3000, Cost Reimbursement Administrative Policies

Revision 21-0; Effective September 1, 2021

3100 HTW CR Services

Revision 21-0; Effective September 1, 2021

Healthy Texas Women Cost Reimbursement (HTW CR) provides funds to agencies that support the overall outcomes of clients served through HTW fee-for-service (FFS). These funds may be used for support services that enhance HTW FFS client service delivery. Cost reimbursement awards may be used to fund personnel, fringe benefits, staff travel, contractual services, equipment, supplies, other direct costs, and indirect costs per state and federal requirements and must be reasonable, allowable and already allocated. Additional information on what is reimbursable under HTW CR is found in 4130, HTW CR Reimbursement.

3200 HTW CR Anticipated Eligibility

Revision 23-1; Effective Sept. 27, 2023

HTW emphasizes the importance of proper family planning and women’s health preventive care. The goal of HTW is for women to have access to women’s health services and not rely upon episodic, acute care. To ensure prompt access to such care, HTW CR grantees can receive reimbursement for services provided to clients awaiting approval of an HTW application if said application is ultimately denied.

HTW CR grantees may use a portion of their cost reimbursement funds for this purpose. 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 (TMHP).

HTW CR grantees are expected to have systems implemented to verify if a client has been approved for HTW. HTW CR grantees are expected to screen clients using the Prescreening Tool on YourTexasBenefits.com, or the “Am I Eligible?” tool on the Healthy Texas Women website. Both tools are acceptable methods for screening for HTW eligibility. If a client is anticipated to be eligible for HTW based on that screening, the grantees may request reimbursement from HHSC from their HTW CR contract for services provided within 90 days from the date the client is first seen by the medical provider. The request for reimbursement cannot be submitted until 45 days after the HTW application was submitted to ensure adequate time for HTW application processing and eligibility determination. HTW CR grantees cannot bill for a client’s services based on anticipated eligibility status more than once in a 12-month period. All services provided must follow the HTW guidelines in the TMPPM.

Clients seen on an anticipated eligibility basis should be recorded for reporting purposes on the monthly HTW CR voucher. For more information on vouchers and required reports, see Section 4200, Data Collection and Reporting.

Note: Anticipated eligibility, as used in this manual, is distinct from Medicaid presumptive eligibility. 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.