The components of SAI are divided into these four categories.
What is Core, PCAM, NCAM,MDCP
100
This a tool that can be completed by either an RN or LVN since it is accounts for services utilized.
What is the ISP tracking tool?
100
This is the form that is submitted to TMHP in order to receive the decision on Medical Necessity and the RUG level.
What is SAI?
100
These are the children who are NOT eligible for Star Kids.
What is children over 21 years old, children in STAR Health or receiving adoptions services, and children in the Truman Smith Children's center.
100
This is what must be filed within 30 days from receipt of the notice of action (adverse determination).
What is an Appeal?
200
This is the program that requires a member to get medical checkups regularly.
What is Texas Health Steps?
200
This is the team that is responsible for authorizing LTSS services for PAS, PCS,CFC, DME, and MDCP.
What is CAT?
200
This is the section of the SAI that must be completed by a RUG certified RN to be eligible for MHM, Respite, TAS, EA,SE, some AA.
What is MDCP?
200
To receive this service the child must be between birth and 3 years of age with disabilities and developmental delays.
What is the eligibility requirement for ECI.
200
This is a specialty team that the Care Manager may refer a member to if a behavioral issue has been identified.
What Behavioral Health/Envolve/Cenpatitco?
300
This program is utilized when specific factors such as a diagnosis of obesity and prescription of antipsychotic medications are identified.
What is SNAP?
300
This is the tab/section the CM must use to make a referral.
What is Care Management - referral summary?
300
This form must be signed at the initial assessment and annually to confirm that the member has a chronic health condition and/or disability with a need for Personal Attendant Services (PAS) or Personal Care Services.
What is PSON?
300
The member must be moving from a facility and need assistance in setting up a household in order to receive this service.
What is TAS?
300
This is a device that can be provided to a member who lives alone or is alone for a period of time and provides safety because the member may call for help/assistance with the push of a button.
What is ERS?
400
Members that have both complex medical and behavioral issues are followed by a lead case manager and are identified as being under this management.
What is Integrated Care Management?
400
When a CM/SC identifies a member that only has a diagnosis of IDD/IDRC but that member could benefit from services this is what the SC does.
What is a referral to the LIDDA or the LMHA?
400
This is the section of the SAI that is used to determine functional limitation and to determine the level of need for CFC services.
What is PCAM?
400
When a member ‘s name reaches the top of this list he/she becomes eligible to be assessed for MDCP services and determination of eligibility begins.
What is Program Support Interest List?
400
These are the STAR Kids service areas.
What is Travis, ElPaso, Bexar, Nueces, Lubbock, Hidalgo, and MRSA West.
500
This is the program that offers Habilitation.
What is CFC?
500
This is an option members have where they have the most control over their services.
What is CDS?
500
This is the form that is used by the LIDDA to determine medical necessity for members with only an IDD diagnosis.
What is DID or IDRC?
500
A referral is made to this department when a member has been hospitalized frequently, is requiring more complex medical needs, or condition has exacerbated.
What is Complex Care Management team.
500
This process is followed when SHP receives a request for prior authorization for a member under age 21, and the request does not contain the complete documentation and/or information.