STAR+PLUS Dallas/Tarrant Expansion Summary
Long Term Services and Supports (LTSS) Provider Advisory
Tarrant Service Area Enrollment Announcement
In the Tarrant Service Area, Bravo Health will be a health plan option for STAR+PLUS clients beginning May 1, 2011. All Tarrant Service Area members have been informed about the availability of Bravo Health plan and will receive enrollment packets in mid-March with health plan enrollment options.
Tarrant Service Area Enrollment Announcement
Overview
In May 2009, HHSC and Evercare of Texas ended their contract for the operation of the Integrated Care Management (ICM) program, which provided services to more than 75,000 aged, blind, and disabled (ABD) Medicaid clients in the Dallas/Tarrant Service Delivery Areas (SDAs). Subsequently, the 2010-11 General Appropriations Act (Article II, Special Provisions, Section 46, S.B. 1, 81st Legislature, Regular Session, 2009), requires HHSC to implement the most cost-effective integrated managed care model for this population.
An analysis of the ICM, Primary Care Case Management (PCCM), and STAR+PLUS Medicaid managed care models resulted in HHSC's conclusion that the most appropriate, cost-effective model to implement in response to the legislative mandate is STAR+PLUS.
Decision to Expand STAR+PLUS
STAR+PLUS is the only proven approach that meets all criteria specified by the Legislature, including cost effectiveness and integration of services. The STAR+PLUS model was created specifically to serve the aged, blind, and disabled population, providing fully integrated acute and long-term services and supports. STAR+PLUS began operating in Harris County in 1998. In 2007, STAR+PLUS was expanded to serve 29 counties in the Bexar, Nueces, Travis, and Harris Expansion Service Areas. There are over 164,000 clients currently being served in the STAR+PLUS program.
Customer service surveys of STAR+PLUS members indicate high levels of satisfaction with the STAR+PLUS program. In particular, members report high levels of satisfaction with the assistance they receive from their service coordinator; in addition, members report that it is easy to get help from a service coordinator when they need it.
STAR+PLUS has been shown to constrain costs while maintaining quality of care for its members. Studies of STAR+PLUS members conducted by the Institute for Child Health Policy have shown that, compared to clients in traditional Medicaid, STAR+PLUS members had fewer hospitalizations and were less likely to visit the Emergency Room[1]; in addition, STAR+PLUS members generally have lower health care costs overall than clients in non-capitated programs[2].
Comparison of STAR+PLUS to ICM
ICM was similar to STAR+PLUS in that the program offered both acute care and long-term services and supports; however, there are some significant differences between ICM and STAR+PLUS program:
- Clients have a choice of different health plans in STAR+PLUS, and can change their health plan if they choose to;
- STAR+PLUS health plans offer extra benefits and services to their members at no cost;
- STAR+PLUS health plans authorize and coordinate long-term services and supports directly with members and providers;
- STAR+PLUS health plans pay claims directly to acute care and long-term services and supports providers;
- STAR+PLUS health plans can negotiate payment rates with the providers in their network;
- STAR+PLUS health plans determine which services require prior authorization and which do not;
- STAR+PLUS is a capitated managed care program, which means that the HMOs are at risk for the cost of covered services to members, with the exception of in-patient hospital services, which are carved out of the model. Thus, the HMOs have an incentive to ensure members receive regular, timely preventive and routine care.
1 , Annual Chart Book 2005, Texas Medicaid Managed Care STAR+PLUS Quality of Care Measures, September, 2006.
2 Institute for Child Health Policy, Provision of Health Care Services to Disabled and Chronically Ill Medicaid Enrollees, Texas STAR+PLUS Focus Study, November 2003.
Map of Dallas and Tarrant Expansion Service Areas
HHSC will expand the STAR+PLUS program into the Dallas and Tarrant Medicaid Service Areas effective February 1, 2011. The following health plans will provide STAR+PLUS services in the designated areas.
Service Area |
STAR+PLUS Health Plans |
Dallas Service Area |
Molina Healthcare of Texas, Superior HealthPlan Plus |
Tarrant Service Area |
AMERIGROUP Community Care, Bravo Health Texas, Inc. |
Stakeholder Resource Materials
STAR+PLUS Expansion Stakeholder Presentation (Sept 2010)
Stakeholder Meeting Presentation (Jan 2010)
Stakeholder Meeting Presentation (May 2010)
STAR+PLUS Regular Stakeholder Meeting Presentation (Nov. 2009)
STAR+PLUS Expansion ERD Stakeholder Forum Presentation (Nov. 2009)
Stakeholder Meeting Presentation (Sept. 2009)
Provider Resource Materials
Long-term Services and Support Provider Presentation (Sept 2010)
DADS Information Letter (July 2010)
DADS Information Letter (April 2010)
Frequently Asked Questions for Acute Care Providers
Frequently Asked Questions for Long-Term Care Providers
Amerigroup LTSS Provider Training Question Log
Bravo LTSS Provider Training Question Log
Molina LTSS Provider Training Question Log
Superior LTSS Provider Training Question Log
Client Resource Materials
Client Introduction Letter (Sept. 2010)
Health Care Frequently Asked Questions for Clients - English and Spanish
Long-term Care Frequently Asked Questions for Clients - English and Spanish