FirstCare STAR Program

• Starting February 2021, the Texas Health and Human Services Commission (HHSC) will transition Medicaid clients to the appropriate type of Medicaid coverage on an ongoing basis when there is an identified change in circumstance.
• If HHSC receives information that your household has a change in circumstances (such as income, expenses, people in the household, etc.) they will move you to the appropriate type of Medicaid coverage based on the eligibility criteria your household meets.
• This does not necessarily mean you will have a reduction in coverage.
• Review the notice for any requests to take action. If the letter is asking for you to take any action, please comply with this request as soon as possible.

Ask you received an actual enrollment form or alert via text/E-mail to select a new plan HHSC will send you either a separate enrollment form if it is determined that you need to pick a new health plan. If this is necessary, you should receive this request within 15 calendar days of the date on the TF0001 Notice about your case.

• HHSC has determined that your new Medicaid program requires you to pick a health plan.
• If you know what plan you want to pick, go ahead and do so and return the form.
• If you need further assistance, HHSC Managed Care can assist. Managed Care hours of operations are 8 a.m. to 6 p.m. CT weekdays.

• HHSC looks at the following information to determine what the appropriate type of Medicaid is for the client:
  • Renewal applications.
  • Reported changes.
  • Information received from other agencies, such as the Social Security Administration.

• Yes, Medicaid coverage will continue for anyone who has coverage during the federal declared public health emergency. The only exceptions could be:
  • Clients who move out of Texas.
  • Clients who voluntarily leave/withdraw from Medicaid.
  • Deceased clients.
• However, if you have received a notice that you are no longer eligible for Medicaid, your coverage may end at the end of the public health emergency.
  • Clients may receive notice on their TF0001 that their Medicaid eligibility/coverage will end with the public health emergency ends.
  • This will happen for one of the following reasons:
    • The household failed to respond to a request from HHSC like a renewal packet or H1020 Request for Missing Information, or
    • HHSC received information via a renewal packet, reported change, or from another agency that indicates the household no longer meets the eligibility requirements.

• Yes, If HHSC receives information that a client no longer meets the criteria for their current type of Medicaid coverage, but
  • DOES meet the criteria for a different type of Medicaid coverage, they will be moved to that type of Medicaid coverage, if it provides the same (or a better) level of coverage.
  • DOES NOT meet the criteria for any other type of Medicaid coverage, they will continue in their same type of Medicaid coverage until the federally-declared public health emergency ends or federal guidance changes.
• The only exceptions are Healthy Texas Women (HTW), Community Attendant Services (CAS), and CHIP.
  • Medicaid clients will not be transitioned to any of these programs from another health care program during the public health emergency.

Providers must submit the Prior Authorization Request Form. The form must include the following information to initiate the prior authorization review process:

• Member name
• Member date of birth
• Member number
• Requesting provider name
• Requesting providers National Provider Identifier (NPI)
• Rendering providers name
• Service requested:
  • Current Procedural Terminology (CPT)
  • Healthcare Common Procedure Coding System (HCPCS)
  • Current Dental Terminology (CDT)
• Service requested start and end date(s)
• Quantity of service units requested based on the CPT, HCPCS, or CDT requested
• Requesting Providers Dated Signature

Please note any prior authorization requests missing essential information will not be processed and a new request will need to be submitted. To avoid delays in authorization or administrative denials, Providers are encouraged to submit sufficient documentation to validate the medical necessity for the services being requested. This may include, current progress notes, history and physical, radiology or laboratory results, consult notes/reports, treatment plans showing progress to goals (e.g. therapy requests), or similar medical record documentation to illustrate medical necessity.

• Authorization Required List
• Supporting Documentation List
• Medicaid Statistics

When BSWH receives a request for prior authorization and the request does not contain complete clinical documentation and/or information:

• BSWH will notify the Member by letter that an authorization request was received but cannot be acted upon until BSWH receives the missing documentation/information from the requesting Provider. The letter will include the following information:
  • A statement that BSHW has reviewed the PA request and is unable to make a decision about the requested services without the submission of additional information.
  • A clear and specific list and description of missing/incomplete/incorrect information or documentation that must be submitted in order to consider the request complete.
  • Timeline for the provider to submit the missing information.
  • Contact information and modes of communication for provider inquiry if necessary.
• BSWH will contact Provider via fax or phone and request documentation for completion of the medical necessity review within three business days of BSWH receipt of request (where applicable).
• If BSWH does not receive the documentation/information by the end of the third business day of our request to the requesting Provider, the request will be submitted to the Medical Director no later than the seventh business day after receipt of request (where applicable).
• BSWH will render a decision no later than the tenth business day after the request received date.

Who qualifies?

Active FirstCare STAR members qualify based on certain conditions. Mindoula will reach out to you if you qualify.

How can Mindoula help?

Mindoula is a behavioral health management vendor that provides tech-enabled (digital) 24/7 case/care management and psychiatric support to members with behavioral health challenges and multiple medical needs.

Programs provided via Mindoula:

• Interpersonal Violence Reduction Program (IVRP)
• Suicide Prevention Program (SPP)
• SUD (Substance Use Disorder) Exposed Pregnancy (SEPP)
• Substance Exposed Living Program (SELP)