STAR+PLUS Member Benefits

Member Handbook

 
Hidalgo Service Area Handbook - Effective March 1, 2014
Tarrant Service Area Handbook - Effective March 1, 2014

 

 

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.
 
  • 72-hour supplies of emergency prescriptions

  • Accessing OB/GYN

  • Advanced Practice Nurse (APRNs)

  • Ambulance services

  • 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.

  • Behavioral health services

  • Birthing services provided by a Physician or Advanced Practice Nurse in a licensed birthing center

  • Chiropractic services

  • Dialysis

  • Disease Management Programs

  • Durable medical equipment and supplies

  • Emergency services

  • Employment assistance

  • Family planning services

  • Health education related to Obesity

  • Home health care services

  • Hospital services, outpatient (inpatient covered if due to a behavioral health issue)

  • Laboratory

  • Lock-In program outpatient drugs

  • Medical checkups and Comprehensive Care Program for children under age 21 through the THSteps Program

  • 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.

  • Optometry, glasses, and contact lenses, if medically necessary

  • Podiatry

  • Prenatal care

  • Primary care services

  • Preventive services including an annual adult well check for patients 21 years of age and over

  • Radiology, imaging, and X-rays

  • Service Coordination

  • Specialty physician services

  • Therapies – physical, occupational and speech

  • Transplantation of organs and tissues

  • Vision


Providers can verify benefits for a STAR+PLUS member online using the HealthSpring Provider Portal.

 

 

Community-Based Long-Term Care Benefits


Cigna-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 Cigna-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

 

  • Personal Attendant Services *

  • Day Activity and Health Services (DAHS)

  • STAR+PLUS Waiver Members have a choice in service delivery options for attendant services, including any of the following:

  • (1) traditional agency option;
    (2) Consumer Directed Services (CDS) option; or
    (3) Service Responsibility Option (SRO).

 

 

HCBS STAR+PLUS Nursing Facility Waiver Services Available to Members who Qualify

  • Adaptive Aids

  • Adult Foster Care

  • Assisted Living and Residential Care Services

  • SPW Dental

  • Emergency Response Services

  • Home Delivered Meals

  • Medical Supplies not available under the HCBS STAR+PLUS Waiver program

  • Minor Home Modifications

  • Nursing Services, in-home

  • Respite Care, in-home or out-of-home

  • Therapy (Physical, Occupational and Speech)

  • Transition Assistance Services


Providers can verify benefits for a STAR+PLUS member online using the Cigna-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.
 
Spell of Illness Limitation – Inpatient Hospitalization

 
  1. For inpatient care for dates of service beginning before September 1, 2013, Cigna-HealthSpring Members are not subject to the Medicaid “Spell of Illness” limitation. 

  2. For inpatient care for dates of service beginning on September 1, 2013, Cigna-HealthSpring Members are subject to the Medicaid “Spell of Illness” limitation.  Reimbursement to hospitals for inpatient services is limited to the Medicaid spell of illness. The spell of illness is defined as 30 days of inpatient hospital care, which may accrue intermittently or consecutively, and includes both acute care and behavioral health/substance abuse inpatient care.  After 30 days of inpatient care is provided, reimbursement for additional inpatient care is not considered until the Member has been out of any acute care facility for 60 consecutive days.

 

Exceptions to the spell of illness are as follows:

 
  • A prior-approved solid organ transplant. The 30-day spell of illness period for transplants begins on the date of the transplant, allowing additional time for the inpatient stay.

  • THSteps-eligible Members who are 20 years of age and younger when a medically necessary condition exists.

 


Prescription Drug Coverage – Cigna-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 Cigna-HealthSpring’s STAR+PLUS Provider Manual.
 
Providers can verify benefits for a STAR+PLUS member online using the Cigna-HealthSpring Provider Portal.

 

 

Cigna-HealthSpring Value-Added Benefits

 

In addition to traditional STAR+PLUS benefits, Cigna-HealthSpring offers certain “value-added” services to its Members. Value-added services are benefits that only Cigna-HealthSpring’s STAR+PLUS Members receive. These benefits have been added to Cigna-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.


Value-Added Services available to all Cigna-HealthSpring STAR+PLUS Members:
 
  • 24-Hour Nurse Advice Line
  • Transportation Services
  • Over-the-Counter Medicines
  • A.M./P.M. 7-day Pill Box
  • Cold & Flu Kit NEW!!
  • First-Aid Kit NEW!!


Value-Added Services Available to Cigna-HealthSpring STAR+PLUS Members based on eligibility:
 
  • Extra dental services for adults
  • Extra vision benefits
  • $30 Gift Card for those who receive their Texas Health Steps checkup within the first 90 days NEW
  • Cigna-HealthSpring Fitness Plus Program
  • Respite Care services
  • Box Fans of Cigna-HealthSpring program
  • Vinyl gloves
  • Bath Mat NEW!!

Providers can verify benefits for a STAR+PLUS member online using the Cigna-HealthSpring Provider Portal.