Revision 18-0; Effective September 4, 2018

When Program Support Unit (PSU) staff authorize the STAR+PLUS Home and Community Based Services (HCBS) program for an initial service authorization in the Service Authorization System Online (SASO), PSU staff must check or create the following records according to Sections 9110 through 9170:

• Authorizing Agent – Initial;
• Enrollment – Initial;
• Service Plan – Initial;
• Service Authorization – Initial;
• Level of Service  – Initial;
• Diagnosis – Initial; and
• Medical Necessity – Initial. 

9110 Authorizing Agent - Initial

Revision 18-0; Effective September 4, 2018

The authorizing agent record in the Service Authorization System Online (SASO) is used to register the authorizing agent begin date with an open ended date for the STAR+PLUS Home and Community Based Services (HCBS) program applicant.

There will normally be one authorizing agent registered in SASO for a STAR+PLUS HCBS program applicant.

Initial individual service plans (ISPs) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal have a system generated authorizing agent. The TMHP LTC Online Portal interfaces with the SASO and records "STAR+PLUS" in the ‘Authorizing Agent’ field and records the managed care organization (MCO) service coordinator's name in the ‘Name’ field.

The TMHP LTC Online Portal will generate changes to the SASO authorizing agent records for a member with a plan code change during an ISP year for which a current or future ISP is in a "processed/complete" status. In this case, a SASO authorizing agent record is created for the initial ISP with a begin date equal to the new managed care organization (MCO) plan effective date. The SASO authorizing agent record for the transferred ISP is automatically ended with the prior MCO plan enrollment end date.

Program Support Unit (PSU) staff do not register an authorizing agent for an electronic ISP.

PSU staff can create authorizing agent record(s) for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm the authorizing agent registration in SASO.  

PSU staff are registered as the authorizing agent when an applicant is authorized in SASO.

To register an authorizing agent record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

1. Select the Authorizing Agent field in the Case Worker functional area.
2. Select Add and a blank Authorizing Agent Details record will appear.
3. Move to the Type field and select CM – Case Manager from the drop-down menu.
4. Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Leave the Send to TMHP field at the default selection N - NO.
6. Move to the Begin Date field and enter the date the record is being created. Leave the End Date field blank.
7. Move to the Authorizing Agent field and enter STAR+PLUS.
8. Leave the Agency field at the default selection 324 - DHS.
9. Move to the Name field and enter the PSU staff’s service area.
10. Move to the Phone field and enter the telephone number of the authorizing agent. Enter the area code, phone number and extension.
11. Move to the Mail Code field and enter the appropriate Managed Care Organization (MCO) plan code from the table below. Note: Six service areas include Medicare-Medicaid Plans (MMP).

Service Area	MCO Plan Name	MCO Plan Code
Bexar	Amerigroup	45
Molina	46
Superior	47
Amerigroup MMP	4F
Molina MMP	4G
Superior MMP	4H
Dallas	Molina	9F
Superior Health Plan	9H
Molina MMP	9J
Superior MMP	9K
El Paso	Amerigroup	34
Molina	33
Amerigroup MMP	3G
Molina MMP	3H
Harris	Amerigroup	7P
United Healthcare	7R
Molina	7S
Amerigroup MMP	7Z
United Healthcare MMP	7Q
Molina MMP	7V
Hidalgo	Cigna-HealthSpring	H7
Molina	H6
Superior	H5
Cigna-HealthSpring MMP	H8
Molina MMP	H9
Superior MMP	HA
Jefferson	Amerigroup	8R
United Healthcare	8S
Molina	8T
Lubbock	Amerigroup	5A
Superior	5B
Medicaid Rural Service Area (RSA) Central Texas	Superior	C4
United Healthcare	C5
Medicaid RSA Northeast Texas	Cigna-HealthSpring	N3
United Healthcare	N4
Medicaid RSA West Texas	Amerigroup	W5
Superior	W6
Nueces	United Healthcare	85
	Superior Health Plan	86
Tarrant	Amerigroup	69
	Cigna-HealthSpring	6C
	Amerigroup MMP	6F
	Cigna-HealthSpring MMP	6G
Travis	Amerigroup	19
	United Healthcare	18

9120 Enrollment - Initial

Revision 18-0; Effective September 4, 2018

The enrollment record in the Service Authorization System Online (SASO) is used to register the enrollment begin and end date for the STAR+PLUS Home and Community Based Services (HCBS) program applicant.

Program Support Staff (PSU) staff will create an enrollment record for STAR+PLUS HCBS program eligibility for applicants whose individual service plan (ISP) was not transmitted electronically.

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register an enrollment record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

1. Select the Enrollment field in the Program and Service functional area.
2. Select Add and a blank Enrollment Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Enrolled From field and select the appropriate entry from the drop-down menu.
5. Move to the Living Arrangement field, and select the appropriate community-based living arrangement from the drop-down menu. The living arrangement must match the information provided in the initial ISP.
6. Move to the Begin Date field and enter the date the member is to be enrolled in his MCO, which will always be the first day of a month.
7. Leave the End Date field blank.
8. Leave the Termination Code and Waiver Type fields at the defaults.
9. Select the Save button. 

9130 Service Plan - Initial

Revision 18-0; Effective September 4, 2018

The Service Plan record in the Service Authorization System Online (SASO) is used to register an individual service plan (ISP) for a STAR+PLUS Home and Community Based Services (HCBS) program member. The service plan record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Resource Utilization Group (RUG) value and the total estimated cost taken from the member’s Form H1700-1, Individual Service Plan (Pg. 1), for members who do not have an electronic ISP.

Program Support Staff (PSU) staff will create a service plan record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register a service plan record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

1. Select the Service Plan field in the Program and Service functional area.
2. Select Add and a blank Service Plan Details record will appear.
3. Leave the Type field at the default selection AN - ANNUAL PLAN.
4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the RUG value entered on the current ISP coverage period, from Form H1700-1.  For a STAR+PLUS HCBS program member who is ventilator use-dependent, enter the annual STAR+PLUS HCBS program ISP cost limit based on the RUG value and ventilator use of the member (6-23 hours or 24 hours continuous).
6. Move to the Begin Date field and enter the effective date of the ISP coverage period.
7. Move to the End Date field and enter the last day of the ISP coverage period.
8. Move to the Amount Authorized field and enter the total estimated cost of all STAR+PLUS HCBS program services authorized for the current ISP coverage period, from Form H1700-1.
9. Leave the Amount Paid field at the default setting of 0.00.
10. Leave the Units Authorized field at the default of 0.00.
11. Leave the Units Paid field at the default of 0.00.
12. Select the Save button. 

9140 Service Authorization - Initial

Revision 18-0; Effective September 4, 2018

If the individual service plan (ISP) is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service authorization records in the Service Authorization System Online (SASO).

Program Support Unit (PSU) staff do not register service authorization records for an electronic individual service plan (ISP).

PSU staff will create a service authorization record, if applicable, for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm service authorization registration in SASO, take a screenshot of the service authorization registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register a service authorization record for STAR+PLUS HCBS program eligibility for a member whose ISP requires manual entry, PSU staff must:

1. Select the Service Authorization field in the Program and Service functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
5. Leave the Fund and Term. Code fields at the defaults.
6. Leave the Agency field at the default selection 324 - DHS.
7. Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
8. Move to the Units field and enter 1.00.
9. Leave the Amount field at the default.
10. Move to the Begin Date field and enter the effective date of the ISP coverage period.
11. Move to the End Date field and enter the last day of the ISP coverage period.
12. Move to the Contract No field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

MCO	Service Area	Contract Number
Molina	Bexar	1014430
Molina MMP	Bexar	1026341
Molina	Harris	1014431
Molina MMP	Harris	1026344
Molina	Jefferson	1019598
Molina	Dallas	1018980
Molina MMP	Dallas	1026342
Molina	El Paso	1019987
Molina MMP	El Paso	1026343
Molina	Hidalgo	1019988
Molina MMP	Hidalgo	1026345
Superior	Bexar	1014433
Superior MMP	Bexar	1026337
Superior	Nueces	1014434
Superior	Dallas	1018981
Superior MMP	Dallas	1026338
Superior	Hidalgo	1019985
Superior MMP	Hidalgo	1026339
Superior	Lubbock	1019986
Superior	Medicaid Rural Service Area (RSA) Central	1025731
Superior	Medicaid RSA West	1025730
United Healthcare	Harris	1014435
United Healthcare MMP	Harris	1026334
United Healthcare	Jefferson	1019600
United Healthcare	Medicaid RSA Central	1025732
United Healthcare	Medicaid RSA Northeast	1025734
United Healthcare	Nueces	1014437
United Healthcare	Travis	1014438
Amerigroup	Bexar	1014439
Amerigroup MMP	Bexar	1026326
Amerigroup	Harris	1014440
Amerigroup MMP	Harris	1026331
Amerigroup	Jefferson	1019599
Amerigroup	Travis	1014442
Amerigroup	El Paso	1019979
Amerigroup MMP	El Paso	1026328
Amerigroup	Lubbock	1019983
Amerigroup	Medicaid RSA West	1025729
Amerigroup	Tarrant	1018977
Amerigroup MMP	Tarrant	1026332
Cigna-HealthSpring	Tarrant	1018979
Cigna-HealthSpring MMP	Tarrant	1026333
Cigna-HealthSpring	Hidalgo	1019984
Cigna-HealthSpring MMP	Hidalgo	1026335
Cigna-HealthSpring	Medicaid RSA Northeast	1025733

9150 Level of Service - Initial

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a Resource Utilization Group (RUG) registered on a level of service (LOS) record in the Service Authorization System Online (SASO). The LOS record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the RUG value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system generated LOS record will have an end date that may need to be extended by Program Support Unit (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: If the MN/LOC Assessment is approved with an effective date of May 13, 2019, the system-generated end date for the LOS record will be May 12, 2020. If the ISP period is June 1, 2019 to May 31, 2020, the LOS record will need to be extended to May 31, 2020, so the member has coverage for the entire ISP period.

To extend an LOS record for a STAR+PLUS HCBS program applicant, PSU staff must:

1. Select the Level of Service field in the Medical functional area.
2. Select the Level of Service record you wish to extend.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If an LOS record has not been created in SASO, PSU staff must complete the following steps to add the record:

1. Select the Level of Service field in the Medical functional area.
2. Select Add and a blank Level of Service Details record will appear.
3. Move to the Type field and select CR – CBA RUG from the drop-down menu.
4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Move to the Level field and enter the RUG level from Form H1700-1, Individual Service Plan (Pg. 1). The RUG level can be verified in the MN/LOC Assessment.
6. Move to the Begin Date field and enter the first day of the ISP period.
7. Move to the End Date field and enter the last day of the ISP period.
8. Select the Save button.

9160 Diagnosis - Initial

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record should be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record will have an end date that may need to be extended by Program Support Staff (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: If MN is approved with an effective date of November 13, 2019, the system generated end date will be November 30, 2020.

To extend a diagnosis record for a STAR+PLUS HCBS program applicant or member:

1. Select the Diagnosis field in the Medical functional area.
2. Select the Diagnosis record you wish to extend.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If a diagnosis record has not been created in SASO, PSU staff must complete the following steps to add the record:

1. Select the Diagnosis field in the Medical functional area.
2. Select Add and a blank Diagnosis Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Begin Date field and enter the first day of the ISP period.
5. Move to the End Date field and enter the last day of the ISP period.
6. Enter up to five diagnoses from the most recent Waiver 3.0 Form, Section I, in TMHP. The diagnosis can be verified in the MN/LOC Assessment.
7. Select Version ICD-10-CM CODE.
8. Select the Save button.

9170 Medical Necessity - Initial

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have an end date that may need to be extended by Program Support Staff (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create an MN record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

Example: If MN is approved with an effective date of May 13, 2019, the system generated end date will be May 31, 2020.

To extend an MN record for a STAR+PLUS HCBS program applicant, PSU staff must:

1. Select the MN field in the Medical functional area.
2. Select the MN record you wish to extend.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If an MN record has not been created in SASO, PSU staff must complete the following steps to add the record:

1. Select the MN field in the Medical functional area.
2. Select Add and a blank MN Details record will appear.
3. Move to the MN field and select Y - YES from the drop-down menu.
4. Move to the Permanent field and select N – NO.
5. Move to the Begin Date field and enter the first day of the ISP period.
6. Move to the End Date field and enter the last day of the ISP period.
7. Select the Save button.

Revision 18-0; Effective September 4, 2018

When Program Support Unit (PSU) staff authorize STAR+PLUS Home and Community Based Services (HCBS) program services for a reassessment of the individual service plan (ISP) in the Service Authorization System Online (SASO), PSU staff must check or create the following records according to Sections 9210 through 9270:

• Authorizing Agent – Reassessment;
• Enrollment – Reassessment;
• Service Plan – Reassessment;
• Service Authorization – Reassessment;
• Level of Service  – Reassessment;
• Diagnosis – Reassessment; and
• Medical Necessity – Reassessment.

9210 Authorizing Agent – Reassessment

Revision 18-0; Effective September 4, 2018

Check the authorizing agent record for accuracy. If there are no changes, leave the authorizing agent record open-ended. Currently, although the Service Authorization System Online (SASO) will accept multiple authorizing agent records, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal will only accept two authorizing agent records when a SASO file is transmitted to TMHP. Therefore, select “NO” in the ‘Send to TMHP’ field for all updates.

Program Support Unit (PSU) staff will create an authorizing agent record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose individual service plan (ISP) was not transmitted electronically.

9220 Enrollment – Reassessment

Revision 18-0; Effective September 4, 2018

Check the enrollment record for accuracy and to be sure it is open-ended. If it is open-ended, make no changes. If it has an end date, delete the end date or create another record with a new begin date. To ensure that there is not a gap in service, the begin date of the enrollment for the new individual service plan (ISP) year is the day after the end date of the previous ISP year.

Program Support Staff (PSU) staff will create a service plan record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

9230 Service Plan – Reassessment

Revision 18-0; Effective September 4, 2018

A new service plan record may need to be created to register the Resource Utilization Group (RUG) cost limit and the amount of services authorized for the new individual service plan (ISP) year.

Because the ISP is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service plan records in the Service Authorization System Online (SASO).

Program Support Unit (PSU) staff do not need to create a service plan record for electronic ISPs.

PSU staff will create a service plan record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the HHS Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

9240 Service Authorization – Reassessment

Revision 18-0; Effective September 4, 2018

If the managed care organization (MCO) uploads a timely reassessment packet, Program Support Unit (PSU) staff create one service authorization record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for the new individual service plan (ISP) year. To ensure there is no gap in service, the begin date of the authorization for the new ISP year is the day after the end date of the previous ISP year.

Because the ISP is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service authorization records in the Service Authorization System Online (SASO).

PSU staff should not need to register service authorization records for electronic ISPs.

PSU staff will create a service authorization record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm service authorization registration in SASO, take a screenshot of the service authorization registration in SASO, and upload the screenshot to the HHS Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

If the MCO does not upload a timely reassessment packet, two service authorization records will be required for STAR+PLUS HCBS program eligibility. The first service authorization record for STAR+PLUS HCBS program eligibility will be entered with service group (SG) 19/service code (SC) 13 for the month(s) for which the ISP was late. The second service authorization record for STAR+PLUS HCBS program eligibility will be entered with SG 19/SC 12 for the remaining ISP period.

To enter a service authorization record for an untimely reassessment for STAR+PLUS HCBS program eligibility for an applicant or member whose ISP is not electronic, PSU staff must:

1. Select the Service Authorization field in the Program and Service functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Service Code field and select 13 – NURSING SERVICES from the drop-down menu.
5. Leave the Fund and Term. Code fields at the defaults.
6. Leave the Agency field at the default selection 324 - DHS.
7. Move to the Unit Type field and select 4 – PER AUTHORIZATION from the drop-down menu.
8. Move to the Units field and enter 1.00.
9. Leave Amount field at the default.
10. Move to the Begin Date field and enter the effective date of the new ISP coverage period.
11. Create two service authorization records. For the first record, move to the End Date field and enter the last day of the month the ISP was received. Note: For the second record, repeat steps 1 through 10. Move to the Begin Date field and enter the first of the next month and move to the End Date field and enter the end date of the ISP period.
12. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

MCO	Service Area	Contract Number
Molina	Bexar	1014430
Molina MMP	Bexar	1026341
Molina	Harris	1014431
Molina MMP	Harris	1026344
Molina	Jefferson	1019598
Molina	Dallas	1018980
Molina MMP	Dallas	1026342
Molina	El Paso	1019987
Molina MMP	El Paso	1026343
Molina	Hidalgo	1019988
Molina MMP	Hidalgo	1026345
Superior	Bexar	1014433
Superior MMP	Bexar	1026337
Superior	Nueces	1014434
Superior	Dallas	1018981
Superior MMP	Dallas	1026338
Superior	Hidalgo	1019985
Superior MMP	Hidalgo	1026339
Superior	Lubbock	1019986
Superior	Medicaid Rural Service Area (RSA) Central	1025731
Superior	Medicaid RSA West	1025730
United Healthcare	Harris	1014435
United Healthcare MMP	Harris	1026334
United Healthcare	Jefferson	1019600
United Healthcare	Medicaid RSA Central	1025732
United Healthcare	Medicaid RSA Northeast	1025734
United Healthcare	Nueces	1014437
United Healthcare	Travis	1014438
Amerigroup	Bexar	1014439
Amerigroup MMP	Bexar	1026326
Amerigroup	Harris	1014440
Amerigroup MMP	Harris	1026331
Amerigroup	Jefferson	1019599
Amerigroup	Travis	1014442
Amerigroup	El Paso	1019979
Amerigroup MMP	El Paso	1026328
Amerigroup	Lubbock	1019983
Amerigroup	Medicaid RSA West	1025729
Amerigroup	Tarrant	1018977
Amerigroup MMP	Tarrant	1026332
Cigna-HealthSpring	Tarrant	1018979
Cigna-HealthSpring MMP	Tarrant	1026333
Cigna-HealthSpring	Hidalgo	1019984
Cigna-HealthSpring MMP	Hidalgo	1026335
Cigna-HealthSpring	Medicaid RSA Northeast	1025733

13. The NPI field is read-only.
14. Select the Save button.

9250 Level of Service – Reassessment

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a Resource Utilization Group (RUG) value registered in the Service Authorization System Online (SASO). The level of service (LOS) record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the RUG value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system-generated LOS record will have a begin and end date that matches the new individual service plan (ISP) year.

Program Support Unit (PSU) staff will create an LOS record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: A member with an initial ISP coverage period of December 1, 2019 through November 30, 2020, is authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective December 1, 2019 through November 30, 2020. These new begin and end dates will be system generated in the LOS record.

9260 Diagnosis – Reassessment

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information from this form to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is commuted, TMHP submits the decision to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record will have a begin and end date that matches the new individual service plan (ISP) year.

Program Support Unit (PSU) staff will create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: A member with an initial ISP coverage period of November 1, 2019 through October 31, 2020, is re-authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective November 1, 2019 through October 31, 2020. These new begin and end dates will be system generated in the diagnosis record.

9270 Medical Necessity – Reassessment

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment for the annual reassessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have a begin date and an end date that matches the new individual service plan (ISP) year.

Program Support Unit (PSU) staff will create an MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

Example: A member with an initial ISP coverage period of February 1, 2019 through Jan. 31, 2020, is authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective February 1, 2019 through January 31, 2020. These new begin and end dates will be system generated in the MN record. The MN record must be forced in SASO to register an MN determination for a reassessment when the MN is approved in the TMHP LTC Online Portal but will not convert to SASO because of a mismatch of member information between the MN/LOC Assessment and the Texas Integrated Eligibility Redesign System (TIERS).

Revision 18-0; Effective September 4, 2018

There are several situations that are considered transfers for STAR+PLUS Home and Community Based Service (HCBS) program members, and the procedures differ for each.

9310 Transfers from One STAR+PLUS Area to Another Area

Revision 23-2; Effective May 15, 2023

Two different situations can occur when a STAR+PLUS Home and Community Based Services (HCBS) program member transfers from one service area (SA) to another SA. The first situation is when a member transfers to a new SA that the current managed care organization (MCO) also operates in, and the member wants to stay with that MCO. The contract number will change even though the member stays with the same MCO. As a result, the member’s records will need to be closed under the previous contract number and opened under the new contract number. The second situation is when the member transfers to a new SA that the current MCO does not operate in, and the member changes MCOs.

The Texas Integrated Eligibility Redesign System (TIERS) updates the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) if the member's individual service plan (ISP) is electronic and the member made a new MCO selection. The TMHP LTCOP automatically interfaces with the Service Authorization System Online (SASO) to: 

• close the SASO registration records for the losing MCO; and 
• create new SASO registration records for the gaining MCO.

Program Support Unit (PSU) staff must manually close SASO registration records when a member’s MCO plan change is not timely. To process the transfer, the gaining PSU staff must:

• close the existing: 
  • Authorizing Agent (service code (SC) 12) record; 
  • Service Authorization (service group (SG) 19/service code (SC) 12) record; 
• open a new: 
  • Authorizing Agent (SC 12) record; and 
  • Service Authorization (SG 19/SC 12) record using the MCO contract number in the new SA.

The gaining PSU staff must complete the following activities to close the Authorizing Agent record:

1. Open the STAR+PLUS HCBS program member’s case in the SASO.
2. Select the Authorizing Agent field from the Case Worker functional area.
3. Select the Authorizing Agent record you wish to close.
4. Select the Modify button to open and modify.
5. Move to the End Date field and enter the effective date of the termination, which is the last day of the month in which the member moved to the new SA.
6. Select the Save button.

The gaining PSU staff must complete the following activities to close the Service Authorization record:

1. Select the Service Authorization field in the Program and Service functional area.
2. Select the appropriate Service Authorization (SC 12) record you wish to close.
3. Select the Modify button to open and modify.
4. Move to the End Date field and enter the effective date of the termination. This will be the last day of the month in which the member moved to the new SA.
5. Move to the Termination Code field and select “23 - Transferred to another service” (or the appropriate code) from the drop-down menu.
6. Select the Save button.
7. Select Submit to SASO.
8. Select Outbox and then Inbox to ensure the case processed accurately.

The Service Authorization record is opened per procedures outlined in determining initial eligibility for STAR+PLUS HCBS program members with the following exceptions:

• The begin date for these records is the first day of the month following the month the member moved to the new SA.
• The end date for the Service Authorization (SC 12) record is the same as the current ISP period.

Example: If a STAR+PLUS HCBS program member with an ISP period of Nov. 1, 2019, to Oct. 31, 2020, transfers to another STAR+PLUS SA on Jan. 15, 2020, the end date for these records remains Oct. 31, 2018.

9320 Transfers from One MCO to Another MCO in the Same Service Area

Revision 18-0; Effective September 4, 2018

If the member's individual service plan (ISP) is electronic and the member made a new managed care organization (MCO) selection timely, the Texas Integrated Eligibility Redesign System (TIERS) updates the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal, which automatically closes the registration for the losing MCO and creates the registration for the gaining MCO in the Service Authorization System Online (SASO). If the member's plan change is not timely, Program Support Unit (PSU) staff follow existing policy, stated below.

PSU staff process the request by closing the existing service authorization record (service code (SC) 12) for the losing MCO and creating a new service authorization record (SC 12) for the gaining MCO.

To close the existing service authorization records, PSU staff must:

1. Move to the Service Authorization field in the Program and Service functional area.
2. Select the appropriate Service Authorization record you wish to close.
3. Select the Modify button.
4. Move to the End Date field and enter the effective date of the termination, which is the last day of the month in which the member was enrolled in the losing MCO.
5. Move to the Termination Code field and select “39 – Other” (or the appropriate code) from the drop-down menu.
6. Select the Save button.
7. Select Submit to SASO.
8. Select Outbox and then Inbox to ensure the case processed accurately.

To create a new service authorization record for the new MCO, PSU staff must:

1. Select the Service Authorization field in the Program and Service functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
5. Leave the Fund and Term. Code fields at the defaults.
6. Leave the Agency field at the default selection 324 - DHS.
7. Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
8. Move to the Units field and enter 1.00.
9. Leave the Amount field at the default.
10. Move to the Begin Date field and enter the new MCO contract number or plan code enrollment date.
11. Move to the End Date field; the end date for the service authorization record is the last day of the ISP coverage period.
12. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

MCO	Service Area	Contract Number
Molina	Bexar	1014430
Molina MMP	Bexar	1026341
Molina	Harris	1014431
Molina MMP	Harris	1026344
Molina	Jefferson	1019598
Molina	Dallas	1018980
Molina MMP	Dallas	1026342
Molina	El Paso	1019987
Molina MMP	El Paso	1026343
Molina	Hidalgo	1019988
Molina MMP	Hidalgo	1026345
Superior	Bexar	1014433
Superior MMP	Bexar	1026337
Superior	Nueces	1014434
Superior	Dallas	1018981
Superior MMP	Dallas	1026338
Superior	Hidalgo	1019985
Superior MMP	Hidalgo	1026339
Superior	Lubbock	1019986
Superior	Medicaid Rural Service Area (RSA) Central	1025731
Superior	Medicaid RSA West	1025730
United Healthcare	Harris	1014435
United Healthcare MMP	Harris	1026334
United Healthcare	Jefferson	1019600
United Healthcare	Medicaid RSA Central	1025732
United Healthcare	Medicaid RSA Northeast	1025734
United Healthcare	Nueces	1014437
United Healthcare	Travis	1014438
Amerigroup	Bexar	1014439
Amerigroup MMP	Bexar	1026326
Amerigroup	Harris	1014440
Amerigroup MMP	Harris	1026331
Amerigroup	Jefferson	1019599
Amerigroup	Travis	1014442
Amerigroup	El Paso	1019979
Amerigroup MMP	El Paso	1026328
Amerigroup	Lubbock	1019983
Amerigroup	Medicaid RSA West	1025729
Amerigroup	Tarrant	1018977
Amerigroup MMP	Tarrant	1026332
Cigna-HealthSpring	Tarrant	1018979
Cigna-HealthSpring MMP	Tarrant	1026333
Cigna-HealthSpring	Hidalgo	1019984
Cigna-HealthSpring MMP	Hidalgo	1026335
Cigna-HealthSpring	Medicaid RSA Northeast	1025733

13. The NPI field is read-only.
14. Select the Save button.
15. Select Submit to SASO.
16. Select Outbox and then Inbox to ensure the case processed accurately.

Revision 18-0; Effective September 4, 2018

After Program Support Unit (PSU) staff verify that the applicant left the nursing facility (NF), PSU staff complete the following steps listed below. PSU staff do not close the Authorizing Agent, Medical Necessity, Level of Service Resource Utilization Group (RUG) records. PSU staff must also ensure Provider Claims Services (PCS) closes the enrollment and service authorization records for service codes (SC) 1, 3, 50 and 60.

For individuals who are not enrolled in STAR+PLUS until they begin receiving the STAR+PLUS Home and Community Based Services (HCBS) program, create a one-day service authorization record for the first day of the month in which a Money Follows the Person (MFP) individual is discharged from an NF, unless the individual discharges on the first day of a month.

Example: An individual who is not enrolled in STAR+PLUS leaves the NF and begins the STAR+PLUS HCBS program on December 25, 2019. PSU staff register the initial individual service plan (ISP) in the Service Authorization System Online (SASO) with an effective date of December 25, 2019 through December 31, 2020. In addition to registering the initial ISP, PSU staff create all the records listed below with a begin date of December 1, 2019, and an end date of December 1, 2019.

PSU staff must check or create the one-day service authorization for the following records for service group (SG) 19 according to Sections 9410 through 9470:

• Authorizing Agent for MFP Applicant (if needed);
• Enrollment for MFP Applicant;
• Service Plan for MFP Applicant;
• Service Authorization for MFP Applicant;
• Level of Service for MFP Applicant;
• Diagnosis for MFP Applicant; and
• Medical Necessity for MFP Applicant.

A one-day overlap of the records listed is allowed.

Note: Individuals released from an NF and authorized for the STAR+PLUS HCBS program should be enrolled under MFP. In the Enrollment record, select "12 – MONEY FOLLOWS THE PERSON” from the drop-down menu in the Enrolled From field. Do not use “Enrolled from nursing facility” to designate MFP members.

To authorize STAR+PLUS HCBS program eligibility for an MFP applicant:

After creating the one-day records above, when applicable, PSU must create the records needed for the ongoing MFP STAR+PLUS HCBS program eligibility. These records must be completed to check or create an initial service authorization for the STAR+PLUS HCBS program according to Sections 9410 through 9470 listed above.

9410 Authorizing Agent for MFP Applicant

Revision 18-0; Effective September 4, 2018

There will be one authorizing agent registered for a Money Follows the Person (MFP) applicant.

Program Support Unit (PSU) staff are registered as the authorizing agent when the initial authorization is authorized.

To register an authorizing agent for an MFP applicant, PSU staff must:

1. Select the Authorizing Agent field in the Case Worker functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Type field and select CM - CASE MANAGER from the drop-down menu.
4. Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Leave the Send to TMHP field at the default selection N - NO.
6. Move to the Begin Date field and enter the date the record is being created. Leave the End Date field blank.
7. Move to the Authorizing Agent ID field and enter STAR+PLUS.
8. Leave the Agency field at the default selection 324 - DHS.
9. Move to the Name field and enter the PSU/ERS staff’s name.
10. Move to the Phone field and enter the telephone number of the authorizing agent. Enter the area code, phone number and extension.
11. Move to the Mail Code field and enter the appropriate Managed Care Organization (MCO) Plan Code. Note: Six service areas include Medicare-Medicaid Plans (MMP).

Service Area	MCO Plan Name	MCO Plan Code
Bexar	Amerigroup	45
Molina	46
Superior	47
Amerigroup MMP	4F
Molina MMP	4G
Superior MMP	4H
Dallas	Molina	9F
Superior Health Plan	9H
Molina MMP	9J
Superior MMP	9K
El Paso	Molina	33
Amerigroup	34
Molina MMP	3G
Amerigroup MMP	3H
Harris	Amerigroup	7P
United Healthcare	7R
Molina	7S
Amerigroup MMP	7Z
United Healthcare MMP	7Q
Molina MMP	7V
Hidalgo	Cigna-HealthSpring	H7
	Molina	H6
	Superior	H5
	Cigna-HealthSpring MMP	H8
	Molina MMP	H9
	Superior MMP	HA
Jefferson	Amerigroup	8R
	United Healthcare	8S
	Molina	8T
Lubbock	Amerigroup	5A
	Superior	5B
Medicaid Rural Service Area (RSA) Central Texas	Superior	C4
	United Healthcare	C5
Medicaid RSA Northeast Texas	Cigna-HealthSpring	N3
	United Healthcare	N4
Medicaid RSA West Texas	Amerigroup	W5
	Superior	W6
Nueces	United Healthcare	85
	Superior Health Plan	86
Tarrant	Amerigroup	69
	Cigna-HealthSpring	6C
	Amerigroup MMP	6F
	Cigna-HealthSpring MMP	6G
Travis	Amerigroup	19
	United Healthcare	18

12. Select the Save button.

9420 Enrollment for MFP Applicant

Revision 18-0; Effective September 4, 2018

The Enrollment record in the Service Authorization System Online (SASO) is used to register the enrollment begin date with an open ended date for the STAR+PLUS Home and Community Based Services (HCBS) program member.

Program Support Staff (PSU) staff will create an enrollment record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the enrollment registration in SASO, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register an authorizing agent for a Money Follows the Person (MFP) applicant, PSU staff must:

1. Select the Enrollment field in the Program and Service functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Enrolled From field and select the appropriate entry from the drop-down menu. If this is an MFP authorization, be sure to select 12 - MONEY FOLLOWS THE PERSON from the drop-down menu.
5. Move to the Living Arrangement field, and select the appropriate community-based living arrangement from the drop-down menu.
6. Move to the Begin Date field and enter the date the member is enrolled in his MCO, which will always be the first day of a month. Leave the End Date field blank.
7. Leave the Termination Code and Waiver Type at the defaults.
8. Select the Save button.

9430 Service Plan for MFP Applicant

Revision 18-0; Effective September 4, 2018

The service plan record is used to register an individual service plan (ISP) for a STAR+PLUS Home and Community Based Services (HCBS) program member. The record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Resource Utilization Group (RUG) value and the total estimated cost of the STAR+PLUS HCBS program services taken from the member’s Form H1700-1, Individual Service Plan (Pg. 1).

Program Support Staff (PSU) staff will create a service plan record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the service plan registration in the Service Authorization System Online (SASO) and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register a service plan for a Money Follows the Person (MFP) applicant, PSU staff must:

1. Select the Service Plan field in the Program and Service functional area.
2. Select Add and a blank Service Plan Details record will appear.
3. Leave the Type field at the default selection AN - ANNUAL PLAN.
4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the RUG value entered on the Level of Service record. For a STAR+PLUS HCBS program member who uses a ventilator, enter the annual STAR+PLUS HCBS program ISP cost limit based on the RUG value and ventilator use of the member (6-23 hours or 24 hours continuous).

Move to the Begin Date field and enter the effective date of the ISP coverage period.

6. Move to the End Date field and enter the last day of the ISP coverage period.
7. Move to the Amount Authorized field and enter the total estimated cost of all  STAR+PLUS HCBS program services authorized for the current ISP coverage period from Form H1700-1.
8. Leave the Amount Paid field at the default setting of 0.00.
9. Leave the Units Authorized field at the default of 0.00.
10. Leave the Units Paid field at the default of 0.00.
11. Select the Save button.

9440 Service Authorization for MFP Applicant

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff create one service authorization record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility.

PSU staff will create a service authorization record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the service authorization registration in the Service Authorization System Online (SASO) and upload the screenshot to the HHS Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register a service authorization record for a Money Follows the Person (MFP) applicant, PSU staff must:

1. Select the Service Authorization field in the Program and Service functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
5. Leave the Fund and Term. Code fields at the defaults.
6. Leave the Agency field at the default selection 324 - DHS.
7. Move to the Unit Type field and select 2 – MONTH from the drop down list.
8. Move to the Units field and enter 1.00.
9. Leave Amount at the default.
10. Move to the Begin Date field and enter the effective date of the ISP coverage period.
11. Move to the End Date field and enter the last day of the ISP coverage period.
12. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

MCO	Service Area	Contract Number
Molina	Bexar	1014430
Molina MMP	Bexar	1026341
Molina	Harris	1014431
Molina MMP	Harris	1026344
Molina	Jefferson	1019598
Molina	Dallas	1018980
Molina MMP	Dallas	1026342
Molina	El Paso	1019987
Molina MMP	El Paso	1026343
Molina	Hidalgo	1019988
Molina MMP	Hidalgo	1026345
Superior	Bexar	1014433
Superior MMP	Bexar	1026337
Superior	Nueces	1014434
Superior	Dallas	1018981
Superior MMP	Dallas	1026338
Superior	Hidalgo	1019985
Superior MMP	Hidalgo	1026339
Superior	Lubbock	1019986
Superior	Medicaid Rural Service Area (RSA) Central	1025731
Superior	Medicaid RSA West	1025730
United Healthcare	Harris	1014435
United Healthcare MMP	Harris	1026334
United Healthcare	Jefferson	1019600
United Healthcare	Medicaid RSA Central	1025732
United Healthcare	Medicaid RSA Northeast	1025734
United Healthcare	Nueces	1014437
United Healthcare	Travis	1014438
Amerigroup	Bexar	1014439
Amerigroup MMP	Bexar	1026326
Amerigroup	Harris	1014440
Amerigroup MMP	Harris	1026331
Amerigroup	Jefferson	1019599
Amerigroup	Travis	1014442
Amerigroup	El Paso	1019979
Amerigroup MMP	El Paso	1026328
Amerigroup	Lubbock	1019983
Amerigroup	Medicaid RSA West	1025729
Amerigroup	Tarrant	1018977
Amerigroup MMP	Tarrant	1026332
Cigna-HealthSpring	Tarrant	1018979
Cigna-HealthSpring MMP	Tarrant	1026333
Cigna-HealthSpring	Hidalgo	1019984
Cigna-HealthSpring MMP	Hidalgo	1026335
Cigna-HealthSpring	Medicaid RSA Northeast	1025733

13. The NPI field is read-only.
14. Select the Save button.

9450 Level of Service for MFP Applicant

Revision 18-0; Effective September 4, 2018

There will be an existing service group (SG) 1 (NF) level of service (LOS) record. However, Program Support Unit (PSU) staff will be required to create a new LOS record for SG 19 STAR+PLUS Home and Community Based Services (HCBS) program. The SG 1 (NF) LOS record can remain open.

All STAR+PLUS HCBS program members must have an LOS registered in the Service Authorization System Online (SASO). The LOS record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

PSU staff will create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members.

To add an LOS record, PSU staff must complete the following steps:

1. Select the Level of Service field in the Medical functional area.
2. Select Add and a blank Level of Service Details record will appear.
3. Move to the Type field and select CR – CBA RUG from the drop-down menu.
4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Move to the Level field and enter the RUG.
6. Move to the Begin Date field and enter the first day of the ISP period.
7. Move to the End Date field and enter the last day of the ISP period.
8. Select the Save button.

9460 Diagnosis for MFP Applicant

Revision 18-0; Effective September 4, 2018

There will be an existing service group (SG) 1 diagnosis record. Program Support Unit (PSU) staff must create a new diagnosis record for SG 19 STAR+PLUS Home and Community Based Services (HCBS) program.

All STAR+PLUS HCBS program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The system-generated diagnosis record will have an end date that may need to be extended by PSU staff through the last day of the month in which the individual service plan (ISP) expires, if applicable.

To add an SG 19 diagnosis record in the SASO, PSU staff must complete the following steps:

1. Select the Diagnosis field in the Medical functional area.
2. Select Add and a blank Diagnosis Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Begin Date field and enter the first day of the ISP period.
5. Move to the End Date field and enter the last day of the ISP period.
6. Enter up to five diagnoses.
7. Leave Version field at the default.
8. Select the Save button.

9470 Medical Necessity for MFP Applicant

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have an end date that may need to be extended by Program Support Unit (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create an MN record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the MN registration in SASO and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

Example: If MN is approved with an effective date of May 13, 2019, the system-generated end date will be May 31, 2020. Note: An open-ended MN record must be terminated with the end-date of the ISP.

PSU staff can create MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

To extend an MN record for an MFP applicant, PSU staff must:

1. Select the MN field in the Medical functional area.
2. Select the existing MN record.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If an MN record has not been created in SASO, PSU staff complete the following steps to add the record:

1. Select the MN field in the Medical functional area.
2. Select Add and a blank MN Details record will appear.
3. Leave the MN field at the default of Y - YES.
4. Leave the Permanent field at the default of N - NO.
5. Move to the Begin Date field and enter the first day of the ISP period.
6. Move to the End Date field and enter the last day of the ISP period.
7. Select the Save button.

To add a service group (SG) 19 diagnosis record in the SASO, PSU staff must complete the following steps:

1. Select the Diagnosis field in the Medical functional area.
2. Select Add and a blank Diagnosis Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Begin Date field and enter the first day of the ISP period.
5. Move to the End Date field and enter the last day of the ISP period.
6. Enter up to five diagnoses.
7. Leave Version field at the default.
8. Select the Save button.

9480 MFPD for STAR+PLUS HCBS Program Applicant

Revision Notice 23-3; Effective Aug. 21, 2023

The option to electronically submit an individual service plan (ISP) for a nursing facility (NF) resident is not available. The managed care organizations (MCO) must not use the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) Money Follows the Person Demonstration (MFPD) check box. Program Support Unit (PSU) staff must continue to manually register this fund code in the Service Authorization System Online (SASO).

PSU staff must follow the instructions for a Money Follows the Person (MFP) applicant above, with the Service Authorization record completed as follows.

1. Select the Service Authorization field in the Program and Service functional Area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
5. Move to the Fund field and select 19MFP – MONEY FOLLOWS PERSON.
6. Leave the Term. Code field at the defaults.
7. Leave the Agency field at the default selection 324 - DHS.
8. Move to the Unit Type field and select 2 – MONTH from the drop-down list.
9. Move to the Units field and enter 1.00.
10. Leave the Amount field at the default.
11. Move to the Begin Date field and enter the effective date of the ISP coverage period.
12. Move to the End Date field and enter the last day of the ISP coverage period.
13. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

MCO	Service Area	Contract Number
Molina	Bexar	1014430
Molina MMP	Bexar	1026341
Molina	Harris	1014431
Molina MMP	Harris	1026344
Molina	Jefferson	1019598
Molina	Dallas	1018980
Molina MMP	Dallas	1026342
Molina	El Paso	1019987
Molina MMP	El Paso	1026343
Molina	Hidalgo	1019988
Molina MMP	Hidalgo	1026345
Superior	Bexar	1014433
Superior MMP	Bexar	1026337
Superior	Nueces	1014434
Superior	Dallas	1018981
Superior MMP	Dallas	1026338
Superior	Hidalgo	1019985
Superior MMP	Hidalgo	1026339
Superior	Lubbock	1019986
Superior	Medicaid Rural Service Area (RSA) Central	1025731
Superior	Medicaid RSA West	1025730
United Healthcare	Harris	1014435
United Healthcare MMP	Harris	1026334
United Healthcare	Jefferson	1019600
United Healthcare	Medicaid RSA Central	1025732
United Healthcare	Medicaid RSA Northeast	1025734
United Healthcare	Nueces	1014437
United Healthcare	Travis	1014438
Amerigroup	Bexar	1014439
Amerigroup MMP	Bexar	1026326
Amerigroup	Harris	1014440
Amerigroup MMP	Harris	1026331
Amerigroup	Jefferson	1019599
Amerigroup	Travis	1014442
Amerigroup	El Paso	1019979
Amerigroup MMP	El Paso	1026328
Amerigroup	Lubbock	1019983
Amerigroup	Medicaid RSA West	1025729
Amerigroup	Tarrant	1018977
Amerigroup MMP	Tarrant	1026332
Cigna-HealthSpring	Tarrant	1018979
Cigna-HealthSpring MMP	Tarrant	1026333
Cigna-HealthSpring	Hidalgo	1019984
Cigna-HealthSpring MMP	Hidalgo	1026335
Cigna-HealthSpring	Medicaid RSA Northeast	1025733

14. The NPI field is read-only.
15. Select the Save button.

Note:  The MCO must notify PSU staff once the 365-day MFPD period has passed using Form H2067-MC, Managed Care Programs Communication. PSU staff must change the Service Authorization record to the default within five business days of the MCO notification.

Revision 18-0; Effective September 4, 2018

To close services that are mutually exclusive, the Community Care Services Eligibility (CCSE) case manager must close the community services authorization with an effective date one day prior to the date the member is eligible for the STAR+PLUS Home and Community Based Services (HCBS) program.

Example: If an individual receiving Family Care (FC), Emergency Response Services (ERS) and Home-Delivered Meals (HDM) becomes eligible for the STAR+PLUS HCBS program on December 1, 2019, the member will begin receiving his or her services through his managed care organization (MCO) on that date. Therefore, the losing CCSE case manager must close the FC, ERS and HDM services with an effective date of November 30, 2019.

Revision 18-0; Effective September 4, 2018

For Medically Dependent Children Program (MDCP)/Comprehensive Care Program (CCP)/Private Duty Nursing (PDN) members who are transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program, Program Support Unit (PSU) staff will enter the initial STAR+PLUS HCBS program eligibility into the Service Authorization System Online (SASO) using the steps for initial eligibility with one exception. The effective begin date for all records will be the first of the month following the member’s 21st birthday.

It is possible the medical records (Medical Necessity, Level of Care or Diagnosis) will have to be extended in SASO to cover the entire individual service plan (ISP) period.

Revision 18-0; Effective September 4, 2018

Program Support Unit staff will manually close all service group (SG) 19 records in the Service Authorization System Online (SASO) when all services for an existing STAR+PLUS Home and Community Based Services (HCBS) program member are terminated.

Revision 18-0; Effective September 4, 2018

If a STAR+PLUS Home and Community Based Services (HCBS) program member files an appeal and requests continued benefits, Program Support Unit (PSU) staff will extend all records (includes Service Authorization, Service Plan, and Enrollment) by four months. To accomplish this, open each record and modify the record. Change the end date to the last day of the month – four months in the future. This is completed each time an extension is needed.

Multiple extensions may be requested if the appeal process has not been finalized.

Continuation of STAR+PLUS HCBS program benefits during a state fair hearing does not apply for Supplemental Security Income denials. Refer to Section 4222.1, Continuation of STAR+PLUS HCBS Program During a State Fair Hearing, for additional information.