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DentaQuest / Superior Health Plan TrainingSTAR Health (Foster Care)STAR + PLUSSTAR Value Added ServicesAdvantage by Superior (Medicare)
SHP_201237
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Agenda
STAR Health (Foster Care)
STAR + PLUS
STAR Pregnant Women Value Added Service (VAS)
Advantage by Superior (Medicare)
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STAR Health Children and Young Adults are Eligible when they are:
In Foster care In Kinship placement (Placed with a family Member or a close friend to the family)
Young adults who choose to remain in a paid foster care placement through the month of their 22nd birthday
Medicaid for Transitional Foster Care Youth (MTFCY) Young adults who aged out of the foster care system at age 18 through the
month of their 21st birthday.
Former Foster Care in Higher Education (FFCHE) STAR Health coverage may be provided from age 21 through the month of
Member’s 23rd birthday Must be in Foster Care on their 18th birthday Must be enrolled in an institution of higher education or technical school in Texas
Newborns born to STAR Health Moms (exception: FFCHE)
STAR Health Eligibility
Members are STAR Health Eligible upon removal from the home
Members can access services with one of the following: 2085-B Form- Designation of Medical Consenter- used as eligibility Superior STAR Health ID card Your Texas Benefits (YTB) Medicaid card
*Please note: If a member has the 2085-B Form but is not
in the DentaQuest or Superior system, the member is still eligible for services.
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2085-B Form-Designation of Medical Consenter
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STAR Health ID Cards
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STAR Health Benefits
Statewide program
STAR Health members receive the same benefits as Medicaid members
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STAR Health Pre-Appeals Process There may be times when a member’s health care provider
may request services that do not meet medical necessity.
In order to minimize service denials, we are committed to the unique nature of foster children. DentaQuest will be responsible for contacting the provider, medical consenter, and/or DFPS to request any additional, related information to help the approval of the service or with the development of other care options to meet the Member’s needs.
DentaQuest will make a decision on a service authorization within 3 days. This process can be extended up to 14 days if more information is needed.
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Reporting Abuse
If you suspect abuse or neglect of a child, report it immediately!
Call: 1-800-252-5400 or 911
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Health Passport Health Passport helps authorized users access health
information for STAR Health Members such as: health history current health status and health problems
Registration is fast and easy. Just go to www.fostercaretx.com to register
For assistance or questions in accessing Health Passport,
please contact the Health Passport Help Desk at:
1-866-714-7996 or by email at tx_passportadmin@centene.com
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Health Passport Advantage
Health Passport provides helpful information including: Prescriptions – a list of prescriptions that were filled at the pharmacy Lab results Immunizations Allergies Visit History (Medicaid claims for 2 years prior to STAR Health enrollment) Health Care Service Plans for those who receive Service Management and
health summaries are located under the forms section Note:
Caregivers who are NOT medical consenters cannot access Health Passport
Medical Consenters who are not DFPS staff cannot access behavioral health
notes Health Passport is not available to some MTFCY and all FFCHE Members
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Confidentiality and Communication Superior will ensure coordination and sharing of child’s health
information between Caregivers, Medical Consenters, DFPS workers, Courts and all health care providers (as appropriate) to guarantee that all Member’s health care needs are met.
DentaQuest and STAR Health, by law, will keep Member’s health records and medical information private. All discussions with doctors or other health care providers will be kept private. We will always make sure that any sharing of medical information will meet all State and Federal confidentiality laws and HIPAA regulations.
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STAR Health Reminders
Caregivers can: Receive form 2085 (B or C) and the Superior ID Card Request information regarding a Member by providing the
DFPS ID Number Medicaid ID Number Members demographics
NOT authorize any services without consent from the Medical Consenter
NOT request a PCP change NOT have access to the Health Passport (unless the
Caregiver is also the Medical Consenter)
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STAR Health Reminders Continued…
Medical Consenters can: Be up to 4 different people in the child’s life Authorize any service for a child (Medical Consenter must be
contacted before any service is given to the child) Request any information from us by providing the child’s
DFPS ID Number Medicaid ID Number Members demographics
Request medical records from a provider Make a PCP change on behalf of the Member Have access to the Health Passport (read-only rights) Be a part of the Pre-Appeals, Appeals and State Fair Hearing
process
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STAR + PLUS STAR+PLUS was 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 Long-Term Services and Support (LTSS) in a managed care
environment Promotes delivery of home and community-based- services
Superior HealthPlan is responsible for coordinating acute and LTSS through the use of a Service Coordinator
Service Coordination is the cornerstone of the STAR+PLUS model
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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
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STAR + PLUS Service Areas
Recipients must reside in a STAR+PLUS service area:
Bexar Dallas Hidalgo Lubbock Nueces
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STAR + PLUS ID Cards
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STAR + PLUS Value Added Services STAR+PLUS Eligible population:
Medicaid Only (non-dual eligible) > 21 years Benefit Limit:
$250 maximum per calendar year Covered Value Added Services
Evaluation: D0120, D0140, D0150, D0170 X-Rays: D0220, D0230, D0270, D0272, D0274, D0330 Cleanings: D1110, D1204, D1206
*Non-covered services are the member’s responsibility
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STAR + PLUS Waiver Benefits
STAR+PLUS Eligible population: Medicaid Waiver and Dual Waiver Adult Members
Benefit Limit: $5000 maximum per individual service plan year
Covered Waiver Dental Services Treatment of injuries to the teeth or supporting structures Dentures and the cost of fitting and preparation Preventative procedures that are required to prevent the
imminent loss of teeth Exhaust Value Added Benefits before accessing
those services through the waiver benefits
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STAR + PLUS Additional Information IF Anesthesia (other than IV sedation) is given while performing dental
services AND/OR services are provided IN an inpatient/outpatient setting: Medicare pays for anyone that is Dual Eligible (not enrolled in Advantage by
Superior) . No authorization is required by Superior. Medicaid Only Member – Anesthesia services and facility are authorized by
and billed directly to Superior & must be performed by a network provider. Providers can visit www.superiorhealthplan.com to determine Participating Providers/Facilities and to view authorization procedures
Report any signs of Abuse or Neglect to Adult Protective Services at 1-800-252-5400 or www.txabusehotline.org
Medical Transportation Program provides transportation to dental appointments Medical Transportation Program doesn’t transport members 17 years or
younger who are not accompanied by a parent or legal guardian
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STAR Value Added Service
Service Areas: Bexar El Paso Hidalgo Lubbock Nueces Travis
Medicaid Rural Service Area – Central
Medicaid Rural Service Area – Northeast
Medicaid Rural Service Area – West
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STAR ID Cards
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STAR Value Added Service
STAR Eligible population: STAR Pregnant Women > 21 years
Benefit Limit: $250 maximum per calendar year
Covered Value Added Services Evaluation: D0120, D0140, D0150, D0170 X-Rays: D0220, D0230, D0270, D0272, D0274, D0330 Cleanings: D1110, D1204, D1206
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Advantage by Superior (Medicare) Superior HealthPlan is a Special Needs Plan
(HMO SNP) for Medicare Superior contracts with Center for
Medicaid/Medicare Services (CMS) Program approved Counties (not Service
Area) Bexar County Nueces County Dallas, Rockwall, Collin (effective 01/01/2013)
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Medicare Advantage ID Cards
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Medicare Advantage Value Added Dental Benefits Medicare Advantage Eligible population:
Dual Eligible Members enrolled in a Medicare SNP Benefit Limit:
$1500 maximum per calendar year $0 Co-pay
Covered Value Added Services Annual Benefit 2 Cleanings per year 2 Oral Exams per year 2 Fluoride Treatments per year 1 Dental X-Ray per year
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Thank You!
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