Revision 19-13; Effective November 5, 2019

The Client Assignment and Registration (CARE) System is an online database used by Program Support Unit (PSU) staff. CARE maintains the enrollment records for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs. PSU staff use CARE to prevent dual enrollment in another Medicaid waiver program.

1820 Community Services Interest List

Revision 19-13; Effective November 5, 2019

Community Services Interest List (CSIL) is an online database used by Interest List Management (ILM) Unit and Program Support Unit (PSU) staff. CSIL maintains an interest list and tracks individuals waiting to receive services for Long Term Services and Supports (LTSS) waiver programs including:

  • Community Living Assistance and Support Services (CLASS);
  • Home and Community-based Services (HCS);
  • Medically Dependent Children Program (MDCP);
  • STAR+PLUS Home and Community Based Services (HCBS) program; and
  • Texas Home Living (TxHmL).

PSU staff use CSIL to verify an individual’s status on the interest list and to prevent dual enrollment in another Medicaid waiver program when an individual is entering the STAR+PLUS HCBS program. PSU staff are required to select the appropriate closure reasons and close the CSIL record when an individual is enrolled in the STAR+PLUS HCBS program.

1830 Health and Human Services Commission Benefits Portal

Revision 19-13; Effective November 5, 2019

The Texas Health and Human Services Commission (HHSC) Benefits portal is an online database used by Program Support Unit (PSU) and Fair Hearings Unit staff. The HHSC Benefits portal maintains state fair hearing documentation, forms and case statuses.

PSU staff use the HHSC Benefits portal to:

  • enter and submit state fair hearing requests;
  • upload state fair hearing documentation and forms;
  • view documents and forms uploaded by the hearings officer; and
  • view the outcome of state fair hearing decisions.

1840 Health and Human Services (HHS) Enterprise Administrative Report and Tracking System

Revision 19-13; Effective November 5, 2019

Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) is an online database used by Program Support Unit (PSU) staff. HEART is a repository of current and historic case records for applicants and members.

PSU staff use HEART to:

  • review an individual’s, applicant’s or member’s case history;
  • open new case records;
  • update existing case records;
  • upload forms, documents and screenshots;
  • add narratives of case actions;
  • set due date reminders for case actions;
  • track progress on cases;
  • create relationships between case records; and
  • close case records.

PSU staff must search for an individual, applicant or member when any contact or correspondence is received from, or relating to, an individual, applicant or member to determine if there is already a case record open. PSU must open a new case record if one does not already exist.  

For medical assistance only (MAO) individuals and applicants, the patient control number (PCN) field will initially be completed with the individual’s Social Security number (SSN). Once a Medicaid identification (ID) number is assigned to the applicant, PSU staff must update the PCN field to the Medicaid ID number in HEART.

PSU staff will document every case action in the narrative, including telephone calls, mail dates, fax dates, form receipt dates and any other relevant information in the HEART narrative. The HEART documentation should be completed so that someone with no prior knowledge of the case can follow along in HEART and come to the same case action decision. PSU staff must follow the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions, when uploading documents.

PSU staff must close the HEART case record when there is no further PSU staff action required. Once a HEART case record is closed, PSU staff cannot add notes or documentation. PSU staff must send a request to the PSU supervisor when a HEART case record needs to be reopened.

1850 Service Authorization System Online

Revision 25-1; Effective Feb. 19, 2025

Service Authorization System Online (SASO) is an online database. It is used by Program Support Unit (PSU) staff as the primary system of record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility records.

SASO uses numerical codes to specify the type of program and services a member is receiving. The STAR+PLUS HCBS program uses:

  • service group (SG) 19; and
  • service code (SC) 12 and 13.

The MCO submits Medical Necessity and Level of Care (MN/LOC) Assessments through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) for those transitioning to the STAR+PLUS HCBS program when they have aged out of a children’s program, interest list releases (ILRs), upgrades, Money Follows the Person (MFP), and reassessment cases. The TMHP LTCOP electronically transfers MN/LOC Assessment records to SASO. PSU staff must verify SASO MN/LOC Assessment records are in alignment with TMHP LTCOP records.

The MCO submits individual service plans (ISPs) through the TMHP LTCOP for ILRs, upgrades and reassessment cases. The TMHP LTCOP electronically transfers ISP records when PSU staff use the Submit to SAS feature in the TMHP LTCOP. PSU staff must verify SASO ISP records are in alignment with TMHP LTCOP records.

The MCO must upload ISPs to the MCOHub for those transitioning to the STAR+PLUS HCBS program because they have aged out of a children’s program and for MFP cases. PSU staff must manually enter ISP records in SASO when the ISP is uploaded to the MCOHub and is not appearing in the TMHP LTCOP. 

MN/LOC Assessment records in SASO include:

  • Level of Service (LOS);
  • Diagnosis (DG); and
  • Medical Necessity (MN).

ISP records in SASO include:

  • Authorizing Agent;
  • Enrollment;
  • Service Plan; and
  • Service Authorization.

PSU staff must ensure the appropriate SC is in place based on the following:

  • SC 12: Use this service code when registering initial service authorizations or annual re-determination service authorizations received up to 90 days before the end date of the current ISP.
  • SC 13: Use this service code if an ISP is received after the end date of the most recent ISP. Register one service authorization using SC 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 SC 12 with an effective date one day after the SC 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, 2019, for an ISP that ended May 31, 2019. To register this reassessment, register one service authorization record using Service Code 13 — Nursing with a begin date of June 1, 2019, and an end date of June 30, 2019. Then, register a second service authorization record using Service Code 12 — Case Management with a begin date of July 1, 2019, and an end date of May 31, 2020.

Example of automatic registration: A reassessment ISP is submitted to the TMHP LTCOP on June 5, 2019, for an ISP that ended May 31, 2019. One service authorization record with Service Code 13 — Nursing will be system-generated with a begin date of June 1, 2019, and an end date of June 30, 2019. A second service authorization record with Service Code 12 — Case Management will be system-generated with a begin date of July 1, 2019, and an end date of May 31, 2020.

PSU staff must contact Provider Claims Services (PCS) staff for help to close SASO nursing facility (NF) records for an applicant who will be discharging a NF to receive STAR+PLUS HCBS program services in the community. PSU staff must contact PCS staff within five business days from the date of NF discharge. PSU staff must confirm the member has been discharged from the NF and community services are negotiated to begin on or after the date of discharge before contacting PCS staff.

PSU staff must complete the following activities when contacting PCS staff:

  • call 512-438-2200 and select Option 1 when prompted to do so;
  • identify themselves as HHSC employees;
  • provide the member’s date of discharge from the NF; and
  • request the NF records in SASO be closed so STAR+PLUS HCBS program services can be authorized.

PCS staff will close SG 1 and 3 Service Authorization, Enrollment, and Authorizing Agent records in SASO, including any SC 60 records. This procedure applies even if the individual is leaving the NF using the MFP process.

PSU staff also use SASO to prevent dual enrollment in another Medicaid waiver program. The following Medicaid waiver programs maintain ISPs in SASO:

  • Medically Dependent Children Program (MDCP);
  • Community Living Assistance & Support Services (CLASS);
  • Deaf Blind with Multiple Disabilities (DBMD);
  • Home and Community-based Services (HCS); and
  • Texas Home Living (TxHmL).

Note: SASO was the primary system of record for MDCP before Nov. 1, 2016. Beginning Nov. 1, 2016, the TMHP LTCOP became the primary system of record for MDCP members. 

1860 Texas Integrated Eligibility Redesign System

Revision 25-1; Effective Feb. 19, 2025

Texas Integrated Eligibility Redesign System (TIERS) is an online database used by Program Support Unit (PSU) staff. TIERS maintains Medicaid eligibility, age and mailing addresses for individuals, applicants and members. PSU staff use TIERS to verify an individual’s, applicant’s or member’s Medicaid eligibility, age and mailing address, and to prevent dual enrollment in another Medicaid waiver program.

PSU staff must complete the following activities to identify managed care members in TIERS:

  • Enter the individual’s, applicant’s or member’s information in the Individual-Search screen and select Search. The results of the search will appear in the Search Results field.
  • Select the hyperlink of the individual’s name in the Search Results field. The Individual-Summary screen will appear.
  • Hover over the Individual # field and select Managed Care from the dropdown menu. The managed care information will appear in the Individual Managed Care History field. The data elements in the Individual Managed Care History field include:
    • Provider — The name of the provider contracted by the managed care organization (MCO) to deliver services to members.
    • Plan — The name and plan code 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 — The date enrollment began under this plan.
    • End Date — The 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.

1870 Texas Medicaid & Healthcare Partnership Long Term Care Online Portal

Revision 25-1; Effective Feb. 19, 2025

The Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) is an online database used by Program Support Unit (PSU), managed care organizations (MCOs) and TMHP staff. TMHP LTCOP maintains the medical necessity and level of care (MN/LOC) and individual service plan (ISP) that contain the services and cost limits for members.

The MCO must submit the MN/LOC Assessment through the TMHP LTCOP to process a determination of medical necessity (MN) and cost limit. MCOs submit the MN/LOC Assessment as an:

  • initial MN/LOC Assessment for an applicant being assessed for the STAR+PLUS Home and Community Based Services (HCBS) program;
  • annual MN/LOC Assessment for a member’s ongoing eligibility for the STAR+PLUS HCBS program;
  • a significant change in status MN/LOC Assessment for a STAR+PLUS HCBS program member requesting a change to their cost limit.

The MCO must generate an amended ISP when a significant change occurs in a member’s condition. The MCO must keep amended ISPs in the MCO’s member case file. The MCO does not provide the amended ISP to PSU staff and does not enter the amended ISP in the TMHP LTCOP. PSU staff must advise the MCO that PSU staff do not process ISPs resulting from a significant change if the MCO uploads an amended ISP to the MCOHub.

The MCO uses the TMHP LTCOP to:

Submittal of the MN/LOC Assessment through the TMHP LTCOP creates MN, Level of Service (LOS) and Diagnosis (DG) records in the Service Authorization System Online (SASO). The cost limit can be found in the LOS record.

PSU staff use the TMHP LTCOP to:

  • review an applicant’s or member’s case history;
  • verify the MCO has submitted the MN/LOC and ISP timely;
  • verify the MN/LOC has an approved MN and a RUG under the cost limit;
  • verify the ISP has the correct date range and identifies at least one unmet need;
  • adjust ISP date ranges, if applicable;
  • monitor the status of MN denials;
  • approve, invalidate and terminate ISPs;
  • add case notes to the narrative history;
  • generate Form H2065-D, for approvals not related to age-outs and nursing facility (NF) residents transitioning to the STAR+PLUS HCBS program and MN denials; and
  • generate reports.

1880 MCOHub

Revision 25-1; Effective Feb. 19, 2025

The MCOHub is a secure online bulletin board used by Program Support Unit (PSU) and managed care organizations (MCOs). The MCOHub contains forms and documents uploaded by PSU staff and MCOs. PSU staff and MCOs use the MCOHub for all communications sent between the two parties.

PSU staff and the MCO:

  • Are only required to upload the English versions of forms to the MCOHub.
  • Are not required to upload the Spanish versions of forms to the MCOHub.

PSU staff must electronically back up documents from the MCO’s ISP and SPW folder daily to prevent loss of form history. PSU staff must not back up documents directly in the MCOHub. Instead, PSU staff must move files daily to a secure location.

The MCOHub automatically purges documents every 14 days due to the volume of documents uploaded.