
- 2131 PSU Procedures for an Individual Who is Approved for a Limited NF Stay and Not Enrolled in Medicaid
- 2132 PSU Procedures for an Individual Who is Approved for a Limited NF Stay with Medicaid and Not Enrolled in STAR Kids
- 2133 PSU Procedures for an Individual Who is Approved for a Limited NF Stay and Currently Enrolled in STAR Kids
- 2134 PSU and MCO Coordination Procedures for an MDCP Applicant Approved for a Limited NF Stay
- 2135 Delays in Limited NF Stay for an Applicant Not Enrolled in STAR Kids
Section 3000, STAR Kids Screening and Assessment and Service Planning
- 3100 STAR Kids Screening and Assessment
- 3200 Member Reassessment
- 3300 Member Service Planning and Authorization
- 3310 Service Planning
- 3320 Service Planning for Medically Dependent Children Services
- 3321 Medically Dependent Children Program Individual Service Plan Revision
- 3322 MDCP Individual Service Plan and Budget Revision
- 3323 Setting Aside Funds in the MDCP Individual Service Plan
- 3324 Individual Service Plan Exceeding the Cost Limit for MDCP Services
- 3325 Multiple MDCP Members in the Same Household
- 3326 Suspension of Medically Dependent Children Program Services
- 3327 Reassessment Individual Service Provider Procedures
- 3328 Reassessment Notification Requirements
- 3400 Member Transfers
- 3500 Member Transition to Adult Programs
Section 4000, STAR Kids Community Services
- 4010 Outline
- 4100 Community First Choice
- 4110 Community First Choice Eligibility
- 4120 Community First Choice Services
- 4130 Community First Choice Assessment and Authorization
- 4140 Functional Assessment for Community First Choice Services
- 4200 Personal Care Services
- 4300 Private Duty Nursing
- 4400 Prescribed Pediatric Extended Care Centers
- 4500 Day Activity and Health Services
- 4600 Medically Dependent Children Program Services
- 4700 Medically Dependent Children Program Respite and Flexible Family Support Services
- 4800 Adaptive Aids, Minor Home Modifications, and Transition Assistance Services
- 4900 Supported Employment and Employment Assistance
Section 5000, Service Delivery Options
- 5010 Selection of a Service Delivery Option
- 5020 Member Decision
- 5100 Agency Option
- 5200 Consumer Directed Services
- 5300 Member Choice and Enrollment in the CDS Option
- 5400 Service Responsibility Option Description
Section 6000, Denials and Disenrollment
- 6050 Description
- 6100 Ten Business Day Adverse Determination Notification
- 6200 Denial/Termination of Medically Dependent Children Program
- 6210 Denial/Termination Due to Death
- 6220 Denial/Termination Due to Residence in a Nursing Facility
- 6230 Denial/Termination of Medicaid Financial Eligibility
- 6240 Denial/Termination as a Result of Exceeding the Cost Limit
- 6250 Denial/Termination of Medical Necessity
- 6260 Denial/Termination Due to Inability to Locate the Member
- 6270 Denial/Termination Due to Failure to Meet Other Program Requirements
- 6280 Denial/Termination for Other Reasons
- 6300 Disenrollment from Managed Care
Section 7000, Complaint, Appeal and Fair Hearing Procedures
- 7100 Managed Care Organization Procedures
- 7200 State Fair Hearing Procedures for Medically Dependent Children Program
- 7300 Post Hearing Actions
- 7400 Continuation of Services
- 7500 Hearing Decision Actions
- 7600 Roles and Responsibilities of Texas HHSC Hearing Officers
- 7700 Fair Hearings for Managed Care Organization Determinations