5100, Initial Referrals for Medically Fragile or GR

Revision 25-1; Effective Feb. 19, 2025

Program Support Unit (PSU) staff must complete the following activities within five business days of receipt of an approved case assignment from Utilization Review (UR) staff for the Medically Fragile group or General Revenue (GR) funds process:

  • confirm the applicant meets all eligibility criteria for the STAR+PLUS Home and Community Based Services (HCBS) program with the allowance of the individual service plan (ISP) exceeding the cost limit;
  • manually or electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF);
  • upload Form H2065-D to the MCOHub, if manually generated;
  • mail Form H2065-D to the member;
  • for Medical Assistance Only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet (PDF), and Form H2065-D to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist;
  • email Enrollment Resolution Services (ERS) Unit staff the following information:
    • an email subject line that reads STAR+PLUS HCBS Enrollment for XX [member’s first and last name initials];
    • the member’s name;
    • Medicaid identification (ID) number;
    • type of request: ILR, MFP or upgrade enrollment;
    • effective date of enrollment;
    • Form H2065-D as an attachment;
  • upload all applicable documents to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
  • document and close the HEART record.