Revision 18-0; Effective September 4, 2018

There are several situations that are considered transfers for STAR+PLUS Home and Community Based Service (HCBS) program members, and the procedures differ for each.

9310 Transfers from One STAR+PLUS Area to Another Area

Revision 23-2; Effective May 15, 2023

Two different situations can occur when a STAR+PLUS Home and Community Based Services (HCBS) program member transfers from one service area (SA) to another SA. The first situation is when a member transfers to a new SA that the current managed care organization (MCO) also operates in, and the member wants to stay with that MCO. The contract number will change even though the member stays with the same MCO. As a result, the member’s records will need to be closed under the previous contract number and opened under the new contract number. The second situation is when the member transfers to a new SA that the current MCO does not operate in, and the member changes MCOs.

The Texas Integrated Eligibility Redesign System (TIERS) updates the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) if the member's individual service plan (ISP) is electronic and the member made a new MCO selection. The TMHP LTCOP automatically interfaces with the Service Authorization System Online (SASO) to: 

  • close the SASO registration records for the losing MCO; and 
  • create new SASO registration records for the gaining MCO.

Program Support Unit (PSU) staff must manually close SASO registration records when a member’s MCO plan change is not timely. To process the transfer, the gaining PSU staff must:

  • close the existing: 
    • Authorizing Agent (service code (SC) 12) record; 
    • Service Authorization (service group (SG) 19/service code (SC) 12) record; 
  • open a new: 
    • Authorizing Agent (SC 12) record; and 
    • Service Authorization (SG 19/SC 12) record using the MCO contract number in the new SA.

The gaining PSU staff must complete the following activities to close the Authorizing Agent record:

  1. Open the STAR+PLUS HCBS program member’s case in the SASO.
  2. Select the Authorizing Agent field from the Case Worker functional area.
  3. Select the Authorizing Agent record you wish to close.
  4. Select the Modify button to open and modify.
  5. Move to the End Date field and enter the effective date of the termination, which is the last day of the month in which the member moved to the new SA.
  6. Select the Save button.

The gaining PSU staff must complete the following activities to close the Service Authorization record:

  1. Select the Service Authorization field in the Program and Service functional area.
  2. Select the appropriate Service Authorization (SC 12) record you wish to close.
  3. Select the Modify button to open and modify.
  4. Move to the End Date field and enter the effective date of the termination. This will be the last day of the month in which the member moved to the new SA.
  5. Move to the Termination Code field and select “23 - Transferred to another service” (or the appropriate code) from the drop-down menu.
  6. Select the Save button.
  7. Select Submit to SASO.
  8. Select Outbox and then Inbox to ensure the case processed accurately.

The Service Authorization record is opened per procedures outlined in determining initial eligibility for STAR+PLUS HCBS program members with the following exceptions:

  • The begin date for these records is the first day of the month following the month the member moved to the new SA.
  • The end date for the Service Authorization (SC 12) record is the same as the current ISP period.

Example: If a STAR+PLUS HCBS program member with an ISP period of Nov. 1, 2019, to Oct. 31, 2020, transfers to another STAR+PLUS SA on Jan. 15, 2020, the end date for these records remains Oct. 31, 2018.

9320 Transfers from One MCO to Another MCO in the Same Service Area

Revision 24-3; Effective Sept. 10, 2024

Texas Integrated Eligibility Redesign System (TIERS) will update the managed care enrollment in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) when:

  • a STAR+PLUS Home and Community Based Services (HCBS) program member has an individual service plan (ISP) in the TMHP LTCOP; and
  • chooses a new managed care organization (MCO) timely before state cutoff.

This update automatically closes the registration for the losing MCO and creates the registration for the gaining MCO in the Service Authorization System Online (SASO).

PSU staff must manually close existing service authorization records in SASO if the member's plan change request is not timely. PSU staff process untimely requests by manually closing the existing service authorization record, service code (SC) 12 for the losing MCO and manually creating a new service authorization record, SC 12, for the gaining MCO in SASO.

PSU staff must complete the following activities when manually closing an existing service authorization record:

  1. Move to the Service Authorization field in the Program and Service functional area.
  2. Select the appropriate Service Authorization record you wish to close.
  3. Select the Modify button.
  4. Move to the End Date field and enter the effective date of the termination, which is the last day of the month in which the member was enrolled in the losing MCO.
  5. Move to the Termination Code field and select 39 – Other or the appropriate code from the drop-down menu.
  6. Select the Save button.
  7. Select Submit to SASO.
  8. Select Outbox and then Inbox to ensure the case processed accurately.

PSU staff must complete the following activities when manually creating a new service authorization record for the new MCO:

  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 new MCO contract number or plan code enrollment date.
  11. Move to the End Date field to align with the last day of the ISP coverage period.
  12. Move to the Contract No. field and enter the appropriate contract number of the MCO.