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 353.1504 - Use of Telecommunications in Service Coordination and Service Management

Current through Reg. 49, No. 28; July 12, 2024
(a) STAR+PLUS.
(1) Managed care organizations (MCOs) must
				  ensure all level 1 and 2 members receive at least one in-person service
				  coordination visit per year.
(2) An
				  in-person assessment satisfies the annual in-person service coordination visit
				  requirement for level 1 and 2 members.
(3) MCOs may offer level 1 and 2 members in
				  STAR+PLUS a choice of audio-visual communication for service coordination in
				  place of an in-person visit if no assessment is occurring.
(A) When an MCO conducts service coordination
				  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 service coordination
				  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.
(4) During a declared state of
				  disaster, HHSC may issue direction to MCOs regarding whether service
				  coordination required to be conducted using face-to-face communication may be
				  conducted through audio-only communication.
(5) MCOs may offer level 3 members in
				  STAR+PLUS a choice of in-person, audio-visual, or audio-only communication for
				  service coordination.
(6) Nursing
				  facility residents must have at least one in-person service coordination visit
				  per year for service planning purposes.
(7) STAR+PLUS MCOs must conduct nursing
				  facility discharge planning visits in-person, including when a member is
				  transitioning to the STAR+PLUS HCBS Program. The in-person nursing facility
				  discharge planning visit may satisfy the requirement for the in-person
				  STAR+PLUS HCBS initial assessment when a nursing facility member is
				  transitioning to the STAR+PLUS HCBS Program. The requirement to conduct the
				  in-person STAR+PLUS HCBS initial assessment is satisfied during the in-person
				  nursing facility discharge planning visit if the MCO:
(A) uses the member's valid Minimum Data Set
				  (MDS) assessment to gather the information necessary to complete the STAR+PLUS
				  HCBS individual service plan; or
(B) conducts a Medical Necessity and Level of
				  Care assessment if the member does not have a valid MDS or in lieu of the
				  member's valid MDS to gather the information necessary to complete the
				  STAR+PLUS HCBS individual service plan.
(8) MCOs must provide service coordination in
				  accordance with §
											353.609 of this chapter (relating
				  to Service Coordination).