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Revision 22-3; Effective Dec. 1, 2022
3410 Transfer from One Managed Care Organization to Another
Revision 23-3; Effective July 21, 2023
A member or their legally authorized representative (LAR) may request a plan change to another managed care organization (MCO) through the state-contracted enrollment broker at any time for any reason. Texas Health and Human Services Commission (HHSC) will make only one plan change per month.
When a member or their LAR wants to change from one MCO to another MCO, the member or LAR submits a request in one of the following ways:
- by logging into YourTexasBenefits.com; or
- by contacting the state-contracted enrollment broker:
- by phone at 800-964-2777;
- by fax at 855-671-6038; or
- by mail at:
HHSC
P.O. Box 149023
Austin TX 78714-9023
Note: Adoption Assistance or Permanency Care Assistance (AAPCA) members should contact the state’s enrollment broker to request transfer.
If the member requests to change MCOs on or before the monthly state cut-off date, the plan change will be effective on the first day of the month following the change request. If the member requests to change MCOs after the monthly state cut-off date, the change will be effective the first day of the second month following the change request. Note: The state cut-off date is not always on the same day every month, but typically occurs mid-month.
Examples:
Cutoff Date – April 12
- If the member requests a transfer on April 9, it take effect May 1.
- If the member requests a transfer on April 20, it take effect June 1.
See the Uniform Managed Care Manual, Chapter 3.4, Attachment C to the Medicaid Managed Care Member Handbook Required Critical Elements for more details.
MCO Transfer Activities (Required Communication Between the Gaining and the Losing MCO)
HHSC Enrollment Operations Management (EOM) staff prepare and send a Monthly Plan Changes report to Program Support Unit (PSU) staff. The report gives a list of STAR Kids program members who have transferred MCOs from the past month. PSU staff sends the report to the regional PSU offices to confirm system changes and makes any necessary updates or transfers. The MCO can find the member-specific plan changes in their Monthly Enrollment (P34) file in MCOHub.
To prevent duplication of activities when a member changes MCOs, the former (or losing) MCO must provide the receiving (or gaining) MCO with information about the results of the MCO’s identification and assessment upon the gaining MCO's request.
Within five business days of receiving the list of members changing MCOs, the gaining MCO must request any documentation in the member's case file from the losing MCO, such as the member's Form 2603, STAR Kids Individual Service Plan (ISP) Narrative, existing prior authorizations, and minor home modifications (MHMs) and adaptive aids (AA) limits reached.
Within five business days of receiving the request, the losing MCO provides the requested documents to the gaining MCO. The gaining MCO must coordinate with the losing MCO to ensure a seamless transition. The gaining MCO must contact the losing MCO for any other required information maintained in the member's case file. If the gaining MCO experiences issues getting this information, the MCO must notify the Managed Care Compliance and Operations (MCCO) Health Plan manager.
Gaining MCO Responsibilities for Continuity of Care
The gaining MCO is responsible for service delivery from the first day of enrollment. Within 10 business days of enrollment of the new member, the gaining MCO must contact the member to discuss services needed by the member. For continuity of care, this includes authorizations, assistance with finding in-network providers, additional assessments, and pending delivery of AAs, MHMs or transition assistance. The STAR Kids Screening and Assessment Instrument (SK-SAI) must be conducted if the member is due for a new assessment, has experienced a significant change in condition, or if otherwise deemed necessary by the gaining MCO. The gaining MCO must adhere to all rules for SK-SAI processing related to member transfers outlined in Appendix I, MCO Business Rules for SK-SAI and SK-ISP.
The gaining MCO must provide services and honor authorizations included in the prior ISP until the member needs a new assessment or until the gaining MCO is able to complete its own SK-SAI, update the ISP, and issue new service authorizations. The gaining MCO must allow the member to continue to receive services with their existing provider and allow an out-of-network authorization to ensure the member’s condition remains stable and services are consistent to meet the member’s need until a network provider can be located and accessed.
3420 Member Transfer from Waiver Program to Medically Dependent Children Program
Revision 23-3; Effective July 21, 2023
If a STAR Kids member in another Medicaid waiver program comes up on the interest list for MDCP, a referral is made to Program Support Unit (PSU) staff.
PSU staff are responsible for completing the following activities within 14 days of the initial request for an MDCP assessment. All attempted contacts with the member or encountered delays must be documented.
PSU staff:
- contact the member and explain MDCP services; and
- send an enrollment packet to the 1915(c) waiver member.
Within two business days of notification of the MCO selection by the waiver member, PSU staff complete Section A of Form H3676, Managed Care Pre-Enrollment Assessment Authorization, and upload it in the MCO's STAR Kids folder on MCOHub, using the appropriate naming convention.
The MCO completes:
- the STAR Kids Screening and Assessment Instrument (SK-SAI), including the MDCP module;
- Form 2604, STAR Kids Individual Service Plan - Service Tracking Tool, and submits it electronically in the Long Term-Care (LTC) Online Portal or through a 278 transaction; and
- Form H3676, Section B and send to PSU staff, once the SK-SAI is complete.
If the information from the MCO is not received within 60 days after the assessment is authorized, PSU staff email the assigned health plan manager as notification the time frame for completing the individual service plan (ISP) was not met.
The MCO must monitor the LTC Online Portal to check the status of the member's ISP and to retrieve Form H2065-D and file in the MCO’s case file.
3430 Member Transfer from MDCP to Another Waiver
Revision 22-2; Effective September 1, 2022
STAR Kids members receiving Medically Dependent Children Program (MDCP) services may be on an interest list for another Medicaid program such as Community Living Assistance and Support Services (CLASS), Home and Community-based Services (HCS), Deaf Blind with Multiple Disabilities (DBMD) or Texas Home Living (TxHmL). The Texas Health and Human Services Commission (HHSC) informs the managed care organization (MCO) that a member receiving MDCP services has come to the top of the interest list for another program and is assessed as eligible for that program.
The service coordinator or case manager must contact Program Support Unit (PSU) staff via Form H2067-MC, Managed Care Programs Communication, to coordinate the end of MDCP services the day prior to the member's enrollment in the new program. PSU staff must coordinate with the member's MCO about the end of MDCP services and the member's transition to another waiver. The member remains enrolled in the same STAR Kids MCO for their state plan services.
3440 Member Transfer from Community Services to STAR Kid
Revision 22-2; Effective September 1, 2022
Program Support Unit (PSU) staff must coordinate the termination of Community Care for the Aged and Disabled (CCAD) services with the Community Care Services Eligibility (CCSE) case worker so that the individual does not experience a break in services and does not receive concurrent services through another waiver or CCAD service.
For individuals entering STAR Kids through the Medically Dependent Children Program (MDCP), CCAD services are terminated by the CCSE case worker no later than the day prior to MDCP enrollment. This is crucial since no MDCP member may receive CCAD and MDCP services on the same day.