5100, MCOHub

Revision 23-2; Effective June 30, 2023

5110 MCOHub Naming Convention and File Maintenance

Revision 23-2; Effective June 30, 2023

MCOHub is a secure Internet bulletin board that the Texas Health and Human Services Commission (HHSC) and managed care organizations (MCOs) use to share information. MCOHub uses specific naming conventions only for documents listed below. HHSC and MCO staff must follow these naming conventions any time one of the following documents is filed in MCOHub.

Form H1700-1, Individual Service Plan

The following forms may be used, if appropriate, in development of the individual service plan (ISP). Only Form H1700-1 and Form H1700-2 are uploaded to the MCO's ISP folder in MCOHub and should not be uploaded in any other folder:

• Form H1700-1, Individual Service Plan;
• Form H1700-2, Individual Service Plan – Addendum;
• Form H1700-3, Individual Service Plan – Signature Page;
• Form H1700-A1, Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/Services;
• Form H2060, Needs Assessment Questionnaire and Task/Hour Guide;
• Form H2060-A, Addendum to Form H2060;
• Form H2060-B, Needs Assessment Addendum, as applicable; and
• Form H6516, Community First Choice Assessment.

This file would be named ##_1700_123456789_ABCD_1_2.doc.

Form H1700-1 and Form H1700-3, completed for non-members, age-outs, and nursing facility (NF) residents transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program, continues to be uploaded to MCOHub.

Form H1700-1, completed for members in the community, is submitted to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal.

Form H3676, Managed Care Pre-Enrollment Assessment Authorization

This form is uploaded to the SPW folder and should not be uploaded in any other folder. An "A" or "B" is added to the sequence number to indicate whether Program Support Unit (PSU) or MCO staff uploaded the form.

This file would be named ##_3676_123456789_ABCD_A_2.doc if uploaded by PSU staff.

This file would be named ##_3676_123456789_ABCD_B_2.doc if uploaded by the MCO.

Form H2065-D, Notification of Managed Care Program Services

Form H2065-D is uploaded to the SPW folder and should not be uploaded in any other folder.

• Denials will be coded with a “D” (denial) immediately following the form’s sequence number. This denial file would be named ##_2065_123456789_ABCD_D_2D.doc.
• Approvals will be coded with an “A” immediately following the sequence number. This approval file would be named ##_2065_123456789_ABCD_D_2A.doc.

If a member has an ISP which is electronically generated, Form H2065-D is available in the "LETTERS" tab of the TMHP LTC Online Portal when the member's ISP is selected. Form H2065-D is uploaded to MCOHub only for individuals without electronic ISPs.

MCOs must check the TMHP LTC Online Portal to check for updates and notifications electronically generated by Program Support Unit (PSU) staff.

Form H2067-MC, Managed Care Programs Communication

This form is uploaded to the SPW folder and should not be uploaded in any other folder. An "M" or "S" is added to the sequence number to indicate whether the MCO or PSU staff uploaded the form.

This file would be named ##_2067_123456789_ABCD_2M.doc if uploaded by the MCO.

This file would be named ##_2067_123456789_ABCD_2S.doc if uploaded by PSU staff.

Additional to the standardized naming convention for Form H2067-MC, a separate naming convention has been developed to address use of Form H2067-MC for NF residents who request transition to the community under the STAR+PLUS Home and Community Based Services (HCBS) program. These individuals are considered expedited cases for application to the STAR+PLUS HCBS program. Both the MCO and PSU staff must be able to readily identify communications specific to these cases.

An "M" or "S" continues to be added to the sequence number to denote, respectively, whether the MCO or PSU staff have uploaded the form. The new naming convention for uploading Form H2067-MC, on both member and non-member cases in an NF, is expanded as follows:

Form H2067-MC file uploaded by the MCO would be named ##_2067_123456789_ABCD_1M_MFP.doc if uploaded by the MCO.

Form H2067-MC file uploaded by the MCO would be named ##_2067_123456789_ABCD_1S_MFP.doc if uploaded by PSU staff.

MCOHub Folders

The STAR+PLUS MCOs use the following folders for all STAR+PLUS HCBS program related uploads. Each MCO has two folders with three-letter identifiers:

• ISP — Individual Service Plan, which contains Form H1700-1 and Form H1700-2; and
• SPW — STAR+PLUS HCBS program, which contains:
  • Form H2065-D, Notification of Managed Care Program Services;
  • Form H3676, Managed Care Pre-Enrollment Assessment Authorization; and
  • Form H2067-MC, Managed Care Programs Communication.

5120 Identifying Managed Care Members in the Texas Integrated Eligibility Redesign System

Revision 23-3; Effective Dec. 1, 2023

The Individual-Summary screen in the Texas Integrated Eligibility Redesign System (TIERS) contains a managed care segment for any individual who is now or has been enrolled in managed care. From the Individual-Search screen, enter the individual's information and select Search. The results of the search will appear in the Search Results field. Select the individual’s name on the hyperlink. The Individual - Summary screen will appear. Hover over the Individual # field and select Managed Care. The individual's managed care information will appear.

Specific managed care information is located under Individual Managed Care History field. The data elements across the bottom of the screen are: Provider – Plan – Program – County – Begin Date – End Date – Status – Eligibility – Candidature.

These fields contain the following information:

Provider — Contains the name of the provider contracted by the managed care organization (MCO) to deliver services to members.

Plan — Contains the name of the MCO providing Medicaid services to the member.

Program — For managed care members, "STARPLUS" will appear in this field.

County — Individual's county of residence.

Begin Date — Date enrollment began under this plan.

End Date — Date enrollment ended under this plan.

Status — Describes the type of action.

Eligibility — Choices are "candidate" (applicant), "enrolled" (active) and "suspended" (closed).

Candidature — Describes the individual's status.

STAR+PLUS Plan Codes

5121 Medicare-Medicaid Plan (MMP) Codes

Revision 23-3; Effective Dec. 1, 2023