PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 123 of 184
• Referring lead screening tests to the TDH Laboratory (for levels 40 or higher) at the Texas Department
of State Health Services. To report lead poisoning, provider can complete the applicable form for
Children or Adults and fax it to 512.458-7699, or call DHSH at 512-458-7269 or toll free at 1-800-588-
1248. The following information must be reported: child’s name, address, date of birth, sex, race and
ethnicity; blood lead level concentration, test date, name and telephone number of testing laboratory;
whether the sample was capillary or venous blood; and the name and city of the attending physician.
Sendero’s Care Coordinators can help organize services with the Member, the Member’s primary care provider
and the public health entity. In cases where services are coordinated and subject to applicable laws, rules and
regulations concerning confidentiality of certain health information, the public health entity is requested to
provide a written report to the primary care provider concerning the services provided by the public health
entity.
Early Childhood Intervention (ECI) Case Management/Service Coordination
The Texas Department of Assistive and Rehabilitative (DARS) Rehabilitative Services oversees the Early
Childhood Intervention program for the State of Texas. Case management and service coordination are
provided to children from birth to three (3) years with a developmental disability and/or developmental delay.
Eligibility for the program is determined by 1) a delay in one or more area of development; 2) atypical
development in which children perform within their appropriate age arrange on test instruments, but whose
patterns of development are different from their peers, and 3) a medically diagnosed condition that has a high
probability of resulting in a developmental delay. The PCP will receive a copy of Individualized Family
Service Plan (IFSP) for Members from ECI. PCP’s are encouraged to refer Members with disabilities or
developmental delays, birth to three (3) years of age, to ECI for services. For more information about ECI or to
refer a child, call the DARS Inquiries Line at 1-800-628-5115.
Mental Health Targeted Case Management
Individuals served through the Texas Department of State Health Services (DSHS) Mental Health and
Substance Abuse (MHSA) program are eligible for services including advocacy, assessment, linkage,
monitoring, crisis intervention, and referral and planning and coordination of services. Priority population
include: substance abuse, mental retardation, autism, pervasive development disorder, children at risk of
removal from preferred environment, children determined by the school system to have a serious emotional
disturbance, children at risk of disruption of the preferred living situation due to psychological symptoms or
those with a functional impairment – GAF (Global Assessment Function) of 50 or below. Providers may obtain
information through the MHSA website www.dshs.state.tx.us/MHSA or by contacting Network Management.
Mental Health Rehabilitation:
Rehabilitative services are covered when provided to persons, regardless of age, who have a single severe
mental disorder excluding mental retardation.
Texas Department of Assitive and Rehabilitative Services (DARS)
DARS may provide additional case management services for the blind and visually impaired Members. This is
limited to one contact per client, per month. The main office in Austin may be contacted at 1-800-252-5204 or
by visiting their website at http://www.dars.state.tx.us/dbs/.
Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475
Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)