FREEDOM OF CHOICE SERVICE DESCRIPTIONS
Texas Health Steps (THSteps): STAR Program Members are free to select any
THSteps enrolled Texas Medicaid Provider to perform THSteps services. Medicaid Members
are eligible for THSteps services until their 21st birthday, based on the Medical
Screening, Immunization, and Adolescent Screening periodicity schedules as published
in Section 39, page 12 of the Texas Medicaid Provider Procedures Manual. The THSteps
screening information should be forwarded to the Member’s PCP in order to complete
the Member's medical record.
Family Planning Services: Family planning services are preventive health,
medical, counseling, and educational services which assist individuals in controlling
their fertility and achieving optimal reproductive and general health. STAR Program
Members are free to select any Texas Medicaid Family Planning Provider to perform
their family planning services. The PCP is encouraged to provide these services
if requested by the patient. However, the patient is not mandated to obtain these
services through the designated PCP.
Strictest confidentiality should be maintained for Members (including minors) seeking
Family Planning services. CHC does not require parental consent for minors who receive
family planning services.
Emergency Room Services: In the event of a true emergency, Members may seek
emergency medical services from the nearest facility. The facility is required to
contact the PCP within 24 hours or the next business day after providing services.
In case of an admission, the facility must also notify CHC within 24 hours or the
next business day, of the admission.
Vision Services: Children (ages 0-20) may receive one eye exam for the purpose
of obtaining eye glasses each state fiscal year (September 1 through August 31).
This limit of one exam within that 12-month period can be expanded in three situations:
1) teacher or school nurse requests eye exam; 2) diopter change of .5 or more; 3)
additional eye exam is medically necessary. Adults (age 21 or over) are eligible
for one examination with refraction for the purpose of obtaining eyeware every 24
For children, there are no limitations on the number of replacements for lost or
destroyed eye wear. This includes necessary major repairs to damaged eyeglasses.
Any diagnosed conditions or abnormalities of the eye which require treatment or
additional services beyond the scope of an exam for refractive errors must be referred
back to the Member’s PCP. Vision care Providers that furnish additional services
must have PCP authorization.
Mental Health and Mental Retardation (MHMR Services): These services include
case management for mental health and mental retardation, mental health rehabilitative
services, and mental retardation diagnosis and assessment through the Texas Department
of Mental Health and Mental Retardation (MHMR, MRDA, MH, MR) and may be provided
without PCP authorization.
Case Management Services: These services include Early Childhood Intervention
(ECI) and Pregnant Women and Infants (PWI) programs. The STAR Program has professional
case managers available for TDH STAR Members. The services provided assist targeted
Members in gaining access to needed medical, social, educational, and other services,
but not actually delivering these services.
School Health and Related Services (SHARS): Those services that are determined
to be medically necessary and reasonable to ensure that Medicaid-eligible children
with disabilities under age 21 receive the benefits accorded to them by federal
and state legislation which guarantees a free and appropriate public education.