Amendment to STAR+PLUS MMP Medicare-Medicaid Demonstration Contract
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Amends and restates provisions of the existing STAR+PLUS Medicare-Medicaid Plan (MMP) contract between CMS, Texas HHSC, and the MMP to add data-sharing requirements, update demonstration year and term dates, modify financial percentage for Demonstration Year 10, and adjust specific statutory/ regulatory appendix provisions. Affects CMS, HHSC, and the listed STAR+PLUS MMP contractor(s).
New Subsection 2.17.2.1.10 requires the STAR+PLUS MMP to share data and Enrollee information as necessary to ensure a smooth transition from the demonstration with CMS, HHSC, and/or any receiving health plan(s).
New Subsection 4.1.2.1.11 establishes Demonstration Year 10 as January 1 - December 31, 2025.
New Subsection 4.2.4.1.11 sets a Demonstration Year 10 percentage at 5.5%.
Subsection 5.8.1.1 replaced to state the Contract shall be in effect through December 31, 2025 and the Dual Demonstration Program will end on December 31, 2025.
Appendix I, I1 language replaced to permit dually eligible beneficiaries to change enrollment on a monthly basis in a Medicare-Medicaid Plan, insofar as certain Social Security Act and implementing regulation provisions are inconsistent with that allowance.
Appendix I, I6 added to modify application of Section 1851(c) and 42 C.F.R. § 422.60(g) insofar as inconsistent with transitioning STAR+PLUS beneficiaries into a D-SNP at the end of the Demonstration.
Definitions
Provider Actions and Data Sharing Requirements
Share Enrollee data for demonstration transitions
STAR+PLUS MMP shall share data and Enrollee information as necessary to ensure a smooth transition from the demonstration with the necessary parties (CMS, HHSC, and/or any receiving health plan(s)). Such data and Enrollee information may include, but is not limited to, prior authorization data, care plans, health risk assessments, and provider network information.
- Provide prior authorization data to receiving entities when requested for transition purposes.
- Transmit care plans and health risk assessments to support continuity of care.
- Share provider network information to enable beneficiary access post-transition.
Coding and Contract Metrics
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