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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 3 STAR Program : 3.3 STAR Program Benefits : 3.3.1 Spell of Illness

3.3.1
STAR clients are not limited to the 30-day spell of illness. The spell of illness limitation is defined as 30 days of inpatient hospital care, which may accrue intermittently or consecutively. After 30 days of inpatient care is provided, reimbursement for additional inpatient care is not considered until the client has been out of an acute care facility for 60 consecutive days. All Medicaid clients who are 20 years of age and younger already are not limited to the 30-day spell of illness.

Texas Medicaid & Healthcare Partnership
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