Current Updates (as of 7/10/2019)
Medicaid Medicare Integration
CMS released the first evaluation report for the Texas Dual Eligible Integrated Care Demonstration Project on May 24, 2019. The report explains the implementation and provides an early analysis of the demonstration project using data from key informant interviews, focus groups, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results, and other data. Results from the evaluation include findings from the project’s inception in March 2015 to December 2017. The demonstration is implemented in six Texas counties with the highest number of Medicare and Medicaid beneficiaries. Highlights from the report include:
• Of the more than 155,000 Medicare-Medicaid enrollees eligible for the demonstration, approximately 43,000, or 28 percent, were enrolled as of November 2017. The enrollment rate has remained between 25 and 30 percent in most months.
• Most focus group participants in 2016 and 2017 indicated that their health or quality of life had improved in the previous 2 years, due to factors such as access to providers or new health benefits, weight loss achieved through Medicare-Medicaid Plan (MMP) programs, reduced out-of-pocket costs, and diminished financial stress. Most enrollees who participated in in depth interviews indicated that MMPs had little or no impact on their lives.
• Sixty-four percent of MMP enrollees responding to the CAHPS survey in 2017 rated their health plan a 9 or 10 on a scale of 0 to 10. This result is consistent with the national MMP average and the national average for Medicare Advantage plans.
(Source: TX Demonstration Project: First Evaluation Report; 5-24-2019)
Past Updates
Managed LTSS Program
Through Medicaid §1115 authority, Texas STAR+PLUS (inception: 1998) provides primary, acute, behavioral, and LTSS (Personal Attendant, Assisted Living, PERS, nursing, Adult Foster Care, dental, respite, home-delivered meals, OT/PT/ST, consumer directed services, home mods, medical supplies) to eligible adults age 21 and older with disability (SSI), adults age 21 and older in Community-Based Alternatives HCBS waiver, adults age 65 and older, and full-benefit Medicare-Medicaid enrollees. Certain groups are excluded, such as people living in nursing facilities, ICFs-MR, and in HCBS waivers other than the community-based alternatives waiver. Enrollment is mandatory for full-benefit Medicare-Medicaid enrollees. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012) Program Website
Under the Healthcare Transformation and Quality Improvement Program §1115 demonstration waiver (Approved 12/12/2011), Texas is expanding STAR and STAR+PLUS (MMLTC) statewide and using savings from the expansion of managed care and the discontinuation of supplemental provider payments to finance new funding pools to assist hospitals and other providers with uncompensated care costs and to promote delivery system transformation and improvement. The Texas Health & Human Services Commission submitted a proposed amendment to the §1115 on 5/3/2012, proposing to add Day Activity Health Services to the existing STAR+PLUS waiver, effective September 1, 2012. The service targets individuals who are eligible for the STAR+PLUS waiver and exceed the financial requirements for Day Activity and Health Services under the §1915(i) authority. Services include nursing and personal care, physical rehabilitation, noon meal and snacks, social, educational and recreational activities, and transportation. (Source: Medicaid.gov)
CMS Approval Letter (12/12/2011)
Approval Document (Effective 12/12/2011)
The Texas Health and Human Services Commission (HHSC) promulgated new permanent payment rules that implement the provider eligibility requirements and payment methodologies approved by CMS under the §1115 Healthcare Transformation and Quality Improvement Program waiver. (Source: Texas Register, June 22, 2012)
State information on the adopted rules
On June 19, 2013, the state submitted a further amendment to its §1115 demonstration waiver; and CMS approved the amendment on March 6, 2014. The amendment allows the state to make several managed care changes to the §1115 waiver, including carving nursing facility services into managed care and adding additional mental health services and HCBS to managed care. The addition of cognitive rehabilitative services is effective March 6, 2014; all other amendment changes are effective September 1, 2014. (Source: CMS.gov)
Request for Amendment (Submitted 6/19/2013)
Approval Document (Effective 3/6/2014 and 9/1/2014)
In a March 2014 information session, Texas HHS verified it will expand STAR+PLUS statewide on September 1, 2014. On this date, the state will implement the Behavioral Health carve-in to managed care and I/DD acute care service carve-ins to managed care. People living in nursing facilities will move into STAR+PLUS Medicaid managed care on March 1, 2015. (Source: HMA Weekly Roundup, January 29, 2014; Texas HHS Managed Care Informational PowerPoint, March 2014, link no longer available; State Health and Human Services website)
Texas HHS Managed Care Informational PowerPoint, link no longer available (3/2014)
On June 16, 2014, the state released an update on its §1115 waiver Delivery System Reform Incentive Payment (DSRIP) project related to Behavioral Health. The five-year Medicaid demonstration waiver includes an $11.4 billion DSRIP pool to support coordinated care and quality improvements through 20 regional healthcare partnerships. (Source: HMA Weekly Roundup, 6/18/2014; Presentation to the House Appropriations Article II Subcommittee: Behavioral Healthcare Projects in the 1115 Transformation Waiver; 6/16/2014)
On March 1, 2015, the state expanded managed care to include nursing home residents. People living in nursing facilities will now receive full Medicaid managed care coverage through a STAR+PLUS health plan. (Source: State HHSC website)
On March 3, 2015, the North Texas Behavioral Health Authority (NTBHA) submitted to HHSC/DSHS a proposed plan to phase out the NorthSTAR behavioral health managed care program and replace it with an administration services organization (ASO) contract to continue the provision of managed behavioral health services in Dallas, Ellis, Rockwall, Navarro, Hunt, and Kaufman Counties. The proposed plan is in line with the Sunset Advisory Commission’s recommendation to transition from NorthSTAR to an updated behavioral health services model. (Source: NTBHA website)
Sunset Issue 9: NorthSTAR PowerPoint Presentation, link no longer available (1/13/2015)
NTBHA Preliminary Plan for Indigent BH Services, link no longer available (3/3/2015)
The Texas Health and Human Services Commission (HHSC) circulated a Request for Information (RFI) for MCOs that are interested in establishing a managed LTSS program for individuals with intellectual and developmental disabilities, or the IDD population, in Texas. Responses were due to HHSC by August 20, 2015. (Source: Texas HHSC, 7/20/2015; HMA Roundup, 7/29/2015)
On October 1, 2015, the Texas Health and Human Services Commission (HHSC) announced awards regarding a request for proposal (RFP) that integrates children eligible for Supplemental Security Income (SSI) and other SSI-related home and community-based service (HCBS) programs into the state’s STAR Kids managed care program. The program goes into effect in the fall of 2016. (Source: RFP Announcement 10/1/2015)
The Texas Health and Human Services Commission (HHSC) has requested CMS approval, through a section 1115 amendment, of the addition of STAR+PLUS HCBS Program slots that were newly appropriated by the 84th Texas Legislature, as well as a new electronic process for assessing the STAR+PLUS HCBS Program individual service plans. (Source: Medicaid.gov 11/30/2015)
The Texas Health and Human Services Commission (HHSC) announced on November 15, 2016, that it will reprocure contracts for the entire state under STAR+PLUS, which is the state’s MLTSS program. Initially HHSC intended on only reprocuring the Dallas and Tarrant areas. The anticipated implementation date is January 1, 2019. (Source: HHSC 11/15/2016)
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On December 22, 2016, the Texas Health & Human Services Commission (HHSC) released a request for information (RFI) regarding the provision of acute care and LTSS through the state’s STAR+PLUS managed care program. Responses were due January 30, 2017. HHSC is seeking information on strategies to provide quality, comprehensive acute and LTSS care in a manner that improves beneficiary health; intervention strategies to avoid disparities in health care delivery to diverse populations and; choice of health plans for STAR+PLUS members. Additionally, respondents were asked to respond with innovative, cost-effective, and evidence-based practices and strategies on the following elements:
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