Texas § GV.540.0851 - STAR KIDS MANAGED CARE PROGRAM

§ GV.540.0851. STAR KIDS MANAGED CARE PROGRAM

STAR KIDS MANAGED CARE PROGRAM. (a) In this section, "health home" means a primary care provider practice or specialty care provider practice that incorporates several features, including comprehensive care coordination, family-centered care, and data management, that are focused on improving outcome-based quality of care and increasing patient and provider satisfaction under Medicaid. (b) Subject to Sections 540.0701 and 540.0753 , the commission shall establish a mandatory STAR Kids capitated managed care program tailored to provide Medicaid benefits to children with disabilities. The program must: (1) provide Medicaid benefits customized to meet the health care needs of program recipients through a defined system of care; (2) better coordinate recipient care under the program; (3) improve recipient: (A) access to health care services; and (B) health outcomes; (4) achieve cost containment and cost efficiency; (5) reduce: (A) the administrative complexity of delivering Medicaid benefits; and (B) the incidence of unnecessary institutionalizations and potentially preventable events by ensuring the availability of appropriate services and care management; (6) require a health home; and (7) for recipients who receive long-term services and supports outside of the Medicaid managed care organization, coordinate and collaborate with long-term care service providers and long-term care management providers. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.