The Texas Health and Human Services Commission and the Medicaid managed care organizations (MCOs) will be in attendance to provide information and answer questions about the STAR and STAR+PLUS Medicaid programs. The MCOs also will offer information about contract opportunities for interested providers.

For additional information regarding this town hall meeting, please contact Mary Helen Barrera at 713-446-4366. Pre-registration is not required to attend.

See New HHSC Contract Provisions for details.  For more information on these provisions, please contact Provider Services.

As a reminder, the following resources are available:

• Getting Started with the Electronic Health Record Incentive Program: http://www.tmhp.com/Pages/HealthIT/HIT_EHR_GettingStarted.aspx
• Frequently Asked Questions: http://www.tmhp.com/Pages/HealthIT/HIT_EHR_FAQ.aspx
• Meaningful Use and Clinical Quality Measures for Hospitals: http://www.tmhp.com/TMHP_File_Library/HealthIT/MU-CQMs%20Summary-hospitals.pdf

Please contact HealthIT@tmhp.com or 1-800-925-9126, option 4, if you have questions.

TMHP/HHSC. Web. 20 December 2011

Effective 8/1/2011, HHSC provided specific procedure codes and modifiers to represent the financial management service fee that is retained by the Consumer Directed Service Agency for the management of the consumer directed services for members. The code and modifiers are:

T2040 mod U3 – Agency fee for STAR+PLUS Waiver (SPW) members = $202.00 per month

T2040 mod U7 – Agency fee for non STAR+PLUS Waiver (SPW) members = $110.00 per month

Effective 9/1/2011, the monthly fee was reduced for STAR+PLUS Waiver members ONLY:
T2040 mod U3 – Agency fee for STAR+PLUS Waiver (SPW) members = $194.02 per month

Due to the creation of the monthly service fee being billed and paid separately from the PAS services, the payment rates for determining the budget and billed by Consumer Directed Service Agencies changed as a result. The change was effective 8/1/2011 to coincide with the effective date of the monthly financial management service fee. The rates are as follows:

The members budget should to be calculated using the payment rate times the number of units authorized during the budget and service plan period, based upon the number of units authorized by the Superior Service Coordinator for PAS.

Thank you for all the Superior work you do!

1. HOW TO ENTER SUPERIOR’S STAY HEALTHY Sweepstakes:

Complete a Texas Health Steps checkup, fill out the form and return it to Superior HealthPlan. Each returned form will be entered into a random drawing.  Prizes will be given out in Travis and Nueces counties as followed unless otherwise noted:

12/15/2011:
I. Nintendo DS 3D Bundle and Game Stop Card
II. 2 Toys R Us Gift Card’s
III. 2 Academy Gift Cards

1/15/2012:
I. IPAD 2
II. 2 Wal-Mart Gift Cards
III. 2 Gatti Town Gift Cards

2/15/2012:
I. Nintendo DS 3D Bundle and Game Stop Card
II. 2 Austin Parks & Pizza Gift Cards (TRAVIS ONLY) / 2 Wal-Mart Gift Cards (NUECES ONLY)
III. 2 Academy Gift Cards

If you did not receive a letter/form in the mail and are due for a Texas Health Steps checkup, call 1-800-783-5386 (toll free) to request one.

2. RANDOM DRAWING: Winners will be selected in a random drawing on or about 12/15/2011, 1/15/2012 and 2/15/12 from among all eligible survey entries. Decisions of Sweepstakes officials are final. Winners will be notified by telephone/mail. Limit one entry per Superior member and one prize per person/household. Odds of winning will depend upon the number of eligible entries received.

3. PRIZES & APPROXIMATE RETAIL VALUES:  Nintendo DS 3D Bundle +$50 Game stop Card = $250; 2 Toys R Us $50 Gift Card’s = $100; 2 Academy $50 Gift Cards = $100; IPAD 2 = $500; 2 Wal-Mart $50 Gift Cards =$100; 2 Gatti Town $50 Gift Cards = $100; 2 Austin Parks & Pizza $50 Gift Cards (AUSTIN) = $100; 2 $50 Wal-Mart Gift Cards = $100 (NUECES); 2 Academy $50 Gift Cards = $100

4. GENERAL RULES:
a) Open only to members of Superior HealthPlan STAR & STAR+PLUS Members who are residents of the State of Texas and are due for a TEXAS HEALTH STEPS Checkup. Members of Superior who are younger than 18 years old as of November 1, 2011 must have the consent of a parent or legal guardian to enter the sweepstakes.
b) The sweepstakes begins at 12:00 a.m. Central Time (“CT”) on Monday, November 7, 2011 and ends on Tuesday, February 14, 2012 at 11:59 p.m. Central Time (“CT”).
c) Employees of Superior HealthPlan and their immediate family members and/or those living in same household of each are not eligible.
d) Void where prohibited by law. No substitution, cash redemption or transfer of prize by winner permitted.
e) All federal, state and local taxes are the sole responsibility of winner. All federal, state and local laws and regulations apply.
f) Noncompliance within this time period may result in disqualification and an alternate will be selected, time permitting.
g) Return of any prize/prize notification as undeliverable may result in disqualification and an alternate may be selected, time permitting.
h) Sponsor reserves the right to substitute prize of equal or greater value.
i) Acceptance of prize constitutes permission to the Sponsor and its Promotional Participants to use winner’s name and/or likeness for purposes of advertising and trade without further compensation, unless prohibited by law.
j) By accepting prize, winners agree to release and hold harmless Sponsor, its Promotional Participants and their respective directors, officers, employees and assigns, against any and all claims, damages, losses, expenses and liability arising out of acceptance/use of prize.
k) Entrants (or entrant’s parent/legal guardian if entrant is deemed a minor in his/her state of residence) assume all liability for any injury or damage caused, or claimed to be caused, by participation in this promotion or the acceptance or use of any prize.
l) By participating in this promotion, entrants (or entrant’s parent/legal guardian if entrant is deemed a minor) agree to be bound by the Official Rules.
m) Sponsor not responsible for any typographical or other error in the printing, the offering or the announcement of any prize or in the administration of the promotion.

This is to notify you that Superior HealthPlan Network (Foster Care), will implement new Private Duty Nurse (PDN) ratios (2:1, 3:1) as mandated by the Legislature. This mandate allows for the increase in nurse to member ratio based upon the member’s health status and meeting certain criteria. Therefore, effective November 1, 2011 and thereafter, each submitted authorization request for PDN hours will be reviewed by a Service Manager for medical necessity and appropriate ratio determination. Existing members currently receiving PDN services, whose condition allows for a higher ratio, will be transitioned on the start date of the new authorization.

Criteria and billing information will be forthcoming.  Please continue checking our website for updates.

Please feel free to call us at any time should you need additional information or have a question regarding our new Private Duty Nurse (PDN) ratios. Our contact # is (866) 912-6283.

Sincerely,

Superior HealthPlan Network

Private Duty Nursing Fee and Billing