A. Unique Features of STAR Health

For those children who are covered by STAR Health, STAR Health provides a full range of Medicaid-covered medical, dental, vision, prescription, behavioral health services, in addition to service coordination, information sharing and other program benefits, including:

•   A Medical Home for each child (meaning a doctor, or other Primary Care Provider (PCP), or PCP Team to oversee care);

•   Immediate enrollment for immediate healthcare benefits;

•   Access to health care through a network of providers (doctors, nurses, hospitals, clinics, psychiatrists, therapists, etc.) specifically recruited for their history and expertise in treating children who have been abused or neglected and who are offered ongoing trainings on such issues;

•   The Health Passport, which is a web-based, secure health information tool which utilizes claims data to provide information on healthcare services including Texas Health Steps medical checkups, immunizations, lab results, prescriptions, the Family Strengths and Needs Assessments (FSNA), the Texas Child and Adolescent Needs and Strengths (CANS) assessments, Psychotropic Medication Utilization Reviews (PMUR), and service plans to medical consenters, caseworkers, and healthcare providers;

•   PMURs to determine if the prescribed medication treatment are within the parameters outlined in the Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version) (Parameters);^[108]

•   STAR Health liaisons who work directly with DFPS Well-Being Specialists and DFPS Clinical Coordinators to assist with resolving any barriers to services that children in foster care might encounter;

•   STAR Health service Coordinators who work directly with the youth and caregiver to assist with service delivery. This includes annual face-to-face visits and regular telephonic outreach. The STAR Health service coordination is a three-tiered model to administer specialized care management;

•   Disease management which provides coordinated healthcare interventions and health education for members with asthma, diabetes, and other chronic or complex conditions, including behavioral health conditions or diseases;

•   STAR Health Specialty Court liaisons work directly with the judiciary and court team. The Specialty Court liaisons observe court hearings and serve as the point of contact for the court team to support the timely identification and provision of appropriate physical and behavioral Medicaid-covered services for STAR Health members to avoid gaps in care, service delays, and the need for additional assessments;

•   STAR Health transition Coordinators to assist youth with activities to ensure a smooth transition to independence and adulthood, including education about their medical care and referrals to support services, as needed;

•   Medical advisory committees to monitor healthcare provider performance; and

•   The following are features of all Medicaid managed care programs:

◦   nursing and behavioral health 24/7 helplines for caregivers and caseworkers; and

◦   licensed and degreed managed care organization (MCO) staff and service coordination teams who coordinate physical and behavioral healthcare and access to other non-Medicaid benefits and resources, including for complex cases.