Revision 20-1; Effective March 16, 2020

The Service Responsibility Option (SRO) empowers the member to manage most day-to-day activities. This includes supervision of the individual providing direct services.

The member decides how services are provided. The SRO leaves the business details to the member's managed care organization (MCO) and contracted provider. The rules for the SRO are found in Texas Administrative Code, Title 40, Chapter 43.

See STAR+PLUS Handbook, Appendix XVII, It's Your Choice: Deciding How to Manage Your Personal Assistance Services, for a comparison of all available service delivery option features.

5410 Service Responsibility Option Roles and Responsibilities

Revision 20-1; Effective March 16, 2020

Form 1582-SRO, Service Responsibility Option Roles and Responsibilities, specifies the roles and responsibilities assigned to the member or legally authorized representative (LAR), provider and managed care organization (MCO). The member or LAR, provider and MCO receive and sign Form 1582-SRO indicating their agreement to accept the service responsibility option responsibilities.

5411 Managed Care Organization Responsibilities

Revision 20-1; Effective March 16, 2020

The intake, referral and assessment procedures for the member or legally authorized representative (LAR) requesting service delivery through the Service Responsibility Option (SRO) are handled in the usual way. The managed care organizations (MCOs) are responsible for:

  • ensuring the member or LAR has an opportunity to make an informed choice by providing an objective and balanced review of the options; and
  • monitoring the quality of services and service delivery.

Once the assessment is complete, the MCO is required to:

  • inform the member about all options for managing services; and
  • review Form 1582-SRO, Service Responsibility Option Roles and Responsibilities, with the member to determine if the SRO is an appropriate choice.

In addition, the MCO's responsibilities include:

  • presenting all service delivery options;
  • documenting the member's or LAR's choice on Form 1584, Consumer Participation Choice;
  • explaining SRO rights, responsibilities and resources to the member or LAR;
  • presenting the MCO provider list and the support consultation provider to the member or LAR;
  • making a referral to the provider(s) selected by the member or LAR;
  • processing the member's request to change service delivery options;
  • redeveloping the service plan when a member's needs change;
  • serving as a resource if the member has health or safety concerns, issues involving the attendant or other service-related concerns;
  • convening a service planning team meeting in instances where the member has:
    • health and safety concerns;
    • difficulty selecting or keeping an attendant; or
    • other issues relating to services that cannot otherwise be resolved; and
  • monitoring services in accordance with 5422, Monitoring.

5412 Agency Responsibilities

Revision 20-1; Effective March 16, 2020

The agency contracted with the managed care organization (MCO) is the attendant's employer and handles the business details (for example, paying taxes and doing the payroll). The agency also orients attendants to policies and standards before sending the attendants to members' homes.

The agency staff:

  • discuss and negotiate potential back-up plans for those times when the attendant is absent from work;
  • send a maximum of three attendants, including any individuals recommended by the member, for the member to review;
  • explain to the selected attendants that the agency is the employer of record and the member is the day-to-day manager;
  • provide agency time sheets to the member and orient the member to the time sheet submission process, including how frequently time sheets must be completed;
  • receive and process attendant time sheets;
  • send new attendants within the required time frame to interview at the member's or LAR's request; and
  • orient the member or LAR to the agency's attendant evaluation process, including forms and the schedule for evaluating attendants.

5413 Member Responsibilities

Revision 20-1; Effective March 16, 2020

The member or legally authorized representative (LAR) is responsible for most of the day-to-day management of the attendant's activities, beginning with interviewing and selecting the person who will be the attendant. To participate in the Service Responsibility Option (SRO), the member or LAR must be capable of performing all management tasks as described below or may identify a representative to assist or perform those management tasks on the member's or LAR’s behalf.

The member or LAR is responsible for:

  • choosing the SRO;
  • choosing the SRO service and support provider(s);
  • meeting with the SRO support provider within 14 days of selecting the SRO;
  • coordinating with the agency supervisor as part of the service planning process by:
    • negotiating the type, frequency and schedule of quality assurance contacts;
    • discussing any concerns about care management;
    • requesting on-site assistance while orienting a new attendant, if desired; and
    • negotiating to develop a back-up plan for when the attendant cannot come to work;
  • selecting personal attendant(s) from candidates sent by the agency, including someone the person recommends to the agency supervisor or someone who has completed the agency pre-employment screening;
  • informing the agency supervisor within 24 hours:
    • of the personal attendant selected;
    • if the attendant gives notice of his intention to quit;
    • if the attendant quits; or
    • if the member wants to dismiss the attendant;
  • training the personal attendant on how to safely perform the approved tasks in the manner desired;
  • supervising the personal attendant;
  • ensuring the attendant only does the tasks authorized in the service plan and works only the number of hours authorized in the service plan;
  • complying with agency payroll and attendance policies;
  • evaluating the attendant's job performance at the time designated by the agency;
  • reviewing, approving and signing agency employee time sheets after the attendant completes them;
  • ensuring employee time sheets are submitted to the agency within the time frames designated by the agency;
  • notifying the agency as soon as possible if the personal attendant will be absent and a substitute is needed;
  • taking responsibility for liability risk if the member or attendant is injured while doing tasks under the member's training and supervision;
  • using the following complaint procedures:
    • If the agency is not fulfilling the expected responsibilities, addressing those issues directly with the agency. If the agency and the member or LAR are not able to resolve the concerns/issues, the member or LAR should contact the managed care organization (MCO).
    • If concerns and issues are still not resolved, the member or LAR may select another agency. The member must contact the MCO to transfer from one agency to another. The MCO will make all necessary arrangements for the transfer.
  • notifying the MCO and/or agency supervisor of any health or safety concerns or issues with the attendant (the member or LAR may, at any time, request a service planning team meeting); and
  • notifying the MCO and agency supervisor if a change to either the agency option or Consumer Directed Services (CDS) is desired. A service planning team meeting will be held to plan for the change.

5420 Managed Care Organization Procedures

Revision 20-1; Effective March 16, 2020

The Service Responsibility Option (SRO) is not a service; it is a service delivery option. All financial and non-financial eligibility criteria, including unmet need and "do not hire" policy, continue to apply for each program area. Unless otherwise stated in this section, managed care organization procedures are not impacted by the member's choice of SRO. Complete all forms currently required and continue to identify any caregivers who are currently providing for the member's needs.

5421 Initial Authorization of Services

Revision 20-1; Effective March 16, 2020

The member's or legally authorized representative's decision to receive services using the Service Responsibility Option does not change the manner in which initial services are authorized. See 3300, Member Service Planning and Authorization, for specific information.

5422 Monitoring

Revision 20-1; Effective March 16, 2020

All monitoring for Service Responsibility Option (SRO) members is done by the managed care organization (MCO) according to the mandated schedule for its specific services. When health and safety issues arise, the MCO staff will:

  • discuss the issues with the agency staff;
  • talk to the member or legally authorized representative (LAR) to determine if the issues can be resolved; and
  • convene a service planning team meeting if the issue cannot be resolved.

Because the member or LAR now shares responsibility for service delivery, the MCO, in addition to other monitoring requirements, must monitor the member's:

  • satisfaction with the SRO; and
  • ability to comply with SRO requirements.

If it is evident that the member is having difficulty in the management of SRO responsibilities, the MCO staff must:

  • consult the agency staff; and
  • advise the member of the option to transfer back to the agency option.

5423 Presentation of SRO

Revision 20-1; Effective March 16, 2020

The managed care organization (MCO) service coordinator must offer the Service Responsibility Option (SRO) upon enrollment and annually thereafter. Additionally, the SRO must be presented to the member or legally authorized representative (LAR) upon request. If the member is interested in transferring to the SRO, the member must sign Form 1582-SRO, Service Responsibility Option Roles and Responsibilities.

The MCO must ensure the member or LAR understands the responsibility he is assuming. Send Form H2067-MC, Managed Care Programs Communication, to the agency to advise it of the member's selection. Notify the agency the member will be contacting it for training. Request the agency to advise the MCO, using Form H2067-MC, when the transition planning is complete. Negotiate a start date with the member and the agency.