The Medicaid Star+Plus Program is in Texas.
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Steps to Alleviate Delays in Filling Needed Prescriptions for Individuals Affected by the STAR+PLUS Managed Care Expansion of Acute Care Services
Effective September 1, 2014, STAR+PLUS services for acute care only will be expanded to include some individuals who have Intellectual or
Developmental Disabilities (IDD) and live in an Intermediate Care Facility for Individuals with Intellectual Disability or Related Conditions (ICF-IID)
or who receive services through one of the following IDD waivers: Community Living Assistance Support Services (CLASS), Deaf Blind with
Multiple Disabilities (DBMD), Home and Community-based Services (HCS) or Texas Home Living (TxHmL).
To ensure individuals experience no delays in receiving necessary medications, particularly in the first weeks following the September 1, 2014
transition, here are some proactive steps for you, as a provider, and your families to take to avoid any possible delay.
- Prior to September 1, 2014, individuals are encouraged to refill any currently prescribed and authorized medication using the
individual's current Medicaid card.
- If an individual takes a medication that has previously needed a prior authorization, is in excess of the usual dosage or
is a non-preferred medication (whether or not on the Preferred Drug List), contact the managed care organization (MCO) after
September 1, 2014. Explain that the individual is currently prescribed the medication and ask what documentation
(prior doctor's orders, reasons for the medication, etc.) you need to provide the MCO to expedite authorization for
the drug to avoid delays in obtaining it after September 1, 2014. Be aware that:
- Although prior authorization (PA) is required for non-preferred medications and medications subject to restrictions for clinical reasons,
MCOs are required to follow certain requirements to ensure continuity of care for clients. The MCOs must ensure that an individual receiving
medications through an approved PA continue to receive the medications for 90 calendar days after the September 1, 2014 expansion or until the
expiration date of the PA, whichever is shorter.
- Prior Authorization call center phone numbers vary by health plan. The Prescriber Assistance Chart identifies prior authorization and member
call center phone numbers for each health plan where you can verify if a medication needs a prior authorization. Please use the member call center number.
- A 72-hour emergency supply of a prescribed drug must be provided when a medication is needed without delay and prior authorization is not available.
Star+Plus is a Medicaid Managed Care program of the Texas Health and Human Services
Commission (HHSC) for adults who are not receiving Medicare. The term "Managed Care" means the
State of Texas hires managed care organizations (MCOs) to manage your health care and the Star+Plus plan
is one option available for eligible Texans with Medicaid. Find your MCOs in Texas.
Who is eligible for Star+Plus?
- Individuals who do NOT have Medicare coverage AND
- Individuals with Intellectual or Developmental Disabilities (IDD), who receive services in an intermediate care facility,
- Individuals with an Intellectual Disability or Related Conditions (ICD-IID),
- Or Individuals with one or more of the following IDD Waivers:
- Community Living Assistance and Support Service (CLASS)
- Deaf Blind and Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
Children and young adults under the age of 21 are voluntary and can choose to enroll
in Star+Plus or remain in traditional Medicaid. Long-term services and supports (LTSS) will continue to be provided through DADS.
What does the Star+Plus plan offer?
- Basic medical coverage and care services to help you with everyday life:
- Doctor visits or other healthcare specialists such as a neurologist or cardiologist
- Medical equipment and supplies
- Promotes independent living
- Encourages frequent medical check ups
- Welcomes you to take part in all care decisions
Individuals will need to choose a health plan or one will be assigned. Texas HHSC has
directed MAXIMUS to host 30 community education sessions in addition to 60 enrollment
events. MAXIMUS is working with provider organizations and local authorities across the state
to coordinate community education sessions. Events will be posted to
|August 15, 2014
||Deadline to select an MCO
|September 1, 2014