REVISED: Provider Statement of Need Form for PAS, PCS and HAB Services

Date: 11/27/18

Superior HealthPlan modified policies on April 1, 2017, to require a Provider Statement of Need (PSON) form for Personal Assistance Services (PAS), Personal Care Services (PCS) and Community First Choice (CFC) Habilitation (HAB) for the STAR+PLUS, STAR Kids, STAR Health and STAR+PLUS MMP programs.

To comply with State requirements, Superior has split the PSON form into two forms specific to population:

• STAR Kids and STAR Health for the pediatric population; and
• STAR+PLUS and STAR+PLUS MMP for the adult population

The changes are concentrated on the STAR Kids/STAR Health version where additional cognitive and behavioral limitations were added. There were only minor changes to the STAR+PLUS/MMP form to remove references of the other two programs.

The new forms were effective November 1, 2018 and are now available for use:

• Provider Statement of Need – STAR+PLUS and STAR+PLUS MMP (PDF)
• Provider Statement of Need – STAR Kids and STAR Health (PDF)

As a reminder, the PSON process does not replace the process for assessing Superior members for PAS, PCS and HAB services. It is an additional element to facilitate holistic collaboration between the provider and Superior’s Service Coordination team, which includes increased communication regarding the member’s functional needs and the way those needs are being met, as well as the opportunity to ensure that any underlying medical conditions or complications are addressed by appropriate medical professionals.

The PSON process is also designed to maintain consistency among Medicaid programs and facilitate transitions between them, in compliance with updated contractual requirements implemented by the Texas Health and Human Services Commission, which require that a PSON process be implemented for both STAR Kids and STAR Health. 

For any questions, please feel free to contact your dedicated Account Manager, or Provider Services at 1-877-391-5921.