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Resumption of In-Person Assessments & Service Coordination Visits

Date: 10/14/21

Texas Health and Human Services (HHS) has provided updated information surrounding the resumption of in-person assessments and service coordination visits during the continued COVID-19 public health emergency (PHE). This update applies to providers conducting assessments and/or service coordination visits for Superior HealthPlan STAR+PLUS, STAR Kids, STAR Health, and Medicaid-Medicare Plans (MMP) members who may or may not be enrolled in Home and Community-based Services (HCBS) and Medically Dependent Children Program (MDCP) waiver programs, or residing in Nursing Facilities and Assisted Living Facilities.

Please note the following updates listed below:

  • If contractually required in-person service coordination visits or assessments (including initial assessments, annual reassessments, or change in condition off cycle reassessment that includes a medical necessity determination) cannot be completed via telehealth or in person, the service coordination contact or assessment may be completed telephonically (audio only) as a last resort, and in compliance with applicable HIPAA regulations.
  • Superior must document barriers to telehealth and in-person contact in the service coordination case notes. If the assessment is entirely telephonic, Superior must attempt to validate the assessment through one of the following methods:
    • Verbal review of the needs identified by the assessment with the member’s primary care provider, specialty physician, or licensed clinical staff in the providers’ offices. Superior must make at least three attempts to verbally review the assessment.
    • Review of available assessments conducted by the member’s providers within the past 6 months. Assessments may include well-child visits, adult wellness visits, progress notes, and letters of medical necessity (this is a non-exhaustive list).
  • Superior must document in the comments section of the assessment or in case notes:
    • the results of the discussion or review with the member’s provider; or
    • the attempts to contact a provider for a discussion or documentation.

For any questions, please email Superior at AM.LTSS@SuperiorHealthPlan.com.