Managed Care Up-dates
At PACSTX's Annual Conference, PACSTX hosted representatives from all five STAR+PLUS managed care organizations along with representatives from HHSC including Debbie Little Smith and Chief Deputy Commissioner Chris Traylor. Below are a few tidbits/clarifications from the plans on the roll-out:
- All five plans have agreed to allow providers (PCPs and specialists) to bill plans without consideration as to whether they are enrolled in the plan's network for the first 90 days of the roll-out, which began September 1. All prior authorizations that were received prior to the roll-out for medications, DME or other services will be honored for 90 days. Molina and Amerigroup have agreed to extend this period to 180 days.
- Amerigroup has a dedicated IDD phone line available M-F from 8:00 a.m. to 5:00 p.m. The phone number is (866) 696 - 0710
- United service coordination phone number is (800) 349 - 0550
- Molina's service coordination phone number is (866) 409 - 0039
- None of the plans will require a prior authorization to see a specialist, even after the 90 or 180 day grace period.
HHSC also hosts an IDD Managed Care Transition Workgroup that meets every two weeks comprised of MCO representatives, HHSC and DADS staff, Maximus (the enrollment broker), IDD providers and advocates. The meeting last week included the following up-dates:
- HHSC has asked TMHP to put up a posting for acute care providers to assure them that individuals may be seen regardless as to whether the PCP is correct on the person's insurance card.
- IDD providers do not need to get denials on DME that are not for acute care and typically only provided through the waiver. IDD providers should not need to get new denials for services that have been delivered through the waiver in the past. Debbie Little Smith is going to follow-up with DADS billing and payment.
- Prior Authorizations for DME - Cigna does not require prior authorizations on DME, Molina does require prior authorizations on DME.
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If an issue goes to MCOs that cannot be solved by close of business it is logged as a complaint and is in complaint data, and tracked, plans want to be first stop
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All plans are closely monitoring out of network claims to circle back with those acute care providers for network contracts.
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IDD providers may register on the MCO websites to access provider portals for Amerigroup, Superior, and United. Molina and Cigna do not have IDD provider access, specific questions related to prior authorizations after the 90 day grace period may be asked of service coordinators.
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All plans are having service coordinators reach out to individuals in your programs, if you have not heard from a service coordinator, HHSC recommends reaching out to service coordinators now to begin developing that relationship, particularly for individuals with complex medical needs.
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Post-Expansion Information Gathering Events Dates - HHSC wants to hear from you regarding the move of individuals with IDD basic medical services to STAR+PLUS.
September 29, Austin, Brown-Heatly Public Hearing Room, 1-4 p.m.
September 30, San Antonio, Alamo Area Council of Governments, 9-12
October 1, Abilene, Betty Hardwick Center, 9-12
October 2, Lubbock, Prosperity Bank Annex Center, 9-12
October 8, Beaumont, Foundation for SW Texas, 9-12
October 9, Houston The Center, 9-12
October 14, El Paso 1-4 Location TBD
October 15, Dallas, Dallas Townhall, 1:30-4:30
October 17, Weslaco, Knapp Medical Center, 8:30 - 11:00 a.m.
The following call-in options have also been provided for those that cannot physically attend the meetings:
Austin - 9/29
1 (877) 226-9790
Access Code: 6473780#
San Antonio - 9/30
1 (877) 226-9790
Access Code: 717183#
Abilene - 10/1
1 (877) 226-9790
Access Code: 6473780#
Lubbock - 10/2
1 (877) 226-9790
Access Code: 6473780#
Beaumont - 10/8
1 (877) 226-9790
Access Code: 6473780#
Houston - 10/9
1 (877) 226-9790
Access Code: 6473780#
Dallas - 10/15
1 (877) 226-9790
Access Code: 6473780#
Note: HHSC is also considering later meetings in Ft. Worth, Tyler and Corpus Christi
Full schedule and more details can be found here.
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