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Community First Health Plans' STAR (State of Texas Access Reform) is a managed care option of the STAR Program for Medicaid clients. The objectives of the STAR Program are to improve the access to care for Members to increase the quality and continuity of care for Members, to decrease the inappropriate usage of the health care delivery system such as Emergency room visits for non-emergencies, to achieve cost-effectiveness and efficiency for the State and to promote provider and member satisfaction. Community First Health Plans is able to ensure these objectives are accomplished because of its diverse, fully credentialed network of physicians, allied health care providers, ancillary providers and hospitals.
Community First Health Plans' network is comprised of physicians (primary care physicians and specialists), allied and ancillary health care providers, hospitals and other facilities selected to provide quality health care to our STAR Members. The Primary Care Physician (PCP) is responsible for managing the overall medical care of patients, and for coordinating referrals to specialists and inpatient/outpatient facilities. A PCP is a Community First Health Plans STAR network provider with one of the following specialties: General Practice, Family Practice, Internal Medicine, Obstetrics and Gynecology (pregnant women only), Pediatrics, Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs). In addition, Community First Health Plans STAR members can access contracted Advance Practice Nurses, Physician Assistants, and Certified Nurse Midwives practicing under the supervision of a physician for appropriate covered services.
The Texas Medicaid Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program is a federally mandated health care program of prevention, diagnosis, and treatment for Medicaid recipients who are ages of birth through 20 years of age. In Texas, the EPSDT program is known as Texas Health Steps. Texas Health Steps is administered by the Department of State Health Services (DSHS).
Through outreach,Texas Health Steps staff, or contractors encourage STAR Members to use Texas Health Steps preventive medical checkup services when they first become eligible for Medicaid/Texas Health Steps and when they are periodically due for their yearly medical checkup in their birthday month.
On request by the client, the Medical Transportation Program (MTP) assists the client with scheduling transportation. Refer to the MTP section on page 23 of this Provider Manual for more detailed information.
Texas Health Steps medical providers must perform medical checkups on any client who is currently enrolled in Medicaid and who are ages of birth through 20 years of age. Providers also are encouraged to notify the client when he or she is due for the next medical checkup according to the Texas Health Steps Periodicity Schedule.
Note: Newly enrolled STAR Members must receive a Texas Health Steps medical checkup within 60 days from enrollment.
The information in this Community First Health Plans manual is an overview that supplements the approved HHSC's version of the 2016 Texas Medicaid Provider Procedures Manual, and specifically the Texas Health Steps section Volume 2 Children’s Services Handbook, Section 5 and Appendix D-F, and Texas Medicaid bi-monthly Bulletins. Providers are to refer to these documents for detailed information about the program.
Community First's STAR/Medicaid service area includes the following counties: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson.
The Texas Managed Medicaid STAR/CHIP formulary, including the Preferred Drug List and any clinical edits, is defined by the Texas Vendor Drug Program.
The following documents are provided in Adobe PDF format. If you do not have Acrobat Reader, it is available free for Mac & PC at Adobe's website.