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Section 1000, State of Texas Access Reform Plus (STAR+PLUS) Managed Care
- 1100 STAR+PLUS Program Overview
- 1200 STAR+PLUS Program Eligibility
- 1300 STAR+PLUS Services and Service Delivery Options
- 1400 MCO Service Coordination
- 1410 MCO Service Coordination for Nursing Facilities
- 1420 MCO Service Coordination for Programs Serving Members with IDD
- 1430 MCO Service Coordination for HCBS – Adult Mental Health Program
- 1440 MCO Service Coordination for the Section 811 Project Rental Assistance Program
- 1450 MCO Service Coordination for the Medicaid for Breast and Cervical Cancer Program
- 1500 Disclosure of Information
- 1510 Confidential Nature of Medical Information – HIPAA
- 1520 Responsible Party to Authorize Disclosure
- 1530 Information May Be Disclosed
- 1600 Member Rights and Responsibilities
- 1700 Notification Requirements
- 1710 PSU Staff Notification Requirements for Applicants and Members
- 1720 PSU Staff Notification Requirements for MCOs
- 1730 PSU Staff Notification Requirements for Medicaid for the Elderly and People with Disabilities or Texas Works
- 1740 PSU Staff Notification Requirements for Enrollment Resolution Services Unit
- 1750 PSU Staff Notification Requirements for Managed Care Compliance and Operations Unit
- 1760 MCO Notification Requirements for Applicants and Members
- 1770 MCO Notification Requirements for PSU Staff
- 1800 PSU Online Database Resources
- 1810 Client Assignment and Registration
- 1820 Community Services Interest List
- 1830 Health and Human Services Commission Benefits Portal
- 1840 Health and Human Services (HHS) Enterprise Administrative Report and Tracking System
- 1850 Service Authorization System Online
- 1860 Texas Integrated Eligibility Redesign System
- 1870 Texas Medicaid & Healthcare Partnership Long Term Care Online Portal
- 1880 TxMedCentral
Section 2000, Reserved for Future Use
Section 3000, STAR+PLUS HCBS Program Eligibility and Services
- 3100 Ancillary Member Resources
- 3110 Medicaid, Medicare and Dual-Eligible Members
- 3111 Dual-Eligible Members
- 3112 Medicaid Eligibility
- 3113 Transmittal of Form H1200
- 3114 Applicants with Medicaid Eligibility
- 3115 Applicants Without Medicaid Eligibility
- 3116 Monthly Income Below the SSI Standard Payment
- 3117 Coordination with the MEPD Specialist
- 3118 Address Changes for Supplemental Security Income Individuals
- 3120 Other Available Services
- 3110 Medicaid, Medicare and Dual-Eligible Members
- 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 Program Requirements
- 3300 Administrative Procedures
- 3310 Intake and Enrollment
- 3311 Interim Services for Individuals Awaiting Managed Care Enrollment
- 3311.1 Interest List Procedures
- 3311.2 Enrollment Procedures Following Release from the Interest List
- 3311.3 Interest List Slot Allocations
- 3311.4 Earliest Date for Adding a Member Back to the Interest List
- 3311.5 Updating Community Services Interest List Records
- 3311.6 Contacting the Interest List Management Unit to Reopen a Closed Interest List Release
- 3312 Managed Care Enrollment
- 3313 Termination of CCSE Services Upon STAR+PLUS HCBS Program Enrollment
- 3314 Managed Care Organization Changes
- 3315 STAR+PLUS HCBS Program Individuals Requesting Non-Managed Care Services
- 3316 Requests for STAR+PLUS HCBS Program from Individuals in 1915(c) Medicaid Waivers
- 3311 Interim Services for Individuals Awaiting Managed Care Enrollment
- 3320 Coordination with Medicaid for the Elderly and People with Disabilities
- 3330 STAR+PLUS Members Requesting an Upgrade to the STAR+PLUS HCBS Program
- 3310 Intake and Enrollment
- 3400 Transferring Into STAR+PLUS
- 3410 Transfer Scenarios
- 3420 Individuals Transitioning Services for Adults
- 3421 Procedures for Children Transitioning from STAR Kids/STAR Health Receiving MDCP or THSteps-CCP, PDN or PPECC
- 3421.1 Twelve Months Prior to the Member's 21st Birthday
- 3421.2 Nine Months Prior to the Member's 21st Birthday
- 3421.3 Six Months Prior to the Member's 21st Birthday
- 3421.4 Five Months Prior to the Member's 21st Birthday
- 3421.5 Within 45 Days of Receiving Notification of a Form H3676 Referral
- 3421.6 Confirm STAR+PLUS HCBS Program Eligibility
- 3421.7 ISP Cost Exceeds 202% of the RUG Cost Limit
- 3422 Transition Policy for Non-Waiver Members Receiving PCS or CFC Only
- 3423 Intrapulmonary Percussive Ventilator
- 3421 Procedures for Children Transitioning from STAR Kids/STAR Health Receiving MDCP or THSteps-CCP, PDN or PPECC
- 3500 Money Follows the Person
- 3510 Money Follows the Person and Managed Care
- 3520 Money Follows the Person Demonstration Entitlement Period Tracking
- 3530 High or Complex Needs Members
- 3600 Ongoing Service Coordination
- 3610 Revising the Individual Service Plan
- 3620 Reassessment
- 3630 Denial or Termination Procedures
- 3631 10-Day Adverse Action Notification
- 3632 Program Support Unit Initiated Denials or Terminations
- 3632.1 Denial or Termination Due to Death
- 3632.2 Denial or Termination Due to Residence in an NF
- 3632.3 Denial or Termination Due to Member Request
- 3632.4 Denial or Termination of Financial Eligibility
- 3632.5 Denial or Termination of MN/LOC Assessment
- 3632.6 Denial or Termination Due to Inability to Locate Member
- 3632.7 Denial or Termination Due to Failure to Meet Other Requirement
- 3632.8 Denial or Termination for Other Reasons
- 3633 Denial or Termination Initiated by the MCO
- 3633.1 Denial or Termination Due to Threats to Health and Safety
- 3633.2 Denial or Termination Due to Hazardous Conditions
- 3633.3 Denial or Termination Due to Harassment, Abuse or Discrimination
- 3633.4 Denial as a Result of Exceeding the Cost Limit
- 3633.5 Denial or Termination Due to Failure to Comply
- 3633.6 Denial or Termination Due to Failure to Pay Copay R&B or QIT
- 3633.7 Denial or Termination Due to Other Reasons
- 3640 Disenrollment Request Policy
Section 4000, STAR+PLUS HCBS Program Services
- 4100 Adult Foster Care
- 4110 Adult Foster Care Introduction
- 4120 Minimum Standards for All AFC Homes and Providers
- 4130 Adult Foster Care Eligibility
- 4140 AFC MCO Procedures
- 4150 Finalizing the Member's Plan of Care
- 4160 Monitoring Quality of Care
- 4170 Significant Changes
- 4180 Annual Reassessment of the AFC Member
- 4200 Assisted Living Services
- 4210 Assisted Living Services Introduction
- 4220 Description of Services
- 4230 Other Services Available to Members
- 4240 Copayment and Room and Board and Requirements
- 4240.1 Room and Board Charges Requirements
- 4240.2 Copayment Requirements
- 4241 Personal Leave
- 4242 Nursing Services for Members in an ALF
- 4243 Response to ALF Member Condition Change
- 4244 Hospital and Nursing Facility Stays
- 4245 Termination Due to Failure to Pay Required Contribution to the Cost of Care
- 4250 Standards for Operation
- 4260 Staffing and Training Requirements
- 4270 Copayment and Trust Fund Records
- 4300 Respite Care Services
- 4400 Emergency Response Services
- 4500 Home-Delivered Meals
- 4600 Transition Assistance Services
- 4610 Transition Assistance Services Introduction
- 4620 Transition Assistance Services Procedures at the Initial Interview
- 4630 Identification of Needed Items and Services
- 4640 Items and Services Included Under TAS
- 4650 Estimated Cost of Items and Services
- 4660 Transition Assistance Services Agency Responsibilities
- 4670 Three-Day Monitor Required
- 4680 Failure to Leave the Nursing Facility
- 4690 Member Notifications and Appeals
Section 5000, Automation and Payment Issues in STAR+PLUS HCBS Program
- 5100 TxMedCentral
- 5200 Service Authorization System Online (SASO)
- 5300 Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal
- 5400 Administrative Payment Process
Section 6000, Reserved for Future Use
Section 7000, Complaints, MCO Internal Appeals and State Fair Hearings
- 7100 MCO Procedures
- 7200 State Fair Hearing Procedures for STAR+PLUS HCBS Program
- 7300 Post State Fair Hearing Actions
- 7400 State Fair Hearing Decision Actions
- 7500 Roles and Responsibilities of HHSC Hearings Officer
Section 8000, Specific STAR+PLUS HCBS Program Services
- 8100 Home and Community Based Services
- 8200 Nursing Services
- 8300 Therapy Services
- 8400 Adaptive Aids and Medical Supplies
- 8410 List of Adaptive Aids and Medical Supplies
- 8420 Approval of Adaptive Aids and Medical Supplies
- 8430 Effects of Changing MCOs on Adaptive Aids Procurements
- 8440 Temporary Lease and Equipment Rental
- 8450 Time Frames for Purchase and Delivery of Adaptive Aids and Medical Supplies
- 8460 Co-Insurance and Deductibles
- 8470 Bulk Purchase of Medical Supplies
- 8500 Dental Services
- 8600 Minor Home Modifications
- 8700 Employment Services
Section 9000, Service Authorization System Online Help File
- 9100 Initial Service Authorization
- 9200 Reassessment Service Authorization
- 9300 Transfers
- 9400 MFP Authorization for STAR+PLUS HCBS Program Applicant
- 9410 Authorizing Agent for MFP Applicant
- 9420 Enrollment for MFP Applicant
- 9430 Service Plan for MFP Applicant
- 9440 Service Authorization for MFP Applicant
- 9450 Level of Service for MFP Applicant
- 9460 Diagnosis for MFP Applicant
- 9470 Medical Necessity for MFP Applicant
- 9480 MFPD for STAR+PLUS HCBS Program Applicant
- 9500 Mutually Exclusive Services within the STAR+PLUS HCBS Program
- 9600 MDCP/CCCP Transitioning to STAR+PLUS HCBS Program
- 9700 Terminations
- 9800 Appeal Extensions for Continued Benefits
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
- 10170 Transfer Between Facilities
- 10180 Transfer Between Managed Care Organizations