On July 11, HHSC released an Opportunity to Participate in the Comprehensive Health Homes for Integrated Care Kids Pilot program. The opportunity is for STAR Kids managed care organizations and health home providers to partner in creating or improving a health home model that provides enhanced care coordination to children with medically complex conditions.
Since the Opportunity to Participate was published, HHSC updated the pilot definition for a “child with medically complex conditions.” The definition now reads:
Individual under 21 years of age who has at least one or more chronic conditions that cumulatively affect three or more organ systems and severely reduces cognitive or physical functioning and that also requires the use of medication, durable medical equipment (DME), therapy, surgery, or other treatments; or one life-limiting illness or rare pediatric disease as defined in section 529(a)(3) of the Food and Drug Administration Safety and Innovation Act (21 U.S.C. 301).
This change is an effort to clarify that patients included in the minimum patient requirement for CHIC Kids health home providers (150 patients in active treatment, through any payer or program, with 80% of patients being children with medically complex conditions) are not required to be enrolled in STAR Kids or Medicaid. The purpose of this requirement is to ensure there are robust systems in place to care for this population.
If interested MCOs or providers experience challenges meeting any minimum patient requirement, reach out to HHSC before the Aug. 12 deadline.
Visit the CHIC Kids Pilot webpage to view the updated Opportunity to Participate and for future updates on the pilot program.