5200, Reassessment 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 member continues to meet 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;
  • electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF), in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
  • mail Form H2065-D to the member;
  • 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.