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Revision 18-2; Effective September 3, 2018
5210 Managed Care Data in the Service Authorization System
Revision 19-1; Effective June 3, 2019
The STAR+PLUS Home and Community Based Services (HCBS) program is authorized by the managed care organization (MCO) and registered by Program Support Unit (PSU) staff in the Service Authorization System Online (SASO) with a Service Group (SG) 19 and a service code (SC). If the member's individual service plan (ISP) is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal registers the appropriate SG/SC combination, which is verified by PSU staff. Service codes are based on the following:
- Service Code 12: Use this service code when registering initial service authorizations or annual re-determination service authorizations received up to 90 days prior to the end date of the current ISP.
- Service Code 13: Use this service code if an ISP is received after the end date of the most recent ISP. Register one service authorization using Service Code 13 effective the day after the end date of the most recent ISP and with an end date that is the end of the month in which the new ISP was received. Register a second service authorization using Service Code 12 with an effective date one day after the Service Code 13 service authorization ends and an end date of one year minus a day from the effective date of the ISP.
Example: A reassessment ISP is received on June 5, 2017, for an ISP that ended May 31, 2017. To register this reassessment, register one service authorization record using "Service Code 13 — Nursing" with a begin date of June 1, 2017, and an end date of June 30, 2017. Then, register a second service authorization record using "Service Code 12 — Case Management" with a begin date of July 1, 2017, and an end date of May 31, 2018.
Example of automatic registration: A reassessment ISP is submitted to the TMHP LTC Online Portal on June 5, 2017, for an ISP that ended May 31, 2017. One service authorization record with "Service Code 13 — Nursing" will be system generated with a begin date of June 1, 2017, and an end date of June 30, 2017. A second service authorization record with "Service Code 12 — Case Management" will be system-generated with a begin date of July 1, 2017, and an end date of May 31, 2018.
5220 Money Follows the Person Demonstration Entitlement Tracking and Service Authorization System Online Data Entry
Revision 23-2; Effective June 30, 2023
Time spent in a nursing facility (NF) does not count toward the 365-day period; therefore, tracking is required to ensure Money Follows the Person Demonstration (MFPD) individuals receive the full 365-day entitlement period. The entitlement period begins the date the individual who agrees to participate in the demonstration is enrolled in the STAR+PLUS Home and Community Based Services (HCBS) program. The managed care organization (MCO) uploads Form H2067, Managed Care Programs Communication, to MCOHub in the MCO folder, indicating the total number of days the member spent in the NF. This information is sent after the 365th day. See 3520, Money Follows the Person Demonstration.
The tables below are intended to assist Program Support Unit (PSU) staff in making accurate entries in the Service Authorization System Online (SASO).
Example 1 — No institutionalization during the 365-day period.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-19 | 1 | 1 | Individual is discharged from the nursing facility (NF). The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-19 | 06-01-19 | 19 | 12 | One-day registration to set the managed care organization (MCO) capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-19 | 06-14-20 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-20 | 06-30-20 | 19 | 12 | PSU staff enters the remaining individual service plan (ISP) period without the 19MFP fund code. | Blank |
Example 2 — Institutionalization during the 365-day period.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-20 | 1 | 1 | Individual is discharged from the NF. The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-20 | 06-01-20 | 19 | 12 | One-day registration to set the MCO capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-20 | 06-14-21 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the remaining ISP period without the 19MFP fund code. | Blank |
The MCO has notified PSU staff this member spent a total of 15 days in the hospital during the MFPD period. PSU staff must correct SASO as follows:
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 06-15-21 | 06-29-21 | 19 | 12 | PSU staff enters the MFPD period for the 15 days the individual was in the hospital. | 19MFP |
| 06-30-21 | 06-30-21 | 19 | 12 | MFPD period reached the 365th day on 06-29-21. ISP had one day remaining. | Blank |
Example 3 — Institutionalization during the 365-day period.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-20 | 1 | 1 | Individual is discharged from the NF. The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-20 | 06-01-20 | 19 | 12 | One-day registration to set the MCO capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-20 | 06-14-21 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the remaining ISP period without the 19MFP fund code. | Blank |
| 07-01-21 | 06-30-22 | 19 | 12 | PSU staff enters reassessment ISP. | Blank |
The MCO has notified PSU staff this member spent a total of 25 days in the hospital during the MFPD period. PSU staff must correct SASO as follows:
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the MFPD period for the 16 of the 25 days the individual was in the hospital. | 19MFP |
| 07-01-21 | 07-09-21 | 19 | 12 | PSU staff enters the MFPD period for the last nine days of the 25-day period in which the individual was in the hospital. | 19MFP |
| 07-10-21 | 06-30-22 | 19 | 12 | PSU staff enters the remainder of the reassessment ISP period. | Blank |
Example 4 — Institutionalization in NF during MFPD period.
Note: The difference between Example 2 and Example 4 is that for NF stays, the PSU staff has to correct STAR+PLUS HCBS program or NF overlaps.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-20 | 1 | 1 | Individual is discharged from the NF. The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-20 | 06-01-20 | 19 | 12 | One-day registration to set the MCO capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-20 | 06-14-21 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the remaining ISP period without the 19MFP fund code. | Blank |
| 08-15-20 | 08-29-20 | 1 | 1 | The NF begin and end dates are derived from forms submitted by NFs. | Blank |
The PSU staff becomes aware this individual spent a total of 15 days in the NF during the MFPD period. PSU staff must correct SASO as follows:
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 06-15-20 | 08-14-20 | 19 | 12 | PSU staff must correct STAR+PLUS HCBS program or NF overlap. | 19MFP |
| 08-30-20 | 06-29-21 | 19 | 12 | PSU staff enters the MFPD period, including the 15 days the member was in the NF. | 19MFP |
| 06-30-21 | 06-30-21 | 19 | 12 | MFPD period reached the 365th day on 06-29-21. ISP had one day remaining. | Blank |