DentaQuest Provider Training Amerigroup Plans Effective 9/1/2013

2 Agenda  Amerigroup Plans Effective 9/1/13  STAR+PLUS Waiver  Medicare Advantage  Amerivantage Classic  Amerivantage Specialty

STAR+PLUS Program  STAR+PLUS was created specifically to serve the elderly and persons with disabilities, typically known as the aged, blind and disabled population (ABD)  Goal-to achieve a seamless continuum of care by integrating acute and comprehensive care  Long-Term Services and Support (LTSS) in a managed care environment  Promotes delivery of home and community-based services  The health plans are responsible for coordinating acute and LTSS through the use of a Service Coordinator.  Service Coordination is the cornerstone of the STAR+PLUS model. 3

STAR+PLUS Members  Mandatory Population  Supplemental Security Income (SSI) eligible adult clients (ages 21 and over)  Medical Assistance Only (MAO) Clients who qualify for 1915 (c) Nursing Facility Waiver (limited number)  Dual Eligibles - those individuals who are covered by Medicare and receive dental benefits or dental value added services  Voluntary Population  SSI Children under the age of 21  Children (under the age of 21) who are Medicaid eligible because they are in a Social Security Exclusion Program 4

STAR+PLUS Waiver Program  STAR+PLUS Eligible population:  Medicaid Waiver and Dual Waiver Adult Members  Covered Waiver Dental Services  Treatment of injuries to the teeth or supporting structures  Dentures and the cost of fitting and preparation  Preventative procedures that are required to prevent the imminent loss of teeth 5

Additional Information STAR+PLUS Waiver  Providers should always check the member’s eligibility prior to rendering services.  Covered dental services that indicate “Yes” in the “Review Required” column of the ORM require documentation of medical necessity and will be subject to clinical review.  These procedures can be rendered before determination of medical necessity but require submission of proper documentation (as indicated in the “Documentation Required” column) with the claim form. 6

STAR+PLUS Service Areas Amerigroup Bexar El Paso Harris Jefferson Lubbock Tarrant Travis 7  Recipients must reside in a covered service area of the health plan they are enrolled in.

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Amerigroup Plans – STAR+PLUS Waiver  STAR+PLUS Eligible population:  Medicaid Waiver and Dual Eligible Waiver Adult Members  Covered Waiver Dental Services  Treatment of injuries to the teeth or supporting structures  Dentures and the cost of fitting and preparation  Preventative procedures that are required to prevent the imminent loss of teeth 9

Amerigroup STAR+PLUS ID Card 10

Amerigroup Plans – Medicare Advantage  Amerigroup contracts with the Centers for Medicare and Medicaid Services (CMS).  Amerivantage Classic  Health Maintenance Organization (HMO) plan designed specifically for people who have Medicare.  Amerivantage Specialty  Health Maintenance Organization Special Needs Plan (HMO SNP) specifically designed for people who have Medicare and Medicaid (dual eligible). 11

Covered Regions:  El Paso Region: El Paso County, Hudspeth County  Fort Worth Region: Denton County, Tarrant County  Houston Region: Brazoria County, Fort Bend County, Harris County, Montgomery County  Lubbock Region: Lubbock County  San Antonio Region: Bexar County, Medina County 12

Amerivantage Classic (Medicare) Dental Benefits  Eligible population:  Members who live in a covered service area  Members that have both Medicare Part A and Medicare Part B  Members that do not have End-Stage Renal Disease (ESRD)  Covered Services  D0120 Periodic Oral Exam (once every six months)  D0272 Bitewing two films (once every 12 months)  D0274 Bitewings four films (once every 12 months)  D1110 Prophylaxis and hygiene instruction-adult (once every six months)  **In addition, Classic Plan members also receive a $250 / quarter comprehensive benefit.** 13

Amerivantage Specialty (Medicare) Dental Benefits  Eligible population:  Members who live in a covered service area  Members that have both Medicare Part A and Medicare Part B  Members that do not have End-Stage Renal Disease (ESRD)  Members that meet special eligibility requirements (dual eligible)  Covered Services  D0120 Periodic Oral Exam (once every six months)  D0272 Bitewing two films (once every 12 months)  D0274 Bitewings four films (once every 12 months)  D1110 Prophylaxis and hygiene instruction-adult (once every six months)  **In addition, Specialty Plan members also receive a $425 / quarter comprehensive benefit.** 14

Amerigroup Medicare Advantage ID Cards 15

16 Questions