SKH Revisions
25-2, Updates Multiple Sections in Handbook
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Revision Notice 25-2; Effective Sept. 1, 2025
The following change(s) were made:
| Section | Title | Change |
|---|---|---|
| 1510 | Medical Necessity Determination | Updates section. |
| 1520 | Individual Cost Limit | Updates section. |
| 2030 | Managed Care Organization Coordination | Updates section. |
| 2111 | Non-STAR Kids Individual Residing in an NF | Updates section. |
| 3310 | Service Planning | Updates section. |
| 3320 | Service Planning for Medically Dependent Children Services | Updates section. |
| 3321 | Medically Dependent Children Program Individual Service Plan Revision | Updates section. |
| 3322 | Medically Dependent Children Program Individual Service Plan and Budget Revision | Updates section. |
| 3324 | Individual Service Plan Exceeding the Cost Limit for Medically Dependent Children Program Services | Updates section. |
| 4600 | Medically Dependent Children Program Services | Updates section. |
| 6240 | Denial Termination as a Result of Exceeding the Cost Limit | Updates section. |
| 7620 | New Assessment Required by Fair Hearing Decision | Updates section. |
| Appendix I | MCO Business Rules for SK-SAI and SK-ISP | Updates section. |
| Appendix VIII | Medically Dependent Children Program (MDCP) Individual Service Plan (ISP) Cost Limits | Updates section. Changes title to MDCP ISP Cost Limits. |
Forms
The following forms were revised in the STAR Kids Handbook:
| Form No. | Title | Change |
|---|---|---|
| Form 2603 Instructions | STAR Kids Individual Service Plan (ISP) Narrative | Updates instructions. |
| Form 2604 | STAR Kids Individual Service Plan – Service Tracking Tool | Updates form. |
25-1, Revises Sections Throughout the Handbook
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Revision Notice 25-1; Effective March 1, 2025
| Section | Title | Change |
|---|---|---|
| 1320 | Service Coordination and Programs Serving Member with Intellectual or Developmental Disabilities | Amends language for clarification purposes. Removes example of PDN. |
| 2030 | Managed Care Organization Coordination | Amends language for clarification purposes. |
| 2112 | STAR Kids Member Residing in an NF | Amends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP. |
| 2210 | Medical Necessity Expiration | Updates instructions for MCOs to submit member SK-SAI’s to the TMHP Long Term Care Online Portal. |
| 3110 | Assessment of Medical Necessity for Community First | Updates to change Medicaid Management Information System to Long Term Care Online Portal. |
| 3120 | Assessment of Medical Necessity for the Medically Dependent Children Program | Updates to change Medicaid Management Information System to Long Term Care Online Portal. |
| 3210 | Reassessment of Medical Necessity or Level of Care | Amends language for clarification purposes. |
| 3320 | Service Planning for Medically Dependent Children Services | Amends language for clarification purposes. Removes language that MCOs receive a response file from TMHP. |
| 3322 | Medically Dependent Children Program Individual Service Plan and Budget Revision | Amends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP. |
| 3329 | Reassessment Notification Requirements | Updates the number of days required for PSU staff requirements if a member files a state fair hearing or external medical review. |
| 4111 | Determining Institutional Level of Care | Amends language for clarification purposes. Removes reference that TMHP makes MN determinations on behalf of HHSC. |
| 4131 | Assessment of Nursing Facility of Care | Amends language for clarification purposes. Removes reference that TMHP evaluates member eligibility for NF services. Replaces references to TMHP with HHSC. |
| 4132 | Reassessment for a Nursing Facility Level of Care | Amends language for clarification purposes. Updates language to include Medicaid Management Information System. |
| 4300 | Private Duty Nursing | Corrects links to TMPPM’s Home Health Nursing and Private Duty Nursing Handbook, and TMPPM’s Children’s Services Handbook. |
| 6200 | Denial/Termination of Medically Dependent Children Program | Amends language for clarification purposes in Provides additional language for clarification of when HHSC terminates MDCP enrollment. |
| 6210 | Denial/Termination Due to Death | Amends language for clarification purposes. Updates language to clarify when HHSC will terminate MDCP enrollment. |
| 6220 | Denial/Termination Due to Residence in a Nursing Facility | Amends language for clarification purposes. |
| 6240 | Denial/Termination as a Result of Exceeding the Cost Limit | Changes title to Denial or Termination as a Result of Exceeding the Cost Limit Amends language for clarification purposes. Updates language to include Medicaid Management Information System. |
| 6250 | Denial/Termination of Medical Necessity | Changes title to Denial or Termination of Medical Necessity Amends language for clarification purposes. Replaces references to TMHP with HHSC. |
| 7300 | State Fair Hearing Requests- Appealing MCO Actions | Removes a reference to applicants and members requesting a state fair hearing for non-eligibility reasons. |
| 7310 | Program Support Unit Coordination | Amends language for clarification purposes. Replaces references to TMHP with HHSC. Updates timeline where staff must enter SFH requests for MDCP eligibility in TIERS. |
| 7312 | Evidence Packet | Amends language for clarification purposes. Replaces reference to TMHP with HHSC Office of Medical Director. |
| 7321 | Presentation of the Evidence Packet | Updates references to TMHP and HHSC, along with the MCO. |
| 7322 | Hearing Decision | Updates references to TMHP and HHSC, along with the MCO. |
| 7410 | Action Taken on the Hearing Decision | Deletes section and changed title to Reserved for Future Use. |
| 7610 | Sustained State Fair Hearing Decisions | Update language. Clarifies that HHSC Fair and Fraud Hearings staff mails out written decisions to the applicant, member or their legally authorized representative. |
| 7612 | Reversed Appeal Decisions | Amends language for clarification purposes. Updates TxMedCentral reference to MCOHub. |
| 7700 | Roles and Responsibilities of Texas Health and Human Services Commission Hearing Officers | Deletes section 7700 and replaced with Section 7800, Community First Choice State Fair Hearing. Amends language for clarification purposes. |
| 7800 | Community First Choice State Fair Hearing | Moves to Section 7700 and deletes Section 7800. |
| Appendix I | MCO Business Rules for SK-SAI and SK-ISP | Updates Section 2.5. Advises MCOs to contact HHSC with more needed information for MDCP MN determinations. |
| Appendix XI | STAR Kids Plan Codes | Updates Amerigroup to Wellpoint and Children’s Medical Center to Aetna for the Dallas Service Area. |
23-4, Sections 1220, 2132, 3200, 3511, 5311, 7200, 7612, Form 2603 Instructions Revised
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Revision Notice 23-4; Effective Dec. 1, 2023
The following change(s) were made:
| Section | Title | Change |
|---|---|---|
| 1220 | Long Term Services and Supports | Amends language for clarification purposes. Updates the definition of attendant care services. |
| 2132 | MCO Coordination Procedures for an MDCP Applicant Approved for a Limited NF Stay | Amends language for clarification purposes. Updates instructions for MCOs around limited nursing facility (NF) stay. Removes the word “service coordinator” from mentions of “MCO service coordinator”. |
| 3200 | Member Reassessment | Removes an incorrect reference to Community First Choice (CFC). Removes the word “service coordinator” from mentions of “MCO service coordinator”. |
| 3511 | STAR+PLUS Transition Activities | Updates link to STAR+PLUS Handbook. |
| 5311 | Developing the Individual Service Plan in the CDS Option | Updates instructions for completing denials, reductions in services and suspensions. Updates instructions in the Consumer Directed Services (CDS) option for a registered nurse (RN). Removes the word “service coordinator” from mentions of “MCO service coordinator”. |
| 7200 | External Medical Review | Amends language around the external medical review (EMR) process. |
| 7612 | Reversed Appeal Decisions | Updates language around PSU procedures for reversed appeal decisions. |
Forms
The following forms were revised in the STAR Kids Handbook:
| Form No. | Title | Change |
|---|---|---|
| Form 2603 Instructions | Form 2603, STAR Kids Individual Service Plan (ISP) Narrative | Revises instructions for when to prepare or update Form 2603. Provides clarification on documenting changes to services on the individual service plan (ISP) and provides clarification for when changes can be made. |
23-3, Changes TexMedCentral Reference to MCOHub Throughout Handbook
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Revision Notice 23-3; Effective July 21, 2023
The following change(s) were made:
| Section | Title | Change |
|---|---|---|
| 1311 | Member Refusal to Participate in Service Coordination | Changes reference from TxMedCentral to MCOHub. |
| 1630 | Communication with the Managed Care Organization | Changes reference from TxMedCentral to MCOHub. |
| 1810 | Program Support Unit Notification Requirements | Changes reference from TxMedCentral to MCOHub. |
| 2030 | Managed Care Organization Coordination | Changes reference from TxMedCentral to MCOHub. |
| 2111 | Non-STAR Kids Individual Residing in an NF | Changes reference from TxMedCentral to MCOHub. |
| 2112 | STAR Kids Member Residing in an NF | Changes reference from TxMedCentral to MCOHub. |
| 2113 | MDCP MFP Applications Pending Due to Delay in NF Discharge | Changes reference from TxMedCentral to MCOHub. |
| 2131 | Individual Who is Approved for a Limited NF Stay | Changes reference from TxMedCentral to MCOHub. |
| 2132 | MCO Coordination Procedures for an MDCP Applicant Approved for a Limited NF Stay | Changes reference from TxMedCentral to MCOHub. |
| 2133 | Delays in Limited NF Stay for an Applicant Not Enrolled in STAR Kids | Changes reference from TxMedCentral to MCOHub. |
| 2210 | Medical Necessity Expiration | Changes reference from TxMedCentral to MCOHub. |
| 2220 | MDCP Start of Care Date for Interest List Releases | Changes reference from TxMedCentral to MCOHub. |
| 2230 | Member Reassessment | Changes reference from TxMedCentral to MCOHub. |
| 3200 | Reassessment of Medical Necessity or Level of Care | Changes reference from TxMedCentral to MCOHub. |
| 3210 | Reassessment of Medical Necessity or Level of Care | Changes reference from TxMedCentral to MCOHub. |
| 3329 | Reassessment Notification Requirements | Changes reference from TxMedCentral to MCOHub. |
| 3410 | Transfer from One Managed Care Organization to Another | Changes all references to TxMedCentral to MCOHub |
| 3420 | Member Transfer from Waiver Program to Medically Dependent Children Program | Changes all references to TxMedCentral to MCOHub |
| 6200 | Denial/Termination of Medically Dependent Children Program | Changes reference from TxMedCentral to MCOHub. |
| 6210 | Denial/Termination Due to Death | Changes reference from TxMedCentral to MCOHub. |
| 6220 | Denial/Termination Due to Residence in a Nursing Facility | Changes reference from TxMedCentral to MCOHub. |
| 6270 | Denial/Termination Due to Failure to Meet Other Program Requirements | Changes reference from TxMedCentral to MCOHub. |
| 6280 | Denial/Termination for Other Reasons | Changes reference from TxMedCentral to MCOHub. |
| 7510 | Continuation of Medically Dependent Children Program Waiver Services During a State Fair Hearing | Changes reference from TxMedCentral to MCOHub. |
| 7520 | Discontinuation of Medically Dependent Children Program Waiver Services During a State Fair Hearing | Changes reference from TxMedCentral to MCOHub. |
| 7800 | Community First Choice State Fair Hearing | Changes reference from TxMedCentral to MCOHub. |
| Appendix IX | Star Kids TxMedCentral Naming Conventions | Changes reference from TxMedCentral to MCOHub. |
| Glossary | Glossary | Changes reference from TxMedCentral to MCOHub. Relocates MCOHub to the M section of the glossary for alphabetical order. |