4000, Reimbursement, Data Collection and Reporting

Revision 23-1; Effective Sept. 27, 2023

4100 HTW CR Reimbursement Guidance

Revision 23-1; Effective Sept. 27, 2023

4110 HTW CR Provider Reimbursement Criteria

Revision 23-1; Effective Sept. 27, 2023

To be reimbursed for HTW CR activities, the organization must meet all requirements as an HTW fee-for-service provider. This includes being a Medicaid (Title XIX) provider in accordance with 1 Texas Administrative Code Chapter 352 Subchapter A and meeting all other eligibility requirements outlined in the TMPPM. Failure to comply with these requirements will result in grant termination.

4120 Texas Medicaid Provider Procedures Manual (TMPPM) and the Healthy Texas Women Program Handbook

Revision 23-1; Effective Sept. 27, 2023

The TMPPM and the Healthy Texas Women Program Handbook within the TMPPM include information related to the HHSC HTW fee-for-service program claims submission process.

Volume 1 of the TMPPM also includes information on claims filing and submissions for Medicaid providers.

Medicaid bulletins and Remittance and Status (R&S) banner messages provide up-to-date claims filing and payment information. The R&S banner messages and the TMPPM are all available on the TMHP website, along with billable service codes.

4130 HTW CR Provider Reimbursement

Revision 23-1; Effective Sept. 27, 2023

HTW grantees may seek reimbursement for program costs by submitting monthly vouchers for expenses outlined in a cost reimbursement budget approved by HHSC, as required for the cost reimbursement program. Supporting documentation must be submitted with each voucher.

HHSC HTW CR funding is used for support services that enhance services provided by the grantee to a client under the HTW fee-for-service (FFS) program. Support services include, but are not limited to:

  • assisting eligible women with enrollment into the HTW program;
  • direct clinical care for women anticipated to be eligible for HTW FFS, who are awaiting approval for an HHSC-approved HTW application and whose application is ultimately denied;
  • staff development and training related to HTW program service delivery; and
  • client and community-based educational activities related to the HTW program.

Costs may be assessed against any of the following categories the grantee identifies during their budget development process:

  • personnel;
  • fringe benefits;
  • travel;
  • equipment and supplies;
  • contractual;
  • other; and
  • indirect costs.

Long-Acting Reversible Contraception (LARC)

LARC devices, such as IUDs and contraceptive implants, may be purchased in bulk using cost reimbursement dollars and should be accounted for in the “equipment and supplies” section of a grantee's budget. The grantee will bill Texas Medicaid & Healthcare Partnership (TMHP) for the insertion of the LARC device only when issued to a client. LARC bulk supply purchases must be listed in the approved cost reimbursement budget.

Providers may obtain LARC products through the existing buy and bill process, which requires providers to purchase LARCs from wholesalers or other sources before obtaining reimbursement upon insertion of the device and opting to receive reimbursement for LARC products as a clinician-administered drug. They can also order a device from a specialty pharmacy for the client to pick up and bring in for insertion.

Claims for Services Provided Under Anticipated Eligibility

Grantee will bill their approved cost reimbursement budget categories based on the cost incurred by personnel to perform services for clients under anticipated eligibility.

To seek reimbursement for these costs, grantee must hold claims at least 45 calendar days from the date of the client’s HTW application submission. Grantees must have documented procedures in place for how they will monitor the eligibility status of “anticipated eligible” clients, and how they will assist clients who are deemed ineligible for HTW.

The purpose of these procedures is to ensure grantees receive proper reimbursement and clients deemed ineligible for HTW are referred to other services for which they may be eligible within a timely manner.

Cost Reimbursement Payment Requirements

The cost reimbursement payment method is based on an approved budget and the submission of expense reimbursement requests. Grantees are required to finance upfront operational costs and request reimbursement for costs incurred. Payments are made by HHSC to reimburse the grantees for actual cash disbursements in accordance with supporting documentation.

As per the HHSC HTW CR grant, the reimbursement amount requested may not exceed 25 percent of the grantee's expected HTW FFS payments for the funding period. Grantee compliance will be assessed by HHSC quarterly. Upon review at each quarter, grantees that have exceeded the 25 percent will be notified and provided technical assistance, followed by appropriate actions as needed to resolve any issues. Annual award determination and reallocation of funds will be based in part on those grantees that leverage a higher percentage for direct services.

Additionally, as per the HHSC HTW CR grant, no more than five percent of the payments received under an HTW CR grant may be used for expenses related to performing administrative functions derived from terms of the grant for subgrantees. Grantee compliance will be assessed by HHSC quarterly. Upon review at each quarter, grantees that have exceeded the five percent will be asked to remit payment to HHSC for the amount exceeded.

Administrative functions include, but are not limited to, the grantee’s personnel costs for provision of oversight and technical assistance with a subgrantee, monitoring subgrantee performance, and all other related general and administrative expenses for administration of the subgrant, such as related fringe, rent and office supplies.

HTW CR Budget Revisions

HHSC, at its sole discretion, may approve fund transfers between categories upon a grantee’s written request. That request must include a detailed explanation that supports the need for the fund transfer. The grantee must seek HHSC’s written approval prior to making any fund transfers.

The approved budget for the state award summarizes the financial aspects of the program as approved during the state award process. It may include either the state and non-state share or only the state share, depending upon the state awarding agency’s requirements. It must be related to performance for program evaluation purposes, whenever appropriate. The local government is required to report deviations from budget or project scope or objective and request prior approval from the state awarding agency for budget and program plan revisions. For more information, visit the Texas Grant Management Guide.

4140 HTW CR Prohibitions

Revision 23-1; Effective Sept. 27, 2023

Prohibitions apply to awarded funds. HTW CR funds may not be used to support the following services, activities and costs:

  • inherently religious activities, such as prayer, worship, religious instruction or proselytization;
  • lobbying;
  • any portion of the salary of, or any other compensation for, an elected or appointed government official;
  • vehicles or equipment for government agencies that are for general agency use and do not have a clear nexus to terrorism prevention, interdiction and disruption (such as mobile data terminals, body cameras, in-car video systems or radar units for officers assigned to routine patrol);
  • weapons, ammunition, tracked armored vehicles, weaponized vehicles or explosives (exceptions may be granted when explosives are used for bomb squad training);
  • admission fees or tickets to any amusement park, recreational activity or sporting event;
  • food, meals, beverages or other refreshments, except for eligible per diem associated with grant-related travel or where pre-approved for working events;
  • membership dues for individuals;
  • any expense or service that is readily available at no cost to the grantee;
  • to replace (i.e., supplant) funds that have been budgeted for the same purpose through non-grant sources;
  • fundraising;
  • statewide projects;
  • the acquisition or construction of facilities; or
  • any other prohibition imposed by federal, state or local law.

4200 Data Collection and Reporting

Revision 23-1; Effective Sept. 27, 2023

4210 Required Reporting and Frequency

Revision 23-1; Effective Sept. 27, 2023

Grantees must submit these reports in an accurate and timely manner throughout the grant term, regardless of status, to report on progress and implementation.

Monthly Voucher Packet and Supporting DocumentationLast business day of the month following the month in which expenses were incurred or services provided. Final voucher is due 45 days after the end of the grant term.
Financial Status Report (FSR)Within 30 calendar days after the end of each quarter. Final FSR is due 45 calendar days after the end of the grant term.

4220 Voucher and Support Submission

Revision 23-1; Effective Sept. 27, 2023

HTW CR grantees will receive a personalized voucher packet at the beginning of each grant year for the purposes of monthly reimbursement and reporting.

The HTW Monthly Voucher Packet and Quarterly Financial Status Report (FSR) must be submitted to the designated email address on the HTW Monthly Voucher Packet.

Quarters for Cost Reimbursement FSR Submission:

  • Quarter 1: September – November
  • Quarter 2: December – February
  • Quarter 3: March – May
  • Quarter 4: June – August

4230 Program Promotion, Outreach and Inreach

Revision 23-1; Effective Sept. 27, 2023

Within 45 days from the start of each fiscal year, grantees must develop and implement an annual plan for promotion and outreach. Grantees are expected to follow the plan and make the plan available for monitoring purposes. This plan must outline the grantee’s goals to:  

  • inform the public of the purpose of the program and available services; 
  • enhance community understanding of its objectives; 
  • disseminate basic family planning and women’s health care knowledge; 
  • enlist community support; and 
  • recruit potential clients for HTW. 

The plan should be based on an assessment of the needs of the community and contain an evaluation strategy. Contractors should consider a variety of program promotion and client outreach strategies in accordance with organizational capacity, availability of existing resources and materials, and the needs and culture of the local community. 

To gauge the efficacy of program promotion and client outreach activities, grantees must complete the biannual survey of promotion and outreach activities. This survey is delivered twice a year and is due within 30 days of receipt. 

Survey SentReporting PeriodSurvey Due Date
Mid-month FebruarySept. 1 – Feb. 28 (Q1 & Q2)Mid-month March
Mid-month AugustMarch 1 – Aug. 30 (Q3 & Q4)Mid-month September

Questions regarding plans and surveys should be submitted to FamPlan@hhs.texas.gov.

Guidance for Promotion and Outreach Plans

The plan should include the determination of the priority population, a recruitment work plan and in-reach and outreach methods.

Contractors should have an array of materials and resources to aid in community awareness. Contractors must develop and maintain relationships with local partners and collaborators that can assist in the recruitment of the priority populations.  Contractors must provide HHSC with current clinic location information. The information provided will be entered into the Healthy Texas Women Find a Doctor function and may be shared with other BCCS contractors.

Contractors must include in their outreach plan how they plan to implement strategies to enroll clients in HTW and raise community awareness of HTW services, including the following activities: 

  • identify priority populations in the community; 
  • identify the populations at highest risk for unintended pregnancies and STIs; 
  • provide culturally competent health education and social support; 
  • help reduce participants’ barriers to accessing clinical services;  
  • establish relationships with internal and external partners to reach eligible clients in the priority populations; 
  • establish relationships with clinic sites offering other HHSC programs (e.g. the Family Planning Program, Breast and Cervical Cancer Services Program and the Primary Healthcare Program) to increase cross-program referrals, coordination and service provision;
  • link and connect participants to partner clinics for Healthy Texas Women services; 
  • educate clients diagnosed with breast or cervical cancer about HTW eligibility requirements and how to apply for services; 
  • provide information to each eligible client in their primary language; and
  • provide access to information that is culturally sensitive, linguistically appropriate and available to the visually and hearing impaired.