Revision 25-1; Effective Feb. 7, 2025

A service authorization (SA) for Targeted Case Management (TCM) is created in the Service Authorization System Online (SASO) for all Medicaid recipients who receive service coordination from a local intellectual and developmental disability authority (LIDDA). LIDDAs cannot create SAs in SASO, so this section explains how SAs are created and terminated. 

4100 TCM Service Authorization for People Not Enrolled in Waiver Services

Revision 25-1; Effective Feb. 7, 2025

4110 Creating a TCM Service Authorization in SASO

Revision 25-1; Effective  Feb. 7, 2025

For Medicaid recipients who receive service coordination from a LIDDA who are not enrolled in Home and Community-based Services (HCS) or Texas Home Living (TxHmL), the first billing for a TCM event creates an SA in SASO. This SA is effective for one year after the first TCM event.

The TCM SA is identified in SASO as service group (SG) 14.

4200 TCM Service Authorization for People Receiving HCS or TxHmL

Revision 25-1; Effective Feb. 7, 2025.

4210 Creating a TCM Service Authorization in SASO

Revision 25-1; Effective Feb. 7, 2025

For people enrolling in HCS or TxHmL, the initial TCM SA in SASO is created when the enrollment Individual Plan of Care (IPC) form is in a processed/complete status on the Long-Term Care (LTC) Online Portal.

The TCM SA is identified in SASO as SG 14.

4211 Creating a TCM Service Authorization Upon Transfer

Revision 25-1; Effective Feb. 7, 2025

For people enrolled in HCS or TxHmL and transferring to a different LIDDA, the transferring LIDDA submits an Individual Movement-LA Reassignment Form (LA Reassignment) on the LTC Online Portal. The receiving LIDDA must acknowledge the reassignment. Once the LA Reassignment form is processed/complete, SASO ends the TCM SA SG 14 for the transferring LIDDA and creates the TCM SA SG 14 for the receiving LIDDA. When the receiving LIDDA submits a TCM claim, the claim will be rejected if the processed/complete LA Reassignment form is not found.

If a rejection occurs, both LIDDAs must work together to make sure the LA Reassignment form was entered, acknowledged and in a processed/complete status for the TCM service dates.

Note: When the receiving LIDDA acknowledges the LA Reassignment form, make sure the following data is entered correctly:

  • LIDDA Provider Number for both the transferring and receiving LIDDAs;
  • LIDDA Contract Number for both the transferring and receiving LIDDAs;
  • Effective Date;
  • New address and county in fields 21-25 under Individual Information; and
  • If a contract number for the program provider, Financial Management Service Agency (FMSA) or both are added, ended or changed, select box 11a on the LA Reassignment form.

Inactivation of an LA Reassignment form does not remove the TCM SA SG 14 from SASO. The TCM SA SG 14 must be removed manually. If the LA Reassignment form contains errors, or was submitted in error or out of sequence, contact IDD Program Improvement at IDD_Program_Improvement@hhs.texas.gov to determine if corrections can be made or if the form must be inactivated.  If inactivation of the LA Reassignment is recommended, IDD Program Improvement will provide recommendations to correct the TCM SA SG 14 in SASO.

4300 Requesting a TCM Service Authorization Closure 

Revision 25-1; Effective Feb. 7, 2025

There is no system automation to end TCM SA SG 14 when a service or program is terminated.

A request for closure of TCM SA SG 14 must be submitted if the person:

  • enrolls in a Medicaid waiver program other that the HCS or TxHmL program;
  • loses Medicaid eligibility after efforts to re-establish have been exhausted;
  • resides in an institution;
  • dies;
  • permanently moves out of state;
  • no longer desires services;
  • cannot be located; or
  • no longer meets the eligibility criteria per 26 Texas Administrative Code Chapter 331, Section 331.7.

If the person will no longer receive TCM, the LIDDA must follow these steps to close the TCM SA SG 14 in SASO.

  1. Use the HHS Regional Map to find the region of the person’s county of residence.
  2. Contact the appropriate regional Claims Management System (CMS) coordinator identified on the regional CMS coordinator list.
  3. Send a secure email to the CMS coordinator with the following information:
    • In the subject line: Request to close SG-14 Service Authorization in SASO;
    • In the body of the email:
    • the person’s full name and Medicaid number;
    • a screenshot of the following from SASO:
      • Service Authorization Summary, SG14 12A/12C records; and
      • Enrollment Summary.
    • a brief description of the request, including the requested end date (MM/DD/YYYY) and the reason for ending the SA; and
    • an acknowledgement statement that:
      • no TCM services were provided after the closure date; and
      • any TCM payments for dates after the TCM closure date may be recouped.
  4. Respond to the CMS coordinator if additional information is requested. 

4400 Billing Resolutions Request

Revision 25-1; Effective Feb. 7, 2025

LIDDAs must use Form 1595, Billing Resolutions Request, to request assistance from HHS for billing rejections, denials or both. The LIDDA faxes or mails the completed Form 1595 to the regional CMS coordinator with supportive documents.

LIDDAs may use the regional CMS coordinator list (PDF) to identify the appropriate CMS coordinator.