STAR+PLUS Handbook

Form Updates

Date

No. and Title

Change
February 15, 2013 Form H1709, STAR+PLUS Nursing Facility Diversion Slot Screening, and Instructions Adds a new form and instructions to facilitate the screening of applicants for a STAR+PLUS Nursing Facility Diversion Slot.
February 15, 2013 Form 2110, Community Care Intake, and Instructions Removes "N/A for STAR+PLUS Area" from the bottom of Page 1 of the form and from the instructions. Adds STAR+PLUS Waiver (SPW) to the instructions in the "Purpose" section and in the "Describe this individual's need for other help" section.
February 1, 2013 Form 3671-2, Individual Service Plan, and Instructions Adds Box 4b for the Service Backup Plan policy.
December 3, 2012 Form H1700-2, Individual Service Plan — SPW (Pg. 2), and Instructions Adds a new form containing both English and Spanish, and instructions (replaces Form 3671-2, Individual Service Plan, Pg. 2).
December 3, 2012 Form H1700-A, Rationale for HCBS STAR+PLUS Waiver Items/Services, and Instructions Adds a new form and instructions.
December 3, 2012 Form H1700-A1, Certification of Completion/Delivery of HCBS STAR+PLUS Waiver Items/Services, and Instructions Adds a new form and instructions.
December 3, 2012 Form H1700-B, Non-HCBS STAR+PLUS Waiver Services, and Instructions Adds a new form and instructions.
October 23, 2012 Form 2065-D, Notification of STAR+PLUS Program Services, Form 2065-DS (Spanish), and instructions Changes to the form include:
  • reformats section divisions;
  • shifts the Medicaid number/PCP/MCO identifier block closer to the bottom of the page;
  • adds a name and Medicaid number field on the top of Page 2; and
  • allows individuals to file appeals up until the effective date of the change.

Changes to the instructions include:

  • reflects the changes to the form, as described above;
  • adds that the effective date is the same as the Individual Service Plan begin date (for all but Money Follows the Person (MFP) cases);
  • removes references to “RC” and “IPC;”
  • removes the inaccurate instruction to complete the effective date for MFP first notifications; and
  • adds additional examples to the section which notifies the member that certain services will continue after the SPW denial.
October 15, 2012 Form 4800-D, DADS Fair Hearing Request Summary, and Instructions
  • Revises the form to add a "Yes" box in Section 6.
  • Revises the instructions to reflect STAR+PLUS policy changes regarding the HHSC Centralized Representation Unit, and the MCO table is updated in Section 2-F.
October 12, 2012 Form 8598, Non-Waiver Services, and Instructions Removed references to the Consolidated Waiver Program (CWP).
October 12, 2012 Form 8604, Transition Assistance Services (TAS) Assessment and Authorization, and Instructions Removed references to the Consolidated Waiver Program (CWP).
September 19, 2012 Form 8001, Medicaid Estate Recovery Receipt Acknowledgement, and Form 8001-S (Spanish) Adds Texas Home Living (TxHmL) Waiver to the list of services and programs affected by the Medicaid Estate Recovery Program.
September 6, 2012 Form 1580, Texas Money Follows the Person Demonstration Project Informed Consent for Participation, Form 1580-S (Spanish) and Instructions Changes Mental Retardation Authority (MRA) to Local Authority (LA), changes health maintenance organization (HMO) to managed care organization (MCO) and changes ICF/MR to Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID).
August 10, 2012 Form H1746-A, MEPD Referral Cover Sheet, Instructions Only Adds detailed instructions for DADS case managers and providers, and corrects the fax number.
August 1, 2012 Form 8001, Medicaid Estate Recovery Receipt Acknowledgement, and Form 8001-S (Spanish) Changes ICF/MR to Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID). Changes consumer to individual.
August 1, 2012 Form 2061, Notification of Medicaid Estate Recovery Program Status, Form 2061-S (Spanish) and Instructions Changes ICF/MR to Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID). Changes applicant/consumer to applicant or individual in the instructions.
June 25, 2012 Form 1582-S, Consumer Directed Services (CDS) Responsibilities (Spanish) Updates the Consumer Directed Services Employer Responsibilities and adds the verification of the Medicaid fraud exclusions as part of eligibility verification process for service providers.
June 8, 2012 Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, and Instructions Deletes "Consumer" from the title and changes "consumer" to “individual” throughout the form and instructions. Removes references to the Consolidated Waiver Program and updates the title of Client Managed Personal Attendant Services. Replaces 1915(b) waiver with STAR+PLUS.
June 5, 2012 Form 1582, Consumer Directed Services (CDS) Responsibilities Updates the Consumer Directed Services Employer Responsibilities and adds the verification of the Medicaid fraud exclusions as part of eligibility verification process for service providers.
May 2, 2012 Form H1746-A, MEPD Referral Cover Sheet, and Instructions Updates the form and revises the instructions so that applications get to the right place or get registered in the system.
May 2, 2012 Form H1746-B, Batch Cover Sheet, Instructions Only Revises the instructions so that applications get to the right place or get registered in the system.
May 1, 2012 Form 1583, Employee Qualification Requirements, Form 1583-S (Spanish), and Instructions Updates the form and revises the instructions in both English and Spanish.
May 1, 2012 Form 1584, Consumer Participation Choice, Form 1584-S (Spanish), and Instructions Separates the form into two forms (both English and Spanish were formerly on the same form). Updates the instructions.
April 4, 2012 Instructions only Form 1581/1581-S, Consumer Directed Services Option Overview Reorganizes existing language and updates existing services.
April 4, 2012 Instructions only Form 1581/1581-S, Corrective Action Plan Reorganizes existing language and updates existing services.