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DADS Provider Alerts — Transition Assistance Services (TAS)

REVISED Automatic Medicaid Managed Care (STAR+PLUS) Enrollment for Some CBA, PHC and DAHS Individuals

Automatic Medicaid Managed Care Enrollment for Some Individuals

Why am I receiving this alert?

You are a provider for one or more of the following:

  • Community Based Alternatives (CBA)
  • Primary Home Care (PHC)
  • Day Activity Health Services (DAHS)

The Health and Human Services Commission (HHSC) wants to make sure you have the latest information regarding the September 1, 2014 expansion of STAR+PLUS to the Medicaid Rural Service Areas (MRSAs).

Some mandatory STAR+PLUS candidates currently receiving CBA, PHC or DAHS program services in the MRSAs did not receive a STAR+PLUS enrollment packet in the mail. HHSC will automatically assign these individuals to a managed care organization (MCO) in the service area in which they live and these individuals will be automatically enrolled in the STAR+PLUS program effective September 1. HHSC will take into consideration the person's current primary care provider, previous medical history, and the STAR MCO they may currently be enrolled with when making this MCO assignment. HHSC is taking this action to ensure the individuals you serve are able to continue receiving their long term services and supports.

The mandatory STAR+PLUS candidates we’re referring to in this letter did not receive an enrollment packet for the following reasons:

  • Invalid addresses in the State Medicaid Eligibility System.
  • A lapse in Medicaid eligibility. Some mandatory candidates lost Medicaid eligibility during July and August and have recently had their Medicaid eligibility reinstated.  This resulted in making them a mandatory candidate for STAR+PLUS effective September 1, 2014.

Who will be automatically enrolled into a MCO?

Mandatory candidates who must enroll in STAR+PLUS are adults age 21 and older residing in the MRSA Central, MRSA West, or MRSA Northeast who:

  • receive Social Security Income (SSI), or SSI-related benefits (including individuals enrolled in PHC or DAHS), and/or
  • are currently enrolled in CBA.

Who is excluded from automatic enrollment into a MCO?

Individuals who are mandatory for STAR+PLUS and reside in an intermediate care facility for individuals with intellectual disabilities and related conditions (ICF-IID) or receive services through Texas Home Living, Home and Community-based Services, Deaf Blind Multiple Disabilities, Community Living Assistance and Support Services waivers will not be automatically enrolled at this time.

How can you help?

Please encourage the individuals you serve to update their address with the appropriate entity to ensure HHSC and the managed care enrollment broker, MAXIMUS, have the correct address. This will help with future mailings and appropriate assignment to a MCO.

Individuals, Medicaid authorized representatives, or representative payees, as appropriate, can provide current address information as follows:

  • Addresses for individuals receiving SSI can be updated through the Social Security Administration (SSA) by calling the SSA at 1-800-772-1213 or contacting the individual’s local SSA office.
  • Addresses for individuals currently not receiving SSI can be updated by calling 2-1-1.

What is the standard managed care enrollment process?

For candidates identified as mandatory for STAR+PLUS after September 1, HHSC will follow the standard enrollment process. These Individuals will receive an enrollment packet from MAXIMUS and have at least 15 days to choose a MCO. If a candidate does not choose an MCO, HHSC will auto-assign the individual to a MCO in the service area in which they live. Individuals can call MAXIMUS at any time to change their MCO or to ask questions by calling 1-877-782-6440. It can take 15 to 45 days for a MCO change to take effect.

Where do I go to learn more about the changes happening on September 1, 2014 ?

Please visit the HHSC website, "Expansion of Medicaid Managed Care" at http://www.hhsc.state.tx.us/medicaid/managed-care/mmc.shtml.

The Department of Aging and Disability Services (DADS) publishes information regarding the transition of LTSS from DADS to the STAR+PLUS program on the DADS website at: www.dads.state.tx.us/providers.

Refer to information letters and alerts regarding managed care and STAR+PLUS topics

(8/25/2014)

Adoption of Repealed Rules in 40 Texas Administrative Code, Chapter 69, Contract Administration

The Texas Health and Human Services Commission, on behalf of the Department of Aging and Disability Services, adopts the repeal of Chapter 69, consisting of §§69.1 - 69.4, 69.11 - 69.19, 69.31 - 69.40, 69.51 - 69.55, 69.71 - 69.73, 69.81, 69.91 - 69.93, 69.101 - 69.103, 69.111 - 69.118, 69.131 - 69.139, 69.151 - 69.160, and 69.171 - 69.186, concerning Contract Administration, without changes to the proposal as published in the April 18, 2014, issue of the Texas Register (39 TexReg 3210).

The adoption of the repealed rules was published in the August 22, 2014 issue of the Texas Register. The adopted rules are effective September 1, 2014.

You may access the rules in the Texas Register online at:
http://www.sos.state.tx.us/texreg/archive/August222014/Adopted%20Rules/40.SOCIAL%20SERVICES%20AND%20ASSISTANCE.html#298

(8/25/2014)

Adoption of Rules in 40 Texas Administrative Code, Chapter 49, Contracting for Community Care Services

The Texas Health and Human Services Commission, on behalf of the Department of Aging and Disability Services, adopts the repeal of Chapter 49, Contracting for Community Care Services, Subchapter A, consisting of §49.1, concerning definitions; Subchapter B, consisting of §§49.11 - 49.18 and §49.20, concerning contractor requirements; Subchapter C, consisting of §§49.31 - 49.33, concerning records; Subchapter D, consisting of §49.41 and §49.42, concerning billings and payments; Subchapter E, consisting of §§49.51 - 49.54, concerning audits, monitoring, and reviews; Subchapter F, consisting of §§49.61 - 49.63, concerning sanctions and terminations; and Subchapter G, consisting of §§49.71 - 49.73, concerning personal attendants wages; and adopts new Chapter 49, Contracting for Community Services, Subchapter A, consisting of §49.101 and §49.102, concerning application and definitions; Subchapter B, consisting of §§49.201 - 49.211, concerning contractor enrollment; Subchapter C, consisting of §§49.301 - 49.312, concerning requirements of a contractor; Subchapter D, Division 1, consisting of §49.401, concerning applicability of Subchapter D; Division 2, consisting of §§49.411 - 49.414, concerning monitoring and investigation; Subchapter E, Division 1, consisting of §49.501, concerning applicability of Subchapter E; Division 2, consisting of §49.511, concerning immediate protection; Division 3, consisting of §§49.521 - 49.523, concerning actions; Division 4, consisting of §§49.531 - 49.534, concerning sanctions; Division 5, consisting of §49.541, appeals; Division 6, consisting of §49.551, concerning termination by contractor; Subchapter F, consisting of §49.601, concerning review by DADS of expiring or terminated contract; and Subchapter G, consisting of §49.701 and §49.702, concerning application denial period, in Chapter 49, Contracting for Community Care Services. New §§49.101, 49.102, 49.204, 49.205, 49.208, 49.304, 49.305, 49.308, 49.309, 49.310, 49.413, 49.522, and 49.551 are adopted with changes to the proposed text published in the April 18, 2014, issue of the Texas Register (39 TexReg 3148). New §§49.201 - 49.203, 49.206, 49.207, 49.209 - 49.211, 49.301 - 49.303, 49.306, 49.307, 49.311, 49.312, 49.401, 49.411, 49.412, 49.414, 49.501, 49.511, 49.521, 49.523, 49.531 - 49.534, 49.541, 49.601, 49.701 and 49.702 are adopted without changes to the proposed text.

The adopted rules were published in the August 22, 2014 issue of the Texas Register.  The adopted rules are effective September 1, 2014.

You may access the rules in the Texas Register online at:
http://www.sos.state.tx.us/texreg/archive/August222014/Adopted%20Rules/40.SOCIAL%20SERVICES%20AND%20ASSISTANCE.html#224

(8/25/2014)

Adoption of Rules in 40 Texas Administrative Code, Chapter 62, Contracting to Provide Transition Assistance Services

The Texas Health and Human Services Commission adopts, on behalf of the Department of Aging and Disability Services, amendments to §62.11, concerning contracting requirements, and §62.41, concerning record keeping; and the repeal of §62.43, concerning reimbursement in Chapter 62, Contracting to Provide Transition Assistance Services.

The adopted rules were published in the August 22, 2014 issue of the Texas Register. The adopted rules are effective September 1, 2014.

You may access the rules in the Texas Register online at:
http://www.sos.state.tx.us/texreg/archive/August222014/Adopted%20Rules/40.SOCIAL%20SERVICES%20AND%20ASSISTANCE.html#295

(8/25/2014)

Chapter 49, Contracting for Community Services Webinar

The Department of Aging and Disability Services (DADS) is hosting three webinars on the proposed Chapter 49, Contracting for Community Services, rule revisions:

August 18, 2014 from 1:30 p.m. until 4 p.m.
Space is limited.
Reserve your Webinar Seat Now at:
https://www1.gotomeeting.com/register/415951600

August 21, 2014 from 1:30 p.m. until 4 p.m.
Space is limited.
Reserve your Webinar Seat Now at:
https://www1.gotomeeting.com/register/322963073

August 26, 2014 from 1:30 p.m. until 4 p.m.
Space is limited.
Reserve your Webinar Seat Now at:
https://www1.gotomeeting.com/register/361402737

With webinars, you may choose to listen to the audio portion of the presentations by using your computer speakers. A phone line will also be available for those who may have a need to call in. Please be aware that attendees who choose the phone option may be subject to long distance phone charges.

After registering, you will receive a confirmation email containing information about joining the webinar.

System Requirements
PC-based attendees:
Required: Windows® 8, 7, Vista, XP or 2003 Server
Mac®-based attendees:
Required: Mac OS® X 10.6 or newer
Mobile attendees
Required: iPhone®, iPad®, Android™ phone or Android tablet

Please contact Kathie Carleton-Morales at Kathie.Carleton-Morales@dads.state.tx.us if you have any questions about the upcoming webinar.

(8/11/2014)

Stakeholder Feedback Sought Regarding Options for the Implementation of Transition Assistance Services (TAS) in the Home and Community-based Services (HCS) Program

The Texas Department of Aging and Disability Services (DADS) added Transition Assistance Service (TAS) by an amendment to the Home and Community-based Services (HCS) waiver which was approved by the Centers for Medicare and Medicaid Services (CMS) on March 4, 2014. CMS approved $1,000 for individuals transitioning from institutions into provider owned or contracted residential settings. Individuals transitioning from institutions into own home or family home settings can use up to $2,500 for TAS.

DADS has encountered a number of information technology challenges surrounding the implementation of TAS in HCS:

  1. TAS providers are not registered in the DADS' Client Assignment and REgistration (CARE) system, a DADS database with demographic, program eligibility, and service planning data for individuals who receive HCS services and supports or have requested HCS services and supports. This is the system used for billing and payment of HCS waiver services.
  2. TAS providers currently bill through Texas Medicaid & Healthcare Partnership (TMHP), the Texas Medicaid program claims administrator. TMHP does not interface with the DADS CARE system.
  3. To allow TAS providers to bill in CARE, TAS providers would need to be registered in the CARE system. This change would delay implementation and require significant funds to complete.

In order to facilitate timely implementation of TAS in HCS, DADS has developed options for billing TAS in the CARE system using one or more of the following options:

  • Option #1: The HCS provider could contract with the TAS providers to deliver TAS.
  • Option #2: HCS providers could contract with DADS to provide TAS. The HCS provider would enter into a separate TAS contract with DADS to deliver TAS. Under a TAS contract, TAS could be provided to individuals enrolling in CLASS, MDCP, DBMD and HCS.Entering into a TAS contract with DADS would not require a TAS provider to deliver TAS to anyone who requests it.
  • Option #3: The HCS provider could deliver the service directly (without the need for a TAS contract), or the HCS provider could contract with the TAS providers to deliver TAS. The HCS waiver would be amended to list HCS providers as eligible to deliver TAS in addition to TAS providers. TAS would be delivered under the providers HCS contract.

DADS is seeking stakeholder feedback regarding these options by COB Monday, July 28, 2014. Feedback can be sent to hcs@dads.state.tx.us.

(7/22/2014)

DADS Guide to Employment for People with Disabilities Now Available

This new publication was designed for people who want to improve employment outcomes for people with disabilities including Texas Department of Aging and Disability Services (DADS) employees, contracted case managers and service coordinators, service providers, and people who receive DADS services and their families.

While some parts of the guide focus on employment services programs, the rest applies to all DADS program participants. As such, all stakeholders are encouraged to use it.

Highlights include:

  • Recommended roles and responsibilities at each stage of a job search
  • Strategies for overcoming the transportation obstacle
  • Tools and guidance for coordinating services with the Texas Department of Assistive and Rehabilitative Services
  • Index of DADS rules related to employment supports
  • Information about Medicaid Buy-In, and other ways to maintain needed services while working
  • Description of Social Security Administration work incentives
(7/3/2014)

Community Outreach Meetings Slated for STAR+PLUS Enrollees

People who are required to be included in the Sept. 1, 2014, STAR+PLUS expansion into the Medicaid Rural Service Areas, as well as those who are voluntarily enrolling in STAR+PLUS, are encouraged to attend a community outreach meeting in their area.

Outreach events provide opportunities for the enrollment broker, MAXIMUS, to educate people about the services and benefits available through the various managed care organizations.

A list of events can be found on the Texas Health and Human Services Commission Website at: http://www.txmedicaidevents.com. Follow the instructions on the page to find an event.

People who are required to be enrolled in STAR+PLUS already may have received a STAR+PLUS introductory letter in the mail. The majority also should have received a STAR+PLUS enrollment packet.

Intermediate care facility (ICF/IID), Community Living and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS) and Texas Home Living (TxHmL) clients who have not received a packet should call 1-877-782-6440 (TTY: 1-800-267-5008).

All others who did not receive either document, should call 1-800-964-2777 (TTY 1-800-267-5008).

To learn more, visit the Expansion of Managed Care webpage, which contains general information about the Medicaid Managed Care Initiatives and frequently asked questions.

If you have a question, please send it via email to: Managed_Care_Initiatives@hhsc.state.tx.us.

(7/2/2014)

HHSC to Host STAR+PLUS Provider Trainings for Long-term Services and Support Providers (Community Based Alternatives (CBA), Primary Home Care (PHC) and Day Activity Health Services (DAHS)

On September 1, 2014, the STAR+PLUS Medicaid managed care program will expand statewide to the rural service areas of Texas (Central, Northeast and West). People who are age 65 or older or who have disabilities and are covered by Medicaid will begin receiving services through a STAR+PLUS managed care health plan. The Texas Health and Human Services Commission is holding provider trainings across the three rural service areas to educate providers on STAR+PLUS managed care and what changes to expect.

The rural service area managed care organizations will be present to answer questions.

On June 26th, 2014, a STAR+PLUS provider training will take place in Tyler. For additional details and training dates, check the meeting notices on the HHSC website for listings entitled, “STAR+PLUS Trainings.”

(5/29/2014)

Information Letters from MAXIMUS Regarding STAR+PLUS Expansion

Beginning the week of May 5, 2014, MAXIMUS began sending a mail-out to individuals who will be covered under the STAR+PLUS Medicaid Managed Care expansion effective September 1, 2014. The expansion will affect individuals who reside in a Medicaid Rural Service Area (MRSA); AND individuals who are not in a MRSA but reside in an ICF/IID or are enrolled in the HCS, TxHmL, CLASS or DBMD waiver program as of September 1, 2014 or later.

MAXIMUS is sending the mail-out to individuals on behalf of the Health and Human Services Commission, in their capacity as the state's enrollment broker for managed care. The mail-out includes the letter, frequently asked questions and a comparison chart for the managed care organizations in each area. The materials (except for the comparison charts) in English and Spanish are posted at http://www.hhsc.state.tx.us/medicaid/managed-care/Letters-from-HHSC.shtml

(5/19/2014)

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