25-1, Miscellaneous Changes

Revision 25-1; Effective Feb. 19, 2025

The following sections were revised in the STAR+PLUS Program Support Unit Operational Procedures Handbook:

Section	Title	Change
1260	Individual Service Plan Cost Limit	Adds policy on Medically Fragile group and General Revenue process.
1400	MCO Service Coordination	Adds policy on Medically Fragile group and General Revenue process.
1850	Service Authorization System Online	Adds clarifying language.
1860	Texas Integrated Eligibility Redesign System	Adds clarifying language.
1870	Texas Medicaid & Healthcare Partnership Long Term Care Online Portal	Adds clarifying language.
1880	TxMedCentral	Updates section title to MCOHub. Adds clarifying language.
3000	STAR+PLUS HCBS Program Eligibility and Services	Updates section title to STAR+PLUS HCBS Program Eligibility.
3232	Payments from the Qualified Income Trust	Removes obsolete policy.
3233	Available QIT Copayment Amount Exceeds the Daily Rate for AFC or AL	Updates section title to Reserved for Future Use. Removes policy language.
3234.1	Calculation Example and Completion of Form 1578	Deletes section.
3235	Refusal to Pay Qualified Income Trust Copayment	Updates section title to Reserved for Future Use. Removes policy language.
3314	Managed Care Organization Changes	Adds clarifying language.
3330	STAR+PLUS Individual Requesting an Upgrade to the STAR+PLUS HCBS Program	Adds clarifying language.
3400	Transferring Into STAR+PLUS	Adds policy on Medically Fragile group and General Revenue process.
3421.7	ISP Cost Exceeds 202% of the RUG Cost Limit	Updates section title to ISP Cost Exceeds 202% of the Cost Limit. Adds policy on Medically Fragile group and General Revenue process.
3525	MFPD Entitlement Tracking and SASO Data Entry	New section.
3530	High or Complex Needs Members	Updates section title to Reserved for Future Use. Removes policy language.
3531	Designation of High Needs Members	Deletes section.
3532	Determination of High Needs Status for Ongoing Members	Deletes section.
3600	Ongoing Service Coordination	Removes policy language.
3610	Revising the Individual Service Plan	Updates section title to Reserved for Future Use. Removes policy language.
3611	MCO Required Notifications from the Provider	Deletes section.
3611.1	Immediate Suspension or Reduction of Services	Deletes section.
3700	Automation and Payment Issues in STAR+PLUS HCBS Program	New section.
3710	Managed Care Data in the Texas Integrated Eligibility Redesign System	New section.
3711	County Code Issues Affecting Enrollment	New section.
3712	Service Interruptions Resulting from County Code Mismatches in TIERS	New section.
4131	AFC Intake, Assessment and Response to Request for Services	Adds clarifying language.
4152	Room and Board Charges and Copayment Requirements	Updates section title to Reserved for Future Use. Removes policy language.
4240	Copayment and Room and Board Requirements	Updates section title to Reserved for Future Use. Removes policy language.
4240.1	Room and Board Charges Requirements	Deletes section.
4240.2	Copayment Requirements	Deletes section.
5000	Automation and Payment Issues in STAR+PLUS HCBS Program	Updates section title to Medically Fragile Group and General Revenue Process. Adds policy on Medically Fragile group and General Revenue process.
5100	TxMedCentral	Updates section title to Initial Referrals. Adds policy on Medically Fragile group and General Revenue process.
5110	File Maintenance	Deletes section.
5120	Maintenance Requirements for Member Information and Forms	Deletes section.
5130	Managed Care Data in the Texas Integrated Eligibility Redesign System	Deletes section.
5130.1	County Code Issues Affecting Enrollment	Deletes section.
5130.2	Service Interruptions Resulting from County Code Mismatches in TIERS	Deletes section.
5131	Identifying Managed Care Members in TIERS	Deletes section.
5200	Service Authorization System Online (SASO)	Updates section title to Reassessment. Adds policy on Medically Fragile group and General Revenue process.
5210	Managed Care Data in SASO	Deletes section.
5220	Closing Institutional Service Records in SASO	Deletes section.
5230	MFPD Entitlement Tracking and SASO Data Entry	Deletes section.
5300	Texas Medicaid and Healthcare Partnership Long Term Care Online Portal	Updates section title to Denials & Terminations. Adds policy on Medically Fragile group and General Revenue process.
5310	Using the TMHP Long Term Care Online Portal	Deletes section.
5400	Administrative Payment Process	Updates section title to Fair Hearings. Adds policy on Medically Fragile group and General Revenue process.
6300.5	Medical Necessity and Level of Care	Adds policy on case monitoring.
6300.10	Other Reasons	Adds denial scenarios that do not require supervisor approval.
9700	Terminations	Adds clarifying language on SASO record closures.
10000	State Plan Long Term Services and Supports	Deletes section.
Appendix IV	Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language	Adds approval language for Room and Board and Copayment for members living in an ALF or AFC and members with a QIT living in a home setting. Updates SPOPH section and SASO code references.
Glossary	Glossary	Updates definition for individual and applicant.