DentaQuest Provider Training Cigna-HealthSpring Effective 9/1/2013

2 Agenda  HealthSpring Plans Effective 9/1/13  STAR+PLUS Value Add  STAR+PLUS Waiver

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  Benefit Limit:  $5000 maximum per individual service plan year  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

STAR+PLUS Service Areas HealthSpring Tarrant Hidalgo 6  Recipients must reside in a covered service area of the health plan they are enrolled in.

7

HealthSpring STAR+PLUS Value Add  STAR+PLUS Value Add Eligible population:  Medicaid Only Members  Benefit Limit:  $500 maximum per benefit year  Covered Dental Services  Limited preventive and diagnostic services  Limited restorative services (see following slide)  No UM review required 8

9 TX HealthSpring STAR+PLUS Value Add $500 Annual Maximum limit applies to all covered codes D0120Periodic oral evaluation - established patient D0140Limited oral evaluation -problem focused D0150Comprehensive oral evaluation - new or established patient D0210 or D0330complete mouth x-rays or panoramic x-rays D0220Intraoral - periapical first film D0230Intraoral - periapical each additional film D0272Bitewings – two films D0274Bitewings – four films D1110Adult prophylaxis D1204 or D1206Topical application of fluoride D21401 surface amalgam D21402 surface amalgam D21603 surface amalgam D2330Resin-based composite - 1 surface, anterior D2331Resin-based composite - 2 surfaces, anterior D2332Resin-based composite - 3 surfaces, anterior D2391Resin-based composite - 1 surface, posterior D2392Resin-based composite - 2 surface, posterior D2393Resin-based composite - 3 surface, posterior D2721Crown - resin with base metal D2751Crown - porcelain with base metal D2791Full cast crown - with base metal D2920Re-cement crown D7140Simple extraction

HealthSpring STAR+PLUS Waiver  STAR+PLUS Eligible population:  Medicaid Waiver and Dual Eligible Waiver Adult Members  Benefit Limit:  $5000 maximum per individual service plan year  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 10

HealthSpring STAR+PLUS Waiver – Additional Information  HealthSpring requires that all services for SPW members are approved by their Service Coordination team prior to rendering services.  All services or “treatment plans” must be submitted to DentaQuest on a prior authorization.  DentaQuest will coordinate with HealthSpring on final approvals.  Standard turn-around-times apply (3 days).  Please include the keyword “SPW” in Box 35 of the authorizations. 11

HealthSpring STAR+PLUS Waiver ID Card Tarrant Service Area 12

HealthSpring STAR+PLUS Value Add ID Card Tarrant Service Area 13

HealthSpring STAR+PLUS Waiver ID Card Hidalgo Service Area 14

HealthSpring STAR+PLUS Value Add ID Card Hidalgo Service Area 15

16 Questions