An official State of Texas website.
Revision 24-2; Effective Oct. 15, 2024
Prenatal and postpartum services must be based on American College of Obstetricians and Gynecologists (ACOG) guidelines.
Grantees may bill FPP for allowable services provided in clinical prenatal care visits for women during the Medicaid for Pregnant Women and the CHIP Perinatal Program enrollment processes. Medically necessary postpartum visits are reimbursable and include interval history, physical examination, assessment, family planning, counseling, education and referral as indicated.
Diagnostic Testing During Pregnancy
Grantees must follow Texas Health and Safety Code, Chapter 81, Subchapter A, Sec. 81.090:
All pregnant women should be tested for the following STIs as early as possible in the pregnancy:
- syphilis,
- HIV infection, and
- hepatitis B infection.
The record of the tests should be retained in the client’s chart.
Tobacco Assessment and Quitline Referral – All women who receive prenatal services should be assessed for tobacco use. Women who use tobacco should be referred to tobacco quit lines. The Texas Tobacco Quitline provides confidential, free and convenient cessation services to Texas residents 13 and older, including quit coaching and nicotine replacement therapy. Services can be accessed by phone at 877-937-7848 (877-YES-QUIT) or online at YesQuit.org. The assessment and referral should be performed by agency staff and documented in the clinical record.
Information for Parents of Newborns Requirement
Chapter 161, 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 give the woman and the infant’s father 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.
Also document in the client's chart that she received this information. The documentation must be retained for a minimum of five years. It is recommended the information be given twice, once at the first prenatal visit and again after delivery.
Information for Parents of Newborn:
Information for Parents of Children
Chapter 161, Health and Safety Code, Subchapter T also requires hospitals, birthing centers, physicians, nurse-midwives and midwives who provide prenatal care during gestation or at delivery to pregnant women on Medicaid to provide the woman and the infant’s father or other adult caregiver for the infant with a resource guide that includes information about the development, health and safety of a child from birth until 5 years old. The resource guide must provide information about medical home, dental care, effective parenting, child safety, importance of reading to a child, expected developmental milestones, health care and other resources available in the state, and selecting appropriate childcare.
A Parent’s Guide to Raising Healthy, Happy Children (PDF) is available through Texans Care for Children.
Provision of Information about Umbilical Cord Blood Donation Requirement
Chapter 162, Health and Safety Code, Subtitle H requires a physician or other person permitted by law to attend a pregnant woman during gestation or at delivery of an infant will give the woman an informational brochure before the third trimester of the woman’s pregnancy, or as soon as reasonably feasible. It should include information about the uses, risks and benefits of cord blood stem cells for a potential recipient, options for future use or storage of cord blood, the medical process used to collect cord blood, any costs that may be incurred by a pregnant woman who chooses to donate or store cord blood after delivery, and average cost of public and private storage.
Referral and Follow-up
Grantees must have written policies and procedures for follow-up on referrals made because of abnormal physical examination or laboratory test findings. These policies must be sensitive to clients’ concerns for confidentiality and privacy and must follow state or federal requirements for transfer of health information.
For necessary services beyond the scope of the grantee, clients must be referred to other providers for care.
Whenever possible, clients should be given a choice of providers to select. When a client is referred to another provider or for emergency clinical care, the grantee must:
- provide pertinent client information to the referral provider and obtain required client consent with proper safeguards to ensure confidentiality by adhering to HIPAA regulations;
- advise the client about their responsibility to comply with the referral; and
- counsel the client about the importance of the referral and follow-up plan.