3500, Member Transition to Adult Programs

Revision 22-2; Effective September 1, 2022

Per the STAR Kids Managed Care Contract, all STAR Kids members begin transition activities at age 15 and periodically meet with a transition specialist to plan their transition to adulthood. Members who receive Medically Dependent Children Program (MDCP) services, Private Duty Nursing (PDN), Community First Choice (CFC) or Personal Care Services (PCS) and are transitioning to adult programs may apply for services through STAR+PLUS, including STAR+PLUS Home and Community Based Services (HCBS) program, in order to continue receiving community-based services and avoid institutionalization beginning the first day of the month following their 21st birthday.

3510 Twelve Months Prior to the Member's 21st Birthday

Revision 22-2; Effective September 1, 2022

Twelve months prior to the 21st birthday of a member receiving services from the Medically Dependent Children Program (MDCP), Private Duty Nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) services, the following process begins.

Each quarter, Texas Health and Human Services Commission (HHSC) Utilization Review (UR) provides a copy of the MDCP PDN Transition Report, which lists individuals enrolled in STAR Kids and receiving MDCP and/or PDN/PPECC services, who may transition to STAR+PLUS or the STAR +PLUS Home and Community Based Services (HCBS) program in the next 12 months, to the:

  • Program Support Unit (PSU) supervisors and managers; and
  • UR unit for the Intellectual and Developmental Disability (IDD) 1915(c) waivers.

The managed care organization (MCO) identifies all members turning age 21 within the next 12 months and schedules a face-to-face visit with the member and the member's available supports, including the legally authorized representative (LAR), if applicable, to initiate the transition process.

During the home visit, the MCO must present an overview of the STAR+PLUS program, including the STAR+PLUS HCBS program and the changes that will take place the first of the month following the member's 21st birthday. The transition activity points to be discussed at the visit by the MCO can be found in Appendix VI, STAR Kids Transition Activities, Transition Activities at Age 20.

The STAR Kids MCO follows up with the member or the LAR every 90 days during the year before the member turns age 21 to ensure transition activities specified in Appendix VI, STAR Kids Transition Activities, have been completed.

3511 STAR+PLUS Transition Activities

Revision 23-4; Effective Dec. 1, 2023

Program Support Unit (PSU) staff for the STAR+PLUS Home and Community Based Services (HCBS) program will follow the STAR+PLUS enrollment guidelines outlined in the STAR+PLUS Handbook, Section 3420, Individuals Transitioning to an Adult Program.

3512 Intrapulmonary Percussive Ventilator Benefit

Revision 22-2; Effective September 1, 2022

Intrapulmonary Percussive Ventilator (IPV) is not currently a benefit of Texas Medicaid, but Texas Health and Human Services Commission (HHSC) has approved IPVs in limited circumstances based on medical necessity (MN) criteria under the Comprehensive Care Program (CCP) on a case-by-case basis.

IPV is not a benefit of Texas Medicaid, with the following exceptions:

  • Children and young adults who have been approved for and are currently utilizing IPV in traditional Medicaid will be allowed to continue using IPV if it is deemed to have a beneficial impact on the health of the child/young adult when he transitions to a STAR Kids managed care organization (MCO).
  • When a member turns age 21 and transitions into STAR+PLUS, young adults who have been approved for and are currently utilizing IPV will be allowed to continue using IPV if it is deemed to have a beneficial impact on the health of a young adult. ┬áThe member will not be subjected to an abrupt removal of equipment. The member will continue to receive ongoing treatment until the final decision is made, on a case-by-case basis, with thorough review and documentation by the MCO and explicit approval by HHSC administration.
  • STAR Kids MCOs will address a new request for IPV on a case-by-case basis based on MN criteria for the member.