Texas § GV.540.0852 - CARE MANAGEMENT AND CARE NEEDS ASSESSMENT

§ GV.540.0852. CARE MANAGEMENT AND CARE NEEDS ASSESSMENT

CARE MANAGEMENT AND CARE NEEDS ASSESSMENT. (a) The commission may require that care management services made available as provided by Section 540.0851 (b)(5)(B): (1) incorporate best practices as the commission determines; (2) integrate with a nurse advice line to ensure appropriate redirection rates; (3) use an identification and stratification methodology that identifies recipients who have the greatest need for services; (4) include a care needs assessment for a recipient; (5) are delivered through multidisciplinary care teams located in different geographic areas of this state that use in-person contact with recipients and their caregivers; (6) identify immediate interventions for transitioning care; (7) include monitoring and reporting outcomes that, at a minimum, include: (A) recipient quality of life; (B) recipient satisfaction; and (C) other financial and clinical metrics the commission determines appropriate; and (8) use innovations in providing services. (b) To improve the care needs assessment tool used for a care needs assessment provided as a component of care management services and to improve the initial assessment and reassessment processes, the commission, in consultation and collaboration with the STAR Kids Managed Care Advisory Committee, shall consider changes that will: (1) reduce the amount of time needed to complete the initial care needs assessment and a reassessment; and (2) improve training and consistency in the completion of the care needs assessment using the tool and in the initial assessment and reassessment processes across different Medicaid managed care organizations and different service coordinators within the same Medicaid managed care organization. (c) To the extent feasible and allowed by federal law, the commission shall streamline the STAR Kids managed care program annual care needs reassessment process for a child who has not had a significant change in function that may affect medical necessity. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.