Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,858
2821-2988 p. ; 28 cm.View a full description of this periodical.
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medical assistance program and are submitted by the depart-
ment under its agreement with the Health and Human Services
Commission to operate the Early and Periodic Screening, Diag-
nosis, and Treatment program as authorized under Acts 1991,
72nd Legislature, First Called Session, Chapter 15, 1.07.
The proposed amendments and new section affect the Human
Resources Code, Chapter 32.
33.13. Purpose [Legal Base].
(a) The Texas Medicaid Early and Periodic, Screening, Diag-
nosis, and Treatment (EPSDT) program is a Title XIX federally-man-
dated program of prevention, diagnosis, and treatment for Medicaid
recipients under age 21 years. In Texas, EPSDT is known as the Texas
Health Steps (THSteps) program. The Texas Department of Health ad-
ministers the medical and dental check-ups and treatment components
of this program.
(b) [The Texas Department of HeaIth must provide required
eary and peridicre. dag.. and treatment (..
screening and treatment services to eligible families or recipients who
request these envces The periodicity ~ched e determines when
speci,4ed screening services are elivered. The department must
pro-vide any] THSteps check-up [EPSDT] services will be provided
when requested by the recipient according to periodic eligibility for
service. [and when medically necessary.] Other THSteps services
will be provided when medical or dental necessity is established and
federal financial participation is available.
(c) The rules in this subchapter implement the medical and
dental check-up, dental treatment, and outreach and informing com-
ponents of THSteps.
33.14. Outreach, Informing, and Support Services.
(a) THSteps or its designee informs [The Texas Department
of Health must inform each family of the availability of] THSteps
[EPSDT] recipients and their families about THSteps services no later
than 60 days after the Medicaid certification date and on a periodic
basis thereafter using a combination of methods including written,
oral, and in-person contact. This notification must be done in writing
and /or in-person using [face-to-face contact in] clear, non-technical
[nonteehnical] language. THSteps uses [The department must use]
procedures suitable for informing persons who are illiterate, blind,
deaf, or who cannot understand the English language.
(b) THSteps recipients [All new eligibles] and families who
become eligible after a period of Medicaid ineligibility are also in-
formed about THSteps services upon recertification and on a periodic
basis thereafter. [must be properly informeH weer a family need
not be informed more than twice in a 2-month period Familieswith
no member receiving any EPSDT services must be informed in writing
of EPSDT at least once each year.]
33.15. Definitions.
The following words or terms, when used in Subchapters A, B, C, D,
and E, shall have the following meanings unless the context clearly
indicates otherwise:
(1) Accompanied--A parent, guardian or authorized adult
who presents a recipient under age 15 at a THSteps medical or dental
check-up, or treatment visit and continues to wait for the child while
the check-up or treatment takes place. It is a requirement of 33.134(e)
of this title (relating to Primary Responsibilities of Medical Check-up
Providers) of Subchapter E that a recipient under the age of 15 be ac-
companied as a condition for reimbursement, unless services are pro-
vided by an exempt entity.(2) Authorized adult--A person, including an adult related
to the child, who is authorized by a child's parent or guardian to accom-
pany that child to a THSteps medical or dental check-up or treatment
visit.
(3) Board--The Texas Board of Health.
(4) EOB--Explanation of Benefits.
(5) EPSDT--Early and Periodic Screening, Diagnosis, and
Treatment is a service of the Medicaid program. EPSDT provides med-
ical and dental check-ups, diagnosis, and treatment to Medicaid eligible
recipients younger than 21 years of age. EPSDT is known in Texas as
Texas Health Steps, (THSteps).
(6) Exempt entity--A child-care facility (as defined in the
Human Resources Code 42.002(3)), school health clinic, and Head
Start programs that are exempt from the parental accompaniment re-
quirement under 33.134(e) of this title of Subchapter E.
(7) FFP--Federal financial participation is the federal gov-
ernment' s share of a state's expenditures under the Medicaid program.
(8) HHSC--The Health and Human Services Commission.
(9) Medicaid--The medical assistance program imple-
mented by the State of Texas under the provisions of Title XIX of the
Social Security Act, as amended, (42.U.S.C. 1396-1396v).
(10) Parental Involvement--The encouragement and in-
volvement in and management of the health care of children receiving
services from an exempt entity as defined in paragraph (6) of this
section. Parental involvement includes the exempt entity notifying the
child's parent, guardian, or other authorized adult before each visit
for a THSteps medical or dental check-up or treatment visit of the
time and place of the child's appointment and encouraging the parent,
guardian, or other authorized adult to attend. Notification shall be
done by the means of communication determined by the exempt entity
to be the most effective. Such communication must be documented
and may include, but is not limited to, one or more of the following
options: a home visit from an outreach worker, written or printed
correspondence, or telephone contact.
(11) Recipient--An individual who has been determined el-
igible for Medicaid.
(12) R&S--A Remittance and Status report that provides
information on pending, paid, denied, and adjusted claims.
(13) TDH--Texas Department of Health.
(14) THSteps--Texas Health Steps (THSteps) is the Texas
name for the federally-mandated Medicaid service known as EPSDT.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.
Filed with the Office of the Secretary of State on March 21, 2003.
TRD-200301855
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: May 4, 2003
For further information, please call: (512) 458-7236
SUBCHAPTER B. RECIPIENT RIGHTS
25 TAC 33.61 - 33.63, 33.6628 TexReg 2858 April 4, 2003 Texas Register
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Texas. Secretary of State. Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003, periodical, April 4, 2003; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth101027/m1/37/: accessed May 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.