Eligibility, federal health care reform legislation, the Perinate program, Medical Health Home, Star Expansion and the Substance Abuse Program were all subjects reviewed during the November HHSC Stakeholder meeting. Below are the highlights on some of the programs discussed during that meeting.
Key Concepts:
· Eligibility – Timeliness will remain an issue for the eligibility program until the current backlog is cleared up.
· STAR plus expansion- STAR plus is different from Integrated Care Management (ICM) models since there is an incentive offered to make sure patients are being seen. A request for a proposal (RFP) should now be posted and program implementation is expected – Spring 2011.
· Perinate program – The Centers for Medicare & Medicaid Services (CMS) sent a letter to HHSC arguing the Perinate program was out of compliance with Medicaid requirements. HHSC notes that CMS believes children should have a Medicaid benefit package for 12 months after birth so HHSC anticipates they can come to some sort of agreement with CMS and continue the program.
· Substance Abuse – A new substance abuse benefit program is being developed for adults in Medicaid. The benefits should be cost-neutral to the overall Medicaid program. Benefits will require approval from CMS. Anticipated implementation is September 2010. Currently, HHSC is working on a benefit summary and program design. The high level summary was posted on the HHSC website to allow for public comments and the comment period has now closed.
