Procedure

STAR Health Coordination Procedure

Refuge House, Inc.
Last updated: July 24, 2026 · Source: policies-procedures/Procedure/STAR Health Coordination Procedure.md

REFUGE HOUSE, INC.

Procedure Information Details
PROCEDURE NAME STAR Health Coordination Procedure
PROCEDURE NUMBER FC10-01.2
RELATED POLICY FC10-01 Physical and Mental Health Care Policy
EFFECTIVE DATE 5/20/25
REVISION DATE January 2026
LAST UPDATED 5/15/2026
LAST APPROVED 5/22/2026
APPLICABLE T3C PACKAGES: APPLICABLE T3C ADD-ON SERVICES:
☒ T3C Basic Foster Family Home ☐ Transition Support Services for Youth & Young Adults
☒ Substance Use Support Services ☐ Kinship Caregiver Support Services
☒ Short-Term Assessment ☐ Pregnant & Parenting Youth or Young Adult
☒ Mental & Behavioral Health
☒ Sexual Aggression/Sex Offender
☒ Complex Medical Needs or Medically Fragile
☒ Human Trafficking Victim/Survivor
☒ Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder
☒ T3C Treatment Foster Family Care

PURPOSE

To establish a standardized process for coordinating with STAR Health to ensure children, youth, and young adults in Refuge House foster care receive comprehensive healthcare services in accordance with T3C requirements.

RELATIONSHIP BETWEEN POLICY AND PROCEDURE

This procedure supports the Physical and Mental Health Care Policy (FC10-01) by providing detailed implementation guidance for STAR Health coordination activities. The policy establishes that "Refuge House will coordinate with STAR Health, medical professionals, and other service providers to ensure that children receive appropriate preventive care, screenings, evaluations, and treatment," and this procedure operationalizes that commitment through specific processes, timeframes, and documentation requirements that fulfill T3C service package obligations.

RESPONSIBILITY

IMPLEMENTATION GUIDANCE

This procedure specifically addresses coordination with STAR Health to fulfill T3C requirements. The T3C Blueprint emphasizes cross-system coordination with STAR Health as a critical component for meeting service package requirements. During the transition period (2025-2027), all requirements in this procedure apply to children in both legacy Service Levels and T3C Packages, with additional T3C-specific requirements clearly marked.

PROCEDURE

1. STAR HEALTH ENROLLMENT AND BENEFITS COORDINATION

Purpose and Overview

STAR Health enrollment and benefits coordination establishes the foundation for all health services that children in foster care will receive during their placement. Our policy emphasizes that "Refuge House will coordinate with STAR Health, medical professionals, and other service providers to ensure that children receive appropriate preventive care, screenings, evaluations, and treatment for identified physical and mental health needs." This coordination begins with ensuring proper enrollment and understanding of available benefits.

STAR Health is the comprehensive managed care program specifically designed for children in foster care, providing medical, dental, vision, behavioral health, and pharmacy services through a coordinated network of providers. Every child in DFPS conservatorship and young adults in Extended Foster Care are automatically enrolled, but verification of enrollment and benefits is essential for ensuring immediate access to services.

The T3C model emphasizes the importance of coordinated care and outcome-focused services. STAR Health coordination supports these goals by providing a single point of contact for health services and ensuring that all of a child's health needs are addressed through an integrated approach that supports their overall well-being and progress toward permanency goals.

Who How When Where Regulatory Reference
Case Manager
  1. Contact STAR Health Member Services at 1-866-912-6283
  2. Verify active enrollment status for the child
  3. Obtain and record STAR Health Member ID number
  4. Document verification of enrollment in Radius
  5. Address any enrollment issues immediately with DFPS/SSCC
 Within 24 hours of placement Phone contact documented in Radius TAC §749.1417; RCC (FY26) §5000
Case Manager
  1. Provide STAR Health Member Services contact information to foster parents
  2. Share STAR Health Member Handbook link with foster parents
  3. Explain basic STAR Health benefits and how to access services
  4. Document orientation provided to foster parents
 Within 3 days of placement Foster parent orientation documentation T3C Blueprint p.47-55; Family engagement
Case Manager
  1. For authorized staff: access and review Health Passport for medical history
  2. For staff without access: request health information from DFPS/SSCC caseworker
  3. Document how health information informs Service Plan development
  4. Include relevant health history in admission assessments
 Within 5 days of placement Health Passport or DFPS coordination T3C Blueprint p.47-55; Assessment requirements
Case Manager
  1. Upon enrollment confirmation, explain available STAR Health resources to foster parents
  2. Assist with understanding provider networks and benefits
  3. Help navigate prior authorization processes when needed
  4. Document all STAR Health coordination activities in Radius
 Ongoing as services are accessed STAR Health benefits coordination RCC (FY26) §5000; service coordination

2. PRIMARY CARE PROVIDER SELECTION AND MANAGEMENT

Purpose and Overview

Primary care provider selection and management ensures that every child has an established medical home through the STAR Health network that can provide comprehensive, coordinated medical care. The policy recognizes that "Foster parents will be actively engaged in the health care process, receiving training, guidance, and support to meet each child's specific health needs," and PCP selection is a crucial area where this engagement begins.

The medical home concept is central to quality healthcare for children, providing a consistent source of care that coordinates all health services and maintains comprehensive health records. For children in foster care who may have experienced disrupted healthcare, establishing a strong relationship with a primary care provider is essential for building trust and ensuring continuity of care.

The T3C model emphasizes the importance of minimizing disruptions in services that children value, and maintaining existing provider relationships when possible supports this goal while ensuring that children continue to receive high-quality care that meets their individual needs.

Who How When Where Regulatory Reference
Case Manager
  1. Assist foster parent with selecting PCP from STAR Health network
  2. Verify provider is accepting new patients
  3. Check provider's location and accessibility for foster family
  4. Document selected PCP information in child's Radius record
  5. Ensure PCP selection supports continuity when possible
 Within 7 days of placement STAR Health provider network TAC §749.1417; Provider coordination
Case Manager
  1. If child had existing PCP relationship, attempt to maintain continuity
  2. Verify existing PCP is in STAR Health network
  3. If not in network, assist with finding comparable provider
  4. Document any provider transitions and reasons
 Within 7 days of placement Provider continuity documentation T3C Blueprint; Service continuity
Case Manager
  1. Support foster parent in establishing relationship with new PCP
  2. Ensure PCP has complete health history and current medications
  3. Facilitate communication between PCP and other providers
  4. Monitor that PCP relationship is meeting child's needs
 Ongoing PCP relationship management TAC §749.1417; Coordinated care
Program Director
  1. Monitor PCP selection and continuity metrics
  2. Address systemic barriers to PCP access
  3. Maintain relationships with key STAR Health PCPs
  4. Ensure adequate provider options in service areas
 Monthly review Administrative oversight T3C Blueprint; Quality assurance

3. BEHAVIORAL HEALTH SERVICES COORDINATION

Purpose and Overview

Behavioral health services coordination ensures that children receive timely access to mental health and behavioral health services through STAR Health. The policy recognizes that many children in foster care have experienced trauma and may have significant behavioral health needs that require specialized services.

Coordination with STAR Health behavioral health services supports the T3C model's emphasis on trauma-informed care and evidence-based treatment. By ensuring children have access to appropriate therapy, psychiatric services, and other behavioral health supports, we create the foundation for healing and positive outcomes.

Who How When Where Regulatory Reference
Case Manager
  1. Identify behavioral health service needs based on assessment
  2. Submit prior authorization requests to STAR Health
  3. Coordinate with STAR Health Service Coordination if needed
  4. Document all authorization activities
 Within 7 days of identified need STAR Health portal T3C Blueprint; TAC §749.1417
Case Manager
  1. Assist foster parents in selecting behavioral health providers
  2. Ensure providers specialize in trauma and child welfare populations
  3. Coordinate therapy schedules with school and other activities
  4. Monitor service delivery and child's progress
 Ongoing Provider coordination T3C Blueprint; TBRI implementation
Case Manager
  1. Ensure psychotropic medication prescribers are STAR Health network providers
  2. Coordinate medication monitoring appointments with psychiatric providers
  3. Track medication effectiveness and side effects
  4. Document integration of medication management with therapy services
  5. Ensure compliance with DFPS Psychotropic Medication Guidelines
 Ongoing for children receiving psychotropic medications Medication management coordination TAC §749.1609, §749.1611; psychotropic medication oversight

4. SUBSTANCE USE SUPPORT SERVICES STAR HEALTH COORDINATION

Purpose and Overview

STAR Health coordination for Substance Use Support Services requires specialized focus on substance use assessment authorization, treatment service coordination, and integration of substance use providers with other healthcare services. These procedures ensure children receive comprehensive, recovery-focused treatment through coordinated STAR Health services.

SU-STAR-1. Comprehensive Substance Use Assessment Authorization

Who How When Where Regulatory Reference
Case Manager
  1. Submit prior authorization request to STAR Health for comprehensive substance use assessment
  2. Include in request: - Initial screening results documenting substance use history - Clinical justification for assessment - Requested provider (qualified in adolescent substance use)
  3. Track authorization status
  4. Escalate if not approved within 5 business days
 Within 7 days of placement STAR Health portal T3C Blueprint; FC-SU-01
Case Manager 2. Upon authorization: - Schedule assessment with approved provider - Verify provider qualifications (adolescent substance use specialty) - Coordinate transportation - Document appointment in case record Within 3 days of authorization Provider scheduling T3C Blueprint

SU-STAR-2. Substance Use Treatment Service Authorization

Who How When Where Regulatory Reference
Case Manager
  1. Based on assessment recommendations, submit authorization requests for: - Individual therapy (weekly minimum) - Group therapy (if recommended) - Intensive outpatient program (if recommended) - Family therapy (if recommended)
  2. Include clinical justification from assessment
  3. Specify provider qualifications needed
 Within 5 days of assessment completion STAR Health portal T3C Blueprint
Case Manager 2. For ongoing services: - Track authorization periods - Submit re-authorization requests 30 days before expiration - Include updated clinical justification - Document all authorization activity Ongoing; re-auth 30 days before expiration STAR Health portal; Radius documentation T3C Blueprint

SU-STAR-3. Medication-Assisted Treatment (MAT) Coordination

Who How When Where Regulatory Reference
Case Manager If MAT recommended:
  1. Submit authorization request for MAT evaluation
  2. Coordinate with STAR Health MAT-waivered provider
  3. Submit authorization for MAT medications
  4. Ensure pharmacy coordination
  5. Document all MAT authorizations
 Per clinical recommendation STAR Health portal; MAT provider T3C Blueprint
Case Manager 2. Ongoing MAT coordination: - Track medication refill authorizations - Coordinate MAT provider appointments - Ensure integration with therapy services - Document MAT compliance Ongoing per MAT protocol STAR Health portal; Radius T3C Blueprint

SU-STAR-4. Integration of Substance Use and Mental Health Providers

Who How When Where Regulatory Reference
Case Manager
  1. Ensure coordination between: - Substance use treatment provider - Mental health therapist (if different) - Psychiatrist (if applicable) - Primary care physician
  2. Facilitate information sharing with appropriate releases
  3. Include all providers in Service Planning team communications
 Ongoing Provider coordination documentation T3C Blueprint
Treatment Director
  1. Provide clinical oversight of provider integration
  2. Ensure treatment approaches are coordinated
  3. Review for Treatment Model alignment
 Monthly minimum Clinical oversight documentation T3C Blueprint

SU-STAR-5. Service Denial Response for Substance Use Services

Who How When Where Regulatory Reference
Case Manager
  1. Upon substance use service denial: - Document denial reason - Notify Treatment Director immediately - Notify SSCC/DFPS within 3 business days
  2. Initiate appeal if appropriate
  3. Explore alternative providers or community resources
 Within 24 hours of denial; SSCC/DFPS within 3 business days Denial documentation; Appeal if applicable T3C Blueprint; RCC Contract

5. SHORT-TERM ASSESSMENT SUPPORT SERVICES STAR HEALTH COORDINATION

Purpose and Overview

STAR Health coordination for Short-Term Assessment requires expedited authorization processes for multiple assessments across various domains. These procedures ensure all necessary assessments can be completed within the time-limited placement period (21/30 days by age).

STASS-STAR-1. Expedited Multi-Domain Authorization Requests

Who How When Where Regulatory Reference
Case Manager
  1. Submit authorization requests for all identified assessments promptly upon admission: - Mental health evaluation - Psychiatric evaluation (if clinically indicated) - Developmental evaluation (if applicable) - Specialty medical evaluations (if indicated) - Psychological testing (if indicated)
  2. Mark requests as time-sensitive due to assessment placement timeline
  3. Include assessment plan documentation
 Within 5 days of admission STAR Health portal T3C Blueprint p.70-71
Case Manager 2. Track all authorization requests: - Create authorization tracking log - Follow up on pending requests every 2 business days - Escalate delays to supervisor immediately - Document all authorization activity Ongoing until all assessments authorized Authorization tracking log T3C Blueprint

STASS-STAR-2. Provider Selection for Assessment Services

Who How When Where Regulatory Reference
Case Manager
  1. Identify appropriate STAR Health providers for each assessment domain: - Verify provider qualifications for child's age - Verify availability within timeline - Consider geographic accessibility
  2. Schedule appointments promptly upon authorization
  3. Coordinate multiple appointments efficiently
 Upon authorization; schedule within 3 days STAR Health provider network T3C Blueprint p.70-71
Case Manager 2. For expedited scheduling: - Contact providers directly to explain time-sensitive nature - Request earliest available appointments - Document scheduling efforts and any barriers Ongoing Provider scheduling documentation T3C Blueprint

STASS-STAR-3. Authorization Tracking for Assessment Completion

Who How When Where Regulatory Reference
Case Manager
  1. Maintain comprehensive authorization tracking: - Authorization request date - Authorization status (pending, approved, denied) - Authorized provider - Appointment scheduled date - Assessment completion date - Results received date
  2. Update tracking log at least weekly
 Ongoing; weekly minimum updates Authorization tracking log T3C Blueprint p.71
Supervisor
  1. Review authorization tracking weekly
  2. Intervene on any delays
  3. Escalate to Program Director if timeline at risk
  4. Document oversight
 Weekly Supervision documentation T3C Blueprint

STASS-STAR-4. Service Coordination Request for Complex Assessment Needs

Who How When Where Regulatory Reference
Case Manager For children with complex assessment needs:
  1. Submit STAR Health Service Coordination request
  2. Request Service Coordinator assistance with: - Multi-provider scheduling - Authorization expedition - Specialty provider identification
  3. Include assessment timeline requirements
 Within 5 days of admission if complex needs identified STAR Health Service Coordination T3C Blueprint p.70-71

STASS-STAR-5. Assessment Service Denial Response

Who How When Where Regulatory Reference
Case Manager
  1. Upon assessment service denial: - Document denial reason immediately - Notify supervisor and Treatment Director - Notify SSCC/DFPS within 3 business days - Initiate appeal immediately (time-sensitive)
  2. Simultaneously explore alternatives: - Alternative STAR Health providers - Community resources - Agency-funded assessment if critical
 Within 24 hours of denial Denial documentation; Appeal; Alternative exploration T3C Blueprint; RCC Contract
Program Director
  1. Review assessment denial
  2. Authorize agency-funded assessment if: - Critical for Service Package determination - Appeal timeline exceeds placement timeline - No alternative available
  3. Document decision
 Within 24 hours of escalation Program Director authorization T3C Blueprint

6. T3C TREATMENT FOSTER FAMILY CARE STAR HEALTH COORDINATION

Purpose and Overview

STAR Health coordination for Treatment Foster Family Care requires authorization and coordination of intensive therapeutic services, including weekly therapy, psychiatric services, and enhanced behavioral health supports. These procedures ensure children receive the intensive level of services required for this highest-level family-based intervention.

TFFC-STAR-1. Intensive Therapy Authorization

Who How When Where Regulatory Reference
Case Manager
  1. Submit authorization request for intensive therapy services: - Individual therapy: Weekly minimum - Family therapy: As clinically indicated - Group therapy: As clinically indicated
  2. Include clinical justification for frequency: - DSM-5 diagnosis documentation - Clinical need supporting weekly frequency - Treatment goals addressed by therapy - Expected duration of intensive services
 Within 7 days of placement STAR Health portal T3C Blueprint p.143-144
Case Manager 2. Specify therapist qualifications in request: - Licensed Therapist - Specializes in serious mental, emotional, and/or behavioral disorders - Experience with Treatment Foster Care population Within authorization request STAR Health portal T3C Blueprint p.137

TFFC-STAR-2. Psychiatric Services Authorization

Who How When Where Regulatory Reference
Case Manager
  1. Submit authorization for psychiatric services: - Initial psychiatric evaluation (if not current within 6 months) - Ongoing medication management - Crisis psychiatric consultation (if needed)
  2. Verify child psychiatrist availability in STAR Health network
  3. Schedule promptly upon authorization
 Within 7 days of placement; evaluation within 30 days STAR Health portal; Psychiatry scheduling T3C Blueprint p.143-144
Case Manager 2. Coordinate psychiatric medication management: - Track medication management appointment authorizations - Ensure re-authorization before expiration - Document all psychiatric services Ongoing per prescriber schedule STAR Health portal; Medication documentation DFPS Psychotropic Guidelines

TFFC-STAR-3. Re-Authorization for Intensive Services

Who How When Where Regulatory Reference
Case Manager
  1. Submit re-authorization requests 30 days before expiration
  2. Include updated clinical justification: - Treatment progress summary - Continued need for intensive frequency - Treatment goals status - Clinical recommendation for continuation
  3. Include Treatment Director statement supporting continuation
 30 days before authorization expiration STAR Health portal T3C Blueprint
Treatment Director
  1. Provide clinical statement for re-authorization
  2. Document continued clinical need
  3. Justify intensive service continuation
 Per re-authorization timeline Clinical statement T3C Blueprint p.144

TFFC-STAR-4. Provider Coordination for Integrated Treatment

Who How When Where Regulatory Reference
Case Manager
  1. Coordinate STAR Health providers for integrated treatment: - Individual therapist - Family therapist (if different) - Psychiatrist - Behavior Support Specialist services
  2. Facilitate provider communication
  3. Ensure releases of information in place
  4. Include all providers in treatment team communications
 Ongoing Provider coordination documentation T3C Blueprint p.144
Treatment Director
  1. Provide clinical oversight of STAR Health services
  2. Ensure provider approaches align with Treatment Model
  3. Review treatment integration monthly
 Monthly minimum Clinical oversight documentation T3C Blueprint p.144

TFFC-STAR-5. STAR Health Coordination for Step-Down Planning

Who How When Where Regulatory Reference
Case Manager
  1. As step-down approaches: - Coordinate therapy frequency reduction authorization - Plan transition of psychiatric services to receiving placement - Ensure STAR Health continuity through step-down - Document service transition plan
  2. Communicate with STAR Health about placement change
 When step-down determined STAR Health coordination; Transition documentation T3C Blueprint p.146

TFFC-STAR-6. Service Denial Response for Intensive Services

Who How When Where Regulatory Reference
Case Manager
  1. Upon intensive service denial: - Document denial reason - Notify Treatment Director immediately - Notify SSCC/DFPS within 3 business days
  2. Initiate appeal with Treatment Director clinical support
  3. Explore alternative providers
 Within 24 hours of denial; SSCC/DFPS within 3 business days Denial documentation; Appeal T3C Blueprint; RCC Contract
Treatment Director
  1. Provide clinical appeal support
  2. Document clinical necessity for intensive services
  3. Recommend alternatives if appeal unsuccessful
 Within 24 hours of denial notification Clinical appeal documentation T3C Blueprint
Program Director 1. If STAR Health cannot provide intensive services: - Authorize agency-funded services if clinically necessary - Document decision and rationale - Ensure services delivered per Service Package requirements Per clinical urgency Program Director authorization RCC (FY26) §5000

7. SERVICE COORDINATION REQUESTS

Purpose and Overview

STAR Health Service Coordination provides enhanced support for children with complex health needs. Service Coordinators can assist with navigating the healthcare system, coordinating multiple providers, and addressing barriers to care. This section establishes procedures for requesting and utilizing Service Coordination effectively.

Who How When Where Regulatory Reference
Case Manager
  1. Identify children who may benefit from Service Coordination: - Complex medical conditions - Multiple providers requiring coordination - History of service access barriers - T3C Service Package with intensive health needs
  2. Submit Service Coordination request to STAR Health
  3. Document request and response
 When complex needs identified; within 5 days of placement for eligible packages STAR Health Service Coordination request T3C Blueprint; TAC §749.1417
Case Manager 1. Collaborate with assigned Service Coordinator: - Share child's health goals and needs - Coordinate provider communications - Address barriers together - Document coordination activities Ongoing when Service Coordinator assigned Service Coordination collaboration documentation T3C Blueprint

8. DOCUMENTATION AND T3C COMPLIANCE

Purpose and Overview

Comprehensive documentation of STAR Health coordination activities ensures compliance with T3C requirements and supports quality care delivery. This documentation serves multiple purposes including regulatory compliance, quality assurance, outcome measurement, and continuous improvement of service coordination practices.

Effective documentation also supports transparency and accountability in service delivery, enabling supervisors, auditors, and oversight bodies to verify that children are receiving appropriate services and that coordination efforts are effective in supporting their needs and goals.

Who How When Where Regulatory Reference
Case Manager
  1. Document all STAR Health coordination activities in Radius including: - Service referrals and authorizations - Communication with STAR Health providers - Service Coordination contacts and outcomes - Resolution of service issues and barriers
  2. Maintain chronological record of all coordination efforts
 Ongoing with each coordination activity Radius STAR Health documentation T3C Blueprint p.47-55; Documentation requirements
Case Manager
  1. Document STAR Health coordination in the child's Service Plan and package-compliance review
  2. Document how STAR Health services support Evidence-informed Treatment Model
  3. Include STAR Health coordination in Service Plan development and reviews
  4. Document outcome measures related to health services
  5. Update documentation as services change or evolve
 Initial completion within 30 days; ongoing updates Service Plan / Radius T3C Blueprint p.47-55; Package compliance
Case Manager
  1. Integrate STAR Health services information in child's Service Plan: - Document all current STAR Health services - Incorporate recommendations from STAR Health providers - Include health goals and expected outcomes - Address how health needs relate to T3C Package goals
  2. Update Service Plans as health services change
 Service Plan development and all reviews Service Plan STAR Health integration TAC §749.1301; Service planning
Program Director
  1. Implement regular review processes for STAR Health coordination: - Monthly review of coordination documentation - Quarterly audit of coordination activities - Assessment of service barriers and resolution effectiveness - Documentation of T3C Package-specific compliance
  2. Provide feedback and training to improve coordination
 Monthly and quarterly reviews Quality assurance monitoring T3C Blueprint p.47-55; Quality improvement

9. MANAGING SERVICE DENIALS, ACCESS BARRIERS, AND COST COVERAGE

Purpose and Overview

Managing service denials and access barriers ensures that children receive necessary health services even when initial requests are denied or when barriers to access exist within the STAR Health system. This section also establishes Refuge House's commitment to ensure service delivery and cover costs when STAR Health and community resources are unavailable.

The T3C model emphasizes that services should be individualized to meet each child's specific needs, and this sometimes requires persistence and creativity in working with managed care systems to ensure that children receive appropriate care that supports their safety, permanency, and well-being goals.

T3C Blueprint References:

9.1 Service Documentation Requirements

T3C Blueprint Requirement: In collaboration with the Medical Consenter, Refuge House must document all services the child, youth, or young adult is receiving.

Who How When Where Regulatory Reference
Case Manager
  1. Document all services child is currently receiving through: - STAR Health - HHSC Behavioral Health - Early Childhood Intervention (if applicable) - Education system - Any other county, community, or state agency
  2. Maintain current service inventory in case record
  3. Update service documentation at each Service Plan review
 Ongoing; updated at each Service Plan review Case record; Service Plan documentation T3C Blueprint (all packages)

9.2 Service Request and Denial Documentation

T3C Blueprint Requirement: Requests for specific services determined necessary as a part of the Service Plan or Service Plan review, and for which the child is referred and the service is not readily available and/or the child is ineligible, must be documented in the case record.

Who How When Where Regulatory Reference
Case Manager
  1. Document all service requests with the following elements: - Date the service request, application, or referral was made - Specific type of service being requested - Status of the service request - Reason provided for any denial (if applicable) - Status of appeals (if applicable)
  2. Maintain service request log with all elements
  3. Update status as changes occur
 Within 24 hours of request submission; updated as status changes Service request tracking log; case notes T3C Blueprint (all packages)

9.3 SSCC/DFPS Notification of Access Challenges

T3C Blueprint Requirement: CPA shall notify SSCC or DFPS caseworker of any challenges encountered with access to services and/or service referral denials within 3 business days.

Who How When Where Regulatory Reference
Case Manager
  1. If service denied by STAR Health or access challenge identified: - Immediately notify Program Director/LCPAA - Within 3 business days, email scanned denial letter to DFPS/SSCC caseworker and Regional Well-being Specialist - Document notification in case notes
  2. Continue to advocate for necessary services
 Within 3 business days of denial or access challenge Email to SSCC/DFPS; case notes T3C Blueprint (all packages); RCC (FY26) §5000
Case Manager 1. Notification must include: - Child identifying information - Service requested - Denial reason or access barrier - Actions being taken to resolve - Request for any available support from DFPS/SSCC With notification Notification documentation T3C Blueprint

9.4 Community Resource Pursuit

T3C Blueprint Requirement: CPA shall seek community resources to obtain any needed services that are not covered through STAR Health.

Who How When Where Regulatory Reference
Case Manager
  1. When services denied or not covered by STAR Health: - Identify potential community resources for similar services - Contact community providers to assess availability - Document outreach efforts and outcomes - Coordinate community services if available
  2. Resources to explore include: - Community mental health centers - Nonprofit service providers - University-based clinics - Faith-based organizations - Other state/county programs
 Immediately upon denial of necessary services Community resource documentation; case notes T3C Blueprint (all packages)

9.5 Cost Coverage Commitment

T3C Blueprint Requirement: If community resources are not available and/or STAR Health does not cover the needed service(s) consistent with the specific Service Package, and as outlined in the CPA's Service Plan or Service Plan review, the Child Placing Agency must ensure delivery of, and cover the cost of the needed service(s) and related supports.

Who How When Where Regulatory Reference
Case Manager 1. When services denied, community resources unavailable, AND service is necessary per Service Plan: - Document all denial and community resource pursuit efforts - Escalate to Program Director with request for agency-funded services - Prepare cost estimate for needed services Immediately upon determination that STAR Health and community resources unavailable Escalation documentation T3C Blueprint (all packages)
Program Director
  1. Review escalation request
  2. Authorize agency-funded services if: - Service is documented as necessary in Service Plan - STAR Health has denied or does not cover service - Community resources are not available - Service is consistent with the child's T3C Service Package
  3. Document authorization decision and rationale
  4. Coordinate service delivery
 Within 24-48 hours of escalation (urgent) or per clinical urgency Program Director authorization; financial documentation T3C Blueprint; RCC (FY26) §5000
Case Manager 1. Once agency-funded services authorized: - Coordinate service delivery with approved provider - Document services provided - Track service costs for reporting - Continue to monitor for STAR Health coverage options Ongoing Service coordination documentation T3C Blueprint

9.6 Appeal Process for Service Denials

Who How When Where Regulatory Reference
Case Manager
  1. Upon service denial: - Review denial reason - Consult with Treatment Director on clinical necessity - Determine if appeal is appropriate - Assist medical consenter with filing appeal if appropriate
  2. For expedited appeals (urgent/emergent): - File immediately - Request expedited review - Document urgency factors
 Immediately upon denial; expedited appeals filed same day STAR Health appeal system; case notes STAR Health guidelines; RCC Contract
Treatment Director 1. Provide clinical support for appeals: - Prepare clinical necessity statement - Document treatment rationale - Request peer-to-peer review with STAR Health medical director if appropriate Per appeal timeline Clinical documentation T3C Blueprint

9.7 Alternative Service Arrangements

Who How When Where Regulatory Reference
Case Manager
  1. While appeals pending or when services unavailable: - Identify alternative services that may meet need - Modify Service Plan to address need through other means - Ensure child's immediate needs are met - Document impact on treatment goals
  2. Consider: - Alternative STAR Health providers - Telehealth options - Modified service frequency - Related services that address same need
 Immediately upon denial of necessary services Alternative service documentation T3C Blueprint

9.8 Provider Network Access Issues

Who How When Where Regulatory Reference
Case Manager
  1. When needed providers not available in STAR Health network: - Request out-of-network authorization - Document efforts to find in-network providers - Work with Service Coordinator (if assigned) to resolve access issues - Elevate to DFPS Regional Well-being Specialist if unresolved
  2. Document all network access issues and resolution efforts
 Within 5 days of identifying network access issues Provider network documentation TAC §749.1417

9.9 Documentation and Compliance Tracking

Who How When Where Regulatory Reference
Case Manager
  1. Maintain comprehensive documentation of: - All services child is receiving (Section 9.1) - All service requests and denials (Section 9.2) - SSCC/DFPS notifications (Section 9.3) - Community resource pursuit (Section 9.4) - Agency cost coverage authorizations (Section 9.5) - Appeals and outcomes (Section 9.6)
  2. Include service documentation summary in each Service Plan review
 Ongoing; summarized at each Service Plan review Service documentation log; Service Plan T3C Blueprint (all packages)
Program Director
  1. Monitor compliance with service documentation requirements
  2. Review agency cost coverage authorizations monthly
  3. Report cost coverage trends to Executive Director
  4. Ensure adequate budget allocation for cost coverage commitments
 Monthly Administrative oversight documentation T3C Blueprint; RCC Contract

9.10 Package-Specific Considerations

Service Package Cost Coverage Considerations Blueprint Reference
Substance Use Recovery-focused services; MAT support; substance use treatment Page 63
Treatment Foster Family Care Intensive therapy services; psychiatric services; behavioral support Page 141
Short-Term Assessment Assessment services; expedited evaluations Pages 71-72
Mental & Behavioral Health Therapy services; psychiatric services; behavioral health Page 82
IDD/Autism Developmental therapies; ABA; communication supports; medical equipment Page 130

10. FOSTER PARENT AND CAREGIVER TRAINING

Purpose and Overview

Foster parent and caregiver training ensures that caregivers have the knowledge and skills necessary to effectively navigate the STAR Health system and support children's health needs. The policy emphasizes that "Foster parents will be actively engaged in the health care process, receiving training, guidance, and support to meet each child's specific health needs," and STAR Health coordination training is essential for this engagement.

Foster parents and caregivers serve as the primary advocates for children's daily health needs and are often the first to identify health concerns or changes in health status. Effective training helps them understand their role in the STAR Health system, know how to access services, and feel confident in supporting children through health care experiences.

The trauma-informed approach recognizes that foster parents need support and training to help children navigate health care systems that may trigger anxiety or trauma responses. Training helps caregivers understand how to provide emotional support and create positive health care experiences for children in their care.

Who How When Where Regulatory Reference
Case Manager
  1. Provide comprehensive STAR Health training including: - Overview of STAR Health system and benefits - How to access services and navigate provider networks - Role of medical consenter vs. foster parent - Medication management responsibilities - When and how to request Service Coordination
  2. Document training provided
 Within 7 days of placement Foster parent STAR Health training T3C Blueprint p.47-55; Caregiver support
Case Manager
  1. Provide trauma-informed training for health care support: - Using TBRI principles during medical appointments - Preparing children for health care visits - Supporting children through medical procedures - Recognizing and responding to health-related trauma triggers
  2. Include health care training in ongoing foster parent support
 Initial training within 7 days; ongoing support Trauma-informed health care training TBRI implementation; Trauma-informed care
Case Manager
  1. Include STAR Health information in pre-service training for new foster parents
  2. Provide annual STAR Health updates to existing foster parents
  3. Create reference materials for foster parents including contact information and processes
  4. Document all STAR Health training provided to foster parents
 Pre-service and annually Systematic STAR Health training TAC §749.1059; Training requirements
Program Director
  1. Ensure STAR Health training curriculum stays current with system changes
  2. Monitor effectiveness of foster parent training through feedback and outcomes
  3. Coordinate with STAR Health representatives for updated training materials
  4. Document training effectiveness and improvement needs
 Ongoing curriculum management Training program oversight T3C Blueprint p.47-55; Training quality

REGULATORY REFERENCES

FORMS/ATTACHMENTS

Standard STAR Health Forms:

Substance Use STAR Health Forms:

Short-Term Assessment STAR Health Forms:

Treatment Foster Family Care STAR Health Forms:

Service Denial and Cost Coverage Forms:

CROSS-REFERENCES

This procedure is cross-referenced in:

REVISION HISTORY

Version Date Author Changes
1.0 5/20/25 Refuge House Leadership Initial procedure
1.1 12/09/25 Refuge House Leadership Added Substance Use, Short-Term Assessment, and Treatment Foster Family Care STAR Health coordination sections
2.0 January 2026 Refuge House Leadership Enhanced Section 9 with explicit service documentation requirements and cost coverage commitment language per T3C Blueprint requirements across all specialized Service Packages

IMPLEMENTATION NOTES

  1. Training Requirement: All Case Managers must be trained on updated service documentation and cost coverage procedures.

  2. Documentation Tools: Service request tracking log template should include all five required elements from Section 9.2.

  3. Budget Allocation: Program Directors should ensure adequate budget allocation exists to fulfill cost coverage commitments.

  4. Reporting: Monthly reporting on service denials, cost coverage authorizations, and resolution outcomes should be included in CQI review.

  5. Consistency: Language in this procedure should be applied consistently across all T3C Service Packages to ensure uniform compliance demonstration to DFPS reviewers.

This procedure document operationalizes the principles established in the corresponding policy by providing specific implementation details (who, when, where, and how). While policies require Board approval and remain relatively stable, procedures may be updated by the Executive Director to adapt to regulatory changes, technological advancements, or operational improvements without requiring Board approval, provided such changes maintain alignment with the policy's intent.

© 2026 Refuge House, Inc. · This is a controlled document. Always refer to the current version.