STAR+PLUS IDD Program 2018
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1 STAR+PLUS IDD Program 2018
2 Agenda Texas STAR+PLUS Program Overview History Program Background
3 STAR+PLUS Program History The 74th Texas Legislature implemented the State of Texas Access Reform Plus (STAR+PLUS) program to create a cost-neutral managed care system which would combine acute care as well as long-term services and supports (LTSS). The STAR+PLUS program does not change Medicaid eligibility or services. It does change the way Medicaid services are delivered.
4 What is STAR+PLUS? STAR+PLUS is a Texas Medicaid managed care program created specifically to serve the elderly and persons with disabilities, typically known as the aged, blind and disabled population (ABD) Goal-to achieve a seamless continuum of care by integrating acute and comprehensive care Long-Term Services and Support (LTSS) in a managed care environment Promotes delivery of home and community-based services The health plans are responsible for coordinating acute and LTSS through the use of a Service Coordinator Service Coordination is the cornerstone of the STAR+PLUS model.
5 STAR+PLUS Members Mandatory Population Supplemental Security Income (SSI) eligible adult clients (ages 21 and over) Medical Assistance Only (MAO) Clients who qualify for 1915 (c) Nursing Facility Waiver (limited number) Dual Eligibles - those individuals who are covered by Medicare and receive dental benefits or dental value added services Voluntary Population SSI Children under the age of 21 Children (under the age of 21) who are Medicaid eligible because they are in a Social Security Exclusion Program
6 Senate Bill 7 (83R) Overview SB 7, Texas 83rd Legislature, Regular Session, requires the Health and Human Services Commission (HHSC) and the Department of Aging and Disability Services (DADS) to jointly design and implement an acute care services and long-term services and supports system for individuals with intellectual and developmental disabilities through managed care. SB 7 included several expansions of Medicaid managed care, including: STAR+PLUS Medicaid Rural Service Areas (MRSA) expansion Nursing facility carve-in, and Integration of acute care for adults with intellectual and developmental disabilities.
7 STAR+PLUS IDD Program (Statewide) Individuals with intellectual and developmental disabilities receive basic health services (acute care) through the STAR+PLUS Medicaid managed care program. Those transitioned into STAR+PLUS for acute care services only: Individuals receiving services in community-based Intermediate Care Facilities for Individuals with Intellectual Disabilities or Related Conditions (ICF-IID) Individuals receiving services in certain DADS 1915(c) waiver programs: Home and Community-based Services (HCS) Community Living Assistance and Support Services (CLASS) Texas Home Living (TxHmL) Deaf Blind with Multiple Disabilities (DBMD) People not included: People in a state supported living center People getting both Medicare and Medicaid (dual eligibles)
8 STAR+PLUS Service Areas Recipients must reside in a covered service area of the health plan they are enrolled in. Superior Amerigroup HealthSpring Bexar Bexar Tarrant Dallas El Paso Hidalgo Hidalgo Harris MRSA Northeast Lubbock Nueces MRSA Central MRSA West Jefferson Lubbock Tarrant Travis MRSA West
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11 Superior IDD Benefits mirror the existing Superior STAR PLUS Value Add plan. Superior IDD members are provided acute care dental services as a direct result of a medical condition that cannot be treated until the dental services have been provided to remedy the situation, or emergency dental services only.
12 HealthSpring IDD Benefits mirror the existing Superior STAR PLUS Waiver plan. Medically necessary dental services provided up to an annual maximum of $5,000 per benefit year per Covered Person.
13 Questions?
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