Referral and Intake

The Referral is the first step. The referral source may be the client, a family member or any other individual. When you receive a referral, get as much information as possible about the client from the referral source.

How to Complete a Referral

• Ask questions to get the needed information about demographics, contact information, health condition and reason for referral.
• Document all information on the Referral & Intake Form (CM-01A), including the date of the referral.
• You must accept a referral unless:
• You are disenrolled as a case manager.
• The referred client lives in a county that you do not cover.
• You have indicated a limitation that excludes the client, such as not accepting pregnant clients.

If you are unable to accept a referral for any of these reasons, direct the referral to the Texas Health Steps helpline (1-877-847-8377) within two business days. You may also contact the helpline directly to make the referral.

If the client is not enrolled in Medicaid, you can refer them to the DSHS Regional Office.

A referral for case management services cannot be denied based on race, color, sex, religion, national origin, language preference, sexual orientation, or type or extent of the high risk or disabling condition.

Note: You cannot maintain a waitlist. You must complete the referral and intake process within seven business days of receiving a referral.

Intake

The next step is to complete the Intake. The information gathered for the Intake is documented on the bottom half of the CM-01A.

• Intake must be completed within seven business days from the referral date.
• Intake must be conducted by an approved case manager.
• Intake must be conducted with the client, parent or guardian prior to submitting the Prior Authorization Request.
• Intake can be completed by phone.

This is not a step that can be conducted without the participation of the client, parent or guardian because the primary purpose is to gather demographic, health and other relevant information to determine the client’s potential eligibility.

How to Complete an Intake

Intake must be completed with the parent or guardian unless:

• You receive written/verbal consent from the parent or guardian to provide services directly to a minor client.
• An unemancipated minor client is pregnant and does not live with her parent or guardian.
• The minor client has been legally emancipated.
• The client is 18 years of age or older and does not have a legal guardian appointed to them.

When speaking with the client, parent or guardian, confirm the information provided by the referral source and document:

• Any additional information provided about the health condition/health risk or high-risk condition.
• The need for assistance in accessing services.
• The date of the intake.
• The source of the information you obtained.

Intakes must be completed for every referral that you receive, and you must maintain records of every Referral and Intake that you complete, even if the client is not eligible to receive CPW services.

What to Do After Your First Contact with the Client, Parent or Guardian

You are required to document the outcome of the referral, regardless of whether the client is eligible for case management services.

1. If the client has eligible needs, proceed to the next step by submitting the Prior Authorization Request through the TMHP PA on the Portal or by faxing form F00186 Case Management for Children and Pregnant Women Initial Prior Authorization Request to 512-514-4212.
2. If only routine medical or dental needs are identified, refer to the Texas Health Steps helpline (1-877-847-8377).
3. If only routine medical transportation needs are identified, refer to the Medical Transportation Program.
4. If only basic needs are identified, refer to 2-1-1 Texas or other community resources.

Multiple Family Members

You may get a referral for a sibling group or identify during Intake that there are multiple members of the household in need of services. In these cases, gather information and conduct individual intakes for each family member who may be eligible for case management services.

Each family member MUST have a distinct need and require individualized services.

If several members of the family all have the same need, then only one child will be approved, as the needs of the siblings can be addressed at the same time.

If there is a global need, such as housing or utility payment assistance, a case will not be approved unless the need is directly related to the client’s health condition or health risk.