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Texas Managed Care Program Features, as of 2020 (1 of 3)FeaturesSTARSTAR PLUSSTAR HEALTHProgram typeComprehensive MCOComprehensive MCO MLTSSComprehensive MCO MLTSSStatewide or region-specific?StatewideStatewideStatewideFederal operating authority1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)1915(a)Program start date12/11/201112/11/201104/01/2008Waiver expiration date (if applicable)09/30/202209/30/2022If the program ended in 2020, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)MandatoryPopulations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)Populations enrolled: Aged, Blind orDisabled Children or AdultsMandatoryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)MandatoryMandatoryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)Populations enrolled: Full DualsPopulations enrolled: Children withSpecial Health Care NeedsMandatoryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryPopulations enrolled: Foster Care andAdoption Assistance aryMandatory452
FeaturesSTARSTAR PLUSSTAR HEALTHPopulations enrolled: Enrollment choice 15 daysperiod15 daysOtherPopulations enrolled: Enrollment broker Maximusname (if applicable)MAXIMUSMAXIMUSPopulations enrolled: Notes onenrollment choice periodMembers are auto-enrolled by theenrollment brokerBenefits covered: Inpatient hospitalphysical healthXXXBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)XXXBenefits covered: Outpatient hospitalphysical healthXXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXXBenefits covered: Partial hospitalization XXXBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinicsand FQHCsXXXBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXXXBenefits covered: Prescription drugsXXXBenefits covered: Prosthetic devicesXXXBenefits covered: EPSDTXXXBenefits covered: Case managementXXXBenefits covered: Home health services X(services in home)XXBenefits covered: Family planningXXBenefits covered: SSA Section 1945authorized Health HomeX453
FeaturesSTARSTAR PLUSSTAR HEALTHBenefits covered: Dental services(medical/surgical)XXXBenefits covered: Dental (preventativeor corrective)XXBenefits covered: Personal care (stateplan option)XXBenefits covered: HCBS waiver servicesXXBenefits covered: Private duty nursingXXBenefits covered: ICF-IDDXBenefits covered: Nursing facilityservicesXBenefits covered: Hospice careXXBenefits covered: Non-EmergencyMedical TransportationXXBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitXXXBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Diagnostic services, podiatrist services,medical supplies, non-prescriptiondrugs, eye glasses, preventive services,nurse midwife services, and pediatric orfamily nurse practitioner services.Diagnostic services, podiatrist services,medical supplies, non-prescriptiondrugs, eye glasses, preventive services,nurse midwife services, and pediatric orfamily nurse practitioner services.Emergency and non-emergencyambulance, audiology and hearing aids,behavioral health services, prenatalcare, birthing services, cancerscreening, diagnostic and treatment;chiropractic services, dialysis, durablemedical equipment, early childhoodDiagnostic services, podiatrist services,medical supplies, non-prescriptiondrugs, eye glasses, preventive services,nurse midwife services, and pediatric orfamily nurse practitioner services.454
FeaturesSTARBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)continuedSTAR PLUSSTAR HEALTHintervention, emergency services,laboratory; mastectomy, breastreconstruction, and related; radiology,therapies, organ transplant,telemedicine; community-based longterm services and supports includinghabilitation, emergency responseservices (ERC) and supportmanagement.Quality assurance and improvement:HEDIS data required?YesYesYesQuality assurance and improvement:CAHPS data required?YesYesYesQuality assurance and improvement:Accreditation required?No, but accreditation considered in plan No, but accreditation considered in plan No, but accreditation considered in planselection criteriaselection criteriaselection criteriaQuality assurance and improvement:Accrediting organizationNCQA, URACNCQA, URACNCQA, URACQuality assurance and improvement:EQRO contractor name (if applicable)Institute for child Health policyInstitute for Child Health PolicyInstitute for Child Health PolicyPerformance incentives: Paymentbonuses/differentials to reward plansXXPerformance incentives: Preferentialauto-enrollment to reward plansXPerformance incentives: Public reportscomparing plan performance on keymetricsXXXPerformance incentives: MCOs/PHPsXrequired or encouraged to pay providersfor value/quality outcomesXXPerformance incentives: Withholds tiedto performance metrics455
FeaturesSTARSTAR PLUSSTAR HEALTHParticipating plans: Plans in ProgramAmerigroup Texas, Inc.; Superior HealthPlan, Inc.; El Paso Health Plans, Inc.,dba El Paso Health; Aetna Better Healthof Texas, Inc.; Community First HealthPlans, Inc.; Seton Health Plan, Inc., dbaDell Children’s Health Plan;UnitedHealthcare Insurance Company,dba United Healthcare Community Plan;Texas Children's Health Plan, Inc.;Molina Healthcare of Texas, Inc.;Driscoll Children's Health Plan; ParklandCommunity Health Plan, Inc.; CookChildren's Health Plan; CommunityHealth Choice Texas, Inc.; Health CareService Corp. (dba Blue Cross BlueShield); SHA. LLC, dba FirstCare HealthPlans; Scott & White Health PlanAmerigroup Texas, Inc.; SuperiorSuperior HealthPlanHealthPlan, Inc; UnitedHealthcareInsurance Company, dba UnitedHealthcare Community Plan; MolinaHealthcare of Texas, Inc.; HealthSpringLife & Health Insurance Co., IncNotes: Program notesSTAR population also includes pregnantwomen. Dental benefits covered by theSTAR program are administered byDental Maintenance Organizations.Enrollment in the STAR Health Programis voluntary for the following populationcategories: 1) Children and youngadults in DFPS conservatorship; 2)Emancipated minors or members age18-22 who voluntarily agree to continuein foster placement; 3) Young adultsage 18-21 who have exited care and areparticipating in the Medicaid forTransitional Foster Care Youth(MTFCY) or Former Foster CareChildren (FFCC) program.4) An infantborn to a mother who is enrolled inSTAR Health; 5) Children through age17 and young adults aged 18 throughthe month of their 21st birthday who arereceiving Supplemental Security Income(SSI) or who were receivingSupplemental Income before becomingeligible for AA or PCA; and Childrenthrough age 17 and young adults aged18 through the month of their 21st whoare enrolled in a 1915(c) MedicaidWaiver and AA or PCA.456
Texas Managed Care Program Features, as of 2020 (2 of 3)FeaturesPACESTAR KIDSMedical Transportation ProgramProgram typeProgram of All-inclusive Care for theElderly (PACE)Comprehensive MCO MLTSSNon-Emergency Medical TransportationStatewide or region-specific?StatewideStatewideStatewideFederal operating authorityPACE1115(a) (Medicaid demonstrationwaivers),1915(b)/1915(c),1945 HealthHomes1915(b)Program start 2022Waiver expiration date (if applicable)If the program ended in 2020, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)VoluntaryPopulations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)Populations enrolled: Aged, Blind orDisabled Children or AdultsVoluntaryMandatoryVoluntaryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)VoluntaryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)VoluntaryPopulations enrolled: Full DualsVoluntaryPopulations enrolled: Children withSpecial Health Care NeedsPopulations enrolled: NativeAmerican/Alaskan ryVoluntaryVoluntary457
FeaturesPACESTAR KIDSMedical Transportation ProgramPopulations enrolled: Foster Care andAdoption Assistance ChildrenExemptMandatoryVoluntaryPopulations enrolled: Enrollment choice N/Aperiod15 daysPre-assignedPopulations enrolled: Enrollment brokername (if applicable)MAXIMUSPopulations enrolled: Notes onenrollment choice periodBenefits covered: Inpatient hospitalphysical healthXXBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: Outpatient hospitalphysical healthXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: Partial hospitalization XXBenefits covered: PhysicianXXBenefits covered: Nurse practitionerXXBenefits covered: Rural health clinicsand FQHCsXXBenefits covered: Clinic servicesXXBenefits covered: Lab and x-rayXXBenefits covered: Prescription drugsXXBenefits covered: Prosthetic devicesXXBenefits covered: EPSDTBenefits covered: Case managementBenefits covered: SSA Section 1945authorized Health HomeXXXX458
FeaturesPACESTAR KIDSBenefits covered: Home health services X(services in home)XBenefits covered: Family planningXBenefits covered: Dental services(medical/surgical)XXBenefits covered: Dental (preventativeor corrective)XXBenefits covered: Personal care (stateplan option)XXBenefits covered: HCBS waiver services XXBenefits covered: Private duty nursingXXBenefits covered: ICF-IDDMedical Transportation ProgramXBenefits covered: Nursing facilityservicesXXBenefits covered: Hospice careXXBenefits covered: Non-EmergencyMedical TransportationXXBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Adult day care/adult foster care;nursing; restorative therapies: physical,occupational, and recreationaltherapies; meals and nutritioncounseling; social work/social services;medical supplies/adaptive aids andminor home modifications;transportation to and from medicalappointments; medical specialists, suchas audiology, dentistry, optometry,podiatry, speech therapy, respite care;medical care provided by a PACEphysician familiar with the history,Diagnostic services, podiatrist services,medical supplies, non-prescriptiondrugs, eye glasses, preventive services,nurse midwife services, and pediatric orfamily nurse practitioner services459
FeaturesPACESTAR KIDSMedical Transportation ProgramBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)continuedneeds, and preferences of eachparticipantQuality assurance and improvement:HEDIS data required?NoYesNoQuality assurance and improvement:CAHPS data required?NoYesNoQuality assurance and improvement:Accreditation required?NoNo, but accreditation considered in plan Noselection criteriaQuality assurance and improvement:Accrediting organizationNCQA, URACQuality assurance and improvement:EQRO contractor name (if applicable)Institute for Child Health PolicyPerformance incentives: Paymentbonuses/differentials to reward plansXPerformance incentives: Preferentialauto-enrollment to reward plansXPerformance incentives: Public reportscomparing plan performance on keymetricsXPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomesParticipating plans: Plans in ProgramXBienvivir Senior Health Services (ElPaso); Silver Star Health Network(Lubbock); The Basics at Jan Werner(Amarillo)Cook Children's Health Plan; HealthCare Service Corporation DBA BlueCross and Blue Shield of Texas(BCBSTX); Children’s Medical CenterHealth Plan; Amerigroup InsuranceCompany; Superior HealthPlan, Inc.;Aetna Better Health of Texas, Inc.;Community First Health Plans, Inc.;UnitedHealthcare Insurance Company,American Medical Response;LogistiCare; Medical TransportationManagement; Project Amistad460
FeaturesPACESTAR KIDSMedical Transportation ProgramParticipating plans: Plans in Programcontinueddba United Healthcare; TexasChildren’s Health Plan, Inc.; DriscollChildren’s Health PlanNotes: Program notes1115 and 1915(c) waivers are applied to Based on the client's county ofthis program.residence, the client is assigned to thesingle broker in the region.461
Texas Managed Care Program Features, as of 2020 (3 of 3)FeaturesChildren's Medicaid Dental ServicesProgram typeDental only (PAHP)Statewide or region-specific?StatewideFederal operating authority1115(a) (Medicaid demonstrationwaivers)Program start date12/11/2011Waiver expiration date (if applicable)09/30/2022If the program ended in 2020, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)Populations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)Populations enrolled: Aged, Blind orDisabled Children or AdultsMandatoryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)MandatoryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)Populations enrolled: Full DualsPopulations enrolled: Children withSpecial Health Care NeedsPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryPopulations enrolled: Foster Care andAdoption Assistance ChildrenExempt462
FeaturesChildren's Medicaid Dental ServicesPopulations enrolled: Enrollment choice 15 daysperiodPopulations enrolled: Enrollment broker MAXIMUSname (if applicable)Populations enrolled: Notes onenrollment choice periodBenefits covered: Inpatient hospitalphysical healthBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)Benefits covered: Outpatient hospitalphysical healthBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)Benefits covered: Partial hospitalizationBenefits covered: PhysicianBenefits covered: Nurse practitionerBenefits covered: Rural health clinicsand FQHCsBenefits covered: Clinic servicesBenefits covered: Lab and x-rayBenefits covered: Prescription drugsBenefits covered: Prosthetic devicesBenefits covered: EPSDTXBenefits covered: Case managementBenefits covered: SSA Section 1945authorized Health HomeBenefits covered: Home health services(services in home)Benefits covered: Family planning463
FeaturesChildren's Medicaid Dental ServicesBenefits covered: Dental services(medical/surgical)XBenefits covered: Dental (preventativeor corrective)XBenefits covered: Personal care (stateplan option)Benefits covered: HCBS waiver servicesBenefits covered: Private duty nursingBenefits covered: ICF-IDDBenefits covered: Nursing facilityservicesBenefits covered: Hospice careBenefits covered: Non-EmergencyMedical TransportationBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Quality assurance and improvement:HEDIS data required?YesQuality assurance and improvement:CAHPS data required?YesQuality assurance and improvement:Accreditation required?No, but accreditation considered in planselection criteriaQuality assurance and improvement:Accrediting organizationURACQuality assurance and improvement:EQRO contractor name (if applicable)Institute for Child Health Policy464
FeaturesChildren's Medicaid Dental ServicesPerformance incentives: Paymentbonuses/differentials to reward plansXPerformance incentives: Preferentialauto-enrollment to reward plansPerformance incentives: Public reportscomparing plan performance on keymetricsXPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsXrequired or encouraged to pay providersfor value/quality outcomesParticipating plans: Plans in ProgramMCNA Insurance Company;DentaQuest USA Insurance Company,Inc.Notes: Program notes465
Dell Children's Health Plan; UnitedHealthcare Insurance Company, . Parkland Community Health Plan, Inc.; Cook Children's Health Plan; Community Health Choice Texas, Inc.; Health Care Service Corp. (dba Blue Cross Blue Shield); SHA. LLC, dba FirstCare Health Plans; Scott & White Health Plan : Amerigroup Texas, Inc.; Superior
