STAR Health Provider Incentive Program
Date: 01/12/21
On October 1, 2018, Superior HealthPlan launched a STAR Health (foster care) 3 in 30 Provider Incentive Program. Primary Care Physicians (PCPs) who provide the 3-Business Day Medical Exam to new STAR Health members are eligible to be incentivized for coordinating all 3 in 30 components during the first 30 days of the member’s STAR Health coverage.
As a reminder, 3 in 30 combines three separate, yet critical, tools for assessing the medical, behavioral and developmental strengths and needs of children and youth entering the Texas Department of Family and Protective Services (DFPS) conservatorship. The 3-Day Medical Exam is a requirement set forth by Senate Bill 11 and the other assessments are required by other Texas Health and Human Services (HHS) and legislative mandates. Together, the three assessments chart the path for ensuring STAR Health members get the care and services they need at the time they enter foster care.
The three components of the 3 in 30 program are:
- 3-Day Medical Exam
- Texas Health Steps Checkup
- Texas Child and Adolescent Needs and Strengths (CANS) 2.0 Child Welfare Assessment
Incentive Program Details
Population
All new STAR Health members who meet the eligibility criteria.
Effective Dates
October 1, 2018 through December 31, 2021
Provider Eligibility Criteria
PCPs who provide the 3-Day Medical Exam may receive incentive payments for coordinating all 3 in 30 components within the first 30 days of foster care coverage. The 3-Day Medical Exam must be completed in order to receive any of the additional services incentives.
Member Eligibility Criteria
Providers are not eligible for incentive payments for new STAR Health members who:
- Enter into custody while in a medical setting, such as a hospital.
- Receive emergent or urgent care from an Emergency Department or Urgent Care Center.
- Enter into custody while in a psychiatric or behavioral health setting.
Incentive Structure
3 in 30 Components | Age 3 and Older | Under 3 Years of Age | Billing Requirement |
|---|---|---|---|
3-Day Medical Exam | $25 Incentive | $25 Incentive | Applicable E&M Code with U2 Modifier |
Texas Health Steps Checkup | $25 Incentive | $25 Incentive | |
Texas Child and Adolescent Needs and Strengths (CANS) 2.0 Welfare Assessment | $25 Incentive | Not Applicable | Procedure Code 90791 with TJ Modifier |
Grand Bonus (if all are conducted) | $25 Incentive | $25 Incentive |
|
Total Possible Incentive | $100/Member | $75/Member |
|
Payment
Payment for incentives will be processed as follows:
- A report will be run quarterly of all members that meet the eligibility criteria, allowing for the 30-day timeframe and a 90-day claims lag (see example in table below).
- A payment and report will be sent to each PCP that provided the 3-Day Medical Examination during the measurement quarter.
- Payment will be made within 45 days of the end of the claims lag timeframe.
Member Eligibility Date | Services Date | Claims Lag | Payment |
|---|---|---|---|
10/1/2019 – 12/31/2019 | 10/1/2019 – 1/30/2020 | Through 4/30/2020 | By 6/15/2020 |
1/1/2020 - 3/31/2020 | 1/1/2020 - 4/30/2020 | Through 7/31/2020 | By 9/15/2020 |
4/1/2020 – 6/30/2020 | 4/1/2020 – 7/30/2020 | Through 10/31/2020 | By 12/15/2020 |
7/1/2020 – 9/30/2020 | 7/1/2020 – 10/30/2020 | Through 1/31/2021 | By 3/15/2021 |
For more information, please reference the 3 in 30 section of the Foster Care Texas Provider Resources webpage.