Appendix XXXV, SASO Data Entry Guide

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Revision Notice 26-2; Effective June 1, 2026

1: Initial Service Authorization

Program Support Unit (PSU) staff must check or create the following records in the Service Authorization System Online (SASO) when authorizing the STAR+PLUS Home and Community Based Services (HCBS) program:

  • Authorizing Agent – Initial;
  • Enrollment – Initial;
  • Service Plan – Initial;
  • Service Authorization – Initial;
  • Level of Service – Initial;
  • Diagnosis – Initial; and
  • Medical Necessity – Initial.

1.1: Authorizing Agent - Initial

PSU staff use the authorizing agent record in the SASO to register the authorizing agent begin date. They use an open-ended date for the STAR+PLUS HCBS program applicant.

There will normally be one authorizing agent registered in the SASO for a STAR+PLUS HCBS program applicant.

Initial individual service plans (ISPs) submitted through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) have a system generated authorizing agent. The TMHP LTCOP interfaces with SASO and records STAR+PLUS in the Authorizing Agent field and the managed care organization (MCO) service coordinator's name in the Name field.

The TMHP LTCOP generates changes to the SASO authorizing agent records for a member with a plan code change during an ISP year where a current or future ISP is in a processed or complete status. An SASO authorizing agent record is created for the initial ISP in cases with a begin date equal to the MCO plan effective date. The SASO authorizing agent record for the transferred ISP is automatically ended with the prior MCO plan enrollment end date.

PSU staff:

  • do not register an authorizing agent for an electronic ISP;
  • create authorizing agent record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically;
  • confirm the authorizing agent registration in SASO; and  
  • register PSU staff’s service area as the authorizing agent when an applicant is authorized in SASO.

PSU staff must complete the following activities when manually registering an authorizing agent record in SASO for the STAR+PLUS HCBS program:

  • Select the Authorizing Agent field in the Case Worker functional area.
  • Select Add and a blank Authorizing Agent Details record appears.
  • Move to the Type field and select CM – Case Manager from the drop-down menu.
  • Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Leave the Send to TMHP field at the default selection N - NO.
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Leave the End Date field blank.
  • Move to the Authorizing Agent field and enter STAR+PLUS.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Name field and enter the PSU staff’s service area.
  • Move to the Phone field and enter the phone number of the authorizing agent. Enter the area code, phone number and extension.
  • Move to the Mail Code field and enter the appropriate MCO plan code.

1.2: Enrollment - Initial

PSU staff use the enrollment record in the SASO to register the enrollment begin and end date for the STAR+PLUS HCBS program applicant.

PSU staff create an enrollment record for STAR+PLUS HCBS program eligibility for applicants whose ISP was not transmitted electronically.

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART).

PSU staff must complete the following activities when manually registering an enrollment record in SASO for a STAR+PLUS HCBS program:

  • Select the Enrollment field in the Program and Service functional area.
  • Select Add and a blank Enrollment Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Enrolled From field and select the appropriate entry from the drop-down menu.
  • Move to the Living Arrangement field and select the appropriate community-based living arrangement from the drop-down menu. The living arrangement must match the information provided in the initial ISP.
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Leave the End Date field blank.
  • Leave the Termination Code and Waiver Type fields at the defaults.
  • Select the Save button.

1.3: Service Plan - Initial

PSU staff use the service plan record in the SASO to register an ISP for a STAR+PLUS HCBS program member. The service plan record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level and the total estimated cost taken from the member’s Form H1700-1, Individual Service Plan, on page 1, for members without an electronic ISP.

PSU staff create a service plan record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to HEART.

PSU staff must complete the following activities when manually registering a service plan record in SASO for a STAR+PLUS HCBS program :

  • Select the Service Plan field in the Program and Service functional area.
  • Select Add and a blank Service Plan Details record appears.
  • Leave the Type field at the default selection AN - ANNUAL PLAN.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the PDPM LTC level entered on the current ISP coverage period, from Form H1700-1.  For a STAR+PLUS HCBS program member who is ventilator use-dependent, enter the annual STAR+PLUS HCBS program ISP cost limit based on the PDPM LTC level and ventilator use of the member (6-23 hours or 24 hours continuous).
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Move to the Amount Authorized field and enter the total estimated cost of all STAR+PLUS HCBS program services authorized for the current ISP coverage period, from Form H1700-1.
  • Leave the Amount Paid field at the default setting of 0.00.
  • Leave the Units Authorized field at the default of 0.00.
  • Leave the Units Paid field at the default of 0.00.
  • Select the Save button.

1.4: Service Authorization - Initial

The TMHP LTCOP automatically generates service authorization records. This is generated in the SASO if the ISP is electronic.

PSU staff:

  • Do not register service authorization records for an electronic ISP.
  • Create a service authorization record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.
  • Must confirm service authorization registration in SASO, take a screenshot of the service authorization registration, and upload the screenshot to the HEART System.

PSU staff must complete the following activities when manually registering a service authorization record in SASO for the STAR+PLUS HCBS program:

  • Select the Service Authorization field in the Program and Service functional area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
  • Leave the Fund and Term. Code fields at the defaults.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
  • Move to the Units field and enter 1.00.
  • Leave the Amount field at the default.
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Move to the Contract No field and enter the appropriate contract number of the MCO.

1.5: Level of Service - Initial

All STAR+PLUS HCBS program members must have a PDPM LTC level registered on a level of service (LOS) record in the SASO. The LOS record is system generated from information received from the TMHPLTCOP. The MCO nurse completes the Medical Necessity and Level of Care (MN/LOC) Assessment and submits the information to the TMHP LTCOP or uses the nursing facility (NF) minimum data set (MDS). TMHP determines MN and the PDPM LTC level and then submits it to the Texas Health and Human Services Commission (HHSC) where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system generated LOS record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires.

PSU staff create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: If the MN/LOC Assessment is approved with an effective date of May 13, 2019, the system-generated end date for the LOS record is May 12, 2020. If the ISP period is June 1, 2019 to May 31, 2020, the LOS record is extended to May 31, 2020, so the member has coverage for the entire ISP period.

PSU staff must complete the following activities when adjusting an LOS record in SASO for the STAR+PLUS HCBS program:

  • Select the Level of Service field in the Medical functional area.
  • Select the Level of Service record you wish to adjust.
  • Select the Modify button to open and modify.
  • Move to the End Date field and change the date to the last day of the ISP period.
  • Select the Save button.

PSU staff must complete the following activities to add a LOS record when one was not created in SASO:

  • Select the Level of Service field in the Medical functional area.
  • Select Add and a blank Level of Service Details record appears.
  • Move to the Type field and select PP – StarPlus PDPM from the drop-down menu.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Level field and enter the PDPM LTC level from Form H1700-1, Individual Service Plan, page 1. The PDPM LTC level can be verified in the MN/LOC Assessment.
  • Move to the Begin Date field and enter the first day of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Select the Save button.

1.6: Diagnosis - Initial

All STAR+PLUS HCBS program members must have a diagnosis registered in SASO. The diagnosis record should be system generated from information received from the TMHPLTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires.

PSU staff create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: If MN is approved with an effective date of Nov. 13, 2019, the system generated end date will be Nov. 30, 2020.

PSU staff must complete the following activities to adjust a diagnosis record in SASO for the STAR+PLUS HCBS program:

  • Select the Diagnosis field in the Medical functional area.
  • Select the Diagnosis record you wish to adjust.
  • Select the Modify button to open and modify.
  • Move to the End Date field and change the date to the last day of the ISP period.
  • Select the Save button.

PSU staff must complete the following activities to add a diagnosis record when one was not created in SASO:

  • Select the Diagnosis field in the Medical functional area.
  • Select Add and a blank Diagnosis Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Begin Date field and enter the first day of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Enter up to five diagnoses from the most recent Waiver 3.0 Form, Section I, in TMHP. The diagnosis can be verified in the MN/LOC Assessment.
  • Select Version ICD-10-CM CODE.
  • Select the Save button.

1.7: Medical Necessity - Initial

All STAR+PLUS HCBS program members must have a MN registered in the SASO. The MN record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then TMHP submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires.

PSU staff create an MN record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the HEART system.

Example: If MN is approved with an effective date of May 13, 2019, the system generated end date is May 31, 2020.

PSU staff must complete the following activities to adjust an MN record for the STAR+PLUS HCBS program:

  • Select the MN field in the Medical functional area.
  • Select the MN record you wish to adjust.
  • Select the Modify button to open and modify.
  • Move to the End Date field and change the date to the last day of the ISP period.
  • Select the Save button.

PSU staff must complete the following activities to add a MN record when one was not created in SASO:

  • Select the MN field in the Medical functional area.
  • Select Add and a blank MN Details record appears.
  • Move to the MN field and select Y - YES from the drop-down menu.
  • Move to the Permanent field and select N – NO.
  • Move to the Begin Date field and enter the first day of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Select the Save button.

2: Reassessment Service Authorization

PSU staff authorize STAR+PLUS HCBS program services for a reassessment of the ISP in the SASO. PSU staff must check or create the following records per sections 9210 through 9270:

  • Authorizing Agent – Reassessment;
  • Enrollment – Reassessment;
  • Service Plan – Reassessment;
  • Service Authorization – Reassessment;
  • Level of Service – Reassessment;
  • Diagnosis – Reassessment; and
  • Medical Necessity – Reassessment.

2.1: Authorizing Agent – Reassessment

Check the authorizing agent record for accuracy. If there are no changes, leave the authorizing agent record open-ended. Currently, although the SASO accepts multiple authorizing agent records, the TMHP LTCOP only accepts two authorizing agent records when an SASO file is transmitted to TMHP. Therefore, select NO in the Send to TMHP field for all updates.

PSU staff creates an authorizing agent record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

2.2: Enrollment – Reassessment

PSU staff must check the enrollment record for accuracy and ensure that it is open-ended. PSU staff make no changes if the record is open-ended. PSU staff delete the end date or create another record with a new begin date if the record has an end date. The begin date of the enrollment for the new ISP year is the day after the end date of the previous ISP year to ensure that there is not a gap in service.

PSU staff creates a service plan record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm enrollment registration in SASO, take a screenshot of the enrollment registration, and upload the screenshot to the HEART System.

2.3: Service Plan – Reassessment

A new service plan record may need to be created to register the PDPM LTC level cost limit and the amount of services authorized for the new ISP year.

The TMHP LTCOP automatically generates service plan records in the SASO when the ISP is submitted.

PSU staff do not need to create a service plan record for electronic ISPs.

PSU staff create a service plan record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff confirm service plan registration in SASO, take a screenshot of the service plan registration, and upload the screenshot to the HEART System.

2.4: Service Authorization – Reassessment

PSU staff create one service authorization record for the STAR+PLUS HCBS program for the new ISP year if the MCO uploads a timely reassessment packet. The begin date of the authorization for the new ISP year is the day after the end date of the previous ISP year to ensure there is no gap in service.

The TMHP LTCOP automatically generates service authorization records in the SASO.

PSU staff must confirm service authorization records generated from the TMHP LTCOP appear in SASO.

PSU staff manually create a service authorization record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Two service authorization records are required for STAR+PLUS HCBS program eligibility if the MCO does not upload a timely reassessment packet. The first service authorization record for STAR+PLUS HCBS program eligibility is entered with service group (SG) 19 and service code (SC) 13 for the month(s) that the ISP was late. The second Service Authorization record for STAR+PLUS HCBS program eligibility is entered with SG 19 and SC 12 for the remaining ISP period.

PSU staff must complete the following activities when manually entering a Service Authorization record for an untimely reassessment for the STAR+PLUS HCBS program:

  • Select the Service Authorization field in the Program and Service functional area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Service Code field and select 13 – NURSING SERVICES from the drop-down menu.
  • Leave the Fund and Term. Code fields at the defaults.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Unit Type field and select 4 – PER AUTHORIZATION from the drop-down menu.
  • Move to the Units field and enter 1.00.
  • Leave Amount field at the default.
  • Move to the Begin Date field and enter the effective date of the new ISP coverage period.
  • Create two service authorization records. For the first record, move to the End Date field and enter the last day of the month the ISP was received. Note: For the second record, repeat steps 1 through 10. Move to the Begin Date field and enter the first of the next month and move to the End Date field and enter the end date of the ISP period.
  • Move to the Contract No. field and enter the appropriate contract number of the MCO.
  • The NPI field is read-only.
  • Select the Save button.

2.5: Level of Service – Reassessment

All STAR+PLUS HCBS program members must have a PDPM LTC level registered in the SASO. The LOS record will be system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines the MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The LOS record is system generated from the information stored in the SASO database. The system-generated LOS record has a begin and end date that matches the new ISP year.

PSU staff create a LOS record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: A member with an initial ISP coverage period of Dec. 1, 2019 through Nov. 30, 2020, is authorized for STAR+PLUS HCBS program eligibility. The new ISP year is effective of Dec. 1, 2019 through Nov. 30, 2020. These new begin and end dates are system generated in the LOS record.

2.6: Diagnosis – Reassessment

All STAR+PLUS HCBS program members must have a diagnosis registered in the SASO. The diagnosis record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information from this form to the TMHP LTCOP or uses NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The diagnosis record is system generated from the information stored in the SASO database. The system-generated diagnosis record will have a begin and end date that matches the new ISP year.

PSU staff will create a diagnosis record for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

Example: A member with an initial ISP coverage period of Nov. 1, 2019, through Oct. 31, 2020, is re-authorized for STAR+PLUS HCBS program eligibility. The new ISP year will be effective Nov. 1, 2019, through Oct. 31, 2020. These new begin and end dates are system generated in the diagnosis record.

2.7: Medical Necessity – Reassessment

All STAR+PLUS HCBS program members must have a MN registered in the SASO. The MN record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment for the annual reassessment and submits the information to the TMHP LTCOP or uses NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in the SASO database. The system-generated MN record has a begin date and an end date that matches the new ISP year.

PSU staff creates an MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

PSU staff must confirm MN registration in SASO, take a screenshot of the MN registration, and upload the screenshot to the HEART System.

Example: A member with an initial ISP coverage period of Feb. 1, 2019, through Jan. 31, 2020, is authorized for STAR+PLUS HCBS program eligibility. The new ISP year is effective Feb. 1, 2019, through Jan. 31, 2020. These new begin and end dates are system generated in the MN record. The MN record must be forced in SASO to register an MN determination for a reassessment when the MN is approved in the TMHP LTCOP but will not convert to SASO because of a mismatch of member information between the MN/LOC Assessment and the TIERS.

3: Transfers

There are several situations considered transfers for STAR+PLUS Home and HCBS for each.

3.1: Transfers from One STAR+PLUS Area to Another Area

Two different situations can occur when a HCBS program member transfers from one service area (SA) to another SA. The first situation is when a member transfers to a new SA that the current MCO also operates in, and the member wants to stay with that MCO. The second situation is when the member transfers to a new SA that the current MCO does not operate in, and the member changes MCOs. The contract number will change when a plan change occurs, even if the member stays with the same MCO in the same SA. As a result, the member’s records will need to be closed under the previous contract number and opened under the new contract number.

The TIERS updates the TMHP LTCOP if the member's ISP is electronic and the member made a new MCO selection. The TMHP LTCOP automatically interfaces with the SASO to:

  • close the SASO registration records for the old MCO; and
  • create new SASO registration records for the new MCO.

PSU staff must manually close SASO registration records when a member’s MCO plan change is not timely. To process the transfer, the PSU staff must:

  • close the existing:
    • Authorizing Agent (SC 12) record;
    • Service Authorization (SG 19/ SC 12) record;
  • open a new:
    • Authorizing Agent (SC 12) record; and
    • Service Authorization (SG 19/SC 12) record using the MCO contract number in the new SA.

The PSU staff must complete the following activities to close the Authorizing Agent record:

  • Open the STAR+PLUS HCBS program member’s case in the SASO.
  • Select the Authorizing Agent field from the Case Worker functional area.
  • Select the Authorizing Agent record you wish to close.
  • Select the Modify button to open and modify.
  • Move to the End Date field and enter the effective date of the termination, which is the last day of the month that the member moved to the new SA.
  • Select the Save button.

The PSU staff must complete the following activities to close the Service Authorization record:

  • Select the Service Authorization field in the Program and Service functional area.
  • Select the appropriate Service Authorization (SC 12) record you wish to close.
  • Select the Modify button to open and modify.
  • Move to the End Date field and enter the effective date of the termination. This will be the last day of the month in which the member moved to the new SA.
  • Move to the Termination Code field and select 23 - Transferred to another service, or the appropriate code, from the drop-down menu.
  • Select the Save button.
  • Select Submit to SASO.
  • Select Outbox and then Inbox to ensure the case processed accurately.

The Service Authorization record is opened per procedures outlined in determining initial eligibility for STAR+PLUS HCBS program members with the following exceptions:

  • The begin date for these records is the first day of the month after the month the member moved to the new SA.
  • The end date for the Service Authorization (SC 12) record is the same as the current ISP period.

Example: If a STAR+PLUS HCBS program member with an ISP period of Nov. 1, 2019, to Oct. 31, 2020, transfers to another STAR+PLUS SA on Jan. 15, 2020, the end date for these records remains Oct. 31, 2018.

3.2: Transfers from One MCO to Another MCO in the Same Service Area

TIERS will update the managed care enrollment in the TMHP LTCOP when:

  • a STAR+PLUS HCBS program member has an ISP in the TMHP LTCOP; and
  • chooses a new MCO timely before state cutoff.

This update automatically closes the registration for the old MCO and creates the registration for the new MCO in the SASO.

PSU staff must manually close existing service authorization records in SASO if the member's plan change request is not timely. PSU staff process untimely requests by manually closing the existing service authorization record, SC 12 for the old MCO and manually creating a new service authorization record, SC 12, for the new MCO in SASO.

PSU staff must complete the following activities when manually closing an existing service authorization record:

  • Move to the Service Authorization field in the Program and Service functional area.
  • Select the appropriate Service Authorization record you wish to close.
  • Select the Modify button.
  • Move to the End Date field and enter the effective date of the termination. This is the last day of the month that the member was enrolled in the old MCO.
  • Move to the Termination Code field and select 39 – Other or the appropriate code from the drop-down menu.
  • Select the Save button.
  • Select Submit to SASO.
  • Select Outbox and then Inbox to make sure the case is processed correctly.

PSU staff must complete the following activities when manually creating a new service authorization record for the new MCO:

  • Select the Service Authorization field in the Program and Service functional area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
  • Leave the Fund and Term. Code fields at the defaults.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Unit Type field and select 2 – MONTH from the drop-down menu.
  • Move to the Units field and enter 1.00.
  • Leave the Amount field at the default.
  • Move to the Begin Date field and enter the new MCO contract number or plan code enrollment date.
  • Move to the End Date field to align with the last day of the ISP coverage period.
  • Move to the Contract No. field and enter the appropriate contract number of the MCO.

4: MFP Authorization for STAR+PLUS HCBS Program Applicant

PSU staff do not close the Authorizing Agent, Medical Necessity, Level of Service PDPM LTC level records. PSU staff must make sure Provider Claims Services (PCS) closes the enrollment and service authorization records for SC 1, 3, 50 and 60. There may be an overlap of STAR+PLUS HCBS program and PCS records in SASO.

Note: Individuals released from an NF and authorized for the STAR+PLUS HCBS program should be enrolled under MFP. In the Enrollment record, select 12 – MONEY FOLLOWS THE PERSON from the drop-down menu in the Enrolled From field. Do not use Enrolled from nursing facility to designate MFP members.

To authorize STAR+PLUS HCBS program eligibility for an MFP applicant:

SU must create the records needed for the ongoing MFP STAR+PLUS HCBS program eligibility. These records must be completed to check or create an initial service authorization for the STAR+PLUS HCBS program.

4.1: Authorizing Agent for MFP Applicant

There will be one authorizing agent record entered for an MFP applicant. PSU staff are entered as the authorizing agent when manually processing an MFP case.

PSU staff must complete the following activities when manually registering an authorizing agent for an MFP applicant:

  • Select the Authorizing Agent field in the Case Worker functional area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Type field and select CM - CASE MANAGER from the drop-down menu.
  • Move to the Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Leave the Send to TMHP field at the default selection N - NO.
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Leave the End Date field blank.
  • Move to the Authorizing Agent ID field and enter STAR+PLUS.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Name field and enter the PSU staff’s service area.
  • Move to the Phone field and enter the phone number of the Authorizing Agent. Enter the area code, phone number and extension.
  • Move to the Mail Code field and enter the appropriate MCO Plan Code.
  • Select the Save button.

4.2: Enrollment for MFP Applicant

PSU staff use the enrollment record in the SASO to register the enrollment begin date with an open-ended date for the STAR+PLUS HCBS program member.

PSU staff:

  • Create an enrollment record for STAR+PLUS HCBS program eligibility for members.
  • Take a screenshot of the enrollment registration in SASO and upload the screenshot to the HEART System.

PSU staff must complete the following activities when manually registering an authorizing agent in SASO for an MFP applicant:

  • Select the Enrollment field in the Program and Service functional area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Enrolled From field and select the appropriate entry from the drop-down menu. If this is an MFP authorization, be sure to select 12 - MONEY FOLLOWS THE PERSON from the drop-down menu.
  • Move to the Living Arrangement field and select the appropriate community-based living arrangement from the drop-down menu.
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Leave the End Date field blank.
  • Leave the Termination Code and Waiver Type at the defaults.
  • Select the Save button.

4.3: Service Plan for MFP Applicant

Use the service plan record to register an ISP for a STAR+PLUS HCBS program member. The record includes the annual STAR+PLUS HCBS program ISP cost limit based on the member’s PDPM LTC level and the total estimated cost of the STAR+PLUS HCBS program services taken from the member’s Form H1700-1, Individual Service Plan. page 1.

PSU staff create a service plan record for STAR+PLUS HCBS program eligibility for members.

PSU staff take a screenshot of the service plan registration in the SASO and upload the screenshot to the HEART System.

PSU staff must complete the following activities when manually registering a service plan record in SASO for a MFP applicant:

  • Select the Service Plan field in the Program and Service functional area.
  • Select Add and a blank Service Plan Details record appears.
  • Leave the Type field at the default selection AN - ANNUAL PLAN.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Ceiling field and enter the annual STAR+PLUS HCBS program ISP cost limit for the PDPM LTC level entered on the Level of Service record. For a STAR+PLUS HCBS program member who uses a ventilator, enter the annual STAR+PLUS HCBS program ISP cost limit based on the PDPM LTC level and ventilator use of the member (6-23 hours or 24 hours continuous).

Move to the Begin Date field and enter the effective date of the ISP coverage period.

  • Move to the End Date field and enter the last day of the ISP coverage period.
  • Move to the Amount Authorized field and enter the total estimated cost of all STAR+PLUS HCBS program services authorized for the current ISP coverage period from Form H1700-1.
  • Leave the Amount Paid field at the default setting of 0.00.
  • Leave the Units Authorized field at the default of 0.00.
  • Leave the Units Paid field at the default of 0.00.
  • Select the Save button.

4.4: Service Authorization for MFP Applicant

PSU staff create one service authorization record for STAR+PLUS HCBS program eligibility.

PSU staff must complete the following activities when manually registering a service authorization record in SASO for a MFP applicant:

  • Select the Service Authorization field in the Program and Service functional area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
  • Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
  • Leave the Fund and Term. Code fields at the defaults.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Unit Type field and select 2 – MONTH from the drop-down list.
  • Move to the Units field and enter 1.00.
  • Leave Amount at the default.
  • Move to the Begin Date field and enter the effective date of the ISP coverage period.
  • Move to the End Date field and enter the last day of the ISP coverage period.
  • Move to the Contract No. field and enter the appropriate contract number of the MCO.
  • The NPI field is read-only.
  • Select the Save button.

4.5: Level of Service for MFP Applicant

There will be an existing SG 1 (NF) LOS record. However, PSU staff must create a new LOS record for SG 19 STAR+PLUS HCBS program. The SG 1(NF) LOS record can stay open.

All STAR+PLUS HCBS program members must have an LOS registered in the SASO. The LOS record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHPLTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

PSU staff create an LOS record, if applicable, for STAR+PLUS HCBS program eligibility for members.

PSU staff must complete the following activities to add an LOS record in SASO:

  • Select the Level of Service field in the Medical functional area.
  • Select Add and a blank Level of Service Details record will appear.
  • Move to the Type field and select PP – StarPlus PDPM from the drop-down menu.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Level field and enter the PDPM LTC level.
  • Move to the Begin Date field and enter the first day of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Select the Save button.

4.6: Diagnosis for MFP Applicant

There will be an existing SG 1 diagnosis record. PSU staff must create a new diagnosis record for SG 19 STAR+PLUS HCBS program.

All STAR+PLUS HCBS program members must have a diagnosis registered in the SASO. The diagnosis record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The system-generated diagnosis record has an end date that may need to be adjusted by PSU staff through the last day of the month that the ISP expires, if applicable.

PSU staff must complete the following activities to add a diagnosis record in SASO:

  1. Select the Diagnosis field in the Medical functional area.
  2. Select Add and a blank Diagnosis Details record appears.
  3. Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  4. Move to the Begin Date field and enter the first day of the ISP period.
  5. Move to the End Date field and enter the last day of the ISP period.
  6. Enter up to five diagnoses.
  7. Leave Version field at the default.
  8. Select the Save button.

4.7: Medical Necessity for MFP Applicant

All STAR+PLUS HCBS program members must have a medical necessity (MN) registered in the SASO. The MN record is system generated from information received from the TMHP LTCOP. The MCO nurse completes the MN/LOC Assessment and submits the information to the TMHP LTCOP or uses the NF MDS. TMHP determines MN and the PDPM LTC level and then submits it to HHSC where the MN/LOC Assessment is stored in the SASO database.

The MN record is system generated from the information stored in SASO. The system-generated MN record’s end date may need adjusting by PSU staff through the last day of the month that the ISP expires. PSU must enter an end date that matches the ISP end date on MN records that appear as permanent, PMN, in SASO.

PSU staff create an MN record for STAR+PLUS HCBS program eligibility for members.

PSU staff takes a screenshot of the MN registration in SASO and upload the screenshot to the HEART System.

Example: If MN is approved with an effective date of May 13, 2019, the system-generated end date is May 31, 2020. Note: An open-ended MN record must be terminated with the end-date of the ISP.

PSU staff can create MN record(s) for STAR+PLUS HCBS program eligibility for members whose ISP was not transmitted electronically.

  • PSU staff must complete the following activities to adjust an MN record in SASO for an MFP applicant:
  • Select the MN field in the Medical functional area.
  • Select the existing MN record.
  • Select the Modify button to open and modify.
  • Move to the End Date field and change the date to the last day of the ISP period.
  • Select the Save button.

PSU staff complete the following activities to add an MN record in SASO:

  • Select the MN field in the Medical functional area.
  • Select Add and a blank MN Details record appears.
  • Leave the MN field at the default of Y - YES.
  • Leave the Permanent field at the default of N - NO.
  • Move to the Begin Date field and enter the first day of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Select the Save button.

PSU staff must complete the following activities to add a diagnosis record in the SASO:

  • Select the Diagnosis field in the Medical functional area.
  • Select Add and a blank Diagnosis Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down menu.
  • Move to the Begin Date field and enter the first day of the ISP period.
  • Move to the End Date field and enter the last day of the ISP period.
  • Enter up to five diagnoses.
  • Leave Version field at the default.
  • Select the Save button.

4.8: MFPD for STAR+PLUS HCBS Program Applicant

The option to electronically submit an ISP for a NF resident is not available. The MCO must not use the TMHP LTCOP MFPD check box. PSU staff must continue to manually register this fund code in the SASO.

PSU staff must follow the instructions for an MFP applicant above and complete the service authorization record as follows.

  • Select the Service Authorization field in the Program and Service functional Area.
  • Select Add and a blank Service Authorization Details record appears.
  • Move to the Service Group field and select 19 - STAR+PLUS from the drop-down list.
  • Move to the Service Code field and select 12 – CASE MANAGEMENT from the drop-down menu.
  • Move to the Fund field and select 19MFP – MONEY FOLLOWS PERSON.
  • Leave the Term. Code field at the defaults.
  • Leave the Agency field at the default selection 324 - DHS.
  • Move to the Unit Type field and select 2 – MONTH from the drop-down list.
  • Move to the Units field and enter 1.00.
  • Leave the Amount field at the default.
  • Move to the Begin Date field and enter the effective date of the ISP period.
  • Move to the End Date field and enter the last day of the MFPD entitlement period. Create a new Service Authorization record without the 19MFP – MONEY FOLLOWS PERSON fund code for the remaining ISP period, as applicable.
  • Move to the Contract No. field and enter the appropriate contract number of the MCO.
  • The NPI field is read-only.
  • Select Force for the Service Authorization record with the 19MFP – MONEY FOLLOWS PERSON code. Enter Member consented to MFPD in the pop-up box.
  • Select the Save button.

The MCO must notify PSU staff once the 365-day MFPD period has passed using Form H2067-MC, Managed Care Programs Communication. PSU staff must change the Service Authorization record to the default within five business days of the MCO notification.

5: Mutually Exclusive Services within the STAR+PLUS HCBS Program

The Community Care Services Eligibility (CCSE) case manager should close the community services authorization with an effective date one day before the date the member is eligible for the STAR+PLUS HCBS program.

Example: If an individual receiving Family Care (FC), Emergency Response Services (ERS) and Home-Delivered Meals (HDM) becomes eligible for the STAR+PLUS HCBS program on Dec. 1, 2019, the member begins receiving his or her services through his MCO on that date. Therefore, the losing CCSE case manager should close the FC, ERS and HDM services with an effective date of Nov. 30, 2019.

6: MDCP or CCCP Transitioning to STAR+PLUS HCBS Program

PSU staff enter the initial STAR+PLUS HCBS program eligibility into the SASO using the steps for initial eligibility. The one exception is for Medically Dependent Children Program (MDCP), Comprehensive Care Program (CCP) or Private Duty Nursing (PDN) members who are transitioning to the STAR+PLUS HCBS program. The effective date for all records are the first of the month following the member’s 21st birthday.

It is possible that the medical records such as Medical Necessity, Level of Care or Diagnosis, will need adjusting in SASO to cover the entire ISP period.

7: Terminations

PSU staff manually close Authorizing Agent, Enrollment, Service Authorization, and Service Plan records in the SASO on the termination effective date when all services for an existing STAR+PLUS HCBS program member are terminated.

PSU staff do not close the MN LOS, and Diagnosis SG 19 – STAR+PLUS records unless the termination is due to the member’s death. In this case the date of death is the termination effective date.

8: Appeal Extensions for Continued Benefits

PSU staff extend all records including Service Authorization, Service Plan and Enrollment, by four months if a STAR+PLUS HCBS program member files an appeal and requests continued benefits. PSU staff must open each record and change the end date to the last day of the month – four months in the future. PSU staff must complete this activity each time an extension is needed. Multiple extensions may be requested if the appeal process is not finalized.

Continuation of STAR+PLUS HCBS program benefits during a state fair hearing does not apply for Supplemental Security Income denials. Refer to 7222.1, Continuation of STAR+PLUS HCBS Program During a State Fair Hearing, for more information.