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Effective Date: 
3/2018

Documents

Instructions

Updated: 3/2018

Purpose

Form H2118 and Form H2118-S must be sent to an individual on a STAR+PLUS Home and Community Based Services (HCBS) program interest list to inform the individual that Program Support Unit (PSU) staff have been unable to contact the individual regarding continued interest in the STAR+PLUS HCBS program

Form H2118 and Form H2118-S informs the individual that:

  • if the individual fails to contact PSU staff within 30 days from the date of the letter, the individual’s name will be removed from the interest list for that service.
  • once the individual’s name is deleted from the list and the individual later would like to receive services from the program, the individual’s name will be placed at the bottom of the list.

Procedure

When to Prepare

PSU staff are required to perform annual contacts for individuals on the STAR+PLUS HCBS program interest list to verify the current address and confirm continued interest in the program. If PSU staff are unable to reach the individual by phone during the annual contact, PSU staff send Form H2118 and Form H2118-S to the address on file within one business day of the attempted contact date. If no response is received from the individual within 30 days of the date of the letter, PSU staff remove the individual from the STAR+PLUS HCBS program interest list and close this record in the Community Services Interest List (CSIL) database, using "Could Not Locate" as the denial reason.

Transmittal

PSU staff prepare an original to be sent to the individual who has expressed an interest in the STAR+PLUS HCBS program.

Form Retention

The Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) is the repository for the electronic case record. Paper copies of Form H2118 and Form H2118-S are not retained. The PSU staff opens a case record in HEART, uploads a copy of the completed form to HEART and sets a due date for 30 days from the date the letter is sent. If no response is received by the due date, PSU staff remove the individual from the STAR+PLUS HCBS program interest list and close this record in the CSIL database, using "Could Not Locate" as the denial reason, and close the HEART case.

Detailed Instructions

Date — PSU staff enters the date the form is completed.

Individual's Name and Address — Self-explanatory. Information should be typed or printed legibly.

HHSC PSU Staff — Enter the name of the PSU staff preparing the form.

Address and Area Code and Telephone No. — Enter the business address of the PSU staff person and area code and telephone number. Information should be typed or printed legibly.

HHSC PSU Staff Signature Line — PSU staff signs the form.