Provider Alert! Reminder on ability to bank respite hours for MDCP members

Attention: All STAR Kids Providers February 1st 2017
Subject: Reminder on ability to bank respite hours for MDCP members

Texas Children’s Health Plan would like to remind all STAR Kids providers who are providing respite care to members of the standards around respite care hours and how Texas Children’s Health Plan manages these hours. The information below is directly from HHSC and is the guidance Texas Children’s Health Plan follows for determining respite care. Please always contact either Texas Children’ Health Plan’s provider relations or the member’s service coordinator for additional information.

All STAR Kids health plans are required to allow flexibility with Medically Dependent Children Program (MDCP) respite hours. MDCP respite hours may be used flexibly or “banked” within the ISP year and as long as the member does not exceed the number of approved respite hours for the ISP year. For examples, a member may have 20 hours a week of respite approved. However, the member may only use 10 hours during one week and would be allowed to “bank” the unused 10 hours for future use during the waiver year. This language is described in the HHSC STAR Kids Handbook, section 4710: “MCOs must develop a process to allow for flexible schedules and allow an MDCP member to ‘bank’ respite hours to use at later point in the ISP year.”

If you have additional questions, please contact your Texas Children’s Health Plan provider relations representatives at 1-800-731-8527. If you are unable to resolve your issue by working with Texas Children’s Health Plan’s provider relations staff, please contact HHSC Health Plan Management (HPM_Complaints@hhsc.state.tx.us) or the Office of the Ombudsman – Managed Care Help (1-866-566-8989) to assist with resolving your concerns and questions.