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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 1. General Information : 1.1 Family Planning Overview

1.1 Family Planning Overview
TMHP processes family planning claims and encounters for two different funding sources:
DSHS awards contracts to agencies across Texas 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, FQHCs, RHCs, and hospital districts. All DSHS-contracted providers must first be enrolled in Title XIX Texas Medicaid.
Client eligibility requirements, reimbursement methodologies, client copayment guidelines, and covered services may differ for each funding source. Family planning funding cannot be used for elective abortion services.
Title XIX funds are available for family planning services provided to Texas Medicaid clients and 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.
DSHS Family Planning Program contracts annually with family planning providers. TMHP processes claims and reimburses providers for services to eligible clients according to the individually granted funds.

Texas Medicaid & Healthcare Partnership
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