• State Update

HHSC Update: Guidance on Coordination with MCOs

HHSC is reminding nursing facility providers of their contractual requirements to inform a member’s managed care organization service coordinator if the member has any of these changes.

  • Has a positive COVID-19 diagnosis. A positive COVID-19 diagnosis is considered a significant change in condition.

  • Has left the NF.

  • Is requesting to return to the community.

The NF is responsible for notifying the service coordinator within one business day of receiving this information. Notification can be via phone, email, or other electronic means. NF providers are also required to submit Form 3618 or Form 3619, as applicable, to HHSC no later than 72 hours after a member’s admission or discharge from the NF.


HHSC has waived face to face service coordination visits through the end of May 2020 for STAR+PLUS MCOs and Dual Demonstration Medicare-Medicaid Plans. HHSC encourages MCOs and MMPs to replace face to face visits with phone or telehealth outreach and requires MCOs and MMPs to conduct the same number of contractually required annual outreach contacts. NF providers should coordinate with the MCO service coordinators for timely phone visits.


If a NF provider needs the member’s designated service coordinator they can contact their MCO’s care coordinator team, listed below.

  • Amerigroup Member Services: 800-600-4441 (TTY 711)

  • Cigna-HealthSpring Service Coordinator: 877-725-2688

  • Molina Healthcare Member Services: 866-449-6849

  • Superior Health Plan Service Coordination: 877-277-9772

  • UnitedHealthcare Member Services: 888-887-9003 (TTY 711)

Email your Medicaid/COVID questions here.


Source:

https://hhs.texas.gov/about-hhs/communications-events/news/2020/05/guidance-nursing-facilities-coordination-managed-care-organizations