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. 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.

2 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. 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. 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.

3 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. 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.

4 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. 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. 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.

5 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. 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.

6 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. 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.

7 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. B-1 , , and Rewards and Services it intends to offer to Service, Flexible Incentives its Members, and each Benefit, or Reward CHIP RSA Att. B-1 Templates and Medicare-Medicaid Plan (MMP) and/or Incentive must Instructions may propose Flexible and be submitted to HHSC.

8 STAR Health Att. B-1. Rewards and/or Incentives it by April 1 of each intends to offer to its year. Enrollees. STAR+PLUS Exp. Att. B-1. MANAGED care TXMedCentral Compliance Annually An MCO's/Dental XXXDELIV with STAR+PLUS MRSA Att. B-1 and Operations Contractor's Value- notice to MCCO. (MCCO). added Services will be effective September 1. STAR Kids Att. B-1 for the following contract period. Medicaid and CHIP Dental Services Att. B-1 MMDD , , and An MMP's Flexible Benefits and Rewards and Incentives will be effective January 1. 8. 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 MMC, CHIP, and The MCO completes the form UMCC Att. A. Article 2. Chapters DMO Marketing, in the Data Management and Member and System to be submitted with CHIP RSA Att. A. Article 2. Provider Materials its material submission for Form and HHSC review and approval.

9 STAR Health Att. A. Article Dependent on the Instructions 2. material submission. STAR+PLUS Exp. Att. A. MANAGED care Article 2. Compliance Data Management As Revised/Other Refer to UMCM and Operations System STAR+PLUS MRSA Att. A. Chapter for (MCCO). Article 2. submission timeframes and STAR Kids Att. A. Article 2. requirements. Medicaid and CHIP Dental Services Att. A. Article 2. MMDD 9. 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 Medicaid/CHIP The MCO completes the form UMCC Att. B-1 Chapters MANAGED care in the Data Management , Alleged Marketing System to report alleged CHIP RSA Att. B-1 and Violation Form and marketing violations to HHSC. Instructions STAR Health Att. B-1 STAR+PLUS Exp. Att. B-1. MANAGED care Compliance Data Management As Revised/Other N/A. STAR+PLUS MRSA Att. B-1 and Operations System (MCCO). STAR Kids Att.

10 B-1 Medicaid and CHIP Dental Services Att. B-1 MMDD 10. 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 Section Financial Statistical The MCO must file four UMCC Att. A and Reports (FSR) and quarterly and two annual Att. B-1 Instructions Financial-Statistical Reports (FSRs) for each SFY, in the CHIP RSA Att. B-1. format and timeframe specified by HHSC. Quarterly Last day of the month FSRs are due no later than 30 STAR Health Att. B-1. following the close of days after the end of the the reporting period quarter. for Quarterly reports; Financial Quarterly STAR+PLUS Exp. Att. B-1. 120 days after the Reporting and TXMedCentral Annually end of the State Fiscal Audit XXXFSR with Year (SFY) for 90-day Coordination notice to FRAC. Note that Experience Rebate STAR+PLUS MRSA Att. B-1. As Revised/Other reports, and 365 days (FRAC). checks, if owed, are due in after the end of the full to HHSC concurrently with SFY for 334-day the 90-day and the 334-day STAR Kids Att.