3410 Transfer from One MCO to Another
Revision 24-3; Effective Aug. 26, 2024
A member or legally authorized representative (LAR) can request to change managed care organizations (MCOs) at any time. However, a member can only be enrolled with one MCO for a given month.
A member or LAR who wants to change from one MCO to another MCO must contact the state-contracted enrollment broker by:
- phone: 800-964-2777;
- fax: 855-671-6038; or
- mail:
HHSC
P.O. Box 149023
Austin TX 78714-9023
Note: Adoption Assistance or Permanency Care Assistance (AAPCA) members must contact the state’s enrollment broker to request transfer.
MCO enrollment changes become effective based on the date the MCO change is requested and processed in relation to state cutoff. The MCO selected before the state cutoff date will be the MCO of record on the first day of the next month. Any MCO change made after the state cutoff date is reflected in the following month.
Examples:
State cutoff date – Nov. 14
- A member requests an MCO change on Nov. 1, 2024. The enrollment effective date for the receiving MCO is Dec. 1, 2024.
- A member requests an MCO change on Nov. 18, 2024. The enrollment effective date for the receiving MCO is Jan. 1, 2025.
Program Support Unit (PSU) staff must refer to Appendix XIV, State Cutoff Charts, for more information on current cutoff dates.
Monthly Plan Changes Report
Enrollment Operations Management (EOM) Unit staff prepares and sends the Monthly Plan Changes report to PSU staff. The report gives a full list of all Medically Dependent Children Program (MDCP) members who have changed MCOs from the previous month. PSU staff are not required to provide the Plan Change Report to the MCOs. MCOs receive the plan change report for their members only through an automated process in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Portal (LTCOP).
The losing MCO and the gaining MCO must coordinate and share applicable member information to prevent a gap in services during the transfer. The gaining MCO must notify the Managed Care Contracts and Oversight (MCCO) Unit staff if they encounter issues getting the transfer packet from the losing MCO. MCCO Unit staff may contact PSU staff for help transferring member information to the gaining MCO.
The gaining MCO will have access to current and historical STAR Kids Screening and Assessment Instruments (SK-SAIs) and STAR Kids - Individual Service Plans (SK-ISPs) in the TMHP LTCOP once the member is enrolled with them.
The gaining MCO is responsible for service delivery from the first day of enrollment. The gaining MCO must provide services and honor authorizations included in the prior SK-ISP until the member receives a new SK-SAI.
3420 Transfer from Another Medicaid Waiver Program to Medically Dependent Children Program
Revision 25-1; Effective May 16, 2025
Title 1 Texas Administrative Code (TAC) Section 353.1155(b)(1)(F) states that Medically Dependent Children Program (MDCP) members cannot be enrolled in more than one Medicaid waiver program at the same time. Refer to Appendix XIX, Mutually Exclusive Services, to determine if two services may be received simultaneously by a member.
Individuals in the following Intellectual and Developmental Disabilities (IDD) waiver programs may be on the interest list for MDCP:
- Community Living Assistance and Support Services (CLASS);
- Deaf Blind with Multiple Disabilities (DBMD);
- Home and Community-based Services (HCS);
- Texas Home Living (TxHmL); or
- Youth Empowerment Services (YES) waiver program.
Program Support Unit (PSU) staff receive a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) interest list release (ILR) case record from Interest List Management (ILM) unit staff when an individual in another IDD waiver program comes to the top of the MDCP interest list (IL) and requests MDCP. PSU staff may also receive notification from IDD waiver program staff.
PSU staff must complete the following activities within three business days of receiving the MDCP ILR case record in HEART or notification from IDD waiver program staff:
- create a case record in HEART, if applicable;
- check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility;
- ensure the individual does not have an open enrollment with another Medicaid waiver program per the procedures below:
- for CLASS (Service Group 2), DBMD (Service Group 16), HCS (Service Group 21), and TxHmL (Service Group 22) waiver programs, check the Service Authorization System Online (SASO) for open Service Authorization records;
- for the YES waiver program, check the TIERS Long Term Services and Supports (LTSS) Eligibility Periods Details screen for an open record;
- mail the following enrollment packet to the individual or legally authorized representative (LAR):
- Form 2600-B, MDCP Waiver Release Letter - Supplemental Security Income;
- Form 2602 , Application Acknowledgement;
- Appendix IV, MDCP Frequently Asked Questions;
- Appendix XX, MDCP Program Description; and
- a postage-paid envelope.
PSU staff must contact the individual or LAR within 14 days from the mail date of the above enrollment packet to:
- verify receipt of the enrollment packet;
- confirm interest in MDCP;
- give a general description of MDCP services; and
- encourage the individual or LAR to complete the enrollment packet and mail it back to PSU staff as quickly as possible, if the individual or LAR did not express interest in MDCP.
PSU staff can accept the individual or LAR’s verbal statement of interest in MDCP. PSU staff must document all contact attempts with the individual, LAR and IDD waiver program staff and any delays in the HEART case record.
PSU staff must refer to 2120, Inability to Contact the Individual, when unable to contact the individual or LAR within 14 days of the enrollment packet mail date.
PSU staff must refer to 2130, Declining Medically Dependent Children Program Services, for notification requirements when an individual or LAR does not have an interest in pursuing MDCP services.
PSU staff must contact the individual or LAR within two business days of receiving an enrollment packet that is incomplete, incorrect or missing information to:
- confirm interest in MDCP;
- advise that the application cannot be processed unless complete information is received; and
- encourage the individual or LAR to complete the enrollment packet and mail it back to PSU staff as quickly as possible, if the individual or LAR does not express interest in MDCP.
PSU must document all contact attempts in the HEART case record.
The individual or LAR is not required to select a managed care organization (MCO) since the individual is already enrolled with a STAR Kids MCO. PSU staff can accept the individual or LAR’s verbal statement of interest in MDCP.
PSU staff must complete the following activities within two business days from the date the individual or LAR expressed interest in MDCP:
- complete Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A;
- upload Form H3676, Section A to the MCOHub;
- upload applicable documents to the HEART case record; and
- document the HEART case record.
The MCO must complete the STAR Kids Screening and Assessment Instrument (SK-SAI) within 30 days from the date PSU staff uploaded Form H3676, Section A to the MCOHub. The SK-SAI is considered complete when the MCO has obtained a physician’s signature on Form 2601, Physician’s Certification.
The MCO must submit the complete SK-SAI to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) within 60 days from the date PSU staff uploaded Form H3676, Section A, to the MCOHub. PSU staff must monitor the TMHP LTCOP for receipt of the completed SK-SAI.
The MCO must submit the following documents within 60 days from the date PSU staff uploaded Form H3676, Section A, to the MCOHub:
- the STAR Kids Individual Service Plan (SK-ISP) to the TMHP LTCOP; and
- Form H3676, Section B to the MCOHub.
PSU staff must monitor the TMHP LTCOP for receipt of the SK-ISP. PSU staff must monitor the MCOHub for receipt of Form H3676, Section B. PSU staff receipt of Form H3676, Section B, from the MCO should not delay the certification of the case, if applicable.
PSU staff must email the Program Support Operations Review Team (PSORT) within two business days of an MCO failing to submit the initial assessment information within the 60-day time frame. The email to PSORT must include:
- an email subject line that reads: MDCP Initial 60-Day XX [plan code] MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
- the following items in the body of the email:
- applicant’s name;
- Social Security number (SSN) or Medicaid identification (ID) number;
- date of birth (DOB);
- name of the MCO and plan code;
- the date information was due from the MCO which will be the 60th day for MDCP;
- a brief description of the delay and any MCO information received; and
- attachments of any pertinent documents received from the MCO such as Form H2067-MC, Managed Care Programs Communication.
PSU staff must continue to monitor the TMHP LTCOP and the MCOHub for receipt of the above information. PSU staff must email any case information received from the MCO to the PSORT mailbox within two business days from its receipt. The follow-up email must include the same email identifier elements listed above.
PSU staff must continue to email the Managed Care Contracts and Oversight (MCCO) Unit staff for MCO non-compliance issues that are unrelated to late initial assessment information. PSU staff must include the following components when emailing MCCO Unit staff:
- an email subject line that reads: MDCP MCO Non-Compliance for XX [first letter of the member’s first and last name];
- the following items in the body of the email:
- applicant’s name;
- SSN or Medicaid ID number;
- DOB;
- name of the MCO and plan code;
- the date information was due from the MCO;
- a brief description of the MCO non-compliance and any MCO information received; and
- attachments of any pertinent documents received from the MCO, if applicable.
PSU staff must contact and coordinate with IDD waiver program staff, the applicant, LAR and MCO as appropriate, ensuring the applicant’s current Medicaid waiver program services end one day before enrollment in MDCP.
PSU staff must complete the following activities within two business days of receipt of all required MDCP eligibility documentation:
- Confirm MDCP eligibility by verifying the applicant:
- is under 21 in TIERS;
- is a Texas resident in TIERS;
- has a compatible Medicaid eligibility for MDCP in TIERS;
- has an approved medical necessity (MN) in the TMHP LTCOP;
- has an SK-ISP with a least one MDCP service; and
- has an SK-ISP within the applicant’s cost limit.
PSU staff must approve the applicant’s enrollment in MDCP the first day of the following month after verifying all MDCP eligibility criteria are met. PSU staff must complete the following activities on the same day they confirm all MDCP eligibility criteria are met:
- generate Form H2065-D, Notification of Managed Care Program Services in the TMHP LTCOP;
- mail Form H2065-D to the member or LAR;
- document the HEART case record that Form H3676, Section B, was not received at the time Form H2065-D for approval was generated; if applicable.
- email the Enrollment Resolution Services (ERS) unit which must include the following information:
- an email subject line that reads: Waiver Transfer for XX [first letter of the member’s first and last name];
- the following items in the body of the email:
- member’s name;
- Medicaid ID number;
- type of request: waiver transfer;
- MN approval date;
- SK-ISP receipt date;
- SK-ISP begin date;
- SK-ISP end date;
- MCO;
- effective date of enrollment; and
- Form H2065-D; and
- upload all applicable documents to the HEART case record;
- document all contacts with the IDD waiver program staff, member, LAR or MCO and any delays; and
- close the HEART record.
PSU staff must complete the following activities for an individual whose MDCP eligibility is undetermined or who declined MDCP:
- manually generate Form 2442, Notification of Interest List Release Closure;
- mail Form 2442 and Appendix XX to the individual or LAR;
- upload all applicable documents to the HEART case record; and
- document and close the HEART record.
The MCO must upload Form H3676, Section B, to the MCOHub within two business days if the applicant fails to meet any MDCP eligibility criteria other than Medicaid financial eligibility. PSU staff may accept Form H2067-MC as notification of a denial. However, PSU staff must document in the HEART case record that Form H3676, Section B, was not received when Form H2065-D was generated, if applicable.
PSU staff must refer to 6000, Denials and Terminations, for more information on processing MDCP applicant denials.
3430 Transfer from MDCP to Another Medicaid Waiver Program
Revision 25-1; Effective May 16, 2025
Title 1 Texas Administrative Code (TAC) Section 353.1155(b)(1)(F) states Medically Dependent Children Program (MDCP) members cannot be enrolled in more than one Medicaid waiver program at the same time. Refer to Appendix XIX, Mutually Exclusive Services, to determine if a member may receive two services simultaneously.
MDCP members may be on an interest list for an Intellectual and Developmental Disabilities (IDD) waiver program, such as:
- Community Living Assistance and Support Services (CLASS);
- Deaf Blind with Multiple Disabilities (DBMD);
- Home and Community-based Services (HCS);
- Texas Home Living (TxHmL); or
- Youth Empowerment Services (YES) waiver program.
Program Support Unit (PSU) may receive notification from IDD waiver program staff or the MDCP member’s managed care organization (MCO) that the MDCP member:
- has come to the top of an IDD waiver program interest list;
- chooses to transfer to the IDD wavier program; or
- is already enrolled with an IDD waiver program.
PSU staff must complete the following activities within two business days from notification:
- create a case record in the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART), if applicable;
- contact and coordinate with IDD waiver program staff by email to determine an MDCP termination date and a start of care (SOC) date for the IDD waiver program;
- The MDCP termination date must be the last day of the month before the IDD waiver SOC date;
- terminate the STAR Kids Individual Service Plan (SK-ISP) and the MCDP Enrollment Form in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) the last day of the month before the IDD waiver SOC date;
- manually generate Form H2065-D, Notification of Managed Care Program Services;
- upload Form H2065-D to the MCOHub;
- mail Form H2065-D to the member, legally authorized representative (LAR) or medical consenter;
- for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet, and Form H2065-D to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the MDCP termination date and the enrollment effective date for the new Medicaid waiver program;
- upload all applicable documents to the HEART case record;
- document all contacts with the IDD waiver program staff, member, LAR, medical consenter or MCO and any delays; and
- close the HEART case record.
Adverse Action is not required when an MDCP member transfers to an IDD waiver program.
3440 Transfer from Community Care Services Eligibility to STAR Kids
Revision 24-4; Effective Dec. 1, 2024
PSU staff must coordinate the termination of Community Care Services Eligibility (CCSE) with the CCSE case worker for individuals entering STAR Kids through the Medically Dependent Children Program (MDCP). This ensures the individual does not experience a break in services and does not receive concurrent services through CCSE services.
CCSE services are terminated by the CCSE case worker in the Service Authorization System Online (SASO) by the day before MDCP enrollment. This is crucial since no MDCP member may receive CCSE and MDCP services on the same day.
PSU staff are not required to provide Form H2065-D, Notification of Managed Care Program Services (PDF), as notification of MDCP certification to the CCSE case manager when requesting CCSE termination in SASO.