Texas Medicaid MCOs Now Require Hearing and Vision Records

Texas Medicaid health plans will not approve an authorization without a record of the
child’s vision and hearing screening. For clients on a plan where this is turned on,
Alpaca asks the family for the record and checks it.

The record comes from the child’s last well-child visit with their pediatrician (Texas
calls this the Texas Health Steps checkup). There is no standard form. Visit notes from
the doctor’s chart, or an export from their electronic health record, are fine. It must
show the result of both the vision and the hearing screening. A record with only one
is rejected by the health plan.

What families do

Families see Checkup Records (Vision and Hearing) in the Action Required list in
the parent portal. Selecting Upload lets them add a PDF or photo, up to 50 MB.

After they upload, the row shows Being reviewed and says This can take up to a day —
no action needed from you right now.

If the document is rejected, the row shows NEEDS ATTENTION with the reason, and the
family uploads a replacement.

What Alpaca does

An Alpaca team member checks that the document is for the right child and shows both
screenings, then verifies or rejects it.

Which health plans

The requirement is set up for these Texas Medicaid plans:

• Aetna Better Health of Texas

• Blue Cross and Blue Shield of Texas (Medicaid)

• Community First Health Plans

• Community Health Choice

• Cook Children’s Health Plan

• Dell Children’s Health Plan

• Driscoll Health Plan

• El Paso Health

• Molina Healthcare of Texas

• Parkland Community Health Plan

• Texas Children’s Health Plan (Medicaid)

• UnitedHealthcare Community Plan of Texas

More plans may be added. If a client’s plan is not on this list and a Texas Medicaid
plan, tell your Alpaca contact.

What it means for your clinic

• Scheduling. A client is not ready for assessment until the record is verified, and
  a client who is not ready cannot be scheduled for assessment or treatment sessions.

• Clients who already have an approved assessment authorization stay ready. Nothing
  changes for them.

• Need to proceed anyway? Ask your Alpaca contact. Alpaca staff can override the
  requirement for a client.

• Authorizations. The record is included with the authorization request, so the
  health plan does not send it back.

It does not apply to commercial plans, plans in other states, or authorizations that
were already submitted.

If something looks wrong