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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 5 STAR+PLUS Program : 5.3 STAR+PLUS Program Benefits : 5.3.2 Spell of Illness

The spell-of-illness limitation applies to clients in the STAR+PLUS Program.
A spell-of-illness 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.
An individual may be discharged from and readmitted to a hospital several times, regardless of the admittance reasons, and still be considered to be in the same spell of illness if 60 days have not elapsed between discharge and readmission.
The spell-of-illness limitation does not apply is the following situations:

Texas Medicaid & Healthcare Partnership
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