Appendices
Appendix I-A, Unusual End Dates Report
Revision 19-7; Effective June 3, 2019
The Unusual End Dates report lists individual service plans (ISPs) with questionable end dates.
Report Fields
PCN – The member's nine-digit Medicaid number.
Name – The member's last name, first name and middle initial (when provided).
SG – The Service Authorization System Online (SASO) Service Group (SG). The STAR+PLUS SG is 19.
SC – The SASO Service Code (SC). The STAR+PLUS SC is 12. SC 13 should not appear on this report; if SC 13 does appear, disregard the line item.
ISP Begin Date – The begin date of the last ISP registered in SASO.
ISP End Date – The end date of the last ISP registered in SASO.
MN Begin Date – The begin date of the last medical necessity (MN) registered in SASO.
MN End Date – The end date of the last MN registered in SASO.
MN – The approval or denial of the MN referenced in the MN begin/end date:
- "Y" means the MN was approved.
- "N" means the MN was denied.
RG – The three-digit Risk Group number.
Enroll Month – The most current enrollment month at the time of the report.
Plan – The two-digit managed care organization (MCO) plan code.
TP – The member’s two-digit Medicaid Type Program.
Program Support Unit (PSU) Entry Fields
Comments – PSU staff must enter appropriate comments after researching the ISP end dates. For example, an ISP with:
- an end date of Oct. 30, 2018, is questionable because there are 31 days in October.
- an end date of Nov. 1, 2018, is questionable because ISPs end on the last day of the month.
- a begin date of Jan. 1, 2018, and an end date of Dec. 31, 2018, is questionable because ISPs are not open-ended, nor do they end prior to the begin date.
Unusual End Dates is a periodic report sent on an as-needed basis. The PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt.
Note: SASO files used by Program Enrollment Support (PES) staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.
Appendix I-B, Individual Service Plan Expiring Report
Revision 19-7; Effective June 3, 2019
The Individual Service Plan (ISP) Expiring report is a check and balance method for the ISP expiring at the end of the report month.
Report Fields
PCN – The member's nine-digit Medicaid number.
Name – The member's last name, first name and middle initial (when provided).
SG – The Service Authorization System Online (SASO) Service Group (SG). The STAR+PLUS SG is 19.
SC – The SASO Service Code (SC). The STAR+PLUS SC is 12. SC 13 should not appear on this report; if SC 13 does appear, disregard the line item.
ISP Begin Date – The begin date of the last ISP registered in SASO.
ISP End Date – The end date of the last ISP registered in SASO.
MN Begin Date – The begin date of the last medical necessity (MN) registered in SASO.
MN End Date – The end date of the last MN registered in SASO.
MN – The approval or denial of the MN referenced in the MN begin/end date:
- "Y" means the MN was approved.
- "N" means the MN was denied.
RG – The three-digit Risk Group number.
Enroll Month – The most current enrollment month at the time of the report.
Plan – The two-digit managed care organization (MCO) plan code.
TP – The member’s two-digit Medicaid Type Program.
Program Support Unit (PSU) Entry Fields
Date 2065D Sent – Enter the date PSU staff uploaded Form H2065-D, Notification of Managed Care Program Services, to TxMedCentral if the:
- MN column has "N" (denied);
- PSU research shows the MN is denied;
- Managed care organization notifies PSU staff of the MN denial;
- PSU staff learn of the MN denial by any other method;
- PSU staff learn of no unmet need at the annual reassessment for the new ISP;
- PSU staff learn of loss of eligibility; or
- PSU staff learn of any other denial reasons.
If the MN column has "Y" (approved), leave the field blank.
Date MN Registered in SAS - The date the MN is registered in SASO.
Date ISP Registered – Enter the date PSU staff registered the ISP in SASO, if uploaded to TxMedCentral or Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal.
Date ISP Posted – The date Form H1700-1, Individual Service Plan (Pg. 1), was uploaded by the MCO to TxMedCentral or TMHP LTC Online Portal.
Comments – PSU staff may enter appropriate comments.
Note: Enter information in the “Comments” field in situations where Form H2065-D is completed but the “Date ISP Registered” is not filled out. The reason entered must provide sufficient detail to ensure clarity.
For expired ISP, Date MCO Contacted – Enter the date the MCO was contacted if the ISP has expired.
Date MCO Contacted, 2nd attempt – Enter the 2nd attempt date the MCO was contacted if the ISP has expired.
Date MCO Contacted, 3rd attempt – Enter the 3rd attempt date the MCO was contacted if the ISP has expired.
The ISP Expiring Report is a monthly report. PSU staff are required to research, resolve and respond within 14 days of receipt.
Scan Call for ISP Expiring Report process:
- PSU staff provide the ISP Expiring Report five business days prior to the scheduled scan call.
- The MCOs research and provide a written status for each member whose ISP expires within 45 days, indicating the status of the member’s reassessment. The MCO must return a completed report to PSU staff two business days prior to the scan call.
- PSU staff review the MCO's responses to determine if the MCO needs to provide clarification regarding any member's ISP status. During the scan call, only the ISP status about which PSU staff have questions are reviewed. There will no longer be a need to review each member for the status of the ISP if the MCO's response is sufficient.
Note: SASO files used by Program Enrollment Support (PES) staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.
Appendix I-C, Mismatched ISP and MN End Dates Report
Revision 19-7; Effective June 3, 2019
The Mismatched Individual Service Plan (ISP) and Medical Necessity (MN) End Dates report shows ISP end dates with MN end dates that do not match.
Report Fields
PCN – The member's nine-digit Medicaid number.
Name – The member's last name, first name and middle initial (when provided).
SG – The Service Authorization System Online (SASO) Service Group (SG). The STAR+PLUS SG is 19.
SC – The SASO Service Code (SC). The STAR+PLUS SC is 12. SC 13 should not appear on this report; if SC 13 does appear, disregard the line item.
ISP Begin Date – The begin date of the last ISP registered in SASO.
ISP End Date – The end date of the last ISP registered in SASO.
MN Begin Date – The begin date of the last MN registered in SASO.
MN End Date – The end date of the last MN registered in SASO.
MN – The approval or denial of the MN referenced in the MN begin/end date:
- "Y" means the MN was approved.
- "N" means the MN was denied.
RG – The three-digit Risk Group number.
Enroll Month – The most current enrollment month at the time of the report.
Plan – The two-digit managed care organization (MCO) plan code.
TP – The member’s two-digit Medicaid Type Program.
Program Support Unit (PSU) Entry Fields
Comments (Date and Action taken) – PSU staff must enter appropriate comments after researching the ISP/MN end dates, which should match. For example, an ISP ends on May 31, 2019, and the MN ends on April 30, 2019. PSU staff must research the reason for the mismatch.
There may be valid situations in which the two dates will not match. For example, a Money Follows the Person (MFP) case has an ISP registered for one day. The MN will not match the one-day registration in this case.
Mismatched ISP and MN End Dates is a periodic report sent on an as-needed basis. PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt.
Note: SASO files used by Program Enrollment Support (PES) staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.
Appendix I-D, Reserved for Future Use
Revision Notice 23-3; Effective Aug. 21, 2023
Appendix I-E, Monthly Plan Changes Report
Revision 19-7; Effective June 3, 2019
The Monthly Plan Changes report gives Program Support Unit (PSU) staff a list of members who have changed managed care organization (MCO) plans. PSU staff must correct the contract number in the Service Authorization System Online (SASO) to reflect all MCO plan changes.
Report Fields
PCN – The member's nine-digit Medicaid number.
Name – The member's last name, first name and middle initial (when provided).
Current Plan – The two-digit MCO plan code in which the member is currently enrolled.
TP – The member's two-digit Medicaid Type Program.
Prior Plan – The two-digit MCO plan code in which the member was formerly enrolled.
RG – The three-digit Risk Group number.
ISP Begin Date – Enter the begin date of the MCO plan change.
ISP End Date – Enter the end date of the MCO plan change.
PSU Entry Fields
Date Completed – PSU staff enter the date SASO corrections were completed.
Comments – Enter any comments relevant to the actions taken.
Monthly Plan Changes is a monthly report. PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt.
Note: SASO files used by Program Enrollment Support (PES) staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.
Appendix I-F, Loss of Eligibility Report
Revision 19-7; Effective June 3, 2019
The STAR+PLUS Loss of Eligibility Report provides to Program Support Unit (PSU) staff a list of STAR+PLUS Home and Community Based Services (HCBS) program members who have lost Medicaid eligibility. PSU staff must conduct coordination activities to either reestablish eligibility or close the authorization(s) in the Service Authorization System Online (SASO).
Report Fields
PCN — The member’s nine-digit Medicaid number.
Name — The member’s last name, first name and middle initial (when provided).
RG — The three-digit Risk Group number.
Plan Code — The two-digit managed care organization (MCO) plan code in which the member is currently enrolled.
TP — The member’s two-digit Medicaid Type Program (TP).
PSU Entry Field
Eligibility Re-established? — PSU staff check the Texas Integrated Eligibility Redesign System (TIERS) to determine if Medicaid eligibility has been reestablished. If it has, enter "Yes;" if not, enter "No."
If yes, is manual managed care enrollment needed? — If the response to the previous column was "Yes," PSU staff must check TIERS to determine if Medicaid eligibility and managed care enrollment have been established. If manual managed care enrollment is needed, send an email to the Program Enrollment Support (PES) mailbox.
If no, provide the date Form H2065-D was sent. — PSU staff enter the date Form H2065-D, Notification of Managed Care Program Services, was sent.
Was the decision appealed? — PSU staff enter "Yes" or "No." (No further action is necessary if the response to this question is "no.") If "Yes," continue to the next section.
If yes, was eligibility re-established? — PSU staff check TIERS to determine if Medicaid eligibility has been re-established. If it has, enter "Yes;" if not, enter "No." (No further action is necessary if the response to this question is "No.")
If eligibility was re-established, is manual managed care enrollment needed? — If the response to the previous column was "Yes," PSU staff must check TIERS to determine if managed care enrollment have been established. If manual managed care enrollment is needed, send an email to the PES mailbox.
Pending at PSU — Enter “Yes” or “No.”
Pending at MCO — Enter “Yes” or “No.”
Pending at MEPD — Enter “Yes” or “No.”
Comments — Enter any comments relevant to the actions taken.
The STAR+PLUS Loss of Eligibility Report is a monthly report. PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt. (The fact that completion of the report itself is due within 14 days of receipt does not negate policy regarding denial notifications. Refer to Section 3622, Notification Requirements. The notification must still be sent within two business days.)
Note: SASO files used by PES staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.
Appendix II, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet
Appendix III, Medicaid Type Program Codes for STAR+PLUS HCBS Program and CFC
Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language
Revision 23-4; Effective Dec 7, 2023
Program Support Unit (PSU) staff must use Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language, to enter approved language in the Reason for Denial and Comments fields on Form H2065-D, Notification of Managed Care Program Services, and Form H2065-DS. PSU staff must not enter additional language in the Reason for Denial or Comments fields of Form H2065-D or Form H2065-DS. PSU staff must consult with their supervisor if they encounter a denial reason or comment not covered in Appendix IV.
Reason for Denial and Comments language is illustrated in both English and Spanish in the tables below.
Denial and Termination Language
This table contains Reason for Denial and Comments field language for Form H2065-D and Form H2065-DS generated for denials and terminations.
PSU staff must enter the associated STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH) section supporting the denial reason on Form H2065-D and H2065-DS, listed in the SPOPH Section column.
Purpose for Form H2065-D | Reason for Denial in Plain Language | Comments in Plain Language | SPOPH Section | Service Authorization System Online (SASO) Code |
---|---|---|---|---|
Unable to Locate | You are not eligible for STAR+PLUS HCBS program because HHSC staff or your health plan cannot locate you to complete the assessment required for the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque el personal de la HHSC o su plan médico no lo han podido localizar para que se someta a la valoración que requiere el programa. | PSU staff must not enter comments language. | 6300.6 | 36 – Individual’s Whereabouts Unknown |
Voluntarily Declined Services | You are not eligible for STAR+PLUS HCBS program because you voluntarily withdrew from the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque abandonó voluntariamente el programa. | PSU staff must not enter comments language. | 6300.3 | 05 – Client Requests Service Termination |
Enrolled in Another Medicaid Waiver Program | You are not eligible for STAR+PLUS HCBS program. This is because you are enrolled in another Medicaid waiver program. You can only be enrolled in one Medicaid waiver program at a time. Usted no reúne los requisitos para el programa STAR+PLUS HCBS. Esto se debe a que usted está inscrito en otro programa con exenciones de Medicaid. Solo puede estar inscrito en uno de los programas con exenciones a la vez. | You are not eligible for STAR+PLUS HCBS program. This is because you are currently enrolled in [Select one: Community Living Assistance and Support Services (CLASS); Deaf Blind with Multiple Disabilities (DBMD); Home and Community-based Services (HCS); Home and Community Based Services – Adult Mental Health (HCBS-AMH); MDCP; Texas Home Living (TxHmL)]. STAR+PLUS HCBS program cannot be authorized. You can only be enrolled in one Medicaid waiver program at a time. Usted no reúne los requisitos para el programa STAR+PLUS HCBS. Esto se debe a que usted está inscrito actualmente en [Select one: Programa de Servicios de Apoyo y Asistencia para Vivir en la Comunidad (CLASS); Programa para Personas Sordociegas con Discapacidades Múltiples (DBMD); Programa de Servicios en el Hogar y en la Comunidad (HCS); Programa de Servicios en el Hogar y en la Comunidad para la Salud Mental del Adulto (HCBS-AMH); MDCP; Programa de Texas para Vivir en Casa (TxHmL)]. No se puede autorizar el programa STAR+PLUS HCBS. Solo puede estar inscrito en uno de los programas con exenciones de Medicaid a la vez. | 6110 | 39 – Other |
Financial Eligibility | You are not eligible for STAR+PLUS HCBS program because you do not meet the financial criteria necessary for the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque no cumple los criterios económicos necesarios para participar en el programa. | Call 2-1-1 if you have questions about the Medicaid application process. Llame al 2-1-1 si tiene preguntas sobre el proceso de solicitud de Medicaid. | 6300.4 | 06 – Client Denied Medicaid Eligibility |
Declined Assessment | You are not eligible for STAR+PLUS HCBS program because you did not let your health plan complete the assessment required for the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque no permitió que el plan médico realizara la valoración que requiere el programa. | PSU staff must not enter comments language. | 6110 | 39 – Other |
Does Not Have an Unmet Need for MAO | You are not eligible for STAR+PLUS HCBS program because you do not need services offered through the program. Usted no puede recibir los servicios del programa HCBS de STAR+PLUS porque no los necesita. | PSU staff must not enter comments language. | 6110 | 13 – no unmet need (Six hour) |
Does Not Have an Unmet Need for SSI | You are not eligible for STAR+PLUS HCBS program because you do not need services offered through the program. Usted no puede recibir los servicios del programa HCBS de STAR+PLUS porque no los necesita. | Your provider services will continue uninterrupted. Los servicios de su proveedor continuarán sin interrupción. | 6110 | 13 – no unmet need (Six hour) |
Failure to Obtain Physician Signature | You are not eligible for STAR+PLUS HCBS program because your doctor didn’t tell us you need the level of care provided in a nursing home. Usted no puede recibir los Servicios en el Hogar y en la Comunidad (HCBS) de STAR+PLUS porque su médico no nos informó que usted necesita el nivel de atención que se ofrece en una casa de reposo. | PSU staff must not enter comments language. | 6300.8 | 39 – Other |
Medical Necessity and Level of Care | Reason for Denial language must be populated through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP). | You are not eligible for STAR+PLUS HCBS program. See the Reason for Denial text box on page 1 of this form and the STAR+PLUS HCBS Program Medical Necessity Denial Attachment for more information. Usted no reúne los requisitos del programa HCBS de STAR+PLUS. Para más información, vea el cuadro “Motivo de la denegación” en la página 1 de este formulario, así como el anexo “Denegación por no existir necesidad médica” del programa HCBS de STAR+PLUS. | 6300.5 | 08 – Loses Level-of-Care (Medical Necessity) |
Exceeding the ISP Cost Limit | You are not eligible for STAR+PLUS HCBS program because the cost of your individual service plan exceeds the maximum amount allowed. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque el costo de su plan individual de servicios excede la cantidad máxima permitida. | PSU staff must not enter comments language. | 6300.7 | 18 – Exceeds Cost Ceiling |
Failure to Return Form H1200 | You are not eligible for STAR+PLUS HCBS program because you did not return the Medicaid application. Usted no puede recibir Servicios en el Hogar y en la Comunidad (HCBS) de STAR+PLUS porque no entregó su solicitud de Medicaid. | Call 2-1-1 if you have questions about the Medicaid application process. Llame al 2-1-1 si tiene preguntas sobre el proceso de solicitud de Medicaid. | 6300.4 | 06 – Client Denied Medicaid Eligibility |
MFP NF Discharge Prior to Eligibility Determination | You are not eligible for the STAR+PLUS HCBS program because you left the nursing facility before HHSC could determine program eligibility. Usted no reúne los requisitos para recibir servicios del programa de HCBS de STAR+PLUS porque abandonó el centro de reposo antes de que la HHSC pudiera determinar si reunía los requisitos del programa | PSU staff must not enter comments language. | 3200 | N/A |
Institutional Stay Over 90 Days | You are not eligible for STAR+PLUS HCBS program because you have entered an institution for a long-term stay, as described in the Code of Federal Regulations (CFR) at Title 42 CFR §441.301(b)(1). Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque ha ingresado en una institución donde tendrá una estancia a largo plazo, como se describe en la sección 441.301(b)(1) del título 42 del Código de Reglamentos Federales (CFR). | You are not eligible for STAR+PLUS HCBS program services while an in-patient of a [Select one: hospital; nursing facility; or intermediate care facility for persons with intellectual disability]. Usted no puede recibir servicios del programa HCBS de STAR+PLUS mientras sea un paciente interno de [Select one: un hospital; un centro de reposo; or un centro de atención intermedia para personas con discapacidad intelectual]. | 6300.2 | 03 – Admitted to Institution |
Moved Out of State | You are not eligible for STAR+PLUS HCBS program because you are not a Texas resident. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque no reside en Texas. | PSU staff must not enter comments language. | 6110 | 01 – Client Leaves the State/County (Catchment Area) |
Under 21 | You are not eligible for STAR+PLUS HCBS because you are 20 or younger. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque es menor de 21 años. | PSU staff must not enter comments language. | 6110 | 39 – Other |
Other | PSU staff must contact supervisor. | PSU staff must contact supervisor. | 6300.10 | 39 – Other |
Approval Language
This table contains Comments field language for Form H2065-D and Form H2065-DS generated for approvals.
Purpose for Form H2065-D | Reason for Denial in Plain Language | Comments in Plain Language | SPOPH Section | Service Authorization System Online (SASO) Code |
---|---|---|---|---|
Medicaid Eligibility Reinstated within Six Months | N/A | Your Medicaid was reinstated on [DATE]. Your STAR+PLUS HCBS program services will continue without interruption. Sus beneficios de Medicaid fueron restablecidos el [DATE]. Usted seguirá recibiendo servicios del programa HCBS de STAR+PLUS sin interrupción. | N/A | N/A |
Initial Form H2065-D for MFP to Community | N/A | You’re eligible for the STAR+PLUS HCBS program. Your services won’t start until you agree with your health plan on a date for you to leave your nursing home. Stay in the nursing home until you and your health plan agree on a date to leave. This makes sure services are in place when you leave the nursing home. You will receive another notice telling you when your STAR+PLUS HCBS program services will begin. Usted cumple los requisitos del programa STAR+PLUS HCBS. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa STAR+PLUS HCBS. | N/A | N/A |
Initial Form H2065-D for SSI MFP to AFC or ALF | N/A | You’re eligible for the STAR+PLUS HCBS program. Your services won’t start until you agree with your health plan on a date for you to leave your nursing home. Stay in the nursing home until you and your health plan agree on a date to leave. This makes sure services are in place when you leave the nursing home. You will receive another notice telling you when your STAR+PLUS HCBS program services will begin. We will also send you a notice telling you how much your room and board and copayment will be. Usted cumple los requisitos del programa STAR+PLUS HCBS. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa STAR+PLUS HCBS. Además, le enviaremos una notificación informándole del costo de su alojamiento, comida y copago. | N/A | N/A |
Initial Form H2065-D for MAO MFP to AFC or ALF | N/A | You’re eligible for the STAR+PLUS HCBS program. Your services won’t start until you agree with your health plan on a date for you to leave your nursing home. Stay in the nursing home until you and your health plan agree on a date to leave. This makes sure services are in place when you leave the nursing home. You will receive another notice telling you when your STAR+PLUS HCBS program services will begin. We will also send you a notice telling you how much your room and board and copayment will be. Usted cumple los requisitos del programa STAR+PLUS HCBS. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa STAR+PLUS HCBS. Además, le enviaremos una notificación informándole del costo de su alojamiento, comida y copago. | N/A | N/A |
Room and Board and Copayment | N/A | You must pay room and board and any copayment. You will pay them every month to your foster care home or assisted living facility. Usted tiene que cubrir los gastos de alojamiento y comida y de cualquier copago. Deberá pagarlos cada mes al hogar de acogida o centro de vida asistida en el que se encuentre. | N/A | N/A |
PSU staff must enter “Pending” and “Calculando” in the Copayment fields on the English and Spanish versions of Form H2065-D, respectively, if the Medicaid for the Elderly and People with Disabilities (MEPD) specialist has not provided copayment amounts at the time Form H2065-D is being generated.
Appendix V, Medicaid Program Actions
Appendix VI, STAR+PLUS Inquiry Chart
Appendix VII, Acronyms
Revision 19-7; Effective June 3, 2019
The following acronyms are used in the STAR+PLUS Home and Community Based Services (HCBS) Program.
Acronym | Description |
---|---|
AA | Adaptive Aids |
ADL | Activity of Daily Living |
AFC | Adult Foster Care |
AL | Assisted Living |
ALF | Assisted Living Facility |
AO | Agency Option |
APS | Adult Protective Services |
CAP | Corrective Action Plan |
CARE | Client Assignment and Registration |
CAS | Community Attendant Services |
CBA | Community Based Alternatives |
CCAD | Community Care for Aged and Disabled |
CCSE | Community Care Services Eligibility |
CCP | Comprehensive Care Program |
CDS | Consumer Directed Services |
CFC | Community First Choice |
CFR | Code of Federal Regulations |
CHIP | Children's Health Insurance Program |
CLASS | Community Living Assistance and Support Services |
CMPAS | Client Managed Personal Attendant Services |
CMS | Claims Management System |
CMS | Centers for Medicare and Medicaid Services |
CNA | Certified Nursing Assistant |
COLA | Cost of Living Adjustment |
CRU | Centralized Representation Unit |
CSHCN | Children with Special Health Care Needs |
CSIL | Community Services Interest List |
DAC | Disabled Adult Child |
DAHS | Day Activity and Health Services |
DBMD | Deaf Blind with Multiple Disabilities |
DDS | Disability Determination Services |
DDU | Disability Determination Unit |
DER | Data Entry Representative |
DFPS | Department of Family and Protective Services |
DIA | Diagnosis |
DID | Determination of Intellectual Disability |
DIU | Data Integrity Unit |
DME | Durable Medical Equipment |
DOB | Date of Birth |
DOD | Date of Death |
DR | Designated Representative |
DSHS | Department of State Health Services |
ERS | Enrollment Resolutions Services |
ERS | Emergency Response Service |
FBR | Federal Benefit Rate |
FC | Family Care Title XX |
FFS | Fee-for-Service |
FH | Fair Hearing |
FHO | Fair Hearings Officer |
FMSA | Financial Management Services Agency |
GR | General Revenue |
HCBS | Home and Community Based Services |
HCS | Home and Community-based Services |
HCSS | Home and Community Support Services |
HCSSA | Home and Community Support Services Agency |
HDM | Home-Delivered Meals |
HEART | Health and Human Services Enterprise Administrative Report and Tracking System |
HHS | Health and Human Services |
HHSC | Health and Human Services Commission |
HICAP | Health Information Counseling and Advocacy Program |
HIPAA | Health Insurance Portability and Accountability Act |
HIPP | Health Insurance Premium Payment Program |
HMA | Health Maintenance Activity |
IADL | Instrumental Activity of Daily Living |
ICF/IID | Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions |
IDD | Intellectual or Developmental Disability |
IDT | Interdisciplinary Team |
ILM | Interest List Management |
IME | Incurred Medical Expense |
ISP | Individual Service Plan |
LAR | Legally Authorized Representative |
LCSW | Licensed Clinical Social Worker |
LIDDA | Local Intellectual and Developmental Disability Authority |
LOC | Level of Care |
LOS | Level of Service |
LTC | Long Term Care |
LTC-R | Long Term Care Regulatory |
LTSS | Long Term Services and Supports |
LVN | Licensed Vocational Nurse |
MAO | Medical Assistance Only |
MBI | Medicaid Buy-In |
MC | Managed Care |
MCO | Managed Care Organization |
MCCO | Managed Care Compliance & Operations |
MDCP | Medically Dependent Children Program |
MDS | Minimum Data Set |
Med ID | Medicaid Identification Card |
MEPD | Medicaid for the Elderly and People with Disabilities |
MERP | Medicaid Estate Recovery Program |
MESAV | Medicaid Eligibility Service Authorization Verification |
MFP | Money Follows the Person |
MFPD | Money Follows the Person Demonstration |
MHM | Minor Home Modification |
MMP | Medicare-Medicaid Plan |
MN | Medical Necessity |
MN/LOC | Medical Necessity and Level of Care |
MRSA | Medicaid Rural Service Area |
MSHCN | Members with Special Health Care Needs |
NF | Nursing Facility |
OT | Occupational Therapy |
OTA | Occupational Therapy Assistance |
PACE | Program of All-inclusive Care for the Elderly |
PAS | Personal Assistance Services |
PCN | Patient Control Number |
PCP | Primary Care Provider; |
PCS | Personal Care Services |
PCS | Provider Claims Services |
PDN | Private Duty Nursing |
PES | Program Enrollment and Support |
PHC | Primary Home Care |
PNA | Personal Needs Allowance |
POC | Plan of Care |
PPECC | Prescribed Pediatric Extended Care Center |
PPS | Premiums Payable System |
PSU | Program Support Unit |
PT | Physical Therapy |
PTA | Physical Therapy Assistance |
QIT | Qualified Income Trust |
QMB | Qualified Medicare Beneficiary |
R&B | Room and Board |
RN | Registered Nurse |
RSDI | Retirement and Survivors Disability Insurance |
RUG | Resource Utilization Group |
SASO | Service Authorization System Online |
SC | Service Code |
SCSA | Significant Change in Status Assessment |
SDX | State Data Exchange |
SE | Supported Employment |
SG | Service Group |
SLMB | Specified Low-Income Medicare Beneficiaries |
SNAP | Supplemental Nutrition Assistance Program |
SO | State Office |
SOC | Start of Care |
SOLQ | State On-Line Query |
SPT | Service Planning Team |
SRO | Service Responsibility Option |
SSA | Social Security Administration |
SSI | Supplemental Security Income |
SSN | Social Security Number |
SSPD | Special Services to Persons with Disabilities |
ST | Speech Therapy |
STAR | State of Texas Access Reform |
STAR+PLUS | State of Texas Access Reform Plus |
STAR+PLUS HCBS program | State of Texas Access Reform Plus Home and Community Based Services program |
STS | Supplemental Transition Support |
TAC | Texas Administrative Code |
TANF | Temporary Assistance to Needy Families |
TAS | Transition Assistance Services |
TDI | Texas Department of Insurance |
THStep-CCP | Texas Health Steps – Comprehensive Care Program |
TIERS | Texas Integrated Eligibility Redesign System |
TMHP | Texas Medicaid & Healthcare Partnership |
TOA | Type of Assistance |
TP | Type Program |
TPR | Third-Party Resource |
TW | Texas Works |
TxHmL | Texas Home Living |
UAP | Unlicensed Assistive Person |
UMCC | Uniform Managed Care Contract |
UMCM | Uniform Managed Care Manual |
WTPY | Wire Third Party Query |
Appendix VIII, Income and Resource Limits
Appendix IX, Time Calculation
Appendix X, STAR+PLUS HCBS Cost Limits
Appendix XI, STAR+PLUS HCBS Program Medical Necessity Denial Attachment
Revision 23-1; Effective April 1, 2023
English: Appendix XI, Fair Hearing Options for STAR+PLUS HCBS Program Denials (PDF)
Appendix XII, STAR+PLUS HCBS Program Description
Revision 19-3; Effective April 10, 2019
English Word: Appendix XII, STAR+PLUS HCBS Program Description
Spanish Word: Appendix XII, Servicios en el Hogar y la Comunidad de STAR+PLUS
Appendix XIII, Your Financial Rights in an Assisted Living Facility STAR+PLUS
Revision 22-2; Effective March 4, 2022
For information about document accessibility, contact Editorial_Services@hhsc.state.tx.us
Your Financial Rights in an Assisted Living Facility STAR+PLUS
Appendix XIV, Determination of High Needs Status for the STAR+PLUS HCBS Program
Revision 18-0; Effective September 4, 2018
An individual entering the STAR+PLUS Home and Community Based Services (HCBS) program is designated as having high needs status if:
- the individual is on ventilator care;
- the individual has high-skilled nursing needs, such as tracheotomy care, wound care, suctioning or feeding tubes; and/or
- the individual will exceed the individual service plan (ISP) cost limit and has needs that will require special services or service delivery, and the community support/resources have not been identified.
Appendix XV, Services Available from Other State Agencies
Appendix XV-A, Department of State Health Services
Appendix XV-C, Texas Veterans Commission
Appendix XV-D, Texas Department of Housing and Community Affairs
Appendix XV-E, Department of Family and Protective Services
Appendix XV-F, Rehabilitation Technology Resource Center
Appendix XVI, SASO Service Group, Service Code and Termination Code
Appendix XVII, State Cutoff Dates
Appendix XVIII, Mutually Exclusive Services
Appendix XIX, Nursing Facility Counter Logic
Appendix XX, STAR+PLUS HCBS Program Eligibility TAC
Revision 22-1; Effective January 31, 2022
English Word: 1 Texas Administrative Code §353.1153 STAR+PLUS Home and Community Based Services (HCBS) Program
Spanish Word: Sección 353.1153 del Título 1 del Código Administrativo de Texas: Servicios en el Hogar y la Comunidad de STAR+PLUS
Appendix XXI, Creating an Appeal in TIERS
Appendix XXII, HHSC Benefits Portal and TIERS Reference Guides
Appendix XXIII, Instructions and Access to CARE
Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers
Appendix XXIX, STAR+PLUS Plan Codes
Revision 24-1; Effective Feb. 22, 2024
STAR+PLUS Plan Codes
Service Area | Plan Name | Plan Codes | Plan Codes Dates |
---|---|---|---|
Bexar | Amerigroup Molina Superior | 45 46 47 | Sept. 1, 2011 Sept. 1, 2011 Sept. 1, 2011 |
Dallas | Molina Superior | 9F 9H | March 1, 2012 March 1, 2012 |
El Paso | Amerigroup Molina | 34 33 | March 1, 2012 March 1, 2012 |
Harris | Amerigroup United Healthcare Molina | 7P 7R 7S | Sept. 1, 2011 Sept. 1, 2011 Sept. 1, 2011 |
Hildago | Cigna-HealthSpring Molina Superior | H7 H6 H5 | March 1, 2012 – Dec. 31, 2021 March 1, 2012 March 1, 2012 |
Jefferson | Amerigroup United Healthcare Molina | 8R 8S 8T | Sept. 1, 2011 Sept. 1, 2011 Sept. 1, 2011 |
Lubbock | Amerigroup Superior | 5A 5B | March 1, 2012 March 1, 2012 |
Medicaid Rural Service Area (RSA) West Texas | Amerigroup Superior | W5 W6 | Sept. 1, 2014 Sept. 1, 2014 |
Medicaid RSA Northeast Texas | Cigna-HealthSpring Molina United Healthcare | N3 P2 N4 | Sept. 1, 2014 – Dec. 31, 2021 Jan 1, 2022 Sept. 1, 2014 |
Medicaid RSA Central Texas | Superior United Healthcare | C4 C5 | Sept. 1, 2014 Sept. 1, 2014 |
Nueces | United Healthcare Superior | 85 86 | Sept. 1, 2011 Sept. 1, 2011 |
Tarrant | Amerigroup Cigna-HealthSpring Molina | 69 6C P1 | Sept. 1, 2011 Sept. 1, 2011 – Dec. 31, 2021 Jan. 1, 2022 |
Travis | Amerigroup United Healthcare | 19 18 | Sept. 1, 2011 Sept. 1, 2011 |
Medicare-Medicaid Plan (MMP) Codes
Service Area | Plan Name | Plan Codes | Plan Code Dates |
---|---|---|---|
Bexar | Amerigroup Molina Superior | 4F 4G 4H | Sept. 1, 2015 Sept. 1, 2015 Sept. 1, 2015 |
Dallas | Molina Superior | 9J 9K | Sept. 1, 2015 Sept. 1, 2015 |
El Paso | Amerigroup Molina | 3G 3H | Sept. 1, 2015 Sept. 1, 2015 |
Harris | Amerigroup United Healthcare Molina | 7Z 7Q 7V | Sept. 1, 2015 Sept. 1, 2015 Sept. 1, 2015 |
Hildago | Cigna-HealthSpring Molina Molina Superior | H8 H9 P3 HA | Sept. 1, 2015 – Dec. 31, 2021 Sept. 1, 2015 Jan. 1, 2022 Sept. 1, 2015 |
Tarrant | Amerigroup Cigna-HealthSpring | 6F 6G | Sept. 1, 2015 Sept. 1, 2015 – Dec. 31, 2021 |
Appendix XXV, Community First Choice Support Management
Appendix XXVI, Reserved for Future Use
Appendix XXVII, PSU Users H1700/ISP Form User Guide
Revision 23-4; Effective Dec. 7, 2023
Appendix XXVIII, County Codes and City and County List
Appendix XXX, Relocation Function
9-2017
Purpose
The relocation function is a component of service coordination. The primary purpose of the relocation function is to support the transition of members and future members who desire to move from an institution to the community. A relocation specialist (RS) works for an entity contracted with a managed care organization (MCO) to perform the relocation function.
Overview of Relocation Function
- Conduct outreach and education to nursing facilities and residents on options for receiving long-term services and supports (LTSS) in the community;
- Identify members interested in relocating;
- Respond to referrals for relocation and conduct relocation assessments;
- Develop and implement person-centered relocation plans;
- Coordinate housing and non-covered community services, as mutually agreed;
- Provide support on day of relocation and conduct follow-up; and
- Collect data on relocations as specified by the Texas Health and Human Services Commission and/or MCOs.
Relocation Tasks
MCO | RS | Both | Conduct Outreach and Education |
---|---|---|---|
X | Conduct regular visits to nursing facilities to educate individuals in the facility, family members and potential referral sources about community-based services, including STAR+PLUS Home and Community Based Services (HCBS), and the availability of assistance with relocation. Educate potential referral sources regarding the availability of STAR+PLUS HCBS. | ||
X | Provide group and individual training to nursing facility staff on relocation services. | ||
X | Encourage a referral to a Local Contact Agency for residents interested in relocating. | ||
MCO | RS | Both | Identify and Refer Individuals Interested in Relocating (non-Minimum Data Set Referrals) |
X | If an RS learns of a member’s desire to move to the community, the RS must notify the member’s MCO. If an MCO learns of a member’s desire to move to the community, the MCO must notify the RS. Either party has three business days to notify the other party. | ||
X | Upon receipt of referral, the RS must make an initial contact face-to-face or by telephone within five business days to schedule a relocation assessment. Initial contact must be with the member or the member’s authorized representative (AR). An AR such as a family member or friend who is knowledgeable of the member’s situation and services may be engaged to support information provided by the member. | ||
X | The MCO service coordinator must contact the member to schedule an assessment for STAR+PLUS HCBS within 14 business days of notification by the RS. The MCO has 45 days to complete all assessment activities related to STAR+PLUS HCBS eligibility. | ||
X | Provide the appropriate Local Intellectual and Developmental Disability Authority (LIDDA) with contact information for members interested in relocating who have an Intellectual or Developmental Disability (IDD). Provide notification to the appropriate MCO that a referral was made to the LIDDA. | ||
MCO | RS | Both | Respond to Referrals for Relocation and Conduct Relocation Assessment |
X | When contacted by the MCO via Form 1579, Referral for Relocation Services, or after referral is received from another source, conduct a face-to-face relocation assessment with the member or AR within 14 business days. An AR such as a family member or friend who is knowledgeable of the member’s situation and services may be engaged to support information provided by the member. The assessment includes, but is not limited to:
|
||
X | Share results from assessment with the MCO. | ||
X | Develop a person-centered relocation plan with the member or AR and others whom he/she chooses to have involved. | ||
X | Advocate with nursing facility staff, RS and service coordinator(s) to support the member’s needs, preferences and goals. | ||
X | Through their respective assessments, the MCO service coordinator and RS identify and include in the MCO service plan and/or RS’ transition plan non-covered community services, including, but not limited to:
|
||
X | Maintain regular, open communication with all parties who are involved in the relocation process. | ||
MCO | RS | Both | Coordinate Housing, Non-Medicaid Community Supports and Discharge |
X | If the member is in need of housing, the RS is primarily responsible to help secure affordable, accessible and integrated housing consistent with the resident’s preferences. The RS assists the member in applying for:
|
||
X | If the member is interested in assisted living, personal care homes or adult foster care, the MCO service coordinator will review options available among contracted providers. | ||
X | Assist the member in accessing community supports, such as food banks, utility assistance, emergency rental assistance and emergency SNAP. | ||
X | Participate in the discharge planning process with the member or AR, service coordinator(s), RS and others important to the member. | ||
X | MCOs will negotiate and set the discharge date in coordination with the RS and other community and social supports, as necessary. | ||
X | If an MCO or RS becomes aware of a change to the discharge date, the MCO or RS must notify the other party immediately. | ||
MCO | RS | Both | Provide Support on Relocation Day and Follow-up |
X | Coordinate with all parties to ensure everything is in place at the time of discharge. | ||
X | Help facilitate the member’s notification to Social Security of the member’s new address as soon as possible after relocating to the community. | ||
X | The MCO service coordinator will remind nursing facility staff to transfer Medicaid benefits from the facility to the community. | ||
X | Be present at new address on relocation day to ensure all services are in place. Assist in setting up household, as needed. | ||
X |
Notify the other party if the member does not have all necessary Medicaid and non-Medicaid supports in place on the day of relocation. |
||
X | Provide follow up, which may include:
|
||
X | Contact the member at least seven times over the course of 90 days post-relocation to ensure a successful transition to the community. Notify the MCO if the member has an unmet need. |
Minimum Qualifications
An MCO must offer a contract to provide the relocation function to an entity with at least five years contracting with the state to provide relocation functions as of Sept. 1, 2016, to members transitioning from institutions to Medicaid community-based LTSS.
An MCO may offer a contract to a new entity to provide the relocation function. The new entity must meet all of the following qualifications:
- Adherence to Health Insurance Portability and Accountability Act (HIPAA) compliant data management requirements and other stipulations of the MCO;
- Experience identifying barriers to relocation for members who express an interest in moving from nursing facilities in Texas to a home and community-based setting;
- Knowledge of community resources for members with disabilities of all ages and how to access those resources;
- Knowledge of community and federal housing resources and how to access those resources, as appropriate;
- Knowledge of Medicaid, including, but not limited to, Medicaid managed care, long term services and supports, eligibility requirements and how to apply and qualify for Medicaid;
- Ability to hire, train, supervise and direct RS staff that ensures the successful transition of members from nursing facilities. The entity is responsible for ensuring any RS is not listed in the HHSC employee misconduct registry, Inspector General (IG) list of excluded entities and individuals, and HHSC do not hire registries. The entity must conduct a fingerprint background check and share the results with the MCO prior to hiring an RS;
- Two years of experience developing transition plans for members; and
- Three years of experience working directly with people with disabilities of all ages or the entity must have at least three years of experience subcontracting with an entity described above to provide the relocation function.
Appendix XXXI, STAR+PLUS Members Transitioning from an NF in One Service Area to the Community in Another Service Area
Appendix XXXII, Create an Appeal Task in the HHSC Benefits Portal
Appendix XXXIII, STAR+PLUS HEART Naming Conventions
Revision 23-4; Effective Dec. 7, 2023
This appendix outlines the screenshots Program Support Unit (PSU) staff must upload to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.
PSU staff must use the HEART Naming Conventions below when uploading documents to the HEART case record. Refer to Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions, for TxMedCentral naming convention instructions.
PSU staff must add a sequence number after the naming convention when more than one of the same form or screenshot is uploaded. For example, PSU staff must name the first Form H1746-A sent or received as 1746_1, the second form sent or received as 1746_2, and the third form sent or received as 1746_3.
PSU staff must include all screenshots, forms, documents and emails marked as “Yes,” in the “Required” column in the HEART case record. PSU staff must include screenshots, forms, documents and emails marked with an “*” in the “Required” column in the HEART case record if used by PSU staff while completing the case.
Interest List Release (ILR)
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual - Medicaid History Screenshot | TIERS ME | Yes |
TIERS Individual - Managed Care Screenshot | TIERS MC | Yes |
SASO Enrollment Screenshot | SASO EN | Yes |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
CSIL Closure Screenshot | CSIL CLOSURE | Yes |
Form 2442 (English) | 2442 | * |
Form 2442-S (Spanish) | 2442-S | * |
Form 2442 Screenshot of Upload to TxMedCentral | Use TxMedCentral Naming Convention | * |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page) | 1200 | * |
Form H1700-1 (if received through TMHP LTCOP) | LTCOP ISP | Yes |
Form H1700-1 (if received through TxMedCentral) | Use TxMedCentral Naming Convention | Yes |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H1826 | H1826 | * |
Form H2053-B | 2053B | * |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | * |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | * |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | * |
Form H2067-MC | Use TxMedCentral Naming Convention | Yes |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | Yes |
Form H3675 | 3675 | * |
Form H3676-A | Use TxMedCentral Naming Convention | Yes |
Form H3676-A Upload to TxMedCentral | 3676A TXMED | Yes |
Form H3676-B | Use TxMedCentral Naming Convention | Yes |
TIERS Copayment Budget Screenshot | TIERS COPAY | * |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from CRU | CRU EMAIL | * |
Emails to and from CCSE | CCSE EMAIL | * |
Emails to and from ERS | ERS EMAIL | * |
Emails to and from ILM Unit | ILM EMAIL | * |
Emails to and from IDD Unit | IDD EMAIL | * |
Emails to and from MCCO | MCCO EMAIL | * |
Emails to and from PSORT | PSORT EMAIL | * |
MEPD Communication Tool | MEPD EMAIL | * |
Note: PSU staff must upload Form 2442 or Form H2065-D in the HEART case record, as appropriate.
Upgrades
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual - Medicaid History Screenshot | TIERS ME | Yes |
TIERS Individual - Managed Care Screenshot | TIERS MC | Yes |
SASO Enrollment Screenshot | SASO EN | Yes |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page) | 1200 | * |
Form H1700-1 (if received through TMHP LTCOP) | LTCOP ISP | Yes |
Form H1700-1 (if received through TxMedCentral) | Use TxMedCentral Naming Convention | Yes |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H1826 | H1826 | * |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | Yes |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | Yes |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | Yes |
Form H2067-MC | Use TxMedCentral Naming Convention | Yes |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | Yes |
TIERS Copayment Budget Screenshot | TIERS COPAY | * |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from CRU | CRU EMAILS | * |
MEPD Communication Tool | MEPD EMAIL | * |
Money Follows the Person (MFP)
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual- Medicaid History Screenshot | TIERS ME | Yes |
TIERS Individual- Managed Care Screenshot | TIERS MC | Yes |
SASO Enrollment Screenshot | SASO EN | Yes |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
CSIL Closure Screenshot | CSIL CLOSURE | Yes |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page) | 1200 | * |
Form H1700-1 (if received through TMHP LTCOP) | LTCOP ISP | Yes |
Form H1700-1(if received through TxMedCentral) | Use TxMedCentral Naming Convention | Yes |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H1826 | H1826 | * |
Form H2053-B | 2053B | * |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | Yes |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | Yes |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | Yes |
Form H2067-MC | Use TxMedCentral Naming Convention | Yes |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | Yes |
TIERS Copayment Budget Screenshot | TIERS COPAY | * |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from CRU | CRU EMAILS | * |
Emails to and from CCSE | CCSE EMAIL | * |
Emails to and from ERS | ERS EMAIL | * |
Emails to and from ILM Unit | ILM EMAIL | * |
Emails to and from MCCO | MCCO EMAIL | * |
Emails to and from PSORT | PSORT EMAIL | * |
Emails to and from the MFPD Reporting Coordinator | 365-DAY EMAIL | * |
MEPD Communication Tool | MEPD EMAIL | * |
Annual Reassessment
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual - Medicaid History Screenshot | TIERS ME | Yes |
TIERS Individual- Managed Care Screenshot | TIERS MC | Yes |
SASO Enrollment Screenshot | SASO EN | * |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1826 | H1826 | * |
Form H1700-1 (if received through TMHP LTCOP) | LTCOP ISP | Yes |
Form H1700-1(if received through TxMedCentral) | Use TxMedCentral Naming Convention | Yes |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | Yes |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | Yes |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | Yes |
Form H2067-MC | Use TxMedCentral Naming Convention | * |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | * |
TIERS Copayment Budget Screenshot | TIERS COPAY | * |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from MCCO | MCCO EMAIL | * |
Emails to and from PSORT | PSORT EMAIL | * |
Transition to Adult Programs (MDCP Age-Out)
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual - Medicaid History Screenshot | TIERS ME | Yes |
SASO Enrollment Screenshot | SASO EN | Yes |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
Form 2114 | 2114 | * |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page) | 1200 | * |
Form H1700-1 (if received through TMHP LTCOP) | LTCOP ISP | Yes |
Form H1700-1(if received through TxMedCentral) | Use TxMedCentral Naming Convention | Yes |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H1826 | H1826 | * |
Form H2053-B | 2053B | * |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | Yes |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | Yes |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | Yes |
Form H2067-MC | Use TxMedCentral Naming Convention | Yes |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | Yes |
Form H2116 | 2116 | * |
Form H3675 | 3675 | * |
Form H3676-A | Use TxMedCentral Naming Convention | Yes |
Form H3676-A Upload to TxMedCentral | 3676A TXMED | Yes |
Form H3676-B | Use TxMedCentral Naming Convention | Yes |
TIERS Copayment Budget Screenshot | TIERS COPAY | * |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from CCSE | CCSE EMAIL | * |
Emails to and from ERS | ERS EMAIL | * |
Emails to and from Higher Needs Coordinator | HN EMAIL | * |
Emails to and from ILM Unit | ILM EMAIL | * |
Emails to and from MCCO | MCCO EMAIL | * |
Emails to and from PSORT | PSORT EMAIL | * |
Emails to and from STAR Kids PSU | PSU EMAIL | * |
Emails to and from UR | UR EMAIL | * |
Emails to and from IDD Unit | IDD EMAIL | * |
MEPD Communication Tool | MEPD EMAIL | * |
Denials and Terminations
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual - Medicaid History Screenshot | TIERS ME | Yes |
SASO Enrollment Screenshot | SASO EN | * |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
CSIL Closure Screenshot | CSIL CLOSURE | * |
Fair Hearing Options for STAR+PLUS HCBS Program Denials | MN DENIAL ATCH | * |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H1826 | H1826 | * |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | * |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | * |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | * |
Form H2067-MC | Use TxMedCentral Naming Convention | * |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | * |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from CRU | CRU EMAIL | * |
Emails to and from ERS | ERS EMAIL | * |
Emails to and from IDD Unit | IDD EMAIL | * |
Emails to and from ILM Unit | ILM EMAIL | * |
Emails to and from MCCO | MCCO EMAIL | * |
MEPD Communication Tool | MEPD EMAIL | * |
Note: PSU staff must upload Form H2067-MC or Form H2065-D in the HEART case record, as appropriate.
Fair Hearings
Item | HEART Naming Convention | Required |
---|---|---|
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
Form 2606 | 2606 | * |
Form 2606-S | 2606-S | * |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H1826 | Form H1826 | * |
Form H2065-D Generated in TMHP LTCOP (English and Spanish) | 2065 | Yes |
Form H2065-D Generated Manually (English and Spanish) | Use TxMedCentral Naming Convention | Yes |
Form H2065-D Screenshot of Upload to TxMedCentral | 2065 TXMED | Yes |
Form H2067-MC | Use TxMedCentral Naming Convention | Yes |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | Yes |
Form H4800 | 4800 | * |
Form H4800-A | 4800A | * |
Form H4800-D | 4800D | * |
Form 4801 | FH COVER LTR | Yes |
Form H4803 | 4803 | Yes |
Form H4806 | 4806 | * |
Form H4807 | 4807 | * |
Appendix XX for All Denials | ELIGIBILITY TAC | Yes |
Copy of Handbook Section Referenced on Form H2065-D | SPOPH [####] | Yes |
Fair Hearing Options for STAR+PLUS HCBS Program Denials | MN DENIAL ATCH | * |
Notice of Hearing Officer’s Decision | APPEAL DECISION LTR | Yes |
HHSC Benefits Portal Screenshot of Hearing Officer’s Decision | TIERS APPEAL DECISION | Yes |
Emails to and from DER Clerk | CLERK EMAIL | * |
Emails to and from CRU | CRU EMAIL | * |
Emails to and from ERS | ERS EMAIL | * |
MEPD Communication Tool | MEPD EMAIL | * |
Disenrollment
Item | HEART Naming Convention | Required |
---|---|---|
TIERS Individual - Medicaid History Screenshot | TIERS ME | Yes |
TIERS Individual - Managed Care Screenshot | TIERS MC | Yes |
SASO Enrollment Screenshot | SASO EN | Yes |
SASO Service Plan Screenshot | SASO SP | * |
SASO Service Authorization Screenshot | SASO SA | Yes |
SASO Medical Necessity Screenshot | SASO MN | Yes |
Form H1746-A (form alone or with fax confirmation page) | 1746 | * |
Form H1746-A Fax Confirmation (if confirmation page only) | 1746 CONF | * |
Form H2067-MC | Use TxMedCentral Naming Convention | Yes |
Form H2067-MC Screenshot of Upload to TxMedCentral | 2067 TXMED | Yes |
Medicaid Managed Care Member Disenrollment Form | DISENFORM | Yes |
Emails for PSU QA Process | QA EMAIL | * |
Emails to and from MCCO | MCCO EMAIL | Yes |
MEPD Communication Tool | MEPD EMAIL | * |
Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions
Revision 18-0; Effective September 4, 2018
TxMedCentral is a secure Internet bulletin board that the Texas Health and Human Commission (HHSC) and managed care organizations (MCOs) use to share information. TxMedCentral uses specific naming conventions only for the documents listed below. HHSC and MCO staff must follow these naming conventions any time one of the following documents is filed in TxMedCentral.
Form H1700-1, STAR+PLUS HCBS Program Individual Service Plan
The following forms may be used, if appropriate, in development of the individual service plan (ISP). Only Form H1700-1, Individual Service Plan (Pg.1), and Form H1700-2, Individual Service Plan – Addendum, are uploaded to the MCO's ISP folder in TxMedCentral and should not be loaded in any other folder:
- Form H1700-1 and Form H1700-2;
- Form H1700-3, Individual Service Plan – Signature Page;
- Form H1700-A1, Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/Services;
- Form H2060, Needs Assessment Questionnaire and Task/Hour Guide;
- Form H2060-A, Addendum to Form H2060;
- Form H2060-B, Needs Assessment Addendum, as applicable; and
- Form H6516, Community First Choice Assessment.
Two-Digit Plan Identification (ID) | Form Number (#) | Member ID, Medicaid # or Social Security Number (SSN) | Member Last Name (first four letters) | Page Number of Form H1700-1 | Sequence Number of Form |
---|---|---|---|---|---|
# # | 1700 | 123456789 | ABCD | 1 | 2 |
This file would be named ##_1700_123456789_ABCD_1_2.doc.
Form H1700-1, completed for non-members, age-outs, and nursing facility (NF) residents transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program, continues to be uploaded to TxMedCentral.
Form H1700-1, completed for members in the community, is submitted to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal.
Form H3676, Managed Care Pre-Enrollment Assessment Authorization
Form H3676 is uploaded to the SPW folder and should not be uploaded in any other folder. An "A" or "B" is added to the sequence number to indicate whether Program Support Unit (PSU) or MCO staff uploaded the form.
Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
---|---|---|---|---|---|
# # | 3676 | 123456789 | ABCD | A or B | 2 |
This file would be named ##_3676_123456789_ABCD_A_2.doc. if uploaded by PSU staff.
This file would be named ##_3676_123456789_ABCD_B_2.doc if uploaded by the MCO staff.
Form H2065-D, Notification of Managed Care Program Services
Form H2065-D is uploaded to the SPW folder and should not be uploaded in any other folder.
Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
---|---|---|---|---|---|
# # | 2065 | 123456789 | ABCD | D | 2D or 2A |
- Denials will be coded with a “D” (denial) immediately following the form’s sequence number. This denial file would be named ##_2065_123456789_ABCD_D_2D.doc.
- Approvals will be coded with an “A” immediately following the sequence number. This approval file would be named ##_2065_123456789_ABCD_D_2A.doc.
If a member has an ISP which is electronically generated, Form H2065-D is available in the "LETTERS" tab of the TMHP LTC Online Portal when the member's ISP is selected. Form H2065-D is uploaded to TxMedCentral only for individuals without electronic ISPs.
MCOs must check the TMHP LTC Online Portal to check for updates and notifications electronically generated by PSU staff.
Form H2067-MC, Managed Care Programs Communication
Form H2067-MC is uploaded to the SPW folder and should not be uploaded in any other folder. An "M" or "S" is added to the sequence number to indicate whether the MCO or PSU uploaded the form.
Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
---|---|---|---|---|---|
# # | 2067 | 123456789 | ABCD | 2M or 2S |
This file would be named ##_2067_123456789_ABCD_2M.doc. if uploaded by the MCO staff.
This file would be named ##_2067_123456789_ABCD_2S.doc. if uploaded by PSU staff.
Additional to the standardized naming convention for Form H2067-MC, a separate naming convention has been developed to address use of Form H2067-MC for NF residents who request transition to the community under the STAR+PLUS Home and Community Based Services (HCBS) program. These individuals are considered expedited cases for application to the STAR+PLUS HCBS program. Both the MCO and PSU staff must be able to readily identify communications specific to these cases.
An "M" or "S" continues to be added to the sequence number to denote, respectively, whether the MCO or PSU staff have uploaded the form. The new naming convention for uploading Form H2067-MC, on both member and non-member cases in a NF, is expanded as follows:
Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section No. | Sequence No. of Form |
---|---|---|---|---|---|
# # | 2067 | 123456789 | ABCD | 1M or 1S | MFP |
Form H2067-MC file uploaded by the MCO would be named ##_2067_123456789_ABCD_1M_MFP.doc. if uploaded by the MCO staff.
Form H2067-MC file uploaded by the MCO staff would be named ##_2067_123456789_ABCD_1S_MFP.doc. if uploaded by PSU staff.
TxMedCentral Folders
The STAR+PLUS MCOs use the following folders for all STAR+PLUS HCBS program related uploads. Each MCO has two folders with three-letter identifiers:
- ISP — Individual Service Plan, which contains Form H1700-1 and Form H1700-2; and
- SPW — STAR+PLUS HCBS program, which contains:
- Form H2065-D;
- Form H3676; and
- Form H2067-MC.
Primary Folder: MCO Three-Letter Identifiers | Secondary Folder: TxMedCentral Folders by Plan |
---|---|
AMC — Amerigroup MCO | AMCISP AMCSPW |
EVR — United Healthcare Community Plan MCO | EVRISP EVRSPW |
MOL — Molina MCO | MOLISP MOLSPW |
SUP — Superior MCO | SUPISP SUPSPW |
BRV — Cigna-HealthSpring MCO | BRVISP BRVSPW |