Designation of Medical Consenter instructions



Instructions for DFPS Caseworker Completing & Issuing Revised Attachment Form 2085-B: Designation of Medical Consenter

Introductory Information | |

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|Form 2085-B Replaces previous Attachment Forms 2085-A, 2085-B, 2085-C and 2085-D. |

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|What is different with the revised Form 2085-B? |

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|Combines information from all of the above forms into the one Form 2085-B |

|Includes updated law and CPS Policy |

|Outlines new Texas Health Steps/Preventive Care timeframes |

|Applies to any medical consenter designated by DFPS or the caregiver when DFPS is medical consenter |

|Applies to a designated medical consenter who is a DFPS employee or Non-DFPS employee (e.g. live-in caregiver, emergency shelter or CPA professional |

|employee). |

|Applies to all children in DFPS conservatorship regardless of placement or program (in state and out of state, TYC/JPC, nursing homes, state supported |

|living centers, ICF-MR) |

|Applies to children on STAR Health, traditional Medicaid, or with other healthcare provision arrangements |

|Moves designated medical consenter information and signatures to the front page |

|Is more user friendly for caregivers, medical consenters, healthcare providers and DFPS staff |

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|This revised Form 2085 -B is available under DFPS Smiley Face Forms. When using the revised Form 2085 -B, DFPS staff should not generate the older |

|version of the Form from IMPACT. (This form should be available in the future within IMPACT.) |

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|Only Form 2085-B dated April 2011 will be valid for designation of medical consenters by DFPS (unless there has been no change in medical consenter for |

|the child). Form 2085-B should be used from the Smiley Face Forms and completed according to these instructions. |

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|DFPS staff should ensure they are using the correct DFPS IMPACT Person identification number (PID) for the medical consenter being designated by using |

|the established Person Search process. If you find the medical consenter has multiple PIDs contact your Regional Foster Care Health Accountability |

|Specialist to determine the correct PID, so accurate information is transferred to STAR Health. Information on Person Search (under the Person |

|Enhancement Project) can be found on the DFPS Intranet at _ link here. |

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|A new Form 2085-B is issued and replaces previous Forms 2085 listed above when there is a change in medical consenter. Examples of when CPS Staff would|

|issue the revised Form 2085-B: |

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|Change in placement requiring a change in medical consenter |

|Transfer of the case between DFPS staff |

|Change in DFPS Caseworker or Supervisor serving as medical consenter (i.e. no longer in the unit or with DFPS) |

|Change in CPA Case manager, Emergency Shelter staff, etc. named as medical consenter |

|DFPS staff issue Attachment Form 2085-B along with Placement Forms 2085 FC, KF, KO, or LR. Use of Attachment Form 2085-B: CPS Policy 6521.13: Issuing |

|Forms 2085-B and 2085-C insert link to CPS Policy here |

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|DFPS staff issue Attachment Form 2085-B: |

|When the court has authorized DFPS to consent to medical care |

|If removing a child in an emergency situation prior to a court hearing/ex-parte being held - (CPS Policy 6521: Making Medical Decisions until Court |

|Hearing) insert link to CPS Policy here. |

|In either situation the medical consenter DFPS is designating has completed the required Informed Consent Training. (CPS Policy 6521.12 Ensuring |

|Training on Informed Consent and Requirements for Medical Consenters) insert link to CPS Policy here |

|To a legally married couple when both are designated as medical consenters |

|Individually to persons designated as primary and backup medical consenters who are not legally married couples |

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|SECTION 1: Medical Consenters (Primary and Back Up) |

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|Note: The revised Form 2085-B must be used from the Smiley Face forms when issuing any new form after __________(date) and must not be generated from |

|IMPACT. When the revised Form 2085 is available within IMPACT (Projected date of December 2011) information about the child, and the medical |

|consenter(s) will pre fill in this section with the exception of: Court Number, Name of Judge, and Phone Number of Court. Staff should ensure that all|

|information is complete within the Form. If the form is not generated from IMPACT, all information will need to be manually entered. This will apply |

|during the time frame that it is available only on Smiley Face. |

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|Enter the Name, DFPS IMPACT Person ID (PID), Medicaid Number and Date of Birth of the child in the boxes in Section 1 |

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|Enter the County, Court number, Cause number, Name of Judge and Phone number of the Court that has jurisdiction over the child's case in the boxes in |

|Section 1 |

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|Enter the name(s) of the Primary medical consenter(s) in the blank in Section 1, and DFPS IMPACT Person ID number(s) in the box in Section 1 |

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|Enter the name(s) of the Back Up medical consenter(s) in Section 1 and DFPS IMPACT Person ID number(s) in the box in Section 1 on a separate Form 2085-B|

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|A second primary or second back up medical consenter may only be designated if part of a legally married couple to the primary or back up medical |

|consenter respectively. Examples are birth parents, kinship caregivers, foster parents, pre-consummated adoptive parents, cottage parents in a basic |

|childcare facility or home and community-based (HCS) Support family caregivers. |

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|SECTION 2: Acknowledgement, Agreement and Signatures. |

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|This section outlines the roles, responsibilities and expectations of the designated medical consenter(s) and includes signature lines for |

|acknowledgement and agreement. |

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|The designated medical consenter, DFPS caseworker and supervisor must sign the form, and |

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|If any of the medical consenter(s) are affiliated with a residential provider (e.g., CPA, emergency shelter, basic childcare facility or home and |

|community based services (HCS) provider), a representative of the residential provider must sign the form. |

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|For detailed information regarding the items within this section, please see the following CPS Policy: |

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|6521.2 Responsibilities of Medical Consenters and Back Up Medical Consenters - insert link to CPS Policy here |

|6521.12 Ensuring Training on Informed Consent and Requirements for Medical Consenters - insert link to CPS Policy here |

|6521.17: Including Medical Information in Court Reports - insert link to CPS Policy here, regarding regular provision of information about the child's |

|medical care. |

|6521.13 Issuing Forms 2085-B and 2085-C - insert link to CPS Policy here, regarding required signatures. |

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|Access to Medical records and Protected Health Information (PHI): DFPS is exempt from the payment of a fee otherwise required or authorized by law to |

|obtain a medical record from a hospital or health care provider if the request for a record is made in the course of an investigation. (Texas Family |

|Code §261.316.) - insert link to Code here |

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|SECTION 3: Medical consenter/caregiver responsibilities - Medical Consent |

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|Staff may consult CPS Policy for additional information on the following Sections in Form 2085-B: |

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|Emergency Medical Care. If the individual authorized to give consent is not available, the physician can decide whether the child's condition is an |

|emergency condition as defined by Texas Family Code §266.009(a) - insert link to Code here. If the physician provides medical care without consent, the |

|physician must notify the medical consenter no later than the second business day after the medical care is provided. CPS Policy 6521.5 Emergency |

|Medical Care - insert link to CPS Policy here |

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|Major Medical Care. Outlined in the Form 2085-B. Although the CPS caseworker and/or supervisor are consulted, the medical consenter provides the |

|consent to the child’s health care provider, verbally or in writing as required by the health care provider. A doctor may require: |

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|verification that CPS provided consent and/or that consultation occurred |

|written consent for treatment from DFPS in addition to consent from the medical consenter |

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|Significant Medical Conditions. Examples in Form 2085-B. CPS Policy 6521.18 Notifying Parents About Significant Medical Conditions - insert link to CPS|

|Policy here |

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|Extraordinary medical procedures. The medical consenter may NOT consent to the following: extraordinary medical procedures which include: |

|withholding or withdrawal of life sustaining treatment CPS Policy 6522 - insert link to CPS Policy here (excerpt "If a medical consenter for a child in |

|DFPS conservatorship is not a DFPS employee, the consenter may not consent to, execute, or sign a DNR order for the child.") |

|organ donation CPS Policy 6523 - insert link to CPS Policy here |

|abortion CPS Policy 6521 - 6521.4 Exception for Abortion - Several CPS policy sections referenced. - insert link to CPS Policy here |

|electroconvulsive therapy |

|aversion therapy |

|any experimental treatment or clinical trial CPS Policy 6524, if a Drug Research Program - insert link to CPS Policy here (defined in policy - a drug |

|research program means a clinical trial, clinical investigation, drug study or active or clinical research to study the effectiveness of an |

|investigational new drug or an approved drug.) |

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|DFPS staff must follow CPS policy for the specific procedure or contact State Office (after utilizing the regional chain of command) for consultation as|

|needed. DFPS staff may also need to consult with the child’s attorney or guardian ad litem, judge, etc. |

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|Special Situations/Exceptions |

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|Medical Consent by Youth -Tex. Family Code §266.010 - insert link to Code here |

|CPS Policy 6521.4 - insert link to CPS Policy here |

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|Inpatient Mental Health Treatment (psychiatric hospital). The medical consenter does not have the authority to consent to the voluntary admission of a|

|child to a facility for inpatient mental health treatment. The child may be admitted on a voluntary basis with the consent of both the child |

|(regardless of age) and a representative of DFPS. (Health and Safety Code §572.001(c) - insert link to Code here; CPS Policy 6529.1 - insert link to CPS|

|Policy here A child who is at least 16 years old may seek voluntary admission in an inpatient mental health facility and be admitted without DFPS |

|consent. §572.001(d) - insert link to Code here |

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|A mental health facility is defined as a state hospital, a private psychiatric facility, a mental health facility licensed or operated by DSHS that |

|provides 24 hour inpatient mental health treatment (does not include an RTC licensed by DFPS) and a local mental health authority or a facility operated|

|by or under contract with a local mental health authority (e.g., Harris County Psychiatric Center in Houston and the University of Texas Medical Branch |

|at Galveston). |

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|As a reminder to staff, CPS Policy 6529.5 Notification of Placement Staff and Star Health - insert link to CPS Policy here. When a child is admitted to|

|an inpatient mental health facility either voluntarily or through a court order, immediately or no later than the next business day the CPS caseworker |

|must notify placement staff and STAR Health Mental Health Member Services or the child’s Cenpatico (doing business as) Integrated Mental Health Services|

|(IMHS) manager at 1-866-218-8263, if the child is enrolled in STAR Health. |

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|Inpatient or Outpatient Substance Abuse Treatment. The medical consenter does not have the authority to consent to the voluntary admission of a child |

|to a facility for substance abuse treatment. The child may be admitted on a voluntary basis with the consent of both the child (regardless of age) and a|

|representative of DFPS. (Tex. Health and Safety Code §462.022(c).- insert link to Code here) A child who is at least 16 years old may seek substance |

|abuse treatment without the consent of DFPS or the medical consenter. (Tex. Health and Safety Code §462.022 (a)(3)) - insert link to Code here |

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|Counseling. Tex. Family Code §32.004 (a) - insert link to Code here |

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|ECI and special education. CPS Policy 6521 - insert link to CPS Policy here |

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|SECTION 4 - Medical Coverage |

|STAR Health Program |

|STAR Health Member Services: 1-866-912-6283. DFPS staff and medical consenters should call this number for information about: |

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|medical, dental, vision, and behavioral health services available to the child through STAR Health |

|how to access Service Management or Service Coordination |

|other health related resources |

|other Medicaid Programs |

|assistance in locating a doctor, nurse, dentist or other specialist in the program |

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|DFPS staff should contact their Regional Well-Being Specialist if they need further assistance accessing services after contacting STAR Health member |

|services. |

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|Medications: DFPS staff should contact the Regional Eligibility specialist if they encounter barriers to having prescription medications filled due to|

|Medicaid eligibility. See also PSA 11-026. - insert link to PSA here |

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|Denial of STAR Health Services. |

|DFPS staff should request a copy of the written correspondence from the caregiver/medical consenter regarding any denied or reduced healthcare service |

|(by STAR Health). |

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|Provide a copy of the letter and any other written information about the denied/reduced service to your Regional Well-Being Specialist (WBS) as soon as |

|possible. |

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|Access to Medical Records and Protected Health Information (PHI). |

|The medical consenter is only entitled to PHI about a child for whom they are currently named the medical consenter. |

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|Health Passport. |

|Health Passport Help Desk: Phone 1-866-714-7996 or e-mail Tx_PassportAdmin@ |

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|DFPS staff and designated medical consenters can access the Health Passport at the following website: |

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|For assistance with Health Passport, DFPS staff and other medical consenters should first contact the STAR Health Health Passport Help Desk via email or|

|by calling the number above. |

|Medical consenters (foster parents, etc.) may contact you (DFPS caseworker) with access issues (multiple PIDs, child not in the system, etc.) |

|DFPS staff may contact their Well-Being Specialist if they continue to be unable to access the Health Passport after contacting the Help Desk. |

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|The Health Passport is not a full medical record, but does include Medicaid Claims that have been paid or denied. Two years of Medicaid Claims data |

|will also be included for newly removed children who had Medicaid coverage prior to entering DFPS custody. |

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|DFPS staff and Medical consenters will be locked out of the Health Passport if the system goes unused for six months. Call the Health Passport Help |

|Desk to have access privilege returned. |

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|If DFPS staff are unable to find information that should be located in the Health Passport such as therapy notes or immunizations, they should contact |

|the Health Passport Help Desk after inquiring with the health care provider to determine whether they entered the information. |

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|DFPS staff should print the entire Health Passport record (when a youth is leaving care, going to adoption, etc.) for a child/youth by using the Printer|

|icon at the top right of each of the eight sections of the Health Passport, and ensuring the dates entered for printing cover all the time the |

|child/youth has been in DFPS conservatorship and STAR Health. For additional assistance contact the Health Passport Help Desk. |

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|Children NOT on STAR Health include (in part): |

|Adjudicated and placed in a Texas Youth Commission (TYC) or Texas Juvenile Probation Commission (TJPC) facility. NOT enrolled in STAR Health or |

|Medicaid. Medical care is provided in accordance with TYC policies, through University of Texas Medical Branch (UTMB). CPS Policy 6577.23 Providing |

|Medical Care to Youth in TYC Custody or on TYC Parole - insert link to Policy here |

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|Child placed Out-of-State on Receiving State's Medicaid (Not on STAR Health). Applies to children placed in another state when DFPS retains custody, |

|(e.g. court ordered relative/kinship placements, child specific contracts, etc.) |

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|Children in these placements can have Traditional Medicaid, private insurance, coverage negotiated during the adoption or PMC process or other |

|appropriate insurance to meet their special needs and circumstances. |

|Section 5: PREVENTIVE CARE |

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|Preventive Care/Texas Health Steps: |

|DFPS staff, medical consenters and caregivers should contact STAR Health member services and request assistance from a Texas Health Steps Coordinator or|

|a Service Coordinator if experiencing any barriers to scheduling timely Texas Health Steps checkups for children enrolled in STAR Health or for |

|assistance in locating a Texas Health Steps provider. |

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|Guidelines for CPS staff can be found in CPS Policy 6525 Medical and Dental Services - insert link to CPS Policy here and in PSA 11-022. DFPS Staff |

|should ensure that the most current information and timeframes within either the policy or the PSA are adhered to. |

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|As a reminder, DFPS staff must also provide pamphlets and other information about Texas Health Steps services and STAR Health services to caretakers and|

|medical consenters and refer them to the Web sites for these programs. Questions about how to obtain particular medical or dental services are directed |

|to the STAR Health and the Texas Health Steps program, as appropriate. CPS Policy 6527.1 Informing Caregivers and Medical Consenters About Health |

|Services - insert CPS Policy link here |

|SECTION 6: (Optional- Replaces Form 2085-D) Approval by medical consenter for preventive care of a child in DFPS conservatorship (Also provide Page 1 |

|of Form 2085-B when utilizing this section) |

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|SECTION 6 of the Revised Form 2085 -B replaces Attachment Form 2085-D. |

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|SECTION 6 can be used by DFPS and Non DFPS Medical consenters. This approval by the medical consenter for preventive care is subject to the agreement |

|by the treating provider, who may request that the designated medical consenter participate in the appointment either in person or by phone. |

|The medical consenter providing this Section to another individual must sign and date this section and provide their phone number. |

|The medical consenter also provides Page 1 of Form 2085-B when utilizing this section |

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|DFPS staff who are medical consenters issue this form when approving another individual to attend a health appointment for a child for preventive care |

|when they are unable to attend themselves. The most frequent use of this form includes: |

|Issuing to Residential Treatment Centers where non-medical consenter staff will be transporting children or attending their medical and behavioral |

|health care appointments with the child |

|Providing to Case Aides/Health Service Technicians (HST) or other DFPS staff who are not designated medical consenters but will transport to and attend |

|health appointments with the child |

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