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5000 Behavioral Health and Healthcare Services

24 Hour Residential Child Care Requirements Guide December 2016

The provider accesses Medicaid through STAR Health for covered medical, dental, vision, and pharmacy services available to the child.

If STAR Health Denies Services

No later than the third business day after the child’s provider receives a STAR Health Denial Letter, the provider emails a scanned copy of the denial letter and the date it was received to the CPS caseworker and the regional well-being specialist.

If Services are Not Available

If neither community nor Medicaid resources are available to fund recommended medical, dental, vision, or pharmaceutical services, the provider requests assistance from the CPS caseworker. The CPS caseworker should be contacted as soon as practicable but no later than the third business day the provider realized services were not available. Help may also be provided by STAR Health and the regional well-being specialist.

If the Provider Has Questions About Treatment

If the provider has any questions or concerns regarding the prescribed recommendations for follow-up treatment, CPS will assist the provider with a resolution.

If a Child is Hospitalized

If a child is hospitalized for medical needs (as opposed to psychiatric needs), the provider must support the child in accordance with the child’s medical needs and supervisory requirements. The provider will provide relief as needed for the child’s caregiver.

5100 Medical Services

24 Hour Residential Child Care Requirements Guide December 2016

The provider is responsible for ensuring that the child receives medical care.

All Children

Each child must receive an initial Texas Health Steps medical checkup within 30 days of entry into DFPS conservatorship.

Unless required more frequently by the child’s medical provider, a subsequent Texas Health Steps medical checkup must be scheduled one year after the previous checkup and no later than the child’s next birthday.

Medical services must be provided by a licensed health care practitioner who is enrolled in Texas Medicaid as a Texas Health Steps provider.

Children Under Three

Children under 36 months of age must receive Texas Health Steps medical checkups in accordance with the Texas Health Steps Periodicity Schedule.

Children with Primary Medical Needs

If a child with primary medical needs is unable to attend Texas Health Steps medical checkups in accordance with required time frames, the caregiver requests written documentation from the child’s primary care physician (PCP).

5200 Dental Services

24 Hour Residential Child Care Requirements Guide December 2016

The provider is responsible for ensuring that the child receives dental care.

All Children

Dental exams must be provided by a licensed dentist who is enrolled in Texas Medicaid as a Texas Health Steps provider or a dental hygienist who is working under the supervision of a licensed dentist who is enrolled in Texas Medicaid as a Texas Health Steps provider.

All children must receive a subsequent checkup six months after the previous checkup.

Children Under Six Months Old When Entering Conservatorship

All children who entered DFPS conservatorship before they were six months old must have a Texas Health Steps dental checkup within 30 days of becoming six months of age.

Children Over Six Months Old When Entering Conservatorship

All children who entered DFPS conservatorship after they were six months old must have a Texas Health Steps dental checkup within 60 days of entry into DFPS conservatorship.

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Children Between Six and Thirty-Five Months Old

All children 6 to 35 months of age who have been determined by a Texas Health Steps provider to be at risk for early tooth decay must have dental checkups as frequently as the child’s Texas Health Steps provider recommends.

Children with Primary Medical Needs

If a child with primary medical needs is unable to attend Texas Health Steps Dental Checkups in accordance with required time frames, the provider requests written documentation from the child’s primary care physician (PCP).

5300 Behavioral Health Services

24 Hour Residential Child Care Requirements Guide December 2016

The provider ensures that behavioral health services are available and provided to the child as needed by a STAR Health Network provider.

The provider accesses Medicaid through STAR Health for Medicaid-covered behavioral health services, unless the court orders DFPS to provide behavioral health services for the child from a non-network provider.

5310 If Medicaid Denies Coverage for Behavioral Health Services

24 Hour Residential Child Care Requirements Guide December 2016

No later than the third business day after the provider receives a STAR Health Denial Letter for a child, the provider emails a scanned copy of the denial letter and the date the letter was received to the CPS caseworker and the regional well-being specialist.

The provider uses community resources to obtain behavioral health services not covered by Medicaid.

If community resources are not available for behavioral health services and/or Medicaid does not cover the services, the provider must pay to provide the services.

The provider complies  with DFPS procedures to request access to the Health Passport for its employees that are not network providers.

5320 Information Provided By the Medical Consenter

24 Hour Residential Child Care Requirements Guide December 2016

Within three business days of the child being placed, the provider ensures that all foster parents and employees who serve as medical consenters provide relevant plans and information to the behavioral health clinicians providing therapy to the child.

5330 Child and Adolescent Needs and Strengths Assessment

24 Hour Residential Child Care Requirements Guide December 2016

The provider ensures that each child age 3 through 17 entering DFPS conservatorship on or after September 1, 2016 is assessed with a Child and Adolescent Needs and Strengths Assessment (CANS) within thirty days of entering DFPS conservatorship.

The provider schedules the CANS appointment with a STAR Health clinician who is certified in the use of CANS and provides transportation to the CANS appointment.

The child’s substitute caregiver should accompany the child to the appointment so he or she can be interviewed by the STAR Health clinician.

A subsequent CANS assessment must be scheduled one year after the previous CANS assessment.

The final CANS summary report will reside in the child’s Health Passport. The CANS assessment recommendations should be addressed in the child’s plan of service or treatment plan.

5400 Psychotropic Medications

24 Hour Residential Child Care Requirements Guide December 2016

The provider follows the guidelines in the Psychotropic Medication Utilization Parameters for Foster Children.

The provider ensures that the child receiving psychotropic medication:

  •  is provided appropriate psychosocial therapies, behavior strategies, and other non-pharmacological interventions; and

  •  is seen by the prescribing physician, physician assistant, or advanced practice nurse in the STAR Health Network at least once every 90 days.

The medical consenter must accompany the child to each of these visits. Seeing the child at least once every 90 days allows the medical practitioner to:

  •  monitor the side effects of the drug;

  •  determine whether the drug is helping the child achieve the treatment goals; and

  •  determine whether continued use of the drug is appropriate.

5410 Responsibilities of the Medical Consenter

24 Hour Residential Child Care Requirements Guide December 2016

If the child is prescribed psychotropic medications, and the caregiver is the medical consenter, he or she must discuss the risks and benefits of the medication with the prescribing provider.

If the medical consenter has additional questions or concerns about the medication regimen for the child, he or she may:

  •  request assistance from a STAR Health Service manager by calling 1-866-912-6283; and

  •  notify the CPS caseworker.

5420 Documentation of Psychotropic Medication

24 Hour Residential Child Care Requirements Guide December 2016

New Medication

For each new psychotropic medication the provider submits the completed Form 4526 Psychotropic Medication Treatment Consent to the caseworker.

The provider does this as soon as possible, but no later than five business days from the date of the appointment at which the medication was prescribed.

Changes to Existing Medication Dosages

The provider notifies the caseworker in writing, within one business day, of any prescribed psychotropic medication and dosage changes.

5430 Required Training on Psychotropic Medication

24 Hour Residential Child Care Requirements Guide December 2016

The provider must ensure that the caregiver who administers psychotropic medications completes the DFPS psychotropic medication computer-based training and the post-test available on the DFPS website Psychotropic Medications – A Guide to Medical Services at CPS.

The caregiver retains documentation of successfully completing the DFPS Psychotropic Medication Training.

5440 Child is the Medical Consenter

24 Hour Residential Child Care Requirements Guide December 2016

A child age 16 or 17 years of age who has been designated by the court as his or her own medical consenter and has been prescribed psychotropic medications must complete the DFPS Psychotropic Medication computer-based training and the post-test available on the DFPS website Psychotropic Medications – A Guide to Medical Services at CPS.

The child must complete the training within seven days of the court’s designation. Within five days of completing the training successfully, the child must submit documentation to the caseworker.

5500 Trauma-Informed Care

24 Hour Residential Child Care Requirements Guide December 2016

DFPS-approved trauma-informed care training can be found at:

Superior Health Plan Training

Trauma Informed Care Training on the DFPS Website

5510 Pre-Service Trauma-Informed Care Training Requirement

24 Hour Residential Child Care Requirements Guide December 2016

Each caregiver and employee who provides direct care must complete a minimum of eight hours of trauma-informed care training before being the only caregiver responsible for a child in care.

Training should include at least one of the DFPS-approved trauma-informed care trainings; a component on adverse child experiences (ACEs) and training and resources related to prevention and management of secondary traumatic stress (compassion fatigue).

5520 Annual Refresher Trauma-Informed Care Training Requirement

24 Hour Residential Child Care Requirements Guide December 2016

Each caregiver and employee who provides direct care must complete at least two hours of trauma-informed care training annually.

Providers may select their own curriculum or model for the annual refresher training, as long as it provides practical information that prepares the caregiver to put into practice and build on what he or she has learned.

5530 Documentation of Trauma-Informed Care Training

24 Hour Residential Child Care Requirements Guide December 2016

Caregivers must keep in their records certifications of completed trauma-informed care training in accordance with minimum standards.

5540 Supplemental Trauma-Informed Care Training

24 Hour Residential Child Care Requirements Guide December 2016

Additional trauma-informed care training options can be found at

National Child Traumatic Stress Network

Texas Health Steps

5600 Documentation of Health Care

24 Hour Residential Child Care Requirements Guide December 2016

The provider maintains written documentation of health care appointments for the child, containing at a minimum:

  •  child’s name and date of birth;

  •  reason for the visit;

  •  date of the examination;

  •  procedures completed;

  •  examination results;

  •  recommended follow-up treatment and scheduled appointments, if any;

  •  medications and changes to medications;

  •  the child’s refusal to accept medical treatment, if applicable;

  •  the circumstances of an injury or medical incident, including date and time of the incident; and

  •  whether the appointment was a Texas Health Steps medical or dental checkup.

The provider must also document that a child with primary medical needs had a medical examination within seven days before or three days after the date of placement.

The provider has the option of using the DFPS template for documentation purposes. See Form 2403 Medical/Dental/Vision/Hearing Examination, available on the Residential Child Care Contracts and Required Forms page of the DFPS website.

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