25-5, Quarterly Revision

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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.

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Forms