SPOPH Revisions

STAR+PLUS Program Support Unit Operational Procedures Handbook

SPOPH Revisions

25-1, Miscellaneous Changes

Revision 25-1; Effective Feb. 19, 2025

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

Section	Title	Change
1260	Individual Service Plan Cost Limit	Adds policy on Medically Fragile group and General Revenue process.
1400	MCO Service Coordination	Adds policy on Medically Fragile group and General Revenue process.
1850	Service Authorization System Online	Adds clarifying language.
1860	Texas Integrated Eligibility Redesign System	Adds clarifying language.
1870	Texas Medicaid & Healthcare Partnership Long Term Care Online Portal	Adds clarifying language.
1880	TxMedCentral	Updates section title to MCOHub. Adds clarifying language.
3000	STAR+PLUS HCBS Program Eligibility and Services	Updates section title to STAR+PLUS HCBS Program Eligibility.
3232	Payments from the Qualified Income Trust	Removes obsolete policy.
3233	Available QIT Copayment Amount Exceeds the Daily Rate for AFC or AL	Updates section title to Reserved for Future Use. Removes policy language.
3234.1	Calculation Example and Completion of Form 1578	Deletes section.
3235	Refusal to Pay Qualified Income Trust Copayment	Updates section title to Reserved for Future Use. Removes policy language.
3314	Managed Care Organization Changes	Adds clarifying language.
3330	STAR+PLUS Individual Requesting an Upgrade to the STAR+PLUS HCBS Program	Adds clarifying language.
3400	Transferring Into STAR+PLUS	Adds policy on Medically Fragile group and General Revenue process.
3421.7	ISP Cost Exceeds 202% of the RUG Cost Limit	Updates section title to ISP Cost Exceeds 202% of the Cost Limit. Adds policy on Medically Fragile group and General Revenue process.
3525	MFPD Entitlement Tracking and SASO Data Entry	New section.
3530	High or Complex Needs Members	Updates section title to Reserved for Future Use. Removes policy language.
3531	Designation of High Needs Members	Deletes section.
3532	Determination of High Needs Status for Ongoing Members	Deletes section.
3600	Ongoing Service Coordination	Removes policy language.
3610	Revising the Individual Service Plan	Updates section title to Reserved for Future Use. Removes policy language.
3611	MCO Required Notifications from the Provider	Deletes section.
3611.1	Immediate Suspension or Reduction of Services	Deletes section.
3700	Automation and Payment Issues in STAR+PLUS HCBS Program	New section.
3710	Managed Care Data in the Texas Integrated Eligibility Redesign System	New section.
3711	County Code Issues Affecting Enrollment	New section.
3712	Service Interruptions Resulting from County Code Mismatches in TIERS	New section.
4131	AFC Intake, Assessment and Response to Request for Services	Adds clarifying language.
4152	Room and Board Charges and Copayment Requirements	Updates section title to Reserved for Future Use. Removes policy language.
4240	Copayment and Room and Board Requirements	Updates section title to Reserved for Future Use. Removes policy language.
4240.1	Room and Board Charges Requirements	Deletes section.
4240.2	Copayment Requirements	Deletes section.
5000	Automation and Payment Issues in STAR+PLUS HCBS Program	Updates section title to Medically Fragile Group and General Revenue Process. Adds policy on Medically Fragile group and General Revenue process.
5100	TxMedCentral	Updates section title to Initial Referrals. Adds policy on Medically Fragile group and General Revenue process.
5110	File Maintenance	Deletes section.
5120	Maintenance Requirements for Member Information and Forms	Deletes section.
5130	Managed Care Data in the Texas Integrated Eligibility Redesign System	Deletes section.
5130.1	County Code Issues Affecting Enrollment	Deletes section.
5130.2	Service Interruptions Resulting from County Code Mismatches in TIERS	Deletes section.
5131	Identifying Managed Care Members in TIERS	Deletes section.
5200	Service Authorization System Online (SASO)	Updates section title to Reassessment. Adds policy on Medically Fragile group and General Revenue process.
5210	Managed Care Data in SASO	Deletes section.
5220	Closing Institutional Service Records in SASO	Deletes section.
5230	MFPD Entitlement Tracking and SASO Data Entry	Deletes section.
5300	Texas Medicaid and Healthcare Partnership Long Term Care Online Portal	Updates section title to Denials & Terminations. Adds policy on Medically Fragile group and General Revenue process.
5310	Using the TMHP Long Term Care Online Portal	Deletes section.
5400	Administrative Payment Process	Updates section title to Fair Hearings. Adds policy on Medically Fragile group and General Revenue process.
6300.5	Medical Necessity and Level of Care	Adds policy on case monitoring.
6300.10	Other Reasons	Adds denial scenarios that do not require supervisor approval.
9700	Terminations	Adds clarifying language on SASO record closures.
10000	State Plan Long Term Services and Supports	Deletes section.
Appendix IV	Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language	Adds approval language for Room and Board and Copayment for members living in an ALF or AFC and members with a QIT living in a home setting. Updates SPOPH section and SASO code references.
Glossary	Glossary	Updates definition for individual and applicant.

24-4, Miscellaneous Changes

Revision 24-4; Effective Dec. 1, 2024

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

Section No.	Title	Change
1710	PSU Staff Notification Requirements for Applicants and Members	Adds clarifying language on Form H2065-D time frames.
3117.2	MAO Applicants Not Previously Certified in TIERS	Updates section title to Reserved for Future Use. Removes policy language.
3120	Other Available Services	Deletes section.
3121	Prescription Drugs	Deletes section.
3122	Over-the-Counter Drugs	Deletes section.
3123	Incurred Medical Expenses	Deletes section.
3124	Medical Transportation Program	Deletes section.
3125	STAR+PLUS HCBS Program Members Requesting Non-Managed Care Services	Deletes section.
3126	STAR+PLUS Members Requesting Non-Managed Care Services	Deletes section.
3126.1	Community Care Services Eligibility	Deletes section.
3127	Health Insurance Premium Payment Program	Deletes section.
3223	Hospice Services in STAR+PLUS	Updates section title to Hospice Services. Adds clarifying language that hospice services can be provided concurrently with STAR+PLUS HCBS program services.
3313	Termination of CCSE Services Upon STAR+PLUS HCBS Program Enrollment	Adds clarifying language that CCSE services cannot be provided concurrently with STAR+PLUS HCBS program services.
3315.2	Requests from STAR+PLUS HCBS Program Members	Updates section title to Reserved for Future Use.
3316	Transfer from Another Medicaid Waiver Program to the STAR+PLUS HCBS Program	Adds clarifying language on PSU actions for MCO non-compliances and how to proceed when Form H2067-MC is posted by the MCO instead of Form H3676.
3421.6	Confirm STAR+PLUS HCBS Program Eligibility	Corrects bullet formatting.
3514.1	STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS Program	Adds clarifying language on PSU actions for MCO non-compliances.
3524	Money Follows the Person Demonstration 365-Day Entitlement Period Tracking	Adds clarifying language on PSU actions in SASO.
3621	Individual Service Plan Expiring Report	Adds section.
3621.1	Reassessment Procedures	Updates section number from 3621 to 3621.1. Adds clarifying language on PSU reassessment procedures.
3622	Reassessment Notification Requirements	Updates section title to Reserved for Future Use. Removes policy language.
6300.8	Failure to Obtain Physician’s Signature	Adds clarifying language for PSU actions when Form H2067-MC is posted by the MCO instead of Form H3676. Removes language requiring PSU to invalidate the ISP in the TMHP LTCOP.
7215	Changes to the State Fair Hearing Request Summary	Adds clarifying language for PSU actions on processing changes to applicant or member’s information after entering the fair hearing into TIERS.
7221.2	Financial Denial by MEPD or TW	Adds appeal request timeliness as a PSU reporting requirement to CRU. Updates Form 4800-D to Form H4800.
7222.1	Continuation of STAR+PLUS HCBS Program During a State Fair Hearing	Updates the time frames for PSU actions following the member requesting a state fair hearing. Adds language about PSU extending the ISP when pending a fair hearing decision for a member receiving continued benefits.
7222.2	Discontinuation of STAR+PLUS HCBS Program Due to Member Not Requesting a State Fair Hearing	Adds language on PSU receiving an alert in TIERS once the fair hearing officer has made a determination.
Appendix XXXIII	STAR+PLUS HEART Naming Conventions	Updates TxMedCentral to MCOHub. Removes Form 2442 MCOHub screenshot language.
Appendix XXXIV	STAR+PLUS MCOHub Naming Conventions	Adds clarifying language that only English versions of forms are required to be uploaded. Adds naming convention for MFPs and COLA. Removes Form 2442 language. Adds MCO folder information for health plans effective Sept. 1. 2024.

24-3, Miscellaneous Changes

Revision Notice 24-3; Effective Sept. 10, 2024

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

Section	Title	Change
3330	STAR+PLUS Members Requesting an Upgrade to the STAR+PLUS HCBS Program	Updates title to STAR+PLUS Individual Requesting an Upgrade to the STAR+PLUS HCBS Program. Removes upgrade denial language. Adds clarifying language.
3510	Money Follows the Person and Managed Care	Updates language relating to the Section 3330 title change.
6300.1	Death	Adds clarifying language that PSU staff take action upon notification.
6300.3	Voluntarily Declined Services	Adds clarifying language for CCSE and PACE.
9110	Authorizing Agent – Initial	Removes MCO plan code information.
9140	Service Authorization – Initial	Removes MCO contract numbers.
9240	Service Authorization – Reassessment	Removes MCO contract numbers.
9320	Transfers from One MCO to Another MCO in the Same Service Area	Removes MCO contract numbers.
9410	Authorizing Agent for MFP Applicant	Removes MCO plan code information.
9440	Service Authorization for MFP Applicant	Removes MCO contract numbers.
9480	MFPD for STAR+PLUS HCBS Program Applicant	Removes MCO contract numbers.
Appendix IV	Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language	Updates Room and Board and Copayment comments language. Adds use of prorate language.
Appendix XXVII	PSU Users H1700 ISP Form User Guide	Updates the linked user guide document.
Appendix XXIX	STAR+PLUS Plan Codes	Updates appendix title to STAR+PLUS Plan Codes and Contract Numbers. Adds MCO contract numbers.

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:

Section	Title	Change
3313	Termination of CCSE Services Upon STAR+PLUS HCBS Program Enrollment	Adds clarifying language on the coordination between PSU and CCSE staff.
3313.1	Procedure for STAR+PLUS HCBS Program Applicants	Corrects the form number for Form 2065-A.
3410	Transfer Scenarios	Updates section title to MCO Transfer Scenarios. Adds clarifying language.
3411	Transferring to Another Service Area with Prior Knowledge	Updates section title to Transferring from One MCO to Another Within the Same Service Area. Adds clarifying language.
3412	Transferring to Another Service Area Without Prior Knowledge	Updates section title to Transferring from One MCO to Another in a Different Service Area. Adds clarifying language.
3413	Transferring from One MCO to Another Within the Same Service Area	Deletes section.
3421.6	Confirm STAR+PLUS HCBS Program Eligibility	Updates the coordination time frame between PSU and IDD waiver program staff.
3514.1	STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS Program	Updates PSU staff time frame for completing case actions.
6300.2	Institutional Stay	Adds clarifying language on Medicaid Part A SNF stays.
7410	Sustained State Fair Hearing Decision	Updates CRU email contents and adds clarifying language.
9110	Authorizing Agent – Initial	Updates MCO name to Wellpoint.
9120	Enrollment - Initial	Updates MCO name to Wellpoint.
9130	Service Plan - Initial	Updates MCO name to Wellpoint.
9140	Service Authorization - Initial	Updates MCO name to Wellpoint.
9410	Authorizing Agent for MFP Applicant	Updates MCO name to Wellpoint.
9420	Enrollment for MFP Applicant	Adds clarifying language.
9480	MFPD for STAR+PLUS HCBS Program Applicant	Updates MCO name to Wellpoint.
Appendix XVII	State Cutoff Dates	Adds 2024 cutoff dates.
Appendix XXIX	Reserved for Future Use	Updates appendix title to STAR+PLUS Plan Codes. Adds clarifying language.
Appendix XXXIV	STAR+PLUS TxMedCentral Naming Conventions	Updates appendix title to STAR+PLUS MCOHub Naming Conventions. Updates MCO name to Wellpoint.