2100, Program Authorization and Services

Revision 23-4; Effective Nov. 17, 2023

HHSC Family Planning Program Overview 

The Texas Health and Human Services Commission (HHSC) Family Planning Program (FPP) provides comprehensive family planning and related health services throughout the state to reduce unintended pregnancies, positively affect future pregnancies and improve the health status of low-income women and men.

Rules

State rules governing the FPP can be found in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 382, Subchapter B

Federal rules for Medicaid are located under Title XIX, Social Security Act, 42 USC Section 1396-1396v et. seq. Grants to States for Medical Assistance Programs

Funding Sources

All HHSC FPP grantees and subgrantees are required to be enrolled providers of services to Medicaid-eligible women and men.

FPP services are funded by state general revenue and federal Temporary Assistance for Needy Families (TANF) to Title XX funds.

2200, Definitions

Revision 23-4; Effective Nov. 17, 2023

The following words and terms, when used in this manual, have the following meanings:

Barrier to Care—A factor that hinders a person from receiving health care. For example, distance, lack of transportation, documentation requirements and copayment amount.

Class D (Clinic) Pharmacy License – A pharmacy license issued to a pharmacy to dispense limited types of drug or devices under a prescription drug order. Information to apply for a Class D Pharmacy License may be found on the Texas State Board of Pharmacy’s website.

Client – A person who has been screened and determined to be eligible for the program. The term client and patient may be used interchangeably in other sources.

Compass 21 – Texas Medicaid & Healthcare Partnership’s automated claims processing system used to process claims for services delivered to HHSC FPP and Medicaid.

Consultation – A type of service provided by a health care provider with expertise in a medical or surgical specialty and who, upon request of another appropriate health care provider, assists with the evaluation or management of a client.

Contraception – The means of pregnancy prevention, including permanent and temporary methods.

Contraceptive Methods – A broad range of birth control options, approved by the U.S. Food and Drug Administration, except for emergency contraception.

Copay or Copayment – Money collected directly from clients for services.

Cost Reimbursement – Funding used to develop and maintain grantee infrastructure for the provision of family planning services.

Diagnosis – The recognition of disease status determined by evaluating the history of the client and the disease process, and the signs and symptoms present. Determining the diagnosis may require some or all the following: microscopic (culture), chemical (blood tests), radiological examinations (X-rays). 

Eligibility Date – Date the grantee or program administrator determines a person becomes eligible for the program.

Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select how this may be achieved. 

Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, this level is determined by the Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.

Fee-for-Service – Payment mechanism for services that are reimbursed on a set rate per unit of service (also known as unit rate). 

Fiscal Year – The state fiscal year is from Sept. 1 through Aug. 31.

Grantee – A non-state entity that receives an award directly from a state awarding agency to carry out an activity under a state program. The term grantee does not include subgrantees.  

Health and Human Services Commission (HHSC) –The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.

Health Care Provider – A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory or rural health center. “Health care provider” is used interchangeably with “provider” throughout this manual.

Healthy Texas Women (HTW) – A Medicaid waiver program administered by HHSC to provide uninsured women with women’s health and family planning services such as women’s health exams, health screenings and birth control. HTW providers must provide client services on a fee-for-service basis and may also, but are not required to, contract with HHSC to provide support services that enhance the HTW fee-for-service client delivery on a cost reimbursement basis. 

Informed Consent – The process by which a health care provider ensures that the benefits and risks of a diagnostic or treatment plan, the benefits and risks of other options, and the benefits and risks of taking no action are explained to a client in a manner that is understandable to that client and allows the person to participate and make sound decisions about her or his own medical care.

Inreach Activities – Activities conducted with the purpose of informing and educating existing clients within an organization about services they are not receiving but may be eligible to receive.

Intimate Partner Violence (IPV) – Physical, sexual or psychological harm by a current or former partner or spouse. IPV may also be referred to as domestic violence or family violence.

Long-Acting Reversible Contraceptives (LARCs) – Methods of contraception that are effective for an extended period without requiring user action. LARCs include intrauterine devices (IUDs) and subdermal contraceptive implants.

Medicaid –The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 subject to Title XIX of the Social Security Act, 42 U.S.C. Section1396, et seq. Reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Minor –In accordance with the Texas Family Code, a person under 18 years old who is not and has not been married or who has not had the disabilities of minority removed for general purposes (i.e., emancipated). In this policy manual, “minor” and “child” may be used interchangeably.

Monthly Voucher Packet – Required forms (B-13X, 4116 and Data Management) to request reimbursement for the categorical contract.

Outreach – Activities that are conducted with the purpose of informing and educating the community about services and increasing the number of people served.

Program Income – Money that is collected directly by the grantee, subgrantee or provider for services provided under the contract award (client copay fees and donations).

Referral – The process of directing or redirecting a medical case or a person to an appropriate specialist or agency for information, help or treatment.

Reproductive Life Plan – A plan that outlines an individual’s personal goals regarding whether to have children, the desired number of children, and the best timing and spacing of children. Counseling should include the importance of developing a reproductive life plan and information about reproductive health, family planning methods and services, and how to obtain preconception health services, as needed.

Subgrantee: A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program; but does not include an individual that is a beneficiary of such a program. A subgrantee may also be a grantee of other state awards directly from a state awarding agency. A subgrantee may also be referred to as a subrecipient.

Texas Medicaid & Healthcare Partnership (TMHP) – The Texas Medicaid Claims and Primary Care Case Management administrator. HHSC contracts with TMHP to process claims for providers.