Appendices

Appendix I, Reserved for Future Use

Appendix II, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet

Appendix III, Medicaid Type Program Codes for STAR+PLUS Home and Community Based Services and Community First Choice

Appendix IV, Reserved for Future Use

Appendix V, Reserved for Future Use

Appendix VI, STAR+PLUS Inquiry Chart

Appendix VII, Acronyms

Revision 18-2; Effective September 3, 2018

 

The following acronyms are used in the STAR+PLUS Program.

Acronym Description
AA Adaptive Aids
ADL Activity of Daily Living
AFC Adult Foster Care
AL Assisted Living
ALF Assisted Living Facility
AO Agency Option
APS Adult Protective Services
CAP Corrective Action Plan
CARE Client Assignment and Registration System
CAS Community Attendant Services
CBA Community Based Alternatives
CCAD Community Care for the Aged and Disabled
CCP Comprehensive Care Program
CDS Consumer Directed Services
CFC Community First Choice
CFR Code of Federal Regulations
CHIP Children's Health Insurance Program
CLASS Community Living Assistance and Support Services
CMPAS Client Managed Personal Attendant Services
CMS Claims Management System
CMS Centers for Medicare and Medicaid Services
CNA Certified Nursing Assistant
COLA Cost of Living Adjustment
CRU Centralized Representation Unit
CSHCN Children with Special Health Care Needs
CSIL Community Services Interest List
DAC Disabled Adult Child
DAHS Day Activity and Health Services
DBMD Deaf Blind with Multiple Disabilities
DDS Disability Determination Services
DDU Disability Determination Unit
DER Data Entry Representative
DFPS Department of Family and Protective Services
DID Determination of Intellectual Disability
DIU Data Integrity Unit
DME Durable Medical Equipment
DOB Date of Birth
DOD Date of Death
DR Designated Representative
DSHS Department of State Health Services
ERS

ERS
Emergency Response Service

Enrollment Resolution Services
FBR Federal Benefit Rate
FC Family Care (Title XX)
FFS Fee-for-Service
FH Fair Hearing
FHO Fair Hearings Officers
FMSA Financial Management Services Agency
GR General Revenue
HCBS Home and Community Based Services
HCS Home and Community-based Services
HCSS Home and Community Support Services
HCSSA Home and Community Support Services Agency
HDM Home Delivered Meals
HEART Health and Human Services Enterprise Administrative Report and Tracking System
HHS Health and Human Services
HHSC Texas Health and Human Services Commission
HICAP Health Information Counseling and Advocacy Program
HIPAA Health Insurance Portability and Accountability Act
HIPP Health Insurance Premium Payment Program
HMA Health Maintenance Activities
IADL Instrumental Activity of Daily Living
ICF-IID Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
IDD Intellectual or Developmental Disability
IDT Interdisciplinary Team
ILM Interest List Management
IME Incurred Medical Expense
ISP Individual Service Plan
LAR Legally Authorized Representative
LCSW Licensed Clinical Social Worker
LIDDA Local Intellectual and Developmental Disability Authority
LOC Level of Care
LOS Level of Service
LTC Long Term Care
LTC-R Long-term Care Regulatory
LTSS Long-term Services and Supports
LVN Licensed Vocational Nurse
MAO Medical Assistance Only
MBI Medicaid Buy-In
MC Managed Care
MCO Managed Care Organization
MCCO Managed Care Compliance & Operations
MDCP Medically Dependent Children Program
MDS Minimum Data Set
Med ID Medicaid Identification Card
MEPD Medicaid for the Elderly and People with Disabilities
MERP Medicaid Estate Recovery Program
MESAV Medicaid Eligibility Service Authorization Verification
MFP Money Follows the Person
MHM Minor Home Modifications
MMP Medicare-Medicaid Plan
MN Medical Necessity
MN/LOC Medical Necessity and Level of Care
MSHCN Members with Special Health Care Needs
NF Nursing Facility
OT Occupational Therapy
PACE Program of All-inclusive Care for the Elderly
PAS Personal Assistance Services
PASRR Preadmission Screening and Resident Review
PCN Patient Control Number
PCP Primary Care Physician
PCS Personal Care Services
PDN Private Duty Nursing
PES Program Enrollment Support
PHC Primary Home Care
PNA Personal Needs Allowance
POC Plan of Care
PPECC Prescribed Pediatric Extended Care Center
PPS Premiums Payable System
PSU Program Support Unit
PT Physical Therapy
QIT Qualified Income Trust
QMB Qualified Medicare Beneficiary
R&B Room and Board
RN Registered Nurse
RSDI Retirement and Survivors Disability Insurance
RUG Resource Utilization Group
SA Service Area
SAS Service Authorization System
SC Service Code
SC Service Coordinator
SCSA Significant Change in Status Assessment
SDX State Data Exchange
SG Service Group
SLMB Specified Low-Income Medicare Beneficiaries
SNAP Supplemental Nutrition Assistance Program
SO State Office
SOC Start of Care
SOLQ State On-Line Query
SPMI Severe and Persistent Mental Illness
STAR+PLUS HCBS program State of Texas Access Reform PLUS Home and Community Based Services program
SRO Service Responsibility Option
SSA Social Security Administration
SSI Supplemental Security Income
SSN Social Security Number
SSPD Special Services to Persons with Disabilities
ST Speech Therapy
STAR State of Texas Access Reform
STAR+PLUS State of Texas Access Reform Plus
STS Supplemental Transition Support
TAC Texas Administrative Code
TANF Temporary Assistance to Needy Families
TAS Transition Assistance Services
TDI Texas Department of Insurance
THSteps-CCP Texas Health Steps – Comprehensive Care Program
TIERS Texas Integrated Eligibility Redesign System
TMHP Texas Medicaid & Healthcare Partnership
TOA Type of Assistance
TP Type Program
TPR Third-Party Resource
TW Texas Works
TxHmL Texas Home Living
UAP Unlicensed Assistive Person
UMCC Uniform Managed Care Contract
UMCM Uniform Managed Care Manual
WTPY Wire Third Party Query

Appendix VIII, Monthly Income/Resource Limits

Appendix IX, Time Calculation

Appendix X, STAR+PLUS HCBS Cost Limits

Appendix XI, Board of Nurse Examiners Rules Pertaining to Delegation

Revision10-0; Effective September 1, 2010

 

Refer to the Texas Administrative Code directly for the most current version of rules concerning registered nurse (RN) delegation of tasks.

 

Appendix XII, Risk Group Matrix

9-2015

 

For information about document accessibility, contact handbookfeedback@hhsc.state.tx.us.

Risk Group Matrix

Appendix XIII, Your Financial Rights in an Assisted Living Facility STAR+PLUS

Revision 18-1; Effective March 1, 2018

 

Your Financial Rights in an Assisted Living Facility STAR+PLUS

Appendix XIV, Determination of High Needs Status for the STAR+PLUS HCBS Program

Revision 17-1; Effective March 1, 2017

 

An individual entering the STAR+PLUS Home and Community Based Services (HCBS) program is designated as having high needs status if:

  • the individual is on ventilator care;
  • the individual has high-skilled nursing needs, such as tracheotomy care, wound care, suctioning or feeding tubes; and/or
  • the individual will exceed the individual service plan cost limit and has needs that will require special services or service delivery, and the community support/resources have not been identified.

Appendix XV, Services Available from Other State Agencies

Appendix XV-A, Department of State Health (DSHS)

Appendix XV-C, Texas Veterans Commission (TVC)

Appendix XV-D, Texas Department of Housing and Community Affairs (TDHCA)

Appendix XV-E, Department of Family and Protective Services (DFPS)

Appendix XV-F, Rehabilitation Technology Resource Center

Appendix XVI, Long Term Services and Supports Codes and Modifiers

9-2019

 

For information about document accessibility, contact handbookfeedback@hhsc.state.tx.us.

Long Term Services and Supports Codes and Modifiers

Appendix XVII, It's Your Choice: Deciding How to Manage Your Personal Assistance Services

3-2018

 

For information about document accessibility, contact handbookfeedback@hhsc.state.tx.us

Click below to view brochure: /doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services/about-cds

Appendix XVIII, Mutually Exclusive Services

Appendix XIX, Nursing Facility Counter Logic

Appendix XX, Nursing Facility Billing Matrix

Revision15-1; Effective September 1, 2015

 

https://hhs.texas.gov/laws-regulations/legal-information/long-term-care-bill-code-crosswalks

Appendix XXI, Reserved for Future Use

Appendix XXII, Reserved for Future Use

Appendix XXIII, Reserved for Future Use

Appendix XXIV Minimum Standards for STAR+PLUS AFC Homes and Home Providers

Appendix XXV, Community First Choice Support Management

Appendix XXVI, Long Term Care Online Portal User Guide for Managed Care Organizations

6-2016

 

For information about document accessibility, contact accessibility@hhsc.state.tx.us

Link to Guide

Appendix XXVII, Reserved for Future Use

Appendix XXVIII, CDS Training for Service Coordinators and CDS Training Manual

7-2019

 

For information about document accessibility, contact accessibility@hhsc.state.tx.us

CDS Training for Service Coordinators

CDS Training Manual

Appendix XXIX, Emergency Response Service Provider Requirements and Service Initiation Requirements

9-2017

 

An Emergency Response Services (ERS) provider contracted with a managed care organization (MCO) must meet the following provider requirements:

  • Have emergency monitoring capability 24 hours a day, seven days a week; and
  • Be equipped to provide verifiable data using technology capable of producing a printed record of the:
    • type of alarm code (test, accidental or emergency);
    • unit subscriber number;
    • date; and
    • time of the activated alarm in seconds. 

An ERS provider contracted with an MCO, prior to delivering the service, must meet the following service initiation requirements. Secure responders who:

  • Go to the member's home if an alarm call is made to a provider; and
  • Take appropriate action, including contacting public service personnel, based on the situation.

Attempt to secure the names of at least two responders from a member on or before the date the provider initiates services. The exceptions are as follows:

  • If the provider is able to secure the name of only one responder from a member, the provider must:
    • designate public service personnel in place of the member's second responder; and
    • document the reason the provider could secure the name of only one responder.
  • If a provider is unable to secure the names of any responders from a member, the provider must:
    • designate public service personnel in place of the member's responders; and
    • send written notification to the service coordinator of the inability to secure the names of any responders within 14 days after initiating services.

Administer an orientation to a responder according to the following requirements:

  • Orient a responder in person, by telephone or in writing on the responder's responsibilities on or before the date the responder is first contacted by the provider and asked to respond to an alarm call;
  • Document the following information concerning the orientation:
    • name and telephone number of the responder;
    • name of the member;
    • date the responder was secured;
    • date of orientation;
    • method of orientation; and
    • topics covered; and
  • Ensure that a responder receives written procedures on how to respond to an alarm call and document the date the procedures were provided to the responder. The provider may mail the written procedures to the responder.

Replace a responder according to the following requirements:

  • A provider must secure a replacement responder when a member's responder is no longer able to participate.
    • If a member has two responders, a provider must secure a second responder within seven days after becoming aware that the member will no longer have two responders.
    • If a member has one responder, a provider must secure a replacement responder within four days after becoming aware that the member's sole responder is no longer able to participate.
    • If a provider is unable to secure any replacement responders, the provider must:
      • designate public service personnel in place of the replacement responders; and
      • provide the case manager with written notification within 14 days after the provider determines it cannot secure a replacement responder.
  • A provider must document the date the provider:
    • became aware that a responder was no longer able to participate; and
    • secured a replacement responder.

Maintain a record of the names of current responders for each member.

Retain documentation of service initiation in a member's file. 

A responder must comply with the following service requirements. Install the equipment according to the following requirements:

  • During an initial home visit, an installer must:
    • install and make an initial test of the equipment;
    • ensure that the equipment has an alternate power source in the event of a power failure;
    • install within limits set forth in manufacturers' installation instructions; and
    • if necessary:
      • purchase a telephone extension cord;
      • connect and run a telephone extension cord not to exceed 50 feet between the wall jack and the equipment; and
      • safely tack the telephone extension cord against the wall or floorboard to prevent a hazard to a member.
  • An installer is not required to:
    • adapt the physical environment in a member's home to make it compatible with the equipment;
    • arrange or pay for relocation of the telephone; or
    • purchase or install electrical extension cords. An installer must not use an electrical extension cord when installing equipment.
  • A provider must document a failure to install the equipment, including the:
    • reason for the delay;
    • date the provider anticipates it will install the equipment or the specific reason the provider cannot anticipate a date; and
    • description of the provider's ongoing efforts to install the equipment, if applicable.

Training a member on the use of the equipment must include:

  • Demonstrating how the equipment works;
  • Having the member activate an alarm call;
  • Explaining to the member that:
    • the member must participate in a system check each month;
    • the member must contact the provider if:
      • his telephone number or address changes; or
      • one or more of his responders change; 
    • the member must not willfully abuse or damage the equipment;
    • a responder can forcibly enter a member's home, if necessary;
    • the procedures for filing a complaint against a provider; and
  • Obtaining a signed release for forcible entry.

Service initiation due dates are as follows:

  • The provider must initiate services within 14 days after the service effective date; and
  • If a member is not available during the time frames, the provider must initiate services within 72 hours or document reason for delay.

An ERS provider contracted with an MCO must document any failure to initiate services by the due date. Documentation must include:

  • The reason for the delay;
  • Either the date the provider anticipates it will initiate services or specific reasons the provider cannot anticipate a service initiation date; and
  • A description of the provider's ongoing efforts to initiate services.

A provider must maintain documentation of service initiation in a member's file.

Appendix XXX, Relocation Function

Appendix XXXI, STAR+PLUS Members Transitioning from an NF in One Service Area to the Community in Another Service Area