Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 353 - MEDICAID MANAGED CARE › Subchapter R - TELECOMMUNICATIONS IN MANAGED CARE SERVICE COORDINATION AND ASSESSMENTS › Section 353.1503 - Use of Telecommunications in Assessments

Current through Reg. 49, No. 28; July 12, 2024
(a) STAR+PLUS.
(1) STAR+PLUS managed care organizations
				  (MCOs) must conduct initial assessments and annual reassessments using
				  HHSC-developed tools for STAR+PLUS HCBS Program eligibility
				  in-person.
(2) STAR+PLUS MCOs must
				  conduct all initial and annual assessments using HHSC-developed tools for
				  functionally necessary covered services such as personal assistance services,
				  Community First Choice services, and day activity and health services,
				  in-person.
(3) Change in condition
				  assessments that require or potentially require a change in the Resource
				  Utilization Group (RUG) level must be conducted in-person.
(4) MCOs may offer to STAR+PLUS members a
				  choice of audio-visual communication in place of in-person change in condition
				  assessments, as long as the assessment does not require or potentially require
				  a change in the RUG level.
(A) When an MCO
				  conducts a change in condition assessment using audio-visual communication,
				  verbal consent must be obtained and documented, and a HIPAA-compliant
				  audio-visual communication product must be used.
(B) If verbal consent for audio-visual
				  communication is not received, the MCO must use in-person
				  communication.
(C) The MCO must
				  inform members who utilize audio-visual communication for change in condition
				  assessments that the member's services will be subject to the following:
(i) The MCO must monitor services for fraud,
				  waste, and abuse.
(ii) The MCO must
				  determine whether additional social services or supports are needed.
(iii) The MCO must ensure that verbal consent
				  to use telecommunications is documented in writing.
(5) A STAR+PLUS MCO may not
				  conduct an initial assessment, annual reassessment, or change in condition
				  assessment without the in-person presence of the member.
(6) During a declared state of disaster, HHSC
				  may issue direction to STAR+PLUS MCOs regarding whether initial, annual
				  renewal, or change in condition assessments may be conducted through
				  audio-visual or audio-only communication for STAR+PLUS members who reside in
				  the area subject to the declared state of disaster.
(7) STAR+PLUS MCOs must adhere to §
											353.1153 of this chapter (relating
				  to STAR+PLUS Home and Community Based Services (HCBS) Program) for STAR+PLUS
				  assessments and service planning, and §
											353.1(c) of this
				  chapter (relating to Purpose) regarding compliance with all terms of the
				  contract with HHSC.
(8) For limited
				  circumstances, STAR+PLUS MCOs may submit, in a manner and format prescribed by
				  HHSC, an exceptions policy for required in-person assessments for approval by
				  HHSC. The policy must be developed by the MCO's clinical staff, such as the
				  Chief Medical Director or the Director's designee.