Request for Medical Service Planning Documents for Individuals Residing in ICF/IID

Originally published by Jerri Lynn Ward, J.D..

DADS has issued Information Letter 14-40 / Provider Letter 14-15 regarding the Expansion of Medicaid Managed Care Acute Care Services – Request for Medical Service Planning Documents for Individuals Residing in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions.

In accordance with the provisions of Senate Bill 7, 83rd Texas Legislature, Regular Session, 2013, an eligible individual residing in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) will receive acute care services through a STAR+PLUS managed care organization (MCO) beginning September 1, 2014.

The MCOs will provide service coordination activities for acute care services only for these individuals. An MCO service coordinator (SC) will be assigned for each individual. In order to provide the most benefit, the MCO SC requires the medical service planning documents to effectively coordinate the individual’s health care needs. Although the ICF/IID provider will continue to develop and implement a service plan and monitor service delivery of the long-term services and supports, the ICF/IID provider will coordinate service delivery with the MCO SC in the provision of acute care services.

As part of this implementation, the Health and Human Services Commission and the Department of Aging and Disability Services (DADS) will need to ensure that the MCOs receive a copy of the most current comprehensive nursing assessment for each individual enrolling into STAR+PLUS within 90 days of September 1, 2014.

DADS will send letters to each ICF/IID provider in August to request the documents for eligible individuals. The letter will provide the ICF/IID with a list of individuals and instructions for submitting the documentation to DADS. There is no action needed at the present time.

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