Texas Health Steps - Performing a Timely Medical Checkup
Who is required to have a Texas Health Steps Checkup?
All Medicaid members under the age of 21 require at least one Texas Health Steps checkup per year (multiple checkups are due for members under 2 years of age).
Why are timely Texas Health Steps checkups important?
Performing timely checkups benefit our members. Checkups may identify potential medical concerns and when these concerns are addressed early on it can improve the health of our members. In addition, newly enrolled members may simplify their re-enrollment process if at the time of re-enrollment, the member is up to date on his/her checkup(s).
When is a member due a Texas Health Steps checkup?
The Department of State Health Services (DSHS) classifies Medicaid members into two categories: new and existing.
New - a member enrolled in the Medicaid program for the first time OR has not been eligible for Medicaid with Community First Health Plans for a minimum of two years. New Medicaid members require a THSteps checkup within 60 days from their enrollment date, regardless of the member's date of birth.
Existing - a Medicaid member who is not considered a new member. THSteps checkups are due based on the periodicity schedule driven by the member's date of birth. An existing member becomes due for a checkup on their birthday and will be considered compliant if the checkup is performed within 60 days from their birthday.
How many checkups are new members required to have?
A newly enrolled member may require more than one checkup within the same year if they have a birthday after they have enrolled in the program.
For example, if a member enrolls on May 1st and has a birthday of July 20th the member would be due for two check-ups:
"New Member" Checkup - DUE May 1st (considered timely if performed before June 29th)
"Existing Member" Checkup (based on periodicity schedule) - DUE July 20th (considered timely if performed before September 17th)
Who do we contact for more Texas Health Steps information?
CFHP has two Provider Representatives dedicated to assisting providers and their staff with any THSteps related issues. Contact your PCP Representative if you would like to schedule a visit with one of these representatives.