3111 Interest List Procedures

Revision 26-2; Effective June 1, 2026

3112 Medicaid Eligibility

Revision 25-2; Effective June 6, 2025

Program Support Unit (PSU) staff must verify each applicant's current eligibility for Medicaid through the Texas Integrated Eligibility Redesign System (TIERS). PSU staff initiate the Medicaid financial eligibility determination process if there is no existing acceptable Medicaid coverage. Refer to Appendix V, MEPD Referral Crosswalk, for individuals with Medicaid eligibility to determine if a program transfer by the MEPD specialist is required.

An applicant who currently has Form H1200, Application for Assistance – Your Texas Benefits, on file with the Texas Health and Human Services Commission (HHSC) may not need to complete a new Form H1200. PSU staff must check with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist about the need for a new Form H1200.

PSU staff must maintain Form H1200 in the applicant’s Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record, if applicable.

3113 Transmittal of Form H1200

Revision 18-0; Effective September 4, 2018

When transmitting Form H1200, Application for Assistance – Your Texas Benefits, Program Support Unit (PSU) staff fax all pages of Form H1200 along with any supporting documentation and Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. PSU staff will upload all pages of Form H1200 and Form H1746-A to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) with the applicant's valid signature.

The original Form H1200 must be kept for three years after the HEART case record is denied or closed. PSU staff must also retain a copy of the successful fax transmittal confirmation in the HEART case record. Scanning Form H1200 and sending by electronic mail is prohibited.

3114 Applicants with Medicaid Eligibility

Revision 18-0; Effective September 4, 2018

At the time of the initial intake for the STAR+PLUS HCBS program, Program Support Unit (PSU) staff must obtain information on the applicant's Medicaid and/or financial status. PSU staff must obtain verification of the applicant's current eligibility for an appropriate type Medicaid program from the Medicaid for the Elderly and People with Disabilities (MEPD) specialist or through inquiry in the Texas Integrated Eligibility Redesign System (TIERS).

To be financially eligible for the STAR+PLUS HCBS program, refer to the mandatory population described in Section 3221, STAR+PLUS Mandatory Groups.

An applicant who receives Supplemental Security Income (SSI) is financially eligible for Medicaid and does not require a financial determination; the Social Security Administration (SSA) has already made this determination.

An applicant receiving services through Community Attendant Services (CAS) (TP14) is not automatically eligible for the STAR+PLUS HCBS program.

MEPD specialists must be consulted for these applicants. Applicants who currently have Form H1200, Application for Assistance – Your Texas Benefits, on file with the Texas Health and Human Services Commission (HHSC) may not need to complete a new Form H1200.

3115 Applicants Without Medicaid Eligibility

Revision 22-3; Effective Sept. 27, 2022

Title 42 Code of Federal Regulations (CFR) Section 431.10, specifies that Medicaid eligibility must be determined by a single state agency. The Texas state plan designates the Texas Health and Human Services Commission (HHSC) as the sole agency with the authority to make eligibility determinations for medical assistance only (MAO) Medicaid cases. The Medicaid for the Elderly and People with Disabilities (MEPD) specialist exclusively determines MAO Medicaid financial eligibility for STAR+PLUS Home and Community Based Services (HCBS) program applicants and members. An individual, applicant or member who does not receive Supplemental Security Income (SSI) may apply for MAO Medicaid.

The individual, applicant or member applies for MAO Medicaid by completing and submitting Form H1200, Application for Assistance – Your Texas Benefits, to the enrollment broker, Program Support Unit (PSU) staff or the MEPD specialist. PSU staff must fax Form H1200 and Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist within two business days of an applicant or member submitting Form H1200 to PSU staff.

3116 Monthly Income Below the SSI Standard Payment

Revision 18-0; Effective September 4, 2018

An applicant in the community (with no ineligible spouse) who has income less than the Supplemental Security Income (SSI) federal benefit rate (FBR) must apply for SSI through the Social Security Administration (SSA). The Texas Health and Human Services Commission (HHSC) cannot determine financial eligibility for these individuals except for cases in which the SSI application for disability has been pending more than 90 days and a decision is made by HHSC Disability Determination Unit (DDU) staff.

If there is a question whether the applicant should apply for SSI or medical assistance only (MAO), Program Support Unit (PSU) staff may consult the regional Medicaid for the Elderly and People with Disabilities (MEPD) specialist.

3117 Coordination with the MEPD Specialist

Revision 18-0; Effective September 4, 2018

The Program Support Unit (PSU) staff must inform the applicant or member without pre-existing Medicaid coverage and/or his or her authorized representative (AR) that the Medicaid for the Elderly and People with Disabilities (MEPD) specialist will complete a financial eligibility (Medicaid) determination. PSU staff must encourage the applicant, member or AR to cooperate with the MEPD specialist and to provide all verifications necessary in a timely fashion.

Any information, including information on third-party insurance, obtained by PSU staff must be shared with the MEPD specialist to prevent the applicant or member from having to provide the information twice.

PSU staff must inform the MEPD specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program according to regional procedures. For those applicants or members already on an appropriate type of Medicaid program, PSU staff must fax:

• Form H1200, Application for Assistance – Your Texas Benefits; and
• Form H1746-A, MEPD Referral Cover Sheet.

An applicant for the STAR+PLUS HCBS program who has medical assistance only (MAO) coverage type Medicaid services may only receive the STAR+PLUS HCBS program after a program transfer to Medicaid waivers is completed by the MEPD specialist. When an applicant or member for the STAR+PLUS HCBS program has MAO coverage type, as indicated in the Texas Integrated Eligibility Redesign System (TIERS), a completed Form H1200 must be sent to the applicant or member. The completed application must be forwarded to the MEPD specialist for processing.

PSU staff must also send an email to MEPD at the HHSC OES MEPD IC mailbox that includes the following information:

• the applicant’s or member’s name;
• applicant’s or member’s Medicaid identification (ID) number;
• individual has MAO coverage-type Medicaid, which will require a program transfer; and
• name and telephone number of the PSU staff contact.

The MEPD specialist will make the necessary changes to allow the MAO coverage-type Medicaid individual to receive the STAR+PLUS HCBS program.

ID of MAO Coverage-Type Medicaid

PSU staff can check TIERS to determine an applicant’s or member’s coverage type. In TIERS, the coverage type on the Search/Summary screen is displayed with the preface of MAO.

Form H1200 is not required for members receiving Supplemental Security Income (SSI).

Note: If a STAR+PLUS HCBS program applicant's or member's application for SSI disability has been pending more than 90 days, the Texas Health and Human Services Commission (HHSC) Disability Determination Unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination. The SSI decision must be adopted when it is received from SSA.

3117.1 Income and Resource Verifications for MEPD

Revision 25-2; Effective June 6, 2025

PSU staff must inform the MEPD specialist of the request for the STAR+PLUS Home and Community Based Services (HCBS) program by faxing:

• Form H1746-A, noting if:
  • the applicant is pending a Medical Necessity and Level of Care (MN/LOC) Assessment and individual service plan (ISP); or
  • the applicant has an approved MN/LOC and ISP;
• Form H1200, if received; and
• any supporting documents, if received.

Texas Health and Human Services Commission (HHSC) Disability Determination unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination, if a STAR+PLUS HCBS applicant’s application for SSI disability has been pending for more than 90 days. The SSI decision must be adopted upon receipt from SSA.

PSU staff must send a second Form H1746-A noting the applicant’s start of care (SOC) for the STAR+PLUS HCBS program if the applicant’s MN/LOC and ISP were pending when the initial Form H1746-A was sent to the MEPD specialist.

3117.2 Reserved for Future Use

Revision 24-4; Effective Dec. 1, 2024

3117.3 Unsigned Applications

Revision 18-0; Effective September 4, 2018

Unsigned applications received by the Medicaid for the Elderly and People with Disabilities (MEPD) specialist are returned to the sender. Program Support Unit (PSU) staff must ensure applications are signed prior to referring to the MEPD specialist; if not, PSU staff are required to obtain signatures when unsigned applications are returned.

The application forms are:

• Form H1200, Application for Assistance – Your Texas Benefits; and
• Form H1200-A, Medical Assistance Only (MAO) Recertification.

If the MEPD specialist receives an unsigned application from HHSC with Form H1746-A, MEPD Referral Cover Sheet, the MEPD specialist returns the application to PSU staff with an annotation on the cover form (Form H1746-A) that the application is unsigned and must be signed before PSU staff can establish a file date. Once PSU staff receive an unsigned application from the MEPD specialist, it is the responsibility of PSU staff to coordinate with the applicant or member to obtain a signed application and return it to the MEPD specialist for processing.

Sending unsigned applications delays the MEPD and HHSC eligibility processes and could adversely affect service delivery to applicants or members.

3117.4 Medicaid Eligibility Decisions Pending Past the Program Due Date

Revision 18-0; Effective September 4, 2018

For most Medicaid for the Elderly and People with Disabilities (MEPD) applications, eligibility decisions are due by the 45th day. However, applications for individuals under the age of 65 may require a 90-day time frame to allow the agency to obtain a disability determination. This applies when the person's age is less than 65 and the person does not receive Retirement, Survivors and Disability Insurance (RSDI), Supplemental Security Income (SSI) or Railroad Retirement (RR). A disability determination by the Texas Health and Human Services Commission (HHSC) is required even if the person has received a Medical Necessity and Level of Care (MN/LOC) Assessment determination under the STAR+PLUS Home and Community Based Services (HCBS) program eligibility component criteria.

For other case actions (for example, program transfers) the MEPD specialist may require time to verify income and resources. This is especially true if the previous case was community-based or included an individual declaration of income or resources. Program Support Unit (PSU) staff will email MEPD at the HHSC OES MEPD IC mailbox, requesting a status update, if the case has been pending more than 45 days.

3117.5 Inquires and Complaints

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff can direct other general inquiries and complaints regarding Medicaid for the Elderly and People with Disabilities (MEPD) applications and programs to the HHSC OES MEPD IC mailbox.

3118 Address Changes for Supplemental Security Income Individuals

Revision 25-2; Effective June 6, 2025

Program Support Unit (PSU) staff must not send address change requests for Supplemental Security Income (SSI) individuals to the Document Processing Center (DPC). PSU staff must inform the individual or authorized representative (AR) to contact the Social Security Administration (SSA) to request the residence address change. The address change will be reflected in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.

Revision 25-2; Effective June 6, 2025

Title 1 Texas Administrative Code (TAC) Chapter 353.1153 states that an individual, applicant or member must be financially eligible for Medicaid to receive the STAR+PLUS Home and Community Based Services (HCBS) program. Program Support Unit (PSU) staff must review Texas Integrated Eligibility Redesign System (TIERS) to determine if a Medicaid financial eligibility determination is required.

A STAR+PLUS HCBS program individual or applicant who is not already Medicaid eligible must complete Form H1200, Application for Assistance – Your Texas Benefits, to be evaluated for financial eligibility. PSU staff must fax the completed Form H1200 to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist within two business days from receipt of the application. The MEPD specialist has 45 days, or up to 90 days, if it is necessary to get a disability determination to complete the application process.

An individual without Medicaid must return a completed and signed Form H1200 within 30 days from the mail date of the application. PSU staff must mail Form 2606, Managed Care Enrollment Processing Delay, and Form H1200 to the individual or applicant within two business days of:

• the 30th day of the mail date of the enrollment packet, if the individual has not returned Form H1200; or
• upon receipt of an incomplete or unsigned Form H1200.

PSU staff must deny the individual within two business days from the 30th day of the date Form 2606 was mailed for failure to return the signed and completed application needed to determine financial eligibility. PSU staff must check TIERS to ensure Form H1200 was not mailed directly to the MEPD specialist before denying the individual or applicant.

Refer to section 3112, Medicaid Eligibility, for more information about financial eligibility for the STAR+PLUS HCBS program.

3210 Reserved for Future Use

Revision 26-2; Effective June 1, 2026

3220 Eligible Groups

Revision 18-0; Effective September 4, 2018

3221 STAR+PLUS Mandatory Groups

Revision 25-2; Effective June 6, 2025

The following groups of individuals must receive services through the STAR+PLUS program. The program designations are used in the following list.

• Supplemental Security Income (SSI) recipients, Texas Integrated Eligibility Redesign System (TIERS) type of assistance (TA) 01, TA 02 and TA 22 — Individuals 21 or over who qualify for this needs-tested program administered by the Social Security Administration (SSA) (full Medicaid recipients).
• Pickle Amendment Group, TIERS type program (TP) 03 — Individuals 21 or over who would continue to be eligible for SSI benefits if cost of living adjustment (COLAs) increases were deducted from his or her countable income.
• Disabled Widow(s)/Widower(s), TIERS TP 21 — Widow(s)/widower(s), 60-65 and with a disability, who:
  • were denied SSI benefits because of entitlement to early aged widow's or widower's benefits;
  • are ineligible for Medicare; and
  • would continue to be eligible for SSI benefits in the absence of those early aged widow's or widower's benefits and any increases in those benefits.
• Another group of TIERS TP 22 recipients include Early Widow(s)/Widower(s), 50-60 and with a disability, who:
  • are ineligible for Medicare and were denied SSI due to an increase in widow's or widower's benefits because of the relaxing of disability criteria; and
  • would continue to qualify for SSI with the exclusion of the Retirement, Survivors and Disability Insurance (RSDI) benefit and all COLA increases.
• Disabled Adult Children (DAC), TIERS TP 18 — Adults over 21 with a disability that began before 22 who would continue to be eligible for SSI benefits if qualified RSDI disabled adult children's benefits are excluded from countable income.
• Medicaid Buy-In, TIERS TP 87 - designated in TIERS as ME — Medicaid Buy In — Disabled working adults over 21 who receive full Medicaid benefits because of buying into the Medicaid program.
• Medicaid for Breast and Cervical Cancer (MBCC) recipients, TIERS TA 67 — Individuals 18 to the 65th birth month who meet eligibility requirements defined in Title 1 Texas Administrative Code (TAC) Chapter 366, Subchapter D.
• STAR+PLUS Home and Community Based Services (HCBS) program members who are medical assistance only (MAO), TIERS TA 10 (ME-Waiver) — Individuals who are eligible for STAR+PLUS because they participate in the STAR+PLUS HCBS program.  
• Most nursing facility (NF) residents, TIERS TP 38 or TA06 (SSI) or TP 17 (medical assistance only (MAO)) — Most individuals living in an NF.

The TIERS TA 10 identifier also designates individuals in Home and Community-based Services (HCS), Medically Dependent Children Program (MDCP) and Community Living Assistance and Support Services (CLASS). Because HCS, CLASS and MDCP individuals are excluded from STAR+PLUS, if a TIERS TA 10 recipient is identified as receiving one of these excluded services, contact Program Support Unit (PSU) staff and provide the details for disenrollment from STAR+PLUS.

3222 STAR+PLUS Excluded Groups

Revision 25-2; Effective June 6, 2025

Refer to Title 1 Texas Administrative Code (TAC) Chapter 353.603, Member Participation for excluded groups.

3230 Financial Eligibility

Revision 25-2; Effective June 6, 2025

Title 1 Texas Administrative Code (TAC) Chapter 353.1153 states that an individual, applicant or member must be financially eligible for Medicaid to receive the STAR+PLUS Home and Community Based Services (HCBS) program. Program Support Unit (PSU) staff must review Texas Integrated Eligibility Redesign System (TIERS) to determine if a Medicaid financial eligibility determination is required.

A STAR+PLUS HCBS program individual or applicant who is not already Medicaid eligible must complete Form H1200, Application for Assistance – Your Texas Benefits, to be evaluated for financial eligibility. PSU staff must fax the completed Form H1200 to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist within two business days from receipt of the application. The MEPD specialist has 45 days, or up to 90 days, if it is necessary to get a disability determination to complete the application process.

An individual without Medicaid must return a completed and signed Form H1200 within 30 days from the mail date of the application. PSU staff must mail Form 2606, Managed Care Enrollment Processing Delay, and Form H1200 to the individual or applicant within two business days of:

• the 30th day of the mail date of the enrollment packet, if the individual has not returned Form H1200; or
• upon receipt of an incomplete or unsigned Form H1200.

PSU staff must deny the individual within two business days from the 30th day of the date Form 2606 was mailed for failure to return the signed and completed application needed to determine financial eligibility. PSU staff must check TIERS to ensure Form H1200 was not mailed directly to the MEPD specialist before denying the individual or applicant.

Refer to section 3112, Medicaid Eligibility, for more information about financial eligibility for the STAR+PLUS HCBS program.

3231 Individual with a Qualified Income Trust

Revision 22-3; Effective Sept. 27, 2022

An individual or applicant who has a qualified income trust (QIT) may be determined eligible for the STAR+PLUS Home and Community Based Services (HCBS) program even though his or her income is greater than the special institutional income limit for the program. Income diverted to the trust does not count for the purposes of determining financial eligibility by the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. However, the total income (including income diverted to the trust) is considered for the calculation of copayment for STAR+PLUS HCBS program services. A person or applicant may be eligible for services if all other eligibility criteria are met, even if the amount they have available for copayment equals or exceeds the total cost of their individual service plan (ISP).

PSU staff must refer questions regarding QIT to Access and Eligibility Services (AES) by generating and faxing Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist.

3232 Payments from the Qualified Income Trust

Revision 25-1; Effective Feb. 19, 2025

An Applicant or member with a qualified income trust (QIT) is responsible for a copayment if they are living in an adult foster care (AFC), assisted living facility (ALF) or home setting. The managed care organization (MCO) must explain to the applicant or member that the funds from the QIT made available for the copayment must be used to purchase STAR+PLUS Home and Community Based Services (HCBS) program services. The member must make payments directly to the AFC, ALF or other service providers. The Medicaid for the Elderly and People with Disabilities (MEPD) specialist determine the copayment amount for members with a QIT.

PSU staff must document the copayment amount for services other than AFC or ALF using Form H2065-D, Notification of Managed Care Program Services (PDF). PSU staff must refer to Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language, when generating Form H2065-D.

The total available QIT copayment amount is not entered on Form H1700-1, Individual Service Plan (PDF), and is not reflected in SASO copayment screens for a QIT member that lives at home.

3233 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

3234 Qualified Income Trust Copayment Agreement

Revision 18-0; Effective September 4, 2018

The managed care organization (MCO) completes Form 1578, Qualified Income Trust (QIT) Copayment Agreement, and documents the:

• service purchased;
• amount available for copayment;
• unit rate;
• units purchased; and
• monthly copayment amount for the specific services.

The units to be purchased must be converted to a monthly amount if that service is not already reported in a monthly format. The monthly copayment amount cannot exceed the total amount for that service for a month. If there are additional copayment funds after the first service is calculated, the copayment is applied to a second (or third) service, if necessary. For persons residing in adult foster care (AFC) or an assisted living facility (ALF), the copayment amount is first applied to the cost of AFC or ALF. If copayment funds remain after being applied to the cost of AFC or AL, the remaining funds must be applied to other services such as nursing, personal assistance services (PAS) or medical supplies. For persons at home, the copayment is first used to purchase nursing, PAS or medical supplies.

Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, Form H2060-A, Addendum to Form H2060, Form H2060-B, Needs Assessment Addendum, or other individual service plan (ISP) attachments should not be modified since the total number of units to be delivered is not changed by the copayment.

3235 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

3236 Copayment and Room and Board

Revision 25-4; Effective Oct. 6, 2025

Members determined to be financially eligible based on the institutional income limit may have to share in the cost of STAR+PLUS Home and Community Based Services (HCBS) program services. These shared costs are paid by the member through room and board (R&B) and copayment charges. The R&B amount is determined by the Social Security Administration (SSA). The copayment amount is determined by the Medicaid for the Elderly and People with Disabilities (MEPD) specialist.

Medical assistance only (MAO) members who are eligible based on the institutional income limit are required to pay R&B and copayment. Supplemental Security Income (SSI) members will only be required to pay R&B and will not have a copayment.

Program Support Unit (PSU) staff use Form H2065 -D, Notification of Managed Care Program Services, to notify the member and managed care organization (MCO) of R&B and copayment amounts. The begin date entered on Form H2065-D for the initial R&B and copayment charges for interest list release (ILR) or upgrade cases will match the STAR+PLUS HCBS program eligibility effective date. The begin date for the initial R&B and copayment for a Money Follows the Person (MFP) case will match the date of relocation from the nursing facility (NF) to the adult foster care (AFC) home or assisted living facility (ALF).

The amount of copayment and R&B for the month is prorated if the member is admitting to an AFC or ALF on a day that is not the first of the month. PSU staff indicate the full amount, noting it should be prorated, on Form H2065-D. The use of prorate language provides assurance to the member that the full amount is not required for the first month since the facility admission was mid-month.

Refer to the Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language, for more information on the use of prorate language and comments in plain language to be entered on Form H2065-D.

The MCO must also explain to the individual that the individual must pay the copayment and R&B amounts directly to the provider contracted to deliver STAR+PLUS HCBS program services. The member may be disenrolled from the STAR+PLUS HCBS program if they fail to pay the agreed-upon copayment and R&B amounts. Refer to 6400, Disenrollment Request Policy, if a member refuses to pay their R&B charges. 

3237 Determining Room and Board Charges

Revision 25-4; Effective Oct. 6, 2025

All members who live in an adult foster care (AFC) or assisted living facility (ALF) must pay room and board (R&B) charges.

The R&B amount is determined by the Social Security Administration (SSA). The SSA determines the R&B amount by applying the following post-eligibility calculations:

• for individuals, the R&B amount is the Supplemental Security Income (SSI) federal benefit rate (FBR) minus the personal needs allowance (PNA);
• for SSI couples, the R&B amount is the SSI FBR for a couple minus the PNA for an individual multiplied by two; or
• for couples with incomes that exceed the SSI FBR for couples, the R&B amount is the couple's income minus the PNA for an individual multiplied by two. This amount cannot exceed double the R&B amount for an individual.

The AFC or ALF can negotiate a lower R&B amount with the member, but they cannot waive it. There is no impact to PSU staff processes if there is an agreement for a lower R&B amount between the AFC or ALF and the member. PSU must continue to enter the R&B fixed amount on the Form H2065-D, Notification of Managed Care Program Services.

3238 Determining Copayment Amounts

Revision 25-4; Effective Oct. 6, 2025

Members who live in an adult foster care (AFC) or assisted living facility (ALF) and members who have a qualified income trust (QIT) may have to pay a copayment.

The Medicaid for the Elderly and People with Disabilities (MEPD) specialist determines the amount of money available for copayment after determining financial eligibility for Medicaid. The copayment amount leaves a personal needs allowance (PNA) of $85 for a single person and $170 for a couple. The MEPD specialist must notify Program Support Unit (PSU) staff of the amount available for the monthly copayment through the MEPD Communication Tool.

The copayment amount is applied only to the cost of services funded through the STAR+PLUS Home and Community Based Services (HCBS) program. The copayment must not exceed the cost of services delivered.

Supplemental Security Income (SSI) recipients, including SSI recipients who also receive Retirement, Survivors and Disability Insurance (RSDI) will not have a copayment.

3239 Copayment Changes

Revision 25-4; Effective Oct. 6, 2025

A member's copayment may change during the time he or she is receiving the STAR+PLUS Home and Community Based Services (HCBS) program. Copayment changes are typically due to a change in income, medical expenses or other circumstances.

The Medicaid for the Elderly and People with Disabilities (MEPD) specialist is responsible for calculating copayment amounts. The MEPD specialist notifies Program Support Unit (PSU) staff through the MEPD Communication Tool of copayment amounts. PSU staff may also determine the copayment amount has changed in Texas Integrated Eligibility Redesign System (TIERS) at reassessment. The MEPD specialist informs PSU staff if corrections to the member's copayment are necessary based on a change in the income amount available for copayment.

PSU staff must complete the following activities within five business days of getting the copayment amounts:

• mail Form H2065-D, Notification of Managed Care Program Services, to the member;
• upload Form H2065-D to the MCOHub;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record.

Copayment changes are always effective on the first day of the month. Adverse action is required if the copayment amount is increasing. The copayment increase is effective the first day of the month after the adverse action period has expired.

Adverse action is not required when:

• the initial Form H2065-D is generated advising the member of the copayment amounts for the first time;
• no changes are happening to ongoing copayment amounts; or
• copayment amounts are decreasing.

The copayment amount is effective the first day of the month after the copayment amount is determined when adverse action is not required.

The MEPD specialist and the managed care organization (MCO) handle issues for underpayments, refunds and copayment amount appeals.

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff operate in each Texas Health and Human Services Commission (HHSC) STAR+PLUS managed care service area. PSU staff provide support necessary for the coordination of long-term services and supports (LTSS), including the STAR+PLUS Home and Community Based Services (HCBS) program, for members who transfer in and out of STAR+PLUS service areas. PSU staff are also the point of contact for the coordination and monitoring of members transitioning from:

• nursing facilities (NFs) to the community, and
• the Medically Dependent Children Program (MDCP) to the STAR+PLUS HCBS program.

Responsibilities of PSU staff include:

• acting as an intermediary in relaying communications between Community Care Services Eligibility (CCSE) staff and the managed care organization (MCO);
• receiving requests for services from CCSE staff performing intake tasks;
• coordinating the application process for the STAR+PLUS HCBS program for NF residents who wish to transition to the community;
• assisting applicants with enrollment through the Texas Health and Human Services Commission (HHSC) enrollment broker to select an MCO and primary care provider (PCP), if necessary;
• coordinating with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist regarding Medicaid eligibility, as appropriate;
• sending service authorizations (Form H3676, Managed Care Pre-Enrollment Assessment Authorization to the MCO to initiate STAR+PLUS HCBS program assessments for applicants;
• serving as the primary contact for transitions in and out of STAR+PLUS service areas;
• assisting CCSE case managers in processing applications for non-Medicaid services by verifying the MCO denied the equivalent service under STAR+PLUS (Refer to section 3510, Money Follows the Person and Managed Care);
• assisting MCO members requesting placement on an interest list for services excluded from managed care (Refer to section 3222, STAR+PLUS Excluded Groups);
• processing applicants released from the STAR+PLUS HCBS program interest list;
• assisting members who are aging out of MDCP and/or Texas Health Steps (THSteps) Comprehensive Care Program (CCP) in transferring to the STAR+PLUS HCBS program (Refer to section 3420, Individuals Transitioning Services for Adults);
• coordinating continuity of care for members suspended or disenrolled from STAR+PLUS;
• approving the STAR+PLUS HCBS program based upon eligibility;
• making Service Authorization System Online (SASO) entries, as required for actions involving STAR+PLUS HCBS program members;
• handling the administrative claims process;
• researching and requesting disenrollment when the member is enrolled inappropriately;
• denying eligibility for the STAR+PLUS HCBS program; and
• handling requests for state fair hearings for applicants or members who are denied STAR+PLUS HCBS program eligibility.

3310 Intake and Enrollment

Revision 18-0; Effective September 4, 2018

When Community Care Services Eligibility (CCSE) staff receive a request for the STAR+PLUS Home and Community Based Services (HCBS) program, CCSE intake staff must assess whether the request for services should be forwarded for processing to the:

• Intellectual or Developmental Disabilities (IDD) Program Eligibility and Support;
• Texas Health and Human Services Commission (HHSC) enrollment broker;
• Program Support Unit (PSU) staff;
• Interest List Management (ILM) Unit staff; or
• appropriate managed care organization (MCO).

Use the chart below to determine how to process requests for services in STAR+PLUS.

Due to member choice issues, MCOs are prohibited from contacting the applicant without the authorization from PSU staff to complete the required STAR+PLUS HCBS assessments. For MDCP members aging out, individuals on the STAR+PLUS HCBS program interest list, or MFP individuals, PSU staff:

• complete Section A of Form H3676, Managed Care Pre-Enrollment Assessment Authorization; and
• upload Form H3676 to TxMedCentral in the MCO’s SPW folder, following the instructions in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions.

Note: When PSU staff check the Texas Integrated Eligibility Redesign System (TIERS) for enrollment, the designation on the Individual – Managed Care screen of “Candidate Eligible” is not verification of enrollment. When enrollment is complete, the Individual – Managed Care screen will display “Enrolled.”

Note: CCSE intake staff must provide information about the Program of All-Inclusive Care for the Elderly (PACE) to individuals during the request and referral process when the individual requesting services is determined to be age 55 years or older and resides in a PACE service area. PACE services are available in designated areas of El Paso, Amarillo/Canyon and Lubbock.  
CCSE intake staff must be aware of the PACE service areas (SAs) and referral procedures. Additional information on PACE can be found at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/program-all-inclusive-care-elderly-pace.

3311 Interim Services for Individuals Awaiting Managed Care Enrollment

Revision 18-0; Effective September 4, 2018

While awaiting enrollment in managed care, individuals are entitled to receive services from the Community Care Services Eligibility (CCSE) program. Referrals to CCSE must be made for all active Medicaid individuals awaiting enrollment for managed care. CCSE case managers may assess these individuals for services if it appears services can be authorized and delivered prior to enrollment.

3311.1 Interest List Procedures

Revision 22-1; Effective January 31, 2022

Interest List Management (ILM) Unit staff are Texas Health and Human Services Commission (HHSC) staff responsible for maintaining and releasing individuals from the STAR+PLUS Home and Community Based Services (HCBS) program interest list. ILM Unit staff must use the Community Services Interest List (CSIL) database to track individuals who request the STAR+PLUS HCBS program. ILM Unit staff must release individuals from the STAR+PLUS HCBS program interest list as slots become available in the program.

ILM Unit staff must use the CSIL database to track nursing facility (NF) residents who are not SSI eligible when a request for the STAR+PLUS HCBS program is received on the interest list hotline. Program Support Unit (PSU) staff must use the CSIL database to track NF residents who are not SSI eligible when a request for the STAR+PLUS HCBS program is received from a Community Care Services Eligibility (CCSE) case manager. ILM Unit or PSU staff must check the CSIL database to verify if the NF resident is on the STAR+PLUS HCBS program interest list when a request for community transition to the STAR+PLUS HCBS program is received. ILM Unit or PSU staff must add, if applicable, and immediately release and assign the individual from the STAR+PLUS HCBS program interest list to pursue the Money Follows the Person (MFP) process if the individual is not in the CSIL database.

ILM Unit staff perform the following activities for individuals who request placement on the STAR+PLUS HCBS program interest list:

• Place individuals on the interest list;
• Maintain annual contact requirements;
• Release individuals from the interest list when funding is available;
• Track STAR+PLUS HCBS program slots allocated for use by individuals who are not mandatory participants; and
• Confirm individuals on the interest list are viable STAR+PLUS candidates before release by:
  • verifying all contact information is correct;
  • checking the Texas Integrated Eligibility Redesign System (TIERS) to determine the Medicaid eligibility status;
  • confirming Texas residency; and
  • verifying the individual is still interested in the STAR+PLUS HCBS program.

The interest list status will automatically update to an inactive status if no response is received from the individual within 120 days of the annual contact and will remain in that status until the individual notifies ILM Unit staff of continued interest.

The HHSC enrollment broker must contact all individuals by phone upon release from the STAR+PLUS HCBS program interest list to notify them of their names reaching the top of the list and a slot has become available.  

The enrollment broker will contact the individual to confirm if the individual wishes to pursue the STAR+PLUS HCBS program. The enrollment broker will mail the enrollment packet if the individual wishes to pursue the STAR+PLUS HCBS program. If the individual does not wish to pursue the STAR+PLUS HCBS program:

• the individual can be added back to the bottom of the interest list for an offer in the future, at the individual’s request; or
• the interest list release (ILR) will be closed with the appropriate closure code in the CSIL database.

The enrollment broker will mail a STAR+PLUS HCBS program enrollment packet to all individuals released from the interest list and interested in pursuing STAR+PLUS HCBS program services. The STAR+PLUS HCBS program enrollment packet includes:

• Form H2053-A, STAR+PLUS Selection Letter;
• Form H3675, Application Acknowledgement;
• Form H2053-B, Health Plan Selection;
• Form H1200, Application for Assistance – Your Texas Benefits;
• Appendix XII, STAR+PLUS HCBS Program Description;
• STAR+PLUS Comparison Charts;
• STAR+PLUS Report Cards; and
• a postage-paid envelope.

The enrollment broker contacts the individual every seven days from the date the enrollment packet is mailed. All enrollment broker contacts will cease when the completed packet is received by the enrollment broker or on the 30th day after mailing the enrollment packet, whichever is sooner. The enrollment broker’s contact attempts include the 14-day contact requirement.

The enrollment broker will contact the applicant or authorized representative (AR) to:

• give a general description of STAR+PLUS HCBS program services;
• provide a list of managed care organizations (MCOs) in their service area (SA) and encourage the member to contact one for service information;
• discuss the importance of choosing an MCO so an assessment and initial individual service plan (ISP) can be completed in order to avoid a delay in eligibility determination for the STAR+PLUS HCBS program; and
• inform the individual that their MCO selection can be changed at any time after the first month of service.

The enrollment broker will fax the signed and completed Form H1200, along with Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist within two business days of receipt from the applicant or AR. The applicant or AR will select an MCO by completing Form H2053-B, Health Plan Selection, or notifying the enrollment broker verbally.

Refer to section 3312, Managed Care Enrollment, for steps to be taken after an individual is released from the STAR+PLUS HCBS program interest list.

3311.2 Enrollment Procedures Following Release from the Interest List

Revision 25-4; Effective Oct. 6, 2025

Program Support Unit (PSU) staff complete the following activities within three business days of the receipt of the STAR+PLUS Home and Community Based Services (HCBS) program interest list release (ILR) case record assignment in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

• check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility;
• ensure that the individual does not have an open enrollment with another Medicaid waiver program per the procedures below:
• check the Service Authorization System Online (SASO) for open Service Authorization and Enrollment records for:
  • Community Living Assistance and Support Services (CLASS) (Service Group (SG) 2);
  • Deaf Blind and Multiple Disabilities (DBMD) (SG 16);
  • Home and Community-based Services (HCS) (SG 21);
  • Texas Home Living (TxHmL) (SG 22); and
• upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization (PDF), Section A, to the MCOHub.

The MCO must complete the following activities within 45 days from the date PSU staff upload Form H3676 to the MCOHub:

• upload Form H3676, Section B, to the MCOHub;
• conduct the Medical Necessity and Level of Care (MN/LOC) Assessment; and
• develop the individual service plan (ISP) using Form H1700-1, Individual Service Plan, and upload it to the MCOHub.

Note: PSU staff must document Form H2067-MC, Managed Care Programs Communication, was received in lieu of Form H3676, Section B, in the HEART case record, if applicable. 

PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet (PDF), to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist noting the applicant has an approved MN/LOC Assessment and ISP within two business days of receipt from the MCO.

PSU staff must notify Program Support Operations Review Team (PSORT) staff by email within two business days of an MCO failing to submit initial assessment information within the 45-day time frame. The email sent to PSORT staff must include:

• an email subject line that reads: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the member’s first and last name];
• individual or applicant’s name;
• Social Security number (SSN) or Medicaid identification (ID) number;
• date of birth (DOB);
• name of the MCO and plan code;
• the date information was due from the MCO;
• a brief description of the delay and any MCO information received; and
• attach any pertinent documents received from the MCO such as Form H2067-MC.

PSU staff must:

• ensure the medical necessity (MN) determination from the Texas Medicaid & Healthcare Partnership (TMHP) nurse or physician is valid by verifying the approval date does not exceed 120 days; and
• upload Form H2067-MC to the MCOHub, advising the MCO to submit a new initial MN/LOC Assessment if the MN approval date exceeds 120 days.

PSU staff must determine if the applicant meets the eligibility criteria for the STAR+PLUS HCBS program within five business days from the MEPD specialist advising the applicant meets Medicaid financial eligibility. PSU staff must complete the activities listed below if the applicant meets the eligibility criteria:

• Electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF) in the TMHP Long Term Care Online Portal (LTCOP). Note: The start of care (SOC) date for the STAR+PLUS HCBS program is the first day of the month, following meeting all eligibility criteria. PSU staff processing does not delay the eligibility begin date.
• Mail Form H2065-D to the member.
• Verify SASO records are in alignment with TMHP LTCOP records.
• Upload Form H2065-D to the MCOHub.
• Fax Form H1746-A (PDF) to the MEPD specialist.
• Notify Enrollment Resolution Services (ERS) unit staff by email. Include in the email to ERS unit staff, this email subject line: STAR+PLUS HCBS Enrollment for XX [member’s first and last name initials];
  • the member’s name;
    • Medicaid ID number;
    • type of request: ILR enrollment;
    • MN approval date;
    • ISP receipt date;
    • ISP begin date;
    • ISP end date;
    • MCO selection;
  • effective date of enrollment;
  • Form H2065-D as an attachment;
• Upload all applicable documents to the HEART case record; and
• Document and close the HEART case record.

Refer to 6000, Denials and Terminations, if the applicant does not meet STAR+PLUS HCBS program requirements at ILR.

3311.3 Interest List Slot Allocations

Revision 18-0; Effective September 4, 2018

Members receiving Medicaid services under any of the programs listed in the chart below must receive those services through managed care. This does not impact the STAR+PLUS member's right to access non-Medicaid services through the Texas Health and Human Services Commission (HHSC). STAR+PLUS Home and Community Based Services (HCBS) program members must receive all services through the STAR+PLUS HCBS program, excluding hospice care. Only STAR+PLUS HCBS members count against slot allocations, as the following table illustrates.

3311.4 Earliest Date for Adding a Member Back to the Interest List

Revision 18-0; Effective September 4, 2018

The earliest date an applicant or member may be added back to the Community Services Interest List (CSIL) database for STAR+PLUS HCBS is the date the applicant is determined to be ineligible for the program or the first date the member is no longer eligible for the program.

Example 1: The applicant is released from the STAR+PLUS HCBS program interest list on March 2, 2019. PSU staff send Form H2065-D, Notification of Managed Care Program Services, notifying the applicant is not eligible for the STAR+PLUS HCBS program on March 28, 2019. The first date the denied applicant can be added back to the STAR+PLUS HCBS program interest list is March 28, 2019.

Example 2: A STAR+PLUS HCBS program member is determined ineligible on March 28, 2019. PSU staff send Form H2065-D to the STAR+PLUS HCBS program member notifying of program termination. Termination is effective April 30, 2019. The first date the denied member can be added back to the STAR+PLUS HCBS program interest list is May 1, 2019.

If the applicant or STAR+PLUS HCBS program member’s name is added back to the interest list prior to the last date of program eligibility, the CSIL database interface match with the Service Authorization System Online (SASO) will cause the name to be removed from the interest list for that program.

3311.5 Updating Community Services Interest List Records

Revision 18-0; Effective September 4, 2018

The Community Services Interest List (CSIL) database must be updated to reflect accurate information. Program Support Unit (PSU) staff must complete data entry in the CSIL database for STAR+PLUS Home and Community Based Services (HCBS) program actions within five business days of the date:

• PSU staff sign Form H2065-D, Notification of Managed Care Program Services, certifying or denying applications, except Money Follows the Person (MFP) certifications; and
• the request for other CSIL database actions (updating information, transferring an individual to another region's interest list or removing a member from the interest list upon request by the individual).

For MFP certifications, the CSIL database is updated when the Service Authorization System Online (SASO) data entry is completed to register the initial individual service plan (ISP). Delaying data entry of the disposition in CSIL for an applicant certified through MFP provisions prevents removing the individual from the interest list before the actual discharge from the nursing facility (NF) is verified.

PSU staff must ensure CSIL database closures are recorded accurately by using the Community Services Interest List (CSIL) User's Guide, available to PSU staff on SharePoint.

3311.6 Contacting the Interest List Management Unit to Reopen a Closed Interest List Release

Revision 20-6; Effective December 18, 2020

Program Support Unit (PSU) staff must submit a request to Interest List Management (ILM) Unit staff to reopen an individual’s closed Community Services Interest List (CSIL) record.

Within two business days of receiving the request to reopen a closed interest list release, PSU staff must email their immediate supervisor requesting to reopen the CSIL record. The email must include the following:

• an email subject line that reads: “S+P Reopen Request for XX [individual’s first and last initials].” For example, the email subject line for a request to reopen a closed CSIL record for Ann Smith would be “S+P Reopen Request for AS”;
• individual’s name;
• interest list identification (ID) number;
• individual’s Medicaid ID number or Social Security number (SSN);
• the individual’s or authorized representative’s (AR’s) contact name and phone number; and
• reason for the request to reopen. For example, a statement indicating that the application for an alternate 1915(c) Medicaid waiver program was denied and the individual now wishes to reapply for STAR+PLUS HCBS.

The PSU supervisor will forward the reopen request to the ILM Unit manager at StarPlusWaiverInterestList@hhsc.state.tx.us if the PSU supervisor agrees the reopen request is appropriate. ILM Unit staff will email PSU staff to provide the outcome of the request within five business days.

If an exception is granted, PSU staff must:   

• contact the individual to begin the application process;
• document the reopen request in the Health and Human Services Enterprise Administrative Report and Tracking System (HEART) case record;
• upload the ILM Unit staff’s decision email to the HEART case record, following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions; and
• keep the HEART case record open until STAR+PLUS HCBS program eligibility is approved or denied.

If an exception is not granted, PSU staff must:

• upload the ILM Unit staff’s decision email to the HEART case record, following the instructions in Appendix XXXIII; and
• close the HEART case record.

3312 Managed Care Enrollment

Revision 18-0; Effective September 4, 2018

The Texas Health and Human Services Commission (HHSC) enrollment broker mails enrollment packets to all Medicaid individuals who are candidates for STAR+PLUS. The enrollment packet contains information about STAR+PLUS, instructions for completing the enrollment form and information about the available STAR+PLUS managed care organizations (MCOs) from which the individual can choose. Individuals can return enrollment forms by mail, complete an enrollment form at an enrollment event or presentation, or call the HHSC enrollment broker and enroll by telephone at 800-964-2777.

Individuals have 30 days after receiving an enrollment packet to select an MCO. If a selection is not made within 30 days, the individual will be assigned to an MCO and a primary care provider (PCP). Failure to choose an MCO could lead to delays in services or default assignment to an MCO. Individual assignments to an MCO or PCP are automatic, using a default process. Individuals assigned through the default process may change their STAR+PLUS MCO and PCP after they have been enrolled at least one month. However, the individual must receive Medicaid services through the assigned MCO and PCP until the individual contacts the MCO or the HHSC enrollment broker at 800-964-2777 to request a change.

Failure to select a PCP may delay services when a physician's order or medical necessity (MN) determination is required.

3313 Termination of CCSE Services Upon STAR+PLUS HCBS Program Enrollment

Revision 24-4; Effective Dec. 1, 2024

The STAR+PLUS Home and Community Based Services (HCBS) program is required to provide all the services needed to enable the member to live safely in the community. Therefore, an individual cannot receive non-managed care Community Care Services Eligibility (CCSE) services and STAR+PLUS HCBS program services concurrently.

Program Support Unit (PSU) staff must coordinate the termination of CCSE with the regional CCSE case manager. This is so the member does not experience a break in services and does not receive concurrent services through another waiver or CCSE service.

PSU staff must complete the following activities within two business days of notification:

• identify the region the member lives in;
• email the regional CCSE mailbox the following information:
  • a subject line that reads “CCSE Closure – STAR+PLUS HCBS Enrollment XX [first letter of the member’s first and last name]”;
  • member’s name;
  • Medicaid ID;
  • start of care (SOC) date for STAR+PLUS Home and Community Based Services (HCBS) program; and
  • managed care organization (MCO).
• ensure the Service Authorization System Online (SASO) reflects the closure of CCSE records with Service Group 7 and have an end date one day before the SOC for the STAR+PLUS HCBS program; and
• follow instructions in section 3311.2, Enrollment Procedures following Release from the Interest List, to complete STAR+PLUS HCBS program enrollment.

PSU staff must encourage the member to contact the MCO to request any CCSE services not in the STAR+PLUS HCBS program individual service plan (ISP).

3313.1 Procedure for STAR+PLUS HCBS Program Applicants

Revision Notice 24-2; Effective May 21, 2024

Program Support Unit (PSU) staff must coordinate the termination of other waiver or Community Care Services Eligibility (CCSE) services with the waiver or CCSE case manager for individuals entering the STAR+PLUS Home and Community Based Services (HCBS) program. This ensures the individual does not experience a break in services and does not receive concurrent services through another waiver or CCSE service.

The CCSE case manager terminates CCSE services in the Service Authorization System Online (SASO) no later than one day prior to the STAR+PLUS HCBS program enrollment. The adverse action notification period does not apply in this situation.

The CCSE case manager must send:

• Form 2065-A, Notification of Community Care Services, to the member denying ongoing CCSE services; and
• Form 2101, Authorization for Community Care Services, to the provider advising the member is transferring from CCSE to the STAR+PLUS HCBS program.

3313.2 Procedure for STAR+PLUS HCBS Program Members

Revision 18-0; Effective September 4, 2018

If it is determined an existing STAR+PLUS Home and Community Based Services (HCBS) program member is receiving any Service Group (SG) 7 Community Care Services Eligibility (CCSE) services, Program Support Unit (PSU) staff must begin denial procedures for the SG 7 service immediately.

If CCSE services are authorized in SASO, the CCSE case manager must immediately send:

• Form H2065-A, Notification of Community Care Services, including a notation to the provider in the comments section that the individual is transferring to the STAR+PLUS HCBS program; and
• Form 2101, Authorization for Community Care Services, to the provider Include a notation in the comments section that the individual is transferring from CCSE to the STAR+PLUS HCBS program.

3314 Managed Care Organization Changes

Revision 25-1; Effective Feb. 19, 2025

An applicant or member may change managed care organization (MCO) plans at any time, for any reason, and regardless of their living arrangement by contacting the Texas Health and Human Services Commission (HHSC) enrollment broker at 800-964-2777. However, for an applicant requesting an MCO change, the transfer will not go into effect until after one full calendar month of STAR+PLUS Home and Community Based Services (HCBS) program service provision.

The HHSC enrollment broker makes plan changes based on the monthly cutoff periods, which occur around the middle of each month. Depending on which day of the month, before or after the HHSC enrollment broker cutoff, the plan change will either occur the first day of the next month or the month after. The change will show up on the 834 daily enrollment file, notifying the MCO of the new member. 

Service Authorization System Online (SASO) records will be automatically updated if the MCO submits the individual service plan (ISP) through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) and the ISP record is in a Processed/Complete or PSU Processed/Complete status.

Program Support Unit (PSU) staff are not required to manually update SASO records to reflect the new MCO contract number and coverage date span for any ISP that was not captured by the above process.

3315 STAR+PLUS HCBS Program Individuals Requesting Non-Managed Care Services

Revision 18-0; Effective September 4, 2018

Requirements of the STAR+PLUS Home and Community Based Services (HCBS) program provide all of the services (excluding hospice) needed to enable the member to live safely in the community. Therefore, non-managed care services cannot be authorized for the STAR+PLUS HCBS program member. A STAR+PLUS HCBS program member requesting additional services must be referred to the managed care organization's (MCO’s) service coordinator.

Hospice services may be authorized along with STAR+PLUS services or the STAR+PLUS HCBS program.

3316 Transfer from Another Medicaid Waiver Program to the STAR+PLUS HCBS Program

Revision 25-4; Effective Oct. 6, 2025

Individuals in the following Medicaid waiver programs may request an assessment for the STAR+PLUS Home and Community Based Services (HCBS) program any time:

• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS);
• Home and Community Based Services – Adult Mental Health (HCBS-AMH) program; or
• Texas Home Living (TxHmL).

Program Support Unit (PSU) supervisors receive requests by:

• email from Interest List Management (ILM) unit staff;
• email from Medicaid waiver program staff;
• email from a Local Intellectual and Developmental Disability Authority (LIDDA); or
• Form H2067-MC, Managed Care Programs Communication uploaded to the MCOHub by the managed care organization (MCO).

The email from ILM unit staff identify STAR+PLUS HCBS program interest list release (ILR) individuals currently enrolled in another Medicaid waiver program.

PSU staff must refer a transfer request received from the LIDDA or MCO to the corresponding Medicaid waiver program staff to confirm the individual wants to pursue the STAR+PLUS HCBS program.

PSU staff must mail the following enrollment packet to the individual within three business days of the first request for a STAR+PLUS HCBS program assessment:

• Form H3675, Application Acknowledgement; and
• Appendix XII, STAR+PLUS HCBS Program Description.

PSU staff must contact the individual or authorized representative (AR) to verify receipt of the enrollment packet. PSU staff explains the STAR+PLUS HCBS program services within 14 days from the mail date of the above enrollment packet. PSU staff must:

• encourage the individual to complete the enrollment packet and mail it back; and
• inform the individual that there might be a delay in eligibility determination for the STAR+PLUS HCBS program if the individual does not return the enrollment packet.

PSU staff can accept the individual’s or AR’s verbal statement of interest in the STAR+PLUS HCBS program or through receipt of Form H3675.

PSU staff must document all attempted contacts with the individual or encountered delays in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub within two business days of the individual’s or AR’s confirmed interest in the STAR+PLUS HCBS program.

The MCO must complete the following activities within 45 days from the date PSU staff upload Form H3676 to the MCOHub:

• submit the Medical Necessity and Level of Care (MN/LOC) Assessment in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
• submit the individual service plan (ISP) in the TMHP LTCOP; and
• complete and upload Section B of Form H3676 to the MCOHub.

PSU staff must:

• monitor the TMHP LTCOP for receipt of the ISP;
• monitor the MCOHub for receipt of Section B of Form H3676 which should not delay the certification of the case, if applicable; and
• document Form H2067-MC was received in lieu of Form H3676, Section B, in the HEART case record, if applicable.

PSU staff must email the Program Support Operations Review Team (PSORT) within two business days of an MCO failing to submit the initial assessment information within the 45-day time frame. The email to PSORT must include:

• This email subject line: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • Social Security number (SSN) or Medicaid identification (ID) number;
  • date of birth (DOB);
  • name of the MCO and plan code;
  • the date information was due from the MCO which is the 45th day for STAR+PLUS HCBS program;  
  • a brief description of the delay and any MCO information received; and
• attachments of any pertinent documents received from the MCO such as Form H2067-MC.

PSU staff must:

• continue to monitor the TMHP LTCOP and the MCOHub for receipt of the above information; and
• email any case information received from the MCO to the PSORT mailbox within two business days from its receipt.

The follow-up email must include the same email identifier elements listed above.

PSU staff must continue to email the Managed Care Contracts and Oversight (MCCO) Unit staff for MCO non-compliance issues unrelated to late initial assessment information. PSU staff must include the following components when emailing MCCO Unit staff:

• This email subject line: STAR+PLUS HCBS MCO Non-Compliance for XX [first letter of the member’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • SSN or Medicaid ID number;
  • DOB;
  • name of the MCO and plan code;
  • the date information was due from the MCO;
  • a brief description of the MCO non-compliance and any MCO information received; and
• attachments of any pertinent documents received from the MCO, if applicable.

PSU staff must coordinate with all other Medicaid waiver program staff, as appropriate, ensuring the current Medicaid waiver program services end the day before enrollment in the STAR+PLUS HCBS program.

PSU staff must complete the following activities within five business days of receiving all required STAR+PLUS HCBS program eligibility documentation:

• confirm STAR+PLUS HCBS program eligibility by verifying:
  • in the Texas Integrated Eligibility Redesign System (TIERS) the applicant:
    • is over 21;
    • has Medicaid eligibility for the STAR+PLUS HCBS program;
  • in the TMHP LTCOP the applicant has an:
    • approved MN/LOC Assessment; and
    • ISP within the applicant’s cost limit which has at least one STAR+PLUS HCBS program service.

PSU staff must complete the following activities the same day they confirm all STAR+PLUS HCBS program eligibility criteria are met:

• manually or electronically generate Form H2065-D, Notification of Managed Care Program Services, with a start of care (SOC) date being the first day of the month following the other Medicaid waiver program's termination;
• mail Form H2065-D to the member;
• upload Form H2065-D to the MCOHub, if manually generated;
• verify SASO records are in alignment with TMHP LTCOP records, if applicable;
• close the Community Services Interest List (CSIL) record, if applicable;
• notify Enrollment Resolution Services (ERS) unit staff by email with the following required information:
  • This email subject line: Waiver Transfer Request for XX [first letter of the member’s first and last name];
  • the member’s name;
  • Medicaid ID number;
  • type of request: waiver transfer;
  • MN approval date;
  • ISP receipt date;
  • ISP begin date;
  • ISP end date;
  • MCO;
  • termination effective date for the other Medicaid waiver program;
  • effective date of enrollment for the STAR+PLUS HCBS program; and
  • Form H2065-D as an attachment.
• for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the STAR+PLUS HCBS program SOC date and the termination date for the other Medicaid waiver program;
• upload applicable documents to the HEART case record; and
• document and close the HEART case record.

Title 1 Texas Administrative Code (TAC) Section 353.1153(a)(1)(F) states that STAR+PLUS HCBS program members cannot be enrolled in more than one Medicaid waiver program at a time. Refer to Appendix XVIII, Mutually Exclusive Services, to decide if two services may be received at the same time.

The MCO must upload Section B of Form H3676 to the MCOHub within two business days if the applicant fails to meet any STAR+PLUS HCBS program eligibility criteria other than Medicaid financial eligibility. PSU staff may accept Form H2067-MC as notification of a denial. However, PSU staff must document in the HEART case record that Section B of Form H3676 was not received at the time Form H2065-D was generated, if applicable.

PSU staff must refer to 6000, Denials and Terminations, for more information on processing STAR+PLUS HCBS applicant denials.

3317 Transfer from STAR+PLUS HCBS Program to Another Medicaid Waiver Program

Revision 25-4; Effective Oct. 6, 2025

Title 1 Texas Administrative Code (TAC) Section 353.1153(a)(1)(F) states that STAR+PLUS Home and Community Based Services (HCBS) members cannot enroll in more than one Medicaid waiver program at a time. Refer to Appendix XVIII, Mutually Exclusive Services, to determine if a member may receive two services at the same time.

A STAR+PLUS HCBS program member may be on an interest list for an Intellectual and Developmental Disabilities (IDD) Medicaid waiver program, such as:

• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS); or
• Texas Home Living (TxHmL).

A STAR+PLUS HCBS program member may also be eligible for another waiver such as the Home and Community Based Services – Adult Mental Health (HCBS-AMH) program that does not have an interest list.

Program Support Unit (PSU) staff may receive notification from Medicaid waiver program staff or the managed care organization (MCO) that the STAR+PLUS HCBS program member:

• is eligible for another Medicaid waiver program;
• chooses to transfer to another Medicaid waiver program; or
• is already enrolled in another Medicaid waiver program.

PSU staff must:

• coordinate the program enrollment effective date with Medicaid waiver program staff; and
• request confirmation of the program enrollment and the enrollment effective date from the Medicaid waiver program staff if the MCO or Local Intellectual and Developmental Disability Authority (LIDDA) notifies PSU staff of a waiver transfer.

The Medicaid waiver program staff must confirm the member’s enrollment effective date.

PSU staff must complete the following activities within three business days from notification:

• create a Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record, if applicable;
• contact and coordinate with Medicaid waiver program staff by email to determine the STAR+PLUS HCBS program termination date and the start of care (SOC) date for the other Medicaid waiver program;
• terminate the individual service plan (ISP) in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) using an end-date that aligns with the termination effective date;
• verify the following service group (SG) 19 records in the Service Authorization System Online (SASO) end the last day of the month before the member’s enrollment in the Medicaid waiver program:
  • Authorizing Agent;
  • Enrollment;
  • Service Plan;
  • Service Authorization.
• manually generate Form H2065-D, Notification of Managed Care Program Services, with a termination effective date one day before other Medicaid waiver’s SOC date;
• mail Form H2065-D to the member;
• upload Form H2065-D to the MCOHub;
• notify Enrollment Resolution Services (ERS) unit staff by email. The email to ERS unit staff must include:
  • This email subject line: Waiver Transfer Request for XX [first letter of the member’s first and last name];
  • the member’s name;
  • Medicaid identification (ID) number;
  • type of request: waiver transfer;
  • MN approval date;
  • ISP receipt date;
  • ISP begin date;
  • ISP end date;
  • MCO selection;
  • termination effective date for the STAR+PLUS HCBS program;
  • enrollment effective date for the other Medicaid waiver program; and
  • Form H2065-D as an attachment;
• for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the STAR+PLUS HCBS program termination date and the SOC date for the other Medicaid waiver program;
• upload all applicable documents to the HEART case record; and
• document and close the HEART case record.

Note: PSU staff must not close Medical Necessity, Level of Service, and Diagnosis SG 19 – STAR+PLUS records in SASO.

3320 Coordination with Medicaid for the Elderly and People with Disabilities

Revision 18-0; Effective September 4, 2018

3321 General Eligibility Issues

Revision 18-0; Effective September 4, 2018

At the initial contact, Program Support Unit (PSU) staff must inform the medical assistance only (MAO) applicant, member or authorized representative (AR) that Medicaid for the Elderly and People with Disabilities (MEPD) specialists will complete a financial eligibility (Medicaid) determination. PSU staff should encourage the applicant, member or AR to cooperate with the MEPD specialist and to provide all verifications necessary in a timely manner.

Any information, including information on third-party insurance, obtained by PSU staff, must be shared with the MEPD specialist to prevent the applicant or member from having to provide the information twice.

PSU staff must inform the MEPD specialists of the request for the STAR+PLUS Home and Community Based Services (HCBS) program by faxing a completed and signed Form H1200, Application for Assistance – Your Texas Benefits, along with Form H1746-A, MEPD Referral Cover Sheet, following the guidelines provided in Appendix II, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet, within two business days of receipt. Form H1200 is not required for members receiving Supplemental Security Income (SSI).

3321.1 Disability Determinations

Revision 18-0; Effective September 4, 2018

The following information is provided for informational purposes only regarding the disability determination process. Program Support Unit (PSU) staff have no role in this process.

If a STAR+PLUS HCBS program applicant or member's application for Supplemental Security Income (SSI) disability has been pending over 90 days, the Texas Health and Human Services Commission (HHSC) Disability Determination Unit (DDU) staff may determine disability, pending the Social Security Administration (SSA) determination. PSU staff will not be notified of the individual's Medicaid for the Elderly and People with Disabilities (MEPD) eligibility status until disability is determined. In order for DDU staff to make a disability determination, the MEPD specialist must obtain the following:

• Form H3034, Disability Determination Socio-Economic Report;
• Form H3035, Medical Information Release/Disability Determination; and
• a copy of the Medical Necessity and Level of Care (MN/LOC) Assessment.

3322 Actions Pending Past the MEPD Due Date

Revision 18-0; Effective September 4, 2018

Because Program Support Unit (PSU) staff depend on the Medicaid for the Elderly and People with Disabilities (MEPD) specialist to determine eligibility for medical assistance only (MAO) applicants, there are times when PSU staff must check with the MEPD specialist regarding the status of an application or program change.

PSU staff must contact the MEPD specialist by sending an email to the HHSC OES MEPD IC mailbox. PSU staff must ensure the MEPD time frame has expired. MEPD specialists have 45 days to complete applications for individuals over age 65. MEPD specialists have 90 days for individuals under age 65 whose disability has not yet been determined by the Social Security Administration (SSA).

3330 STAR+PLUS Individual Requesting an Upgrade to the STAR+PLUS HCBS Program

Revision 26-2; Effective June 1, 2026

The managed care organization (MCO) must:

• Use Form H2067-MC, Managed Care Programs Communication, to advise Program Support Unit (PSU) staff that a STAR+PLUS individual requests an upgrade into the STAR+PLUS Home and Community Based Services (HCBS) program. 
• Note the following in the comments section of Form H2067-MC:
  • the Medicaid type of assistance (TOA); 
  • if the MCO will use an existing Medical Necessity and Level of Care (MN/LOC) Assessment or will be completing a new one; and
  • if a Supplemental Security Income (SSI) individual is receiving Community First Choice (CFC) services or not.
• Upload Form H2067-MC to the MCOHUB within three business days of the request for an upgrade.

PSU staff do not have to respond to the Form H2067-MC received from the MCO.

The MCO may choose to use an existing MN/LOC Assessment on file if the assessment date does not exceed 120 days from the upgrade start of care (SOC) date. PSU staff must take the following actions depending on if the MN/LOC Assessment is valid and with consideration to the MCO’s assessment preference:

• close the Medical Necessity (MN), Level of Service (LOS), and Diagnosis (DG) records in the Service Authorization System Online (SASO) with an end date one day before the STAR+PLUS HCBS program SOC date if the MCO requests to submit a new initial MN/LOC Assessment; or
• extend the end date of the MN, LOS, and DG records in SASO to align with the STAR+PLUS HCBS individual service plan (ISP) end date if the MCO requests to use an existing valid MN/LOC Assessment.

A significant change MN/LOC Assessment and nursing facility (NF) Minimum Data Set (MDS) cannot be used for an upgrade. 

A STAR+PLUS individual with one of the following Medicaid types of assistance TOAs may be eligible to upgrade to the STAR+PLUS HCBS program:

• Pickle (type program (TP)-03)
• Earnings Transitional (TP-07)
• Texas Temporary Assistance for Needy Families (TANF) Family Level (TP-08)
• SSI (TP-12 and TP-13)
• Medicaid for Breast and Cervical Cancer (MBCC) (TP-14)
• Disabled Adult Child (TP-18)
• Disabled Widow(er) (TP-21)
• Early Aged Widow(er) (TP-22)
• Pregnant Women (TP-40)
• Former Foster Care Children (FFCC) (type assistance (TA)-82)
• Medicaid Buy-in (TP-87)

The above Medicaid TOAs represent full Medicaid eligibility. PSU staff do not require review by the MEPD specialist except for applicants receiving MBCC. PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist for upgrade applicants who are receiving MBCC. This must be done within two business days of receipt of the upgrade request. PSU must check the Program Transfer box. They must note in the Comments section on Form H1746-A that this case requires a financial eligibility determination. The MEPD specialist provides PSU staff with a determination on if the MBCC applicant meets financial eligibility. The MEPD specialist updates Texas Integrated Eligibility Redesign System (TIERS) to reflect a program transfer to ME-Waivers if the MBCC applicant meets financial eligibility for the STAR+PLUS HCBS program.

An individual who receives TANF Level Families or Pregnant Women TOAs must be enrolled in STAR+PLUS to be eligible for an upgrade into the STAR+PLUS HCBS program. An individual enrolled in STAR must go through the interest list release (ILR) process.

The MCO must complete and submit:

• the initial MN/LOC Assessment, as applicable; and 
• Form H1700-1, Individual Service Plan.

This must be done in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) within 45 days of an applicant’s identified need or request to upgrade into the STAR+PLUS HCBS program.

PSU staff complete the following activities within five business days of verifying all eligibility criteria is met:

• email the regional Community Care Services Eligibility (CCSE) mailbox requesting the closure of all Service Group (SG) 7 records in SASO, if applicable;
  • identify the CCSE region by referring to Appendix XXXVIII, CCSE Region by Service Area; 
  • the closure date must be one day before the start of care (SOC) for the STAR+PLUS HCBS program;
• electronically generate Form H2065-D, Notification of Managed Care Program Services, in the TMHP LTCOP;
• mail Form H2065-D to the member;
• verify SASO records are in alignment with TMHP LTCOP records;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record.

The start of care (SOC) date on Form H2065-D is the first day of the month after all eligibility criteria is met.

Refer to 6000, Denials and Terminations, if the applicant does not meet STAR+PLUS HCBS program requirements during the upgrade process.

Revision 25-1; Effective Feb. 19, 2025

Mandatory STAR+PLUS program members may continue to receive their current non-Medicaid services from the Texas Health and Human Services Commission (HHSC) until the managed care organization (MCO) is able to authorize Medicaid services. For example, a member would be able to continue to receive Family Care until the MCO authorizes personal attendant services (PAS). STAR+PLUS members are also entitled to be placed on an interest list for non-Medicaid services following policy specified in the Case Manager Community Care for Aged and Disabled (CM-CCAD) Handbook, 2230, Interest List Procedures.

Any application for new long-term services and supports (LTSS) from HHSC requires the mandatory member to be sent to his or her MCO first. This must be coordinated through Program Support Unit (PSU) staff. Refer to 3315, STAR+PLUS HCBS Program Individuals Requesting Non-Managed Care Services.

Some STAR+PLUS Home and Community Based Services (HCBS) program applicants or members transferring in and out of STAR+PLUS will have an individual service plan (ISP) that is over the cost limit and is approved for the Medically Fragile group or general revenue (GR) funds process. For these applicants or members, the losing service area (SA) MCO must inform the gaining SA MCO of the Medically Fragile group or GR funds status. The gaining SA MCO must follow the Medically Fragile group or GR funds process.

3410 MCO Transfer Scenarios

Revision Notice 25-2; Effective June 6, 2025

The applicant, member, or authorized representative (AR) must contact the enrollment broker by phone at 800-964-2777 to change from one managed care organization (MCO) to another MCO. The MCO transfer may occur within the same service area (SA) or in another SA.

An applicant, member, or AR may request to change MCOs at any time, for any reason, and regardless of their living arrangement. However, for an applicant requesting an MCO change, the transfer will not go into effect until after one full calendar month of STAR+PLUS Home and Community Based Services (HCBS) program service provision. All MCO enrollment changes become effective based on the date the MCO change is requested and processed, in relation to the state cutoff. Refer to Appendix XVII, State Cutoff Dates, for more information.

3411 Transferring from One MCO to Another Within the Same Service Area

Revision 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff may become aware of an applicant or member transferring from one managed care organization (MCO) to another within the same service area (SA):

• by finding a child individual service plan (ISP) H1700 record in Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP); or 
• from the MCO uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

PSU staff must make sure the contract number in the Service Authorization System Online (SASO) is updated to reflect the new managed care organization’s (MCO’s) contract number.

PSU staff must complete the following manual actions in the Service Authorization System Online (SASO), within three business days from notification, if applicable: 

• close service authorization record using the MCO transfer date; and
• create a new service authorization record using the new MCO’s contract number.

The old MCO must transfer all relevant information to the new MCO using a secure file transfer protocol (SFTP) or secure email. Relevant information includes: 

• the individual service plan (ISP); 
• Medical Necessity and Level of Care (MN/LOC) Assessment; and 
• Form H2065-D, Notification of Managed Care Program Services. 

The new MCO is responsible for service delivery beginning the first day of enrollment. The new MCO must honor authorizations included in the prior ISP until the member requires a new MN/LOC Assessment.

The new MCO must notify Managed Care Contracts and Oversight (MCCO) unit staff if they encounter issues getting the transfer packet from the old MCO. MCCO unit staff may contact PSU staff for help transferring member information to the gaining MCO.

3412 Transferring from One MCO to Another in a Different Service Area

Revision Notice 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff may become aware of an applicant or member transferring from one managed care organization (MCO) to another in a different service area (SA):

• by finding a child individual service plan (ISP) H1700 record in Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP); or
• from the MCO uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

Program Support Unit (PSU) staff must complete the following activities. This must be done within five business days of being aware of the transfer of an applicant or member to another MCO in a different SA:

• create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record;
• verify the applicant or member’s address and managed care enrollment is updated in Texas Integrated Eligibility Redesign System (TIERS);
• manually close the Service Authorization System Online (SASO) Service Authorization record using the MCO transfer date, if applicable; and
• manually create a new SASO Service Authorization record using the new MCO’s contract number, if applicable.

PSU staff must complete the following activities. This must be done within two business days of determining an applicant or member does not have an updated address or managed care enrollment in TIERS:

• advise the MCO to help the Supplemental Security Income (SSI) applicant or member contact the Social Security Administration (SSA) to update their address; or
• fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist noting the address change for medical assistance only (MAO) applicants and members.

TIERS tries to assign an applicant or member to a companion plan automatically when their address is updated in TIERS and reflects an SA change. A companion plan is defined as an MCO that operates the same managed care line in multiple SAs. TIERS systematically refers the applicant or member to the enrollment broker if a companion plan is unavailable.

The enrollment broker tries to get a new MCO selection from the member. The enrollment broker defaults the member to an MCO if a selection is not provided within 15 days. The defaulted MCO selection is made using the Texas Health and Human Services Commission (HHSC) approved default logic and is processed at the next state cutoff. The HHSC-approved default logic considers the member’s medical history, including prior enrollments, primary care providers (PCPs), claims data, and any family plans about the program type and SA.

PSU staff must make sure the MCO submits the Medical Necessity and Level of Care (MN/LOC) Assessment and ISP for applicants. The MCO must do this within 45 days from the date PSU staff upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub.

For members, PSU staff must confirm all STAR+PLUS Home and Community Based Services (HCBS) program eligibility within five business days of receipt of Form H1700-1. The process is abbreviated since the member already has the following:

• an MN/LOC Assessment;
• a Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level; and
• financial eligibility determination by the MEPD specialist, if applicable.

PSU staff coordinates all appropriate activities between the MCOs, applicant, member or authorized representative (AR), Enrollment Resolution Services (ERS) unit staff and other key parties. This helps make sure there is a successful transition.

PSU staff must complete the following activities within five business days from notification of the transfer:

• confirm the applicant or member’s address and managed care enrollment is updated in TIERS;
• make sure the contract number in SASO is updated to reflect the new MCO’s contract number;
• for MAO members, email ERS unit staff the following information:
  • this subject line: STAR+PLUS HCBS MCO Transfer Enrollment Request for XX [member’s first and last name initials]”;
  • the member’s name;
  • Medicaid identification (ID) number;
  • type of request: MCO change;
  • medical necessity (MN) approval date;
  • ISP receipt date;
  • ISP begin date;
  • ISP end date;
  • MCO selection;
  • effective date of enrollment;
• upload all applicable documents to the HEART case record; and
• document and close the HEART case record.

PSU staff must complete the following activities within two business days of determining an applicant or member does not have an updated address or managed care enrollment in TIERS:

• contact the applicant or member by phone to select an MCO from the new SA; or
• mail an enrollment packet containing the following documents, if the applicant or member does not provide an MCO selection:
  • Form H2053-B, Health Plan Selection;
  • STAR+PLUS Comparison Charts; and
  • STAR+PLUS Report Cards.

Refer to Appendix XXXI, STAR +PLUS Members Transitioning from an NF in one Service Area to the Community in Another Service Area, for more information, and for SA changes occurring for a Money Follows the Person (MFP) case.

3420 Individuals Transitioning Services for Adults

Revision 18-0; Effective September 4, 2018

STAR Kids and STAR Health eligibility will terminate the last day of the month in which the member's 21st birthday occurs and the member must receive services through programs serving adults beginning the first day of the first month following the individuals 21st birthday. The following services end at the end of the month following the member's 21st birthday.

• Medically Dependent Children Program (MDCP) operated by STAR Kids or STAR Health managed care organizations (MCOs); and
• Texas Health Steps (THSteps) Comprehensive Care Program (CCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) services.

Note: Depending on eligibility requirements, some members may continue to receive services except MDCP, through STAR Health until age 22.

In addition to the programs and services above, individuals for Community First Choice (CFC) services and personal care services (PCS) must transition to an adult program.

Members who receive MDCP, PDN, PPECC, CFC or PCS and transition to adult programs may apply for services through STAR+PLUS or the STAR+PLUS Home and Community Based Services (HCBS) program to continue to receive community services and avoid institutionalization beginning the 1st of the month following their 21st birthday.

3421 Procedures for Children Transitioning from STAR Kids/STAR Health Receiving MDCP or THSteps-CCP, PDN or PPECC

Revision 18-0; Effective September 4, 2018

Members may receive a combination of the following services:

• Medically Dependent Children Program (MDCP);
• private duty nursing (PDN); or
• prescribed pediatric extended care center (PPECC) services.

3421.1 Twelve Months Prior to the Member's 21st Birthday

Revision 26-2; Effective June 1, 2026

The Texas Health and Human Services Commission (HHSC) Utilization Review (UR) unit provides a copy of the Medically Dependent Children Program (MDCP)-Private Duty Nursing (PDN) Transition Report, to the following each quarter:

• Program Support Unit (PSU) staff; and
• UR Unit for Intellectual or Developmental Disabilities (IDD) Waiver/Community Services/Hospice staff.

The MDCP-PDN Transition Report lists STAR Kids or STAR Health members who may transition to STAR+PLUS or the STAR+PLUS Home and Community Based Services (HCBS) program in the next 18 months and are receiving:

• MDCP,
• PDN;
• Comprehensive Care Program (CCP) services; or 
• Prescribed Pediatric Extended Care Center (PPECC) services. 

The STAR Kids and STAR Health managed care organizations (MCOs) identify all members turning 21 within the next 12 months and schedule a face-to-face home visit with the member and the member's support person, including the authorized representative (AR), if applicable, to initiate the transition process.

The MCO must present an overview of the STAR+PLUS HCBS program, and the changes that will take place when the member transitions to the adult program during the home visit.  The MCO must make a referral to the Utilization Review (UR) unit mailbox if they believe the member meets high needs criteria. 

Designated PSU staff must:

• monitor the MDCP-PDN Transition Report and identify all members receiving MDCP, PDN or PPECC services turning 21 in 12 months and not enrolled in one of the following IDD 1915(c) Medicaid waivers:
  • CLASS;
  • DBMD;
  • HCS; or
  • TxHmL;
• create a case record in HEART noting:
  • if the MCO determines the member is high needs; 
  • the program type the member is transitioning from; and
  • the due date for the nine-month contact; and
• assign the HEART case record to regional PSU staff.

PSU staff must not upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub earlier than five months before the member's 21st birthday.

3421.2 Nine Months Before the Member's 21st Birthday

Revision 23-4; Effective Dec. 7, 2023

Nine months before the 21st birthday of a member receiving the Medically Dependent Children Program (MDCP), Texas Health Steps (THSteps) Comprehensive Care Program (CCP), Private Duty Nursing (PDN) or Prescribed Pediatric Extended Care Center (PPECC) service, the following process begins.

The STAR Kids and STAR Health managed care organization (MCO) must:

• monitor transition activities with the member and the member's available supports, including his or her authorized representative (AR), every 90 days during the year before the member turns 21; and
• notify Program Support Unit (PSU) staff of any issues or concerns by uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

PSU staff must:

• monitor the MDCP-PDN Transition Report and identify all members transitioning from STAR Kids and receiving MDCP and PDN or PPECC turning 21 in nine months and not enrolled in one of the following Medicaid waiver programs:
  • Community Living Assistance and Support Services (CLASS);
  • Deaf Blind with Multiple Disabilities (DBMD);
  • Home and Community-based Services (HCS); or
  • Texas Home Living (TxHmL);
• mail the STAR Kids member or AR a STAR+PLUS enrollment packet, including:
  • Form 2114, Nine-Month Transition Letter;
  • Form H2053-B, Health Plan Selection;
  • Form H1200, Application for Assistance – Your Texas Benefits;
  • Appendix XII, STAR+PLUS HCBS Program Description;
  • STAR+PLUS Comparison Charts; and
  • STAR+PLUS Report Cards.

PSU staff must update the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record by:

• documenting the date Form 2114 was sent out to the member or AR;
• documenting the due date for the phone contact 30 days from the date the STAR+PLUS Home and Community Based Services (HCBS) program enrollment packet is mailed; and
• upload all applicable documents to the HEART case record.

Note: PSU staff must upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub no earlier than five months before the member's 21st birthday.

PSU staff must contact the member or AR within 30 days from the date the enrollment packet was mailed to discuss:

• The transition process and review the enrollment packet.
• STAR Kids eligibility, MDCP, PDN and PPECC services will terminate on the last day of the month that the member's 21st birthday occurs.
• The STAR+PLUS HCBS program is an option available to eligible members at 21. PSU staff must also present an overview of the array of services available within the STAR+PLUS HCBS program.
• The STAR+PLUS HCBS program enrollment packet sent to the member is reviewed. The enrollment packet contains a list of the STAR+PLUS MCOs in the SA and a comparison chart to help the member in making an MCO selection. The member will choose a STAR+PLUS MCO in their SA to conduct the Medical Necessity and Level of Care (MN/LOC) Assessment for services and oversee the delivery of services.
• The importance of choosing an MCO six months before the 21st birthday to avoid having a gap in services.
• The member can change MCOs any time after the first month of enrollment.
• The STAR+PLUS HCBS program has a cost limit based on a medical assessment, the MN/LOC Assessment. The assessment determines the cost limit for the individual service plan (ISP).
• To be eligible for the STAR+PLUS HCBS program, an ISP must be developed within the cost limit, meet the member's needs and ensure health and safety.
• The STAR+PLUS HCBS program will be denied if an ISP cannot be developed within the cost limit that ensures member's health and safety in the community.
• The ISP considers all resources available to meet the member's needs, including community supports, other programs, and what the member's informal support system can provide to meet the member's needs.
• The STAR+PLUS HCBS program assessment process will begin six months before the member's 21st birthday. PSU staff will contact the member to begin the application process and find out which MCO has been selected. The member has 30 days to select an MCO. An MCO will be selected for the member after 30 days if one has not been selected.
• The MCO service coordinator will contact the member to begin the MN/LOC Assessment for services and assist the member or AR identify and develop additional resources and community supports to help meet the member's needs.
• The MCO service coordinator will help the member determine the services needed within this service array to meet his or her needs and ensure health and safety. Example: A member who primarily requires nursing services can have an ISP developed with the maximum number of nursing hours within the cost limit while the member's other needs are met through other resources.
• Reassure the member or AR every effort will be made to ensure a successful transition to the STAR+PLUS HCBS program.
• The member may potentially receive an enrollment packet from the Texas Health and Human Services Commission (HHSC) enrollment broker and the importance of selecting the same MCO.

PSU staff must update the HEART case record by noting the due date for the six-month contact.

The following chart outlines the responsibilities to monitor the MDCP-PDN Transition Report and contact members transitioning from STAR Kids or STAR Health and receiving MDCP and PDN or PPECC nine months before the member's 21st birthday:

Nine-Month Transition Chart

3421.3 Six Months Prior to the Member's 21st Birthday

Revision 18-0; Effective September 4, 2018

Six months prior to the 21st birthday of a member receiving the Medically Dependent Children Program (MDCP) or Texas Health Steps (THSteps) Comprehensive Care Program (CCP), Private Duty Nursing (PDN) or Prescribed Pediatric Extended Care (PPECC) services, the following process begins.
The Utilization Review (UR) Unit must:

• monitor the MDCP-PDN Transition Report and identify all members turning age 21 in six months receiving CCP/PDN through fee-for-service (FFS) or STAR Health and not enrolled in one of the following Intellectual or Developmental Disability (IDD) 1915(c) Medicaid waivers:
  • Community Living Assistance and Support Services (CLASS);
  • Deaf Blind with Multiple Disabilities (DBMD);
  • Home and Community-based Services (HCS); or
  • Texas Home Living (TxHmL).
• coordinate with Program Support Unit (PSU) staff if it is determined the member is high needs and/or will need to be assessed for the STAR+PLUS Home and Community Based Services (HCBS) program.

The IDD Waiver/Community Services/Hospice UR Unit staff will:

• monitor the MDCP-PDN Transition Report for members enrolled in one of the following 1915(c) Medicaid waivers for IDD and who are turning age 21 in the next six months:
  • CLASS;
  • DBMD;
  • HCS; or
  • TxHmL; or
• make a STAR+PLUS HCBS program referral to PSU staff by email using Form H2067-MC, Managed Care Programs Communication, for members requesting a STAR+PLUS HCBS program assessment, or whose proposed waiver plan exceeds the member cost limit for the IDD 1915(c) Medicaid waiver listed above.

PSU staff must:

• monitor the MDCP-PDN Transition Report and identify all members referenced in 3421, Children Transitioning from STAR Kids or STAR Health Receiving MDCP or THSteps-CCP, PDN or PPECC, turning age 21 in six months and not enrolled in one of the IDD 1915(c) Medicaid waivers listed above;
• not reach out to members in CLASS, DBMD, HCS or TxHmL, unless the IDD Waiver/Community Services/Hospice UR Unit submits a referral, as documented above;
• send Form H2116, Age-Out MDCP and PDN Contact Letter, to the member if the MCO choice has not been obtained;
• contact the member or authorized representative (AR) if the MCO choice has not been obtained by telephone to:
  • review the STAR+PLUS enrollment packet discussed at the 12-month or the nine-month contact;
  • inform the member or AR of a 30-day time frame to choose a managed care organization (MCO) and a primary care physician (PCP);
  • explain if the member or AR does not timely choose an MCO, the Texas Health and Human Services Commission (HHSC) will assign an MCO for the member; and
  • explain that the member can change MCOs any time after the first month of enrollment.
• email the UR Unit at the HHSC UR High Needs CCR mailbox regarding all possible high needs situations; and
• update the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record, documenting the:
  • contact or contact attempt date;
  • MCO selection; and
  • due date for the five-month contact.

Note: PSU staff must not upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to TxMedCentral in the MCO's SPW folder earlier than five months prior to the member's 21st birthday.

The following chart outlines the responsibilities for agency referrals and PSU staff action for members enrolled in STAR Kids or STAR Health and receiving MDCP, PDN or PPECC transitioning six months prior to the member's 21st birthday.

Six-Month Transition Chart

3421.4 Five Months Prior to the Member's 21st Birthday

Revision 18-0; Effective September 4, 2018

Five months prior to the 21st birthday of a member receiving Medically Dependent Children Program (MDCP) or Texas Health Steps (THSteps) Comprehensive Care Program (CCP), private duty nursing (PDN), or Prescribed Pediatric Extended Care Centers (PPECC) services, and within 30 days of the previous contact, Program Support Unit (PSU) staff contact the member or authorized representative (AR) by telephone.

If the member or AR receiving MDCP or CCP/PDN or PPECC has made a managed care organization (MCO) and primary care provider (PCP) choice:

• the member or AR receiving MDCP-PDN or PPECC informs PSU staff of the MCO choice; and
• PSU staff inform the:
  • member that he or she must remain with this MCO through the first month of STAR+PLUS enrollment to ensure a smooth transition and service continuity;
  • MCO of the member's choice by uploading Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to TxMedCentral in the MCO's SPW folder, following the instructions in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions; and
  • MCO of members receiving 50 or more PDN hours, by noting the PDH hours in the comments field of Form H3676, Section A.

If the member or AR has not made an MCO and PCP choice:

• PSU staff inform the member or AR that if an MCO is not selected within seven days from the PSU staff contact, one will be assigned; and
• if the selection is not made within seven days from the PSU staff contact, PSU staff:
  • select an MCO for the member;
  • inform the member that:
    • an MCO has been selected; and
    • he or she must remain with this MCO through the first month of STAR+PLUS enrollment to ensure a smooth transition and service continuity; and
• inform the MCO of the choice by uploading Form H3676 to TxMedCentral in the MCO's SPW folder, following the instructions in Appendix XXXIV.

Note: Within 14 days of the PSU staff uploading date of Form H3676, the MCO must schedule the initial home visit with the MDCP or CCP or PDN member or AR.

3421.5 MCO Actions After Receiving Form H3676 Referral

Revision 23-2; Effective May 15, 2023

The managed care organization (MCO) must complete the following activities within 45 days of receiving Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section A, from Program Support Unit (PSU) staff:

• conduct and submit the Medical Necessity and Level of Care (MN/LOC) Assessment to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
  • Note: The MCO must not submit the initial MN/LOC Assessment earlier than 150 days prior to the member’s 21st birthday;
• complete Form H1700-1, Individual Service Plan, Form H1700-2, Individual Service Plan – Addendum and Form H1700-3, Individual Service Plan – Signature Page;
• upload Form H1700-1 to TxMedCentral, once an approved MN/LOC Assessment is received; and
• complete Form H3676, Section B, and upload to TxMedCentral.

3421.6 Confirm STAR+PLUS HCBS Program Eligibility

Revision 25-4; Effective Oct. 6, 2025

Program Support Unit (PSU) staff must confirm ongoing Medicaid eligibility in the Texas Integrated Eligibility Redesign System (TIERS) within two business days of receipt of Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section B, from the managed care organization (MCO).

PSU staff must coordinate with Medicaid waiver program staff by email, if the member is enrolled in an Intellectual or Developmental Disability (IDD) waiver program, within five business days of receipt of the following from the MCO:

• Form H3676, Section B;
• an approved and valid Medical Necessity and Level of Care (MN/LOC) assessment; and
• the STAR+PLUS Home and Community Based Services (HCBS) program individual service plan (ISP).

The email to the Medicaid waiver program staff must include:

• a subject line that reads: [IDD waiver program acronym] Transition to STAR+PLUS HCBS for XX [first letter of the member's first and last name];
• member’s name;
• Medicaid identification (ID) number;
• the Medicaid waiver program termination date; and
• the STAR+PLUS HCBS program start of care (SOC) date.

PSU staff must confirm STAR+PLUS HCBS program eligibility:

• no earlier than 45 days before the transition to an adult program; and
• by verifying the following eligibility criteria:
  • an approved and valid MN/LOC Assessment submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) and updated in the Service Authorization System Online (SASO);
  • an ISP within the cost limit that includes at least one STAR+PLUS HCBS program service; and
  • continued Medicaid financial eligibility in the Texas Integrated Eligibility Redesign System (TIERS).

Note: A valid medical necessity (MN) does not exceed 150 days from the date of TMHP approval for applicants transitioning to an adult program. PSU staff must upload Form H2067-MC, Managed Care Programs Communication, to the MCOHub requesting the MCO submit a new initial MN/LOC Assessment in the TMHP LTCOP if the MN exceeds 150 days from the date of TMHP approval.

PSU staff must complete the following activities within five business days of confirming approval of STAR+PLUS HCBS program eligibility:

• establish the SOC date which is the first of the month following the member's 21st birthday;
  • SOC Date Examples:
    • A member receiving Medically Dependent Children Program (MDCP) or Comprehensive Care Program (CCP), private duty nursing (PDN) or Prescribed Pediatric Extended Care Centers (PPECC) services has their 21st birthday on March 3, 2019. STAR+PLUS enrollment is effective April 1, 2019.
    • A member receiving MDCP or CCP, PDN or PPECC services has their 21st birthday on April 1, 2019. STAR+PLUS enrollment is effective May 1, 2019.
• manually or electronically generate Form H2065-D, Notification of Managed Care Program Services;
• upload Form H2065-D to the MCOHub, if manually generated;
• mail Form H2065-D to the member;
• email Enrollment Resolution Services (ERS) unit staff the following information:
  • an email subject line that reads: [MDCP or Medicaid waiver program] Transition to STAR+PLUS HCBS for XX [first letter of the member's first and last name];
  • the member's name;
  • Medicaid ID number;
  • ISP begin and end date for the STAR+PLUS HCBS program;
  • MCO selection and plan code; and
  • Form H2065-D as an attachment;
• fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist as notification of the program change from MDCP or an Medicaid waiver program to the STAR+PLUS HCBS program;
• verify Medicaid waiver program staff have closed IDD records in SASO, if applicable;
• verify SASO records are aligned with TMHP LTCOP records;
• upload applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record.

Refer to 6000, Denials and Terminations, for more information on denying an applicant trying to transition to an adult program.

3421.7 ISP Cost Exceeds 202% of the Cost Limit

Revision 25-1; Effective Feb. 19, 2025

The managed care organization (MCO) must provide documentation to the Texas Health and Human Services Commission (HHSC) Utilization Review (UR) Transition/High Needs coordinator if the individual service plan (ISP) cost exceeds 202 percent of the cost limit.

The UR Unit may request a clinical review of the case to consider the use of the Medically Fragile group or General Revenue (GR) funds process to cover costs more than 202 percent of the cost limit. The UR Unit provides the final determination letter to the MCO and Program Support Unit (PSU) staff if a clinical review is conducted.

Note: HHSC UR staff coordinates with the member, authorized representative (AR) and the MCO to discuss the process for HHSC to request the use of the Medically Fragile group GR funds process for services above the cost limit.

Refer to 5000, Medically Fragile Group and General Revenue Process, for more information on processing cases submitted for Medically Fragile group and GR funds process consideration.

3422 Transition Policy for Non-Waiver Individuals and Applicants Receiving PCS or CFC Only

Revision 25-2; Effective June 6, 2025

STAR Kids and STAR Health eligibility terminates the last day of the month that the non-waiver program individual's or applicant's 21st birthday occurs. The individual or applicant must receive services through programs serving adults beginning the first day of the month after the individual's or applicant's 21st birthday.

Individuals and applicants with STAR+PLUS must transition their personal care services (PCS) and Community First Choice (CFC) services to an adult program. Some individuals or applicants may continue to receive PCS or CFC through STAR Health until 22, depending on eligibility requirements.

The Texas Health and Human Services Commission (HHSC) enrollment broker will reach out to the individual or applicant 30 days before the individual's or applicant's 21st birthday and provide the individual or applicant with a STAR+PLUS enrollment packet. The individual or applicant is allowed 15 days to make a managed care organization (MCO) selection. The HHSC enrollment broker selects an MCO for the individual or applicant if the individual or applicant has not made a selection after 15 days, as outlined in Title 1 Texas Administrative Code (TAC) Chapter 353.403(d)(3), Enrollment and Disenrollment.

3423 Intrapulmonary Percussive Ventilator

Revision 18-0; Effective September 4, 2018

Members who were approved for, and are using, an intrapulmonary percussive ventilator (IPV) are permitted to continue using the IPV if it is deemed to have a beneficial impact on the health of the member. The member must not be subjected to abrupt removal of the equipment. The member continues to receive ongoing IPV treatment until a final decision is made by the STAR+PLUS managed care organization (MCO), on a case-by-case basis, including thorough review and documentation by the MCO and explicit approval by the Texas Health and Human Services Commission (HHSC) Office of the Medical Director (OMD).

Revision 18-0; Effective September 4, 2018

Refer to section 3311.1, Interest List Procedures, for information regarding use of the Community Services Interest List (CSIL) database to track Money Follows the Person (MFP) applications from individuals who are not yet members of a managed care organization (MCO).

3510 Money Follows the Person and Managed Care

Revision 24-3; Effective Sept. 10, 2024

The Money Follows the Person (MFP) procedure allows Medicaid-eligible nursing facility (NF) residents to receive services in the community by transitioning to long-term services and supports (LTSS). The managed care organization (MCO) must perform the functional assessment and service planning for residents who need the STAR+PLUS Home and Community Based Services (HCBS) program.

The MCO may use an NF’s Minimum Data Set (MDS) medical necessity (MN) as long as the MN/LOC Assessments are approved and have not yet expired. A MN/LOC Assessment will expire 120 days after the assessment date. The MCO may not use the NF’s MN/LOC Assessment for upgrades. Refer to Section 3330, STAR+PLUS Individual Requesting an Upgrade to the STAR+PLUS HCBS Program, for more information about upgrades.

One of the eligibility requirements for MFP is that the individual be approved for the STAR+PLUS HCBS program before leaving the NF. The applicant must reside in the NF until a final determination by PSU staff is made indicating approval of the STAR+PLUS HCBS program. PSU staff must deny the applicant if they discharge from the NF before receiving Form H2065-D, Notification of Managed Care Program Services, approval. PSU staff must deny the applicant by generating Form H2065-D.

Refer to Section 3310, Intake and Enrollment, for more information about MFP.

3511 Money Follows the Person Procedure

Revision 18-0; Effective September 4, 2018  
   
A referral is made through the Texas Health and Human Services Commission (HHSC) Access and Eligibility Services (AES) when a nursing facility (NF) resident wishes to receive services in the community through the STAR+PLUS Home and Community Based Services (HCBS) program. Community Care Services Eligibility (CCSE) intake staff must refer all Money Follows the Person (MFP) requests to Program Support Unit (PSU) staff. Referrals can be made by anyone, including family members, NF staff, relocation specialists and HHSC case managers.

3512 MFP Applications Pending Due to Delay in NF Discharge

Revision 18-0; Effective September 4, 2018

In keeping with the Promoting Independence (PI) Initiative, the Program Support Unit (PSU) and managed care organizations (MCOs) staff are obligated to assist the nursing facility (NF) applicant or member who wants to return to the community by providing information and referrals to possible resources in the community. However, in situations where specific eligibility criteria will not be met in the foreseeable future, PSU staff have the option to deny the request for services. Time frames are set as a guideline for denying requests pending service arrangements.

A four calendar month time frame is the guideline used in determining pending, or denying, requests for services. The assessment process does not stop during this period; however, eligibility cannot be established until the member is ready to discharge from the NF.

Examples:

• A STAR+PLUS Home and Community Based Services (HCBS) program applicant has a definite date of discharge within four calendar months from the date services were requested. Allow the referral to remain open until the applicant is ready to discharge and coordinate the transfer to the community.
• A STAR+PLUS HCBS program applicant is in the process of making living arrangements that will allow him to leave the NF within four calendar months from the date services were requested. Allow the application to remain open.

If the applicant has an estimated date of discharge that may or may not go beyond the four calendar month period, PSU staff should keep the request for services open. Refer to Section 3513, Applications Pending More than Four Calendar Months Due to Delay in NF Discharge, for information about applications pending more than four calendar months.

3513 Applications Pending More than Four Calendar Months Due to Delay in NF Discharge

Revision 23-2; Effective May 15, 2023

Program Support Unit (PSU) and managed care organization (MCO) staff must use their judgment and work with applicants who have arrangements pending, but not finalized. PSU staff should keep the request for services open if the applicant has an estimated discharge date that goes beyond a four calendar month period.

PSU staff must refer Money Follows the Person (MFP) cases pending beyond four calendar months to the PSU supervisor when an applicant:

• has not established living arrangements to return to the community;
• cannot decide when to return to the community; or
• has no viable plan or support system in the community.

3514 STAR+PLUS Individual Residing in a Nursing Facility

Revision Notice 25-5; Effective Dec. 17, 2025

The managed care organization (MCO) must upload Form H2067-MC, Managed Care Programs Communication, to the MCOHub to inform Program Support Unit (PSU) staff of an individual’s request to transition to the community through the Money Follows the Person (MFP) process.

PSU staff must complete the following within two business days of receipt of Form H2067-MC:

• create a Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record;
• check the Texas Integrated Eligibility Redesign System (TIERS) for the Medicaid type program (TP);
• check the Community Services Interest List (CSIL) database to check if the individual is on an Intellectual or Developmental Disability (IDD) 1915(c) Medicaid waiver interest list;
• determine, per the procedures below, if the member has either an open enrollment or services are temporarily suspended in an IDD 1915(c) Medicaid waiver:
• check the Service Authorization System Online (SASO) Enrollment and Service Authorization records to see if a record exists with an end date and termination code for:
  • Community Living Assistance and Support Services (CLASS) (Service Group (SG) 2)
  • Deaf Blind with Multiple Disabilities (DBMD) (SG 16)
  • Home and Community-based Services (HCS) (SG 21)
  • Texas Home Living (TxHmL) (SG 22)
  • Note: A service authorization record containing an end date, but no termination code indicates the 1915(c) Medicaid waiver program is temporarily suspended
• upload Form H2067-MC to  the MCOHub to inform the MCO if the individual is:
  • on an IDD 1915(c) Medicaid waiver interest list; or
  • enrolled in an IDD 1915(c) Medicaid waiver, including the enrollment status.

The MCO must complete the following activities within 45 days of becoming aware of an individual’s requesting to transition to the community:

• Determine if the individual wants to pursue the STAR+PLUS Home and Community Based Services (HCBS) program if he or she is temporarily suspended from a 1915(c) Medicaid waiver program.
• Use the nursing facility (NF) Minimum Data Set (MDS) to determine medical necessity (MN) or conduct the Medical Necessity and Level of Care (MN/LOC) Assessment in lieu of the MDS.
  • The MCO must conduct the MN/LOC Assessment if there is no valid MDS.
  • A denied MN/LOC Assessment decision cannot be used to deny an applicant who has a valid MDS. The MDS and Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level must be used for the MN determination.
  • A MN record must be in SASO so the individual service plan (ISP) registration does not suspend. The SASO MN record must match the ISP effective dates. The MN/LOC Assessment end date must be adjusted to match the ISP end date, if necessary.
• Upload Form H2067-MC to the MCOHub if a Supplemental Security Income (SSI) or SSI-related member is receiving personal assistance services (PAS) or emergency response services (ERS).
• Develop the ISP using Form H1700-1, Individual Service Plan.

PSU staff must send an email to the Program Support Operations Review Team (PSORT) mailbox within two business days of an MCO failing to submit initial assessment information within the 45-day time frame. The email sent to the PSORT mailbox must include:

• this email subject line: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the member’s first and last name];
• individual or applicant’s name;
• Social Security number (SSN) or Medicaid identification (ID) number;
• date of birth (DOB);
• name of the MCO and plan code;
• the date information was due from the MCO;
• a brief description of the delay and any MCO information received; and
• attach any pertinent documents received from the MCO such as Form H2067-MC.

Refer to Appendix XXXV, SASO Data Entry Guide, MFP Authorization for STAR+PLUS HCBS Program Applicant, for more information on SASO actions.

3514.1 STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS Program

Revision 25-4; Effective Oct. 6, 2025

The managed care organization (MCO) must determine if the individual wants to pursue the STAR+PLUS Home and Community Based Services (HCBS) program if he or she is temporarily suspended from another Medicaid waiver program. The person has the option to remain in their current Medicaid waiver program or choose the STAR+PLUS HCBS program. The MCO must:

• get the person’s waiver selection within the initial 45-day time frame for assessment; and
• notify Program Support Unit (PSU) staff of the individual’s waiver selection by uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub.

PSU staff must complete the following activities within two business days of receipt of Form H2067-MC from the MCO advising that the individual has selected another Medicaid waiver program:

• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record.

PSU staff must complete the following activities within five business days of receipt of Form H2067-MC from the MCO notifying PSU staff the individual has selected the STAR+PLUS HCBS program:

• add the individual to the STAR+PLUS HCBS program interest list in the Community Services Interest List (CSIL) database, if applicable;
• immediately release and assign the individual from the interest list in the CSIL database;
• upload all applicable documents to the HEART case record; and
• document the HEART case record.

The MCO must upload the following information to the MCOHub within 45 days of the individual’s request to transition into the STAR+PLUS HCBS program:

• Form H1700-1, Individual Service Plan, if the individual service plan (ISP) has expired or one did not previously exist; and
• Form H2067-MC notifying PSU staff if the nursing facility (NF) discharge date is known.

PSU staff must email the Program Support Operations Review Team (PSORT) within two business days of an MCO failing to submit the initial assessment information within the 45-day time frame. The email to PSORT must include:

• an email subject line that reads: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • Social Security number (SSN) or Medicaid identification (ID) number;
  • date of birth (DOB);
  • name of the MCO and plan code;
  • the date information was due from the MCO which will be the 45th day for STAR+PLUS HCBS program;  
  • a brief description of the delay and any MCO information received; and
• attachments of any pertinent documents received from the MCO such as Form H2067-MC.

PSU staff must:

• continue to monitor the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) and the MCOHub for receipt of the above information; and
• email any case information received from the MCO to the PSORT mailbox within two business days from its receipt.

The follow-up email must include the same email identifier elements listed above.

PSU staff must continue to email the Managed Care Contracts and Oversight (MCCO) Unit staff for MCO non-compliance issues unrelated to late initial assessment information. PSU staff must include the following components when emailing MCCO Unit staff:

• an email subject line that reads: STAR+PLUS HCBS MCO Non-Compliance for XX [first letter of the member’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • SSN or Medicaid ID number;
  • DOB;
  • name of the MCO and plan code;
  • the date information was due from the MCO;
  • a brief description of the MCO non-compliance and any MCO information received; and
  • attachments of any pertinent documents received from the MCO, if applicable.

PSU staff must complete the following activities within five business days of receipt of all required documentation from the MCO:

• confirm STAR+PLUS HCBS program eligibility based upon:
  • Medicaid financial eligibility;
  • an approved Medical Necessity and Level of Care (MN/LOC) Assessment; and
  • an ISP with:
    • at least one STAR+PLUS HCBS program service per ISP year; and
    • a cost within the individual's cost limit; and
• manually generate the initial Form H2065-D, Notification of Managed Care Program Services;
• mail the initial Form H2065-D to the member;
• upload the initial Form H2065-D to the MCOHub;
• upload all applicable documents to the HEART case record; and
• document the HEART case record.

Note: refer to Form H2065-D instructions for more information on field entries.

The MCO collaborates with the relocation specialist, NF, applicant and PSU staff to identify a proposed discharge date. The MCO must upload Form H2067-MC to the MCOHub within two business days of the discharge date being determined. PSU staff must upload Form H2067-MC to the MCOHub within two business days of being notified by any other entity of a different NF discharge date, inquiring which discharge date is acceptable. The MCO must respond within two business days by uploading Form H2067-MC to the MCOHub advising of the correct scheduled discharge date.

The MCO must upload Form H2067-MC to the MCOHub within two business days following the date of the applicant discharge from the NF.

PSU staff must complete the following activities within five business days of being notified of the NF discharge:

• manually generate the second Form H2065-D;
• mail the second Form H2065-D to the member;
• upload the second Form H2065-D to the MCOHub;
• fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist, if applicable, to advise of the start of care (SOC) for the STAR+PLUS HCBS program and request a program transfer in Texas Integrated Eligibility Redesign System (TIERS);
• verify that NF records in the Service Authorization System Online (SASO), Service Groups (SG) 1 and 3, reflect the NF end date;
  • contact the Texas Health and Human Services Commission (HHSC) Long Term Care (LTC) Provider Claims Services at 512-438-2200; and
  • select option 1 to request closure of the NF service authorization in SASO if the NF end date has not processed within five business days from the date of discharge;
• close the CSIL database record using the appropriate closure code;
• upload applicable documents to the HEART case record; and
• document and close the HEART case record.

Note: Refer to Form H2065-D instructions for more information on field entries.

PSU staff must create SASO entries within one business day of mailing the second Form H2065-D to the MFP member. Refer to Appendix XXXV, SASO Data Entry Guide, and Appendix XVI, SASO Service Group, Service Code and Termination Code, for more information on SASO entries.

Refer to 6300, Denials and Terminations, if the individual or applicant is denied eligibility for the STAR+PLUS HCBS program.

Refer to 6300.10, Other Reasons, for more information on denying an individual or applicant choosing to leave the NF before being determined eligible for the STAR+PLUS HCBS program.

3515 Non-STAR+PLUS Individual Residing in a Nursing Facility

Revision Notice 26-2; Effective June 1, 2026

Program Support Unit (PSU) staff may receive a referral for a non-STAR+PLUS individual living in a nursing facility (NF) who requests to transition to the community through the Money Follows the Person (MFP) process from the:

• regional Community Care Services Eligibility (CCSE) staff; or
• individual’s legally authorized representative (LAR).

PSU staff must complete the following within two business days of the referral:

• create a Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record;
• check the Community Services Interest List (CSIL) database to determine if the member is on an Intellectual or Developmental Disability (IDD) 1915(c) Medicaid waiver interest list;
• determine if the member has either an open enrollment or suspended services in an IDD 1915(c) Medicaid waiver by reviewing the:
  • Service Authorization System Online (SASO) Enrollment and Service Authorization records for a record with an end date and termination code for:
    • Community Living Assistance and Support Services (CLASS) (Service Group (SG) 2);
    • Deaf Blind with Multiple Disabilities (DBMD) (SG 16);
    • Home and Community-based Services (HCS) (SG 21); or
    • Texas Home Living (TxHmL) (SG 22).

Note: A service authorization record with an end date but no termination code indicates the 1915(c) Medicaid waiver program is suspended.

PSU staff complete the following within two business days of being notified the individual wants to pursue a 1915(c) Medicaid waiver program:

• notify the appropriate IDD waiver unit staff by email;
• upload all applicable documents to the HEART case record; and
• document and close the HEART case record.

PSU staff must complete the following within two business days of notification the individual chooses to apply for the STAR+PLUS HCBS program:

• check the Texas Integrated Eligibility Redesign System (TIERS) to verify if Form H1200, Application for Assistance – Your Texas Benefits, was already submitted for the nursing facility (NF) stay;
• contact or attempt to contact the individual, or authorized representative (AR) by phone to explain the Medicaid application process, the selection of a managed care organization (MCO) and the importance of promptly returning the application packet that PSU staff mail to the individual, if applicable;
• mail an enrollment packet to the individual including:
  • Form H1200, if applicable;
  • Appendix XII, STAR+PLUS HCBS Program Description;
  • Form H2053-B, Health Plan Selection;
  • STAR+PLUS Comparison Charts; and
  • STAR+PLUS Report Cards;
• inform the individual during the phone contact that their MCO selection can be changed at any time after the first month of service;
• add the individual to the STAR+PLUS HCBS program interest list in the CSIL database; and
• immediately release and assign the individual from the interest list in the CSIL database.

PSU staff must complete the following within 14 days of mailing the enrollment packet to the individual:

• discuss with the individual the importance of: 
  • immediately submitting Form H1200 if PSU staff have not received Form H1200 from the individual and TIERS does not have a record of submission;
  • choosing an MCO, if the individual did not select one during the initial contact, explaining the MCO conducts the Medical Necessity and Level of Care (MN/LOC) Assessment and develops the initial individual service plan (ISP) to facilitate an eligibility determination for the STAR+PLUS HCBS program; and
• document all contacts and attempted contacts in the HEART case record.

PSU staff must:

• Check TIERS to verify Form H1200 was submitted if the individual states Form H1200 was submitted during the 14-day follow-up contact.
• Fax MEPD Form H1746-A, Referral Cover Sheet, and Form H1200 to the MEPD specialist within two business days of receipt of Form H1200. 
• Notate the individual is requesting to pursue the MFP process on From H1746-A.

PSU staff must deny the individual requesting the STAR+PLUS HCBS program if Form H1200 is not received within 30 days from the date PSU staff mailed Form H1200 to the individual. They do this within two business days of the 30^th day that PSU staff mailed Form H1200 by:

• documenting in the HEART case record Form H1200 was not received within 30 days;
• Uploading applicable documents to the HEART case record; and
• Closing the HEART case record.

PSU staff must complete the following activities within two business days from the date the individual makes an MCO selection. This can be done verbally or in writing, or from the date the member is defaulted to an MCO:

• check SASO to determine if the applicant has a current MN/LOC Assessment;
• complete Section A of Form H3676, Managed Care Pre-Enrollment Assessment Authorization, indicating:
  • if the applicant is on a 1915(c) Medicaid waiver program interest list;
  • if the applicant has a current medical necessity (MN) by entering the Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level; and
  • expiration date in Item 6;
• upload Form H3676 to the MCOHub; and
• upload applicable documents to the HEART case record.

PSU staff must default the individual to an MCO if a selection is not made within 30 days of mailing the enrollment packet to the individual. 

The MCO must complete the following activities within 45 days from receipt of Form H3676:

• Conduct the MN/LOC Assessment if there is no valid Minimum Data Set (MDS) or complete its own MN/LOC Assessment in lieu of using the NF MDS. The MCO must complete the MN/LOC Assessment if there is no valid MDS.
  • A denied MN/LOC Assessment decision cannot be used to deny an applicant who has a valid MDS. The MDS and PDPM LTC level must be used for the MN determination.
  • A MN record must be found in SASO so the ISP registration does not suspend. The SASO MN record must match the ISP effective dates. The MN/LOC Assessment end date must be adjusted to match the ISP end date, if necessary.
  • Develop the ISP using Form H1700-1, Individual Service Plan.

PSU staff must send an email to the Program Support Operations Review Team (PSORT) mailbox within two business days of an MCO failing to submit initial assessment information within the 45-day time frame. The email sent to the PSORT mailbox must include:

• this email subject line: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the member’s first and last name];
• individual or applicant’s name;
• Social Security number (SSN) or Medicaid identification (ID) number;
• date of birth (DOB);
• name of the MCO and plan code;
• the date information was due from the MCO;
• a brief description of the delay and any MCO information received; and
• attach any pertinent documents received from the MCO such as Form H2067-MC. 

3515.1 Non-STAR+PLUS Individual Transitioning to the Community with STAR+PLUS HCBS Program

Revision 25-4; Effective Oct. 6, 2025

Program Support Unit (PSU) staff must:

• collaborate with involved parties throughout the STAR+PLUS Home and Community Based Services (HCBS) program eligibility determination process to help with problem resolution and to document any delays; and
• track and document all actions and communications in the Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record until all STAR+PLUS HCBS program enrollment activities are complete.

The managed care organization (MCO) must upload the following information to the MCOHub within 45 days of receiving Form H3676, Managed Care Pre-Enrollment Assessment Authorization, from PSU staff:

• Form H1700-1, Individual Service Plan;
• Form H3676 with Section B completed; and
• Form H2067-MC, Managed Care Programs Communication, notifying PSU staff of the NF proposed discharge date.

Note: PSU staff must document Form H2067-MC, Managed Care Programs Communication, was received in lieu of Form H3676, Section B, in the HEART case record, if applicable.

PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist within two business days of receiving the approved individual service plan (ISP) and Medical Necessity and Level of Care (MN/LOC) Assessment if Medicaid is pending. PSU staff must note the individual is asking to pursue the Money Follows the Person (MFP) process on Form H1746-A. The MEPD specialist notifies PSU staff upon completion of the evaluation for financial eligibility through the MEPD Communications Tool.

PSU staff must complete the following activities within two business days of receiving all required eligibility documentation from the MCO and the MEPD specialist, when applicable:

• confirm STAR+PLUS HCBS program eligibility based upon:
  • Medicaid eligibility;
  • an approved MN/LOC Assessment;
  • an ISP with:
    • at least one STAR+PLUS HCBS program service per ISP year; and
    • a cost within the individual's cost limit.
• manually generate the initial Form H2065-D, Notification of Managed Care Program Services*;
• *Note: refer to Form H2065-D instructions for more information on field entries;
• mail the initial Form H2065-D to the member;
• upload the initial Form H2065-D to the MCOHub;
• upload applicable documents to the HEART case record; and
• document the HEART case record.

The MCO:

• collaborates with the relocation specialist, nursing facility (NF), member and PSU staff to identify a proposed discharge date; and
• must upload Form H2067-MC to the MCOHub within two business days of the discharge date being determined.

PSU staff must:

• upload Form H2067-MC to the MCOHub within two business days of being notified by any other entity of a different NF discharge date; and
• ask which discharge date is acceptable.

The MCO must:

• respond within two business days by uploading Form H2067-MC to the MCOHub advising of the correct discharge date; and
• upload Form H2067-MC to the MCOHub within two business days of the date the applicant is discharging from the NF.

PSU staff must complete the following within five business days of being notified of the NF discharge:

• manually generate the second Form H2065-D*;
• * Note: refer to Form H2065-D instructions for more information on field entries;
• mail the second Form H2065-D to the member;
• upload the second Form H2065-D on the MCOHub;
• fax Form H1746-A to the MEPD specialist to advise of the start of care (SOC) for the STAR+PLUS HCBS program and request a program transfer in Texas Integrated Eligibility Redesign System (TIERS);
• verify that NF records in the Service Authorization System Online (SASO) reflect the NF end date;
  • contact the Texas Health and Human Services Commission (HHSC) Long Term Care (LTC) Provider Claims Services at 512-438-2200; and
  • select option 1 to request closure of the NF service authorization in SASO, if the NF end date has not processed within five business days from the date of discharge;
• create one-day STAR+PLUS HCBS program service authorization record in SASO for the first day of the month that an MFP applicant is discharged from the NF.
• close the Community Services Interest List (CSIL) database record using the appropriate closure code;
• notify Enrollment Resolution Services (ERS) unit staff by email, for Medical Assistance Only (MAO) members. The email to ERS unit staff must include the following:
  • the email subject line: STAR+PLUS HCBS MFP Enrollment Request for XX [member’s first and last name initials];
  • the member’s name;
  • Medicaid identification (ID) number;
  • type of request: MFP NF discharge;
  • medical necessity (MN) approval date;
  • ISP receipt date;
  • ISP begin date;
  • ISP end date;
  • MCO selection;
  • effective date of enrollment which is the date of NF discharge; and
  • Form H2065-D as an attachment;
• upload applicable documents to the HEART case record; and
• document and close the HEART case record.

Refer to  6300, Denials and Terminations, if the individual or applicant is denied eligibility for the STAR+PLUS HCBS program.

Refer to  6300.10, Other Reasons, for more information on denying an individual or applicant who chooses to leave the NF before being determined eligible for the STAR+PLUS HCBS program.

3520 Money Follows the Person Demonstration

Revision Notice 23-3; Effective Aug. 21, 2023

3521 Money Follows the Person Demonstration Introduction

Revision Notice 23-3; Effective Aug. 21, 2023

The Money Follows the Person Demonstration (MFPD) was implemented to eliminate barriers and enable Medicaid-eligible individuals to transition from nursing facilities (NFs) to the community and receive necessary long-term services and supports (LTSS) in the setting of the individual's choice. Participation in MFPD does not affect the type or amount of services received or how the individual receives the services. A member participating in MFPD receives the same services delivered to other STAR+PLUS Home and Community Based Services (HCBS) program members.

3522 Screening Criteria for Money Follows the Person Demonstration Eligibility

Revision Notice 23-3; Effective Aug. 21, 2023

The managed care organizations (MCO) must apply the following screening criteria to determine if an applicant is potentially eligible to participate in the Money Follows the Person Demonstration (MFPD). To be eligible for MFPD, the applicant must be eligible for the STAR+PLUS Home and Community Based Services (HCBS) program and meet the following criteria:

• reside continuously in an institutional setting, including days during a Medicare certified skilled nursing facility (SNF) stay following a stay in a Medicaid certified nursing facility (NF), for at least 60 days before  the STAR+PLUS HCBS eligibility date;
• be enrolled in MFPD before leaving a Medicaid certified NF;
• be Medicaid eligible under Title XIX of the Social Security Act;
• be transitioning from an NF into a qualified residence that includes:
  • a home owned or leased by the applicant or the applicant's family;
  • an apartment with an individual lease that includes living, sleeping, bathing and cooking areas where the applicant or applicant’s family has domain;
  • Assisted Living (AL) apartment (Service Code 19);
  • Residential Care apartment (Service Code 19A); or
  • Adult Foster Care (AFC) home with no more than four unrelated individuals living in the home; and
• agree to participate in the MFPD by completing Form 1580, Texas Money Follows the Person Demonstration Project Informed Consent for Participation.

3522.1 Screening for 60-Day Qualifying Institutional Stay

Revision Notice 23-3; Effective Aug. 21, 2023

For purposes of the Money Follows the Person Demonstration (MFPD), an institutional setting is defined as a: 

• Medicaid certified nursing facility (NF);
• Medicaid certified skilled nursing facility (SNF);
• intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID);
• state supported living center; or
• hospital.

A continuous stay in a combination of the settings above may meet the 60-day qualifying institutional stay. 

Example: An MFPD applicant resides continuously in a Medicaid certified NF for 30 days, in a hospital for 15 days and then re-enters the NF for another 15 days. This applicant would meet the 60-day institutional residency requirement for MFPD.

The MFPD applicant does not have to live in the Medicaid certified NF or other institution for 60 days at the time they indicate a desire to transition to the community. The MFPD applicant meets the screening criteria if it appears likely they will live in a Medicaid certified NF or other institution for at least 60 days before the discharge date from the NF.

3522.2 MCO Reporting of 60-Day Qualifying Institutional Stay

Revision Notice 23-3; Effective Aug. 21, 2023

The managed care organization (MCO) must notify Program Support Unit (PSU) staff of a Money Follows the Person Demonstration (MFPD) applicant using Form H2067-MC, Managed Care Programs Communication. The MCO must check box 10, MFP Demonstration Consent Obtained, and enter the institutional admission and discharge dates in the Comments section. PSU staff are not required to verify if the applicant has met the 60-day institutional stay requirement.

3523 Enrollment in Money Follows the Person Demonstration

Revision Notice 23-3; Effective Aug. 21, 2023

Program Support Unit (PSU) staff must designate a member as being enrolled in the Money Follows the Person Demonstration (MFPD) by modifying Service Authorization System Online (SASO) records. Refer to Section 9480, MFPD for STAR+PLUS HCBS Program Applicant, for more information on PSU staff actions in SASO for MFPD members.

PSU staff must select the fund type "19MFP-Money Follows the Person" in the SASO Service Authorization record for the first individual service plan (ISP) participation period in MFPD. PSU staff must remove this fund type after the MFPD entitlement period or if the member withdraws from MFPD. Refer to Section 3524, Money Follows the Person Demonstration Entitlement Period Tracking, for more information on SASO entries once the enrollment period has ended.

The member may withdraw from MFPD at any time by informing the managed care organization (MCO). The MCO must upload Form H2067-MC, Managed Care Program Communications, to TxMedCentral to notify PSU staff of the member’s withdrawal from MFPD. Although MFPD eligibility may end upon withdrawal from MFPD, the member continues to receive STAR+PLUS Home and Community Based Services (HCBS) program services if the member continues to meet all STAR+PLUS HCBS eligibility criteria.

3524 Money Follows the Person Demonstration 365-Day Entitlement Period Tracking

Revision 24-4; Effective Dec. 1, 2024

A Money Follows the Person Demonstration (MFPD) member is entitled to 365 days of participation in MFPD. Time spent in an institutional setting does not count toward the 365-day entitlement period. The managed care organization (MCO) tracks the enrollment period to ensure the MFPD member receives the full 365 days.

The entitlement period begins the date the MFPD member enrolls in the STAR+PLUS Home and Community Based Services (HCBS) program. The MCO must notify Program Support Unit (PSU) staff once the MFPD period has ended by uploading Form H2067-MC, Managed Care Program Communications, to the MCOHub. The MCO must notate the MFPD entitlement period start and end dates in the Comments section of Form H2067-MC.

Example: The member chose to participate in MFPD and was enrolled in the STAR+PLUS HCBS program, effective June 1, 2019, with an initial individual service plan (ISP) effective June 1, 2019, through May 31, 2020.

• If there are no institutional stays during the initial ISP period, the MFPD entitlement period ends when the ISP period ends on May 31, 2020.
• If the MFPD member enters an institution for 10 days in April 2020, the MFPD entitlement period is suspended during the period of institutionalization. The MFPD enrollment period resumes when the members return to the community and continues until the end of the 365-day entitlement period. In this example, the MFPD entitlement period ends on June 10, 2020, after the ISP end date of May 31, 2020.
• If the MFPD member is authorized for a new MFPD service during the initial ISP period and there are no institutional stays, the MFPD entitlement period would still end on May 31, 2020.

PSU staff must complete the following activities within two business days of notification that the MFPD entitlement period has ended:

• close the Service Authorization record in Service Authorization System Online (SASO) containing the Fund Type 19MFP-Money Follows the Person with an end date that matches the MFPD enrollment period;
• create a new Service Authorization record without the Fund Type 19MFP-Money Follows the Person for the remaining individual service plan (ISP) period, as applicable;  
• notify the MFPD reporting coordinator by email and include the following required text:
  • An email subject line that reads: MFPD Entitlement Period End [MM/YYYY]; and
  • Form H2067-MC received from the MCO notating MFPD entitlement period information as an attachment;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record. 

Example: the email subject line for an MFPD member with an entitlement period ending Nov. 30, 2022, would be MFPD Entitlement Period Ending 11/2022.

• Form H2067-MC received from the MCO notating MFPD entitlement period information as an attachment;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record.

3525 MFPD Entitlement Tracking and SASO Data Entry

Revision 25-4; Effective Oct. 6, 2025

Time spent in a nursing facility (NF) does not count toward the Money Follows the Person Demonstration (MFPD) 365-day period. Therefore, the managed care organization (MCO) tracks to ensure MFPD members receive the full 365-day entitlement period. The entitlement period starts the date the member is enrolled in the STAR+PLUS Home and Community Based Services (HCBS) program. The MCO uploads Form H2067-MC, Managed Care Programs Communication, to the MCOHub, showing the total number of days the member spent in the NF. The MCO must send this information to Program Support Unit (PSU) staff after the 365^th day.

3530 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

Revision 25-1; Effective Feb. 19, 2025

3610 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

3620 Reassessment

Revision 18-0; Effective September 4, 2018

3621 Individual Service Plan Expiring Report

Revision 24-4; Effective Dec. 1, 2024

The assigned Program Support Unit (PSU) staff reviews the Individual Service Plan (ISP) Expiring Report for the STAR+PLUS Home and Community Based Services (HCBS) program monthly to ensure reassessments are conducted on time. The ISP Expiring Report details members with ISPs that expire within the next 90 days.

The assigned PSU staff provides this report to the managed care organizations (MCOs) before the monthly call with PSU staff. The MCOs must provide a status update for all members who have ISPs expiring within the next 45 days. Only ISPs expiring within 45 days require a status update from the MCO.

The process to manage the ISP Expiring Report follows:

• PSU staff provide the ISP Expiring Report to the MCO point of contact, the Program Support Operations Review Team (PSORT), and to the Managed Care Contracts and Oversight (MCCO) Unit staff by email five business days before the scheduled monthly call. The day of the call is considered the sixth business day.
• The MCO must research and provide a written status for each member whose ISP expires within 45 days by completing the columns highlighted in red on the spreadsheet.
• The MCO must return a completed report to PSU staff within two business days before the monthly call.
• PSU staff review the MCO responses to determine if the MCO needs to provide clarification about any member’s ISP status. Only ISP statuses that PSU staff have questions on are reviewed during the monthly call. There is no need to review each member for the status of the ISP if the MCO response is sufficient. PSU staff use the columns in blue on the spreadsheet for internal tracking purposes.

Note: The monthly call may also be held if PSU staff or the MCO need to discuss items unrelated to the ISP Expiring Report.

The assigned PSU staff must check the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) to determine if the MCO has submitted the member’s ISP before the ISP end date. The assigned PSU staff must email PSORT the ISP Expiring Report each month as notification of late MCO reassessment activity. The ISP Expiring Report must be in an Excel spreadsheet format and edited so that it only identifies ISPs being reported as delinquent. The subject line for the email must read: STAR+PLUS HCBS Reassessment Delinquencies for [Month].

The assigned PSU staff is not required to send a follow up email to PSORT when the MCO submits the following documents for reassessment delinquencies:

• Form H2067-MC, Managed Care Programs Communication (PDF);
• the MN/LOC; or
• the ISP.

3621.1 Reassessment Procedures

Revision 25-2; Effective June 6, 2025

The managed care organization (MCO) must complete annual assessment activities within 45 days of the individual service plan (ISP) expiration date. Assessment activities include:

• conducting an annual Medical Necessity and Level of Care (MN/LOC) assessment;
• developing Form H1700-1, Individual Service Plan (PDF); and
• submitting the MN/LOC and ISP to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).

Designated Program Support Unit (PSU) staff must:

• search the TMHP LTCOP for ISPs submitted daily; and
• create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and assign it to a designated PSU staff person.

PSU staff must complete the following activities within five business days of receipt of the reassessment HEART case record:

• verify ongoing Medicaid financial eligibility and managed care enrollment is active in Texas Integrated Eligibility Redesign System (TIERS);
• check the TMHP LTCOP to verify the member has:
  • an approved MN/LOC Assessment;
  • an ISP that is within the cost limit that includes at least one STAR+PLUS HCBS program service;
• verify that personal assistance services (PAS) and emergency response services (ERS) are not included in the ISP services for a member who receives Supplemental Security Income (SSI) or SSI-related Medicaid, such as Medicaid for Disabled Adult Children (DAC) or Pickle Medicaid;
  • Note: PAS and ERS must be authorized through Community First Choice (CFC) for a SSI or SSI-related Medicaid recipient;
• verify the Service Authorization System Online (SASO) service authorization records are accurate;
• electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF), if the member continues to meet STAR+PLUS HCBS program requirements;
• mail Form H2065-D to the member;
• upload applicable documents to the HEART case record; and
• document the HEART case record.

Refer to 9200, Reassessment Service Authorization, for more information on SASO record verifications.

PSU staff must ensure the member's ISP is entered into the SASO annually. The MCO must upload the ISP to the MCOHub if they are experiencing issues submitting it electronically in the TMHP LTCOP. PSU staff must manually enter the ISP into SASO within five business days of receipt of the reassessment HEART case record, but not after the ISP end date if the MCO cannot submit the ISP electronically.

Refer to 6000, Denials and Terminations, if the member does not meet STAR+PLUS HCBS program requirements at reassessment.

Refer to 7000, Applicant or Member Complaints and State Fair Hearings, if the member files a state fair hearing within the adverse action notification period.

Revision 25-1; Effective Feb. 19, 2025

3710 Managed Care Data in the Texas Integrated Eligibility Redesign System

Revision 25-1; Effective Feb. 19, 2025

3711 County Code Issues Affecting Enrollment

Revision 25-1; Effective Feb. 19, 2025

The Service Authorization System Online (SASO) reflects the residence county as recorded in the Texas Integrated Eligibility Redesign System (TIERS). Correction to the county code must be done in TIERS. Program Support Unit (PSU) staff must inform the Medicaid for the Elderly and People with Disabilities (MEPD) specialist by faxing Form H1746-A, MEPD Referral Cover Sheet (PDF), to correct the county code. Incorrect county code records in TIERS can cause enrollment problems for applicants or members in STAR+PLUS.

Supplemental Security Income Cases

TIERS derives the county based on the residential Zoning Improvement Plan (ZIP) code provided by the Social Security Administration (SSA) if an individual receives Supplemental Security Income (SSI). A ZIP code may appear incorrectly in TIERS because of one of the following reasons:

• data entry error; or
• a ZIP code crosses county lines.

Either of these issues can cause TIERS to assign the wrong county.

Non-SSI Cases

TIERS contains the county code entered by the MEPD specialist if the individual has any SSI type program (TP) other than TP 12 or TP 13. The following may be the cause of an individual not having TP 12 or TP 13:

• an individual moves without notifying the MEPD specialist; or
• an MEPD specialist enters an incorrect county code.

What to Do to Resolve Address Issues Affecting Enrollment

1. Perform an inquiry in TIERS.
2. Identify the TP in TIERS by cross referencing Appendix III, Medicaid Type Program Codes for STAR+PLUS HCBS Program and CFC.
3. Refer the matter to the MEPD specialist to correct the residence county field if the TP is anything but 12 or 13 and the residence county is incorrect.
4. If the TP is 12 or 13:

• Determine the residence ZIP code recorded in TIERS.
• If the residence ZIP code is not correct, the individual must report the correct ZIP code to SSA.

4. PSU staff must email the Data Integrity Unit (DIU) mailbox the following information if the residence ZIP code in TIERS is correct but the county is incorrect:

• individual’s name as recorded in TIERS;
• individual’s Medicaid identification (ID) number;
• residence ZIP code; and
• residence county as it should be reflected in TIERS.

The DIU can update TIERS to correct the error. The correction takes place during the next TIERS cutoff processing, usually around the 20th day of the month. SASO should reflect the corrected county during the first TIERS-to-SASO reconciliation that occurs after TIERS cutoff, usually the day after cutoff.

3712 Service Interruptions Resulting from County Code Mismatches in TIERS

Revision 25-1; Effective Feb. 19, 2025

Participation in managed care programs is based on an individual’s residence county, as recorded in the Texas Integrated Eligibility Redesign System (TIERS). Therefore, service interruptions can occur when the TIERS record shows the wrong residence county code.

The Service Authorization System Online (SASO) reflects the residence county as recorded in TIERS and is updated through a monthly interface. As a result of this, incorrect county code data in SASO must be corrected in TIERS. The manner in which this correction occurs depends on the individual’s type program (TP).

PSU must complete the following activities if a residential county code is incorrect and the individual receives services under:

• Perform an inquiry in TIERS.
• Identify the TP in TIERS by cross referencing Appendix III, Medicaid Type Program Codes for STAR+PLUS HCBS Program and CFC.
  • For TP 12 or 13 in TIERS: advise the applicant, member or authorized representative (AR) to contact the Social Security Administration (SSA) to request a correction. The Data Integrity Unit (DIU) can correct problems in TIERS that result from Zoning Improvement Plan (ZIP) codes that cross county lines. In these situations, SSA assigns a default county code in the computer program matrix, which is transferred to TIERS data files. Results of correction requests to the DIU mailbox, take place during the next TIERS cutoff, usually around the 20th day of the month. SASO will reflect the corrected county during the first TIERS-to-SASO reconciliation that occurs after TIERS cutoff, usually the day after cutoff. Describe the needed change in the email and send the following information:
    • individual’s name as recorded in TIERS;
    • individual’s Medicaid identification (ID) number; and
    • correct ZIP code and residence county as it should be reflected in TIERS.
  • For TP 03, TP 18, TP 19, TP 21, TP 50, TP 87 or TP 88 in TIERS: fax Form H1746-A, MEPD Referral Cover Sheet (PDF), to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist assigned to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and request a correction.
  • For Supplemental Nutrition Assistance Program (SNAP): fax Form H1746-A to the MEPD specialist assigned to the HEART case record and request a correction.

3720 Administrative Payment Process

Revision 25-2; Effective June 6, 2025

Program Support Unit (PSU) staff must authorize the managed care organization (MCO) to start services on the date the member who is aging out of the following programs becomes eligible for the STAR+PLUS Home and Community Based Services (HCBS) program:

• the Texas Health Steps-Comprehensive Care Program (THSteps-CCP);
• the Medically Dependent Children Program (MDCP); or
• was approved for a nursing facility diversion (NFD) slot.

The start of care (SOC) date for the STAR+PLUS HCBS program may not be the first of the month. The MCO must follow the administrative payment process for STAR+PLUS services provided between the eligibility date and the managed care enrollment date, as applicable, if the eligibility date is not the first of the month. The administrative payment process must be used for the Texas Health and Human Services Commission (HHSC) to issue payment to the MCO and for the MCO to pay the provider.

The MCO must complete the following activities once PSU staff authorize the MCO to provide services:

• prepares Form 1500, Health Insurance Claim; and
• submits Form 1500 to the MCO within the 95-day filing deadline.

The MCO verifies the following within five business days of receiving Form 1500 from the provider:

• the provider was authorized to deliver the services billed on the form;
• the information on the form meets the clean claim requirements, defined in the Uniform Managed Care Manual (UMCM), Section 2.0; and
• the claim met the 95-day filing deadline.

Once the MCO verifies this information, the MCO:

• sends Form 1500 by secure email to the PSU staff if approved; or  
• denies payment by the MCO denial process if the provider:
  • is not authorized to deliver the services;
  • did not meet the clean claim requirements; or
  • did not meet the 95-day filing deadline.

PSU staff must complete the following activities within two business days of receiving Form 1500:

• verify the member is Medicaid eligible and has a valid Medical Necessity and Level of Care (MN/LOC) Assessment and individual service plan (ISP);
• prepare Form 4116, Authorization for Expenditures;
• email Form 4116, Form 1500, a screenshot of the Service Authorization screen from Service Authorization Services Online (SASO), and screenshots of the Medicaid eligibility and Managed Care enrollment screens in Texas Integrated Eligibility Redesign System (TIERS) to the Enrollment Resolution Services (ERS) unit mailbox; and
• create a Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record and upload applicable documents.

The assigned ERS unit staff must complete the following activities within two business days from the receipt of the email from PSU staff:

• verify the member is Medicaid eligible; and
• review the claim to determine if it will be paid or denied.

The ERS unit staff complete the following activities if the decision is to approve to pay the administrative payment:

• email the approved Form 4116 to the Contract Compliance and Support (CCS) unit mailbox for processing; and
• notify by email the PSU staff who emailed the request that the administrative payment was approved.

The following activities occur if the decision is to approve the administrative payment:

• the CCS Unit sends the approved payment voucher to the state comptroller for processing and payment to the MCO; and
• the MCO pays the provider within one week of receipt of payment from the state comptroller.

The ERS unit staff will notify by email the PSU staff who submitted the request for administrative payment if the decision is to deny the administrative payment. This email response also includes the reason for denial.

PSU staff must complete the following activities within two business days of receipt of email from ERS unit staff:

• notify the MCO of the approval or denial decision by uploading Form H2067-MC, Managed Care Programs Communication, to the MCOHub;
• upload the email from ERS unit and the MCO notification to the HEART case record; and
• close the HEART case record.