22-3, Update to Sections 1000, 2000, 3000, 4000, 5000, 6000, 7000 and Appendix III

Revision Notice 22-3; Effective Dec. 1, 2022

The following change(s) were made:

Section Title Change
1000 Overview and Eligibility Updates citations. Updates language for clarification purposes to multiple sections. Corrects grammatical errors. Updates links. Revises Section 1220 to update the definition of personal care services (PCS) and clarify language around Community First Choice (CFC) services. Revises Section 1230 to clarify language around service delivery options. Updates language throughout to align with House Bill (H.B.) 4 requirements. Removes the list of Medically Dependent Children Program (MDCP) eligibility criteria in Section 1500 and replaces it with a Texas Administrative Code (TAC) reference. Revises Section 1619.2 to show HHSC as the facility licensing authority. 
2000 Medically Dependent Children Program Intake and Initial Application Updates links. Revises Section 2132 to update instructions for an MDCP limited nursing facility (NF) stay.
3000 STAR Kids Screening and Assessment and Service Planning Updates links. Amends language for clarification purposes in multiple sections. Revises Section 3320 to include instructions for MDCP assessments/reassessments. Revises Section 3321 to update language around significant change in condition.
4000 STAR Kids Community Services Amends language for clarification purposes in multiple sections. Updates citations and links. Adds language to Section 4811 to highlight that managed care organizations (MCOs) can choose to pay excess costs beyond the service limit for adaptive aids on a case-by-case basis. Updated which form to use for transition assistance services (TAS) in Section 4830. Updates language regarding Texas Workforce Solutions-Vocational Rehabilitation Services (TWS-VRS) in multiple sections.
5000 Service Delivery Options Amends language for clarification purposes in multiple sections. Removes “Support Consultation” from consumer directed services (CDS) definitions. Updates links and references. Removes outdated language. Revises Section 5313 to align with H.B. 4 requirements. Corrects grammatical errors.
6000 Denials and Disenrollment Amends language for clarification purposes in multiple sections. Updates links and references. Revises Section 6100 language to replace section language around adverse benefit determination with a reference to the Uniform Managed Care Manual (UMCM). Revises Section 6250 language around an applicant/member who does not meet medical necessity (MN) criteria for MDCP and clarifies instructions for MCOs. Changes Section 6260 title to “Unable to Locate” and adds clarifying instructions for MCOs. 
7000 Complaint, Appeal and Fair Hearing Procedures Updates links and references. Adds contact information for the Ombudsman in Section 7110. Amends language for clarification purposes in multiple sections. Adds new Sections 7200, 7300, 7411, and 7800. Renumbers multiple sections. Removes Program Support Unit (PSU) procedures from multiple sections. Amends language in multiple sections around State Fair Hearings (SFHs). Removes previous Sections 7211, 7214, 7221, 7222, 7230, 7231, 7520, 7521, and 7700. Revises Section 7312 to add instructions for MCOs to prepare the evidence packet. Adds references to the STAR Kids PSU Operational Handbook (SKOPH). Changes title of Section 7220 to “7320, Additional State Fair Hearing Requirements and Information”. Adds language to Section 7500 around continuation of benefits. Revises Sections 7510 and 7520 language around continuation/discontinuation of MDCP services during an SFH. Revises Section 7610 language around sustained SHF decisions. Capitalizes “state fair hearing” in multiple sections. Updates examples in Section 7611 to use more recent dates. Adds “considers all testimony and exhibits” to list of HHSC hearings officer responsibilities in Section 7700.
Appendix III LTSS Billing Matrix and Crosswalk Updated billing matrix to align with NCCI-related edits.