3300, Administrative Procedures

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff operate in each Texas Health and Human Services Commission (HHSC) STAR+PLUS managed care service area. PSU staff provide support necessary for the coordination of long-term services and supports (LTSS), including the STAR+PLUS Home and Community Based Services (HCBS) program, for members who transfer in and out of STAR+PLUS service areas. PSU staff are also the point of contact for the coordination and monitoring of members transitioning from:

  • nursing facilities (NFs) to the community, and
  • the Medically Dependent Children Program (MDCP) to the STAR+PLUS HCBS program.

Responsibilities of PSU staff include:

  • acting as an intermediary in relaying communications between Community Care Services Eligibility (CCSE) staff and the managed care organization (MCO);
  • receiving requests for services from CCSE staff performing intake tasks;
  • coordinating the application process for the STAR+PLUS HCBS program for NF residents who wish to transition to the community;
  • assisting applicants with enrollment through the Texas Health and Human Services Commission (HHSC) enrollment broker to select an MCO and primary care provider (PCP), if necessary;
  • coordinating with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist regarding Medicaid eligibility, as appropriate;
  • sending service authorizations (Form H3676, Managed Care Pre-Enrollment Assessment Authorization) to the MCO to initiate STAR+PLUS HCBS program assessments for applicants;
  • serving as the primary contact for transitions in and out of STAR+PLUS service areas;
  • assisting CCSE case managers in processing applications for non-Medicaid services by verifying the MCO denied the equivalent service under STAR+PLUS (Refer to Section 3510, Money Follows the Person and Managed Care);
  • assisting MCO members requesting placement on an interest list for services excluded from managed care (Refer to Section 3222, STAR+PLUS Excluded Groups);
  • processing applicants released from the STAR+PLUS HCBS program interest list;
  • assisting members who are aging out of MDCP and/or Texas Health Steps (THSteps) Comprehensive Care Program (CCP) in transferring to the STAR+PLUS HCBS program (Refer to Section 3420, Individuals Transitioning Services for Adults);
  • coordinating continuity of care for members suspended or disenrolled from STAR+PLUS;
  • approving the STAR+PLUS HCBS program based upon eligibility;
  • making Service Authorization System Online (SASO) entries, as required for actions involving STAR+PLUS HCBS program members;
  • handling the administrative claims process;
  • researching and requesting disenrollment when the member is enrolled inappropriately;
  • denying eligibility for the STAR+PLUS HCBS program; and
  • handling requests for state fair hearings for applicants or members who are denied STAR+PLUS HCBS program eligibility.

3310 Intake and Enrollment

Revision 18-0; Effective September 4, 2018

When Community Care Services Eligibility (CCSE) staff receive a request for the STAR+PLUS Home and Community Based Services (HCBS) program, CCSE intake staff must assess whether the request for services should be forwarded for processing to the:

  • Intellectual or Developmental Disabilities (IDD) Program Eligibility and Support;
  • Texas Health and Human Services Commission (HHSC) enrollment broker;
  • Program Support Unit (PSU) staff;
  • Interest List Management (ILM) Unit staff; or
  • appropriate managed care organization (MCO).

Use the chart below to determine how to process requests for services in STAR+PLUS.

Type of IndividualEnrolled with a STAR+PLUS MCO?How does CCSE handle this request?
Full Medicaid individual applying for the STAR+PLUS HCBS programNo.

Forward the request to the HHSC enrollment broker. Supplemental Security Income (SSI) or other full Medicaid program individuals never go on the STAR+PLUS HCBS program interest list, whether the individual is enrolled with STAR+PLUS or not.

The HHSC enrollment broker determines what is preventing MCO enrollment and takes action to resolve the issue, which may include referral to the HHSC or contact with the individual.

Full Medicaid individual applying for the STAR+PLUS HCBS programYes.Refer the individual to the MCO for the STAR+PLUS HCBS program. This individual will never go on the interest list.
Medically Dependent Children Program (MDCP) member who is turning age 21No. MDCP is excluded from STAR+PLUS.The MDCP_PDN Transition Report is emailed to the PSU supervisor identifying individuals who are turning age 21 within the next 18 months and who receive MDCP and/or PDN. See the procedures for transition from MDCP to the STAR+PLUS HCBS program in Section 3420, Individuals Transitioning Services for Adults. These individuals never go on the interest list.
Medical assistance only (MAO) applicant for the STAR+PLUS HCBS programNo.CCSE staff receiving the request will place the individual on the STAR+PLUS HCBS program interest list.
Nursing facility (NF) resident applying for the STAR+PLUS HCBS programYes.The resident must be referred to the MCO for an upgrade to the STAR+PLUS HCBS program.
NF resident applying for the STAR+PLUS HCBS programNo.All Money Follows the Person (MFP) individuals are placed on the interest list by CCSE intake staff and immediately assigned. The Community Services Interest List (CSIL) database assignment automatically generates an email notifying PSU staff of the referral.

Due to member choice issues, MCOs are prohibited from contacting the applicant without the authorization from PSU staff to complete the required STAR+PLUS HCBS assessments. For MDCP members aging out, individuals on the STAR+PLUS HCBS program interest list, or MFP individuals, PSU staff:

  • complete Section A of Form H3676, Managed Care Pre-Enrollment Assessment Authorization; and
  • upload Form H3676 to TxMedCentral in the MCO’s SPW folder, following the instructions in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions.

Note: When PSU staff check the Texas Integrated Eligibility Redesign System (TIERS) for enrollment, the designation on the Individual – Managed Care screen of “Candidate Eligible” is not verification of enrollment. When enrollment is complete, the Individual – Managed Care screen will display “Enrolled.”

Note: CCSE intake staff must provide information about the Program of All-Inclusive Care for the Elderly (PACE) to individuals during the request and referral process when the individual requesting services is determined to be age 55 years or older and resides in a PACE service area. PACE services are available in designated areas of El Paso, Amarillo/Canyon and Lubbock.  
CCSE intake staff must be aware of the PACE service areas (SAs) and referral procedures. Additional information on PACE can be found at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/program-all-inclusive-care-elderly-pace.

3311 Interim Services for Individuals Awaiting Managed Care Enrollment

Revision 18-0; Effective September 4, 2018

While awaiting enrollment in managed care, individuals are entitled to receive services from the Community Care Services Eligibility (CCSE) program. Referrals to CCSE must be made for all active Medicaid individuals awaiting enrollment for managed care. CCSE case managers may assess these individuals for services if it appears services can be authorized and delivered prior to enrollment.

3311.1 Interest List Procedures

Revision 22-1; Effective January 31, 2022

Interest List Management (ILM) Unit staff are Texas Health and Human Services Commission (HHSC) staff responsible for maintaining and releasing individuals from the STAR+PLUS Home and Community Based Services (HCBS) program interest list. ILM Unit staff must use the Community Services Interest List (CSIL) database to track individuals who request the STAR+PLUS HCBS program. ILM Unit staff must release individuals from the STAR+PLUS HCBS program interest list as slots become available in the program.

ILM Unit staff must use the CSIL database to track nursing facility (NF) residents who are not SSI eligible when a request for the STAR+PLUS HCBS program is received on the interest list hotline. Program Support Unit (PSU) staff must use the CSIL database to track NF residents who are not SSI eligible when a request for the STAR+PLUS HCBS program is received from a Community Care Services Eligibility (CCSE) case manager. ILM Unit or PSU staff must check the CSIL database to verify if the NF resident is on the STAR+PLUS HCBS program interest list when a request for community transition to the STAR+PLUS HCBS program is received. ILM Unit or PSU staff must add, if applicable, and immediately release and assign the individual from the STAR+PLUS HCBS program interest list to pursue the Money Follows the Person (MFP) process if the individual is not in the CSIL database.

ILM Unit staff perform the following activities for individuals who request placement on the STAR+PLUS HCBS program interest list:

  • Place individuals on the interest list;
  • Maintain annual contact requirements;
  • Release individuals from the interest list when funding is available;
  • Track STAR+PLUS HCBS program slots allocated for use by individuals who are not mandatory participants; and
  • Confirm individuals on the interest list are viable STAR+PLUS candidates before release by:
    • verifying all contact information is correct;
    • checking the Texas Integrated Eligibility Redesign System (TIERS) to determine the Medicaid eligibility status;
    • confirming Texas residency; and
    • verifying the individual is still interested in the STAR+PLUS HCBS program.

The interest list status will automatically update to an inactive status if no response is received from the individual within 120 days of the annual contact and will remain in that status until the individual notifies ILM Unit staff of continued interest.

The HHSC enrollment broker must contact all individuals by phone upon release from the STAR+PLUS HCBS program interest list to notify them of their names reaching the top of the list and a slot has become available.  

The enrollment broker will contact the individual to confirm if the individual wishes to pursue the STAR+PLUS HCBS program. The enrollment broker will mail the enrollment packet if the individual wishes to pursue the STAR+PLUS HCBS program. If the individual does not wish to pursue the STAR+PLUS HCBS program:

  • the individual can be added back to the bottom of the interest list for an offer in the future, at the individual’s request; or
  • the interest list release (ILR) will be closed with the appropriate closure code in the CSIL database.

The enrollment broker will mail a STAR+PLUS HCBS program enrollment packet to all individuals released from the interest list and interested in pursuing STAR+PLUS HCBS program services. The STAR+PLUS HCBS program enrollment packet includes:

The enrollment broker contacts the individual every seven days from the date the enrollment packet is mailed. All enrollment broker contacts will cease when the completed packet is received by the enrollment broker or on the 30th day after mailing the enrollment packet, whichever is sooner. The enrollment broker’s contact attempts include the 14-day contact requirement.

The enrollment broker will contact the applicant or authorized representative (AR) to:

  • give a general description of STAR+PLUS HCBS program services;
  • provide a list of managed care organizations (MCOs) in their service area (SA) and encourage the member to contact one for service information;
  • discuss the importance of choosing an MCO so an assessment and initial individual service plan (ISP) can be completed in order to avoid a delay in eligibility determination for the STAR+PLUS HCBS program; and
  • inform the individual that their MCO selection can be changed at any time after the first month of service.

The enrollment broker will fax the signed and completed Form H1200, along with Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist within two business days of receipt from the applicant or AR. The applicant or AR will select an MCO by completing Form H2053-B or notifying the enrollment broker verbally.

Refer to Section 3312, Managed Care Enrollment, for steps to be taken after an individual is released from the STAR+PLUS HCBS program interest list.

3311.2 Enrollment Procedures Following Release from the Interest List

Revision 23-2; Effective May 15, 2023

Program Support Unit (PSU) staff complete the following activities within three business days of the receipt of the STAR+PLUS Home and Community Based Services (HCBS) program interest list release (ILR) case record assignment in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

  • check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility;
  • ensure that the individual does not have an open enrollment with another Medicaid waiver program per the procedures below:
    • check the Service Authorization System Online (SASO) for open Service Authorization and Enrollment records for:
      • Community Living Assistance and Support Services (CLASS) (Service Group (SG) 2);
      • Deaf Blind and Multiple Disabilities (DBMD) (SG 16);
      • Home and Community-based Services (HCS) (SG 21); 
      • Texas Home Living (TxHmL) (SG 22); and 
  • upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, to TxMedCentral, following the instructions in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions.

The MCO must complete the following activities within 45 days from the date PSU staff upload Form H3676 to TxMedCentral:

  • upload Form H3676, Section B, to TxMedCentral;
  • conduct the Medical Necessity and Level of Care (MN/LOC) Assessment; and
  • develop the individual service plan (ISP) using Form H1700-1, Individual Service Plan, and upload it to TxMedCentral.

PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist noting the applicant has an approved MN/LOC Assessment and ISP within two business days of receipt from the MCO.

PSU staff must notify Program Support Operations Review Team (PSORT) staff by email within two business days of an MCO failing to submit initial assessment information within the 45-day time frame. The email sent to PSORT staff must include:

  • an email subject line that reads: “STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the member’s first and last name].” For example, the email subject line for an MCO non-compliance for Ann Smith would read “STAR+PLUS HCBS 45-Day 9B MCO Non-Compliance for AS”;
  • individual or applicant’s name;
  • Social Security number (SSN) or Medicaid identification (ID) number;
  • date of birth (DOB);
  • name of the MCO and plan code;
  • the date information was due from the MCO;
  • a brief description of the delay and any MCO information received; and
  • attach any pertinent documents received from the MCO (e.g., Form H2067-MC).

PSU staff must ensure the medical necessity (MN) determination from the Texas Medicaid & Healthcare Partnership (TMHP) nurse or physician is valid by verifying the approval date does not exceed 120 days. PSU staff must upload Form H2067-MC to TxMedCentral, following the instructions in Appendix XXXIV, advising the MCO to submit a new initial MN/LOC Assessment if the MN approval date exceeds 120 days.

PSU staff must determine if the applicant meets the eligibility criteria for the STAR+PLUS HCBS program within five business days from the MEPD specialist advising the applicant meets Medicaid financial eligibility. PSU staff must complete the following activities if the applicant meets the eligibility criteria:

  • generate Form H2065-D, Notification of Managed Care Program Services, following the instructions in Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language;
    • Note: The start of care (SOC) date for the STAR+PLUS HCBS program is the first day of the month, following meeting all eligibility criteria. PSU staff processing does not delay the eligibility begin date.
  • mail Form H2065-D to the member;
  • create SASO entries following procedures in Section 9100, Initial Service Authorization;
  • upload Form H2065-D to TxMedCentral following the instructions in Appendix XXXIV; 
  • fax Form H1746-A and Form H2065-D to the MEPD specialist; 
  • notify Enrollment Resolution Services (ERS) Unit staff by email. The email to ERS Unit staff must include:
  • an email subject line that reads “STAR+PLUS HCBS Enrollment for XX [member’s first and last name initials].” For example, the email subject line for a ILR for Ann Smith would be “STAR+PLUS HCBS Enrollment for AS”;
    • the member’s name;
    • Medicaid ID number;
    • type of request (i.e., ILR enrollment);
    • MN approval date;
    • ISP receipt date;
    • ISP begin date;
    • ISP end date;
    • MCO selection;
    • effective date of enrollment; 
    • Form H2065-D;
  • upload all applicable documents to the HEART case record, following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions; and
  • document and close the HEART case record.

Refer to Section 6000, Denials and Terminations, if the applicant does not meet STAR+PLUS HCBS program requirements at ILR.

3311.3 Interest List Slot Allocations

Revision 18-0; Effective September 4, 2018

Members receiving Medicaid services under any of the programs listed in the chart below must receive those services through managed care. This does not impact the STAR+PLUS member's right to access non-Medicaid services through the Texas Health and Human Services Commission (HHSC). STAR+PLUS Home and Community Based Services (HCBS) program members must receive all services through the STAR+PLUS HCBS program, excluding hospice care. Only STAR+PLUS HCBS members count against slot allocations, as the following table illustrates.

Texas Integrated Eligibility Redesign System (TIERS) Type of Assistance (TA)Program DescriptionCounts Against Interest List Slot Allocation?
TP 03Medical assistance only (MAO) Medicaid – PickleNo
TA 03Manual Supplemental Security Income (SSI) recipient waiversNo
TA 02 SSI recipient waiversNo
TP 13 SSI MedicaidNo
TA 10 Medicaid waiversYes
TP 18Medicaid for Disabled Adult Children (DAC)No
TP 21 Disabled Widows/Widowers MedicaidNo
TA 01SSI Denied ChildNo
TP 22 Early aged Widows/Widowers MedicaidNo
TP 51 Rider 51 waiversNo
TP 87Medicaid Buy-inNo

3311.4 Earliest Date for Adding a Member Back to the Interest List

Revision 18-0; Effective September 4, 2018

The earliest date an applicant or member may be added back to the Community Services Interest List (CSIL) database for STAR+PLUS HCBS is the date the applicant is determined to be ineligible for the program or the first date the member is no longer eligible for the program.

Example 1: The applicant is released from the STAR+PLUS HCBS program interest list on March 2, 2019. PSU staff send Form H2065-D, Notification of Managed Care Program Services, notifying the applicant is not eligible for the STAR+PLUS HCBS program on March 28, 2019. The first date the denied applicant can be added back to the STAR+PLUS HCBS program interest list is March 28, 2019.

Example 2: A STAR+PLUS HCBS program member is determined ineligible on March 28, 2019. PSU staff send Form H2065-D to the STAR+PLUS HCBS program member notifying of program termination. Termination is effective April 30, 2019. The first date the denied member can be added back to the STAR+PLUS HCBS program interest list is May 1, 2019.

If the applicant or STAR+PLUS HCBS program member’s name is added back to the interest list prior to the last date of program eligibility, the CSIL database interface match with the Service Authorization System Online (SASO) will cause the name to be removed from the interest list for that program.

3311.5 Updating Community Services Interest List Records

Revision 18-0; Effective September 4, 2018

The Community Services Interest List (CSIL) database must be updated to reflect accurate information. Program Support Unit (PSU) staff must complete data entry in the CSIL database for STAR+PLUS Home and Community Based Services (HCBS) program actions within five business days of the date:

  • PSU staff sign Form H2065-D, Notification of Managed Care Program Services, certifying or denying applications, except Money Follows the Person (MFP) certifications; and
  • the request for other CSIL database actions (updating information, transferring an individual to another region's interest list or removing a member from the interest list upon request by the individual).

For MFP certifications, the CSIL database is updated when the Service Authorization System Online (SASO) data entry is completed to register the initial individual service plan (ISP). Delaying data entry of the disposition in CSIL for an applicant certified through MFP provisions prevents removing the individual from the interest list before the actual discharge from the nursing facility (NF) is verified.

PSU staff must ensure CSIL database closures are recorded accurately by using the Community Services Interest List (CSIL) User's Guide, available to PSU staff on SharePoint.

3311.6 Contacting the Interest List Management Unit to Reopen a Closed Interest List Release

Revision 20-6; Effective December 18, 2020

Program Support Unit (PSU) staff must submit a request to Interest List Management (ILM) Unit staff to reopen an individual’s closed Community Services Interest List (CSIL) record.

Within two business days of receiving the request to reopen a closed interest list release, PSU staff must email their immediate supervisor requesting to reopen the CSIL record. The email must include the following:

  • an email subject line that reads: “S+P Reopen Request for XX [individual’s first and last initials].” For example, the email subject line for a request to reopen a closed CSIL record for Ann Smith would be “S+P Reopen Request for AS”;
  • individual’s name;
  • interest list identification (ID) number;
  • individual’s Medicaid ID number or Social Security number (SSN);
  • the individual’s or authorized representative’s (AR’s) contact name and phone number; and
  • reason for the request to reopen. For example, a statement indicating that the application for an alternate 1915(c) Medicaid waiver program was denied and the individual now wishes to reapply for STAR+PLUS HCBS.

The PSU supervisor will forward the reopen request to the ILM Unit manager at StarPlusWaiverInterestList@hhsc.state.tx.us if the PSU supervisor agrees the reopen request is appropriate. ILM Unit staff will email PSU staff to provide the outcome of the request within five business days.

If an exception is granted, PSU staff must:   

  • contact the individual to begin the application process;
  • document the reopen request in the Health and Human Services Enterprise Administrative Report and Tracking System (HEART) case record;
  • upload the ILM Unit staff’s decision email to the HEART case record, following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions; and
  • keep the HEART case record open until STAR+PLUS HCBS program eligibility is approved or denied.

If an exception is not granted, PSU staff must:

  • upload the ILM Unit staff’s decision email to the HEART case record, following the instructions in Appendix XXXIII; and
  • close the HEART case record.

3312 Managed Care Enrollment

Revision 18-0; Effective September 4, 2018

The Texas Health and Human Services Commission (HHSC) enrollment broker mails enrollment packets to all Medicaid individuals who are candidates for STAR+PLUS. The enrollment packet contains information about STAR+PLUS, instructions for completing the enrollment form and information about the available STAR+PLUS managed care organizations (MCOs) from which the individual can choose. Individuals can return enrollment forms by mail, complete an enrollment form at an enrollment event or presentation, or call the HHSC enrollment broker and enroll by telephone at 800-964-2777.

Individuals have 30 days after receiving an enrollment packet to select an MCO. If a selection is not made within 30 days, the individual will be assigned to an MCO and a primary care provider (PCP). Failure to choose an MCO could lead to delays in services or default assignment to an MCO. Individual assignments to an MCO or PCP are automatic, using a default process. Individuals assigned through the default process may change their STAR+PLUS MCO and PCP after they have been enrolled at least one month. However, the individual must receive Medicaid services through the assigned MCO and PCP until the individual contacts the MCO or the HHSC enrollment broker at 800-964-2777 to request a change.

Failure to select a PCP may delay services when a physician's order or medical necessity (MN) determination is required.

3313 Termination of CCSE Services Upon STAR+PLUS HCBS Program Enrollment

Revision 23-4; Effective Dec. 7, 2023

Code of Federal Regulations (CFR) Section 431.213, Exceptions from advance notice.

The agency may mail a notice not later than the date of action if:

  • the agency has factual information confirming the death of a recipient;
  • the agency receives a clear written statement signed by a recipient that;
    • he or she no longer wants services; or
    • gives information that requires termination or reduction of services and indicates that he or she understands that this must be the result of supplying that information;
  • the recipient has been admitted to an institution where he or she is ineligible under the plan for further services;
  • the recipient's whereabouts are unknown and the post office returns agency mail directed to him or her indicating no forwarding address (See Section 431.231 (d) of this subpart for procedure if the recipient's whereabouts become known);
  • the agency establishes the fact that the recipient has been accepted for Medicaid services by another local jurisdiction, state, territory or commonwealth;
  • a change in the level of medical care is prescribed by the recipient's physician.

Program Support Unit (PSU) staff must coordinate the termination of Community Care Services Eligibility (CCSE) with the CCSE case manager, so the member does not experience a break in services and does not receive concurrent services through another waiver or CCSE service. 

PSU staff must complete the following activities within two business days of notification:

  • contact the PSU supervisor to obtain the contact information for the CCSE case manager; 
  • email the CCSE case manager the following information: 
    • a subject line that reads “CCSE Closure – STAR+PLUS HCBS Enrollment XX [first letter of the member’s first and last name].” For example, the email subject line for a STAR+PLUS HCBS program termination for Ann Smith would be “STAR+PLUS HCBS Termination for AS”;
    • member’s name;
    • Medicaid ID;
    • start of care (SOC) date for STAR+PLUS HCBS program; 
    • managed care organization (MCO);
    • Form H2065-D, Notification of Managed Care Program Services;
  • ensure the Service Authorization System Online (SASO) reflects the closure of CCSE records with Service Group 7 and have an end date one day before the SOC for the STAR+PLUS HCBS program; and
  • follow instructions in  Section 3311.2, Enrollment Procedures following Release from the Interest List, to complete STAR+PLUS HCBS program enrollment.

PSU staff must encourage the member to contact the MCO to request any CCSE services not included in the STAR+PLUS HCBS program individual service plan (ISP).

3313.1 Procedure for STAR+PLUS HCBS Program Applicants

Revision 18-0; Effective September 4, 2018

For individuals entering the STAR+PLUS Home and Community Based Services (HCBS) program, Program Support Unit (PSU) staff must coordinate the termination of other waiver or Community Care Services Eligibility (CCSE) services with the waiver or CCSE case manager. This ensures the individual does not experience a break in services and does not receive concurrent services through another waiver or CCSE service.

It is not necessary to provide an adverse action period prior to closing the authorization in the Service Authorization System Online (SASO).

CCSE services are terminated by the CCSE case manager no later than the day prior to STAR+PLUS HCBS program enrollment. This is crucial since no STAR+PLUS HCBS program individual may receive CCSE and STAR+PLUS HCBS program services on the same day. The CCSE case manager must send:

  • Form H2065-A, Notification of Community Care Services, denying ongoing Texas Health and Human Services Commission (HHSC) services to the member; and
  • Form 2101, Authorization for Community Care Services, to the provider. Include a notation in the comments section that the individual is transferring from CCSE to the STAR+PLUS HCBS program.

3313.2 Procedure for STAR+PLUS HCBS Program Members

Revision 18-0; Effective September 4, 2018

If it is determined an existing STAR+PLUS Home and Community Based Services (HCBS) program member is receiving any Service Group (SG) 7 Community Care Services Eligibility (CCSE) services, Program Support Unit (PSU) staff must begin denial procedures for the SG 7 service immediately.

If CCSE services are authorized in SASO, the CCSE case manager must immediately send:

  • Form H2065-A, Notification of Community Care Services, including a notation to the provider in the comments section that the individual is transferring to the STAR+PLUS HCBS program; and
  • Form 2101, Authorization for Community Care Services, to the provider. Include a notation in the comments section that the individual is transferring from CCSE to the STAR+PLUS HCBS program.

3314 Managed Care Organization Changes

Revision 18-0; Effective September 4, 2018

Members may change managed care organization (MCO) plans as often as monthly by contacting the Texas Health and Human Services Commission (HHSC) enrollment broker at 800-964-2777. The HHSC enrollment broker makes plan changes based on the monthly cutoff periods, which occur around the middle of each month. Depending on which day of the month (before or after the HHSC enrollment broker cutoff), the plan change will either occur the first day of the next month or the month after. The change will show up on the 834 daily enrollment file, notifying the MCO of the new member. Program Support Unit staff, when notified by the member, HHSC or an MCO that a member has elected to change MCOs, will update the Service Authorization System Online (SASO) to change the previous MCO to the new MCO.

3315 STAR+PLUS HCBS Program Individuals Requesting Non-Managed Care Services

Revision 18-0; Effective September 4, 2018

Requirements of the STAR+PLUS Home and Community Based Services (HCBS) program provide all of the services (excluding hospice) needed to enable the member to live safely in the community. Therefore, non-managed care services cannot be authorized for the STAR+PLUS HCBS program member. A STAR+PLUS HCBS program member requesting additional services must be referred to the managed care organization's (MCO’s) service coordinator.

Hospice services may be authorized along with STAR+PLUS services or the STAR+PLUS HCBS program.

3315.1 Requests from Individuals Awaiting Managed Care Enrollment

Revision 18-0; Effective September 4, 2018

While awaiting enrollment in managed care, individuals are entitled to receive services from the Community Care Services Eligibility (CCSE) program. Referrals to CCSE must be made for all full Medicaid recipients awaiting enrollment for managed care. CCSE staff may assess these individuals for services if it appears services can be authorized and delivered prior to enrollment.

3315.2 Requests from STAR+PLUS HCBS Program Members

Revision 18-0; Effective September 4, 2018

Requirements of the federal 1115 waiver dictate that the STAR+PLUS Home and Community Based Service (HCBS) program provide the services (excluding hospice) needed to enable the member to live safely in the community. Therefore, non-managed care services cannot be authorized for STAR+PLUS HCBS program members. STAR+PLUS HCBS program members requesting additional services must be referred to the managed care organization's (MCOs) service coordinator.

Hospice services may be authorized along with STAR+PLUS services or the STAR+PLUS HCBS program.

3316 Transfer from Another Medicaid Waiver Program to the STAR+PLUS HCBS Program

Revision 24-1; Effective Feb. 22, 2024

Individuals in the following Medicaid waiver programs may request an assessment for the STAR+PLUS Home and Community Based Services (HCBS) program at any time:

  • Community Living Assistance and Support Services (CLASS);
  • Deaf Blind with Multiple Disabilities (DBMD);
  • Home and Community-based Services (HCS);
  • Home and Community Based Services – Adult Mental Health (HCBS-AMH) program; or
  • Texas Home Living (TxHmL).

Program Support Unit (PSU) supervisors receives a report by email from Interest List Management (ILM) Unit staff. The email identifies STAR+PLUS HCBS program interest list release individuals currently enrolled in another Medicaid waiver program. PSU staff may also receive a referral from Medicaid waiver program staff if an individual is enrolled in another Medicaid waiver program and is requesting the STAR+PLUS HCBS program. Refer any Medicaid waiver program transfer request received from the managed care organization (MCO) or Local Intellectual and Developmental Disability Authority (LIDDA) to the PSU supervisor. 

PSU staff must mail the following enrollment packet to the individual within three business days of the initial request for a STAR+PLUS HCBS program assessment:

PSU staff must contact the individual or authorized representative (AR) to verify receipt of the enrollment packet and explain the STAR+PLUS HCBS program services within 14 days from the mail date of the above enrollment packet. PSU staff must:

  • encourage the individual to complete the enrollment packet and mail it back; and
  • inform the individual that there might be a delay in eligibility determination for the STAR+PLUS HCBS program if the individual does not return the enrollment packet.

PSU staff can accept the individual’s or AR’s verbal statement of interest in the STAR+PLUS HCBS program or through receipt of Form H3675.

PSU staff must document all attempted contacts with the individual or encountered delays in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub within two business days of the individual’s or AR’s confirmed interest in the STAR+PLUS HCBS program.

The MCO must complete the following activities within 45 days from the date PSU staff upload Form H3676 to the MCOHub:

  • submit the Medical Necessity and Level of Care (MN/LOC) Assessment in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
  • submit the individual service plan (ISP) in the TMHP LTCOP; and
  • complete and upload Section B of Form H3676 to the MCOHub.

PSU staff must email the Program Support Operations Review Team (PSORT) if the MCO does not provide the MN/LOC Assessment, Form H1700-1 or Form H3676 within 45 days from the date PSU staff uploads Form H3676 to the MCOHub.

PSU staff must complete the following activities within two business days of receipt of all required STAR+PLUS HCBS program eligibility documentation:

  • confirm STAR+PLUS HCBS program eligibility by verifying the individual:
    • is over 21 in the Texas Integrated Eligibility Redesign System (TIERS);
    • has Medicaid eligibility for the STAR+PLUS HCBS program in TIERS;
    • has an approved MN/LOC Assessment in the TMHP LTCOP;
    • has an individual service plan (ISP) with at least one STAR+PLUS HCBS program service; and
    • has an ISP Resource Utilization Group (RUG) value within the individual’s cost limit.

PSU staff must approve the applicant’s enrollment in the STAR+PLUS HCBS program the first day of the following month after verifying all STAR+PLUS HCBS program eligibility criteria are met.

PSU staff must complete the following activities within two business days of verifying all STAR+PLUS HCBS program eligibility criteria are met:

  • manually or electronically generate Form H2065-D, Notification of Managed Care Program Services, with a SOC date being the first day of the month following the other Medicaid waiver program's termination;
  • mail Form H2065-D to the member;
  • upload Form H2065-D to the MCOHub, if manually generated;
  • notify the Enrollment Resolution Services (ERS) Unit staff by email with the following required information:
    • an email subject line that reads “Waiver Transfer Request for XX [first letter of the member’s first and last name]”;
    • the member’s name;
    • Medicaid identification (ID) number;
    • type of request (i.e., waiver transfer);
    • MN approval date;
    • ISP receipt date;
    • ISP begin date;
    • ISP end date;
    • MCO;
    • termination effective date for the other Medicaid waiver program;
    • effective date of enrollment for the STAR+PLUS HCBS program; and
    • Form H2065-D.
  • for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet, and Form H2065-D to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the STAR+PLUS HCBS program start of care (SOC) date and the termination date for the other Medicaid waiver program;
  • upload applicable documents to the HEART case record; and
  • document and close the HEART case record.

PSU staff must coordinate with all other Medicaid waiver program staff, as appropriate, ensuring the current Medicaid waiver program services end the day before enrollment in the STAR+PLUS HCBS program.

Title 1 Texas Administrative Code (TAC) Section 353.1153(a)(1)(F) states that STAR+PLUS HCBS program members cannot be enrolled in more than one Medicaid waiver program at a time. Refer to Appendix XVIII, Mutually Exclusive Services, to determine if two services may be received simultaneously.

3317 Transfer from STAR+PLUS HCBS Program to Another Medicaid Waiver Program

Revision Notice 24-1; Effective Feb. 22, 2024

Title 1 Texas Administrative Code (TAC) Section 353.1153(a)(1)(F) states that STAR+PLUS Home and Community Based Services (HCBS) members are not able to enroll in more than one Medicaid waiver program at a time. Refer to Appendix XVIII, Mutually Exclusive Services, to determine if a member may receive two services simultaneously.

A STAR+PLUS HCBS program member may be on an interest list for an Intellectual and Developmental Disabilities (IDD) Medicaid waiver program, such as:

  • Community Living Assistance and Support Services (CLASS);
  • Deaf Blind with Multiple Disabilities (DBMD);
  • Home and Community-based Services (HCS); or
  • Texas Home Living (TxHmL).

A STAR+PLUS HCBS program member may also be eligible for another waiver such as the Home and Community Based Services – Adult Mental Health (HCBS-AMH) program that does not have an interest list.

Program Support Unit (PSU) staff may receive notification from Medicaid waiver program staff or the managed care organization (MCO) that the STAR+PLUS HCBS program member:

  • is eligible for another Medicaid waiver program;
  • chooses to transfer to another Medicaid waiver program; or
  • is already enrolled in another Medicaid waiver program.

PSU staff must coordinate the program enrollment effective date with IDD waiver program staff. PSU staff must request confirmation of the program enrollment and the enrollment effective date from the IDD waiver program staff if the MCO or Local Intellectual and Developmental Disability Authority (LIDDA) notifies PSU staff of a waiver transfer. The IDD waiver program staff must confirm the member’s enrollment effective date. 

PSU staff must complete the following activities within three business days from notification:

  • create a Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record, if applicable;
  • contact and coordinate with Medicaid waiver program staff by email to determine the STAR+PLUS HCBS program termination date and the start of care (SOC) date for the other Medicaid waiver program;
  • terminate the individual service plan (ISP) in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) using an end-date that aligns with the termination effective date;
  • verify the following service group (SG) 19 records in SASO the last day of the month before the member’s enrollment in the Medicaid waiver program:
    • Authorizing Agent;
    • Enrollment;
    • Service Plan;
    • Service Authorization.
  • manually generate Form H2065-D, Notification of Managed Care Program Services, with a termination effective date one day before other Medicaid waiver’s start of care (SOC) date;
  • mail Form H2065-D to the member;
  • upload Form H2065-D to the MCOHub;
  • notify the Enrollment Resolution Services (ERS) Unit staff by email. The email to ERS Unit staff must include:
    • an email subject line that reads “Waiver Transfer Request for XX [first letter of the member’s first and last name].” For example, the email subject line for a waiver transfer for Ann Smith would be “Waiver Transfer Request for AS”;
    • the member’s name;
    • Medicaid identification (ID) number;
    • type of request (i.e., waiver transfer);
    • MN approval date;
    • ISP receipt date;
    • ISP begin date;
    • ISP end date;
    • MCO;
    • termination effective date for the STAR+PLUS HCBS program;
    • enrollment effective date for the other Medicaid waiver program; and
    • Form H2065-D;
  • for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet, and Form H2065-D to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the STAR+PLUS HCBS program termination date and the start of care (SOC) date for the other Medicaid waiver program;
  • upload all applicable documents to the HEART case record; and
  • document and close the HEART case record.

Note: PSU staff must not close Medical Necessity, Level of Service, and Diagnostic SG 19 – STAR+PLUS records in SASO.

3320 Coordination with Medicaid for the Elderly and People with Disabilities

Revision 18-0; Effective September 4, 2018

3321 General Eligibility Issues

Revision 18-0; Effective September 4, 2018

At the initial contact, Program Support Unit (PSU) staff must inform the medical assistance only (MAO) applicant, member or authorized representative (AR) that Medicaid for the Elderly and People with Disabilities (MEPD) specialists will complete a financial eligibility (Medicaid) determination. PSU staff should encourage the applicant, member or AR to cooperate with the MEPD specialist and to provide all verifications necessary in a timely manner.

Any information, including information on third-party insurance, obtained by PSU staff, must be shared with the MEPD specialist to prevent the applicant or member from having to provide the information twice.

PSU staff must inform the MEPD specialists of the request for the STAR+PLUS Home and Community Based Services (HCBS) program by faxing a completed and signed Form H1200, Application for Assistance – Your Texas Benefits, along with Form H1746-A, MEPD Referral Cover Sheet, following the guidelines provided in Appendix II, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet, within two business days of receipt. Form H1200 is not required for members receiving Supplemental Security Income (SSI).

3321.1 Disability Determinations

Revision 18-0; Effective September 4, 2018

The following information is provided for informational purposes only regarding the disability determination process. Program Support Unit (PSU) staff have no role in this process.

If a STAR+PLUS HCBS program applicant or member's application for Supplemental Security Income (SSI) disability has been pending over 90 days, the Texas Health and Human Services Commission (HHSC) Disability Determination Unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination. PSU staff will not be notified of the individual's Medicaid for the Elderly and People with Disabilities (MEPD) eligibility status until disability is determined. In order for DDU staff to make a disability determination, the MEPD specialist must obtain the following:

  • Form H3034, Disability Determination Socio-Economic Report;
  • Form H3035, Medical Information Release/Disability Determination; and
  • a copy of the Medical Necessity and Level of Care (MN/LOC) Assessment.

3322 Actions Pending Past the MEPD Due Date

Revision 18-0; Effective September 4, 2018

Because Program Support Unit (PSU) staff depend on the Medicaid for the Elderly and People with Disabilities (MEPD) specialist to determine eligibility for medical assistance only (MAO) applicants, there are times when PSU staff must check with the MEPD specialist regarding the status of an application or program change.

PSU staff must contact the MEPD specialist by sending an email to the HHSC OES MEPD IC mailbox. PSU staff must ensure the MEPD time frame has expired. MEPD specialists have 45 days to complete applications for individuals over age 65. MEPD specialists have 90 days for individuals under age 65 whose disability has not yet been determined by the Social Security Administration (SSA).

3330 STAR+PLUS Members Requesting an Upgrade to the STAR+PLUS HCBS Program

Revision 22-1; Effective January 31, 2022

Medicaid members enrolled in STAR+PLUS qualify for Medicaid eligibility through various program types. Some members who request the STAR+PLUS Home and Community Based Services (HCBS) program may be Medicaid eligible through one of the following Medicaid program types (TPs):

  • Pickle (TP-03);
  • Disabled Adult Child (TP-18);
  • Disabled Widow(er) (TP-21);
  • Early Aged Widow(er) (TP-22);
  • Medicaid Buy-in (TP-87); or
  • Medicaid for Breast and Cervical Cancer (MBCC) (TA-67).

The above Medicaid programs represent full Medicaid eligibility; however, they do not consider transfer of assets and substantial home equity reviews required to establish financial eligibility for the STAR+PLUS HCBS program. Therefore, these Medicaid types are not eligible for an upgrade and enrollment in the STAR+PLUS HCBS program until the Medicaid for the Elderly and People with Disabilities (MEPD) specialist tests for the additional criteria.

The managed care organization (MCO) must notify the Program Support Unit (PSU) staff by uploading Form H2067-MC, Managed Care Programs Communication, to TxMedCentral within three business days of an upgrade request for a member who has one of these Medicaid program types. PSU staff must contact the member within three business days of receiving Form H2067-MC to advise the member to complete and return Form H1200, Application for Assistance - Your Texas Benefits, to PSU staff.

PSU staff fax the signed and completed Form H1200 and Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist within two business days of receipt from the member. PSU staff must refer to Appendix II, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet, when completing Form H1746-A.

The MCO service coordinator must complete the following activities within 45 days of a STAR+PLUS individual’s request for the STAR+PLUS HCBS program:

  • complete the Medical Necessity and Level of Care (MN/LOC) Assessment and submit it to Texas Medicaid & Healthcare Partnership (TMHP) to request medical necessity (MN); and
  • upload Form H1700-1, Individual Service Plan (Pg. 1), to TxMedCentral.

PSU staff review Form H1700-1 to determine if the member meets eligibility criteria for the STAR+PLUS HCBS program within five business days of receipt of Form H1700-1 from the MCO.

The MCO must inform PSU staff within three business days by uploading Form H2067-MC to TxMedCentral if an MN/LOC Assessment for an upgrade is denied. PSU staff fax Form H1746-A and Form H2065-D, Notification of Managed Care Program Services, to the MEPD specialist as notification of denial within three business days of PSU staff receiving Form H2067-MC from the MCO.

PSU staff must complete the following activities if an applicant does not meet STAR+PLUS HCBS program eligibility requirements:

  • follow actions in Section 6000, Denials and Terminations, to deny the request;
  • mail Form H2065-D within three business days to the applicant; and
  • upload Form H2065-D to TxMedCentral following the instructions in Appendix XXXIV.

PSU staff will process the member’s upgrade if the member is eligible by:

  • manually generating Form H2065-D and mailing it to the member;
  • uploading Form H2065-D in TxMedCentral in the MCO's SPW folder, following the instructions in Appendix XXXIV;
  • faxing Form H1746-A and Form H2065-D to the MEPD specialist; and
  • confirming Service Authorization System Online (SASO) entries to authorize eligibility for the STAR+PLUS HCBS program are complete and accurate. PSU staff will correct existing SASO records as needed.