Revision 26-2; Effective Sept. 1, 2026

Mailing Address

Primary Health Care Program
North Austin Complex
4601 W Guadalupe St., Mail Code 0224   
Austin TX 78751-2920

Email

PrimaryHealthCare@hhs.texas.gov

Website

Primary Health Care Program

Revision 26-2; Effective Sept. 1, 2026

The Texas Health and Human Services Commission (HHSC) Primary Health Care (PHC) Program Policy Manual is a guide for grantees who deliver HHSC PHC services in Texas. This program policy manual provides grantees with the information needed to comply with program requirements. Information is subject to change with advance notice from HHSC. Grantees are required to comply with all updates made to the policy manual.

Federal and state laws on reporting abuse, operation of health facilities, professional practice, insurance coverage and similar topics can also impact the delivery of PHC services. Grantees are required to be aware of and comply with existing laws.

Revision 26-2; Effective Sept. 1, 2026

Statute

The Primary Health Care Services Act, House Bill 1844, is the statutory authority for the Primary Health Care (PHC) program administered by HHSC. The act defines the specific target population, eligibility, reporting and coordination requirements for PHC.

Rules

The rules for PHC services in Texas are in the Texas Administrative Code (TAC), Title 26, Part 1, Chapter 364, Subchapter A. The PHC program rules require that, at a minimum, a grantee must provide the following six priority PHC services:

• diagnosis and treatment,
• emergency medical services,
• family planning services,
• preventive health services,
• health education, and
• laboratory, x-ray, nuclear medicine or other appropriate diagnostic services.

PHC provides services through contracted providers – grantees – for people who are at or below 200% of the Federal Poverty Level (FPL) and cannot access the same care through other funding sources or programs. Grantees must make sure services provided to clients are accessible in terms of cost, scheduling and distance.

Funding Sources

State general revenue funds PHC program services. HHSC PHC funds are allocated through a competitive application process. HHSC selects applicants to provide services with negotiated contracts. Many types of organizations provide PHC program services, such as local health departments, medical schools, hospitals, private nonprofit agencies, community-based clinics, federally qualified health centers (FQHCs) and rural health clinics. 

Providers must enroll with the Texas Medicaid & Healthcare Partnership (TMHP) to provide PHC program services. 

State and federal law prohibits the use of contracted funds awarded by HHSC to pay the direct or indirect costs of abortion procedures. This includes overhead, rent, phones and utilities.

Revision 26-2; Effective Sept. 1, 2026

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

Adjusted Gross Household Income  – The gross household income before taxes, minus any allowable deductions. The adjusted gross household income is used to calculate the Federal Poverty Level (FPL) percentage.

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

Applicant – A person who applies to receive PHC services.

Barrier to Care – A factor that hinders a person from receiving health care. For example, proximity or distance, lack of transportation, documentation requirements and co-payment amount can impact access to services.

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

Confidentiality – The state of keeping information private and not sharing it without permission.

Consultation – A service provided by a health care provider with expertise in a medical or surgical specialty.

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

Co-payment or Co-pay – Money collected directly from clients for services.

Dental Services – Diagnostic, preventive and therapeutic dental services provided to an eligible client in a dental office, clinic or by teledentistry. Dental services are optional in the PHC program and are not included in the six required priority health services.

Department of State Health Services (DSHS) – The agency responsible for public health in the state of Texas.

Dependent Care Deduction – The expense of providing care for a dependent. This expense must be both necessary for employment and incurred by an employed person. Allowable deductions are actual expenses, up to $200 per month for each child younger than 2 years old and $175 per month for each child 2 years or older.  

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

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

Diagnostic Services – Activities related to the diagnosis made by a physician or other health professional.

Diagnostic Studies or Diagnostic Tests – Tests ordered by a health care practitioner to evaluate a client's health status for diagnostic purposes.

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

Emergency Services – Urgent care services provided for an unexpected health condition that requires immediate attention. Clinical emergency situations include:

• anaphylaxis
• syncope
• cardiac arrest
• shock
• hemorrhage
• respiratory difficulties in response to environmental emergencies, which include natural and man-made disaster situations

Family Composition or Household – A person living alone or a group of two or more people related by birth, marriage including common law, or adoption. They live together and are legally responsible for the support of the other person.

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

Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, this level is determined by the Department of Health and Human Services. FPL varies per family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.

Fiscal Year – The state fiscal year is Sept. 1 through Aug. 31. The federal fiscal year is Oct. 1 through Sept. 30.

Grantee – A non-state entity that receives an award directly from the state awarding agency to carry out an activity under a state program. The term does not include subgrantees or subrecipients.

Gross Household Income  – The total countable income of the household before taxes. For descriptions of countable income refer to Appendix I, Definition of Income.

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 or Provider – A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, group of clinicians, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory or rural health center that provide health care services.

Health Education – The process of educating or teaching people about lifestyles and daily activities that promote physical, mental and social well-being. This process may be provided to a person or to a group of people.

Health Screening – Providing tests, such as blood glucose, serum cholesterol and fecal occult blood, to determine the need for intervention and maybe a more comprehensive evaluation.

Laboratory or Informally, Lab – A facility that measures or examines materials derived from the human body to provide information on diagnosis, for monitoring prevention or treatment of disease.

Laboratory, X-ray or other Appropriate Diagnostic Services – Studies or tests ordered by the client’s health care practitioner(s). Physicians, dentists and mid-level providers can provide these services to evaluate a client’s health status for diagnostic purposes.

Managing Conservator – A person designated by a court to have daily legal responsibility for a child.

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

Minor – Per the Texas Family Code, 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. In this policy manual, minor and child may be used interchangeably.

Payor Source – Programs, benefits or insurance that pays for the service provided.

Preventive Health Care – Services include, but are not limited to the following: immunizations, risk assessments, health histories and baseline physicals for early detection of disease and restoration to a previous state of health, and prevention of further deterioration or disability.

Program Income – Money collected directly by the grantee, subrecipient or provider for services provided under the grant award such as third-party reimbursements, Title XIX, private insurance and client co-pay fees and donations. 

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

Service Member – A member or former member of the state military forces or a component of the U.S. Armed Forces, including a reserve component. This includes active duty, reserve and veterans of the U.S. Armed Forces and active and former members of the Texas National Guard and the Texas State Guard.

Subgrantee or Subrecipient –  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 or subrecipient may also be a grantee of other state awards directly from a state awarding agency. Refer to the Texas Grant Management Standards.

Teledentistry  – A health service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist. The providers act within the scope of the dentist's or health professional's license or certification to provide dental care to a patient at a different physical location using telecommunications or information technology. 

Telehealth Service – A health service, other than a telemedicine medical service, delivered by a health professional licensed, certified or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification or entitlement to a client at a different physical location than the health professional using telecommunications or information technology.

Telemedicine Medical Service – A health care service delivered to a client at a different physical location than the physician or health professional using telecommunications or information technology. Service is done by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state. and acting within the scope of the physician’s or health professional’s license.

Texas Resident – A person who lives within the geographic boundaries of Texas.

Treatment – Any specific procedure used to cure or improve a disease or pathological condition.

Unduplicated Client – A client who is counted only one time during the program’s fiscal year, regardless of the number of visits, encounters or services they receive. Example: One client seen four times during the year is counted as one unduplicated client.

Vision Care or Vision Services – Basic visual screening, management and treatment of minor eye issues provided by a primary health care practitioner. In the context of the Primary Health Care program, vision services are optional and are not included in the six required priority health services.

Revision 26-2; Effective Sept. 1, 2026

Maintaining Clinic Information on 2-1-1

Grantees must maintain current and accurate information on 211Texas.org for all clinic locations providing PHC services. Grantees may use the Add or Edit Your 2-1-1 Listing link at the top of the webpage to add a new listing or update their active clinic location information. 

In the comment box for 2-1-1 staff review, first-time grantees without an existing listing must note that they are a Primary Health Care (PHC) Program grantee and specify which clinic locations will serve PHC clients. 

Grantees with existing listing(s) may update their PHC designations by contacting their local 2-1-1 resource manager or by selecting Service Revision Request on their listing(s) on the 2-1-1 website.

At a minimum, grantees must maintain current information on each clinic, including its:

• phone number
• physical location
• hours of operation
• services provided

At the beginning of each fiscal year, grantees will receive a notification from their HHSC program contact of any active 2-1-1 listings servicing PHC clients. Grantees will be asked to confirm all listed information is current or indicate any needed changes to:

• clinic location(s)
• hours of operation
• contact information
• services provided

Grantees will have 10 calendar days to respond from the date HHSC requests the information.

Grantees must notify HHSC of any changes made to their clinic information within 30 days of the change throughout the grant year.

3110 Client Access

Revision 26-2; Effective Sept. 1, 2026

Grantees must make sure clients are provided services in a timely and non-discriminatory manner per all Texas Health and Human Services (HHS) policies. Grantees must adhere to the following guidelines:

• Have a policy in place to identify and reduce barriers to client care, including making sure clinic or reception room wait times are reasonable.
• Have a policy in place that delineates the timely provision of services, including:
  • Applicants deemed eligible for PHC 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 contraceptive method.
• Have a policy in place that requires qualified staff to assess and prioritize a client’s needs.
• Provide referral sources for services outside the scope of PHC. 
• Manage funds to make sure established clients continue to receive services throughout the budget year, including after allocated funds are expended. 
• Inform people of PHC services and encourage them to bring required documents to the first visit for eligibility processing.
• Comply with all applicable civil rights and anti-discrimination laws, regulations, and contract terms and conditions as outlined in the Requirements for Contractors. 
• Display appropriate exterior signage that identifies the entity as a health care facility.

Revision 26-2; Effective Sept. 1, 2026

Grantees must obey state laws that govern the reporting of suspected abuse and neglect. Grantees must have written policies and procedures in place for the detection and appropriate reporting of abuse, neglect and exploitation of:

• the elderly and adults with disabilities, Texas Human Resources Code, Chapter 48, and
• child abuse and neglect, Texas Family Code, Chapter 261.

Grantees must provide annual training that includes the requirements outlined in the following sections:

• Reporting an Emergency or Suspicion of Abuse
• Child Abuse and Neglect Reporting, Compliance and Monitoring
• Human Trafficking, and Domestic and Intimate Partner Violence.

Reporting an Emergency or Suspicion of Abuse

For cases that pose an immediate threat to a person, call 9-1-1 or the appropriate local law enforcement agency.

For situations that do not pose an immediate threat, or to report suspected abuse or neglect, grantees should use the secure Texas Abuse Hotline website or call the Texas Abuse Hotline at 800-252-5400.

3210 Child Abuse and Neglect Reporting, Compliance and Monitoring

Revision 26-2; Effective Sept. 1, 2026

A grantee’s policies must include:

• How child abuse reporting requirements will be implemented throughout their agency, including how staff will be trained and how internal monitoring will be done to ensure timely reporting.
• The requirement that medical professionals must make a report no later than 24 hours after first suspecting a child has been abused, neglected, or is a victim of an offense.
• How to determine, document, report and track instances of sexual or non-sexual abuse or neglect for all children 17 years old and younger.

For more information on abuse and neglect reporting, refer to the Texas Department of Family and Protective Services website.

3220 Human Trafficking

Revision 26-2; Effective Sept. 1, 2026

Grantees must comply with all state and federal anti-trafficking laws. This includes the Trafficking Victims Protection Act of 2000 and Texas Occupations Code, Chapter 116 and 301. These regulations require health practitioners to complete an HHSC-Approved Human Trafficking Course for every licensure renewal period.

Grantees must display signs about human trafficking in areas where clients and the public can easily see them. This includes lobbies, waiting rooms, front reception desks and locations where people apply for and receive services.

Grantees must have a written policy on human trafficking which includes:

• the definition of human trafficking
• how to identify possible situations of human trafficking
• what to do and who to report to if human trafficking is suspected
• mandatory reporting of suspected child human trafficking
• victim support resources
• annual staff training

References for human trafficking policy development:

• HHS Texas Human Trafficking Resource Center
• HHS Health Care Practitioner Training Page
• Governor’s Child Sex Trafficking Team
• HHS National Human Trafficking Hotline webpage or call 888-373-7888
• Rescue and Restore Campaign by the U.S. Department of Health and Human Services. Contains multiple resources for health care providers, social service personnel and law enforcement identify and aid trafficking victims. Includes slide presentations for training purposes.

3230 Domestic and Intimate Partner Violence

Revision 26-2; Effective Sept. 1, 2026

Intimate partner violence (IPV) includes 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 threat of harm. This type of violence can exist regardless of the presence of sexual intimacy.

Grantees must comply with all requirements in Texas Family Code, Chapter 91 and have a written policy about the assessment and prevention of domestic violence and IPV. Clients who experience IPV are not required to submit information to verify income eligibility if doing so jeopardizes the client's safety or imposes a barrier to receiving services.

Any medical professional who treats a person for injuries they have reason to believe were caused by IPV is required to provide the person with the Notice to Victims on the HHSC Family Violence Program webpage.

More information and resources on IPV are on the Centers for Disease Control and Prevention website. Grantees can also contact the National Domestic Violence Hotline at 800-799-7233. The hotline operates 24 hours a day, seven days a week and provides interpretation services in over 200 languages.

Revision 26-2; Effective Sept. 1, 2026

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

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

Grantees are required by HIPPA to develop and distribute a notice that provides a clear explanation of privacy rights and practices. 

This Notice of Privacy Practices must be given to clients:

• at the first appointment,
• upon request,
• at least every three years. 

Grantees must post this notice in a clear and easy to find location for clients to review. It must be included on the organization’s website.

Grantees must make sure all employees and volunteers receive training on client confidentiality during orientation. Grantees also must make all employees and volunteers aware that violation of the law about confidentiality may result in civil damages and criminal penalties. All employees, volunteers, subrecipients, board members 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.

Grantees must document the client’s preferred method of communication, such as cell phone, email, work phone or text, and preferred language in the client’s record.

Each client must receive verbal assurance of confidentiality, an explanation of what confidentiality means, and any applicable exceptions, such as abuse reporting. Grantees must also provide clients with a copy of their confidentiality policy or agreement. Clients must sign this policy or agreement, and the grantee must maintain a signed copy in the client's record.

More information on confidentiality and required postings is available on these HHSC and U.S. Department of Health and Human Services (HHS) webpages:

• HIPAA and Privacy Laws – HHSC
• Notice of Privacy Practices for Protected Health Information – HHS.gov
• Your Rights Under HIPAA – HHS.gov for information for individuals
• HIPAA Guidance Materials – HHS.gov for information for providers 

3310 Minors and Confidentiality

Revision 26-2; Effective Sept. 1, 2026

Except as permitted by law, providers are legally required to maintain the confidentiality of care provided to minors. Confidential care does not apply when the law requires parental notification or consent, or when the law requires the provider to report health information, such as cases of contagious disease or abuse. Privacy refers to a person’s ability to control access to their personal information. Confidentiality in health care is the obligation of the health care provider to refrain from disclosing protected health information. While confidentiality is inherent in maintaining a patient's privacy, it is not an absolute right.

The HIPAA Privacy Rule requires covered entities to treat a personal representative the same as the person about the use and disclosure of that person’s protected health information. In most cases, parents serve as the personal representatives of their minor children. Parents may exercise personal rights, such as access to medical records, on behalf of their minor children. Review 45 Code of Federal Regulations Section 164.502(g).

For more information, review the Adolescent Health – A Guide for Providers webpage.

3320 Civil Rights

Revision 26-2; Effective Sept. 1, 2026

HHSC contracts require grantees to comply with state and federal antidiscrimination laws. This includes state rules in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 395, Subchapter B, Rule 395.11.

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

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 including limited English proficiency (LEP)
  • sex
  • age
  • religion
  • disability
• have a policy that addresses client rights and responsibilities that is applicable to all people who request 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 grantee's nondiscrimination policies;
• notify everyone who applies for services of the grantee's nondiscrimination policies and complaint procedures; and
• 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.

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

Limited English Proficiency – LEP

To comply with civil rights requirements related to LEP, grantees must:

• take reasonable steps to make sure people with LEP have meaningful access to its programs and services;
• not require a person with LEP to use friends or family members as interpreters:
  • a family member or friend may serve as a person’s interpreter if the person requests it; and
  • the family member or friend does not compromise the effectiveness of the service or violate client confidentiality; and
• make sure people with language service needs, including people with LEP and disabilities, are aware that the grantee will provide an interpreter free of charge. 

3330 Required Signage

Revision 26-2; Effective Sept. 1, 2026

Grantees that provide direct services to clients must display certain HHS posters about civil rights. The posters must be displayed where clients and the public can easily see them, such as lobbies, waiting rooms, front reception desks, and locations where people apply for and receive HHS services. The following posters are required:

• Americans with Disabilities Act (English PDF)
• Americans with Disabilities Act (Spanish PDF)
• Know Your Rights - Clients and Applicants (English PDF)
• Know Your Rights - Clients and Applicants (Spanish PDF)
• Need a Sign Language Interpreter? (PDF)
• Need an Interpreter? (PDF)

Grantees must display signs about human trafficking and suicide prevention, including the 988 Suicide and Crisis Lifeline. Signs must be displayed where clients and the public can easily view them, such as lobbies, waiting rooms, front reception desks, and locations where people apply for and receive services.

Examples of suitable flyers are available here:

• Human Trafficking Signage, English and Spanish – OAG
• 988 Suicide & Crisis Lifeline Poster, English – SAMHSA
• 988 Suicide & Crisis Lifeline Poster, Spanish – SAMHSA
• Suicide Warning Signs for Youth Poster – SAMHSA
• Texting 988 Poster 1, Spanish – SAMHSA
• Texting 988 Poster 2, English – SAMHSA

More mental health and suicide prevention resources are available at:

• Behavioral Health Provider Resources
• Suicide Prevention
• 988 Partner Toolkit – SAMHSA
• Find Resources or a Provider – You're Not Alone | Mental Health Texas

3340 Termination of Services

Revision 26-2; Effective Sept. 1, 2026

Grantees must never deny services to an eligible client because of an inability 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 effectively and safely provide services; or
• the client’s behavior jeopardizes their own safety, or the safety of clinic staff or others.

A termination of services must be included in the grantee’s policy.

If a grantee denies, modifies, suspends or terminates services to a client, an explanation must be documented in the client’s record. A client has the right to appeal the denial, modification, suspension or termination of services by following the Resolution of Complaints process.

3350 Resolution of Complaints

Revision 26-2; Effective Sept. 1, 2026

Grantees must make sure clients can express concerns about the care they’ve received. Grantees must also make sure any complaints or concerns are handled in a consistent and timely manner. A grantee’s policy and procedure manuals must explain the process clients may follow if they are not satisfied with the care received. This process includes:

• Grantees must investigate and resolve a complaint or concern within 30 business days, beginning on the day they are notified by the aggrieved client.
• Clients may contact the grantee during and after the resolution of an investigation to receive more information on the grantee's decision or to help correct the issue.
• Grantees must provide the client with contact information to the HHS Office of the Ombudsman. If a client has requested 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.
• All complaints and concerns must be documented in the client's record.

3360 Research, Human Subject Clearance

Revision 26-2; Effective Sept. 1, 2026

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

The grantee must have a policy in place that shows approval will be obtained from the HHSC PHC program, as well as the IRB, before instituting any research activities. The grantee must also make sure all staff are made aware of this policy through staff training. Documentation of training on this topic must be maintained.

Revision 26-2; Effective Sept. 1, 2026

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

• safeguarded against loss and 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, home and office visits.

Written consent is required for the release of personally identifiable information. Written consent is not required when personally identifiable information is necessary to provide services to the client or as required by law with appropriate safeguards for confidentiality. If the client 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 federal and state law.

If the client 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. 

When information is requested, grantees should release only the specific information requested. Information collected for reporting purposes may only be disclosed in summary, statistical or other format that does not identify clients. Upon request, clients transferring to other providers must be provided with a copy or summary of their record to expedite continuity of care. Electronic records are acceptable as medical records.

Grantees, providers and subrecipients must maintain all records that pertain to client services, contracts and payments for the period specified by HHSC. Requirements about time limits for submitted claims are in TAC Title 1, Part 15, Chapter 354, Rule 354.1003. Requirements for medical record maintenance are in TAC Title 22, Part 9, Chapter 163. Grantees must follow contract provisions, maintain medical records for at least seven years after the contract closes, and follow the retention standards of the appropriate licensing entity. All records of services must be accessible to HHSC representatives to examine at any reasonable time as required by law.

Revision 26-2; Effective Sept. 1, 2026

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

Grantees also must verify that all staff who provide services to PHC clients have the appropriate licenses and certifications required by applicable law. All licenses and certifications must be current, valid and in good standing, and must remain so for the term of the grant. All staff must be appropriately identified with a name badge.

Personnel policies and procedures, including those for contracted personnel, must include:

• job descriptions that specify any required qualifications and licensure;
• 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.

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

All medical care for PHC clients must be provided under the supervision, direction and responsibility of a qualified medical director. The designated medical director must be a licensed Texas physician. All dental care for PHC clients must be provided under the supervision, direction and responsibility of a qualified licensed dentist. The designated dental director must be a licensed Texas dentist.

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.

Grantees must establish, annually review and train staff on PHC program requirements and policies. This includes reviewing and updating staff on any updates to the program’s policy manual and required forms that may 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. 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 to HHSC of:

• chief executive officer (CEO), signature authority
• chief financial officer (CFO), fiscal contact
• program director or program manager, program contact

Grantees must make sure at least one representative:

• Communicates program information. Responsible for disseminating information to PHC program administrative and clinic staff.
• Has HHSC SharePoint access. Can view and upload program and grant information via HHSC’s web-based applications on the SharePoint site. 
  • Must have an Outlook or Microsoft Office 365 account.
  • Must sign and submit a Family Clinical Services Extranet and Data Upload Security Agreement form for each staff person accessing the site. 
• Attends relevant HHSC webinars during the fiscal year.
  • Grantees should aim for representation at one or more relevant technical assistance, training or evaluation webinars.
  • HHSC may designate certain webinars as mandatory, such as for a priority policy or procedure change, and will notify grantees accordingly.
  • To receive participation credit, attendees must complete any required sign-in sheet, registration or survey within the specified time frame.

Revision 26-2; Effective Sept. 1, 2026

Grantees must always maintain a safe environment and provide clean and well-maintained facilities where services are delivered. Appropriate space must be provided for exam rooms, client intake, waiting areas and clinical and administrative staff attendance and functions.

Clinic sites must be geographically close to the target population(s) the grantee plans to serve. 

3610 Hazardous Materials and Waste

Revision 26-2; Effective Sept. 1, 2026

Grantees must have written policies and procedures that 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.

3620 Fire Safety

Revision 26-2; Effective Sept. 1, 2026

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

3630 Medical Equipment

Revision 26-2; Effective Sept. 1, 2026

Grantees must have a written policy and maintain documentation of the maintenance, testing and inspection of medical equipment, including an automated external defibrillator (AED). Documents must include:

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

Medications and medical supplies must be kept in locked storage.

3640 Radiology Equipment and Standards

Revision 26-2; Effective Sept. 1, 2026

All facilities that provide radiology services, including dental X-rays, must:

• have 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 (PDF).

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

3645 Laboratory Standards

Revision 26-2; Effective Sept. 1, 2026

All facilities providing laboratory services must have a current Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver. CLIA requires that any facility examining human specimens for the diagnosis, prevention, treatment of a disease or for an assessment of health must register with the federal Centers for Medicare & Medicaid Services (CMS) and obtain CLIA certification.

3650 Smoking and Vaping Ban

Revision 26-2; Effective Sept. 1, 2026

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

Revision 26-2; Effective Sept. 1, 2026

Medical Emergencies

Grantees must be adequately prepared to handle clinical emergency situations. Each site must:

• have a written plan for the management of on-site medical emergencies and emergencies that require ambulance services.
• have staff trained in basic CPR and emergency medical action, who must be present during all hours of clinic operations.
• maintain emergency resuscitative drugs, supplies, and equipment appropriate to the services provided at that site and appropriately trained staff when clients are present.
• maintain documents in personnel files that confirm staff are trained in the medical emergencies plans or protocols.

Dental Emergencies

The dental office or clinic must have a written emergency plan that includes criteria to manage emergencies. The plan must be reviewed annually and as needed. Requirements for emergencies are at the Texas State Board of Dental Examiners website and in the Texas Administrative Code, Title 22, Part 5, Chapter 108, Rule 108.7, Minimum Standard of Care, General.

3710 Emergency Preparedness

Revision 26-2; Effective Sept. 1, 2026

Grantees must have a written safety plan that includes an emergency evacuation plan and a disaster response plan.

Disaster Response Plan

Grantees must have a written disaster response plan that addresses how staff must respond to emergency situations such as:

• fires
• flooding
• power outage
• bomb threats

The disaster plan must identify the procedures and processes that will be initiated during a disaster. The staff position(s) responsible for each activity must also be identified. A disaster response plan must be in writing, formally communicated to staff and be available to employees in the workplace for review. An employer with 10 or fewer employees may communicate the plan verbally.

Review the  Occupational Safety and Health Administration website for more resources on facilities and equipment.
 

3720 Emergency Preparedness

Revision 25-3; Effective Nov. 14, 2025

Grantees must have a written safety plan that includes maintenance of fire safety equipment, an emergency evacuation plan, and a disaster response plan.

Disaster Response Plan

Grantees must have a written disaster response plan that addresses how staff must respond to emergency situations such as:

• fires;
• flooding;
• power outage; and
• bomb threats.

The disaster plan must identify the procedures and processes that will be initiated during a disaster and the staff position(s) 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. An employer with 10 or fewer employees may communicate the plan to them verbally. 

Review the  Occupational Safety and Health Administration website for more resources on facilities and equipment.  

Revision 26-2; Effective Sept. 1, 2026

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 PHC services. Grantees must have a Quality Management (QM) program tailored to their organizational structure and the services they provide. The goals of the quality management program should ensure availability and accessibility of services, quality and continuity of care. Grantees should integrate QM concepts and methodologies 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
• teamwork

The QM program must be developed and implemented in a way that provides for the ongoing evaluation of services. Grantees should have:

• a comprehensive quality work 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 subcontract to provide PHC services must also address how quality will be evaluated and how compliance with HHSC policies and basic standards will be assessed with subrecipients.

3810 QM Committee

Revision 26-2; Effective Sept. 1, 2026

The committee is an important part of the QM program. The committee’s membership consists of the organization’s key leadership, including the:

• executive director or CEO
• medical director
• dental director
• other appropriate staff where applicable

The committee must review and approve a quality work plan for the organization annually.

The QM Committee must meet at least quarterly to:

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

Meeting dates, a list of the attendees and minutes of the discussion and actions taken by the committee must be maintained.

3820 Comprehensive Quality Work Plan

Revision 26-2; Effective Sept. 1, 2026

The comprehensive quality work plan must:

• be reviewed annually
• include clinical and administrative standards to monitor services
• include a process for credentialing and peer review of clinicians
• identify personnel responsible for implementing, monitoring, evaluating and reporting
• establish timelines for quality management activities
• identify tools and forms to be used
• outline reporting to the QM Committee

3830 Quality Assurance Activities

Revision 26-2; Effective Sept. 1, 2026

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 client record reviews to ensure compliance with program requirements and clinical standards of care;
• utilization review;
• defining, reporting, tracking and following up on adverse outcomes;
• client satisfaction surveys and reporting of 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), including protocols, for mid-level providers;
• annual review of all standing orders (SOs) and clinical protocols;
• up-to-date performance evaluations to include primary license verification, valid Drug Enforcement Agency (DEA) number, as applicable, and other required licenses or certifications; and
• annual review of all policies and forms.

The review or revision date must be clearly noted on each policy, form, agreement and order that is in use.

3840 Subrecipient Quality and Compliance

Revision 26-2; Effective Sept. 1, 2026

Grantees who subcontract 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 subrecipient. This includes:

• annual license verification or the primary source verification
• clinical record review
• eligibility and billing review
• utilization review
• on-site facility review
• annual client satisfaction evaluation process
• compliance with all abuse and neglect, and civil rights requirements

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 QM Committee and should be documented.
 

Revision 26-2; Effective Sept. 1, 2026

Grantees must determine and document PHC eligibility before rendering services. Grantees must have a policy that outlines the procedures to determine program eligibility and the staff member(s) responsible for eligibility screening.

To assess eligibility for PHC, grantees must use the most recent version of Form 3029, Application for Program Benefits, 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.

Alternate Eligibility Screening Tool

An Alternate Eligibility Screening Tool (AEST), created by the grantee may be used in place of Form 3029 with prior written approval by the PHC program. 

To apply for approval, grantees must send a request to the PHC program mailbox with AEST Request in the subject line.

The HHSC PHC program contact will send grantees an AEST Request Form to complete. Grantees must complete the form and return it to the program mailbox with the proposed AEST.

The AEST must contain all required elements of Form 3029

HHSC must review and approve before use. Grantees must use Form 3029 until they have received written approval of the proposed AEST from HHSC. The grantee must maintain and retain proof of approval and must make the approval available during Quality Assurance visits.

Once a grantee receives approval for the use of the AEST, the following requirements apply:

• Grantees must request approval from the PHC program for any revisions to their eligibility screening tool and include a copy of the revised tool.
• The AEST is only approved for use during the current grant term. If a grantee is awarded funding under a subsequent grant, the grantee must resubmit the AEST for review and written approval, even if no changes have been made to the tool since the last written approval.
• Any changes made to Form 3029 that are considered requirements for eligibility by HHSC must be incorporated into the grantee-developed AEST. Grantees must submit their AEST with the incorporated changes within 60 calendar days after notification of a change to Form 3029 for rereview and approval.

The PHC program reserves the right to request edits or withdraw its approval of the use of an alternate eligibility tool. The PHC program will notify the grantee of the decision in writing and include the date the AEST must be discontinued.

Revision 26-2; Effective Sept. 1, 2026

For a person to receive PHC services, three criteria must be met:

• gross family income at or below 200% of the Federal Poverty Level (FPL)
• Texas resident
• not eligible for other programs or benefits providing the same services

Grantees must require residency verification, but such verification should not jeopardize delivery of services. Grantees must require income verification for countable income, except in cases when submitting the income verification jeopardizes the client's right to confidentiality or imposes a barrier to receive services. In these special cases, the grantee must waive the requirement for income verification. Note the reasons for waiving verification of income in the client’s record.

Eligibility determinations for PHC can be made by conducting interviews over the phone or in person for new applicants and to re-certify current clients. Phone interviews for eligibility determinations must comply with all eligibility guidelines outlined in program policy.

If a client is unable to sign the Acknowledgment section of Form 3029, Application for Program Benefits, the eligibility staff may read the statements to the applicant over the phone and document that the applicant affirms the statements. The documentation must include the date and time of the applicant's affirmation and the eligibility staff person’s signature. The client must sign the document at the time of their next visit to the clinic.

Revision 26-2; Effective Sept. 1, 2026

Potential Eligibility and Referral to Other Programs

The PHC program is the payer of last resort. Grantees must screen applicants for Medicaid, CHIP, Medicaid for Pregnant Women, CHIP Perinatal and any other applicable benefit programs. Applicants must apply for any programs for which they appear eligible. Grantees must document screening for other programs on Form 3029, Application for Program Benefits. Applicants who do not fully comply with applying for other benefit programs are not eligible for PHC. PHC will not reimburse services provided to these applicants.

If a client appears eligible and applies for any of these other benefit programs, they must be granted Presumptive Eligibility for PHC while awaiting benefit determination. The client is responsible for submitting proof of application or a denial letter before the presumptive eligibility period ends. If a client does not seem eligible for any other program, document this on the application.

All Medicaid, CHIP, Medicaid for Pregnant Women, CHIP Perinatal or other benefit program applications must be submitted promptly following PHC eligibility assessment. If a client was denied Medicaid or CHIP services, the denial letter must be included with their application. Grantees may use the HHSC Your Texas Benefits website to help screen for client eligibility. Call 2-1-1 for more information about HHSC benefits.

Applicants generally are not eligible for the PHC program if they are enrolled in another third-party payer program, such as:

• private health insurance
• Medicaid or Medicare
• TRICARE
• Workers’ Compensation
• Veterans Affairs Benefits
• other federal, state, or local public health care coverage that provides the same services

Information for Former Military Service Members

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.

Household

A household consists of a person living alone or a group of two or more people related by birth, marriage, including common-law marriage or adoption who live together and are legally responsible for the support of the other person.

Legal responsibility for support exists between:

• people 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.

All children younger than 18 years must be counted as part of the household, including a pregnant client’s unborn children. Once a child turns 18, they must complete their own program application, listing themselves as the applicant and including any income they earn.

Documentation of Family Composition

If family relationships are unclear, request one of the following items:

• birth certificate
• baptismal certificate
• school records
• other documents or proof of familial relationship determined valid by the grantee to establish the dependency of the family member with the client or head of household

Family members who receive other health care benefits must be included in the household. The grantee has discretion to document any special circumstances in the calculation of family composition.

Documentation of Residency

To be eligible for PHC services, a person must:

• be physically present within the state of Texas;
• have the intent to remain within the state, whether permanently or for an indefinite period; and
• not claim residency in any other state or country.

If a person is younger than 18 years old, their parent or guardian must also be a resident of Texas and meet the criteria above.

There is no requirement about the length of time a person must live in Texas to establish residency for the purposes of PHC eligibility.

Document proof of residency provided by the client on Form 3029, Application for Program Benefits. For documentation of residency, one of the following items may be provided:

• valid Texas driver license
• current voter registration
• rent or utility receipts for one month before the month of application
• motor vehicle registration
• school records
• medical cards or other similar benefit cards
• property tax receipt
• mail addressed to the applicant, their spouse or children if they live together
• other documents considered valid by the grantee

If none of the listed items are available, residency may be verified through one of the following:

• observance of personal effects and living arrangement
• statements from landlords, neighbors or other reliable sources

If an applicant’s residency is unclear or questionable, explain and document concerns if necessary. If a family is otherwise eligible, but residency is in question, the household is entitled to services until residency information is verified.

Applicants do not lose their residency status because of temporary absences from the state. For example, a seasonal worker who travels during certain times, but maintains a home in Texas and returns to that home after temporary absences is considered a Texas resident.

Documentation of Income

All income received must be included. If an unmarried applicant lives with a partner, count the partner’s income only if the applicant and partner have mutual children together, including unborn children. Income is calculated before taxes – gross household income. Income is reviewed and determined either countable or exempt based on the source of the income, as defined in Appendix I, Definition of Income. Grantees must have a written PHC income verification policy.

Documentation of income for PHC services must be provided to complete Form 3029. Declarations of unknown income will not be accepted as documentation.

Provide the following documentation:

• at least two pay periods that accurately represent their gross earnings dated within 60 days before the application processing date; or
• one month’s pay only if paid the same gross amount monthly, unless special circumstances are noted on the application.

The pay periods must accurately reflect the applicant’s usual and customary earnings. Proof may include:

• copy(ies) of the most recent paycheck(s) stub or monthly earning statement(s)
• employer’s written verification of gross monthly income
• optional forms, Form 3049 and Form 3051
• award letters
• domestic relation printouts of child support payments received
• statement of support
• unemployment benefits statement or letter from the Texas Workforce Commission
• court orders or public decrees to verify support payments
• notes for cash contributions
• other documents or proof of income determined valid by the grantee

Grantees must require income verification for countable income. In cases when submitting the income verification jeopardizes the client's safety or confidentiality, or imposes a barrier to receipt of services, the grantee must waive this requirement and document the reason.

Optional Forms

The following forms are optional. They may be used to help complete the income and employment verification process:

• Form 3049, Employment Verification
• Form 3051, Statement of Self-Employment Income

Monthly Income Conversions

If income payments are received in lump sums or at longer intervals than monthly, such as seasonal employment, the income is prorated over the time the income is expected to cover. Income received weekly, every two weeks or twice a month must be converted as:

• weekly income is multiplied by 4.33
• income received every two weeks is multiplied by 2.17
• income received twice monthly is multiplied by 2

Allowable Income Deductions

Dependent care expenses may be deducted from total income. This expense must be both necessary for employment and incurred by an employed person. Documentation must be provided. Allowable deductions are actual expenses up to:

• $200 per child per month for children under two
• $175 per child per month for each dependent two or older
• $175 per adult with disabilities per month

Legally required child support payments made by a member of the household must be deducted from gross household income. Documentation of payments must be provided. Convert payments made weekly, every two weeks or twice a month by using one of the conversion factors listed above.

Gross household income less any allowable deductions is the Adjusted Gross Household Income.

Calculation of Applicant's Federal Poverty Level Percentage

The grantee must determine the household Federal Poverty Level (FPL) percentage using current U.S. Department of Health and Human Services federal poverty guidelines. The guidelines are subject to change near the start of each calendar year.

To calculate the household FPL percentage:

• determine the monthly adjusted gross household income
• determine the household size
• determine the current federal poverty level amount based on the household size
• divide the household’s total monthly adjusted gross income by the corresponding poverty limit amount
• multiply by 100

Documenting Special Circumstances

Special circumstances may prevent an applicant from providing the required documentation for verification purposes. Document these types of circumstances appropriately on Form 3029.

Client Fees and Co-pays

Grantees may assess a co-pay for services from PHC clients. Grantees who choose to collect co-pays must comply with the following guidelines:

• No PHC client will be denied services based on an inability to pay.
• Clients with a household FPL at or below 100% will not be charged a co-pay.
• Clients with a household FPL above 100% may be charged a co-pay of no more than $30 per visit.
• Grantees must have a written co-pay policy which clearly defines how co-pay amounts are determined.
• Clients with an assessed co-pay must be given a billing statement at the time of service. A copy must be kept in the client’s record.
• Any outstanding balance may not be turned over to a collection agency or reported delinquent to a credit reporting agency.
• Any outstanding balance must not prohibit a client from receiving services.
• All policies and procedures about co-pay collection must be approved by the grantee’s board of directors.
• Co-pays must be reported as program income in the Monthly Reimbursement Packet (MRP). The grantee must complete B25 and E25.

Grantees may choose to use the optional co-pay table in the Appendix II, Optional Co-Pay Table Based on Monthly Federal Poverty Level. This table is updated each calendar year after the new federal poverty guidelines are published.

Other Fees

Grantees must not charge clients administrative fees for items such as processing or transfer of medical records and copies of immunization records.

Grantees may bill clients for services outside the scope of PHC allowable services if the service is provided at the client’s request and the client is made aware of their financial responsibility for the charges before services are provided.

Client Responsibility for Reporting Changes

A client must report changes to the following no later than 30 calendar days after the client is made aware of any changes:

• income
• family composition
• residence
• current address
• employment
• medical insurance coverage
• receipt of Medicaid, CHIP, CHIP Perinatal or other third-party coverage benefits

The client may report changes in person or by mail, email, phone or through someone acting on the client’s behalf. If changes result in the client no longer meeting eligibility criteria, the client’s eligibility will be terminated. The grantee must issue Form 3047, Notice of Ineligibility, to the client upon termination and include the date of termination.

Continuation of Services

Once awarded grant funds are spent, grantees must continue serving their existing PHC clients through the end of their clients’ determined eligibility periods.

Any funding sources other than PHC awarded program funds used to provide PHC services must be reported as non-HHSC funds on the Monthly Report Form and the quarterly Financial Status Report (FSR), also known as Form 269A.

Grantees do not have to screen potential new clients for program eligibility once awarded grant funds are exhausted. However, if screenings are completed and potential clients are determined eligible before funds are expended, the grantee must provide services to those clients.

Eligibility

Full program eligibility begins on the date the grantee determines a client is eligible for the program and all the following requirements are met:

• all program eligibility requirements are met
• program application is completed and signed
• all verification documents are submitted

To notify an applicant of eligibility, the grantee must issue Form 3012, Verification of Eligibility, to the applicant.

Presumptive Eligibility

PHC emphasizes the importance of prevention and early intervention. The goal of PHC is for clients to be part of the health care system and not rely on episodic acute care. An applicant’s medical needs must be met quickly and appropriately, using available resources in the community.

Presumptive eligibility provides short-term access to health care services when an applicant:

• screens as potentially eligible for services
• has an emergent medical need
• lacks the documentation required to achieve full eligibility

Grantees are only required to treat emergent medical needs during the presumptive eligibility period.

Grantees must establish a presumptive eligibility period of a minimum of 30 days and up to a maximum of 90 days in their eligibility policy. During this presumptive eligibility period, clients are expected to produce the necessary verification documents.

For clients who submit all required verification documents and are determined to be fully eligible during or at the end of their presumptive eligibility period, full eligibility will be granted. The eligibility expiration date will be calculated 12 months from the day presumptive eligibility began.

To notify an applicant of Presumptive Eligibility, the grantee must issue Form 3045, Presumptive Eligibility Notice to the client.

If no other documentation is available, the grantee may:

• waive the requirement to submit the eligibility documentation; or
• approve full eligibility on a case-by-case basis if the grantee determines submitting the documentation creates a barrier to care.

These circumstances must be documented in the client’s record.

Clients are limited to one presumptive eligibility period per two calendar years.

Ineligibility

If an applicant is determined to be ineligible for program services after the screening process is complete, the applicant must be given Form 3047, Notice of Ineligibility. The applicant must also be informed of their right to appeal the eligibility decision, using the process described on the Notice of Ineligibility.

Supplemental Benefits

Applicants receiving benefits from other sources, such as Children’s Medicaid or Medicaid for Pregnant Women, may also be eligible for partial PHC coverage. This supplemental or wraparound coverage is limited to services provided by PHC but not covered by other sources. Whenever federal, state, private or other benefits are available for payment of clients receiving PHC covered services, do not use any PHC funds for such care. An example of supplemental benefits is providing health education services to Medicaid-eligible clients since Medicaid does not provide health education services. The grantee must inform the client that supplemental services are of limited scope.

Adjunctive Eligibility

An applicant is considered adjunctively – automatically – eligible for PHC program services at an initial or renewal eligibility screening if the applicant is currently enrolled in one or more of the following programs:

• Children’s Medicaid
• Medicaid for Pregnant Women
• Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
• Supplemental Nutrition Assistance Program (SNAP)

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

*Note: Presentation of the Your Texas Benefits card does not completely verify current enrollment in the Children’s Medicaid or Medicaid for Pregnant Women program. To verify enrollment, grantees must call Texas Medicaid & Healthcare Partnership (TMHP) at 800-925-9126 or access TexMedConnect. For a client's current enrollment status, grantees must enter two of the following four data elements:

• patient control number
• date of birth
• Social Security number
• last name

If the applicant’s current enrollment status cannot be verified during the eligibility screening process, adjunctive eligibility must not be granted. The grantee then determines eligibility per usual protocols.

Annual Eligibility Determination

Annual eligibility determination is required for all PHC clients. Client eligibility must be redetermined every 12 months, using the most recent version of Form 3029, Application for Program Benefits.

Grantees must have a system in place to track client eligibility expiration dates to determine when a new application is needed.

Revision 26-2; Effective Sept. 1, 2026

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

A client’s verbal consent for general treatment may be obtained by phone. This type of consent is acceptable for treatment provided through telemedicine. To record a client’s verbal consent, the agency staff must read the consent form to the applicant and document that the applicant affirms by giving their verbal consent for treatment. The document must include the date and time of the applicant’s consent and the signature of the agency staff who obtained consent. The client must sign the consent at their next visit to the clinic.

Consent information must be effectively communicated to every client in an understandable manner. This communication must allow the client to participate, make decisions about their own medical care, and address any disabilities that impair communication in compliance with Limited English Proficiency regulations. 

Grantees must not require a married client’s spouse to consent to the client’s services. Only the client may consent, unless legally incapable of doing so. In such cases, a parent, legal guardian or caregiver must consent on their behalf. Consent must never be obtained in a manner that could be perceived as coercive. 

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

5110 Consent for Dental Procedures

Revision 26-2; Effective Sept. 1, 2026

Written informed consent for dental procedures must be obtained and must comply with the Texas Administrative Code (TAC), State Board of Dental Examiners, Rule 108.7, Minimum Standards of Care. 

5120 Consent for Sterilization Procedures

Revision 26-2; Effective Sept. 1, 2026

Two consent forms are required for sterilization procedures:

• Sterilization Consent Form – English or Spanish and Instructions
• Texas Medical Disclosure Panel Consent Form.

5130 Texas Medical Disclosure Panel Consent

Revision 26-2; Effective Sept. 1, 2026

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

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

The grantee must make sure the client provides informed consent for procedures per TMDP. The treatments and procedures that require full disclosure of specific risks and hazards by a physician or health care provider to a patient or person authorized to consent for the patient are in List A of TAC, Title 25, Part 7, Chapter 602. The procedures that do not require disclosure of specific risks and hazards are in List B of TAC, Title 25, Part 7, Chapter 603.

The TMDP has several procedure-specific disclosure and consent forms for use. 

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

5140 Consent for Services Provided to Minors

Revision 26-2; Effective Sept. 1, 2026

A parent generally must consent to treatment for minors. A minor is a person younger than 18 who has never been married and never been declared an adult by a court – emancipated. However, there are certain circumstances when a minor may consent for their own treatment.

Requirements for parental consent for the provision of family planning services to minors vary per the funding source that subsidizes the services. Providers may provide pregnancy testing, care related to pregnancy, HIV testing, sexually transmitted infection (STI) testing and treatment, including prescription drugs, without the consent of the minor’s parent, managing conservator or guardian only as authorized by Chapter 32 of the Texas Family Code or by federal law or regulations.

Resources and References:

• Adolescent Health – A Guide for Providers (PDF)
• Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Texas Women Program (PDF)
• Chapter 151 of the Texas Family Code, Rights and Duties in Parent-Child Relationship
• Chapter 32 of the Texas Family Code, Consent to Treatment of Child by Non-Parent or Child
• Pelvic Exams – Chapter 167A of the Health and Safety Code

5150 Consent for HIV Tests

Revision 26-2; Effective Sept. 1, 2026

For HIV testing consent (PDF), grantees must comply with Texas Health and Safety Code.

Revision 26-2; Effective Sept. 1, 2026

Scope of Services: Six Priority Primary Health Care Services

1. Diagnosis and Treatment

This includes diagnosis and treatment of common acute and chronic disease that affect the client’s general health. Services include first contact with a client for an undiagnosed health concern, and continuing care of varied medical conditions not limited by cause or organ system. Services must not be limited to only one service such as family planning, breast and cervical cancer screening or podiatry.

2. Emergency Medical Services

Services must be for urgent care for an unexpected health condition that requires immediate attention as determined by the appropriate medical staff. These must be services that can be treated in a primary care clinic or setting.

3. Family Planning Services

These are preventive health and medical services that help a person control fertility and achieve optimal reproductive and general health. Services include:

• Contraceptive services such as pregnancy prevention and birth spacing, including:
  • long-acting reversible contraceptives (LARCs)
  • oral contraceptive pills
  • medroxyprogesterone injections
  • sterilizations
  • natural family planning
• Pregnancy testing
• Preconception health screenings for:
  • nutrition and obesity
  • hypertension
  • diabetes
  • cholesterol
  • smoking
  • substance use
  • other high-risk behaviors
  • social issues, non-medical drivers of health
  • mental health
• Sexually transmitted infection (STI) services, as follows:
  • syphilis, chlamydia and gonorrhea screening and treatment
  • HIV screening

Counseling and education on abstinence, preconception, pregnancy and infertility 

4. Preventive Health Services

These services may include:

• Immunizations – these services are provided in an appropriate setting for vaccine preventable diseases.
• Cancer screening services – these must be medically necessary and by clinical recommendation and include:
  • Clinical breast examinations
  • Mammograms
  • Pelvic examinations Note: Must be administered per Chapter 167A of the Health and Safety Code
  • Cervical cancer screening
  • Screenings for chronic conditions including screenings for hypertension, diabetes and other chronic conditions as indicated.
  • Health screening to determine the need for intervention and possibly a more comprehensive evaluation and may include:
    • taking a personal and family health history
    • performing a physical examination, laboratory tests or radiological examination
    • may be followed by counseling, education, referral or further testing
    • examples such as blood pressure, blood sugar testing and cholesterol screening

5. Health Education

Planned learning experiences based on sound theories. They provide people, groups and communities the opportunity to increase knowledge and skills needed to make healthy decisions.

6. Diagnostic Laboratory and Radiological Services

These services must be medically necessary. They are technical laboratory and radiological services ordered and provided by, or under the direction of, a physician in an office or a facility other than a hospital inpatient setting.

Grantees are strongly encouraged to visit the U.S. Preventive Services Task Force website for more guidance on preventive services.

Telemedicine

Providers may provide services by telemedicine if appropriate.

Providers who provide telemedicine services must follow all rules of the Texas Occupations Code, Chapter 111. They must have written policies and procedures on the following:

• informed consent
• confidentiality of the client’s clinical information
• ensure appropriate quality care
• prevent abuse and fraud in the use of telemedicine services
• ensure adequate supervision of health professionals who are not physicians and who provide telemedicine care
• establish the maximum number of health professionals that a physician may supervise through telemedicine services

Client Health Records and Documentation of Encounters

Providers must make sure a patient health record is established for every person who receives clinical services. It must meet the requirements of the TAC Title 22, Part 9, Chapter 163, Subchapter A, Rule 163.1.

All client health records must be:

• Complete, legible and an accurate documentation of all client encounters, including those by phone, email or text.
• Written in ink without erasures or deletions and documented in the electronic medical record (EMR) or electronic health record (EHR).
• Signed by the provider making the entry, including the name of the provider, the provider’s title and the date for each entry.
  • Electronic signatures are allowable to document the encounter, provider review of care or both.
  • Stamped signatures are not permitted.
• Readily accessible to assure continuity of care and availability to clients.
• Systematically organized to allow easy documentation and prompt retrieval of information.

All client health records must include:

• client identification and personal data, including financial eligibility;
• the client’s preferred language and method of communication;
• client contact information, including the best way and alternate ways to reach the client to ensure continuity of care, confidentiality and compliance with HIPAA regulations;
• a complete medication list, including prescription, nonprescription medications and dietary supplements, updated at each encounter;
• a complete listing of all allergies and adverse reactions to medications, food and environmental substances such as latex, including specifying when a client has no known allergies. This information should be prominently displayed in the client’s record and updated at each encounter;
• a plan of care, updated as appropriate, and consistent with diagnoses, assessments and 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;
• documentation of client education and counseling with attention to risks identified through the health risk assessment; and
• updated records at every visit as appropriate, documenting the reason for the visit, relevant history, physical exam findings, and pertinent screening and diagnostic tests with results and treatment plan.

Initial Medical History and Risk Assessment

A comprehensive medical history must be obtained during the initial or early subsequent clinical visit along with the elements required for the Client Health Record listed above. It should be appropriately adapted to the age and sex of the client and include:

• Reason for the visit and current health status
• History of present illness, if indicated
• Past medical history to include all serious illnesses, hospitalizations, surgical procedures, pertinent biopsies, accidents, exposures to blood and blood products, and mental health history
• Age-appropriate immunizations
• Immunization status or assessment
  • Record or history of immunizations, including immunity to rubella based on a history of vaccine or documented serology testing
  • Rubella immunity testing in women of reproductive age must be provided if the status cannot be determined by history or previous testing
  • PHC providers can voluntarily participate in the DSHS Adult Safety Net (ASN) Program or the Texas Vaccines for Children (TVFC). Both programs provide vaccines at no cost
• Review of systems with pertinent positives and negatives documented in the chart
• Current and past tobacco, alcohol and substance use or abuse
• Occupational and environmental hazard exposure
• Environmental safety such as seat belt and car seat use, bicycle helmets, nutritional and physical activity assessment, and living arrangements
• Assessment for sexual and intimate partner violence (IPV) that is mandated by Texas Family Code, Chapter 261. For any positive result, the client should be offered referral to a family violence shelter to comply with Texas Family Code, Chapter 91
• Pertinent family history
• Pertinent partner history, including injectable drug use, number of partners, STIs and HIV history and risk factors, and sex of sexual partners
• Cervical and breast cancer screening history, noting any abnormal results and treatment, and dates of most recent testing
• A reproductive health history as detailed below

Grantees may screen adults for anxiety and depression as recommended by the U.S. Preventive Services Task Force.

Reproductive health history in female clients of reproductive age must include:

• Menstrual history, including last normal menstrual period
• Pertinent sexual behavior history, including family planning practices such as past and current birth control use, number of partners, sex of sexual partners, last sexual encounter and sexual abuse
• Obstetrical history
• Gynecological and urological conditions
• STIs and STDs
• HIV history, risks and exposure

Reproductive health history in male clients of reproductive age must include:

• Pertinent sexual behavior history, including family planning practices such as past and current birth control use, number of partners, sex of sexual partners, last sexual encounter and history of sexual abuse
• Genital and urologic conditions, as indicated
• STIs or STDs
• HIV history, risks and exposure

Physical Assessment

A periodic preventive health care visit allows clinicians to address issues of wellness and health risk reduction as well as current findings and client concerns. The periodic preventive health care visit must include an update of the person’s health record, as described in the Client Health Record section above. It must also include appropriate screening, assessment, health education and counseling, and immunizations based on the client’s age, risk factors, preferences and concerns.

All clients must be provided an appropriate physical assessment as indicated by health history and health risk assessment. A physical examination is not essential before the provision of most contraceptive methods and should not be a barrier to the client receiving a method of contraception.

The initial physical exam may be deferred if the client history and presentation do not reveal potential problems that require immediate evaluation. The comprehensive physical exam should be performed within six months of the initial visit unless the clinician identifies a compelling reason for extended deferral. Such reason must be documented in the client record.

Program protocols should be developed accordingly. They must be consistent with national evidence-based guidelines.

A new client baseline physical exam must include the following components:

Clients 21 years and older:

• Height measurement
• Body Mass Index (BMI), waist measurement or other measurement to assess for underweight, overweight and obesity
• Blood pressure evaluation
• Cardiovascular assessment
• Other systems as indicated by history and health risk assessment (HRA) such as evaluation of thyroid, lungs and abdomen

A periodic primary health visit physical exam must include the following components:

Clients 21 years and older:

• Height measurement annually until five years post menarche for females and annually until 20 years old for males
• Weight measurement annually to assess for underweight, overweight and obesity
• Blood pressure evaluation
• Other systems as indicated by history including evaluation of thyroid, heart, lungs and abdomen

Baseline and periodic health assessments for clients zero through 20 years old must include the following components*:

• Health history
• Health risk assessment
• Preventive health education to include anticipatory guidance, provided to parent(s) or child, as appropriate
• Physical exam
• Immunizations

*Review Texas Health Steps Provider Information Periodicity Schedules.

Episodic or acute care visit:

• History of present illness
• Physical assessment focused on presenting problem(s)
• Laboratory tests based on presenting problem(s)
• Interventions appropriate to current findings

Resources

U.S. Preventive Services Task Force (USPSTF)

Centers for Disease Control and Prevention (CDC)

Texas Medical Board

Agency for Healthcare Research and Quality

National Heart, Lung and Blood Institute

Texas Medicaid & Healthcare Partnership (TMHP)

Current Procedural Terminology (CPT) – American Medical Association

ICD-10 Resources – Centers for Medicare & Medicaid Services

Healthy Lifestyle Intervention

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

Counseling on Healthy Lifestyle Choices

Based on the needs of each client, advise them on the impact of smoking, the use of tobacco products, and to avoid exposure to second-hand smoke.

The Texas Tobacco Quitline provides confidential, free, and convenient cessation services to Texas residents 13 and older, including quit coaching and nicotine replacement therapy. Access services by phone at 877-YES-QUIT (877-937-7848) or online at YesQuit.org.

Counsel clients on healthy eating patterns and offer access to relevant information.

Advise clients to engage in physical activity or resistance training tailored to their individual health condition and risks.

Laboratory Tests

All clients presenting for an initial, annual, routine follow-up or problem-related visit must be provided appropriate laboratory and diagnostic tests as indicated by history, health risk assessment (HRA), physical examination or clinical assessment.

The following tests or procedures must be provided:

• Colorectal cancer screening in people 45 and older
• Cervical cancer screening for females 21 years and older as per the U.S. Preventive Services Task Force (USPSTF) recommendations
• Human Papillomavirus (HPV) screening for female clients who are 21 years or older per the U.S. Preventive Services Task Force (USPSTF) cervical cancer screening recommendations
• HIV screening**
• STI screening, per CDC guidelines
• Pregnancy testing must be provided on-site
• Rubella serology, if status not previously established by client history and documented in chart, either on-site or by referral
• Other labs as indicated by HRA, history and physical, either on-site or by referral

Note: Initial tests may be deferred until the initial physical exam is provided.

Agencies must have written plans to address laboratory and other diagnostic test orders, results and follow-up to include:

• Tracking and documentation of tests ordered and performed for each client
• Tracking test results and documentation in clients’ records
• Mechanism to notify clients of results in a manner that ensures confidentiality, privacy and prompt appropriate follow-up
• Provider must comply with state and local STI reporting requirements

**HIV screening must be provided on-site. Providers should follow CDC recommendations that all clients 13-64 years be screened at least once for HIV infection.

• Anyone likely to be at high risk for HIV should be rescreened at least annually.
• CDC also recommends that screening is provided after notifying the client that testing will be performed as part of general medical consent unless the client declines, called opt-out screening.
• The provision of negative test results by phone must follow procedures that ensure client confidentiality, proper identification of the client and include the provision of prevention counseling.
• Providers may provide positive HIV test results by phone if they follow procedures that ensure client confidentiality and proper identification of the client and include the provision of prevention counseling.
• Providers may provide positive HIV test results to client 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 knowledgeable about HIV prevention and HIV testing.
• Provide clients whose risk screenings assessment reveals high risk behaviors directly with risk reduction counseling or refer for more extensive risk reduction counseling by a Department of State Health Services (DSHS) HIV/STD program trained risk reduction specialist.

Visit the DSHS HIV/STD website to find a DSHS HIV/STD program provider.

Resources

American College of Obstetricians and Gynecologists (ACOG)

Morbidity and Mortality Weekly Report (MMWR) Sexually Transmitted Diseases Treatment Guidelines, 2021

Expedited Partner Therapy

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

HHSC endorses the CDC recommendations for EPT. Clinic sites implementing EPT should develop necessary policies, procedures and standing orders (SOs) to reflect the CDC guidelines. Review the DSHS HIV/STD website for more information on implementing EPT.

Radiology Procedures

Provide PHC clients with appropriate radiologic tests. This includes the technical procedure and the interpretation of the X-ray, as indicated by history and clinical assessment about the current reason for visit. If a provider cannot provide radiological services on-site, the provider must have a memorandum of understanding (MOU) with another provider and make the services available through referral.

Family Planning Services

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

Contraceptive Counseling and Education

Providers must offer clients a wide array of contraceptive options appropriate for their 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).

A specific contraceptive method that requires more clinical expertise outside the training of the PHC contracted clinicians, such as sterilization, may be provided by referral.

If a provider offers a method or service by referral, they must be provided to clients at the referral site at no fee or at the same discounted client fee that would be charged if the method or service were provided on-site. The referring site must have a written agreement with the referral site to provide the method or service to clients under this condition.

Note: PHC grantees must follow current state and federal laws as they pertain to abortion services.

Counseling Adolescents

Provide adolescents 17 and younger personalized family planning counseling and medical services that meet their specific needs. Appointments should be available to them for counseling and medical services as soon as possible. Based on the needs of each client, grantees should address:

• all methods of contraception, including abstinence
• discussion about contraceptive options and safe sex practices that reduce risk of STI, HIV and pregnancy
• identifying and resisting sexual coercion
• discussion about partner, dating and family violence, and available resources and assistance

Perinatal Clinical Guidelines

Provide prenatal and postpartum services based on American College of Obstetricians and Gynecologists (ACOG) or other nationally recognized, evidence-based guidelines.

State-Mandated Education

Information for Parents of Newborns 

Health and Safety Code, Subchapter T, Section 161.501 requires hospitals, birthing centers, physicians, nurse-midwives and midwives who provide prenatal care to pregnant women during gestation or at delivery to provide them and additional parent(s) or other adult caregiver(s) Information for Parents of Newborns (PDF). This guide includes information about immunization, newborn screening, postpartum depression and shaken baby syndrome.

Grantees must document that the client received this information. The documents must be retained for a minimum of five years. It is recommended that the information be given twice, once at the first prenatal visit and again after delivery.

A Parent’s Guide to Raising Healthy, Happy Children

A Parent’s Guide to Raising Healthy, Happy Children (PDF) is designed for parents and adult caregivers of children. The guide provides information about the development, health and safety of children from birth to 5 years.

Dental Clinical Policy

Provide dental services based on American Dental Association (ADA) or other nationally recognized, evidence-based guidelines.

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

Grantees must help clients meet identified PHC needs, either directly or by referral. When services required as part of the HHSC PHC grant are provided by referral, the grantee must establish a written agreement with a referral resource for the provision of services and cost reimbursement. They must make sure the client is charged no more than the appropriately assessed co-pay fee.

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

• tracking pending tests until results are reviewed by the provider and the client is notified of their results and recommended follow-up;
• 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 and promoting timely, appropriate follow-up, and complying with state or federal requirements for transfer of health information;
• 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 sexually transmitted infections (STI) reporting requirements.

Before a person is considered lost to follow-up, the grantee must make at least three documented attempts to contact the person using a protocol where 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 suitable processes for the population they serve. Providers also should adapt their usual processes to the known circumstances and preferences of the person they are trying to contact.

For services determined to be necessary that are not provided by the grantee, refer clients to other resources for care.

For referral purposes, grantees are expected to have established communications with federally qualified health centers (FQHCs) or HHSC-funded organizations that provide breast cancer and cervical cancer services, if there are any such providers within their service area. Whenever possible, give clients a choice of referral resources to select from.

When a client is referred to another resource because of an abnormal finding or for emergency clinical care, the grantee must:

• Plan for the provision of pertinent client information to the referral resource.
• Get required client consent with appropriate safeguards to ensure confidentiality, including adhering to HIPAA regulations.
• Advise the client about their responsibility to comply with the referral.
• Follow up to find out if the referral was completed.
• Document the outcome of the referral.

Clients who have an abnormal clinical breast exam (CBE) or cervical cytology findings may be scheduled to return for repeat exams for an appropriate follow up by the clinician. For clients whose cervical cytology test or CBE result in an abnormal finding that requires referral for services beyond those available through PHC, grantees can, whenever possible, refer to an HHSC Breast and Cervical Cancer Services (BCCS) grantee. To promote the most effective use of limited resources, PHC grantee clinicians should be familiar with nationally recognized guidelines and algorithms describing recommended practices for abnormal cervical cytology and CBE results.

Revision 26-2; Effective Sept. 1, 2026

Grantees that provide clinical services must develop and maintain written clinical prescriptive authority agreements (PAAs), protocols and standing orders (SOs) to comply with statutes and rules that govern medical, dental and nursing practice and consistent with national evidence-based clinical guidelines. 

5310 Prescriptive Authority Agreements

Revision 26-2; Effective Sept. 1, 2026

The grantee must make sure that advanced practice providers (APPs) maintain a properly executed prescriptive authority agreement (PAA). APPs include advanced practice registered nurses (APRNs) and physician assistants (PAs). The PAA must meet all the requirements of the Texas Occupations Code (TOC), Title 3, Subtitle B, Chapter 157. The PAA and any amendments must be reviewed at least annually, dated and signed by the parties to the agreement. The PAA must:

• be in writing and signed and dated by the parties to the agreement;
• state the name, address and all professional license numbers of the 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 patient emergencies;
• state the general process for communication and sharing information between the physician and the APRN or PA to whom the physician has delegated prescriptive authority related to the care and treatment of patients;
• if alternate physician supervision is to be used, designate one or more alternate physicians who may:
  • provide appropriate supervision on a temporary basis per the requirements established by the PAA and the requirements of TOC Chapter 157, Subchapter A; and
  • participate in the prescriptive authority quality assurance and improvement plan meetings required under TOC Section 157.0512; and
• describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that include:
  • chart review, with the number of charts to be reviewed determined by the physician and advanced practice registered nurse or physician assistant; and
  • periodic meetings between the advanced practice registered nurse or physician assistant and the physician.

References

Texas Occupations Code, Title 3, Subtitle B, Chapter 157 Authority of Physicians to Delegate Certain Medical Acts

TAC, Title 22, Part 11, Chapter 222 Advanced Practice Registered Nurses with Prescriptive Authority

Delegation Protocol for Advanced Practice Providers

APRNs and PAs are required to have delegated authority from a licensed physician to provide medical aspects of patient care. Physician delegation occurs through protocols or other written authorization. This delegation historically has occurred through a protocol or other written authorization. Rather than require multiple documents, delegation protocols can be included in the PAA.

References

TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1(11) Protocols and Rule 169.2(a) 

TAC Title 22, Part 9, Chapter 169, Subchapter B, Rule 169.5 Delegation to Physician Assistants and Advanced Nurse Practitioners

Texas Occupations Code Title 3, Subtitle B, Chapter 157, Subchapter B Delegation to Advanced Practice Registered Nurses and Physician Assistants 

TAC Title 22, Part 11, Rule 221.13(d)(1-2) Texas Board of Nursing, Delegation Protocols or written authorization requirements for APRNs

5320 Protocols

Revision 26-2; Effective Sept. 1, 2026

APRNs and PAs are required to have delegated authority from a licensed physician to provide medical aspects of patient care. Physician delegation occurs through protocols or other written authorization. This delegation has historically occurred through a protocol or other written authorization. Rather than require multiple documents, delegation protocols can be included in the PAA.

References

TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1(11) Protocols and Rule 169.2(a) 

TAC Title 22, Part 9, Chapter 169, Subchapter B, Rule 169.5 Delegation to Physician Assistants and Advanced Nurse Practitioners

Texas Occupations Code Title 3, Subtitle B, Chapter 157 Authority of Physicians to Delegate Certain Medical Acts

TAC Title 22, Part 11,  Rule 221.13(d)(1-2) Texas Board of Nursing, Delegation Protocols or written authorization requirements for APRNs

5330 Standing Orders

Revision 26-2; Effective Sept. 1, 2026

Standing Orders (SOs) include Standing Delegation Orders, Standing Medical Orders and written protocols. These terms are defined in TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1(12-14).

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

• development and approval by the delegating physician per 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 follow
• a notation of the level of supervision required, unless specified by other law
• plans for addressing patient emergencies
• annual review signed by the delegating physician
• maintenance at the facility or practice site

References

Texas Board of Nursing Position Statements 15.5 Nurses with Responsibility for Initiating Physician Standing Orders

TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1

Definitions and Rule 169.2(b)

11-2019

For information about document accessibility, contact accessibility@hhsc.state.tx.us.

Definition of Income

Revision 26-1; Effective March 1, 2026

For information about document accessibility, contact accessibility@hhsc.state.tx.us.

Optional Co-Pay Table Based on 2026 Monthly Federal Poverty Level (FPL) - (PDF)

Revision 26-2; Effective Sept. 1, 2026

Forms

The following forms were revised in the Primary Health Care Program Policy Manual:

Revision 26-1; Effective March 1, 2026

Revision 25-3; Effective Nov. 14, 2025

Forms

The following forms were revised in the Primary Health Care Program Policy Manual.

Revision 25-2; Effective March 25, 2025