Revision 19-0; Effective July 1, 2019

 

 

1100 Purpose and Program Background

Revision 19-0; Effective July 1, 2019

 

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

Medicaid Title XIX of the Social Security Act was created by Congress in 1965. All agencies that receive HHSC FPP funding are required to be enrolled providers of services to Medicaid-eligible women and men. (Federal regulation citation: Title XIX, Social Security Act, [42 USC § 1396-1396v et. seq.] Grants to States for Medical Assistance Programs).

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

The state rules that apply most specifically to FPP services in Texas are found in the Texas Administrative Code (TAC), Title 1, Part 15, Chapter 382, Subchapter B.

 

1110 Purpose of FPP Policy Manual

Revision 19-0; Effective July 1, 2019

 

The Family Planning Program Policy Manual is a guide for contractors who deliver HHSC FPP services in Texas. FPP providers must also follow policies and procedures as established by the Texas Medicaid Program in the Texas Medicaid Provider Procedures Manual (TMPPM).

Federal and state laws related to reporting of child abuse, operation of health facilities, professional practice, insurance coverage and similar topics also impact family planning services. Contractors are required to be aware of, and comply with, existing laws. 

Family planning contractors also must be in compliance with the DSHS Standards for Public Health Clinic Services. For additional information about HHSC FPP services, access the HHSC Family Planning Program website.

 

1200 Definitions

Revision 19-0; Effective July 1, 2019

 

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

Class D Pharmacy License – A pharmacy license issued to a pharmacy to dispense a limited type of drug or devices under a prescription drug order (e.g., XYZ Health Clinic). Information to apply for a Class D Pharmacy License may be found at: http://www.tsbp.state.tx.us/files_pdf/INSTRUCTIONS_CLASS_D_PHY.pdf.

Client – An individual who has been screened and been determined to be eligible for the program.

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

Confidentiality – The state of keeping information private and not sharing it without permission.

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 and/or management of a patient.

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

Contraceptive Method – Any birth control option approved by the United States Food and Drug Administration, except for emergency contraception.

Contractor Any entity that HHSC has contracted with to provide services. The contractor is the responsible entity even if there is a subcontractor involved who implements the services.

Co-pay or Co-payment – Money collected directly from clients for services.

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

Elective Abortion – The intentional termination of a pregnancy by an attending physician who knows that the female is pregnant, using any means that is reasonably likely to cause the death of the fetus. The term does not include the use of any such means to terminate a pregnancy that resulted from an act of rape or incest; in a case which a female suffers from a physical disorder, physical disability or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy, that would, as certified by a physician, place the female in danger of death or risk of substantial impairment of a major bodily function unless an abortion is performed; or in a case in which a fetus has a life-threatening physical condition that, in reasonable medical judgement, regardless of the provision of life-saving treatment, is incompatible with life outside the womb.

Eligibility Date – The date the contractor determines an individual eligible for the program. The eligibility expiration date will be twelve months after the eligibility date.

Family Planning Services – Educational or comprehensive medical services that assist women and men to plan their families, whether it is to achieve, postpone or prevent pregnancy. If a woman chooses to become pregnant, Family Planning Services can enable the individual to determine freely the number and spacing of her children and how this may be achieved. Services include, but are not limited to, contraceptive and preconception health services (e.g., health screening for obesity, smoking and mental health), counseling/education, pregnancy testing (if indicated), and health history, physical examinations, lab tests, STI/STD screening and services (including HIV/AIDS).

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 form of poverty guidelines. Public assistance programs, such as Medicaid, define eligibility income limits as some 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 – State fiscal year from September 1 through August 31.

Health and Human Services Commission (HHSC) – State agency with administration and oversight responsibilities for designated HHSC agencies.

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 Service Region (HSR) – Counties grouped within specified geographic service areas throughout the state.

Healthy Texas Women (HTW) – A state-funded 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.

Household – For the purpose of eligibility determination, the household consists of a person living alone or a group of two or more persons related by birth, marriage (including common law) or adoption, who reside together and are legally responsible for the support of the other person. If an unmarried applicant lives with a partner, only count the partner’s income and children as part of the household group if the applicant and his or her partner have mutual children together. Unborn children should also be included. Treat individuals who are 18 years of age as adults. No children aged 18 and older or other adults living in the home should be counted as part of the household group.

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 patient in a manner that is understandable to that patient and allows the person to participate and make sound decisions regarding her or his own medical care.

Intended Pregnancy – Pregnancy a woman reports as timed well or desired at the time of conception.

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 birth control that provide effective contraception 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 for in Texas Human Resources Code Chapter 32 and subject to Title XIX of the Social Security Act (42 U.S.C. §1396 et seq.). Medicaid reimburses for health care services delivered to low-income individuals who meet eligibility guidelines.

Minor – In Texas, a minor is a person under 18 years of age who has never been married and never been declared an adult by a court (emancipated). (See Texas Family Code Section 101.003.)

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

Program Income – Monies collected directly by the contractor or provider for services provided under the contract award (i.e., reimbursements from the fee-for-service contract, patient co-pay fees and donations).

Provider – An individual clinician or group of clinicians who provide services.

Referral – The process of directing or redirecting (as 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 optimal 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 obtaining preconception health services, as appropriate.

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

 

1300 Acronyms

Revision 19-0; Effective July 1, 2019

 

ADA Americans with Disabilities Act
AMA American Medical Association
A/R Accounts Receivable
BCCS Breast and Cervical Cancer Services
CBE Clinical Breast Exam
CDC Centers for Disease Control and Prevention
CHIP Children’s Health Insurance Program
CPT Current Procedural Terminology
DES Diethylstilbestrol
EOB Explanation of Benefit
EDI Electronic Data Interchange
FPP Family Planning Program
FPL Federal Poverty Level
FRR Financial Reconciliation Report
FSR Financial Status Report
HHSC Texas Health and Human Services Commission
HIPAA Health Insurance Portability and Accountability Act
HIV Human Immunodeficiency Virus
HPV Human Papilloma Virus
HSV Herpes Simplex Virus
HTW Healthy Texas Women
IRB Institutional Review Board
IUD Intrauterine Device
LARC Long-Acting Reversible Contraceptive
LEP Limited English Proficiency
NPI National Provider Identifier
NPPES National Plan and Provider Numeration System
PDPT Patient-Delivered Partner Therapy
QA Quality Assurance
QM Quality Management
PAA Prescriptive Authority Agreement
SDO Standing Delegation Orders
STD Sexually Transmitted Disease
STI Sexually Transmitted Infection
TAC Texas Administrative Code
TANF Temporary Assistance for Needy Families
TMHP Texas Medicaid & Healthcare Partnership
TMPPM Texas Medicaid Provider Procedures Manual
TPI Texas Provider Identifier
WIC Special Supplemental Nutrition Program for Women, Infants and Children