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Revision 22-2; Effective March 4, 2022
Program Support Unit (PSU) staff must mail Form H2065-D, Notification of Managed Care Program Services, to the member no later than 12 business days prior to the termination effective date. This requirement ensures:
- the member maintains services while Form H2065-D travels through the mail; and
- the member has enough time to request a state fair hearing with the option of maintaining continued STAR+PLUS Home and Community Based Services (HCBS) program services until a state fair hearing decision is rendered.
Day zero is the day PSU staff mail Form H2065-D to the member.
The STAR+PLUS HCBS program termination dates are typically on the last day of the month. PSU staff must manually extend the end date all service group (SG) 19 records in the Service Authorization System Online (SASO) to the last day of the following month if:
- the 12th business day is beyond the current ISP end date; and
- the adverse action notification period applies.
See the example chart below for further clarification.
Example Chart
| Form H2065-D Sent | Original ISP End Date | Adverse Action Expiration Date: 12th Business Day | Extend ISP in SASO for Adverse Action | Form H2065-D Termination Date | Member Requests State Fair Hearing | Services Continue During State Fair Hearing? |
|---|---|---|---|---|---|---|
| 6/12/20 | 7/31/20 | 6/30/20 | No | 7/31/20 | 7/15/20 | Yes |
| 6/1/20 | 6/30/20 | 6/17/20 | No | 6/30/20 | 7/2/20 | No |
| 6/25/20 | 6/30/20 | 7/13/20 | Yes | 7/31/20 | 7/17/20 | Yes |
| 6/25/20 | 6/30/20 | 7/13/20 | Yes | 7/31/20 | 7/13/20 | Yes |
| 8/28/20 | 8/31/20 | 9/15/20 | Yes | 9/30/20 | 9/14/20 | Yes |
The adverse action notification period does not apply to all member terminations. The adverse action notification period does not apply when:
- PSU staff has factual information confirming the death of a member;
- the member submits a signed written statement waiving their right to the adverse action notification period and understands their services will end;
- the member is denied Medicaid financial eligibility for the STAR+PLUS HCBS program;
- the member is admitted to an institution for 90 consecutive days where STAR+PLUS HCBS program services cannot be delivered;
- the member accepts Medicaid services by another jurisdiction, state, territory or commonwealth; or
- the member chooses to enroll in another Medicaid waiver program.