Revision 18-1; Effective June 15, 2018

 

7100  Texas Integrated Eligibility Redesign System (TIERS)

Revision 17-1; Effective March 15, 2017

 

The Texas Health and Human Services Commission uses the Texas Integrated Eligibility Redesign System (TIERS) as the system of record.

 

7110  TIERS Inquiries

Revision 17-1; Effective March 15, 2017

 

Texas Health and Human Services Commission (HHSC) staff must use the Texas Integrated Eligibility Redesign System (TIERS) to determine the eligibility status of individuals applying for services or an individual currently receiving services.

Inquiries can be completed in two different ways. HHSC staff may use the HHSC Benefits Portal or they may use TIERS.

Refer to Appendix XXVII, HHSC Benefits Portal and TIERS Inquiry Desk Guide, which provides instruction for completing inquiries for individuals applying for services and individuals receiving services using both options.

 

7200  Determination of Financial Eligibility Based on Automated Records

Revision 17-1; Effective March 15, 2017

 

Refer to Appendix XIV, SAVERR/TIERS Type Program Chart, to determine how existing coverage affects eligibility for Community Care for Aged and Disabled Services.

 

7210  Safeguarding Personally Identifiable Information

Revision 17-1; Effective March 15, 2017

 

All personally identifiable information (PII) obtained from the Social Security Administration (SSA) must be safeguarded. Wire Third Party Query (WTPY) System, State On Line Query (SOLQ) or other SSA documentation is considered SSA-protected and cannot be printed or kept in the case record.

Staff must not print or file PII (WTPY/SOLQ) printouts in individual case records. Staff must document the date they verified and viewed the online/printed verification, the amount of income and source (WTPY, SOLQ, other) used to verify the information.

If a WTPY or SOLQ report must be printed for a specific purpose such as a legal request or legislative inquiry, the document must not be filed in the case record or sent for imaging. SSA documents must be stored in a central locked filing cabinet only accessible by Texas Health and Human Services Commission authorized staff.

 

7220  Financial Eligibility Based on Receipt of Medicaid Buy-In Program Services

Revision 18-1; Effective June 15, 2018

 

Working Texans are able to purchase health insurance through Medicaid by paying a monthly premium through the Medicaid Buy-In (MBI) program. Participants in MBI must meet specific work, disability, resource and income requirements. Not all MBI recipients pay a premium. Premiums are determined on a sliding scale based on an individual's income.

Categorical Eligibility Status Verification

Individuals applying for Long-term Services and Supports (LTSS) who have MBI coverage are categorically eligible for all Title XX Community Care programs, Title XIX Day Activity and Health Services and Primary Home Care. 

MBI coverage can only be verified by:

  • searching the Texas Integrated Eligibility Redesign System (TIERS) database for Type Program (TP) 87 coverage (this information will not appear on the System for Applications, Verifications, Eligibility Reports and Referral inquiry screens); or
  • an award letter sent to the individual documenting MBI eligibility.

Staff may contact either the regional TIERS coordinator or a Special Workers Assisting with TIERS (SWAT) member to verify an applicant's MBI status.

MBI and Receipt of Waiver Services

An MBI recipient interested in an LTSS waiver program should be added to the appropriate interest list. The case worker can determine if an applicant is an MBI recipient by looking in the TIERS database. The MBI program is coded TP 87, ME-Medicaid Buy-In.

More information about the MBI program is available in Section M-1000, Medicaid Buy-In (MBI) Program, of the Medicaid for the Elderly and People with Disabilities Handbook.

 

7230  Hierarchy of Individual Identification Data

Revision 17-1; Effective March 15, 2017

 

Before certifying an applicant who has a previously assigned individual number, compare information in the Texas Integrated Eligibility Redesign System (TIERS) to the information in the case record. Note and clear any discrepancies with the individual or other staff involved. Individual demographic information (individual name exactly as it appears in Social Security Administration (SSA) records for date of birth, Social Security number and individual number, if available) should not be entered into a database before a State On Line Query (SOLQ), Wired Third Party Query (WTPY) System or other SSA documentation has been received confirming the validity of the data. See Section 7210, Safeguarding Personally Identifiable Information, for important SSA data security information.

The computer system retains only one set of identification information for each individual. When an individual is active in more than one program area, the identification information is shared by the staff involved. Only the staff member with the highest priority over the information can change the identification information. The following priority applies:

  • A program area supplying benefits to an individual takes precedence over a program area not supplying benefits to that individual. Example: Temporary Assistance for Needy Families (TANF) caretaker information takes precedence over TANF payee information; status in group Code 1 (Medical Assistance Only (MAO) recipient) information takes precedence over Code 3 (MAO eligible spouse) information; and an active case takes precedence over a denied case.
  • For name and birth date identification data:
Priority is given to: Over:
MAO TANF, Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP)
TANF SSI, SNAP
SSI SNAP

 

  • For sex and race identification data:
Priority is given to: Over:
MAO TANF, SNAP, SSI
TANF SNAP, SSI
SNAP SSI

 

 

7230.1  Address Changes for SSI Recipients

Revision 17-1; Effective March 15, 2017

 

For individuals on Supplemental Security Income (SSI) who move from one address to another, inform the individual or his responsible party to contact the Social Security Administration (SSA) to request the residence address change. The address change will be reflected in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.

HHSC case workers must not send address change requests for SSI recipients to the TIERS Document Processing Center (DPC) in Austin. Although HHSC staff are able to make those address changes, the addresses will revert back to the address on the SSI record at the next state cut off. The address change must be made by SSA.

 

7240  Merge and Separate

Revision 17-1; Effective March 15, 2017

 

If an individual is erroneously assigned more than one individual number, or two or more individuals are erroneously assigned the same individual number, the problem should be reported to the state office Data Control Unit.

If the case must be certified prior to merging, decide which number to enter, using the following rules to select the individual number. If you have:

  • an active individual and denied individual in the same or different program area, use the individual number from the active case.
  • two individual numbers in different program areas, use the individual number from the case with Medicaid coverage.
  • an active individual receiving benefits and an active individual not receiving benefits in the same program area, use the individual number from the case receiving benefits.
  • a denied individual with Medicaid and one denied individual with no Medicaid, use the individual number from the denied case with Medicaid.
  • denied individuals in the same program area, use the individual number most recently denied.

 

7300  Service Authorization System (SAS) Wizards and Use Requirements

Revision 17-1; Effective March 15, 2017

 

The Service Authorization System (SAS) is the primary repository of service information for all individuals enrolled in the Texas Health and Human Services Commission (HHSC) Long-term Services and Supports (LTSS) programs. SAS accepts and maintains information relevant to the individual's authorizations for LTSS. Services must be authorized in SAS before a provider can receive payment for services delivered to an individual.

SAS contains wizards with prompting sequences that take the user through a series of windows required for authorization or denial of services. Wizards used to authorize or terminate Community Care for Aged and Disabled (CCAD) services are the:

  • Financial Wizard;
  • Functional Wizard; and
  • Authorization Wizard.

Detailed instructions for using SAS wizards are contained in the SAS Help Files.

 

7310  Requirement to Use SAS Wizards

Revision 17-1; Effective March 15, 2017

 

Regional management must ensure the use of the Community Care for Aged and Disabled (CCAD) Service Authorization System (SAS) wizards to:

  • enhance the accuracy of eligibility determinations, service plans, service authorizations and data;
  • improve documentation of individual satisfaction;
  • provide a database for provider monitoring and case reading sample selection; and
  • ensure compliance with federal regulations for program delivery.

Wizards must be used to document the following case actions:

  • authorizations, including initials, ongoing reassessments and changes;
  • monitoring;
  • terminations; and
  • denials.

 

7320  Use of the Monitoring Wizard

Revision 18-1; Effective June 15, 2018

 

The Service Authorization System (SAS) Monitoring Wizard must be used to document all required monitoring contacts. Additional contacts should be recorded using Form 2058, Case Activity Report.

Entry of Form 2314, Satisfaction and Service Monitoring, data must occur before the end of the month in which the action is due.

Form 2314 is used at monitoring visits to document the individual's assessment of how well CCAD services are meeting his needs. It is important to document the level of individual satisfaction by accurately completing and entering Form 2314 in the SAS Monitoring Wizard for all appropriate actions, as specified in the section above.

Form 2314, Section II, Overall Satisfaction on Services, is used to document the individual's perception of:

  • services authorized;
  • services requested but not authorized; and
  • reasons for dissatisfaction.

The case worker may also use Form 2314 at monitoring visits to document information that substantiates a discrepancy with the individual's perception of an issue. The Monitor Detail screen in the SAS Monitoring Wizard is used to record the actions taken.

  • Problems Alleged – Check this box for each service the individual expresses issues or dissatisfaction.
  • Reason – Enter the applicable dissatisfaction code listed in the Form 2314 instructions.
  • Action – Enter the applicable action code listed in the instructions.

Example: The individual requests additional attendant care hours. The case worker reviews the plan and approves the increase. The required Form 2314 information is recorded on the SAS Monitor Detail screen for personal attendant services:

  • Form 2314, Section II, Client Satisfied: "No."

SAS Monitor Detail screen, Problems Alleged: enter a check.

  • Form 2314, Section IV, Reason for Dissatisfaction: "B-1, Wants Hours Increased."

SAS Monitor Detail Screen, Reason: enter "B-1."

  • Form 2314, Section IV, Action: enter "SP – Change Service Plan."

SAS Monitor Detail Screen, Action: enter "SP."

Some action codes result in referrals to other HHSC staff, such as contract managers, regional nurses or supervisors. In the SAS Monitoring Wizard Client Satisfaction window, the case worker selects: Monitoring Status: Follow-Up Required. Generate.

Staff completing follow-up actions update the SAS monitoring record by entering the additional fields on the Monitor Detail screen:

  • Concurs with Previous? Yes or No;
  • Problems Alleged;
  • Reason; and
  • Action.

The Monitoring Status field on the Client Satisfaction screen will be changed to Completed once follow-up and resolution is complete.

The Overall Client Satisfaction question must be completed to document the individual's overall satisfaction with services. Document the individual's level of satisfaction after the resolution of any alleged dissatisfaction.

Regional management is accountable for ensuring compliance with the established use of Form 2314 and the SAS Monitoring Wizard. The data entered provides a database for provider monitoring and ensures compliance with federal regulations.

 

7330  Narrative Documentation for SAS Wizards

Revision 17-1; Effective March 15, 2017

 

The Service Authorization System (SAS) Monitoring Wizard must be used to document:

  • all required monitoring contacts;
  • the 30-day monitoring required for Consumer Directed Services;
  • all complaints received from individuals regarding their service plans;
  • provider changes;
  • all calls received from the individual that require case worker action;
  • Day Activity and Health Services provider changes; and
  • other scheduled monitoring or follow-up contacts, as appropriate.

Entry of Form 2314, Satisfaction and Service Monitoring, data must occur before the end of the month in which the action is due.

Form 2314 is used to document the individual's assessment of how well CCAD services are meeting his needs. It is important to document the level of individual satisfaction by accurately completing and entering Form 2314 in the SAS Monitoring Wizard for all appropriate actions, as specified in the section above.

Form 2314, Section II, Overall Satisfaction on Services, is used to document the individual's perception of:

  • services authorized;
  • services requested but not authorized; and
  • reasons for dissatisfaction.

The case worker may also use Form 2314 to document information that substantiates a discrepancy with the individual's perception of an issue.

The Monitor Detail screen in the SAS Monitoring Wizard is used to record the actions taken.

  • Problems Alleged – Check this box for each service the individual expresses issues or dissatisfaction.
  • Reason – Enter the applicable dissatisfaction code listed in the Form 2314 instructions.
  • Action – Enter the applicable action code listed in the instructions.

Example: The individual requests additional attendant care hours. The case worker reviews the plan and approves the increase. The required Form 2314 information is recorded on the SAS Monitor Detail screen for personal attendant services:

  • Form 2314, Section II, Client Satisfied: "No."

SAS Monitor Detail screen, Problems Alleged: enter a check.

  • Form 2314, Section IV, Reason for Dissatisfaction: "B-1, Wants Hours Increased."

SAS Monitor Detail Screen, Reason: enter "B-1."

  • Form 2314, Section IV, Action: enter "SP – Change Service Plan."

SAS Monitor Detail Screen, Action: enter "SP."

Some action codes result in referrals to other HHSC staff, such as contract managers, regional nurses or supervisors. In the SAS Monitoring Wizard Client Satisfaction window, the case worker selects: Monitoring Status: Follow-Up Required. Generate.

Staff completing follow-up actions update the SAS monitoring record by entering the additional fields on the Monitor Detail screen:

  • Concurs with Previous? Yes or No;
  • Problems Alleged;
  • Reason; and
  • Action.

The Monitoring Status field on the Client Satisfaction screen will be changed to Completed once follow-up and resolution is complete.

The Overall Client Satisfaction question must be completed to document the individual's overall satisfaction with services. Document the individual's level of satisfaction after the resolution of any alleged dissatisfaction.

Regional management is accountable for ensuring compliance with the established use of Form 2314 and the SAS Monitoring Wizard. The data entered provides a database for provider monitoring and ensures compliance with federal regulations.

 

7400  Community Services Interest List

Revision 17-1; Effective March 15, 2017

 

The Community Services Interest List (CSIL) is a web-based application for keeping track of individuals waiting to receive services in various Community Care programs. The CSIL replaces the manual tracking systems used by different community care programs.

The CSIL can be used for a variety of functions. The system works in real time and as soon as you enter data into the system, it is accessible to anyone with the correct permissions. Some functions are restricted to a few people with specific permissions. Permissions are designated by user groups. A "user group" is made up of users who have permission to perform various functions in the CSIL application. Example: The IL Admin group will be able to perform some functions that the IL Worker group is not allowed to do. Your region will decide to which group(s) you will be assigned. You may be assigned to more than one group, but the system allows you to work in only one group at a time.

The CSIL system is used to:

  • enter an individual in CSIL directly or through the Long Term Care Services Intake (NTK) System;
  • track monitoring contacts;
  • update information on individuals in CSIL;
  • do group releases of individuals on CSIL when slots are available;
  • let supervisors assign individuals to case workers;
  • close individuals off the interest list when certified;
  • search for individuals on the CSIL; and
  • determine the individual's status on the CSIL.

Complete instructions for use of the CSIL can be found in the Web Based Training website at http://palms.hhsc.state.tx.us/login/login.asp?refpage=default.asp.

 

7500  Communication Tools

Revision 18-1; Effective June 15, 2018

 

7510  Outlook Mailboxes for Communication from Medicaid for the Elderly and People with Disabilities (MEPD)

Revision 18-1; Effective June 15, 2018

 

HHSC Information Technology (IT) has established Outlook resource mailboxes and Outlook procedures for HHSC staff to access electronic information sent by MEPD staff using the MEPD Communication Tool.


HHSC will have regional staff designated to monitor MEPD communication by following the steps below to access the resource mailbox in Outlook.

1. With Outlook open, select File from the menu. Then select Account Settings and again, select Account Settings
select File from the menu
2. Select Change from the list of options
select File from the menu
3. Select More Settings.
select More Settings
4. Select Advance from the menu then Add.
Microsoft Exchange Screen
5. Enter the region's designated Alias as listed in the table below. (For example, "mecreg01" is entered for Region 1
Add Mailbox Screen

 

Resource Mailbox Display Name Alias
HHSC ME Communication Region 1 mecreg01
HHSC ME Communication Region 2/9 mecreg29
HHSC ME Communication Region 3 mecreg03
HHSC ME Communication Region 4/5 mecreg45
HHSC ME Communication Region 6 mecreg06
HHSC ME Communication Region 7 mecreg07
HHSC ME Communication Region 8 mecreg08
HHSC ME Communication Region 10 mecreg10
HHSC ME Communication Region 11 mecreg11

 

6. Once the alias is entered, select OK, Next, Finish, then Close. HHSC regional designated Resource Mailbox users will access the region's resource mailbox folder in the Outlook tree.
Mailbox Folder Screen

 

Resource Mailbox owners designated by regional management will be able to add, edit or delete Resource Mailbox users by right-clicking on the mailbox folder. Resource Mailbox owners must contact the Consolidated Help Desk (512-438-4720) if assistance is needed to add, edit or delete Resource Mailbox users.

Permission to forward information from the resource mailbox requires configuration of a separate Outlook profile. Resource Mailbox owners should submit a Help Desk ticket to have this completed for the authorized users.

The regional Resource Mailbox folder will have a single password that will be shared by all authorized users in that region. It is important that one person per mailbox be designated to maintain the password. All other authorized users must understand they are not to reset the password.