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| 2007 Provider Manual |
| Harris Service Area including:
Brazoria, Fort Bend, Galveston, Harris, Montgomery,
Waller Counties |
| Bexar Service Area including: Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson counties |
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| Section I Introduction |
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| Molina Healthcare of Texas, Inc. (Molina) is a newly
formed for-profit corporation in the State of Texas, and
a subsidiary of Molina Healthcare, Inc. Molina
Healthcare, Inc. (MHI) is a publicly traded, multi-state
managed care organization that arranges for the delivery
of health care services to persons eligible for Medicaid
and other programs for low-income families and
individuals. The parent company's operations are based
in Long Beach, California. MHI was incorporated in the
state of Delaware. |
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| MHI was founded in 1980 by C. David Molina, M.D. as
a provider organization serving the Medicaid population
through a network of primary care clinics in California.
In 1994, Molina Healthcare of California received its
license as a health maintenance organization, and began
operating as a health plan. Over the past several years,
MHI has expanded our operations into multiple states.
MHI established a Utah health plan in 1997 and later
acquired health plans in Michigan and Washington. MHI
now operates health plans in California, Washington,
Michigan, Utah, New Mexico and Ohio. |
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| Vision Statement |
| Molina Healthcare is an innovative healthcare
leader providing quality care and accessible services in
an efficient and caring manner. |
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| Core Values |
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We strive to be an exemplary
organization; |
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We provide quality service; |
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We are healthcare innovators and
respond quickly to change; |
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We respect each other and value
ethical business practices; |
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We are careful in the management of
our financial resources; |
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We care about the people we serve. |
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| Objectives of the
Program(s) |
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| CHIP |
| Children's Health Insurance (CHIP)
Program is for children under the age of 19. The CHIP
program is available to children whose families have low
to moderate income, who earn too much money to qualify
for Medicaid, and who do not have private insurance. |
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| The objectives of the CHIP program are
to: |
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Raise awareness of the children's
health insurance options available in the State; |
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Health Texas families obtain and
utilize affordable coverage of their uninsured
children (0-19); |
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Increase the number of insured
children within the state; |
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Decrease the cost of healthcare by
utilizing comprehensive and preventative care. |
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| STAR |
| The State of Texas Access Reform
(STAR) Program offers Medicaid services to those
eligible through a Managed Care delivery. The STAR
program gives members the same benefits as Medicaid plus
additional features. These include: |
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Unlimited prescriptions for Members
and their children |
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Certain Value-Added services
(unavailable to regular Medicaid Members) |
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A covered physical exam once a year
for adults, and |
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Hospital stay privileges as long as
medically necessary |
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| The objectives of the STAR and STAR+PLUS programs are to: |
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Promote a system of health care
delivery that provides coordinated and improved
access to comprehensive health care and enhanced
provider and client satisfaction. |
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Improve health outcomes by ensuring
the quality of health care provided to members and
by promoting wellness and prevention. |
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Achieve cost effectiveness without
compromising access and quality. |
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Implement and administer the
program in a way that meets state and federal
requirements. |
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Evaluate the effectiveness and
efficiency of the Medicaid managed care program. |
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Hire, train, retain, and develop a
diverse, competent and productive staff. |
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Maintain a flexible, team-oriented
environment that supports the knowledge and
experience of individuals, and promotes employee
morale and creativity. |
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Build partnerships with our
customers by: regular communication; responding in a
timely and accurate manner; and consistently seeking
input for program improvements and strategic
planning. |
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Increase quality and continuity of care for,Medicaid members; |
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Improve the access to care for members; |
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Achieve cost-effectiveness and efficiency,for the State; |
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Decrease inappropriate usage of the,health care delivery system; |
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Promote provider and member satisfaction; |
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Integrate acute and one-term care services |
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Coordinate Medicare services for members,who have SSI-Medicare and Medicaid |
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| The goal of the Molina STAR+PLUS Program is to deliver quality, effective, and timely Coordinated services in partnership with our providers in a holistic approach addressing the physical, psychological,
social and environmental needs of each member. |
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