The Children with Special Health Care Needs (CSHCN) Services Program covers growth hormones for people with specific diagnoses involving growth hormone deficiency. If an initial or extension request cannot be approved based on the above criteria, the approval request may be sent for medical review and reconsideration to program staff for medical review and reconsideration.
When to Prepare
Prescribing providers only use this form for people enrolled in the CSHCN Services Program. A program-approved provider must complete and sign this form annually, certifying that the individual requires these medications.
How to Submit
Providers should send the completed form by fax or mail to the CSHCN Services Program.
Texas Health and Human Services
CSHCN Services Program
Mail Code 1938
P.O. Box 149030
Austin, TX 78714-9947
Refer comments or questions about this form to the CSHCN Services Program at 800-252-8023.