FAQ - Title V, X, & XX Family Planning 07






Title V Page II-31 references fertility regulation and lists which contraceptive methods must be provided onsite minimally. The contractor provides some of the items on the list onsite. However, they do not have a pharmacy license and provide those items by prescription with a locally contracted pharmacy. This agency is also an FQHC and they provide the prescriptions free of charge. The client simply has to pick it up from the Pharmacy.
Are they in compliance with this requirement or not? (3/2007)

Yes, the contractor is in compliance with this policy. There are advantages for clients if the contractor has an on-site pharmacy, since the client does not have to go to another location to obtain drugs and supplies. If the contractor does not have an on-site pharmacy, however, and the client is not charged any fee for the drugs and supplies beyond the appropriately assessed co-share payment, it is acceptable to provide the contraceptive methods through an outside pharmacy. In a future revision of the policy manual, we will modify the wording of that section to indicate that the minimally required methods are to be provided directly or not through referral to another provider.

If a female patient comes into the clinic asking for a pregnancy test, does she have to see a provider? Can the MA conduct the pregnancy test and give the results.(3/2007)
Pregnancy tests may be provided by non-medical personnel based on your agency's standing delegation orders. Staff performing the tests should be trained by a licensed clinical provider and documentation of this training should be maintained. If a medical record is not established for these clients, a written log should be maintained with the following information at a minimum: patient name or a unique identifier, the pregnancy test series number, the results of the pregnancy test, and contact information, should follow-up be required. If the client is eligible for WHP or Title XX, eligibility documentation would also need to be maintained.

For clients that fall into the age and income range that would qualify them for WHP come into the clinic for non-covered WHP services (abnormal pap follow-up, STI treatment, etc.), can we still charge them a co-pay fee for these services? Would this be billed as a Title X encounter? (2/2007)
Yes. For clients that prescreen eligible for WHP and receive additional services not covered by WHP, you may charge them co-pay for the non- WHP services based on the Title X sliding fee scale. You should report this as a Title X encounter and include the costs on your monthly Title X voucher.

Are family planning contractors still required to provide emergency contraceptive pills (ECP) to clients now that they are available over-the-counter to individuals 18 years of age and older? If so, is it necessary for a client to have a physical exam prior to receiving the ECP?
DSHS contractors that receive Titles V, X, and/or XX funds for family planning services continue to have the responsibility to provide ECP to clients according to clinical indications and protocols or standing delegation orders established by the contractor. Historically, family planning contractors have always provided some nonprescription birth control methods such as condoms and foams or gels. In the case of ECP, a prescription is still required for clients under the age of 18. A physical exam is not required specifically in order to provide ECP to a client. All clients must be provided an appropriate physical assessment as indicated by client history. The initial physical exam may be deferred if the client history does not reveal potential problems requiring immediate evaluation. Contractors are allowed to limit provision of ECP to established clients if that is the contractor agency policy.

Does Title V cover office visits, contraceptive supplies and medications for things such as STD's and yeast for men? The manual contradicts itself in several places. The following are examples in the manual that lead a contractor to believe that male office visits, counseling, etc. will be covered by the grant. In the Introduction under General Information page v, the definition of Family Planning; In Section II, Chapter 1 page 3 "Screening and Eligibility Determination states "Females 9of childbearing age) and males, who have not had sterilization surgery of other condition resulting in sterilization and who are seeking family planning services; Section II Chapter 3 page 19 & 20 describe components of a medical visit -BOTH male and female; Section II Chapter 3 pages 25-26 describe components of counseling- BOTH male and female; Appendix A page 4 gives a totally different description than any where else in the manual.
Yes Title V does cover office visits, contraceptive supplies and medications. You are correct that Appendix A page 4 is contradictory to all your other citations. We missed updating that form, and are in the process of doing that now. It will be corrected and reposted on the website.

If a patient refuses a pap smear exam but requests a contraceptive method that contains hormones such as birth control pills, the patch, the depo shot, are we allowed to provide the contraceptive to that client? I found that in the Title X/XX manual, Section II Chapter 3 - Clinical Guidelines (II-11) it is stated that for female clients age 20 or younger, initial cervical cancer screening test may be delayed until three years after initiation of vaginal intercourse or at age 21 years, whichever comes first. However, it also states all initial and routine follow-up family planning clients must be provided appropriate laboratory and diagnostic tests or interventions as indicated by contractor policy or procedure or clinician judgment and that specific laboratory or diagnostic tests are required for the provision of specific methods of contraception. With all this taken into consideration, is it safe to say then, that patient cannot receive contraceptives because (1) our medical provider's clinician judgment inclines her to perform a pap smear exam for contraceptives containing hormones and (2) the patient is refusing a component (laboratory) of family planning?
It is the judgment of the clinician that determines whether a client should be provided a contraceptive method without first having received a pelvic exam and/or cervical cancer screening test, because only the clinician can medically assess the individual client's risks based on health history. DSHS family planning policy, however, does not require a physical exam or cervical cancer screening prior to provision of a contraceptive method. The family planning policy manuals state: "All clients must be provided an appropriate physical assessment as indicated by client history. The initial physical exam may be deferred if the client history does not reveal potential problems requiring immediate evaluation but should not be deferred beyond 6 months, unless in the clinician's judgment there is a compelling reason for the deferral." The manuals further state: "Initial tests may be deferred until the initial exam is provided." (DSHS manuals referenced above as applicable policy.) Particularly in the case of adolescents, the requirement to have a pelvic exam may deter them from obtaining a birth control method even though they are sexually active and do not desire pregnancy. The book Contraceptive Technology (Robert A. Hatcher, et.al., 18th Revised Edition, 2004, p.412) advises: "… a pelvic examination is not needed for an asymptomatic woman prior to initiating OCs, even if the woman has not had a recent Pap smear."

There are two kinds of Antibody Rubella lab screenings, the IGM (German measles specific) and the IGT (German measles antibody). Which one is covered by family planning? The description on the DSHS Family Planning Procedure Codes for Title X/XX Contractors sheet is vague. Should be procedure code 86762.)
The appropriate test for screening for rubella immunity is the IgG. Use procedure code 86762 to submit claims for this service.

A Title V applicant has private insurance that covers Family Planning services. Their private insurance does not cover Depo, which is the method the applicant prefers. If the applicant meets the eligibility criteria, can the applicant be covered by Title V for Depo provera since her insurance won't cover Depo? (10/2006)
Title V is for clients who do not have insurance or insurance does not cover the service they are needing as long as they are Title V eligible.




A 17 year old Title X/XX client is referred to Title V for dysplasia services. Is parental consent required for Title V dysplasia services even though it was not required for the annual exam? Is parental consent required for Title V dysplasia services even though it was not required for the annual exam? (06/2007)
If the dysplasia services are paid for with Title V funds then the client must meet all Title V eligibility criteria/requirements, including the requirement for parental consent if the client is a minor.

If an agency is getting PPD for TB skin testing from the Immunization program can they still bill for administering and reading the TB skin test results under billing code #86580? (06/2007)
Yes. Contractors may ask for reimbursement for any item on the Title V Maternal-Child Services Report 185 and 186 forms.

Is there a rule regarding whether a client is considered new or established (for billing purposes) when they annually renew their eligibility but do not seek clinical services annually i.e. – client has been eligible for services but has had a break in clinical services received greater than 2 or 3 years. (4/2007)
In the 2nd paragraph under “Annual Re-certification” it states “A client can be a new client only once.” Page II-14. Under “Eligibility Determination” it is also stated that the Statement of Applicants Rights and Responsibilities does not have to be signed again unless there is a break in services longer than two years. Page II-10

A CHIP Perinatal client has a tubal after she gives birth.

Question: Can the woman giving birth through the Chip Perinate program become a WHP or Title V/X/XX FP client immediately after she gives birth and is no longer pregnant as long as she meets the eligibility criteria for the Family Planning program? If so, can the applicable FP program be used to cover charges relating to the tubal?

For example, after a woman -- who is not eligible for WHP due to citizenship status -- gives birth and receives a tubal, could the provider bill a DSHS FP program for the

tubal-related portion of the charges as long as the services were being provided by a DSHS contractor and/or subcontractor? (5/2007)

Title V, X, XX, will pay for a tubal for a woman who has just given birth through the Chip Perinate program as long as the client meets all eligibility criteria for the funding source to which the services will be charged.

However, this is not true for WHP. Very few women will be able to transition from CHIP Perinatal to WHP, and the transition cannot be immediate.  CHIP Perinatal clients are either non-citizens or above 185% of FPL.  Both categories are ineligible for WHP.  Right now, about 2 percent of CHIP Perinatal women are citizens with incomes above 185% of FPL.  It is possible that the higher household income she entered CHIP with will decrease after she has the baby and she will qualify for WHP through income.  However, women on CHIP do not qualify for WHP.  She will continue to be on CHIP until the end of the month in which she has the baby, so WHP would not be able to pick these few women up until the month after the birth.  


Scenario: According to DSHS Family Planning manuals, “Title V contractors must determine WHP eligibility at every visit if the client does not have a WHP Medicaid card.”

Question: Currently, eligibility staff complete and submit a WHP application for all FP clients who screen eligible for WHP. If that same client returns to one of our FP contractors after 45 days, the eligibility staff requests to see their WHP card. If they don’t have a WHP card, eligibility staff go online to see if they are classified as eligible for WHP. If the applicant is not classified as either eligible or denied, then the services provided previously are billed to a DSHS FP program based on eligibility.

Does the above statement in the FP manuals require that contractors repeat the entire process including: re-screening for WHP, re-completing & re-submitting the WHP application, and pending the billing for another 45-day cycle?

(If that is the case, is there flexibility within the eligibility guidelines that would allow for practices that would simplify having to complete the entire process, since we are hearing from contractors that the WHP screening and application process adds approximately 30-45 minutes to the eligibility determination process for each client. For example, if the client states that “nothing has changed” since they previously applied for WHP, can the eligibility staff refax the same WHP application form and documents that were sent previously and simply write-in a new date on the WHP application?) (5/2007)

All clients must be re-screened for WHP eligibility at each visit unless they have been certified as WHP eligible. In addition, the Women’s Health Program would prefer that providers submit a new application with a new client signature each time a WHP application is filed, even if no information has changed since a previous application was submitted. Please refer future questions regarding the WHP application process to the WHP toll-free information line at: 1-866-993-9972.

For the current fiscal year, the patient is enrolled in TVMCH and delivers the baby in the hospital. While in the hospital if she wants a tubal, can we bill TV FP for the service even though she was originally enrolled in TVMCH?
A Title V MCH client may simultaneously be enrolled for Title V Family Planning services. In that case, Title V Family Planning funds may be used to cover the costs of a tubal sterilization provided at the time of delivery. The Title V contractor obtains reimbursement for sterilization costs by submitting a claim for procedure code 58600, which includes all services associated with the sterilization. As with any family planning client, however, all consent requirements must be met prior to the sterilization procedure.

Is there a way that a Family Planning provider can be reimbursed for providing immunizations to a FP client?
(There's not a Procedure Code in the FP manuals for immunizations, but can they possibly bill Title X for the cost of providing the service?) (4/2007)
Provision of immunizations is not currently a reimbursed Family Planning service. In order to offer immunizations at no cost to clients 18 years of age and younger, contractors may with to consider participating in the Texas Vaccines for Children Program. The web link is: http://www.dshs.state.tx.us/immunize/tufe/default.shtm.

If a client comes to the clinic for a STD or pap, refusing birth control, do you still have to screen them for the WHP and have them fill out the application? Or, would they just be self pay clients. (3/2007)
It is generally assumed that if a client comes into a family planning clinic that they are seeking family planning services. Receipt of birth control is not a requirement for receipt of family planning services. If a client comes into your family planning clinic to receive family planning related services and you plan to bill them to Title X or Title XX or bill the client based on your Title X sliding fee scale, then that client would be considered a family planning client. Clients must be screened for WHP prior to billing any other source of funding.

When are vaginal rings going to be added? Patients are requesting this, but my staff is saying they haven't been added yet as billable under WHP. (2/2007)
The WHP covers the vaginal ring (brand name NuvaRing) under prescription drugs with a prescription to be filled by a pharmacy participating in the Vendor Drug Program. It is not known at this time when the vaginal ring will be added as a reimbursable service for Title V or Title XX or if it will be added as a service to be reimbursed on a 2017 claim form for WHP.

I understand that if a client refuses to be screened and apply for the WHP then a contractor may not see them under FP V, X, XX. What about if the client fills out the application but fails to bring in the requested documentation (ex. proof of income, ID's, etc.) can a contractor bill TV, X, XX after the 45 days?(2/2007)
If after 45 days the contractor cannot verify WHP eligibility for a client, the contractor may bill Title V, Title X, or Title XX. If the client returns, the contractor must assist them in completing the WHP eligibility process again.

When a contractor processes lipid panel (procedure code 80061) internally and does not send to DSHS lab, they are required to still report the services in their billing. Can they also bill for triglycerides procedure code 84478 to be reimbursed $7.95? (2/2007)
Title V contractors must submit all laboratory procedures listed in the Title V Family Planning Policy Manual to the DSHS laboratory. If the contractor chooses to utilize a different lab, it is at the contractor's expense. They cannot bill Title V and they cannot charge the patient.

If someone is potentially eligible for Medicaid, should we still fill out the WHP application? Understanding that once they receive Medicaid they will no longer be eligible for WHP? (2/2007)
Yes, you should still complete the WHP application on clients potentially eligible for Medicaid. You should also refer them to the nearest Medicaid office in order for them to apply for Medicaid.

WHP - Does the WHP pay for Cholesterol Screening?(2/2007)
No, Cholesterol Screening is not currently paid for by the WHP.

For clients that fall into the age and income range that would qualify them for WHP come into the clinic for non-covered WHP services (abnormal pap follow-up, STI treatment, etc.), can we still charge them a co-pay fee for these services? Would this be billed as a Title X encounter?(2/2007)
Yes. For clients that prescreen eligible for WHP and receive additional services not covered by WHP, you may charge them co-pay for the non- WHP services based on the Title X sliding fee scale. You should report this as a Title X encounter and include the costs on your monthly Title X voucher.

Many contractors are concerned about implementation of WHP and referral/follow-up for abnormal PAP's, STD treatment, etc. that WHP will not cover. Will contractors be able to use Title V FP or MCH (Dysplasia) funds to pay for the services that are not covered by the WHP? Reference pages II-4 and II-13.(2/2007)
If a contractor has a WHP patient who has an abnormal PAP, they may be referred to a Title V M&CH provider who is funded for dysplasia services if they meet the Title V eligibility requirements.

When a provider performs a wet mount to determine vaginal infection, the CPT code for this 87210 is not a reimburseable procedure according to the manual. However, CPT code 87205 states that it is "smear, primary source, with interpretations", this could be interpreted as including a wet mount. Can this code be billed for this service? Currently the only code approved for reimbursement by Title V or Title XX that is appropriate for billing wet mount is 87205 so, yes, this is the correct code to use.

Can an agency use Title X/XX funds for providing FP services to a client when confidentiality is an issue with the Women's Health Program? The agency contacted the Women's Health Program Help Desk and was told that the client must release an address for the purpose of receiving mail. The client does not want to release this information due to confidentiality.
For purposes of completing a Women's Health Program (WHP) application, the client has the option of providing an alternative address that would not compromise her confidentiality. The agency may not use Title V or Title X/XX funds to cover services for a client that is screened as potentially eligible for WHP unless a WHP application is submitted and the client is determined to be not eligible for WHP or 45 days has elapsed and there has been no determination of eligibility.

Since funding eligibility may not be determined until 45 days after the FP visit, how will cost sharing be handled to ensure it is equitable for all clients receiving FP services with Title V, X and/or XX funding?
For a client who is screened as potentially eligible for Women's Health Program (WHP), an application for WHP is to be submitted and no cost sharing fee is to be collected. If the client is ultimately determined not to be eligible for WHP, but is eligible for Title V, Title X, or Title XX, the appropriate cost sharing fee for services already provided may be assessed at the next clinic visit by that client. In accordance with policy, however, clients must never be denied services because of inability to pay current fees or any fees owed.

I have a question regarding the Women's Health Program. If a patient applies and is denied for coverage, she may be eligible for XX, V, or X. If she is eligible for one of these programs and falls into a category requiring a copay, do we collect the copay at the next visit?
Yes. Once a client is denied coverage under the Women's Health Program, if she is eligible for Title V, Title X, or Title XX, you may collect copay for the previous visit at the next visit.

Who should be billed for the initial services during the 45- day waiting period? Also, are laboratory costs covered that are accrued by the WHP program?
Contractors cannot bill Title V, Title X, or Title XX until after the 45-day waiting period has been met or the client has been denied by the Women's Health Program. Some laboratory costs are allowable by the Women's Health Program. These allowable procedure codes can be found on the HHSC website under benefits at: http://www.texaswomenshealth.org/

Our agency is wanting to conduct a mother/daughter awareness workshop on HPV prevention and would like to have this done in our rural communities. In conjunction with the workshop we will refer them for services to our centers and apart of that, we would like to offer the Gardasil vaccine. I would like to know if Title X will pay for the expense of the vaccine? No. At this time the HPV vaccine is not an allowable expense for Title X.

What is the dollar amount Title XX reimburses for male and female sterilization complications? What happens if the cost of the complication exceeds the reimbursement rate? Is there a time limit on reimbursement of sterilization complications? What is the process to receive reimbursement for a sterilization complication?
There is currently not a process in place with TMHP for the reimbursement for a sterilization complication. We are currently developing a process and an update will be provided as soon as the process is completed and ready to be implemented.

Regarding Completion of the Presumptive Eligibility Form. - Sometimes patients seen on a presumptive eligibility basis cannot schedule a return appointment to complete the eligibility process until they are able to check their calendar, childcare arrangements, etc. Instead of an exact time and date, can the provider staff write in something like "within 30 days" in the "Date & Time" block at the bottom of the page? If unable to document an exact date and time to return to complete the eligibility process, it is allowable to write in something like "within 30 days" in the "Date & Time" block. However, remember that the process has to be completed within 90 days or the client becomes self-pay.

Page 2 of the instructions for the Screening & Eligibility Determination Form, #2 at the bottom of the page states that a female age 12 through 45 is potentially eligible for Title V services. Is this correct? Mu understanding was that Title V MCH covered women who were pregnant (regardless of their age) and that Title V FP covered women of child bearing age (which could vary depending on the applicant)
Title V MCH cares for pregnant women, regardless of age, as long as they meet the eligibility criteria. Title V FP cares for women of child bearing age, which varies in clients, as long as they meet the eligibility criteria.

An 18 year old female at 140% FPL from Arkansas goes to the Texarkana clinic which is a Title X & XX clinic site. Their Title X funds are depleted. Can she be a Title XX client eve though she's from Arkansas since X supersedes XX?
No. This is a billing question, not a service delivery question. Title X does not have a residency requirement for service delivery, but Title XX requires that you be a Texas resident in order to bill for reimbursement.

Title V FP - If the agency is not funded by PHC, do they still have to screen for PHC on the eligibility form and refer out? Do they need to circle that on the form?
If an agency does not have PHC funds, they do not have to screen the client or family members PHC eligible. The screening and eligibility form is for the agency to screen for the eligibility of the funding sources they have and to rule out Medicaid eligibility. Mark "Not Eligible" if not screening for PHC or on blank line write "NA for PHC or PHC not screened". The same instructions would be true if an agency does not have Title V funding but do have PHC.

Would it be a finding during a review if an individual from Mexico who completes the eligibility form writes the date as they would write it in Mexico rather than the way it is written in the U.S.
No, it would not be a finding. The contractors may want to advise on how to write the numerical month, date, year or have the client write the abbreviation for each month, then date and year.

Title V FP -Can a Medicaid card with the address of a relative taking care of a child be used as proof of guardianship as well as residency?
Medicaid card with the address of a relative taking care of a child can be used as proof of residency. (TV MCH, Section II Chapter 1, page II-6) However, the Medicaid card cannot be used for proof of guardianship. Per Regina Perez, HHSC: A family friend who is caring for a parentless child, may have the child apply for Medicaid as an independent child. Medicaid does not require proof of guardianship when a non-parent is applying for Medicaid for the child.

If you have Title V-FP and Title X funding in one clinic, but only see Title V clients one day a week and Title X clients another day a week in the clinic, do you need consent for a minor on the days you only see Title V clients?(10/2006)
You must always obtain parental consent for Title V clients to receive family planning services.

Can Problem Counseling (99402 FP) be billed for HIV counseling if a client is found to be HIV positive during family planning exam?(10/2006) Yes.

Does the code 99213 (Subsequent Office Visit), need the FP modifier? (10/2006)
No, but it must be billed with a family planning diagnosis code.

Can code 99402 FP (Problem Counseling) be billed more than once per visit? This would be if someone had several different problems that needed to be addressed. (10/2006)
No. Problem counseling should not be billed more than one time for any client visit no matter how many different "problems" are addressed.

Is the administration of Depo covered? We know the actual medication is covered, but can we bill for the actual delivery of the injection? (They mentioned code 90772 or old code 90782?) (10/2006)
The procedure code for administering injections, including Depo, is not a benefit under Titles V and XX. However this is a benefit under Title XIX.

The Screening and Eligibility Form, income section questions 4 asks if anyone in the household is receiving TANF, Food Stamps, etc., the policy has Food Stamps listed as income which is not counted. The instructions list Food Stamps as unearned income to be counted. (10/2006)

Each numbered item on page one is an item of its own. Number 1 is family information. Number 2 is list of the household's income. Number 3 is inquiring about health care coverage. Number 5 is inquiring whether anyone in the household is pregnant.

Number 4 is inquiring whether any household members are on TANF, Food Stamps, Workers Compensation, and/or disability benefits. This information can be used by the clinic to make appropriate referrals and is not necessarily used in determining eligibility.

Income Section, page 3, instructions, "Food Stamps" will be removed because it is not a form of earned or unearned income.

The signature block states the applicants spouse may also sign and date the form. The policy states each PHC eligible client who is a legal adult is required to sign and date the form. PHC policy, Section II-3, states: "Each PHC eligible client, who is a legal adult, is required to sign and date the form. If confidentiality of services is a concern, separate forms for spouses may be completed." (10/2006)
Signature area of page 1 on the form will have the signature instructions removed and "If applicable", will appear next to "Signature-Spouse". Clinics shall defer to funding source policy manual for spousal signature policy.

In the Eligibility Determination Section to be completed by staff, clients who are screened potentially eligible for Medicaid would they be checked as not eligible or pending determination. Wouldn't they be checked as pending determination with comment "pending Medicaid?"(10/2006)
Yes, they would be checked as pending determination with comment "pending Medicaid". "Not eligible" is only used when an individual is not eligible for any funding source.

Does the agency place a copy in the client file of the Screening and Eligibility Determination Instructions, (FPL table)? The table that is updated every April? How will we know if the QA review if they used a current table? (10/2006)
It is not necessary to require the FPL table in each chart. The table is in the instructions for the eligibility clerk to use. The QA staff will have their own FPL table to refer to if necessary. This table is updated every April and sent out to the contractors and DSHS staff.

Will we no longer collect ss#? There is no place for this? (10/2006)
We no longer require collection of the social security number. Clinics may collect if required by agency policy.

Page 2 Document any special circumstances. What would be an example of a "special circumstance". (10/2006) Screening and Eligibility Determination Form for Medical Services Assistance, page 2, "Special Circumstances" area is for the provider staff to document any special circumstances not already noted in this section if applicable per page 3 of the form instructions. PHC policy manual, Section II Chapter 1 page II-1 states "Special circumstances may occur in the disclosure of information, documentation of pertinent facts, or events surrounding the client's application for services that make decisions and judgments by the contractor staff necessary. These circumstances should be documented in the case record on the Screening and Eligibility Determination Form for Medical Services Assistance."

Type of Title V/PHC service and who is eligible. What does "Full" mean?(10/2006)
PHC clients may be eligible for full, presumptive, or supplemental services. PHC policy manual, Introduction, page v and Section II Chapter 1 page II-9 defines presumptive eligibility. PHC policy manual, Section II Chapter 1 page II-11 explains supplemental benefits. Full eligibility means the client is eligible for ALL PHC benefits.

If a person is presumptive and they will need to come back to bring back their information do they still need to give them slip with an appointment?(10/2006)
In the past they gave them the bottom portion of the presumptive elig form. Yes, the client is to receive a slip with an appointment to complete the eligibility process. The new Presumptive Eligibility Form is still designed to cut the bottom portion to give to the client.

Please clarify the difference between signatures for "Person who helped complete this application" and "Applicant's representative" on pg. 1 of the form and when to use each of them.(10/2006)
There is no difference between "Person who helped complete this application" and "Applicant's Representative". With this said, in the near future the form will be revised with "Applicant's Representative and 2nd Date" removed and "Relationship to client" added.

Regarding the "Type of Title V/PCH service and who is eligible box" on pg. 2 of the form, please provide clarification on completion of this box. For example, how would you complete this box if you have a family of 3 people, the mother eligible for Title V Family Planning and PHC as a supplemental, the father if eligible for full PHC; and the child is eligible for Title V MCH and PHC supplemental.
Use the letter of the appropriate family member for full, presumptive, or supplemental to save space. Can also designate if it is Title V or PHC with each letter.

Regarding the "Determined Eligible For" box on pg 2 of the form: If a mother applies for PHC and her child is on Chip, would you check the "not eligible" box or check the blank box in the "Determined Eligible" box and write in CHIP on the blank line?(10/2006)
Check the blank box in the "Determined Eligible" box and write in CHIP on the blank line. The "Not Eligible" box is only for not eligible for any funding sources.

If an applicant applies for a program, has all the verifying documentation, and is determined eligible, does the staff have to check the "Potentially Eligible" box as well as the "Determined Eligible" box. Or can they put NA in the "Potentially Eligible" box and just check the "Determined Eligible" box?(10/2006)
Just check the "Determined Eligible" box. It is acceptable to also mark NA in the "Potentially Eligible" box, however, it is not necessary.



The WHP application has a field for "residence address" and a field for "mailing address." If applicant provides addresses in both fields, will notification of eligibility be sent to the "mailing address?" If the applicant does not provide an address in the "mailing address" field, does WHP automatically send correspondence to the "residence address"? (2/2007)
Yes, if we are only provided with a residence address we will mail correspondence there. And we do require an address to process an application.

The residence address is used to determine if the woman lives in Texas, one our of eligibility criteria. If a mailing address is provided as well, we will send all correspondence to that address. In April or May we will release an updated application that clarifies in the box for mailing address that an applicant should provide a mailing address if due to confidentiality concerns she cannot receive WHP mail at her residence.

In one of the agency's teen clinics, a policeman came in wanting to see the records of one of their clients (a teen who had signed their own consent for services. He stated it was related to a criminal investigation. The clinic declined to allow him to see the record without a release and contacted their legal dept. The policeman later returned with a release of information signed by the client's parent. When the agency legal dept was notified, they instructed the clinic to release the information. The clinic still declined until they could get some further clarification. Does releasing a confidential teen client's records based on a release signed by the parent or guardian violate Title X federal regulations? Does the fact that this is a criminal investigation change things? If their legal dept is incorrect, do we need them to talk with DSHS Office of General Counsel?
The DSHS Family Planning Manual for Title X and Title XX policy on release of medical record information is found in Section 1 Chapter 4 . It indicates the following: The written consent of the client is required for the release of personally identifiable information, except as my be necessary to provide services to the client or as required by law, with appropriate safeguards for confidentiality.

Title X regulations (42 CFR , 59.11) All information as to personal facts and circumstances obtained by the project staff about individuals receiving services must be held confidential and must not be disclosed without the individual's documented consent, except as may be necessary to provide services to the patient or as required by law, with appropriate safeguards for confidentiality. Otherwise, information may be disclosed only in summary, statistical or other form which does not identify particular individuals.

It is DSHS policy to refer contractors to their own legal counsel for advice on specific situations.

This question relates to the new WHP program. We have been sending pap smear tests to the DSHS lab in San Antonio for Title V These are now Title XIX Medicaid. Do they still go to DSHS lab or do we send to a private lab? You may continue to submit to the DSHS lab. Detailed instructions for submitting WHP lab tests to the DSHS laboratory can be found on the DSHS website under announcements at: http://www.dshs.state.tx.us/famplan/

Why is the date signed different on the sterilization consent form in English than the Spanish version? If this is done to try to conform to cultural differences, can it be changed? This difference is causing a lot of confusion in the clinics. (10/2006) There is a formatting issue with the Spanish version of the form. We are working to resolve this problem.

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Last updated July 05, 2012