Common use of Allowable Services Clause in Contracts

Allowable Services. Attachment A Grantees must enroll as Medicaid providers with Texas Medicaid & Healthcare Partnership (TMHP). Grantees must complete the required Medicaid provider enrollment application forms and enter into a written Medicaid provider agreement with HHSC, the single State Medicaid agency. Applicant must maintain an active Texas Medicaid provider status. For additional information on how to apply visit Medicaid Provider Enrollment. Grantees must offer, with HHSC prior approval, some or all the following women’s preventive health services in the MHU. Grantees must maximize reimbursement of allowable services through established programs such as Medicaid, Healthy Texas Women, Family Planning Program, or Breast & Cervical Cancer Services prior to utilizing MHU funds. Services that must be offered include, but are not limited to: • Contraceptive services (pregnancy prevention and birth spacing), that may include: o Long-Acting Reversible Contraceptives (LARCs); o Oral contraceptive pills; o Three-month (medroxyprogesterone) injections; and o Sterilizations. • Pregnancy testing and counseling. • Health screenings, and diagnostics if feasible, as follows: o Breast cancer screening (Clinical breast exams and mammograms); o Cervical cancer screening (Pap smears and other cervical cancer screenings); and o Screening for hypertension, diabetes, and elevated cholesterol. • Pharmaceutical treatment for post-partum depression, hypertension, diabetes, and elevated cholesterol. • Preconception health (for example, screening for nutrition and obesity, tobacco and substance use, other high-risk behaviors, social issues, and mental health). • Sexually transmitted infection (STI) services, including, but not limited to: o Chlamydia, syphilis, and gonorrhea screening and treatment; and o HIV screening. If feasible, grantees must identify HTW, FPP, and BCC providers within 50 miles of each site MHU services are provided. Grantee must establish a process to refer MHU clients to local HTW, FPP, and BCC providers for ongoing service provision and follow-up. Grantees must provide MHU clients with patient navigation services, including: • An assessment of the client’s barriers to women’s preventive health services. The assessment of barriers must include screening for non-medical service needs with an assessment tool provided by the System Agency when available. Attachment A • Client education and support. • Resolution of client barriers (for example, transportation and translation services). • Client tracking and follow-up to monitor progress in completing needed services and follow-ups. • Collection of data to evaluate the primary outcomes of patient navigation, including client adherence to service recommendations and clients lost to follow-up. Grantees must have a minimum of a Class D Pharmacy license or must enter into one or more Memorandums of Understanding (MOUs) with local pharmacies in the community to ensure MHU client access to needed pharmaceuticals. Grantees must have dedicated staff to conduct client reminders via text, phone call, automated electronic health record, or other method or must contract for this service with each specific site location. Grantees must establish a process for communicating results to clients via mailed letters, phone calls, patient portals, or other method or must contract for this service with an affiliated clinic or hospital, or with each specific site location.