Revision 17-1; Effective March 15, 2017

The Texas Health and Human Services Commission uses the Texas Integrated Eligibility Redesign System (TIERS) as the system of record.

7110 TIERS Inquiries

Revision 21-4; Effective Sept.1, 2024

Use TIERS Inquiry to determine the financial eligibility status of people applying for or receiving services.

Use one of the following two ways to complete inquiries in the HHSC Benefits Portal:

• PT Inquiry; or
• clicking the application to launch TIERS.

Refer to the HHSC Benefits Portal and TIERS Inquiry Overview, found in the Program Area Learning Management System (PALMS).

Revision 24-4; Effective Sept. 1, 2024

Refer to Appendix XIV, TIERS Type Program Chart, to determine how existing coverage affects eligibility for Community Care Services Eligibility.

7210 Safeguarding Personally Identifiable Information

Revision 24-4; Effective Sept. 1, 2024

All personally identifiable information (PII) obtained from the Social Security Administration (SSA) must be safeguarded. Wire Third Party Query (WTPY) System, State Online Query (SOLQ) or other SSA documentation is considered SSA-protected and cannot be printed or kept in the case record.

Staff must not print or file PII WTPY/SOLQ printouts in the person’s case records. Staff must document the date they verified and viewed the online or printed verification, the amount of income and source, WTPY, SOLQ, or other used to verify the information.

If a WTPY or SOLQ report must be printed for a specific purpose such as a legal request or legislative inquiry, the document must not be filed in the case record or sent for imaging. SSA documents must be stored in a central locked filing cabinet accessible by Texas Health and Human Services Commission authorized staff.

7220 Financial Eligibility Based on Receipt of Medicaid Buy-In Program Services

Revision 24-4; Effective Sept. 1, 2024

Working Texans can purchase health insurance through Medicaid by paying a monthly premium through the Medicaid Buy-In (MBI) program. Participants in MBI must meet specific work, disability, resource and income requirements. Not all MBI recipients pay a premium. Premiums are determined on a sliding scale based on a person's income.

Categorical Eligibility Status Verification

People applying for long-term services and supports (LTSS) who have MBI coverage are categorically eligible for all Title XX Community Care programs, Title XIX Day Activity and Health Services and Primary Home Care.

MBI coverage must be verified by one of the following:

• Searching the Texas Integrated Eligibility Redesign System (TIERS) database for Type Program (TP) 87 coverage. The (TP) 87 information will not appear on the System for Applications, Verifications, Eligibility Reports and Referral inquiry screens.
• An award letter sent to the person documenting MBI eligibility.

Staff may contact the regional TIERS coordinator or a special workers assisting with TIERS (SWAT) member to verify an applicant's MBI status.

MBI and Receipt of Waiver Services

Add an MBI recipient interested in an LTSS waiver program to the appropriate interest list. The caseworker can determine if an applicant is an MBI Medicaid Buy-In.

More information about the MBI program is available in Section M-1000, Medicaid Buy-In (MBI) Program, of the Medicaid for the Elderly and People with Disabilities Handbook.

7230 Hierarchy of A Person's Identification Data

Revision 24-4; Effective Sept. 1, 2024

Before certifying an applicant with a previously assigned Individual number, compare information in the Texas Integrated Eligibility Redesign System (TIERS) to the information in the case record. Note and clear any discrepancies with the applicant or other staff involved. An applicant’s demographic information must be entered exactly as it appears in the Social Security Administration (SSA) records for date of birth, Social Security number and Individual number, if available.  The demographic information should not be entered into a database before a State On Line Query (SOLQ), Wired Third Party Query (WTPY) System or other SSA documentation is received confirming the validity of the data. Review Section 7210, Safeguarding Personally Identifiable Information, for important SSA data security information.

The computer system keeps only one set of identification information for each person. When a person is active in more than one program area, staff members share the identification information. Only the staff member with the highest priority over the information can change the identification information. The following priority applies:

• A program area supplying benefits to a person takes precedence over a program area not supplying benefits to that person.
  • Example: Temporary Assistance for Needy Families (TANF) caretaker information takes precedence over TANF payee information;
  • status in group Code 1 (Medical Assistance Only (MAO) recipient) information takes precedence over Code 3 (MAO eligible spouse) information; and
  • an active case takes precedence over a denied case.
• For name and birth date identification data:

• For sex and race identification data:

7230.1 Address Changes for SSI Recipients

Revision 24-4; Effective Sept. 1, 2024

Tell a person on Supplemental Security Income (SSI) or their responsible party to contact the Social Security Administration (SSA) to request the residence address change when the person changes addresses. The address change will be in the Texas Integrated Eligibility Redesign System (TIERS) after SSA makes the change.

HHSC caseworkers must not send address change requests for SSI recipients to the TIERS Document Processing Center (DPC) in Austin. Although HHSC staff can make those address changes, the addresses will revert to the address on the SSI record at the next state cut off. The address change must be made by SSA.

7240 Merge and Separate

Revision 24-4; Effective Sept. 1, 2024

If a person is wrongly assigned more than one Individual Number or two or more people are assigned the same Individual Number, the caseworker must report the problem to the state office Data Control Unit.

If the case must be certified before merging, decide which number to enter using the following rules to select the Individual Number. If you have:

• An active person and a denied person in the same or different program area, use the Individual Number from the active case.
• Two Individual Numbers in different program areas, use the Individual Number from the case with Medicaid coverage.
• An active person receiving benefits and an active person not receiving benefits in the same program area, use the Individual Number from the case receiving benefits.
• A denied person with Medicaid and one denied person with no Medicaid, use the Individual Number from the denied case with Medicaid.
• Denied people in the same program area, use the Individual Number most recently denied.

Revision 26-1; Effective Mach 1, 2026

The Service Authorization System Online (SASO) is the primary repository of service information for all applicants and recipients enrolled in the Texas Health and Human Services Commission (HHSC) long-term services and supports (LTSS) programs. SASO accepts and maintains information relevant to the applicant's or recipient's authorizations for LTSS. Services must be authorized in SASO before a provider can receive payment.

SASO contains wizards with prompting sequences that lead the user through a series of windows required for authorization or denial of services. Wizards used to authorize or terminate Community Care Services Eligibility (CCSE) are the:

• financial wizard;
• functional wizard; and
• authorization wizard.

7310 Requirement to Use SASO Wizards

Revision 26-1; Effective March 1, 2026

Regional management must make sure the Community Care Services Eligibility (CCSE) SASO wizards is used to:

• enhance the accuracy of eligibility determinations, service plans, service authorizations and data;
• improve documentation of recipient satisfaction;
• provide a database for provider monitoring and case reading sample selection; and
• ensure compliance with federal regulations for program delivery.

SASO Wizards must be used to document the following case actions:

• authorizations, including initials, adding more services, ongoing reassessments and changes;
• monitoring;
• terminations; and
• denials.

7320 Use of the SASO Monitoring Wizard

Revision 25-4; Effective Sept. 1, 2025

SASO Monitoring Wizard documents all required monitoring contacts with Community Care Services Eligibility (CCSE) recipients.

Document the recipient’s assessment of how well CCSE services meet their needs on Form 2314, Satisfaction and Service Monitoring and enter in the SASO Monitoring Wizard. Data entry must occur before the end of the month when the action is due. When a person expresses dissatisfaction with a particular service or if the caseworker identifies a concern with a particular service, then caseworkers should document this information using Form 2314.

Note: Record added contact with the recipient outside of the monitoring home visit or phone call, such as other changes or complaints using regional procedures. Do not use Form 2314, Satisfaction and Service Monitoring.

Some information gathered at a monitoring home visit or phone call may cause action codes to send referrals to HHSC staff. This staff may include contract managers, regional nurses or supervisors. When a referral is needed, CCSE staff go to the SASO Monitoring Wizard Client Satisfaction window, select Monitoring Status: Follow-Up Required, then Generate.

To complete follow-up actions, update the SASO monitoring record by entering the additional fields on the Monitor Detail screen:

• Concurs with Previous? Yes or No
• Problems Alleged
• Reason
• Action  

The Monitoring Status field on the Client Satisfaction screen changes to Completed once follow-up and resolution are complete.

The Overall Client Satisfaction question must be completed to document the recipient’s overall service satisfaction. Document the recipient’s level of satisfaction after any alleged dissatisfaction is resolved.

Regional management ensures compliance by using Form 2314 and the SASO Monitoring Wizard. The information entered provides a database for provider monitoring and ensures compliance with federal regulations.

7330 Reserved for Future Use

Revision 20-2; Effective June 1, 2020

Revision 24-4; Effective Sept.1, 2024

The Community Services Interest List (CSIL) is a web-based application for tracking people interested in receiving services in various Community Care programs if funding is not available.

The CSIL can be used for a variety of functions. The system works in real- time, and once data is entered into the system, it is accessible to anyone with the correct permissions. Some functions are restricted to a few people with specific permissions. Permissions are designated by user groups. A user group is made up of users with permission to perform various functions in the CSIL application. Example: The CSIL Admin group can perform some functions that the CSIL Worker group cannot. Regional management decides which group(s) staff will be assigned, and more than one group may be approved.

The CSIL system is used to:

• enter a person on CSIL directly or through the Long-Term Care Services Intake (NTK) System;
• track monitoring contacts;
• update information on people listed on CSIL;
• release groups of people listed on CSIL when funding is available;
• let supervisors assign people’s interest requests to caseworkers;
• close people from the interest list when certified;
• search for people listed on the CSIL; and
• determine a person's status on the CSIL.

Find complete instructions for use of the CSIL on the Web Based Training website.

7510 Outlook Mailboxes for Communication from Medicaid for the Elderly and People with Disabilities (MEPD)

Revision 18-1; Effective June 15, 2018

HHSC Information Technology (IT) has established Outlook resource mailboxes and Outlook procedures for HHSC staff to access electronic information sent by MEPD staff using the MEPD Communication Tool.

HHSC will have regional staff designated to monitor MEPD communication by following the steps below to access the resource mailbox in Outlook.

1. With Outlook open, select File from the menu. Then select Account Settings and again, select Account Settings

2. Select Change from the list of options

3. Select More Settings.

4. Select Advance from the menu then Add.

5. Enter the region's designated Alias as listed in the table below. (For example, "mecreg01" is entered for Region 1.

6. Once the alias is entered, select OK, Next, Finish, then Close. HHSC regional designated Resource Mailbox users will access the region's resource mailbox folder in the Outlook tree.

Resource Mailbox owners designated by regional management will be able to add, edit or delete Resource Mailbox users by right-clicking on the mailbox folder. Resource Mailbox owners must contact the Consolidated Help Desk (512-438-4720) if assistance is needed to add, edit or delete Resource Mailbox users.

Permission to forward information from the resource mailbox requires configuration of a separate Outlook profile. Resource Mailbox owners should submit a Help Desk ticket to have this completed for the authorized users.

The regional Resource Mailbox folder will have a single password that will be shared by all authorized users in that region. It is important that one person per mailbox be designated to maintain the password. All other authorized users must understand they are not to reset the password.