What do I bring with me to my doctor’s appointments?

Bring a list of medicines you and/or your child are taking. If you take your child, also remember to take your child’s shot records.

STAR Members: You must take both your Texas Benefit Medicaid Card and your DHP ID Card.

CHIP Members: You must take your DHP ID Card.

How do I change my Primary Care Provider (PCP)?

Having a medical home is very important. It makes sure that you and/or your child have a doctor that you know and trust for all your medical needs. If for any reason you need to change your PCP, call Member Services at 1-877-220-6376 (Nueces) or 1-855-425-3247 (Hidalgo).

When will my PCP change become effective?

You may change your PCP at anytime. If you call BEFORE the 5th of the month, the change will become effective immediately. If you call AFTER the 5th of the month, the change will be effective the first of the next month. You need to continue to see your current PCP until the change is effective.

Can a clinic be my PCP?

You and/or your child may choose a clinic as your PCP. This can be a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC). A hospital-based clinic such as the Spohn Family Health Clinics can also be your PCP. To choose a clinic as your PCP or if you have questions, call Member Services at 1-877-220-6376 (Nueces) or 1-855-425-3247 (Hidalgo).

How many times may I change my PCP?

There is no limit on how many times you can change your or your child’s primary care provider. You can change primary care providers by calling us toll-free at Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-4253247

What is an emergency medical condition?

Emergency medical condition means a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:

• Placing the patient’s health in serious jeopardy;
• Serious impairment of bodily functions;
• Serious dysfunction of any bodily organ or part;
• Serious disfigurement; or
• In the case of a pregnant women, serious jeopardy to the health of a woman and her unborn child.

You and/or your child have an EMERGENCY medical need if:

• You think you and/or your child’s condition is life threatening;
• You and/or your child has serious pain; or
• Serious harm could come to you and/or your child if you do not get immediate medical care.

How do I get medical care after my PCP’s office is closed?

If you and/or your child gets sick at night or on the weekend and cannot wait to get medical care, call your PCP for advice. If you and/or your child have a fever or a sore throat and you are not sure what to do, call your PCP’s office. Your PCP or another doctor are available by phone 24 hours a day, 7 days a week.

What do I do if my child and/or I become sick when out of town or traveling?

If you and/or your child get sick while you are out of town or out of state, call your PCP. Your PCP’s phone number is listed on the front of your DHP ID card. You may also call Member Services at the number on the back of your ID card. If you and/or your child have an emergency while you are out of town or out of state, go to the nearest ER.

Driscoll Health Plan does not cover any care outside of the United States.

If I don’t have a car, can I get a ride to the doctor’s office?

If you are a STAR member and need a ride to the doctor’s office, you can get help from SafeRide Health which offers NEMT (Non-Emergency Medical Transportation) services to DHP members.

Phone Reservations: 1-833-694-5881

If you are a CHIP member and need a ride to the doctor’s office, SafeRide Health offers transportation services to medical appointments.

Phone Reservations: 1-833-694-5881

We can help you with a ride to the doctor.

When do I need a referral?

Your PCP will tell you when you and/or your child need to see a specialist. Your PCP will make sure that you and/or your child get the special care needed. Most of the time you cannot go to another doctor or get a special service if your PCP does not agree to make a referral. A referral is when your PCP sends you to another doctor. You should expect the specialist to give you an appointment within 2 weeks for non-urgent care or within 24 hours for urgent care.

What do I do if I get a bill?

If you get a bill, call Member Services at the numbers shown above, and someone will help you. When you call, please have your ID card and doctor’s bill. Member Services will need this information to help you.

Who do I call if I get a bill from my/my child’s doctor?

If you are a CHIP member: If you get a bill from your Primary Care Provider or other Doctor, call Member Services at 1-877-451-5598 and someone will call the Doctor’s office. We will help to explain your benefits and copayments.

What do I have to do if I move?

You must report your new address before getting any services in your new area unless it is an emergency. If you have moved out of the DHP service area you will be reassigned to a new health plan. You will continue to get care through DHP until the address is changed.

If you are a STAR member: As soon as you have your new address, give it to HHSC benefits office and call Driscoll Health Plan Member Services Department at Nueces SA: 1-877-220-6376 or Hidalgo SA: 1-855-425-3247. Before you get Medicaid services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you are a CHIP member: As soon as you have your new address, give it to HHSC by calling 2-1-1 or updating your account on yourtexasbenefits.com and call the Driscoll Health Plan Member Services Department at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.
If you are a CHIP Perinate member: As soon as you have your new address, give it to the HHSC by calling 2-1-1, or updating your account on yourtexasbenefits.com and calling Driscoll Health Plan Member Services at 1-877-451-5598. Before you get CHIP services in your new area, you must call Driscoll Health Plan Member Services, unless you need emergency services. You will continue to get care through Driscoll Health Plan until HHSC changes your address.

What do I do if I lost my Member ID Card?

If you lose your ID card, call us right away at 1-877-324-7543 to get a new one. We can mail you one right away. If you move or change phone numbers, call us so we can send you another ID card. We always need to have your correct address and phone number.

What do I do if I need member materials in a different format?

Our staff speaks English or Spanish and can help you with questions. We also have special services for people who have trouble reading, hearing, seeing, or speaking a language other than English or Spanish. You can ask for member materials in audio, larger print, Braille, and other languages. To get help, call our Member Services toll-free number on your ID card.

Who do I contact for a ride?

SafeRide Health offers NEMT (Non-Emergency Medical Transportation) services to DHP members.

Phone Reservations: 1-833-694-5881

All standard-distance medical transportation should be requested 48 hours in advance and long-distance trips should be requested 5 business days in advance.

You can contact SafeRide Health “Where’s my ride?” phone number at 1-833-694-5881 to locate your driver upon pick-up.

For more information visit: driscollhealthplan.com/transportation 

What is service coordination? 

Service coordination is a service Driscoll Health Plan provides for you. You and your Service Coordinator will work together to assess your health needs. Together you will:

• Create a care plan,
• Organize all your services, and
• Monitor your progress toward your health care goals.

When you enroll with Driscoll Health Plan, you will have a Service Coordinator available to you.

Your Service Coordinator will:

• Call you and get to know you and your health care, long-term care, and behavioral health needs.
• Use a health risk assessment to help decide if you need more help right away.
• Talk with any case managers, doctors, or other persons that you say are important for your care needs.
• Help you find the services you need in your community.
• Write a care plan with you, your family’s, and your doctor’s help.
• Stay in contact with you to check up on your health.
• Keep track of your care plan to see if you are meeting your care plan goals.

 How do I get a hold of my service coordinator?

 If you have any questions, contact your Service Coordinator or call the Service Coordination line toll free at:

Nueces: 1-844-508-4672

Hidalgo: 1-844-508-4674

You can also call Member Services who can help you get in touch your Service Coordinator: Call toll free at 1-877-324-7543.

How do I change my PCP?

Driscoll Health Plan wants you to be happy with your Primary Care Provider. You can change your Primary Care Provider if:

• You are not happy with the Primary Care Provider’s care.

• You need a different doctor to take care of you.
• You move farther away from the Primary Care Provider.
• The Primary Care Provider is no longer a part of Driscoll Health Plan’s network.
• You do not get along with the Primary Care Provider.

You can change Primary Care Provider by calling Member Services. The Driscoll Health Plan Provider Directory lists all Primary Care Providers and can be found on our website at: http://driscollhealthplan.com/find-a-provider

 What is Disease Management?

Driscoll Health Plan has a program for Members who have asthma and/or diabetes.  The program helps you and your family to understand and take care of your disease.  Our goal is for you to have better health.  Your Service Coordinator will call to explain the program and will assess your Asthma and/or Diabetes during a scheduled visit.  The Service Coordinator will work with you and your doctor to create a plan.

How do I choose an in network specialist?  

Your doctor will tell you if you need to see a specialist.  A specialist is a doctor for certain types of health care like cardiology for heart health or orthopedics for bones and joints.  For help on choosing a specialist in our network call Service Coordination toll-free at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

How do I file a complaint?

We want to help you. If you have questions about how to file a complaint, please call Member Services toll-free at 1-877-324-7543.  A Driscoll Health Plan Member Services Advocate can help you file a complaint.

If you feel that your complaint has not been resolved after you’ve gone through the Driscoll Health Plan complaint process, you can also file a complaint through the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989. If you would like to make your complaint in writing, please send it to the following address:

Texas Health and Human Services Commission

Health Plan Operations – H-320

P.O. Box 85200

Austin, TX  78708-5200

ATTN:  Resolution Services

If you can get on the Internet, you can send your complaint in an email to

HPM_Complaints@hhsc.state.tx.us.

How do I file an appeal? 

There might be times when the DHP’s Medical Director denies your services.  When this happens, you can appeal for the denial of payment for services in whole or in part. We will send you a letter if services are denied. The form to appeal the denial will be included. For help with how to fill out the appeal form call Member Services toll free at 1-877-DCHP-KIDS.  A Member Advocate can assist you with your appeal.

Do I qualify for Minor Home Modifications?

Minor Home Modifications must be needed to ensure health, welfare and safety or to support independence in the home.   Some STAR Kids members might be able to get Minor Home Modifications, such as MDCP members.

Driscoll Health Plan will cover changes to existing bathrooms and doorways, as well as ramps.

For more information about Minor Home Modifications, contact your Service Coordinator or the Service Coordination Line toll-free at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

What is respite?

Respite care is temporary help for caregivers from the responsibilities of caring for a person with special needs. Services might be delivered in the home or out of the home.  Respite care can be a few hours provided:

• on a one-time basis
• overnight or
• extended care

 What is a Value Added Service?

When you join Driscoll Health Plan, you get some services that Medicaid does not offer. These services are at no cost to you.  They are to help promote healthy lifestyles, and improve health outcomes.

Some of these services are:

• Asthma Services
• Extra Eyeglass Benefits
• Gifts for Completing Checkups
• ID Wristbands
• Sensory Items
• Community-Based Specialty Services
• Sports/School Physicals
• Extra Transportation Services
• Special Needs Camp
• Pest Control Services

 Who do I contact for a ride?

SafeRide Health offers NEMT (Non-Emergency Medical Transportation) services to DHP members.

Phone Reservations: 1-833-694-5881

All standard-distance medical transportation should be requested 48 hours in advance and long-distance trips should be requested 5 business days in advance.

You can contact SafeRide Health “Where’s my ride?” phone number at 1-833-694-5881 to locate your driver upon pick-up.

For more information visit: driscollhealthplan.com/transportation 

Who do I contact for non-covered medications?

If your doctor cannot be reached to approve a prescription, you may be able to get a three-day emergency supply of your medication.

Call Member Services toll-free at:  1-877-324-7543 for help with your medications and refills.

How Do I get routine eye exams for my child?

To get eye exams or glasses, call Envolve at:

Nueces: 1-844-305-8300

Hidalgo: 1-844-725-6410

You do not need a referral from your doctor for routine eye checkups from ophthalmologists or optometrists in Envolve’s provider network.

How do I get family planning services?

Family planning services, like birth control and counseling, are very private. You can have a once a year visit, counseling, and tests. You can also have drugs and supplies that prevent pregnancy. Ask your doctor if he or she offers family planning services such as birth control. If you do not feel comfortable talking with your doctor, call Member Services toll free at 1-877-324-7543.  You may also contact your Service Coordinator for help. You can go to any family planning clinic that will take Medicaid.

 How do I find a pharmacy?

To find a network pharmacy, visit the pharmacy network list at www.driscollhealthplan.com.  You may also contact Member Services toll free at 1-877-324-7543 for help finding a network drug store.

 How do I get OB/GYN services?  

You have the right to pick an OB/GYN without a referral from your Primary Care Provider.  You can also have the OB/GYN doctor be your Primary Care Provider. To pick an OB/GYN, or if you want to have the OB/GYN doctor be your Primary Care Provider, call Member Services toll free at:  1-877-324-7543.

 What are Consumer Directed Services (CDS)?

In STAR Kids, you may select how you would like some Long Term Services and Supports delivered.

• Agency Option (AO): all services provided and managed by an agency
• Service Responsibility Option (SRO): individuals manage day-to-day activities while the provider agency manages business activities
• CDS option: individuals manage day-to-day and business activities

CDS option gives you more choices and control over how some of your LTSS services are delivered.

If you choose the CDS option, you will be able to:

• Find, screen, hire and fire the people who provide services to you or our staff.
• Train and direct your staff

Services that can be managed by CDS will depend on your Waiver. Some of these services may include:

• attendant care
• speech, physical and occupational therapy
• respite care
• employment assistance
• flexible family support

If you choose to be in CDS, you will contract with a Financial Management Services Agency (FMSA).  FMSA will:

• Provide Training and support to help you with your staff,
• Do your payroll and,
• File your taxes.

Call the Service Coordination Line toll-free at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

 What do I do if my child needs Personal Care Services?

Personal Care Services (PCS) helps with everyday tasks like bathing, eating, dressing, and walking.  PCS can also help you to fix meals and do light housework. Your Service Coordinator will assess your need for this service at each home visit. Call your Service Coordinator for help or call the Service Coordination Line at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

 What do I do if I want Community First Choice Services for my child?

Community First Choice (CFC) services may be provided in home or in a community-based setting.  CFC provides basic attendant services and supports.  The services you can get in CFC are:

• Help with daily tasks like dressing, bathing, and eating.
• Services to help you learn how to care for yourself.
• Emergency Response Services (ERS): Backup systems and supports, like electronic devices, to help members who live alone or are alone for a large part of the day.
• Training on how to select, manage, and dismiss an attendant.

For help call the Service Coordination Line toll-free at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

 My child was requesting durable medical equipment/supplies and is now in STAR Kids, what do I do now?

Some durable medical equipment (DME) and products normally found in a pharmacy are covered by STAR Kids Medicaid. For all Members, Driscoll Health Plan pays for nebulizers, ostomy supplies, and other covered supplies and equipment if they are medically necessary. For children (birth through age 20), Driscoll HealthPlan also pays for medically necessary prescribed over-the-counter drugs, diapers, formula, and some vitamins and minerals.

Call Members Services for more information about these benefits.

Can I/my child still see the same doctors?

Yes, you can see the same doctor as your child if the doctor takes care of adults.   You can call your child’s doctor and ask them or you can call Member Services.  Member Service can help you in finding out if the doctor takes care of adults.

If your child’s doctor does take care of adults and you want to change your doctor you will need to call Member Services to change your doctor of record.   Service Coordination can also help you with scheduling an appointment for your child.  Call the Service Coordination Line toll-free at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

 My child was receiving Personal Care Services and is now in STAR Kids, what will happen now?

These services will continue until your DHP Service Coordinator assesses your needs and determines the number of hours you will require. Call your Service Coordinator or the Service Coordination Line toll-free at:

Nueces: 1-844-508-4673

Hidalgo: 1-844-508-4675

What to do if I get a bill? 

You are not responsible for co-pays or deductibles. If you get a bill, call Member Services and we can help you. Have your Member ID card and the bill when you call. We can call the provider’s office for you. You are responsible for services that are not covered by Medicaid. The following are not covered by DHP.
• Going to a specialist without getting a referral
• Going to an out-of-network provider without getting a referral
• Choosing to go to a Urgent Care instead of an Emergency Room when you are out of town

What do I have to do if I move?

As soon as you have your new address, give it to the HHSC benefits office by dialing 2-1-1 and call Driscoll Health Plan Member Services Department at Nueces SA: 1-844-508-4672 or Hidalgo SA: 1-844-508-4674. Before you get Medicaid services in your new area, you must call Driscoll Health Plan, unless you need emergency services. You will keep getting care through Driscoll Health Plan until HHSC changes your address.

What if I can’t get a hold of my Primary Care Provider?

Your doctor is available by phone 24 hours a day, 7 days a week.  If you get sick at night or on the weekend you can call your doctor’s office for help.  The office will have an answering service or message on how to contact the doctor. They should return your call within 30 minutes.

You may also go to an in-network After Hours Clinic or Urgent Care Center for sudden illness. You should contact your doctor’s office if you are unsure about going to an After Hours Clinic or Urgent Care.

 What if my child is going out of State for an appointment?

If you need to see a doctor out of area, contact your Service Coordinator. All appointments for out of area appointments require prior authorization.

Electronic Visit Verification Rights and Responsibilities

Electronic Visit Verification (EVV)

STAR Kids Program

Frequently Asked Questions

• What is Electronic Visit Verification (EVV)?

Electronic Visit Verification (EVV) is a computer-based tracking system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the precise time a service delivery visit begins and ends. The EVV program was implemented to replace paper-based attendant timesheets.

• What services are required to be verified by EVV?

Services that require EVV are:

• Personal Care Services (PCS)
• In-home Respite Services
• Flexible Family Support Services
• Community First Choice (CFC) services, Personal Assistance Services (PAS) and Habilitation (HAB).

• Do I need to get a home landline to receive or continue my services?

No. EVV does not require you to get a home landline phone. If you do not have a home landline phone or you do not want your personal attendant to use your home landline phone, a Small Alternative Device (SAD) will be ordered and placed in your home. The SAD must remain in your home at all times. Your personal attendant will use the SAD to clock in and clock out to verify services were delivered.

• What should I do if someone tries to remove or removes the SAD device from my home?

The device must remain in your home at all times.  If the device is removed or damaged for any reason, you must tell your provider agency immediately.

• I do not have a home landline but I have a cell phone. Can my personal attendant use my personal cell phone to call the EVV system?

No. Cell phones are not allowed to be used to clock in and clock out of the EVV system. The attendant should never ask to use the individual/member’s cell phone to clock in and clock out.

Note: There are two exceptions to the use of a cell phone:

• If you are a Consumer Directed Services (CDS) employer.
• To call in SAD values into the EVV system.

• Do I have to pay for using the services?

There is no cost to you for EVV services.

• What telephone service types are approved for EVV use?
  • Allowable Phone Types:
    • Wired phone connected to a phone jack in the wall
    • Cable internet provider (e.g., Time Warner, Comcast, AT&T, etc.)
    • Non-Fixed Voice over Internet Protocol (VoIP) (e.g., Portable alternative phone services that use VoIP, including but not limited to MagicJack, or Vonage)
    • Fixed VoIP

• Unallowable Phone Types:
  • Mobile Phone
  • Cellular-enabled device or tablet

• Can I receive services in the community with EVV?

Yes.  The use of EVV does not change the location and way services are delivered.  You may still receive services in accordance with your service plan and existing program rules.

• Who do I contact if I have questions?

You may contact DHP Service Coordination or Member Services at:

• Service Coordination – Hidalgo: 1-844-508-4675
• Service Coordination – Nueces: 1-844-508-4673
• Member Services – Hidalgo: 1-844-508-4674
• Member Services – Nueces: 1-844-508-4672

The Center for Medicaid and CHIP Services (CMS) gave direction to health plans about how you access your health care information. You can access your health care information in new and innovative ways. Driscoll Health Plan has contracted with Connected Health to allow third-party mobile apps you select to access your health care data. The data they collect about you should be used to support your health care needs. We encourage you to stay informed about Connected Health’s privacy and security practices. Click here to learn how to protect and secure your health information.

You can also find more information here for the CMS ruling with helpful tips when using third-party apps.

Driscoll Data Connect helps teams build better experiences for patients, caregivers, and providers. Click here to login or create a new account.