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STAR Kids Handbook

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STAR Kids Handbook

  • Section 1000, Overview and Eligibility
  • Section 2000, Medically Dependent Children Program Intake and Initial Application
  • Section 3000, STAR Kids Screening and Assessment and Service Planning
  • Section 4000, STAR Kids Community Services
  • Section 5000, Service Delivery Options
  • Section 6000, Denials and Terminations
  • Section 7000, Complaint, Appeal and Fair Hearing Procedures
  • Section 8000, Utilization Management and Review by the State
  • Appendices
  • Upcoming Form Revisions
  • Forms
  • Glossary
  • Revisions
  • HHSC Policy Updates
  • Contact Us
  • Printer-friendly version

 

Section 1000, Overview and Eligibility

  • 1100 Legal Basis and Values
    • 1110 Mission Statement
  • 1200 STAR Kids Services and Service Delivery Options
    • 1210 Acute Care Services
    • 1220 Long Term Services and Supports
    • 1230 Service Delivery Options for Certain LTSS
  • 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
    • 1410 MDCP Program Goal
  • 1500 Medically Dependent Children Program Eligibility
    • 1510 Medical Necessity Determination
      • 1511 Medical Necessity Determination for Applicants/Members Residing in NFs
      • 1512 Medical Necessity Determination for Applicants/Members Not Residing in NFs
    • 1520 Individual Cost Limit
    • 1530 Unmet Need for at Least One Waiver Service
    • 1540 Age
    • 1550 Citizenship
    • 1560 Living Arrangement
    • 1570 Financial Eligibility
  • 1600 Disclosure of Information
    • 1610 Confidential Nature of a Case Record
      • 1611 Establishing Identity for Contact Outside the Interview Process
        • 1611.1 Telephone Contact
        • 1611.2 In-Person Contact
        • 1611.3 Verification and Documentation
      • 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
        • 1619.1 Adults and Emancipated Minors
        • 1619.2 Unemancipated Minors
        • 1619.3 Deceased Members
    • 1620 Confidential Information on Notifications
    • 1630 Correcting Information
    • 1640 Communication with the Managed Care Organization
    • 1650 Alternate Means of Communication
  • 1700 Citizenship and Identity Verification
    • 1710 Supplemental Security Income Recipients
      • 1712 Medicare Recipients
      • 1713 All Other Individuals
  • 1800 Member Rights and Responsibilities
  • 1900 Notifications
    • 1910 Program Support Unit Notification Requirements
    • 1920 MCO Notification Requirements

Section 2000, Medically Dependent Children Program Intake and Initial Application

  • 2010 Initial Requests for Medically Dependent Children Program
  • 2020 Individual Who Receives STAR Health
    • 2021 Individual Who Receives Other Types of Medicaid
  • 2030 Managed Care Organization Coordination
  • 2100 Money Follows the Person
  • 2110 Traditional Money Follows the Person
    • 2111 Non-STAR Kids Individual Residing in an NF
    • 2112 STAR Kids Member Residing in an NF
    • 2113 MDCP MFP Applications Pending Due to Delay in NF Discharge
  • 2120 MFP Limited NF Stay Option for a Medically Fragile Individual
    • 2121 Money Follows the Person Procedures for Requesting a Limited Nursing Facility Stay
  • 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
    • 3110 Assessment of Medical Necessity for Community First Choice
    • 3120 Assessment of Medical Necessity for the Medically Dependent Children Program
  • 3200 Member Reassessment
    • 3210 Reassessment of Medical Necessity or Level of Care
  • 3300 Member Service Planning and Authorization
    • 3310 Service Planning
      • 3311 Updates to the Individual Service Plan
    • 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
        • 3327.1 Process for Reviewing the Individual Service Plan Expiring Report
      • 3328 Reassessment Notification Requirements
  • 3400 Member Transfers
    • 3410 Transfer from One Managed Care Organization to Another
    • 3420 Member Transfer from Waiver Program to MDCP
    • 3430 Member Transfer from MDCP to Another Waiver
    • 3440 Member Transfer from Community Services to STAR Kids
  • 3500 Member Transition to Adult Programs
    • 3510 Procedures for Children Transitioning from STAR Kids Receiving MDCP, PDN or PPECC
      • 3511 Twelve Months Prior to the Member's 21st Birthday
      • 3512 STAR+PLUS Transition Activities
      • 3513 Intrapulmonary Percussive Ventilator Benefit
    • 3520 Transition Policy for Non-Waiver Members Receiving Personal Care Services or Community First Choice Only

Section 4000, STAR Kids Community Services

  • 4010 Outline
  • 4100 Community First Choice
    • 4110 Community First Choice Eligibility
      • 4111 Determining Institutional Level of Care
    • 4120 Community First Choice Services
      • 4121 Community First Choice Personal Assistance
      • 4122 Community First Choice Habilitation
      • 4123 Community First Choice Emergency Response Service
      • 4124 Community First Choice Support Management
    • 4130 Community First Choice Assessment and Authorization
      • 4131 Assessment for a Nursing Facility Level of Care
        • 4131.1 Reassessment for a Nursing Facility Level of Care
      • 4132 Assessment for an Intermediate Care Facility Level of Care
        • 4132.1 Reassessment for an Intermediate Care Facility Level of Care
      • 4133 Assessment for an Institution Providing Psychiatric Services Level of Care
        • 4133.1 Reassessment for an Institution for Mental Disease Level of Care
    • 4140 Functional Assessment for Community First Choice Services
      • 4140.1 Reassessment of Functional Need for Community First Choice
  • 4200 Personal Care Services
    • 4210 Assessment for Personal Care Services
      • 4211 Reassessment for Personal Care Services
    • 4220 Personal Care Services Providers
  • 4300 Private Duty Nursing
    • 4310 Assessment for Private Duty Nursing
      • 4311 Reassessment and Reauthorization
    • 4320 Providers of Private Duty Nursing
    • 4330 Private Duty Nursing and Prescribed Pediatric Extended Care Center Services
  • 4400 Prescribed Pediatric Extended Care Centers
    • 4410 Assessment for Prescribed Pediatric Extended Care
      • 4411 Reassessment and Reauthorization
    • 4420 Providers of Prescribed Pediatric Extended Care
    • 4430 Private Duty Nursing and Prescribed Pediatric Extended Care Center Services
  • 4500 Day Activity and Health Services
    • 4510 Assessment for Day Activity and Health Services
      • 4511 Reassessment for Day Activity and Health Services
    • 4520 Day Activity and Health Services Providers
  • 4600 Medically Dependent Children Program Services
  • 4700 Medically Dependent Children Program Respite and Flexible Family Support Services
    • 4710 Medically Dependent Children Program Respite
      • 4711 In-Home Respite
        • 4711.1 Attendant with Delegated Tasks
      • 4712 Out-of-Home Respite
    • 4720 Respite Limits
    • 4730 Reserved for Future Use
    • 4740 Reserved for Future Use
    • 4750 Flexible Family Support Services
      • 4751 Flexible Family Support Services in Child Care
      • 4752 Flexible Family Support Services for Independent Living
      • 4753 Flexible Family Support Services in Post-Secondary Education
      • 4754 Flexible Family Support Services Requiring Delegated Tasks
    • 4760 Flexible Family Support Services Limits
  • 4800 Adaptive Aids, Minor Home Modifications, and Transition Assistance Services
    • 4810 Adaptive Aids
      • 4811 Service Limits on Adaptive Aids
    • 4820 Minor Home Modifications
      • 4821 Service Limits on Minor Home Modifications
    • 4830 Transition Assistance Services
      • 4831 Deposits
      • 4832 Moving Expenses
      • 4833 Site Preparation
      • 4834 Limits on Transition Assistance Services
      • 4835 Transition Assistance Services Agency Responsibilities
      • 4836 Three-Day Monitor Requirement
      • 4837 Failure to Leave the Facility
  • 4900 Supported Employment and Employment Assistance
    • 4910 Employment Assistance
      • 4911 Coordination with Texas Workforce Commission for Employment Assistance
      • 4912 Employment Assistance Providers
    • 4920 Supported Employment
      • 4921 Coordination with Texas Workforce Commission for Supported Employment
      • 4922 Supported Employment Providers

Section 5000, Service Delivery Options

  • 5010 Selection of a Service Delivery Option
  • 5020 Member Decision
  • 5100 Agency Option
    • 5110 Description
  • 5200 Consumer Directed Services
    • 5210 Overview
      • 5211 Consumer Directed Services Definitions
      • 5212 STAR Kids Services Available Under the Consumer Directed Services Option
    • 5220 Advantages and Risks of the Consumer Directed Services Option
      • 5221 Advantages of Consumer Directed Services (CDS) Service Delivery Option
      • 5222 Potential Risks Associated with the Consumer Directed Services Option
    • 5230 Member and Financial Management Service Agency Responsibilities
      • 5231 Member Responsibilities
      • 5232 Financial Management Service Agency Responsibilities
    • 5240 Member Choice in the Consumer Directed Services Option
      • 5241 Presentation of the Consumer Directed Services Option
  • 5300 Initiating the Consumer Directed Services Option
    • 5310 Declining the Consumer Directed Services Option
    • 5320 Determining the Individual Service Plan
      • 5321 Initiation of and Transition to the Consumer Directed Services Option
      • 5322 Initiation and Orientation of the Member as Employer
      • 5323 Employer and Employee Acknowledgment of Exemption from Nursing Licensure
      • 5324 Authorizing Consumer Directed Services
      • 5325 Ongoing Requirements
      • 5326 Service Back-Up Plans
      • 5327 Corrective Action Plans
      • 5328 Budgets
  • 5400 Service Responsibility Option Description
    • 5410 Service Responsibility Option Roles and Responsibilities
      • 5411 Managed Care Organization Responsibilities
      • 5412 Agency Responsibilities
      • 5413 Member Responsibilities
    • 5420 Managed Care Organization Procedures
      • 5421 Initial Authorization of Services
      • 5422 Monitoring
      • 5423 Procedures for Ongoing Members

Section 6000, Denials and Terminations

  • 6050 Description
  • 6100 Ten-Day Adverse Action Notification
    • 6110 Denial of Medical Necessity/Individual Service Plan
    • 6120 Denial of Medicaid Eligibility
    • 6130 Unable to Locate
  • 6200 Program Support Unit Initiated Denials/Terminations
    • 6210 Denial/Termination Due to Death
    • 6220 Denial/Termination Due to Residence in a Nursing Facility
    • 6230 Denial/Termination Due to Member Request
    • 6240 Denial/Termination of Financial Eligibility
    • 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 Denial/Termination Initiated by the Managed Care Organization
    • 6310 Denial/Termination Due to Threats to Health and Safety
    • 6320 Denial/Termination Due to Hazardous Conditions or Reckless Behavior
    • 6330 Denial/Termination Due to Harassment, Abuse or Discrimination
    • 6340 Denial as a Result of Exceeding the Cost Limit
    • 6350 Denial/Termination Due to Failure to Comply with Mandatory Requirements
    • 6360 Denial/Termination Due to Failure to Pay
    • 6370 Denial/Termination Due to Other Reasons

Section 7000, Complaint, Appeal and Fair Hearing Procedures

  • 7100 Managed Care Organization Procedures
    • 7110 Managed Care Organization Complaint Procedures
    • 7120 Managed Care Organization Internal Appeal Procedures
      • 7121 Expedited Managed Care Organization Internal Appeals
  • 7200 State Fair Hearing Procedures for Medically Dependent Children Program
    • 7210 Program Support Unit Procedures
      • 7211 Designated Data Entry Representative Procedures
      • 7212 Fair Hearings and Appeals Procedures
      • 7213 Evidence Packet
      • 7214 Fair Hearing Request Summary (Addendum)
    • 7220 Special Procedures for Cases – MEPD or TW Determined Financial Eligibility
      • 7221 Centralized Representation Unit
      • 7222 Program Support Unit Procedures
    • 7230 Evidence Packet and Hearing Decision
      • 7231 Uploading the Appeals Evidence Packet into the State Portal
      • 7232 Presentation of the Evidence Packet
      • 7233 Hearing Decision
  • 7300 Post Hearing Actions
    • 7310 Action Taken on the Hearing Decision
  • 7400 Continuation of Services
    • 7410 Continuation of MDCP Waiver Services During a State Appeal
    • 7420 Discontinuation of MDCP Waiver Services During a State Fair Hearing
  • 7500 Hearing Decision Actions
    • 7510 Sustained Appeal Decisions
      • 7511 Sustained Decisions – Termination Effective Dates
    • 7520 Reversed Appeal Decisions
      • 7521 Reversed Decisions – Effective Dates
      • 7522 New Assessment Required by Fair Hearing Decision
      • 7523 Request to Withdraw an Appeal
  • 7600 Roles and Responsibilities of Texas HHSC Hearing Officers
  • 7700 Fair Hearings for Managed Care Organization Determinations

Section 8000, Utilization Management and Review by the State

  • 8100 Description
  • Section 1000, Overview and Eligibility
  • Section 2000, Medically Dependent Children Program Intake and Initial Application
  • Section 3000, STAR Kids Screening and Assessment and Service Planning
  • Section 4000, STAR Kids Community Services
  • Section 5000, Service Delivery Options
  • Section 6000, Denials and Terminations
  • Section 7000, Complaint, Appeal and Fair Hearing Procedures
  • Section 8000, Utilization Management and Review by the State
  • Appendices
  • Upcoming Form Revisions
  • Forms
  • Glossary
  • Revisions
  • HHSC Policy Updates
  • Contact Us
Section 1000, Overview and Eligibility ›

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