Revision 19-1; Effective June 3, 2019
5310 Using the TMHP Long Term Care Online Portal
Revision 21-2; Effective August 1, 2021
The managed care organization (MCO) must submit the Medical Necessity and Level of Care (MN/LOC) Assessment through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal to process a determination of MN and associated resource utilization group (RUG) value. MCOs submit the MN/LOC Assessment as an:
- Initial assessment, submitted when an applicant or individual is being assessed for the STAR+PLUS Home and Community Based Services (HCBS) program or eligibility for Community First Choice (CFC) services.
- Annual assessment.
- Significant change in status assessment for members only receiving CFC as an upgrade for HCBS.
The MCO has the ability to correct or inactivate assessments submitted within specific time frames. Corrections are completed when certain data elements require correction (refer to the TMHP Community Waiver User Guide to determine which fields are correctable). Inactivations are completed when a correction is needed after the 14-day correction time frame allowable time to submit corrections has passed and when the field(s) requiring correction are not correctable and to remove the assessment from the TMHP LTC Online Portal.
The MCO has access to the TMHP LTC Online Portal to:
- check and verify MN status and RUG;
- review workflow actions that result from the submittal of the MN/LOC Assessment or the Individual Service Plan (ISP);
- manage and take action in response to workflow messages; and
- submit Form H1700-1, Individual Service Plan, for initial, change, and reassessment of members with the exception of age-outs and nursing facility (NF) residents transitioning to the STAR+PLUS HCBS program.
More information about submitting Form H1700-1 through the TMHP LTC Online Portal is available in Appendix XXVI, Long Term Care Online Portal User Guide for Managed Care Organizations.
Submittal of the MN/LOC Assessment through the TMHP LTC Online Portal creates MN, Level of Service (LOS) and Diagnosis (DIA) records in the Service Authorization System Online (SASO). The RUG value is located in the LOS record.
Status messages appear in the TMHP LTC Online Portal workflow folder when an MN/LOC Assessment is submitted. Additionally, error messages with status codes appear when TMHP processing cannot be completed. Status messages may be generated when:
- assessments have missing information;
- the system cannot match the assessment to an applicant or individual record;
- the individual is enrolled in another 1915c Medicaid waiver program;
- assessment forms are out of sequence;
- corrections are made to assessments after SASO records have been generated based on the assessment;
- changes occur in MN or LOS status that affect applicant or individual services; or
- previous SASO records were manually changed within the current individual service plan (ISP) period.
This list is not all inclusive.
Messages will appear in the workflow folder to indicate whether or not the TMHP LTC Online Portal action was processed as complete. In some situations, MN, LOS and DIA records will not be generated to SASO; in other situations, SASO records will be generated but messages may still appear in the workflow for required action.
- may update SASO records and/or take specific case actions based on the MN and RUG information found in the TMHP LTC Online Portal;
- must document responses in the TMHP LTC Online Portal to workflow messages appearing for an individual by clicking on applicable buttons related to the messages; and
- must check TMHP LTC Online Portal workflow items to process case actions.
CMS coordinators need to contact PSU staff to update SASO records and/or take specific case actions based on the MN and RUG information found in the TMHP LTC Online Portal.