2000, Authorization, Services and Definitions

Revision 21-0; Effective September 1, 2021

2100 HTW Cost Reimbursement

Revision 21-0; Effective September 1, 2021

Improving the health of women, mothers and children is critical to the future of Texas. Texas Health and Human Services Commission (HHSC) provides a continuum of care through an array of women’s health and family planning-related services, including Healthy Texas Women (HTW). Through HTW cost reimbursement, HHSC provides reimbursement for support services important to maintaining the HTW program and enhancing HTW direct care services.

2200 HTW Fee-for-Service (FFS)

Revision 23-1; Effective Sept. 27, 2023

Claims for direct clinical care services provided to clients are reimbursed using the fee-for-service (FFS) reimbursement method.

FFS claims are not funded under HTW CR. The HTW FFS component is managed through the HHSC Medicaid and CHIP Services Division (MCS). Information on this process, as well as general program policies and procedures, are located in the Healthy Texas Women (HTW) Handbook, which is included in the Texas Medicaid Provider Procedures Manual (TMPPM). Grantees should refer to the TMPPM for more information on the HTW FFS program and provider requirements including, but not limited to, the following areas:

  • Client Rights and Access
  • Client Eligibility
  • Covered FFS Procedures and Codes
  • FFS Billing Requirements
  • Consent Requirements
  • Abuse and Neglect Reporting
  • Provider Certification and Requirements

2300 Guidance on Services for Minors

Revision 21-0; Effective September 1, 2021

Provider responsibilities and guidance concerning the treatment of minors under HTW, including requirements for confidentiality and consent, is available on the HHS website.

2400 Authorization

Revision 21-0; Effective September 1, 2021

State rules for HTW services can be found in the Texas Administrative Code (TAC), Title 1, Part 15, Chapter 382, Subchapter A. The current TAC does not reflect recent changes to the HTW program, as covered in the Texas Medicaid Providers Procedures Manual (TMPPM), and is in the process of being updated.

2500 Definitions

Revision 23-1; Effective Sept. 27, 2023

The following words and terms, when used in this manual, have the following meanings, which are exclusive to HTW CR:

Anticipated Eligibility – When a client’s HTW application has not yet been processed and approved by HHSC, HTW CR grantees may provide services (up to 90 days) to clients who have been screened using the Prescreening Tool on YourTexasBenefits.com, or the “Am I Eligible?” tool on the Healthy Texas Women website, and who are anticipated to be eligible based on that screening. HTW CR grantees may use a portion of their cost reimbursement funds to provide services for a limited time to a person who is anticipated to be eligible for HTW if the application for HTW is ultimately denied. If a client’s HTW application is ultimately approved, cost reimbursement funds may not be used to support services for that client as those costs must be billed to the HTW program through Texas Medicaid & Healthcare Partnership. Specific billing requirements are outlined in Section 3000, Cost Reimbursement Administrative Policies. Services for anticipated eligible clients must follow the TMPPM guidelines. Anticipated eligibility, as used in this manual, is distinct from Medicaid presumptive eligibility. Note: Before federal approval of the 1115 Medicaid waiver, HTW cost reimbursement contracts and policy guidance historically referred to allowability and reimbursement for presumptive eligibility in HTW.

Class D (Clinic) Pharmacy License – A pharmacy license issued to a pharmacy to dispense limited types of drugs 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.

Client – A person who is eligible to receive medical care, treatment or services. The term “client” and “patient” may be used interchangeably in other sources.

Contraceptive Methods – A broad range of birth control options, approved by the U.S. Food and Drug Administration, except for emergency contraception.

Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select the means by which this may be achieved.

Fee-for-Service (FFS) – The payment mechanism for services that are reimbursed on a set rate per unit of service (also known as unit rate).

Fiscal Year (FY) – State fiscal year, September 1 – August 31.

Grantee – A non-state entity that receives an award directly from the 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) – Provides support for the Health and Human Services agencies, administers the state’s Medicaid and other client service programs, sets policies, defines covered benefits and determines client eligibility for major programs.

Healthy Texas Women (HTW) – A program administered by HHSC to provide 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 an FFS basis, and may also, but are not required to, contract with HHSC to provide support services that enhance the HTW FFS client delivery on a cost reimbursement basis.

HTW Cost Reimbursement – The funding mechanism for qualified agencies that supports the overall outcomes of client services provided through the HTW FFS program. These funds may be used for support services that enhance HTW FFS client service delivery.

HTW FFS – Women’s health and family planning client services provided through the HTW program on an FFS basis through the Texas Medicaid & Healthcare Partnership system. General program policies and procedures are included in the Healthy Texas Women (HTW) Handbook, which is included in the Texas Medicaid Provider Procedures Manual (TMPPM).

HTW Provider – A Medicaid-enrolled health care provider that performs covered HTW services. An HTW provider’s agency may be contracted with HHSC to receive additional funding through a cost reimbursement contract to support the HTW FFS program. Indirect Costs – Costs incurred for a common or joint purpose benefiting more than one project or cost objective of a grantee's organization and not readily identified with a project or cost objective. More information on indirect cost rates is available online here.

Long-Acting Reversible Contraceptives (LARCs) – Methods of birth control that provide highly effective contraception 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, and subject to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

Minor – In accordance with the Texas Family Code, a person under 18 years of age who is not and has not been married or who has not had the disabilities of minority removed for general purposes (i.e., emancipated).

Outreach – Activities that are conducted with the purpose of informing and educating the community about HTW services and reaching eligible clients.

Program Income – Money collected directly by the grantee , subgrantee, or provider for activities covered under the cost reimbursement contract award and revenue from HTW FFS.

Service – Any client encounter at a facility that results in the client having a medical or health-related need met.

Subgrantee – A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program; but does not include an individual 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. A subgrantee may also be referred to as a subrecipient. 

Texas Medicaid & Healthcare Partnership (TMHP) – The Texas Medicaid Claims administrator. HHSC contracts with TMHP to process claims for providers.