Contractors will not be reimbursed for services provided to clients who do not access these alternative assistance programs. Services are often provided to clients whose screening results indicate they are potentially Medicaid, CHIP or CHIP Perinatal eligible, but the client has not yet completed or received notification of acceptance or rejection of an application.
At the start of each contract year, contractors will receive a personalized invoice and reporting workbook for their organization from their contract manager. The workbook is required to be completed and sent monthly to HDS. ADS hhsc. This process leaves the template intact for later use in future months. Each monthly invoice and reporting workbook will cover services provided, or expenses incurred, in a preceding month as applicable to the contract. An important note about the Monthly Activity Report is that this report counts the unduplicated number of clients receiving billable services by age, race and ethnicity on their first visit.
Each client is counted once at the beginning of the fiscal year each September or at the time of their first visit and is not to be counted in that category again. This definition allows an individual client to be counted up to four times within a given fiscal year as they receive different types of services provided by different contract types. A visit is defined as a single complete clinical encounter of a client with a provider. Errors can occur that result in a contractor receiving payment for more services than delivered in a service month or under-billing for services provided.
Errors that result in over-billing can be corrected by subtracting the over-billing from the next month, adjusting all information. Contractors must maintain records that document the necessary information for services provided and billed for reimbursement. Documentation will be audited during HHSC on-site quality assurance reviews and fiscal monitoring reviews. Contractors must continue to submit the monthly invoice and reporting workbook even after contract ceilings have been reached.
Contractors may have claims after the submission of their August billing. You may claim any additional services by submission of an invoice and reporting workbook prior to October All claims for reimbursement for services delivered must be submitted within 45 days of the end of the contract term as HHSC Title V MCH FFS contracts require closure of the contract attachment within 45 days of the end of the contract term. Reimbursement requests submitted more than 45 days following the end of the contract term will not be paid.
The FRR must include all reimbursements and adjustments in payment for the contract term and be submitted within 60 days of the completion of the contract year, i. None of the billing or the reporting forms may be altered in any manner.
The log should contain at least the clients name, date of service and procedure code for each service billed. Box Austin, TX Helpline 8 a. Title V MCH Fee-for-Service contractors provide services intending to: Significantly reducing infant mortality; Providing comprehensive care for women before, during, and after pregnancy and childbirth; and Providing preventive and primary care services for infants, children and adolescents.
Provider — An individual clinician or group of clinicians who provide services. Revision ; Effective December 18, This section assists the contractor in conducting administrative activities such as assuring client access to services and managing client records. The contractor must: Have a policy in place that delineates the timely provision of services.
Have policies in place to identify and eliminate possible barriers to client care. Have a policy in place that requires qualified staff to assess and prioritize client needs. Provide referral resources for individuals who cannot be served or cannot receive a specific needed service. Child Abuse Reporting, Compliance and Monitoring Contractors are required to develop policies and procedures that comply with the child abuse reporting guidelines and requirements set forth in Chapter of the Texas Family Code.
Contractors must develop an internal policy specific to: How child abuse reporting requirements will be implemented throughout their agency; How staff will be trained; and How internal monitoring will be done to ensure timely reporting. During Quality Assurance QA monitoring, the following procedures will be utilized to evaluate compliance: The contractor's process to ensure that staff is reporting child abuse as required by Chapter To verify compliance, contract monitors will review that the contractor: Has an internal policy which details how the contractor will determine, document, report and track instances of abuse, sexual or non-sexual, for all individuals under the age of 17 in compliance with Texas Family Code, Chapter ; Followed their internal policy; and Has documented staff training on child abuse reporting requirements and procedures.
Human Trafficking HHSC mandates that contractors comply with state laws governing the reporting of abuse and neglect. References for human trafficking policy development: Texas Human Trafficking Resource Center website Human trafficking into and within the United States: A review of the literature on human trafficking in the U.
Minors and Confidentiality Except as permitted by law, a provider is legally required to maintain the confidentiality of care provided to a minor. Termination of Services A qualifying individual must never be denied services due to an inability to pay. Resolution of Complaints Contractors must ensure that clients can express concerns about care received and to further ensure that those complaints are handled in a consistent manner.
The records must be kept confidential and secure, as follows: Safeguarded against loss and use by unauthorized persons; Secured by lock when not in use or inaccessible to unauthorized persons; and Maintained in a secure environment in the facility, as well as during transfer between clinics and in between home and office visits.
Hazardous Materials Contractors must have written policies and procedures that address: The handling, storage, and disposing of hazardous materials and waste according to applicable laws and regulations; The handling, storage, and disposing of chemical and infectious waste including sharps; and An orientation and education program for personnel who manage or have contact with hazardous materials and waste.
Fire Safety Contractors must have a written fire safety policy that includes a schedule for testing and maintenance of fire safety equipment.
Medical Equipment Contractors must have a written policy and maintain documentation of the maintenance, testing and inspection of medical equipment including the Automated External Defibrillator AED. Documentation must include: Assessments of the clinical and physical risks of equipment through inspection, testing and maintenance; Reports of any equipment management problems, failures and use errors; An orientation and education program for personnel who use medical equipment; and Manufacturer recommendations for care and use of medical equipment.
Smoking Ban Contractors must have written policies that prohibit smoking in any portion of their indoor facilities. Disaster Response Plan Contractors must have written and oral plans that address how staff must respond to emergency situations i.
Each site must have staff trained in basic cardiopulmonary resuscitation CPR and emergency medical action. Staff trained in CPR must be present during all hours of clinic operations. There must be written protocols to address vaso-vagal reactions, anaphylaxis, syncope, cardiac arrest, shock, hemorrhage and respiratory difficulties.
Each site must maintain emergency resuscitative drugs, supplies, and equipment appropriate to the services provided at that site and appropriately trained staff when clients are present. Documentation must be maintained in personnel files that staff has been trained regarding these written plans or protocols. Emergency Preparedness There must be a written safety plan that includes maintenance of fire safety equipment, an emergency evacuation plan and a disaster response plan.
Contractors are expected to develop quality processes based on four core QM principles that focus on: The client; Systems and processes; Measurement; and Teamwork. The QM Committee must meet at least quarterly to: Receive reports of monitoring activities; Make decisions based on the analysis of data collected; Determine quality improvement actions to be implemented; and Reassess outcomes and goal achievement. HHSC contractors who subcontract for the provision of services must also address how quality will be evaluated and how compliance with policies and basic standards will be assessed with the subcontracting entities, including: Annual license verification primary source verification ; Clinical record review; Eligibility and billing review; On-site facility review; Annual client satisfaction evaluation process; and Child abuse training and reporting for subcontractor staff.
Revision ; Effective December 18, This section provides policy requirements for eligibility, client services community activities and clinical guidelines. Procedures and Terminology When Determining Title V MCH FFS Eligibility Household 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.
Eligibility will end on the last day of the month the child becomes 18 years of age unless the child is: A full-time high school student as defined by the school, attends an accredited GED class or regularly attends vocational or technical training in place of high school; and Expected to graduate from one of the above before or during the month of his or her 19th birthday.
Legal responsibility for support exists between: Persons who are legally married including common-law marriage ; A legal parent and a minor child including unborn children ; or A managing conservator and a minor child. A managing conservator is a person designated by a court to have daily legal responsibility for a child. Documentation of Family Composition If family relationships appear questionable, one of the following items shall be requested: Birth certificate; Baptismal certificate; School records; or Other documents or proof of family relationship determined valid by the contractor to establish the dependency of the family member upon the client or head of household.
Documentation of Residency To be eligible for Title V MCH FFS services, an individual must be physically present within the geographic boundaries of Texas and: Have the intent to remain within the state, whether permanently or for an indefinite period; Not claim residency in any other state or country; or If an individual is less than 18 years of age, a parent, managing conservator, care taker or guardian is a resident of Texas as defined above.
Individuals described below are not eligible to receive Title V MCH FFS services: Inmates of correctional facilities; Residents of state schools or federal schools; and Patients in federal institutions or state psychiatric hospitals. If none of the listed items are available, residence may be verified through: Observance of personal effects and living arrangement; or Statements from landlords, neighbors or other reliable sources.
Income All income received must be included. Income Deductions Dependent care expenses shall be deducted from total income in determining eligibility.
Monthly Income Conversions If income payments are received in lump sums or at longer intervals than monthly, such as seasonal employment, the income is prorated over the period the income is expected to cover.
Income received weekly, every two weeks or twice a month must be converted as follows: Weekly income is multiplied by 4. Statements of Support Unless the person providing the support to the individual is present during the interview and has acceptable documentation of identity, a statement of support will be required. Decision Pended If eligibility cannot be determined because components that pertain to the eligibility criteria are missing, the contractor may issue Form , Office of Primary and Specialty Health Request for Information.
Individuals who are assessed a co-pay should be presented with the bill at the time of service. Clients who declare an inability to pay a co-pay shall not be denied services, have an account with an outstanding balance turned over to a collection agency or reported delinquent to a credit reporting agency. Revision ; Effective September 15, This section describes the requirements and recommendations for contractors pertaining to the delivery of direct clinical services to clients.
Texas Medical Disclosure Panel Consent The Texas Medical Disclosure Panel TMDP was established by the Texas Legislature to: determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to their patients or persons authorized to consent for their patients; and establish the general form and substance of such disclosure.
Consent for Services Provided to Minors Generally, a parent must consent to treatment for minors. Client Health Records and Documentation of Encounters Providers must ensure that a patient health record is established for every individual who receives clinical services. Stamped signatures are not allowable. Readily accessible to assure continuity of care and availability to clients; and Systematically organized to allow easy documentation and prompt retrieval of information.
If the patient has no known allergies, this should be listed. Case Management Title V case management is for all pregnant women and infants under 1 year of age who have a need for health-related services.
Referral and Follow-Up Contractors must have written policies and procedures for follow-up on referrals that are made because of abnormal physical examination or laboratory test findings. When a client is referred to another resource because of an abnormal finding or for emergency clinical care, the contractor must: Plan for the provision of pertinent client information to the referral resource obtaining required client consent with appropriate safeguards to ensure confidentiality, i.
Perinatal Laboratory and Other Diagnostic Tests All initial and return prenatal visits must include appropriate laboratory and diagnostic tests, as indicated by weeks of gestation and clinical assessment. Contractors must have written plans to address laboratory and other diagnostic test orders, results and follow-up to include: Tracking and documentation of tests ordered and performed for each patient; Tracking of test results and documentation in patient records; and A mechanism to address abnormal results, facilitate continuity of care and assure confidentiality, adhering to HIPAA regulations i.
Non-Stress Test NST Fetal well-being assessment to be performed in the presence of identified risk factors, as indicated, once a viable gestational age has been reached. Perinatal Dental Services Providers are expected to follow rules and regulations established by the Dental Practice Act. These include: Comprehensive and periodic oral evaluations; Radiographs; and Preventive and therapeutic dental services.
Space maintainers are designed to prevent tooth movement and may be a benefit in the following situations: After premature loss of deciduous or primary tooth first or second molar s tooth identification TID : A, B, I and J for clients who are one through 12 years of age procedure codes D, D After premature loss of deciduous or primary tooth, first or second molar s TID: K, L, S and T for clients who are one through 12 years of age procedure codes D, D After loss of a permanent first molar s TID: 3 and 14 for clients who are 3 years of age or older procedure code D After loss of a permanent first molar s TID: 19 and 30 for clients who are 3 years of age or older procedure codes D, D The following age restrictions and limitations will be enforced during quality reviews: D is a benefit for clients 6 years of age or older.
D is a benefit for clients 13 years of age or older. D and D are a benefit for clients 12 years of age or older. Direct restoration of a primary tooth through the use of a prefabricated crown is a once in a lifetime restoration, same TID, any provider. Exceptions may be considered when pretreatment X-ray images, intra-oral photos and narrative documentation clearly support the medical necessity for the replacement of the prefabricated crown D, D, D Dental Examination All dental visits must include an oral examination.
Resource DSHS Oral Health Improvement Program Perinatal Education and Counseling Services Contractors must have written plans for patient education that include goals and content outlines to ensure consistency and accuracy of information provided, and that identify mechanisms used to ensure patient understanding of the information. Tobacco Assessment and Quit Line Referral All women receiving prenatal services should be assessed for tobacco use.
State-Mandated Education Information for Parents of Newborns Requirement Chapter , Health and Safety Code, Subchapter T requires hospitals, birthing centers, physicians, nurse-midwives, and midwives who provide prenatal care to pregnant women during gestation or at delivery to provide the woman and the father of the infant or other adult caregiver for the infant with a resource pamphlet that includes information on postpartum depression, shaken baby syndrome, immunizations, newborn screening, pertussis and sudden infant death syndrome.
Someday Starts Now — Website that offers tools for health care providers to help patients make healthy decisions today so they can be ready for a baby in the future. Common questions asked by parents. Related Links. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website's privacy policy when you follow the link. Program Operations Manual means the operations manual of the Program , most recently updated on October 24, , and to be updated in accordance with Section I. Operations Manual means a manual containing procedures, instructions and guidance for use by operational personnel in the execution of their duties;.
Program services means services that include all of the following provided they are pursuant to a program agreement: program needs assessment and development, job task analysis, curriculum development and revision, instruction, instructional materials and supplies, computer software and upgrades, instructional support, administrative and student services, related school to career training programs, skill or career interest assessment services and testing and contracted services.
Operating Manual means the document that contains the procedures and forms for the operation of bungee jumping equipment and activity at a site. Project Implementation Manual means the manual adopted by the Recipient through the PCU on November 30, , for the purposes of defining the detailed implementation arrangements for the Project, and setting forth, inter alia: i the detailed Project staffing plan for each stakeholder; ii the Project monitoring and evaluation modalities; and iii the terms, procedures and conditions for the initial management and operation of the national CARG scheme, as the same may be amended from time to time with the agreement of the Association.
Project Manual means the volume usually assembled for the Work which may include the bidding requirements, sample forms, and other Contract Documents.
Cdc immunization program operations manual. Number of Pages: Pages. The BC Immunization Manual is updated regularly. The updated version of a section is published immediately on this page.
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