Appendix XXXI, PSU Activities for STAR+PLUS HCBS Applicants and Members Transitioning from an NF in One Service Area to the Community in Another Service Area

8-2026

Step 1: The losing managed care organization (MCO) must complete the following activities within 14 business days of an applicant or member’s request to transfer from a nursing facility (NF) to the community in another service area (SA): 

  • Meet with the applicant or member to explain the transition process.
  • Inform the member that they must:
    • contact the Social Security Administration (SSA) if they receive Supplemental Security Income (SSI) or SSI-related Medicaid; or 
    • call 211 if they receive medical assistance only (MAO) Medicaid; and 
    • they must do this to update their address once they discharge from a nursing facility (NF) and move to a new SA so they do not encounter a delay in service delivery.
  • Determine if the applicant or member is requesting help from a relocation specialist. 
  • Upload Form H2067-MC, Managed Care Programs Communication, to the MCOHub to advise Program Support Unit (PSU) staff of: 
    • the request to transition from an NF in one SA to the community in a different SA;
    • the losing MCO contact information; and
    • the name of the gaining MCO in the new SA if the applicant or member has chosen one.

Step 2: PSU staff must complete the following activities within three business days of receipt of Form H2067-MC:

  • create a case in the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART);
  • check the Community Services Interest List (CSIL) database to see if the member is on a Texas Health and Human Services Commission (HHSC) 1915(c) Medicaid waiver interest list;
  • determine if the member has an open enrollment or if services were temporarily suspended in an HHSC 1915(c) Medicaid waiver;
  • inform the member that they must:
  • contact the SSA if they receive SSI or SSI-related Medicaid; or
  • call 211 if they receive MAO Medicaid to update their address when they discharge from a NF and move to a new SA so they do not encounter a delay in service delivery;
  • provide the member a list of MCOs in the new SA; 
  • discuss the importance of choosing an MCO so:
    •  the assessment and individual service plan (ISP) are transferred timely; 
    • there is no delay in service delivery once the member transitions to the new SA; and
  • follow-up weekly with the member until the member makes an MCO selection, if applicable. 

Applicants and members can remain enrolled with the same MCO if their MCO operates in the gaining SA. The applicant or member are defaulted to an MCO in the gaining SA by PSU staff if they have not selected one within 30 days of the transfer request. 

Step 4: PSU staff notify the losing and gaining MCO of the member's MCO choice or default MCO selection within three business days by uploading Form H2067-MC to the MCOHub. 

Step 5: The losing MCO must complete the following activities within 45 days of the applicant or member’s transfer request:

  • determine if medical necessity (MN) is based on the Minimum Data Set (MDS) or a valid Medical Necessity and Level of Care (MN/LOC) Assessment; and
  • submit the ISP in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) or upload to the MCOHub.

Step 6: PSU staff must complete the following activities within five business days of receipt of a valid MN and ISP:

  • confirm the member continues to meet all STAR+PLUS Home and Community Based Services (HCBS) program eligibility; 
  • generate the initial Form H2065-D, Notification of Managed Care Program Services, indicating the eligibility begin date; 
  • mail the initial Form H2065-D to the member; and 
  • upload two copies of the initial Form H2065-D to MCOHub, one for the losing MCO and one for the gaining MCO.

Step 7: The gaining MCO must complete the following activities once the initial Form H2065-D is received:

  • coordinate with the losing MCO, relocation specialist, NF, and member to identify a proposed discharge date; 
  • upload Form H2067-MC to the MCOHub within one business day of learning the discharge date as notification to PSU staff of the discharge date;
  • offer a choice of providers and coordinate the delivery of all services;
  • coordinate with the losing MCO to help the member review assisted living facility (ALF) or adult foster care (AFC) homes available in the gaining SA, if applicable; and
  • inform the member who chooses to live in an ALF or AFC home setting about room and board (R&B) and copayment requirements, if applicable.

PSU staff must immediately notify the gaining MCO if any other entity notifies PSU staff of a different discharge date. The gaining MCO must respond with the correct scheduled discharge date by uploading Form H2067-MC to the MCOHub within two business days of receipt of notification from PSU staff.

Step 8: PSU staff must complete the following activities within five business days following the relocation:

  • generate the second Form H2065-D indicating the ISP begin and end dates; 
  • mail the second Form H2065-D to the member; 
  • upload the second Form H2065-D to the MCOHub as notification to the gaining MCO; 
  • email the Enrollment Resolution Services (ERS) mailbox advising that the member has moved; and
  • fax Form H1746-A, MEPD Referral Cover Sheet, to the MEPD specialist as notification of the relocation for MAO members. 

Step 9: PSU staff must ensure all the MCO records in Service Authorization System Online (SASO) match the information in the Texas Integrated Eligibility Redesign System (TIERS) managed care screen once the member's plan change is effective.

Step 10: The MCO responsible for payment of services depends on the start of care (SOC) date shown on the second Form H2065-D.

  • If the SOC date is between the first day and 10th day of the month, April for example: 
    • PSU staff coordinate with ERS to enroll the member in the gaining MCO for the month, in this example, April. 
    • The MCO may need to notify providers so they hold claims with a date of service following the end of the previous month.
    • ERS retroactively enrolls the member in the gaining MCO for the month, in this example, of April. 
    • The losing MCO is responsible for NF claims for the member until the end of the previous month, in this example, March.
    • The gaining MCO is responsible for claims once the individual is its member, in this example, April 1.  
  • If the SOC date is between the 11th day and the 25th day of the month of April for example, April:
    • The losing MCO is responsible for claims until the individual transferring is no longer its member.
    • The losing PSU staff coordinate with ERS to prospectively enroll the individual in the gaining MCO for the next month.
    • The gaining MCO is responsible for claims once the individual is its member in the next month.
  • If the SOC date is between 26th day and last day of the month:
    • The gaining PSU staff send the final Form H2065-D to the losing MCO, the gaining MCO and the losing PSU staff.
    • The losing PSU staff coordinate with ERS to prospectively or retroactively enroll the individual in the gaining MCO for the month following discharge.
    • The losing MCO is responsible for claims until the end of the month.
    • The gaining MCO is responsible for claims once the individual is its member in the next month.
    • The MCO may need to notify providers so they hold claims with a date of service following the end of the previous month.

Appears In

  • STAR+PLUS Handbook
  • STAR+PLUS Program Support Unit Operational Procedures Handbook