Revision 25-1; Effective Feb. 19, 2025

3610 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

3620 Reassessment

Revision 18-0; Effective September 4, 2018

3621 Individual Service Plan Expiring Report

Revision 24-4; Effective Dec. 1, 2024

The assigned Program Support Unit (PSU) staff reviews the Individual Service Plan (ISP) Expiring Report for the STAR+PLUS Home and Community Based Services (HCBS) program monthly to ensure reassessments are conducted on time. The ISP Expiring Report details members with ISPs that expire within the next 90 days.

The assigned PSU staff provides this report to the managed care organizations (MCOs) before the monthly call with PSU staff. The MCOs must provide a status update for all members who have ISPs expiring within the next 45 days. Only ISPs expiring within 45 days require a status update from the MCO.

The process to manage the ISP Expiring Report follows:

  • PSU staff provide the ISP Expiring Report to the MCO point of contact, the Program Support Operations Review Team (PSORT), and to the Managed Care Contracts and Oversight (MCCO) Unit staff by email five business days before the scheduled monthly call. The day of the call is considered the sixth business day.
  • The MCO must research and provide a written status for each member whose ISP expires within 45 days by completing the columns highlighted in red on the spreadsheet.
  • The MCO must return a completed report to PSU staff within two business days before the monthly call.
  • PSU staff review the MCO responses to determine if the MCO needs to provide clarification about any member’s ISP status. Only ISP statuses that PSU staff have questions on are reviewed during the monthly call. There is no need to review each member for the status of the ISP if the MCO response is sufficient. PSU staff use the columns in blue on the spreadsheet for internal tracking purposes.

Note: The monthly call may also be held if PSU staff or the MCO need to discuss items unrelated to the ISP Expiring Report.

The assigned PSU staff must check the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) to determine if the MCO has submitted the member’s ISP before the ISP end date. The assigned PSU staff must email PSORT the ISP Expiring Report each month as notification of late MCO reassessment activity. The ISP Expiring Report must be in an Excel spreadsheet format and edited so that it only identifies ISPs being reported as delinquent. The subject line for the email must read: STAR+PLUS HCBS Reassessment Delinquencies for [Month].

The assigned PSU staff is not required to send a follow up email to PSORT when the MCO submits the following documents for reassessment delinquencies:

3621.1 Reassessment Procedures

Revision 24-4; Effective Dec. 1, 2024

The managed care organization (MCO) must complete annual assessment activities within 45 days of the individual service plan (ISP) expiration date. Assessment activities include:

  • conducting an annual Medical Necessity and Level of Care (MN/LOC) assessment;
  • developing Form H1700-1, Individual Service Plan (PDF); and
  • submitting the MN/LOC and ISP to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).

Designated Program Support Unit (PSU) staff must:

  • search the TMHP LTCOP for ISPs submitted daily; and
  • create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and assign it to a designated PSU staff person.

PSU staff must complete the following activities within five business days of receipt of the reassessment HEART case record:

  • verify ongoing Medicaid financial eligibility and managed care enrollment is active in Texas Integrated Eligibility Redesign System (TIERS);
  • check the TMHP LTCOP to verify the member has:
    • an approved MN/LOC Assessment;
    • an ISP that is within the cost limit that includes at least one STAR+PLUS HCBS program service;
  • verify that personal assistance services (PAS) and emergency response services (ERS) are not included in the ISP services for a member who receives Supplemental Security Income (SSI) or SSI-related Medicaid, such as Medicaid for Disabled Adult Children (DAC) or Pickle Medicaid;
    • Note: PAS and ERS must be authorized through Community First Choice (CFC) for a SSI or SSI-related Medicaid recipient;
  • verify the Service Authorization System Online (SASO) service authorization records are accurate;
  • electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF), if the member continues to meet STAR+PLUS HCBS program requirements;
  • mail Form H2065-D to the member;
  • upload applicable documents to the HEART case record; and
  • document the HEART case record.

Refer to Section 9200, Reassessment Service Authorization, for more information on SASO record verifications.

PSU staff must ensure the member's ISP is entered into the SASO annually. The MCO must upload the ISP to the MCOHub if they are experiencing issues submitting it electronically in the TMHP LTCOP. PSU staff must manually enter the ISP into SASO within five business days of receipt of the reassessment HEART case record, but not later than the ISP end date if the MCO is not able to submit the ISP electronically.

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

Refer to Section 7000, Applicant or Complaints, Internal MCO Appeals and State Fair Hearings, if the member files a state fair hearing within the adverse action notification period.