23-3, Updates Sections 3421.6, 5120, 5121 and Appendix XIII

Revision Notice 23-3; Effective Dec. 1, 2023

The following change(s) were made:

SectionTitleChange
3421.6Individual Service Plan Cost Exceeds 202 Percent of the Resource Utilization Group Cost LimitUpdates section.
5120Identifying Managed Care Members in the Texas Integrated Eligibility Redesign SystemUpdates section. Deletes reference to Cigna-HealthSpring.
5121Medicare-Medicaid Plan (MMP) CodesUpdates section. Deletes reference to Cigna-HealthSpring.
Appendix XIIIYour Financial Rights in an Assisted Living Facility STAR+PLUSUpdates appendix.

23-2, Changes TxMedCentral to MCOHub Throughout Handbook

Revision Notice 23-2; Effective June 30, 2023

The following change(s) were made:

SectionTitleChange
2130Communication with the Managed Care OrganizationChanges references from TxMedCentral to MCOHub and updates notification email address
2211Program Support Unit Notification RequirementsChanges references from TxMedCentral to MCOHub
3238Determining Copayment AmountsChanges references from TxMedCentral to MCOHub
3239Copayment ChangesChanges references from TxMedCentral to MCOHub
3241.1Medical Necessity Determination for Applicants Residing in Nursing FacilitiesChanges references from TxMedCentral to MCOHub
3242.2Unmet Need for at Least One STAR+PLUS Home and Community Based Services Program ServiceChanges references from TxMedCentral to MCOHub
3310Intake and EnrollmentChanges references from TxMedCentral to MCOHub
3312.1Enrollment Procedures Following Release from the Interest ListChanges references from TxMedCentral to MCOHub
3315.3Requests from STAR+PLUS Services MembersChanges references from TxMedCentral to MCOHub
3316Requests for STAR+PLUS Home and Community Based Services Program from Participants in 1915(c) Medicaid WaiversChanges references from TxMedCentral to MCOHub
3330STAR+PLUS Members Requesting an Upgrade to the STAR+PLUS Home and Community Based Services ProgramChanges references from TxMedCentral to MCOHub
3411STAR+PLUS Home and Community Based Services Program Member Transferring to Another Service Area with Prior KnowledgeChanges references from TxMedCentral to MCOHub
3412STAR+PLUS Home and Community Based Services Program Member Transferring to Another Service Delivery Area Without Prior KnowledgeChanges references from TxMedCentral to MCOHub
3413STAR+PLUS Home and Community Based Services Program Member Transferring from One MCO to Another Within the Same Service AreaChanges references from TxMedCentral to MCOHub
3421.1Twelve Months Prior to the Member's 21st BirthdayChanges references from TxMedCentral to MCOHub
3421.2Nine Months Prior to the Member's 21st BirthdayChanges references from TxMedCentral to MCOHub
3421.3Five Months Prior to the Member's 21st BirthdayChanges references from TxMedCentral to MCOHub
3421.4Within 45 Days of Receiving Notification of a Form H3676 ReferralChanges references from TxMedCentral to MCOHub
3421.5Confirm STAR+PLUS Home and Community Based Services Program EligibilityChanges references from TxMedCentral to MCOHub
3513Applications Pending More than Four Calendar Months Due to Delay in Nursing Facility DischargeChanges references from TxMedCentral to MCOHub
3514STAR+PLUS Members Residing in a FacilityChanges references from TxMedCentral to MCOHub
3514.1Transition to Community with STAR+PLUS Home and Community Based Services ProgramChanges references from TxMedCentral to MCOHub
3515Non-STAR+PLUS Members Residing in a Nursing FacilityChanges references from TxMedCentral to MCOHub
3523Enrollment in Money Follows the Person DemonstrationChanges references from TxMedCentral to MCOHub
3524Money Follows the Person Demonstration Entitlement Period TrackingChanges references from TxMedCentral to MCOHub
3610Revising the Individual Service PlanChanges references from TxMedCentral to MCOHub
3621Reassessment ProceduresChanges references from TxMedCentral to MCOHub
3622Notification RequirementsChanges references from TxMedCentral to MCOHub
3623.1Upgrades and Interest List ReleasesChanges references from TxMedCentral to MCOHub
3632STAR+PLUS Home and Community Based Services (HCBS) Denial/Termination ReasonsChanges references from TxMedCentral to MCOHub
3632.1Denial or Termination Due to DeathChanges references from TxMedCentral to MCOHub
4410Continuation of STAR+PLUS Waiver Services During an AppealChanges references from TxMedCentral to MCOHub
4420Discontinuation of HCBS STAR+PLUS Waiver Services During an AppealChanges references from TxMedCentral to MCOHub
5100TxMedCentralChanges references from TxMedCentral to MCOHub
5110Money Follows the Person Demonstration Entitlement Tracking and Service Authorization System Online Data EntryChanges references from TxMedCentral to MCOHub
5220TxMedCentral Naming Convention and File MaintenanceChanges references from TxMedCentral to MCOHub
5400Administrative Payment ProcessChanges references from TxMedCentral to MCOHub
6114Service PlanChanges references from TxMedCentral to MCOHub
7152Copayment and Room and Board RequirementsChanges references from TxMedCentral to MCOHub
7171Termination of Adult Foster Care ServicesChanges references from TxMedCentral to MCOHub
7241.1Copayment RequirementsChanges references from TxMedCentral to MCOHub
7246Termination Due to Failure to Pay the Required Contribution to the Cost of CareChanges references from TxMedCentral to MCOHub
7250Standards for OperationChanges references from TxMedCentral to MCOHub
7430ERS Member EligibilityChanges references from TxMedCentral to MCOHub
GlossaryGlossaryChanges references from TxMedCentral to MCOHub
Appendix XXXISTAR+PLUS Members Transitioning from an NF in One Service Area to the Community in Another Service AreaChanges references from TxMedCentral to MCOHub
Form H1700-3 and InstructionsIndividual Service Plan – Signature PageChanges references from TxMedCentral to MCOHub

23-1, Adds Sections in 1100

Revision Notice 23-1; Effective March 1, 2023

The following change(s) were made:

SectionTitleChange
1132Home and Community Based Services (HCBS) SettingsAdds new section.
1132.1Services and Settings Subject to HCBS Settings Rules RequirementsAdds new section.
1132.2Requirements for HCBS SettingsAdds new section.
1133Access to the CommunityAdds new section.
1134EmploymentAdds new section.
1134.1ALF and AFC SettingsAdds new section.
1135Setting ChoiceAdds new section.
1136Privacy, Dignity and Respect, and Freedom from Coercion and RestraintAdds new section.
1137Initiative, Autonomy and IndependenceAdds new section.
1138Choice Regarding Services and Supports, and Who Provides ThemAdds new section.
1139Requirements for ALF and AFC ProvidersAdds new section.
1139.1Residential AgreementAdds new section.
1139.2Door LocksAdds new section.
1139.3Choice of Room and RoommateAdds new section.
1139.4Room Furnishings and DecorationsAdds new section.
1139.5Control of Daily Schedule and Access to FoodAdds new section.
1139.6VisitationAdds new section.
1139.7Physical AccessibilityAdds new section.
1139.8Modifications to HCBS Settings Rule RequirementsAdds new section.

22-3, Revises Section 1000 and Appendix XXII

Revision Notice 22-3; Effective August 3, 2022

The following change(s) were made:

RevisedTitleChange
1143.1.1Services Included Under the MCO Capitation PaymentRevised services.
Appendix XXIIReserved for Future UseUpdated appendix title to MCO Transition Specialist Pilot Project and added content.