Welcome to the training on Building a Comprehensive and Effective Medical Home provided by the Texas Department of State Health Services (DSHS) and the Texas Health and Human Services Commission (HHSC).
The goal of this module is to equip Texas Health Steps providers and others to build comprehensive and effective medical homes that serve children and adolescents with and without special health-care needs, regardless of their racial, ethnic, socioeconomic, and health status.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Interpret the definition of a medical home.
- Create a medical home approach for a child with special health-care needs.
- Integrate preventive service components into care delivery.
- Manage one practice tool for developing and sustaining a medical home.
- Organize a comprehensive care plan to support a patient’s individualized care in the medical home.
- Employ a systematic practice change to improve access and delivery of care.
- Specify how specialists and subspecialists can support coordination of care.
Please note this module expires on 6/17/2018.
Continuing Medical Education
The Texas Department of State Health Services is accredited by the Texas Medical Association (TMA) to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service (TMA provider #4006803) designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is an accredited provider (P0180) of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 contact hour(s) of Continuing Social Work Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.5 total entry-level Category I contact education contact hours.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.5 contact hour/s of continuing education for Certified Community Health Workers.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service certifies that this attendee participated in the educational activity listed above. The Texas Department of State Health Services, Continuing Education Service has awarded 1.5 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. Planning Committee/ Author Name of Commercial interest Nature of the Relationship LeAnn Kridelbaugh Salary Employment (Director of Medical Home Initiatives).
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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- American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2007). Joint Principles of the Patient-Centered Medical Home. Patient Centered Primary Care Collaborative.
- American Academy of Pediatrics. (2014). Education in Quality Improvement for Pediatric Practice.
- American Academy of Pediatrics, healthychildren.org. (2013). Crime, Violence and Your Child.
- American Academy of Pediatrics. (n.d.). Improving the Medical Home Through the Use of Health Information Technology: A Fact Sheet for Health Care Professionals.
- American Academy of Pediatrics, Pediatric History Center, Oral History Project. (2004). Calvin C. J. Sia, MD. Interviewed by James E. Strain, Aug. 14, 2004, Honolulu, HI.
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- American Academy of Pediatrics and U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (n.d.). Building Your Medical Home toolkit.
- Association of Maternal & Child Health Programs. (2014). National Standards for Improving Quality Systems of Care for Children and Youth with Special Health Care Needs.
- Boudreau, A. A., Goodman, E., Kurowski, D., Perrin, J. M., Cooley, W. C., & Kuhlthau, K. (2014). Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs. [Abstract]. Pediatrics, 133(6): 1046-1053. doi:10.1542/peds.2013-2174.
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- Center for Medical Home Improvement. (2006). Medical Home Index.
- Center for Medical Home Improvement. (2006). Medical Home Family Index and Survey.
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- Child and Adolescent Health Measurement Initiative. (2012). National Survey of Children's Health 2011/12. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website.
- Child and Adolescent Health Measurement Initiative. (2012). 2009/10 National Survey of Children with Special Health Care Needs.
- Collins, S., Piper, K. B., & Owens, G. (2013). The Opportunity for Health Plans to Improve Quality and Reduce Costs by Embracing Primary Care Medical Homes. American Health & Drug Benefits, 6(1): 30–38.
- Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee. (2014). Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems. Pediatrics, 133(5): e1451-e1460.
- Elliott, V. S. (2012). Can a specialty practice be a patient-centered medical home? American Medical News.
- Got Transition™. Center for Health Care Transition Improvement. (2014). Six Core Elements of Health Care Transition 2.0.
- Guttmacher Institute. (2015). Fact Sheet: Unintended Pregnancy in the United States.
- Homer, C. J. & Baron, R. J. (2010). How to Scale Up Primary Care Transformation: What We Know and What We Need to Know? Journal of General Internal Medicine, 25(6): 625-629. doi: 10.1007/s11606-010-1260-x.
- Jackson, R. (2006). Parental Health Literacy and Children’s Dental Health: Implications for the Future. Pediatric Dentistry, 28(1).
- Kraft, C. (2014). Healthcare Texting: Right Format for Today's Families. American Academy of Pediatrics (AAP) Experience National Conference & Exhibition.
- Lone Star Circle of Care. (n.d.). Community health centers.
- Long, W. E., Bauchner, H., Sege, R. D., Cabral, H. J., & Garg, A. (2012). The value of the medical home for children without special health care needs. Pediatrics 129(1): 87-98.
- McAllister, J. W., Presler, E., & Cooley, W.C. (2007). Medical Home Practiced-Based Care Coordination: A Workbook.
- McManus, M. A., Pollack, L. R., Cooley, W. C., McAllister, J. W., Lotstein, D., Strickland, B., & Mann, M. Y. (2013). Current Status of Transition Preparation Among Youth With Special Needs in the United States. Pediatrics, 131(6): 1090-1097. doi:10.1542/peds.2012-3050.
- Margolius, D. (2013). Less Tinkering, More Transforming: How to Build Successful Patient-Centered Medical Homes. [Abstract]. Journal of the American Medical Association, Internal Medicine, 173(18): 1702-1703. doi:10.1001/jamainternmed.2013.8964.
- Medical Home Initiatives for Children With Special Needs Project Advisory Committee. (2002, Reaffirmed 2008). Policy statement: The medical home. Pediatrics, 110(1): 184-186.
- Mosquera, R. A., Avritscher, E. C., Samuels, C. L., Harris, T. S., Pedroza, C., Evans, P., … &, J. E. (2014). Effect of an Enhanced Medical Home on Serious Illness and Cost of Care Among High-Risk Children With Chronic Illness: A Randomized Clinical Trial. [Abstract.] Journal of the American Medical Association, 312(24): 2640-2648. doi:10.1001/jama.2014.16419.
- National Alliance for Caregiving.
- National Center for Medical Home Implementation. (2012). Spotlight on Child Health Issues: Mental Health & Medical Home.
- National Center for Medical Home Implementation. (n.d.).
- National Center for Medical Home Implementation. (2011). Webinars.
- National Committee for Quality Assurance. (n.d.). Patient-Centered Medical Home.
- National Committee for Quality Assurance. (2013). NCQA Patient-Centered Specialty Practice Recognition.
- Norwood, K. W. & Slayton, R. L. (2013). Clinical Report: Oral health care for children with developmental disabilities. Pediatrics 113(3): 614-619.
- Parent to Parent of New York State. (2013). Tip Sheets for Caregivers of Individuals with Special Health Care Needs.
- Schiavo, J. H. (2011). Oral Health Literacy in the Dental Office: The Unrecognized Patient Risk Factor. Journal of Dental Hygiene, 85(4): 248-255.
- Sharifi, M., Dryden, E. M., Horan, C. M., Price, S., Marshall, R., Hacker, K., Finkelstein, J. A., & Taveras, E. M. (2013). Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews. Journal of Medical Internet Research, 15(12): e272. doi: 10.2196/jmir.2780.
- Taylor, E. F., Lake, T., Nysenbaum, J., Peterson, G., & Meyers, D. (2011). Coordinating care in the medical neighborhood: critical components and available mechanisms. White Paper (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2). AHRQ Publication No. 11-0064. Rockville, MD: Agency for Healthcare Research and Quality.
- Texas Children’s Pediatrics Community Cares Program. (n.d.).
- Texas Health and Human Services Commission. (2017). Take Time Texas.
- Texas Department of State Health Services. (2017). Children with Special Health Care Needs (CSHCN) Services Program.
- Texas Department of State Health Services, Children with Special Health Care Needs (CSHCN) Services Program. (2013). Family Support Services.
- Texas Department of State Health Services. (2017). First Dental Home.
- Texas Department of State Health Services. (2016). Medical Home Work Group.
- Texas Department of State Health Services. (2014). Oral Evaluation and Fluoride Varnish in the Medical Home.
- Texas Department of State Health Services. (2014). Texas Health Steps.
- Texas Medicaid & Healthcare Partnership. (2015). Texas Medicaid Provider Procedures Manual.
- Texas Parent to Parent (TxP2P). (n.d.).
- The National Alliance to Advance Adolescent Health. Gottransition.org. (n.d.). Six core elements of health care transition.
- Townley, C., & Mooney, K. (2014). The Role of Hospitals in Medical Home Initiatives and Strategies to Secure Their Support and Participation. State Health Policy.
- TransforMED. (n.d.).
- TBD SECTION 1 VIDEO REFERENCE http://www.txhealthsteps.com/docebo_40x/files/doceboLms/scorm/52882_24_1365443732_introduction-to-medical-home.zip_content/section-1.php functions 12/16/14\\
- University of Minnesota. (2013). Fact Sheet—Family Caregivers of Children with Special Health Care Needs: The Need for Caregiver Support as Truly Family-Centered Care.
- U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2020. Maternal, Infant, and Child Health, Health Services. Washington, DC.
- American Academy of Pediatrics. (2014). Mental Health Initiatives.
- American Academy of Pediatrics. (2014). Index of Current Procedural Terminology (CPT) Codes for Medical Home.
- American Academy of Pediatrics. (n.d.). Medical Home for Children Exposed to Violence.
- American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians, Transitions Clinical Report Authoring Group. (2011). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics, 128(1): 182-200.
- American Academy of Pediatric Dentistry. (n.d.).
- American Hospital Association. (2012). Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes.
- Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, and Section on Developmental and Behavioral Pediatrics, Shonkoff, J. P., Siegel, B. S., Dobbins, M. I., Earls, M. F., Garner, A. S., McGuinn, L. Pascoe, J., & Wood, D. L. (2011). Policy Statement: Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. Pediatrics, e224-e231. doi:10.1542/peds.2011-2662.
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- National Center for Medical Home Implementation. (n.d.). Medical Homes @ Work Issues, Spotlight on Child Health Issues.
- National Center for Medical Home Implementation. (n.d.). Texas Medical Home information.
- National Center for Medical Home Implementation. (n.d.). Transitioning From a Pediatric to an Adult Medical Home.
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- Nielsen, M., Langner, B., Zema, C., Hacker, T., & Grundy, P. (2012). Benefits of implementing the primary care patient-centered medical home: A review of cost & quality results. Patient-Centered Primary Care Collaborative.
- Office of the National Coordinator for Health Information Technology. (2014). Certified Health IT Product List.
- Office of the National Coordinator for Health Information Technology. (2015). Regional Extension Centers.
- Patient-Centered Primary Care Collaborative. (2014). The Medical Home’s Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013.
- Patient-Centered Primary Care Collaborative. (2014). Behavioral Health Integration into the PCMH.
- Texas Department of State Health Services. (2015). Mental Health Screening Tools.
- Texas Department of State Health Services. (2015). Mental Health Services for Children and Adolescents.
- Texas Department of State Health Services. (2015). Texas Health Steps Child Health Clinical Record Forms.
- Texas Department of State Health Services. (2015). Texas Health Steps Provider Information.
- Texas Medicaid & Healthcare Partnership. (n.d.). Electronic Health Record (EHR) Incentive Program.
- The Child & Adolescent Health Initiative. (n.d.). Children with Special Health Care Needs (CSHCN) Screener.
- National Center for Medical Home Implementation’s How to Partner with Your Physician, a website with checklists, tips, and videos to help patients and families work together with health-care providers.
- Parent Companion First Five Years, a bilingual website focusing on young children with disabilities that was created to comfort, inspire, and connect parents to helpful disability resources.
- Texas Department of State Health Services. (2015). Anticipatory Guidance-A Guide for Providers. Texas Health Steps.
- Texas Department of State Health Services. (2015). There’s always help: suicide prevention - DV0771. Audiovisual Library.
- Texas Department of State Health Services. (2015). Think about it: driving and choosing to drink (closed captioned) - DV0768. Audiovisual Library.
- Texas Department of State Health Services. (2015). Children with Special Health Care Needs (CSHCN) Services Program.
- Texas Health and Human Services Commission. (n.d.). Texas Medicaid and CHIP. Medical Transportation Program.
- Texas Parent to Parent (TxP2P). (n.d.).
- American Academy of Pediatric Dentistry. Frequently Asked Questions (for parents and caregivers).
- American Academy of Pediatric Dentistry. Mychildrensteeth.org (website for families).
- American Academy of Pediatrics. Children’s Oral Health: Family Resources.
- American Academy of Pediatrics. healthychildren.org web page: Oral Health.
- American Dental Association. How to Care for Your Child’s Teeth.
- American Dental Association. Find Dental Care for Your Kids, which helps families search for dental clinics using their home address.
- Texas Department of State Health Services. Early Childhood Caries.
- Texas Department of State Health Services. Brush-Up on Healthy Teeth.
- Texas Department of State Health Services. Healthy Mouths: What You Need to Know About Your Teeth.
- Texas Department of State Health Services. Keep your child smiling.
The medical definition provided in this module was obtained from the U.S. Department of Health and Human Services.
Related coursesCE Credit
Culturally Effective Health CareCE: 1.25Promote effective communication and improve health outcomes for culturally diverse patients and their families. Includes guidelines for obtaining informed consent and using interpretation services in the medical home.CE Credit
Transition Services for Children and Youth with Special Health-Care NeedsCE: 1.5Learn to develop and implement transition plans for patients with chronic health conditions or disabilities as they approach school age or adulthood.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.