The Medicaid Star+Plus Program is in Texas.

DADS has issued the following Provider Alerts or Bulletins:

Steps to Alleviate Delays in Filling Needed Prescriptions for Individuals Affected by the STAR+PLUS Managed Care Expansion of Acute Care Services

Effective September 1, 2014, STAR+PLUS services for acute care only will be expanded to include some individuals who have Intellectual or Developmental Disabilities (IDD) and live in an Intermediate Care Facility for Individuals with Intellectual Disability or Related Conditions (ICF-IID) or who receive services through one of the following IDD waivers: Community Living Assistance Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS) or Texas Home Living (TxHmL).

To ensure individuals experience no delays in receiving necessary medications, particularly in the first weeks following the September 1, 2014 transition, here are some proactive steps for you, as a provider, and your families to take to avoid any possible delay.

1. Prior to September 1, 2014, individuals are encouraged to refill any currently prescribed and authorized medication using the individual's current Medicaid card.
2. If an individual takes a medication that has previously needed a prior authorization, is in excess of the usual dosage or is a non-preferred medication (whether or not on the Preferred Drug List), contact the managed care organization (MCO) after September 1, 2014. Explain that the individual is currently prescribed the medication and ask what documentation (prior doctor's orders, reasons for the medication, etc.) you need to provide the MCO to expedite authorization for the drug to avoid delays in obtaining it after September 1, 2014. Be aware that:
   • Although prior authorization (PA) is required for non-preferred medications and medications subject to restrictions for clinical reasons, MCOs are required to follow certain requirements to ensure continuity of care for clients. The MCOs must ensure that an individual receiving medications through an approved PA continue to receive the medications for 90 calendar days after the September 1, 2014 expansion or until the expiration date of the PA, whichever is shorter.
   • Prior Authorization call center phone numbers vary by health plan. The Prescriber Assistance Chart identifies prior authorization and member call center phone numbers for each health plan where you can verify if a medication needs a prior authorization. Please use the member call center number.
   • A 72-hour emergency supply of a prescribed drug must be provided when a medication is needed without delay and prior authorization is not available.