1700, Notification Requirements

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1710 PSU Staff Notification Requirements for Applicants and Members

Revision 24-4; Effective Dec. 1, 2024

Form H2065-D, Notification of Managed Care Program Services (PDF), is the legal notice showing program-level eligibility for approvals, denials, and terminations for the STAR+PLUS Home and Community Based Services (HCBS) program. Program Support Unit (PSU) staff are responsible for preparing and mailing Form H2065-D to the applicant, member, or authorized representative (AR) advising of actions taken for STAR+PLUS HCBS program eligibility. PSU staff must mail English and Spanish versions of Form H2065-D to the applicant, member or AR.

Form H2065-D includes:

  • approval, denial or termination effective dates;
  • plain language that can be understood by the applicant, member or AR;
  • room and board (R&B) and copayment charges, if applicable;
  • cost-of-living adjustment (COLA) for room and board (R&B) charges, if applicable; and
  • fair hearing rights.

PSU staff generate Form H2065-D manually or electronically through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) depending on the case action being taken. PSU staff must follow the instructions in Appendix IV, Form H2065-D STAR+PLUS HCBS Program Reason for Denial and Comments Language, to ensure language entered on the form can be understood by the applicant, member or AR.

PSU staff must notify the applicant, member, or AR of program eligibility approval within five business day of verifying eligibility criteria was met by using Form H2065-D. This time frame applies to all case types, including:

  • interest list releases (ILRs);
  • upgrades;
  • Money Follows the Person (MFP) process; and
  • reassessments.

PSU staff must notify the applicant, member or AR of a program eligibility denial or termination using Form H2065-D upon notification eligibility criteria is not being met. PSU staff time frames for mailing Form H2065-D varies depending on the denial or termination type. For example, PSU staff must mail Form H2065-D for a denial or termination within:

  • three business days for upgrades; and
  • two business days for all other denials and terminations.

PSU staff must provide the English version of Form H2065-D to the MCO. PSU staff can generate Form H2065-D manually or electronically through the TMHP LTCOP. PSU staff must upload Form H2065-D to the MCOHub, if Form H2065-D is generated manually. The MCO must retrieve a copy of Form H2065-D through the TMHP LTCOP if Form H2065-D is generated electronically.

1720 PSU Staff Notification Requirements for MCOs

Revision 19-13; Effective November 5, 2019

Program Support Unit (PSU) staff must use Form H2067-MC, Managed Care Programs Communication, for all communications sent to the managed care organization (MCO). PSU staff upload Form H2067-MC to TxMedCentral in the MCO’s STAR+PLUS folder, following the instruction in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions. Time frames for PSU staff uploading Form H2067-MC can vary between one and five business days depending on the situation. PSU staff must refer to policy in this handbook for specific time frame direction.

1730 PSU Staff Notification Requirements for Medicaid for the Elderly and People with Disabilities or Texas Works

Revision 25-2; Effective June 6, 2025

Program Support Unit (PSU) staff may be required to coordinate STAR+PLUS Home and Community Based Services (HCBS) program eligibility determinations with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist, depending on the applicant or member’s Medicaid type of assistance (TOA). PSU staff must refer to Appendix V, MEPD Referral Crosswalk, to determine if MEPD coordination is required. PSU staff coordinate by faxing Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist. The MEPD specialist may respond using the MEPD Communication Tool. PSU staff can monitor Texas Integrated Eligibility Redesign System (TIERS) for updates to Medicaid eligibility.

PSU staff must fax Form H1746-A to the MEPD specialist when:

  • Form H1200, Application for Assistance – Your Texas Benefits, is received from an applicant;
  • Medical Necessity (MN) is approved or denied in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP); and
  • the individual service plan (ISP) is received and the applicant is authorized to enroll in the STAR+PLUS HCBS program.

PSU staff must fax Form H1746-A to the MEPD specialist for denials and terminations not related to a Medicaid financial denial. PSU staff is not required to fax Form H1746-A to the MEPD specialist for applicants and members receiving Supplemental Security Income (SSI) who are being denied or terminated. 

1740 PSU Staff Notification Requirements for Enrollment Resolution Services Unit

Revision 19-13; Effective November 5, 2019

Program Support Unit (PSU) staff must notify the Enrollment Resolution Services (ERS) Unit for medical assistance only (MAO) applicants that meet STAR+PLUS Home and Community Based Services (HCBS) program eligibility and do not show a managed care organization (MCO) enrollment in the Texas Integrated Eligibility Redesign System (TIERS). PSU staff must also notify the ERS Unit of MAO members having their STAR+PLUS HCBS program eligibility terminated.

The email to the ERS Unit mailbox must include:

  • a subject line including the type of request with the applicant’s first and last initial;
  • applicant or member name;
  • Social Security number (SSN) or Medicaid identification (ID) number;
  • eligibility or termination effective date;
  • any other relevant information; and
  • any supporting documentation (e.g., Form H2065-D, Notification of Managed Care Program Services).

1750 PSU Staff Notification Requirements for Program Support Operations Review Team

Revision 26-3; Effective Aug. 14, 2026

Program Support Unit (PSU) staff must notify Program Support Operations Review Team (PSORT) of managed care organization (MCO) non-compliances related to late initial and annual assessment activities. 

PSORT is responsible for:

  • escalating non-compliance cases to Managed Care Contracts and Oversight (MCCO) unit staff;
  • tracking communications between the MCO and MCCO unit staff; 
  • generating reports; and
  • identifying trends.

Initial Assessment Reporting

PSU staff must send an email to PSORT within three business days of the initial assessment non-compliance occurrence. The email sent to the PSORT mailbox includes:

  • this email subject line: STAR+PLUS HCBS Initial 45 Day MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
  • applicant’s name;
  • Social Security number (SSN) or Medicaid identification (ID) number;
  • date of birth (DOB);
  • name of the MCO and plan code;
  • the date information was due from the MCO; 
  • a brief description of the delay and any MCO information received; and
  • attach any pertinent documents received from the MCO. 

PSORT does not have to:

  • respond to PSU staff confirming receipt of the notification; or 
  • disclose the outcome of the MCO non-compliance.

PSU staff must continue to monitor the MCOHub and the Texas Medicaid Health Care Partnership (TMHP) Long Term Care Online Portal (LTCOP) for receipt of the following from the MCO:  

PSU staff must email any case information received to the PSORT mailbox within three business days of receipt. The follow-up email includes the same email identifier elements listed above.

PSU staff do not have to notify PSORT of upgrade activities that go past the 45-day time frame after an individual’s request for an upgrade.

Annual Assessment Reporting

The assigned PSU staff must notify PSORT of late MCO reassessment activity. They do this by sending the ISP Expiring Report to the PSORT mailbox each month. The ISP Expiring Report only identifies the ISP’s the assigned PSU staff must report as late. The ISP Expiring Report must be in an Excel spreadsheet format. The subject line for email must read: STAR+PLUS HCBS Reassessment Delinquencies for [Month].   

PSU staff do not have to send a follow up email to PSORT when the MCO submits Form H2067-MC, MN/LOC Assessment, or the ISP for reassessment delinquencies. 

1760 PSU Staff Notification Requirements for Managed Care Contracts and Oversight Unit

Revision 26-3; Effective Aug. 14, 2026

Program Support Unit (PSU) staff must notify Managed Care Contracts and Oversight (MCCO) unit staff of managed care organization (MCO) non-compliance issues that are unrelated to late assessment activity. 

Examples include an MCO failure to notify PSU staff timely of: 

  • a nursing facility (NF) discharge;
  • a medical necessity (MN) denial; or
  • a member being admitted to an institution.

PSU staff notify MCCO unit staff within three business days of finding a MCO non-compliance. PSU notify MCCO by sending an email to the MCCO mailbox. The email must include:

  • this email subject line: STAR+PLUS HCBS MCO Non-Compliance for XX [first letter of the applicant or member’s first and last name];
  • the following items in the body of the email:
    • applicant or member’s name;
    • social security number (SSN) or Medicaid identification (ID) number;
    • date of birth (DOB);
    • name of the MCO and plan code;
    • the date information was due from the MCO;
    • a brief description of the MCO non-compliance and any MCO information received; and
    • attachments of any pertinent documents received from the MCO, if applicable.

1770 MCO Notification Requirements for Applicants and Members

Revision 26-3; Effective Aug. 14, 2026

The managed care organization (MCO) is responsible for notifying the applicant, member or authorized representative (AR) when a service is denied, reduced or terminated. This is considered an adverse action and the applicant, member or AR has a right to appeal. Appeal rights of STAR+PLUS Home and Community Based Services (HCBS) program applicants or members are in the Texas Medicaid and CHIP - Uniform Managed Care Manual.  

1780 MCO Notification Requirements for PSU Staff

Revision 26-3; Effective Aug. 14, 2026

The managed care organization (MCO) must use Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section B, and Form H2067-MC, Managed Care Programs Communication, for all communications sent to Program Support Unit (PSU) staff, as applicable. The MCO must upload Form H3676, Section B, or Form H2067-MC to the MCOHub. PSU staff will retrieve all MCO postings daily from the MCOHub.

The MCO has 45 days from the date PSU staff uploaded Form H3676, Section A, to the MCOHub, to upload Form H3676, Section B, for applicants. The MCO has between one business day and 14 days to upload Form H2067-MC, depending on the situation for an applicant or member. Specific MCO time frames for Form H2067-MC are defined throughout this handbook.