Revision 19-7; Effective June 3, 2019

 

The Individual Service Plan (ISP) Expiring report is a check and balance method for the ISP expiring at the end of the report month.

Report Fields

PCN – The member's nine-digit Medicaid number.

Name – The member's last name, first name and middle initial (when provided).

SG – The Service Authorization System Online (SASO) Service Group (SG). The STAR+PLUS SG is 19.

SC – The SASO Service Code (SC). The STAR+PLUS SC is 12. SC 13 should not appear on this report; if SC 13 does appear, disregard the line item.

ISP Begin Date – The begin date of the last ISP registered in SASO.

ISP End Date – The end date of the last ISP registered in SASO.

MN Begin Date – The begin date of the last medical necessity (MN) registered in SASO.

MN End Date – The end date of the last MN registered in SASO.

MN – The approval or denial of the MN referenced in the MN begin/end date:

  • "Y" means the MN was approved.
  • "N" means the MN was denied.

RG – The three-digit Risk Group number.

Enroll Month – The most current enrollment month at the time of the report.

Plan – The two-digit managed care organization (MCO) plan code.

TP – The member’s two-digit Medicaid Type Program.

 

Program Support Unit (PSU) Entry Fields

Date 2065D Sent – Enter the date PSU staff uploaded Form H2065-D, Notification of Managed Care Program Services, to TxMedCentral if the:

  • MN column has "N" (denied);
  • PSU research shows the MN is denied;
  • Managed care organization notifies PSU staff of the MN denial;
  • PSU staff learn of the MN denial by any other method;
  • PSU staff learn of no unmet need at the annual reassessment for the new ISP;
  • PSU staff learn of loss of eligibility; or
  • PSU staff learn of any other denial reasons.

If the MN column has "Y" (approved), leave the field blank.

Date MN Registered in SAS - The date the MN is registered in SASO.

Date ISP Registered – Enter the date PSU staff registered the ISP in SASO, if uploaded to TxMedCentral or Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal.

Date ISP Posted – The date Form H1700-1, Individual Service Plan (Pg. 1), was uploaded by the MCO to TxMedCentral or TMHP LTC Online Portal.

Comments – PSU staff may enter appropriate comments.

Note: Enter information in the “Comments” field in situations where Form H2065-D is completed but the “Date ISP Registered” is not filled out. The reason entered must provide sufficient detail to ensure clarity.

For expired ISP, Date MCO Contacted – Enter the date the MCO was contacted if the ISP has expired.

Date MCO Contacted, 2nd attempt – Enter the 2nd attempt date the MCO was contacted if the ISP has expired.

Date MCO Contacted, 3rd attempt – Enter the 3rd attempt date the MCO was contacted if the ISP has expired.

The ISP Expiring Report is a monthly report. PSU staff are required to research, resolve and respond within 14 days of receipt.

 

Scan Call for ISP Expiring Report process:

  • PSU staff provide the ISP Expiring Report five business days prior to the scheduled scan call.
  • The MCOs research and provide a written status for each member whose ISP expires within 45 days, indicating the status of the member’s reassessment. The MCO must return a completed report to PSU staff two business days prior to the scan call.
  • PSU staff review the MCO's responses to determine if the MCO needs to provide clarification regarding any member's ISP status. During the scan call, only the ISP status about which PSU staff have questions are reviewed. There will no longer be a need to review each member for the status of the ISP if the MCO's response is sufficient.

Note: SASO files used by Program Enrollment Support (PES) staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.