STAR+PLUS Handbook

Section 4000

Complaint and Appeal Procedures
Table of Contents

4100
Managed Care Organization Procedures
4110
MCO Complaint Procedures
4120
MCO Appeal Procedures
4121
Expedited MCO Appeals
4200
Appeal Procedures for STAR+PLUS Staff
4210
SPSU Coordinator Procedures
4211
Designated DER Procedures
4212
Fair Hearings and Appeals Procedures
4213
Hearing Packet
4220
Special Procedures for Cases MEPD or TW Determined Financial Eligibility
4221
Centralized Representation Unit
4222
Centralized Representaiton Unit Procedures
4230
Regional Responsibilities
4231
Uploading the Appeals Evidence Packet into the TIERS Application
4232
Presentation of the Hearing Packet
4233
Presentation of the Evidence
4234
Hearing Decision
4300
Post Hearing Actions
4310
Action Taken on the Hearing Decision
4400
Continuation of Services
4410
Continuation of STAR+PLUS Waiver Services During an Appeal
4420
Discontinuation of HCBS STAR+PLUS Waiver Services During an Appeal
4500
Hearing Decision Actions
4510
Sustained Appeal Decisions
4511
Sustained Decisions – Termination Effective Dates
4520
Reversed Appeal Decisions
4521
Reversed Decisions – Effective Dates
4600
Roles and Responsibilities of HHSC Fair Hearings Officers
4700
Fair Hearings for MCO Decisions