25-1, Revises Sections Throughout the Handbook

Revision Notice 25-1; Effective March 1, 2025

Section	Title	Change
1320	Service Coordination and Programs Serving Member with Intellectual or Developmental Disabilities	Amends language for clarification purposes. Removes example of PDN.
2030	Managed Care Organization Coordination	Amends language for clarification purposes.
2112	STAR Kids Member Residing in an NF	Amends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP.
2210	Medical Necessity Expiration	Updates instructions for MCOs to submit member SK-SAI’s to the TMHP Long Term Care Online Portal.
3110	Assessment of Medical Necessity for Community First	Updates to change Medicaid Management Information System to Long Term Care Online Portal.
3120	Assessment of Medical Necessity for the Medically Dependent Children Program	Updates to change Medicaid Management Information System to Long Term Care Online Portal.
3210	Reassessment of Medical Necessity or Level of Care	Amends language for clarification purposes.
3320	Service Planning for Medically Dependent Children Services	Amends language for clarification purposes. Removes language that MCOs receive a response file from TMHP.
3322	Medically Dependent Children Program Individual Service Plan and Budget Revision	Amends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP.
3329	Reassessment Notification Requirements	Updates the number of days required for PSU staff requirements if a member files a state fair hearing or external medical review.
4111	Determining Institutional Level of Care	Amends language for clarification purposes. Removes reference that TMHP makes MN determinations on behalf of HHSC.
4131	Assessment of Nursing Facility of Care	Amends language for clarification purposes. Removes reference that TMHP evaluates member eligibility for NF services. Replaces references to TMHP with HHSC.
4132	Reassessment for a Nursing Facility Level of Care	Amends language for clarification purposes. Updates language to include Medicaid Management Information System.
4300	Private Duty Nursing	Corrects links to TMPPM’s Home Health Nursing and Private Duty Nursing Handbook, and TMPPM’s Children’s Services Handbook.
6200	Denial/Termination of Medically Dependent Children Program	Amends language for clarification purposes in Provides additional language for clarification of when HHSC terminates MDCP enrollment.
6210	Denial/Termination Due to Death	Amends language for clarification purposes. Updates language to clarify when HHSC will terminate MDCP enrollment.
6220	Denial/Termination Due to Residence in a Nursing Facility	Amends language for clarification purposes.
6240	Denial/Termination as a Result of Exceeding the Cost Limit	Changes title to Denial or Termination as a Result of Exceeding the Cost Limit Amends language for clarification purposes. Updates language to include Medicaid Management Information System.
6250	Denial/Termination of Medical Necessity	Changes title to Denial or Termination of Medical Necessity Amends language for clarification purposes. Replaces references to TMHP with HHSC.
7300	State Fair Hearing Requests- Appealing MCO Actions	Removes a reference to applicants and members requesting a state fair hearing for non-eligibility reasons.
7310	Program Support Unit Coordination	Amends language for clarification purposes. Replaces references to TMHP with HHSC. Updates timeline where staff must enter SFH requests for MDCP eligibility in TIERS.
7312	Evidence Packet	Amends language for clarification purposes. Replaces reference to TMHP with HHSC Office of Medical Director.
7321	Presentation of the Evidence Packet	Updates references to TMHP and HHSC, along with the MCO.
7322	Hearing Decision	Updates references to TMHP and HHSC, along with the MCO.
7410	Action Taken on the Hearing Decision	Deletes section and changed title to Reserved for Future Use.
7610	Sustained State Fair Hearing Decisions	Update language. Clarifies that HHSC Fair and Fraud Hearings staff mails out written decisions to the applicant, member or their legally authorized representative.
7612	Reversed Appeal Decisions	Amends language for clarification purposes. Updates TxMedCentral reference to MCOHub.
7700	Roles and Responsibilities of Texas Health and Human Services Commission Hearing Officers	Deletes section 7700 and replaced with Section 7800, Community First Choice State Fair Hearing. Amends language for clarification purposes.
7800	Community First Choice State Fair Hearing	Moves to Section 7700 and deletes Section 7800.
Appendix I	MCO Business Rules for SK-SAI and SK-ISP	Updates Section 2.5. Advises MCOs to contact HHSC with more needed information for MDCP MN determinations.
Appendix XI	STAR Kids Plan Codes	Updates Amerigroup to Wellpoint and Children’s Medical Center to Aetna for the Dallas Service Area.