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 is under the direction of the Department of State Health Services. It 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 DSHS contract with ValueOptions outlines the requirements for performance, and is rigorously managed. ValueOptions must spend at least 88% of their State payments on direct services. ValueOptions' clinical care managers individually review case presentations for clinical need, and make authorization decisions accordingly. ValueOptions also pays provider claims for service. An expanded provider network contracts with ValueOptions to provide authorized care. Providers compete with one another for market share, and in this competitive environment, enrollees are free to choose any appropriate provider for their behavioral healthcare needs.
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.
The Unique NorthSTAR Approach
- Blended funding - State and local agencies contribute wrap-around funds for a person's treatment. No longer does a person have to mine the various agencies and departments to receive services.
- Integrated services - Mental health and chemical dependency treatment are coordinated under behavioral health, allowing integrated treatment in a single system of care.
- Care management - Individuals receive the proper amount of cost-efficient care.
- Data-based decision support - A modern data warehouse and decision support software is used to evaluate and manage the system of care.
- Behavioral Health Organization - Services are provided via a fully capitated contract with a licensed behavioral health organization.
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NorthSTAR RFP Timeline
NorthSTAR Enrollee Handbook and Provider Directory
NorthSTAR Quality Monitoring Strategies
NorthSTAR Medicaid 1915 (b) Waiver documents
- 2011-2013 Waiver Appendix D (MS Excel) Revised; Posted December 6, 2011
- 2011-2013 Waiver Renewal (PDF) Posted October 4, 2011
- 2011-2013 Waiver Attachment (MS Word) Posted October 4, 2011
- SFY 2012 Medicaid Ratesetting Methodology (MS Word) Posted January 10, 2012
- SFY 2012 Actuarial Certification (PDF) Posted January 10, 2012
- SFY2013 NorthSTAR Contract and Capitation Rates CMS Approval (PDF) Posted September 20, 2012
- Please note that the above document is not ADA compliant as it is a scanned copy of a letter delivered via postal mail. In brief, the document states that the Centers for Medicare and Medical Services (CMS) approved Texas' request to amend capitation rates for the NorthSTAR 1915(b) Waiver for the participating Behavioral Health Organization serving the Dallas Service Area. The approved rate amendment proposed a decrease to monthly premium rates for State Fiscal Year (SFY) 2013 from the previous fiscal year's rates for four of the five risk groups. Use of updated base experience (SFY2011) for the development of these rates resulted in rates that were lower than projected when the SFY2012 rates were developed. The rate amendment was requested effective September 1, 2012. Should you need assistance with the content of this document due to accessibility issues, please contact Wendy Cook at firstname.lastname@example.org.
- SFY2013 Actuarial Rate Certification (MS Word) Posted October 10, 2012
- Amended Capitation Rates 8-1-2012 through 8-31-2012 CMS Approval (PDF) Posted August 14, 2012
- 2011-2013 NorthSTAR Waiver Renewal CMS Approval (PDF) Posted January 10, 2012