Texas Health Steps Provider Education

Transcription

1 Texas Health Steps Provider Education This presentation is designed to educate physicians and health care providers in UnitedHealthcare network regarding Texas Health Steps (THSteps) as applicable to UnitedHealthcare STAR and STAR+PLUS members through 20 years of age. The information applies to those enrolled through Texas Medicaid & Healthcare Partnership (TMHP) as THSteps providers and those considering enrollment to serve this population. In addition to this UnitedHealthcare resource, information about Texas Health Steps is also available through TMHP and the Texas Health and Human Services Commission (HHSC). The current Texas Medicaid Provider Procedures Manual Children s Services Handbook prevails in authority of THSteps policy and procedures. Provider Recognition Upon completion of this training you may choose to allow HHSC to post your name on their website so that families may see the names of providers enrolled in THSteps who are current with requirements and expectations. Indicate in the brief survey after this presentation if you choose to have your name posted to the HHSC website, or call Customer Service at to give your consent. Once you ve completed this THSteps provider communication, please take a few moments to complete a brief survey online. 1 For your convenience, a survey is also included in this presentation if you prefer to complete and fax. Texas Health Steps Provider Education Overview The Texas Medical Assistance (Medicaid) Program was implemented in 1967, under Title XIX of the federal Social Security Act and Chapter 23 of the Texas Human Resources Code. The cost of Medicaid is shared by the state of Texas and the federal government. The Texas Health and Human Services Commission (HHSC) is the single state Medicaid agency responsible for the program. Administration of the program is through contracts and agreements with medical providers, claims administrators, enrollment brokers, managed care organizations, and state agencies including the Texas Department of State Health Services (DSHS). Frew, et al.v. Janek, et al. As a participant in the Medicaid program, Texas must meet certain federal requirements including that it has an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for children. In Texas this program is THSteps. Mothers of children eligible for state services in Texas, sought conjunctive relief in 1996 against state agencies and various state officials. Frew,et al. v. Janek, et al. claimed that the Texas program did not meet federal requirements. 1

2 The following Corrective Actions were ordered in 2007 as part of Frew, et al. v. Janek, et al. Consent Decree, which has been revised over the years: Case Management Checkup Reports and Plans for Lagging Counties Checkups Health Outcome Measures and Dental Assessment Managed Care Outreach and Informing Prescription and Non-Prescription Medication; Medical Equipment and Supplies Adequate Supply of Health Care Providers Health Care Provider Training Toll-Free Numbers Transportation Program Texas Health Steps Provider Enrollment THSteps provider enrollment is handled by the Texas Medicaid contractor TMHP. Information is available at TMHP.com and includes contact information for regionally-based DSHS Provider Relations representatives who are available to assist you. Providers serving Medicaid members require a national provider identification (NPI) number per the Health Insurance Portability and Accountability Act (HIPAA). UnitedHealthcare requires providers to include this information on encounter submissions where appropriate. A Texas provider identification (TPI) number is also necessary to serve Medicaid members. See TPI and NPI application information in the billing section of this resource. Texas Health Steps Provider Training DSHS provides continuing education and training at no cost to THSteps providers. This training is mandatory for THSteps enrollment and available for any health care professional. The training includes information regarding the program s preventive health, mental health, oral health and case management services. THSteps online courses are accredited by: American Nurses Credentialing Center National Commission for Health Education Credentialing Texas Medical Association Texas State Board of Social Worker Examiners Registered Nurses Providing Texas Health Steps Medical Checkups Physicians must establish an RN s competency to perform THSteps Medical checkups for THSteps members as required by the physician s scope of the practice, before delegating this responsibility to the RN. See Texas Medicaid Provider Procedures Manual. Volume 2: Children s Services Handbook, Section Requirements for Registered Nurses Who Provide Medical Checkups for additional information. The RN must have completed all required THSteps online education modules prior to performing THSteps checkups. The RN or the RN s employer must maintain documentation of the completion of all required modules. The supervising physician must be on site or immediately available to furnish assistance and direction to the RN during the THSteps checkup. Any follow-up or referral to a physician, the visit must be offered within 14 days. Use the RN modifier, TD, when billing for an RN THSteps checkup. RNs in Federally Qualified Health Centers should bill using SA. Periodicity Schedule The THSteps Periodicity Schedule outlines comprehensive health screening guidelines and the expected timeline for completion. Keep current with the most recently updated Periodicity Schedule online at TMHP.com. (See THSteps then THSteps Resources.) View360 Available through UnitedHealthcareOnline.com, this physician tool provides participating physicians with information for UnitedHealthcare Community Plan members who may need specific treatments or screenings consistent with national quality guidelines and specific to HEDIS. Information includes members who may need to schedule an annual THSteps Medical checkup or preventive screenings.

3 THSteps Medical Checkup Components Comprehensive Health and Developmental History Developmental Screening Mental Health Nutritional Screening Tuberculosis (TB) Screening Comprehensive Unclothed Physical Examination Measurements (CDC recommends that health care providers: Use the WHO growth standards to monitor growth for infants and children ages 0 to 2 years of age. Use the CDC growth charts for children age 2 years and older.) Sensory Screening Vision Services Hearing Services Dental Services (Limited oral screening for caries and general health of the teeth and oral mucosa is part of the physical examination. In addition to the federal requirements, THSteps policy requires referral to a dentist at six months of age and every six months thereafter until the dental home has been established.) Immunizations Laboratory Screening Health Education and Anticipatory Guidance Oral Evaluation and Fluoride Varnish Oral Evaluation and Fluoride Varnish (OEFV) 1 offers limited services aimed at improving the oral health of children from ages six months through 35 months. Providers must complete OEFV training offered by the Texas Department of State Health Services Oral Health Program to become certified to bill for this service. All other medical team members are encouraged to take the online training. THSteps physicians, physician assistants, and advanced practice nurses, once trained, are eligible to provide the following related services that must be performed as part of a THSteps medical checkup: Intermediate oral evaluation Fluoride varnish application Dental anticipatory guidance Referral to a dental home Laboratory Tests and Screenings The Periodicity Schedule outlines expectations for the following tests and screenings: Newborn screening panel Blood lead Anemia Hyperlipidemia Tuberculin Skin Test (TST) Type 2 diabetes Sexually transmitted disease/sexually transmitted infection screening (STD/SDI) HIV test Contact the Texas Department of State Health Services Laboratory at , ext or go to for information regarding procedures and resources. Children of Farmworkers Children of farmworkers are identified as needing additional assistance because of the following factors that may contribute to poor health: unconventional living conditions, migratory work patterns, poverty, poor nutrition, lack of education and illiteracy. TMHP is continuing its efforts to increase the number of children of farmworkers who receive timely THSteps medical and dental checkups. When UnitedHealthcare identifies a member as being a child of a farmworker, we provide accelerated health care services as recommended in the Periodicity Schedule including immunizations and screenings to accommodate the family s work schedule. UnitedHealthcare also hosts health fairs and presentations to community-based organizations to identify farmworkers and assist them with receiving medical care. Please contact our Outreach Team at when you identify a member who is a child of a farmworker. The for this Team is texashealthsteps@uhc.com.

4 Early Childhood Intervention Early Childhood Intervention (ECI) is a statewide program for families with children from birth to age three with disabilities and developmental delays. ECI provides developmental services through local agencies and organizations to help these children reach their potential. Children under age 3 need to be referred to ECI for services as soon as possible but in no case longer than 7 days of being identified as having a potential delay. To refer a child to ECI, contact the Department of Assistive and Rehabilitative Services Inquiries Line at or dars.inquiries@dars.state.tx.us. Visit ECI2 for a list of resources, including a medical list of qualifying conditions and the nearest location. Children 3 years and older with a delay or suspected disability or delay must be referred to the child s school district Child Find Coordinator. Children With Special Health Care Needs The Children with Special Health Care Needs (CSHCN) Services Program serves any child who: Has a serious ongoing illness, a chronic or complex condition, or a disability that has lasted or is anticipated to last for a significant period of time. Requires regular, ongoing therapeutic intervention and evaluation by appropriately trained personnel. All STAR+PLUS Medicaid members are included as children with special health care needs. To enroll as a provider for the CSHCN Services Program, please call Eligible children receive medical, dental and mental health care, including: Prescription drugs Special therapies Care management Family support services Travel to health care visits Assistance with insurance premiums Teens and Young Adults: Prevention and Treatment Members as young as age 13 years through age 20 do not receive the important prevention and treatment they need. The Periodicity Schedule includes the following screenings, immunizations and assessments. The chart below includes value-added services, available at no cost to the member, that correspond with this population and THSteps. Screenings, Immunizations and Assessments Vision screenings Hearing screenings Dental referrals Mental health and substance use disorder assessments Optum (under the trade name - United Behavioral Health) is contracted with UnitedHealthcare to provide mental health and substance use disorder interventions. Over-the-counter tobacco cessation products are a Value-added Service. Anemia screening (risk-based for females through age 16) Vitamins and minerals prescribed to treat a condition are a covered benefit. Hyperlipidemia (risk-based) Weight Watchers and Join for Me are Value-added Services. Type 2 diabetes (risk-based) Weight Watchers and Join for Me are Value-added Services available to at-risk members. TB Questionnaire with test of at-risk** STD/STI screening (risk-based)** HIV (risk-based)** Tetanus, diphtheria, pertussis vaccine (if not already received)*** Human papillomavirus vaccine (if not already received)*** Human papillomavirus booster (unless first dose administered at age 16 or older)*** Annual Influenza vaccine*** Meningococcal booster at age 16*** ***Members age16 and older are able to consent without parent for examination and treatment for suicide prevention, chemical addiction or dependency, or for sexual, physical, or emotional abuse. ***Members age 16 and older are able to consent without parent for diagnosis and treatment of infectious, contagious, or communicable disease that is reportable to the Texas Department of State Health Services (DSHS). ***Consult Centers for Disease Control and Prevention, Advisory Commission of Immunization Practices (ACIP) 2 for updates to these recommendations.

5 Treatment without Parental Consent Several conditions allow teens to obtain medical treatment without parental consent. The DSHS Adolescent Health A Guide for Professionals offers guidelines on health and health-related legal issues pertinent to the adolescent years. In addition, THSteps online provider training offers adolescent health courses, which address screening, identifying and treating high risk behaviors, and consent and confidentiality. Minors can consent to treatment by a physician or a dentist when the minor is: On active duty with armed services Age 16 and older and residing apart from parents, or managing conservator or guardian and managing his or her own financial affairs Unmarried and pregnant and consenting to treatment related to pregnancy other than abortion Unmarried and the parent of a child, has actual custody of that child and consents for him or her Consenting to diagnosis or treatment of an infectious, contagious, or communicable disease that is reportable to DSHS Consenting to examination or treatment for chemical addiction, dependency, or any other condition directly related to chemical use Consenting for counseling for suicide prevention, chemical addiction or dependency, or for sexual, physical, or emotional abuse Teens and Young Adult Wellness Counseling and Assessment The American College of Preventive Medicine (ACPM) training for primary care providers (PCPs) featuring practice tools for treating adolescents including discussion about depression and obesity. In its adolescent wellness exam considerations, the ACPM recommends providers seek opportunities to ensure privacy for adolescents and consider the following: Many adolescents have not yet had a private and confidential visit with their provider. Adolescents who have a private and confidential visit are more likely to have had counseling with their provider. Private visits are two to three times more likely to include counseling for risk behaviors in general, especially sexual activity, emotional health and relationships. Advocates for Youth, 2 established in 1980 as the Center for Population Options, offers best practices for youth-friendly clinical services including respect, confidentiality, cultural sensitivity and teen perspective. Make sure staff has a clear understanding of the state s laws on informed consent and confidentiality. Train all clinic staff about the importance of guarding adolescents confidentiality. Ensure that receptionists, medical assistants, technicians, and clinicians understand how sensitive youth may be to any incident or disclosure of medical records, name, appointment, test results, and/or the reason for seeking care. When any teen is accompanied to the clinic by a parent or guardian, always have counseling time alone with them and this may help encourage the teen to share a health problem or concern that they would not in the presence of a parent. Be willing to treat unaccompanied minors who come into the clinic or practice without a parent. Refer a minor to a pharmacy where her/his confidentiality will be respected and where the pharmacist will call the clinician (not the parents) with questions about a prescription. Please note that transportation may be an issue for teens and young adults getting to/from your office and the pharmacy. See transportation section of this presentation for resources that are available for these members. Delivering Services to Teens and Young Adults When a teen or young adult receives treatment for an illness, consider anticipating or catching up the Periodicity Schedule as appropriate. An office visit provided for a separately identifiable service on the same day as a planned procedure is considered for reimbursement with medical documentation. The modifier 25 should be appended to the evaluation and management code to indicate that the evaluation was provided for a separately identifiable service. A Special Invitation A word from you could be the impetus for a teen or young adult to come in for a checkup and preventive services. To assist you, we have designed reminder letters that can be customized with your information to send to members regarding scheduled appointments or services needed. The letters are posted in English and Spanish at UHCCommunityplan.com. Select Provider Forms and then see Member Applicable Resources.

6 Language Translation Services UnitedHealthcare contracts with the following language assistance programs at no cost to you or the member. Alliance for Multicultural Community Services You are obligated to assist members who may have limited English proficiency or reading skills. An interpreter/translation service through the Alliance for Multicultural Community Services is available at the request of the member or the provider. Customer Service ( ) can coordinate these over-the-phone interpretive services in more than 70 available languages. Telephone interpreting services are also available for members who are hearing-impaired, deaf or speech-impaired. The Alliance for Multicultural Community Services can be contacted directly from 8 a.m. to 5 p.m. Monday through Friday at TDD/TTY AT&T Language Line The AT&T Language Line is available in more than 200 languages, around the clock, 365 days a year. Contact UnitedHealthcare Customer Service at for assistance coordinating these services. Services for the hearing impaired are available at TDD/TTY. Pharmacy Benefits OptumRx, our pharmacy benefits manager, will adhere to the state-approved formulary and preferred drug list (PDL). You may view the list of covered drugs at UHCCommunityplan.com. Select Healthcare Professional then Texas and Pharmacy Program. Prescriber requests for authorizations can be made by calling or faxing authorization to Medications can be dispensed as an emergency 72-hour supply when drug therapy must start without delay and prior authorization is not available. This rule applies to non-preferred drugs on the PDL and to any drug that is affected by a clinical or PA edit. When submitting a 72-hour supply, please submit the following: Prior Authorization Type Code (Field 461-EU) = 8 Prior Authorization Number Submitted (Field 462-EU) = Day Supply in the claim segment of the billing transaction (Field 405-D5) = 3 Preferred Drug List For STAR, STAR+PLUS and CHIP members, providers may utilize Epocrates, an outpatient RX online Medicaid formulary resource. This information can be found at Epocrates provides instant access to information on the drugs covered by Medicaid using a Palm or Pocket PC handheld device. To register for the service, go to the Epocrates website and sign up for Epocrates Rx. Preferred Drug lists by program are listed at UHCCommunityPlan.com. Electronic Prescribing Electronic prescribing (e-prescribing or erx) gives prescribing physicians the means to send prescriptions electronically to a pharmacy. This is enabled with the authorized exchange of data from the Pharmacy Benefit Manager or payer and the prescriber. E-prescribing can help providers save time and money and help eliminate medication confusion. We offer e-prescribing for pharmacy claims via surescripts. Vaccines Texas Vaccines for Children Being a Texas Vaccines For Children (TVFC) provider means children, birth through 18 years, receive immunizations in their provider s office, and uninsured children do not have to be referred to a public health center in order to receive free immunizations. In order to participate in TVFC, please complete and sign the following: Enrollment and provider profile forms Agreement to screen for eligibility Agreement to maintain screening records The Immunization Branch Central Office is located in Austin, Texas and can be contacted at

7 Immunization Tool: ImmTrac The ImmTrac registry gives providers and other authorized entities secure, online access to the Texas immunization registry. In addition to online access to ImmTrac, an electronic data import process is available to providers who are currently entering data into a client encounter or electronic health records system. If the child is not found in the registry, a parental consent form will be sent electronically in order to register the child in ImmTrac. Providers without computers or internet access, can report immunizations by using a Paper Reporting Form. The form is available by calling ImmTrac Customer Support at A Comprehensive Clinic Assessment software application is also available for assessing immunizations practices within a clinic, private practice or other environment where immunizations are provided. More information is available through the Centers for Disease Control and Prevention web site CDC.gov. Transportation Non-Emergency Medical Transportation Non-emergency medical transportation provided by the Medical Transportation Program (MTP) and Medical Transportation Management (MTM) is available to members who have no other means of transportation to get to the doctor, dentist or pharmacy. Transportation services include prearranged van pick-up, bus passes or money for gasoline. In some cases the program may pay for overnight lodging and meals for members younger than 21 and the person with whom they are traveling. To set up services for non-emergency medical transportation, the family or a representative (including staff from the PCP office) can call: Hidalgo, Nueces and Travis SDAs: Harris and Jefferson SDAs: LogistiCare UnitedHealthcare is contracted with LogistiCare for non-emergent medical transportation if MTP and MTM are not available. Visit LogistiCare s Texas-specific site for the following. Frequently Asked Questions that cover such topics as: how much notice is required how to set up a hospital discharge how to secure services Downloadable forms for transportation services are available at facilityinfo.logisticare.com or at logisticare.com. For information about services, call LogistiCare at or their Ride Assist line at Patient Education DSHS offers resources for families regarding: Medical transportation Dental checkups Medical checkups Newborn hearing screening Case management for Children and Pregnant Women To order these materials, visit THSteps Catalogue to order publications online. For questions about placing an order, please call Member information is also available from UnitedHealthcare Community Plan detailing specialists and contact information. Call to have these delivered to your office. Missed Appointments When a STAR or STAR+PLUS UnitedHealthcare member misses an appointment please call the member to reschedule. If necessary assist them in securing transportation or refer the member to UnitedHealthcare Community Plan for assistance at or texashealthsteps@uhc.com. Also, complete online or fax the Provider Outreach Referral Service Form (formerly known as Missed Appointment Form ) to THSteps at

8 The THSteps Provider Outreach Referral Service is utilized by THSteps providers who request outreach and follow-up for a THSteps patient. This outreach service is administered by the THSteps program and provides necessary outreach and follow-up with THSteps patients, such as: Contacting a member to schedule a follow-up appointment Contacting a member to reschedule a missed appointment Contacting a member to assist with scheduling transportation to the appointment Contacting a member for other patient-related outreach services Disease Management Criteria for member participation in the UnitedHealthcare Disease Management program are: Enrolled in a plan in which UnitedHealthcare is the payer for acute services Moderate-high risk score on the health risk assessment Diagnosed with a chronic and/or complex condition, such as: Asthma Chronic obstructive pulmonary disease Congestive heart failure Coronary artery disease Diabetes High-risk pregnancy Call STAR Care Management for members is based on identification of risk. Call STAR+PLUS Service Coordination for all members enrolled in STAR+PLUS. Reporting Child Abuse and Neglect Each contractor/provider shall comply with the provisions of state law (Chapter 261 of the Texas Family Code) related to investigation of reported child abuse and neglect and the HHSC policy. Contractor/ provider staff shall respond to disclosures or suspicions of abuse/neglect of minors by reporting to appropriate agencies no later than 48 hours after the provider first has cause to believe the child has been or may be abused, neglected or is the victim of the offense of indecency with a child. Txabusehotline.org Texas Abuse Hotline at Emergency reporting at 911 Case Management for Children and Pregnant Women This THSteps service is available to members from birth through age 20 and pregnant women who receive Medicaid benefits and have health problems or are at risk for health problems. A case manager will visit the eligible member to determine: What services may be needed such as connecting the member with a social worker or nurse Location of physician or therapist or other health care professional near where he/she lives How to help the member find and obtain medically-necessary services Whether the member is getting the services they need Case managers can help members to access medical and dental services; medical supplies or equipment; and information on school or education issues. Providers or members can call Case Management for Children and Pregnant Women Monday to Friday, 8 a.m. to 8 p.m. at To learn more, visit their website at dshs.state.tx.us. DME Limited durable medical equipment (DME) items are available through the medical benefits plan for pharmacies that are Medicaid DME medical providers including: Orally administered iron salts Insulin syringes and needles Aerosol holding chambers Blood glucose meters Blood glucose reagent strips Diabetic lancets and devices Hypertonic saline solution Oral bowel evacuants Oral electrolyte solution

9 Billing THSteps administrative codes are updated periodically. Visit TMHP.org for codes for medical checkups, and immunizations for STAR or STAR+PLUS members. Every child that is a patient of yours and a member of STAR or STAR+PLUS must have one of the following codes and corresponding THSteps medical checkups every year: For oral evaluation and fluoride varnish, please use procedure code with U5 modifier. A new checkup and evaluation and management visit performed on the same day may both be reimbursed as new patient visits if the member meets the new patient requirements. TMHP Online Fee Lookup 5 provides fee information for Medicaid, CSHCN and THSteps programs. Users can also search TMHP.com for fee information on specified procedure codes, by provider type and by specialty. Obtaining Necessary NPI and TPI Numbers The following methods are available for applying for NPI and TPI numbers: Method NPI Number TPI Number Website nppes.com.hhs.gov TMHP.com Phone Mailing Address NPI Enumerator P.O. Box 6059 Fargo, ND TMHP Attn: Provider Enrollment P.O. Box Austin, TX Texas State Billing Guidelines Claims must be received by UnitedHealthcare within 95 days of the date of service for the claim to be considered for payment. Providers must file appeals or adjustment requests within 120 days from the date of disposition as per Texas Medicaid Provider Procedures Manual available at TMHP.com. When a Medicaid client has other health insurance, the other insurance must be billed by the provider before billing the Texas Medicaid Program. If the third party resource has not responded to or has delayed payment on a provider s claim for more than 110 days from the date the claim was billed, Medicaid will consider the claim for reimbursement. UnitedHealthcare follows the Texas State Medicaid Program for claims filing, appeals and adjustment guidelines. See Texas Claims Procedures, then Claims Manual. Update Your Contact Information The TMHP Basic Provider Search needs to accurately list your practice information so that members may find you. Visit TMPH.com, select TexMedConnect and log in to update your profile. Providers can make changes to the following demographics. Changes involving your identification numbers or name need to be submitted to TMHP using a Provider Information Change Form. Address, telephone numbers and office hours Languages spoken Additional sites where services are provided Accepting new patients Additional services offered Client age or gender limitations Counties served Medicaid waiver programs The UnitedHealthcare provider search Find a Doctor. To keep your contact information current, submit updated information to Provider Relations using the Provider Address and Tax Updates form located at UHCCommunityPlan.com or call Customer Service at UnitedHealthcare Provider Resources Network Management This is your resource for contractual issues, fee schedules and ensuring that your contract information is correct. Call Physician Advocate Provider Advocates are responsible for education and guidance when interfacing with UnitedHealthcare. They can be reached via at providerservicestx@uhc.com. They conduct town halls, host webinars and are also available for office visits. For immediate assistance, contact Customer Service where a team is dedicated to answer provider questions at

10 Provider Engagement Consultants The Provider Engagement team is an innovative approach by UnitedHealthcare to engage our high volume primary care providers, federally qualified health centers and rural health clinics to offer a concierge experience through high level customer service. The team focuses on providing a thorough explanation of health plan attributes, processes, health education and outcomes to our provider community. Member Advocates Member advocates support the member experience of UnitedHealthcare. They are bilingual in English and Spanish, but are able to secure other language translation as necessary. A member advocate becomes involved upon request as the result of a call to Customer Service. Some of their services include the following: Maintain or renew membership Secure a primary care provider that meets members cultural and language needs Obtain covered services Change a PCP, if necessary Locate a specialist, hospital or other needed providers Assist with filing a complaint Note a name or address change for member Value-added Services Value-added services are offered in addition to covered benefits and are available to UnitedHealthcare members for not additional cost. For additional information or to refer a member to a specific service, call Customer Service at Once you ve completed this Texas Health Steps provider communication, please take a few moments to complete a brief survey online. For your convenience, a survey is also included in this presentation if you prefer to complete and fax. Online Resources Texas Medicaid Provider Procedure Manual Medicaid and THSteps Forms HHSC THSteps Training Texas Pediatric Society: THSteps Education Texas Department of State Health Services Texas Health and Human Services Commission TMHP THSteps UnitedHealthcareOnline.com UHCCommunityPlan.com

11 Survey 1. Welcome to the UnitedHealthcare Texas Health Steps Survey. Please begin by telling us about you. Name of Provider or Group TAX ID or NPI(s) of training Attendees UnitedHealthcare Provider Advocate 2. In what type of training did you participate (please check below)? Provider Advocate Visit Webinar Town Hall UnitedHealthcare Community plan Texas Health Steps Compact Disk (CD) Telephone 3. Enter Date Here 4. Please rate your satisfaction regarding the information you received today about Texas Health Steps (please check). Topics Medical Checkup Periodicity Schedule Required Elements of a Checkup Required Lab Tests Importance of updating provider contact information to ensure accurate provider directories and the Medicaid Online Provider Lookup Immunization Schedule The process of acceleration of Texas Health Steps services for children of migrant farm workers missed appointment referrals and assistance provided by the Texas Health Steps Outreach and Informing Unit Available services, such as medical transportation and disease management and specialist services Claims filing and billing codes 72-hour emergency supply prescription policy and procedures Requirements of the Frew Consent Decree and Corrective Action Orders Outpatient Prescription Drug Prior Authorization Process How to access the Medicaid formulary and Preferred Drug List (PDL) of Health and Human Services Commissions (HHSC) website How to use HHSC s free subscription service for accessing the Medicaid formulary through PDL through the internet and hand-held devices Scope of Durable Medical Equipment (DME) and other items commonly found in a pharmacy that are available for class members Strongly Disagree Disagree Agree Strongly Agree 5. If you are a Texas Health Steps Certified Provider, you qualify to be recognized on the Texas Health and Human Services Commission website as having completed this training. Do you consent to being recognized (check one)? Yes No If yes, enter your name here as you would like it to appear (please print).

12 Survey 6. Are you a Registered Nurse (RN) that performs Texas Health Steps Checkups? Or do RNs at your practice perform Texas Health Steps Checkups (check one)? Yes No 7. Please take a moment to enter the number of each Medicaid Provider from your practice that participated in or benefits from today s training (please note number of each profession in appropriate box) Advanced Practice Nurse Family Practice Physician Pediatrician General Medicine MD Internal Medicine MD Physician s Assistant Nurse (RN, LVN) Hematology/Oncology MD Neonatologist Nephrologist Neurologist Ophthalmologist Pulmonologist Surgeon Dental Primary Care Dental Specialist Dental Hygienist Psychiatrist Psychologist Optometrist Social Worker Dietician Home Health Behavior Health NOS Pharmacist Staff Pharmacist Pharmacy Technician Other Thank you for taking the time to compete this survey today! Please return this completed survey via any of the following avenues: uhc_cp_prov_relations@uhc.com Fax: Mail: UnitedHealthcare Provider Relations Southwest Freeway, Suite 800 Sugar Land, TX 77478

13 Reference Page Agency Website Telephone Number Texas Medicaid & Healthcare Partnership (TMHP) Texas Health and Human Services Commission (HHSC) Texas Medicaid Provider Procedures Manual Children s Services Handbook Provider Survey Texas Department of State Health Services (DSHS) Frew, et al.v. Janek, et al. Corrective Actions Texas Health Steps Provider Enrollment Application Regionally DSHS Provider Relations Representatives Health Insurance Portability and Accountability Act (HIPAA) Texas Provider Identification number (TPI) National Practitioner Identifier (NPI) Instructions Requirements for Registered Nurses Who Provide THSteps Checkups Texas Health Steps (THSteps) Online Training Current/Vol2_Children s_services_handbook html# aspx?pid=zhxzzxxcmz9ukqz THSteps%20Provider%20Enrollment%20Application.pdf texas%20medicaid%20provider%20enrollment%20 application.pdf do?forward=static.instructions Children s_services_handbook html# Periodicity Schedule Texas Health Steps (THSteps) Home Page Texas Health Steps (THSteps) Medical Checkup Components UnitedHealthcare Online is the provider website for UnitedHealthcare: View components.shtm CmaAction.do?channelId=5bae2db818b7a210Vgn VCM f10b10a Oral Evaluation and Fluoride Varnish Oral Evaluation and Fluoride Varnish training Department of State Health Services (DSHS) Laboratory , ext Early Childhood Intervention (ECI)

14 Reference Page Agency Website Telephone Number Early Childhood Intervention (ECI) Resources Children With Special Health Care Needs Services Program The Center for Disease Control and Prevention (CDC) vaccination schedules Center for Disease Control (CDC) Vaccine-specific recommendations Texas Department of State Health Services (DSHS) Adolescent Health Guide for Providers American College of Preventative Medicine vacc-specific/index.html Advocates for Youth UnitedHealthcareCommunityPlan Provider Forms provider-forms Alliance Translation Services Call Customer Service at Language Line Translation Services Call Customer Service at Epocrates UnitedHealthcareCommunityPlan Pharmacy Program pharmacy-program Surescripts Texas Vaccines for Children The Texas Department of State Health Services (DSHS) The Center for Disease Control and Prevention) The Center for Disease Control and Prevention (CDC) The Texas Department of State Health Services (DSHS) Medical Transportation LogistiCare LogistiCare Facility Home Page Department of State Health Services (DSHS) Medicaid Transportation Texas Health Steps (THSteps) Resource Catalog downloads.aspx

15 Reference Page Agency Website Telephone Number Texas Health Steps (THSteps) Provider Outreach Referral Form pageid=29814&id= &terms=missed +appointment+form Reporting Abuse and Neglect Case Management for Children and Pregnant Women Texas Health Steps Quick Reference Guide Texas Medicaid and Healthcare Partnership (TMHP) Fee Schedule The National Plan and Provider Enumeration System Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment The Texas Health and Human Services Commission (HHSC) Uniform Managed Care Manual Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment Provider Information Change Form Texas Medicaid and Healthcare Partnership (TMHP) Provider Update Information Form UnitedHealthcareCommunityPlan Find a Physician UnitedHealthcareCommunityPlan Provider Address and Tax ID Number Change Form Texas Pediatric Society is a chapter of the American Academy of Pediatrics UnitedHealthcare Online is the provider website for UnitedHealthcare UnitedHealthcareCommunityPlan Texas Provider Information UnitedHealthcareCommunityPlan Value-added Services Survey THStepsQRG/THSteps_QRG.pdf Home.aspx Enrollment/Provider-Information-Change-Form.pdf with_tmhp.pdf find-a-physician.html dam/communityplan/healthcareprofessionals/ providerinformation/tx-change-of-addressand-tax-id-form-2011.pdf do?viewkey=preloginmain&forwardtoken= PreLoginMain /TX/provider-information communityplan/healthcareprofessionals/bulletins/ TX-Chip-Star-StarPlusMembers pdf portal/title.aspx?pid=zhxzzxxcmz9ukqz