Revision 20-1; Effective March 16, 2020
Revision 18-2; Effective September 3, 2018
Revision 19-1; Effective June 3, 2019
TxMedCentral is a secure Internet bulletin board that the Texas Health and Human Services Commission (HHSC) and managed care organizations (MCOs) use to share information. TxMedCentral uses specific naming conventions only for documents listed below. HHSC and MCO staff must follow these naming conventions any time one of the following documents is filed in TxMedCentral.
The following forms may be used, if appropriate, in development of the individual service plan (ISP). Only Form H1700-1 and Form H1700-2 are uploaded to the MCO's ISP folder in TxMedCentral and should not be uploaded in any other folder:
| Two-Digit Plan Identification (ID) | Form Number (#) | Member ID, Medicaid # or Social Security Number (SSN) | Member Last Name (first four letters) | Page Number of Form H1700 | Sequence Number of Form |
|---|---|---|---|---|---|
| ## | 1700 | 123456789 | ABCD | 1 | 2 |
This file would be named ##_1700_123456789_ABCD_1_2.doc.
Form H1700-1, completed for non-members, age-outs, and nursing facility (NF) residents transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program, continues to be uploaded to TxMedCentral.
Form H1700-1, completed for members in the community, is submitted to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal.
This form is uploaded to the SPW folder and should not be uploaded in any other folder. An "A" or "B" is added to the sequence number to indicate whether Program Support Unit (PSU) or MCO staff uploaded the form.
| Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
|---|---|---|---|---|---|
| ## | 3676 | 123456789 | ABCD | A or B | 2 |
This file would be named ##_3676_123456789_ABCD_A_2.doc if uploaded by PSU staff.
This file would be named ##_3676_123456789_ABCD_B_2.doc if uploaded by the MCO.
Form H2065-D is uploaded to the SPW folder and should not be uploaded in any other folder.
| Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
|---|---|---|---|---|---|
| ## | 2065 | 123456789 | ABCD | D | 2D or 2A |
If a member has an ISP which is electronically generated, Form H2065-D is available in the "LETTERS" tab of the TMHP LTC Online Portal when the member's ISP is selected. Form H2065-D is uploaded to TxMedCentral only for individuals without electronic ISPs.
MCOs must check the TMHP LTC Online Portal to check for updates and notifications electronically generated by Program Support Unit (PSU) staff.
This form is uploaded to the SPW folder and should not be uploaded in any other folder. An "M" or "S" is added to the sequence number to indicate whether the MCO or PSU staff uploaded the form.
| Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
|---|---|---|---|---|---|
| ## | 2067 | 123456789 | ABCD | 2M or 2S |
This file would be named ##_2067_123456789_ABCD_2M.doc if uploaded by the MCO.
This file would be named ##_2067_123456789_ABCD_2S.doc if uploaded by PSU staff.
Additional to the standardized naming convention for Form H2067-MC, a separate naming convention has been developed to address use of Form H2067-MC for NF residents who request transition to the community under the STAR+PLUS Home and Community Based Services (HCBS) program. These individuals are considered expedited cases for application to the STAR+PLUS HCBS program. Both the MCO and PSU staff must be able to readily identify communications specific to these cases.
An "M" or "S" continues to be added to the sequence number to denote, respectively, whether the MCO or PSU staff have uploaded the form. The new naming convention for uploading Form H2067-MC, on both member and non-member cases in an NF, is expanded as follows:
| Two-Digit Plan ID | Form # | Member ID, Medicaid # or SSN | Member Last Name (first four letters) | Section Number | Sequence Number of Form |
|---|---|---|---|---|---|
| ## | 2067 | 123456789 | ABCD | 1M or 1S | MFP |
Form H2067-MC file uploaded by the MCO would be named ##_2067_123456789_ABCD_1M_MFP.doc if uploaded by the MCO.
Form H2067-MC file uploaded by the MCO would be named ##_2067_123456789_ABCD_1S_MFP.doc if uploaded by PSU staff.
The STAR+PLUS MCOs use the following folders for all STAR+PLUS HCBS program related uploads. Each MCO has two folders with three-letter identifiers:
| Primary Folder: MCO Three-Letter Identifiers | Secondary Folder: TxMedCentral Folders by Plan |
|---|---|
| AMC — Amerigroup MCO | AMCISP AMCSPW |
| EVR — United Healthcare Community Plan MCO | EVRISP EVRSPW |
| MOL — Molina MCO | MOLISP MOLSPW |
| SUP — Superior MCO | SUPISP SUPSPW |
| BRV — Cigna-HealthSpring MCO | BRVISP BRVSPW |
Revision 19-1; Effective June 3, 2019
The Individual-Summary screen in the Texas Integrated Eligibility Redesign System (TIERS) contains a managed care segment for any individual who is currently or has been enrolled in managed care. From the Individual-Search screen, enter the individual's information and select Search. The results of the search will appear in Search Results field. Select the individual’s name on the hyperlink. The Individual - Summary screen will appear. Hover over the Individual # field and select Managed Care. The individual's managed care information will appear.
Specific managed care information is located under Individual Managed Care History field. The data elements across the bottom of the screen are: Provider – Plan – Program – County – Begin Date – End Date – Status – Eligibility – Candidature.
These fields contain the following information:
Provider — Contains the name of the provider contracted by the managed care organization (MCO) to deliver services to members.
Plan — Contains the name of the MCO providing Medicaid services to the member.
Program — For managed care members, "STARPLUS" will appear in this field.
County — Individual's county of residence.
Begin Date — Date enrollment began under this plan.
End Date — Date enrollment ended under this plan.
Status — Describes the type of action.
Eligibility — Choices are "candidate" (applicant), "enrolled" (active) and "suspended" (closed).
Candidature — Describes the individual's status.
STAR+PLUS Plan Codes
| Service Area | Plan Name | Plan Codes | Plan Codes Dates |
|---|---|---|---|
| Bexar | Amerigroup | 45 | Sept 1, 2011 |
| Molina | 46 | Sept 1, 2011 | |
| Superior | 47 | Sept 1, 2011 | |
| Dallas | Molina | 9F | March 1, 2012 |
| Superior | 9H | March 1, 2012 | |
| El Paso | Amerigroup | 34 | March 1, 2012 |
| Molina | 33 | March 1, 2012 | |
| Harris | Amerigroup | 7P | Sept 1, 2011 |
| United Healthcare | 7R | Sept 1, 2011 | |
| Molina | 7S | Sept 1, 2011 | |
| Hidalgo | Cigna-HealthSpring | H7 | March 1, 2012 |
| Molina | H6 | March 1, 2012 | |
| Superior | H5 | March 1, 2012 | |
| Jefferson | Amerigroup | 8R | Sept 1, 2011 |
| United Healthcare | 8S | Sept 1, 2011 | |
| Molina | 8T | Sept 1, 2011 | |
| Lubbock | Amerigroup | 5A | March 1, 2012 |
| Superior | 5B | March 1, 2012 | |
| Medicaid Rural Service Area (RSA) West Texas | Amerigroup | W5 | Sept 1, 2014 |
| Superior | W6 | Sept 1, 2014 | |
| Medicaid RSA Northeast Texas | Cigna-HealthSpring | N3 | Sept 1, 2014 |
| United Healthcare | N4 | Sept 1, 2014 | |
| Medicaid RSA Central Texas | Superior | C4 | Sept 1, 2014 |
| United Healthcare | C5 | Sept 1, 2014 | |
| Nueces | United Healthcare | 85 | Sept 1, 2011 |
| Superior | 86 | Sept 1, 2011 | |
| Tarrant | Amerigroup | 69 | Sept 1, 2011 |
| Cigna-HealthSpring | 6C | Sept 1, 2011 | |
| Travis | Amerigroup | 19 | Sept 1, 2011 |
| United Healthcare | 18 | Sept 1, 2011 |
Revision 19-1; Effective June 3, 2019
| Service Area | Plan Name | Plan Codes | Plan Codes Dates |
|---|---|---|---|
| Bexar | Amerigroup | 4F | 9/1/15 |
| Molina | 4G | 9/1/15 | |
| Superior | 4H | 9/1/15 | |
| Dallas | Molina | 9J | 9/1/15 |
| Superior | 9K | 9/1/15 | |
| El Paso | Amerigroup | 3G | 9/1/15 |
| Molina | 3H | 9/1/15 | |
| Harris | Amerigroup | 7Z | 9/1/15 |
| United Healthcare | 7Q | 9/1/15 | |
| Molina | 7V | 9/1/15 | |
| Hidalgo | Cigna-HealthSpring | H8 | 9/1/15 |
| Molina | H9 | 9/1/15 | |
| Superior | HA | 9/1/15 | |
| Tarrant | Amerigroup | 6F | 9/1/15 |
| Cigna-HealthSpring | 6G | 9/1/15 |
Revision 18-2; Effective September 3, 2018
Revision 19-1; Effective June 3, 2019
The STAR+PLUS Home and Community Based Services (HCBS) program is authorized by the managed care organization (MCO) and registered by Program Support Unit (PSU) staff in the Service Authorization System Online (SASO) with a Service Group (SG) 19 and a service code (SC). If the member's individual service plan (ISP) is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal registers the appropriate SG/SC combination, which is verified by PSU staff. Service codes are based on the following:
Example: A reassessment ISP is received on June 5, 2017, for an ISP that ended May 31, 2017. To register this reassessment, register one service authorization record using "Service Code 13 — Nursing" with a begin date of June 1, 2017, and an end date of June 30, 2017. Then, register a second service authorization record using "Service Code 12 — Case Management" with a begin date of July 1, 2017, and an end date of May 31, 2018.
Example of automatic registration: A reassessment ISP is submitted to the TMHP LTC Online Portal on June 5, 2017, for an ISP that ended May 31, 2017. One service authorization record with "Service Code 13 — Nursing" will be system generated with a begin date of June 1, 2017, and an end date of June 30, 2017. A second service authorization record with "Service Code 12 — Case Management" will be system-generated with a begin date of July 1, 2017, and an end date of May 31, 2018.
Revision 20-1; Effective March 16, 2020
Time spent in a nursing facility (NF) does not count toward the 365-day period; therefore, tracking is required to ensure Money Follows the Person Demonstration (MFPD) individuals receive the full 365-day entitlement period. The entitlement period begins the date the individual who agrees to participate in the demonstration is enrolled in the STAR+PLUS Home and Community Based Services (HCBS) program. The managed care organization (MCO) uploads Form H2067, Managed Care Programs Communication, to TxMedCentral in the MCO folder, indicating the total number of days the member spent in the NF. This information is sent after the 365th day. See Section 3520, Money Follows the Person Demonstration.
The tables below are intended to assist Program Support Unit (PSU) staff in making accurate entries in the Service Authorization System Online (SASO).
Example 1 — No institutionalization during the 365-day period.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-19 | 1 | 1 | Individual is discharged from the nursing facility (NF). The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-19 | 06-01-19 | 19 | 12 | One-day registration to set the managed care organization (MCO) capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-19 | 06-14-20 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-20 | 06-30-20 | 19 | 12 | PSU staff enters the remaining individual service plan (ISP) period without the 19MFP fund code. | Blank |
Example 2 — Institutionalization during the 365-day period.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-20 | 1 | 1 | Individual is discharged from the NF. The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-20 | 06-01-20 | 19 | 12 | One-day registration to set the MCO capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-20 | 06-14-21 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the remaining ISP period without the 19MFP fund code. | Blank |
| The MCO has notified PSU staff this member spent a total of 15 days in the hospital during the MFPD period. PSU staff must correct SASO as follows: | |||||
| 06-15-21 | 06-29-21 | 19 | 12 | PSU staff enters the MFPD period for the 15 days the individual was in the hospital. | 19MFP |
| 06-30-21 | 06-30-21 | 19 | 12 | MFPD period reached the 365th day on 06-29-21. ISP had one day remaining. | Blank |
Example 3 — Institutionalization during the 365-day period.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-20 | 1 | 1 | Individual is discharged from the NF. The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-20 | 06-01-20 | 19 | 12 | One-day registration to set the MCO capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-20 | 06-14-21 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the remaining ISP period without the 19MFP fund code. | Blank |
| 07-01-21 | 06-30-22 | 19 | 12 | PSU staff enters reassessment ISP. | Blank |
| The MCO has notified PSU staff this member spent a total of 25 days in the hospital during the MFPD period. PSU staff must correct SASO as follows: | |||||
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the MFPD period for the 16 of the 25 days the individual was in the hospital. | 19MFP |
| 07-01-21 | 07-09-21 | 19 | 12 | PSU staff enters the MFPD period for the last nine days of the 25-day period in which the individual was in the hospital. | 19MFP |
| 07-10-21 | 06-30-22 | 19 | 12 | PSU staff enters the remainder of the reassessment ISP period. | Blank |
Example 4 — Institutionalization in NF during MFPD period.
Note: The difference between Example 2 and Example 4 is that for NF stays, the PSU staff has to correct STAR+PLUS HCBS program or NF overlaps.
| Begin Date | End Date | Service Group | Service Code | Comments | Fund Code |
|---|---|---|---|---|---|
| 02-13-19 | 06-15-20 | 1 | 1 | Individual is discharged from the NF. The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| 06-01-20 | 06-01-20 | 19 | 12 | One-day registration to set the MCO capitation payment. SASO record entered by PSU staff. | Blank |
| 06-15-20 | 06-14-21 | 19 | 12 | PSU staff enters SASO record and enters fund code as 19MFP for the entire period. | 19MFP |
| 06-15-21 | 06-30-21 | 19 | 12 | PSU staff enters the remaining ISP period without the 19MFP fund code. | Blank |
| 08-15-20 | 08-29-20 | 1 | 1 | The NF begin and end dates are derived from forms submitted by NFs. | Blank |
| The PSU staff becomes aware this individual spent a total of 15 days in the NF during the MFPD period. PSU staff must correct SASO as follows: | |||||
| 06-15-20 | 08-14-20 | 19 | 12 | PSU staff must correct STAR+PLUS HCBS program or NF overlap. | 19MFP |
| 08-30-20 | 06-29-21 | 19 | 12 | PSU staff enters the MFPD period, including the 15 days the member was in the NF. | 19MFP |
| 06-30-21 | 06-30-21 | 19 | 12 | MFPD period reached the 365th day on 06-29-21. ISP had one day remaining. | Blank |
Revision 19-1; Effective June 3, 2019
Revision 19-1; Effective June 3, 2019
The managed care organization (MCO) must submit the Medical Necessity and Level of Care (MN/LOC) Assessment through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal to process a determination of MN and associated resource utilization group (RUG) value. MCOs submit the MN/LOC Assessment as an:
The MCO has the ability to correct or inactivate assessments submitted within specific time frames. Corrections are completed when certain data elements require correction (refer to the TMHP Community Waiver User Guide to determine which fields are correctable). Inactivations are completed when a correction is needed after the 14-day correction time frame allowable time to submit corrections has passed and when the field(s) requiring correction are not correctable and to remove the assessment from the TMHP LTC Online Portal.
The MCO has access to the TMHP LTC Online Portal to:
More information about submitting Form H1700-1 through the TMHP LTC Online Portal is available in Appendix XXVI, Long Term Care Online Portal User Guide for Managed Care Organizations.
Submittal of the MN/LOC Assessment through the TMHP LTC Online Portal creates MN, Level of Service (LOS) and Diagnosis (DIA) records in the Service Authorization System Online (SASO). The RUG value is located in the LOS record.
Status messages appear in the TMHP LTC Online Portal workflow folder when an MN/LOC Assessment is submitted. Additionally, error messages with status codes appear when TMHP processing cannot be completed. Status messages may be generated when:
This list is not all inclusive.
Messages will appear in the workflow folder to indicate whether or not the TMHP LTC Online Portal action was processed as complete. In some situations, MN, LOS and DIA records will not be generated to SASO; in other situations, SASO records will be generated but messages may still appear in the workflow for required action.
PSU staff:
CMS coordinators need to contact PSU staff to update SASO records and/or take specific case actions based on the MN and RUG information found in the TMHP LTC Online Portal.
Revision 19-1; Effective June 3, 2019
When an individual is aging out of the Texas Health Steps Comprehensive Care Program (THSteps-CCP), Medically Dependent Children Program (MDCP) or has been approved for a nursing facility (NF) diversion slot, the managed care organization (MCO) must authorize services to start on the day of eligibility for the STAR+PLUS Home and Community Based Services (HCBS) program, which may not be the first of the month. If the eligibility date is not the first of the month, the MCO must follow the administrative payment process for STAR+PLUS services provided between the eligibility date and the managed care enrollment date, as applicable. The administrative payment process must be used for the Texas Health and Human Services Commission (HHSC) to issue payment to the MCO and for the MCO to pay the provider.
Once the MCO authorizes services, the provider:
Within five business days of receiving Form 1500, the MCO verifies the provider was authorized to deliver the services billed on Form 1500, the information on Form 1500 meets the clean claim requirements as defined in the Uniform Managed Care Manual, Chapter 2.0, and the claim met the 95-day filing deadline. Once the MCO verifies this information, the MCO:
Within two business days of receiving Form 1500, PSU staff follow the requirements in this handbook section.
If the decision is to approve the administrative payment, the following also occurs:
If the decision is to deny the administrative payment, ERS staff email the PSU staff who emailed the request that the administrative payment has been denied and the reason for the denial.
Within two business days of receipt of email from the ERS, the PSU staff who submitted the request for administrative payment notify the MCO of the approval or denial decision by uploading Form H2067-MC, Managed Care Programs Communication, to TxMedCentral.