An official State of Texas website.
Revision 22-2; Effective September 1, 2022
Program Support Unit (PSU) staff determine the Medically Dependent Children Program (MDCP) waiver start of care (SOC) date for individuals coming off the MDCP interest list, and for STAR Kids members completing the Money Follows the Person (MFP) limited nursing facility stay process. PSU staff will notify managed care organizations (MCOs) of the MDCP SOC date and individual service plan (ISP) effective date on Form H2065-D, Notification of Managed Care Program Services
2210 Medical Necessity Expiration
Revision 23-3; Effective July 21, 2023
A medical necessity (MN) approval is valid for 120 days from the date of the Texas Medicaid & Healthcare Partnership (TMHP) determination for an individual seeking the Medically Dependent Children Program (MDCP) prior to approval. After 120 days from the date of TMHP determination, Program Support Unit (PSU) staff will notify the managed care organization (MCO) by uploading Form H2067-MC, Managed Care Programs Communication, to MCOHub in the MCO’s STAR Kids folder. The MCO must complete a new STAR Kids Screening and Assessment Instrument (SK-SAI) for the member and submit to TMHP for a new MN determination.
MFP Limited Nursing Facility Stay Example
An individual seeking MDCP through the MFP limited stay option receives an approved MN in TMHP on August 2, 2021. The individual wishes to complete the MFP limited stay by entering the nursing facility (NF) on August 11, 2021, and discharging on August 12, 2021. On August 10, 2021, the individual notifies the MCO they are unable to enter the NF on August 11, 2021, and would like to reschedule admission to January 16, 2022. The current MN approved August 2, 2021, expires November 30, 2021. The MCO must complete a new SK-SAI and obtain an MN approval from TMHP before the PSU can approve the NF limited stay of January 16, 2022.
Interest List Release Example
An individual released from the interest list receives an approved MN from TMHP on August 2, 2021. The current MN expires November 30, 2021. The individual met all other MDCP eligibility criteria on December 15, 2021. The MCO must complete a new SK-SAI to obtain an MN approval from TMHP before the PSU can approve the applicant.
2220 MDCP Start of Care Date for Interest List Releases
Revision 23-3; Effective July 21, 2023
The Medically Dependent Children Program (MDCP) waiver start of care (SOC) date for individuals being released from the interest list is based on the following criteria:
- Medicaid eligibility effective date, if applicable;
- the date the medical necessity (MN) was approved from a STAR Kids Screening and Assessment Instrument (SK-SAI) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal; and
- The date Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool, is uploaded to MCOHub or the TMHP LTC Online Portal.
Program Support Unit (PSU) staff determine the MDCP SOC date. If the date falls on the first day of the month, the eligibility and ISP effective date on Form H2065-D, Notification of Managed Care Program Services, is the first day of that month. If the date falls between the second and the last day of the month, the eligibility and ISP effective date is the first date of the following month.
2230 MDCP Start of Care Date for STAR Kids Members Completing the MFP Limited NF Stay
Revision 23-3; Effective July 21, 2023
The Medically Dependent Children Program (MDCP) waiver start of care (SOC) date for STAR Kids members being assessed through the Money Follows the Person (MFP) limited nursing facility (NF) stay process is based on the following criteria:
- The date the medical necessity (MN) was approved from a STAR Kids Screening and Assessment Instrument (SK-SAI) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal;
- The date the individual was discharged from a nursing facility; and
- The date Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool, is uploaded to MCOHub or the TMHP LTC Online Portal.
Program Support Unit (PSU) staff determine the MDCP SOC date. The MDCP effective date will be the first of the month in which the member met all MFP limited stay eligibility criteria and was discharged from the NF. Example: A member who has met all eligibility criteria for the MFP limited stay leaves the NF December 12, 2021, and begins MDCP services December 12, 2021. The eligibility date on Form H2065-D will be December 1, 2021.