Title V Maternal and Child Health Fee-for-Service Program Policy Manual

1000, Program Contact Information and Purpose of Manual

Body

1100 Program Contact Information

Revision 26-2; Effective Sept. 1, 2026

Mailing Address

Title V MCH Fee-For-Service Program
North Austin Complex
4601 W. Guadalupe St., Mail Code 0224
Austin TX 78751-2920

Email

titlevffs@hhs.texas.gov

Websites

Title V Maternal and Child Health Fee for Service Program

1200 Purpose of Manual

Revision 26-2; Effective Sept. 1, 2026

The Texas Health and Human Services Commission (HHSC) Title V Maternal and Child Health Fee-for-Service (TVFFS) Program Policy Manual is a guide for grantees who deliver HHSC TVFFS services in Texas. This 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 TVFFS services. Grantees are required to be aware of and comply with existing laws.

2000, Program Authorization, Services and Definitions

Body

2100 Program Authorization and Services

Revision 26-2; Effective Sept. 1, 2026

Title V Maternal and Child Health Fee-for-Services Program Background

The purpose of the Maternal and Child Health (MCH) Services Title V Block Grant is to create federal and state partnerships. These partnerships provide direct services to low-income women and children who are not eligible for Medicaid, Children’s Health Insurance Program (CHIP), CHIP Perinatal or another payer source that covers these same services. Title V Maternal and Child Health Fee-for-Services (TVFFS) grantees provide services that:

  • significantly reduce infant mortality,
  • include comprehensive care for women before, during and after pregnancy and childbirth, and
  • include preventive and primary care services for infants, children and adolescents.

Legal Authority

Through Title V of the Social Security Act (SSA) of 1935, the federal government pledged to support state efforts to improve the health of all mothers and children. The MCH Block Grant Program under Title V of the SSA was created in 1981 to consolidate multiple programs. These programs support a more comprehensive, coordinated approach to meeting states’ individual needs consistent with the applicable health status goals and national health objectives now identified in Healthy People 2030.

Within Texas, TVFFS operates within a framework articulated by the Texas Legislature and Texas Health and Human Services Commission (HHSC).

States are required to use awarded federal funds as follows:

  • 30% for preventive or primary care services for children
  • 30% for services for children with Special Health Care Needs
  • Up to 10% on administrative costs
  • Remaining funds to support other MCH populations, such as pregnant women and mothers

Funding Sources

TVFFS program services are funded by state general revenue and federal funds through the Title V MCH Block Grant. HHSC TVFFS funds are allocated through a competitive application process. After the funds are allocated, selected applicants negotiate contracts with HHSC to provide services.

2200 Definitions

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 TVFFS 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 copayment amount can impact access to services.

Case Management – Relating to pregnant women, this means making sure they have access to quality prenatal, delivery and postpartum care. With respect to infants, children and adolescents, it means making sure they have access to quality preventive and primary care services.

Children’s Health Insurance Program (CHIP) – A program for children in families that earn too much money to qualify for Medicaid but can’t afford to buy private insurance.

CHIP Perinatal Program – A health insurance program that provides limited coverage during pregnancy and postpartum for women who don’t qualify for Medicaid and don’t have health insurance.

Children and Adolescents – People from their first birthday through their 21st year.

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. 

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

Dental Services – Diagnostic, preventive and therapeutic dental services that are provided to an eligible client and are performed in a dental office or clinic.

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 two years and $175 per month for each child two 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 the 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.

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. 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.

Fee-for-Service (FFS) – The payment mechanism for services that are reimbursed on a set rate per unit of service, also known as unit rate.

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

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 minor is a person younger than 18 years of age 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.

Nutritional Services – The provision of services to identify the nutritional status of a person and offer instruction. Instruction includes appropriate dietary information based on the client’s needs such as age, sex and health status. This may be provided to a person on a one-to-one basis or to a group of people.

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

Prescription Drugs, Devices and Durable Supplies – Medically necessary pharmaceuticals and medical supplies that are capable of withstanding wear, which are needed for the treatment of a diagnosed condition.

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 copay fees and donations.

Promotores or Community Health Worker (CHW) – A person who, with or without compensation, helps connect people in their community with health care and social services. A certified CHW is someone with current certification issued by DSHS.

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

Referral Agency – An agency that provides a service for a TVFFS client that the TVFFS grantee does not provide and is not a reimbursable TVFFS service.

Service Member – A member or former member of the state military forces or a component of the United States Armed Forces, including a reserve component. This includes active duty, reserve, and veterans of the United States Armed Forces as well as 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 that 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 by 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 than the dentist or health professional using telecommunications or information technology. 

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

Telemedicine – A health care service delivered 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 to a patient at a different physical location than the physician or health professional using telecommunications or information technology.

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

Transportation – Services that may be provided to transport a client to receive required health care services. Transportation could be provided by a private vehicle, public transportation, a project site vehicle or an emergency medical vehicle.

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, for each Title V program they participate in, which includes: Prenatal Medical, Prenatal Dental, Child Health and Child Dental. If a client participates in more than one Title V program, only their first visit of the fiscal year will be counted as an unduplicated client for each program they participate in.

3000, Administrative Policy

Body

Revision 26-2; Effective Sept. 1, 2026

This section provides guidance to grantees on conducting administrative activities, including ensuring client access to services and managing client records.

3100 Accessibility

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 TVFFS 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 Title V Fee-for-Service (TVFFS) Program grantee and specify which clinic locations will serve TVFFS clients.

Grantees with existing listing(s) may update their TVFFS 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, and
  • services provided.

At the beginning of each fiscal year, grantees will receive a notification from their HHSC program contact manager of any active 2-1-1 listings servicing TVFFS 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, or
  • 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 nondiscriminatory 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 defines the timely provision of services, including:
    • Applicants deemed eligible for TVFFS must be given an appointment as soon as possible and no later than 30 days from the initial request.
  • Have a policy in place that requires qualified staff to assess and prioritize a person’s needs.
  • Provide referral sources for services outside the scope of TVFFS.
  • Manage funds to make sure established clients continue to receive services throughout the budget year, including after allocated funds are expended.
  • Inform people of TVFSS 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.

3200 Abuse and Neglect Reporting

Revision 26-2; Effective Sept. 1, 2026

Grantees must obey state laws governing 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:

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

Grantees must develop child abuse and neglect policies and procedures that comply with the reporting guidelines and requirements in Texas Family Code, Chapter 261. A grantee’s policies must include:

  • How child abuse reporting requirements will be implemented throughout the agency, including how staff will be trained and how internal monitoring will be conducted to ensure timely reporting.
  • The requirement that medical professionals must make a report no later than the 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 or 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, including the Trafficking Victims Protection Act of 2000 and Texas Occupations Code Chapters 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 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, and
  • annual staff training.

References for human trafficking policy development:

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. IPV 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 (PDF) 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, which operates 24 hours a day, seven days a week and provides interpretation services in over 200 languages.

3300 Confidentiality

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

Grantees are required by HIPAA 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.

The notice must be posted 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 about 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 signed confidentiality policy or agreement, and the grantee must maintain a 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:

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 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 regarding the use and disclosure of that person’s protected health information. In most cases, parents serve as the personal representatives of their minor children, and may exercise personal rights on their behalf – such as accessing medical records – as outlined in 45 Code of Federal Regulations Section 164.502(g).

For more information, see Texas Health Steps (THSteps).

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.

For more information about nondiscrimination laws and regulations, refer to 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, or
    • 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 related to civil rights. The posters must be displayed in areas 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 HHS services. The following posters are required:  

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

Examples of suitable flyers are available on the following Office of the Attorney General (OAG) and Substance Abuse and Mental Health Services Administration (SAMHSA) websites:

More mental health and suicide prevention resources are available at:

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, the safety of clinic staff or others.

A termination of services policy 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 and that 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, including:

  • 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 help to 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 TVFFS clients as subjects, the use of TVFFS client records or any data collected from TVFFS clients, TVFFS 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 TVFFS 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 training. Documentation of training on this topic must be maintained.

3400 Client Records Management

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. 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 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.

3500 Personnel Policies and Procedures

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 TVFFS 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 TVFFS 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 TVFFS 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.

At least one provider who has an active medical or dental license in Texas must be in the grantee’s network. The provider must have at least five years of medical or dental practice experience, respective to the program services they intend to provide.

Safeguards must be established to prohibit a grantee’s 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 TVFFS 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 or 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, and
  • program director or program manager, program contact.

Grantees must make sure at least one representative:

  • Communicates program information. Responsible for disseminating information to TVFFS 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.

3600 Facilities and Equipment

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 intends 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 documents 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 user errors,
  • an orientation and education program for personnel who use medical equipment, and
  • manufacturer recommendations for 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:

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

3650 Laboratory Standards

Revision 26-2; Effective Sept. 1, 2026

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

3660 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.

3700 Emergency Responsiveness

Revision 26-2; Effective Sept. 1, 2026

Medical Emergencies

Grantees must adequately prepare 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 have appropriately trained staff when clients are present, and
  • 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 plan that includes criteria for management of 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.

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, and
  • bomb threats.

The disaster plan must identify the procedures 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. For an employer with 10 or fewer employees, the plan may be communicated verbally.

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

3800 Quality Management

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 TVFFS 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, and 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 TVFFS services must also address how quality will be evaluated and how compliance with HHSC policies and basic standards will be assessed with the 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, and
  • 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, and
  • reassess outcomes and goal achievement.

Meeting dates, a list of 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, at minimum:

  • 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, and
  • 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, all agencies that provide client services must adopt the following practices:

  • ongoing review of eligibility, billing and client records 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 survey data to HHSC in the frequency, manner and format the defined by the commission,
  • 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 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 as the primary source verification,
  • clinical record review,
  • eligibility and billing review,
  • utilization review,
  • on-site facility review,
  • annual client satisfaction evaluation process, and
  • 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.

4000, Eligibility and Fees

Body

Revision 26-2; Effective Sept. 1, 2026

This section provides policy requirements for client eligibility determinations, client fees and the continuity of client services.

4100 Eligibility and Assessment of Co-pay and Fees

Revision 26-2; Effective Sept. 1, 2026

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

To assess eligibility for TVFFS, 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 TVFFS program.

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

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

4200 Client Eligibility Screening Process

Revision 26-2; Effective Sept. 1, 2026

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

  • gross family income at or below 185% of the Federal Poverty Level (FPL),
  • Texas resident, and
  • not eligible for other programs or benefits providing the same services.

The TVFFS Child Health and Dental program serves people from birth until their 22nd birthday. The TVFFS Prenatal Medical and Dental program serves pregnant women of any age through three months postpartum, and through three months following a pregnancy loss.

Application and eligibility determinations for TVFFS can be made by conducting interviews in person or over the phone. Phone interviews for eligibility determinations must comply with all eligibility guidelines outlined in this manual.

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.

4300 Procedures and Terminology When Determining TVFFS Eligibility

Revision 26-2; Effective Sept. 1, 2026

Potential Eligibility and Referral to Other Programs

The TVFFS program is the payor of last resort. Grantees must screen applicants for Children’s 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. Applicants who do not fully comply with applying for other benefit programs are not eligible for TVFFS. TVFFS will not reimburse services provided to these applicants.

The grantee must notify the client that they must apply for any program for which they appear eligible. If a client does not screen as eligible for any other program, this must be documented on the application form.

All Children’s Medicaid, CHIP, Medicaid for Pregnant Women, CHIP Perinatal or other benefit program applications must be submitted promptly following TVFFS eligibility assessment. If a client was denied Medicaid or CHIP services, the denial letter must be included with their application.

All pregnant women served by TVFFS must apply for Medicaid or CHIP Perinatal programs.

Providers are required to inform, encourage and assist pregnant women in the CHIP Perinatal and Medicaid for Pregnant Women application process. A maximum of two clinical prenatal care visits are allowed for women in the process of applying for and enrolling in the CHIP Perinatal and Medicaid for Pregnant Women programs.

Grantees may use the HHSC Your Texas Benefits website to help screen for client eligibility. More information about HHSC benefits can also be obtained by calling 2-1-1.

TVFFS prenatal clients who enroll in a managed care organization (MCO) that does not provide dental benefits will remain eligible for TVFFS Prenatal Dental benefits. These clients must provide documentation that their MCO does not provide dental benefits to continue receiving TVFFS dental benefits. This documentation must be maintained in the client’s record.

If a client appears eligible and applies for any of these other benefit programs, they must be granted Presumptive Eligibility for TVFFS while awaiting benefit determination. The client is responsible for submitting proof of application or a denial letter before the presumptive eligibility period ends.

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, 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 their 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 are 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 Date of Birth

Documentation of date of birth must be provided for clients who apply for the Child Health or Child Dental programs. One of the following should be provided and a copy should be kept with the client’s application: 

  • birth certificate,
  • baptismal certificate,
  • school records, or
  • other documents or proof of date of birth determined valid by the grantee.

Documentation of Family Composition

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

  • birth certificate,
  • baptismal certificate,
  • school records, or
  • 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 TVFFS 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 TVFFS 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, or
  • 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, or
  • 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 TVFFS income verification policy.

Documentation of income for TVFFS 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 the 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 person’s usual and customary earnings. Proof may include:

  • copy(ies) of the most recent paycheck(s) or stub or monthly earning statement(s)
  • employer’s written verification of gross monthly income,
  • optional Form 3049, Employment Verification,
  • optional Form 3051, Statement of Self-Employment Income,
  • 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, and
  • 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:

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 period the income is expected to cover. Income received weekly, every two weeks or twice a month must be converted as follows:

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

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 younger than 2,
  • $175 per child per month for each dependent 2 or older, and
  • $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 by using current U.S. Department of Health and Human Services federal poverty guidelines. The guidelines are subject to change around the beginning 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, and
  • 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 TVFFS clients. Grantees who choose to collect co-pays must comply with these guidelines:

  • No TVFFS 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 will be determined.
  • Clients who are assessed a co-pay must be given a billing statement at the time of service and 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. An outstanding balance will not prohibit a client from receiving services.
  • All policies and procedures regarding co-pay collection must be approved by the grantee’s board of directors.
  • Co-pays must be reported as program income on the Monthly Reimbursement Packet (MRP). The grantee must complete B25 and E25.

Grantees may choose to use the optional co-pay table in Appendix II, Optional Co-Pay Table Based on Monthly Federal Poverty Level (FPL). 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 TVFFS 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, and
  • 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 TVFFS clients through the end of their clients’ determined eligibility periods.

Grantees do not have to screen potential new clients for TVFFS 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,
  • program application is completed and signed, and
  • all verification documents are submitted.

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

Presumptive Eligibility

Presumptive eligibility provides short-term access to health care services for up to 90 days when an applicant:

  • screens as potentially eligible for services,
  • has a medical or dental need, and
  • lacks the documents required to achieve full eligibility.

Grantees must establish a presumptive eligibility period of 90 days in their eligibility policy. During this period, clients are expected to produce the necessary documents or be enrolled in other applicable programs, such as Medicaid or CHIP.

For clients who submit all required documents and are determined to be fully eligible before the end of their presumptive eligibility period, full eligibility will be granted. The eligibility expiration date will be calculated 12 months from the first day presumptive eligibility began. For Perinatal benefits, the eligibility expiration date is at three months postpartum or at three months after a pregnancy loss.

Child Health and Dental (CHD) clients are limited to one presumptive eligibility period per two calendar years.

Prenatal Medical and Dental (PMD) clients are limited to one presumptive eligibility period per pregnancy.

If the client enrolls in a Medicaid or CHIP program during the presumptive eligibility period, TVFFS enrollment will end on the date Medicaid or CHIP program eligibility begins.

The grantee must issue Form 3045, Presumptive Eligibility Notice to notify an applicant of Presumptive Eligibility.

Ineligibility

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

Annual Eligibility Determination

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

Perinatal benefits expire at three months postpartum or at three months following a pregnancy loss. Grantees must have a system in place to track client eligibility expiration dates to determine when a new application is needed.

5000, Clinical Guidelines

Body

Revision 26-2; Effective Sept. 1, 2026

This section describes the requirements and recommendations for the delivery of direct clinical services to clients. Grantees should also develop protocols consistent with national evidence-based guidelines, appropriate to the target population.

5100 General Consent

Revision 26-2; Effective Sept. 1, 2026

Grantees must obtain the client’s written and voluntary general consent for 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 per 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.

Consent for Dental Procedures

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.

Texas Medical Disclosure Panel Informed Consent

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 assure that 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 the TAC, Title 25, Part 7, Chapter 603.

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

Consent for Services Provided to Minors

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 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, 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

Consent for HIV Testing

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

5200 Clinical Policy

Revision 26-2; Effective Sept. 1, 2026

Telemedicine

Providers may provide services by telemedicine if appropriate.

Providers that offer telemedicine services must follow all rules of the Texas Occupations Code (TOC), Chapter 111 and must have written policies and procedures for:

  • obtaining informed consent,
  • maintaining confidentiality of the client’s clinical information,
  • ensuring appropriate, quality care,
  • preventing abuse and fraud in the use of telemedicine services,
  • ensuring adequate supervision of health professionals who are not physicians and who provide telemedicine care, and
  • establishing the maximum number of health professionals a physician may supervise through telemedicine services.

Client Health Records and Documentation of Encounters

Providers must make sure a client health record is established for every person who receives clinical services. Providers also must meet the requirements of the General Documentation Provisions in TAC Title 22, Part 9, Chapter 163, Subchapter A.

All client health records must be:

  • Complete, legible and accurate documentation of all client encounters, including those by phone, email or text.
  • Written in ink, without erasures or deletions, or documented in the electronic medical record (EMR) or electronic health record (EHR).
  • Signed by the provider making the entry, including the name and title of the provider, and the date for each entry.
  • Electronic signatures are allowable to document the encounter or provider review of care.
  • Stamped signatures are not allowable.
  • 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 prescribed and nonprescribed medications and dietary supplements, updated at each encounter,
  • a complete list of all allergies and adverse reactions to medications, food and environmental substances such as latex, including specifying when a client has no known allergies,
  • information updated at each encounter that is prominently displayed in the client’s record,
  • a plan of care, updated as appropriate, consistent with diagnoses and assessments, which are consistent with clinical findings,
  • documentation of recommended follow-up care, recommended 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 as appropriate at every visit to document the reason for the visit, relevant history, physical exam findings, pertinent screening and diagnostic tests with results and a treatment plan.

Case Management

Grantees should provide case management services to clients who need assistance accessing community resources for services the grantee does not provide. Referrals to other resources must be documented in the clinical record.

Referral and Follow-Up

Grantees must have written policies and procedures for follow-up on referrals that are made to other providers. These policies must be sensitive to clients’ concerns about confidentiality and privacy and must follow state or federal requirements for transfer of health information.

Clients should be given a choice of referral resources to choose from whenever possible. When a client is referred to another provider of care, the grantee must:

  • transmit client’s information, with client’s consent, to the referral resource while maintaining confidentiality and adhering to HIPAA regulations;
  • advise the client about her or his responsibility to comply with the referral;
  • follow up to determine if the referral was completed; and
  • document the outcome of the referral.

Before a grantee can consider a client as lost to follow-up, the grantee must have at least three documented attempts to contact the client.

5300 Perinatal Clinical Guidelines

Revision 26-2; Effective Sept. 1, 2026

Perinatal Services

Provide prenatal and postpartum services based on American College of Obstetricians and Gynecologists (ACOG) guidelines. Perinatal visits include medical history, physical examination, laboratory and diagnostic testing, and education and counseling.

Grantees may bill TVFFS for allowable services provided during the CHIP-Perinatal or Medicaid for Pregnant Women enrollment process. Review the Monthly Reporting Packet (MRP) for reimbursable procedure codes.

Postpartum visits are reimbursable for a period of three months following delivery or a pregnancy loss. Postpartum visits include a:

  • history,
  • physical exam,
  • laboratory and diagnostic testing, and
  • education and counseling.

Perinatal Laboratory and Other Diagnostic Tests

Perinatal visits should include appropriate laboratory and diagnostic tests, as indicated by weeks of gestation and clinical assessment. Grantees must have written plans to address laboratory and other diagnostic test orders, results and follow-up to include:

  • tracking and documenting orders and results;
  • a plan to address abnormal results, facilitate continuity of care by making results accessible to the delivering hospital, facility or provider; and 
  • ensuring confidentiality that adheres to HIPAA regulations.

Resources

DSHS Congenital Syphilis Consultation Hotline, 833-623-6327

ACOG Syphilis Screening Algorithm 

Ultrasounds

Obstetrical ultrasounds will be reimbursed as recommended by ACOG guidelines. Review the MRP for reimbursable procedure codes.

Nonstress Test

Nonstress tests (NST) may be billed as often as the provider deems the procedure to be medically necessary.

Biophysical Profile and Fetal Biophysical Profile

The Biophysical Profile (BPP) and Fetal Biophysical Profile (FBPP) test combines a nonstress test and fetal ultrasound to evaluate a baby's:

  • heart rate,
  • breathing,
  • movements,
  • muscle tone, and
  • amniotic fluid level.

May be billed as often as the provider deems the procedure to be medically necessary.

Perinatal Education and Counseling Services

Grantees must have written plans for client education that include goals and content outlines to ensure consistency and accuracy of information provided. Education must be appropriate to the client’s age, level of knowledge and background, and be presented in an unbiased manner.

Depression and Anxiety Screening

ACOG recommends all perinatal clients be screened for depression and anxiety symptoms with a standardized, validated tool at:

  • the first obstetric visit,
  • 24-28 weeks gestation, and
  • the comprehensive postpartum visit. 

Examples of validated depression and anxiety screening tools include:

Supplemental screening tools include:

Tobacco Assessment and Quit Line Referral

All women who receive prenatal and postpartum services should be assessed for tobacco use. Refer women who use tobacco to tobacco quit lines. The Texas Tobacco Quitline provides confidential, free and convenient smoking cessation services to Texas residents 13 years and older, including quit coaching and nicotine replacement therapy. Services can be accessed by phone at 877-937-7848 (877-YES-QUIT) or online at YesQuit.org. The assessment and referral should be performed by agency staff and documented in the clinical record.

Substance Use Disorder Screening, Brief Intervention and Referral to Treatment

All women who receive prenatal and postpartum services should be screened for substance use disorder through screening, brief intervention, and referral to treatment (SBIRT). Routine screening should be done at the first comprehensive prenatal visit and should use a validated screening tool, including 4Ps, 5Ps, NIDA Quick Screen, CRAFFT, T-ACE, ASSIST and TWEAK.

SBIRT and mental health resources:

Nutrition Counseling

Nutritional counseling by a licensed dietitian is not billable to TVFFS. Clients may be referred to Women, Infants and Children (WIC) for nutritional counseling.

5310 State-Mandated Education

Revision 26-2; Effective Sept. 1, 2026

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 give the woman and the infant's father or other adult caregiver 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 was given 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.

Provision of Information about Umbilical Cord Blood Donation Requirement

Health and Safety Code, Subtitle H, Section 162.018 requires a physician or other person permitted by law to attend a pregnant woman during gestation or at delivery of an infant to give the woman an informational brochure:

  • before the third trimester of the woman’s pregnancy, or
  • as soon as possible.

The brochure should include information about:

  • the uses, risks and benefits of cord blood stem cells for a potential recipient,
  • options for future use or storage of cord blood,
  • the medical process used to collect cord blood,
  • any costs that may be incurred by a pregnant woman who chooses to donate or store cord blood after delivery, and
  • average cost of public and private storage.

An Umbilical Cord Blood Banking and Donation Brochure is available through DSHS.

Resources

5320 Initial Prenatal Visit Requirements

Revision 26-2; Effective Sept. 1, 2026

Grantees are encouraged to refer first-time moms to Nurse-Family Partnership for those located within a participating Texas county. Referrals must be made on or before 28 weeks gestation.

Comprehensive Medical History – Initial Visit

A comprehensive medical history documented at the initial prenatal visit must address:

  • current health status, including:
    • symptoms of pregnancy, and
    • acute and chronic medical conditions,
  • significant history, including:
    • hospitalizations,
    • surgeries,
    • biopsies, and
    • blood transfusions and other exposure to blood products,
  • current medications, including prescription, over the counter, and complementary and alternative medications,
  • allergies, sensitivities or reactions to medicines or other substance(s),
  • immunization status or assessment, including Rubella status,
  • mental health history including current and past mental health conditions,
  • pertinent history of immediate family, including genetic conditions,
  • pertinent partner history, including:
    • injectable drug use,
    • number of partners STI and HIV history, and
    • other risk factors,
  • reproductive health history must include:
    • menstrual history, including last normal menstrual period,
    • sexual activity history, including:
      • family planning practices,
      • number of partners,
      • sex of partners, and
      • sexual abuse, as indicated,
    • detailed obstetrical history,
    • gynecological and urologic conditions,
    • STIs, including hepatitis B and C, and HIV risks and exposure,
    • cervical cancer screening history:
      • date and results of last Pap test or other cervical cancer screening test, and
      • note of any abnormal results and treatment,
  • social history and health risk assessment:
    • home environment, including living arrangements,
    • family dynamics with assessment for family violence including safety assessment, when indicated which is mandated by Texas Family Code, Chapter 261,
    • human trafficking,
    • tobacco, alcohol, medications, recreational drug use or abuse and exposure, drug dependency including type, duration, frequency and route,
    • nutritional history,
    • occupational hazards or environmental toxin exposure,
    • ability to perform activities of daily living (ADL),
    • risk assessment, including:
      • diabetes,
      • heart disease,
      • intimate partner violence,
      • injury or malignancy, and
  • systems review documenting pertinent positives and negatives in the health record.

Physical Exam – Initial Visit

For any part of the exam that is deferred, document the reason(s) for deferral in the client health record.

  • height measurement,
  • weight measurement, with documentation of pre-pregnancy weight and assessment for underweight, overweight and obesity,
  • blood pressure evaluation,
  • cardiovascular assessment,
  • visual inspection of external genitalia and anus,
  • pelvic exam, including estimate of uterine size per Chapter 167A of the Health and Safety Code,
  • fetal heart rate for gestational age more than 12 weeks, and
  • other systems, as indicated by history and the health risk assessment.

Laboratory and Diagnostic Tests – Initial Visit

Perform lab and diagnostic tests as recommended by ACOG guidelines for client’s weeks of gestation, those mandated by law, and as indicated by risk assessment, history or physical exam. 

The following tests are state-mandated by the Health and Safety Code 81.090 during the initial visit:

Education – Initial Visit

Base client education on history, risk assessment and physical exam. It must cover:

  • nutrition and weight gain,
  • physical activity and exercise,
  • sexual activity,
  • environmental or work hazards,
  • travel,
  • alcohol use and substance abuse,
  • when and where to get emergency care,
  • anticipated course of prenatal care, including prenatal testing,
  • injury prevention, including seat belt use,
  • cocooning infants and children against pertussis including immunization of family members and potential caregivers of the infant,
  • toxoplasmosis precautions,
  • referral to WIC,
  • use of medications, and
  • other education and counseling as indicated by state mandate, risk assessment, history and physical exam.

5330 Return Prenatal Visits Requirements

Revision 26-2; Effective Sept. 1, 2026

Interval Medical History – Return Visit

Interval history, including:

  • symptoms of infections,
  • symptoms of preterm labor,
  • headaches or visual changes,
  • fetal movement at more than18 weeks,
  • family violence screening when client is more than 28 weeks, and
  • intimate partner violence assessment at least once each trimester.

Physical Exam – Return Visit

For any portion of the examination that is deferred, document the reason(s) for deferral in the client health record.

  • weight measurement,
  • blood pressure evaluation,
  • uterine size and fundal height,
  • fetal heart rate at more than 12 weeks,
  • fetal lie or position at more than 30 weeks, and
  • other systems, as shown by history or other findings.

Laboratory and Diagnostic Tests – Return Visit

Perform lab and diagnostic tests as recommended by ACOG guidelines for client’s weeks of gestation, those mandated by law, and as indicated by risk assessment, history or exam.

The following tests are state-mandated by the Health and Safety Code 81.090 during the third trimester, but not earlier than the 28th week of pregnancy:

Return Prenatal Visit Education

Education should be appropriate to weeks of gestation and based on history, risk assessment and physical exam, including but not limited to:

  • signs and symptoms of preterm labor beginning in the second trimester,
  • warning signs and symptoms of pregnancy induced hypertension (PIH),
  • breastfeeding,
  • selecting a provider for the infant, and
  • postpartum family planning.

5340 Postpartum Visits Requirements

Revision 26-2; Effective Sept. 1, 2026

Interval Medical History – Postpartum Visit

Interval history, including:

  • labor and delivery history, noting maternal and neonatal complications,
  • infant bonding,
  • breastfeeding and infant feeding issues,
  • symptoms of infections,
  • symptoms of excessive or abnormal vaginal bleeding,
  • assessment for postpartum depression, The Texas Clinician’s Postpartum Depression Toolkit (PDF),
  • intimate partner violence assessment, and
  • family planning and contraception including current method or future plans.

Postpartum Visit Physical Exam

Document the reason(s) for deferral in the client’s health record, for any portion of the examination that is deferred:

  • weight,
  • blood pressure evaluation,
  • breast and axilla exam,
  • abdomen exam,
  • pelvic exam, including uterine size per Chapter 167A of the Health and Safety Code, and
  • systems indicated by history or risk profile and other findings.

Laboratory and Diagnostic Tests – Postpartum Visit

Perform lab tests as recommended by accepted standards of care for client’s weeks of gestation, those mandated by law, and indicated by risk assessment, history or exam. Review the MRP for covered lab tests.

Education – Postpartum Visit 

Client education should include:

  • physiologic changes,
  • signs and symptoms of common complications,
  • care of the breast,
  • care of perineum and abdominal incision, if indicated,
  • physical activity and exercise,
  • breastfeeding and infant feeding,
  • resumption of sexual activity,
  • family planning and contraception, and
  • depression and post-partum depression.

5350 Perinatal Dental Services

Revision 26-2; Effective Sept. 1, 2026

Providers are expected to follow rules and regulations established by the Dental Practice Act.

Review the MRP for reimbursable procedure codes.

Perinatal dental services are provided to pregnant women through three months post-partum. These include:

  • comprehensive and periodic oral evaluations,
  • radiographs, and
  • preventive and therapeutic dental services.

Procedure Code Limitations

Space maintainers are designed to prevent tooth movement and may help after premature loss of a deciduous primary first or second molar(s) in the following situations:

  • TID: A, B, I, and J – a for clients who are 1 through 12 years old using procedure codes D1510 and D1516.
  • TID: K, L, S and T – for clients who are 1 through 12 years old using procedure codes D1510 and D1517. 

The following procedure codes have age restrictions and limitations:

  • D2950 Not allowed on primary teeth, restricted to 4 years and older
  • D2952 Not allowed on primary teeth, restricted to 13 years and older and not payable with D2950
  • D3310, D3320 and D3330, restricted to 6 and older, reimbursement for a root canal includes all appointments necessary to complete the treatment
  • D2933 and D2934 are benefits for anterior primary teeth only, TID C- H and M R
  • Direct restoration of a primary tooth with the use of a prefabricated crown is a once in a lifetime restoration, same TID, any provider. Exceptions may be considered when pre-treatment X-ray images, intra-oral photos, and narrative documentation clearly support the medical necessity for the replacement of the prefabricated crown – D2930, D2933, D2934.

Perinatal Dental Visit History

Document a medical and dental history at the initial dental visit. Update a history and reason for the visit at each visit. Dental history must include:

  • history of the present problem,
  • relevant past medical history, including reproductive history and pregnancy status,
  • allergies, sensitivities or reactions to medicines or other substances,
  • current medications, prescriptions, over the counter and complementary and alternative medicines,
  • use of tobacco and alcohol, including type, duration, frequency and route, and
  • screening and reporting, if indicated, for abuse and neglect per Texas Family Code, Chapter 261.

Perinatal Dental Examination

All dental visits must include an oral examination. Initial and return dental visit must include:

  • limited head and neck examination for the initial visit and as indicated for return visits,
  • blood pressure and pulse as indicated,
  • radiographs and photographs as indicated,
  • prescription(s), if indicated,
  • treatment plan of care, and
  • procedure(s) and treatment provided.

Perinatal Dental Education and Counseling

Dental education and counseling are provided by dentists or dental hygienists as it relates to prevention of dental disease and achieving oral health. Education should include:

  • oral hygiene instruction;
  • healthier eating and drinking habits to reduce the risk of tooth decay;
  • safety of dental treatment while pregnant;
  • impact of the mother’s oral health on the pregnancy and infant;
  • oral hygiene for infants and children; and
  • individualized education based on history, exam, procedures, or risks.

Resource

5400 Child and Adolescent Clinical Guidelines

Revision 26-2; Effective Sept. 1, 2026

Child and Adolescent Services

Provide services based on recommendations of the American Academy of Pediatrics (AAP), Texas Health Steps Checkup Components (PDF) and the Texas Health Steps Periodicity Schedule. An annual, comprehensive Well Child visit must include a health history and risk assessment, comprehensive physical exam, age-appropriate immunizations, age-appropriate laboratory tests, and health education and counseling. 

Review the MRP for reimbursable procedure codes. Grantees may not bill for a Texas Health Steps medical checkup until all required components are completed. Only one visit may be billed per day, per client. If a client returns on a different day to complete required components of a Texas Health Steps exam, an additional visit may not be charged.

Well Child and Adolescent History and Risk Assessment

A health history and risk assessment for all clients must include:

  • reason for visit,
  • current health status, including any changes in personal health history,
  • current medications, including prescription, over-the-counter, and complementary and alternative medicines,
  • allergies, sensitivities or reactions to medicines or other substance(s),
  • exposure to or use of tobacco, alcohol and drugs; including type, duration, frequency and route,
  • review of systems,
  • assessment for family violence including a safety assessment when indicated,
  • reproductive health history, when appropriate, must include:
    • menstrual history, including last normal menstrual period,
    • sexual behavior history, including:
      • family planning practices,
      • sexual abuse,
    • gynecological and urologic conditions,
    • STIs and HIV risks and exposure, and
    • cervical cancer screening beginning at 21 years. 

Additionally, a new client health history must be obtained and retained in the medical record for reference at future checkups and does not need to be repeated at subsequent checkups. It must include the following:

  • If client is younger than five years old, include a history related to pregnancy, delivery and neonatal conditions
  • Family medical history
  • Personal medical history

Well Child and Adolescent Physical Examination

For well child and adolescent annual visits, a complete physical exam is required. A comprehensive, unclothed physical exam also includes all the components listed below. For any portion of the exam that is deferred, document the reason(s) for deferral.

Measurements and percentiles, as appropriate, should document:

  • length, height and weight measurements,
  • growth chart percentiles,
  • frontal-occipital head circumference for 2 years and younger,
  • body mass index (BMI) beginning at 2 years, and
  • blood pressure beginning at 3 years.

Well Child and Adolescent Screenings

For well child and adolescent annual visits, all appropriate Texas Health Steps Periodicity Schedule screenings must be completed. 

  • Complete developmental screening at checkups from birth through 6 years. Providers should follow the Texas Health Steps Periodicity Schedule (PDF) and must use one of the following validated, standardized tools at Developmental and Autism Screening Tools.
  • Conduct mental health screening at each well-child checkup and when appropriate Providers should follow the Texas Health Steps Periodicity Schedule (PDF) and must use one of the following validated, standardized Mental Health Screening Tools.
  • Perform screening for maternal postpartum depression at infant checkups up to 12 months. Find screening tools in The Texas Clinician’s Postpartum Depression Toolkit (PDF). 
  • Sensory screening should include vision acuity and audiometric hearing screening at various ages following the Texas Health Steps Periodicity Schedule. Documents of test results from a school vision or hearing screening program may replace the required screening if conducted within 12 months of the checkup.
  • Documents of test results from a school vision or hearing screening program may replace the required screening if conducted within 12 months of the checkup.
  • Limited oral screening for caries and general health of the teeth and oral mucosa is part of the physical examination. Refer to a dentist at six months and every six months after.
  • Nutritional screening must be performed at every well-child visit.
  • Risk screening, including family violence, lead, tuberculosis and adolescent lifestyle.

Well Child and Adolescent Immunizations

For well-child and adolescent annual visits, all appropriate American Academy of Pediatrics (AAP) recommended immunizations must be offered. 

  • Screen for and administer immunizations according to AAP Guidelines. 
  • HHSC recommends TVFFS grantees enroll as a Texas Vaccines for Children (TVFC) provider. Providers may obtain vaccines free of charge from the Texas Vaccines for Children (TVFC) Program for TVFFS clients, ages birth through 18 years. Providers must not charge the client or TVFFS program for these vaccines, but vaccine administration may be billed.

Well Child and Adolescent Laboratory Tests

For well-child and adolescent annual visits, all appropriate Texas Health Steps Periodicity Schedule laboratory tests must be completed. 

  • Well child and adolescent visits must include appropriate laboratory testing as required on  the Texas Health Steps Periodicity Schedule and identified risk factors. Review TVFFS MRP for billable lab tests.
  • Grantees can submit all TVFFS laboratory testing to the laboratory of their choice, with the exception of Newborn Screening (NBS) Tests. NBS Tests must be submitted to the Texas Department of State Health Services (DSHS) laboratory.
  • Grantees and subrecipients must have a DSHS laboratory submitter number to submit specimens to the laboratory.
  • Laboratory results completed within the past month are acceptable for use for children 2 years and younger and up to 90 days for those 3 years and older.
  • Grantees must have a process to notify clients of results and ensures confidentiality and timely, appropriate follow-up.

Well Child and Adolescent Education and Counseling

  • Health education and counseling must be provided at each checkup, and documentation must include a recommended return visit date. 
  • Education and counseling should be based on health history, risk assessment, physical exam, and must cover the following:
    • age-appropriate anticipatory guidance including injury prevention, behavior, health promotion and nutrition.
    • child development.
    • immunizations.
    • when and where to get emergency care.
    • risk factors identified during the visit.
    • referral to WIC, if applicable.
    • information on parenting and postpartum counseling, if applicable, as mandated by Health and Safety Code, Chapter 161, Subchapter T, Section 161.501.
    • other education and counseling, if applicable. 

Office Visits

In addition to well-child visits, office visits are available for reasons such as illness, follow-up care, sports physicals, or acute and chronic management. Office visits must include the reason for visit, problem-focused history, medication and allergy review, limited physical exam and appropriate lab tests, if indicated by condition, and recommended return visit date.

Resources

5410 Child and Adolescent Dental Services

Revision 26-2; Effective Sept. 1, 2026

Providers must follow rules and regulations established by the Dental Practice Act, provided to children from birth through 21 years. These include:

  • diagnostic services including comprehensive and periodic oral evaluations and radiographs,
  • preventive services including fluoride treatment and placement of dental sealants to any tooth at risk of dental decay, and
  • therapeutic services including restorative treatment.

Review the MRP for reimbursable procedure codes.

For children younger than 6 months, medically necessary dental services may be provided because of oral trauma, early childhood caries or both.

Procedure Code Limitations

Space maintainers are designed to prevent tooth movement. They may help in the following situations:

  • After premature loss of a deciduous primary first or second molar(s), TID: A, B, I and J, for clients who are 1 through 12 years old using procedure codes D1510 and D1516.
  • After premature loss of a deciduous primary first or second molar(s), TID: K, L, S and T, for clients who are 1 through 12 years old using procedure codes D1510 and D1517.

The following procedure codes have age restrictions and limitations:

  • D2950 is not allowed on primary teeth. Is restricted to 4 and older.
  • D2952 is not allowed on primary teeth. Is restricted to 13 and older and is not payable with D2950.
  • D3310, D3320 and D3330 are restricted to 6 and older. Reimbursement for a root canal includes all appointments necessary to complete the treatment.
  • D2933 and D2934 are benefits for anterior primary teeth only – TID C-H, M-R.
  • Direct restoration of a primary tooth with a prefabricated crown is a once in a lifetime restoration, same TID, any provider. Exceptions may be considered when pre-treatment X-ray images, intra-oral photos and narrative documentation clearly support the medical necessity for the replacement of the prefabricated crown – D2930, D2933, D2934.

Child and Adolescent Dental History

Document pertinent medical and dental history at the first dental visit. Reason for the visit must be updated at each visit. Dental history must include:

  • history of the present problem,
  • relevant past medical history, including pregnancy status, as applicable,
  • allergies, sensitivities or reactions to medicines or other substances,
  • current medications, prescriptions and over the counter, complementary and alternative medicines,
  • use of tobacco and alcohol including type, duration, frequency and route, and
  • screening for abuse and neglect – and reporting, if indicated as mandated by Texas Family Code, Chapter 261.

Child and Adolescent Dental Exam

All dental visits must include an oral exam. The initial or return dental visit must include:

  • limited head and neck exam for the initial visit and as indicated for return visits,
  • blood pressure and pulse, as indicated,
  • radiographs and photographs, as indicated,
  • prescription(s), if indicated,
  • treatment plan of care, and
  • procedure(s) and treatment provided.

Child and Adolescent Dental Education and Counseling

Dental education and counseling is provided by dentists or dental hygienists for the prevention of dental disease and achieving oral health. Education should include: 

  • oral hygiene instruction,
  • healthier eating and drinking habits to reduce the risk of tooth decay, and
  • individual education based on history, exam, procedures or risks.

Resources

5500 Requirements for Advanced Practice Providers

Revision 26-2; Effective Sept. 1, 2026

Grantees that employ advanced practice providers must maintain prescriptive authority agreements and delegation protocols for each advanced practice provider.

Prescriptive Authority Agreements for Advanced Practice Providers 

The grantee must make sure 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 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 include: 

  • 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 that may not be prescribed;
  • provide a general plan to address consultation and referral;
  • provide a plan to address 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 to document the implementation of the plan that include:
    • chart review, with the number of charts to be reviewed determined by the physician and APRN or PA; and
    • periodic meetings between the APRN or PA and the physician.

 

References

Delegation Protocol for APPs

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 prescriptive authority agreement.

References

5600 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). Standing orders authorize an RN, LVN or other health professional to implement specific orders for a patient with or developing a condition or symptoms. 

General standards for standing delegation orders, standing medical orders and protocols require:

  • development and approval by the delegating physician or 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 be followed,
  • a notation of the level of supervision required, unless specified by other law,
  • plans to address patient emergencies,
  • annual review signed by the delegating physician, and
  • maintenance at the facility or practice site.

References

5700 Dental Delegation

Revision 26-2; Effective Sept. 1, 2026

Grantees must abide by delegation rules set forth by the Dental Practice Act and Texas State Board of Dental Examiners Rules. A licensed dentist may delegate verbally or in writing a service, task or procedure to a dental hygienist under the supervision and responsibility of the dentist, per the Dental Practice Act. A dentist is not required to be on the premises when the dental hygienist performs a delegated act. A licensed dentist may delegate to a qualified and trained dental assistant acting under the dentist’s general or direct supervision any dental act that is reasonable, and a prudent dentist would find is within the scope of sound dental judgment to delegate specified by the Dental Practice Act. Physical presence does not require the supervising dentist to be in the treatment room when the dental assistant performs the service if the dentist is in the dental office or clinic. A delegating dentist is responsible for a dental act performed by the person the dentist delegates the act.

References

6000, Reimbursement, Data Collection and Reporting

Body

Revision 26-2; Effective Sept. 1, 2026

This section provides policy requirements for: 

  • Submitting for reimbursement
  • Data collection
  • Required reports

Grantee must have written policies and procedures in compliance with state and federal guidelines to address financial management systems and secure data storage.

Submission of the Monthly Invoice and Monthly Reporting Packet

The reimbursement officer sends the Monthly Reporting Packet (MRP) for both programs by email at the start of each state fiscal year. Each MRP submission should only include services provided in the preceding month as applicable to the grant. Late or absent submissions can impact HHSC midyear utilization determination, which is decided during the second quarter of the state fiscal year. The September MRP for both programs must be submitted and reimbursed by Dec. 1. Submissions that do not meet the above requirement will not be processed.

Send monthly submissions to HDS.ADS@hhs.texas.gov. They are due within 30 business days after the end of the preceding service month. Billing or reporting forms may not be altered in any manner.

Grantees need to:

  • complete the date and contact information on the Monthly Reimbursement Request (MRR),
  • supply supporting documents – billing strip,
  • complete the service quantities on the 185 and 186 tabs, and
  • complete demographic data and unduplicated number of clients on the Monthly Activity tab.

Appropriate Supporting Documentation

Grantees must maintain a monthly billing log, also known as billing strips, either automated or manual, to support their MRP submissions. The log should contain a unique client number, client’s age at time of service, date of service and procedure code for each service billed.

Reconciling Discrepancies on Previously Submitted MRP

Incorrect or missing information that requires clarification or follow-up by HHSC staff may delay payment. A response is required within five business days of the initial outreach to the grantee. Discrepancies can occur that result in a grantee receiving payment for services not billed appropriately during a service month. This can be corrected by subtracting the amount from the next month, adjusting all information.

If an MRP requires a correction, grantees should resubmit a corrected MRP with supporting documents as a new email submission to HDS.ADS@hhs.texas.gov.

Grantees must maintain records that document the necessary information for services provided and billed for reimbursement.

Supplemental Invoices

Instances can occur that result in missed reporting of a prior month’s services that have not yet been billed to TVFFS. Any services performed before the current service month must be submitted as a supplemental invoice, with a separate invoice for each service month applicable. Use your MRP to submit the supplemental invoice to HDS.ADS@hhs.texas.gov. Include supplemental in the subject line. 

Submission and Reporting After Entire Contract Award is Expended

Grantees must continue to submit the MRP even after the contract award has been expended. Grantees bill for allowable services provided to eligible clients and will receive reimbursement up to their grant award amount. Once all award funds have been expended, no other funds will be available for reimbursement. Grantees who have exhausted their awarded funds must continue to serve their existing clients.

An MRP must be submitted even if the requested reimbursement amount is zero. Any cost over the contract award after deducting program income should be reflected under Non-HHSC Funding. This submission must continue reporting expenditures on any program income collected monthly and to provide HHSC with statistical information about the use of services.

Submission of Final Invoice and MRP

Grantees may have claims after the submission of their August billing. Added services must be submitted within 45 calendar days after the end of the contract term. Mark this as final. Submit the final invoice and MRP before this date if the 45-day deadline falls on a weekend. Reimbursement requests submitted over 45 days after the contract term end will not be paid.

Submission of Financial Reconciliation Report

The Financial Reconciliation Report (FRR) must include all reimbursements and adjustments in payment for the contract term. The FRR must be submitted to HDS.ADS@hhs.texas.gov 60 calendar days from the end of the contract year, which is Oct. 31.

Appendix I, Definition of Income

Body

Revision 23-2; Effective Sept. 8, 2023

Definition of Income

Types of IncomeCountableExempt
Adoption Payments X
Cash Gifts and Contributions*X 
Child Support Payments*X 
Child's Earned Income X
Crime Victim's Compensation* X
Disability Insurance BenefitsX 
Dividends, Interest and Royalties*X 
Educational Assistance X
Energy Assistance X
Foster Care Payment X
In-Kind Income X
Job Training X
Loans (Noneducational)*X 
Lump-Sum Payments*XX
Military Pay*X 
Mineral Rights*X 
Pensions and Annuities*X 
ReimbursementsX 
Retirement, Survivors and Disability(RSDI)/Social Security Payments*X 
Self-Employment Income*X 
Social Security Disability Income (SSDI)X 
Supplemental Security Income (SSI) Payments X
Temporary Assistance for Needy Families (TANF) X
Unemployment Compensation*X 
Veterans Affairs (VA)*XX
Wages and Salaries, Commissions*X 
Workers’ Compensation*X 

*Explanation of countable income provided below.

Cash Gifts and Contributions – Count unless they are made by a private, nonprofit organization based on need and total $300 or less per household in a federal fiscal quarter. The federal fiscal quarters are January through March, April through June, July through September and October through December. If these contributions exceed $300 in a quarter, count the excess amount as income in the month received.

Exempt any cash contribution for common household expenses, such as food, rent, utilities and items for home maintenance if it is received from a noncertified household member who:

  • lives in the home with the certified household member; 
  • shares household expenses with the certified household member; and
  • no landlord or tenant relationship exists.

Child Support Payments – Count as income after deducting $75 from the total monthly child support payments the household receives.

Disability Insurance Payments/SSDI – Countable. SSDI is a payroll tax-funded, federal insurance program of the Social Security Administration.

Dividends, Interest and Royalties – Countable. Exception: Exempt dividends from insurance policies as income. Count royalties, minus any amount deducted for production expenses and severance taxes.

In-Kind Income – Exempt. An in-kind contribution is any gain or benefit to a person that is not in the form of money or check payable directly to the household, such as clothing, public housing or food.

Loans (Noneducational) – Count as income unless there is an understanding that the money will be repaid, and the person can reasonably explain how they will repay it.

Lump-Sum Payments – Count as income in the month received if the person receives it or expects to receive it more often than once a year. Exempt lump sums received once a year or less, unless specifically listed as income.

Military Pay – Count military pay and allowances for housing, food, base pay and flight pay, minus pay withheld to fund education under the G.I. Bill.

Mineral Rights – Countable. A payment received from the excavation of minerals, such as oil, natural gas, coal, gold, copper, iron, limestone, gypsum, sand, gravel, etc.

Pensions and Annuities – Countable. A pension is any benefit derived from former employment, such as retirement benefits or disability pensions.

Reimbursements – Countable, minus the actual expenses. Exempt a reimbursement for future expenses only if the household plans to use it as intended.

RSDI/Social Security Payments – Count the RSDI benefit amount, including the deduction for the Medicare premium, minus any amount that is being recouped for a prior RSDI overpayment.

Self-Employment Income – Count the total gross earned, minus the allowable costs of producing the self-employment income.

SSI Payments – Exempt SSI benefits.

Terminated Employment – Count terminated income in the month received. Use actual income and do not use conversion factors if terminated income is less than a full month’s income. Income is terminated if it will not be received in the next usual payment cycle.

Unemployment Compensation Payments – Count the gross benefit less any amount being recouped for an Unemployment Insurance Benefit (UIB) overpayment.
 
VA Payments – Count the gross VA payment, minus any amount being recouped for a VA overpayment. Exempt VA special needs payments, such as annual clothing allowances or monthly payments for an attendant for disabled veterans.

Wages, Salaries, Tips and Commissions – Count the actual (not taxable) gross amount.

Workers’ Compensation – Count the gross payment, minus any amount being recouped for a prior workers’ compensation overpayment or paid for attorney’s fees. Note: Texas Workforce Commission (TWC) or a court sets the amount of the attorney’s fee to be paid. 

26-2, Miscellaneous Revisions

Body

Revision 26-2; Effective Sept. 1, 2026

SectionTitleChange
1000Contact Information and PurposeUpdates title to Program Contact Information and Purpose of Manual.
1100Contact InformationUpdates title to Program Contact Information. 
1200Purpose of the ManualUpdates language.
2000Program Authorization, Services and DefinitionsUpdates title to Program Authorization, Services and Definitions.
2100Program Authorization and ServicesUpdates language and links. 
2200DefinitionsUpdates language. Adds definitions for AEST, Applicant and Service Member. Removes Diagnosis and Treatment, Provider and Recertification.  
3000Administrative PolicyUpdates language. 
3100AccessibilityUpdates language. Updates instructions for Maintaining Clinic Information on 2-1-1. 
3110Client AccessAdds new section number. Updates language. 
3200Abuse and Neglect ReportingUpdates language. 
3210Child Abuse and Neglect Reporting, Compliance, and MonitoringAdds new section number. Updates language. Updates mandatory reporting timeframe from 48 hours to 24 hours. 
3220Human TraffickingAdds new section number. Updates language and links. Removes the use of screening tool. 
3230Domestic and Intimate Partner ViolenceAdds new section number. Updates language and links. 
3300ConfidentialityUpdates language and links. 
3310Civil RightsRemoves section.
3310Minors and ConfidentialityAdds new section number. Updates language. 
3320Required SignageRemoves section.
3320Civil RightsAdds section. Updates language. Adds Grant Terms and Conditions. Adds Limited English Proficiency – LEP requirements.
3330Complaints and Termination of ServicesRemoves section. 
3330Required SignageAdds section. Updates links.
3340Research, Human SubjectsRemoves section.
3340Termination of ServicesAdds section. Updates language.
3350Resolution of ComplaintsAdds new section number. Updates language.
3360Research, Human Subjects ClearanceMoves section to 3360. Updates language.
3400Records ManagementUpdates title to Client Records Management. Updates language and links. 
3500Personnel Policies and ProceduresUpdates language. 
3600Facilities and EquipmentUpdates language. 
3610Hazardous Materials and WasteAdds new section number.
3620Fire SafetyAdds new section number. Updates language. 
3630Medical EquipmentAdds new section number. Updates language. 
3640Radiology Equipment and StandardsAdds new section number. Updates language and links. 
3650Laboratory StandardsAdds new section number. Updates language.
3660Smoking and Vaping BanAdds new section number. Updates language. 
3700Emergency ResponsivenessUpdates language.
3710Emergency PreparednessAdds new section.
3800Quality ManagementUpdates language. 
3810QM CommitteeAdds section number. Updates language. 
3820Comprehensive Quality Work PlanAdds new section number.
3830Quality Assurance ActivitiesAdds new section number.
3840Subrecipient Quality and ComplianceAdds new section number.
3900Fiscal Policies and RequirementsRemoves section. 
4000Eligibility and FeesUpdates language. 
4100Eligibility and Assessment of Co-pay and FeesUpdates language.
4200Client Eligibility Screening ProcessAdds new section number. Updates language. 
4300Procedures and Terminology When Determining TVFFS EligibilityAdds new section number. Updates language and links. 
5000Clinical GuidelinesUpdates language.
5100General ConsentUpdates language and links.
5200Clinical PolicyUpdates language and links.
5300Perinatal Clinical GuidelinesUpdates language and links. Adds links. 
5310State-Mandated Education.Updates language and links. 
5320Initial Prenatal Visit RequirementsUpdates language and links. 
5330Return Prenatal Visits RequirementsUpdates language. 
5340Postpartum Visits RequirementsUpdates language. 
5350Perinatal Dental ServicesUpdates language. 
5400Child and Adolescent Clinical GuidelinesUpdates language and links. 
5410Child and Adolescent Dental ServicesUpdates language.
5500Prescriptive Authority Agreements, Clinical Protocols and Standing Delegation OrdersUpdates title to Requirements for Advanced Practice Providers. Updates language and links. 
5600Standing Delegation OrdersUpdates title to Standing Orders. Updates language and links. 
5700Dental DelegationAdds new section number. Updates language and links. 
6000Reimbursement, Data Collection and ReportingUpdates language.
6100Reimbursement, Data Collection and ReportsRemoves section. 

26-1, Updates Appendix II

Body

Revision 26-1; Effective March 1, 2026

SectionTitleChange
Appendix IIOptional Co-Pay Table Based on Monthly Federal Poverty Level (FPL)Updates Optional Co-Pay Table Based on Monthly Federal Poverty Level (FPL).

25-4, Update

Body

Revision 25-4; Effective Dec. 15, 2025

SectionTitleChange
3200Abuse and Neglect ReportingUpdates the mandatory reporting requirements. 

25-3, Miscellaneous Revisions

Body

Revision 25-3; Effective Sept. 1, 2025

SectionTitleChange
1100Grant InformationUpdates mailing address and website link.
1200Purpose of ManualUpdates purpose statement.
2200DefinitionsAdds new and updates definitions.
3100AccessibilityUpdates language and links.
3200Abuse and Neglect ReportingUpdates language and links. Adds more resources related to human trafficking.
3300ConfidentialityUpdates language and links. Adds resources related to confidentiality and required postings.
3310Civil RightsUpdates language.
3320Required SignageUpdates language and links. Adds guidance for human trafficking signage.
3330Complaints and Termination of ServicesUpdates language.
3340Research, Human Subjects ClearanceUpdates language.
3400Records ManagementUpdates section title and language.
3500Personnel Policies and ProceduresAdds new guidance related to personnel qualifications and participation in mandatory HHSC trainings.
3600Facilities and EquipmentAdds new guidance about medication and medical supply storage. Updates links.
3700Emergency ResponsivenessUpdates language and links.
3800Quality ManagementUpdates language.
3900Fiscal Policies and RequirementsAdds new section about financial management systems.
4100Eligibility and Assessment of Co-pay and FeesUpdates language throughout to clarify and adds new links. Simplifies guidance about household and family composition. Adds new instruction on calculation of Federal Poverty Limits (FPLs). Adds new limits on presumptive eligibility periods.
5100General ConsentUpdates language and links.
5200Clinical PolicyUpdates language and links.
5300Perinatal Clinical GuidelinesUpdates screening requirements for anxiety, depression and substance use disorders.
5310Initial Prenatal Visit RequirementsChanges section title to State-Mandated Education and adds new content.
5320Initial Prenatal Visit RequirementsPreviously section 5310.
5330Return Prenatal Visits RequirementsPreviously section 5320.
5340Postpartum Visits RequirementsPreviously section 5330.
5350Perinatal Dental ServicesPreviously section 5340.
5400Child and Adolescent Clinical GuidelinesUpdates language and links. Provides new resources for clinical guidance.
5410Child and Adolescent Dental ServicesUpdates language.
5500Prescriptive Authority Agreements, Clinical Protocols and Standing Delegation OrdersUpdates language to align with statute. Corrects links.