5310 Using the TMHP Long Term Care Online Portal

Revision 24-1; Effective Feb. 22, 2024

The managed care organization (MCO) must submit the Medical Necessity and Level of Care (MN/LOC) Assessment through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) to process a determination of MN and the Resource Utilization Group (RUG) value. MCOs submit the MN/LOC Assessment as an:

  • initial MN/LOC Assessment for an applicant or individual being assessed for the STAR+PLUS Home and Community Based Services (HCBS) program;
  • annual MN/LOC Assessment for a member's ongoing eligibility for the STAR+PLUS HCBS program; 
  • a significant change in status MN/LOC Assessment for a STAR+PLUS HCBS program member requesting a change to their RUG.

The MCO must generate an amended individual service plan (ISP) when a significant change occurs in a member’s condition. The MCO must keep amended ISPs in the MCO’s member case file. The MCO does not provide the amended ISP to Program Support Unit (PSU) staff and does not enter the amended ISP in the TMHP LTCOP. PSU staff must advise the MCO that PSU staff do not process ISPs resulting from a significant change if the MCO uploads an amended ISP to the MCOHub.

The MCO has access to the TMHP LTCOP to:

  • check and verify MN status and RUG;
  • review workflow actions that result from the submittal of the MN/LOC Assessment or the individual service plan (ISP);
  • manage and act in response to workflow messages; and
  • submit Form H1700-1, Individual Service Plan, for initial, change, and reassessment of members except for age-outs and nursing facility (NF) residents transitioning to the STAR+PLUS HCBS program.

Submittal of the MN/LOC Assessment through the TMHP LTCOP creates MN, Level of Service (LOS) and Diagnosis (DIA) records in the Service Authorization System Online (SASO). The RUG value is in the LOS record.

Status messages appear in the TMHP LTCOP workflow folder when an MN/LOC Assessment is submitted. Error messages with status codes appear when TMHP processing cannot be completed. Status messages may generate when:

  • assessments have missing information;
  • the system cannot match the assessment to an applicant or individual record;
  • the individual is enrolled in another Medicaid waiver program;
  • assessment forms are out of sequence;
  • corrections are made to assessments after submission to SASO records have already been generated based on the assessment;
  • changes occur in MN or LOS status that affect the member’s services; or
  • PSU staff manually changed historic SASO records within the current ISP period.

This list is not all-inclusive.

PSU staff must:

  • document responses in the TMHP LTCOP to workflow messages appearing for an individual by clicking on applicable buttons related to the messages; and
  • check TMHP LTCOP workflow items to process case actions.