SAI
What are the modules of the SAI assessment?
The STAR Kids SAI includes three modules: 1. The Core Module 2. The Nursing Care Assessment Module (NCAM) 3. The MDCP Module (8.1.38.17)
There are two service delivery options Aetna offers for PCS what are they? Must reference contract number
There are two service delivery options available to Aetna STAR Kids Members for the delivery of services: 1. Consumer Directed Services (CDS) option; 2. Agency option (Service responsibility option (SRO);not available) 8.1.37
What are the 8 core components of services coordination according to the HHSC contract ?
1. Provide a holistic evaluation of the Member's individual dynamics, needs and preferences. 2. Educate and help provide health-related information to the Member, the Member's LAR, and others in the Member's Support Network; 3. Help identify the Member's physical, behavioral, functional, and psychosocial needs; 4. Engage the Member and the Member's LAR and other caretakers in the design of the Member's Individual Service Plan (ISP); 5. Connect the Member to Covered and non-covered services necessary to meet the Member's identified needs; 6. Monitor to ensure the Member's access to covered services is timely and appropriate; 7. Coordinate Covered and non-Covered Services; and 8. Intervene on behalf of the Member if approved by the Member (8.18.38)
What is the definition of Value added Services according to the HHCS contract ?
The MCO may propose additional services for coverage. These are referred to as “Value-added Services.” Value-added Services may be actual Healthcare Services, health-related benefits, Family Support Services, or positive incentives that HHSC agrees will promote wellness and improved health outcomes among Members (8.1.2.3 Contract)
When must an ISP be updated ?
1. at least annually; 2. following a significant change in health condition that impacts service needs; 3. upon request from the Member or the Member’s LAR; 4. at the recommendation of the Member's PCP; 5. following a change in life circumstance; and 6. following the STAR Kids Screening and Assessment Process or re-assessment process. (8.1.38.3
A change in condition is defined as what ?
any physical or mental change that results in either an improvement or decline in the Member’s overall health status or level of function.
When must you access for Personal care services ?
the MCO Service Coordinator must present information about the three service delivery options to Members at the following times: 1. at initial assessment; 2. at annual reassessment or annual contact with the STAR Kids Member; and 3. at the Member’s request. 8.1.37
The MCO must operate a toll-free Nurse hotline and a toll-free Member hotline. What is the number to the toll-free nurse hotline?
Name 7 Value Added Services for Star Kids Members?
$25 OTC Monthly, carpet Cleaning, Pest Control, Asthma supplies,$25 Gift Card BH 7 day visit, Promise Program, Respite LV1 , Well Child visit Gift card, Smart Phone, Sport Physical, ( https://www.aetnabetterhealth.com/texas/whats-covered-star-kids.html)
All Level _____ Members must receive a minimum of four Face-to-face Service Coordination visits annually, in addition to monthly telephonic Service Coordination contacts, unless otherwise requested by the Member or Member’s LAR. A Face-to-face Service Coordination visit may be counted as a monthly telephonic contact as long as there are no additional needs identified during the Face-to-face that require coordination of the Member’s needs
1 (8.1.38.61
What is a BIP and what section of SAI is it listed?
A behavioral Intervention Plan is used to support the individual to help them change their behaviors. A BIP typically includes activities such as teaching the individual alternative behaviors assisting the individual in identifying and avoiding behavior triggers. Found in Section C (SAI manual pg 34)
In the ___________option, the Member or the Member’s LAR is the employer of record and retains control over the hiring, management, and termination of service providers . The Member or Member's LAR is responsible for ensuring that the employee or contracted service provider meets all applicable qualifications and requirements.
CDS (8.1.37.1
What is the HHCS Mission Statement for the Star Kids Program
HHSC’s mission is to provide individually appropriate Medicaid managed care services to children and young adults with disabilities to enable them to live and thrive in a setting that maximizes their health, safety, and overall well-being(Sect 1.5 Contract)
What is the asthma benefit per year?
$100 benefit per year (https://www.aetnabetterhealth.com/texas/whats-covered-star-kids.html)
The purpose of a Service Coordinator is to maximize a Member's health, wellbeing, and independence. Service Coordination should consider and address the Member’s situation as a whole, including his or her medical, behavioral, social, and educational needs. The Service Coordinator must work with the Member’s_____ to coordinate all Covered Services, Non-capitated Services, and non-covered services available through other sources.
PCP (8.1.38.7)
Section I of the SAI is _____________and __________ _________ and the look back period is what?
Cognition and executive Functioning 30days (pg 74 SAI manual)
What is the definition of ADL and what are the ADL's listed in the SAI
Activities of Daily Living
Locomotion or mobility, positioning, eating, transferring, toileting, dressing, personal hygiene, bathing ( SAI manual pg 87)
Level 1 Members include what Member types/
1. MDCP STAR Kids Members 2. Members with Complex Needs or a history of developmental or Behavioral Health issues (multiple outpatient visits, hospitalization, or institutionalization within the past year) 3. Members with SED or SPMI. 4. Members at risk for institutionalization. (8.1.38.61
Who are the 3 dental providers for Star Kids Plan?
Denta Quest, MCNA Dental , United Healthcare Dental
(https://www.aetnabetterhealth.com/texas/whats-covered-star-kids.html)
Each MCO is responsible for conducting ongoing transition planning starting when the Member turns ___ years old.
15 (8.1.38.8)
Name the six waiver programs eligible for Star Kids?
MDCP- Medically Dependent Children Program
HCS-Home and Community- based Services
CLASS- Community Living Assistance and Supports Services
DBMD-Deaf Blind with Multiple Disabilities
TxHmL-Texas Home Living
YES-Youth Empowerment Services
What is the difference between CFC and PCS ? Must list reference source
The primary difference between CFC and OCS is that CFC includes habilitation. (SAI Manual pg 92)
How do you become approved for Community First Choice ?
MN, MDCP, Waiver, LIDDA
If pregnant member completes first 3 prenatal visits they are eligible for what VAS ?
$50 worth of baby supplies (diapers, wipes and other items): Complete first three prenatal visits.
(https://www.aetnabetterhealth.com/texas/rewards-program.html)
The purpose of______________ Program is to prevent unnecessary placement of an individual in a long-term care facility and to support deinstitutionalization of individuals who reside in nursing facilities by providing them with support services in the community.
Medically Dependent Children (8.3)