Newborn Screening Program Benefits

Contractors Providing Benefits

The Department of State Health Services (DSHS) works with contractors to provide newborn screening benefits and services to eligible clients in Texas using Newborn Screening Program (NBS) Benefits. To provide these approved services and benefits, contractors are required to understand and be knowledgeable of terminology, eligibility screening requirements and processes as well as comply with specific federal and state laws and procedures. 

The NBS Benefits Contractor Procedures Manual and Supplement Benefits Lists provide important information to contractors. NBS Benefits reimburses enrolled providers for the provision of specified services to eligible clients in accordance with the NBS Program rules. 

Contractor Manual 

The contractor manual describes benefit provider qualifications, the client eligibility process, and billing and reimbursement. The supplements to the manual are separately posted to allow for ease of updating as needed. 

Newborn Screening Program Benefits Forms
Forms are PDF files unless otherwise indicated. 

Eligibility Forms 

Monthly Billing and Report Forms  

Optional Forms

Eligibility Requirements

NOTE: NBS Benefits is a payer if last resort. This means that all applicants first must apply for Medicaid, Children's Health Insurance Program (CHIP), and Children with Special Health Care Needs (CSHCN) before applying for NBS Benefits.

Infants, children, and adults are prioritized by need as funds are available and meet the following:

  • Have income at or below 350% of Federal Poverty Income Level
  • Are diagnosed with disorder identified by Newborn Screening Program
  • Are a bona fide resident of the State of Texas
  • Have an annual renewal review
  • Are ineligible for other programs providing the same services such as:
    • Medicaid recipients
    • Children with Special Health Care Needs (eligible if on waiting list)
    • Children’s Health Insurance (CHIP) program
    • CHIP Perinatal
    • Title V Genetic Services
    • Private Insurance

Benefits Provided

  • Dietary supplements, metabolic foods (formulas), and low-protein foods 
  • Medications
  • Vitamins
  • Confirmatory testing, evaluation, and follow-up care
  • Reimbursement to specialists for telephone consults 

Eligible Providers  

  • Medical geneticists and clinics
  • Centers specializing in metabolic, endocrine and hematological disorders
  • Laboratories that provide confirmatory testing
  • Pharmacies that provide vitamins, medications, dietary supplements (metabolic foods)
  • Manufacturers or retailers of medical foods that provide low-protein foods, formulas, dietary supplements, and vitamins

Newborn Screening Disorders

All Texas newborns are screened for more than 50 rare conditions that can cause developmental delays, major illness or even death. 

Questions? 

Email nbsbenefits@dshs.texas.gov or call 1-800-252-8023 ext. 2682 for questions or if you need additional information about NBS program benefits.

Open enrollment information

Please email Kimberly Tolbert if you have questions about open enrollment. 

Last updated March 12, 2019