Revisions

23-4, Miscellaneous Changes

Revision Notice 23-4; Effective Aug. 21, 2023

The following sections were revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

Section	Title	Change
1210	Medical Necessity Determination	Clarifies Program Support Unit (PSU) staff’s role for the STAR Kids individual service plan (SK-ISP) cost limit.
1210.2	Medical Necessity Approval Time Frame for Initial Eligibility Determinations	Adds new section about medical necessity (MN) approval time frame for initial eligibility determinations.
1614	Verifying the Identity of an Applicant, Member, LAR, AR or Third Party Individual	Changes section title to Establishing Identity.
1614.1	Telephone Communication	Clarifies PSU staff processes for verifying phone communication. Changes section title to Phone Communication.
1615	Information That May Be Disclosed	Clarifies PSU staff procedures for processing Form H1826, Case Information Release.
1810	Program Support Unit Staff Notification Requirements	Updates PSU staff notification requirements.
2002	Medical Necessity Determination	Clarifies PSU staff’s role regarding the SK-ISP cost limit.
2002.2	Medical Necessity Approval Time Frame for Initial Eligibility Determinations	Adds new section for MN approval time frame for initial eligibility determinations.
3210.2	Reassessment of Medical Necessity Determination	Clarifies PSU staff’s role regarding the SK-ISP cost limit.
3325	Reserved For Future Use	Adds new section.
3328	Reassessment Notification Requirements	Updates PSU staff notification requirements.
3430	Transfer from MDCP to Another Medicaid Waiver Program	Clarifies PSU staff notification requirements for the Medically Dependent Children Program (MDCP) member transfers to another 1915(c) waiver program.
7000	Applicant or Member Complaints and State Fair Hearings	Changes section title to Applicant or Member Appeal Requests and State Fair Hearings.
7100	Reserved for Future Use	Changes section title to Appeals and State Fair Hearings. Adds Texas Administrative Code (TAC) language and definitions.
7210	Program Support Unit Staff Procedures for Completing Form H4800	Changes section title to Entering a State Fair Hearing In TIERS. Updates PSU staff procedures for entering a fair hearing in the Texas Integrated Eligibility Redesign System (TIERS).
7214	Changes to the State Fair Hearing Request Summary	Updates PSU staff procedures for submitting fair hearing changes.
7221	Type of Denials	Clarifies PSU staff procedures for processing a fair hearing.
7221.1	Medical Necessity Denial by Texas Medicaid & Healthcare Partnership	Clarifies PSU staff procedures for supplemental security income (SSI) denials or terminations.
7221.3	Supplemental Security Income Denial by the Social Security Administration	Removes section.
7221.4	Other Denial Reasons	Clarifies PSU staff procedures for other denial or termination reasons.
7222.1	Continuation of Medically Dependent Children Program Services During a State Fair Hearing	Clarifies PSU staff procedures for continuing MDCP during a fair hearing.
7233	State Fair Hearing Decision	Adds fair hearing decision definitions.
7310	Action Taken on the State Fair Hearing Decision	Clarifies PSU staff procedure for processing fair hearing decisions.
7510	Sustained State Fair Hearing Decision for Applicants	Adds fair hearing decision definition for sustained fair hearing decision. Clarifies PSU staff procedure for processing a sustained fair hearing decision.
7510.1	Sustained State Fair Hearing Decision for Applicants	Adds new section.
7510.2	Sustained State Fair Hearing Decision for Members With Continued MDCP Benefits	Adds new section.
7510.3	Sustained State Fair Hearing Decision for Members Without Continued MDCP Benefits	Adds new section.
7511	Sustained Decision – Termination Effective Date	Clarifies PSU staff procedure for processing a sustained fair hearing decision.
7520	Reversed State Fair Hearing Decision	Adds fair hearing decision definition for reversed fair hearing decision. Clarifies PSU staff procedure for processing a reversed fair hearing decision.
7520.1	Reversed State Fair Hearing Decision for Applicants	Adds new section.
7520.2	Reversed State Fair Hearing Decision for Members With Continued Benefits	Adds new section.
7520.3	Reversed State Fair Hearing Decision for Members Without Continued Benefits	Adds new section.
7521	Reversed Decision – Effective Date	Clarifies PSU staff procedure for processing a reversed fair hearing decision.
7600	Roles and Responsibilities of Texas Health and Human Services Commission Hearings Officer	Adds TAC language.
Appendix XI	HHSC Benefits Portal and TIERS Reference Guides	Changes appendix title. Includes additional reference guides.
Appendix XXIV	Fair Hearing and Interest List Options for MDCP Denials - Members	Corrects links and text.
Appendix XXIX	Fair Hearing and Interest List Options for Aging Out of MDCP	Updates PDFs on landing page and bolding in PDF.
Appendix XXVII	Fair Hearing Options for MDCP Denials - Applicants	Updates PDFs on landing page and bolding in PDF.
Form 2128 Instructions	Form 2128 Instructions	Corrects miscellaneous content.

23-3, Miscellaneous Changes

Revision Notice 23-3; Effective May 22, 2023

The following sections were revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

Section	Title	Change
1220	Individual Cost Limit	Adds clarifying language about Utilization Review (UR).
1270	Financial Eligibility	Adds Form 2606 references and removes Form H2065-D denial reason language.
1420	Service Coordination and Programs Serving Members with Intellectual or Developmental Disabilities	Reserves section for future use.
1430	Service Coordination and the Youth Empowerment Services Waiver Program	Reserves section for future use.
1440	Service Coordinators and Home and Community Based Services - Adult Mental Health	Reserved for Future Use. Removes personal needs allowance language.
2410	Traditional Money Follows the Person	Adds clarifying language about Money Follows the Person process.
2412.4	Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Program Support Unit Coordination	Adds clarifying language about the Money Follows the Person process.
2412.5	Traditional Money Follows the Person Non-STAR Kids Nursing Facility Residents: Denials	Adds clarifying language about the Money Follows the Person process.
2413.4	Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Program Support Unit Staff Coordination	Adds clarifying language about the Money Follows the Person process.
2413.5	Traditional Money Follows the Person STAR Kids Nursing Facility Residents: Denials	Adds clarifying language about the Money Follows the Person process.
2414	MDCP Money Follows the Person Delays in NF Discharge.	Adds clarifying language about the Money Follows the Person process.
3300	Member Service Planning and Authorization	Clarifies member service planning process.
3310	Service Planning	Clarifies member service planning process.
3311	Updates to Individual Service Plan	Removes section.
3320	Service Planning for Medically Dependent Children Program Services	Clarifies MDCP service planning process.
3321	Medically Dependent Children Program Individual Service Plan Revision	Clarifies MDCP service planning process.
3322	Medically Dependent Children Program Individual Service Plan and Budget Revision	Reserves section for further use.
3323	Setting Aside Funds in the Medically Dependent Children Program Individual Service Plan	Reserves section for further use.
3325	Multiple Medically Dependent Children Program Members in the Same Household	Removes section.
3500	Transition from Medically Dependent Children Program to Adult Programs	Updates title. Adds clarifying information about transitions to adult programs.
3510	Procedures for Children Transitioning from STAR Kids Receiving MDCP, PDN or PPECC	Renames Section. Adds clarifying information about transitions to adult programs.
3511	Twelve Months Prior to the Member’s 21st Birthday	Removes section.
3512	STAR+PLUS Transition Activities	Removes section.
3513	Intrapulmonary Percussive Ventilator Benefit	Removes section.
6300.9	Failure to Meet Other Program Requirements	Renames section title to, No Longer Meets the Age Requirement for MDCP, and includes denial processes for MDCP members transitioning to adult programs.
6300.10	Other Reasons	Adds miscellaneous updates.
7213	State Fair Hearing Evidence Packet	Adds Form 4801 references.
7222.2	Termination of MDCP Services Due to a Member Not Requesting a State Fair Hearing	Changes section title to, Discontinuation of MDCP Services Due to Member Not Requesting a State Fair Hearing. Adds clarifying language. Changes time frame in which PSU staff will upload the state fair hearing evidence packet.
7231	Uploading the State Fair Hearing Evidence Packet to the HHSC Benefits Portal	Changes section title to, Uploading the State Fair Hearing Evidence Packet. Adds clarifying language. Changes time frame in which PSU staff will upload the state fair hearing evidence packet.
7520	Reversed State Fair Hearing Decision	Updates PSU staff time frame for generating Form H2065-D and adds clarifying language.
Appendix II	Form H2065-D MDCP Reason for Denial and Comments Language	Adds denial reason and comments language.
Appendix IX	STAR Kids TxMedCentral Naming Conventions	Corrects naming conventions.
Appendix XVIII	STAR Kids HEART Naming Conventions	Updates and adds HEART naming conventions.
Appendix XXI	Reserved for Future Use	Update section title to, Creating an Appeal in TIERS. Adds information on creating an appeal in TIERS.
Appendix XXX	County Codes and City and County List	Adds new appendix to house county codes, city codes and a list of counties.
Form 2128	120 Day Notice	Adds form to handbook.

23-2, Miscellaneous Changes

Revision Notice 23-2; Effective April 1, 2023

The following section was revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

Section	Title	Change
Appendix XVIII	STAR Kids HEART Naming Conventions	Updates and adds HEART naming conventions.
Appendix XXIV	Fair Hearing and Interest List Release Options - Members	Updates section title. Changes fair hearing request time frame to 90 days.
Appendix XXVII	Fair Hearing Options for MDCP Denials - Applicants	Updates section title. Changes fair hearing request time frame to 90 days.
Appendix XXIX	Fair Hearing and Interest List Options for Aging Out of MDCP	Adds a new appendix for fair hearing and interest list options for members who are transitioning out of MDCP.

23-1, Miscellaneous Changes

Revision Notice 23-1; Effective Jan. 16, 2023

The following section was revised in the STAR Kids Program Support Unit Operational Procedures Handbook:

Section	Title	Change
Appendix XIV	State Cutoff Dates	Updates with 2023 cut off dates.