Revision 23-2; Effective Sept. 29, 2023

The grantee must ensure clients are provided services in a timely and nondiscriminatory manner. The grantee must adhere to the following guidelines:

• have a policy in place that delineates the timely provision of services;
• provide services to people deemed eligible as soon as possible and no later than 30 days from the initial request;
• maintain reasonable clinic and reception room wait times that do not present a barrier to care;
• comply with all applicable civil rights laws and regulations outlined in 2320, Nondiscrimination;
• have a policy in place that requires qualified staff to assess and prioritize a client’s needs;
• provide referrals for people that cannot be served, or cannot receive a specific service;
• manage funds to ensure established clients continue to receive services throughout the budget year, including after allocated funds are expended;
• inform people of program services and encourage them to bring required documentation to the initial visit for eligibility processing; and
• have policies to identify and eliminate possible barriers to care.

Revision 24-2; Effective Sept. 20, 2024

Grantees must comply with state laws that govern the reporting of suspected abuse and neglect of children, adults with disabilities or people 65 years or older. Grantees and providers must develop policies and procedures that follow the reporting guidelines and requirement in Human Resources Code, Chapter 48 which requires suspected abuse, neglect or exploitation of an elderly person, a person with a disability or a person receiving services from certain home and community-based providers to be reported.

Reporting an Abuse Emergency

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

Reporting a Suspicion of Abuse

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

2210 Human Trafficking

Revision 25-3; Effective Sept. 1, 2025

Grantees must comply with all state and federal anti-trafficking laws, including the Trafficking Victims Protection Act of 2000, Texas Occupations Code Sections 116.002 and 116.003. This requires health practitioners to complete an HHS-Approved Human Trafficking Course for every licensure renewal period.

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

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

• the definition of human trafficking;
• how to identify possible situations of human trafficking;
• the screening tool used 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.

Resources for Human Trafficking Policy Development

• Texas Health and Human Services Human Trafficking Resource Center
• Texas Health and Human Services Health Care Practitioner Training Page
• Human trafficking into and within the United States: A review of the literature on human trafficking in the U.S. for the U.S. Department of Health and Human Services
• Resource Library on the National Human Trafficking website
• Rescue and Restore Campaign by the U.S. Department of Health and Human Services
  • Contains multiple resources for health care providers, social service personnel and law enforcement for identifying and aiding trafficking victims.
  • Includes slide presentations for training purposes.

2220 Domestic and Intimate Partner Violence (IPV)

Revision 25-1; Effective Feb. 4, 2025

Intimate partner violence (IPV) describes physical, sexual or psychological harm by a current or former partner or spouse. Per Texas Human Resources Code, Chapter 51, family violence may also include emotional harm and a threat of harm. IPV can exist regardless of the presence of sexual intimacy.

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

Grantees also must have a written policy about assessment and prevention of domestic and intimate partner violence. The policy must include the provision of annual staff training.

Revision 24-2; Effective Sept. 20, 2024

2310 Confidentiality

Revision 25-3; Effective Sept. 1, 2025

Grantees must comply with the U.S Health Insurance Portability and Accountability Act of 1996 (HIPAA) established standards for privacy protection. The HIPAA Privacy Rule requires grantees 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, and at a minimum, every three years. The notice must be posted in a clear and easy to find location for clients to review. It also must be posted on the organization’s website. More information on health information privacy is on the U.S. Department of Health and Human Services Notice of Privacy Practices website and Notice of Privacy Practices for Protected Health Information website.

Grantees must make sure all employees and volunteers receive training about client confidentiality during orientation and be made aware that violation of the law about confidentiality may result in civil damages and criminal penalties. A health care provider’s staff, paid and unpaid, must be informed during orientation of the importance of keeping client information confidential. All employees, volunteers, subrecipient, board members and advisory board members must sign a confidentiality statement during orientation.

A grantee 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. Clients must be told that confidentiality means information is kept private and not shared without permission. They also must be told about any applicable exceptions such as abuse reporting. Grantees are required to provide clients with a copy of the signed confidentiality policy or agreement and maintain a copy in the client's record. Grantees must not require consent for services from the spouse of a married client.

2320 Nondiscrimination and Limited English Proficiency

Revision 25-3; Effective Sept. 1, 2025

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

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

Contract 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, including policies for serving people with LEP and people with disabilities, and HHSC complaint procedures;
• notify all people who apply for services of the grantee's nondiscrimination policies and complaint procedures; and
• prominently display civil rights posters in common areas, including lobbies and waiting rooms, front reception desks and locations where clients apply for services. Posters are on the Civil Rights Office website.

Direct questions about this section and civil rights matters to the HHSC Civil Rights Office.

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 people with language service needs, including people with LEP and disabilities, aware that the grantee will provide an interpreter free of charge.

2330 Termination of Services

Revision 24-2; Effective Sept. 20, 2024

A grantee 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:

• they are disruptive, unruly, threatening or uncooperative to the extent the client seriously impairs the grantee’s ability to effectively and safely provide services; or
• their behavior jeopardizes their own safety, or the safety of clinic staff or others.

A client has the right to appeal the denial, modification, suspension or termination of services. See 2340, Resolution of Complaints.

Grantees must have a written policy related to termination of services. For more information, see the Fair and Fraud Hearings website.

2340 Resolution of Complaints

Revision 24-2; Effective Sept. 20, 2024

Grantees must make sure clients can express concerns about care received and that those concerns are handled in a consistent manner. A grantee’s policy must explain the process to follow if the client is not satisfied with the care received. This process must include:

1. Grantees must investigate and resolve a concern within 30 business days after the grantee receives the concern.
2. Clients may contact a grantee’s clinic to see if the clinic can explain the decision or correct the problem.
3. If a client remains unsatisfied with how the concern was handled, grantee may encourage the client to send an email to BCCSProgam@hhs.texas.gov.
4. Grantees must provide the client with contact information to the HHS Office of the Ombudsman.
5. All concerns must be documented in the client’s record.

2350 Reserved for Future Use

Revision 24-2; Effective Sept. 20, 2024

2360 Freedom of Choice

Revision 22-0; Effective August 15, 2022

Clients have the right to choose health care providers, without coercion or intimidation. Acceptance of health care services does not preclude eligibility for, or receipt of, any other service or assistance.

2370 Research (Human Subject Clearance)

Revision 23-2; Effective Sept. 29, 2023

To participate in proposed research that would involve the use of BCCS clients as subjects, the use of BCCS clients’ records or any data collected from BCCS clients, BCCS 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 Home.

The grantee must have a policy in place that indicates that prior approval will be obtained from HHSC before instituting any research activities. The grantee must also ensure that all staff are made aware of this policy through staff training. Documentation of training on this topic must be maintained. Federal BCCS funds may not be used for research.

Revision 24-2; Effective Sept. 20, 2024

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

Consent information must be effectively communicated to every client in an understandable manner. This communication must allow the client to participate, make sound decisions about their own medical care, and address any disabilities that impair communication in compliance with LEP regulations. Only the client who receives services may give consent. When the client is legally unable to consent, a parent, in the case of an unemancipated minor, or court-appointed legal guardian must consent on the client’s behalf. Consent must never be obtained in a manner that could be perceived as coercive.

Also, as described below, the grantee must obtain informed consent of the client for procedures per the Texas Medical Disclosure Panel.

Clients who enter BCCS for services must also sign consent that authorizes the grantee to enter or view client protected health information in the statewide Med-IT® database. If this statement is not included in the general consent, an additional consent must be developed for the client to sign and included with the general consent in the client health record.

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

2410 Texas Medical Disclosure Panel Consent

Revision 24-2; Effective Sept. 20, 2024

Grantees must obtain the client’s informed consent for procedures per the Texas Medical Disclosure Panel (TMDP). The Texas Legislature established TMDP to:

• determine which risks and hazards related to medical care and surgical procedures health care providers or physicians must disclose to their clients or people authorized to consent for their clients; and
• establish the general form and substance of such disclosure. TMDP developed a list of procedures that require full and specific disclosure, List A, for certain procedures. More information is on the TMDP webpage and in the Civil Practice and Remedies Code, Chapter 74.102.

For all other procedures not on List A, the physician must disclose through a procedure-specific consent all risks that a reasonable client would want to know. This includes all risks that:

• are inherent to the procedure, one which exists in and is inseparable from the procedure itself, and
• could influence a reasonable person’s decision to consent to the procedure.

Revision 25-3; Effective Sept. 1, 2025

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

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

The client’s written consent is required to release personally identifiable information, except as may be necessary to provide services to the client or as required by law, with appropriate safeguards for confidentiality. HIV information must be handled per law. Refer to the DSHS HIV/STD Program Laws, Rules, and Authorization webpage for more information.

When information is requested, grantees should release only the specific information requested. Information collected for reporting purposes may be disclosed only in summary, statistical or other form that does not identify clients. Providers must give clients transferring to other providers, upon request, 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, Section 354.1003. Requirements for medical record maintenance are in TAC Title 22, Part 9, Chapter 163. Grantees must follow contract provisions, maintain medical records for at least seven years after the contract closes, and follow the retention standards of the appropriate licensing entity. All records about services must be accessible for examination at any reasonable time to HHSC representatives and as required by law.

2510 Personnel Policy and Procedures

Revision 25-3; Effective Sept. 1, 2025

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

• job descriptions;
• a written orientation plan for new staff to include skills evaluation and competencies appropriate for the position; and
• a performance evaluation process for all staff.

Job descriptions, including those for contracted personnel, must specify required qualifications and licensure. All staff must be appropriately identified with a name badge.

Grantees must designate:

• one (1) Medicaid for Breast and Cervical Cancer (MBCC) point-of-contact with responsibilities to provide training and technical help to staff helping with and submitting MBCC applications; and
• one (1) Evidence-Based Intervention (EBI) point-of-contact with responsibilities to oversee and support HHSC BCCS-sponsored and clinic-level EBI projects. The EBI contact is responsible for providing training and technical assistance to staff implementing EBI projects. The EBI contact, or a designee, is required to attend EBI-specific meetings and webinars.

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

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

Grantees must establish, annually review, and train staff on BCCS program requirements and policies, including any updates to the Program Policy Manual and required forms that occur during the Grant Term.

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

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

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

Whether positions are funded under this grant or not, grantees must notify HHSC in writing, within 30 calendar days of any change in:

• any grant-funded positions;
• Chief Executive Officer (CEO), Chief Financial Officer (CFO), program director or program manager;
• MBCC point-of-contact; and
• EBI point-of-contact.

Grantees must ensure that at least one representative with capabilities and responsibility to disseminate information to program administrative and clinic staff:

• attends a minimum of two priority technical assistance webinars offered by HHSC during the fiscal year. These specific webinars are identified as mandatory or priority in HHSC’s electronic mail. To receive credit for participating, attendees must follow HHSC’s directions including completion of any sign-in sheet, registration, or survey within the specified time frame; and
• has access to the HHSC’s web-based applications on the SharePoint site. The grantee must sign and submit a Family Clinical Services Extranet and Data Upload Security Agreement form for each grantee staff person accessing HHSC’s SharePoint site. Grantees must ensure users of HHSC’s SharePoint site have an Outlook or Microsoft Office 365 account.

Revision 24-2; Effective Sept. 20, 2024

2610 Facilities and Equipment

Revision 25-3; Effective Sept. 1, 2025

Grantees must:

• Maintain a safe environment and have appropriate exterior signage to identify funded entity as a health care facility.
• Provide clean and well-maintained facilities where services can be delivered with space for exam rooms, client intake, waiting areas and space for clinical and administrative staff.
• Have written policies and procedures that address the handling of hazardous materials, fire safety and medical equipment.

Hazardous Materials

Grantees must have written policies and procedures that address:

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

Fire Safety

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

Medical Equipment

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

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

Radiology Equipment and Standards

All facilities that provide radiology services must:

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

Refer to the Texas Department of State Health Services, Radiation Control Program for information on X-ray machine registration.

Smoking and Vaping Ban

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

Disaster Response Plan

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

Refer to the Help for Employers | OSHA.gov | Occupational Safety and Health Administration for more resources on facilities and equipment.

Clinical 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, emergencies that require ambulance services and hospital admission.
• have staff trained in basic cardiopulmonary resuscitation (CPR) and emergency medical action. Staff trained in CPR must be present at all hours of clinic operations.
• maintain emergency resuscitative drugs, supplies and equipment appropriate to the services provided at that site and appropriately trained staff when clients are present.
• maintain documents in personnel files that confirm staff are trained in the written plans or protocols.

Suicide Prevention

Grantees must display signage related to suicide prevention, including the 988 Suicide and Crisis Lifeline. This signage must be displayed in areas where clients and the public can easily refer to them, such as lobbies, waiting rooms, front reception desks and locations where people apply for and receive services.

Examples of a suitable flyers are on the Substance Abuse and Mental Health Services Administration (SAMHSA) website at:

• 988 Suicide & Crisis Lifeline Poster (English)
• 988 Suicide & Crisis Lifeline Poster (Spanish)
• Suicide Warning Signs for Youth Poster
• Texting 988 Poster 1 (Spanish)
• Texting 988 Poster 2 (English)

Additional mental health and suicide prevention resources are available at:

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

Revision 24-2; Effective Sept. 20, 2024

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 services. Grantees must be able to meet the management standards per 2 Code of Federal Regulations Part 200.

QA/QI processes are intended to:

• improve screening and diagnostic services;
• link structure and process and include standards, measurement and actions;
• identify and remedy root causes of quality problems;
• meet client needs; and
• focus on high-volume, costly, high-risk or problem-prone aspects of care.

These aims are achieved by assessing performance, making changes based on the assessment and monitoring improvement. Steps to QA/QI include:

• Quality monitoring – The BCCS performance indicators are designed specifically for this purpose and represent aspects of care that align with the purpose of the NBCCEDP.
• Quality assessment – Assessing quality provides organizations with an opportunity to measure performance against standards, such as targets or benchmarks. Quality assessment creates a bridge between monitoring and improvement by establishing a common understanding of the quality of services provided and identifying opportunities for improvement.
• Quality improvement – QI strives to find strategies that will institute a change and continuously improve quality.

A Quality Management (QM) program must be developed and implemented that provides for ongoing evaluation of services. Grantees should have a comprehensive plan for the internal review, measurement and evaluation of services, the analysis of monitoring data, and the development of strategies for improvement and sustainability.

Grantees who subcontract to provide services must also address how quality will be evaluated and how compliance with HHSC policies and basic standards will be assessed with the subrecipients.

The QM Committee, whose membership consists of key leadership of the organization, includes the executive director, chief executive officer or both; the medical director; and other appropriate staff where applicable, annually reviews and approves the quality work plan for the organization.

2710 Quality Management (QM) Committee

Revision 23-2; Effective Sept. 29, 2023

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, minutes of the discussion and actions taken by the QM Committee and a list of the attendees must be maintained.

2720 Comprehensive Quality Work Plan

Revision 22-0; Effective August 15, 2022 

The comprehensive quality work plan, at a minimum, must:

• include clinical and administrative standards by which services will be monitored;
• include a process for credentialing and peer review of clinicians;
• identify those responsible for implementing, monitoring, evaluating and reporting;
• establish timelines for quality monitoring activities;
• identify tools and forms to be used; and
• outline reporting to the QM Committee.

2730 Quality Assurance Activities

Revision 25-3; Effective Sept. 1, 2025

Although each organization’s quality assurance program is unique, the following activities must be undertaken by all agencies providing client services:

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

2740 Subrecipient Quality and Compliance

Revision 25-3; Effective Sept.1, 2025

Grantees who subcontract with subrecipients to provide services must also address how quality is evaluated and how compliance with policies and basic standards is assessed with the subrecipient. This includes at a minimum:

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

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

2750 Clinical Quality Assurance

Revision 25-3; Effective Sept.1, 2025

Ambulatory Surgical Centers

Ambulatory surgical centers providing services must be Centers for Medicare and Medicaid Services (CMS) certified, state-licensed and Joint Commission-accredited, as applicable. Review the HHS Ambulatory Surgical Centers website for more information.

Mammography Quality Assurance

All grantees and subrecipients that provide mammography services must:

• possess a current Certification of Mammography Systems from each mammography unit who must be fully accredited or undergoing accreditation; and
• possess a current mammography facility certificate from the appropriate agency certifying compliance with the U.S. Food and Drug Administration Mammography Quality Standards, at 21 CFR Part 900.

The Mammography Radiation Control Program may be contacted for certification questions and information on inspection results, escalated enforcement or cease and desist status.

Cytology Quality Assurance

Grantees and subrecipients that provide screening and diagnostic cytology services must have current documentation that shows the agency meets all quality assurance standards required by the BCCS program under state and federal laws.

All cytology laboratories that provide services to grantees and subrecipients must:

• possess a current, unrevoked and unsuspended registration certificate issued by the U.S. Department of Health and Human Services per the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88) (42 U.S.C. Section 263a); and
• have a mechanism for expedited notification of Pap tests which are CIN III or greater, such that the clinic is notified by the next business day after the case is signed out.

Human Papillomavirus (HPV) Quality Assurance

Grantees must assure all HPV tests are:

• for high-risk oncogenic types; and
• FDA approved and clinically validated.

Utilization Review

To make sure clients receive high-quality care and funds are expended per program policies, BCCS performs utilization review of billed services. Grantees not in compliance with billing guidelines may be required to refund the BCCS program for services inappropriately billed.

2810 Fee-for-Service Reimbursement

Revision 25-3; Effective Sept.1, 2025

Client data must be entered in Med-IT® no later than 45 days after each service was provided. The fee-for-service component of funding pays for direct medical services on a fee-for-service basis. Each grantee is responsible for determining a person’s eligibility for clinical services. HHSC reimburses grantees on a fee-for-service basis for services that have been provided to eligible clients. Grantees must continue to provide services to established clients and submit claims for client services even after the grant funding limit has been met.

Grantees must file claims electronically through the Med-IT^® system. Those claims must be filed within the following time frames:

• Initial claims submission must be submitted within 45 days of the date of service on the claim. If the 45th day falls on a weekend or holiday, the filing deadline is extended until the next business day.
• All claims must be submitted and processed within 60 days after the end of the grant period.
• All claims must continue to be billed even after the grant funding limit has been met.

Grantees may contact Med-IT® Helpdesk for questions about claims and payment status.

HHSC reviews BCCS services and procedures grantee submits electronically to HHSC for processing.

Reimbursable Codes

Fee-for-service reimbursement is limited to a prescribed set of procedure codes approved by BCCS. The approved list of reimbursable codes is in Med-IT® and referenced in the BCCS Appendix VI, BCCS Billing Guideline. Grantees may email the BCCS Program to request more services be added to the program by requesting a Topic Nomination Form.  

Grantees may submit claims for a person’s office visits that reflect different levels of service for new and established people. A new person is defined as one who has not received clinical services at the grantee’s clinics during the previous three years. The level of services, which determines the procedure code to be billed for that client visit, is indicated by a combination of factors such as the complexity of the problem addressed, and the time spent with the client by clinic providers. The American Medical Association (AMA) publishes materials related to Current Procedural Terminology (CPT) coding that includes guidance on office visit codes (Evaluation and Management Services).

2820 Cost Reimbursement

Revision 25-3; Effective Sept.1, 2025

Cost Reimbursement provides funds to grantees that support the overall outcomes of clients served through BCCS Fee-for-Service. These funds must be used for support services that enhance BCCS Fee-for-Service client service delivery. Cost reimbursement awards must be used for client travel and may also be used for categories listed below per state and federal requirements.

Costs must be reasonable, allowable and already allocated, and may be assessed against any of the following optional categories the grantee identifies during its budget development process:

1. Administrative Personnel
2. Personnel Travel
3. Equipment
4. Supplies
5. Contractual
6. Other allowable direct costs not listed in any previous categories.

Grantees may request reimbursement for costs by submitting a monthly voucher packet for expenses outlined in a categorical budget approved by HHSC, as required for categorical cost reimbursement. Supporting documentation must be submitted with each voucher packet. HHSC will provide grantees with a personalized voucher packet and Financial Status Report (FSR) form at the beginning of each grant year. Grantees must submit the monthly voucher packet and the quarterly FSR to the designated email address on the forms.

• B-13X Form Budget Category monthly expenditures, program income and non-HHSC funding;
• Form 4116, Authorization for Expenditures;
• data management form Required Data Collection; and
• supporting documentation, such as a general ledger, must be submitted monthly with each voucher packet.

Categorical Budget Revisions

HHSC, at its sole discretion, may approve fund transfers between categories within the approved budget workbook upon a grantee’s written request. The request must include a detailed explanation that supports the need for the fund transfer. The grantee must seek HHSC’s written approval before making any fund transfers. Visit the Texas Grant Management Standards (TxGMS), Statewide Procurement Division, Version 2 for more information. Grantees must submit a revised budget to HHSC for review any time a budget revision is made.