3000, Cost Reimbursement Administrative Policies

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Revision 21-0; Effective September 1, 2021

3100 HTW CR Services

Revision 21-0; Effective September 1, 2021

Healthy Texas Women Cost Reimbursement (HTW CR) provides funds to agencies that support the overall outcomes of clients served through HTW fee-for-service (FFS). These funds may be used for support services that enhance HTW FFS client service delivery. Cost reimbursement awards may be used to fund personnel, fringe benefits, staff travel, contractual services, equipment, supplies, other direct costs, and indirect costs per state and federal requirements and must be reasonable, allowable and already allocated. Additional information on what is reimbursable under HTW CR is found in 4130, HTW CR Reimbursement.

3110 HTW CR Patient Navigation Services

Revision 25-2; Effective Sept. 1, 2025

If a grantee is awarded funding for a dedicated HTW CR patient navigator, a policy must be in place to make sure the following services and activities are provided.

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

3200 HTW CR Anticipated Eligibility

Revision 25-2; Effective Sept. 1, 2025

HTW emphasizes the importance of proper family planning and women’s health preventive care. HTW’s goal is to provide women access to women’s health services and not rely on episodic, acute care. To ensure prompt access to such care, HTW CR grantees can receive reimbursement for services provided to clients awaiting approval of an HTW application if said application is ultimately denied.

HTW CR grantees may use a portion of their cost reimbursement funds for this purpose. If a client’s HTW application is ultimately approved, cost reimbursement funds may not be used to support services for that client. Those costs must be billed to the HTW program through Texas Medicaid & Healthcare Partnership (TMHP).

Grantees must screen all HTW applicants for eligibility in the following programs that provide family planning services in this order:

  • Medicaid;
  • HTW;
  • FPP;
  • BCCS;
  • PHC; and
  • Any other system agency-funded health program for which the Grantee holds a grant agreement.

If a grantee believes an applicant should be enrolled in multiple HHSC-funded programs, alert applicable HHSC program mailboxes for further guidance.

HTW CR grantees are expected to have policies in place to verify if a client has been approved for HTW. HTW CR grantees are expected to screen clients using the Prescreening Tool on YourTexasBenefits.com, or the Am I Eligible? tool on the Healthy Texas Women website. Both tools are acceptable methods for screening for HTW eligibility. If a client is anticipated to be eligible for HTW based on that screening, the grantees may request reimbursement from HHSC from their HTW CR contract for services provided within 90 days from the date the client is first seen by the medical provider. The request for reimbursement cannot be submitted until 45 days after the HTW application was submitted to ensure adequate time for HTW application processing and eligibility determination. HTW CR grantees cannot bill for a client’s services based on anticipated eligibility status more than once in a 12-month period. All services provided must follow the HTW guidelines in the TMPPM.

Clients seen on an anticipated eligibility basis should be recorded for reporting purposes on the monthly HTW CR voucher. For more information on vouchers and required reports, refer to 4200, Data Collection and Reporting.

Note: Anticipated eligibility, as used in this manual, is distinct from Medicaid presumptive eligibility. Before federal approval of the 1115 Medicaid waiver, HTW cost reimbursement contracts and policy guidance historically referred to allowability and reimbursement for presumptive eligibility in HTW.