Effective September 1, 2014
STAR+PLUS Managed Care is expanding to include ACUTE CARE SERVICES for individuals:
- residing in ICF-IID facilities or
- enrolled in an Intellectual and Developmental Disability (IDD) Waiver program.
IDD Waiver Programs:
The four IDD Waiver Programs are:
- Community Living Assistance and Support Services (CLASS)
- Deaf Blind with Multiple Disabilities (DBMD)
- Home and Community-bases Services (HCS) and
- Texas Home Living (TxHmL)
STAR+PLUS Managed Care Expansion:
- Individuals residing in state supported living centers
- individuals receiving both Medicaid and Medicare Part B benefits
Is voluntary for:
- Individuals 20 years of age or younger who receive Supplemental Security Income (SSI) or SSI-related services
Acute Care Services:
are typically based on an isolated event or part of routine health maintenance and include:
- visits to a primary care physician or specialty physician’s office;
- hospital or emergency room visits; and
- prescription medications.
Long-term Services and Supports (LTSS):
are any “long-term” services and supports received through Medicaid, in addition to acute care; or Medicaid card services.
- certain individuals receive LTSS through STAR+PLUS
- services received in an ICF or IDD waiver program are LTSS
Individuals may not receive LTSS through STAR+PLUS and an ICF or IDD waiver and at the same time.
How does this affect me or the individuals in my program?
- Maintaining a Level of Care (LOC) with no lapse in authorizations
- Preventing loss of Medicaid eligibility
- Preventing breaks in services
If a lapse in LOC authorization or Medicaid eligibility occurs:
Risks for the individual include:
- denied doctor, clinic, or hospital visits and prescription medications; and
- loss of Medicaid eligibility; or
- loss of ICF/IID eligibility due enrollment into STAR+PLUS for LTSS.
Risks for the ICF-IID provider:
- Difficulty accessing necessary acute care services and prescriptions on behalf of an individual
- Non-payment due to loss of Medicaid eligibility
Preventing LOC authorization lapses:
Avoid the need to submit a Purpose Code E:
- Develop a tracking method, such as a spreadsheet, to record LOC expiration dates
- Begin working on LOC renewals early enough to allow sufficient time for DADS to make an authorization determination before the previous LOC authorization expires
- Schedule interdisciplinary team (IDT) meetings well in advance when possible to account for difficulty in coordinating schedules.
- Prior to submitting a LOC packet to DADS for review, conduct a thorough quality check of the submission to ensure it is accurate and complete to avoid delays in authorization determinations
Preventing Loss of Medicaid Eligibility:
- Develop a tracking method to record Medicaid recertification due dates for individuals served in your program
- Assist the individual or their authorized representative to complete the Medicaid recertification packet and submit all required documentation to HHSC before the deadline.
- educate individuals and their authorized representatives about the importance of maintaining Medicaid eligibility
- frequently remind them to contact you for assistance regarding any communication they receive their Medicaid eligibility or SSI benefits.
Exceptions for ICF-IID residents:
ICF-IID residents who live in the following counties will continue to use their “Your Texas Benefits” card for behavioral health services.
Behavioral health services include:
- psychiatry services,
- counseling for adults,
- inpatient mental health services,
- outpatient mental health services, and
- substance abuse treatment.
ICF-IID residents will continue to use their “Your Texas Benefits” card for dental services, including intravenous sedation as part of a dental procedure.
STAR+PLUS covers intravenous sedation if a dental condition jeopardizes the individual’s overall health.
CF providers are encouraged to remind dental provider to scan the individual’s “Your Texas Benefits” card at each dental visit, to verify eligibility.
Where can I find more information?
- Visit the HHSC Medicaid Managed Care Initiatives website:
- Visit the DADS ICF/IID program website:
- Register for email alerts! Have your employee’s register too!
- Read the recently posted Provider Information Letters!
- Read this recently posted flyer:
What if I have questions?
Questions about this presentation may be sent to: firstname.lastname@example.org
Updated: April 14, 2016