Beginning July 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will implement several enhancements to the TMHP Long-Term Care Online Portal (LTCOP). After the enhancements are implemented, existing information and training materials will be updated.
The following is an overview of the enhancements that are scheduled to be implemented:
Form Processing Improvements
1. Accuracy on the enrollment forms will be improved by indicating whether a person is enrolled in another waiver program.
This will improve the enrollment process for people who are leaving another waiver program to enroll in Home and Community-based Services (HCS) and Texas Home Living (TxHmL) and will help prevent dual enrollments.
2. HCS and TxHmL pre-enrollment forms will not be allowed to be submitted if the person is currently pre-enrolled, pending enrollment, or enrolled. Additionally, the following forms will not be allowed to be submitted if the person is currently enrolled in HCS or TxHmL:
- 8578 Intellectual Disability Related Condition (ID/RC) Assessment Purpose Code (PC) 2
- 3608 Enrollment Individual Plan of Care (IPC)
- 8582 Enrollment IPC
The above changes will allow the system to correctly pair enrollment forms and update form statuses, which eliminates the need to inactivate and resubmit enrollment forms.
3. The following fields will autofill on 8578 ID/RC PC 2 assessments, based on data that was previously entered on the person’s pre-enrollment form:
- Local Case Number
- Verification of Freedom of Choice indication
- Verification of Freedom of Choice Signature Date
This will reduce data entry and the potential for form discrepancies.
4. Providers and local intellectual and developmental disability authorities (LIDDAs) will not be able to submit forms if they are not currently associated with the person.
This will decrease the potential for forms to be submitted out of sequence, which can only be corrected by the Texas Health and Human Services Commission (HHSC) staff.
5. Users will not be allowed to change the person’s mailing address on the 3608/8582 IPC forms.
This will decrease the potential that the system will autofill subsequent forms with incorrect addresses.
6. 3608/8582 IPC submissions will no longer require users to enter at least one program provider service or consumer-directed service (CDS) when they request only Community First Choice (CFC) services.
This will prevent unnecessary rejections and processing delays.
7. Provider information will not be required for 3608/8582 IPCs and 3616 Request for Termination forms with only CDS services.
This will ensure that accurate information is available, which means fewer delays in the submission of forms.
8. 3608/8582 IPCs that exceed the service limits will not be allowed to be submitted.
This will reduce delays in the submission of forms and expedite 3608/8582 IPC processing, which means that claims are submitted faster, and payment is expedited.
9. Information about how to request a reconsideration and administrative hearing will be added to the instructions for level of need (LON) denial and reconsideration letters, which are generated on the LTCOP.
This will streamline the process for requesting a reconsideration and hearing for LON denials.
10. The character limit for the email address of the service coordinator on the 3616 Request for Termination form will be increased to 50 characters.
This will ensure that the service coordinator’s correct email address is entered.
Extending, Adding, or Modifying User Functionality
1. HHSC will be able to remand 3608/8582 IPC enrollment forms to LIDDAs for corrections prior to the approval of services. LIDDAs will be able to use the Update button to change the data on the form. Once the changes are saved, the form will go to HHSC for review.
This will expedite the enrollment process.
2. HHSC will be able to automatically implement a fair hearing decision on a prior 8578 ID/RC assessment.
This will reduce administrative burden and reflect accurate information on the LTCOP and TexMedConnect Medicaid Eligibility Service Authorization Verification (MESAV) system.
3. Providers and LIDDAs will be able to update additional fields and add services when correcting 3608/8582 IPCs, including processed IPCs.
Note: This enhancement is not applicable to enrollment IPCs.
This will reduce billing delays by allowing providers and LIDDAs to make timely corrections.
4. Providers and LIDDAs will be able to accurately certify the explanation of benefits fields when using the Use as Template button on a 3608/8582 IPC renewal.
This will ensure accurate certification when using a form template.
5. Providers and LIDDAs will be able to update the location code and reactivate location availability requests on applicable forms.
This will allow providers and LIDDAs to restart the location validation and will reduce the need for HHSC staff to correct the form.
6. 3608/8582 IPCs will be able to be submitted after the fair hearing decision is attained on the associated 8578 ID/RC PC 3 or PC 4, and the decision is in one of the following statuses:
- Level of Care (LOC) Decision Sustained During Appeal
- LON Sustained During Reconsideration
- LON Sustained During Administrative Review
This will reduce administrative burden and delays in the processing of the forms.
7. Providers and LIDDAs will be able to change the county to another county within the current service area when returning a person from suspension. If the new county is not within the current service area, the change is not allowed.
This will decrease the potential for incorrect information on the form.
LTCOP Will Be a More Centralized Information Platform
1. A person’s current provider or LIDDA will be able to view the person’s historical forms for their specific waiver program.
This will give providers and LIDDAs a comprehensive view of a person’s forms.
2. Providers and LIDDAs will be able to upload and attach required documentation when submitting applicable forms on the LTCOP.
This will allow submission of supporting documents on the LTCOP rather than across multiple platforms, which will expedite review, submission, and payment.
3. The following information on the Individual Detail page will be based on the most recent applicable form with an effective date range that spans the current date:
- Current physical address
- Location code
- Estimated annual cost
This will reduce administrative burden and provide current information when doing an Individual Search or viewing the Dashboard.
4. Providers will be able to view and export provider contract data from the Dashboard.
Note: Public provider contract information will be available on the LTCOP, excluding contract capacity information. LIDDAs are required to use the HHS Slot Tracking system to view a public provider’s contract capacity information.
This will reduce administrative burden by giving a comprehensive view of provider contract details.
5. Providers will be able to search, view, and export location information using the new Provider Location Search screen.
This will reduce administrative burden and prevent delays in the processing of forms by giving a comprehensive view of provider location information on a single platform.
6. The service coordinator’s name will be added to the search results when the provider or LIDDA performs a Form Status Inquiry (FSI).
This will reduce administrative burden and allow service coordinators to quickly identify 8578 ID/RC assessments and 3608/8582 IPCs that require their review.
7. Providers will be able to maintain and search Staff ID information on the LTCOP using the new Staff ID screens.
This will reduce administrative burden by maintaining Staff ID information on a single platform.
8. LIDDAs will be able to create HCS and TxHmL service coordination units, assign personnel to each unit, and view and maintain service coordinator assignment information on the LTCOP. The initial service coordinator assignment will be made on the HCS and TxHmL pre-enrollment form using the new Enrollment Service Coordinator field.
This will reduce administrative burden by eliminating dual system data entry and by maintaining information on a single platform.
9. Providers will be able to view and export additional data with more search date parameters using the Remittance and Status (R&S) Reports. The additional data will include:
- Medicaid number
- Submission date
- Level type
- Level service
- Line Item Control Number (LICN)
- Healthcare Common Procedure Coding System (HCPCS) code
This will reduce administrative burden by receiving data for annual cost reporting on a single platform.
Account Preparation and Additional Resources
To prepare for these changes, HCS and TxHmL providers and LIDDAs that do not have an LTCOP account must create an administrator or user account. Instructions on how to create an account are available in the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide (QRG).
Additionally, providers and LIDDAs are encouraged to visit the TMHP 1915(c) Waiver Programs web page for recent news, reference materials, education, and bulletins.
For more information, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7).