ILR TAT
Interest List
Interest List Referral HCBS Services
ILR HCBS Forms
ILR HCBS Process
100

Number of days to contact member once you receive an activity for Interest List Referral.

What is five days?

100

Interest List Referrals are considered this type of member?

What is applicant?  An interest list referral is an applicant to HCBS, they do not become our members until they decide with MCO they want to go with and we receive the H2065-D approval.

100

 This benefit provides hot, nutritious meals that are delivered to the member's home.

What is HCBS Home Delivered Meals?

100

A government program that pays for health care services. Some of these services are for people as they grow older. Medicaid pays for services that help people stay in their own home. It also pays for people to move to a facility, such as a nursing home, if that is what they need. To help pay for these long-term care services, every state must have a this form signed.

What is Form 8001 Medicaid Estate Recovery Program Receipt Acknowledgement? 

100
  • This process
  • identifies existing supports and services necessary to achieve the individual's desired outcomes.
  • Identifies natural supports available to the individual and negotiates needed service system supports.
  • Occurs with the support of a group of people chosen by the individual (or the legally authorized representative (LAR) on the individual's behalf).
  • Accommodates the individual's style of interaction and preferences regarding time and setting.

What is person-centered service plan?

200

Number of days you have to complete an in-person visit once you receive an activity for Interest List referral?

What is fourteen days?

200

If an unmet immediate need is identified what type of referral are you able to send to assist the applicant?

What is a community referral?

200

This HCBS service is available on an emergency or short-term basis to relieve those persons normally providing unpaid care for a STAR+PLUS HCBS program member unable to care for himself or herself.

What is Respite Care Services?

200

Name of Form that is used to record the identifying information of the STAR+PLUS Home and Community Based Services (HCBS) program applicant or member.

What is form H1700-01 Individual Service Plan?

200

Aapplicants are able to request any HCBS service and SC should approve it.

What is No, Service Coordinator is steward of Medicaid Funds, Medicaid HCBS is the last payor source.  SC exhaust all possible payer source.  SC makes the determination if they meet medical necessity for each service added to H1700-01 Individual Service Plan.

300

The number of days you have to complete the documentation including the MD MN/LOC signature Letter.

What is 45 calendar days from the H3676 date.

300

The name of STAR+PLUS wait list to HCBS program.

What is interest list referral?

300

This HCBS service is an electronic monitoring system and are used by functionally impaired adults who live alone or who are functionally isolated in the community.

What is Emergency Response Services?

300

The purpose of this form is to document the STAR+PLUS Home and Community Based Services (HCBS) program benefits that will be provided to the applicant or member and establish the medical need and rationale for all items or services included on Form H1700-1, Individual Service Plan.

What is form H1700-2 Individual Service Plan Addendum.

300

The process that will be followed if the ISP cost exceeds 202% of ISP RUG cost level.

Medically Fragile Process, the HHSC’s High Needs Utilization Review (UR) and General revenue (GR) process.

400

The number of days to follow up on services with member and providers if an issue is identified.

What is seven days?

400

The name of assessment needed to determine medical necessity for interest list.

What is the MN/LOC?

400

This HCBS provides 24-hour living arrangements and personal care services and supports for persons who, because of physical or behavioral conditions, are unable to live independently. Services and supports may include assistance and/or supervision with daily living, including meal preparation, housekeeping, companion services, personal care, nursing tasks and provision of, or arrangement for, transportation

What is Adult Foster Care?

400

This form is used to:

  • record the applicant’s or member's choice to receive the STAR+PLUS Home and Community Based Services (HCBS) program as an alternative to nursing facility care;
  • document the applicant’s, member’s or authorized representative’s acceptance of the individual service plan (ISP); and
  • document the service coordinator’s verification that the applicant’s or member’s medical need and rationale for waiver services has been established by the managed care organization (MCO) and all services identified are appropriate to meet the needs of the applicant or member.

What is form H1700-3 Individual Service Plan – Signature Page

400

The name of process when applicant is denied medical necessity.

What is right to an appeal?

500

The number of days before the end of ISP you have to complete a reassessment for HCBS.

What is no earlier than 90 days and not later than 45 days?

500

What section of H3676 do we complete once we receive the form H2065-D approval.

What is section B of form H3676?

500

This HCBS provide a 24-hour living arrangement for persons who, because of physical or mental limitation, are unable to continue independent functioning in their own homes.

What is Assisted Living Services?

500

This is used as an instrument for collecting and documenting essential information regarding the applicant's or member's request or need for personal assistance services (PAS).

What is H2060 Needs Assessment Questionnaire and Task/Hour Guide?

500

This happens if the member refuses to sign form 8001 Medicaid Estate Recovery Form.

SC will continue with the HCBS assessment if the applicant does not decline HCBS program.  Applicant is not required to sign form.  Documentation should be present SC informed applicant that MERP still applies even though they refused to sign.

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