Transitioning to Texas Medicaid managed care: What customers need to know

Ken BellTexas MedicaidLeave a Comment

Transitioning to Texas Medicaid Managed Care/MCO

Late last year, the Texas Health and Human Services Commission (HHSC) announced that most Texas Medicaid long-term care services will transition to the STAR+PLUS managed care program in 2014.

Starting on Sept. 1, 2014, approximately 60,000 Texas nursing facility residents will be transitioned from Fee-For-Service (FFS; traditional Medicaid) to STAR+PLUS managed care. It is important for skilled nursing facilities (SNFs) to understand how these important changes may affect their reimbursement processes.

For SimpleCFS™ users, here’s what is not changing:

  • SimpleCFS customers will still be able to submit required Texas Medicaid forms (LTCMI, 3618, 3619, and PL1) to TMHP through our software.
  • SimpleCFS customers will still be able to view TMHP Medicaid Eligibility and Service Authorization Verification (MESAV) information through our software.

What will change is who claims are paid to:

  • Most SNF residents who are on Medicaid will transition to Texas STAR+PLUS managed care starting Sept. 1, 2014. Claims for residents who transition to STAR+PLUS will be submitted to and paid by a Managed Care Organization (MCO); not TMHP.
  • Residents who are not eligible for STAR+PLUS (such as women in the breast and cervical cancer program who are in a SNF, and children in SNFs who will be excluded from managed care) will have claims submitted to and paid directly by TMHP through TexMedConnect.
  • Hospice services will continue to be paid out of traditional Medicaid FFS.

More info is available

We have more details, plus links to some important resources, in our SimpleLTC Support Center article. Please review that to be sure you’re prepared for the changes – and as always, please contact us with any questions!

Leave a Reply

Your email address will not be published.