STAR Kids Program Support Unit Operational Procedures Handbook

24-4, Miscellaneous Changes

Revision Notice 24-4; Effective Dec. 1, 2024

The following sections were revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

Section No.TitleChange
1000STAR Kids Overview and EligibilityAdds clarifying language about MCO requirements for amended ISPs.
1270Financial EligibilityAdds clarifying language on individuals with an active TOA in TIERS and those who require Form 2606, Managed Care Enrollment Processing Delay.
1330Service Delivery Options for Certain Long-Term Services and SupportsUpdates link to MDCP service delivery options.
1631Program Support Unit Communications with Managed Care OrganizationsChanges TxMedCentral to the MCOHub.
1820Managed Care Organization Notification Requirements for PSU StaffChanges TxMedCentral to the MCOHub.
2310Contacting the Interest List Management Unit to Reopen a Closed Interest List ReleaseRemoves ILM email address and adds clarifying language.
2410Traditional Money Follows the PersonAdds clarifying language and reference to Section 1200, Medically Dependent Children Program Eligibility.
2411Medically Dependent Children Program EligibilityDeletes duplicate section. Information found in Section 1200, Medically Dependent Children Program Eligibility. Updated title to Reserve for Future Use.
2411.1Texas Administrative Code Medically Dependent Children Program Eligibility RequirementsDeletes section. Information found in Section 1200.1, Texas Administrative Code Medically Dependent Children Program Eligibility Requirements.
2411.2Texas Administrative Code Medical Necessity Determination RequirementsDeletes section. Information found in Section 1210.1 Texas Administrative Code Medical Necessity Determination Requirements.
3210.2Reassessment of Medical Necessity DeterminationRemoves reference to Uniform Managed Care Manual (UMCM). Updates sections for Denials and Terminations and Reassessment activities.
3300Member Service Planning and AuthorizationAdds clarifying language about MCO requirements for significant change ISPs.
3320Service Planning for Medically Dependent Children Program ServicesAdds clarifying language on reporting delinquent reassessments.
3321Medically Dependent Children Program Individual Service Plan RevisionChanges TxMedCentral to the MCOHub.
3327Reassessment Individual Service Plan ProceduresUpdates section title to Individual Service Plan Expiring Report. Adds clarifying language.
3327.1Process for Reviewing the Individual Service Plan Expiring ReportUpdates section title to Reassessment Procedures. Adds clarifying language.
3328Reassessment Notification RequirementsDeletes section.
3440Transfer from Community Care for Aged and Disabled Services to STAR KidsUpdates section title to Transfer from Community Care Services Eligibility to STAR Kids. Adds clarifying language on coordination with CCSE staff.
3500Transition from Medically Dependent Children Program to Adult ProgramsRemoves language for clarification.
3510Twelve Months Before the Member's 21st BirthdayAdds clarifying language.
3520Transition Policy for Non-Waiver Individuals and Applicants Receiving PCS or CFC OnlyAdds clarifying language.
7210Entering a State Fair Hearing In TIERSAdds clarifying language.
7221.2Financial Denial by Medicaid for the Elderly and People with Disabilities or Texas WorksUpdates language for clarification.
7222.1Continuation of Medically Dependent Children Program Services During a State Fair HearingChanges time to extend a SK-ISP for continued benefits. Updates activities to complete to ensure continued benefits.
7222.2Discontinuation of Medically Dependent Children Program Services During a State Fair HearingAdds clarifying language.
Appendix IIForm H2065-D MDCP Reason for Denial and Comments LanguageUpdates Room and Board and Copayment comments language. Adds use of prorate language.
Appendix IXSTAR Kids TxMedCentral Naming ConventionsUpdates title to Appendix IX, STAR Kids MCOHub Naming Conventions. Adds clarifying language.
Appendix XVIIISTAR Kids HEART Naming ConventionsRemoves language for clarification and changes TxMedCentral to the MCOHub.

24-3, Miscellaneous Changes

Revision 24-3; Effective Aug. 26, 2024

The following sections were revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

Section No.TitleChange
1210Medical Necessity DeterminationAdds language about Medically Dependent Children Program (MDCP) Enrollment Form. Changes managed care organization (MCO) medical necessity (MN) submissions to the Office of Medical Director (OMD) from Texas Medicaid & Healthcare Partnership (TMHP).
1220Individual Cost LimitChanges MCO MN submissions to OMD from TMHP.
2002Medical Necessity DeterminationAdds language about MDCP Enrollment Form.
2020Interest List Management Unit ResponsibilitiesAdds language for adding individuals to MDCP interest list (IL).
2220Managed Care Organization CoordinationAdds Program Support Operations Review Team (PSORT) contact for issues of initial non-compliance. Updates Managed Care Contracts and Oversight (MCCO) Unit name and clarifies role. Changes MCO MN submissions to OMD from TMHP.
2300Interest List Release ClosuresAdds language for adding individuals to MDCP IL.
3210.2Reassessment of Medical Necessity DeterminationChanges MCO MN submissions to OMD from TMHP.
3327.1Process for Reviewing the Individual Service Plan Expiring ReportUpdates MCCO’s name. Adds PSORT to the process of managing the Individual Service Plan (ISP) Expiring Report.
3410Transfer from One MCO to AnotherAdds clarifying language on state cutoff dates and MCOs’ and MCCO’s role in transfer process.
3420Transfer from Another Medicaid Waiver Program to Medically Dependent Children ProgramAdds PSORT contact for issues of initial non-compliance. Updates MCCO’s name and clarifies role. Updates Intellectual and Developmental Disability (IDD) waiver programs and clarifies IDD waiver identification process. Clarifies language for processing Form 2442.
3430Transfer from MDCP to Another Medicaid Waiver ProgramUpdates IDD waiver programs and changes time frame to process MDCP termination.
6300.1DeathClarifies language for processing notification of death. Adds MDCP Enrollment Form.
6400Disenrollment Request PolicyUpdates MCCO’s name.
6500ISPs Invalidated or Terminated in ErrorClarifies subject line for emails sent internally to HHSC staff.
7212Generation of the State Fair Hearing PacketAdds OMD as a FH participant.
7213State Fair Hearing Evidence PacketAdds OMD as a FH participant.
7510.2Sustained State Fair Hearing Decision for Members With Continued MDCP BenefitsAdds ERS notification requirement.  
7520.2Reversed State Fair Hearing Decision for Members With Continued MDCP BenefitsAdds MCO and MCCO notification requirements.
Appendix XXVISTAR Kids Plan CodesUpdates MCO name to Wellpoint. Corrects plan code or plan name for Dallas and Travis service areas. Add UnitedHealth Care Dental plan. 

23-4, Miscellaneous Changes

Revision Notice 23-4; Effective Aug. 21, 2023

The following sections were revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

SectionTitleChange
1210Medical Necessity DeterminationClarifies Program Support Unit (PSU) staff’s role for the STAR Kids individual service plan (SK-ISP) cost limit. 
1210.2Medical Necessity Approval Time Frame for Initial Eligibility DeterminationsAdds new section about medical necessity (MN) approval time frame for initial eligibility determinations.
1614Verifying the Identity of an Applicant, Member, LAR, AR or Third Party IndividualChanges section title to Establishing Identity.
1614.1Telephone Communication Clarifies PSU staff processes for verifying phone communication. Changes section title to Phone Communication.
1615Information That May Be DisclosedClarifies PSU staff procedures for processing Form H1826, Case Information Release. 
1810Program Support Unit Staff Notification RequirementsUpdates PSU staff notification requirements.
2002Medical Necessity DeterminationClarifies PSU staff’s role regarding the SK-ISP cost limit.
2002.2Medical Necessity Approval Time Frame for Initial Eligibility DeterminationsAdds new section for MN approval time frame for initial eligibility determinations.
3210.2Reassessment of Medical Necessity DeterminationClarifies PSU staff’s role regarding the SK-ISP cost limit.
3325Reserved For Future UseAdds new section.
3328Reassessment Notification RequirementsUpdates PSU staff notification requirements.
3430Transfer from MDCP to Another Medicaid Waiver ProgramClarifies PSU staff notification requirements for the Medically Dependent Children Program (MDCP) member transfers to another 1915(c) waiver program. 
7000Applicant or Member Complaints and State Fair HearingsChanges section title to Applicant or Member Appeal Requests and State Fair Hearings. 
7100Reserved for Future UseChanges section title to Appeals and State Fair Hearings. Adds Texas Administrative Code (TAC) language and definitions.
7210Program Support Unit Staff Procedures for Completing Form H4800Changes section title to Entering a State Fair Hearing In TIERS. Updates PSU staff procedures for entering a fair hearing in the Texas Integrated Eligibility Redesign System (TIERS).
7214Changes to the State Fair Hearing Request SummaryUpdates PSU staff procedures for submitting fair hearing changes.
7221Type of DenialsClarifies PSU staff procedures for processing a fair hearing.
7221.1Medical Necessity Denial by Texas Medicaid & Healthcare PartnershipClarifies PSU staff procedures for supplemental security income (SSI) denials or terminations.
7221.3Supplemental Security Income Denial by the Social Security AdministrationRemoves section.
7221.4Other Denial ReasonsClarifies PSU staff procedures for other denial or termination reasons.
7222.1Continuation of Medically Dependent Children Program Services During a State Fair HearingClarifies PSU staff procedures for continuing MDCP during a fair hearing.
7233State Fair Hearing DecisionAdds fair hearing decision definitions.
7310Action Taken on the State Fair Hearing DecisionClarifies PSU staff procedure for processing fair hearing decisions.
7510Sustained State Fair Hearing Decision for ApplicantsAdds fair hearing decision definition for sustained fair hearing decision. Clarifies PSU staff procedure for processing a sustained fair hearing decision.
7510.1Sustained State Fair Hearing Decision for ApplicantsAdds new section.
7510.2Sustained State Fair Hearing Decision for Members With Continued MDCP BenefitsAdds new section.
7510.3Sustained State Fair Hearing Decision for Members Without Continued MDCP BenefitsAdds new section.
7511Sustained Decision – Termination Effective DateClarifies PSU staff procedure for processing a sustained fair hearing decision.
7520Reversed State Fair Hearing DecisionAdds fair hearing decision definition for reversed fair hearing decision. Clarifies PSU staff procedure for processing a reversed fair hearing decision.
7520.1Reversed State Fair Hearing Decision for ApplicantsAdds new section.
7520.2Reversed State Fair Hearing Decision for Members With Continued BenefitsAdds new section.
7520.3Reversed State Fair Hearing Decision for Members Without Continued BenefitsAdds new section.
7521Reversed Decision – Effective DateClarifies PSU staff procedure for processing a reversed fair hearing decision.
7600Roles and Responsibilities of Texas Health and Human Services Commission Hearings OfficerAdds TAC language.
Appendix XIHHSC Benefits Portal and TIERS Reference GuidesChanges appendix title. Includes additional reference guides.
Appendix XXIVFair Hearing and Interest List Options for MDCP Denials - MembersCorrects links and text.
Appendix XXIXFair Hearing and Interest List Options for Aging Out of MDCPUpdates PDFs on landing page and bolding in PDF.
Appendix XXVIIFair Hearing Options for MDCP Denials - ApplicantsUpdates PDFs on landing page and bolding in PDF.
Form 2128 InstructionsForm 2128 InstructionsCorrects miscellaneous content.

23-3, Miscellaneous Changes

Revision Notice 23-3; Effective May 22, 2023

The following sections were revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

SectionTitleChange
1220Individual Cost LimitAdds clarifying language about Utilization Review (UR).
1270Financial EligibilityAdds Form 2606 references and removes Form H2065-D denial reason language.
1420Service Coordination and Programs Serving Members with Intellectual or Developmental DisabilitiesReserves section for future use.
1430Service Coordination and the Youth Empowerment Services Waiver ProgramReserves section for future use.
1440Service Coordinators and Home and Community Based Services - Adult Mental HealthReserved for Future Use. Removes personal needs allowance language.
2410Traditional Money Follows the PersonAdds clarifying language about Money Follows the Person process.
2412.4Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Program Support Unit CoordinationAdds clarifying language about the Money Follows the Person process.
2412.5Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: DenialsAdds clarifying language about the Money Follows the Person process.
2413.4Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Program Support Unit Staff CoordinationAdds clarifying language about the Money Follows the Person process.
2413.5Traditional Money Follows the Person STAR Kids Nursing Facility Residents: DenialsAdds clarifying language about the Money Follows the Person process.
2414MDCP Money Follows the Person Delays in NF Discharge.Adds clarifying language about the Money Follows the Person process.
3300Member Service Planning and AuthorizationClarifies member service planning process.
3310Service PlanningClarifies member service planning process.
3311Updates to Individual Service PlanRemoves section.
3320Service Planning for Medically Dependent Children Program ServicesClarifies MDCP service planning process.
3321Medically Dependent Children Program Individual Service Plan RevisionClarifies MDCP service planning process.
3322Medically Dependent Children Program Individual Service Plan and Budget RevisionReserves section for further use.
3323Setting Aside Funds in the Medically Dependent Children Program Individual Service PlanReserves section for further use.
3325Multiple Medically Dependent Children Program Members in the Same HouseholdRemoves section.
3500Transition from Medically Dependent Children Program to Adult ProgramsUpdates title. Adds clarifying information about transitions to adult programs.
3510Procedures for Children Transitioning from STAR Kids Receiving MDCP, PDN or PPECCRenames Section. Adds clarifying information about transitions to adult programs.
3511Twelve Months Prior to the Member’s 21st BirthdayRemoves section.
3512STAR+PLUS Transition ActivitiesRemoves section.
3513Intrapulmonary Percussive Ventilator BenefitRemoves section.
6300.9Failure to Meet Other Program RequirementsRenames section title to, No Longer Meets the Age Requirement for MDCP, and includes denial processes for MDCP members transitioning to adult programs. 
6300.10Other ReasonsAdds miscellaneous updates.
7213State Fair Hearing Evidence PacketAdds Form 4801 references.
7222.2Termination of MDCP Services Due to a Member Not Requesting a State Fair HearingChanges section title to, Discontinuation of MDCP Services Due to Member Not Requesting a State Fair Hearing. Adds clarifying language. Changes time frame in which PSU staff will upload the state fair hearing evidence packet.
7231Uploading the State Fair Hearing Evidence Packet to the HHSC Benefits PortalChanges section title to, Uploading the State Fair Hearing Evidence Packet. Adds clarifying language. Changes time frame in which PSU staff will upload the state fair hearing evidence packet.
7520Reversed State Fair Hearing DecisionUpdates PSU staff time frame for generating Form H2065-D and adds clarifying language.
Appendix IIForm H2065-D MDCP Reason for Denial and Comments LanguageAdds denial reason and comments language.
Appendix IX STAR Kids TxMedCentral Naming ConventionsCorrects naming conventions.
Appendix XVIIISTAR Kids HEART Naming ConventionsUpdates and adds HEART naming conventions.
Appendix XXIReserved for Future UseUpdate section title to, Creating an Appeal in TIERS. Adds information on creating an appeal in TIERS.
Appendix XXXCounty Codes and City and County ListAdds new appendix to house county codes, city codes and a list of counties.
Form 2128120 Day NoticeAdds form to handbook.