9400, MFP Authorization for STAR+PLUS HCBS Program Applicant

Revision 18-0; Effective September 4, 2018

After Program Support Unit (PSU) staff verify that the applicant left the nursing facility (NF), PSU staff complete the following steps listed below. PSU staff do not close the Authorizing Agent, Medical Necessity, Level of Service Resource Utilization Group (RUG) records. PSU staff must also ensure Provider Claims Services (PCS) closes the enrollment and service authorization records for service codes (SC) 1, 3, 50 and 60.

For individuals who are not enrolled in STAR+PLUS until they begin receiving the STAR+PLUS Home and Community Based Services (HCBS) program, create a one-day service authorization record for the first day of the month in which a Money Follows the Person (MFP) individual is discharged from an NF, unless the individual discharges on the first day of a month.

Example: An individual who is not enrolled in STAR+PLUS leaves the NF and begins the STAR+PLUS HCBS program on December 25, 2019. PSU staff register the initial individual service plan (ISP) in the Service Authorization System Online (SASO) with an effective date of December 25, 2019 through December 31, 2020. In addition to registering the initial ISP, PSU staff create all the records listed below with a begin date of December 1, 2019, and an end date of December 1, 2019.

PSU staff must check or create the one-day service authorization for the following records for service group (SG) 19 according to Sections 9410 through 9470:

• Authorizing Agent for MFP Applicant (if needed);
• Enrollment for MFP Applicant;
• Service Plan for MFP Applicant;
• Service Authorization for MFP Applicant;
• Level of Service for MFP Applicant;
• Diagnosis for MFP Applicant; and
• Medical Necessity for MFP Applicant.

A one-day overlap of the records listed is allowed.

Note: Individuals released from an NF and authorized for the STAR+PLUS HCBS program should be enrolled under MFP. In the Enrollment record, select "12 – MONEY FOLLOWS THE PERSON” from the drop-down menu in the Enrolled From field. Do not use “Enrolled from nursing facility” to designate MFP members.

To authorize STAR+PLUS HCBS program eligibility for an MFP applicant:

After creating the one-day records above, when applicable, PSU must create the records needed for the ongoing MFP STAR+PLUS HCBS program eligibility. These records must be completed to check or create an initial service authorization for the STAR+PLUS HCBS program according to Sections 9410 through 9470 listed above.

9410 Authorizing Agent for MFP Applicant

Revision 18-0; Effective September 4, 2018

There will be one authorizing agent registered for a Money Follows the Person (MFP) applicant.

Program Support Unit (PSU) staff are registered as the authorizing agent when the initial authorization is authorized.

To register an authorizing agent for an MFP applicant, PSU staff must:

1. Select the Authorizing Agent field in the Case Worker functional area.
2. Select Add and a blank Service Authorization 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 ID 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/ERS staff’s name.
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. Note: Six service areas include Medicare-Medicaid Plans (MMP).

12. Select the Save button.

9420 Enrollment for MFP Applicant

Revision 18-0; Effective September 4, 2018

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

Program Support Staff (PSU) staff will create an enrollment record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the enrollment registration in SASO, 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 authorizing agent for a Money Follows the Person (MFP) applicant, PSU staff must:

1. Select the Enrollment 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 Enrolled From field and select the appropriate entry from the drop-down menu. If this is an MFP authorization, be sure to select 12 - MONEY FOLLOWS THE PERSON 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.
6. Move to the Begin Date field and enter the date the member is enrolled in his MCO, which will always be the first day of a month. Leave the End Date field blank.
7. Leave the Termination Code and Waiver Type at the defaults.
8. Select the Save button.

9430 Service Plan for MFP Applicant

Revision 18-0; Effective September 4, 2018

The service plan record is used to register an individual service plan (ISP) for a STAR+PLUS Home and Community Based Services (HCBS) program member. The 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 of the STAR+PLUS HCBS program services taken from the member’s Form H1700-1, Individual Service Plan (Pg. 1).

Program Support Staff (PSU) staff will create a service plan record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the service plan registration in the Service Authorization System Online (SASO) 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 for a Money Follows the Person (MFP) applicant, 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 Level of Service record. For a STAR+PLUS HCBS program member who uses a ventilator, 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).

Move to the Begin Date field and enter the effective date of the ISP coverage period.

6. Move to the End Date field and enter the last day of the ISP coverage period.
7. 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.
8. Leave the Amount Paid field at the default setting of 0.00.
9. Leave the Units Authorized field at the default of 0.00.
10. Leave the Units Paid field at the default of 0.00.
11. Select the Save button.

9440 Service Authorization for MFP Applicant

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff create one service authorization record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility.

PSU staff will create a service authorization record for STAR+PLUS HCBS program eligibility for members.

PSU staff will take a screenshot of the service authorization registration in the Service Authorization System Online (SASO) and upload the screenshot to the 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 a Money Follows the Person (MFP) applicant, 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 list.
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 list.
8. Move to the Units field and enter 1.00.
9. Leave Amount 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).

13. The NPI field is read-only.
14. Select the Save button.

9450 Level of Service for MFP Applicant

Revision 18-0; Effective September 4, 2018

There will be an existing service group (SG) 1 (NF) level of service (LOS) record. However, Program Support Unit (PSU) staff will be required to create a new LOS record for SG 19 STAR+PLUS Home and Community Based Services (HCBS) program. The SG 1 (NF) LOS record can remain open.

All STAR+PLUS HCBS program members must have an LOS registered 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 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.

PSU staff will create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members.

To add an LOS record, PSU staff must complete the following steps:

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.
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.

9460 Diagnosis for MFP Applicant

Revision 18-0; Effective September 4, 2018

There will be an existing service group (SG) 1 diagnosis record. Program Support Unit (PSU) staff must create a new diagnosis record for SG 19 STAR+PLUS Home and Community Based Services (HCBS) program.

All STAR+PLUS HCBS program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis 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 system-generated diagnosis record will have an end date that may need to be extended by PSU staff through the last day of the month in which the individual service plan (ISP) expires, if applicable.

To add an SG 19 diagnosis record in the SASO, PSU staff must complete the following steps:

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.
7. Leave Version field at the default.
8. Select the Save button.

9470 Medical Necessity for MFP Applicant

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 Unit (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.

PSU staff will take a screenshot of the MN registration in SASO 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. Note: An open-ended MN record must be terminated with the end-date of the ISP.

PSU staff can create MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

To extend an MN record for an MFP applicant, PSU staff must:

1. Select the MN field in the Medical functional area.
2. Select the existing MN record.
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 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. Leave the MN field at the default of Y - YES.
4. Leave the Permanent field at the default of 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.

To add a service group (SG) 19 diagnosis record in the SASO, PSU staff must complete the following steps:

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.
7. Leave Version field at the default.
8. Select the Save button.

9480 MFPD for STAR+PLUS HCBS Program Applicant

Revision Notice 23-3; Effective Aug. 21, 2023

The option to electronically submit an individual service plan (ISP) for a nursing facility (NF) resident is not available. The managed care organizations (MCO) must not use the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) Money Follows the Person Demonstration (MFPD) check box. Program Support Unit (PSU) staff must continue to manually register this fund code in the Service Authorization System Online (SASO).

PSU staff must follow the instructions for a Money Follows the Person (MFP) applicant above, with the Service Authorization record completed as follows.

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 list.
4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
5. Move to the Fund field and select 19MFP – MONEY FOLLOWS PERSON.
6. Leave the Term. Code field at the defaults.
7. Leave the Agency field at the default selection 324 - DHS.
8. Move to the Unit Type field and select 2 – MONTH from the drop-down list.
9. Move to the Units field and enter 1.00.
10. Leave the Amount field at the default.
11. Move to the Begin Date field and enter the effective date of the ISP coverage period.
12. Move to the End Date field and enter the last day of the ISP coverage period.
13. 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).

14. The NPI field is read-only.
15. Select the Save button.

Note:  The MCO must notify PSU staff once the 365-day MFPD period has passed using Form H2067-MC, Managed Care Programs Communication. PSU staff must change the Service Authorization record to the default within five business days of the MCO notification.