Revision 25-3; Effective Oct. 29, 2025

Mailing Address

HHSC Family Planning Program
North Austin Complex, Mail Code 0224
4601 W. Guadalupe Street,
Austin, TX 78751-2920

Helpline

8 a.m. to 5 p.m. Central Time
Monday through Friday
Austin Phone No. 512-776-7796

Provider questions: 800-925-9126 
TMHP contact center, pick option 5

Email

• famplan@hhs.texas.gov
• fcs_contracts@hhs.texas.gov

Websites

• Family Planning Provider Resources
• Healthy Texas Women Family Planning Program 

Revision 24-2; Effective Oct. 15, 2024

The Family Planning Program Policy Manual is a guide for grantees who deliver HHSC FPP services in Texas. FPP providers must also follow policies and procedures per the Texas Medicaid Program in the Texas Medicaid Provider Procedures Manual (TMPPM).

Federal and state laws about reporting child abuse, health facilities operation, professional practice, insurance coverage and related topics also affect family planning services. Grantees must be aware of and follow existing laws.

Revision 24-2; Effective Oct. 15, 2024

HHSC Family Planning Program Overview

The Texas Health and Human Services Commission (HHSC) Family Planning Program (FPP) is a non-Medicaid program that provides comprehensive family planning and related health services throughout the state to reduce unintended pregnancies, positively affect future pregnancies and improve the health status of low-income women and men.

Funding Sources

All HHSC FPP grantees and subgrantees must be enrolled providers of services to Medicaid-eligible women and men.

FPP services are funded by state general revenue and federal Temporary Assistance for Needy Families (TANF) to Title XX funds.

Rules

State rules governing the FPP are in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 382, Subchapter B.

Federal rules for Medicaid are in Title XIX, Social Security Act, 42 USC Section 1396-1396v et. seq. Grants to States for Medical Assistance Programs. 

Revision 25-3; Effective Oct. 29, 2025

The following words and terms, when used in this manual, have the following meanings.

Abortion – As defined in Texas Health and Safety Code Section 245.002.

Alternate Eligibility Screening Tool (AEST) – An HHSC-approved eligibility screening form substitute, such as in-house form, an electronic form or phone interview, that contains the required information for determining eligibility.

Applicant – A person who applies to receive services under FPP, including a current client who applies to renew.

Barrier to Care – A factor that hinders a person from receiving health care. Distance, lack of transportation, documentation requirements and copayment amount can impact access to services.

Class D (Clinic) Pharmacy License – A license issued to a pharmacy to dispense limited types of drugs or devices under a prescription drug order. Information on how to apply for a Class D Pharmacy License is on the Texas State Board of Pharmacy’s website (PDF).

Client – A person who has been screened and determined to be eligible for the program.

Compass 21 – Texas Medicaid and Healthcare Partnership’s automated system used to process claims for services delivered to HHSC FPP and Medicaid.

Consultation – A type of service given by a health care provider with expertise in a medical or surgical specialty. Helps with the evaluation or management of a client when another appropriate health care provider requests assistance.

Contraception – The means of pregnancy prevention, including permanent and temporary methods.

Contraceptive Methods – A broad range of pregnancy prevention options approved by the U.S. Food and Drug Administration.

Copay or Copayment – Money collected directly from clients for services.

Cost Reimbursement – The basis for reasonable, allowable and allocable Grant Project Direct Costs.

Covered Services – A service that is reimbursable under FPP.

Diagnosis – The recognition of disease status determined by evaluating the client history, the disease process and the signs and symptoms present. Determining the diagnosis may require some or all the following:

• microscopic – culture;
• chemical – blood tests; and
• radiological examinations – X-rays.

Eligibility Date – Date the grantee or program administrator determines a person becomes eligible for the program.

Family Planning Program Provider – A health care provider contracted with HHSC and qualified to perform covered services.

Family Planning Services – Educational or comprehensive medical activities that enable clients to freely decide the number and spacing of their children and select how this may be achieved.

Federal Poverty Level (FPL) – The household income guidelines issued annually and published in the Federal Register by the U.S. Department of Health and Human Services. FPL varies by family size. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.

Fee-for-Service – Payment mechanism for services that are reimbursed on a set rate per unit of service. This is also known as unit rate.

Fiscal Year – The state fiscal year is from Sept. 1 through Aug. 31.

Grantee – An entity HHSC has contracted with to provide services. The grantee is the responsible entity, even if a subgrantee provides the service.

Health and Human Services Commission (HHSC) –The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.

Health Care Provider – A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory or rural health center.

Healthy Texas Women (HTW) – A Medicaid waiver program administered by HHSC. The program provides uninsured women with women’s health and family planning services such as women’s health exams, health screenings and contraception. HTW providers must provide client services on a fee-for-service basis. They may also contract with HHSC to give support services that enhance the HTW fee-for-service client delivery on a cost reimbursement basis. This is not required.

Informed Consent – A health care provider makes sure the benefits and risks of a diagnostic or treatment plan, the benefits and risks of other appropriate options, and the benefits and risks of taking no action are explained to a client in a manner that is understandable to that person and allows the client to participate and make sound decisions about their own medical care.

In-reach Activities – Activities that inform and educate existing clients within an organization about services they may be eligible to receive.

Intimate Partner Violence (IPV) – Physical, sexual or psychological harm by a current or former partner or spouse. IPV may also be referred to as domestic violence or family violence.

Long-Acting Reversible Contraceptives (LARCs) – Methods of contraception that are effective for an extended period without required user action. LARCs include intrauterine devices (IUDs) and subdermal contraceptive implants.

Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 is subject to all the rules in Title XIX of the Social Security Act, 42 USC Section 1396. It reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Minor – Per the Texas Family Code, a minor is a person younger than 18 years who is not and has not been married, or who has not had the disabilities of minority removed for general purposes such as emancipated.

Monthly Voucher Packet – Required forms, B-13X, 4116 and Data Management, to request reimbursement for the categorical component of the contract.

Outreach – Activities conducted to inform and educate the community about services and increase the number of people served.

Patient Navigator – A person who provides personalized assistance to clients to eliminate barriers to timely care across all segments of the health care continuum, including application assistance for Family Planning Program (FPP).

Program Income – Money collected directly by the grantee, subgrantee or provider for services provided under the contract award such as client copay fees and donations.

Referral – The process of directing or redirecting a medical case or a person to an appropriate specialist or agency for information, help or treatment.

Reproductive Life Plan – A plan that outlines a person’s individual goals about having children, the desired number of children, and the best timing and spacing of children. Counseling should include the importance of developing a reproductive life plan, information about reproductive health, family planning methods and services, and how to get preconception health services as needed.

Subgrantee – A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program. It does not include a person who is a beneficiary of such a program. A subgrantee may also be a grantee of other state awards directly from a state awarding agency. Refer to the Texas Grant Management Standards, Appendix 2, p.57 (PDF).

Telemedicine – A health care service delivered with telecommunications or information technology to a client at a different physical location than a physician or health professional. The physician must be licensed in this state and act within the scope of their license. The health professional must act under the delegation and supervision of a physician licensed in this state and act within the scope of their license.

Texas Medicaid and Healthcare Partnership (TMHP) – The Texas Medicaid Claims and Primary Care Case Management administrator. HHSC contracts with TMHP to process claims for providers.

Revision 24-2; Effective Oct. 15, 2024

Grantees must make sure services are provided in a timely and nondiscriminatory manner and must:

• have a policy in place to identify and eliminate possible barriers to client care, including making sure clinic or reception room wait times do not present a barrier to care;
• have a policy in place that describes the timely provision of services as follows:
  • applicants deemed eligible for FPP should be given an appointment as soon as possible and no later than 30 days from the initial request;
  • clients who request a contraceptive method but cannot be given a clinical appointment immediately must be offered a non-prescription method; and
  • minors younger than 18 years old be met with as soon as possible, with every effort made to provide an appointment within two weeks of the request;
• have a policy in place that requires qualified staff to assess and prioritize a person’s needs;
• provide referral sources for services outside the scope of FPP.
• manage funds to make sure established people continue to receive services throughout the budget year, Sept. 1 through Aug. 31;
• inform people of FPP services and encourage them to bring required documentation to the first visit for eligibility processing;
• comply with all laws, regulations and contract terms and conditions, as outlined in Section 3500, Nondiscrimination and Limited English Proficiency.

Grantees may not deny services to a qualifying person based on the person’s inability to pay.  

Revision 24-2; Effective Oct. 15, 2024

Grantees must obey state laws that govern the reporting of suspected abuse and neglect of children, adults with disabilities or people 65 years or older.

The Texas Human Resources Code, Chapter 48, requires suspected abuse, neglect or exploitation of an elderly person, a person with a disability or an individual receiving services from certain home and community-based providers be reported. Grantees must have an agency policy about abuse, neglect and exploitation of the elderly and adults with disabilities and must provide annual staff training.

Reporting an Abuse Emergency

To report an emergency that involves the abuse or neglect of children, adults with disabilities, people 65 years or older, or an individual receiving services from certain home and community-based providers, contact the Texas Abuse Hotline at 800-252-5400 or online at TXAbuseHotline.org. For cases that pose an imminent threat or danger to the person, call 9-1-1 or any local or state law enforcement agency.

Call the Texas Abuse Hotline at 800-252-5400 for situations including:

• Serious injuries.
• Any injury to a child 5 years or younger.
• Immediate need for medical treatment, including suicidal thoughts.
• Sexual abuse where the abuser has or will have access to the victim within the next 24 hours.
• Children 5 years and younger who are alone or are likely to be left alone within the next 24 hours.
• Anytime you believe your situation requires action in less than 24 hours.

Reporting a Suspicion of Abuse

For situations that do not require immediate investigation and to report suspicions of abuse, neglect and exploitation of children, adults with disabilities, people 65 years of age or older, or an individual receiving services from certain home and community-based providers, use the Department of Family and Protective Services Texas Abuse Hotline.

3210 Child Abuse Reporting, Compliance and Monitoring

Revision 24-2; Effective Oct. 15, 2024

Grantees and providers must develop policies and procedures that follow the reporting guidelines and requirements in Texas Family Code, Chapter 261. Grantee must develop an internal policy to determine:

• how child abuse reporting requirements will be implemented throughout their agency;
• how staff will be trained; and
• how internal monitoring will be done to make sure reporting is timely.

During quality assurance (QA) monitoring, compliance with the following criteria will be evaluated:

• The grantee's process must make sure staff is reporting abuse as required by Texas Family Code, Chapter 261. To verify compliance, QA monitors examine the grantee to make sure they:
  • have an internal policy which details how the grantee will determine, document, report and track instances of sexual and non-sexual abuse, for all people younger than 18 years in compliance with the Texas Family Code, Chapter 261;
  • follow their own internal policy; and
  • document staff training on child abuse reporting requirements and procedures.
• The grantee’s internal policy must clearly describe the reporting process for child abuse.

Resources for child abuse reporting policy development are found at the Texas Abuse Hotline.

3220 Human Trafficking

Revision 25-3; Effective Oct. 29, 2025

HHSC requires grantees to obey state laws that govern the reporting of abuse and neglect. As part of the requirement that grantees follow applicable federal laws, family planning grantees also must follow anti-trafficking laws, including the Trafficking Victims Protection Act of 2000, 22 USC Section 7101, and all items that follow the item cited.

Grantees must have a written policy on human trafficking which includes the provision of annual staff training.

Grantees must display signage related to human trafficking in areas where clients and the public can easily see them. Such areas include lobbies, waiting rooms, front reception desks and locations where people apply for and receive services.

Resources for Human Trafficking Policy Development

• Texas Health and Human Services Human Trafficking Resource Center webpage
• Texas Health and Human Services Health Care Practitioner Training webpage

Health care professionals and organizations must adhere to reporting requirements per Chapter 91 of the Texas Family Code.

Grantees also must have a written policy related to assessment and prevention of domestic violence and IPV, including the provision of annual staff training.

3230 Domestic and Intimate Partner Violence

Revision 25-1; Effective Jan. 29, 2025

The Centers for Disease Control and Prevention Intimate Partner Violence Prevention webpage describes intimate partner violence (IPV) as physical, sexual or psychological harm by a current or former partner or spouse. Per Texas Human Resources Code, Chapter 51, family violence may also include emotional harm and a threat of harm. IPV can exist regardless of the presence of sexual intimacy.

Health care professionals and organizations must adhere to reporting requirements outlined in Chapter 91 of the Texas Family Code.

Grantees also must have a written policy related to assessment and prevention of domestic violence and IPV, including the provision of annual staff training.

Revision 25-3; Effective Oct. 29, 2025

All contracting agencies must comply with the U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards for protection of privacy.

An FPP provider must maintain all health care information as confidential to the extent required by law.

Grantees must make sure all employees and volunteers receive training about client confidentiality during orientation. Employees and volunteers also must understand that violation of the law about confidentiality may result in civil damages and criminal penalties. A health care provider’s paid and unpaid staff must be told during orientation of the importance of keeping client information confidential. Refer to 1 Texas Administrative Code (TAC) Section 382.125(c). Grantees must provide a confidentiality policy that makes sure staff are informed during orientation of the importance of keeping client information confidential. All employees, volunteers, subrecipients and advisory board members must sign a confidentiality statement during orientation.

Grantees must monitor client records to make sure only appropriate staff and HHSC may access the records. A grantee must document the person’s preferred method of follow-up for clinic services, such as by cell phone, email, work phone or text, as well as preferred language, in the client’s record. Each client must receive verbal assurance of confidentiality, an explanation of confidentiality, which means information is kept private and not shared without permission, and any applicable exceptions such as abuse reporting. Grantees must provide clients with a copy of their signed confidentiality policy or agreement and maintain a copy in client's record.

An FPP provider may not require consent for family planning services from the spouse of a married client. Refer to 1 TAC Section 382.125.

For information specific to minors and confidentiality, refer to Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Texas Women Program (PDF).

Revision 25-3; Effective Oct. 29, 2025

Per the HHSC Uniform Terms and Conditions – Grant Version 2.16.1 (PDF), HHSC grantees must comply with state and federal anti-discrimination laws, including:

• Title VI of the Civil Rights Act of 1964
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794 (PDF)
• Americans with Disabilities Act of 1990, 42 U.S.C. Section 12101 et seq.
• Age Discrimination Act of 1975, 42 U.S.C. Sections 6101-6107
• Title IX of the Education Amendments of 1972, 20 U.S.C. Sections 1681 et seq.
• Accessible services to persons with limited English proficiency and speech or sensory impairments as noted in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 395, Subchapter B.

HHSC contracts require grantees to comply with state and federal antidiscrimination laws including state rules in TAC Title 1, Part 15, Chapter 395, Subchapter B, Section 395.11.

Find more information about nondiscrimination laws and regulations on the HHSC Civil Rights website and the HHSC Civil Right Office, Requirements for Contractors website.

Grant Terms and Conditions

To ensure compliance with nondiscrimination laws, regulations and policies, grantees must:

• sign a written assurance to comply with applicable federal and state nondiscrimination laws and regulations.
• have a written policy that states the agency does not discriminate based on race, color, national origin, sex, age, religion or disability. Grantees also must provide this Civil Rights policy to clients and put a signed copy in the client’s record that shows they have received a copy.
• have a written policy that addresses individual rights and responsibilities that applies to everyone who requests family planning services.
• have procedures to notify the HHSC Civil Rights Office of any program or service-related discrimination allegation or complaint no more than 10 calendar days after the allegation or complaint.
• make sure all grantee staff are trained in the nondiscrimination policies.
• make sure applicants for family planning services are made aware of the grantee’s nondiscrimination policies and complaint procedures.
• prominently display Civil Rights Posters in English and Spanish as applicable in common areas, including lobbies and waiting rooms, the front reception desk and locations where people apply for services. Posters are on the Civil Rights Office website.
• have a Civil Rights policy that includes all the bulleted components, including civil rights posters in Spanish and English as applicable.

More information about nondiscrimination laws and regulations is on the HHSC Civil Rights Office webpage.

Revision 24-2; Effective Oct. 15, 2024

3510 Resolution of Complaints

Revision 24-2; Effective Oct. 15, 2024

Grantees must have a Client Rights policy that explains the process to file complaints and concerns about care received to HHSC, and make sure those complaints and concerns are handled in a consistent and timely manner. Grantees’ policy and procedure manuals must explain the process clients may follow if they are not satisfied with the care received.

1. Grantees must investigate and resolve a complaint or concern within 30 business days, beginning on the day they are notified by the aggrieved client.
2. Clients may contact the grantee during and after the resolution of an investigation to receive more information on the grantee's decision or help to correct the issue.
3. Grantees must provide the client with contact information to the HHS Office of the Ombudsman. If a client requests more help from the Ombudsman, a grantee must not terminate services to that client until a final decision is rendered by HHSC, unless there is a viable risk to the safety of the aggrieved client, clinic staff or others.
4. All complaints and concerns must be documented in the client's record.

3520 Termination of Services

Revision 25-2; Effective April 25, 2025

A qualifying person must never be denied services because they are not able to pay.

Grantees have the right to terminate services to a client if the client is disruptive, unruly, threatening or uncooperative to the extent that the client seriously impairs the grantee’s ability to provide services effectively and safely. Grantees also have the right to terminate services if the client’s behavior jeopardizes their own safety, clinic staff or others. A person has the right to appeal the denial, suspension or termination of services. Refer to 1 TAC Section 382.111.

For more information, refer to Fair and Fraud Hearings page on the HHSC website.

The grantee’s policy manual must include policies for termination of services.

3530 Freedom of Choice

Revision 24-2; Effective Oct. 15, 2024

FPP clients are guaranteed the right to voluntarily choose qualified family planning providers and methods without coercion or intimidation. Acceptance of family planning services may not be required for eligibility for, or receipt of, any other service or assistance from the entity or person who would provide the service or assistance.

3540 Research, Human Subject Clearance

Revision 24-2; Effective Oct. 15, 2024

Grantees must get prior approval from their own internal Institutional Review Board (IRB) and HHSC to participate in proposed research that would involve FPP clients as subjects and the use of client records or any data collected from FPP clients. For information about the process, visit the Institutional Review Board website.

The grantee must have a policy that states approval will be obtained from HHSC before it institutes any research activities. The grantee must make sure all staff members are aware of this policy through staff training. The grantee must keep documentation of training on this topic.

Revision 25-2; Effective April 25, 2025

Grantees must have an organized and secure client record system. The grantee must make sure records are organized, readily accessible and available to the client upon request with a signed release of information. Records must be kept confidential and secure as follows:

• safeguarded against loss or use by unauthorized people;
• secured by lock when not in use and inaccessible to unauthorized people; and
• maintained in a secure environment in the facility and during transfer between clinics and between home and office visits.

The person’s written consent is required to release personally identifiable information, except as may be necessary to provide services to the person, or as required by law, with appropriate safeguards for confidentiality. If the person is a minor, the minor’s parent, managing conservator or guardian must authorize the release per Chapter 32 of the Texas Family Code, federal law or regulations. Emancipated or married minors authorize the release of their own information. HIV information should be handled per state and federal code. Refer to the HHS Law, Rules, and Authorization webpage.

Grantees must release only the specific information requested when information is requested. Information collected for reporting purposes may be disclosed only in summary, statistical or other forms that do not identify individuals. People transferring to other providers must be provided with a copy or summary of their record upon request to ensure continuity of care. Electronic records are acceptable as medical records.

Grantees and sub-grantees must maintain all records of client services, contracts and payments for the time specified by HHSC.

Requirements are in Texas Administrative Code Title 1, Part 15, Section 354.1003, Time Limits for Submitted Claims, Section 354.1004, Retention of Records and in Title 22, Part 9, Chapter 163, Medical Records. Grantees must follow contract provisions, maintain medical records for at least seven years after the contract closes and follow the retention standards of the relevant licensing entity. All records about services must be accessible for examination at any reasonable time to representatives of HHSC and as required by law. 

Revision 24-2; Effective Oct. 15, 2024

3710 Personnel Policy and Procedures

Revision 25-3; Effective Oct. 29, 2025

Grantees must develop and maintain personnel policies and procedures to make sure all staff are hired, trained and evaluated appropriately for their job position. Personnel policies and procedures must include:

• job descriptions;
• a written orientation plan for new staff members that includes a statement of skills, competencies appropriate for the position or both; and
• a performance-evaluation process for all staff members.

Job descriptions, including those for contracted personnel, must specify required qualifications and licensure.

Grantees must show evidence that employees meet all required qualifications and receive annual training. Job evaluations should include observation of staff-client interactions during clinical, counseling and educational services.

Grantees must establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain. All employees and board members must complete a conflict-of-interest statement during orientation. All medical care must be provided under the supervision, direction and responsibility of a qualified medical director. The designated medical director for a grantee must be a licensed Texas physician.

Grantees must establish, annually review and train staff on FPP requirements, including any updates to this manual and required forms that occur during the Grant Term.

Grantees must have a documented plan for organized staff development. The plan must have an assessment of:

• training needs;
• quality assurance indicators; and
• changing regulations and requirements.

Staff development must include orientation and in-service training for all personnel and volunteers. Nonprofit entities must provide orientation for board members and government entities must provide orientation for their advisory committees. Employee orientation and continuing education must be documented in agency personnel files.

Grantees must notify and provide updated contact information in writing within 30 calendar days of a change, whether funded under this contract or not, to HHSC of:

• Any grant-funded positions; and
• chief executive officer (CEO), chief financial officer (CFO), program director or program manager;

Grantees must make sure at least one representative, the capabilities to disseminate information to program administrative and clinic staff:

• attend a minimum of two priority technical assistance webinars offered by HHSC during the fiscal year. These specific webinars will be identified as mandatory or priority in HHSC’s electronic mail. To receive credit for participating, attendees must follow HHSC’s directions including completion of any sign-in sheet, registration, survey within the specified time frame or all three; and
• has access to the HHSC’s web-based applications – SharePoint site. The grantee must sign and submit a Family Clinical Services Extranet and Data Upload Security Agreement form for each grantee staff person accessing HHSC’s web-based applications – SharePoint site. 

Grantees must make sure users of HHSC’s web-based applications have an Outlook or Microsoft Office 365 account.

3720 Facilities and Equipment

Revision 25-3; Effective Oct. 29, 2025

Grantees must maintain a safe environment. Grantee must provide clean and well-maintained facilities where services can be delivered with space for exam rooms, client intake, waiting areas and space for clinical and administrative staff. Grantees must have policies and procedures that address hazardous materials and waste, fire safety and medical equipment.

Hazardous Materials and Waste

Grantees must have written policies and procedures to address:

• the handling, storage and disposal of hazardous materials and waste per applicable laws and regulations;
• the handling, storage and disposal of chemical and infectious waste, including sharps; and
• an orientation and education program for personnel who manage or have contact with hazardous materials and waste.

Fire Safety

Grantees must have a written fire safety policy that includes a schedule for testing and maintenance of fire safety equipment. Evacuation plans for the premises must be clearly posted and visible to all staff and clients.

Medical Equipment

Grantees must have a written policy and keep documentation of the maintenance, testing and inspection of medical equipment, including automated external defibrillators (AEDs). Documentation must include:

• assessments of the clinical and physical risks of equipment through inspection, testing and maintenance;
• reports of any equipment management problems, failures and user errors;
• an orientation and education program for personnel who use medical equipment; and
• manufacturer recommendations for care and use of medical equipment.

Radiology Equipment and Standards

All facilities that provide radiology services must:

• possess a current Certificate of Registration from the Texas Department of State Health Services (DSHS) Radiation Control Program;
• Comply with Texas Administrative Code, Title 25, Part 1, Chapter 289, Texas Regulations for Control of Radiation; and
• Post Notice to Employees, Texas Regulations for Control of Radiation.

For information on X-ray machine registration, review the DSHS Radiation Control Program webpage.

Smoking and Vaping Ban

Grantees must have written policies that prohibit smoking and vaping in any portion of their indoor facilities. If a grantee contracts with another entity to provide health services, the subgrantee must uphold this policy.

Disaster Response Plan

Grantees must have written plans that address how staff will respond to emergencies such as fires, flooding, power outages and bomb threats. The disaster plan must identify the procedures and processes to be initiated during a disaster and the staff position responsible for each activity. A disaster response plan must be in writing, formally communicated to staff and kept in the workplace available to employees for review. For an employer with 10 or fewer employees, the plan may be communicated verbally.

For resources on facilities and equipment, review the Occupational Safety and Health Administration Compliance Assistance Guide.

Clinical Emergencies

Grantees must be adequately prepared to handle clinical emergencies as follows:

• There must be a written plan for the management of on-site medical emergencies, emergencies that require ambulance services and hospital admission;
• Each site must have staff trained in basic cardiopulmonary resuscitation (CPR) and emergency medical action. Staff trained in CPR must be present during all hours of clinic operations;
• There must be written protocols to address vasovagal reactions, anaphylaxis, syncope, cardiac arrest, shock, hemorrhage and respiratory difficulties;
• Each site must maintain emergency resuscitative drugs, supplies and equipment appropriate to the services provided at that site and appropriately trained staff when clients are present; and
• Documentation must be maintained in personnel files that staff have been trained on these written plans or protocols.

Suicide Prevention Signage

Grantees are encouraged to display signage related to suicide prevention, including the 988 Suicide and Crisis Lifeline. If a grantee elects to display such signage, it must be displayed in areas where clients and the public can easily see it, such as lobbies, waiting rooms, front reception desks and locations where people apply for and receive services.

Examples of suitable flyers are available on the Substance Abuse and Mental Health Services Administration (SAMHSA) webpages:

• 988 Suicide & Crisis Lifeline Poster, English
• 988 Suicide & Crisis Lifeline Poster, Spanish
• Suicide Warning Signs for Youth Poster
• Texting 988 Poster 1, Spanish
• Texting 988 Poster 2, English
• 988 Partner Toolkit

More mental health and suicide prevention resources are at the:

• Texas Health and Human Services (HHS) Behavioral Health Services Provider webpage
• HHS Suicide Prevention webpage
• Find Resources or a Provider, You're Not Alone Mental Health Texas webpage

Revision 25-3; Effective Oct. 29, 2025

Quality assurance and quality improvement (QA/QI) support the quality of clinical service delivery. Grantees must use internal QA/QI systems and processes to monitor FPP services. Grantees must have a quality management (QM) program based on their organizational structure and on the services they provide. The goals of the quality program should ensure availability and accessibility of services, quality and continuity of care. Grantees should integrate QM concepts and methods into the organization’s structure and day-to-day operations.

Grantees are expected to develop quality processes based on four core QM principles that focus on:

• the client;
• systems and processes;
• measurement; and
• teamwork.

The QM program must be developed and implemented in a way that provides for ongoing evaluation of services. Grantees should have a written, comprehensive plan for the internal review, measurement and evaluation of services, the analysis of monitoring data, and the development of strategies for improvement and sustainability. Grantees who subaward for the provision of services must also address how quality will be evaluated and how compliance with HHSC policies and basic standards will be assessed with the subgrantees.

An important part of the QM program is the QM committee, whose members are key leaders of the organization, including the executive director or chief executive officer, medical director and other appropriate staff where applicable. The committee must annually review and approve a quality work plan for the organization.

The QM committee must meet at least quarterly to:

• receive reports of monitoring activities;
• make decisions based on the analysis of data collected;
• determine QI actions to be implemented; and
• reassess outcomes and goal achievement.

Meeting dates, minutes of the discussion, actions taken by the committee and a list of the attendees must be maintained and made available during QA/QI reviews. The comprehensive quality work plan, at a minimum, must:

• be reviewed annually;
• include clinical and administrative standards that will be used to monitor services;
• include the process for credentialing and peer review of clinicians;
• identify people responsible for implementing, monitoring, evaluating and reporting;
• establish timelines for QM activities;
• identify tools and forms to be used; and
• outline reporting to the QM committee.

Although each organization’s QM program is unique, the following activities must be undertaken by all agencies that provide client services:

• ongoing eligibility, billing and clinical record reviews to ensure compliance with program requirements and clinical standards of care;
• utilization review;
• tracking and reporting of adverse outcomes;
• client satisfaction surveys and reporting survey data to HHSC in the frequency, manner and format defined by HHSC;
• annual review of facilities to maintain a safe environment, including an emergency safety plan;
• annual review and update of all prescriptive authority agreements (PAAs) for mid-level providers;
• annual review of all standing delegation orders and clinical protocols used;
• annual review of all policies and forms; and
• up-to-date personnel performance evaluations to include primary license verification, Drug Enforcement Administration and immunization status.

The review or revision date must be clearly noted on each policy, form, agreement, order, etc. used.

Grantees who subaward for the provision of services must also address how quality will be evaluated and how compliance with policies and basic standards will be assessed with the subgrantee, to include at a minimum:

• annual license verification, the primary source verification;
• clinical record review;
• billing and eligibility review;
• utilization review;
• facility on-site review;
• annual client satisfaction evaluation process; and
• child abuse training and reporting for subgrantee staff.

Data from these activities must be presented to the QM committee. Plans to improve quality should result from the data analysis and reports considered by the committee and should be documented.

Revision 25-3; Effective Oct. 29, 2025

Grantees must regularly collect and maintain data that measures the performance and effectiveness of program activities as specified in their grant agreement. The following outcome measures are acceptable:

1. Improving health outcomes:
   1. Increased screening rates; and
   2. Managing chronic disease.
2. Reducing health care costs:
   1. Avoidable emergency department visits;
   2. Hospitalizations and hospital readmission rates;
   3. Symptom-free days; and
   4. Quality-adjusted life years.
3. Other outcome measures proposed by applicant and approved by HHSC.

Grantees must submit a quarterly narrative in the Performance Measures Report that addresses their progress toward their specific goals. More information about frequency and submission is in 8000, Quality Management.

Revision 25-3; Effective Oct. 29, 2025

Grantees must perform an eligibility screening assessment on everyone who present for services.

Applicants must be screened in this order:

• Medicaid;
• Healthy Texas Women (HTW);
• Family Planning Program (FPP); and
• Any other HHSC-funded health program for which the grantee holds a grant agreement.

If a person is eligible for:

• Medicaid, HTW, or FPP, they are not eligible for BCCS.
• Any other HHSC-funded health program for which the grantee holds a Grant Agreement, enroll the person in the program that best matches their primary need.

For Clients with Emergency Medicaid

Clients eligible for Emergency Medicaid coverage through pregnancy and 12-month postpartum period only receive treatment of emergency medical conditions. These clients are considered underinsured and may be enrolled for FPP services if they meet all other eligibility requirements. FPP does not provide any emergency services.

Eligibility screening criteria and processes are described below.

4110 Screening for Medicaid

Revision 24-2; Effective Oct. 15, 2024

If the client has a Medicaid card, it can be used to document Medicaid eligibility.

How to know if a person is covered by Medicaid

• They will be issued a Your Texas Benefits card.
• They should show their Your Texas Benefits card at the point-of-service delivery.

Even with this card, providers must verify Medicaid eligibility by calling Texas Medicaid and Healthcare Partnership (TMHP) at 800-925-9126 or log on to TexMedConnect to check the member’s Medicaid ID number (PCN).

4120 Screening for HTW

Revision 25-3; Effective Oct. 29, 2025

Healthy Texas Women (HTW) is a Medicaid waiver program administered by HHSC to provide eligible uninsured women with women’s health and family planning services, such as women’s health exams, health screenings and contraception. HTW providers must provide clinical services on a fee-for-service basis. They may also, but are not required to, contract with HHSC to provide support services that enhance clinical service delivery on a cost reimbursement basis.

Potential female clients who are 15 through 44 years old, are U.S. citizens or qualified immigrants and live in Texas must be screened for HTW eligibility.

To screen for HTW, grantees may use the Prescreening Tool on the Your Texas Benefits website, or the Am I Eligible? tool on the HTW website. Both tools are acceptable methods for screening for HTW eligibility.

If the applicant is determined to be ineligible for HTW, either by screening as ineligible or by client's presentation of the denial letter or reason for denial, then screening for FPP can take place.

Rescreening for HTW

• If the applicant seeks services within 45 calendar days from the application submission date, and the person has undetermined HTW eligibility, then grantees are not required to rescreen for HTW.
• If the applicant has been screened eligible but the application determination was deemed ineligible for HTW, a copy of the denial letter or reason for denial must be maintained in the person’s record. If an applicant does not provide a copy of the denial letter or reason for denial, providers should discuss their application or advise them to contact 866-993-9972 to discuss the status of their application.
• If a person indicates they would not meet eligibility requirements for HTW and refuses to be screened for the program, document the refusal and reason in the client’s record. This documentation should be reviewed annually, and eligibility screening and application offered if a change in circumstances would indicate a change in eligibility. Applicants who were initially screened ineligible for HTW because of their citizenship or immigration status must be rescreened annually or when the the person reports a change in their citizenship or immigration status.

4130 Screening for and Determining FPP Eligibility

Revision 25-3; Effective Oct. 29, 2025

Grantees must determine and document FPP eligibility before rendering services. To assess eligibility for services, grantees must use Form 1065, Breast and Cervical Cancer Services (BCCS) Program or Family Planning Program (FPP) Eligibility Application, or an HHSC-approved eligibility screening form substitute, such as in-house form, electronic form or phone interview that contains the required information for determining eligibility.

If a grantee wants to use an Alternate Eligibility Screening Tool (AEST), the grantee must send a request to famplan@hhs.texas.gov with AEST Request in the subject line. HHSC staff must review and approve before use. Grantees must use Form 1065 until they receive approval to use an AEST. The grantee must maintain and retain proof of approval and must make the approval available during Quality Assurance visits.

The eligibility assessment may be completed over the phone or in the office. The completed eligibility form must be kept in the person’s record and must show their FPL and the co-pay amount they may be charged. A person’s eligibility must be assessed annually. If eligibility is determined over the phone, the grantee is authorized to sign the form on the applicant’s behalf with a digital ID or handwritten signature.

Eligibility Requirements

A male or female is eligible for FPP if they:

• are 64 years old or younger.
• live in Texas. Grantees must verify and document residency but such verification should not jeopardize delivery of services.
• have countable income that does not exceed 250% of the federal poverty level (FPL). Review Definition of Income for the Family Planning Program in 9000, Resources.

Grantees must require income verification. If the methods used for income verification jeopardize the person’s right to confidentiality or impose a barrier to receipt of services, the grantee must waive this requirement and approve full eligibility. Reasons for waiving verification of income must be noted in the person’s record. Review Calculation of Applicant’s Federal Poverty Level (FPL) Percentage in 4140, Adjunctive Income Eligibility and Calculation of Applicant Income.

Grantees determine eligibility at the point of service per program policy and procedures.

4140 Adjunctive Income Eligibility and Calculation of Applicant Income

Revision 25-3; Effective Oct. 29, 2025

An applicant is considered adjunctively, automatically, income eligible for services at an initial or renewal eligibility screening if they currently are enrolled in one of the following programs:

• Children’s Health Insurance Program (CHIP) Perinatal
• Supplemental Nutrition Assistance Program (SNAP)
• Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

Applicants determined to be adjunctively income eligible have met the income requirements through their participation in other income-tested programs. Except for calculating the client’s income, grantees must follow all screening procedures outlined in 4100, Client Eligibility Screening Process, before enrolling applicants determined adjunctively income eligible in FPP.

The applicant must be able to provide proof of active enrollment in the adjunctively income eligible program. Acceptable eligibility verification documentation may include:

To verify eligibility for CHIP Perinatal, providers must call TMHP at 800-925-9126 or log on to TexMedConnect to check the member’s Medicaid ID number (PCN).

If the applicant’s current enrollment status cannot be verified during the eligibility screening process, adjunctive income eligibility would not be granted. The grantee would then determine income eligibility according to usual protocols.

Calculation of Applicant’s Federal Poverty Level (FPL) Percentage – The maximum monthly income amounts by household size are based on the U.S. Department of Health and Human Services Federal Poverty Guidelines. The guidelines are subject to change around the beginning of each calendar year.

The steps to determine the applicant’s actual household FPL percentage are the following below.

Step 1

To determine FPP eligibility, the household is defined as a person who lives alone or a group of two or more persons related by birth, marriage, common-law marriage or adoption who live together and who are legally responsible for the support of the other person. Treat applicants who are 18 years old as adults. No one 18 years and older or other adults living in the home should be counted as part of the household group.

Legal responsibility for support exists between:

• persons who are legally married, including common-law marriage;
• a legal parent and a minor child, including unborn children; or
• a managing conservator and a minor child. A managing conservator is a person designated by a court to have daily legal responsibility for a child.

Step 2

Determine the applicant’s total monthly income amount.

To determine income eligibility, count the income of the following people if they are living together:

• The people 18 through 64 years old applying for FPP;
  • the person’s spouse; and
  • the person’s children 18 and younger; or
• The person 17 years or younger applying for FPP;
  • the person’s parent(s);
  • the person’s siblings 18 years and younger; and
  • the person’s children.
• For an unmarried applicant who lives with a partner, only count the partner’s income and children as part of the household if the applicant and their partner have mutual children together. Unborn children should also be included.
• All income received must be included. Income is calculated before taxes – gross. Income is reviewed and determined countable or exempt based on the source of the income per 9000, Resources, Definition of Income. Grantees must have a written income verification policy.
• Proof of income documentation may include:
  • copy(ies) of the most recent paycheck(s), pay stub or monthly earning statement(s);
  • employer’s written verification of gross monthly income;
  • award letters;
  • domestic relation printouts of child support payments;
  • statement of support;
  • unemployment benefits statement or letter from the Texas Workforce Commission;
  • award letters, court orders or public decrees to verify support payments;
  • notes for cash contributions; and
  • other documents or proof of income the grantee determines valid.
• For unemancipated, unmarried people younger than 18 years, if parental consent is required for the receipt of services per Section 32 of the Texas Family Code, the family's income must be considered to determine the charge for the service.
• Income Deductions: Dependent care expenses must be deducted from total income to determine eligibility. Allowable deductions are actual expenses up to $200 per child per month for children younger than 2, $175 per child per month for each dependent 2 years and older, and $175 per adult with disabilities per month. Legally obligated child support payments made by a member of the household group must also be deducted. Payments made weekly, every two weeks or twice a month must be converted to a monthly amount with one of the conversion factors listed below.
• Monthly Income Calculation: If income is received in lump sums or at longer intervals than monthly, such as seasonal employment, the income is prorated over the period the income is expected to cover. Income received weekly, every two weeks or twice a month must be converted as follows:
  • weekly income is multiplied by 4.33;
  • income received every two weeks is multiplied by 2.17; and
  • income received twice monthly is multiplied by 2.

Step 3

Divide the applicant’s total monthly income amount by the maximum monthly income amount at 100% of the FPL for the household size.

Step 4

Multiply by 100 to reach a percentage.

4150 Former Military Service Members

Revision 25-3; Effective Oct. 29, 2025

Applicants who served in any branch of the U.S. Armed Forces, Reserves or National Guard may be eligible for more benefits and services and must be referred to the Texas Veterans Portal for more information. Former female military service members must also be referred to the Texas Veterans Commission’s Women Veterans Program.

4160 Client Travel

Revision 25-3; Effective Oct. 29, 2025

If awarded funding for client travel, grantees must establish a policy for providing financial travel support to and from clinic or mobile location(s). Grantees must make sure clients who receive travel assistance live within the HHSC-approved service delivery area. Criteria for client travel support must be income based and include a justification of need. Grantee may include other factors.

Grantees may provide travel services through options such as bus passes, vouchers and rideshare apps like Uber or Lyft.

4170 Patient Navigation Services

Revision 25-3; Effective Oct. 29, 2025

If grantee is using cost reimbursement funds for a dedicated patient navigator, a policy must be in place to make sure the following services and activities are provided:

1. Application assistance to clients screening eligible for the following preventive and primary health programs:
   1. HTW;
   2. FPP;
   3. BCCS; and
   4. Primary Health Care (PHC).
2. Nonmedical service needs assessment provided by HHSC that identifies barriers to transportation, childcare, housing, food and employment. Grantee may use a comparable, alternative tool with prior written approval by HHSC. Grantee must administer these assessments during initial visit. All clients must be screened annually.
3. Education, appropriate referrals and follow-ups to show any resolution of barriers. Grantee must document these activities and support services in the client record including:
   1. Information about covered program benefits
   2. Attempt to resolve client barriers such as application assistance for SNAP benefits, referrals to local resources and client travel.
4. Document person’s refusal, lost to follow-up and good faith effort, as appropriate.
   1. Good faith effort is defined as at least three documented attempts to assist with applications or to navigate a person to services via phone, email, text or other preferred method of communicating with the person.
   2. Personal contact attempts can be made by office visit, phone, home visit, mail or a combination of these methods. Attempts to contact the person must be written or presented verbally. When appropriate, contact the client in their primary language if the client has limited English proficiency. The grantee must include appropriate provisions for the visually and hearing impaired.   
   3. Before closing a person’s record as a refusal, a thorough review of the person’s plan, recommendations and the following navigator's actions must be conducted to ensure proper closure.
5. Document informed refusal from the person if they fail to keep appointments, complete the Non-Medical Service needs assessment or refuse recommended procedures. If the person cannot, or will not, sign an informed refusal, the grantee must document verbal refusal.

Revision 24-2; Effective Oct. 15, 2024

Co-pays

If a grantee opts to charge a co-pay for services, a co-pay schedule must be developed and implemented with enough proportional increments so that inability to pay is never a barrier to service. The following co-pay guidelines apply.

• Clients must not be denied services based on an inability to pay.
• Clients with a household federal poverty level (FPL) at or below 100% must not be charged a co-pay.
• Clients may not be charged an added co-pay for services provided by referral.
• Clients assessed a co-pay must be presented with the bill at the time of service.
• Grantees must keep records of individual co-pays paid and any balance owed.
• Grantees must have a system for aging accounts receivable, which must be documented in the grantee’s policy and procedures and must clearly indicate a period for removing balances from a person’s account because of inability to pay.
• Grantees must maintain a co-pay schedule, approved by HHSC in advance, which must have proportional FPL increments and co-pay amounts. Note: HHSC provides an example of a co-pay schedule to grantees annually, following release of the Federal Poverty Guidelines. Grantees may opt to use the pre-approved Optional Co-Pay Table Based on Monthly Federal Poverty Level (FPL), which is in section 9000, Resources.
• The maximum co-pay amount must not exceed $30 per visit.
• The co-pay schedule must be updated when the revised Federal Poverty Guidelines are released annually.
• Co-pays collected by the grantee are considered program income and must be used to support the delivery of FPP services.
• Grantees must have policies and procedures about co-pay collection, which must be approved by the grantee’s governing body.
• Signs indicating this policy must be visibly posted at grantee clinic sites.

Other Fees

Clients must not be charged administrative fees for items such as processing or transfer of medical records, copies of immunization records, etc. Grantees can bill clients for services outside the scope of allowable services if the service is provided at the person’s request and the client is made aware of their responsibility for paying for the charges.

Insurance

Services may be provided to people with third-party insurance if the confidentiality of the person is a concern or if the person’s insurance deductible is 5% or more of their monthly income. Most insurance deductibles are given as an annual amount. FPP household incomes are figured as a monthly amount. To compare an annual deductible with a monthly income, multiply the monthly income by 12 and then determine 5% of that amount. Review the example below for a monthly household income of $1,000:

1. Determine the total household’s monthly income.
2. Determine the total household’s annual income by multiplying the monthly income by 12 (months).
3. Determine 5% of the total annual income by multiplying it by 0.05 (5%).

Another way to make the comparison is to divide the annual insurance deductible into a monthly amount. See the example below for an annual insurance deductible of $6,000 and a monthly household income of $1,000:

1. Determine the household’s monthly insurance deductible by dividing the annual deductible by 12.
2. Determine 5% of the total monthly household income by multiplying it by 0.05.

Date Eligibility Begins  

An applicant is eligible for services on the date the grantee determines the applicant is eligible for the program and signs the completed application.

Annual Recertification

Annual eligibility determination and recertification is required for all clients who receive services. Client eligibility must be redetermined every 12 months. Grantees must have a system in place to track client eligibility and renewal status on an annual basis.

Client Responsibility for Reporting Changes

A client must report changes in the following areas no later than 30 calendar days after the client is aware of the change:

• income,
• household composition,
• residence,
• current address,
• employment,
• types of medical insurance coverage, and
• receipt of Medicaid, CHIP or other third-party coverage benefits.

The client may report changes by mail, phone, in person or through someone acting on the client's behalf. If changes result in the client no longer meeting eligibility criteria, the client is denied continued services. By signing Form 1065, Eligibility Application, the client attests to the truth of the information provided. 

Revision 25-3; Effective Oct. 29, 2025

Grantees must continue to serve their existing clients for the duration of the budget year – Sept. 1 through Aug. 31 – even if all awarded funds have been expended.

If other funding sources are used to provide services offered through FPP, the funds must be reported as non-HHSC funds on the monthly Form 4116, Authorization for Expenditures, and the quarterly Financial Status Report (FSR) Form 269A.

Revision 25-2; Effective April 25, 2025

Grantees must follow the Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Texas Women Program for specific guidance on the treatment of minors within the program.

Revision 25-3; Effective Oct. 29, 2025

Grantees must obtain the person’s written, informed and voluntary general consent to receive services before receiving any clinical services. A general informed consent explains the types of services provided and how a person’s information may be shared with other entities for reimbursement or reporting purposes. If a person does not receive services for a period of three years or more, a new general consent must be signed before reinitiating delivery of services.

Consent information must be communicated to every person in a manner that is easy to understand. This communication must allow the person to participate, make sound decisions about their own medical care and address disabilities that impair communication in compliance with Limited English Proficiency regulations. Only the person receiving services may give consent. For situations when the person is legally unable to consent, a parent, in the case of an unemancipated minor, or legal guardian must consent on their behalf. Consent must never be coerced or obtained in a manner that could be perceived as coercive.

The grantee also must obtain the informed consent of the person receiving services for procedures as required by the Texas Medical Disclosure Panel. Refer to 5210, Texas Medical Disclosure Panel Consent.

Grantees should consult a qualified attorney to determine the appropriateness of the consent forms used by their health care agency.

5210 Texas Medical Disclosure Panel Consent

Revision 25-3; Effective Oct. 29, 2025

The Texas Legislature established the Texas Medical Disclosure Panel (TMDP) to:

• determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to their clients or persons authorized to consent for their clients; and
• establish the general form and substance of such disclosure.

TMDP developed List A, informed consent, which requires full and specific disclosure for certain procedures. List A is in the Texas Administrative Code (TAC) Title 25, Part 7, Chapter 602, Section 602.1.

Grantees that directly perform tubal sterilization, vasectomy or both, which are List A procedures, must also complete the TMDP Disclosure and Consent Form. This consent is in addition to the Sterilization Consent Form noted in 5620, Sterilization Procedures, Consent, Billing and Reporting.

For procedures not on List A, the physician must disclose, through a procedure-specific consent, all risks that a reasonable person would want to know about. This includes all risks that are inherent to the procedure, which are risks that exist in and are inseparable from the procedure itself, and that are material and could influence a reasonable person to decide to consent to the procedure.

More details on sterilization procedures, consent and reimbursement are in 5620.

5220 Consent for HIV Tests

Revision 24-2; Effective Oct. 15, 2024

Grantees must follow the Texas Health and Safety Code:

• Section 81.105 Informed Consent
• Section 81.106 General Consent

Revision 25-3; Effective Oct. 29, 2025

To facilitate immediate client access to and compliance with contraceptive methods, related medications and drugs for treatment of chronic diseases specified in 5000, Clinical Guidelines, grantees must be capable of providing pharmaceutical services to family planning clients at each clinic site funded by HHSC.

Grantees are required to have at least:

• a Class D pharmacy on-site with an expanded drug formulary to include chronic disease management at each HHSC family planning clinic site,
• applied for a Class D pharmacy license with expanded drug formulary through the Texas Pharmacy Licensing Board or
• obtained approval for a Class D pharmacy exemption from HHSC.

To petition the Texas State Board of Pharmacy to expand formulary, reference Texas Administrative Code (TAC) Title 22, Part 15, Chapter 291, Subchapter E, Section 291.93(e)(D).

Grantees who have a Class A or Class C on-site pharmacy are not required to have a pharmacy exemption. However, grantees are required to notify HHSC of their on-site pharmacy type via email at famplan@hhs.texas.gov.

It is the grantee’s responsibility to make sure all HHSC FPP-covered contraceptive methods and medications approved for reimbursement are made available.

Pharmacies must follow federal and state laws about security and recordkeeping for drugs and devices. The inventory, supply and provision of pharmaceuticals must be conducted per state pharmacy laws and professional practice regulations. It is essential that each facility keep an adequate supply and variety of drugs and devices on-site to effectively manage the contraceptive needs of its clients.

Class D Pharmacy Exemption

If extenuating circumstances prohibit a license from being granted, or if having an exemption would facilitate client access to contraceptive methods, related medications and drugs for treatment of chronic diseases, a grantee may request an exemption to the requirement to have at least a Class D pharmacy.

A request for an exemption must be made to HHSC in writing with Form 1061, Class D Pharmacy License Exemption Request. Requests will be considered on a case-by-case basis. A request for an exemption must:

• describe the process through which a person obtains medication from the referral pharmacy or pharmacies, and
• demonstrate that referring clients to an off-site pharmacy benefits the agency, clients or both.

The following criteria must be met to be considered for an exemption:

• A signed and fully executed memorandum of understanding (MOU) with referral pharmacy or pharmacies which includes the purpose of cooperation and details coordination between the grantees and the referral pharmacy or pharmacies to provide the following medications:
  • non-clinician administered hormonal contraceptive methods such as:
    • oral contraceptives,
    • transdermal hormonal patch contraceptives, and
    • vaginal hormonal ring contraceptives.
  • medications for treatment of:
    • uncomplicated diabetes,
    • elevated cholesterol,
    • uncomplicated hypertension, and
    • postpartum depression.
  • other medications necessary to treat the health care needs of the family planning client population.
• The agreement made with a referral pharmacy or pharmacies must not create barriers to the client receiving the prescribed medication.
• The referral pharmacy or pharmacies must be within a reasonable distance of participating clients.
• Clients do not incur added costs, such as a copayment, to obtain medications.
• The grantee has a written policy that makes sure clients can obtain prescribed medication refills from the cooperating pharmacy or pharmacies without an added clinic visit unless post-medically indicated or necessary.

HHSC staff will review an exemption request. Depending on the justification and circumstances specific to each clinic site, HHSC staff may or may not grant the request. HHSC staff reserves the right to approve or deny an exemption request based on the merit of the justification.

The pharmacy exemption process is not complete until the grantee receives written approval or denial from HHSC. Once approved by HHSC, the pharmacy exemption is valid for the life of the grant. Grantees are responsible for notifying HHSC of any changes to clinic’s pharmacy status.

Note: The grantee must provide the following contraceptive methods and services on-site, regardless of Class D pharmacy exemption status:

• injectable hormonal contraceptives;
• barrier methods and spermicides; and
• counseling and education on sexual abstinence.

Revision 25-3; Effective Oct. 29, 2025

Requirement for Documenting Reproductive Health Services

All clients should receive services related to reproductive health or contraception at least annually. Clients who use long-acting reversible contraception, such as an intrauterine device or implantable hormonal contraceptive device, and patients who have undergone permanent sterilization may continue to receive services under the program if they meet eligibility requirements.

The guiding principle of FPP is to improve the reproductive health of clients to make sure every pregnancy and every baby is healthy. At each client encounter, including those for treatment of other conditions such as an abnormal Pap smear follow-up, the provider must educate the client on how the service being provided relates to reproductive health or contraception. This must be documented in the client record.

For clients who have undergone sterilization and for women who are post-menopausal or have had a hysterectomy, this counseling and documentation are not required when receiving covered services. This must be documented in the medical record at least annually.

Client Health Records and Documentation of Encounters

Providers must make sure a client health record, the medical record, is created for every person who obtains clinical services. Refer to 3600, Client Records Management.

All client health records must be:

• a complete, legible and correct documentation of all clinical encounters, including those that take place by phone.
• written in ink, without erasures or deletions, or documented in the Electronic Health Record (EHR) or Electronic Medical Record (EMR).
• signed by the provider who makes the entry, including name of provider, provider title and date for each entry. Note: Electronic signatures are allowed to document provider review of care, but stamped signatures are not allowed.
• readily accessible to ensure continuity of care and availability to clients.
• systematically organized to allow easy documentation and prompt retrieval of information.

The client health record must include the person’s:

• identification and personal data, including financial eligibility.
• preferred language and method of communication.
• contact information, including the best and alternate ways to reach the person to ensure continuity of care, confidentiality and compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations.
• problem list, updated as needed at each encounter, which indicates significant illnesses and medical conditions.
• complete medication list, including prescription and nonprescription medications and dietary supplements, updated at each encounter.
• complete list of all medication allergies and adverse reactions, and other allergic reactions displayed in a prominent place and confirmed or updated at each encounter. If the person has no known allergies, this should be properly noted.
• documentation of past medical history, which includes all:
  • serious illnesses;
  • hospitalizations;
  • surgical procedures;
  • pertinent biopsies;
  • accidents;
  • exposures to blood products; and
  • mental health history.
• record or history of immunizations, including immunity to rubella based on a history of vaccine or documented serology testing.
• health risk survey and assessment, including:
  • past and current tobacco, alcohol and substance use or misuse;
  • domestic or intimate partner violence or abuse. For any positive result, the person must be offered referral to a family violence shelter per Texas Family Code, Chapter 91;
  • occupational and environmental hazard exposure;
  • environmental safety such as seat belt use, car seat use and bicycle helmets;
  • nutritional and physical activity assessment; and
  • living arrangements, updated as appropriate at each encounter.
• encounter-relevant history and physical exam pertinent to the person’s reason for presentation, with appropriate laboratory and other studies as indicated, updated at each encounter.
• plan of care, updated as appropriate, that is consistent with diagnoses and assessments consistent with clinical findings.
• documentation of recommended follow-up care, scheduled return visit dates and follow-up for missed appointments.
• documentation of informed consent or refusal of services that includes, at a minimum:
  • a general consent for treatment;
  • a person’s refusal of testing;
  • sterilization consent forms, noted in 5620, Sterilization Procedures, Consent, Billing and Reporting, if applicable;
  • a completed Texas Medical Disclosure Panel Consent form for surgical services provided, if applicable; and
  • for required or recommended services refused or declined by the person, documentation of the service offered, counseling provided and the person’s decision to decline.
• any special documents or considerations required for minors younger than 18 years per the Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Texas Women Program (PDF).
• an update for every clinic visit, with the reason for the visit and documentation of assessments and the services provided.

Revision 25-3; Effective Oct. 29, 2025

FPP seeks to promote the general and reproductive health of Texas residents. FPP provides safe and effective family planning services to people through 64 years old who live in Texas and meet program eligibility requirements.

The following services are covered:

• annual family planning and preventive health care visit;
• pregnancy testing and counseling;
• all methods of contraceptive services, including necessary follow-up and surveillance;
• certain health screening and diagnostic services, including:
  • screening, diagnosis and treatment of cervical intraepithelial neoplasia;
  • cervical cancer screening and diagnosis;
  • breast cancer screening and diagnosis;
  • screening and outpatient treatment for sexually transmitted infections (STIs);
  • HIV screening;
  • limited prenatal care services;
  • recommended immunizations;
  • screening and treatment for postpartum depression;
  • uncomplicated diabetes screening and treatment;
  • uncomplicated hypertension screening and treatment;
  • screening and treatment for elevated cholesterol; and
  • preconception health, such as:
    • screening for nutrition and obesity,
    • tobacco and substance use,
    • other high-risk behaviors, social issues and
    • mental health.

A complete list of reimbursable codes for the Family Planning Program are in 9000, Resources, Family Planning Program Reimbursable Current Procedural Terminology (CPT) Codes.

Grantees may request more services be added to the program by emailing the program mailbox at famplan@hhs.texas.gov and requesting a Topic Nomination Form.   

5510 Initial Clinical Visit

Revision 25-3; Effective Oct. 29, 2025

At the first clinical visit or an early follow-up visit, take a comprehensive health history adapted for the person’s sex. It must be taken to include the elements required for the client health record in 5400, Client Health Records and Documentation of Encounters, and the following:

• the reason for the visit and current health status;
• a review of systems with documentation of pertinent positives and negatives;
• a reproductive health history for women including:
  • menstrual history;
  • complete obstetrical history;
  • sexual activity history including contraceptive practices, number and sex of partners;
  • sexually transmitted infection (STI) and HIV history and risk factors, if currently sexually active; and
  • a reproductive life plan;
• a reproductive health history for men including:
  • sexual activity history including contraceptive practices, number and sex of partners, STI and HIV history, and risk factors;
  • if currently sexually active; and
  • a reproductive life plan;
• additional health history for women:
  • cervical and breast cancer screening history that note any abnormal results and treatment, and dates of the most recent testing;
  • other history of gynecological conditions;
  • other history of genital or urological conditions; and
  • family health and genetic history.
• Screening for depression, using tools such as Patient Health Questionare-9 (PHQ-9) or other relevant depression screening tools, at the initial visit and subsequent visits if clinically indicated. Grantees must provide client education and referrals as needed.
• Screening for substance use, using tools such as Screening, Brief Intervention and Referral to Treatment (SBIRT) or other relevant substance use screening tools at the initial visit and subsequent visits if clinically indicated.
• Grantees must provide client education and referrals as needed.

Update the record as appropriate at all following visits. Do this at the annual primary health care and problem visits. Include the reason for the visit and documenting current the current health status.

Annual Comprehensive Family Planning Visit, Physical Examination and Testing

The annual family planning visit offers an excellent opportunity for providers to address wellness and health risk reduction issues and findings, or client concerns. The annual visit must include an update of the person’s health record per the client health record in 5400, and documentation of appropriate screening, assessment, counseling and immunizations. These are based on the person’s age, risk factors, preferences and concerns.

All clients must undergo a physical exam annually as part of the family planning visit. The physical exam may be postponed if the person’s history and current health status do not suggest issues that need an urgent exam. Unless the clinician finds a compelling reason for delay, do not postpone the annual physical exam more than six months. Document the reason for the postponement in the client’s record.

A breast or pelvic exam may be performed only with the consent of the client. Clients must be offered a suitable method of contraception without delay, even if the physical exam is postponed or an otherwise asymptomatic person declines any or all components of the exam.

Pelvic exams must be administered in compliance with Chapter 167A of the Health and Safety Code.

The family planning visit should include all the following components at least annually, in addition to other components suggested by history and presenting signs and symptoms.

Note: All findings, including tests, results, the person’s notification of results or the person’s refusal or other reason for not testing or performing a specified part of the exam, should be documented in the medical record:

• Measurement of height, weight and blood pressure (BP) screening for hypertension.
• Calculation of body mass index (BMI) with assessment for underweight, overweight or obesity, with counseling if indicated on achieving and maintaining a healthful body weight. A BMI calculator for adults and a BMI calculator for children and teens are available from the Centers for Disease Control and Prevention.

Recommended components for exams for females:

• Clinical breast exam, breast cancer risk assessment and breast cancer screening, as appropriate, based on person’s age, risk and preferences:
  • counseling on breast awareness and advice to report any symptom or sign of concern to the person;
  • screening for cervical cancer beginning at 21 years old regardless of sexual history, and continuing as indicated based on the client’s age, previous test results and treatment history;
  • pelvic exam, in compliance with Chapter 167A of the Health and Safety Code:
    • for all consenting clients 21 years and older; or
    • consenting clients younger than 21 years old, only if indicated by the medical history:
      • pelvic exams include:
        • visual exam of the external genitalia, vaginal introitus, urethral meatus and perianal area;
        • speculum exam of the cervix and vagina; and
        • bimanual exam of the cervix, uterus and adnexa, and when indicated, rectovaginal exam;
  • pregnancy testing, available on-site, and if the pregnancy test is positive, the person must be given information on safe health practices during pregnancy and referred for appropriate physical evaluation and initiation of prenatal care, within 15 days; and
  • rubella immunity testing in women of reproductive age if the status cannot be determined by history or previous testing.

Recommended components for exams for males:

• Visual and manual exam of the external genitalia including scrotum, penis and testicles and visual inspection of the perianal area;
• assessment for hernia;
• palpation of the prostate as indicated by history, risk factors and person’s age; and
• advice on testicular awareness and recommendation to report any symptom or sign that is of concern to the person.

Recommended components for exams for all clients regardless of sex:

• Other exams as indicated by history, signs and symptoms, and the client’s concerns, for example, thyroid, heart, lungs, abdomen and similar concerns, are:
  • diabetes screening as appropriate for age and risk factors;
  • sexually transmitted infections;
  • cholesterol and serum lipid testing;
  • thyroid stimulating hormone;
  • immunizations as indicated, health care providers can voluntarily participate in the Texas Department of State Health Services (DSHS) Adult Safety Net (ASN) vaccine program, which provides certain vaccines at no cost;
  • screening for depression and substance use;
  • other testing, if indicated;
• appropriate family planning counseling and treatment; and
• healthful lifestyle interventions and counseling as indicated based on age, risk factors and client interest and receptiveness.

Counseling and Education

All clients must receive up-to-date, person-centered education and counseling in their preferred language. It must be presented in a way they can understand and to demonstrate their understanding. The education must be documented in the medical record. Personalized education enables the person to understand the range of available services and how to access them, to make informed decisions about family planning, to reduce personal health risk and to understand the importance of recommended tests, health promotion and disease prevention strategies.

Specific clinical policies must be in place for counseling and other services provided to minors younger than 18 years old, to include at least the following:

• Counseling of minors, including:
  • all medically approved methods of contraception, including abstinence;
  • prevention of STIs and HIV;
  • recognition and avoidance of sexual coercion; and
  • domestic, partner, dating and family violence, offering help as needed.
• Minors must be provided personalized family planning counseling and family planning medical services that meet their specific needs.
• Counseling and clinical services to minors must be expedited so appointments are made available as soon as possible.
• Appointment schedules are flexible enough to accommodate access for minors who request services.
• Grantees must get parental consent before they provide counseling for minors who seek family planning services.

Minors must be assured their privacy and confidentiality will be protected within the parameters of applicable law, including the Health Insurance Portability and Accountability Act (HIPAA), Texas Family Code, Chapter 32, and 5100, Minors, Consent and Confidentiality.

5520 Requirements for Policies to Ensure Appropriate Follow-up and Continuity of Care

Revision 24-2; Effective Oct. 15, 2024

Providers must develop and maintain policies and procedures to make sure timely follow-up and continuity of care, to include at a minimum:

• tracking pending tests until results are reviewed by the provider and the client is notified of their results with recommended follow-up as applicable;
• documentation of all tests and results in the client’s health record;
• a mechanism to inform clients promptly of test results that protects the person’s privacy and confidentiality while supporting timely and appropriate follow-up;
• a mechanism to track client compliance with recommended follow-up care, schedule return visits and follow-up on missed appointments; and
• a process to ensure compliance with all applicable state and local laws for disease reporting.

Before a person is considered lost to follow-up, the grantee must make at least three documented attempts to contact the person with a protocol in which subsequent attempts involve a more intensive effort to contact the person. Example: A phone call on the first attempt, a letter by regular mail on the second attempt and a certified letter on the third attempt.

Providers should develop processes that are suitable for the population they serve and adapt their usual processes to the known circumstances and preferences of the person whom they are trying to contact.

5530 Visits About a Particular Medical Concern, Problem Visits

Revision 24-2; Effective Oct. 15, 2024

For all problem visits, the following elements must be documented in the medical record:

• Reason for the visit;
• Appropriate interval medical history and focused history relevant to the problem reported; and
• Relevant physical examination and testing as indicated, and an assessment and prescribed treatment.

5540 Referrals

Revision 24-2; Effective Oct. 15, 2024

When a person is referred to another provider of services for consultation or continuation of care, the chart must reflect a record of the purpose for the referral, the name of the provider consulted or referred to, the counseling that the person received about the purpose of the referral and about questions the person had about the referral. Pertinent information about the person and relevant parts of the medical record must be provided to the referral clinician, and this provision of information must also be documented in the medical record. The results of the consultation or referral must be documented in the medical record.

When services covered under FPP are to be provided only by referral, the grantee must establish a written agreement with a referral resource for the provision of services and for the reimbursement of costs and make sure the client is not charged by the referral resource for these services.

Grantees must maintain a written policy reflecting these requirements for referral activities.

5550 Telemedicine

Revision 24-2; Effective Oct. 15, 2024

Providers may offer services by telemedicine if appropriate.

Providers who offer telemedicine services must follow all rules of the Texas Occupations Code 111.001 and must have written policies and procedures for doing so that include:

• informed consent;
• appropriate, quality care;
• prevention of abuse and fraud in the use of telemedicine services;
• adequate supervision of health professionals who are not physicians and who provide telemedicine care; and
• establish the maximum number of health professionals a physician may supervise through telemedicine services.

5560 Prescriptive Authority Agreements

Revision 25-2; Effective April 25, 2025

When services are provided by an advanced practice registered nurse (APRN) or physician assistant (PA), it is the responsibility of the grantee to make sure a properly executed prescriptive authority agreement (PAA) is in place for each mid-level provider. The PAA must meet all the requirements delineated in Texas Occupations Code, Chapter 157, including the following criteria:

• be in writing and signed and dated by the parties to the agreement;
• be reviewed at least annually, including amendments;
• kept on-site where the APRN or PA provides care;
• include the name, address and all professional license numbers of all parties to the agreement;
• state the nature of the practice, practice locations or practice settings;
• identify the types or categories of drugs or devices that may be prescribed, or the types or categories of drugs or devices that may not be prescribed;
• provide a general plan for addressing consultation and referral;
• provide a plan for addressing client emergencies;
• describe the general process for communication and sharing of information between the physician and the APRN or PA to whom the physician has delegated prescriptive authority related to the care and treatment of clients;
• if alternate physician supervision will be used, appoint one or more alternate physicians who may:
  • provide appropriate temporary supervision following the requirements established by the PAA and the requirements of this section; and
  • participate in the prescriptive authority quality assurance and improvement plan meetings required under this section;
• describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that includes:
  • chart review, with the number of charts to be reviewed determined by the physician and APRN or PA; and
  • periodic meetings between the APRN or PA and the physician at a location determined by the physician, APRN or physician assistant.

References

• Texas Occupations Code Title 3, Subtitle B, Chapter 157, Authority of Physicians to Delegate Certain Medical Acts
• Texas Administrative Code Title 22, Part 11, Chapter 222, APRN’s with Prescriptive Authority
• Texas Administrative Code Title 22, Part 9, Chapter 183, Physician Assistants
• Texas Nurse Practice Act Subchapter I, Sections 301.4011, 301.402, 301.4025, 301.407 Regarding Duty of Nurse to Report and Duty of State Agency to Report (PDF)

5570 Standing Delegation Orders

Revision 25-3; Effective Oct. 29, 2025

Standing Delegation Orders (SDOs) are written instructions, orders, rules or procedures designed for a client population with specific diseases, disorders, health problems or sets of symptoms. This type of order provides a general set of conditions and circumstances when action can be instituted before being examined or evaluated by a physician. Clinics must have written SDOs in place per TAC Title 22, Part 9, Chapter 169, Subchapter A.

Standing delegation orders may permit administering or providing the following types of dangerous drugs if specifically ordered by or using a pre-signed prescription from the delegating physician:

• oral contraceptives;
• diaphragms and contraceptive creams and jellies;
• topical anti-infectives for vaginal use;
• oral anti-parasitic drugs for treatment of pinworms;
• topical anti-parasitic drugs;
• antibiotic drugs for treatment of venereal disease; or
• immunizations.

General standards for SDOs, Standing Medical Orders, and Protocols require:

• development and approval by the delegating physician or in accordance with facility bylaws and policies;
• the order or protocol to be in writing and signed by the delegating physician;
• a description of the specific instructions, orders, protocols, or procedures to be followed,
• a notation of the level of supervision required, unless specified by other law;
• plans for addressing client emergencies;
• annual review signed by the delegating physician; and
• maintenance at the facility or practice site.

The grantee must have a process in place to make sure SDOs are reviewed, signed and dated at least annually by the supervising physician responsible for the delivery of the medical care covered by the orders and by other appropriate staff. SDOs must be kept on-site.

References

Texas Administrative Code Title 22, Part 9, Chapter 169, Delegation

Revision 25-3; Effective Oct. 29, 2025

Reproductive Life Plan

Providers should encourage all clients to develop a reproductive life plan, which includes an outline of each person’s plan for having children. The following questions can be useful to help clients develop the plan:

• Do you have children?
• Do you want to have children?
• If yes, how many children would you like to have?
• When would you like to start having children?
• If you want more than one child, at what intervals would you like to have them?
• If you have children, do you want to have more children?

Plans for having a family can change with time. Providers must take the person’s plan into account when counseling on contraceptive and family planning services. The provider can help the person by providing the following:

• Contraceptive services if the person is sexually active and does not want pregnancy.
• Pregnancy testing and counseling to any female who may be pregnant or who requests such testing. Initiate or provide referral for prenatal services if the test is positive.
• Services to help the female and her partner achieve a healthy pregnancy if pregnancy is desired and the female is not pregnant.

Contraceptive Counseling and Education

At each encounter for services, clients must receive client-centered counseling and education to make informed decisions about family planning, including information on preventing STIs and HIV, the results of the physical exam and other testing, method-specific counseling as described below, and other counseling as suggested by the history and clinical evaluation.

Providers must offer clients a wide array of contraceptive options right for the person’s health status and reproductive plan. Review the Texas LARC Toolkit (PDF) for more information on implementing a program to provide long-acting reversible contraception (LARC).

Specific Method Access Requirements for Grantees

Grantees must make sure the following requirements are met for client access to contraceptive methods:

• LARC methods must be available on-site or by referral. Providers typically purchase LARC devices directly from the manufacturer or a third-party distributor. Providers may get LARC products through the existing buy and bill process. This requires providers to purchase LARCs from wholesalers or other sources before being reimbursed upon insertion of the device and opting to receive reimbursement for LARC products as a clinician-administered drug. Buy and bill is the preferred option as it allows for same-day insertion. Grantees can also order a device from a specialty pharmacy for the client to pick up and bring in for insertion. Grantees are expected to maximize any discount available for purchasing multiple devices at a time.
• Male and female sterilization must be made available on-site or by referral.
• All grantees must make injectable hormonal contraceptive agents, male and female condoms, spermicides, diaphragms, cervical caps, and counseling and education on sexual abstinence available on-site.
• Grantees with a Class D pharmacy must also make oral and transdermal hormonal contraceptive agents or vaginal hormonal contraceptive rings available on-site. Grantees that have received an approved exemption to the Class D pharmacy requirement must make sure these methods are readily accessible to clients through a referral pharmacy.

The table below outlines the requirements for on-site availability of contraceptive methods and anti-infective agents for grantees:

Contraceptive Methods that May Be Provided by Referral

If a clinician associated with a grantee does not offer covered contraceptive services that require a special level of training or expertise, such as  sterilization, intrauterine device, hormonal implant and diaphragm fitting, these services may be offered by referral to another provider at no added cost to the client. Grantees that offer such services by referral must have a written agreement with the referral provider to offer the method or service under this condition.

Non-Covered Services

Per Texas Administrative Code Title 1, Part 15, Chapter 382, Subchapter B, Section 382.113(b), Non-Covered Services, services not provided through FPP include:

• counseling on and provision of abortion services; and
• other services that cannot be appropriately billed with a permissible procedure code.

No state funds appropriated to Texas Health and Human Services may be used to pay the direct or indirect abortion procedures costs including overhead, rent, phone service and utilities.

Grantees must implement adequate controls to make sure claims submitted for FPP services do not seek reimbursement for any benefit not covered by the program.

Distinguishing Federal Title X Family Planning Program Funds

The Title X Family Planning Program is a funding program established by Congress in 1970 to provide comprehensive family planning and related preventative services to low-income and uninsured people. The Office of Population of Affairs (OPA) administers this program is under the U.S. Department of Health and Human Services.

The Title X Family Planning Program is federally funded and operates nationwide. FPP is a state-specific initiative designed to provide similar services within the framework and regulations set by the state of Texas.

HHSC recognizes grantees may be recipients of funds from both Title X and FPP. As allowable services differ between the programs, grantees are strongly encouraged to use the following language in their clinical operations policy to make sure a clear delineation of service delivery, claims and billing are covered by FPP:

Clients may be dual eligible for both the HHSC FPP and Federal Title X programs. Allowable billing codes approved through HHSC FPP must match the services rendered. An FPP grantee must provide HHSC with all information HHSC requires upon request to determine the provider's compliance with this section.

References and Resources

American College of Obstetricians and Gynecologists Clinical Information

5610 Preconception Services

Revision 25-3; Effective Oct. 29, 2025

The goal of preconception care is to establish a foundation for the best possible outcome of every pregnancy. Quality preconception care incorporates all components of general health care included in this manual. Attention should be paid to the following components:

• Awareness and treatment of chronic medical conditions, such as diabetes, hypertension, thyroid disease, epilepsy and asthma:
  • Well-controlled blood sugar, as indicated by normal hemoglobin A1C before and early in pregnancy can substantially reduce the risk of birth defects in the babies of mothers with Type 1 and Type 2 diabetes.
  • Women with hyperthyroidism or hypothyroidism should be treated as necessary to make sure they are euthyroid before and during pregnancy to reduce the risk of miscarriage and preterm birth.
  • Women with a history of phenylketonuria should be counseled on the need to follow a low-phenylalanine diet before and during pregnancy to reduce the risk of birth defects and serious developmental delay.
• Screening, as indicated, for conditions that may be undiagnosed.
• Confirming immunizations are current.
• Medications, both prescription and non-prescription, and potential radiation exposure in early pregnancy. In general, the lowest effective dose of necessary medications is preferred, but clients should be cautioned against stopping or changing medications without first consulting their doctor. An untreated or incompletely treated medical condition might pose greater risk to the fetus and mother than the medication prescribed.
• Prevention of STIs and HIV.
• Nutrition and food insecurity.
• Occupational and environmental exposures to health risks and teratogens.
• Tobacco and substance use and other high-risk behaviors.
• Family medical history and genetic risk.
• Domestic violence and intimate and partner violence.
• Social issues, such as non-medical drivers of health.
• Mental health.

References and Resources

American College of Obstetricians and Gynecologists (ACOG) Clinical Information

5620 Sterilization Procedures, Consent, Billing and Reporting

Revision 25-3; Effective Oct. 29, 2025

Conditions for Sterilization Procedures

Clients who want to have a vasectomy, tubal ligation or occlusion sterilization procedure must:

• be 21 years or older;
• be mentally competent – clients are presumed mentally competent unless adjudicated incompetent for sterilization;
• not be institutionalized in a correctional facility, mental hospital or other rehabilitative facility;
• not give consent during labor or childbirth; and
• not give consent if under the influence of alcohol or drugs.

Date of Sterilization

Per ACOG, Consent for Sterilization Form is required before undergoing any sterilization procedure, including postpartum sterilization, interval sterilization and hysterectomy. This form must be signed at least 30 days before the date of the procedure for a practitioner or health care facility to be reimbursed. The consent remains valid for 180 days. The only exception is in cases of emergency abdominal surgery or premature delivery. In these situations, the consent must be signed at least 72 hours before the procedure.

Sterilization Waiting Period

A waiting period of at least 30 days, but no more than 180 days, is required between a person’s documented consent for sterilization and the date of service for the sterilization procedure.

Exceptions to Waiting Period

Exceptions to the required waiting period are allowed in the following situations:

• Sterilization following premature delivery. There must be at least 72 hours between the date of consent and the date of surgery. The informed consent must have been given at least 30 days before the expected date of delivery (EDD). The client’s EDD must be documented when there are less than 30 days between the date of the client’s consent and date of surgery.
• Sterilization following emergency abdominal surgery. Circumstances must be described on the Sterilization Consent form. Operative report(s) that detail the need for emergency abdominal surgery are required. There must be at least 72 hours between the date of consent and the date of surgery.

Consent for Sterilization Required Forms

For clients who choose sterilization, two consent forms must be signed by the person after the provision of counseling on method-specific risks and benefits and all the person’s questions have been answered:

• The Sterilization Consent Form in English or Spanish: The grantee must make sure the form is complete and correct before submitting it to TMHP. The Sterilization Consent Form is necessary for both abdominal and trans-cervical sterilization.
• A Texas Medical Disclosure Panel Consent for the surgical procedure by which sterilization will be performed must be signed by the person after full disclosure of the possible risks and benefits and all the client’s questions are answered.

The client may choose a witness to be present when consent is obtained. The consent for sterilization is valid for 180 days from the date of the client’s signature.

The consent form must be signed and dated by the:

• person to be sterilized;
• interpreter, if one is provided;
• person who obtains the consent; and
• physician who will perform the sterilization procedure.

Consent is not considered to be informed consent if the person to be sterilized is:

• in labor or delivering an infant or infants; or
• under the influence of alcohol or other substances that affect the person’s state of awareness.

Sterilization Billing and Reporting

Grantees can receive reimbursement for vasectomy, tubal ligation or occlusion sterilization procedures through FPP Fee-for-Service. The client may not be billed for any cost above the reimbursement rates. Client copays for sterilizations must follow the grantee’s established, HHSC-approved copay policy and may not exceed the allowable amount.

Allowable sterilization codes and descriptions are presented in 9000, Resources, Family Planning Program Reimbursable Current Procedural Terminology (CPT) Codes.

Complications and Reimbursement

Grantees may request reimbursement through TMHP for costs associated with client complications related to sterilizations, contraceptive implants or intrauterine devices (IUDs). Grantees may be reimbursed for approved charges up to $1,000 per occurrence. To request reimbursement, grantees should provide TMHP with the following information:

• a copy of the Remittance and Status (R&S) Report that shows a sterilization, contraceptive implant or IUD procedure was performed on the client in question;
• a narrative summary that details the procedure performed and related complications, if any;
• all surgical and progress notes for the client related to the complications of the sterilization procedure;
• the initial operative report for the sterilization surgery; and
• a completed paper 2017 Claim Form professional claim form that details the procedures for which the grantee seeks reimbursement and date of occurrence. List all procedures related to the complication even if they are not typically reimbursable under FPP.

References

American College of Obstetricians and Gynecologists (ACOG), Access to Postpartum Sterilization
ACOG Clinical Information
Code of Federal Regulations, Title 42, Chapter IV, Subchapter C, Part 441, Subpart F
Texas Administrative Code Title 25, Part 7, Chapter 601, Section 601.4

Revision 24-2; Effective Oct. 15, 2024

5710 Cervical Cancer Screening

Revision 25-3; Effective Oct. 29, 2025

General Considerations for Cervical Cancer Screening

Cervical cancer screening is primarily performed with the Pap test and the HPV DNA test. FPP uses U.S. Preventive Services Task Force (USPSTF) cervical cancer screening recommendations.

Clinical guidelines for cervical screening by age are:

• Younger than 21: Not eligible for cervical cancer screening.
• 21-29: Cervical cytology, Pap smear, alone every three years, with reflex HPV testing when cytology reveals atypical squamous cells of undetermined significance (ASCUS).
• 30-64: Cervical cytology, Pap smear, alone every three years, with reflex HPV testing for ASCUS or cervical cytology and HPV co-testing every five years, which is preferred.

Special circumstances may warrant alterations in screening intervals, as determined by a clinician. Special circumstances must always be documented in the client’s medical record. These may include:

• Clients considered high-risk such as HIV positive, immunosuppressed, exposed to diethylstilbestrol (DES) in utero or history of cervical cancer.
• Clients who had a hysterectomy for cervical intraepithelial neoplasia (CIN) disease. These clients may continue screening for 20 years.
• Clients who have had cervical cancer. These clients may be screened indefinitely if they are in good health.
• Applicants who have had a hysterectomy for benign disease and the cervix is still present. These people may be eligible for cervical cancer screening services. Funds can be used to pay for an initial exam to tell if the cervix is still present.

Components of Cervical Cancer Screening

The clinical components of cervical cancer screening are:

• Pelvic exam
• Pap test
• HPV test if indicated
• Clinical breast exam (CBE) if indicated
• Client education and
• Tobacco assessment and Quitline referral if indicated

The grantee must document the CBE and cervical cancer screening components in the client’s medical record.

A cervical health history must be included as part of the cervical cancer screening. The health history includes the:

• Date and results of the last pelvic examination and Pap test;
• Date and results of any past diagnostic procedures and treatments for cervical disease;
• Date of last menstrual period and pregnancy history;
• Medication history, including current or previous use of hormones such as hormone replacement therapy and oral contraceptives;
• Risk factors for cervical cancer; and
• Description of present pelvic symptoms.

Clinical components of cervical cancer screening must be performed by a:

• Physician
• Physician’s assistant
• Nurse practitioner
• Certified nurse midwife
• A qualified registered nurse with specialized training as required under standing delegation orders (SDOs)

The RN’s specialized training for cervical cancer screening must be documented in the personnel record, such as an educational certificate, a degree or continuing education credits.

Grantees must have policies and procedures to make sure health care providers follow evidence-based clinical guidelines and provide clinical services consistent with current nationally recognized standards of care.

HPV DNA testing is a reimbursable procedure when used for screening with Pap testing, which is co-testing, and for follow-up of abnormal Pap results per the American Society for Colposcopy and Cervical Pathology (ASCCP) algorithms. The following guidelines apply:

• For women 30 through 64 years, the following screenings are recommended:
  • co-testing, which is combined cervical cytology and HPV testing, every five years;
  • cervical cytology testing alone, with reflex HPV testing when cytology reveals ASCUS, every three years; and
  • screening with the FDA-approved primary HPV screening test every five years. If the primary HPV test is used for screening, it should be done per interim guidance provided by the ASCCP.
• It is reasonable to perform annual cervical cytology testing in women with in utero exposure to diethylstilbestrol.
• For any client with an abnormal result, more testing and follow-up should be dictated by findings, diagnosis and current evidence-based guidelines, such as that of the ASCCP.

Follow-Up for Abnormal Cervical Screening

When the results of the pelvic exam, cervical cancer screening Pap test, or both are abnormal, further diagnostic follow-up is required. A normal Pap test does not rule out cancer if a woman has a cervical lesion on pelvic exam. A colposcopy, cervical biopsy or both are allowed if determined appropriate by the clinician after an abnormal pelvic exam.

Grantees must follow the ASCCP algorithms for the management of the specific type of abnormal result and in consideration of special populations such as pregnant women and clients 20 years.

5720 Breast Cancer Screening

Revision 24-2; Effective Oct. 15, 2024

The summary of cited guideline recommendations provided in this section reflect the ages of eligibility for FPP, age 64 and younger, and do not include guideline recommendations for clients outside this range.

Risk Screening and Client Counseling

All women should undergo a risk assessment to find out if they are at high risk for breast cancer. Women considered high risk include those who have:

• a known genetic mutation such as BRCA 1 or 2; 
• have first-degree relatives with premenopausal breast cancer or known genetic mutation;
• a history of radiation treatment to the chest area before age 30, typically for Hodgkin’s lymphoma;
• a lifetime risk of 20% or more for development of breast cancer based on risk assessment models that are largely dependent on family history; or
• Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.

Providers can choose the risk assessment method they prefer to determine if a woman is at high risk for breast cancer. Women at high risk for breast cancer should be screened with both an annual mammogram and an annual breast MRI.

All clients should be counseled on breast awareness and advised to be familiar with their breasts and to report any changes such as a mass, lump, thickening or nipple discharge promptly.

All clients should be counseled on the benefits and risks of mammography. If a client has the option of having a 3-D mammogram, she should be counseled on the benefits and risks of 3-D mammograms versus 2-D mammograms to make an informed decision.

Breast Cancer Screening Frequency

The USPSTF recommends biennial screening mammography for women 40 to 74 years old.

FPP recommends that grantees and providers counsel all eligible clients about the benefits, potential harms and limitations of screening, and discuss client risk factors to determine if screening is medically indicated.

Components of Breast Cancer Screening

The grantee must provide a complete breast cancer screening, which includes a mammogram, individualized client education, tobacco use assessment and Quit Line referral if indicated, and may include a clinical breast examination (CBE). The grantee must document the breast cancer screening components in the client’s medical record.

A breast health history must be included as part of the breast cancer screening. The health history includes:

• date and time intervals of previous mammograms
• results of previous mammograms
• date and results of the last CBE
• date and results of any previous breast surgery
• date of last menstrual period
• medication history, including current or previous use of hormones such as hormone replacement therapy and oral contraceptives
• other risk factors for breast cancer such as personal history of breast cancer or family history of first-degree relatives with breast cancer
• description of breast symptoms if any

Breast Cancer Screening Follow-up and Referral for Treatment

Clients with an abnormality found on screening or a specific breast complaint, including a mass, lump, thickening or nipple discharge, should be promptly evaluated as indicated. Providers should have procedures in place to make sure they offer:

• appropriate individual education and counseling,
• referral for further evaluation, including other testing and biopsy when indicated,
• communication and coordination with the client and other providers, and
• proper follow-up through the conclusion of the case.

For clients who require referral for services beyond those available through the grantee, grantees are encouraged to refer these clients to an HHSC Breast and Cervical Cancer Services (BCCS) grantee. Information is available at Texas Health and Human Services Breast and Cervical Cancer Services webpage and Texas Works Handbook, X-900, Medicaid Eligibility.

Eligible clients in need of treatment for biopsy-proven breast cancer may apply for coverage under the Medicaid for Breast and Cervical Cancer Program. More information is available in Section 3354 of the Breast and Cervical Cancer Services Policy Manual and in the Texas Works Handbook, X-900.

5730 Sexually Transmitted Disease and Infection Screening and Treatment

Revision 25-3; Effective Oct. 29, 2025

The summary of cited guideline recommendations in this section reflect the ages of eligibility for FPP, which is 64 years and younger, and do not address clients outside this range.

Screening and treatment of sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) must follow the current guidelines for screening and treatment from the Centers for Disease Control and Prevention (CDC). A risk assessment should be completed for all clients to determine the testing indicated and documented in the medical record. An overview of STD and STI screening recommendations follows. For detailed information, visit the CDC links above.

HIV Screening

• Grantees must provide HIV testing on-site or by referral.
• If HIV testing is done, verbal or written consent must be documented in the medical record. If the client refuses testing, the refusal must be documented. All clients 13 to 64 years old should be screened at least once for HIV per a policy that provides HIV education and allows clients to opt out of screening. With an opt-out screening, clients are informed, before testing, that HIV testing is done as part of the general consent for care and that they are free to decline testing. The test is performed if they do not decline.
• Clients who engage in high-risk sexual practices or share injection drug paraphernalia should be tested annually.
• Clients who seek testing or treatment of STDs and STIs should be tested for HIV at the same time.
• Grantees may provide negative HIV test results to clients in person, by phone or by the same method or manner as the results of other diagnostic or screening tests. The provision of negative test results by phone must follow procedures that address a client’s confidentiality, identification of the client and prevention counseling.
• Grantees must always provide positive HIV test results to clients in a face-to-face encounter with an immediate opportunity for counseling and referral to community support services. Test results must be provided by staff who are knowledgeable about HIV prevention and HIV testing.
• Clients whose risk assessment reveals high-risk behaviors should be provided directly, or referred for, more extensive risk reduction counseling by a Department of State Health Services (DSHS) HIV-STD program-trained risk reduction specialist.

Clients with a diagnosis of HIV should be referred to a DSHS HIV-STD program grantee for treatment and monitoring. To find a DSHS HIV-STD program grantee, visit DSHS HIV-STD Program.

Chlamydia and Gonorrhea Screening

• Grantees must provide chlamydia and gonorrhea screening.
• Annual chlamydia and gonorrhea screening should be provided for all sexually active women younger than 25 years. If a pelvic exam is not performed, as in asymptomatic women younger than 21 and other women who decline a pelvic exam screening can be performed with a nucleic acid amplification technique on a urine sample or a vaginal swab obtained by the client.
• Testing should be provided for all symptomatic women and asymptomatic women with increased risk at 25 years and older. Indications include:
  • new or multiple sex partners;
  • a partner who has another partner;
  • exposure to an STD or STI;
  • symptoms or signs of cervicitis, an STD or STI;
  • history of pelvic inflammatory disease;
  • a positive test for an STD or STI in the previous 12 months; and
  • sex work or drug use.
• Treated clients should be retested three to four months after treatment to assess evidence of reinfection.
• All women who are pregnant or attempting pregnancy should be tested.
• Routine screening of males for chlamydia and gonorrhea should follow current CDC guidelines.

Herpes Simplex Virus (HSV) Screening

• Routine screening of asymptomatic clients for genital HSV infection is not recommended in the general or pregnant population.
• Testing, counseling and treatment of symptomatic clients who have genital lesions, and management of affected pregnant clients should follow current CDC guidelines.
• The preferred tests to confirm the diagnosis in clients with active genital ulcers or mucocutaneous lesions are cell culture and polymerase chain reaction (PCR) assay.
• Type-specific serologic testing is appropriate in some circumstances:
  • for clients presenting for evaluation of an STD, STI or both, especially those who report multiple sexual partners, and clients with HIV infection;
  • for men who have sex with men and whose HSV infection status is unknown, type-specific serologic testing may be appropriate to evaluate an undiagnosed genital tract infection;
  • when infection is suspected, but no lesions are present, a culture or PCR assay is not indicated if no lesions are present;
  • when the diagnosis is uncertain and virologic tests, that is culture and PCR, are negative in a symptomatic client; or
  • for counseling clients about the risk of infection by a partner with known infection, especially during pregnancy.

Syphilis Screening for Men and Non-pregnant Women

• Men and non-pregnant women who are at an increased risk of infection should undergo screening for syphilis.
• Men younger than 29, men who have sex with men, and men and women who are living with HIV have a higher risk for syphilis infection.
• Other factors associated with increased prevalence of syphilis infection include a history of incarceration or transactional sex work, geography and race or ethnicity.
• Routine screening for syphilis in a non-pregnant population that is not at increased risk of syphilis infection is not recommended as it may yield a high false-positive rate, leading to overtreatment.
• Screening should follow current CDC guidelines.

Other Screening and Pregnant Women

Screening for other infections and more frequent screening should be considered as appropriate based on the person’s condition, risk factors and concerns.

Pregnant Women

• All pregnant women should undergo screening for syphilis, HIV by an opt-out policy, and hepatitis B surface antigen as early as possible in the pregnancy.
• Clients younger than 25 and women at increased risk should also have chlamydia and gonorrhea testing.

Expedited Partner Therapy

Expedited Partner Therapy (EPT) is the clinical practice of treating the sex partners of clients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the client to take to their partner without the health care provider first examining the partner.

Clinic sites that implement EPT should develop necessary policies, procedures and standing delegation orders (SDOs) to reflect the CDC guidelines. Visit the DSHS HIV/STD website for more information on EPT implementation.

Reference

American College of Obstetricians and Gynecologists Clinical Information

5740 Diabetes Mellitus Screening

Revision 24-2; Effective Jan. 29, 2025

Grantees must evaluate all clients for risk factors for diabetes annually and provide screening lab work as appropriate. Grantees must have a process and policy in place for the diagnosis and treatment of clients with uncomplicated diabetes.

While treatment protocols for diabetes are beyond the scope of this manual, providers are encouraged to seek information from trusted sources such as the:

• American Diabetes Association Standards of Care in Diabetes; and
• American College of Obstetricians and Gynecologists.

Providers must have a policy and process in place to refer clients with complex needs that are not covered services under FPP.

5750 Hypertension Screening

Revision 25-1; Effective Jan. 29, 2025

Grantees must screen all clients for hypertension annually. Grantees must have a process and policy in place for the diagnosis and treatment for clients diagnosed with uncomplicated hypertension.

While treatment protocols for hypertension are beyond the scope of this manual, providers can seek information from trusted sources such as the:

• American College of Obstetricians and Gynecologists; and
• Centers for Disease Control and Prevention.

Providers must have a policy and process in place to refer clients with complex needs that are not covered services under FPP.

5760 High Cholesterol Screening

Revision 25-1; Effective Jan. 29, 2025

Grantees must screen all clients for high cholesterol annually. Grantees must have a process and policy in place for the diagnosis and treatment for clients diagnosed with high cholesterol.

While treatment protocols for high cholesterol are beyond the scope of this manual, providers can seek information from trusted sources such as the:

• American College of Obstetricians and Gynecologists; and
• Centers for Disease Control and Prevention.

Providers must have a policy and process in place to refer clients with complex needs that are not covered services under FPP.

5770 Depression Screening

Revision 25-3; Effective Oct. 29, 2025

Grantees must perform depression screening for all clients at the initial visit and subsequent visits as clinically indicated. FPP providers must have a process and policy in place for screening and initial treatment of depression.

A standardized self-administered screening tool with review and follow-up questions in a face-to-face interview with the provider will ensure consistency and efficiency in the screening process. The following depression screening tools are available online:

• Patient Health Questionnaire-2 (PHQ-2); Spitzer, Kroenke and Williams, 2003
• Patient Health Questionnaire-9 (PHQ-9); Spitzer, Kroenke and Williams, 1999

Providers must have a policy and process in place to refer clients with complex needs that are not covered services under FPP.

5780 Substance Use Screening

Revision 25-3; Effective Oct. 29, 2025

Grantees must perform substance use screening for all clients at the initial visit and subsequent visits as clinically indicated. FPP providers must have a process and policy in place for screening and initial treatment of substance use disorder.

A standardized self-administered screening tool with review and follow-up questions in a face-to-face interview with the provider will ensure consistency and efficiency in the screening process. The following substance use screening tools are available online:

• Screening, Brief Intervention and Referral to Treatment (SBIRT)
• Tobacco, Alcohol, Prescription medication and other Substance use (TAPS)

Providers must have a policy and process in place to refer clients with complex needs that are not covered services under FPP.

5790 Postpartum Depression Screening

Revision 25-3; Effective Oct. 29, 2025

Postpartum depression screening must be performed if a client was pregnant in the past year.

Providers can review The Texas Clinician’s Postpartum Depression Toolkit for a detailed review of screening for postpartum depression.

Postpartum depression can be a serious and sometimes life-threatening condition. All new mothers should be screened for postpartum depression at their initial postpartum visit. For those who screen negative, screening should be repeated at a later visit.

A standardized self-administered screening tool with review and follow-up questions in a face-to-face interview with the provider will ensure consistency and efficiency in the screening process. The following postpartum depression screening tools are available online and have been validated for use in postpartum clients:

• Edinburgh Postnatal Depression Scale (EPDS); Cox, Holden and Sagovsky, 1987
• Patient Health Questionnaire-9 (PHQ-9); Spitzer, Kroenke and Williams, 1999
• Postpartum Depression Screening Scale (PDSS); Tatano Beck and Gable, 2002

Postpartum Referral for Treatment

FPP covers screening and initial treatment for postpartum depression diagnosis.

While treatment protocols for postpartum depression are beyond the scope of this manual, providers can seek information from trusted sources such as the:

• Texas Health and Human Services;
• Texas Clinician’s Postpartum Depression Toolkit (PDF); and
• American College of Obstetricians and Gynecologists.

Providers must have a policy and process in place for the referral of clients with complex needs that are not covered services under FPP.

The Perinatal Psychiatry Access Network (PeriPAN), can enhance provider capacity to provide the perinatal mental health standard of care for FPP clients need. There is no cost to FPP providers or clients for this evidence-based, clinician-to-clinician program. Texas PeriPAN offers real-time access to a multidisciplinary network of mental health experts, including reproductive psychiatrists for peer-to-peer consults by phone and vetted and personalized referrals and resources. Contact information and details on how to access this resource are on the PeriPAN website.

For severe and persistent behavioral health issues, consult with Local Mental Health Authorities or Local Behavioral Health Authorities or call 211.

Clinicians are recommended to use their preferred screening tool for Suicide Risk Assessment for clients served.

Revision 24-2; Effective Oct. 15, 2024

All clients should receive a risk assessment at least annually to find areas where lifestyle modifications might reduce the risk of future disease and improve health outcomes and quality of life.

Counseling on healthful lifestyle choices should cover the following areas:

• smoking and tobacco use,
• healthy eating patterns, and
• physical activity and fitness.

Counseling should be catered toward the client’s current health needs and family planning goals. Counseling should include relevant information and guidance accessible to the client.

Smoking and Tobacco Use

Based on the needs of each client, they should be advised on the impact of smoking, the use of tobacco products and to avoid exposure to second-hand smoke.

Healthy Eating Patterns

Clients should be counseled on healthy eating patterns and offered access to information and guidance relevant to their needs. This may include limiting salt intake or advising a specific diet plan if needed.

Physical Activity and Fitness

Clients should be advised to engage in moderate-intensity aerobic activity, vigorous aerobic activity or a combination of both each week. Moderate-intensity activities include walking, social dancing or gardening, while vigorous-intensity activities include running, jumping rope or swimming laps. Physical activity should always be tailored to their individual health condition, risks and abilities.

Revision 25-1; Effective Jan. 29, 2025

Base prenatal and postpartum services on American College of Obstetricians and Gynecologists (ACOG) guidelines.

Grantees may bill FPP for allowable services provided in clinical prenatal care visits for women during the Medicaid for Pregnant Women and the CHIP Perinatal Program enrollment processes. Medically necessary postpartum visits are reimbursable and include interval history, physical examination, assessment, family planning, counseling, education and referral as indicated.

Diagnostic Testing During Pregnancy

Grantees must follow Texas Health and Safety Code, Chapter 81, Subchapter A, Sec. 81.090:

All pregnant women should be tested for the following STIs as early as possible in the pregnancy:

• syphilis;
• HIV infection; and
• hepatitis B infection.

Retain the record of the tests in the client’s chart.

Tobacco Assessment and Quitline Referral – All women who receive prenatal services should be assessed for tobacco use. Refer women who use tobacco to tobacco quit lines. The Texas Tobacco Quitline provides confidential, free and convenient cessation services to Texas residents13 and older, including quit coaching and nicotine replacement therapy. Access services by phone at 877-937-7848 (877-YES-QUIT) or online at YesQuit.org. Agency staff should perform and document the assessment and referral in the clinical record.

Information for Parents of Newborns Requirement

Chapter 161, Health and Safety Code, Subchapter T requires hospitals, birthing centers, physicians, nurse-midwives and midwives who provide prenatal care to pregnant women during gestation or at delivery to give the woman and the infant’s father or other adult caregiver for the infant with a resource pamphlet that includes information on:

• postpartum depression;
• shaken baby syndrome;
• immunizations;
• newborn screening;
• pertussis; and
• sudden infant death syndrome.

Document in the client's chart that she received this information. The documentation must be retained for at least five years. It is recommended the information be given twice, once at the first prenatal visit and again after delivery.

Information for Parents of Newborn:

• English, Revised Sept. 2024 (PDF)
• Spanish, Revised Sept. 2024 (PDF)

Information for Parents of Children

Chapter 161, Health and Safety Code, Subchapter T also requires hospitals, birthing centers, physicians, nurse-midwives and midwives who provide prenatal care during gestation or at delivery to pregnant women on Medicaid to provide the woman and the infant’s father or other adult caregiver for the infant with a resource guide that includes information about the development, health and safety of a child from birth until 5 years old. The resource guide must provide information about medical home, dental care, effective parenting, child safety, importance of reading to a child, expected developmental milestones, health care and other resources available in the state, and selecting appropriate childcare.

A Parent’s Guide to Raising Healthy, Happy Children (PDF)

Provision of Information about Umbilical Cord Blood Donation Requirement

Chapter 162, Health and Safety Code, Subtitle H requires a physician or other person permitted by law to attend a pregnant woman during gestation or at delivery of an infant to give the woman an informational brochure before the third trimester of the woman’s pregnancy, or as soon as reasonably feasible. It should include information about the uses, risks and benefits of cord blood stem cells for a potential recipient, options for future use or storage of cord blood, the medical process used to collect cord blood, any costs that may be incurred by a pregnant woman who chooses to donate or store cord blood after delivery, and average cost of public and private storage.

Referral and Follow-up

Grantees must have written policies and procedures for follow-up on referrals made because of abnormal physical examination or laboratory test findings. These policies must be sensitive to clients’ concerns for confidentiality and privacy and must follow state or federal requirements for transfer of health information.
For necessary services beyond the scope of the grantee, clients must be referred to other providers for care.

Whenever possible, clients should be given a choice of providers to select. When a client is referred to another provider or for emergency clinical care, the grantee must:

• provide pertinent client information to the referral provider and obtain required client consent with proper safeguards to ensure confidentiality by adhering to HIPAA regulations;
• advise the client about their responsibility to comply with the referral; and
• counsel the client about the importance of the referral and follow-up plan.

Revision 25-3; Effective Oct. 29, 2025

Grantees must engage in promotion and outreach activities in each of the counties designated as a service area during the grant term.

FPP grantees are required to develop an annual plan for promotion and outreach within 45 calendar days from the start of each fiscal year. Grantees are expected to follow the plan and make the plan available for monitoring purposes. This plan must outline the grantee’s goals to:

• inform the public of the program’s purpose and available services;
• enhance community understanding of its objectives;
• disseminate basic family planning and women’s health care knowledge;
• enlist community support; and
• recruit potential clients for FPP.

The plan must be based on an assessment of the needs of the geographic community and contain an evaluation strategy. Grantees must consider a variety of program promotion and client in-reach and outreach strategies per:

• organizational capacity;
• availability of existing resources and materials; and
• the needs of the local community.

Revision 25-3; Effective Oct. 29, 2025

To gauge the efficacy of program promotion and client in-reach and outreach activities, grantees must complete the biannual survey of promotion and outreach activities. This survey is delivered twice a year and is due within 30 days of receipt.

Submit questions about the surveys to famplan@hhs.texas.gov.

Guidance for Promotion and Outreach Plans

The plan should include how the priority population was determined, a recruitment work plan and in-reach and outreach methods.

Grantees should have many materials and resources to promote community awareness. Grantees must develop and maintain relationships with local partners and collaborators who can help recruit in the priority populations. 

Grantees must include in their outreach plan a description of how they plan to implement strategies to enroll clients in FPP and how to raise community awareness of FPP services. The outreach plan must describe how the grantee plans to:

• identify priority populations in the community;
• identify the populations at highest risk for unintended pregnancies and STIs;
• provide health education and social support;
• help reduce participant barriers to accessing clinical services;
• establish relationships with internal and external partners to reach eligible clients in the priority populations;
• establish relationships with clinic sites that offer other HHSC programs, such as the Breast and Cervical Cancer Services (BCCS) Program, the Primary Health Care Program and Healthy Texas Women to increase cross-program referrals, coordination and service provision;
• link and connect participants to partner clinics for Family Planning Program services;
• educate partners, including subgrantees, other health care providers, community organizations and coalitions about Medicaid for the Breast and Cervical Cancer (MBCC) program and how to refer a non-BCCS diagnosed client for MBCC screening appropriately;
• educate clients diagnosed with breast or cervical cancer about MBCC eligibility requirements and how to apply for services;
• provide information to each eligible client in their primary language; and
• provide access to information that is linguistically appropriate and available to the visually and hearing impaired.

Revision 25-3; Effective Oct. 29, 2025

Grantees must complete a Clinic Location Survey each fiscal year. The survey must be completed within 10 days from the date HHSC requests the information.

This survey provides HHSC with current clinic location information. Responses are used to update the Healthy Texas Women Find a Doctor search function.

Grantees also must notify HHSC of any changes made to their clinic information within 30 days of the change. To update this information, email famplan@hhs.texas.gov to request link to the Clinic Information Survey.

It may take up to 30 days to see changes reflected on Healthy Texas Women website.

Revision 25-3; Effective Oct. 29, 2025

Covered services provided through FPP are reimbursed per TAC Chapter 355 Grantees may seek reimbursement for costs with one of the following methods:

• submitting monthly vouchers for expenses outlined in a categorical budget approved by HHSC, as required for categorical cost reimbursement; or
• submitting claims to TMHP for direct clinical care services with the fee-for-service reimbursement method, which are then paid by HHSC.

Grantees may designate up to 25% of their total award on a categorical cost reimbursement basis. The remainder of their award will be paid on a fee-for-service basis. Grantees may designate up to 100% of their total award on a fee-for-services basis. Annual award determination and reallocation of funds will be based in part on those grantees that leveraged a higher percentage for direct services.

FPP is the payer of last resort. In situations where a grantee is awarded multiple HHSC program grants, consult this manual for instances where limited dual certification for grantee billing is allowed.

An FPP provider may not use any FPP funds received to pay the direct or indirect costs, including overhead, rent, phones, equipment and utilities, of abortions.

Categorical Cost Reimbursement

The categorical portion of FPP funding is used to develop and support grantee infrastructure for the provision of family planning services. These funds may be used for support services that enhance fee-for-service client service delivery. Cost reimbursement awards may be used to fund personnel, fringe benefits, staff travel, contractual services, equipment, supplies, and other direct and indirect costs per state and federal requirements, and must be reasonable, allowable and already allocated.

Costs may be assessed against any of the following categories the grantee identifies during its budget development process:

• personnel
• fringe benefits
• travel
• equipment and supplies
• contractual
• indirect costs
• other

Note: Indirect costs are incurred for a common or joint purpose that benefits more than one project or cost objective of a grantee’s organization, and not readily identified with a project or cost objective. More information is on the HHS Indirect Cost Rates webpage.

Up to 25% of funds may be disbursed to grantees through a voucher system as expenses are incurred during the grant period. Grantees must still submit vouchers monthly, even if program income equals or exceeds program expenses, or if the grant reimbursement award has been met. When program expenses exceed program income, the monthly voucher will result in a payment. Program income includes all patient copays and donations.

To request reimbursement for the categorical grant, the following documents, which comprise the voucher packet, must be submitted by the last business day of the following month when expenses were incurred or services provided:

• B-13X Form Budget Category monthly expenditures, program income and non-HHSC funding
• Form 4116, Authorization for Expenditures
• Data management form Required Data Collection
• Supporting documentation, such as a general ledger

Categorical Budget Revisions

HHSC, at its sole discretion, may approve fund transfers between categories within the approved budget workbook upon a grantee’s written request. The request must include a detailed explanation that supports the need for the fund transfer. The grantee must seek HHSC’s written approval before making any fund transfers. For more information, visit the Texas Grant Management Guide (PDF). Grantees must submit a revised budget to HHSC for review any time a budget revision is made.

Fee-for-Service Reimbursement

The fee-for-service (FFS) component of FPP funding reimburses for direct medical services and supplies provided to eligible people. Up to 100% of funds may be reimbursed on a fee-for-service basis. Each grantee is responsible for determining a person’s eligibility for clinical services. Grantees must continue to provide services to established people and to submit and appeal claims for individual services even after the grant funding award has been met.

All grantees are required to submit claims for all direct services to TMHP with the appropriate claim form on the TMHP website. The Texas Medicaid Provider Procedures Manual (TMPPM) provides detailed instructions on how to complete the form, including required and optional fields. Grantees may also submit claims electronically with a modified CMS-1500 electronic claim form. For help with this process, contact TMHP Provider Relations at provider.relations@tmhp.com.

All claims or appeals must be filed within certain time frames:

• Initial Claims Submission: Submitted within 95 calendar days of the date of service on the claim or date of any third-party insurance explanation of benefit (EOB). If the 95th day falls on a weekend or holiday, the filing deadline is extended to the next business day.
• Appeals: Submitted within 120 calendar days of the date on the Remittance and Status (R&S) Report on which the claim reaches a finalized status. If the 120th day falls on a weekend or holiday, the filing deadline is extended to the next business day. If the claim is denied for late filing because of the initial submission deadline, documentation of timely filing must be submitted with the claim appeal. Refer to the TMPPM for more information.
• All claims and appeals must be submitted and processed within 60 calendar days of the end of the grant period.
• All claims and appeals must continue to be submitted even after the grant funding award has been met.
• An FPP provider may request a review of a denied claim. The request must be submitted as an administrative appeal under Title 1, Chapter 354, Subchapter I, Division 3, Appeals.

For answers to questions about claims and payment status, grantees may contact the TMHP Contact Center from 7 a.m. to 7 p.m. (CT), Monday through Friday, at 800-925-9126.

HTW Claims Pending Eligibility Determination

Grantees may provide services to people deemed eligible for FPP who have pending HTW applications. In such cases, grantees may file a claim for reimbursement any time after the person has a current FPP eligibility form on file.

When submitting a claim under FPP through TMHP, grantees are not required to add anything to the claim submission to indicate that the client has a pending application with HTW. If the applicant becomes eligible for HTW, the FPP claims will be recouped and reprocessed under the HTW program. This action will show on the FPP Remittance and Status Report (R&S) as a recoupment and then on the HTW R&S as a payment. Grantees are not required to resubmit the claim to HTW.

Codes for Reimbursement

Reimbursement is limited to a prescribed set of procedure codes approved by HHSC. Grantees may search for fee information for specified procedure codes using the TMHP Online Fee Lookup. The fee information is accurate for the current date or for a specified prior date of service. Providers who have an account on TMHP.com can log in to search for the fees that apply specifically to them. All other users can search for fees by provider type and specialty.

For a complete list of valid procedure codes, visit 9000, Resources, Family Planning Program Reimbursable Current Procedural Terminology (CPT) Codes.

Grantees may submit claims for office visits that reflect various levels of service for new and established clients. A new client is one who has not received clinical services at the grantee’s clinic or clinics during the previous three years. The level of services, which determines the procedure code to be billed for that visit, is indicated by a combination of factors such as the complexity of the problem addressed and the time spent with the person by clinic providers.

The American Medical Association (AMA) publishes materials related to Current Procedural Terminology (CPT) coding that includes guidance on office visit codes with Evaluation and Management Services (E/M).

Medroxyprogesterone Acetate Injection

Providers may not bill a lower complexity office visit code (99211/99212) when the primary purpose is for the person to receive an injection of Medroxyprogesterone acetate (Depo-Provera/DMPA/depo). Grantees should bill the injection fee (96372) with the Depo-Provera contraceptive method (J1050).

Retroactive Eligibility

Medicaid Retroactive Eligibility: Copays collected from a person who is found to be eligible retroactively for Medicaid must be refunded to the person. If a claim has been paid and later the person receives retroactive Title XIX (Medicaid) eligibility, TMHP recoups or adjusts the funds paid from FPP and processes the claim as Title XIX. An accounts receivable (A/R) is then established for the adjusted claim. Note: Grantees must refund HHSC the amount of any FPP A/R balance that may remain at the end of a state fiscal year.

The grantee’s FPP R&S Reports reflect the retroactive Title XIX adjustment with EOB message Recoupment is due to Title XIX retro eligibility. Grantees can get help with reconciling R&S reports through the TMHP Contact Center from 7 a.m. to 7 p.m. CT, Monday through Friday, at 800-925-9126. A TMHP Provider Relations representative is also available for questions about reconciling reports. A representative can be found by region on the TMHP website.

Claims Submitted with Laboratory Services

If a Title XIX retroactive eligibility claim includes laboratory services and the grantee is not CLIA certified for the date of service on the claim, TMHP will deny the laboratory services. The Title XIX R&S report will reflect EOB 00488 message: Our records indicate that there is not a CLIA number on file for this provider number or the CLIA is not valid for the dates of services on the claim.

When this occurs, the laboratory that performed the procedures must refile laboratory charges with TMHP to receive Title XIX reimbursement. For claims past the 95-day filing deadline, the laboratory must follow their Medicaid appeals process. Grantees must arrange with their contracted laboratory to recoup any funds paid to the laboratory for lab services for FPP people before Title XIX retro eligibility determination.

Donations

Voluntary donations from people are permissible. However, people must not be pressured to make donations, and donations must not be a prerequisite to the provision of services or supplies. Donations are considered program income per specification of the grant’s general provisions. All donations must be documented by source, amount and date they were received by the grantee. Grantees must have a written policy on the collection of donations. Individual donations collected by the grantee must be used to support the delivery of family planning services.

Revision 26-1; Effective March 1, 2026

The following changes(s) were made:

Revision 25-3; Effective Oct. 29, 2025

The following changes(s) were made in the Family Planning Program (FPP) Policy Manual:

Revision 25-2; Effective April 25, 2025

The following changes(s) were made:

Revision 25-1; Effective Jan. 29, 2025

The following changes(s) were made: