DentaQuest / Superior Health
Plan Training
Effective 2/1/2013
STAR Health (Foster Care)
STAR + PLUS
STAR Value Added Services
Advantage by Superior (Medicare)
SHP_201237
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)
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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 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 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 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 1800-252-5400 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 Health Plan is a Special Needs Plan
(HMO SNP) for Medicare
 Superior contracts with Center for
Medicaid/Medicare Services (CMS)
 Program approved Counties (not Service
Area)
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Bexar County
Nueces County
Dallas
Rockwall
Collin
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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
 Covered Value Added Services Annual Benefit
 2 Cleanings per year
 2 Oral Exams per year
 1 Dental X-Ray per year
*Note: Services are excluded form the maximum
 Comprehensive Benefit Limit:
 $750 maximum per calendar year for comprehensive
services
 $0 Co-pay
 No UM review
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Questions
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