25-5, Quarterly Revision
Body
Revision Notice 25-5, Effective Dec. 1, 2025
The following sections were revised in the Community Care Services Eligibility (CCSE) Handbook:
| Section | Title | Change |
|---|---|---|
| 2221 | Request for STAR+PLUS Services | Adds clarification that people with ME-Nursing Facility Medicaid can be approved for PHC with CCSE services while waiting on MEPD determination of CAS. |
| 2723 | Freedom of Choice | Adds link to related policy. |
| 2740 | Fraud Detection and Documentation | Changes title to Fraud, Waste and Abuse Detection and Documentation. |
| 2741 | Provider Fraud | Changes title to Provider Fraud, Waste and Abuse. |
| 2742 | Responding to Allegations of Provider Fraud | Changes title to Responding to Allegations of Provider FWA. |
| 2743 | Individual Fraud | Changes title to Personal FWA. |
| 2744 | Responding to Allegations of Individual Fraud | Changes title to Responding to Allegations of Personal FWA. |
| 2745 | Reporting Suspected Fraud in the Consumer Directed Services Option | Changes title to Reporting Suspected Personal or Provider FWA. Updates policy and contact information to coincide with Office of Inspector General (OIG). |
| 2750 | Fraud Referrals | Changes title to Reporting Suspected FWA in the Consumer Directed Services Option. Updates policy and contact information to coincide with OIG. |
| 2751 | Development of the Fraud Referral Packet | Changes title to Reserve for Future Use. Deletes section, combines information with other sections. |
| 2752 | Expedited Referrals | Updates contact information for OIG. |
| 2753 | Referral of Potential Fraud | Changes title to Reserve for Future Use. Deletes section, combines information with other sections. |
| 2830.1 | People Who Refuse to Comply with Electronic Visit Verification Requirements | Adds link to related policy. |
| 2911 | Notice to the Provider for Continuing Services | Adds link to related policy. |
| 4520 | Eligibility | Adds link to TAC. |
| 4632 | Financial Eligibility | Adds clarification that allows people discharged from institution with ME-Nursing Facility Medicaid can receive PHC service with CCSE pending financial determination from MEPD. |
| 4634 | Practitioner’s Statement of Medical Need | Adds link to TAC. Adds clarification to current policy on obtaining new Form 3052 after denial for any reason. |
| 4665 | Service Initiation and Delivery | Adds link to TAC. |
| 4722 | Emergency Care Eligibility | Adds link to TAC. |
| 4731 | Assessment | Adds link to TAC. |
| 4740 | Individual Contribution to the Cost of Care | Changes title to Personal Contribution to the Cost of Care. Adds link to TAC. |
| 4750 | Personal Leave | Adds link to TAC. |
| 4760 | Hospital, Nursing Home or Institutional Facility Stays | Adds link to TAC. |
| 4771 | Facility Reporting and Notification Requirements | Adds link to TAC. |
| 4910 | SSPD Program Description | Deletes outdated SSPD Policy. Adds link to Appendix XX, Mutually Exclusive Services. |
| 6121 | Individual Decision | Changes title to Personal Decision. |
| 6321 | Personal Responsibilities | Adds link to TAC. |
| 6322.2 | Presentation of the CDS Option | Adds link to TAC. |
| 6323 | FMSA Responsibilities | Adds link to TAC. |
| 6330 | Individual Decision | Changes title to Personal Decision. Adds link to TAC. |
| 6332.1 | Pre-Enrollment Requirements | Adds clarification for negotiating begin date for services for people currently receiving services under the agency option transferring to the CDS option and new people starting directly on the CDS option. |
| Appendix VIII | Residential Care and Emergency Care Mental and Physical Characteristics | Adds section back to CCSE handbook from The Loop. Updates language based on HHS Brand Guide rules. |
| Appendix XIV | TIERS Type Program and Type Assistance Chart | Updates TA 10 ME-Waivers, remove TxHmL from eligibility for CCSE services. TP 17 ME- Nursing Facility Resident adds if discharged from facility they can be eligible for CCSE services. |
| Appendix XX | Mutually Exclusive Services | Added additional HHS programs to chart. Removed SSPD 24hr. SAC no longer CCSE Title XX program. |
Forms
The following forms were revised in the CCSE Handbook:
| Form No. | Title | Change |
|---|---|---|
| Form 2060 | Needs Assessment Questionnaire, Task and Hour Guide | Adds clarification about adding an additional purchased task when the task is not currently purchased. |
| 2065-A | Notification of Community Care Services Attachment A | Adds new denial code under 39 with Spanish translation for contact termination. |
| 2065-A | Notification of Community Care Services. Instructions | Adds example for change in priority status. |