Professional Services Spotlight: Helping Texas Health Plans Stay Compliant and Efficient with MNLOC Assessment Enhancements
When state regulations change, health plans must be ready to respond—particularly when those changes impact core Medicaid services. That was the case in 2025 when the State of Texas mandated updates to the Medical Necessity and Level of Care (MNLOC) assessment process. MNLOC is a required evaluation used to determine eligibility for long-term services and supports (LTSS), such as those covered under the STAR+PLUS waiver program.
Health plans operating Medicaid lines of business in Texas needed to implement these updates quickly to remain compliant. Several organizations relying on HealthEdge GuidingCare® engaged the HealthEdge® Global Professional Services team to help deliver the required enhancements.
What is MNLOC and Why Does It Matter for Health Plans?
MNLOC is a comprehensive, state-mandated assessment that evaluates a person’s medical condition, cognitive ability, behavioral health, and functional status to determine whether they require nursing facility-level care. The results of this assessment are submitted to the Texas Medicaid & Healthcare Partnership (TMHP) for adjudication, with outcomes that drive downstream service planning and authorization.
For health plans serving Medicaid populations, MNLOC assessments are a cornerstone of LTSS program compliance. The process is meant to ensure:
- Adherence to state and federal guidelines
- Accurate benefit utilization
- Alignment with value-based care models
- Prevention of unnecessary institutionalization
- Delivery of services based on individual member needs
Revamping the MNLOC Workflow
The MNLOC assessment is only one part of a broader workflow that spans technology systems and departments. First, care managers conduct the assessment within the GuidingCare platform. That data is then transmitted to the TMHP portal, where it is processed and returned with Resource Utilization Group (RUG) values. These values guide service authorizations generated within GuidingCare, enabling health plans operating in Texas to deliver timely and appropriate care.
The Global Professional Services team enhanced the payer’s MNLOC workflow by building a direct API integration from GuidingCare to the TMHP portal, eliminating the need for health plans to serve as intermediaries. This simplification improved response times and enabled faster service authorizations while maintaining regulatory compliance.
Automation That Supports Care Managers
To reduce manual effort and ensure consistency, the Global Professional Services team built automation directly into the MNLOC assessment workflow. For example, when a care manager enters start and end dates for a service, the GuidingCare platform automatically calculates the appropriate duration based on allowable hours per week and the availability of family caregivers. The system pulls data from related assessments, applies state-specific logic, and pre-populates relevant fields, helping deliver accurate, actionable information without complex manual calculations.
This level of configurability makes it easier for care teams to comply with requirements without pulling focus from delivering person-centered care.
Built to Scale, Delivered with Speed
One of the biggest differentiators of the HealthEdge Global Professional Services team is its deep expertise in both the GuidingCare platform and state-specific Medicaid workflows. When the MNLOC update was announced, Global Professional Services delivered the required solution on a compressed timeline—less than 2 weeks from start to finish. This rapid execution was made possible by GuidingCare’s modern architecture and Global Professional Services’ close collaboration with HealthEdge product experts.
Because Global Professional Services works closely with the GuidingCare product team, health plans benefit from faster, higher-quality services and solutions, something third-party consulting firms often struggle to match. This alignment also reduces long-term maintenance burdens and ensures that future regulatory changes can be addressed efficiently across markets.
Reducing Costs and Complexity
As part of the implementation, Global Professional Services migrated data storage from a commercial third-party solution to a custom .NET framework built by the HealthEdge team. The new framework eliminated recurring third-party licensing fees and helped health plan customers improve alignment with the GuidingCare platform to enhance care coordination.
Strategic Compliance, Operational Confidence
To keep pace with evolving Medicaid programs, health plans need agile solutions that can adapt to regulations without disrupting care coordination and delivery. The MNLOC workflow project highlights how the HealthEdge Global Professional Services team supports operational agility through a unique combination of technical expertise, regulatory insights, and seamless collaboration with product teams.
With HealthEdge Global Professional Services, health plans don’t just meet compliance deadlines. They gain a trusted partner that helps them streamline operations, reduce administrative burden, and deliver high-quality, value-based care.
Learn more about our Global Professional Services offerings.
