Common use of Coordination with Texas Department of Family and Protective Services Clause in Contracts

Coordination with Texas Department of Family and Protective Services. The HMO must cooperate and coordinate with the Texas Department of Family and Protective Services (TDFPS) (formerly the Department of Protective and Regulatory Services) for the care of a child who is receiving services from or has been placed in the conservatorship of TDFPS. The HMO must comply with all provisions related to Covered Services, including Behavioral Health Services, in the following documents: • A court order (Order) entered by a Court of Continuing Jurisdiction placing a child under the protective custody of TDFPS. • A TDFPS Service Plan entered by a Court of Continuing Jurisdiction placing a child under the protective custody of TDFPS. • A TDFPS Service Plan voluntarily entered into by the parents or person having legal custody of a Member and TDFPS. The HMO cannot deny, reduce, or controvert the Medical Necessity of any health or Behavioral Health Services included in an Order. The HMO may participate in the preparation of the medical and behavioral care plan prior to TDFPS submitting the health care plan to the Court. Any modification or termination of court-ordered services must be presented and approved by the court having jurisdiction over the matter. A Member or the parent or guardian whose rights are subject to an Order or Service Plan cannot use the HMO’s Complaint or Appeal processes, or the HHSC Fair Hearing process to Appeal the necessity of the Covered Services. The HMO must include information in its Provider Manuals and training materials regarding:

Coordination with Texas Department of Family and Protective Services. The HMO must cooperate and coordinate with the Texas Department of Family and Protective Services (TDFPS) (formerly the Department of Protective and Regulatory Services) for the care of a child who is receiving services from or has been placed in the conservatorship of TDFPS. The HMO must comply with all provisions related to Covered Services, including Behavioral Health Services, in the following documents: • A court order (Order) entered by a Court of Continuing Jurisdiction placing a child under the protective custody of TDFPS. • A TDFPS Service Plan entered by a Court of Continuing Jurisdiction placing a child under the protective custody of TDFPS. • A TDFPS Service Plan voluntarily entered into by the parents or person having legal custody of a Member and TDFPS. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 8 Version 1.0 The HMO cannot deny, reduce, or controvert the Medical Necessity of any health or Behavioral Health Services included in an Order. The HMO may participate in the preparation of the medical and behavioral care plan prior to TDFPS submitting the health care plan to the Court. Any modification or termination of court-ordered services must be presented and approved by the court having jurisdiction over the matter. A Member or the parent or guardian whose rights are subject to an Order or Service Plan cannot use the HMO’s Complaint or Appeal processes, or the HHSC Fair Hearing process to Appeal the necessity of the Covered Services. The HMO must include information in its Provider Manuals and training materials regarding:

Coordination with Texas Department of Family and Protective Services. The HMO must cooperate and coordinate with the Texas Department of Family and Protective Services (TDFPS) (formerly the Department of Protective and Regulatory Services) for the care of a child who is receiving services from or has been placed in the conservatorship of TDFPS. The HMO must comply with all provisions related to Covered Services, including Behavioral Health Services, in the following documents: • A court order (Order) entered by a Court of Continuing Jurisdiction placing a child under the protective custody of TDFPS. • A TDFPS Service Plan entered by a Court of Continuing Jurisdiction placing a child under the protective custody of TDFPS. • A TDFPS Service Plan voluntarily entered into by the parents or person having legal custody of a Member and TDFPS. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 8 Version 1.7 The HMO cannot deny, reduce, or controvert the Medical Necessity of any health or Behavioral Health Services included in an Order. The HMO may participate in the preparation of the medical and behavioral care plan prior to TDFPS submitting the health care plan to the Court. Any modification or termination of court-ordered services must be presented and approved by the court having jurisdiction over the matter. A Member or the parent or guardian whose rights are subject to an Order or Service Plan cannot use the HMO’s Complaint or Appeal processes, or the HHSC Fair Hearing process to Appeal the necessity of the Covered Services. The HMO must include information in its Provider Manuals and training materials regarding: