Freedom of Choice Service Descriptions
Texas Health Steps
STAR Program Members are free to select any Texas Health Steps enrolled Texas Medicaid Provider to perform Texas Health Steps services. Medicaid Members are eligible for Texas Health Steps 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 Texas Health Steps screening information should be forwarded to the Member’s Primary Care Provider in order to complete the Member's medical record.
Children (ages 0-20) may receive one eye exam for the purpose of obtaining eyeglasses each state fiscal year (Sept. 1 through Aug. 31). This limit of one exam within that 12-month period can be expanded in three situations:
- teacher or school nurse requests eye exam;
- diopter change of .5 or more;
- additional eye exam is medically necessary.
Adults (age 21 or over) are eligible for one examination with refraction for the purpose of obtaining eyewear every 24 months. For children, there are no limitations on the number of replacements for lost or destroyed eyewear. This includes necessary major repairs to damaged eyeglasses. Any diagnosed conditions or abnormalities of the eye that require treatment or additional services beyond the scope of an exam for refractive errors must be referred back to the Member’s Primary Care Provider. Vision care Providers who furnish additional services must have Primary Care Provider authorization.
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 Primary Care Provider is encouraged to provide these services if requested by the patient. However, the patient is not mandated to obtain these services through the designated Primary Care Provider. Strictest confidentiality should be maintained for Members (including minors) seeking family planning services. Community does not require parental consent for minors who receive family planning services.
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 Primary Care Provider authorization.
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 Primary Care Provider within 24 hours or the next business day after providing services. In case of an admission, the facility must also notify Community within 24 hours or the next business day after the admission.
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.