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