Revision 24-1; Effective May 1, 2024

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.

Birth Control—The means of pregnancy prevention, which includes permanent and temporary methods.

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 (PDF).

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 given by a health care provider with expertise in a medical or surgical specialty. When another appropriate health care provider requests assistance, helps with the evaluation or management of a client.

Contraception – Refer to Birth Control above.

Contraceptive Methods – A broad range of birth control options, that are approved by the U.S. Food and Drug Administration.

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 or culture;
• chemical or blood tests; and
• radiological examinations or 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 a family needs for food, clothing, transportation, shelter and other necessities. In the United States the Department of Health and Human Services determines this level. FPL varies by 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. This is 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. The program provides 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. They may also contract with HHSC to give support services that enhance the HTW fee-for-service client delivery on a cost reimbursement basis. This is not required. 

Informed Consent – The process a health care provider uses to ensure that the following are explained to a client in an understandable way allowing the person to participate and make sound decisions about her or his own medical care. The benefits and risks of: 

• a diagnostic or treatment plan;
• other options; and 
• taking no action. 

Inreach Activities – Activities done to inform and educate 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 birth control 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 is subject to all the rules in Title XIX of the Social Security Act, 42 U.S.C. Section1396. It reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Minor –Per with the Texas Family Code, a minor is a person under 18 years old who is not and has not been married. They also have not had the disabilities of minority removed for general purposes such as being 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 to inform and educate 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 such as 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 a person’s individual goals about if they should 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 get 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. It does not include a person 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 or 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.