Revision 18-0; Effective September 4, 2018

 

 

9100 Initial Service Authorization

Revision 18-0; Effective September 4, 2018
 
When Program Support Unit (PSU) staff authorize the STAR+PLUS Home and Community Based Services (HCBS) program for an initial service authorization in the Service Authorization System Online (SASO), PSU staff must check or create the following records according to Sections 9110 through 9170:

  • Authorizing Agent – Initial;
  • Enrollment – Initial;
  • Service Plan – Initial;
  • Service Authorization – Initial;
  • Level of Service  – Initial;
  • Diagnosis – Initial; and
  • Medical Necessity – Initial.

 
9110 Authorizing Agent - Initial

Revision 18-0; Effective September 4, 2018
 
The authorizing agent record in the Service Authorization System Online (SASO) is used to register the authorizing agent begin date with an open ended date for the STAR+PLUS Home and Community Based Services (HCBS) program applicant.

There will normally be one authorizing agent registered in SASO for a STAR+PLUS HCBS program applicant.

Initial individual service plans (ISPs) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal have a system generated authorizing agent. The TMHP LTC Online Portal interfaces with the SASO and records "STAR+PLUS" in the ‘Authorizing Agent’ field and records the managed care organization (MCO) service coordinator's name in the ‘Name’ field.

The TMHP LTC Online Portal will generate changes to the SASO authorizing agent records for a member with a plan code change during an ISP year for which a current or future ISP is in a "processed/complete" status. In this case, a SASO authorizing agent record is created for the initial ISP with a begin date equal to the new managed care organization (MCO) plan effective date. The SASO authorizing agent record for the transferred ISP is automatically ended with the prior MCO plan enrollment end date.

Program Support Unit (PSU) staff do not register an authorizing agent for an electronic ISP.

PSU staff can create authorizing agent record(s) for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm the authorizing agent registration in SASO.  

PSU staff are registered as the authorizing agent when an applicant is authorized in SASO.

To register an authorizing agent record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

  1. Select the Authorizing Agent field in the Case Worker functional area.
  2. Select Add and a blank Authorizing Agent Details record will appear.
  3. Move to the Type field and select CM – Case Manager from the drop-down menu.
  4. Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
  5. Leave the Send to TMHP field at the default selection N - NO.
  6. Move to the Begin Date field and enter the date the record is being created. Leave the End Date field blank.
  7. Move to the Authorizing Agent field and enter STAR+PLUS.
  8. Leave the Agency field at the default selection 324 - DHS.
  9. Move to the Name field and enter the PSU staff’s service area.
  10. Move to the Phone field and enter the telephone number of the authorizing agent. Enter the area code, phone number and extension.
  11. Move to the Mail Code field and enter the appropriate Managed Care Organization (MCO) plan code from the table below. Note: Six service areas include Medicare-Medicaid Plans (MMP).
Service Area MCO Plan Name MCO Plan Code
Bexar Amerigroup 45
Molina 46
Superior 47
Amerigroup MMP 4F
Molina MMP 4G
Superior MMP 4H
Dallas Molina 9F
Superior Health Plan 9H
Molina MMP 9J
Superior MMP 9K
El Paso Amerigroup 34
Molina 33
Amerigroup MMP 3G
Molina MMP 3H
Harris Amerigroup 7P
United Healthcare 7R
Molina 7S
Amerigroup MMP 7Z
United Healthcare MMP 7Q
Molina MMP 7V
Hidalgo Cigna-HealthSpring H7
Molina H6
Superior H5
Cigna-HealthSpring MMP H8
Molina MMP H9
Superior MMP HA
Jefferson Amerigroup 8R
United Healthcare 8S
Molina 8T
Lubbock Amerigroup 5A
Superior 5B
Medicaid Rural Service Area (RSA) Central Texas Superior C4
United Healthcare C5
Medicaid RSA Northeast Texas Cigna-HealthSpring N3
United Healthcare N4
Medicaid RSA West Texas Amerigroup W5
Superior W6
Nueces United Healthcare 85
Superior Health Plan 86
Tarrant Amerigroup 69
Cigna-HealthSpring 6C
Amerigroup MMP 6F
Cigna-HealthSpring MMP 6G
Travis Amerigroup 19
United Healthcare 18

 

  1. Select the Save button.

 

    9120 Enrollment - Initial

    Revision 18-0; Effective September 4, 2018
     
    The enrollment record in the Service Authorization System Online (SASO) is used to register the enrollment begin and end date for the STAR+PLUS Home and Community Based Services (HCBS) program applicant.

    Program Support Staff (PSU) staff will create an enrollment record for STAR+PLUS HCBS program eligibility for applicants whose individual service plan (ISP) was not transmitted electronically.

    PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    To register an enrollment record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

    1. Select the Enrollment field in the Program and Service functional area.
    2. Select Add and a blank Enrollment Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Enrolled From field and select the appropriate entry from the drop-down menu.
    5. Move to the Living Arrangement field, and select the appropriate community-based living arrangement from the drop-down menu. The living arrangement must match the information provided in the initial ISP.
    6. Move to the Begin Date field and enter the date the member is to be enrolled in his MCO, which will always be the first day of a month.
    7. Leave the End Date field blank.
    8. Leave the Termination Code and Waiver Type fields at the defaults.
    9. Select the Save button.

     

    9130 Service Plan - Initial

    Revision 18-0; Effective September 4, 2018
     
    The Service Plan record in the Service Authorization System Online (SASO) is used to register an individual service plan (ISP) for a STAR+PLUS Home and Community Based Services (HCBS) program member. The service plan record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Resource Utilization Group (RUG) value and the total estimated cost taken from the member’s Form H1700-1, Individual Service Plan (Pg. 1), for members who do not have an electronic ISP.

    Program Support Staff (PSU) staff will create a service plan record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    To register a service plan record for a STAR+PLUS HCBS program applicant whose ISP requires manual entry, PSU staff must:

    1. Select the Service Plan field in the Program and Service functional area.
    2. Select Add and a blank Service Plan Details record will appear.
    3. Leave the Type field at the default selection AN - ANNUAL PLAN.
    4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    5. Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the RUG value entered on the current ISP coverage period, from Form H1700-1.  For a STAR+PLUS HCBS program member who is ventilator use-dependent, enter the annual STAR+PLUS HCBS program ISP cost limit based on the RUG value and ventilator use of the member (6-23 hours or 24 hours continuous).
    6. Move to the Begin Date field and enter the effective date of the ISP coverage period.
    7. Move to the End Date field and enter the last day of the ISP coverage period.
    8. Move to the Amount Authorized field and enter the total estimated cost of all STAR+PLUS HCBS program services authorized for the current ISP coverage period, from Form H1700-1.
    9. Leave the Amount Paid field at the default setting of 0.00.
    10. Leave the Units Authorized field at the default of 0.00.
    11. Leave the Units Paid field at the default of 0.00.
    12. Select the Save button.

     

    9140 Service Authorization - Initial

    Revision 18-0; Effective September 4, 2018
     
    If the individual service plan (ISP) is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service authorization records in the Service Authorization System Online (SASO).

    Program Support Unit (PSU) staff do not register service authorization records for an electronic individual service plan (ISP).

    PSU staff will create a service authorization record, if applicable, for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

    PSU staff must confirm service authorization registration in SASO, take a screenshot of the service authorization registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    To register a service authorization record for STAR+PLUS HCBS program eligibility for a member whose ISP requires manual entry, PSU staff must:

    1. Select the Service Authorization field in the Program and Service functional area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
    5. Leave the Fund and Term. Code fields at the defaults.
    6. Leave the Agency field at the default selection 324 - DHS.
    7. Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
    8. Move to the Units field and enter 1.00.
    9. Leave the Amount field at the default.
    10. Move to the Begin Date field and enter the effective date of the ISP coverage period.
    11. Move to the End Date field and enter the last day of the ISP coverage period.
    12. Move to the Contract No field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).
    MCO Service Area Contract Number
    Molina Bexar 1014430
    Molina MMP Bexar 1026341
    Molina Harris 1014431
    Molina MMP Harris 1026344
    Molina Jefferson 1019598
    Molina Dallas 1018980
    Molina MMP Dallas 1026342
    Molina El Paso 1019987
    Molina MMP El Paso 1026343
    Molina Hidalgo 1019988
    Molina MMP Hidalgo 1026345
    Superior Bexar 1014433
    Superior MMP Bexar 1026337
    Superior Nueces 1014434
    Superior Dallas 1018981
    Superior MMP Dallas 1026338
    Superior Hidalgo 1019985
    Superior MMP Hidalgo 1026339
    Superior Lubbock 1019986
    Superior Medicaid Rural Service Area (RSA) Central 1025731
    Superior Medicaid RSA West 1025730
    United Healthcare Harris 1014435
    United Healthcare MMP Harris 1026334
    United Healthcare Jefferson 1019600
    United Healthcare Medicaid RSA Central 1025732
    United Healthcare Medicaid RSA Northeast 1025734
    United Healthcare Nueces 1014437
    United Healthcare Travis 1014438
    Amerigroup Bexar 1014439
    Amerigroup MMP Bexar 1026326
    Amerigroup Harris 1014440
    Amerigroup MMP Harris 1026331
    Amerigroup Jefferson 1019599
    Amerigroup Travis 1014442
    Amerigroup El Paso 1019979
    Amerigroup MMP El Paso 1026328
    Amerigroup Lubbock 1019983
    Amerigroup Medicaid RSA West 1025729
    Amerigroup Tarrant 1018977
    Amerigroup MMP Tarrant 1026332
    Cigna-HealthSpring Tarrant 1018979
    Cigna-HealthSpring MMP Tarrant 1026333
    Cigna-HealthSpring Hidalgo 1019984
    Cigna-HealthSpring MMP Hidalgo 1026335
    Cigna-HealthSpring Medicaid RSA Northeast 1025733
    1. The NPI field is read-only.
    2. Select the Save button.

     

    9150 Level of Service - Initial

    Revision 18-0; Effective September 4, 2018
     
    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a Resource Utilization Group (RUG) registered on a level of service (LOS) record in the Service Authorization System Online (SASO). The LOS record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the RUG value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The LOS record is system generated from the information stored in the SASO database. The system generated LOS record will have an end date that may need to be extended by Program Support Unit (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

    PSU staff will create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    Example: If the MN/LOC Assessment is approved with an effective date of May 13, 2019, the system-generated end date for the LOS record will be May 12, 2020. If the ISP period is June 1, 2019 to May 31, 2020, the LOS record will need to be extended to May 31, 2020, so the member has coverage for the entire ISP period.

    To extend an LOS record for a STAR+PLUS HCBS program applicant, PSU staff must:

    1. Select the Level of Service field in the Medical functional area.
    2. Select the Level of Service record you wish to extend.
    3. Select the Modify button to open and modify.
    4. Move to the End Date field and change the date to the last day of the ISP period.
    5. Select the Save button.

    If an LOS record has not been created in SASO, PSU staff must complete the following steps to add the record:

    1. Select the Level of Service field in the Medical functional area.
    2. Select Add and a blank Level of Service Details record will appear.
    3. Move to the Type field and select CR – CBA RUG from the drop-down menu.
    4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    5. Move to the Level field and enter the RUG level from Form H1700-1, Individual Service Plan (Pg. 1). The RUG level can be verified in the MN/LOC Assessment.
    6. Move to the Begin Date field and enter the first day of the ISP period.
    7. Move to the End Date field and enter the last day of the ISP period.
    8. Select the Save button.

     

    9160 Diagnosis - Initial

    Revision 18-0; Effective September 4, 2018

    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record should be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record will have an end date that may need to be extended by Program Support Staff (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

    PSU staff will create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    Example: If MN is approved with an effective date of November 13, 2019, the system generated end date will be November 30, 2020.

    To extend a diagnosis record for a STAR+PLUS HCBS program applicant or member:

    1. Select the Diagnosis field in the Medical functional area.
    2. Select the Diagnosis record you wish to extend.
    3. Select the Modify button to open and modify.
    4. Move to the End Date field and change the date to the last day of the ISP period.
    5. Select the Save button.

    If a diagnosis record has not been created in SASO, PSU staff must complete the following steps to add the record:

    1. Select the Diagnosis field in the Medical functional area.
    2. Select Add and a blank Diagnosis Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Begin Date field and enter the first day of the ISP period.
    5. Move to the End Date field and enter the last day of the ISP period.
    6. Enter up to five diagnoses from the most recent Waiver 3.0 Form, Section I, in TMHP. The diagnosis can be verified in the MN/LOC Assessment.
    7. Select Version ICD-10-CM CODE.
    8. Select the Save button.

     
    9170 Medical Necessity - Initial

    Revision 18-0; Effective September 4, 2018
     
    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have an end date that may need to be extended by Program Support Staff (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

    PSU staff will create an MN record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    Example: If MN is approved with an effective date of May 13, 2019, the system generated end date will be May 31, 2020.

    To extend an MN record for a STAR+PLUS HCBS program applicant, PSU staff must:

    1. Select the MN field in the Medical functional area.
    2. Select the MN record you wish to extend.
    3. Select the Modify button to open and modify.
    4. Move to the End Date field and change the date to the last day of the ISP period.
    5. Select the Save button.

    If an MN record has not been created in SASO, PSU staff must complete the following steps to add the record:

    1. Select the MN field in the Medical functional area.
    2. Select Add and a blank MN Details record will appear.
    3. Move to the MN field and select Y - YES from the drop-down menu.
    4. Move to the Permanent field and select N – NO.
    5. Move to the Begin Date field and enter the first day of the ISP period.
    6. Move to the End Date field and enter the last day of the ISP period.
    7. Select the Save button.

     
    9200 Reassessment Service Authorization

    Revision 18-0; Effective September 4, 2018
     
    When Program Support Unit (PSU) staff authorize STAR+PLUS Home and Community Based Services (HCBS) program services for a reassessment of the individual service plan (ISP) in the Service Authorization System Online (SASO), PSU staff must check or create the following records according to Sections 9210 through 9270:

    • Authorizing Agent – Reassessment;
    • Enrollment – Reassessment;
    • Service Plan – Reassessment;
    • Service Authorization – Reassessment;
    • Level of Service  – Reassessment;
    • Diagnosis – Reassessment; and
    • Medical Necessity – Reassessment.

     

    9210 Authorizing Agent – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    Check the authorizing agent record for accuracy. If there are no changes, leave the authorizing agent record open-ended. Currently, although the Service Authorization System Online (SASO) will accept multiple authorizing agent records, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal will only accept two authorizing agent records when a SASO file is transmitted to TMHP. Therefore, select “NO” in the ‘Send to TMHP’ field for all updates.

    Program Support Unit (PSU) staff will create an authorizing agent record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose individual service plan (ISP) was not transmitted electronically.

     
    9220 Enrollment – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    Check the enrollment record for accuracy and to be sure it is open-ended. If it is open-ended, make no changes. If it has an end date, delete the end date or create another record with a new begin date. To ensure that there is not a gap in service, the begin date of the enrollment for the new individual service plan (ISP) year is the day after the end date of the previous ISP year.

    Program Support Staff (PSU) staff will create a service plan record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

    PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

     
    9230 Service Plan – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    A new service plan record may need to be created to register the Resource Utilization Group (RUG) cost limit and the amount of services authorized for the new individual service plan (ISP) year.

    Because the ISP is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service plan records in the Service Authorization System Online (SASO).

    Program Support Unit (PSU) staff do not need to create a service plan record for electronic ISPs.

    PSU staff will create a service plan record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for members whose ISP was not transmitted electronically.

    PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the HHS Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.
     

    9240 Service Authorization – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    If the managed care organization (MCO) uploads a timely reassessment packet, Program Support Unit (PSU) staff create one service authorization record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility for the new individual service plan (ISP) year. To ensure there is no gap in service, the begin date of the authorization for the new ISP year is the day after the end date of the previous ISP year.

    Because the ISP is electronic, the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal automatically generates service authorization records in the Service Authorization System Online (SASO).

    PSU staff should not need to register service authorization records for electronic ISPs.

    PSU staff will create a service authorization record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    PSU staff confirm service authorization registration in SASO, take a screenshot of the service authorization registration in SASO, and upload the screenshot to the HHS Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    If the MCO does not upload a timely reassessment packet, two service authorization records will be required for STAR+PLUS HCBS program eligibility. The first service authorization record for STAR+PLUS HCBS program eligibility will be entered with service group (SG) 19/service code (SC) 13 for the month(s) for which the ISP was late. The second service authorization record for STAR+PLUS HCBS program eligibility will be entered with SG 19/SC 12 for the remaining ISP period.

    To enter a service authorization record for an untimely reassessment for STAR+PLUS HCBS program eligibility for an applicant or member whose ISP is not electronic, PSU staff must:

    1. Select the Service Authorization field in the Program and Service functional area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Service Code field and select 13 – NURSING SERVICES from the drop-down menu.
    5. Leave the Fund and Term. Code fields at the defaults.
    6. Leave the Agency field at the default selection 324 - DHS.
    7. Move to the Unit Type field and select 4 – PER AUTHORIZATION from the drop-down menu.
    8. Move to the Units field and enter 1.00.
    9. Leave Amount field at the default.
    10. Move to the Begin Date field and enter the effective date of the new ISP coverage period.
    11. Create two service authorization records. For the first record, move to the End Date field and enter the last day of the month the ISP was received. Note: For the second record, repeat steps 1 through 10. Move to the Begin Date field and enter the first of the next month and move to the End Date field and enter the end date of the ISP period.
    12. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

     

    MCO Service Area Contract Number
    Molina Bexar 1014430
    Molina MMP Bexar 1026341
    Molina Harris 1014431
    Molina MMP Harris 1026344
    Molina Jefferson 1019598
    Molina Dallas 1018980
    Molina MMP Dallas 1026342
    Molina El Paso 1019987
    Molina MMP El Paso 1026343
    Molina Hidalgo 1019988
    Molina MMP Hidalgo 1026345
    Superior Bexar 1014433
    Superior MMP Bexar 1026337
    Superior Nueces 1014434
    Superior Dallas 1018981
    Superior MMP Dallas 1026338
    Superior Hidalgo 1019985
    Superior MMP Hidalgo 1026339
    Superior Lubbock 1019986
    Superior Medicaid Rural Service Area (RSA) Central 1025731
    Superior Medicaid RSA West 1025730
    United Healthcare Harris 1014435
    United Healthcare MMP Harris 1026334
    United Healthcare Jefferson 1019600
    United Healthcare Medicaid RSA Central 1025732
    United Healthcare Medicaid RSA Northeast 1025734
    United Healthcare Nueces 1014437
    United Healthcare Travis 1014438
    Amerigroup Bexar 1014439
    Amerigroup MMP Bexar 1026326
    Amerigroup Harris 1014440
    Amerigroup MMP Harris 1026331
    Amerigroup Jefferson 1019599
    Amerigroup Travis 1014442
    Amerigroup El Paso 1019979
    Amerigroup MMP El Paso 1026328
    Amerigroup Lubbock 1019983
    Amerigroup Medicaid RSA West 1025729
    Amerigroup Tarrant 1018977
    Amerigroup MMP Tarrant 1026332
    Cigna-HealthSpring Tarrant 1018979
    Cigna-HealthSpring MMP Tarrant 1026333
    Cigna-HealthSpring Hidalgo 1019984
    Cigna-HealthSpring MMP Hidalgo 1026335
    Cigna-HealthSpring Medicaid RSA Northeast 1025733
    1. The NPI field is read-only.
    2. Select the Save button.

     

    9250 Level of Service – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a Resource Utilization Group (RUG) value registered in the Service Authorization System Online (SASO). The level of service (LOS) record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the RUG value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The LOS record is system generated from the information stored in the SASO database. The system-generated LOS record will have a begin and end date that matches the new individual service plan (ISP) year.

    Program Support Unit (PSU) staff will create an LOS record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    Example: A member with an initial ISP coverage period of December 1, 2019 through November 30, 2020, is authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective December 1, 2019 through November 30, 2020. These new begin and end dates will be system generated in the LOS record.

     

    9260 Diagnosis – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information from this form to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is commuted, TMHP submits the decision to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record will have a begin and end date that matches the new individual service plan (ISP) year.

    Program Support Unit (PSU) staff will create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    Example: A member with an initial ISP coverage period of November 1, 2019 through October 31, 2020, is re-authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective November 1, 2019 through October 31, 2020. These new begin and end dates will be system generated in the diagnosis record.

     

    9270 Medical Necessity – Reassessment

    Revision 18-0; Effective September 4, 2018
     
    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment for the annual reassessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have a begin date and an end date that matches the new individual service plan (ISP) year.

    Program Support Unit (PSU) staff will create an MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    Example: A member with an initial ISP coverage period of February 1, 2019 through Jan. 31, 2020, is authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective February 1, 2019 through January 31, 2020. These new begin and end dates will be system generated in the MN record. The MN record must be forced in SASO to register an MN determination for a reassessment when the MN is approved in the TMHP LTC Online Portal but will not convert to SASO because of a mismatch of member information between the MN/LOC Assessment and the Texas Integrated Eligibility Redesign System (TIERS).

     

    9300 Transfers

    Revision 18-0; Effective September 4, 2018
     
    There are several situations that are considered transfers for STAR+PLUS Home and Community Based Service (HCBS) program members, and the procedures differ for each.
     

    9310 Transfers from One STAR+PLUS Area to Another Area

    Revision 18-0; Effective September 4, 2018
     
    There are two different situations that can occur when a STAR+PLUS member transfers from one service area to another service area. The first is when a member transfers to a new service area that the current managed care organization (MCO) also serves, and the member wants to stay with that MCO. Even though the member is staying with the same MCO, the contract number will change and the member’s records will need to be closed under the previous contract number and opened under the new contract number. The second is when the member changes MCOs in the new service area.

    If the member's individual service plan (ISP) is electronic and the member made a new MCO selection timely, the Texas Integrated Eligibility Redesign System (TIERS) updates the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal, which automatically closes the registration for the losing MCO and creates the registration for the gaining MCO in the Service Authorization System Online (SASO). If the member's MCO plan change is not timely, Program Support Unit (PSU) staff follow existing policy, stated below.

    To process the transfer, the losing PSU staff close the existing authorizing agent and service authorization (service code (SC) 12) records. The gaining PSU staff open a new Authorizing Agent and service authorization record SC 12 using the MCO contract number in the new service area.

    To close the authorizing agent record, PSU staff must:

    1. Open the STAR+PLUS Home and Community Based Services (HCBS) program member’s case in the SASO.
    2. Select the Authorizing Agent field from the Case Worker functional area.
    3. Select the Authorizing Agent record you wish to close.
    4. Select the Modify button to open and modify.
    5. Move to the End Date field and enter the effective date of the termination, which is the last day of the month in which the member moved to the new service area.
    6. Select the Save button.

    To close the Service Authorization record, PSU staff must:

    1. Select the Service Authorization field in the Program and Service functional area.
    2. Select the appropriate Service Authorization (SC 12) record you wish to close.
    3. Select the Modify button to open and modify.
    4. Move to the End Date field and enter the effective date of the termination. This will be the last day of the month in which the member moved to the new service area.
    5. Move to the Termination Code field and select “23 - Transferred to another service” (or the appropriate code) from the drop-down menu.
    6. Select the Save button.
    7. Select Submit to SASO.
    8. Select Outbox and then Inbox to ensure the case processed accurately.

    Once the gaining PSU staff verify the month in which the member moves to the new service area, the gaining PSU staff is responsible for opening the authorizing agent and service authorization (SC 12) records necessary to authorize the STAR+PLUS HCBS program in the new service area.

    The service authorization records are opened according to procedures outlined in initial service authorizations for STAR+PLUS HCBS program members with the following exceptions:

    • The begin date for these records is the first day of the month following the month the member moved to the new service area.
    • The end date for the Service Authorization (SC 12) record is the same as the current ISP period.

    Example: If a STAR+PLUS HCBS program member with an ISP period of November 1, 2019 to October 31, 2020, transfers to another STAR+PLUS service area on January 15, 2020, the end date for these records remains October 31, 2018.
     

    9320 Transfers from One MCO to Another MCO in the Same Service Area

    Revision 18-0; Effective September 4, 2018
     
    If the member's individual service plan (ISP) is electronic and the member made a new managed care organization (MCO) selection timely, the Texas Integrated Eligibility Redesign System (TIERS) updates the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal, which automatically closes the registration for the losing MCO and creates the registration for the gaining MCO in the Service Authorization System Online (SASO). If the member's plan change is not timely, Program Support Unit (PSU) staff follow existing policy, stated below.

    PSU staff process the request by closing the existing service authorization record (service code (SC) 12) for the losing MCO and creating a new service authorization record (SC 12) for the gaining MCO.

    To close the existing service authorization records, PSU staff must:

    1. Move to the Service Authorization field in the Program and Service functional area.
    2. Select the appropriate Service Authorization record you wish to close.
    3. Select the Modify button.
    4. Move to the End Date field and enter the effective date of the termination, which is the last day of the month in which the member was enrolled in the losing MCO.
    5. Move to the Termination Code field and select “39 – Other” (or the appropriate code) from the drop-down menu.
    6. Select the Save button.
    7. Select Submit to SASO.
    8. Select Outbox and then Inbox to ensure the case processed accurately.

    To create a new service authorization record for the new MCO, PSU staff must:

    1. Select the Service Authorization field in the Program and Service functional area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
    5. Leave the Fund and Term. Code fields at the defaults.
    6. Leave the Agency field at the default selection 324 - DHS.
    7. Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
    8. Move to the Units field and enter 1.00.
    9. Leave the Amount field at the default.
    10. Move to the Begin Date field and enter the new MCO contract number or plan code enrollment date.
    11. Move to the End Date field; the end date for the service authorization record is the last day of the ISP coverage period.
    12. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).
    MCO Service Area Contract Number
    Molina Bexar 1014430
    Molina MMP Bexar 1026341
    Molina Harris 1014431
    Molina MMP Harris 1026344
    Molina Jefferson 1019598
    Molina Dallas 1018980
    Molina MMP Dallas 1026342
    Molina El Paso 1019987
    Molina MMP El Paso 1026343
    Molina Hidalgo 1019988
    Molina MMP Hidalgo 1026345
    Superior Bexar 1014433
    Superior MMP Bexar 1026337
    Superior Nueces 1014434
    Superior Dallas 1018981
    Superior MMP Dallas 1026338
    Superior Hidalgo 1019985
    Superior MMP Hidalgo 1026339
    Superior Lubbock 1019986
    Superior Medicaid Rural Service Area (RSA) Central 1025731
    Superior Medicaid RSA West 1025730
    United Healthcare Harris 1014435
    United Healthcare MMP Harris 1026334
    United Healthcare Jefferson 1019600
    United Healthcare Medicaid RSA Central 1025732
    United Healthcare Medicaid RSA Northeast 1025734
    United Healthcare Nueces 1014437
    United Healthcare Travis 1014438
    Amerigroup Bexar 1014439
    Amerigroup MMP Bexar 1026326
    Amerigroup Harris 1014440
    Amerigroup MMP Harris 1026331
    Amerigroup Jefferson 1019599
    Amerigroup Travis 1014442
    Amerigroup El Paso 1019979
    Amerigroup MMP El Paso 1026328
    Amerigroup Lubbock 1019983
    Amerigroup Medicaid RSA West 1025729
    Amerigroup Tarrant 1018977
    Amerigroup MMP Tarrant 1026332
    Cigna-HealthSpring Tarrant 1018979
    Cigna-HealthSpring MMP Tarrant 1026333
    Cigna-HealthSpring Hidalgo 1019984
    Cigna-HealthSpring MMP Hidalgo 1026335
    Cigna-HealthSpring Medicaid RSA Northeast 1025733

     

    1. The NPI field is read-only.
    2. Select the Save button.
    3. Select Submit to SASO.
    4. Select Outbox and then Inbox to ensure the case processed accurately.

     

    9400 MFP Authorization for STAR+PLUS HCBS Program Applicant

    Revision 18-0; Effective September 4, 2018
     
    After Program Support Unit (PSU) staff verify that the applicant left the nursing facility (NF), PSU staff complete the following steps listed below. PSU staff do not close the Authorizing Agent, Medical Necessity, Level of Service Resource Utilization Group (RUG) records. PSU staff must also ensure Provider Claims Services (PCS) closes the enrollment and service authorization records for service codes (SC) 1, 3, 50 and 60.

    For individuals who are not enrolled in STAR+PLUS until they begin receiving the STAR+PLUS Home and Community Based Services (HCBS) program, create a one-day service authorization record for the first day of the month in which a Money Follows the Person (MFP) individual is discharged from an NF, unless the individual discharges on the first day of a month.

    Example: An individual who is not enrolled in STAR+PLUS leaves the NF and begins the STAR+PLUS HCBS program on December 25, 2019. PSU staff register the initial individual service plan (ISP) in the Service Authorization System Online (SASO) with an effective date of December 25, 2019 through December 31, 2020. In addition to registering the initial ISP, PSU staff create all the records listed below with a begin date of December 1, 2019, and an end date of December 1, 2019.

    PSU staff must check or create the one-day service authorization for the following records for service group (SG) 19 according to Sections 9410 through 9470:

    • Authorizing Agent for MFP Applicant (if needed);
    • Enrollment for MFP Applicant;
    • Service Plan for MFP Applicant;
    • Service Authorization for MFP Applicant;
    • Level of Service for MFP Applicant;
    • Diagnosis for MFP Applicant; and
    • Medical Necessity for MFP Applicant.

    A one-day overlap of the records listed is allowed.

    Note: Individuals released from an NF and authorized for the STAR+PLUS HCBS program should be enrolled under MFP. In the Enrollment record, select "12 – MONEY FOLLOWS THE PERSON” from the drop-down menu in the Enrolled From field. Do not use “Enrolled from nursing facility” to designate MFP members.

    To authorize STAR+PLUS HCBS program eligibility for an MFP applicant:

    After creating the one-day records above, when applicable, PSU must create the records needed for the ongoing MFP STAR+PLUS HCBS program eligibility. These records must be completed to check or create an initial service authorization for the STAR+PLUS HCBS program according to Sections 9410 through 9470 listed above.

     
    9410 Authorizing Agent for MFP Applicant

    Revision 18-0; Effective September 4, 2018
     
    There will be one authorizing agent registered for a Money Follows the Person (MFP) applicant.

    Program Support Unit (PSU) staff are registered as the authorizing agent when the initial authorization is authorized.

    To register an authorizing agent for an MFP applicant, PSU staff must:

    1. Select the Authorizing Agent field in the Case Worker functional area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Type field and select CM - CASE MANAGER from the drop-down menu.
    4. Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
    5. Leave the Send to TMHP field at the default selection N - NO.
    6. Move to the Begin Date field and enter the date the record is being created. Leave the End Date field blank.
    7. Move to the Authorizing Agent ID field and enter STAR+PLUS.
    8. Leave the Agency field at the default selection 324 - DHS.
    9. Move to the Name field and enter the PSU/ERS staff’s name.
    10. Move to the Phone field and enter the telephone number of the authorizing agent. Enter the area code, phone number and extension.
    11. Move to the Mail Code field and enter the appropriate Managed Care Organization (MCO) Plan Code. Note: Six service areas include Medicare-Medicaid Plans (MMP).
    Service Area MCO Plan Name MCO Plan Code
    Bexar Amerigroup 45
    Molina 46
    Superior 47
    Amerigroup MMP 4F
    Molina MMP 4G
    Superior MMP 4H
    Dallas Molina 9F
    Superior Health Plan 9H
    Molina MMP 9J
    Superior MMP 9K
    El Paso Molina 33
    Amerigroup 34
    Molina MMP 3G
    Amerigroup MMP 3H
    Harris Amerigroup 7P
    United Healthcare 7R
    Molina 7S
    Amerigroup MMP 7Z
    United Healthcare MMP 7Q
    Molina MMP 7V
    Hidalgo Cigna-HealthSpring H7
    Molina H6
    Superior H5
    Cigna-HealthSpring MMP H8
    Molina MMP H9
    Superior MMP HA
    Jefferson Amerigroup 8R
    United Healthcare 8S
    Molina 8T
    Lubbock Amerigroup 5A
    Superior 5B
    Medicaid Rural Service Area (RSA) Central Texas Superior C4
    United Healthcare C5
    Medicaid RSA Northeast Texas Cigna-HealthSpring N3
    United Healthcare N4
    Medicaid RSA West Texas Amerigroup W5
    Superior W6
    Nueces United Healthcare 85
    Superior Health Plan 86
    Tarrant
     
    Amerigroup 69
    Cigna-HealthSpring 6C
    Amerigroup MMP 6F
    Cigna-HealthSpring MMP 6G
    Travis Amerigroup 19
    United Healthcare 18
    1. Select the Save button.

     

    9420 Enrollment for MFP Applicant

    Revision 18-0; Effective September 4, 2018
     
    The Enrollment record in the Service Authorization System Online (SASO) is used to register the enrollment begin date with an open ended date for the STAR+PLUS Home and Community Based Services (HCBS) program member.

    Program Support Staff (PSU) staff will create an enrollment record for STAR+PLUS HCBS program eligibility for members.

    PSU staff will take a screenshot of the enrollment registration in SASO, and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    To register an authorizing agent for a Money Follows the Person (MFP) applicant, PSU staff must:

    1. Select the Enrollment field in the Program and Service functional area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Enrolled From field and select the appropriate entry from the drop-down menu. If this is an MFP authorization, be sure to select 12 - MONEY FOLLOWS THE PERSON from the drop-down menu.
    5. Move to the Living Arrangement field, and select the appropriate community-based living arrangement from the drop-down menu.
    6. Move to the Begin Date field and enter the date the member is enrolled in his MCO, which will always be the first day of a month. Leave the End Date field blank.
    7. Leave the Termination Code and Waiver Type at the defaults.
    8. Select the Save button.

     

    9430 Service Plan for MFP Applicant

    Revision 18-0; Effective September 4, 2018
     
    The service plan record is used to register an individual service plan (ISP) for a STAR+PLUS Home and Community Based Services (HCBS) program member. The record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Resource Utilization Group (RUG) value and the total estimated cost of the STAR+PLUS HCBS program services taken from the member’s Form H1700-1, Individual Service Plan (Pg. 1).

    Program Support Staff (PSU) staff will create a service plan record for STAR+PLUS HCBS program eligibility for members.

    PSU staff will take a screenshot of the service plan registration in the Service Authorization System Online (SASO) and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    To register a service plan for a Money Follows the Person (MFP) applicant, PSU staff must:

    1. Select the Service Plan field in the Program and Service functional area.
    2. Select Add and a blank Service Plan Details record will appear.
    3. Leave the Type field at the default selection AN - ANNUAL PLAN.
    4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    5. Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the RUG value entered on the Level of Service record. For a STAR+PLUS HCBS program member who uses a ventilator, enter the annual STAR+PLUS HCBS program ISP cost limit based on the RUG value and ventilator use of the member (6-23 hours or 24 hours continuous).

    Move to the Begin Date field and enter the effective date of the ISP coverage period.

    1. Move to the End Date field and enter the last day of the ISP coverage period.
    2. Move to the Amount Authorized field and enter the total estimated cost of all  STAR+PLUS HCBS program services authorized for the current ISP coverage period from Form H1700-1.
    3. Leave the Amount Paid field at the default setting of 0.00.
    4. Leave the Units Authorized field at the default of 0.00.
    5. Leave the Units Paid field at the default of 0.00.
    6. Select the Save button.

     
    9440 Service Authorization for MFP Applicant

    Revision 18-0; Effective September 4, 2018
     
    Program Support Unit (PSU) staff create one service authorization record for STAR+PLUS Home and Community Based Services (HCBS) program eligibility.

    PSU staff will create a service authorization record for STAR+PLUS HCBS program eligibility for members.

    PSU staff will take a screenshot of the service authorization registration in the Service Authorization System Online (SASO) and upload the screenshot to the HHS Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    To register a service authorization record for a Money Follows the Person (MFP) applicant, PSU staff must:

    1. Select the Service Authorization field in the Program and Service functional area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
    4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
    5. Leave the Fund and Term. Code fields at the defaults.
    6. Leave the Agency field at the default selection 324 - DHS.
    7. Move to the Unit Type field and select 2 – MONTH from the drop down list.
    8. Move to the Units field and enter 1.00.
    9. Leave Amount at the default.
    10. Move to the Begin Date field and enter the effective date of the ISP coverage period.
    11. Move to the End Date field and enter the last day of the ISP coverage period.
    12. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).
    MCO Service Area Contract Number
    Molina Bexar 1014430
    Molina MMP Bexar 1026341
    Molina Harris 1014431
    Molina MMP Harris 1026344
    Molina Jefferson 1019598
    Molina Dallas 1018980
    Molina MMP Dallas 1026342
    Molina El Paso 1019987
    Molina MMP El Paso 1026343
    Molina Hidalgo 1019988
    Molina MMP Hidalgo 1026345
    Superior Bexar 1014433
    Superior MMP Bexar 1026337
    Superior Nueces 1014434
    Superior Dallas 1018981
    Superior MMP Dallas 1026338
    Superior Hidalgo 1019985
    Superior MMP Hidalgo 1026339
    Superior Lubbock 1019986
    Superior Medicaid Rural Service Area (RSA) Central 1025731
    Superior Medicaid RSA West 1025730
    United Healthcare Harris 1014435
    United Healthcare MMP Harris 1026334
    United Healthcare Jefferson 1019600
    United Healthcare Medicaid RSA Central 1025732
    United Healthcare Medicaid RSA Northeast 1025734
    United Healthcare Nueces 1014437
    United Healthcare Travis 1014438
    Amerigroup Bexar 1014439
    Amerigroup MMP Bexar 1026326
    Amerigroup Harris 1014440
    Amerigroup MMP Harris 1026331
    Amerigroup Jefferson 1019599
    Amerigroup Travis 1014442
    Amerigroup El Paso 1019979
    Amerigroup MMP El Paso 1026328
    Amerigroup Lubbock 1019983
    Amerigroup Medicaid RSA West 1025729
    Amerigroup Tarrant 1018977
    Amerigroup MMP Tarrant 1026332
    Cigna-HealthSpring Tarrant 1018979
    Cigna-HealthSpring MMP Tarrant 1026333
    Cigna-HealthSpring Hidalgo 1019984
    Cigna-HealthSpring MMP Hidalgo 1026335
    Cigna-HealthSpring Medicaid RSA Northeast 1025733
    1. The NPI field is read-only.
    2. Select the Save button.

     

    9450 Level of Service for MFP Applicant

    Revision 18-0; Effective September 4, 2018
     
    There will be an existing service group (SG) 1 (NF) level of service (LOS) record. However, Program Support Unit (PSU) staff will be required to create a new LOS record for SG 19 STAR+PLUS Home and Community Based Services (HCBS) program. The SG 1 (NF) LOS record can remain open.

    All STAR+PLUS HCBS program members must have an LOS registered in the Service Authorization System Online (SASO). The LOS record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    PSU staff will create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members.

    To add an LOS record, PSU staff must complete the following steps:

    1. Select the Level of Service field in the Medical functional area.
    2. Select Add and a blank Level of Service Details record will appear.
    3. Move to the Type field and select CR – CBA RUG from the drop-down menu.
    4. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    5. Move to the Level field and enter the RUG.
    6. Move to the Begin Date field and enter the first day of the ISP period.
    7. Move to the End Date field and enter the last day of the ISP period.
    8. Select the Save button.

     

    9460 Diagnosis for MFP Applicant

    Revision 18-0; Effective September 4, 2018

    There will be an existing service group (SG) 1 diagnosis record. Program Support Unit (PSU) staff must create a new diagnosis record for SG 19 STAR+PLUS Home and Community Based Services (HCBS) program.

    All STAR+PLUS HCBS program members must have a diagnosis registered in the Service Authorization System Online (SASO). The diagnosis record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The system-generated diagnosis record will have an end date that may need to be extended by PSU staff through the last day of the month in which the individual service plan (ISP) expires, if applicable.

    To add an SG 19 diagnosis record in the SASO, PSU staff must complete the following steps:

    1. Select the Diagnosis field in the Medical functional area.
    2. Select Add and a blank Diagnosis Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Begin Date field and enter the first day of the ISP period.
    5. Move to the End Date field and enter the last day of the ISP period.
    6. Enter up to five diagnoses.
    7. Leave Version field at the default.
    8. Select the Save button.

     

    9470 Medical Necessity for MFP Applicant

    Revision 18-0; Effective September 4, 2018
     
    All STAR+PLUS Home and Community Based Services (HCBS) program members must have a medical necessity (MN) registered in the Service Authorization System Online (SASO). The MN record will be system generated from information received from the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. The managed care organization (MCO) nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTC Online Portal or uses the nursing facility (NF) minimum data set (MDS). After TMHP determines MN and the Resource Utilization Group (RUG) value is computed, TMHP submits the decision back to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

    The MN record is system generated from the information stored in the SASO database. The system-generated MN record will have an end date that may need to be extended by Program Support Unit (PSU) staff through the last day of the month in which the individual service plan (ISP) expires.

    PSU staff will create an MN record for STAR+PLUS HCBS program eligibility for members.

    PSU staff will take a screenshot of the MN registration in SASO and upload the screenshot to the Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART), following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions.

    Example: If MN is approved with an effective date of May 13, 2019, the system-generated end date will be May 31, 2020. Note: An open-ended MN record must be terminated with the end-date of the ISP.

    PSU staff can create MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

    To extend an MN record for an MFP applicant, PSU staff must:

    1. Select the MN field in the Medical functional area.
    2. Select the existing MN record.
    3. Select the Modify button to open and modify.
    4. Move to the End Date field and change the date to the last day of the ISP period.
    5. Select the Save button.

    If an MN record has not been created in SASO, PSU staff complete the following steps to add the record:

    1. Select the MN field in the Medical functional area.
    2. Select Add and a blank MN Details record will appear.
    3. Leave the MN field at the default of Y - YES.
    4. Leave the Permanent field at the default of N - NO.
    5. Move to the Begin Date field and enter the first day of the ISP period.
    6. Move to the End Date field and enter the last day of the ISP period.
    7. Select the Save button.

    To add a service group (SG) 19 diagnosis record in the SASO, PSU staff must complete the following steps:

    1. Select the Diagnosis field in the Medical functional area.
    2. Select Add and a blank Diagnosis Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
    4. Move to the Begin Date field and enter the first day of the ISP period.
    5. Move to the End Date field and enter the last day of the ISP period.
    6. Enter up to five diagnoses.
    7. Leave Version field at the default.
    8. Select the Save button.

     

    9480 MFPD for STAR+PLUS HCBS Program Applicant

    Revision 18-0; Effective September 4, 2018
     
    At this time, the option to electronically submit an individual service plan (ISP) for a nursing facility (NF) resident is not available. Managed care organizations (MCOs) must not use the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal Money Follows the Person Demonstration (MFPD) check box. Program Support Unit (PSU) staff continue to manually register this fund code in the Service Authorization System Online (SASO).

    PSU staff must follow the instructions for a Money Follows the Person (MFP) applicant above, with the service authorization record completed as follows.

    1. Select the Service Authorization field in the Program and Service functional Area.
    2. Select Add and a blank Service Authorization Details record will appear.
    3. Move to the Service Group field and select 19 - STAR+PLUS from the drop down list.
    4. Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
    5. Move to the Fund field and select 19MFP – MONEY FOLLOWS PERSON.
    6. Leave the Term. Code field at the defaults.
    7. Leave the Agency field at the default selection 324 - DHS.
    8. Move to the Unit Type field and select 2 – MONTH from the drop down list.
    9. Move to the Units field and enter 1.00.
    10. Leave the Amount field at the default.
    11. Move to the Begin Date field and enter the effective date of the ISP coverage period.
    12. Move to the End Date field and enter the last day of the ISP coverage period.
    13. Move to the Contract No. field and enter the appropriate contract number of the MCO. Use the following chart to determine the correct contract number. Note: Six service areas include Medicare-Medicaid Plans (MMP).

     

    MCO Service Area Contract Number
    Molina Bexar 1014430
    Molina MMP Bexar 1026341
    Molina Harris 1014431
    Molina MMP Harris 1026344
    Molina Jefferson 1019598
    Molina Dallas 1018980
    Molina MMP Dallas 1026342
    Molina El Paso 1019987
    Molina MMP El Paso 1026343
    Molina Hidalgo 1019988
    Molina MMP Hidalgo 1026345
    Superior Bexar 1014433
    Superior MMP Bexar 1026337
    Superior Nueces 1014434
    Superior Dallas 1018981
    Superior MMP Dallas 1026338
    Superior Hidalgo 1019985
    Superior MMP Hidalgo 1026339
    Superior Lubbock 1019986
    Superior Medicaid Rural Service Area (RSA) Central 1025731
    Superior Medicaid RSA West 1025730
    United Healthcare Harris 1014435
    United Healthcare MMP Harris 1026334
    United Healthcare Jefferson 1019600
    United Healthcare Medicaid RSA Central 1025732
    United Healthcare Medicaid RSA Northeast 1025734
    United Healthcare Nueces 1014437
    United Healthcare Travis 1014438
    Amerigroup Bexar 1014439
    Amerigroup MMP Bexar 1026326
    Amerigroup Harris 1014440
    Amerigroup MMP Harris 1026331
    Amerigroup Jefferson 1019599
    Amerigroup Travis 1014442
    Amerigroup El Paso 1019979
    Amerigroup MMP El Paso 1026328
    Amerigroup Lubbock 1019983
    Amerigroup Medicaid RSA West 1025729
    Amerigroup Tarrant 1018977
    Amerigroup MMP Tarrant 1026332
    Cigna-HealthSpring Tarrant 1018979
    Cigna-HealthSpring MMP Tarrant 1026333
    Cigna-HealthSpring Hidalgo 1019984
    Cigna-HealthSpring MMP Hidalgo 1026335
    Cigna-HealthSpring Medicaid RSA Northeast 1025733
    1. The NPI field is read-only.
    2. Select the Save button.

    Note: Once the 365-day time frame for MFPD has passed, the fund code in the Service Authorization record will be changed to the default by PSU, when Form H2067-MC, Managed Care Programs Communication, is received from the MCO.
     

    9500 Mutually Exclusive Services within the STAR+PLUS HCBS Program

    Revision 18-0; Effective September 4, 2018
     
    To close services that are mutually exclusive, the Community Care Services Eligibility (CCSE) case manager must close the community services authorization with an effective date one day prior to the date the member is eligible for the STAR+PLUS Home and Community Based Services (HCBS) program.

    Example: If an individual receiving Family Care (FC), Emergency Response Services (ERS) and Home-Delivered Meals (HDM) becomes eligible for the STAR+PLUS HCBS program on December 1, 2019, the member will begin receiving his or her services through his managed care organization (MCO) on that date. Therefore, the losing CCSE case manager must close the FC, ERS and HDM services with an effective date of November 30, 2019.
     

    9600 MDCP/CCCP Transitioning to STAR+PLUS HCBS Program

    Revision 18-0; Effective September 4, 2018
     
    For Medically Dependent Children Program (MDCP)/Comprehensive Care Program (CCP)/Private Duty Nursing (PDN) members who are transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program, Program Support Unit (PSU) staff will enter the initial STAR+PLUS HCBS program eligibility into the Service Authorization System Online (SASO) using the steps for initial eligibility with one exception. The effective begin date for all records will be the first of the month following the member’s 21st birthday.

    It is possible the medical records (Medical Necessity, Level of Care or Diagnosis) will have to be extended in SASO to cover the entire individual service plan (ISP) period.
     

    9700 Terminations

    Revision 18-0; Effective September 4, 2018
     
    Program Support Unit staff will manually close all service group (SG) 19 records in the Service Authorization System Online (SASO) when all services for an existing STAR+PLUS Home and Community Based Services (HCBS) program member are terminated.
     

    9800 Appeal Extensions for Continued Benefits

    Revision 18-0; Effective September 4, 2018
     
    If a STAR+PLUS Home and Community Based Services (HCBS) program member files an appeal and requests continued benefits, Program Support Unit (PSU) staff will extend all records (includes Service Authorization, Service Plan, and Enrollment) by four months. To accomplish this, open each record and modify the record. Change the end date to the last day of the month – four months in the future. This is completed each time an extension is needed.

    Multiple extensions may be requested if the appeal process has not been finalized.

    Continuation of STAR+PLUS HCBS program benefits during a state fair hearing does not apply for Supplemental Security Income denials. Refer to Section 4222.1, Continuation of STAR+PLUS HCBS Program During a State Fair Hearing, for additional information.