Texas Health Steps, Schemes and Mind Maps of Public Law

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Texas Health Steps

Presentation

This Texas Health Steps (THSteps)

presentation will cover:

 Background

 THSteps Medical

 Scheduling

 Checkup Components

 Laboratory

 Special Circumstances

 Documentation and Billing

 THSteps Dental

 Related Programs and Resources

Statutory Requirements

 Communicable Disease Reporting

 Early Childhood Intervention (ECI) referrals

 Parental Accompaniment

 Newborn Blood Screen

 Newborn Hearing Screen

 Critical Congenital Heart Disease (CCHD) Screen

 Blood Lead Level Screen

 Abuse and Neglect Reporting

Texas Medicaid Provider Procedures Manual (TMPPM)

Children’s Services Handbook

5.1.2: THSteps Statutory State Requirements

Compliance with Federal Legislation

 HHSC complies with Health & Human Services (HHS)

regulations that protect against discrimination.

 All contractors must agree to comply with the

following:

 Title VI of the Civil Rights Act of 1964 (Public Law

 88 - 352), Section 504 of the Rehabilitation Act of 1973

 (Public Law 93-112), The Americans with Disabilities

 Act of 1990 (Public Law 101-336), Title 40, Chapter 7

 of the TAC.

 Health and Safety Code 85.113 as described in “Model

Workplace Guidelines for Businesses, State Agencies, and

State Contractors” on page G-2.

Texas Health Steps

Medical Checkup

THSteps Checkup Scheduling

Selecting a provider

Checkups - In fee-for-service (FFS) Medicaid,

clients have freedom of choice when choosing

a THSteps checkup provider. In managed

care, a client needs to contact their health

plan to determine how to access THSteps

checkups.

Treatment (If non PCP) - Referral may be

required through PCP for evaluation and/or

management of conditions identified during a

THSteps medical checkup.

THSteps Checkup Scheduling

Checkups should be scheduled based on

the ages indicated on the THSteps

Medical Checkup Periodicity Schedule.

[Publication E03-13634]

Families should be encouraged to

schedule as soon as the child becomes

due for a checkup.

THSteps Checkup Scheduling

Number of

Age Range Allowed

Checkups

Birth through 11 months 6

(Does not include the newborn or 12 months)

1 through 4 years of age 7

5 through 11 years of age 7

12 through 17 years of age 6

18 through 20 years of age 3

Checkup Timeliness for Managed Care

New Members-

 Newborns within 14 days of enrollment.

 No later than within 90 days of enrollment for all other eligible

children.

Existing Members-

 For children under age 36 months, a checkup is defined as timely

if received within 60 days beyond the periodic due date based on

their birth date.

 For children 36 months and older, a checkup is defined as timely if

it occurs within 364 calendar days after the child’s birthday in a

non-leap year or 365 calendar days after the child’s birthday in a

leap year.

 Checkups received before the periodic due date are not reportable

as timely medical checkups.

THSteps Checkup Timeliness

Children less than 12 months of age-

Checkups in this age group occur within two

weeks of due date based on child's date of birth.

Children 12 months of age or older-

 Should have a yearly checkup as soon as

they become due.

 May be completed anytime after their

birthday (timely).

 Will not be considered late unless the child

does not have the checkup prior to their next

birthday.

THSteps Checkup

Required Components

Medical Checkup Requirements

Federally Mandated Components-

 Comprehensive Health and Developmental

History

 Comprehensive Unclothed Physical

Examination

 Immunizations

 Laboratory Screening

 Health Education/Anticipatory Guidance

State Requirement-

Dental referral every 6 months until a dental

home is established.

Complete THSteps Checkup

Complete only if it includes:

All required components, or

documentation of why a particular

component could not be completed.

Previous results may be used to meet

the checkup requirements if completed

within:

 Preceding 30 days for children who are

two years of age and younger.

 Preceding 90 days for children who are

three years of age and older.

Comprehensive Health History

o Nutritional Screening

o Developmental Surveillance and

Screening

o Mental Health Screening

o Tuberculin Skin Test (TST)