2000, Program Authorization, Services and Definitions

2000, Program Authorization, Services and Definitions acarreras Fri, 12/04/2020 - 02:00
Body

Revision 20-0; Effective December 18, 2020

 

2100 Program Authorization and Services

Revision 20-0; Effective December 18, 2020

 

Title V Maternal and Child Health Fee-for-Services Program Background

The purpose of the Maternal and Child Health (MCH) Services Title V Block Grant is to create federal/state partnerships to provide direct services to low income women and children not eligible for Medicaid/Children’s Health Insurance Program (CHIP), CHIP Perinatal or another payer source that covers these same services. 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.

Legal Authority

Through Title V of the Social Security Act (SSA) of 1935, the federal government pledged to support state efforts to improve the health of all mothers and children. The MCH Block Grant Program under Title V of the SSA was created in 1981 to consolidate multiple programs to support a more comprehensive coordinated approach to meeting states’ individual needs consistent with the applicable health status goals and national health objectives now identified in Healthy People 2010.

Within Texas, Title V operates within a framework articulated by the Texas Legislature and Texas Health and Human Services Commission (HHSC).

States are required to use federal funds awarded as follows:

  • At least 30% for preventive/primary care services for pregnant women, mothers, infants up to age one and children;
  • At least 30% for services for children with special health care needs; and
  • No more than 10% on administration.

Funding Sources

Title V MCH FFS program services are funded both by state general revenue and federal funds through the Title V MCH Block Grant. HHSC Title V MCH FFS funds are allocated through a competitive application process, after which selected applicants negotiate contracts with HHSC to provide services.

 

2200 Definitions

Revision 20-0; Effective December 18, 2020

 

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

Case Management – An individualized approach for each person that involves the integration of personal, social and vocational support services. Case management aims to assist clients to navigate social service systems and attain the highest quality of care.

Children’s Health Insurance Program (CHIP) – A health insurance program for non-Medicaid eligible children with a family income up to 200% Federal Poverty Level (FPL).

CHIP Perinatal Program – An HHSC program that provides medical coverage for perinatal care of unborn children of non-Medicaid eligible women with an income up to 202% FPL.

Children and Adolescents – Persons from their first birthday through the 21st year of age.

Client – An individual who has been screened, determined to be eligible for services and has successfully completed the eligibility process.

Contractor – Any entity 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-Payments – Monies collected directly from clients for services. The amount collected each month should be deducted from the Monthly Reimbursement Request and is considered program income.

Consultation – A type of service provided by a physician 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.

Dental Services – Diagnostic, preventive and therapeutic dental services provided to children age 0 through their 21st year, pregnant women, and post-partum women up to three months post-delivery.

Department of State Health Services (DSHS) – The agency responsible for administering physical and mental health-related prevention, treatment and regulatory programs for the state of Texas.

Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. 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 define eligibility income limits as some percentage of FPL.

Fiscal Year – State fiscal year: September 1 through August 31. Federal fiscal year: October 1 through September 30.

Health and Human Services Commission (HHSC) – The state agency that has oversight responsibilities for designated health and human services agencies, including DSHS, and administers certain health and human services programs.

Medicaid – Title XIX of the Social Security Act; reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Minor – A person who has not reached his/her 18th birthday and who has not had the classification of minor removed in court, or who is not or never has been married or recognized as an adult by the state of Texas.

Nutritional Services – The provision of services to identify the nutritional status of an individual and instruction which includes appropriate dietary information based on the client’s needs, i.e., age, sex, health status, culture. This may be provided to an individual on a one-to-one basis or to a group of individuals.

Payer Source – Programs, benefits or insurance that pays for the service provided.

Prescription Drugs, Devices and Durable Supplies – Medically necessary pharmaceuticals and medical supplies (capable of withstanding wear) which are needed for the treatment of a diagnosed condition.

Preventive Health Care – Services include, but are not limited to the following: immunizations, risk assessments, health histories and baseline physicals for early detection of disease and restoration to a previous state of health, and prevention of further deterioration and/or disability.

Program Income – Monies collected directly by the contractor/provider for services provided under the grant award.

Promotor(a) or Community Health Worker (CHW) – A person who, with or without compensation, is a liaison and provides cultural mediation between health care and social services and the community. A certified CHW is an individual with current certification as a CHW issued by DSHS.

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

Recertification – The process of rescreening and determining eligibility for the next state fiscal year.

Referral – The process of directing or redirecting (as a medical case or a patient) to an appropriate specialist or agency for definitive treatment; to direct to a source for help or information.

Referral Agency – An agency that will provide a service for the Title V MCH FFS client that the Title V MCH FFS contractor does not provide, and it is not a reimbursable Title V MCH FFS service.

Subcontractor – An agency that does all or part of the work required in the original contract for the HHSC contractor for the Title V MCH FFS reimbursement rate or agreed amount.

Texas Resident – An individual who resides within the geographic boundaries of the state of Texas.

Transportation – Services that may be provided to transport a client for receiving required health care services. Transportation could be provided via private vehicle, public transportation, project site vehicle or emergency medical vehicle.

Unduplicated Client – Clients are counted only once per category regardless of the number of services they receive; a client can be counted once in prenatal, dysplasia and children/adolescent health as appropriate. One client seen four times in one category is counted as one unduplicated client and a family of three seen once is counted as three unduplicated clients.