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Texas Transition Plan Narrative 4 16 12

Texas Transition Plan Narrative 4 16 12

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Published by Jeff Bair
Narrative of Texas plan for women's health.
Narrative of Texas plan for women's health.

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Published by: Jeff Bair on Apr 17, 2012
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01/23/2013

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Texas Women’s Health ProgramTransition PlanApril 16, 2012Background
S.B. 747, 79
th
Legislature, Regular Session, 2005, directed the Health and HumanServices Commission (HHSC) to establish a five-year demonstration program to expandaccess to family planning services for women through Medicaid. HHSC submitted aSection 1115(a) research and demonstration waiver to the Centers for Medicare andMedicaid Services (CMS), which became effective January 1, 2007, and was due toexpire December 31, 2011.Pursuant to the 2012-13 General Appropriations Act (Article II, Health and HumanServices Commission, Rider 62, House Bill 1, 82
nd
Legislature, Regular Session, 2011)HHSC sought a renewal of the Medicaid Women’s Health Program demonstrationwaiver; however, CMS has confirmed that they will not renew the program becauseHHSC must adhere to the state law directing that affiliates of abortion providers areprohibited from participating in the Women’s Health Program.Therefore, in accordance with Governor Perry’s directive, Texas has elected to continuethe Women’s Health Program without Title XIX funding and to transition it to a purelystate-funded program outside of the Title XIX medical assistance program. TheMedicaid Women’s Health Program will be renamed the “Texas Women’s HealthProgram” (TWHP), and will be established within the Texas Department of State HealthServices (DSHS) pursuant to the department’s authority under state law to administerPrimary Health Care Program services. DSHS will contract with HHSC through aninteragency contract to administer the day-to-day operations of the TWHP. HHSC hasdeveloped a plan to phase out Medicaid funding and transition the Medicaid program to aprogram funded exclusively with state general revenue. This will be a seamless transitionfor clients and providers.There will be no disruption in client services during the transition to a state-fundedprogram. HHSC will need to make a number of administrative and operational changesto implement TWHP. The transition plan provides proposed timelines and detail on whatactions are necessary by HHSC and DSHS to ensure transition of the program withoutdisruption for clients and providers.
The Texas Women’s Health Program
The Texas Women’s Health Program, like its Medicaid predecessor program, will offerfamily planning services for low-income women. The goals of the program are to:(1)
 
Improve health outcomes for low-income women and babies;(2)
 
Reduce expenditures for Medicaid-paid births and other state and local health careand social services costs;
1
 
(3)
 
Ensure continuity of care for women who currently receive services through theMedicaid Women’s Health Program following termination of the Medicaid program;and(4)
 
Facilitate access to state-qualified health care providers.
Covered Populations
The transition plan does not change who qualifies for the program.
TWHP will continueto offer family planning services to women ages 18 through 44 with incomes at or below 185percent of the Federal Poverty Level.
Women must be United States citizens or qualifiedaliens, as well as Texas residents.
Eligible Services
Women participating in TWHP will receive the same services they do today under theMedicaid demonstration waiver as well as a new service: treatment for sexuallytransmitted diseases.Specifically, TWHP will provide the following services.
 
Comprehensive health history and evaluation;
 
Physical examination;
 
Screening for and treatment of sexually transmitted diseases;
 
The full range of allowable Medicaid family planning services, includingscreenings for diabetes, hypertension, elevated serum cholesterol level, anemia,vaginal infection, and tuberculosis, as well as breast and cervical cancer;
 
Assessment of health risk factors;
o
 
Client-centered counseling and education regarding:
o
 
Basic human reproductive anatomy and physiology;
o
 
Sexual abstinence as the only 100 percent effective method of preventingpregnancy or infection with sexually transmitted diseases (includingHuman Immunodeficiency Virus, or HIV);
o
 
Promotion of abstinence as the preferred choice of behavior related to allsexual activity for unmarried persons;
o
 
Reduction of health risks;
o
 
All Food and Drug Administration-approved methods of contraception,except emergency contraception; and
o
 
Individualized counseling on any contraceptive method selected by theclient, except emergency contraception;
 
Provision of a contraceptive method, except emergency contraception, based onclient choice and absence of medical contraindications;
 
Information on potential resources for the treatment of non-covered healthconditions identified by Women’s Health Program services; and
 
Referral of non-covered medical problems to appropriate specialty healthproviders.
 
A participant who is identified as at-risk for cardiovascular disease and diabeteswill receive preventive counseling at the initial family planning visit and anyfollow-up family planning visits to ensure that her preferred method of 2
 
contraception is suitable to her current condition or risk factors, which mayinclude:
o
 
Hypertension;
o
 
Elevated cholesterol;
o
 
Obesity/Overweight (as measured by Body Mass Index);
o
 
Smoking;
o
 
Alcohol abuse; and
o
 
Low physical activity.
 
Treatment for sexually transmitted diseases.
As noted, the state will expand TWHP to include sexually transmitted disease treatment sothat a client with a sexually transmitted disease can receive treatment from her regular familyplanning provider without being referred elsewhere. While the Medicaid Women’s HealthProgram includes basic health screenings that identify the presence of specific diseases andhealth conditions, women who are diagnosed with a sexually transmitted disease at a familyplanning exam must be referred for medical treatment and appropriate follow-up. TWHP willpay the costs associated with the treatment of clients’ sexually transmitted diseases.
 
Outreach Plan
During the transition period, HHSC will employ a two-pronged outreach strategytargeting both current Medicaid Women’s Health Program providers and clients andqualified TWHP providers and clients.
Client Outreach
The client outreach plan identifies a variety of methods that will be used to target clients,including mailings, radio broadcasts and distribution of outreach materials throughcommunity-based organizations. The client outreach plan includes an active referralprocess for clients if their current provider no longer qualifies to participate in theprogram.
Client Referral process
To ensure clients can access a qualified provider, HHSC has developed an active clientreferral process during the transition process. HHSC is expanding the scope of the clientand provider call centers to assist current Medicaid Women’s Health Program clients andfuture TWHP clients locate a provider. TWHP clients will be directed to the call center if they need assistance finding a provider. Call center staff will answer questions andprovide clients with a list of providers in their area and encourage clients to call back if they need further assistance.If a client calls back for assistance, call center staff will actively search for a provider thatwill accept the client. If a provider cannot be identified for the client, call center staff will escalate to appropriate Medicaid and Provider Relations staff who will recruitadditional providers.
Provider Outreach
Provider outreach is another critical component of the transition plan. The plan’sprovider outreach priorities are to:3

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