An official State of Texas website.
Case Management for Children and Pregnant Women offers help in every county in Texas.
Become a Provider
- Learn about becoming a provider (PDF)
- CPW Services: Provider Enrollment in Texas Medicaid with TMHP (PDF)
- New Doula and CHW Provider Types for CPW Case Management Services Available December 1, 2024
- Updates to CPW Program Services Benefit Criteria Effective December 1, 2024
Case Management and Pregnant Women Services Provider Resources
- PEMS Best Practices (PDF)
- PEMS Quick Start (PDF)
- Terms (PDF)
- MCO Facility Credentialing One Pager (PDF)
- Final MCP Practitioner Credentialing One Pager (PDF)
- What a CPW Provider needs to know about the CPW Carve-In (PDF)
- Case Management Webinar for Existing CPW Providers
- Case Management Webinar for New Potential CPW Providers
Contact Program Staff
Health and Human Services Commission
Case Management for Children and Pregnant Women
Mail Code H310
P.O. Box 149030, Austin, Texas 78714-9030
701 W. 51st St., Austin, Texas 78751-3199
Email Case Management
Relay Texas Dial 7-1-1
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, Medicaid Policy, HIPAA and all other applicable state and federal rules and regulations.
Case Management
- CM-01A, Referral and Intake (PDF)
- CM-02, Family Needs Assessment (PDF)
- CM-02A, Migrant Information Form (PDF)
- CM-03E-S, Service Plan (PDF, English/Spanish)
- CM-03ConE-S, Service Plan Consent (PDF, English/Spanish)
- CM-04, Follow-Up Form (PDF)
- CM-04A, Follow-Up Documentation (PDF)
- CM-05, Progress Notes (PDF)
- CM-07E-S, Referral Form (PDF, English/Spanish)
- CM-08E-S, Case Closure Form (PDF, English/Spanish)
- CM-09E-S, Case Transfer (PDF, English/Spanish)
- CM-10, Notification of Significant Provider Changes (PDF)
- CM-11, Record of Billed Services [Optional] (PDF)
- CM-12, Authorization to Disclose Protected Health Information (PDF in English)
- CM-12S, Authorization to Disclose Protected Health Information (PDF in Spanish)
Quality Assurance
- CM-15, Provider Systems Review (PDF)
- CM-16, Record Review Tool for Providers (PDF)
- CM-18, QMS Client Referral Log (Excel)
- HIPAA Example (PDF)
Marketing Materials
Providers may order brochures and other marketing materials on the THSteps Catalog.
Providers wanting to create their own marketing materials must follow the guidelines provided.
Make a Referral to Case Management
- Call 877-THSteps (877-847-8377).
- Contact the person’s Medicaid Health Plan (MCO).
- Contact a case manager (PDF) for persons enrolled in fee-for-service.
- Complete a referral form (PDF) and fax to Texas Health Steps. The fax number is 512-533-3867.
Rules and Policies
Providers must comply with the Case Management for Children and Pregnant Women, Medicaid policies, and state rules and regulations:
- 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
Prior Authorization
Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.
Effective for dates of service on or after July 1, 2024, prior authorization will no longer be required for fee-for-service Case Management for Children and Pregnant Women (CPW) program services.
The initial intake service requirements will be updated. Providers must complete a comprehensive visit within thirty (30) business days if the CPW initial intake indicates that the client is eligible and has a need for CPW services.
All CPW services will still require documentation to support the medical necessity of the service rendered. All records are subject to retrospective review.
For more information, call the TMHP Contact Center at 800-925-9126.
Free Continuing Education Units/Credits
The Texas Health Steps Online Provider Education Course Catalog offers FREE CE Courses to enhance your ability to provide preventive health, mental health, oral health and case management services to Medicaid eligible children in Texas.