3237 Determining Room and Board Charges Revision 17-; Effective 1, 2017 All STAR+PLUS Home and Community Services (HCBS) program must pay the room and board charges to be eligible for Assisted Living (AL). Room and board cannot be waived, but an AL facility may choose to accept an individual for a lower amount. STAR+PLUS HCBS program policy does not direct the facility to accept or reject the individual. The room and board charge for an individual is fixed at the amount remaining after subtracting $85 from the Supplemental Security Income (SSI) federal benefit rate (FBR). FBR current amounts are found in , Monthly Income/Resource Limits, which is updated when the FBR changes. For couples both partners are residing in AL or Adult Foster Care (AFC) settings, $170 is subtracted from the couple's income so each member of the couple keeps $85 a month for personal needs and the remainder is the room and board charge for the couple. Due to the difference in income between couples and individuals, the amount of room and board charge for a couple depends on income. For SSI couples, the room and charge is the FBR for a couple minus the $170 personal needs allowance. For couples who are not SSI recipients, but income is less than the current FBR for an individual doubled, the room and board charge is their monthly income minus the $170 for personal needs. For couples whose income exceeds twice the SSI FBR for an individual, the full room and board charge for two individuals is required. The AL/AFC participant will keep $85 a month for personal needs. Refer to , STAR+PLUS Inquiries Chart, for instructions about who to contact for information on how to calculate room and board for a partial month. 3238 Determining Copayment Amounts Revision 17-; Effective 1, 2017 After determining financial eligibility for Medicaid, Medicaid for the Elderly and People with Disabilities (MEPD) determine the amount of money available for copayment. MEPD send ,
Examples: Upgrades An individual has an MED of 07-01-17, an approved MN/LOC submittal date of and an ISP posted 11-01-17. The eligibility effective date on Form H2065-D is An individual has an MED of 07-01-17, an approved MN/LOC submittal date of and an ISP posted 10-20-17. The eligibility effective date on Form H2065-D is Interest List An individual has an MED of 07-01-17, an approved MN/LOC submittal date of 6-15-17, and an ISP posted 7-01-17. The eligibility effective date on Form H2065-D is 7-01-17. An individual has an MED of 07-01-17, an approved MN/LOC submittal date of 6-15-17, and an ISP posted 7-20-17. The eligibility effective date on Form H2065-D is 8-01-17. 3623.2 s of Children's Programs Revision 17-; Effective 1, 2017 The effective date on , Notification of Managed Care Program Services, for of the Medically Dependent Children Program (MDCP) Comprehensive Care Program (CCP) 3623.3 Money Follows the Person/Money Follows the Person Demonstration Nursing Facility Releases Revision 17-; Effective 1, 2017
May 22 May 22 May 31 May 24 June 30* ISP and MN/LOC must be corrected to June 30. June 30 June 9 May 31 June 11 June 30 Managed care organization should have submitted an ISP and MN/LOC for June 1. If forms are not submitted, enter Service Group 19/Service Code 13 for June 1 through June 30. *The 10-day adverse action period expires after the end of the month. 3631.4 Unable to Locate Revision 17-1; Effective 1, 2017 Date HHSC Informed Current Individual Service Plan (ISP) End Date Date Form Sent Form Termination Date Service Authorization System Action December 31 May 31 January 2 January 31 ISP and Medical Necessity/Level of Care (MN/LOC) must be corrected to January 31. May 3 May 31 May 5 May 31 None May 5 May 31 May 27 June 30* ISP and MN/LOC must be corrected to June 30. June 9 May 31 June 11 June 30 Managed care organization should have submitted an ISP and MN/LOC for June 1. If these forms are not submitted, enter Service Group 19/Service Code 13 for June 1 through June 30. *The 10-day adverse action period expires after the end of the month.
3632 Program Support Unit Initiated Denials/Terminations Revision 17-; Effective 1, 2017 The following sections contain policy citations that must be included on , Notification of Managed Care Program Services, when the denial or termination action is initiated by Texas Health and Human Services Commission (HHSC) staff. 3632.1 Denial/Termination Due to Death Revision 17-; Effective 1, 2017 Upon learning of the death of a member, Program Support Unit (PSU) must send to the managed care organization (MCO) within two business days of verification: , Managed Care Programs Communication; or , MEPD Referral Cover Sheet. Form H1746-A must be sent to the Medicaid for the Elderly and People with Disabilities (MEPD) , if appropriate. Do not send a notice to the member's address or family. The effective date is the date of death. If the member was receiving Supplemental Security Income (SSI) and the eligibility records reflect that SSI has been denied, PSU must use the same effective date of denial as the SSI denial date. If the eligibility records reflect SSI is still active, PSU must contact the Social Security Administration to notify it of the date of the member's death. If a member's Medicaid eligibility has been denied due to in the Texas Integrated Eligibility Redesign System (TIERS), the appropriate entries must be made to end enrollment in the Service Authorization System. Services must be denied/terminated once death of the member has been confirmed by PSU via: TIERS; obituaries in the local newspaper; contact with family or friends; notification from the MCO; or other reliable sources.