Revision 19-1; Effective March 1, 2019

 

O-3100 Reserved for Future Use

Revision 11-2; Effective June 1, 2011

 

 

O-3200 STAR+PLUS Waiver (SPW)

Revision 19-1; Effective March 1, 2019

 

STAR+PLUS is a Texas Medicaid managed care program designed to provide health care and acute and long-term services and supports through a managed care system.

The SPW program is a Home and Community-Based Services waiver program approved for the managed care delivery system and designed to allow individuals who would otherwise require nursing home or other forms of institutionalized care to receive long-term services and supports in order to be able to live in the community.

 

Multiple Program Processing

If MEPD completes the financial determination and the person does not meet the HHSC waiver eligibility component criteria or there is no available waiver slot, certify the person for other benefits for which the person may be entitled, such as QMB or SLMB, as soon as eligibility can be determined. If the application is due, use delay of certification procedures for the ME-Waiver eligibility determination group (EDG).

This allows the application to remain open for an additional 90 days.

HHSC notifies MEPD by completing and sending Form H1746-A, MEPD Referral Cover Sheet, to the Austin Data Processing Center. MEPD continues to notify HHSC of eligibility status using the MEPD communication tool (http://dadsview.dads.state.tx.us/me-to-dads/) or Form H2067, Case Information.

When the person meets all pending HHSC waiver eligibility component criteria and there is an available slot, complete a disposition of the ME-Waiver EDG.

If the delay of certification period is expiring and the person still does not meet the HHSC waiver eligibility component criteria or there is still no available slot, proceed with denial of the ME-Waiver EDG. The MEPD specialist informs HHSC of the denial using Form H2067 or the MEPD communication tool.

The STAR+PLUS Support Unit (SPSU) sends Form 3676-MC, Managed Care Pre-Enrollment Assessment Authorization, to the MEPD specialist. Form 3676-MC documents medical necessity and the individual service plan (ISP). The MEPD specialist completes Section D, items 42 through 47, of Form 3676-MC and returns it to SPSU.