Revision 17-1; Effective June 1, 2017

 

 

8100 Description

Revision 17-1; Effective June 1, 2017

 

Utilization Review (UR) is a division within the Medicaid Children's Health Insurance Program (CHIP) Division of the Texas Health and Human Services Commission (HHSC). UR was created by Senate Bill 348, 83rd Legislature Regular Session, 2013. This bill amended Section 533.00281 of the Texas Government Code to allow HHSC to review utilization of the STAR+PLUS Home and Community Based Services (HCBS) Program. HHSC has extended the scope of UR to include review of appropriate utilization of STAR Kids Medically Dependent Children Program (MDCP) services as well as state plan services provided in STAR Kids.

STAR Kids managed care organizations (MCOs) must make documents, assessments, notes and authorizations contained in a STAR Kids member's file available upon request from UR. STAR Kids MCOs must participate and make appropriate staff available for reviews conducted by UR upon request from that division.