Revision 19-7; Effective June 3, 2019

 

The STAR+PLUS Loss of Eligibility Report provides to Program Support Unit (PSU) staff a list of STAR+PLUS Home and Community Based Services (HCBS) program members who have lost Medicaid eligibility. PSU staff must conduct coordination activities to either reestablish eligibility or close the authorization(s) in the Service Authorization System Online (SASO).

 

Report Fields

PCN — The member’s nine-digit Medicaid number.

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

RG — The three-digit Risk Group number.

Plan Code — The two-digit managed care organization (MCO) plan code in which the member is currently enrolled.

TP — The member’s two-digit Medicaid Type Program (TP).

 

PSU Entry Field

Eligibility Re-established? — PSU staff check the Texas Integrated Eligibility Redesign System (TIERS) to determine if Medicaid eligibility has been reestablished. If it has, enter "Yes;" if not, enter "No."

If yes, is manual managed care enrollment needed? — If the response to the previous column was "Yes," PSU staff must check TIERS to determine if Medicaid eligibility and managed care enrollment have been established. If manual managed care enrollment is needed, send an email to the Program Enrollment Support (PES) mailbox.

If no, provide the date Form H2065-D was sent. — PSU staff enter the date Form H2065-D, Notification of Managed Care Program Services, was sent.

Was the decision appealed? — PSU staff enter "Yes" or "No." (No further action is necessary if the response to this question is "no.") If "Yes," continue to the next section.

If yes, was eligibility re-established? — PSU staff check TIERS to determine if Medicaid eligibility has been re-established. If it has, enter "Yes;" if not, enter "No." (No further action is necessary if the response to this question is "No.")

If eligibility was re-established, is manual managed care enrollment needed? — If the response to the previous column was "Yes," PSU staff must check TIERS to determine if managed care enrollment have been established. If manual managed care enrollment is needed, send an email to the PES mailbox.

Pending at PSU — Enter “Yes” or “No.”

Pending at MCO — Enter “Yes” or “No.”

Pending at MEPD — Enter “Yes” or “No.”

Comments — Enter any comments relevant to the actions taken.

The STAR+PLUS Loss of Eligibility Report is a monthly report. PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt. (The fact that completion of the report itself is due within 14 days of receipt does not negate policy regarding denial notifications. Refer to Section 3622, Notification Requirements. The notification must still be sent within two business days.)

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