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4100.1 Community First Choice
Revision 22-3; Effective Sept. 9, 2022
Community First Choice (CFC) is available to all STAR Kids members who meet an institutional level of care (LOC) for a hospital, nursing facility (NF), intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID), or an institution for mental disease. CFC services include personal care services (CFC-PCS), Emergency Response Services (CFC-ERS), support management, and habilitation (CFC-HAB).
The managed care organization (MCO) must ensure the member receives at least one waiver service per month to maintain CFC eligibility.
CFC-PCS provides help with activities of daily living (ADLs), instrumental activities of daily living (IADLs) through hands-on assistance, supervision, cueing or both, to include nurse-delegated tasks. Members may not be authorized for State Plan PCS and CFC-PCS at the same time.
CFC-HAB provides assistance with acquisition, maintenance, and enhancement of skills necessary for the member to accomplish ADLS, IADLs and health-related tasks.
CFC-ERS provides assistance for members who live alone, are alone for large parts of the day, or have no regular caregiver for extended periods of time and who would otherwise require extensive routine supervision. This service connects a member to an emergency response services (ERS) provider who notifies local authorities, like paramedics of a member's emergency.
CFC support management provides voluntary training on how to select, manage and dismiss attendants.
Refer to the STAR Kids Handbook (SKH) for more information about CFC services.
4100.2 Personal Care Services
Revision 22-3; Effective Sept. 9, 2022
Personal Care Services (PCS) is a benefit under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program (CCP), known in Texas as the Texas Health Steps Comprehensive Care Program (THSteps-CCP).
PCS provides help with activities of daily living (ADLs), instrumental activities of daily living (IADLs) and health-related tasks through hands-on assistance, supervision, or cueing, including nurse-delegated tasks.
A member may not be authorized to receive both PCS and Community First Choice (CFC) services at the same time.
Refer to the STAR Kids Handbook (SKH) for more information about PCS.
4100.3 Private Duty Nursing
Revision 22-3; Effective Sept. 9, 2022
Private duty nursing (PDN) is a benefit under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program (CCP), known in Texas as the Texas Health Steps Comprehensive Care Program (THSteps-CCP).
PDN is nursing services for members who:
- meet medical necessity (MN) criteria outlined in the STAR Kids Screening and Assessment Instrument (SK-SAI); and
- require individualized, continuous skilled care beyond the level of skilled nursing visits provided under Texas Medicaid home health services.
Refer to the STAR Kids Handbook (SKH) for more information about PDN.
4100.4 Prescribed Pediatric Extended Care Centers
Revision 22-3; Effective Sept. 9, 2022
Prescribed Pediatric Extended Care Center (PPECC) services is a benefit under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Comprehensive Care Program (CCP), known in Texas as the Texas Health Steps Comprehensive Care Program (THSteps-CCP).
PPECC is a facility that provides nonresidential basic services, including medical, nursing, psychosocial, therapeutic, and developmental services to medically dependent or technologically dependent members under 21 years for up to 12 hours per day.
Refer to the STAR Kids Handbook (SKH) for more information about PPECC.
4100.5 Day Activity and Health Services
Revision 22-3; Effective Sept. 9, 2022
Day activity health services (DAHS) for members 18 through 20. DAHS includes nursing and personal care services, therapy extension services, nutrition services, transportation services and other supportive services.
Refer to the STAR Kids Handbook (SKH) for more information about DAHS.