This is to notify you that Superior HealthPlan Network (Foster Care) will begin new Private Duty Nursing (PDN) ratios as required by the Legislature. Beginning November 1, 2011, Superior will review each PDN request for:

• medical necessity
• appropriate hours
• additional information to see if 2 or 3 children can be cared for by one nurse based on the child’s current condition.

This change will begin with any new request, any request for a change in hours and any request to continue private duty nursing.

Superior is working with the Texas Department of Family Protective Services, the Texas Health and Human Services Commission, and the Home Health Agencies to make this change. We will continue to keep you updated.

Please call our Member Services Department if you have any questions about your health care services. Our staff is bilingual in English and Spanish. Please call us at 1-866-912-6283.

Sincerely,

Superior HealthPlan Network

Readability Stat: 8.9

• Austin (STAR and CHIP)
• Corpus Christi (STAR, STAR+PLUS and CHIP)
• El Paso (STAR and CHIP)
• Lubbock (STAR and CHIP)
• San Antonio (STAR, STAR+PLUS and CHIP)

Superior’s statewide Foster Care and CHIP Rural Service Area (RSA) products, as well as its Dallas STAR+PLUS program, will continue under contracts that were previously awarded as part of earlier bid processes.  Superior’s total membership in Texas as of June 30, 2011 was 470,400.

In addition, the new contract award expands Superior’s STAR, STAR+PLUS and CHIP product offerings as follows:

• The new 10 county Hidalgo Service Area (STAR and STAR+PLUS)
• Medicaid RSA West Texas
• Medicaid RSA Central Texas
• Medicaid RSA North-East Texas
• Lubbock (STAR+PLUS)

The total eligible population for Superior’s newly awarded service areas and products is expected to exceed 800,000.  The new Texas contract is expected to commence late in the first quarter of 2012.

All of these service areas and products will now include the management of the pharmacy benefit for Superior’s members.  In addition, the state has added inpatient facility services to the managed care structure for the STAR+PLUS program.

Tom Wise, President and Chief Executive Officer of Superior said, “We look forward to continuing to serve the state, our members and our provider network while expanding into additional areas of Texas and delivering quality healthcare programs.”

“Centene is pleased to extend our distinctive and personalized healthcare model to this larger population,” said Michael Neidorff, Chairman and Chief Executive Officer of Centene, “while ensuring access and continuing to save the state money. Centene has a long and successful history in Texas and we take great pride in expanding our relationship with the state.”

“We continue to be pleased with our success on competitive RFPs, particularly our reprocurement expansions in Arizona, Massachusetts and now Texas, as well as recent awards in Kentucky and Louisiana,” added Jesse Hunter, Centene’s Executive Vice President for Corporate Development and Operating Committee Chair.

Centene reiterates its earnings guidance range for 2011, which incorporates the start-up costs associated with this award.

About Centene Corporation

Centene Corporation, a Fortune 500 company, is a leading multi-line healthcare enterprise that provides programs and related services to the rising number of under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care, long-term care, other state-sponsored programs and Medicare (Special Needs Plans). Centene’s CeltiCare subsidiary offers states unique “exchange-based” and other cost-effective coverage solutions for low-income populations. The company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health, life and health management, managed vision, telehealth services, and pharmacy benefits management. More information regarding Centene is available at www.centene.com.

The information provided in this press release contains forward-looking statements that relate to future events and future financial performance of Centene.  Subsequent events and developments may cause the Company’s estimates to change.  The Company disclaims any obligation to update this forward-looking financial information in the future.  Readers are cautioned that matters subject to forward-looking statements involve known and unknown risks and uncertainties, including economic, regulatory, competitive and other factors that may cause Centene’s or its industry’s actual results, levels of activity, performance or achievements to be materially different from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements.  Actual results may differ from projections or estimates due to a variety of important factors, including Centene’s ability to accurately predict and effectively manage health benefits and other operating expenses, competition, membership and revenue projections, timing of regulatory contract approval, changes in healthcare practices, changes in federal or state laws or regulations, inflation, provider contract changes, new technologies, reduction in provider payments by governmental payors, major epidemics, disasters and numerous other factors affecting the delivery and cost of healthcare.  The expiration, cancellation or suspension of Centene’s Medicaid Managed Care contracts by state governments would also negatively affect Centene.

We can help you. Call Superior Member Services at 1-866-912-6283. Tell us what type of bill you are getting.
We need to know:

Remember: Do not go to a doctor who is not your child’s primary care physician without first getting approval from Superior. If you do, Superior will not pay the other doctor, and you may get billed for the services.

HHSC. Web. 21 June 2011 

]]> http://www.fostercaretx.com/2011/06/21/your-texas-benefits-medicaid-card/feed/langswitch_lang/en/ 0 http://www.fostercaretx.com/2010/10/20/children’s-checkups-–-texas-health-steps/ http://www.fostercaretx.com/2010/10/20/children’s-checkups-–-texas-health-steps/#comments Wed, 20 Oct 2010 16:46:03 +0000 rdipasquale http://demo.fostercaretx.com/?p=1328 Texas Health Steps are free for children with Medicaid from birth through 20 years of age. Children also get free vaccines at the checkup to stay healthy. All children newly enrolled in the STAR Health Program will need a Texas Health Steps checkup within 30 days of enrollment.
Need Help?
Contact a Superior Texas Health Steps Coordinator at 1-866-807-9990. They can help you: find a doctor for your child’s Texas Health Steps exam; Set up a checkup; answer questions about checkups or Texas Health Steps exams and get an early exam if your family is traveling for seasonal farm work
Are you a Provider interested in enrolling for Texas Health Steps exams?
Contact Texas Medicaid & Healthcare Partnership (1-800-925-9126) or view more information at their website

Read more on Children’s Checkups – Texas Health Steps…

Who is Superior HealthPlan Network?

Superior HealthPlan Network (Superior) is the managed care company selected by the Texas Health and Human Services Commission to manage the STAR Health program. Superior works very closely with the Texas Department of Family and Protective Services (DFPS) to make sure foster children throughout the state get the services they need.

STAR Health offers:

• An Integrated Medical Home where each foster care child has access to primary care physicians, behavioral health clinicians, specialists, dentists, vision services and more.
• Care Coordination Services to help children, families, and caregivers understand their benefits, get help with appointments, assist with transportation and identify local community resources.
• Training programs (onsite and online) that offer clinical expertise and program information to families, caregivers, clinicians, caseworkers, child advocates and members of the judiciary.

STAR Health Benefits and Services:

• Preventive Health which includes regular checkups and immunizations, office visits, visits to the dentist and visits for eye checkups
• Behavioral Health Care including emotional, behavioral or developmental health care services
• Hospital coverage including inpatient services such as hospitalizations and surgeries
• Prescriptions and medical supplies which includes medications prescribed by a physician and medical supplies such as glucose strips and bandages
• Telemedicine including consultations and assessments done by a provider using teleconference capability
• Health Passport our on-line access to health information for children in Foster Care

For more information on the STAR Health program and to learn more about the services, please call Superior HealthPlan Network’s Member Services Department at (866) 912-6283.

For training opportunities, please visit the Resources section of the website

• All children newly enrolled in the STAR Health Program will need a Texas Health Steps checkup within 30 days of enrollment.
• Annual medical checkups for existing Members age 36 months and older are due on the child’s birthday.
• The annual medical checkup is considered timely if it occurs within one year of the child’s birthday.

*Reminder:

• Requirements do not apply to Members moving from placement to placement.
• New Members who are 6 months and over must have a dental checkup within 60 days of enrolling in the STAR Health Program.
• After that, EVERY child must have a dental checkup every six months through the age 20.

Please go to our Texas Health Steps page for more information

• Checking to see if you/your child is due for a dental checkup
• Finding a dentist in your area
• Scheduling a dental checkup for you/your child if needed

And don’t forget: All new STAR Health Members age 6 months and over must have a dental checkup within 60 days of enrolling into the STAR Health Program. Then you/your child must have a dental checkup every 6 months after that. Delta can help you with that too! If you have any questions, please feel free to contact Delta Dental at 1-866-287-3419. New ID cards were mailed out in May with Delta information. Please call Superior HealthPlan at 1-866-912-6283 if you did not receive a new ID card. We will be more than happy to send you one!