An official State of Texas website.
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. |