PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 86 of 184
Tuberculosis Services Provided by DSHS Approved Provider
All confirmed or suspected cases of Tuberculosis must be referred to the Infectious Disease Control Unit of the
DSHS using the forms and procedures for reporting TB adopted by DSHS. Sendero will assist providers in
referring to the Local Tuberculosis Control Health Authority within 1 day of diagnosis for a contact
investigation. The provider must document the referral to the local health authority in the Member’s medical
records that may be reviewed by DSHS and the local authority. Providers should notify Sendero on any referral
made to the local health authority.
Sendero must coordinate with the local health authority to ensure that Members with confirmed or suspected TB
have a contact investigation and receive directly observed therapy. Sendero will report any Member who is
non-compliant, drug-resistant, or who is or may be posing a health threat to DSHS or the local authority.
Sendero will cooperate with the local health authority in enforcing the control measures and quarantine
procedures contained in Chapter 81 of the Health and Safety Code.
DADS Hospice Services
The Department of Aging and Disability Services (DADS) manages the Hospice Program through provider
enrollment contracts with hospice agencies. Coverage of services follow the amount duration and scope of
services specified in the Medicare Hospice Program. Hospice pays for services related to the treatment of the
client’s terminal illness and for certain physician services (not the treatments). Hospice care includes medical
and support services designed to keep clients comfortable and without pain during the last weeks and months
before death.
Texas Health Steps Case Management
Texas Health Steps Case Management for Children & Pregnant Women provides services to children with a
health condition/health risk, birth through 20 years of age and to high-risk pregnant women of all ages, in order
to help them gain access to medical, social, educational and other health-related services. The Texas Health
Steps phone number is 1-877-847-8377 (877-THSTEPS). Providers can call in a request, complete the referral
form and fax it to Texas Health Steps SSU at 512-533-3867, or contact a regional contracted provider. Sendero
Health Plans Whole Person Health Support program can also help these members attain the care they need. If
you or the member or parent would prefer, you can contact a contracted Case Management vendor in our
service area. A current list of these licensed and contracted vendors can be found at
www.dshs.state.tx.us/caseman/hsr7.shtm.
ST 2.6 Pharmacy/Navitus
Sendero Health Plans has an arrangement with Navitus Health Solutions, a pharmacy benefit management
company to administer pharmacy benefits for the STAR program. For questions related to the formulary, “How
to” find a list of covered drugs, “How to” find a preferred drug list, the process for requesting a prior
authorization (PA), prescription over-rides, quantity limits, brand necessity or formulary exceptions, please
contact Navitus at 877-908-6023 or access the Navitus website through www.senderohealth.com.
NAVITUS SUPPORTS E-PRESCRIBING FOR MEDICAID
Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475
Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)