Texas Children's Health Plan (TCHP) provides healthcare for children and young adults with disabilities through a Texas Health and Human Services Commission (HHSC) program called STAR Kids. The STAR Kids program is a Medicaid managed care program providing integrated acute and long-term services and supports in a Medicaid managed care environment for disabled persons (mainly Supplemental Security Income (SSI) eligible Medicaid clients). The STAR Kids program also covers individuals with intellectual disabilities or related conditions who do not qualify for Medicare and who receive services through the ICF-IID program or an IDD Waiver program (acute care and behavioral health services only – long-term services and supports are provided by the Health and Human Services Commission (HHSC). In addition to the objectives of the STAR program, the STAR Kids program aims to:
- Integrate acute and long-term care services and supports
- Coordinate Medicare services for clients who are dual eligible
Private Duty Nursing (PDN) Services Reminder
Thank you for your continued partnership and the care you provide to our members. TCHP would like to remind you of the contractual obligations as a network provider with TCHP to provide the authorized hours of PDN services to each member under your care. When unforeseen circumstances occur, TCHP must be notified immediately when a PDN commitment is unfulfilled and a member will be left unattended so that we can help arrange for an alternative provider, if necessary. Your points of contact are:
- TCHP’s Provider Relations Department must be contacted. Providers can reach the Provider Relations Department at providerelations@texaschildrens.org or 1-800-731-8527.
- The member’s Primary Care Physician (PCP) or authorizing physician should also be notified. If you are unsure of the PCP, please call our Care Coordination Department at 1-866-219-5411.
- TCHP’s assigned Service Coordinator must be contacted should a STAR Kids member have one. Providers can reach the Service Coordination department at 832-828-1004 or 1-877-213-5508.
- If you are unsure of the Service Coordinator, or the member does not have a Service Coordinator, you must contact our Care Coordination Department at 1-866-219-5411.
- Additionally, TCHP’s Service Coordinators are available to assist with emergency preparedness plans, identifying coverage, and to review and assess members based on the complexity and frequency of their care needs. Notifications and explanations related to changes need to be discussed with the member and their legally authorized representative. You can access these resources by contacting the Service Coordination department for the STAR Kids member at TCHP by calling 832-828-1004 or 1-877-213-5508.
Prior Authorization Information and Resources
Prior Authorization requirements are available on our website, click here to view this guidance. A toolkit for speech therapy, physical therapy, and occupational therapy is available on our website, click here for Provider Resources.
Signatures
Texas Children’s Health Plan follows the Texas Medicaid Provider Procedures Manual (TMPPM) Section 5.1 which permits prescribing or ordering providers, dispensing providers, clients’ responsible adults, and clients to sign prior authorization forms and supporting documentation using electronic or wet signatures.
Billing
For information on billing and claim administration, please refer to the STAR Kids Provider Manual on our Forms and Manuals page.
Electronic Visit Verification
For information on EVV, please see information on our Electronic Visit Verification resource page.
HHS STAR Kids
Visit the HHS STAR Kids website at https://hhs.texas.gov/services/health/star-kids.
Department of Family and Protective Services (DFPS)
Visit the Department of Family and Protective Services website for policies and information https://www.dfps.state.tx.us/I_Am/teachers.asp
