Case Management for Children and Pregnant Women offers help in every county in Texas.
Become a Provider
- Learn more about case management (PDF)
- Learn about becoming a provider (PDF)
- Watch the Case Management Potential Provider Tutorial.
Contact Program Staff
Department of State Health Services
Case Management for Children and Pregnant Women
Mail Code 1938
P.O. Box 149347, Austin, Texas 78714-9347
1100 W. 49th St., Austin, Texas 78756-3199
Phone: 512-776-2168
Fax: 512-776-7574
Toll Free: 800-252-8023, extension 2168
Email Case Management
Relay Texas Dial 7-1-1
- Vacant, 512-776-6664, Case Management Branch Manager
- Elaine Mittel, 512-776-3885, Case Management Program Consultant
- Diana Barajas, 512-776-6249, Case Management Program Consultant
- Jennifer Borja-Smith, 512-776-6833, Case Management Program Consultant
- Vacant, 512-776-3026, Personal Care Services Program Consultant
- Nelda Rabun, 512-776-6591, Personal Care Services Program Consultant
- Dagny Schmidt, 512-776-2168, Administrative Assistant to Branch Manager
Download the Health Service Regional Office Contacts list (PDF).
Download the Case Management Providers by Region list (PDF).
Forms
Specific documentation for the comprehensive visit and follow-up visits, the billable components of case management, are required. All forms below are in MS Word format, unless otherwise noted, and may be completed electronically or printed. All case management activities must be documented and maintained in a client record. Providers must ensure that documentation for case management activities complies with the requirements of Case Management for Children and Pregnant Women Rule and Policy, Medicaid Policy, HIPAA and all other applicable state and federal rules and regulations.
Case Management
- CM-01, Initial Prior Authorization Request
- CM-01A, Referral and Intake
- CM-02, Family Needs Assessment
- CM-02A, Migrant Information Form
- CM-03E-S, Service Plan-English/Spanish
- CM-03E-V, Service Plan-English/Vietnamese
- CM-03ConE-S, Service Plan Consent-English/Spanish
- CM-03ConE-V, Service Plan Consent-English/Vietnamese
- CM-04, Follow-Up Form
- CM-04A, Follow-Up Documentation
- CM-05, Progress Notes
- CM-06, Prior Authorization Request for Additional Visits
- CM-06A, Request to Change Authorization to Another Case Manager
- CM-07E-S, Referral Form-English/Spanish
- CM-07E-V, Referral Form-English/Vietnamese
- CM-08E-S, Case Closure Form-English/Spanish
- CM-08E-V, Case Closure Form-English/Vietnamese
- CM-09E-S, Case Transfer-English/Spanish
- CM-09E-V, Case Transfer-English/Vietnamese
- CM-10, Notification of Significant Provider Changes
- CM-11, Record of Billed Services (Optional)
- CM-12, Authorization to Disclose Protected Health Information - English
- CM-12S, Authorization to Disclose Protected Health Information - Spanish
- CM-12V, Authorization to Disclosure Protected Health Information-Vietnamese
Quality Assurance
- CM-15, Provider Systems Review
- CM-16, Record Review Tool for Providers
- CM-18, QMS Client Referral Log (XLSX)
- HIPAA Example (PDF)
Marketing Materials
Providers may order brochures and other marketing materials on the THSteps Catalog.
Make a Referral to Case Management
Providers may choose to complete a referral form (MS Word) and fax it to Texas Health Steps. The fax number is 512-533-3867.
For clients enrolled in STAR or Traditional Medicaid, you can make a referral by:
- Calling 877-THSteps (877-847-8377).
- Contacting a case manager (PDF).
- Submitting the Case Management Referral form (MS Word).
For clients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the Request for Case Management for STAR Kids Clients (MS Word).
Rules & Policies
Providers must comply with the Case Management for Children and Pregnant Women policies, Medicaid policies, and state rules and regulations:
- Case Management for Children and Pregnant Women Policies, Revised April 2019 (PDF)
- Case Management for Children and Pregnant Women Policies FY2018 (PDF), October 4, 2017
- Case Management for Children and Pregnant Women Rules - Texas Administrative Code (TAC), Title 25, Part 1, Chapter 27
- Texas Medicaid Provider Procedures Manual
- Health Insurance Portability and Accountability Act of 1996
- Requirements for Reporting Abuse or Neglect, as outlined in Chapter 261 of the Texas Family Code
- Texas State Board of Social Workers Examiners Rules- Regulations, Texas Administrative Code (TAC) Title 22, Part 34, Chapter 781
- Texas Board of Nursing Rules and Regulations, Texas Administrative Code (TAC), Title 22, Part 11, Chapters 211 – 227
Submit a Prior Authorization
HHSC will accept the following requests through the authorization request website. Note: This system is for use by approved Case Management for Children and Pregnant Women providers only.
- CM-01 (Initial Prior Authorization Request)
- CM-06 (Request for Additional Visits)
- CM-06A (Request to Change Authorization to Another Case Manager)
HHSC staff will fax a response using the Response to Authorization Request form.
Download the Guide to Prior Authorization System (PDF)
If you have any questions, please contact Dagny Schmidt at 512-776-2168 or email to askcm@hhs.texas.gov.
Training
After receiving approval by HHSC to provide case management services, case management providers must complete a mandatory training. Please contact your DSHS Regional Representative for information about enrolling in a Case Management for Children and Pregnant Women training. Monthly training is offered. Call for dates.
Pre-Training Requirements
Once approved to provide case management services, providers must complete the following modules as a prerequisite to Case Management for Children and Pregnant Women training. These modules provide information that is essential to the provision of case management services and can be accessed at the Texas Health Steps Online Provider Education website.
- Medicaid Case Management Services in Texas: A Course for Case Managers
- Transition Services for Children and Youth with Special Health-Care Needs
- Texas Medicaid Services for Children
Free Continuing Education Units/Credits
The Texas Health Steps Online Provider Education website offers FREE CE Courses to enhance your ability to provide preventive health, mental health, oral health & case management services to Medicaid eligible children in Texas.