Revision 25-1; Effective May 16, 2025

The managed care organization (MCO) must collaborate with the member and legally authorized representative (LAR) to create and update Form 2604, STAR Kids Individual Service Plan – Service Tracking Tool (SK-ISP). The MCO develops the SK-ISP using a person-centered process with the support of a group of people chosen by the member or LAR.

The SK-ISP articulates assessment findings from the STAR Kids Screening and Assessment Instrument (SK-SAI). It includes short and long-term goals, service needs and member preferences.

The MCO uses the SK-ISP to:

  • document findings from the SK-SAI;
  • develop a plan for services received through the MCO;
  • document services received through third-party sources;
  • identify a member's strengths, preferences, support needs and desired outcomes;
  • identify what is important to the member;
  • identify natural supports available to the member and needed service system supports;
  • document the member's preferences for when and how to receive services;
  • identify special needs, requests, or considerations the MCO or providers should know when supporting the member; and
  • document the member's unmet needs.

The MCO must:

  • write the SK-ISP in plain language that is clear to the member or LAR and, if requested, must be furnished in Spanish or another language;
  • submit the electronic SK-ISP to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP), as applicable;
  • create and update the SK-ISP at least annually, as applicable;
  • ensure that all assessments are timed to prevent any lapse in service authorization or program eligibility;
  • provide a printed or electronic copy of the SK-ISP to the member or LAR following any significant update;
  • provide the Texas Health and Human Services Commission (HHSC) staff with the SK-ISP upon request;
  • keep any amended SK-ISP in an MCO member's case file;
  • not provide significant change SK-ISPs to Program Support Unit (PSU) staff;
  • not submit any significant change SK-ISPs to the TMHP LTCOP; and
  • authorize all services identified on the SK-ISP.

The SK-ISP must be within the member's cost limit. PSU staff do not calculate the SK-ISP cost limit. It is automatically calculated in the TMHP SK-ISP Annual Cost Limit field.

PSU staff must refer to 1 Texas Administrative Code (TAC) Section 353.1155, and the STAR Kids Handbook (SKH) for more information about the MDCP cost limit.

3310 Service Planning

Revision 23-3; Effective May 22, 2023

Form 2603, STAR Kids Individual Service Plan (SK-ISP) Narrative, is designed to complement the STAR Kids Screening and Assessment Instrument (SK-SAI) and to develop the SK-ISP. The managed care organization (MCO) is responsible for completing Form 2603. The MCO maintains Form 2603 in the MCO's case file.

At a minimum, Form 2603 must account for the following information:

  • a summary document describing the recommended service needs identified through the SK-SAI;
  • covered services currently received;
  • covered services not currently received but the member may benefit from;
  • a description of non-covered services that could benefit the member;
  • member and family goals and service preferences;
  • natural strengths and supports of the member, including helpful family members, community supports or special capabilities;
  • a description of roles and responsibilities for the member, legally authorized representative (LAR), others in the member's support network, key service providers, the member's health home, the MCO and the member's school with respect to maintaining and maximizing the health and well-being of the member;
  • a plan for coordinating and integrating care between providers and covered and non-covered services;
  • short and long-term goals for the member's health and well-being;
  • services provided to the member through other third-party resources (TPR) and the sources or providers of those services;
  • plans specifically related to transitioning to adulthood for members 15 and older;
  • a list of Medicaid state plan services the member is receiving or is approved to receive, including service type, provider, hours per week, begin and end date, and if the member has chosen the Consumer Directed Services (CDS) option or Service Responsibility Option (SRO), if applicable;
  • a brief rationale for the services; and
  • any other information to describe strategies to meet service objectives and member goals.

The MCO must include the items listed above in the SK-ISP.

3320 Service Planning for Medically Dependent Children Program Services

Revision 24-4; Effective Dec. 1, 2024

The STAR Kids individual service plan (SK-ISP) contains a list of all the member's services including Medically Dependent Children Program (MDCP) services. The managed care organization (MCO) lists MDCP services on Form 2603, STAR Kids Individual Service Plan Narrative (PDF). The list of MDCP services on Form 2603 must match the services listed on the electronic Form 2604, STAR Kids Individual Service Plan - Service Tracking Tool (PDF).

The MCO must submit Form 2604 to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) before the start date of the member's SK-ISP.

The MCO must collaborate with the member or legally authorized representative (LAR) to create the SK-ISP to ensure MDCP services do not exceed the member's cost limit. Only MDCP services count toward the cost limit. Program Support Unit (PSU) staff will not calculate the SK-ISP cost limit. It is automatically calculated in the TMHP LTCOP SK-ISP Annual Cost Limit field.

The MCO must initiate a reassessment for MDCP to determine and validate the need for continued services listed on the SK-ISP for each member before the end date of the annual STAR Kids Screening and Assessment Instrument (SK-SAI). The MCO must ensure all member reassessment activities, including submitting the SK-ISP to the TMHP LTCOP, are completed no earlier than 90 days and by 30 days before the expiration of the member's current SK-ISP on file. Failure to complete and submit timely reassessments may result in the member losing MDCP or Medicaid eligibility.

Program Support Unit (PSU) staff must refer to Section 3327, Individual Service Plan Expiring Report, for information on reporting delinquent MCO reassessments.

3321 Medically Dependent Children Program Individual Service Plan Revision

Revision 24-4; Effective Dec. 1, 2024

It may be necessary for the managed care organization (MCO) to revise the STAR Kids individual service plan (SK-ISP) within the SK-ISP period due to situations outlined in the STAR Kids Contract, Section 8.1.39.1 (PDF).

The MCO must retain the amended SK-ISP in the MCO's member case file.

The MCO must not submit the revised SK-ISP in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) or upload it to the MCOHub.

3322 Reserved for Future Use

Revision 23-3; Effective May 22, 2023

 

3323 Reserved for Future Use

Revision 23-3; Effective May 22, 2023

 

3324 Reserved For Future Use

Revision 22-3; Effective Sept. 9, 2022

 

3325 Reserved For Future Use

Revision 23-4; Effective Aug. 21, 2023

 

3326 Suspension of Medically Dependent Children Program Services

Revision 18-0; Effective September 4, 2018

To remain eligible for Medically Dependent Children Program (MDCP) services, a member must receive one MDCP service monthly. In the event that the member travels out of state, is admitted to a hospital or nursing facility (NF), or is unable to receive a waiver service in a particular month, the STAR Kids managed care organization (MCO) must document the suspension of waiver services in the member’s case file. The MCO must document the:

  • dates during which services are suspended; and
  • reason for suspension.

A member may not have services suspended longer than 90 days. If a member’s services are suspended 91 days or more, the MCO must notify the Program Support Unit using Form H2067-MC, Managed Care Programs Communication, and request closure of MDCP enrollment, following procedures in Section 2000, Medically Dependent Children Program Intake and Initial Application. Closure of MDCP enrollment may result in disenrollment from STAR Kids, loss of Medicaid eligibility, or both.

3327 Individual Service Plan Expiring Report

Revision 24-4; Effective Dec. 1, 2024

The assigned Program Support Unit (PSU) staff review the Individual Service Plan (ISP) Expiring Report for the Medically Dependent Children Program (MDCP) monthly to ensure reassessments are conducted timely. The ISP Expiring Report details members with ISPs that expire in the next 90 days.

The MCOs must provide a status update for all members who have ISPs expiring in the next 45 days. Only ISPs expiring in 45 days require a status update from the MCO.

The process to manage the ISP Expiring Report follows:

  • The MCO must:
    • research and provide a written status for each member whose ISP expires in 45 days; and
    • return a completed report to PSU staff within two business days of the monthly call.
  • PSU staff review the MCO responses to determine if the MCO needs to provide clarification about any member’s ISP status. Only ISP statuses that PSU staff have questions on are reviewed during the monthly call. There is no need to review each member for the status of the ISP if the MCO response is sufficient.

Note: The monthly call may also be held if PSU staff or the MCO need to discuss items unrelated to the ISP Expiring Report.

The assigned PSU staff must check the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) to determine if the MCO has submitted the member’s SK-ISP before the SK-ISP end date. The assigned PSU staff must email PSORT the ISP Expiring Report each month as notification of late MCO reassessment activity. The ISP Expiring Report must be in an Excel spreadsheet format and edited so that it only identifies SK-ISPs being reported as delinquent. The subject line for the email must read: MDCP Reassessment Delinquencies for [Month].

The assigned PSU staff is not required to send a follow up email to PSORT when the MCO submits the following documents for reassessment delinquencies:

3327.1 Reassessment Procedures

Revision 24-4; Effective Dec. 1, 2024

The managed care organization (MCO) must complete annual assessment activities within 45 days of the individual service plan (ISP) expiration date. Assessment activities include:

  • conducting an annual STAR Kids Screening and Assessment Instrument (SK-SAI) assessment;
  • developing the STAR Kids individual service plan (SK-ISP); and
  • submitting the SK-SAI and SK-ISP to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).

Designated Program Support Unit (PSU) staff must:

  • search the TMHP LTCOP for SK-ISPs submitted daily; and
  • create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and assign it to a designated PSU staff person.

PSU staff must complete the following activities within five business days of receipt of the reassessment HEART case record:

  • ensure the member’s SK-ISP is authorized annually;
  • check the Texas Integrated Eligibility Redesign System (TIERS) to verify the member:
    • is under 21;
    • has ongoing Medicaid financial eligibility and is actively enrolled in managed care;
  • check the TMHP LTCOP to verify the member has:
    • an approved medical necessity (MN) and SK-SAI;
    • a SK-ISP that is within the cost limit that contains at least one Medically Dependent Children Program (MDCP) service;
  • electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF), in the TMHP LTCOP if the member continues to meet all MDCP requirements;
  • mail Form H2065-D to the member or legally authorized representative (LAR);
  • upload applicable documents to the HEART case record; and
  • document the HEART case record.

PSU staff must refer to:

  • Section 6300, Denials and Terminations, if the member does not meet MDCP requirements at reassessment.
  • Section 7000, Applicant or Member Appeal Requests and State Fair Hearings, if the member or LAR files a state fair hearing within the adverse action notification period.