UNIFORM MANAGED CARE MANUAL

1 UNIFORM MANAGED care MANUAL . CHAPTER Deliverables Requirements Matrix Version Effective Date: June 25, 2021. Applicability of Chapter This chapter applies to MANAGED care Organizations (MCOs) participating in the STAR, STAR+PLUS [including the Medicare-Medicaid Dual Demonstration (MMDD)], CHIP, STAR Health, and STAR Kids Programs, and Dental Contractors providing Children's Medicaid and CHIP Dental Services to Members through dental health plans. In this chapter, references to CHIP or the CHIP MANAGED care Program(s) apply to the CHIP Program and the CHIP Dental Contractors. References to Medicaid or the Medicaid MANAGED care Program(s) apply to the STAR, STAR+PLUS, STAR Health, and STAR Kids Programs, and the Medicaid Dental Contractors.

2 The term MCO includes health maintenance organizations (HMOs), exclusive provider organizations (EPOs), insurers, Dental Contractors, Medicare-Medicaid Plans (MMPs), and any other entities licensed or approved by the Texas Department of Insurance. A deliverable listed below applies to the MMPs if (1) a specific MMDD contract section number is included in the Contract Reference column, or (2) if no MMDD contract section is cited, the applicable UMCM chapter listed specifically includes the MMDD. The requirements in this chapter apply to all 1. Programs, except where noted. This matrix is not all inclusive and is provided only as a convenience to the MCO.

3 The absence on this form of any item otherwise required by contract does not relieve the contractor of its duty under the contract. The contract prevails if there are any language conflicts between this matrix and the contract. UMCM Deliverable Template Chapters Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM STAR+PLUS STAR+PLUS MCO submits the Chapter Attendant care methodology it will use to UMCC Att. B-1 Enhanced Payment implement and pay enhanced Methodology payments to its Long-term STAR+PLUS Exp.

4 Att. B-1. Services and Supports Providers, including a To be provided To be provided To be provided To be provided description of the timing of STAR+PLUS MRSA Att. B-1. the payments, in accordance with the requirements in the UMCM and the intent of 1 TAC. 2. Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM Provider Directory 1. The Provider Directory for 1. Updated in Chapters , each applicable MCO accordance with 42. UMCC Att. B-1 , , Program, and any substantive or as , and revisions, must be approved directed by HHSC.

5 CHIP RSA Att. B-1 by HHSC prior to publication Substantive revisions and distribution and must must be approved STAR Health Att. B-1. include the critical elements prior to use. Refer to 1. Data in the UNIFORM MANAGED care UMCM Chapter for Management MANUAL . The Provider submission STAR+PLUS Exp. Att. B-1 1. Other System Directory listing revisions do requirements. MANAGED care not require review and Compliance 2. Quarterly approval from HHSC. and Operations STAR+PLUS MRSA Att. B-1. (MCCO). 2. TXMedCentral 2. Quarterly XXXLIB with projections and due STAR Kids Att. B-1 notice to MCCO. 2. The MCO must update the date set by the HHSC.

6 Provider Directory listing in Administrative Medicaid and CHIP Dental the hard copy Provider Services Contractor Services Att. B-1 Directory on a quarterly (usually the Friday basis. after cutoff prior to MMDD the start of the quarter). 3. Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM Provider MANUAL The MCO must prepare and UMCC Att. B-1 Chapters , issue a Provider MANUAL (s), , , including any necessary CHIP RSA Att. B-1 , and specialty manuals ( , Prior to publication behavioral health) to all STAR Health Att.

7 B-1. and distribution to existing Network Providers. Providers, including The Provider MANUAL must revisions contain the critical elements STAR+PLUS Exp. Att. B-1. MANAGED care defined in the UNIFORM Compliance Data Management MANAGED care MANUAL . As Revised/Other and Operations System STAR+PLUS MRSA Att. B-1. Refer to UMCM (MCCO). Chapter for submission STAR Kids Att. B-1 timeframes and requirements. Medicaid and CHIP Dental Services Att. B-1 MMDD 4. Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM Member Handbook The Member Handbook for UMCC Att.

8 B-1 Chapters , each applicable MCO Program , , must, at a minimum, meet CHIP RSA Att. B-1 , , the Member Materials , requirements specified in the STAR Health Att. B-1. contract and must include the Prior to use critical elements in the UNIFORM MANAGED care STAR+PLUS Exp. Att. B-1. MANUAL . MANAGED care Compliance Data Management As Revised/Other Refer to UMCM. STAR+PLUS MRSA Att. B-1 and Operations System Chapter for (MCCO). submission timeframes and STAR Kids Att. B-1 requirements. Medicaid and CHIP Dental Services Att. B-1 and MMDD 5. Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM Member ID Cards The Member ID cards for each UMCC Att.

9 B-1 Chapters , applicable MCO Program , , must, at a minimum, meet CHIP RSA Att. B-1 , , the Member Materials and requirements specified in the STAR Health Att. B-1 Prior to use contract and must include the critical elements in the MANAGED care UNIFORM MANAGED care STAR+PLUS Exp. Att. B-1. Compliance Data Management MANUAL . As Revised/Other Refer to UMCM. and Operations System Chapter for (MCCO). STAR+PLUS MRSA Att. B-1 submission timeframes and requirements. STAR Kids Att. B-1 Medicaid and CHIP Dental Services Att. B-1 6. Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM MCO Notification of The MCO must provide notice UMCC Att.

10 B-1 Chapters a Medicaid Other of other events to the HHSC. and Event Form and Administrative Services STAR Health Att. B-1 Instructions Contractor. STAR+PLUS Exp. Att. B-1. Notice must be MANAGED care provided by close of STAR+PLUS MRSA Att. B-1 Compliance TXMedicaidEvents As Revised/Other business at least two and Operations Business Days prior to (MCCO). the event. STAR Kids Att. B-1 Medicaid and CHIP Dental Services Att. B-1 MMDD 7. Report Frequency: UMCM Responsible Monthly, Chapter(s) Deliverable Name Deliverable Description Contract References Due Date HHSC Submitted to Quarterly, or Section Program Area Annually, As Revised/Other UMCM Value-added Once each year , each MCO A request to add, Chapters , Services, Flexible and Dental Contractor may enhance, delete, or , , , Benefits, and propose the Value-added reduce a Value-added UMCC Att.