STAR and STAR+PLUS Contiguous County Expansion Summary
Transition Information for LTSS Providers
August 29, 2011
This article responds to inquiries from long term services and supports (LTSS) providers in the Bexar, Harris, Jefferson, Nueces, and Travis Service Delivery Areas related to authorization and billing issues with the Contiguous Expansion of STAR+PLUS effective September 1, 2011.
Billing for DME, HM, and dental services
Durable medical equipment (DME), home modification (HM), and dental services authorized under the DADS service plan and completed prior to September 1, 2011, will be paid for by DADS. DME, HM, and dental services authorized under the DADS service plan and completed on or after September 1, 2011, will be paid for by the member’s managed care organization (MCO). DME, HM, and dental providers will be required to contact the MCO to coordinate the completion of the services. MCOs are required to instruct providers on how to submit claims for adjudication.
Timely responses from MCOs
Providers attempting to contract with an MCO who do not get a timely response may wish to send inquiries or complaints the HHSC Command Center. See contact information below.
Provider referral process
Providers should be aware that neither HHSC nor the MCOs are allowed to make referrals that would favor and give advantage to any particular provider. Each MCO provides contracted providers with a provider manual that describes this process.
Verifying client eligibility
Providers should verify eligibility for each client they serve at the beginning of the month or prior to providing services. A provider that knows of a client who should be in managed care can submit a fax or e-mail inquiry to the HHSC Command Center.
Providers with questions related to consumers losing Medicaid or on Medicaid Hold, should use the normal protocol for researching Medicaid eligibility, such as researching the Medicaid Eligibility & Service Authorization Verification (MESAV). These types of issues should not be referred to the HHSC Command Center.
Contact information for questions or complaints
HHSC Command Center (operational through October 31, 2011)
Medicaid/CHIP Health Plan Management (starting November 1, 2011)
Contact information for health plans:
Go to the following link: http://www.tmhp.com/Pages/PCCM/STAR_Expansion.aspx
and click on HMO Representatives in Expansion Counties
Additional Information on the STAR and STAR+PLUS Contiguous Counties Expansion
Starting September 1, 2011, Primary Care Case Management (PCCM) clients in 28 of the counties contiguous to existing STAR and STAR+PLUS service areas will receive services through one of these two Medicaid managed care programs. However, Supplemental Security Income (SSI) children will remain voluntary enrollees in managed care, and SSI adults will remain voluntary STAR enrollees if STAR+PLUS is not available in their county.
The expansion also brings changes to the current STAR and STAR+PLUS service areas.
- The Harris and Harris Expansion service areas will combine into a single service area for clients in Brazoria, Fort Bend, Galveston, Harris, Montgomery, and Waller counties.
- A new Jefferson Service Area will be created to serve clients in Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, and Walker counties.
Stakeholder Resource Materials
Provider Resource Materials
- Provider Training Calendar
- Acute Care Provider Presentation: STAR/STAR+PLUS
- Long-term Services and Supports Provider Presentation: STAR/STAR+PLUS
- Long-term Services and Supports Provider Frequently Asked Questions: STAR+PLUS
- El Paso and Lubbock Provider Presentation: STAR
- Contiguous County Expansion Information on the TMHP Website
Sample Member Enrollment Packets
STAR and STAR+PLUS enrollment packets were mailed in June 2011. Members must pick a health plan and main doctor by August 12 or they will be automatically assigned to a health plan.
To enroll, members can:
- Call toll-free 1-800-964-2777 (TTY: 1-800-267-5008).
- Mail the enrollment form to the address in the packet.
- Take the enrollment form to an HHSC benefits office.
Sample enrollment packets:
Client Resource Materials - Community Outreach Meeting Calendar
Client Introduction Letters and Frequently Asked Questions (FAQs)
- STAR Frequently Asked Questions English | Spanish
- STAR Introduction Letter English | Spanish
- STAR Introduction Letter (El Paso and Lubbock) English | Spanish
- STAR+PLUS Frequently Asked Questions English | Spanish|
- STAR+PLUS Introduction Letter English | Spanish
- STAR+PLUS Introduction Letter (Voluntary)—For people age 20 and under who have SSI. English | Spanish|