STAR+PLUS Member Benefits
Texas Medicaid Program Benefits
The following services are benefits of the Texas Medicaid Program. Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM) and the bi-monthly Texas Medicaid Bulletins for a more inclusive listing of limitations and exclusions.
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Ambulance services
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Audiology services, including hearing aids for adults; audiology services and hearing aids for children under age twenty-one (21) are a Non-Capitated Service. Non-Capitated Services are discussed in greater detail in the Provider Manual.
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Behavioral health services
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Birthing services provided by a Physician or Advanced Practice Nurse in a licensed birthing center
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Chiropractic services
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Dialysis
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Durable medical equipment and supplies
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Emergency Services
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Family planning services
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Home health care services
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Hospital services, outpatient (inpatient covered if due to a behavioral health issue)
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Laboratory
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Medical checkups and Comprehensive Care Program for children under age 21 through the THSteps Program
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Oral evaluation and fluoride varnish in the Medical Home in conjunction with Texas Health Steps medical checkup for children 6 months through 35 months of age.
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Optometry, glasses, and contact lenses, if medically necessary
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Podiatry
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Prenatal care
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Primary care services
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Preventive services including an annual adult well check for patients 21 years of age and over
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Radiology, imaging, and X-rays
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Specialty physician services
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Therapies – physical, occupational and speech
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Transplantation of organs and tissues
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Vision
Providers can verify benefits for a STAR+PLUS member online using the HealthSpring Provider Portal.
Community-Based Long-Term Care Benefits
HealthSpring must provide all Long Term Support Services currently covered under the traditional, fee-for-service Medicaid program. The following non-inclusive list of community-based, long-term care services are included under HealthSpring’s STAR+PLUS Program. Providers can refer to the STAR+PLUS Member Handbook for a more inclusive listing of the limitations and exclusions that apply to each benefit category.
Services Available to all STAR+PLUS Members
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STAR+PLUS Waiver Members have a choice in service delivery options for attendant services, including any of the following:
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(1) traditional agency option;
(2) Consumer Directed Services (CDS) option; or
(3) Service Responsibility Option (SRO).
1915(c) Nursing Facility Waiver Services Available to Members who Qualify
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Adaptive Aids
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Adult Foster Care
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Assisted Living and Residential Care Services
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SPW Dental
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Emergency Response Services
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Home Delivered Meals
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Medical Supplies not available under the 1915(b) Waiver program
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Minor Home Modifications
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Nursing Services, in-home
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Respite Care, in-home or out-of-home
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Therapy (Physical, Occupational and Speech)
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Transition Assistance Services
Providers can verify benefits for a STAR+PLUS member online using the HealthSpring Provider Portal.
Enhanced STAR+PLUS Benefits
Under the STAR+PLUS Program, members have access to two (2) enhanced benefits, above and beyond what is available under the traditional, fee-for-service Medicaid program. Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM) and the bi-monthly Texas Medicaid Bulletins for a more inclusive listing of limitations and exclusions.
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Spell of Illness Limitation – Under traditional Medicaid, inpatient behavioral health care is covered for thirty (30) days. After thirty (30) days, additional inpatient behavioral health care is not covered until the Member has been out of the facility for sixty (60) consecutive days. Inpatient behavioral health care may accrue intermittently or consecutively. This is known as the “spell of illness” limitation. Unlike traditional Medicaid, HealthSpring Members are not subject to “spell of illness” limitations for inpatient behavioral health care.
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Prescription Drug Coverage – HealthSpring Members who are not covered by Medicare are eligible for unlimited prescription drug coverage as described under the Texas Medicaid Formulary and administered through the Texas Vendor Drug Program. Dual-eligible Members do not receive prescription drug coverage through the Texas Medicaid Program because coverage is available through Medicare Part D. Additional information about prescription drug coverage for STAR+PLUS Members is discussed in greater detail in HealthSpring’s STAR+PLUS Provider Manual.
Providers can verify benefits for a STAR+PLUS member online using the HealthSpring Provider Portal.
HealthSpring Value-Added Benefits
In addition to traditional STAR+PLUS benefits, HealthSpring offers certain “value-added” services to its Members. Value-added services are benefits that only HealthSpring’s STAR+PLUS Members receive. These benefits have been added to HealthSpring’s STAR+PLUS Program in order to promote healthy lifestyles and improve health outcomes for Members. Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM) and the bi-monthly Texas Medicaid Bulletins for a more inclusive listing of limitations and exclusions.
Services Available to all HealthSpring STAR+PLUS Members
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24-Hour Nurse Advice Line
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Over-the-Counter Medications (limit of $10/month)
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Active&Fit program
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Respite Care services
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Fans of HealthSpring program
Services Available to HealthSpring STAR+PLUS Medicaid only Members
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Enhanced transportation services
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Extra dental services for adults and pregnant women
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Extra vision benefits
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Extra behavior benefits - NEW! (effective 3/1/2013)
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$10 Calling Card for those who receive their Texas Health Steps checkup within the first 90 days - NEW! (effective 3/1/2013)
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Additional information about Value-added Benefits for STAR+PLUS Members is discussed in greater detail in HealthSpring’s STAR+PLUS Provider Manual.
Providers can verify benefits for a STAR+PLUS member online using the HealthSpring Provider Portal.