STAR, STAR Health: COVID-19 and Applicability of EPSDT for Some Adults in STAR and STAR Health

Background:

To comply with House Resolution (H.R.) 6201 (116th Congress, 2019-2020; Public Law No: 116-127), state Medicaid programs cannot terminate or reduce access to benefits available to beneficiaries beginning March 18, 2020, through the end of the public health emergency.

Key Details:

STAR and STAR Health members who turn 21 on or after March 18, 2020, remain entitled to medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, known in Texas as the Texas Health Steps Comprehensive Care Program. This program includes services such as private duty nursing. STAR and STAR Health MCOs must ensure these members have access to the same amount, duration, and scope of services as they did prior to turning 21, and receive these services if medically necessary, through the end of the public health emergency.

Action:

STAR and STAR Health MCOs must ensure their systems can continue to reimburse providers for EPSDT services for these members who turned 21 during the public health emergency.

Resources:

For more information about Texas Health Steps and the Comprehensive Care Program, see the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook.

Contact:

Meghan Young at Meghan.Young@hhsc.state.tx.us