Volume XXX, Number 8
 August 2015

Dual-Eligibles Demonstration to Begin on August 1 for SNFs in Select Counties

On August 1, 2015 the Dual-Eligibles Demonstration will be implemented for SNFs in select counties in Texas. Senate Bill 1, 83rd Legislature, Regular Session, Article II, Section 51, Subsection (b)(21) directed the Health and Human Services Commission (HHSC) to implement the Dual Eligibles Integrated Care Demonstration Project, also referred to as the Dual Demonstration. According to HHSC, the Dual Demonstration is a fully integrated, capitated model that involves a three-party agreement between:

  • A managed care organization (MCO) with an existing STAR+PLUS contract;
  • HHSC; and
  • The Centers for Medicare & Medicaid Services (CMS)

Under the Demonstration, HHSC has oversight of Medicaid, and CMS has oversight of Medicare. The goals of the Demonstration are:

  • Integrate the fragmented model of care for dual eligible clients
  • Test new payment and service delivery model
  • Require one health plan to be responsible for the full array of services
  • By having one Medicare-Medicaid plan (MMP), Medicare and Medicaid benefits work together to better meet members’ health care needs.

Although the Dual Demonstration was implemented for other long term care providers on March 1, 2015, for nursing facilities the implementation date was postponed until August 1, 2015. Further, nursing facility client enrollment will be phased in over the next three months according to the following schedule:

  • August 1, 2015 – All eligible Nursing Facility residents Bexar and El Paso counties.
  • September 1, 2015 – All eligible Nursing Facility residents in Harris County
  • October 1, 2015 – All eligible Nursing Facility residents in Dallas, Hidalgo, and Tarrant counties.

Enrollment for most eligible individuals will be done by passive enrollment. Through passive enrollment, eligible beneficiaries are enrolled into a MMP following a notification process that identifies the MMP selected for them if the beneficiary takes no action. Also, enrollment is always prospective. Beneficiaries can, at any time, select a different MMP or decline enrollment into an MMP and opt-out of the demonstration. Those who choose to opt-out of the demonstration will be re-enrolled into their former STAR+PLUS Medicaid plan, or another STAR+PLUS plan if requested. Enrollment in the Dual Demonstration is optional for dual eligible individuals who live in the designated counties and meet the following criteria:

  • 21 years of age and older
  • Enrolled in Medicare Parts A, B, and D; and are receiving full Medicaid benefits
  • Eligible for, or enrolled in, the Medicaid STAR+PLUS program, which serves members who have disabilities and those who meet a Nursing Facility level of care and get STAR+PLUS home and community based waiver services

Listed below are sources of information that providers may find useful:

MMP Provider Helplines

  • Amerigroup: 1-855-817-5790
  • United: 1-888-887-9003
  • Cigna HealthSpring: 1-877-653-0331
  • Superior: 1-877-391-5921
  • Molina: 1-866-449-6849

Enrollment Broker Helpline

  • MAXIMUS: 1-877-782-6440

Texas Medicaid Events Website

Additional Information:

THCA has been actively involved in a series of meetings between providers, HHSC, and the MCOs in an effort to make the implementation of the Dual Demonstration as smooth as possible. Even at this late date, many questions about the project remain unanswered and much is still unknown. However, THCA’s staff, Managed Care Committee, and other active THCA members will continue to work with the agency and the MCOs collaboratively as this demonstration project continues to evolve.

President’s Report


 Legislative Update


 Commitment to Care

If you have any questions about the THCA C to C Initiative or would like to share your facilities successes please contact me at gbwilliams@txhca.org or call (512) 458-1257.


State News

  • Dual-Eligibles Demonstration to Begin on August 1 for SNFs in Select Counties


National News


Announcements & Recognitions

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