Texas Medicaid Single Case Agreement

The MCO will retain CCA registration requirements for health care facilities until February 28, 2018, as outlined in Texas Government Code 533.00251. The MCO can only terminate a network provider contract with a Gfb0 if, to HHSC`s satisfaction, the MCO demonstrates a good reason for prior termination. Yes, targeted case management for people with mental illness and rehabilitated mental health services are available through management care. For patients with severe and persistent mental illness, such as schizophrenia, severe depression, bipolar disorder, and children and adolescents aged 3 to 17 who are diagnosed with severe and persistent mental illness, they have targeted mental health medical services and mental health rehabilitation services. HHSC has been given the legal order to provide these services as part of Medicaid-managed care, in order to ensure better coordination of care by integrating physical and behavioural care into these Medicaid recipients. The STAR-PLUS (SC) service coordinators are the MCO representatives, who are responsible for coordinating services and managing the coaching of STAR-PLUS members. All residents of care facilities have a designated MCO service coordinator who, as part of the team, supports care planning in care facilities. MCO service coordinators will be responsible for coordinating and ensuring the provision of additional and acute care services to care facilities. MCO service coordinators are required to conduct a personalized visit with each member at least quarterly. MCO service coordinators will also work with residents, families and other case coordinators/managers to ensure a smooth transition in the Community (if any). The answers to the questions posed by health care providers are as follows.

To answer questions, please email Managed_Care_Initiatives@hhsc.state.tx.us. Other providers who care for nurses should submit their rights directly to the MCO. STAR-PLUS health plans employ service coordinators. They also use mandated agencies or other collaborators to identify members` needs. The STAR-PLUS MCOs will enter into a direct contract with Denern of NF Add-on Services. In addition, MCOs are responsible for authorizing NF add-on services. Suppliers have up to 95 days from the date of service to apply for additional NF service. HHSC will continue to set THE RUG rates paid to care facilities under STAR-PLUS, including an increase in the number of people. Prior to implementation, HHSC will conduct a comprehensive review of MCOs claims procedures, focusing on their ability to properly assess claims in care facilities. An application from a contract-related provider to obtain a single rate for care facilities must be considered within 10 days of the submission and the right to a complementary installation service submitted by a contract provider must be reviewed within 30 days. HHSC will make a “Go or No-Go” provision based on the preparation findings for unit care rate applications. HHSC staff will monitor ongoing supplier complaints and monitor trends to identify and resolve billing issues.

Finally, STAR-PLUS MCOs pay a network care provider 18 per cent interest per year on all unit rates of the own rights care facility that are not storytellers under the 10-day requirement.

  • Uncategorized
  • April 13, 2021

Booking info

Jory Bice
Mission, BC

647 522-5679
email: jory@discotoast.com