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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)