DOCUMENT HISTORY LOG - Texas Health and Human Services



|DOCUMENT HISTORY LOG |

|STATUS1 |DOCUMENT |EFFECTIVE |DESCRIPTION3 |

| |REVISION2 |DATE | |

|Baseline |N/A |June 1, 2010 |Initial version of Uniform Managed Care Manual Chapter 12.20 “Frew Quarterly Monitoring Report Managed Care |

| | | |Organization Response Template.” |

|Revision |2.0 |March 10, 2012 |Revision 2.0 applies to contracts issued as a result of HHSC RFP numbers X29-10-0020 and X29-12-0002. |

| | | |Chapter 12.20 is revised to include Frew pharmacy requirements and reorganized to match Frew reporting changes. |

|Revision |2.1 |August 1, 2012 |Section I is modified to clarify the requirements. |

| | | |Section II is modified to remove the phrase “in the directories is accurate” from Item 2 and to reword Item 3. |

| | | |Section III is modified to clarify the requirements. |

| | | |Section V is modified to clarify the requirements and to add “(STAR Health ONLY)” to Item 6. |

| | | |Section VI is modified to add description of the MCO’s instructions to class members on accessing Complaints, |

| | | |Appeals, and Fair Hearings. |

| | | |Section VII is modified to add Consent Decree ¶ 246. |

| | | |Section VIII is modified to clarify the requirements. |

| | | |Section IX is modified to clarify the requirements. |

| | | |Section X is modified to clarify the requirements. |

| | | |Section XII is modified to clarify the requirements. |

| | | |Section XIII is modified to clarify the requirements. |

|Revision |2.2 |March 25, 2015 |“¶ 142” is added. |

| | | |“¶ 179” is added. |

| | | |“¶ 191” is added. |

| | | |“¶ 192, ¶ 212, ¶ 240” is added. |

| | | |“¶ 193” is added. |

| | | |“¶ 195” is added. |

| | | |“¶ 244” is added. |

| | | |“¶ 246” is added. |

| | | |“¶¶ 264-268” is added. |

| | | |Section I. “¶ 64, ¶ 65, ¶¶ 176-181, ¶ 193” is deleted. |

| | | |Section II. “¶ 93” is deleted. |

| | | |Section III. “¶¶ 124-130” is deleted. |

| | | |Section IV. “¶ 190” is deleted. |

| | | |Section V. “¶ 192” is deleted. |

| | | |Section VI. “¶ 195” is deleted. |

| | | |Section VII. “¶ 197, ¶ 246” is deleted. |

| | | |Section VIII. “¶ 205” is deleted. |

| | | |Section IX. “¶¶ 207-208” is deleted. |

| | | |Section X. “¶ 236” is deleted. |

| | | |Section XI. “¶ 240” is deleted. |

| | | |Section XII. “¶ 244” is deleted. |

| | | |Section XIII. “¶¶ 264-269” is deleted. |

|Revision |2.3 |November 15, 2015 |Revision 2.3 applies to contracts issued as a result of HHSC RFP numbers X29-10-0020, X29-12-0002, X29-13-0042, |

| | | |and X29-13-0071. |

|Revision |2.4 |March 1, 2017 |"Reporting Period (MMM YYYY - MMM YYYY)" is added. |

| | | |"Consent Decree ¶ 142" is modified to change the heading to "Contract Requirement," the contract references are |

| | | |added, and the STAR Health heading is changed to STAR Kids. |

| | | |"Consent Decree ¶ 179" is modified to add "STAR Kids Response". |

| | | |"Consent Decree ¶ 191" is modified to clarify the requirements and to add "STAR Kids Response". |

| | | |"Consent Decree ¶ 192, ¶ 212, ¶ 240" is modified to change "¶ 240" to "¶ 245", to add STAR Kids to the |

| | | |requirements, and to add "STAR Kids Response". |

| | | |"Consent Decree ¶ 193" is modified to add "STAR Kids Response". |

| | | |"Consent Decree ¶ 195" is modified to add "STAR Kids Response". |

| | | |"Consent Decree ¶ 244" is modified to add "STAR Kids Response". |

| | | |"Consent Decree ¶ 246" is modified to add "STAR Kids Response". |

| | | |"Consent Decree ¶¶ 264-268" is modified to add "STAR Kids Response". |

|Revision |2.5 |September 1, 2017 |Revision 2.5 applies to contracts issued as a result of HHSC RFP numbers X29-10-0020, X29-12-0002, X29-12-0003, |

| | | |X29-13-0042, and X29-13-0071. |

| | | |"Contract Requirement: Cooperation with Head Start to ensure members have access to THSteps services " is |

| | | |deleted. |

| | | |"Consent Decree ¶ 179" is modified to add (Not applicable for STAR Health or STAR+PLUS) to the header; to add |

| | | |"For STAR Kids and Children's Medicaid Dental Services" to the requirements; to remove the row for "STAR+PLUS |

| | | |Response"; and to add a row for "Children's Medicaid Dental Services Response". |

| | | |"Consent Decree ¶ 191" is modified to clarify the requirements; to remove the rows for "STAR Response," |

| | | |"STAR+PLUS Response," "STAR Kids Response," and "STAR Health Response"; and to add a row for "Response". |

| | | |"Consent Decree ¶ 192, ¶ 212, ¶ 245" is modified to add Dental and STAR Health to "Timely Medical Checkups" and |

| | | |clarify the requirements; to delete the requirements for "Timely Medical and Dental Checkups (STAR Health)"; to |

| | | |remove STAR+PLUS and add Dental Plans to "Children of Migrant Farmworkers - Accelerated Services" and to clarify|

| | | |the requirements; to add (STAR, STAR+PLUS, STAR Health, STAR Kids and Dental Plans) to Scheduling Assistance and|

| | | |to clarify the requirements; to remove the rows for "STAR Response," "STAR+PLUS Response," "STAR Kids Response,"|

| | | |and "STAR Health Response"; and to add rows for "Response for timely checkups," "Response for accelerating |

| | | |services for farmworker children," and "Response for assistance scheduling appointments and linking to |

| | | |transportation". |

| | | |"Consent Decree ¶ 193" is modified to clarify the requirements; to remove the rows for "STAR Response," |

| | | |"STAR+PLUS Response," "STAR Kids Response," and "STAR Health Response"; and to add a row for "Response". |

| | | |"Consent Decree ¶ 195" is modified to clarify the requirements; to remove the rows for "STAR Response," |

| | | |"STAR+PLUS Response," "STAR Kids Response," and "STAR Health Response"; and to add a row for "Response". |

| | | |"Consent Decree ¶ 244" is modified to change the heading from "Choice of Primary Care Provider and specialty |

| | | |providers" to Assistance locating providers"; to clarify the requirements; to remove the rows for "STAR |

| | | |Response," "STAR+PLUS Response," "STAR Kids Response," and "STAR Health Response"; and to add a row for |

| | | |"Response". |

| | | |"Consent Decree ¶ 246" is modified to remove the rows for "STAR Response," "STAR+PLUS Response," "STAR Kids |

| | | |Response," and "STAR Health Response" and to add a row for "Response". |

| | | |"Consent Decree ¶¶ 264-268" is modified to clarify the requirements and to add a row for "Children's Medicaid |

| | | |Dental Services Response". |

|Revision |2.6 |February 1, 2019 |"Consent Decree ¶ 179" is deleted. |

| | | | |

| | | |"Consent Decree ¶ 191" is deleted. |

| | | | |

| | | |"Consent Decree ¶ 195" is deleted. |

|Revision |2.6.1 |February 19, 2019 |Chapter 12.20 reposted to correct format errors. Consent Decree 191 table is completely deleted and blank |

| | | |version boxes at the end of the chapter have been deleted. |

| |

|1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions. |

|2 Revisions should be numbered according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second |

|revision. |

|3 Brief description of the changes to the document made in the revision. |

|Managed Care Organization Name: | |

|Reporting Period (MM/YYYY - MM/YYYY) | |

|Program(s) Included in the Report |Children’s Medicaid Dental Services |

| |STAR STAR Health STAR Kids |

| |STAR+PLUS |

| |No Members less than 21 were enrolled in STAR+PLUS during this reporting period. This report contains no |

| |STAR+PLUS content. |

| |Members less than 21 were enrolled in STAR+PLUS during this reporting period. This report contains content |

| |applicable to STAR+PLUS. |

|Consent Decree ¶ 192: Provide timely medical checkups to all members, and accelerated services to FWC; ¶ 212 (STAR Health): Provide timely medical and dental checkups; ¶ 245: Help members birth |

|through age 20 enrolled in Medicaid managed care schedule appointments (applicable to STAR, STAR Health, STAR Kids, STAR+PLUS, and Children’s Medicaid Dental Services) |

|TIMELY MEDICAL and DENTAL CHECKUPS (STAR, STAR+PLUS, STAR Health, STAR Kids, and Dental Plans) |

|Explain actions the MCO takes of education and encouragement or other means used to assure members new to the MCO receive a medical or dental checkup within 90 days of enrollment (or for STAR |

|Health, initial THSteps medical checkup within 30 days of enrollment and an initial THSteps dental checkup within 60 days of enrollment). If process varies by managed care program (e.g., STAR and|

|STAR Kids) or service area explain differences within response. Include information on the following in the response: |

|Describe the MCO’s ongoing processes of education and encouragement or other means used to assure new members receive a medical or dental checkup within 90 days of enrollment |

|Describe any activities conducted during the reported quarter of education and encouragement or other means used to assure new members received a medical or dental checkup within 90 days of |

|enrollment |

|Explain actions the MCO takes of education and encouragement or other means used to assure existing members receive medical or dental checkups timely when due. Include information on the |

|following in the response: |

|Describe the MCO’s ongoing processes of education and encouragement or other means used to assure existing members receive timely medical or dental checkups when due |

|Describe any activities conducted during the reported quarter of education and encouragement or other means used to assure existing members received timely medical or dental checkups when due |

|FWC – Accelerated Services (STAR, STAR Kids, and Dental Plans) |

|Describe the MCO’s process to accelerate services to FWC before they relocate temporarily with their parents for work. If process varies by managed care program (e.g. STAR and STAR Kids) or |

|service area explain differences within response. Include information on the following in the response: |

|Describe any activities the MCO conducted during the reported quarter to confirm that FWC received accelerated services |

|Provide a count of the actively enrolled FWC who needed and received accelerated services during the reported quarter |

|SCHEDULING ASSISTANCE (STAR, STAR+PLUS, STAR Health, STAR Kids, and Dental Plans) |

|Describe the MCO’s process to assist members with scheduling appointments. If methods vary by managed care program (e.g., STAR and STAR Kids) or service area explain differences within response. |

|Include information on the following in the response: |

|Describe the method(s) the MCO uses to inform members that the MCO can assist the member with scheduling appointments |

|If available, provide the number of appointments the MCO scheduled for members birth through age 20 during the reported quarter |

|Describe the MCO’s process to link members who need transportation assistance with the Medical Transportation Program. Include information on the following in the response: |

|Describe the method(s) the MCO uses to inform members of the Medical Transportation Program |

|If available, provide the number of member referrals the MCO made for transportation assistance through the Medical Transportation Program for members birth through age 20 during the reported |

|quarter |

|Response for timely checkups (STAR, STAR Health, STAR Kids, STAR+PLUS, Dental Plans) |

| |

|Response for accelerating services for farmworker children (STAR, STAR Kids, Dental Plans) |

| |

|Response for assistance scheduling appointments and linking to transportation (STAR, STAR Health, STAR Kids, STAR+PLUS, Dental Plans) |

| |

| |

|Consent Decree ¶ 193: Cooperation with outreach units (applicable to STAR, STAR Health, STAR Kids, STAR+PLUS, and Children’s Medicaid Dental Services) |

|Describe the MCO’s activities to coordinate with the MAXIMUS THSteps Outreach and Informing Unit during the reported quarter to ensure members birth through age 20 who miss medical checkups |

|receive prompt services. If process varies by managed care program (e.g. STAR and STAR Kids) or service area explain differences within response. |

|Response |

| |

| |

|Consent Decree ¶ 244: Assistance locating providers (applicable to STAR, STAR Health, STAR Kids, STAR+PLUS, and Children’s Medicaid Dental Services) |

|Describe the MCO’s process to ensure when a member birth through age 20 requests assistance locating a provider, the MCO gives him/her the choice of providers of the appropriate type, in a |

|convenient location, and who are accepting new patients. If process varies by managed care program (e.g. STAR and STAR Kids) or service area explain differences within response. |

|Describe the MCO’s process to inform members of their right to change their Primary Care Provider (PCP)/Main Dentist. If process varies by managed care program (e.g. STAR and STAR Kids) or service|

|area explain differences within response. |

|Response |

| |

| |

|Consent Decree ¶ 246: DSHS regional staff notification to MCO regarding an inadequate supply of providers (applicable to STAR, STAR Health, STAR Kids, STAR+PLUS, and Children’s Medicaid Dental |

|Services) |

|If DSHS regional provider relations staff notified the MCO during the reported quarter about a potential provider shortage within the MCO’s provider network, provide a description of the issue(s) |

|with an explanation of the actions the MCO took to address the issue(s), including the outcome of the MCO’s actions. If not applicable, indicate no notification received. |

|Response |

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| |

|Consent Decree ¶ 264-268: Case management plan to meet healthcare needs (applicable to STAR, STAR Health, STAR Kids, STAR+PLUS, and Children’s Medicaid Dental Services) |

|Describe the MCO’s relationship with providers of Case Management for Children and Pregnant Women services in each of its Service Area(s). Include information on the following in the response: |

|How the MCO coordinates with Case Management for Children and Pregnant Women to refer members birth through age 20 for services |

|How the MCO informs members birth through age 20, including FWC when applicable, of Case Management for Children and Pregnant Women services and encourages members who need the services to get |

|them |

|A count of members referred to Case Management for Children and Pregnant Women during the reported quarter, if applicable |

|Describe the MCO’s case management, care coordination, care management, service coordination, and/or service management program(s). Include information on the following in the response: |

|What services the MCO offers and how the MCO identifies and refers members for these services |

|How the MCO informs members birth through age 20, including FWC when applicable, of these services and encourages receipt of these services |

|STAR Response |

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|STAR+PLUS Response |

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|STAR Kids Response |

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|STAR Health Response |

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|Children's Medicaid Dental Services Response |

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| |

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¶ 192, ¶ 212, ¶ 240 Added by Version 2.2 and modified by Versions 2.4 and 2.5

¶ 193 Added by Version 2.2 and modified by Versions 2.4 and 2.5

¶ 244 Added by Version 2.2 and modified by Versions 2.4 and 2.5

¶ 246 Added by Version 2.2 and modified by Versions 2.4 and 2.5

¶¶ 264-268 Added by Version 2.2 and modified by Versions 2.4 and 2.5

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