Billing Process for Long-Term Services and Supports Providers …

Originally published by Jerri Lynn Ward, J.D..

DADS has issued Information Letter 14-49 titled Billing Process for Long-Term Services and Supports Providers Transitioning to STAR+PLUS.

The Health and Human Services Commission (HHSC) is expanding the STAR+PLUS Medicaid

managed care program to the existing Medicaid Rural Service Areas (MRSAs) including West,

Central, and Northeast Texas. With this expansion, most individuals who are age 65 or older or

who have a disability will get their basic health services (acute care), and Long-Term Services and

Supports (LTSS) through a STAR+PLUS Managed Care Organization (MCO). In the Fall of 2013,

HHSC began conducting statewide Medicaid Managed Care Initiative Information Sessions to

inform the targeted providers and individuals of this expansion. The HHSC conducted provider

trainings in the targeted areas and the presentation can be found on the Managed Care Initiatives

website: Medicaid Managed Care Initiatives.

Contracts and Provider Payments

With the September 1, 2014 implementation of the STAR+PLUS expansion in the MRSA

counties, the Community Based Alternatives (CBA) program will be terminated. As a result,

DADS will cancel all CBA contracts. CBA providers who have not received a contract

cancellation notice must contact the Community Services Contract line at (512) 438-3550. Current

contracted providers will still be able to deliver and receive payment for Title XX Day Activity

Health Services (DAHS), Community Attendant Services, Family Care, Adult Foster Care,

Emergency Response Services, Home Delivered Meals, and Residential Care for SSI individuals

who are enrolled in the STAR+PLUS program, excluding those receiving the STAR+PLUS Home

and Community Based Services waiver and are not duplicated services. Client Managed Personal

Attendant Services (CMPAS) providers will be able to deliver and receive payment for services for

non-SSI and non-SSI-related individuals or SSI and SSI-related CMPAS individuals with a spouse

as the paid attendant.

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.

Provider Communications Regarding STAR+PLUS Program Expansion

DADS publishes information regarding the transition of LTSS from DADS to the STAR+PLUS

program on DADS website at: http://ift.tt/1n0l42H. Please refer to information letters

and alerts regarding Managed Care and STAR+PLUS topics.

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