DentaQuest / Superior Health Plan TrainingSTAR Health (Foster Care)STAR + PLUSSTAR Value Added ServicesAdvantage by Superior (Medicare)

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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

Member’s 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)

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 member’s 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 Member’s 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@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 child’s health

information between Caregivers, Medical Consenters, DFPS workers, Courts and all health care providers (as appropriate) to guarantee that all Member’s health care needs are met.

DentaQuest and STAR Health, by law, will keep Member’s 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 child’s 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 child’s

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 STAR+PLUS 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 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 STAR+PLUS 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 STAR+PLUS service area:

Bexar Dallas Hidalgo Lubbock Nueces

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STAR + PLUS ID Cards

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STAR + PLUS Value Added Services STAR+PLUS Eligible population:

Medicaid Only (non-dual eligible) > 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 member’s responsibility

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STAR + PLUS Waiver Benefits

STAR+PLUS 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.superiorhealthplan.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 doesn’t 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 > 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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Thank You!