Texas Health Steps
Program
THSteps Medical Checkup
 Comprehensive and periodic evaluation of:
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Medical History and Current Health Status
Comprehensive Physical Examination
Developmental Screening
Mental Health Screening
Vision & Hearing Screening
Immunizations/TB Screening
Laboratory Screening
Anticipatory Guidance
Periodicity Schedules
 Specifies the required screening procedures at each stage of client’s life
 Twelve checkups required up to age three
 Annual checkups after age three
Exceptions to Periodicity
 Medically necessary (developmental delay or suspected abuse)
 Environmental high‐risk
 Required for Head Start enrollment, daycare, foster care or pre‐adoption
Separate Reimbursable Components
of THSteps Medical Checkup
 Initial Point of Care Blood Lead Testing
 Tuberculin Skin Test (TST)
 Developmental and autism screening
 Vaccine Administration
 Oral Evaluation and Fluoride Varnish (OEFV)
Point‐Of‐Care Blood Lead Testing
• Initial screening only using a venous or capillary specimen, and specimens must be either sent to DSHS lab or test must be performed in the provider’s office using point‐of‐care testing.(mandatory at 12 and 24 months or any first checkup after 12 or 24 months of age, if there is no documented blood lead level results available. (only thru age 6)
• Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver needed
• Procedure code 83655 with modifier QW may be reimbursed to THSteps
medical provider when point‐ of‐ care testing is performed in the provider’s office. (does not apply to RHC or FQHC)
• Separate reimbursement Lead Testing
Follow‐up
• Blood lead level of 5 mcg/dL or greater
• Venous specimen
• Laboratory of provider’s choice
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Lead Reporting
 Must submit results to  Childhood Lead Poisoning Prevention Program (CLPPP) for children 14 years of age or younger
http://www.dshs.state.tx.us/lead/child.shtm
 Adult Blood Lead Epidemiology and Surveillance Program (ABLES) for individuals 15 years of age or older
http://www.cdc.gov/niosh/topics/ables/txables.html
 Report all results (elevated and non‐elevated)
 Child Blood Lead Reporting, Form F09‐11709 or the Point‐of‐Care Blood Lead Testing report Form Pb‐111, can be found at www.dshs.state.tx.us/lead/providers.shtm or by calling 1‐800‐588‐1248
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TB Screening
Administer TB Risk Screening Tool annually beginning at 12 months of age.
The questionnaire is available at:
www.dshs.state.tx.us/thsteps/forms.shtm
Administer a tuberculin skin test (TST) (CPT code 86580) if risk for possible exposure is identified. A follow‐up visit (CPT code 99211) is required to read all TSTs. 9
TB Screening
Tuberculosis (TB) Questionnaire
The only required form for a THSteps checkup.
Ways to document the questionnaire:
1. Document the results of the completed tool in the checkup record, or
2. Retain or scan completed questionnaire in the record, or
3. Include and document the answers to the TB Questionnaire within a provider‐created medical record. 10
Developmental and Autism Screening
Ages(
Standardized Screening Tools
Autism Screening Tool
9 months
Ages and Stages Questionnaire
(ASQ) or
Parents Evaluation of Developmental Status (PEDS)
1 year
ASQ or PEDS (if not completed at 9 months or if provider/parental concern)
18 months
ASQ or PEDS
Modified Checklist of Autism in Toddlers (M‐CHAT)
24 months
30 months
ASQ or PEDS
ASQ or PED if not completed at 24 months or if provider/parental concern
M‐CHAT (as of 4‐1‐15)
3 years
ASQ, ASQ‐SE or PEDS
Developmental and Autism Screening
 Developmental screening (procedure code 96110)  Autism Screening (procedure code 96110 with modifier U6)
 May be reimbursed if completed on same day as checkup, exception‐to‐periodicity checkup, or follow‐up visit to a THSteps checkup
Mental Health Screening
 Mental health screening for behavioral, social, and emotional development is required at each THSteps
checkup. A validated standardized mental health screening tool must be used once per lifetime between 12 and 18 years of age. Providers must use one of four validated and standardized mental health screen tools:
Pediatric Symptom Checklist (PSC‐35)
Pediatric Symptom Checklist (Y‐PSC)
Personal Health Questionnaire (PHQ‐9)
Car, Relax, Alone, Friends, Forget, Trouble
(CRAFFT)
Developmental Referrals
 If a client has been previously identified with a condition and is currently receiving treatment, the associated screening may be omitted with proper documentation.
 Referral for in‐depth evaluation of development should be provided when parents express concern about their child’s development, regardless of scoring on a standardized development screen tool.
 Federal and state laws require a referral be made to an Early Childhood Intervention (ECI) program as soon as possible, but no longer than seven days after identification. (for birth thru 35 months)
 If the client is 3 years of age or older, referral should be made to the local school district’s special education program.
Vaccine Administration
Each medical checkup:
• Assess immunization status.
• Administer according to the ACIP recommendations unless
o Medically contraindicated, or o parent’s reason of conscience (including religious beliefs).
If an indicated vaccine or toxoid was not administered, the reason must be documented in the client’s medical record. Providers must not refer clients to the local health department or other entity for immunizations. THSteps Checkups & Immunizations
o Vaccines and toxoids must be administered according to the current ACIP “Recommended Childhood and Adolescent Immunization Schedule‐United States.” o Vaccines/toxoids must be obtained from TVFC for clients who are birth through 18 years of age and are not reimbursed separately. Oral Evaluation
and Fluoride Varnish (OEFV) During THSteps medical checkup for ages 6 through 35 months‐
• Limited oral evaluation
• Fluoride varnish application
• Referral to dental home
Provided by trained and certified‐
• Physicians
• Physician Assistants • Advanced Practice Registered Nurses http://www.dshs.state.tx.us/dental/OEFV.shtm
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Oral Evaluation
and Fluoride Varnish (OEFV)  To be billed on the same date of service as a medical checkup visit  Limited to six services per lifetime by any provider.  Procedure code 99429 must be billed with modifier U5 and diagnosis code V202
Oral Evaluation and Fluoride Varnish (OEFV)
 Provider must submit the completed the Oral Evaluation and Fluoride Varnish (OEFV) Certification Request form and fax (or scan and email) it to DSHS ALONG with the continuing education certificate (CE) that was printed when the training module was completed.  Necessary forms can be found at http://www.dshs.state.tx.us/dental/OEFVmats.shtm
 Contact Person: Louise Friedman 512‐776‐2110 or [email protected]
Laboratory Testing
Test
Laboratory
Second Newborn Screening
DSHS Lab
Blood Lead Screening
DSHS Lab or Point‐of‐Care
Anemia Screening
DSHS Lab or Point‐of‐Care
Glucose
DSHS Lab or Provider’s Choice
Total Cholesterol/Hyperlipidemia
DSHS Lab or Provider’s Choice
Lipid Profile
DSHS Lab or Provider’s Choice
HIV
DSHS Lab or Provider’s Choice
Gonorrhea/Chlamydia
DSHS Lab
Syphilis
DSHS Lab or Provider’s Choice
M(1
M(2
Anemia
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Ages for anemia screening‐12 months of age
Dyslipidemia
• Hyperlipidemia screening is based on risk assessment. THSteps
does not provide a formal risk assessment. Providers may refer to the AAP policy statement on cholesterol screening for more information.
• Mandatory screening will be required once for all clients 9 through 11 years of age and again at 18 through 20 years of age, regardless of risk.
• Specimens may be sent to the laboratory of the provider’s choice, including the DSHS lab. Slide 21
M(1
Moulton,Margie (DSHS), 1/19/2016
M(2
Moulton,Margie (DSHS), 1/19/2016
• Type 2 Diabetes
• Screening for risk of Type 2 diabetes is based on risk assessment. THSteps does not provide a formal risk assessment tool.
• Specimens may be sent to the laboratory of the provider’s choice, including the DSHS lab.
STD Testing
• Syphilis testing should be performed on adolescents that are high risk for infection.
Specimens may be sent to the Medicaid laboratory of the provider’s choice including the DSHS lab in Austin.
• Testing for gonorrhea and chlamydia should be performed on adolescents that are at high risk for infection.
(Only accepted testing for chlamydia and gonorrhea is the applified probe technique.
HIV Testing
• It is critical to maintain confidentiality when caring for clients, as well as their specimens.
• Testing should be performed only after informed consent is obtained from the adolescent. Informed consent does not have to be written as long as there is documentation in the medical record that the test has been explained and consent has been obtained or denied.
• HIV screening is risk based for all clients 11 through 20 years of age. Mandatory screening is required once for all clients 16 through 18 years of age, regardless of risk.
• Provider may submit specimen to DSHS lab or any Medicaid lab of choice.
DSHS Laboratory
 THSteps providers must register with the lab to receive submitter number and to obtain lab and shipping supplies at no cost
 All specimens sent to the DSHS Lab must use their supplies
 There is no separate reimbursement for the collection and mailing of specimens. This is part of the bundled fee.
DSHS Laboratory
1‐888‐963‐7111, Ext 7318 or 512‐458‐7318
www.dshs.state.tx.us/lab/mrs_intro.shtm
Email: [email protected]
THSteps Provider Outreach Referral Service
The THSteps Provider Outreach Referral Service is utilized by THSteps providers who request outreach and followup on behalf of a THSteps patient. This service provides necessary outreach such as:
• Contacting a patient to schedule a follow up appointment.
• Contacting a patient to reschedule a missed appointment.
• Contacting a patient to assist with scheduling transportation to the appointment. • Contacting a patient for other patient‐related outreach services. http://www.dshs.state.tx.us/thsteps/POR.shtm
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THSteps Provider Outreach Referral Service
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Case Management
 Conducted by licensed social worker or registered nurse
 Provides comprehensive family assessment during a home visit
 Makes referrals to community resources  Follow‐up/monitoring  Supportive help to become self‐sufficient
Case Management for Children and Pregnant Women 
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Medicaid
Children aged 0‐21 years who have medical condition
“High Risk” pregnant women
Have a need for case management
Desire for case management
Case Management can help with:
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Family problems
School/education issues
Financial problems
Special medical needs
 Adaptive equipment
 Therapy needs
 Overcoming barriers to families
 Promoting self‐reliance
Making a Referral
http://www.dshs.state.tx.us/caseman/
Call THSteps at 1‐877‐847‐8377 or
Fax CM Referral form to 512‐533‐3867
Case Management Referral Pad
• Designed for providers to make referrals for Case Management
• Order at http://www.dshs.state.tx.us/thsteps/THStepsCatalog.shtm
• Two-sided pads have 50 referral forms
Related Programs and Resources
• Personal Care Services (PCS)
• Children with Special Health Care Needs program (CSHCN)
• Online Provider Education (OPE)
Personal Care Services (PCS)
PCS is a Medicaid benefit that assists eligible clients who require assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) because of a physical, cognitive
or behavioral limitation related to their disability or chronic health condition. Personal Care Services (PCS)
Client Referrals
 A client referral can be provided by anyone who recognizes a client need for PCS including, but not limited to, the following:
o Client or family member.
o A primary practitioner, primary care provider, or medical home.
o A licensed health professional who has a therapeutic relationship with the client and ongoing clinical knowledge of the client.
DSHS social workers process referrals, assess clients, and submit prior authorizations to TMHP for services.
PCS Referral Line: 1‐888‐276‐0702
Children with Special Health Care Needs Program (CSHCN)
Benefit Summary The Children with Special Health Care Needs (CSHCN)
Program serves:
• Children who have special health‐care needs.
• Individuals of any age who have cystic fibrosis.
The program helps clients with their: • Medical, dental and mental health care • Drugs • Special therapies • Case Management • Family Support Services
• Travel to health care visits
• Insurance premiums
Children With Special Health Care Needs Services Program (CSHCN)
 The Children with Special Health Care Needs (CSHCN) Services Program provides services to children with extraordinary medical needs, disabilities, and chronic health conditions.  Insurance program similar to Medicaid but with it’s own set of eligibility criteria
 Medicaid, CHIP, and commercial health insurance benefits, if any, must be utilized before CSHCN health benefits. 37
Children with Special Health Care Needs (CSHCN)
Eligibility Summary The program is available to anyone who
• lives in Texas, (includes undocumented residents).
• is under 21 years old (or any age with cystic fibrosis).
• has a certain level of family income.
• has a medical problem that  is expected to last at least 12 months.  will limit one or more major life activities.  needs more health care than what children usually need.  has physical symptoms. (This means that the program does not cover clients with only a mental, behavioral or emotional condition, or a delay in development.) CSHCN Application Information » Please visit www.dshs.state.tx.us/cshcn.clapplforms.shtm
to download an application » Or in the DFW area Contact the Arlington CSHCN Eligibility Office at 817‐264‐4619
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THSteps Online Provider Education
 Offers over 50 modules of a variety of topics for continuing education credit for various health care professionals
 FREE of charge
 Go to: www.txhealthsteps.com
THSteps Resource Catalog
THSteps offers brochures, posters and other outreach resources, at no cost to Medical and Dental Providers, Schools, Community Based Organizations (CBO's), Case Managers and other THSteps Partners.
Materials cover a variety of topics, including:
• Medical Checkup • Dental Checkup • Case Management for Children and Pregnant Women
http://www.dshs.state.tx.us/thsteps/THStepsCatalog.shtm
THSteps Resource Catalog
Email a request to [email protected] to receive a log in/password to place an order.
Include the following information:
 Organization Name  Physical Street Address (Cannot ship to PO Boxes)
 City, State, Zip Code
 Contact Person
 Telephone (With area code)  Email address (Email address is required to receive an online account to order publications)
For additional information:
Margie Moulton
Texas Department of State Health Services
Texas Health Steps Program
817‐264‐4902
[email protected]