Providers are contracted with managed care organizations (MCOs) to provide STAR+PLUS HCBS program services identified on the individual service plan (ISP). The STAR+PLUS HCBS program provides individuals with an array of services necessary to allow the individual to remain in or return to a community setting. Individuals receiving STAR+PLUS Home and Community Based Services (HCBS) program services may reside alone, with family members or others at locations of their choice in the community, including adult foster care (AFC) homes or in licensed assisted living facilities (ALFs). Individuals enrolled in the STAR+PLUS program may select a service delivery model for personal assistance services (PAS) or Community First Choice (CFC) services identified on Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, Form H6516, Community First Choice Assessment, and Form H2060-A, Addendum to Form H2060.
Revision 18-2 Effective September 3, 2018 Within the constraints imposed by the cost limit on a member's ISP, the program promotes the member's active involvement and choices regarding the services provided.Individuals and members are provided the education, support and services needed to support the member's efforts to remain in or return to the community.Services must support the member's efforts to retain or regain as much independence as possible in the activities of daily living (ADLs), living arrangement and other areas of personal choice, and in meeting any goals.The individual service plan (ISP) reflects the member's active participation in the assessment and planning process and his or her responsibility to provide as much self-care as possible.Services provided to the member must provide safe, cost-effective, and medically or functionally necessary alternatives to nursing facility (NF) placement that allow the member the opportunity to use and maintain family and community contacts and services.Members use available family, community and third-party services and resources, as well as those provided through the STAR+PLUS HCBS program to meet their needs and identified goals.The service delivery system is accessible to the member, responsive to his or her needs and preferences, and flexible in honoring choices regarding living arrangement, services and mode of service delivery.Members receive services based on their choices and ongoing assessment of their medical and functional needs.The principles and practices that form the foundation for the STAR+PLUS Home and Community Based Services (HCBS) program are based on the following values: Government Code, Title 4, Executive Branch, Subtitle I, Health and Human Services, Chapter 533, Medicaid Managed Care Program.Statutory basis for the STAR+PLUS program: For a dictionary of acronyms used in the STAR+PLUS Program, refer to Appendix VII, Acronyms.
See the Glossary for the definition of terms specific to the STAR+PLUS program. The STAR+PLUS Home and Community Based Services (HCBS) program is a program approved for the managed care delivery system, designed to allow individuals who qualify for nursing facility (NF) care to receive LTSS in order to be able to live in the community.Įlements of the STAR+PLUS system are different from traditional service delivery. Service coordination means that plan members, family members, and providers can work together to help members get acute care, LTSS, Medicare services for dually-eligible members and other community support services. It is a specialized case management service for program members who need or request it. Service coordination, available to all members, is the main feature of the STAR+PLUS program. The program has increased the number and types of providers available to Medicaid members. The STAR+PLUS program provides a continuum of care with a wide range of options and increased flexibility to meet individual needs. These services are delivered through providers contracted with managed care organizations (MCOs). The STAR+PLUS program combines acute care and LTSS, such as assisting in a member's home with activities of daily living (ADLs), home modifications, respite (short-term supervision) and personal assistance services (PAS). It does change the way Medicaid services are delivered. The STAR+PLUS program does not change Medicaid eligibility or services.
#STAR STABLE CODES DEC 2021 PLUS#
The 74th Texas Legislature implemented the State of Texas Access Reform Plus (STAR+PLUS) program to create a cost-neutral managed care system to combine acute care with long-term services and supports (LTSS).
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