SPOPH Appendices

SPOPH Appendices

Appendix I-A, Unusual End Dates Report

Revision 19-7; Effective June 3, 2019

The Unusual End Dates report lists individual service plans (ISPs) with questionable end dates.

Report Fields

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

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

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

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

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

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

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

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

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

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

RG – The three-digit Risk Group number.

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

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

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

Program Support Unit (PSU) Entry Fields

Comments – PSU staff must enter appropriate comments after researching the ISP end dates. For example, an ISP with:

an end date of Oct. 30, 2018, is questionable because there are 31 days in October.
an end date of Nov. 1, 2018, is questionable because ISPs end on the last day of the month.
a begin date of Jan. 1, 2018, and an end date of Dec. 31, 2018, is questionable because ISPs are not open-ended, nor do they end prior to the begin date.

Unusual End Dates is a periodic report sent on an as-needed basis. The PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt.

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

Appendix I-B, Individual Service Plan Expiring Report

Revision 19-7; Effective June 3, 2019

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

Report Fields

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

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

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

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

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

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

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

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

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

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

RG – The three-digit Risk Group number.

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

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

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

Program Support Unit (PSU) Entry Fields

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

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

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

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

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

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

Comments – PSU staff may enter appropriate comments.

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

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

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

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

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

Scan Call for ISP Expiring Report process:

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

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

Appendix I-C, Mismatched ISP and MN End Dates Report

Revision 19-7; Effective June 3, 2019

The Mismatched Individual Service Plan (ISP) and Medical Necessity (MN) End Dates report shows ISP end dates with MN end dates that do not match.

Report Fields

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

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

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

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

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

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

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

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

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

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

RG – The three-digit Risk Group number.

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

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

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

Program Support Unit (PSU) Entry Fields

Comments (Date and Action taken) – PSU staff must enter appropriate comments after researching the ISP/MN end dates, which should match. For example, an ISP ends on May 31, 2019, and the MN ends on April 30, 2019. PSU staff must research the reason for the mismatch.

There may be valid situations in which the two dates will not match. For example, a Money Follows the Person (MFP) case has an ISP registered for one day. The MN will not match the one-day registration in this case.

Mismatched ISP and MN End Dates is a periodic report sent on an as-needed basis. PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt.

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

Appendix I-D, Loss of Enrollment Report

Revision 26-1; Effective Feb. 20, 2026

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

Report Fields

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

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

RG — The three-digit risk group number.

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

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

PSU Entry Field

Eligibility Re-established? — PSU staff check the Texas Integrated Eligibility Redesign System (TIERS) to determine if Medicaid eligibility or managed care enrollment was reestablished. Enter yes, if it has and enter no, if not.

Is manual managed care enrollment needed, if yes? — PSU staff must check TIERS to determine if Medicaid eligibility and managed care enrollment were established if the response to the previous column was yes. PSU staff send an email to the Enrollment Resolution Services (ERS) mailbox if manual managed care enrollment is needed.

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

Was the decision appealed? — PSU staff enter yes or no. No further action is needed if the response to this question is no. Continue to the next section, if yes.

Was eligibility re-established, if yes? — PSU staff check TIERS to determine if Medicaid eligibility or managed care enrollment was re-established. Enter yes, if it has enter no if not. No further action is necessary if the response to this question is no.

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

Pending at PSU — Enter yes or no.

Pending at MCO — Enter yes or no.

Pending at MEPD — Enter yes or no.

Comments — Enter any comments relevant to the actions taken.

The STAR+PLUS Loss of Enrollment Report is a monthly report. PSU staff must research, resolve and respond to the requestor within 14 days of receipt. Completion of the report itself is due within 14 days of receipt and does not negate policy about denial notifications. Refer to 1700, Notification Requirements. The notification must still be sent within two business days.

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

Appendix II, Guidelines for Completing Form H1746-A, MEPD Referral Cover Sheet

Appendix III, Medicaid Type Program Codes for STAR+PLUS HCBS Program and CFC

Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language

Revision 25-2; Effective June 6, 2025

Program Support Unit (PSU) staff must use Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language, to enter approved language in the Reason for Denial and Comments fields on Form H2065-D, Notification of Managed Care Program Services, and Form H2065-DS. PSU staff must not enter additional language in the Reason for Denial or Comments fields of Form H2065-D or Form H2065-DS. PSU staff must consult with their supervisor if they encounter a denial reason or comment not covered in Appendix IV.

Reason for Denial and Comments language is illustrated in both English and Spanish in the tables below.

Denial and Termination Language

This table contains Reason for Denial and Comments field language for Form H2065-D and Form H2065-DS generated for denials and terminations.

PSU staff must enter the associated STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH) section supporting the denial reason on Form H2065-D and H2065-DS, listed in the SPOPH Section column.

Purpose for Form H2065-D	Reason for Denial in Plain Language	Comments in Plain Language	SPOPH Section	Service Authorization System Online (SASO) Code
Unable to Locate	You are not eligible for STAR+PLUS HCBS program because HHSC staff or your health plan cannot locate you to complete the assessment required for the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque el personal de la HHSC o su plan médico no lo han podido localizar para que se someta a la valoración que requiere el programa.	PSU staff must not enter comments language.	6300.6	36 – Individual’s Whereabouts Unknown
Voluntarily Declined Services	You are not eligible for STAR+PLUS HCBS program because you voluntarily withdrew from the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque abandonó voluntariamente el programa.	PSU staff must not enter comments language.	6300.3	05 – Client Requests Service Termination
Enrolled in Another Medicaid Waiver Program	You are not eligible for STAR+PLUS HCBS program. This is because you are enrolled in another Medicaid waiver program. You can only be enrolled in one Medicaid waiver program at a time. Usted no reúne los requisitos para el programa STAR+PLUS HCBS. Esto se debe a que usted está inscrito en otro programa con exenciones de Medicaid. Solo puede estar inscrito en uno de los programas con exenciones a la vez.	You are not eligible for STAR+PLUS HCBS program. This is because you are currently enrolled in [Select one: 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); MDCP; Texas Home Living (TxHmL)]. STAR+PLUS HCBS program cannot be authorized. You can only be enrolled in one Medicaid waiver program at a time. Usted no reúne los requisitos para el programa STAR+PLUS HCBS. Esto se debe a que usted está inscrito actualmente en [Select one: Programa de Servicios de Apoyo y Asistencia para Vivir en la Comunidad (CLASS); Programa para Personas Sordociegas con Discapacidades Múltiples (DBMD); Programa de Servicios en el Hogar y en la Comunidad (HCS); Programa de Servicios en el Hogar y en la Comunidad para la Salud Mental del Adulto (HCBS-AMH); MDCP; Programa de Texas para Vivir en Casa (TxHmL)]. No se puede autorizar el programa STAR+PLUS HCBS. Solo puede estar inscrito en uno de los programas con exenciones de Medicaid a la vez.	6110	39 – Other
Loss of Medicaid Financial Eligibility	You are not eligible for STAR+PLUS HCBS program because you do not meet the financial criteria necessary for the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque no cumple los criterios económicos necesarios para participar en el programa.	Call 2-1-1 if you have questions about the Medicaid application process. Llame al 2-1-1 si tiene preguntas sobre el proceso de solicitud de Medicaid.	6300.4	06 – Client Denied Medicaid Eligibility
Loss of SSI Eligibility	You are not eligible for the STAR+PLUS HCBS program because you lost your Supplemental Security Income (SSI) eligibility. To be eligible for the STAR+PLUS HCBS program, you must regain eligibility for Medicaid. You can call the Social Security Administration at 800-772-1213 or 800-325-0778 (TTY) to request an appeal of your SSI denial. You can also reapply for Medicaid by calling 2-1-1 or completing Form H1200, Application for Assistance – Your Texas Benefits. Usted no califica para el programa HCBS de STAR+PLUS porque ya no reúne los requisitos para recibir Seguridad de Ingreso Suplementario (SSI). Para calificar para el programa HCBS de STAR+PLUS, debe volver a reunir los requisitos de Medicaid. Puede llamar a la Administración de Seguro Social al 800-772-1213 o al 800-325-0778 (TTY) para apelar la denegación de SSI. También puede presentar una nueva solicitud de Medicaid llamando al 2-1-1 o llenando el formulario H1200, Solicitud de asistencia en Your Texas Benefits.	N/A	6300.4	06 – Client Denied Medicaid Eligibility
Declined Assessment	You are not eligible for STAR+PLUS HCBS program because you did not let your health plan complete the assessment required for the program. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque no permitió que el plan médico realizara la valoración que requiere el programa.	PSU staff must not enter comments language.	6300.10	39 – Other
Does Not Have an Unmet Need for MAO	You are not eligible for STAR+PLUS HCBS program because you do not need services offered through the program. Usted no puede recibir los servicios del programa HCBS de STAR+PLUS porque no los necesita.	PSU staff must not enter comments language.	6300.10	13 – no unmet need (Six hour)
Does Not Have an Unmet Need for SSI	You are not eligible for STAR+PLUS HCBS program because you do not need services offered through the program. Usted no puede recibir los servicios del programa HCBS de STAR+PLUS porque no los necesita.	Your provider services will continue uninterrupted. Los servicios de su proveedor continuarán sin interrupción.	6300.10	13 – no unmet need (Six hour)
Failure to Obtain Physician Signature	You are not eligible for STAR+PLUS HCBS program because your doctor didn’t tell us you need the level of care provided in a nursing home. Usted no puede recibir los Servicios en el Hogar y en la Comunidad (HCBS) de STAR+PLUS porque su médico no nos informó que usted necesita el nivel de atención que se ofrece en una casa de reposo.	PSU staff must not enter comments language.	6300.8	39 – Other
Medical Necessity and Level of Care	Reason for Denial language must be populated through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).	You are not eligible for STAR+PLUS HCBS program. See the Reason for Denial text box on page 1 of this form and the STAR+PLUS HCBS Program Medical Necessity Denial Attachment for more information. Usted no reúne los requisitos del programa HCBS de STAR+PLUS. Para más información, vea el cuadro “Motivo de la denegación” en la página 1 de este formulario, así como el anexo “Denegación por no existir necesidad médica” del programa HCBS de STAR+PLUS.	6300.5	08 – Loses Level-of-Care (Medical Necessity)
Exceeding the ISP Cost Limit	You are not eligible for STAR+PLUS HCBS program because the cost of your individual service plan exceeds the maximum amount allowed. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque el costo de su plan individual de servicios excede la cantidad máxima permitida.	PSU staff must not enter comments language.	6300.7	18 – Exceeds Cost Ceiling
Failure to Return Form H1200	You are not eligible for STAR+PLUS HCBS program because you did not return the Medicaid application. Usted no puede recibir Servicios en el Hogar y en la Comunidad (HCBS) de STAR+PLUS porque no entregó su solicitud de Medicaid.	Call 2-1-1 if you have questions about the Medicaid application process. Llame al 2-1-1 si tiene preguntas sobre el proceso de solicitud de Medicaid.	6300.10	39 – Other
MFP NF Discharge Prior to Eligibility Determination	You are not eligible for the STAR+PLUS HCBS program because you left the nursing facility before HHSC could determine program eligibility. Usted no reúne los requisitos para recibir servicios del programa de HCBS de STAR+PLUS porque abandonó el centro de reposo antes de que la HHSC pudiera determinar si reunía los requisitos del programa	PSU staff must not enter comments language.	6300.10	N/A
Institutional Stay Over 90 Days	You are not eligible for STAR+PLUS HCBS program because you have entered an institution for a long-term stay, as described in the Code of Federal Regulations (CFR) at Title 42 CFR Section 441.301(b)(1). Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque ha ingresado en una institución donde tendrá una estancia a largo plazo, como se describe en la sección 441.301(b)(1) del título 42 del Código de Reglamentos Federales (CFR).	You are not eligible for STAR+PLUS HCBS program services while an in-patient of a [Select one: hospital; nursing facility; or intermediate care facility for persons with intellectual disability]. Usted no puede recibir servicios del programa HCBS de STAR+PLUS mientras sea un paciente interno de [Select one: un hospital; un centro de reposo; or un centro de atención intermedia para personas con discapacidad intelectual].	6300.2	03 – Admitted to Institution
Moved Out of State	You are not eligible for STAR+PLUS HCBS program because you are not a Texas resident. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque no reside en Texas.	PSU staff must not enter comments language.	6300.10	01 – Client Leaves the State/County (Catchment Area)
Under 21	You are not eligible for STAR+PLUS HCBS because you are 20 or younger. Usted no puede recibir servicios del programa HCBS de STAR+PLUS porque es menor de 21 años.	PSU staff must not enter comments language.	6300.10	39 – Other
Other	PSU staff must contact supervisor.	PSU staff must contact supervisor.	6300.10	39 – Other

Approval Language

This table contains Comments field language for Form H2065-D and Form H2065-DS generated for approvals.

Purpose for Form H2065-D	Reason for Denial in Plain Language	Comments in Plain Language	SPOPH Section	Service Authorization System Online (SASO) Code
ILR, Upgrade, and Reassessment - Room and Board and Copayment for Members Residing in an ALF or AFC	N/A	You must pay room and board and copayment. You will pay them every month to your foster care home or assisted living facility. Your first month of room and board and copayment may be prorated based on your admission date to the facility. Your health plan will help you work with the facility on payments that are prorated. Debe pagar alojamiento, comida y copago. Deberá pagarlos cada mes al hogar de acogida o al centro de vida asistida en el que se encuentre. El pago del primer mes de alojamiento, comida y copago puede prorratearse en función de la fecha de ingreso en el centro. Su plan médico le ayudará a coordinar con el centro los pagos prorrateados.	N/A	N/A
ILR, Upgrade, Reassessment - Copayment for a QIT Member Residing in a Home Setting	N/A	You have a qualified income trust and must pay a copay. You’ll pay it every month to your service providers. Your first month of copay may be prorated based on the date your services begin. Your health plan will help you work with your service providers on prorated payments. Usted tiene un fideicomiso para la aprobación de los ingresos y debe realizar un copago. Lo pagará todos los meses a sus proveedores de servicios. El copago del primer mes puede prorratearse según la fecha en que comiencen sus servicios. Su plan médico le ayudará a coordinar los pagos prorrateados con sus proveedores de servicios.	N/A	N/A
MFP – Initial Form H2065-D for MFP to Community	N/A	You’re eligible for the STAR+PLUS HCBS program. Your services won’t start until you agree with your health plan on a date for you to leave your nursing home. Stay in the nursing home until you and your health plan agree on a date to leave. This makes sure services are in place when you leave the nursing home. You will receive another notice telling you when your STAR+PLUS HCBS program services will begin. Usted cumple los requisitos del programa STAR+PLUS HCBS. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa STAR+PLUS HCBS.	N/A	N/A
MFP – Initial Form H2065-D for SSI MFP to AFC or ALF	N/A	You’re eligible for the STAR+PLUS HCBS program. Your services won’t start until you agree with your health plan on a date for you to leave your nursing home. Stay in the nursing home until you and your health plan agree on a date to leave. This makes sure services are in place when you leave the nursing home. You will receive another notice telling you when your STAR+PLUS HCBS program services will begin. We will also send you a notice telling you how much your room and board and copayment will be. Usted cumple los requisitos del programa STAR+PLUS HCBS. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa STAR+PLUS HCBS. Además, le enviaremos una notificación informándole del costo de su alojamiento, comida y copago.	N/A	N/A
MFP - Initial Form H2065-D for MAO MFP to AFC or ALF	N/A	You’re eligible for the STAR+PLUS HCBS program. Your services won’t start until you agree with your health plan on a date for you to leave your nursing home. Stay in the nursing home until you and your health plan agree on a date to leave. This makes sure services are in place when you leave the nursing home. You will receive another notice telling you when your STAR+PLUS HCBS program services will begin. We will also send you a notice telling you how much your room and board and copayment will be. Usted cumple los requisitos del programa STAR+PLUS HCBS. Usted no empezará a recibir los servicios hasta que haya acordado con el personal de su plan médico la fecha en que usted saldrá de la casa de reposo. Le pedimos que permanezca en la casa de reposo hasta que usted y su plan médico hayan acordado la fecha de su salida. Esto garantizará que sus servicios estén disponibles cuando usted salga de la casa de reposo. Usted recibirá otra notificación informándole cuándo comenzará a recibir los servicios del programa STAR+PLUS HCBS. Además, le enviaremos una notificación informándole del costo de su alojamiento, comida y copago.	N/A	N/A
MFP – Second Form H2065-D for Room and Board and Copayment for Members Residing in an ALF or AFC	N/A	You must pay room and board and copayment. You will pay them every month to your foster care home or assisted living facility. Your first month of room and board and copayment may be prorated based on your admission date to the facility. Your health plan will help you work with the facility on payments that are prorated. Debe pagar alojamiento, comida y copago. Deberá pagarlos cada mes al hogar de acogida o al centro de vida asistida en el que se encuentre. El pago del primer mes de alojamiento, comida y copago puede prorratearse en función de la fecha de ingreso en el centro. Su plan médico le ayudará a coordinar con el centro los pagos prorrateados.	N/A	N/A
Medicaid Reinstatement - Eligibility Regained within Six Months	N/A	Your Medicaid was reinstated on [DATE]. Your STAR+PLUS HCBS program services will continue without interruption. Sus beneficios de Medicaid fueron restablecidos el [DATE]. Usted seguirá recibiendo servicios del programa HCBS de STAR+PLUS sin interrupción.	N/A	N/A

PSU staff must enter Pending and Calculando in the Copayment fields on the English and Spanish versions of Form H2065-D if the Medicaid for the Elderly and People with Disabilities (MEPD) specialist has not provided copayment amounts at the time Form H2065-D is being generated.

PSU staff must enter the full R&B and copayment amounts for members admitting to an ALF or AFC on the first day of the month. PSU staff must enter the full R&B and copayment amounts for the first month of eligibility along with (prorate) and (prorrateo) if the member is admitting to an ALF or AFC on any other day of the month.

Appendix V, MEPD Referral Crosswalk

Appendix VI, STAR+PLUS Inquiry Chart

Appendix VII, Acronyms

Revision Notice 26-2; Effective June 1, 2026

The STAR+PLUS Home and Community Based Services (HCBS) Program uses the following acronyms.

Acronym	Description
AA	Adaptive Aids
ADL	Activity of Daily Living
AFC	Adult Foster Care
AL	Assisted Living
ALF	Assisted Living Facility
AO	Agency Option
APS	Adult Protective Services
A&M	Appeals and Mitigation
CAP	Corrective Action Plan
CARE	Client Assignment and Registration
CAS	Community Attendant Services
CBA	Community Based Alternatives
CCAD	Community Care for Aged and Disabled
CCSE	Community Care Services Eligibility
CCP	Comprehensive Care Program
CDS	Consumer Directed Services
CFC	Community First Choice
CFR	Code of Federal Regulations
CHIP	Children's Health Insurance Program
CLASS	Community Living Assistance and Support Services
CMPAS	Client Managed Personal Attendant Services
CMS	Claims Management System
CMS	Centers for Medicare and Medicaid Services
CNA	Certified Nursing Assistant
COLA	Cost of Living Adjustment
CSHCN	Children with Special Health Care Needs
CSIL	Community Services Interest List
DAC	Disabled Adult Child
DAHS	Day Activity and Health Services
DBMD	Deaf Blind with Multiple Disabilities
DDS	Disability Determination Services
DDU	Disability Determination Unit
DER	Data Entry Representative
DFPS	Department of Family and Protective Services
DIA	Diagnosis
DID	Determination of Intellectual Disability
DIU	Data Integrity Unit
DME	Durable Medical Equipment
DOB	Date of Birth
DOD	Date of Death
DR	Designated Representative
DSHS	Department of State Health Services
ERS	Enrollment Resolutions Services
ERS	Emergency Response Service
FBR	Federal Benefit Rate
FC	Family Care Title XX
FFS	Fee-for-Service
FH	Fair Hearing
FHO	Fair Hearings Officer
FMSA	Financial Management Services Agency
GR	General Revenue
HCBS	Home and Community Based Services
HCS	Home and Community-based Services
HCSS	Home and Community Support Services
HCSSA	Home and Community Support Services Agency
HDM	Home-Delivered Meals
HEART	Health and Human Services Enterprise Administrative Report and Tracking System
HHS	Health and Human Services
HHSC	Health and Human Services Commission
HICAP	Health Information Counseling and Advocacy Program
HIPAA	Health Insurance Portability and Accountability Act
HIPP	Health Insurance Premium Payment Program
HMA	Health Maintenance Activity
IADL	Instrumental Activity of Daily Living
ICF/IID	Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
ID	Identification
IDD	Intellectual or Developmental Disability
IDT	Interdisciplinary Team
ILM	Interest List Management
IME	Incurred Medical Expense
ISP	Individual Service Plan
LAR	Legally Authorized Representative
LCSW	Licensed Clinical Social Worker
LIDDA	Local Intellectual and Developmental Disability Authority
LOC	Level of Care
LOE	Loss of Enrollment
LOS	Level of Service
LTC	Long Term Care
LTC-R	Long Term Care Regulatory
LTCOP	Long Term Care Online Portal
LTSS	Long Term Services and Supports
LVN	Licensed Vocational Nurse
MAO	Medical Assistance Only
MBI	Medicaid Buy-In
MC	Managed Care
MCO	Managed Care Organization
MCCO	Managed Care Compliance & Operations
MDCP	Medically Dependent Children Program
MDS	Minimum Data Set
Med ID	Medicaid Identification Card
MEPD	Medicaid for the Elderly and People with Disabilities
MERP	Medicaid Estate Recovery Program
MESAV	Medicaid Eligibility Service Authorization Verification
MFP	Money Follows the Person
MFPD	Money Follows the Person Demonstration
MHM	Minor Home Modification
MMP	Medicare-Medicaid Plan
MN	Medical Necessity
MN/LOC	Medical Necessity and Level of Care
MRSA	Medicaid Rural Service Area
MSHCN	Members with Special Health Care Needs
NF	Nursing Facility
OT	Occupational Therapy
OTA	Occupational Therapy Assistance
PACE	Program of All-inclusive Care for the Elderly
PAS	Personal Assistance Services
PCN	Patient Control Number
PCP	Primary Care Provider;
PCS	Personal Care Services
PCS	Provider Claims Services
PDN	Private Duty Nursing
PDPM	Patient-Driven Payment Model
PES	Program Enrollment and Support
PHC	Primary Home Care
PNA	Personal Needs Allowance
POC	Plan of Care
PPECC	Prescribed Pediatric Extended Care Center
PPS	Premiums Payable System
PSU	Program Support Unit
PT	Physical Therapy
PTA	Physical Therapy Assistance
QIT	Qualified Income Trust
QMB	Qualified Medicare Beneficiary
R&B	Room and Board
RN	Registered Nurse
RSDI	Retirement and Survivors Disability Insurance
RUG	Resource Utilization Group
SASO	Service Authorization System Online
SC	Service Code
SCSA	Significant Change in Status Assessment
SDX	State Data Exchange
SE	Supported Employment
SG	Service Group
SLMB	Specified Low-Income Medicare Beneficiaries
SNAP	Supplemental Nutrition Assistance Program
SO	State Office
SOC	Start of Care
SOLQ	State On-Line Query
SPT	Service Planning Team
SRO	Service Responsibility Option
SSA	Social Security Administration
SSI	Supplemental Security Income
SSN	Social Security Number
SSPD	Special Services to Persons with Disabilities
ST	Speech Therapy
STAR	State of Texas Access Reform
STAR+PLUS	State of Texas Access Reform Plus
STAR+PLUS HCBS program	State of Texas Access Reform Plus Home and Community Based Services program
STS	Supplemental Transition Support
TAC	Texas Administrative Code
TANF	Temporary Assistance to Needy Families
TAS	Transition Assistance Services
TDI	Texas Department of Insurance
THStep-CCP	Texas Health Steps – Comprehensive Care Program
TIERS	Texas Integrated Eligibility Redesign System
TMHP	Texas Medicaid & Healthcare Partnership
TOA	Type of Assistance
TP	Type Program
TPR	Third-Party Resource
TW	Texas Works
TxHmL	Texas Home Living
UAP	Unlicensed Assistive Person
UMCC	Uniform Managed Care Contract
UMCM	Uniform Managed Care Manual
WTPY	Wire Third Party Query

Appendix VIII, Income and Resource Limits

Appendix IX, Time Calculation

Appendix X, STAR+PLUS HCBS Cost Limits

Appendix XI, STAR+PLUS HCBS Program Medical Necessity Denial Attachment

Revision 25-3; Effective Aug. 4, 2025

English: Appendix XI, Fair Hearing Options for STAR+PLUS HCBS Program Denials (PDF)

Spanish: Appendix XI, Opciones de audiencia imparcial para las denegaciónes del programa HCBS de STAR+PLUS (PDF)

Appendix XII, STAR+PLUS HCBS Program Description

Revision 19-3; Effective April 10, 2019

English Word: Appendix XII, STAR+PLUS HCBS Program Description

Spanish Word: Appendix XII, Servicios en el Hogar y la Comunidad de STAR+PLUS

Appendix XIII, Your Financial Rights in an Assisted Living Facility STAR+PLUS

Revision 25-2; Effective June 6, 2025

Your Financial Rights in an Assisted Living Facility STAR+PLUS

Appendix XIV, Reserved for Future Use

Revision Notice 26-2; Effective June 1, 2026

Appendix XV, Services Available from Other State Agencies

Appendix XV-A, Department of State Health Services

Appendix XV-C, Texas Veterans Commission

Appendix XV-D, Texas Department of Housing and Community Affairs

Appendix XV-E, Department of Family and Protective Services

Appendix XV-F, Rehabilitation Technology Resource Center

Appendix XVI, SASO Service Group, Service Code and Termination Code

Appendix XVII, State Cutoff Dates

Appendix XVIII, Mutually Exclusive Services

Appendix XIX, Nursing Facility Counter Logic

Appendix XX, STAR+PLUS HCBS Program Eligibility TAC

Revision 22-1; Effective January 31, 2022

English Word: 1 Texas Administrative Code §353.1153 STAR+PLUS Home and Community Based Services (HCBS) Program

Spanish Word: Sección 353.1153 del Título 1 del Código Administrativo de Texas: Servicios en el Hogar y la Comunidad de STAR+PLUS

Appendix XXI, Creating an Appeal in TIERS

Appendix XXII, HHSC Benefits Portal and TIERS Reference Guides

Appendix XXIII, Instructions and Access to CARE

Appendix XXIV, Minimum Standards for STAR+PLUS AFC Homes and Home Providers

Appendix XXIV, STAR+PLUS Service Area by County

Revision 26-2; Effective June 1, 2026

Service Area	County
Bexar Service Area:	Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson counties.
Dallas Service Area:	Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwell counties.
Harris Service Area:	Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton counties.
El Paso Service Area:	El Paso and Hudspeth counties.
Hidalgo Service Area:	Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy and Zapata counties.
Jefferson Service Area:	Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker counties.
Lubbock Service Area:	Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher and Terry counties.
Medicaid Rural Service Area (RSA) Central Texas Service Area (Waco):	Bell, Blanco, Bosque, Brazos, Burleson, Colorado, Comanche, Coryell, DeWitt, Erath, Falls, Freestone, Gillespie, Gonzales, Grimes, Hamilton, Hill, Jackson, Lampasas, Lavaca, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Somervell and Washington counties.
Medicaid RSA Northeast Texas Service Area (Tyler):	Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Cooke, Delta, Fannin, Franklin, Grayson, Gregg, Harrison, Henderson, Hopkins, Houston, Lamar, Marion, Montague, Morris, Nacogdoches, Panola, Rains, Red River, Rusk, Sabine, San Augustine, Shelby, Smith, Titus, Trinity, Upshur, Van Zandt and Wood counties.
Medicaid RSA West Texas Service Area (Abilene):	Andrews, Archer, Armstrong, Bailey, Baylor, Borden, Brewster, Briscoe, Brown, Callahan, Castro, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Concho, Cottle, Crane, Crockett, Culberson, Dallam, Dawson, Dickens, Dimmit, Donley, Eastland, Ector, Edwards, Fisher, Foard, Frio, Gaines, Glasscock, Gray, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Howard, Irion, Jack, Jeff Davis, Jones, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lipscomb, Loving, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Palo Pinto, Parmer, Pecos, Presidio, Reagan, Real, Reeves, Roberts, Runnels, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Taylor, Terrell, Throckmorton, Tom Green, Upton, Uvalde, Val Verde, Ward, Wheeler, Wichita, Wilbarger, Winkler, Yoakum, Young and Zavala counties.
Nueces Service Area:	Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kennedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio and Victoria counties.
Tarrant Service Area:	Denton, Hood, Johnson, Parker, Tarrant, and Wise counties.
Travis Service Area:	Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis and Williamson counties.

Appendix XXV, Community First Choice Support Management

Appendix XXVI, HEART Case Record Assignment Procedures

Appendix XXVII, PSU Users H1700/ISP Form User Guide

Revision 24-3; Effective Sept. 10, 2024

Link to PSU Users H1700/ISP Form User Guide found here.

Appendix XXVIII, County Codes and City and County List

Appendix XXIX, STAR+PLUS Plan Codes and Contract Numbers

Revision 25-5; Effective Dec. 17, 2025

STAR+PLUS Plan Codes

Service Area	Plan Name	Plan Codes	Contract Number	Plan Codes Effective Dates
Bexar	Community First Health	S1	1033142	Sept. 1, 2024
Bexar	Molina	46	1014430	Sept. 1, 2011
Bexar	Superior	47	1014433	Sept. 1, 2011 – Aug. 31, 2024
Bexar	United Healthcare	S5	1033147	Sept. 1, 2024
Bexar	Wellpoint	45	1014439	Sept. 1, 2011 – Aug. 31, 2024
Dallas	Molina	9F	1018980	March 1, 2012
Dallas	Superior	9H	1018981	March 1, 2012
Dallas	United Healthcare	S6	1033148	Sept. 1, 2024
El Paso	El Paso Health	S2	1033143	Sept. 1, 2024
El Paso	Molina	33	1019987	March 1, 2012
El Paso	Wellpoint	34	1019979	March 1, 2012 – Aug. 31, 2024
Harris	Community Health Choice	S3	1033145	Sept. 1, 2024
Harris	Molina	7S	1014431	Sept. 1, 2011
Harris	United Healthcare	7R	1014435	Sept. 1, 2011
Harris	Wellpoint	7P	1014440	Sept. 1, 2011 – Aug. 31, 2024
Hidalgo	Cigna-HealthSpring	H7	1019984	March 1, 2012 – Dec. 31, 2021
Hidalgo	Molina	H6	1019988	March 1, 2012
Hidalgo	Superior	H5	1019985	March 1, 2012
Hidalgo	United Healthcare	S7	1033149	Sept. 1, 2024
Jefferson	Molina	8T	1019598	Sept. 1, 2011
Jefferson	United Healthcare	8S	1019600	Sept. 1, 2011 – Aug. 31, 2024
Jefferson	Wellpoint	8R	1019599	Sept. 1, 2011
Lubbock	Superior	5B	1019986	March 1, 2012
Lubbock	Wellpoint	5A	1019983	March 1, 2012
Medicaid Rural Service Area (RSA) West Texas	Superior	W6	1025730	Sept. 1, 2014
Medicaid Rural Service Area (RSA) West Texas	Wellpoint	W5	1025729	Sept. 1, 2014
Medicaid RSA Northeast Texas	Cigna-HealthSpring	N3	1025733	Sept. 1, 2014 – Dec. 31, 2021
Medicaid RSA Northeast Texas	Molina	P2	1031928	Jan. 1, 2022
Medicaid RSA Northeast Texas	United Healthcare	N4	1025734	Sept. 1, 2014
Medicaid RSA Central Texas	Superior	C4	1025731	Sept. 1, 2014
Medicaid RSA Central Texas	United Healthcare	C5	1025732	Sept. 1, 2014
Nueces	Superior	86	1014434	Sept. 1, 2011
Nueces	United	85	1014437	Sept. 1, 2011 – Aug. 31, 2024
Nueces	Wellpoint	S9	1033141	Sept. 1, 2024
Tarrant	Cigna-HealthSpring	6C	1018979	Sept. 1, 2011 – Dec. 31, 2021
Tarrant	Molina	P1	1031927	Jan. 1, 2022
Tarrant	United Healthcare	S8	1033140	Sept. 1, 2024
Tarrant	Wellpoint	69	1018977	Sept. 1, 2011 – Aug. 31, 2024
Travis	Superior	S4	1033146	Sept. 1, 2024
Travis	United	18	1014438	Sept. 1, 2011
Travis	Wellpoint	19	1014442	Sept. 1, 2011 – Aug. 31, 2024

Medicare-Medicaid Plan (MMP) Codes

Service Area	Plan Name	Plan Codes	Contract Number	Plan Codes Dates
Bexar	Molina	4G	1026341	Sept. 1, 2015 – Dec. 31, 2025
Bexar	Superior	4H	1026337	Sept. 1, 2015 – Dec. 31, 2025
Bexar	Wellpoint	4F	1026326	Sept. 1, 2015 – Aug. 31, 2024
Dallas	Molina	9J	1026342	Sept. 1, 2015 – Dec. 31, 2025
Dallas	Superior	9K	1026338	Sept. 1, 2015 – Dec. 31, 2025
El Paso	Molina	3H	1026343	Sept. 1, 2015 – Dec. 31, 2025
El Paso	Wellpoint	3G	1026328	Sept. 1, 2015 – Aug. 31, 2024
Harris	Molina	7V	1026344	Sept. 1, 2015 – Dec. 31, 2025
Harris	United Healthcare	7Q	1026334	Sept. 1, 2015 – Dec. 31, 2025
Harris	Wellpoint	7Z	1026331	Sept. 1, 2015 – Aug. 31, 2024
Hidalgo	Cigna-HealthSpring	H8	1026335	Sept. 1, 2015 – Dec. 31, 2021
Hidalgo	Molina	H9	1026345	Sept. 1, 2015 – Dec. 31, 2025
Hidalgo	Superior	HA	1026339	Sept. 1, 2015 – Dec. 31, 2025
Tarrant	Cigna-HealthSpring	6G	1026333	Sept. 1, 2015– Dec. 31, 2021

Appendix XXX, Relocation Function

9-2017

Purpose

The relocation function is a component of service coordination. The primary purpose of the relocation function is to support the transition of members and future members who desire to move from an institution to the community. A relocation specialist (RS) works for an entity contracted with a managed care organization (MCO) to perform the relocation function.

Overview of Relocation Function

Conduct outreach and education to nursing facilities and residents on options for receiving long-term services and supports (LTSS) in the community;
Identify members interested in relocating;
Respond to referrals for relocation and conduct relocation assessments;
Develop and implement person-centered relocation plans;
Coordinate housing and non-covered community services, as mutually agreed;
Provide support on day of relocation and conduct follow-up; and
Collect data on relocations as specified by the Texas Health and Human Services Commission and/or MCOs.

Relocation Tasks

MCO	RS	Both	Conduct Outreach and Education
MCO	RS	Both	Identify and Refer Individuals Interested in Relocating (non-Minimum Data Set Referrals)
MCO	RS	Both	Respond to Referrals for Relocation and Conduct Relocation Assessment
MCO	RS	Both	Coordinate Housing, Non-Medicaid Community Supports and Discharge
MCO	RS	Both	Provide Support on Relocation Day and Follow-up
		X	Conduct regular visits to nursing facilities to educate individuals in the facility, family members and potential referral sources about community-based services, including STAR+PLUS Home and Community Based Services (HCBS), and the availability of assistance with relocation. Educate potential referral sources regarding the availability of STAR+PLUS HCBS.
		X	Provide group and individual training to nursing facility staff on relocation services.
	X		Encourage a referral to a Local Contact Agency for residents interested in relocating.
		X	If an RS learns of a member’s desire to move to the community, the RS must notify the member’s MCO. If an MCO learns of a member’s desire to move to the community, the MCO must notify the RS. Either party has three business days to notify the other party.
	X		Upon receipt of referral, the RS must make an initial contact face-to-face or by telephone within five business days to schedule a relocation assessment. Initial contact must be with the member or the member’s authorized representative (AR). An AR such as a family member or friend who is knowledgeable of the member’s situation and services may be engaged to support information provided by the member.
X			The MCO service coordinator must contact the member to schedule an assessment for STAR+PLUS HCBS within 14 business days of notification by the RS. The MCO has 45 days to complete all assessment activities related to STAR+PLUS HCBS eligibility.
	X		Provide the appropriate Local Intellectual and Developmental Disability Authority (LIDDA) with contact information for members interested in relocating who have an Intellectual or Developmental Disability (IDD). Provide notification to the appropriate MCO that a referral was made to the LIDDA.
	X		When contacted by the MCO via Form 1579, Referral for Relocation Services, or after referral is received from another source, conduct a face-to-face relocation assessment with the member or AR within 14 business days. An AR such as a family member or friend who is knowledgeable of the member’s situation and services may be engaged to support information provided by the member. The assessment includes, but is not limited to: goals of the member with regard to community living; preferences for post-relocation housing; information regarding informal support; information regarding finances and need for support; need for post-relocation non-waiver supports; history of unsuccessful relocation attempts and reasons attempts were not successful; and barriers to relocation.
	X		Share results from assessment with the MCO.
		X	Develop a person-centered relocation plan with the member or AR and others whom he/she chooses to have involved.
		X	Advocate with nursing facility staff, RS and service coordinator(s) to support the member’s needs, preferences and goals.
		X	Through their respective assessments, the MCO service coordinator and RS identify and include in the MCO service plan and/or RS’ transition plan non-covered community services, including, but not limited to: help setting up a utility or telephone account; non-medical transportation, including mainline, special transit and local transportation providers; start-up groceries, as needed; or banking, bill payment and direct deposit.
		X	Maintain regular, open communication with all parties who are involved in the relocation process.
		X	If the member is in need of housing, the RS is primarily responsible to help secure affordable, accessible and integrated housing consistent with the resident’s preferences. The RS assists the member in applying for: Project Access, as indicated; Section 811 Project Rental Assistance, as available; and other affordable housing options, as necessary.
X			If the member is interested in assisted living, personal care homes or adult foster care, the MCO service coordinator will review options available among contracted providers.
		X	Assist the member in accessing community supports, such as food banks, utility assistance, emergency rental assistance and emergency SNAP.
		X	Participate in the discharge planning process with the member or AR, service coordinator(s), RS and others important to the member.
X			MCOs will negotiate and set the discharge date in coordination with the RS and other community and social supports, as necessary.
		X	If an MCO or RS becomes aware of a change to the discharge date, the MCO or RS must notify the other party immediately.
		X	Coordinate with all parties to ensure everything is in place at the time of discharge.
		X	Help facilitate the member’s notification to Social Security of the member’s new address as soon as possible after relocating to the community.
X			The MCO service coordinator will remind nursing facility staff to transfer Medicaid benefits from the facility to the community.
		X	Be present at new address on relocation day to ensure all services are in place. Assist in setting up household, as needed.
		X	Notify the other party if the member does not have all necessary Medicaid and non-Medicaid supports in place on the day of relocation.
		X	Provide follow up, which may include: determining if there are unresolved issues related to transfer of benefits, health, emotional well-being, etc.; communicating all unresolved medical issues to the MCO service coordinator; and assisting the member in addressing unmet needs.
	X		Contact the member at least seven times over the course of 90 days post-relocation to ensure a successful transition to the community. Notify the MCO if the member has an unmet need.

Minimum Qualifications

An MCO must offer a contract to provide the relocation function to an entity with at least five years contracting with the state to provide relocation functions as of Sept. 1, 2016, to members transitioning from institutions to Medicaid community-based LTSS.

An MCO may offer a contract to a new entity to provide the relocation function. The new entity must meet all of the following qualifications:

Adherence to Health Insurance Portability and Accountability Act (HIPAA) compliant data management requirements and other stipulations of the MCO;
Experience identifying barriers to relocation for members who express an interest in moving from nursing facilities in Texas to a home and community-based setting;
Knowledge of community resources for members with disabilities of all ages and how to access those resources;
Knowledge of community and federal housing resources and how to access those resources, as appropriate;
Knowledge of Medicaid, including, but not limited to, Medicaid managed care, long term services and supports, eligibility requirements and how to apply and qualify for Medicaid;
Ability to hire, train, supervise and direct RS staff that ensures the successful transition of members from nursing facilities. The entity is responsible for ensuring any RS is not listed in the HHSC employee misconduct registry, Inspector General (IG) list of excluded entities and individuals, and HHSC do not hire registries. The entity must conduct a fingerprint background check and share the results with the MCO prior to hiring an RS;
Two years of experience developing transition plans for members; and
Three years of experience working directly with people with disabilities of all ages or the entity must have at least three years of experience subcontracting with an entity described above to provide the relocation function.

Appendix XXXI, STAR+PLUS Members Transitioning from an NF in One Service Area to the Community in Another Service Area

Appendix XXXII, Create an Appeal Task in the HHSC Benefits Portal

Appendix XXXIII, STAR+PLUS HEART Naming Conventions

Revision 25-4; Effective Oct. 6, 2025

This appendix outlines the screenshots Program Support Unit (PSU) staff must upload to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must use the HEART Naming Conventions below when uploading documents to the HEART case record. Refer to Appendix XXXIV, STAR+PLUS MCOHub Naming Conventions, for the MCOHub naming convention instructions.

PSU staff must add a sequence number after the naming convention when more than one of the same form or screenshot is uploaded. For example, PSU staff must name the first Form H1746-A sent or received as 1746_1, the second form sent or received as 1746_2, and the third form sent or received as 1746_3.

PSU staff must include all screenshots, forms, documents and emails marked as Yes in the Required column in the HEART case record. PSU staff must include screenshots, forms, documents and emails marked with an * in the Required column in the HEART case record if used by PSU staff while completing the case.

Interest List Release (ILR)

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
CSIL Closure Screenshot	CSIL CLOSURE	Yes
Form 2442 (English)	2442	*
Form 2442-S (Spanish)	2442-S	*
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1700-1 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form H1700-1 (if received through the MCOHub)	Use the MCOHub Naming Convention	Yes
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	H1826	*
Form H2053-B	2053B	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	*
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	*
Form H2065-D Screenshot of Upload to the MCOHub	2065 MCOHub	*
Form H2067-MC	Use the MCOHub Naming Convention	Yes
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	Yes
Form H3675	3675	*
Form H3676-A	Use the MCOHub Naming Convention	Yes
Form H3676-A Upload to the MCOHub	3676A MCOHub	Yes
Form H3676-B	Use the MCOHub Naming Convention	Yes
TIERS Copayment Budget Screenshot	TIERS COPAY	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from A&M	A&M EMAIL	*
Emails to and from CCSE	CCSE EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Note: PSU staff must upload Form 2442 or Form H2065-D in the HEART case record, as appropriate.

Upgrades

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1700-1 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form H1700-1 (if received through the MCOHub)	Use the MCOHub Naming Convention	Yes
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	H1826	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	Yes
Form H2065-D Screenshot of Upload to the MCOHub	2065 MCOHub	Yes
Form H2067-MC	Use the MCOHub Naming Convention	Yes
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	Yes
TIERS Copayment Budget Screenshot	TIERS COPAY	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from A&M	A&M EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Money Follows the Person (MFP)

Item	HEART Naming Convention	Required
TIERS Individual- Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual- Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
CSIL Closure Screenshot	CSIL CLOSURE	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1700-1 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form H1700-1(if received through the MCOHub)	Use the MCOHub Naming Convention	Yes
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	H1826	*
Form H2053-B	2053B	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	Yes
Form H2065-D Screenshot of Upload to the MOCHub	2065 MCOHub	Yes
Form H2067-MC	Use the MCOHub Naming Convention	Yes
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	Yes
TIERS Copayment Budget Screenshot	TIERS COPAY	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from A&M	A&M EMAIL	*
Emails to and from CCSE	CCSE EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*
Emails to and from the MFPD Reporting Coordinator	365-DAY EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Annual Reassessment

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual- Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	*
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1826	H1826	*
Form H1700-1 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form H1700-1(if received through the MCOHub)	Use the MCOHub Naming Convention	Yes
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	Yes
Form H2065-D Screenshot of Upload to the MCOHub	2065 MCOHub	Yes
Form H2067-MC	Use the MCO Hub Naming Convention	*
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	*
TIERS Copayment Budget Screenshot	TIERS COPAY	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*

Transition to Adult Programs (MDCP Age-Out)

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
Form 2114	2114	*
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1700-1 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form H1700-1(if received through the MCOHub)	Use the MCOHub Naming Convention	Yes
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	H1826	*
Form H2053-B	2053B	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	Yes
Form H2065-D Screenshot of Upload to the MCOHub	2065 MCOHub	Yes
Form H2067-MC	Use the MCOHub Naming Convention	Yes
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	Yes
Form H2116	2116	*
Form H3675	3675	*
Form H3676-A	Use the MCOHub Naming Convention	Yes
Form H3676-A Upload to the MCOHub	3676A MCOHub	Yes
Form H3676-B	Use the MCOHub Naming Convention	Yes
TIERS Copayment Budget Screenshot	TIERS COPAY	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from CCSE	CCSE EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from Higher Needs Coordinator	HN EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*
Emails to and from STAR Kids PSU	PSU EMAIL	*
Emails to and from UR	UR EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Denials and Terminations

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
SASO Enrollment Screenshot	SASO EN	*
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
CSIL Closure Screenshot	CSIL CLOSURE	*
Fair Hearing Options for STAR+PLUS HCBS Program Denials	MN DENIAL ATCH	*
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	H1826	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	*
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	*
Form H2065-D Screenshot of Upload to the MCOHub	2065 MCOHub	*
Form H2067-MC	Use the MCOHub Naming Convention	*
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from A&M	A&M EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Note: PSU staff must upload Form H2067-MC or Form H2065-D in the HEART case record, as appropriate.

Fair Hearings

Item	HEART Naming Convention	Required
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	Form H1826	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use the MCOHub Naming Convention	Yes
Form H2065-D Screenshot of Upload to the MCOHub	2065 MCOHub	Yes
Form H2067-MC	Use the MCOHub Naming Convention	Yes
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	Yes
Form H4800	4800	*
Form H4800-A	4800A	*
Form H4800-D	4800D	*
Form 4801	FH COVER LTR	Yes
Form H4803	4803	Yes
Form H4806	4806	*
Form H4807	4807	*
Appendix XX for All Denials	ELIGIBILITY TAC	Yes
Copy of Handbook Section Referenced on Form H2065-D	SPOPH [####]	Yes
Fair Hearing Options for STAR+PLUS HCBS Program Denials	MN DENIAL ATCH	*
Notice of Hearing Officer’s Decision	APPEAL DECISION LTR	Yes
HHSC Benefits Portal Screenshot of Hearing Officer’s Decision	TIERS APPEAL DECISION	Yes
Emails to and from DER Clerk	CLERK EMAIL	*
Emails to and from A&M	A&M EMAIL	*
Emails to and from ERS	ERS EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Disenrollment

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Plan Screenshot	SASO SP	*
SASO Service Authorization Screenshot	SASO SA	Yes
SASO Medical Necessity Screenshot	SASO MN	Yes
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H2067-MC	Use the MCOHub Naming Convention	Yes
Form H2067-MC Screenshot of Upload to the MCOHub	2067 MCOHub	Yes
Medicaid Managed Care Member Disenrollment Form	DISENFORM	Yes
Emails for PSU QA Process	QA EMAIL	*
Emails to and from MCCO	MCCO EMAIL	Yes
MEPD Communication Tool	MEPD EMAIL	*

Appendix XXXIV, STAR+PLUS MCOHub Naming Conventions

Revision 26-2; Effective June 1, 2026

The MCOHub is a secure Internet bulletin board that the Texas Health and Human Commission (HHSC) Program Support Unit (PSU) staff and the managed care organization (MCO) use to share information securely. The MCOHub uses specific naming conventions only for the documents listed below. PSU staff and the MCO must follow these naming conventions any time either the MCO or PSU staff uploads one of the following documents to the MCOHub.

PSU staff and the MCO:

Are only required to upload the English versions of forms to the MCOHub.
Are not required to upload the Spanish versions of forms to the MCOHub.

Form H3676, Managed Care Pre-Enrollment Assessment Authorization

Interest List Release and Age-Outs

PSU staff and the MCO must upload Form H3676 to the SPW folder but must not upload this form to any other folder.

PSU staff must enter two commas after the last letter of the individual or applicant’s last name if the last name contains two letters. For example: AB,,. PSU staff must enter one comma after the last letter of the individual or applicant’s last name if the last name contains three letters. For example: ABC,.

Two-Digit Plan Identification (ID)	Form No.	Member ID, Medicaid No. or Social Security No. (SSN)	First Four Letters of Member's Last Name	Section No.	Sequence No. of Form Examples
# #	3676	123456789	ABCD	A or B	1, 2, 3, 4

Examples:

The naming convention for this form must be ##_3676_123456789_ABCD_A_1 when PSU staff first complete and upload Section A.
The naming convention for this form must be ##_3676_123456789_ABCD_A_2 when PSU staff complete and upload Section A of this form a second time.
The naming convention for this form must be ##_3676_123456789_ABCD_B_1 when the MCO first completes and uploads Section B in response to Section A.
The naming convention for this form must be ##_3676_123456789_ABCD_B_2 when the MCO completes and uploads Section B of this form a second time.

Money Follows the Person (MFP)

PSU staff must use a separate naming convention to address the use of Form H3676 for non-STAR+PLUS nursing facility (NF) residents who request to transition to the community under the STAR+PLUS Home and Community Based Services (HCBS) program. These individuals are considered expedited cases for application to the STAR+PLUS HCBS program. Add the acronym MFP, for Money Follows the Person, to the section number in the naming convention to achieve rapid identification.

PSU staff must enter two commas after the last letter of the individual or applicant’s last name if the last name contains two letters. For example: AB,,. PSU staff must enter one comma after the last letter of the individual or applicant’s last name if the last name contains three letters. For example: ABC,.

Two-Digit Plan ID	Form #	Member ID or SSN	Member Last Name (first four letters)	Section Number	Sequence Number of Form
# #	3676	123456789	ABCD	A or B	1MFP, 2MFP, 3MFP, 4MFP

Examples:

The naming convention for this form must be ##_3676_123456789_ABCD_A_1MFP when PSU staff first complete and upload this form.
The naming convention for this form must be ##_3676_123456789_ABCD_A_2MFP when PSU staff complete and upload this form a second time.
The naming convention for this form must be ##_3676_123456789_ABCD_B_1MFP when the MCO first completes and uploads this form.
The naming convention for this form must be ##_3676_123456789_ABCD_B_2MFP when the MCO completes and uploads this form a second time.

Form H1700-1, STAR+PLUS HCBS Program Individual Service Plan

The MCO must:

Complete and upload Form H1700-1 to the individual service plan (ISP) folder in the MCOHub for non-members, age-outs, and nursing facility (NF) residents transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program.
Complete and submit Form H1700-1 to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) for members in the community.

The MCO must not upload Form H1700-1 to any other folder in the MCOHub. The MCO is not required to upload Form H1700-1 to the MCOHub if submitted through the TMHP LTCOP.

Two-Digit Plan ID	Form No.	Member ID, Medicaid No. or SSN	First Four Letters of Member's Last Name	Page No. of Form H1700-1	Sequence No. of Form Examples
# #	1700	123456789	ABCD	1	1, 2, 3

Examples:

The naming convention for this form must be ##_1700_123456789_ABCD_1_1 when the MCO first completes and uploads this form.
The naming convention for this form must be ##_1700_123456789_ABCD_1_2 when the MCO completes and uploads this form a second time.

Form H2067-MC, Managed Care Programs Communication

PSU staff and the MCO must complete and upload Form H2067-MC to the SPW folder in the MCOHub. PSU staff and the MCO must not upload this form to any other folder. An M or S is added to the sequence number to indicate if the MCO or PSU staff uploads the form to the MCOHub. An M indicates the MCO. An S indicates PSU staff.

PSU staff must enter two commas after the last letter of the individual or applicant’s last name if the last name contains two letter, for example: AB,,. PSU staff must enter one comma after the last letter of the individual or applicant’s last name if the last name contains three letters, such as, ABC,.

Two-Digit Plan ID	Form No.	Member ID, Medicaid No. or SSN	First Four Letters of Member's Last Name	Section No.	Sequence No. of Form Examples
# #	2067	123456789	ABCD		1S, 2S, 3S or 1M, 2M, 3M

PSU staff must add a C to the end of naming convention if this form is uploaded to the MCOHub as notification of a cost-of-living adjustment (COLA).

Examples:

The naming convention for this form must be ##_2067_123456789_ABCD_1S when PSU staff first complete and upload this form.
The naming convention for this form must be ##_2067_123456789_ABCD_1S_C when PSU staff first complete and upload this form and it is related to a COLA.
The naming convention for this form must be ##_2067_123456789_ABCD_2S when PSU staff complete and upload this form a second time.
The naming convention for this form must be ##_2067_123456789_ABCD_1M when the MCO first completes and uploads this form.
The naming convention for this form must be ##_2067_123456789_ABCD_2M when the MCO completes and uploads this form a second time.

Money Follows the Person (MFP)

PSU staff must use a separate naming convention to address the use of Form H2067-MC for NF residents who request transition to the community under the STAR+PLUS HCBS program. These individuals and applicants are considered expedited cases for application to the STAR+PLUS HCBS program. Add the acronym MFP, for Money Follows the Person, to the section number in the naming convention to achieve rapid identification.

An M or S is added to the sequence number to indicate if the MCO or PSU staff uploads the form to the MCOHub. An M indicates the MCO. An S indicates PSU staff.

PSU staff must enter two commas after the last letter of the individual or applicant’s last name if the last name contains two letter, such as, AB,,. PSU staff must enter one comma after the last letter of the individual or applicant’s last name if the last name contains three letters, such as ABC,.

Two-Digit Plan ID	Form No.	Member ID, Medicaid No. or SSN	First Four Letters of Member's Last Name	Section No.	Sequence No. of Form Examples
# #	2067	123456789	ABCD	MFP	1S, 2S, 3S or 1M, 2M, 3M

Examples:

The naming convention for this form must be ##_2067_123456789_ABCD_MFP_1S when PSU staff initially complete and upload this form.
The naming convention for this form must be ##_2067_123456789_ABCD_MFP_2S when PSU staff complete and upload this form a second time.
The naming convention for this form must be ##_2067_123456789_ABCD_MFP_1M when the MCO initially completes and uploads this form.
The naming convention for this form must be ##_2067_123456789_ABCD_MFP_2M when the MCO completes and uploads this form a second time.

Form H2065-D, Notification of Managed Care Program Services

PSU staff must complete and upload Form H2065-D to the SPW folder in the MCOHub if the form is generated manually. PSU staff must not upload this form to any other folder. An A is used for a Form H2065-D approval, and a D is added to the sequence number to show if the form is denying STAR+PLUS HCBS program eligibility.

PSU staff must generate Form H2065-D electronically in the TMHP LTCOP if applicable. PSU staff and the MCO must access Form H2065-D in the Letters tab of the TMHP LTCOP if the MCO submitted the applicant or member’s ISP through the TMHP LTCOP. PSU staff is only required to upload Form H2065-D to the MCOHub for Form H2065-Ds generated manually.

PSU staff must enter two commas after the last letter of the applicant or member’s last name if the last name contains two letters, such as, AB,,. PSU staff must enter one comma after the last letter of the applicant or member’s last name if the last name contains three letters, such as, ABC,.

Two-Digit Plan ID	Form No.	Member ID, Medicaid No. or SSN	First Four Letters of Member's Last Name	Section No.	Sequence No. of Form Examples
# #	2065	123456789	ABCD	D	1D, 2D, 3D or 1A, 2A, 3A

Examples:

The naming convention for this form must be ##_2065_123456789_ABCD_D_1D when PSU staff deny an applicant or member eligibility for the STAR+PLUS HCBS program.
The naming convention for this form must be ##_2065_123456789_ABCD_D_1A when PSU staff approve an applicant or member eligibility for the STAR+PLUS HCBS program.
The naming convention for this form must be ##_2065_123456789_ABCD_D_2D when PSU staff deny an applicant or member eligibility for the STAR+PLUS HCBS program and complete and upload this file a second time.
The naming convention for this form must be ##_2065_123456789_ABCD_D_2A when PSU staff approve an applicant or member eligibility for the STAR PLUS HCBS program and complete and upload this file a second time.

MCOHub Folders

The STAR+PLUS MCOs use the following folders for all STAR+PLUS HCBS program related uploads. Each MCO has two folders with three-letter identifiers:

ISP — Individual Service Plan, which contains Form H1700-1; and
SPW — STAR+PLUS HCBS program, which contains forms:
- H2065-D;
- H3676; and
- H2067-MC.

Primary Folder: MCO Identifiers	Secondary Folder: MCOHub Folders by Plan
AMG — Wellpoint	AMGISP and AMGSPW
CFHP – Community First Health Plans	CFHPISP and CFHPSPW
CHC – Community Health Choice	CHCISP and CHCSPW
EPH – El Paso Health	EPHISP and EPHSPW
MOL — Molina	MOLISP and MOLSPW
SUP — Superior	SUPISP and SUPSPW
UHC — United Healthcare Community Plan	UHCISP and UHCSPW

Appendix XXXV, SASO Data Entry Guide

Revision Notice 26-2; Effective June 1, 2026

1: Initial Service Authorization

Program Support Unit (PSU) staff must check or create the following records in the Service Authorization System Online (SASO) when authorizing the STAR+PLUS Home and Community Based Services (HCBS) program:

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

1.1: Authorizing Agent - Initial

PSU staff use the authorizing agent record in the SASO to register the authorizing agent begin date. They use an open-ended date for the STAR+PLUS HCBS program applicant.

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

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

The TMHP LTCOP generates changes to the SASO authorizing agent records for a member with a plan code change during an ISP year where a current or future ISP is in a processed or complete status. An SASO authorizing agent record is created for the initial ISP in cases with a begin date equal to the MCO plan effective date. The SASO authorizing agent record for the transferred ISP is automatically ended with the prior MCO plan enrollment end date.

PSU staff:

do not register an authorizing agent for an electronic ISP;
create authorizing agent record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically;
confirm the authorizing agent registration in SASO; and
register PSU staff’s service area as the authorizing agent when an applicant is authorized in SASO.

PSU staff must complete the following activities when manually registering an authorizing agent record in SASO for the STAR+PLUS HCBS program:

Select the Authorizing Agent field in the Case Worker functional area.
Select Add and a blank Authorizing Agent Details record appears.
Move to the Type field and select CM – Case Manager from the drop-down menu.
Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
Leave the Send to TMHP field at the default selection N - NO.
Move to the Begin Date field and enter the effective date of the ISP period.
Leave the End Date field blank.
Move to the Authorizing Agent field and enter STAR+PLUS.
Leave the Agency field at the default selection 324 - DHS.
Move to the Name field and enter the PSU staff’s service area.
Move to the Phone field and enter the phone number of the authorizing agent. Enter the area code, phone number and extension.
Move to the Mail Code field and enter the appropriate MCO plan code.

1.2: Enrollment - Initial

PSU staff use the enrollment record in the SASO to register the enrollment begin and end date for the STAR+PLUS HCBS program applicant.

PSU staff create an enrollment record for STAR+PLUS HCBS program eligibility for applicants whose ISP was not transmitted electronically.

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART).

PSU staff must complete the following activities when manually registering an enrollment record in SASO for a STAR+PLUS HCBS program:

Select the Enrollment field in the Program and Service functional area.
Select Add and a blank Enrollment Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Enrolled From field and select the appropriate entry from the drop-down menu.
Move to the Living Arrangement field and select the appropriate community-based living arrangement from the drop-down menu. The living arrangement must match the information provided in the initial ISP.
Move to the Begin Date field and enter the effective date of the ISP period.
Leave the End Date field blank.
Leave the Termination Code and Waiver Type fields at the defaults.
Select the Save button.

1.3: Service Plan - Initial

PSU staff use the service plan record in the SASO to register an ISP for a STAR+PLUS HCBS program member. The service plan record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level and the total estimated cost taken from the member’s Form H1700-1, Individual Service Plan, on page 1, for members without an electronic ISP.

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

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to HEART.

PSU staff must complete the following activities when manually registering a service plan record in SASO for a STAR+PLUS HCBS program :

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

1.4: Service Authorization - Initial

The TMHP LTCOP automatically generates service authorization records. This is generated in the SASO if the ISP is electronic.

PSU staff:

Do not register service authorization records for an electronic ISP.
Create a service authorization record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.
Must confirm service authorization registration in SASO, take a screenshot of the service authorization registration, and upload the screenshot to the HEART System.

PSU staff must complete the following activities when manually registering a service authorization record in SASO for the STAR+PLUS HCBS program:

Select the Service Authorization field in the Program and Service functional area.
Select Add and a blank Service Authorization Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
Leave the Fund and Term. Code fields at the defaults.
Leave the Agency field at the default selection 324 - DHS.
Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
Move to the Units field and enter 1.00.
Leave the Amount field at the default.
Move to the Begin Date field and enter the effective date of the ISP period.
Move to the End Date field and enter the last day of the ISP period.
Move to the Contract No field and enter the appropriate contract number of the MCO.

1.5: Level of Service - Initial

All STAR+PLUS HCBS program members must have a PDPM LTC level registered on a level of service (LOS) record in the SASO. The LOS record is system generated from information received from the TMHPLTCOP. The MCO nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTCOP or uses the nursing facility (NF) minimum data set (MDS). TMHP determines MN and the PDPM LTC level and then submits it to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system generated LOS record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires.

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

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

PSU staff must complete the following activities when adjusting an LOS record in SASO for the STAR+PLUS HCBS program:

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

PSU staff must complete the following activities to add a LOS record when one was not created in SASO:

Select the Level of Service field in the Medical functional area.
Select Add and a blank Level of Service Details record appears.
Move to the Type field and select PP – StarPlus PDPM from the drop-down menu.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Level field and enter the PDPM LTC level from Form H1700-1, Individual Service Plan, page 1. The PDPM LTC level can be verified in the MN/LOC Assessment.
Move to the Begin Date field and enter the first day of the ISP period.
Move to the End Date field and enter the last day of the ISP period.
Select the Save button.

1.6: Diagnosis - Initial

All STAR+PLUS HCBS program members must have a diagnosis registered in SASO. The diagnosis record should be system generated from information received from the TMHPLTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires.

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

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

PSU staff must complete the following activities to adjust a diagnosis record in SASO for the STAR+PLUS HCBS program:

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

PSU staff must complete the following activities to add a diagnosis record when one was not created in SASO:

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

1.7: Medical Necessity - Initial

All STAR+PLUS HCBS program members must have a MN registered in the SASO. The MN record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then TMHP submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires.

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

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the HEART system.

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

PSU staff must complete the following activities to adjust an MN record for the STAR+PLUS HCBS program:

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

PSU staff must complete the following activities to add a MN record when one was not created in SASO:

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

2: Reassessment Service Authorization

PSU staff authorize STAR+PLUS HCBS program services for a reassessment of the ISP in the SASO. PSU staff must check or create the following records per sections 9210 through 9270:

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

2.1: Authorizing Agent – Reassessment

Check the authorizing agent record for accuracy. If there are no changes, leave the authorizing agent record open-ended. Currently, although the SASO accepts multiple authorizing agent records, the TMHP LTCOP only accepts two authorizing agent records when an SASO file is transmitted to TMHP. Therefore, select NO in the Send to TMHP field for all updates.

PSU staff creates an authorizing agent record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

2.2: Enrollment – Reassessment

PSU staff must check the enrollment record for accuracy and ensure that it is open-ended. PSU staff make no changes if the record is open-ended. PSU staff delete the end date or create another record with a new begin date if the record has an end date. The begin date of the enrollment for the new ISP year is the day after the end date of the previous ISP year to ensure that there is not a gap in service.

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

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the HEART System.

2.3: Service Plan – Reassessment

A new service plan record may need to be created to register the PDPM LTC level cost limit and the amount of services authorized for the new ISP year.

The TMHP LTCOP automatically generates service plan records in the SASO when the ISP is submitted.

PSU staff do not need to create a service plan record for electronic ISPs.

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

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the HEART System.

2.4: Service Authorization – Reassessment

PSU staff create one service authorization record for the STAR+PLUS HCBS program for the new ISP year if the MCO uploads a timely reassessment packet. The begin date of the authorization for the new ISP year is the day after the end date of the previous ISP year to ensure there is no gap in service.

The TMHP LTCOP automatically generates service authorization records in the SASO.

PSU staff must confirm service authorization records generated from the TMHP LTCOP appear in SASO.

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

Two service authorization records are required for STAR+PLUS HCBS program eligibility if the MCO does not upload a timely reassessment packet. The first service authorization record for STAR+PLUS HCBS program eligibility is entered with service group (SG) 19 and service code (SC) 13 for the month(s) that the ISP was late. The second Service Authorization record for STAR+PLUS HCBS program eligibility is entered with SG 19 and SC 12 for the remaining ISP period.

PSU staff must complete the following activities when manually entering a Service Authorization record for an untimely reassessment for the STAR+PLUS HCBS program:

Select the Service Authorization field in the Program and Service functional area.
Select Add and a blank Service Authorization Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Service Code field and select 13 – NURSING SERVICES from the drop-down menu.
Leave the Fund and Term. Code fields at the defaults.
Leave the Agency field at the default selection 324 - DHS.
Move to the Unit Type field and select 4 – PER AUTHORIZATION from the drop-down menu.
Move to the Units field and enter 1.00.
Leave Amount field at the default.
Move to the Begin Date field and enter the effective date of the new ISP coverage period.
Create two service authorization records. For the first record, move to the End Date field and enter the last day of the month the ISP was received. Note: For the second record, repeat steps 1 through 10. Move to the Begin Date field and enter the first of the next month and move to the End Date field and enter the end date of the ISP period.
Move to the Contract No. field and enter the appropriate contract number of the MCO.
The NPI field is read-only.
Select the Save button.

2.5: Level of Service – Reassessment

All STAR+PLUS HCBS program members must have a PDPM LTC level registered in the SASO. The LOS record will be system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines the MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system-generated LOS record has a begin and end date that matches the new ISP year.

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

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

2.6: Diagnosis – Reassessment

All STAR+PLUS HCBS program members must have a diagnosis registered in the SASO. The diagnosis record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information from this form to the TMHP LTCOP or uses NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

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

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

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

2.7: Medical Necessity – Reassessment

All STAR+PLUS HCBS program members must have a MN registered in the SASO. The MN record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment for the annual reassessment and submits the information to the TMHP LTCOP or uses NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record has a begin date and an end date that matches the new ISP year.

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

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the HEART System.

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

3: Transfers

There are several situations considered transfers for STAR+PLUS Home and HCBS for each.

3.1: Transfers from One STAR+PLUS Area to Another Area

Two different situations can occur when a HCBS program member transfers from one service area (SA) to another SA. The first situation is when a member transfers to a new SA that the current MCO also operates in, and the member wants to stay with that MCO. The second situation is when the member transfers to a new SA that the current MCO does not operate in, and the member changes MCOs. The contract number will change when a plan change occurs, even if the member stays with the same MCO in the same SA. As a result, the member’s records will need to be closed under the previous contract number and opened under the new contract number.

The TIERS updates the TMHP LTCOP if the member's ISP is electronic and the member made a new MCO selection. The TMHP LTCOP automatically interfaces with the SASO to:

close the SASO registration records for the old MCO; and
create new SASO registration records for the new MCO.

PSU staff must manually close SASO registration records when a member’s MCO plan change is not timely. To process the transfer, the PSU staff must:

close the existing:
- Authorizing Agent (SC 12) record;
- Service Authorization (SG 19/ SC 12) record;
open a new:
- Authorizing Agent (SC 12) record; and
- Service Authorization (SG 19/SC 12) record using the MCO contract number in the new SA.

The PSU staff must complete the following activities to close the Authorizing Agent record:

Open the STAR+PLUS HCBS program member’s case in the SASO.
Select the Authorizing Agent field from the Case Worker functional area.
Select the Authorizing Agent record you wish to close.
Select the Modify button to open and modify.
Move to the End Date field and enter the effective date of the termination, which is the last day of the month that the member moved to the new SA.
Select the Save button.

The PSU staff must complete the following activities to close the Service Authorization record:

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

The Service Authorization record is opened per procedures outlined in determining initial eligibility for STAR+PLUS HCBS program members with the following exceptions:

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

Example: If a STAR+PLUS HCBS program member with an ISP period of Nov. 1, 2019, to Oct. 31, 2020, transfers to another STAR+PLUS SA on Jan. 15, 2020, the end date for these records remains Oct. 31, 2018.

3.2: Transfers from One MCO to Another MCO in the Same Service Area

TIERS will update the managed care enrollment in the TMHP LTCOP when:

a STAR+PLUS HCBS program member has an ISP in the TMHP LTCOP; and
chooses a new MCO timely before state cutoff.

This update automatically closes the registration for the old MCO and creates the registration for the new MCO in the SASO.

PSU staff must manually close existing service authorization records in SASO if the member's plan change request is not timely. PSU staff process untimely requests by manually closing the existing service authorization record, SC 12 for the old MCO and manually creating a new service authorization record, SC 12, for the new MCO in SASO.

PSU staff must complete the following activities when manually closing an existing service authorization record:

Move to the Service Authorization field in the Program and Service functional area.
Select the appropriate Service Authorization record you wish to close.
Select the Modify button.
Move to the End Date field and enter the effective date of the termination. This is the last day of the month that the member was enrolled in the old MCO.
Move to the Termination Code field and select 39 – Other or the appropriate code from the drop-down menu.
Select the Save button.
Select Submit to SASO.
Select Outbox and then Inbox to make sure the case is processed correctly.

PSU staff must complete the following activities when manually creating a new service authorization record for the new MCO:

Select the Service Authorization field in the Program and Service functional area.
Select Add and a blank Service Authorization Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
Leave the Fund and Term. Code fields at the defaults.
Leave the Agency field at the default selection 324 - DHS.
Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
Move to the Units field and enter 1.00.
Leave the Amount field at the default.
Move to the Begin Date field and enter the new MCO contract number or plan code enrollment date.
Move to the End Date field to align with the last day of the ISP coverage period.
Move to the Contract No. field and enter the appropriate contract number of the MCO.

4: MFP Authorization for STAR+PLUS HCBS Program Applicant

PSU staff do not close the Authorizing Agent, Medical Necessity, Level of Service PDPM LTC level records. PSU staff must make sure Provider Claims Services (PCS) closes the enrollment and service authorization records for SC 1, 3, 50 and 60. There may be an overlap of STAR+PLUS HCBS program and PCS records in SASO.

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

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

SU must create the records needed for the ongoing MFP STAR+PLUS HCBS program eligibility. These records must be completed to check or create an initial service authorization for the STAR+PLUS HCBS program.

4.1: Authorizing Agent for MFP Applicant

There will be one authorizing agent record entered for an MFP applicant. PSU staff are entered as the authorizing agent when manually processing an MFP case.

PSU staff must complete the following activities when manually registering an authorizing agent for an MFP applicant:

Select the Authorizing Agent field in the Case Worker functional area.
Select Add and a blank Service Authorization Details record appears.
Move to the Type field and select CM - CASE MANAGER from the drop-down menu.
Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
Leave the Send to TMHP field at the default selection N - NO.
Move to the Begin Date field and enter the effective date of the ISP period.
Leave the End Date field blank.
Move to the Authorizing Agent ID field and enter STAR+PLUS.
Leave the Agency field at the default selection 324 - DHS.
Move to the Name field and enter the PSU staff’s service area.
Move to the Phone field and enter the phone number of the Authorizing Agent. Enter the area code, phone number and extension.
Move to the Mail Code field and enter the appropriate MCO Plan Code.
Select the Save button.

4.2: Enrollment for MFP Applicant

PSU staff use the enrollment record in the SASO to register the enrollment begin date with an open-ended date for the STAR+PLUS HCBS program member.

PSU staff:

Create an enrollment record for STAR+PLUS HCBS program eligibility for members.
Take a screenshot of the enrollment registration in SASO and upload the screenshot to the HEART System.

PSU staff must complete the following activities when manually registering an authorizing agent in SASO for an MFP applicant:

Select the Enrollment field in the Program and Service functional area.
Select Add and a blank Service Authorization Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Enrolled From field and select the appropriate entry from the drop-down menu. If this is an MFP authorization, be sure to select 12 - MONEY FOLLOWS THE PERSON from the drop-down menu.
Move to the Living Arrangement field and select the appropriate community-based living arrangement from the drop-down menu.
Move to the Begin Date field and enter the effective date of the ISP period.
Leave the End Date field blank.
Leave the Termination Code and Waiver Type at the defaults.
Select the Save button.

4.3: Service Plan for MFP Applicant

Use the service plan record to register an ISP for a STAR+PLUS HCBS program member. The record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s PDPM LTC level and the total estimated cost of the STAR+PLUS HCBS program services taken from the member’s Form H1700-1, Individual Service Plan. page 1.

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

PSU staff take a screenshot of the service plan registration in the SASO and upload the screenshot to the HEART System.

PSU staff must complete the following activities when manually registering a service plan record in SASO for a MFP applicant:

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

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

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

4.4: Service Authorization for MFP Applicant

PSU staff create one service authorization record for STAR+PLUS HCBS program eligibility.

PSU staff must complete the following activities when manually registering a service authorization record in SASO for a MFP applicant:

Select the Service Authorization field in the Program and Service functional area.
Select Add and a blank Service Authorization Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
Leave the Fund and Term. Code fields at the defaults.
Leave the Agency field at the default selection 324 - DHS.
Move to the Unit Type field and select 2 – MONTH from the drop-down list.
Move to the Units field and enter 1.00.
Leave Amount at the default.
Move to the Begin Date field and enter the effective date of the ISP coverage period.
Move to the End Date field and enter the last day of the ISP coverage period.
Move to the Contract No. field and enter the appropriate contract number of the MCO.
The NPI field is read-only.
Select the Save button.

4.5: Level of Service for MFP Applicant

There will be an existing SG 1 (NF) LOS record. However, PSU staff must create a new LOS record for SG 19 STAR+PLUS HCBS program. The SG 1(NF) LOS record can stay open.

All STAR+PLUS HCBS program members must have an LOS registered in the SASO. The LOS record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHPLTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

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

PSU staff must complete the following activities to add an LOS record in SASO:

Select the Level of Service field in the Medical functional area.
Select Add and a blank Level of Service Details record will appear.
Move to the Type field and select PP – StarPlus PDPM from the drop-down menu.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
Move to the Level field and enter the PDPM LTC level.
Move to the Begin Date field and enter the first day of the ISP period.
Move to the End Date field and enter the last day of the ISP period.
Select the Save button.

4.6: Diagnosis for MFP Applicant

There will be an existing SG 1 diagnosis record. PSU staff must create a new diagnosis record for SG 19 STAR+PLUS HCBS program.

All STAR+PLUS HCBS program members must have a diagnosis registered in the SASO. The diagnosis record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The system-generated diagnosis record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires, if applicable.

PSU staff must complete the following activities to add a diagnosis record in SASO:

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

4.7: Medical Necessity for MFP Applicant

All STAR+PLUS HCBS program members must have a medical necessity (MN) registered in the SASO. The MN record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in SASO. The system-generated MN record’s end date may need adjusting by PSU staff through the last day of the month that the ISP expires. PSU must enter an end date that matches the ISP end date on MN records that appear as permanent, PMN, in SASO.

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

PSU staff takes a screenshot of the MN registration in SASO and upload the screenshot to the HEART System.

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

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

PSU staff must complete the following activities to adjust an MN record in SASO for an MFP applicant:
Select the MN field in the Medical functional area.
Select the existing MN record.
Select the Modify button to open and modify.
Move to the End Date field and change the date to the last day of the ISP period.
Select the Save button.

PSU staff complete the following activities to add an MN record in SASO:

Select the MN field in the Medical functional area.
Select Add and a blank MN Details record appears.
Leave the MN field at the default of Y - YES.
Leave the Permanent field at the default of N - NO.
Move to the Begin Date field and enter the first day of the ISP period.
Move to the End Date field and enter the last day of the ISP period.
Select the Save button.

PSU staff must complete the following activities to add a diagnosis record in the SASO:

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

4.8: MFPD for STAR+PLUS HCBS Program Applicant

The option to electronically submit an ISP for a NF resident is not available. The MCO must not use the TMHP LTCOP MFPD check box. PSU staff must continue to manually register this fund code in the SASO.

PSU staff must follow the instructions for an MFP applicant above and complete the service authorization record as follows.

Select the Service Authorization field in the Program and Service functional Area.
Select Add and a blank Service Authorization Details record appears.
Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
Move to the Fund field and select 19MFP – MONEY FOLLOWS PERSON.
Leave the Term. Code field at the defaults.
Leave the Agency field at the default selection 324 - DHS.
Move to the Unit Type field and select 2 – MONTH from the drop-down list.
Move to the Units field and enter 1.00.
Leave the Amount field at the default.
Move to the Begin Date field and enter the effective date of the ISP period.
Move to the End Date field and enter the last day of the MFPD entitlement period. Create a new Service Authorization record without the 19MFP – MONEY FOLLOWS PERSON fund code for the remaining ISP period, as applicable.
Move to the Contract No. field and enter the appropriate contract number of the MCO.
The NPI field is read-only.
Select Force for the Service Authorization record with the 19MFP – MONEY FOLLOWS PERSON code. Enter Member consented to MFPD in the pop-up box.
Select the Save button.

The MCO must notify PSU staff once the 365-day MFPD period has passed using Form H2067-MC, Managed Care Programs Communication. PSU staff must change the Service Authorization record to the default within five business days of the MCO notification.

5: Mutually Exclusive Services within the STAR+PLUS HCBS Program

The Community Care Services Eligibility (CCSE) case manager should close the community services authorization with an effective date one day before the date the member is eligible for the STAR+PLUS HCBS program.

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

6: MDCP or CCCP Transitioning to STAR+PLUS HCBS Program

PSU staff enter the initial STAR+PLUS HCBS program eligibility into the SASO using the steps for initial eligibility. The one exception is for Medically Dependent Children Program (MDCP), Comprehensive Care Program (CCP) or Private Duty Nursing (PDN) members who are transitioning to the STAR+PLUS HCBS program. The effective date for all records are the first of the month following the member’s 21st birthday.

It is possible that the medical records such as Medical Necessity, Level of Care or Diagnosis, will need adjusting in SASO to cover the entire ISP period.

7: Terminations

PSU staff manually close Authorizing Agent, Enrollment, Service Authorization, and Service Plan records in the SASO on the termination effective date when all services for an existing STAR+PLUS HCBS program member are terminated.

PSU staff do not close the MN LOS, and Diagnosis SG 19 – STAR+PLUS records unless the termination is due to the member’s death. In this case the date of death is the termination effective date.

8: Appeal Extensions for Continued Benefits

PSU staff extend all records including Service Authorization, Service Plan and Enrollment, by four months if a STAR+PLUS HCBS program member files an appeal and requests continued benefits. PSU staff must open each record and change the end date to the last day of the month – four months in the future. PSU staff must complete this activity each time an extension is needed. Multiple extensions may be requested if the appeal process is not finalized.

Continuation of STAR+PLUS HCBS program benefits during a state fair hearing does not apply for Supplemental Security Income denials. Refer to 7222.1, Continuation of STAR+PLUS HCBS Program During a State Fair Hearing, for more information.

Appendix XXXVI, Long Term Services and Supports

Appendix XXXVII, STAR Kids Transition Activities

Appendix XXXVIII, CCSE Region by Service Area

Revision 25-2; Effective June 6, 2025

PSU Service Area	Counties	CCSE Mailbox
Bexar	Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson Counties	Region 8
Dallas	Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall Counties	Region 3
El Paso	El Paso and Hudspeth Counties	Region 10
Harris	Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton Counties	Region 6
Hildalgo	Maverick County	Region 8
Hildalgo	Cameron, Duval, Hidalgo, Jim Hogg, McMullen, Starr, Webb, Willacy and Zapata Counties	Region 11
Jefferson	Hardin, Jasper, Jefferson, Newton, Orange, Polk, San Jacinto and Tyler Counties	Region 5
Jefferson	Chambers, Liberty and Walker Counties	Region 6
Lubbock	Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher and Terry Counties	Region 1
Medicaid Rural Service Area (MRSA) – Central	Comanche County	Region 2
	Erath and Somervell Counties	Region 3
	Colorado County	Region 6
	Bell, Blanco, Bosque, Brazos, Burleson, Coryell, Falls, Freestone, Grimes, Hamilton, Hill, Lampasas, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba and Washington Counties.	Region 7
	DeWitt, Gillespie, Gonzales, Jackson and Lavaca Counties	Region 8
MRSA – Northeast	Montague County	Region 2
	Cooke, Fannin and Grayson Counties	Region 3
	Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt and Wood Counties	Region 4
	Angelina, Houston, Nacogdoches, Sabine, San Augustine, Shelby, and Trinity Counties	Region 5
MRSA - West	Armstrong, Bailey, Briscoe, Castro, Childress, Cochran, Collingsworth, Dallam, Dickens, Donley, Gray, Hall, Hansford, Hartley, Hemphill, King, Lipscomb, Moore, Motley, Ochiltree, Oldham, Parmer, Roberts, Sherman, Wheeler and Yoakum Counties	Region 1
	Archer, Baylor, Brown, Callahan, Clay, Coleman, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Nolan, Runnels, Scurry, Shackelford, Stephens, Stonewall Taylor, Throckmorton, Wichita, Wilbarger, and Young Counties	Region 2
	Palo Pinto County	Region 3
	Dimmit, Edwards, Frio, Kerr, Kinney, La Salle, Real, Uvalde, Val Verde and Zavala Counties	Region 8
	Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling Sutton, Terrell, Tom Green, Upton, Ward and Winkler Counties	Region 9
	Brewster, Culberson, Jeff Davis and Presidio Counties	Region 10
Nueces	Calhoun, Goliad, Karnes, and Victoria Counties	Region 8
Nueces	Aransas, Bee, Brooks, Jim Wells, Kenedy, Kleberg, Live Oak, Nueces, Refugio and San Patricio Counties	Region 11
Tarrant	Denton, Hood, Johnson, Parker, Tarrant and Wise Counties	Region 3
Travis	Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, and Williamson Counties	Region 7

Appendix XXXIX, CSIL Closure Guide