Persons on the HCBS waivers CLASS, HCS, TxHML, DBMD and in ICF-IID facilities

The individual care you want. The support you need.

If you're elderly, disabled or living with an illness, your health needs are unique. Our job is to make it as easy as possible for you to meet those needs. To do that, we start with what our members have told us is most important.

• A doctor you know and trust, who's close to you. You can choose from thousands of physicians and hospitals across Texas.
• Support for those who support you. We get to know your family, your caregivers and those who help you in the community.
• Help with coordinating your care. Your Service Coordinator can help you get the most from your benefits.

For more information about the pharmacies, hosipitals, specialists and other providers in the UnitedHealthcare Community Plan network, you can call us at 1-888-887-9003, TDD: 711.

All your Medicaid benefits and more*

We know that health care can be confusing. That’s why our health plans are designed to make things simpler for you.

• You can choose your own doctor. Find a primary doctor in your neighborhood. Your doctor can send you to thousands of specialists, too.
• 24/7 NurseLine^SM You or a caregiver can call our nurses for advice, day or night.
• Prescription drugs. Get the medicine you need at a pharmacy near you.
• Vision and dental. Have regular eye and dental exams. We cover glasses and contact lenses too.
• Mental health. Counseling and other treatments are covered.
• A Service Coordinator. If you need extra help managing your condition, one of our Service Coordinators will work with you to get the care you need.
• Transportation. If you need help getting to the doctor, we can pick you up. Even stop at the pharmacy on the way home.
• Value-added benefits. Earn free gift cards when you take healthy steps. You'll get rewards when you have your yearly wellness exam or complete a weight loss program.
  * Please Note: Some benefits may not apply to all members or service areas.

Employment

Employment Assistance and Supported Employment are benefits offered to the STAR+PLUS Waiver members only effective 9/1/2014.

Employment Assistance (EA) services provide assistance to the member to help locate competitive employment or self-employment. EA services include, but are not limited to, the following:

• Identifying an member's employment preferences, job skills, and requirements for a work setting and work conditions;
• Locating prospective employers offering employment compatible with an member's identified preferences, skills, and requirements; and
• Contacting a prospective employer on behalf of an member and negotiating the member's employment.

Supported Employment (SE) services provide assistance to the member in order to sustain paid employment, to a member who, because of a disability, requires intensive, ongoing support to be self-employed, work from home, or perform in a work setting at which members without disabilities are employed. SE includes employment adaptations, supervision, and training related to a member's diagnosis.

Competitive employment is work:

• In the competitive labor market, in which anyone may compete for employment, that is performed on a full-time or part-time basis in an integrated setting; and
• In which a member is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by members without disabilities.

Additional Waiver Services

Intellectual and Developmental Disability (IDD)

Effective September 1, 2014, STAR+PLUS services will be expanded to include some individuals who have Intellectual and Developmental Disabilities (IDD) and live in an ICF-IID or who receive services through one of the following IDD waivers: CLASS, DBMD, HCS or TxHmL.  Individuals who receive services through one of these five programs and are dual eligible will not be included in this expansion.  Children who are SSI eligible and not dual eligible may elect to enroll into STAR+PLUS at this time.  Individuals served in these programs that are enrolled into STAR+PLUS will get their ACUTE CARE SERVICES ONLY through managed care and will continue to get their long-term services and supports (LTSS) through the Department of Aging and Disability Services (DADS).

The managed care organizations (MCOs) will provide service coordination activities for these individuals (members), but the MCO will have responsibility only for acute care services. 

Every United Healthcare Community Plan member will be assigned a Service Coordinator who will work with families and the DADS waiver staff to arrange and coordinate acute care services for the IDD population for STAR+PLUS members only.

Acute benefits include but are not limited to: all inpatient and outpatient medical and behavioral health services, therapies, durable medical equipment and supplies, early childhood intervention, family planning services, home health care services and prescription medications.

STAR+PLUS HCBS Waiver Services Provided Through CBA in Traditional Medicaid

The list of services includes:

• Adaptive aids and medical supplies
• Adult foster care
• Assisted living
• Dental
• Emergency response services
• Financial management services
• Home delivered meals
• Minor home modifications
• Nursing
• Occupational therapy
• Personal assistance services
• Physical therapy
• Prescription drugs, unless the person is eligible for both Medicare and Medicaid
• Respite
• Speech, hearing and language therapy
• Support consultation
• Transition assistance services

FAQs for Acute Care Benefits for HCBS Waiver Members

Nursing Facility Information

Will my STAR+PLUS benefits change if I am in a Nursing Facility?

Starting March 1, 2015, people who have Medicaid and are eligible for STAR+PLUS and live in a nursing facility will get their basic health services (acute care) and long-term care services through STAR+PLUS. People who get both Medicaid and Medicare (dual eligible) will get their basic health services through Medicare and their long-term care services through STAR+PLUS Medicaid.

How will people who live in a nursing facility and their families find out about this change and about which facilities are in the STAR+PLUS network?

HHSC will reach out to nursing facility residents and their legally authorized representatives using a variety of tools including direct letters. HHSC also will provide nursing facilities with information about the upcoming changes.

What is the role of the UnitedHealthcare Community Plan Nursing Facility Service Coordinator?

Service Coordinators represent the health plan at the nursing facility. They are responsible for service coordination and care management for STAR+PLUS program members. All STAR+PLUS members living in a nursing facility will have the same health plan service coordinator. The health plan service coordinator will meet in person with the STAR+PLUS member four times a year.

Health Plan Nursing Facility Service Coordinators are responsible for**:

• Working with the member, family, nursing facility care coordinator and staff, and others to make a service plan. A service plan includes services given through the nursing facility, add-on services, acute medical services, behavioral health services, and primary or specialty care.
• Participating in nursing facility care planning meetings by phone or in person, with the member’s permission.
• Reviewing the member's service plan including the nursing facility plan of care, at least once a year or when there is a change in health.
• Visiting members living in nursing facilities in person at least four times a year.
• Helping to collect applied income when a nursing facility has not been successful.
• Meeting requirements of the Texas Promoting Independence Initiative (PII). The quarterly in-person visits can include assessments required under the PII. The service coordinator can serve as the contact person for a member who moves back to the community under PII.
• Working with discharge planning staff to plan discharge and transition from the nursing facility.
  
  ** Please note: The following populations are excluded:
• Children and young adults under age 21.
• Truman W. Smith Children's Care Center Residents.
• State Veteran's home residents.

ADDITIONAL BEHAVIORIAL HEALTH SERVICES

Mental Health Targeted Case Management and Psychosocial Rehabilitation

Mental Health Targeted Case Management and Psychosocial Rehabilitation are for Members with a severe and persistent mental illness (SPMI) or a severe emotional disturbance (SED). The following Mental Health Rehabilitative Services may be provided to individuals with an SPMI or a SED as defined in the DSM-IV-TR and who require rehabilitative services as determined by either the ANSA or the CANS:

• Adult Day Program
• Medication Training and Support
• Crisis Intervention
• Skills Training and Development
• Psychosocial Rehabilitative Services

Assessment, referral and education are provided. Services include:

• Intermediate care for cases requiring outpatient care through a clinical facility/li>
• Case management
• Inpatient and discharge follow-up
• Behavioral Health Wellness Assessment

Targeted Case Management

• Must be face to face
• Include regular, but at least annual, monitoring of service effectiveness
• Proactive crisis planning and management for individuals
• Targeted case management is a Medicaid billable service provided separate from MCO service coordination
• MCO must ensure that STAR Service Management units and STAR+PLUS Service Coordinators coordinate with providers of TCM to ensure integration of behavioral and physical health needs of Members.
• MCO must ensure that if a Member loses Medicaid eligibility, STAR Service Management units and STAR+PLUS Service Coordinators refer the Member to Local Mental Health Authorities that can provide indigent mental health care.

Mental Health Rehabilitative Services include

• Crisis Intervention Services
• Medication Training and Support Services
• Psychosocial Rehabilitative Services
• Skills Training and Development Services
• Day Programs for Acute Needs

Mental Health Targeted Case Management

The following Mental Health Targeted Case Management services may be provided to individuals with an SPMI or a SED as defined in the DSM-IV-TR and who require the service as determined by either the ANSA or the CANS.

• Case management for people who have SED (child, 3 through 17 years of age), which includes routine and intensive case management services.
• Case management for people who have SPMI (adult, 18 years of age or older).

Employment related services that provide training and supports that are not job specific and have as their focus the development of skills to reduce or overcome the symptoms of mental illness that interfere with the individual’s ability to make vocational choices, attain or retain employment can be provided under Skills Training and Development. These services should not be confused with Employment Assistance or Supported Employment allowed under the HCBS STAR+PLUS Waiver.

It's easy to join us. Follow these three steps to sign up for STAR+PLUS:

    1. Call Us at 1-800-964-2777.

    2. Pick UnitedHealthcare Community Plan as your insurance plan.

    3. Pick your doctor.

If you already have Medicaid STAR+PLUS, call 1-800-964-2777 and select UnitedHealthcare Community Plan as your insurance plan.