9100, Initial Service Authorization

Revision 18-0; Effective September 4, 2018

When Program Support Unit (PSU) staff authorize the STAR+PLUS Home and Community Based Services (HCBS) program for an initial service authorization in the Service Authorization System Online (SASO), PSU staff must check or create the following records according to Sections 9110 through 9170:

• Authorizing Agent – Initial;
• Enrollment – Initial;
• Service Plan – Initial;
• Service Authorization – Initial;
• Level of Service  – Initial;
• Diagnosis – Initial; and
• Medical Necessity – Initial. 

9110 Authorizing Agent - Initial

Revision 18-0; Effective September 4, 2018

The authorizing agent record in the Service Authorization System Online (SASO) is used to register the authorizing agent begin date with an open ended date for the STAR+PLUS Home and Community Based Services (HCBS) program applicant.

There will normally be one authorizing agent registered in SASO for a STAR+PLUS HCBS program applicant.

Initial individual service plans (ISPs) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal have a system generated authorizing agent. The TMHP LTC Online Portal interfaces with the SASO and records "STAR+PLUS" in the ‘Authorizing Agent’ field and records the managed care organization (MCO) service coordinator's name in the ‘Name’ field.

The TMHP LTC Online Portal will generate changes to the SASO authorizing agent records for a member with a plan code change during an ISP year for which a current or future ISP is in a "processed/complete" status. In this case, a SASO authorizing agent record is created for the initial ISP with a begin date equal to the new managed care organization (MCO) plan effective date. The SASO authorizing agent record for the transferred ISP is automatically ended with the prior MCO plan enrollment end date.

Program Support Unit (PSU) staff do not register an authorizing agent for an electronic ISP.

PSU staff can create authorizing agent record(s) for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm the authorizing agent registration in SASO.  

PSU staff are registered as the authorizing agent when an applicant is authorized in SASO.

To register an authorizing agent record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

1. Select the Authorizing Agent field in the Case Worker functional area.
2. Select Add and a blank Authorizing Agent Details record will appear.
3. Move to the Type field and select CM – Case Manager from the drop-down menu.
4. Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Leave the Send to TMHP field at the default selection N - NO.
6. Move to the Begin Date field and enter the date the record is being created. Leave the End Date field blank.
7. Move to the Authorizing Agent field and enter STAR+PLUS.
8. Leave the Agency field at the default selection 324 - DHS.
9. Move to the Name field and enter the PSU staff’s service area.
10. Move to the Phone field and enter the telephone number of the authorizing agent. Enter the area code, phone number and extension.
11. Move to the Mail Code field and enter the appropriate Managed Care Organization (MCO) plan code from the table below. Note: Six service areas include Medicare-Medicaid Plans (MMP).

9120 Enrollment - Initial

Revision 18-0; Effective September 4, 2018

The enrollment record in the Service Authorization System Online (SASO) is used to register the enrollment begin and end date for the STAR+PLUS Home and Community Based Services (HCBS) program applicant.

Program Support Staff (PSU) staff will create an enrollment record for STAR+PLUS HCBS program eligibility for applicants whose individual service plan (ISP) was not transmitted electronically.

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register an enrollment record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

1. Select the Enrollment field in the Program and Service functional area.
2. Select Add and a blank Enrollment Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Enrolled From field and select the appropriate entry from the drop-down menu.
5. Move to the Living Arrangement field, and select the appropriate community-based living arrangement from the drop-down menu. The living arrangement must match the information provided in the initial ISP.
6. Move to the Begin Date field and enter the date the member is to be enrolled in his MCO, which will always be the first day of a month.
7. Leave the End Date field blank.
8. Leave the Termination Code and Waiver Type fields at the defaults.
9. Select the Save button. 

9130 Service Plan - Initial

Revision 18-0; Effective September 4, 2018

The Service Plan record in the Service Authorization System Online (SASO) is used to register an individual service plan (ISP) for a STAR+PLUS Home and Community Based Services (HCBS) program member. The service plan record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Resource Utilization Group (RUG) value and the total estimated cost taken from the member’s Form H1700-1, Individual Service Plan (Pg. 1), for members who do not have an electronic ISP.

Program Support Staff (PSU) staff will create a service plan record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register a service plan record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

1. Select the Service Plan field in the Program and Service functional area.
2. Select Add and a blank Service Plan Details record will appear.
3. Leave the Type field at the default selection AN - ANNUAL PLAN.
4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the RUG value entered on the current ISP coverage period, from Form H1700-1.  For a STAR+PLUS HCBS program member who is ventilator use-dependent, enter the annual STAR+PLUS HCBS program ISP cost limit based on the RUG value and ventilator use of the member (6-23 hours or 24 hours continuous).
6. Move to the Begin Date field and enter the effective date of the ISP coverage period.
7. Move to the End Date field and enter the last day of the ISP coverage period.
8. Move to the Amount Authorized field and enter the total estimated cost of all STAR+PLUS HCBS program services authorized for the current ISP coverage period, from Form H1700-1.
9. Leave the Amount Paid field at the default setting of 0.00.
10. Leave the Units Authorized field at the default of 0.00.
11. Leave the Units Paid field at the default of 0.00.
12. Select the Save button. 

9140 Service Authorization - Initial

Revision 18-0; Effective September 4, 2018

If the individual service plan (ISP) is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service authorization records in the Service Authorization System Online (SASO).

Program Support Unit (PSU) staff do not register service authorization records for an electronic individual service plan (ISP).

PSU staff will create a service authorization record, if applicable, for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm service authorization registration in SASO, take a screenshot of the service authorization registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

To register a service authorization record for STAR+PLUS HCBS program eligibility for a member whose ISP requires manual entry, PSU staff must:

1. Select the Service Authorization field in the Program and Service functional area.
2. Select Add and a blank Service Authorization Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
5. Leave the Fund and Term. Code fields at the defaults.
6. Leave the Agency field at the default selection 324 - DHS.
7. Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
8. Move to the Units field and enter 1.00.
9. Leave the Amount field at the default.
10. Move to the Begin Date field and enter the effective date of the ISP coverage period.
11. Move to the End Date field and enter the last day of the ISP coverage period.
12. Move to the Contract No field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

9150 Level of Service - Initial

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a Resource Utilization Group (RUG) registered on a level of service (LOS) record in the Service Authorization System Online (SASO). The LOS record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the RUG value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system generated LOS record will have an end date that may need to be extended by Program Support Unit (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: If the MN/LOC Assessment is approved with an effective date of May 13, 2019, the system-generated end date for the LOS record will be May 12, 2020. If the ISP period is June 1, 2019 to May 31, 2020, the LOS record will need to be extended to May 31, 2020, so the member has coverage for the entire ISP period.

To extend an LOS record for a STAR+PLUS HCBS program applicant, PSU staff must:

1. Select the Level of Service field in the Medical functional area.
2. Select the Level of Service record you wish to extend.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If an LOS record has not been created in SASO, PSU staff must complete the following steps to add the record:

1. Select the Level of Service field in the Medical functional area.
2. Select Add and a blank Level of Service Details record will appear.
3. Move to the Type field and select CR – CBA RUG from the drop-down menu.
4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
5. Move to the Level field and enter the RUG level from Form H1700-1, Individual Service Plan (Pg. 1). The RUG level can be verified in the MN/LOC Assessment.
6. Move to the Begin Date field and enter the first day of the ISP period.
7. Move to the End Date field and enter the last day of the ISP period.
8. Select the Save button.

9160 Diagnosis - Initial

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record should be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record will have an end date that may need to be extended by Program Support Staff (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: If MN is approved with an effective date of November 13, 2019, the system generated end date will be November 30, 2020.

To extend a diagnosis record for a STAR+PLUS HCBS program applicant or member:

1. Select the Diagnosis field in the Medical functional area.
2. Select the Diagnosis record you wish to extend.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If a diagnosis record has not been created in SASO, PSU staff must complete the following steps to add the record:

1. Select the Diagnosis field in the Medical functional area.
2. Select Add and a blank Diagnosis Details record will appear.
3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
4. Move to the Begin Date field and enter the first day of the ISP period.
5. Move to the End Date field and enter the last day of the ISP period.
6. Enter up to five diagnoses from the most recent Waiver 3.0 Form, Section I, in TMHP. The diagnosis can be verified in the MN/LOC Assessment.
7. Select Version ICD-10-CM CODE.
8. Select the Save button.

9170 Medical Necessity - Initial

Revision 18-0; Effective September 4, 2018

All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have an end date that may need to be extended by Program Support Staff (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

PSU staff will create an MN record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

Example: If MN is approved with an effective date of May 13, 2019, the system generated end date will be May 31, 2020.

To extend an MN record for a STAR+PLUS HCBS program applicant, PSU staff must:

1. Select the MN field in the Medical functional area.
2. Select the MN record you wish to extend.
3. Select the Modify button to open and modify.
4. Move to the End Date field and change the date to the last day of the ISP period.
5. Select the Save button.

If an MN record has not been created in SASO, PSU staff must complete the following steps to add the record:

1. Select the MN field in the Medical functional area.
2. Select Add and a blank MN Details record will appear.
3. Move to the MN field and select Y - YES from the drop-down menu.
4. Move to the Permanent field and select N – NO.
5. Move to the Begin Date field and enter the first day of the ISP period.
6. Move to the End Date field and enter the last day of the ISP period.
7. Select the Save button.