This is important because in the NorthSTAR program did not cover ambulance transportation, when the beneficiaries are switched over to a MCO plan, ambulance benefits should follow the general medical necessity rules.
The NorthSTAR Program is a publicly funded managed care approach to the delivery of mental health and chemical dependency services to the eligible residents of Dallas, Ellis, Collin, Hunt, Navarro, Rockwall and Kaufman counties. NorthSTAR provides a comprehensive mental health/substance abuse benefit package for all eligible individuals, and access to benefits is determined by clinical need, not funding source. Client services to both eligible Medicaid and medically indigent individuals are managed under contract with the State by a behavioral health organization (BHO), ValueOptions. The North Texas Behavioral Health Authority (NTBHA) serves as the local behavioral health (mental health and substance abuse) authority for the entire NorthSTAR service area, and functions include planning, oversight, single portal authority functions, as well as a local problem solving resource that includes ombudsman services.
In accordance with legislative direction and the Health and Human Services Commission Sunset Report, the Department of State Health Services (DSHS) and the Health and Human Services Commission (HHSC) are working to plan a successful transition for NorthSTAR in the Dallas Medicaid service delivery area. The goal is for persons with Medicaid to get their behavioral health services through their existing managed care organization (MCO) or Traditional Medicaid, and for the indigent population to receive those services from local organizations. The anticipated transition date for these changes is January 1, 2017.