Specialists

Articles with relevant information for Specialists.

Physician Incentive Program (updated Jan. 2019)

Texas Children’s Health Plan is introducing its new Physician Incentive Program in an effort to align with state performance and quality measures. The new program focuses on rewarding physician groups for reducing Potentially Preventable Emergency Room Visits (PPV) as well as improving utilization of preventive care based on the Healthcare Effectiveness Data and Information Set (HEDIS) measures. More Information

Telemedicine support now available

Texas Children's Health Plan supports the delivery of telemedicine, telehealth and telemonitoring services to its members. Telemedicine and telehealth services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services. Telemedicine and telehealth services do not require authorization when provided by an in-network provider, except in the case of telemonitoring services. Of note, Texas Children’s Health Plan will not cover telemedicine or telehealth services that are provided through only synchronous [...]

Reminder: Tdap vaccine coverage for CHIP Perinatal members

The Tetanus, Diphtheria, and Acellular Pertussis (Tdap) vaccine is part of routine prenatal care and is a covered benefit for CHIP Perinatal members. Claims are being appropriately reimbursed for this service. This vaccine is recommended by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG) as part of routine prenatal care: CDC: https://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html AAP: https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Updates-TDAP-Recommendations.aspx ACOG: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Update-on-Immunization-and-Pregnancy-Tetanus-Diphtheria-and-Pertussis-Vaccination Resources: Original Notice: https://hhs.texas.gov/about-hhs/communications-events/news/2017/12/reminder-chip-p-coverage-tdap-vaccine Contact: Shuchita.Madan@hhsc.state.tx.us

Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral Health Authorization Form to download. As a reminder, the following essential information is required to start the authorization process: Member Name, [...]

Help your patients keep their New Year’s resolutions in 2019!

Texas Children’s Health Plan offers two programs that can help your patients stick to their New Year’s resolutions well into 2019! The Keep Fit program is available to STAR and CHIP patients ages 10-18 with a BMI of 20+. This program helps kids learn fun, easy ways to stay active and make smart food choices. It offers health coaching, four health and fitness sessions, at-home workout materials, and a quarterly newsletter – all at no cost to the member’s family. [...]

What does Service Coordination mean for your STAR Kids patients?

As a provider, you may have questions regarding the role Service Coordination plays in the lives of our STAR Kids members. At Texas Children’s Health Plan, the goal of Service Coordination is to optimize health to ensure that the member’s tomorrow is better than his or her today. Service Coordination is a person-centered approach to care and each of our members is assigned an appropriately licensed Service Coordinator. In order for that to happen, our Service Coordinators are responsible [...]

What is the Medically Dependent Children’s Program (MDCP) Waiver?

If you have STAR Kids patients, there’s a chance some of them receive the Medically Dependent Children’s Program (MDCP) waiver, which is a home and community based services program. The goal of this program is to support families and children by preventing institutionalization and hospitalization, while helping them remain safely in their homes with the appropriate services. Examples of these services include flexible family support service, respite, minor home modifications, adaptive aids, transition assistance services, employment assistance, supported employment, [...]

Dr. Katy Ostermaier joins Texas Children’s Health Plan as Medical Director for STAR Kids

This past fall, Texas Children’s Health Plan was thrilled to welcome Dr. Katy Ostermaier as the new Medical Director for STAR Kids. Dr. Ostermaier joins us from Texas Children’s Hospital, where she started the Special Needs Primary Care Clinic and served as the Clinic Chief for the Spina Bifida Clinic and the Down Syndrome Clinic. She completed medical school and her pediatric residency at Baylor College of Medicine, where she joined the faculty after completing her training. Dr. Ostermaier [...]

Identifying and treating Seasonal Affective Disorder (SAD)

Season affective disorder (SAD) is a type of depression that appears related to seasonal changes. This recurrent depression may happen every year and occurs most commonly in the fall and winter when the daylight hours shorten, but it may also occur in the spring and summer. SAD may affect up to 5% of the population and seems to be more common in Northern climates and in individuals with a personal history of depression and those with a close relative [...]

Reminder: Tdap Vaccine Coverage for CHIP Perinatal Members

This reminder is to ensure that all providers are knowledgeable on which vaccines are covered for CHIP Perinatal (CHIP-P) members. Based on guidance from the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG), the Tetanus, Diphtheria, and Acellular Pertussis (Tdap) vaccine is routine prenatal care and is covered in CHIP-P. As noted in the ACOG committee opinion: “The overwhelming majority of morbidity and mortality attributable to pertussis infection occurs [...]