24-2, Miscellaneous Changes

Revision Notice 24-2; Effective May 21, 2024

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

SectionTitleChange
3313Termination of CCSE Services Upon STAR+PLUS HCBS Program EnrollmentAdds clarifying language on the coordination between PSU and CCSE staff.
3313.1Procedure for STAR+PLUS HCBS Program ApplicantsCorrects the form number for Form 2065-A.
3410Transfer ScenariosUpdates section title to MCO Transfer Scenarios. Adds clarifying language.
3411Transferring to Another Service Area with Prior KnowledgeUpdates section title to Transferring from One MCO to Another Within the Same Service Area. Adds clarifying language.
3412Transferring to Another Service Area Without Prior KnowledgeUpdates section title to Transferring from One MCO to Another in a Different Service Area. Adds clarifying language.
3413Transferring from One MCO to Another Within the Same Service AreaDeletes section.
3421.6Confirm STAR+PLUS HCBS Program EligibilityUpdates the coordination time frame between PSU and IDD waiver program staff.
3514.1STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS ProgramUpdates PSU staff time frame for completing case actions.
6300.2Institutional StayAdds clarifying language on Medicaid Part A SNF stays.
7410Sustained State Fair Hearing DecisionUpdates CRU email contents and adds clarifying language.
9110Authorizing Agent – InitialUpdates MCO name to Wellpoint.
9120Enrollment - InitialUpdates MCO name to Wellpoint.
9130Service Plan - InitialUpdates MCO name to Wellpoint.
9140Service Authorization - InitialUpdates MCO name to Wellpoint.
9410Authorizing Agent for MFP ApplicantUpdates MCO name to Wellpoint.
9420Enrollment for MFP ApplicantAdds clarifying language.
9480MFPD for STAR+PLUS HCBS Program ApplicantUpdates MCO name to Wellpoint.
Appendix XVIIState Cutoff DatesAdds 2024 cutoff dates.
Appendix XXIXReserved for Future UseUpdates appendix title to STAR+PLUS Plan Codes. Adds clarifying language.
Appendix XXXIVSTAR+PLUS TxMedCentral Naming ConventionsUpdates appendix title to STAR+PLUS MCOHub Naming Conventions. Updates MCO name to Wellpoint.

24-1, Miscellaneous Changes

Revision Notice 24-1; Effective Feb. 22, 2024

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

SectionTitleChange
1410MCO Service Coordination for Nursing FacilitiesDeletes section.
1420MCO Service Coordination for Programs Serving Members with IDDDeletes section.
1430MCO Service Coordination for HCBS - Adult Mental Health ProgramDeletes section.
1440MCO Service Coordination for the Section 811 Project Rental Assistance ProgramDeletes section.
1450MCO Service Coordination for and the Medicaid for Breast and Cervical Cancer ProgramDeletes section.
3316Transfer from Another Medicaid Waiver Program to the STAR+PLUS HCBS ProgramAdds start of care date for Form H2065-D. Updates ERS email contents. 
3317Non-STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS ProgramAdds termination date for Form H2065-D and updates ERS email contents. Clarifies PSU coordination is only required for IDD waiver programs. 
4112MCO Contracting OptionsUpdates section title to Reserved for Future Use. Removes policy language.
4170Significant ChangesUpdates section title to Reserved for Future Use. Removes policy language.
5131Identifying Managed Care Members in TIERSRemoves MMP and STAR+PLUS plan codes. 
5310Using the TMHP Long Term Care Online PortalAdds language that MCOs do not upload amended ISPs to the MCOHub.
6300.6Unable to LocateAdds policy on processing upgrade denials.
6300.10Other ReasonsAdds policy that supervisor approval is not required for denials if the applicant is under 21. 
6400Disenrollment Request PolicyAdds policy for failure to pay R&B and copayment. 
7210Timely or Non-timely State Fair Hearing RequestAdds policy for entering an appeal in TIERS. Clarifies the fair hearings officer determines if there is good cause for non-timely appeal requests.
7212DER Procedures for Entering State Fair Hearing RequestAdds policy for creating and documenting fair hearing requests. 
8200Nursing ServicesUpdates section title to Reserved for Future Use. Removes policy language.
8210Nursing ServicesRemoves section title and policy language.
10100Long Term Services and SupportsRemoves section title and policy language.
10111DAHS LimitationsRemoves section title and policy language.
10120Day Activity and Health Services ProvidersRemoves section title and policy language.
10130Assessment for Day Activity and Health ServicesRemoves section title and policy language.
10140Reassessment for Day Activity and Health ServicesRemoves section title and policy language.
10150Authorization for Day Activity and Health ServicesRemoves section title and policy language.
10160ReauthorizationRemoves section title and policy language.
10170Transfer Between FacilitiesRemoves section title and policy language.
10180Transfer Between Managed Care OrganizationsRemoves section title and policy language.
10181Gaining MCO in Same Service AreaRemoves section title and policy language.
10182Gaining MCO in Different Service AreaRemoves section title and policy language.
Appendix XXIXSTAR+PLUS Plan CodesUpdates section title to STAR+PLUS Plan Codes. Adds STAR+PLUS and MMP plan codes. 

23-4, Miscellaneous Changes

Revision Notice 23-4; Effective Dec. 7, 2023

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

SectionTitleChange
3239Copayment ChangesAdds clarifying language on copayment begin dates and adverse action.
3313Termination of CCSE Services Upon STAR+PLUS HCBS Program EnrollmentCorrects email subject lines.
3316Requests for STAR+PLUS HCBS Program from an Individual in 1915(c) Medicaid WaiverUpdates section title to “Transfer from Another Medicaid Waiver Program to the STAR+PLUS HCBS Program” and adds clarifying language.
3317Transfer from STAR+PLUS HCBS Program to Another Medicaid Waiver ProgramAdds clarifying language on actions taken in the TMHP LTCOP.
3421.2Nine Months Prior to the Member’s 21st BirthdayRemoves use of Form H3675.
3514.1STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS ProgramUpdates PSU staff timeframes to complete case actions from two business days to five business days.
3515.1Non-STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS ProgramUpdates PSU staff timeframes to complete case actions from one business day to five business days.
6300.1DeathAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.2Institutional StayAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.3Voluntarily Declined ServicesAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.5Medical Necessity and Level of CareAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.6Unable to LocateAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.7Exceeding the ISP Cost LimitAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.8Failure to Obtain Physician’s SignatureAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.9Failure to Meet Other Program RequirementsAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
6300.10Other ReasonsAdds clarifying language on actions taken in the TMHP LTCOP and SASO and correct email subject lines.
Appendix IIIMedicaid Type Program Codes for STAR+PLUS HCBS Program and CFCAdds clarifying language for Earnings Transitional and TANF Medicaid types.
Appendix IVForm H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments LanguageAdds HCBS-AMH to waiver transfer denial reason.
Appendix XXVIIPSU Users H1700 ISP Form User GuideAdds new linked user guide.
Appendix XXXIIISTAR+PLUS HEART Naming ConventionsAdds TIERS copayment budget screenshot.
GlossaryGlossaryAdds new terms for AFC, ALF, and HCBS-AMH.

23-3, Miscellaneous Changes

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

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

SectionTitleChange
1521.1Phone CommunicationAdds clarifying language on Form H1826.Updates title .
1530 Information That May Be DisclosedAdds clarifying language on Form H1826.
3317 Requests for a 1915(c) Medicaid Waiver from a STAR+PLUS HCBS Program MemberAdds new section and policy language. 
3520Money Follows the Person Demonstration Entitlement Period TrackingUpdates section title to “Money Follows the Person Demonstration.” Removes policy language. 
3521 Money Follows the Person Demonstration IntroductionAdds new section and policy language. 
3522Screening Criteria for Money Follows the Person Demonstration EligibilityAdds new section and policy language.
3522.1Screening for 60-Day Qualifying Institutional StayAdds new section and policy language.
3522.2Program Support Unit Staff Verification of 60-Day Qualifying Institutional StayAdds new section and policy language.
3523 Enrollment in Money Follows the Person DemonstrationAdds new section and policy language.
3524 Money Follows the Person Demonstration Entitlement Period TrackingAdds new section and policy language.
3623.1Upgrades and Interest List ReleasesAdds clarifying language on MCO resubmissions of MN/LOC Assessments. 
5230MFPD Entitlement Tracking and SASO Data EntryAdds clarifying language.
5310Using the TMHP Long Term Care Online PortalAdds clarifying language on MCO resubmissions of MN/LOC Assessments.
7211PSU Staff Procedures for Completing Form 4800-DUpdates TIERS data entry for SSI fair hearings and procedures for completing Form 4800-D.
7221.3Supplemental Security Income Denial by the Social Security AdministrationUpdates TIERS data entry for SSI fair hearings.
7400State Fair Hearing Decision ActionsAdds fair hearing decision definitions.
9480STAR+PLUS HCBS Program and Nursing Facility Overlap ReportAdds clarifying language.
Appendix I-DType of DenialsUpdates section title to “Reserved for Future Use”. Removes  policy language.
Appendix XXIIHHSC Benefits Portal and TIERS Inquiry Desk GuideAdds supporting documents.
Appendix XXXIIISTAR+PLUS HEART Naming ConventionsAdds MFPD Reporting Coordinator email naming convention.