New Development Regarding Medicaid STAR+PLUS Network Provider Agreements for Texas Nursing Homes

by Jackson Walker
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Beginning this fall, Texas nursing home reimbursement will be converted to Medicaid Managed Care. In preparation for the Medicaid Managed Care rollout, Texas Managed Care Organizations ("MCOs") recently sent out network provider agreements to all Texas nursing homes. Texas nursing homes will be allowed to participate in up to three provider networks but nursing homes may have received network provider agreements from as many as five of the MCOs under contract with the Texas Health and Human Services Commission ("THHSC") to manage Medicaid long term care services. These proposed network provider agreements each contained different terms and conditions and provided for very short response times for providers to review and return the agreements.

The Texas Health Care Association ("THCA") has been working with THHSC in an attempt to ensure clarity and consistency in the network provider agreements for Texas nursing homes who wish to continue to provide services to Medicaid beneficiaries. In a new development, THHSC has sent the following communication to Texas nursing homes:

 

HHSC is working closely with the nursing facility community and managed care organizations (MCOs) to ensure clarity and consistency in STAR+PLUS program requirements. Based on recommendations from nursing facilities and MCOs, HHSC is coordinating efforts to produce a standardized STAR+PLUS network provider agreement for nursing facilities. Once this process is complete, nursing facilities will receive the new STAR+PLUS network provider agreement. STAR+PLUS MCOs will give non-contracted nursing facilities additional opportunities to participate in their networks, and will not enforce prior deadlines for submitting signed contracts. Any nursing facility that previously signed a contract will be given the new version of the provider agreement referenced above as a replacement. No further action is required at this time.

 


This represents welcome news for Texas long term care providers who were struggling to review and timely respond to the deadlines for returning the network provider agreements.  It is not clear when the replacement contracts will be distributed to providers but the anticipated date for the inclusion of Texas nursing home providers in the Medicaid Managed Care program is still anticipated to proceed as scheduled on September 1, 2014.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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