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2.2 Family Planning Overview
TMHP processes family planning claims and encounters for four different funding sources administered through DSHS and the Health and Human Services Commission (HHSC). These funding sources include Titles XIX, V and XX, and X.
Agencies across Texas are awarded contracts for Titles V, X, and XX to provide services to low-income individuals who may not qualify for Texas Medicaid services. These awards are granted through a competitive procurement process. DSHS contracts with a variety of providers, including local health departments, universities, medical schools, private nonprofit agencies, RHCs, and hospital districts.
Some contractors receive more than one type of funding. All contractors serve Texas Medicaid-eligible clients. Client eligibility requirements, reimbursement methodologies, client copayment guidelines, and covered services differ for each funding source. Titles XIX, V and XX, and X funding can not be used for elective abortion services.
• Title XIX funds are available for family planning services provided to Texas Medicaid clients including limited family planning services provided to Women's Health Program (WHP) clients. TMHP processes Title XIX claims and reimburses eligible services on a fee-for-service basis for family planning providers and a prospective payment system basis for FQHC and RHC providers.
•Titles V and XX funds are granted annually by DSHS to contracted family planning providers. TMHP processes Titles V and XX claims and reimburses providers for services to eligible clients according to the individually granted funds.
•Title X encounters do not result in payments to the providers. To receive payment, providers must submit monthly or quarterly Financial Status Reports (FSRs) forms, along with a paper payment voucher, to the DSHS Contract Development and Support Branch and Claims Processing Unit. Title X providers continue to receive reimbursement from the Comptroller.
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