3300, Administrative Procedures

Revision 18-0; Effective September 4, 2018

Program Support Unit (PSU) staff operate in each Texas Health and Human Services Commission (HHSC) STAR+PLUS managed care service area. PSU staff provide support necessary for the coordination of long-term services and supports (LTSS), including the STAR+PLUS Home and Community Based Services (HCBS) program, for members who transfer in and out of STAR+PLUS service areas. PSU staff are also the point of contact for the coordination and monitoring of members transitioning from:

• nursing facilities (NFs) to the community, and
• the Medically Dependent Children Program (MDCP) to the STAR+PLUS HCBS program.

Responsibilities of PSU staff include:

• acting as an intermediary in relaying communications between Community Care Services Eligibility (CCSE) staff and the managed care organization (MCO);
• receiving requests for services from CCSE staff performing intake tasks;
• coordinating the application process for the STAR+PLUS HCBS program for NF residents who wish to transition to the community;
• assisting applicants with enrollment through the Texas Health and Human Services Commission (HHSC) enrollment broker to select an MCO and primary care provider (PCP), if necessary;
• coordinating with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist regarding Medicaid eligibility, as appropriate;
• sending service authorizations (Form H3676, Managed Care Pre-Enrollment Assessment Authorization to the MCO to initiate STAR+PLUS HCBS program assessments for applicants;
• serving as the primary contact for transitions in and out of STAR+PLUS service areas;
• assisting CCSE case managers in processing applications for non-Medicaid services by verifying the MCO denied the equivalent service under STAR+PLUS (Refer to 3510, Money Follows the Person and Managed Care);
• assisting MCO members requesting placement on an interest list for services excluded from managed care (Refer to 3222, STAR+PLUS Excluded Groups);
• processing applicants released from the STAR+PLUS HCBS program interest list;
• assisting members who are aging out of MDCP and/or Texas Health Steps (THSteps) Comprehensive Care Program (CCP) in transferring to the STAR+PLUS HCBS program (Refer to 3420, Individuals Transitioning Services for Adults);
• coordinating continuity of care for members suspended or disenrolled from STAR+PLUS;
• approving the STAR+PLUS HCBS program based upon eligibility;
• making Service Authorization System Online (SASO) entries, as required for actions involving STAR+PLUS HCBS program members;
• handling the administrative claims process;
• researching and requesting disenrollment when the member is enrolled inappropriately;
• denying eligibility for the STAR+PLUS HCBS program; and
• handling requests for state fair hearings for applicants or members who are denied STAR+PLUS HCBS program eligibility.

3310 CCSE Referrals for the STAR+PLUS HCBS Program

Revision 26-3; Effective Aug. 14, 2026

Individuals may receive Community Care Services Eligibility (CCSE) services while waiting for managed care enrollment.  Regional CCSE staff must determine who to contact when a request for the STAR+PLUS Home and Community Based Services (HCBS) program is received. CCSE staff may contact:

• Intellectual or Developmental Disabilities (IDD) Program Eligibility and Support staff;
• the Texas Health and Human Services Commission (HHSC) enrollment broker;
• Program Support Unit (PSU) staff;
• Interest List Management (ILM) unit staff; or
• the managed care organization (MCO).

CCSE staff use the table below to determine how to process requests for services in STAR+PLUS HCBS program.

Regional CCSE staff may give information about the Program of All-Inclusive Care for the Elderly (PACE) to individuals. They do this during the request and referral process if the individual requesting services: 

• is 55 years or older; and 
• lives in a PACE service area (SA). 

3311 Interim Services for Individuals Awaiting Managed Care Enrollment

Revision 18-0; Effective September 4, 2018

While awaiting enrollment in managed care, individuals are entitled to receive services from the Community Care Services Eligibility (CCSE) program. Referrals to CCSE must be made for all active Medicaid individuals awaiting enrollment for managed care. CCSE case managers may assess these individuals for services if it appears services can be authorized and delivered prior to enrollment.

3311.1 Interest List Management and Enrollment Broker Procedures

Revision 26-3; Effective Aug. 14, 2026

Interest List Management (ILM) unit staff are Texas Health and Human Services Commission (HHSC) staff. They are responsible for maintaining and releasing individuals from the STAR+PLUS Home and Community Based Services (HCBS) program interest list. ILM unit staff use the Community Services Interest List (CSIL) database to track individuals who request the STAR+PLUS HCBS program. ILM unit staff must release individuals from the STAR+PLUS HCBS program interest list as slots become available in the program.

ILM unit staff perform the following activities for individuals who request placement on the STAR+PLUS HCBS program interest list:

• place individuals on the interest list;
• maintain annual contact requirements;
• release individuals from the interest list when funding is available;
• track STAR+PLUS HCBS program slots allocated for use by individuals who are not mandatory participants; and
• confirm individuals on the interest list are viable STAR+PLUS candidates before release by:
  • verifying all contact information is correct;
  • checking the Texas Integrated Eligibility Redesign System (TIERS) to determine the Medicaid eligibility status;
  • confirming Texas residency; and
  • verifying the individual is still interested in the STAR+PLUS HCBS program.

The interest list status automatically updates to an inactive status if no response is received from the individual within 120 days of the annual contact. It remains in that status until the individual notifies ILM unit staff of continued interest.

The CSIL database is also used to track nursing facility (NF) residents who  request services through the STAR+PLUS HCBS program. This is done when a request for the STAR+PLUS HCBS program is received:

• by ILM unit staff on the interest list hotline;
• by Program Support Unit (PSU) from managed care organizations (MCOs); or
• from regional Community Care Services Eligibility (CCSE) staff.

ILM unit or PSU staff must complete the following when a NF facility resident requests a community transition to the STAR+PLUS program: 

• check the CSIL database to verify if the NF resident is on the STAR+PLUS HCBS program interest list;
• add the individual to the STAR+PLUS HCBS interest list, if applicable; and
• immediately release and assign the individual from the STAR+PLUS HCBS program interest list to pursue the Money Follows the Person (MFP) process.

The HHSC enrollment broker must contact all individuals by phone upon release from the STAR+PLUS HCBS program interest list. This is done to notify them their names reached the top of the list and a slot is available.  

The enrollment broker contacts the individual to confirm if the individual wants to pursue the STAR+PLUS HCBS program. The enrollment broker mails an enrollment packet if the individual wants to pursue the STAR+PLUS HCBS program. If the Individuals do not wish to pursue the STAR+PLUS HCBS program:

• the individual can be added back to the bottom of the interest list for an offer in the future, if requested; or
• the interest list release (ILR) record is closed with the appropriate closure code in the CSIL database.

The enrollment broker mails a STAR+PLUS HCBS program enrollment packet to all individuals released from the interest list and interested in pursuing STAR+PLUS HCBS program services. The STAR+PLUS HCBS program enrollment packet includes:

• Form H2053-A, STAR+PLUS Selection Letter;
• Form H3675, Application Acknowledgement;
• Form H2053-B, Health Plan Selection;
• Form H1200, Application for Assistance – Your Texas Benefits;
• Appendix XII, STAR+PLUS HCBS Program Description;
• STAR+PLUS Comparison Charts;
• STAR+PLUS Report Cards; and
• a postage-paid envelope.

The enrollment broker contacts the individual every seven days from the date the enrollment packet is mailed. All enrollment broker contacts cease when the completed packet is received by the enrollment broker or on the 30th day after mailing the enrollment packet, whichever is sooner. The enrollment broker’s contact attempts include the 14-day contact requirement.

The enrollment broker contacts the applicant or authorized representative (AR) to:

• give a general description of STAR+PLUS HCBS program services;
• provide a list of managed care organizations (MCOs) in their service area (SA);
• encourage the member to contact an MCO for service information;
• discuss the importance of choosing an MCO so an assessment and initial individual service plan (ISP) is completed to avoid a delay in eligibility determination for the STAR+PLUS HCBS program; and
• inform the individual that their MCO selection can be changed at any time after the first month of service.

The enrollment broker will fax the signed and completed Form H1200, along with Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist within three business days of receipt from the applicant or AR. The applicant or AR selects an MCO by completing Form H2053-B, Health Plan Selection, or notifying the enrollment broker verbally.

Refer to 3312, Managed Care Enrollment, for steps to be taken after an individual is released from the STAR+PLUS HCBS program interest list.

3311.2 Enrollment Procedures Following Release from the Interest List

Revision 25-4; Effective Oct. 6, 2025

Program Support Unit (PSU) staff complete the following activities within three business days of the receipt of the STAR+PLUS Home and Community Based Services (HCBS) program interest list release (ILR) case record assignment in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART):

• check the Texas Integrated Eligibility Redesign System (TIERS) to verify Medicaid financial eligibility;
• ensure that the individual does not have an open enrollment with another Medicaid waiver program per the procedures below:
• check the Service Authorization System Online (SASO) for open Service Authorization and Enrollment records for:
  • Community Living Assistance and Support Services (CLASS) (Service Group (SG) 2);
  • Deaf Blind and Multiple Disabilities (DBMD) (SG 16);
  • Home and Community-based Services (HCS) (SG 21);
  • Texas Home Living (TxHmL) (SG 22); and
• upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization (PDF), Section A, to the MCOHub.

The MCO must complete the following activities within 45 days from the date PSU staff upload Form H3676 to the MCOHub:

• upload Form H3676, Section B, to the MCOHub;
• conduct the Medical Necessity and Level of Care (MN/LOC) Assessment; and
• develop the individual service plan (ISP) using Form H1700-1, Individual Service Plan, and upload it to the MCOHub.

Note: PSU staff must document Form H2067-MC, Managed Care Programs Communication, was received in lieu of Form H3676, Section B, in the HEART case record, if applicable. 

PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet (PDF), to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist noting the applicant has an approved MN/LOC Assessment and ISP within two business days of receipt from the MCO.

PSU staff must notify Program Support Operations Review Team (PSORT) staff by email within two business days of an MCO failing to submit initial assessment information within the 45-day time frame. The email sent to PSORT staff must include:

• an email subject line that reads: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the member’s first and last name];
• individual or 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 such as Form H2067-MC.

PSU staff must:

• ensure the medical necessity (MN) determination from the Texas Medicaid & Healthcare Partnership (TMHP) nurse or physician is valid by verifying the approval date does not exceed 120 days; and
• upload Form H2067-MC to the MCOHub, advising the MCO to submit a new initial MN/LOC Assessment if the MN approval date exceeds 120 days.

PSU staff must determine if the applicant meets the eligibility criteria for the STAR+PLUS HCBS program within five business days from the MEPD specialist advising the applicant meets Medicaid financial eligibility. PSU staff must complete the activities listed below if the applicant meets the eligibility criteria:

• Electronically generate Form H2065-D, Notification of Managed Care Program Services (PDF) in the TMHP Long Term Care Online Portal (LTCOP). Note: The start of care (SOC) date for the STAR+PLUS HCBS program is the first day of the month, following meeting all eligibility criteria. PSU staff processing does not delay the eligibility begin date.
• Mail Form H2065-D to the member.
• Verify SASO records are in alignment with TMHP LTCOP records.
• Upload Form H2065-D to the MCOHub.
• Fax Form H1746-A (PDF) to the MEPD specialist.
• Notify Enrollment Resolution Services (ERS) unit staff by email. Include in the email to ERS unit staff, this email subject line: STAR+PLUS HCBS Enrollment for XX [member’s first and last name initials];
  • the member’s name;
    • Medicaid ID number;
    • type of request: ILR enrollment;
    • MN approval date;
    • ISP receipt date;
    • ISP begin date;
    • ISP end date;
    • MCO selection;
  • effective date of enrollment;
  • Form H2065-D as an attachment;
• Upload all applicable documents to the HEART case record; and
• Document and close the HEART case record.

Refer to 6000, Denials and Terminations, if the applicant does not meet STAR+PLUS HCBS program requirements at ILR.

3311.3 Interest List Slot Allocations

Revision 18-0; Effective September 4, 2018

Members receiving Medicaid services under any of the programs listed in the chart below must receive those services through managed care. This does not impact the STAR+PLUS member's right to access non-Medicaid services through the Texas Health and Human Services Commission (HHSC). STAR+PLUS Home and Community Based Services (HCBS) program members must receive all services through the STAR+PLUS HCBS program, excluding hospice care. Only STAR+PLUS HCBS members count against slot allocations, as the following table illustrates.

3311.4 Earliest Date for Adding a Member Back to the Interest List

Revision 18-0; Effective September 4, 2018

The earliest date an applicant or member may be added back to the Community Services Interest List (CSIL) database for STAR+PLUS HCBS is the date the applicant is determined to be ineligible for the program or the first date the member is no longer eligible for the program.

Example 1: The applicant is released from the STAR+PLUS HCBS program interest list on March 2, 2019. PSU staff send Form H2065-D, Notification of Managed Care Program Services, notifying the applicant is not eligible for the STAR+PLUS HCBS program on March 28, 2019. The first date the denied applicant can be added back to the STAR+PLUS HCBS program interest list is March 28, 2019.

Example 2: A STAR+PLUS HCBS program member is determined ineligible on March 28, 2019. PSU staff send Form H2065-D to the STAR+PLUS HCBS program member notifying of program termination. Termination is effective April 30, 2019. The first date the denied member can be added back to the STAR+PLUS HCBS program interest list is May 1, 2019.

If the applicant or STAR+PLUS HCBS program member’s name is added back to the interest list prior to the last date of program eligibility, the CSIL database interface match with the Service Authorization System Online (SASO) will cause the name to be removed from the interest list for that program.

3311.5 Updating Community Services Interest List Records

Revision 18-0; Effective September 4, 2018

The Community Services Interest List (CSIL) database must be updated to reflect accurate information. Program Support Unit (PSU) staff must complete data entry in the CSIL database for STAR+PLUS Home and Community Based Services (HCBS) program actions within five business days of the date:

• PSU staff sign Form H2065-D, Notification of Managed Care Program Services, certifying or denying applications, except Money Follows the Person (MFP) certifications; and
• the request for other CSIL database actions (updating information, transferring an individual to another region's interest list or removing a member from the interest list upon request by the individual).

For MFP certifications, the CSIL database is updated when the Service Authorization System Online (SASO) data entry is completed to register the initial individual service plan (ISP). Delaying data entry of the disposition in CSIL for an applicant certified through MFP provisions prevents removing the individual from the interest list before the actual discharge from the nursing facility (NF) is verified.

PSU staff must ensure CSIL database closures are recorded accurately by using the Community Services Interest List (CSIL) User's Guide, available to PSU staff on SharePoint.

3311.6 Contacting the Interest List Management Unit to Reopen a Closed Interest List Release

Revision 20-6; Effective December 18, 2020

Program Support Unit (PSU) staff must submit a request to Interest List Management (ILM) Unit staff to reopen an individual’s closed Community Services Interest List (CSIL) record.

Within two business days of receiving the request to reopen a closed interest list release, PSU staff must email their immediate supervisor requesting to reopen the CSIL record. The email must include the following:

• an email subject line that reads: “S+P Reopen Request for XX [individual’s first and last initials].” For example, the email subject line for a request to reopen a closed CSIL record for Ann Smith would be “S+P Reopen Request for AS”;
• individual’s name;
• interest list identification (ID) number;
• individual’s Medicaid ID number or Social Security number (SSN);
• the individual’s or authorized representative’s (AR’s) contact name and phone number; and
• reason for the request to reopen. For example, a statement indicating that the application for an alternate 1915(c) Medicaid waiver program was denied and the individual now wishes to reapply for STAR+PLUS HCBS.

The PSU supervisor will forward the reopen request to the ILM Unit manager at StarPlusWaiverInterestList@hhsc.state.tx.us if the PSU supervisor agrees the reopen request is appropriate. ILM Unit staff will email PSU staff to provide the outcome of the request within five business days.

If an exception is granted, PSU staff must:   

• contact the individual to begin the application process;
• document the reopen request in the Health and Human Services Enterprise Administrative Report and Tracking System (HEART) case record;
• upload the ILM Unit staff’s decision email to the HEART case record, following the instructions in Appendix XXXIII, STAR+PLUS HEART Naming Conventions; and
• keep the HEART case record open until STAR+PLUS HCBS program eligibility is approved or denied.

If an exception is not granted, PSU staff must:

• upload the ILM Unit staff’s decision email to the HEART case record, following the instructions in Appendix XXXIII; and
• close the HEART case record.

3312 Managed Care Enrollment

Revision 26-3; Effective Aug. 14, 2026

Individuals can: 

• return enrollment forms by mail;
• complete an enrollment form at an enrollment event or presentation; or
• call the HHSC enrollment broker and enroll by phone at 800-964-2777. 

Individuals have 30 days after receiving an enrollment packet to select an MCO. The individual is assigned to an MCO and a primary care provider (PCP) if a selection is not made within 30 days. Failure to choose an MCO could cause delays in services or default assignment to an MCO. Individual assignments to an MCO or PCP are automatic, using a default process. Individuals assigned through the default process may change their STAR+PLUS MCO and PCP after they are enrolled at least one month. However, the individual must receive Medicaid services through the assigned MCO and PCP until the individual contacts the MCO or the HHSC enrollment broker at 800-964-2777 to request a change. 

Failure to select a PCP may delay services when a physician's order or medical necessity (MN) determination is required.

PSU staff can check to determine if an individual is enrolled in a MCO by checking the Individual – Managed Care screen in Texas Integrated Eligibility Redesign System (TIERS). The status must state Enrolled. A Candidate Eligible status does not reflect an active enrollment. 

3313 Termination of CCSE Services Upon STAR+PLUS HCBS Program Enrollment

Revision 26-3; Effective Aug. 14, 2026

The STAR+PLUS Home and Community Based Services (HCBS) program is required to provide all services needed to enable a member to live safely in the community. Therefore, a member cannot receive non-managed care Community Care Services Eligibility (CCSE) services and STAR+PLUS HCBS program managed care services concurrently.

Program Support Unit (PSU) staff must coordinate the termination of CCSE services with the regional CCSE staff. This is so the member does not experience a break in services and does not receive concurrent services through another waiver or CCSE service. 

PSU staff must complete the following activities within three business days of notification:

• identify the region the member lives in using Appendix XXXVIII, CCSE Region by Service Area; 
• email the regional CCSE mailbox the following information:
  • this email subject line: CCSE Closure – STAR+PLUS HCBS Enrollment XX [first letter of the member’s first and last name];
  • member’s name;
  • Medicaid ID;
  • start of care (SOC) date for STAR+PLUS Home and Community Based Services (HCBS) program; and
  • managed care organization (MCO).
• make sure the Service Authorization System Online (SASO) reflects the closure of CCSE records with Service Group (SG) 7 and have an end date one day before the SOC for the STAR+PLUS HCBS program; and
• follow instructions in 3311.2, Enrollment Procedures following Release from the Interest List, to complete STAR+PLUS HCBS program enrollment.

PSU staff must encourage the member to contact the MCO to request any CCSE services not in the STAR+PLUS HCBS program individual service plan (ISP).

3314 Managed Care Organization Changes

Revision 25-1; Effective Feb. 19, 2025

An applicant or member may change managed care organization (MCO) plans at any time, for any reason, and regardless of their living arrangement by contacting the Texas Health and Human Services Commission (HHSC) enrollment broker at 800-964-2777. However, for an applicant requesting an MCO change, the transfer will not go into effect until after one full calendar month of STAR+PLUS Home and Community Based Services (HCBS) program service provision.

The HHSC enrollment broker makes plan changes based on the monthly cutoff periods, which occur around the middle of each month. Depending on which day of the month, before or after the HHSC enrollment broker cutoff, the plan change will either occur the first day of the next month or the month after. The change will show up on the 834 daily enrollment file, notifying the MCO of the new member. 

Service Authorization System Online (SASO) records will be automatically updated if the MCO submits the individual service plan (ISP) through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) and the ISP record is in a Processed/Complete or PSU Processed/Complete status.

Program Support Unit (PSU) staff are not required to manually update SASO records to reflect the new MCO contract number and coverage date span for any ISP that was not captured by the above process.

3315 STAR+PLUS HCBS Program Individuals Requesting Non-Managed Care Services

Revision 18-0; Effective September 4, 2018

Requirements of the STAR+PLUS Home and Community Based Services (HCBS) program provide all of the services (excluding hospice) needed to enable the member to live safely in the community. Therefore, non-managed care services cannot be authorized for the STAR+PLUS HCBS program member. A STAR+PLUS HCBS program member requesting additional services must be referred to the managed care organization's (MCO’s) service coordinator.

Hospice services may be authorized along with STAR+PLUS services or the STAR+PLUS HCBS program.

3316 Transfer from Another Medicaid Waiver Program to the STAR+PLUS HCBS Program

Revision 25-4; Effective Oct. 6, 2025

Individuals in the following Medicaid waiver programs may request an assessment for the STAR+PLUS Home and Community Based Services (HCBS) program any time:

• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS);
• Home and Community Based Services – Adult Mental Health (HCBS-AMH) program; or
• Texas Home Living (TxHmL).

Program Support Unit (PSU) supervisors receive requests by:

• email from Interest List Management (ILM) unit staff;
• email from Medicaid waiver program staff;
• email from a Local Intellectual and Developmental Disability Authority (LIDDA); or
• Form H2067-MC, Managed Care Programs Communication uploaded to the MCOHub by the managed care organization (MCO).

The email from ILM unit staff identify STAR+PLUS HCBS program interest list release (ILR) individuals currently enrolled in another Medicaid waiver program.

PSU staff must refer a transfer request received from the LIDDA or MCO to the corresponding Medicaid waiver program staff to confirm the individual wants to pursue the STAR+PLUS HCBS program.

PSU staff must mail the following enrollment packet to the individual within three business days of the first request for a STAR+PLUS HCBS program assessment:

• Form H3675, Application Acknowledgement; and
• Appendix XII, STAR+PLUS HCBS Program Description.

PSU staff must contact the individual or authorized representative (AR) to verify receipt of the enrollment packet. PSU staff explains the STAR+PLUS HCBS program services within 14 days from the mail date of the above enrollment packet. PSU staff must:

• encourage the individual to complete the enrollment packet and mail it back; and
• inform the individual that there might be a delay in eligibility determination for the STAR+PLUS HCBS program if the individual does not return the enrollment packet.

PSU staff can accept the individual’s or AR’s verbal statement of interest in the STAR+PLUS HCBS program or through receipt of Form H3675.

PSU staff must document all attempted contacts with the individual or encountered delays in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must upload Form H3676, Managed Care Pre-Enrollment Assessment Authorization, to the MCOHub within two business days of the individual’s or AR’s confirmed interest in the STAR+PLUS HCBS program.

The MCO must complete the following activities within 45 days from the date PSU staff upload Form H3676 to the MCOHub:

• submit the Medical Necessity and Level of Care (MN/LOC) Assessment in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
• submit the individual service plan (ISP) in the TMHP LTCOP; and
• complete and upload Section B of Form H3676 to the MCOHub.

PSU staff must:

• monitor the TMHP LTCOP for receipt of the ISP;
• monitor the MCOHub for receipt of Section B of Form H3676 which should not delay the certification of the case, if applicable; and
• document Form H2067-MC was received in lieu of Form H3676, Section B, in the HEART case record, if applicable.

PSU staff must email the Program Support Operations Review Team (PSORT) within two business days of an MCO failing to submit the initial assessment information within the 45-day time frame. The email to PSORT must include:

• This email subject line: STAR+PLUS HCBS Initial 45-Day XX [plan code] MCO Non-Compliance for XX [first letter of the applicant’s first and last name];
• the following items in the body of the email:
  • 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 which is the 45th day for STAR+PLUS HCBS program;  
  • a brief description of the delay and any MCO information received; and
• attachments of any pertinent documents received from the MCO such as Form H2067-MC.

PSU staff must:

• continue to monitor the TMHP LTCOP and the MCOHub for receipt of the above information; and
• email any case information received from the MCO to the PSORT mailbox within two business days from its receipt.

The follow-up email must include the same email identifier elements listed above.

PSU staff must continue to email the Managed Care Contracts and Oversight (MCCO) Unit staff for MCO non-compliance issues unrelated to late initial assessment information. PSU staff must include the following components when emailing MCCO Unit staff:

• This email subject line: STAR+PLUS HCBS MCO Non-Compliance for XX [first letter of the member’s first and last name];
• the following items in the body of the email:
  • applicant’s name;
  • SSN or Medicaid ID number;
  • 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.

PSU staff must coordinate with all other Medicaid waiver program staff, as appropriate, ensuring the current Medicaid waiver program services end the day before enrollment in the STAR+PLUS HCBS program.

PSU staff must complete the following activities within five business days of receiving all required STAR+PLUS HCBS program eligibility documentation:

• confirm STAR+PLUS HCBS program eligibility by verifying:
  • in the Texas Integrated Eligibility Redesign System (TIERS) the applicant:
    • is over 21;
    • has Medicaid eligibility for the STAR+PLUS HCBS program;
  • in the TMHP LTCOP the applicant has an:
    • approved MN/LOC Assessment; and
    • ISP within the applicant’s cost limit which has at least one STAR+PLUS HCBS program service.

PSU staff must complete the following activities the same day they confirm all STAR+PLUS HCBS program eligibility criteria are met:

• manually or electronically generate Form H2065-D, Notification of Managed Care Program Services, with a start of care (SOC) date being the first day of the month following the other Medicaid waiver program's termination;
• mail Form H2065-D to the member;
• upload Form H2065-D to the MCOHub, if manually generated;
• verify SASO records are in alignment with TMHP LTCOP records, if applicable;
• close the Community Services Interest List (CSIL) record, if applicable;
• notify Enrollment Resolution Services (ERS) unit staff by email with the following required information:
  • This email subject line: Waiver Transfer Request for XX [first letter of the member’s first and last name];
  • the member’s name;
  • Medicaid ID number;
  • type of request: waiver transfer;
  • MN approval date;
  • ISP receipt date;
  • ISP begin date;
  • ISP end date;
  • MCO;
  • termination effective date for the other Medicaid waiver program;
  • effective date of enrollment for the STAR+PLUS HCBS program; and
  • Form H2065-D as an attachment.
• for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the STAR+PLUS HCBS program SOC date and the termination date for the other Medicaid waiver program;
• upload applicable documents to the HEART case record; and
• document and close the HEART case record.

Title 1 Texas Administrative Code (TAC) Section 353.1153(a)(1)(F) states that STAR+PLUS HCBS program members cannot be enrolled in more than one Medicaid waiver program at a time. Refer to Appendix XVIII, Mutually Exclusive Services, to decide if two services may be received at the same time.

The MCO must upload Section B of Form H3676 to the MCOHub within two business days if the applicant fails to meet any STAR+PLUS HCBS program eligibility criteria other than Medicaid financial eligibility. PSU staff may accept Form H2067-MC as notification of a denial. However, PSU staff must document in the HEART case record that Section B of Form H3676 was not received at the time Form H2065-D was generated, if applicable.

PSU staff must refer to 6000, Denials and Terminations, for more information on processing STAR+PLUS HCBS applicant denials.

3317 Transfer from STAR+PLUS HCBS Program to Another Medicaid Waiver Program

Revision 25-4; Effective Oct. 6, 2025

Title 1 Texas Administrative Code (TAC) Section 353.1153(a)(1)(F) states that STAR+PLUS Home and Community Based Services (HCBS) members cannot enroll in more than one Medicaid waiver program at a time. Refer to Appendix XVIII, Mutually Exclusive Services, to determine if a member may receive two services at the same time.

A STAR+PLUS HCBS program member may be on an interest list for an Intellectual and Developmental Disabilities (IDD) Medicaid waiver program, such as:

• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS); or
• Texas Home Living (TxHmL).

A STAR+PLUS HCBS program member may also be eligible for another waiver such as the Home and Community Based Services – Adult Mental Health (HCBS-AMH) program that does not have an interest list.

Program Support Unit (PSU) staff may receive notification from Medicaid waiver program staff or the managed care organization (MCO) that the STAR+PLUS HCBS program member:

• is eligible for another Medicaid waiver program;
• chooses to transfer to another Medicaid waiver program; or
• is already enrolled in another Medicaid waiver program.

PSU staff must:

• coordinate the program enrollment effective date with Medicaid waiver program staff; and
• request confirmation of the program enrollment and the enrollment effective date from the Medicaid waiver program staff if the MCO or Local Intellectual and Developmental Disability Authority (LIDDA) notifies PSU staff of a waiver transfer.

The Medicaid waiver program staff must confirm the member’s enrollment effective date.

PSU staff must complete the following activities within three business days from notification:

• create a Texas Health and Human Services (HHS) Enterprise Administrative Record Tracking System (HEART) case record, if applicable;
• contact and coordinate with Medicaid waiver program staff by email to determine the STAR+PLUS HCBS program termination date and the start of care (SOC) date for the other Medicaid waiver program;
• terminate the individual service plan (ISP) in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) using an end-date that aligns with the termination effective date;
• verify the following service group (SG) 19 records in the Service Authorization System Online (SASO) end the last day of the month before the member’s enrollment in the Medicaid waiver program:
  • Authorizing Agent;
  • Enrollment;
  • Service Plan;
  • Service Authorization.
• manually generate Form H2065-D, Notification of Managed Care Program Services, with a termination effective date one day before other Medicaid waiver’s SOC date;
• mail Form H2065-D to the member;
• upload Form H2065-D to the MCOHub;
• notify Enrollment Resolution Services (ERS) unit staff by email. The email to ERS unit staff must include:
  • This email subject line: Waiver Transfer Request for XX [first letter of the member’s first and last name];
  • the member’s name;
  • Medicaid identification (ID) number;
  • type of request: waiver transfer;
  • MN approval date;
  • ISP receipt date;
  • ISP begin date;
  • ISP end date;
  • MCO selection;
  • termination effective date for the STAR+PLUS HCBS program;
  • enrollment effective date for the other Medicaid waiver program; and
  • Form H2065-D as an attachment;
• for medical assistance only (MAO) members, fax Form H1746-A, MEPD Referral Cover Sheet to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist notating the STAR+PLUS HCBS program termination date and the SOC date for the other Medicaid waiver program;
• upload all applicable documents to the HEART case record; and
• document and close the HEART case record.

Note: PSU staff must not close Medical Necessity, Level of Service, and Diagnosis SG 19 – STAR+PLUS records in SASO.

3320 Reserved for Future Use

Revision 26-3; Effective Aug. 14, 2026

3330 STAR+PLUS Individual Requesting an Upgrade to the STAR+PLUS HCBS Program

Revision 26-2; Effective June 1, 2026

The managed care organization (MCO) must:

• Use Form H2067-MC, Managed Care Programs Communication, to advise Program Support Unit (PSU) staff that a STAR+PLUS individual requests an upgrade into the STAR+PLUS Home and Community Based Services (HCBS) program. 
• Note the following in the comments section of Form H2067-MC:
  • the Medicaid type of assistance (TOA); 
  • if the MCO will use an existing Medical Necessity and Level of Care (MN/LOC) Assessment or will be completing a new one; and
  • if a Supplemental Security Income (SSI) individual is receiving Community First Choice (CFC) services or not.
• Upload Form H2067-MC to the MCOHUB within three business days of the request for an upgrade.

PSU staff do not have to respond to the Form H2067-MC received from the MCO.

The MCO may choose to use an existing MN/LOC Assessment on file if the assessment date does not exceed 120 days from the upgrade start of care (SOC) date. PSU staff must take the following actions depending on if the MN/LOC Assessment is valid and with consideration to the MCO’s assessment preference:

• close the Medical Necessity (MN), Level of Service (LOS), and Diagnosis (DG) records in the Service Authorization System Online (SASO) with an end date one day before the STAR+PLUS HCBS program SOC date if the MCO requests to submit a new initial MN/LOC Assessment; or
• extend the end date of the MN, LOS, and DG records in SASO to align with the STAR+PLUS HCBS individual service plan (ISP) end date if the MCO requests to use an existing valid MN/LOC Assessment.

A significant change MN/LOC Assessment and nursing facility (NF) Minimum Data Set (MDS) cannot be used for an upgrade. 

A STAR+PLUS individual with one of the following Medicaid types of assistance TOAs may be eligible to upgrade to the STAR+PLUS HCBS program:

• Pickle (type program (TP)-03)
• Earnings Transitional (TP-07)
• Texas Temporary Assistance for Needy Families (TANF) Family Level (TP-08)
• SSI (TP-12 and TP-13)
• Medicaid for Breast and Cervical Cancer (MBCC) (TP-14)
• Disabled Adult Child (TP-18)
• Disabled Widow(er) (TP-21)
• Early Aged Widow(er) (TP-22)
• Pregnant Women (TP-40)
• Former Foster Care Children (FFCC) (type assistance (TA)-82)
• Medicaid Buy-in (TP-87)

The above Medicaid TOAs represent full Medicaid eligibility. PSU staff do not require review by the MEPD specialist except for applicants receiving MBCC. PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist for upgrade applicants who are receiving MBCC. This must be done within two business days of receipt of the upgrade request. PSU must check the Program Transfer box. They must note in the comments section on Form H1746-A that this case requires a financial eligibility determination. The MEPD specialist provides PSU staff with a determination on if the MBCC applicant meets financial eligibility. The MEPD specialist updates Texas Integrated Eligibility Redesign System (TIERS) to reflect a program transfer to ME-Waivers if the MBCC applicant meets financial eligibility for the STAR+PLUS HCBS program.

An individual who receives TANF Level Families or Pregnant Women TOAs must be enrolled in STAR+PLUS to be eligible for an upgrade into the STAR+PLUS HCBS program. An individual enrolled in STAR must go through the interest list release (ILR) process.

The MCO must complete and submit:

• the initial MN/LOC Assessment, as applicable; and 
• Form H1700-1, Individual Service Plan.

This must be done in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) within 45 days of an applicant’s identified need or request to upgrade into the STAR+PLUS HCBS program.

PSU staff complete the following activities within five business days of verifying all eligibility criteria is met:

• email the regional Community Care Services Eligibility (CCSE) mailbox requesting the closure of all Service Group (SG) 7 records in SASO, if applicable;
  • identify the CCSE region by referring to Appendix XXXVIII, CCSE Region by Service Area; 
  • the closure date must be one day before the start of care (SOC) for the STAR+PLUS HCBS program;
• electronically generate Form H2065-D, Notification of Managed Care Program Services, in the TMHP LTCOP;
• mail Form H2065-D to the member;
• verify SASO records are in alignment with TMHP LTCOP records;
• upload all applicable documents to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record; and
• document and close the HEART case record.

The start of care (SOC) date on Form H2065-D is the first day of the month after all eligibility criteria is met.

Refer to 6000, Denials and Terminations, if the applicant does not meet STAR+PLUS HCBS program requirements during the upgrade process.