DentaQuest / Superior Health Plan Training STAR Health (Foster Care) STAR PLUS STAR Value Added Services Advantage by Superior (Medicare)

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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 Members 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)

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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 members 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 Members 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_at_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
  childs health
• information between Caregivers, Medical
  Consenters, DFPS workers, Courts and all health
  care providers (as appropriate) to guarantee that
  all Members health care needs are met.
• DentaQuest and STAR Health, by law, will keep
  Members 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 childs 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
  childs
• 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

• STARPLUS 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 comprehensive care
• 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
  STARPLUS 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 STARPLUS service
  area
• Bexar
• Dallas
• Hidalgo
• Lubbock
• Nueces

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STAR PLUS ID Cards
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STAR PLUS Value Added Services

• STARPLUS Eligible population
• Medicaid Only (non-dual eligible) gt 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 members
  responsibility

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STAR PLUS Waiver Benefits

• STARPLUS 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.superiorhealthpl
  an.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 doesnt 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 gt 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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Questions