4100, General Principles

Revision 23-4; Effective Sept. 22, 2023

A program shall provide the basic health care services established by HHSC in this handbook or less restrictive health care services. The basic health care services are:

  • Physician services
  • Annual physical examinations
  • Immunizations
  • Medical screening services
    • Blood pressure
    • Blood sugar
    • Cholesterol screening
  • Laboratory and X-ray services
  • Family planning services
  • Skilled nursing facility services
  • Prescription drugs
  • Rural health clinic services
  • Inpatient hospital services
  • Outpatient hospital services

In addition to providing basic health care services, a program may provide other department-established optional health care services that the county determines to be cost effective. The department-established optional health care services are:

  • Advanced practice nurse services provided by:
    • Nurse practitioner services
    • Clinical nurse specialist
    • Certified nurse midwife (CNM)
    • Certified registered nurse anesthetist
  • Ambulatory surgical center (freestanding) services
  • Colostomy medical supplies and equipment
  • Counseling services provided by:
    • Licensed clinical social worker (LCSW)
    • Licensed marriage family therapist (LMFT)
    • Licensed professional counselor (LPC)
    • Ph.D. psychologist
  • Dental Care
  • Diabetic medical supplies and equipment
  • Durable medical equipment (DME)
  • Emergency medical services
  • Home and community health care services
  • Physician assistant services
  • Vision care, including eyeglasses
  • Federally qualified health center services
  • Occupational therapy services
  • Physical therapy services
  • Other medically necessary services or supplies that the local governmental municipality or entity determines to be cost effective

Services or supplies must be reasonable and medically necessary for diagnosis and treatment.

For a listing of services, supplies and expenses that may not be CIHCP benefits, refer to the Texas Provider Procedures Medicaid Manual at Section 1 Provider Enrollment and Responsibilities, Texas Medicaid Limitations and Exclusions.

Chapter 61, Health and Safety Code, Section 61.035, states, “The maximum county liability for each state fiscal year for health care services provided by all assistance providers, including hospital and skilled nursing facility, to each eligible county resident is:

  • $30,000; or
  • the payment of 30 days of hospitalization or treatment in a skilled nursing facility, or both, or $30,000, whichever occurs first, if the county provides hospital or skilled nursing facility services to the resident.”

Thirty days of hospitalization refers to inpatient hospitalization. Use the client’s actual dates-of-service when determining which fiscal year to apply the maximum county liability.

For the claim payment to be considered, a claim should be received:

  • within 95 days from the approval date for services provided before the household was approved;
  • within 95 days from the date of service for services provided after the approval date; or
  • within the agreed upon time frame in a legal contract between the providers and the local indigent program.

The payment standard is determined by the date the claim is paid.

For additional information on claim payment, see 4400, User’s Guide to Fee Schedules.