The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK MARCH 2023 3 CPT ONLY - COPYRIGHT 2022 AMERICAN MEDICAL ASSOCIATION. Here are some tools specific to Texas to make it easier. To gauge the efficacy of program promotion and client outreach activities, contractors must monitor and evaluate the planned activities and implementation and record these evaluations on Form 1060, Health and Developmental Services (HDS) Promotion and Outreach Quarterly Report. HTW provides for a continuous 12-month certification period with the following limited health care benefits: Note: For people 15-17, a parent or legal guardian's signature is required. HTW Plus is an enhanced, cost-effective, limited postpartum care services package available to women enrolled in HTW who have been pregnant in the last 12 months. Texas Medicaid; Long-Term Care (LTC) 1915(c) Waiver Programs; Healthy Texas Women (HTW) Family Planning; Texas Health Steps; CSHCN Services Program; Children's Health Insurance Program (CHIP) Medical Transportation Program (MTP) Vendor Drug Program; Topics. The proposed effective date is Sept. 1, 2018, for a five-year period ending Aug. 31, 2023. Find a Doctor. The Healthy Texas Women (HTW) service package includes family planning services, related preventive health services that are beneficial to reproductive health, and Clinical breast examination: A health care provider, such as a doctor or nurse, looks at and feels the breast and underarms for skin changes or lumps during a health check-up. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements. Keep up with whats new at HHS. WebUnauthorized access to this site and misuse of its information assets may be prosecuted under Texas State statutes regarding the use of individually identifiable personal health information (PHI) and The United States regulations and laws regarding the use of individually identifiable personal health information (PHI). Are a woman between the ages of 18 to 44 years old. WebClient Eligibility Lookup. Contractors are required to be aware of and comply with current laws, as well as the policies put forth in the Texas Medicaid Provider Procedures Manual (TMPPM). Use the denial reason, Denied 15-17 without parent or legal guardians signature. Want to talk to someone about healthcare choices available for women with low income? WebMedicaid for pregnant women A pregnant woman can receive Medicaid benefits during pregnancy and up to two months after birth if she meets certain income requirements. The HTW FFS component is managed through the HHSC Medicaid and CHIP Services Division (MCS). ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW. If an applicant or family member receives the following services, they are considered adjunctively eligible for the HHSC Family Planning Program at an initial or renewal eligibility screening: However, if an applicant does not participate in the above services, they will be asked to prove income eligibility. 1 General Information The information in this handbook is intended for Healthy Texas Women (HTW) program providers. postpartum depression and other mental health conditions; cardiovascular and coronary conditions; and. To learn more about application guidelines for Medicaid, download our free guide today. A-500, Age/Relationship. Each of the womens health programs provides a unique set of services and has its own eligibility requirements. Indirect Costs Costs incurred for a common or joint purpose benefiting more than one project or cost objective of a contractors organization and not readily identified with a project or cost objective. Upon review at each quarter, contractors that have exceeded the 25 percent will be notified and provided technical assistance, followed by appropriate actions as needed to resolve any issues. The R&S banner messages and the TMPPM are all available on the TMHP website, along with billable service codes. Texas Medicaid eligibility requirements ensure that low-income residents of the state can obtain health care coverage. 1. The request for reimbursement cannot be submitted until 45 days after the HTW application was submitted to ensure adequate time for HTW application processing and eligibility determination. as soon as possible. Some standards for Medicaid benefits eligibility come from the federal level, while others are established at the state level. Any other prohibition imposed by federal, state or local law. This tool will help direct you to the programs that might be right for you. This policy manual has been structured to provide contractor staff with information needed to comply with cost reimbursement requirements. Long-acting reversible contraception (LARC) is a highly effective contraceptive option with high rates of patient satisfaction and method continuation. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT. The TMPPM and the Healthy Texas Women Program Handbook within the TMPPM include information related to the HHSC HTW fee-for-service program claims submission process. A-810, Contraceptive Methods A broad range of birth control options, approved by the U.S. Food and Drug Administration, except for emergency contraception. HTW CR funds may not be used to support the following services, activities and costs: Contractors must submit these reports in an accurate and timely manner throughout the contract term, regardless of status, to report on progress and implementation. Remember, every ounce of breast milk counts. Some examples of long-acting reversible contraception include an intrauterine device (IUD) and a birth control implant. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt. Specific Medicaid income requirements will depend on the particular Medicaid program to which the candidate is applying. Learn More Texas Medicaid; Long-Term Care (LTC) 1915(c) Waiver Programs; Healthy Texas Women (HTW) Family Planning; Texas Health Steps; CSHCN Services Program; Children's Health Insurance Program (CHIP) Medical Transportation Program (MTP) Vendor Drug Program; Topics. Last Name. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. State rules for HTW services can be found in the Texas Administrative Code (TAC), Title 1, Part 15, Chapter 382, Subchapter A. Colposcopy: A healthcare provider looks at the cervix with a special microscope. Log into your account or call 2-1-1 and select Option 2. The contractor will bill Texas Medicaid & Healthcare Partnership (TMHP) for the insertion of the LARC device only when issued to a client. All applicants must fall within Medicaid income limits established by officials. Once HTW: Who can Apply? No. Please visit the Healthy Texas Women page on the TMHP website to view the HTW Texas Medicaid Provider Procedures Manual for instructions on how to bill for HTW services. Medicaid and the Childrens Health Insurance Program can provide health care for low-income children and families and long-term services and supports for people with disabilities and seniors. Am I Eligible? A-820, Regular Medicaid Coverage. as soon as possible. Call 2-1-1. State law no longer allows the woman to be covered. Web4.1.5 Newborn Eligibility. Texas Medicaid has a wide variety of programs that help low-income women, families, seniors, and kids stay healthy, including: If you want to help provide health care to low-income women, families, seniors, and kids, you can enroll as a Texas Medicaid provider through the Provider Enrollment and Management System (PEMS). Services include: As a grantee of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), HHSC Breastand Cervical Cancer Services is partly funded through the Centers for Disease Control and Prevention. The main goal of preconception health care is to provide health promotion, counseling, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. Please direct clients to HealthyTexasWomen.org. Texas Medicaid Provider Procedures Manual, Breast and Cervical Cancer Services (BCCS) program, Children's Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Title V Maternal Child Health Fee-For-Service Program, Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Texas Women Program, Family Planning Program | Healthy Texas Women. On April 1, 2023, the state of Texas will begin the process of rechecking Medicaid eligibility for about 2.7 million Texas women and children who currently receive Medicaid coverage. Box 149347Austin, TX 78714-9347Phone: 512-776-7796Fax: 512-776-7203Email: BCCSProgram@hhsc.state.tx.us. CHIP For questions or to find a doctor, call . (Look for the "Go to TexMedConnect" button). Some former individuals on TP 08, TP 43, TP 44, and TP 48 remain eligible for Transitional Program Income Money collected directly by the contractor, subcontractor, or provider for activities covered under the cost reimbursement contract award and revenue from HTW FFS. CDT is provided as is without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Want to talk to someone about healthcare choices available for women with low income? The HHSC Breast and Cervical Cancer Services (BCCS) program offers free breast and cervical cancer screening and diagnostic services throughout Texas to eligible women. This plan should outline the contractors goals to: The plan should be based on an assessment of the needs of the community and contain an evaluation strategy. This Agreement will terminate upon notice if you violate its terms. This mammogram provides more pictures using different angles than a screening mammogram does. Have completed the Medicaid enrollment process through the Texas Medicaid & Healthcare Partnership (TMHP). The site includes research, links to state programs and data related to breast and cervical cancer. Medicaid for Parents and Caretakers. Medicaid Buy-In for Adults. Log into your account or call 2-1-1 and select Option 2. WebTo find out if you can get CHIP Perinatal, apply for Medicaid and we'll determine if you qualify. HHSC contracts with TMHP to process claims for providers. More than 500,000 Texans have lost Medicaid coverage since COVID-era continuous enrollment for the federal health insurance program All rights reserved. Learn More; Apply; I don't have health insurance, and I need family planning services. 4. Annual award determination and reallocation of funds will be based in part on those contractors that leverage a higher percentage for direct services. You must be a U.S. citizen or qualified non-citizen to get Medicaid for Pregnant Women. The purpose of these procedures is to ensure contractors receive proper reimbursement and clients deemed ineligible for HTW are referred to other services for which they may eligible within a timely manner. Revision 13-2; Effective April 1, 2013 A831 Three Months Prior Coverage Revision 15-4; Effective October 1, 2015 Medical Programs except TP 40 Applicants may be eligible for Medicaid coverage during the three-month period before the month they apply for Medical Programs. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. 5:32 PM on Jul 17, 2023 CDT. For example, adults may qualify to receive Medicaid benefits in TX if they have a disability, are pregnant, care for a child, are 65 years of age or older or take part in the Medicaid Buy-In. . This Medicaid eligibility expansion would allow adults who are not parents or caretakers to qualify for Medicaid based on income alone. Applicants can apply online, by mail or in person. BCCS: Benefits. The local government is required to report deviations from budget or project scope or objective and request prior approval from the state awarding agency for budget and program plan revisions. HEALTHY TEXAS WOMEN PROGRAM HANDBOOK MARCH 2021 3 CPT ONLY - COPYRIGHT 2020 AMERICAN MEDICAL ASSOCIATION. If a person forgets their Your Texas Benefits Medicaid card, a provider (i.e., doctor, dentist or pharmacy) can verify Medicaid coverage by: calling the TMHP Contact Center at 800-925-9126; or. These funds may be used for support services that enhance HTW FFS client service delivery. Contraception, except emergency contraception, is provided through a family planning clinic or by prescription at an on-site or local pharmacy. The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid 2 Healthy Texas Women (HTW) Program Overview The goal of HTW is to expand access to womens health and family planning services to reduce unintended pregnancies, positively affect the outcom e of future pregnancies, and There is not a separate provider enrollment process for HTW Plus. The childs mother is eligible for Medicaid or would be eligible if pregnant. An individual is eligible for services beginning the date the contractor determines the individual eligible for the program and signs the completed application. WebEligibility Programs Use this page to see all the resources that might be available to you, then visit the program website to learn how to apply. Individuals in need of treatment for postpartum depression must be referred to a provider of behavioral health services. Around 5 million Texans rely on Medicaid, which mainly provides health coverage for children, but some adults with disabilities and pregnant women can also receive To qualify for Texas Medicaid, candidates must provide accurate and up-to-date information on the application form. The terms contractor and contract may be used interchangeably with grantee and grant in other sources. Please visit our. The contractor is the responsible party even if there is a subcontractor involved who provides the services. Health and Human Services Commission (HHSC) Provides support for the Health and Human Services agencies, administers the states Medicaid and other client service programs, sets policies, defines covered benefits and determines client eligibility for major programs. Texas Medicaid Provider Procedures Manual (TMPPM). First Name is an optional field. That request must include a detailed explanation that supports the need for the fund transfer. To ensure coverage continues if you're eligible, report changes (contact HTW Fee-for-Service Womens health and family planning client services provided through the HTW program on a fee-for-service basis through the Texas Find a Doctor. 2. Talk to your doctor about any over-the-counter medications you may be taking as some of these are not good to take during pregnancy. Preconception health is defined as the state of a woman's health before she becomes pregnant; it focuses on conditions and risk factors that could affect a woman and/or her unborn baby. Contractor An entity that HHSC has contracted with for HTW cost reimbursement activities. To seek reimbursement for these costs, contractors must hold claims at least 45 calendar days from the date of the clients HTW application submission. All services provided must follow the HTW guidelines in the TMPPM. Research, Funding, & Educational Resources, Center for Health Emergency Preparedness & Response, Texas Comprehensive Cancer Control Program, Cancer Resources for Health Professionals, Resources for Cancer Patients, Caregivers and Families, Food Manufacturers, Wholesalers, and Warehouses, Asbestos Hazard Emergency Response Act (AHERA), Emergency Medical Services (EMS) Licensure, National Electronic Disease Surveillance System (NEDSS), Health Care Information Collection (THCIC), Maternal & Child Health (MCH) - Information for Parents of Newborn Children, Position Statement on Infant Feeding, Updated 2010. Some standards for Medicaid benefits eligibility come from They can also order a device from a specialty pharmacy for the client to pick up and bring in for insertion. If a woman becomes pregnant while she is covered by FPP, contractors may bill FPP for allowable services provided in clinical prenatal care visits for women during the Medicaid for Pregnant Women and CHIP Perinatal enrollment processes. Learn about breastfeeding Its never too early to start preparing for breastfeeding. More information on indirect cost rates is available online here. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials. If you are currently enrolled in Medicaid for Pregnant Women, you may be automatically enrolled in the HTW program when your coverage ends. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. The change helped increase the number of Texans on Medicaid from 3.9 million in 2019 to 5.9 million earlier this year. However, to qualify for Medicaid benefits, applicants must meet some basic standards. Contractors must have documented procedures in place for how they will monitor the eligibility status of anticipated eligible clients, and how they will assist clients who are deemed ineligible for HTW. WebUnauthorized access to this site and misuse of its information assets may be prosecuted under Texas State statutes regarding the use of individually identifiable personal health information (PHI) and The United States regulations and laws regarding the use of individually identifiable personal health information (PHI). Texas Health and Human Services Commission (HHSC) provides a continuum of care through an array of womens health and family planning-related services, including Healthy Texas Women (HTW). Before sharing sensitive information, make sure youre on an official government site. In addition to total household income, the size of a household also plays a factor in whether or not a family qualifies for Medicaid and receives assistance. AMA/ADA End User License Agreement If questions arise, clients should contact 866-993-9972 to discuss the status of their application. All rights reserved. Apply for Benefits. Prior coverage may be continuous or there may be interrupted periods as soon as possible. WebThe Healthy Texas Women program offers free women's health and family planning services to eligible, low-income women. WebUnauthorized access to this site and misuse of its information assets may be prosecuted under Texas State statutes regarding the use of individually identifiable personal health Both Form 1080 and Form 1060 should be submitted to HTWContracts@hhs.texas.gov. TDD users can call: 512-424-6597. Webwomens health programs will save the state $12.8 million in General Revenue Funds ($157.8 million in All Funds) by decreasing healthcare costs to the Childrens Health Insurance Program and the Texas Medicaid program. Use this My Family Health Portrait tool to record you and your partners family histories. General Policy, W-510. CDT is a trademark of the ADA. inform the public of the purpose of the program and available services; enhance community understanding of its objectives; disseminate basic family planning and womens health care knowledge. Other health care. You must be a U.S. citizen or qualified non-citizen to get Medicaid for Pregnant Women. HHSC FPP contracted providers must screen all family planning applicants for eligibility in the following programs that provide family planning services, in this order: Once a client is deemed ineligible for Medicaid and HTW, the clinic will determine whether a client is eligible for FPP.
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