AETNA BETTER HEALTH OF TEXAS STAR Kids Newsletter

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1 AETNA BETTER HEALTH OF TEXAS STAR Kids Newsletter Fall 2016 Table of contents Aetna Better Health of Texas welcomes STAR Kids from CEO, Patrina Fowler... 1 A word from our Chief Medical Offcer of STAR Kids... 1 What is STAR Kids?... 2 STAR Kids value added services... 2 Behavioral health... 3 Frequently Asked Questions about out of area and out of network providers. 3 News you can use... 4 Are you already a part of our network?... 4 Provider training webinars... 5 Resources & important numbers... 5 Our culture At a glance AM Aetna Better Health of Texas welcomes STAR Kids from CEO, Patrina Fowler On behalf of the Aetna Better Health plan, we would like to welcome both new and existing providers to our STAR Kids program. STAR Kids is effective November 1st and will be serviced in the following counties: Denton, Hood, Johnson, Parker, Tarrant and Wise. This is a special introductory issue, so please review each STAR Kids related article and continue to use our website to stay connected with our managed care plan. A word from our Chief Medical Offcer of STAR Kids Angela Moemeka, M.D, M.B.A, F.A.A.P Medical Director, Aetna Better Health Texas Dr. Moemeka is Medical Director, STAR Kids Managed Care Program at Aetna Better Health Texas. In this role she provides medical leadership for this transformative program serving children and youth with special health care needs. She is a Fellow in the American Academy of Pediatrics, and Diplomate of the American Board of Pediatrics. She has extensive experience in developing, implementing, and evaluating community based pediatric interventions, and serves on multiple community boards and committees including the Texas Medical Association, Texas Pediatric Association, Dallas County Medical Society and Head Start of Greater Dallas. Continued on page 2 1

2 A word from our Chief Medical Offcer of STAR Kids Continued from page 1 As a graduate of the University of Connecticut School of Medicine, Dr. Moemeka spent over a decade as a private practice physician, hospitalist and population health leader with the Eastern Connecticut Health Network, Temple University Health System, Community Health Center (CHC, Inc.) in CT, and Children s Health System of Texas. She also possesses a Six Sigma Green Belt Certification along with an M.B.A. from the Fox School of Business at Temple University. Her area of interest is specifically Developmental and Behavioral Pediatrics. She has worked extensively with pediatric psychologists. What is STAR Kids? STAR Kids is for children and young adults age 20 and younger who receive Supplement Security Income (SSI) Medicaid or who are enrolled in a home and community based waiver programs. Waiver programs include: Medically Dependent Children Program (MDCP) Plan responsible for all claims (Children with high medical needs). Limited number allowed on the waiver program and the waiting list is long. This will probably represent only about 10% or less of the STAR Kids members. Community Living Assistance and Support Services (CLASS) Deaf Blind with Multiple Disabilities (DBMD) Home and Community Based Services (HCS) Texas Home Living (TxHmL) Youth Empowerment Services (YES) STAR Kids will deliver basic medical services and long term services and supports (LTSS) through a health plan the member chooses: Main feature includes service coordination Health plan service coordinator makes home visits to find out what the member needs all members must be assessed with the SAI tool. Timing will be according to level of need. Coordinates with Medicaid, Medicare, and waiver providers May authorize community based LTSS Coordinates other services and supports like setting up rides to doctor visits, etc. STAR Kids value added services Aetna Better Health of Texas STAR Kids has developed several value added services and extra benefits to provide our STAR Kids members with the best healthcare experience possible. Call us at STRKIDS ( ), TTY/TDD , with any questions you have about these services and benefits. Value added services How does it work? Extra help getting a ride Need help getting to your child's doctor appointment? We can provide members and their caregiver with bus tokens or cab fare. Vision services We offer $100 towards the cost of frames, glass lenses or contact lenses. Call Superior Vision at Well child exam $15 gift card Members that have their annual well child exam can get a $15 gift card. Additional hours of respite care Help with members with asthma We will offer up to ten (10) additional hours of respite care per month for eligible members on MDCP and coordinated care waivers who have exhausted their respite benefits. Members with asthma and are part of our disease management program can get one of the following services, up to $100: Pest control Hypoallergenic bedding Vent cleaning Deep carpet cleaning 2

3 Behavioral health Aetna Better Health covers health for you as a whole person. Providers can support good initiation and continuation of care that includes help for mental health problems like depression. Providers can also educate parents through a variety of methods focused on addressing their child s needs. We want your children to be healthy in body and in mind Our health plan covers services for our members as a whole person. Patients are more likely to adhere to a treatment plan if they feel that the provider and staff are concerned and invested in their well being. As a provider you know that treatment plans consists of a variety of options to address behavioral health problems like depression or substance abuse. You don t need a referral Our participating Behavioral health providers may treat any patient without a referral. Please refer to our provider manual for additional information. You can get help anytime, day or night If you have mental health, alcohol or drug problems and need help right away, call STRKIDS ( ), option 9 or (TTY/TDD). We re here 24 hours a day, 7 days a week: Your benefits include but are not limited to: Counseling Help with drug or alcohol abuse Help managing your medicines Access to a service coordinator Our providers may need to get plan approval on some services before our members can receive them. A service coordinator will work with our members and provider(s). Together they will meet all your mental and physical health needs. Emergency care is covered anywhere in the United States. For more information review our provider manual or contact us at Member Services at STRKIDS ( ), (TTY/TDD). Frequently Asked Questions about out of area and out of network providers Q: One or more of a member s providers are in another service area. Can the member join a STAR Kids health plan in that other service area? area? A: No, members must choose a STAR Kids health plan in the service area where they live. Q: Can members see doctors and specialists outside their service area? A: Health plans must have an adequate network of providers and provide services members need inside their service area. Health plans can pay providers outside their service area in certain situations, such as emergency services and to maintain ongoing care with an existing provider. Sometimes members might need to go outside their service area to get the care they need. The STAR Kids health plan members select will have a process to help them if they must see providers outside their service area. Please have members call their service coordinator if they need to see a provider in a different service area. Q: The closest provider to a member is outside their service area. Do they have to travel a long way to see a provider in their service A: STAR Kids health plans are able to include providers outside their home service areas in their networks. A member s health plan service coordinator will work with them to find the providers and care they need, when they need them. 3

4 News you can use Electronic Visit Verification (EVV) Vendor Selection What is Electronic Visit Verification (EVV)? EVV is a telephone and computer based system that electronically verifies service visits occur and documents the precise time service begins and ends. Which providers must use EVV? STAR Kids (effective Nov. 1, 2016) Personal Care Services (PCS) In home respite services Flexible family support services Community First Choice (Personal Assistant Services/ Habilitation) How does EVV work? When an attendant provides services to an individual/ member in the home or the community, the attendant must use the HHSC approved EVV system and: The individual/member home landline telephone or An HHSC approved small alternative device (SAD) How do providers get started with EVV? 1. Research HHSC approved EVV vendors - Data Logic (VESTA) Software - MEDsys Software Solutions 2. Select an HHSC approved EVV vendor 3. Complete the Form H1002, Provider Electronic Visit Verification Vendor System Selection 4. Send the completed Provider EVV Vendor System Selection Form to Texas Medicaid and Healthcare Partnership (TMHP) at: Texas Medicaid Healthcare Partnership (TMHP) / Accenture Fax: EVV@tmhp.com Are you already a part of our network? We are committed to continuing our partnership with our existing providers who are a member of our STAR Kids network. If you are visiting our webpage and are currently not participating with our plan we invite you to join our network. In support of our commitment to the delivery of quality health care services to our members, we have a formal, structured credentialing and contracting processes in place. Upon review of your letter of interest and receipt of your completed Prospective Provider Form, (please complete and fax to ) you must complete the following to be eligible to provide care to Aetna Better Health of Texas members: Submit the credentialing application correctly and completely Be fully credentialed by Aetna, as applicable New providers will be sent a Participating Provider Agreement. Providers joining an existing group must complete the applicable contract documents to be added to the existing contract. Sign and return all contract documents Upon complete credentialing and full execution of contract documents, you will receive notice from the Aetna Better Health Provider Relations department with the effective date of participation, along with the fully executed contract (if it is a new contract) Providers have a right to expedited credentialing Providers should not schedule or see Aetna Better Health members until notified of the participation effective date. For more information, please contact STAR Kids Provider Relations at the following numbers: Medicaid STAR: STRKIDS or Bexar:

5 Provider training webinars In preparation of the STAR Kids launch, we invite you to participate in the following webinar training sessions. Please select the session that best pertains to your specialty type and the services that will be offered. We will also reserve time for questions and answers after each session. For more information on dates and times of our webinars, please register by clicking the link access our STAR Kids section on the provider web portal at: aetnabetterhealth.com/texas/providers/info/ and click on Star Kids Training NEW or contact Provider Relations for more information at STRKIDS follow the prompts and choose Provider Services/Relations. Our culture At a glance At Aetna, we are dedicated to adhering to the highest legal, ethical and business conduct standards. The Aetna Way a core set of values that guide our decisions and actions each day reflects that dedication. Integrity is one of the core values expressed in The Aetna Way. Acting with integrity means: Behaving ethically Honoring commitments Doing the right thing for the right reason Aetna s commitment to integrity means complying with our Code of Conduct and our legal and regulatory obligations, exercising sound judgment and making the right choices in conducting Aetna s business. Resources & important numbers STAR Kids STRKIDS Long Term Services & Supports (LTSS) Fax STAR Kids STRKIDS Provider Relations and Member Services Medical Management Medicaid Tarrant Medicaid Eligibility Verification AIS Superior Vision LogistiCare Medical Transportation (For Medicaid members only) (Aetna Bexar County) (Aetna Tarrant County) Nurse Line Behavioral Health Provider Credentialing Report Fraud, Waste or Abuse Fax Numbers Aetna Prior Authorization fax# Aetna Inpatient Authorization fax# CVS Caremark (Pharmacy) CVS Caremark Help Desk BIN# /PCN: ADV /GROUP# RX8801 5

6 AETNA BETTER HEALTH OF TEXAS Provider Relations P.O. Box Dallas, TX