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Section 1000, State of Texas Access Reform Plus (STAR+PLUS) Managed Care
- 1100 Program Overview
- 1200 MCO Service Coordination
- 1210 Service Coordinators and Nursing Facilities
- 1220 MCO Service Coordinators and Programs Serving Members with IDD
- 1230 Service Coordinators and HCBS – Adult Mental Health Program
- 1240 MCO Service Coordinators and Section 811 Project Rental Assistance
- 1250 Service Coordinators and the Medicaid for Breast and Cervical Cancer Program
Section 2000, Legal Requirements
- 2100 Disclosure of Information
- 2200 Member Rights and Responsibilities
Section 3000, STAR+PLUS HCBS Program Eligibility and Services
- 3100 Ancillary Member Resources
- 3110 Medicaid, Medicare and Dual-Eligibles
- 3120 Other Available Services
- 3200 Eligibility
- 3210 Service Areas
- 3220 Eligible Groups
- 3230 Financial Eligibility
- 3231 Income Diversion Trust
- 3232 Payments from the Qualified Income Trust
- 3233 Available QIT Copayment Amount Exceeds the Daily Rate for AFC or AL
- 3234 Qualified Income Trust Copayment Agreement
- 3235 Refusal to Pay Qualified Income Trust Copayment
- 3236 Copayment and Room and Board
- 3237 Determining Room and Board Charges
- 3238 Determining Copayment Amounts
- 3239 Copayment Changes
- 3240 STAR+PLUS HCBS Requirements
- 3300 Administrative Procedures
- 3310 Intake and Enrollment
- 3320 Coordination with MEPD
- 3330 STAR+PLUS Members Requesting an Upgrade to STAR+PLUS HCBS
- 3400 Transferring Into STAR+PLUS
- 3410 Transfer Scenarios
- 3420 Individuals Transitioning to Services for Adults
- 3421 Procedures for Children Transitioning from STAR Kids/STAR Health
- 3421.1 Twelve Months Prior to the Member's 21st Birthday
- 3421.2 Nine Months Prior to the Member's 21st Birthday
- 3421.3 Five Months Prior to the Member’s 21st Birthday
- 3421.4 Within 45 Days of Receiving Notification of a Form H3676 Referral
- 3421.5 Confirm STAR+PLUS HCBS Eligibility
- 3421.6 ISP Cost Exceeds 202% of the RUG Cost Limit
- 3422 Intrapulmonary Percussive Ventilator
- 3421 Procedures for Children Transitioning from STAR Kids/STAR Health
- 3500 Money Follows the Person
- 3510 Money Follows the Person and Managed Care
- 3520 Money Follows the Person Demonstration
- 3521 Money Follows the Person Demonstration Introduction
- 3522 Screening Criteria for Money Follows the Person Demonstration Eligibility
- 3523 Enrollment in Money Follows the Person Demonstration
- 3524 Money Follows the Person Demonstration Entitlement Period Tracking
- 3525 Documentation of the 90-Day Qualifying Institutional Stay Required for MFPD Eligibility in the STAR+PLUS HCBS Program
- 3530 High/Complex Needs Members
- 3600 Ongoing Service Coordination
- 3610 Revising the Individual Service Plan
- 3611 MCO Required Notifications from the Provider
- 3620 Reassessment
- 3630 Denial or Termination
- 3631 Ten Business Adverse Determination Notification
- 3632 STAR+PLUS Home and Community Based Services (HCBS) Denial/Termination Reasons
- 3632.1 Denial or Termination Due to Death
- 3632.2 Denial or Termination Due to Institutional Stay
- 3632.3 Denial or Termination Due to Member Request
- 3632.4 Denial or Termination of Medicaid Financial Eligibility
- 3632.5 Denial or Termination of MN/LOC
- 3632.6 Denial or Termination Due to Exceeding the ISP Cost Limit
- 3632.7 Denial or Termination Due to Inability to Locate Member
- 3632.8 Denial or Termination Due to Not Requiring at Least One Waiver Service
- 3632.9 Denial or Termination for Other Reasons
- 3633 Disenrollment
- 3610 Revising the Individual Service Plan
Section 4000, Complaints, Internal MCO Appeals and State Fair Hearings
- 4100 Managed Care Organization Procedures
- 4200 Appeal Procedures for Program Support Staff
- 4300 Post Hearing Actions
- 4400 Continuation of Services
- 4500 Hearing Decision Actions
- 4600 Roles and Responsibilities of HHSC Fair Hearings Officers
- 4700 Fair Hearings for MCO Decisions
Section 5000, Automation and Payment Issues in STAR+PLUS
Section 6000, Specific STAR+PLUS HCBS Program Services
- 6100 Home and Community Based Services
- 6200 Nursing Services
- 6300 Therapy Services
- 6400 Adaptive Aids and Medical Supplies
- 6410 List of Adaptive Aids and Medical Supplies
- 6420 Approval of Adaptive Aids and Medical Supplies
- 6430 Effects of Changing MCOs on Adaptive Aids Procurements
- 6440 Temporary Lease and Equipment Rental
- 6450 Time Frames for Purchase and Deliver of Aids and Supplies
- 6460 Co-Insurance and Deductibles
- 6470 Bulk Purchase of Medical Supplies
- 6500 Dental Services
- 6600 Minor Home Modifications
- 6700 Employment Services
Section 7000, STAR+PLUS HCBS Program and Services
- 7100 Adult Foster Care
- 7110 Introduction
- 7120 Minimum Standards for All AFC Homes and Providers
- 7130 Adult Foster Care Eligibility
- 7140 AFC MCO Procedures
- 7150 Finalizing the Member's Plan of Care
- 7160 Monitoring Quality of Care
- 7170 Significant Changes
- 7180 Annual Reassessment of the AFC Member
- 7200 Assisted Living Services
- 7300 Respite Care Services
- 7400 Emergency Response Services
- 7500 Home-Delivered Meals
- 7600 Transition Assistance Services
- 7610 Introduction
- 7620 Procedures at the Initial Interview
- 7630 Identification of Needed Items and Services
- 7650 Estimated Cost of Items and Services
- 7660 Transition Assistance Services Agency Responsibilities
- 7670 Three-Day Monitor Required
- 7680 Failure to Leave the Facility
- 7690 Member Notifications and Appeals
Section 8000, Service Delivery Options
- 8100 Selection of a Service Delivery Option
- 8200 Consumer Directed Services
- 8210 Overview
- 8220 Member Choice in the CDS Option
- 8230 Developing the Individual Service Plan in the CDS Option
- 8240 Initiation of and Transition to CDS Option
- 8300 Service Responsibility Option (SRO) Description
Section 9000, Utilization Review Purpose
Section 10000, State Plan Long Term Services and Supports
- 10100 Long Term Services and Supports
- 10110 Day Activity and Health Services
- 10120 Day Activity and Health Services Providers
- 10130 Assessment for Day Activity and Health Services
- 10140 Reassessment for Day Activity and Health Services
- 10150 Authorization for Day Activity and Health Services
- 10160 Reauthorization of Day Activity and Health Services
- 10170 Transfer Between Facilities
- 10180 Transfer Between MCOs