Molina Dual Options STAR+PLUS MMP | 2021
Provider and Pharmacy Online Directory Information
This Provider and Pharmacy Online Directory includes information about provider and pharmacy types in Molina Dual Options STAR+PLUS MMP and search results of all the plan’s providers and pharmacies as of the date of your search. The search results contain provider and pharmacy address and contact information as well as other details such as days and hours of operations, specialties, and skills. Key terms and their definitions appear in alphabetical order in the last chapter of the Member Handbook.
- Molina Dual Options STAR+PLUS MMP is a health plan that contracts with both Medicare and Texas Medicaid program to provide benefits of both programs to enrollees.
- Molina Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ethnicity, national origin, religion, gender, sex, age, mental or physical disability, health status, receipt of healthcare, claims experience, medical history, genetic information, evidence of insurability, geographic location.
- This Online Directory displays health care professionals (such as doctors, nurse practitioners, and psychologists), facilities (such as hospitals or clinics), and support providers (such as Adult Day Health and Home Health providers) that you may see as a Molina Dual Options STAR+PLUS MMP member based on your search results. We also display pharmacies that you may use to get your prescription drugs.
- We will refer to these groups as “network providers” in this Directory. These providers signed a contract with us to provide you services. This searchable online directory contains all Molina Dual Options STAR+PLUS MMP full network of provider for the State of Texas. For additional information contact, Member Services at (866) 856-8699, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., local time.
- This Directory includes providers of both Medicare and Texas Medicaid services
- ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (866) 856-8699, TTY al 711, lunes a viernes, de 8:00 a.m. a 8:00 p.m., hora local. Esta es una llamada gratuita.
- You can get this document for free in other formats, such as large print, braille, or audio. Call (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. The call is free.
- You can ask that we always send you information in the language or format you need. This is called a standing request. We will keep track of your standing request so you do not need to make separate requests each time we send you information. To get this document in a language other than English, please contact the State at (800) 252-8263, TTY: 711, Monday – Friday, 8 a.m. to 5 p.m., local time to update your record with the preferred language. To get this document in an alternate format, please contact Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. A representative can help you make or change a standing request. You can also contact your Service Coordinator for help with standing requests.
- More information in regards to Nursing Facility can be found in the Molina Dual Options STAR+PLUS MMP Member Handbook. If you have additional questions, please call Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
- Nursing Facility providers can get a copy of the Nursing Facility Provider Manual by visiting MolinaHealthcare.com/provider or by calling Provider Services at (855) 322-4080, Monday – Friday, 8 a.m. to 5 p.m., central time.
- The list is up-to-date as of the current date shown at the bottom page of the searchable online directory , but you need to know that:
- Some Molina Dual Options STAR+PLUS MMP network providers may have been added or removed from our network after your online directory search.
- Some Molina Dual Options STAR+PLUS MMP providers in our network may no longer be accepting new members. If you are having trouble finding a provider who will accept new members, call Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time and we will help you.
- To get the most up-to-date information about Molina Dual Options STAR+PLUS MMP’s network providers in your area, visit MolinaHealthcare.com/Duals or call Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. The call is free.
Doctors and other health care professionals in Molina Dual Options STAR+PLUS MMP’s network are listed on pages based on your Provider search. Pharmacies in our network are listed on pages base on your Pharmacy search.
Providers Key terms
This section explains key terms you’ll see in our Provider and Pharmacy Online Directory
- Providers are health care professionals and support providers such as doctors, nurses, pharmacists, therapists, and other people who provide care and services. Services include medical care, long-term services and supports (LTSS), supplies, prescription drugs, equipment and other services.
- The term “providers” also include facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long-term services and supports.
- Providers that are a part of our plan's network are called network providers.
- Network providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay nothing for covered services.
- A Primary Care Provider (PCP) is a physician, nurse practitioner, or health care professional and/or medical home or clinic (Federally Qualified Health Centers -FQHC) who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time. Your PCP will also give you a prior authorization (PA) if you need to see a specialist or other provider.
- Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
- Oncologists care for patients with cancer.
- Cardiologists care for patients with heart conditions.
- Orthopedists care for patients with certain bone, joint, or muscle conditions.
- You may need a referral to see a specialist or someone that is not your PCP. A referral means that your primary care provider (PCP) must give you approval before you can see someone that is not your PCP. If you don’t get a referral, Molina Dual Options STAR+PLUS MMP may not cover the service.
- Referrals from your network PCP are not needed for:
- Emergency care;
- Urgently needed care;
- Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are outside the plan’s service area; or
- Services from a women's health specialist.
- Additionally, if you are eligible to get services from Indian health providers, you may see these providers without a referral. We must pay the Indian health provider for those services even if they are out of our plan’s network.
- More information on referrals is available in Chapter 3 of the Member Handbook.
- You also have access to a Service Coordinator and a Service Coordination team that you choose.
- A Service Coordinator helps you manage your medical providers and services.
- Your Service Coordination team led by a Service Coordinator, is a group of advocates and providers working together to provide you with medical, behavioral health, substance use treatment, Long Term Services and Supports, and social needs. You have access to and input in the development of your own Service Coordination Team. The Service Coordination Team must include, first and foremost, you and/or your Legally Authorized Representative (LAR). You can tell us who else you would like to participate. Unless you tell us otherwise, your Service Coordination Team will include:
Your Service Coordination Team can also include the following people, if it is appropriate and if you agree:
- You and/or your LAR
- Your Service Coordinator
- Your Primary Care Provider (PCP)
- Your behavioral health clinician (if you have one)
- Your long-term services and supports (LTSS) providers (if you have them).
- A pharmacist, and
- Representatives from the facility where you receive care
- Nurses, specialists, social workers, and other people who can provide expert advice
- Family members
- Other informal caregivers
- State agency or other case managers.
- Everyone on the Service Coordination team works together to make sure your care is coordinated. This means that they make sure tests and labs are done once and the results are shared with the appropriate providers. It also means that your PCP should know all medicines you take so that he or she can reduce any negative effects. Your PCP will always get your permission before sharing your medical information with other providers. The goal of Service Coordination is to collaboratively assess the member’s unique health needs, create individualized care plans with prioritized goals, and facilitate services that minimize barriers to care so the member can live in the least restrictive environment with optimal health outcomes.
Primary Care Provider (PCP)
You can get services from any provider who is in our network and accepting new members.
First, you should choose a Primary Care Provider. You may be able to have a specialist act as your PCP. For example, a women's health specialist, medical home or clinic who gives you routine health care can act as your PCP. In some special cases, a specialist may act as a PCP if the specialist performs primary care functions, including but not limited to FQHCs, rural health clinics, health departments, and other similar community clinics. Please request this by calling Member Services at the number below. Molina Dual Options STAR+PLUS MMP will review for medical necessity/appropriateness and will obtain the written agreement from the specialist that he or she is willing to accept responsibility for coordination of all of the member’s health care needs. If the specialist is not willing to serve as the PCP, the request cannot be approved.
To choose a PCP, go to the list of providers on page based on your search results and choose a provider:
- that you use now, or
- who has been recommended by someone you trust, or
- whose offices are easy for you to get to.
- If you want help in choosing a PCP, please call Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. The call is free. Or, visit MolinaHealthcare.com/Duals.
- If you have questions about whether we will pay for any medical service or care that you want or need, call Member Services and ask before you get the service or care.
Long-term services and supports (LTSS)
As a Molina Dual Options STAR+PLUS MMP member, you may be able to get long-term services and supports (LTSS), such as Personal Assistance Services (PAS) and Day Activity and Health Services (DAHS). These services promote independence and allow members to safely reside in a community setting for as long as possible. LTSS helps people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital.
Members can get different kinds and amounts of LTSS. If you think you need LTSS, you can talk to your Service Coordinator about how to apply for these services, and all of the resources available to you under the plan.
How to identify providers in Molina Dual Options STAR+PLUS MMP’s network
You may need a referral to see someone who is not a Primary Care Provider. There is more information about referrals under the Key Terms
section of this Provider and Pharmacy Online Directory
You must get all of your covered services from providers within our network. If you go to providers who are not in Molina Dual Options STAR+PLUS MMP’s network (without prior authorization or approval from us), you will have to pay the bill.
“A prior authorization
is an approval from Molina Dual Options STAR+PLUS MMP before you can get a specific service, drug, or see an out-of-network provider. Molina Dual Options STAR+PLUS MMP may not cover the service or drug if you don’t get approval.”
The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. No services are covered outside the United States. You can also go outside the plan for other non-emergency services if Molina Dual Options STAR+PLUS MMP gives you permission first.
- You may change providers within the network at any time during the year. If you have been going to one network provider, you do not have to keep going to that same provider. You may change your PCP for any reason, at any time. You can call Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time, if you want more information about our Molina Dual Options STAR+PLUS MMP providers or if you need help changing your PCP. Member Services will make the PCP change effective on the first day of the following month.
- Molina Dual Options STAR+PLUS MMP works with all the providers in our network to accommodate the needs of people with disabilities. The search results of network providers include information about the accommodations they provide.
- If you need to see a provider and are not sure if they offer the accommodations you need, Molina Dual Options STAR+PLUS MMP can help you. Talk to your Service Coordinator for assistance.
How to find Molina Dual Options STAR+PLUS MMP providers in your area
To learn how to search for providers refer to the “Help
” link located on the top portion of the searchable online directory page.
If you have questions about Molina Dual Options STAR+PLUS MMP or require assistance in selecting a PCP, please call our Member Service Department at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. You can also visit MolinaHealthcare.com/Duals
This Online Directory of Molina Dual Options STAR+PLUS MMP’s network providers contains:
- Health care professionals including primary care physicians, specialists, and mental health providers, such as outpatient behavioral health providers; and
- Facilities including hospitals, nursing facilities, and mental health facilities; and
- Support providers including those providing adaptive aids/medical equipment, adult foster care, assisted living, cognitive rehabilitation therapy, day activity and health services, dental services, emergency response services, employment assistance, financial management services, home delivered meals, minor home modifications, nursing services, occupational therapy, personal assistance services, physical therapy, respite, speech therapy, supported employment, and transition assistance services.
Providers are listed in alphabetical order by last name. In addition to contact information, provider listings also include specialties and skills, for example, such as languages spoken or completion of cultural competence training.
“Cultural competence training
is additional instruction for our health care providers that helps them better understand your background, values, and beliefs to adapt services to meet your social, cultural, and language needs.”
Molina Dual Options STAR+PLUS MMP’s network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
You can also search pharmacies that are in our network but are outside our service area of: Bexar, Dallas, El Paso, Harris, and Hidalgo in which you live. You may also fill your prescriptions at these pharmacies. Please contact Molina Dual Options STAR+PLUS MMP at (866) 856-8699, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., local time, for additional information.
- Molina Dual Options STAR+PLUS MMP members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the Molina Dual Options STAR+PLUS MMP Member Handbook for more information.
- Some network pharmacies may not be listed in this Online Directory.
- Some network pharmacies may have been added or removed from our plan after these search results.
For up-to-date information about Molina Dual Options STAR+PLUS MMP network pharmacies in your area, please visit our web site at MolinaHealthcare.com/Duals
or call Member Services at (866) 856-8699, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., local time. The call is free.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook
and Molina Dual Options STAR+PLUS MMP’s List of Covered Drugs
. The List of Covered Drugs can be found at MolinaHealthcare.com/Duals
How to identify pharmacies in Molina Dual Options STAR+PLUS MMP’s network
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-order pharmacies send covered prescription drugs to members through the mail or shipping companies.
- Home infusion pharmacies prepare prescription drugs that are given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.
- Long-term care (LTC) pharmacies serve residents of long-term care facilities, such as nursing homes.
- You are not required to continue going to the same pharmacy to fill your prescriptions.
You are not required to use a mail order pharmacy to fill your prescriptions.
Long-term supplies of prescriptions
- Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.
- 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.
You can get prescription drugs shipped to your home through our network mail order delivery program which is called CVS Caremark Mail Service Pharmacy Program
. The pharmacy will contact you, by phone, to get your approval before shipping any prescriptions. If we are unable to reach you for approval, your prescription will not be sent to you.
Typically, you should expect to get your prescription drugs within 10 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at (888) 838-3769, TTY: 711, 24 hours a day, 7 days a week. To learn more about mail order pharmacies, see Chapter 5 of the Member Handbook.
Home infusion pharmacies
You can get home infusion therapy if Molina Dual Options STAR+PLUS MMP has approved your prescription and if you get your prescription from an authorized prescriber.
Home Infusion Pharmacies services all counties in the Molina Dual Options STAR+PLUS MMP service area. For more information on home infusion services and pharmacies, contact Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
Long-term care pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Molina Dual Options STAR+PLUS MMP through the facility’s pharmacy or another network pharmacy. To learn more about drug coverage in special cases, see Chapter 5 of the Member Handbook
Long-Term Care Pharmacies services all counties in the Molina Dual Options STAR+PLUS MMP service area. For more information on Long-Term Care services and pharmacies, contact Member Services at (866) 856-8699, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
How to find Molina Dual Options STAR+PLUS MMP pharmacy in your area
You can get your drugs covered at any of our network pharmacies. This includes our network pharmacies outside of our service area.
To search for a pharmacy type within our network, go to MolinaHealthcare.com/ProviderSearch
and click on “Find a Pharmacy”. Then, select your state and coverage plan. A notification pop up will appear, letting you know the link will take you away from MolinaHealthcare.com/Duals
. Click “OK” to be directed to the next page that will allow you complete your pharmacy search. Next, enter ZIP code or city and state. You can further refine your search by specifying a pharmacy name and type. All pharmacies shown on the searchable online directory are available in our Network.
If you have questions about any of the above, please contact Member Services or visit MolinaHealthcare.com/Duals