Revision 19-0; Effective September 1, 2019

 

This section provides policy requirements for submitting reimbursement, data collection and required reports.

 

4100 Reimbursement

Revision 19-0; Effective September 1, 2019

 

 

 

4110 Provider Reimbursement Criteria

Revision 19-0; Effective September 1, 2019

 

To be reimbursed for HTW fee-for-service, the following eligibility requirements must be met:

  • Must be a Medicaid (Title XIX) provider in accordance with 1 Texas Administrative Code Chapter 352.
  • Must have completed the HTW certification process through the Texas Medicaid & Healthcare Partnership (TMHP) portal attesting that they do not perform or promote elective abortions and are not affiliated with an entity that performs or promotes elective abortions.

Providers can complete the certification in one of the following ways:

  • Existing Medicaid providers can complete the certification process through their TMHP portal account.
  • Providers that are not already enrolled in Texas Medicaid can complete the HTW certification process as part of the provider enrollment process or as part of the paper Texas Medicaid Provider Enrollment Application.
  • Annual recertification is required for all HTW providers.

Per Texas Administrative Code, Title 1, Part 15, Chapter 382, Subchapter A, Rule §382.5, providers must not perform or promote elective abortions outside the scope of HTW and must not be an affiliate of an entity that performs or promotes elective abortions. In offering or performing an HTW service, the respondent must not promote elective abortion within the scope of HTW and must maintain physical and financial separation between its HTW activities and any elective abortion-performing or abortion-promoting activity, as evidenced by the following:

  • Physical separation of HTW services from any elective abortion activities, no matter what entity is responsible for the activities.
  • A governing board or other body that controls the HTW health care provider has no board members who are also members of the governing board of an entity that performs or promotes elective abortions.
  • Accounting records that confirm that none of the funds used to pay for HTW services directly or indirectly support the performance or promotion of elective abortions by an affiliate.
  • Display of signs and other media that identify HTW and the absence of signs or materials promoting elective abortion in the provider's location or in the provider's public electronic communications.
  • Does not use, display or operate under a brand name, trademark, service mark, or registered identification mark of an organization that performs or promotes elective abortions.

The term “promote” used here means advancing, furthering, advocating or popularizing elective abortion by, for example:

  • Taking affirmative action to secure elective abortion services for an HTW client (such as making an appointment, obtaining consent for the elective abortion, arranging for transportation, negotiating a reduction in an elective abortion provider fee, or arranging or scheduling an elective abortion procedure); however, the term does not include providing upon the patient's request neutral, factual information and nondirective counseling, including the name, address, telephone number and other relevant information about a provider.
  • Furnishing or displaying to an HTW client information that publicizes or advertises an elective abortion service or provider.
  • Using, displaying or operating under a brand name, trademark, service mark, or registered identification mark of an organization that performs or promotes elective abortions.

When enrolling as a Title XIX provider, Clinical Laboratory Improvement Amendments (CLIA) information must be provided. For public health agencies that provide limited numbers of tests, one CLIA certificate is all that is required for all clinics. Note: Based on the type of CLIA certificate a provider has, certain procedure codes may or may not be reimbursed. Visit the Clinical Laboratory Improvement Amendments (CLIA) website for more information.

Failure to comply with these requirements will result in contract termination.

 

4120 Provider Identifiers

Revision 19-0; Effective September 1, 2019

 

When a contractor’s Medicaid application is approved, TMHP assigns the contractor a nine-digit Texas Provider Identifier (TPI). Contractors must have a unique TPI for each clinical service site.

Contractors must submit claims to TMHP using the billing TPI where clinical services are rendered. Contractors must not provide women’s health and family planning services at one clinic site and bill those services to TMHP using the TPI of a different clinic site. If an additional TPI clinic site is required, providers must contact TMHP and complete the enrollment process.    

The TPI is used in conjunction with a National Provider Identifier (NPI) to identify the provider for claims processing. An NPI is a 10-digit number assigned randomly by the National Plan and Provider Numeration System (NPPES). Contractors may apply for a NPI at the NPPES website.

When a provider obtains their NPI, they are required to attest to NPI data for each of their current TPI. For more information on NPI and the attestation process, visit the TMHP website.

 

4130 Texas Medicaid Provider Procedures Manual

Revision 19-0; Effective September 1, 2019

 

The Texas Medicaid Provider Procedures Manual (TMPPM) includes information related to HHSC HTW fee-for-service program claims submission. In addition, Medicaid bulletins and Remittance and Status (R&S) banner messages provide up-to-date claims filing and payment information. The R&S banner messages and TMPPM are all available on the TMHP website.

 

4140 Reimbursement for Healthy Texas Women Services

Revision 19-0; Effective September 1, 2019

 

HTW contractors may seek reimbursement for project costs by submitting monthly vouchers for expenses outlined in a categorical budget approved by HHSC, as required for the categorical cost reimbursement method.

 

Cost Reimbursement

HHSC HTW Cost Reimbursement Program funding is used for support services that enhance services provided by the contractor to a client under the HTW Fee-for-Service Program. Support services include, but are not limited to:  

  • Assisting eligible women with enrollment into the HTW Program;
  • Direct clinical care for women deemed presumptively eligible for the HTW Fee-for-Service Program;
  • Staff development and training related to HTW Program service delivery; and
  • Client and community based educational activities related to the HTW Program. Costs may be assessed against any of the following categories the contractor identifies during their budget development process:
    • personnel;
    • fringe benefits;
    • travel;
    • equipment and supplies;
    • contractual;
    • other; and
    • indirect costs.

Note: Indirect costs are costs incurred for a common or joint purpose benefiting more than one project or cost objective of the respondent’s organization and not readily identified with a particular project or cost objective. Typical examples of indirect costs may include general administration and general expenses, such as salaries and expenses of executive officers, personnel administration and accounting; depreciation or use allowances on buildings and equipment; and costs of operating and maintaining facilities.

Long-Acting Reversible Contraception (LARC) devices, such as IUDs and contraceptive implants, may be purchased in bulk using categorical dollars and should be accounted for in the “equipment and supplies” section of a contractor’s budget. The contractor will bill TMHP for the insertion of the LARC device only when issued to a patient.

Reimbursement is requested by using a purchase voucher and supporting schedule.  Vouchers and supporting documentation must be submitted monthly within 30 days following the end of the month in which the costs were incurred.

To request reimbursement for the categorical contract, the following forms must be submitted monthly within 30 days following the end of the month in which the costs were incurred:

  • Form 4116 , State of Texas Purchase Voucher; and
  • Internal Form 1811, Healthy Texas Women Supporting Schedule for Reimbursement Vouchers (previously Form B13-H).

The following forms must be submitted within 45 days following the end of the contract term:

  • Final Form 4116 , State of Texas Purchase Voucher; and
  • Final Form 1811, Healthy Texas Women Supporting Schedule for Reimbursement Vouchers.

The Client Services Contracting Unit (CSCU) website provides necessary financial forms.

 

HTW Claims Pending Eligibility Determination

Contractors must hold claims up to 45 calendar days for clients who were screened as presumptively eligible and have applied to HTW. If a client’s HTW eligibility has not been determined after 45 calendar days, the contractor may bill the service to the HHSC HTW Cost Reimbursement Program if the client has a current eligibility form on file. If the contractor files an HHSC HTW Cost Reimbursement Program claim for a potentially HTW-eligible client before the end of the 45-day waiting period, the contractor must include a copy of the client’s HTW denial letter in the client record before filing the claim or encounter.  

 

IUD and Contraceptive Implant Complications

Contractors may request reimbursement for costs associated with patient complications related to IUD or contraceptive implant insertions or removals. Contractors may be reimbursed for approved charges up to $1,000 per occurrence. To request reimbursement, contractors should provide the HHSC HTW Program with the following information:

  • A copy of the R&S report showing that an IUD or contraceptive implant insertion or removal procedure was performed on the client in question;
  • A narrative summary detailing the procedure performed and any related complications;
  • All surgical and progress notes for the client related to the complication of the IUD or contraceptive implant insertion or removal procedure; and
  • A completed CMS 1500 Claim Form or a 2017 Family Planning Claim Form detailing the procedures for which the contractor is seeking reimbursement (list all procedures related to the complication even if they are not typically reimbursable under the HHSC HTW Program).

 

4150 Retroactive Eligibility

Revision 19-0; Effective September 1, 2019

 

Title XIX Retroactive Eligibility

Retroactive eligibility occurs when a client has applied for Medicaid coverage but has not yet been assigned a Medicaid client number at the time of service. Clients who are eligible for Title XIX (Medicaid) medical assistance receive three months prior eligibility to cover any medical expenses incurred during that period.

 

4200 Data Collection and Reporting

Revision 19-0; Effective September 1, 2019

 

 

 

4210 Required Reports

Revision 19-0; Effective September 1, 2019

 

Financial Reporting

Voucher and Report Submission

Program Information:

Program Name: HHSC Healthy Texas Women

Contract Type: Categorical

Contract Term: September 1 thru August 31

Voucher:  Voucher 1

Voucher Name: Form 4116, State of Texas Purchase Voucher.

Submission Date: By the last business day of the following month. Final voucher due within 45 days after end of the contract term.

Submit Copy to:

Name of Unit/Branch Original Signature Required Accepted Method of Submission No. of Copies
  Yes No    
Women's Health & Educational
Services Mailbox:
WHSFinance@hhsc.state.tx.us
Instructions: Attach internal Form 1811, Healthy Texas Women Supporting Schedule for Reimbursement Vouchers (previously B13-H) to voucher Form 4116.
  X Email (preferred) or Fax 1

 

Note: Vouchers must be submitted each month even if there are zero expenditures. Vouchers must still be submitted each month for actual expenditures of the program even if the contract limit has been reached.  

Voucher: Report 1 Supporting

Report Name: Form 1811, Healthy Texas Women Supporting Schedule for Reimbursement Vouchers.

Submission Date: By the last business day of the following month. Final Form 1811 due within 45 days after end of the contract term.

Submit Copy to:

Name of Unit/Branch Original Signature Required Accepted Method of Submission No. of Copies
  Yes No    
Women's Health & Educational
Services Mailbox:
WHSFinance@hhsc.state.tx.us
Instructions: Attach Form 1811 to Form 4116.
  X Email (preferred) or Fax 1

 

Financial Report: Report 1

Report Name: Financial Status Report Form 269A

Submission Date: Reports are due throughout the current State Fiscal Year as follows: Quarter 1: September 1 through November 30; Quarter 2: December 1 through February 28/29; Quarter 3: March 1 through May 31; Quarter 4: June 1 through August 31. Submit 30 days after the end of each quarter. The final quarterly FSR is due 45 days after the end of the contract term. The final quarter report includes all final charges and expenses associated with the categorical program contract. Mark it as "Final."

Submit Copy to:

Name of Unit/Branch Original Signature Required Accepted Method of Submission No. of Copies
  Yes No    
Women's Health & Educational
Services Mailbox:
WHSFinance@hhsc.state.tx.us
Instructions: Form 269A must have an original signature (scanned email or fax accepted).
X   Email (preferred) or Fax 1

 

Financial Status Reports (FSRs) for Categorical HTW Contracts

The HHSC HTW Program operates using the fee-for-service (FFS) award, and not categorical award. All revenue directly generated by FFS reimbursement (not including the FFS reimbursement) is considered program income on the quarterly FSRs. HTW contractors are required to identify and report receipt and expenditure of any program income quarterly and annually on the FSR Form 269a. See quarters for categorical FSR submission below. Program income and FFS funds (services delivered) must be expended each month, prior to invoicing HHSC for allowable program expenditures reimbursement by categorical funds.

The quarterly reports are due 30 days following the end of each quarter of the contract term. The final FSR, Form 269A, is due within 45 days after the end of the contract term, unless stipulated differently in the contract attachment following the end of the contract term. HHSC reserves the right to base funding levels, in part, upon the contractor’s proficiency in identifying, billing, collecting and reporting income, and in utilizing it for the delivery of family planning services.

Quarters for Categorical FSR submission:

Quarter 1: September through November
Quarter 2: December through February
Quarter 3: March through May
Quarter 4: June through August

HTW Categorical Budget Revisions

Contractors may shift up to 10% of their total HTW categorical direct budget between categories, except equipment, without prior approval. However, if the amount being shifted is greater than 10 percent of the contractor’s total budget, the contractor must receive prior approval from HHSC. In such case, contractors are required to submit a revised budget for review.

Programmatic Reporting

Contractors must complete requested reports in accordance with the contract.