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Section 1000, STAR Kids Overview and Eligibility
- 1200 Medically Dependent Children Program Eligibility
- 1400 Service Coordination through the Managed Care Organization
- 1410 Service Coordination Requirements
- 1420 Service Coordination and Programs Serving Members with Intellectual or Developmental Disabilities
- 1430 Service Coordination and the Youth Empowerment Services Waiver Program
- 1440 Service Coordinators and Home and Community Based Services – Adult Mental Health
- 1600 Disclosure of Information
- 1610 Confidential Nature of Medical Information – Health Insurance Portability and Accountability Act
- 1620 Alternate Means of Communication with the Applicant or Member
- 1630 Confidential Information on Notifications
- 1640 Applicant or Member Correction of Information
- 1650 Disposal of Records
Section 2000, Medically Dependent Children Program Intake and Initial Application
- 2010 Initial Requests for Medically Dependent Children Program
- 2020 Interest List Management Unit Responsibilities
- 2030 Program Support Unit Staff Responsibilities
- 2100 Enrollment Following Release from the Interest List
- 2100.1 Individuals Not Enrolled in Medicaid, Including an Individual Enrolled in the Children’s Health Insurance Program
- 2100.2 Individual Who Receives Supplemental Security Income or SSI-Related Medicaid
- 2100.3 Individual Who Receives STAR Health
- 2100.4 Individual Who Receives Other Types of Medicaid
- 2110 Managed Care Organization Selection
- 2120 Inability to Contact the Individual
- 2130 Declining Medically Dependent Children Program Services
- 2200 Receipt of Enrollment Packet
- 2300 Interest List Release Closures
- 2400 Money Follows the Person
- 2410 Traditional Money Follows the Person
- 2420 Money Follows the Person Limited NF Stay Option for a Medically Fragile Individual
- 2421 Money Follows the Person Procedures for Requesting a Limited Nursing Facility Stay
- 2422 Money Follows the Person Limited Nursing Facility Stay Procedures
- 2423 HHSC Nurse or Physician Review of Medical Fragility
- 2424 Physician Determination of Medical Fragility
- 2425 Individual Not Meeting the Medically Fragile Criteria
- 2426 ILM Unit Procedures for Assigning an Individual Approved for a Limited NF Stay to PSU Staff
- 2427 PSU Procedures for an Individual Approved for a Limited NF Stay
- 2427.1 PSU Procedures for an Individual Approved for a Limited NF Stay without Medicaid
- 2427.2 PSU Procedures for an Individual Approved for a Limited NF Stay with Medicaid and Not Enrolled in STAR Kids
- 2427.3 PSU Procedures for an Individual Approved for a Limited NF Stay and Currently Enrolled in STAR Kids
- 2428 PSU and MCO Staff Coordination Procedures for an MDCP Applicant Approved for a Limited NF Stay
- 2429 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 Program Services
- 3321 Medically Dependent Children Program Individual Service Plan Revision
- 3322 Medically Dependent Children Program Individual Service Plan and Budget Revision
- 3323 Setting Aside Funds in the Medically Dependent Children Program Individual Service Plan
- 3324 Individual Service Plan Exceeding the Cost Limit for MDCP Services
- 3325 Multiple Medically Dependent Children Program Members in the Same Household
- 3326 Suspension of Medically Dependent Children Program Services
- 3327 Reassessment Individual Service Plan Provider Procedures
- 3328 Reassessment Notification Requirements
- 3400 Member Transfers
- 3500 Transition from Medically Dependent Children Program 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 Modification and Transition Assistance Services
- 4900 Supported Employment and Employment Assistance
Section 5000, Reserved for Future Use
Section 6000, Denials and Terminations
- 6050 Description
- 6100 Ten-Day Adverse Action Notification
- 6200 Program Support Unit Staff 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 Program Requirements and Service Delivery Provisions
- 6360 Denial/Termination Due to Failure to Pay
- 6370 Denial/Termination Due to Other Reasons
Section 7000, Applicant or Member Complaints, Internal MCO Appeals and State Fair Hearings
- 7100 Managed Care Organization Procedures
- 7200 State Fair Hearing Procedures for Medically Dependent Children Program
- 7300 Post State Fair Hearing Actions
- 7400 Reserved for Future Use
- 7500 State Fair Hearing Decision Actions
- 7600 Roles and Responsibilities of Texas Health and Human Services Commission Hearings Officer