25.2.3.2 Newborn ServicesEligibility Process A child is deemed eligible for the Texas Medicaid Program for up to 12 months of age if the mother is receiving Medicaid at the time of the child's birth, the child continues to live with the mother, and the mother continues to be eligible for Medicaid or would be eligible for Medicaid if she were pregnant. Therefore, it is not acceptable for a hospital to require a deposit for newborn care from a Medicaid client. The child's eligibility ends if the mother relinquishes her parental rights or if it is determined that the child is no longer part of the mother's household. Hospitals should complete the HHSC Form 7484, "Hospital Report (Newborn Child or Children) HHSC Form 7484", to provide information about each child born to a mother eligible for Medicaid. If the newborn's name is known, the name must be on the form. The use of Baby Boy or Baby Girl delays the assignment of a number. Filing this form will expedite the assignment of a Medicaid client number for the newborn child. The form should not be completed for stillbirths. The form should be completed by the hospital within five days of the child's birth and should be sent to HHSC at the address identified on the form. The five-day time frame is not mandatory; however, prompt submission expedites the process of determining the child's eligibility. Hospitals should duplicate the form as needed. HHSC, DADS, and TMHP do not supply the forms. Note: Providers may call the HHSC Bureau of Vital Statistics at 1-800-452-9115 for details on how to transmit newborn information electronically. After receiving a completed form, HHSC verifies the mother's eligibility and within 10 days sends notices to the hospital, mother, caseworker, and attending physician if identified. The notice includes the child's Medicaid client number and the effective date of coverage. After the child has been added to the eligibility file, HHSC issues a Medicaid Identification Form (Form H3087). Providers should submit address changes to the following address:
Texas Medicaid & Healthcare Partnership The attending physician's notification letter is sent to the address on file by license number at the Texas Medical Board. It is imperative the address be kept current to ensure timely notification of attending physicians. Physicians should submit address changes to the following address:
Texas Medical Board Claims submitted for services provided to a newborn child eligible for Medicaid are filed using the newborn child's Medicaid client number. Note: When billing for a Medicaid Managed Care client, providers must adhere to the Medicaid Managed Care health plans' guidelines for newborn billing. Screening A newborn hearing screening must be offered to all newborns as part of their newborn hospital stay. This screening procedure is not diagnostic and will not reimburse separately from the usual newborn delivery payment. Special investigations and examination codes are not appropriate for use with hearing screening of infants. For more information about newborn hearing screening contact:
Department of State Health Services All newborns who have abnormal screening results should be referred to a local Program for Amplification for Children in Texas (PACT) provider for follow-up care. PACT provides services and hearing aids for children 20 years of age and younger who have permanent hearing loss and are eligible for Medicaid. Obtain a current list of PACT providers at www.dshs.state.tx.us/audio/program.shtm or the following address:
DSHS Refer newborns with suspected genetic disorders or with a positive newborn screening test for a genetic work-up as appropriate. Refer to: "Genetic Services" . Hepatitis B Immunizations Newborns should be given the first dose of hepatitis B vaccine before discharge from the hospital or birthing center. Hepatitis B vaccine for newborns is provided by the Texas Vaccines for Children (TVFC) Program. Hospitals and birthing centers may obtain vaccine at no cost by enrolling in the TVFC Program. For more information on enrolling in the TVFC Program, refer to "Texas Vaccines for Children Program Packet" or call the DSHS Immunization Division toll-free at 1-800-252-9152. The recommended administration of the hepatitis B vaccine to newborns before discharge from the hospital has been established as the standard of care and should not be considered as a reason to upcode to a different DRG. The reimbursement for the administration of hepatitis B vaccine to newborns is included in the DRG payment. The Texas Medicaid Program will not reimburse for the cost of the vaccine for newborns. Providers must enroll in the TVFC Program to obtain vaccine at no cost. Consult the vaccine package insert for information on proper administration and dosing. |
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Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved. |
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