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

1. DentaQuest Provider TrainingCigna-HealthSpringEffective 9/1/2013

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

3. 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.

4. 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

5. 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

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

8. 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

10. 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

11. 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.

12. HealthSpring STAR+PLUS Waiver ID CardTarrant Service Area

13. HealthSpring STAR+PLUS Value Add ID CardTarrant Service Area

14. HealthSpring STAR+PLUS Waiver ID CardHidalgo Service Area

15. HealthSpring STAR+PLUS Value Add ID CardHidalgo Service Area

16. Questions