1810 Program Support Unit Staff Notification Requirements

Revision 23-4; Effective Aug. 21, 2023

Form H2065-D, Notification of Managed Care Program Services, is the legal notice Program Support Unit (PSU) staff must mail to the applicant, member, legally authorized representative (LAR) or medical consenter indicating:

  • the Medically Dependent Children Program (MDCP) eligibility for approvals, denials and terminations for MDCP; 
  • the right to a state fair hearing, as applicable;
  • annual cost-of-living adjustments (COLA) for room and board (R&B) charges; and
  • a fair hearing officer’s ruling to reverse an MDCP denial or termination.

PSU staff must mail the English and Spanish versions of Form H2065-D to the applicant, member, LAR or medical consenter.

PSU staff generate Form H2065-D manually or electronically through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) as applicable. PSU staff must follow the instructions in Appendix II, Form H2065-D MDCP Reason for Denial and Comments Language, when completing Form H2065-D.

PSU staff must notify the applicant, member, LAR or medical consenter of MDCP approval using Form H2065-D upon verification that the applicant or member meets all eligibility criteria. PSU staff time frames for mailing Form H2065-D vary depending on the approval type. For example, PSU staff must mail Form H2065-D for an approval within: 

  • 24 hours of the nursing facility (NF) discharge for the Money Follows the Person (MFP) limited NF stay process;
    • Note: The applicant must meet all MDCP, and MFP limited NF stay eligibility criteria before admission to the NF for the limited NF stay.
  • One business day from the date the applicant meets all MDCP eligibility criteria for the first Form H2065-D used in the Traditional MFP process;
  • five business days from the date of NF discharge for the second Form H2065-D used in the Traditional MFP process;
    • Note: The applicant must meet all MDCP and MFP eligibility criteria before discharging from the NF.
  • two business days from the date the member meets all MDCP eligibility criteria for interest list releases (ILRs); and
  • five business days from the date the member is determined to continue to meet all MDCP eligibility criteria for reassessments.

PSU staff must notify the applicant, member, LAR or medical consenter of a program eligibility denial or termination using Form H2065-D upon notification that eligibility criteria is not being met within two business days.

PSU staff must provide the English version of Form H2065-D to the managed care organization (MCO) either: 

  • electronically through the TMHP LTCOP; or
  • manually by uploading to TxMedCentral following the instructions in Appendix IX, STAR Kids TxMedCentral Naming Conventions, as applicable. 
     

1820 Managed Care Organization Notification Requirements for PSU Staff

Revision 21-10; Effective October 25, 2021

The managed care organization (MCO) must use Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section B, and Form H2067-MC, Managed Care Programs Communication, for all communications sent to Program Support Unit (PSU) staff, as applicable. The MCO must upload Form H3676, Section B, or Form H2067-MC to TxMedCentral. PSU staff will retrieve all MCO postings daily from TxMedCentral.

The MCO has 60 days from the date PSU staff uploaded Form H3676, Section A, to TxMedCentral, to upload Form H3676, Section B, for individuals or applicants. The MCO has between one business day and 14 days to upload Form H2067-MC, depending on the situation for an individual, applicant or member. Specific MCO time frames for Form H2067-MC are defined throughout this handbook.

1830 Notifications with Medicaid for the Elderly and People with Disabilities or Texas Works Involvement

Revision 18-0; Effective September 4, 2018

Some actions are based on decisions related to Medicaid financial eligibility determined by Medicaid for the Elderly and People with Disabilities (MEPD) specialists. Program Support Unit (PSU) staff must coordinate changes, approvals, and denials of Medically Dependent Children Program (MDCP) services with the MEPD specialist.

Although the MEPD specialist is required to notify the applicant, member, legally authorized representative (LAR) or authorized representative (AR) of all Medicaid eligibility decisions, PSU staff are required to mail the MDCP applicant, member, LAR or AR the notification of denial of MDCP services on Form H2065-D, Notification of Managed Care Program Services. PSU staff also fax the MEPD specialist a copy of Form H2065-D at initial certification and denial for case actions that involve Medicaid eligibility. PSU staff communications with MEPD that do not include Form H2065-D must include Form H1746-A, MEPD Referral Cover Sheet. MEPD specialists communicate with PSU staff through the MEPD Communication Tool.