Information Letter No. 16-36
Service Coordination in STAR Kids for Individuals Under Age 21
As described in Information Letter No. 16-26 dated July 5, 2016, most individuals under 21 years of age who are enrolled in the ICF/IID Program or in the HCS, TxHmL, DBMD, and CLASS programs (ICF/IID waiver programs) will receive their acute care and most other Medicaid State Plan services through the STAR Kids managed care program beginning November 1, 2016.
Every member of STAR Kids will have access to a managed care organization service coordinator (MCO SC). The MCO SC is responsible for ensuring the appropriate and timely provision of acute care services and other state plan benefits not provided by the ICF/IID Program or an ICF/IID waiver program for an individual. The level of service coordination provided by the MCO SC, including the number of required visits will be based on an assessment completed by the managed care organization (MCO) and will vary by an individual’s medical needs and the preference of the individual or legally authorized representative (LAR).
The persons currently responsible for development and implementation of an ICF/IID Program or ICF/IID waiver program service plan and monitoring of service delivery will continue to have this responsibility (See Tables 1 and 2). To coordinate an individual’s STAR Kids managed care services and ICF/IID Program or ICF/IID waiver program services, the person who leads the development of the individual’s service plan, as identified on Tables 1 and 2, should encourage the individual and LAR to invite the MCO SC to meetings in which the service plan is developed and other meetings in which the MCO SC’s participation would be beneficial.
In addition, the persons who develop, implement, and monitor the ICF/IID Program or an ICF/IID waiver program service plan, as identified on Tables 1 and 2, should coordinate with the MCO SC for the ongoing care of an individual.
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