Payment Responsibility for CDTF during Transition Scenario CDTF Charge. All Other Covered Services 1 Enrollee prospectively moves from Medicaid FFS to STAR+PLUS MMP New STAR+PLUS MMP New STAR+PLUS MMP 2 Enrollee moves from STAR+PLUS MMP to other Texas Medicaid MCO Former STAR+PLUS MMP New MCO 3 Enrollee moves from STAR+PLUS MMP to Medicaid FFS (Involuntary Disenrollment) Former STAR+PLUS MMP Medicaid FFS 4 Enrollee moves from other Texas Medicaid MCO to STAR+PLUS MMP Former MCO New STAR+PLUS MMP 5 Enrollee moves between STAR+PLUS MMPs Former STAR+PLUS MMP New STAR+PLUS MMP The responsible party will pay the CDTF charge until the earlier of: (1) date of Discharge from the CDTF, or (2) loss of eligibility. The New MCO may evaluate for medical necessity of the CDTF stay prior to the end of the authorized services period. For Enrollees who move from STAR+PLUS MMP into Star Health, the date of Discharge from the CDTF includes extended stay days, as described in the Texas Medicaid Provider Procedures Manual. Skilled Nursing Facility Services – Payment for skilled nursing facility (SNF) stays for Enrollees who change Enrollment is treated differently than for inpatient hospital stays. The SNF payment is split by the day, according to the Medicare Claims Processing Manual, Chapter 6, Section 90: SNFs follow the requirements of the agreement they have with the STAR+PLUS MMP. In cases where the Enrollee may have enrolled or disenrolled from the STAR+PLUS MMP during the billing period, the SNF will split the bill and send the STAR+PLUS MMP’s portion to it and the remaining portion to the new Medicare Advantage plan or Medicare Administrative Contractor for Original Medicare. Nursing Facility Services – The following table describes payment responsibility for enrollment changes that occur during a Nursing Facility stay, beginning on the Enrollee’s Effective Date of coverage with the new MCO. Table 2-2 Payment Responsibility for Nursing Facility during Transition Scenario Nursing Facility Charge All Other Covered Services 1 Enrollee moves from Medicaid FFS to STAR+PLUS MMP New STAR+PLUS MMP New STAR+PLUS MMP 2 Enrollee moves from other Texas Medicaid MCO to STAR+PLUS MMP New STAR+PLUS MMP New STAR+PLUS MMP 3 Enrollee moves between STAR+PLUS MMPs New STAR+PLUS MMP New STAR+PLUS MMP Custom DME and Augmentative Device - The following table describes payment responsibility for enrollment changes that occur when a prior authorization exists for custom DME, before the delivery of the product. Table 2-3 Payment Responsibility for Custom DME and A...
