420.002 Provider Selection Criteria and Requirements for the Texas Infertility Prevention Project

Policy Number	420.002
Effective Date	November 2, 2015
Revision Date	July 19, 2023
Subject Matter Expert	Public Health Follow-Up Manager
Approval Authority	HIV/STD Section Director
Signed by	Josh Hutchison

1.0 Purpose

The purpose of this policy is to describe the criteria the Texas Department of State Health Services (DSHS) uses to select local programs and providers to participate in the Texas Infertility Prevention Project (TIPP). It also outlines the responsibilities of TIPP clinic partners.

The mission of TIPP is to increase access to clinical services to diagnose and treat chlamydia (CT) and gonorrhea (GC), two common sexually transmitted diseases (STDs). The project targets groups with disproportionate rates of infection. TIPP is a collaboration between the DSHS HIV/STD Prevention and Care Unit, the DSHS Pharmacy Branch, and the DSHS Laboratory Services Section. DSHS works with a TIPP administrative agency (TIPP AA) to collaborate with TIPP clinic partners across the state to carry out the goals of TIPP.

TIPP activities include:

• Identifying, screening, and treating individuals at high risk for CT and GC infections;
• Counseling people at risk for or with GC or CT on risk-reduction practices;
• Treating and counseling partners of people with GC or CT; and
• Referring people for other medical services, as appropriate.

TIPP provides GC/CT screening supplies, laboratory services, medications for treatment, resources for training, and other resources to enhance client services for TIPP clinic partners to perform these services. In exchange for these resources, TIPP clinic partners follow TIPP GC/CT screening and treatment guidelines. They also submit GC/CT test results, demographic data, and behavioral data DSHS uses to plan local and national projects.

TIPP offers in-kind assistance only; TIPP does not offer direct financial assistance. The Centers for Disease Control and Prevention (CDC) supports in-kind assistance under Section 318 of the Public Health Services Act.
 

2.0 Definitions

318 Funds – Project funding under Section 318 of the U.S. Public Health Service Act awarded by the CDC to state and local health departments for STD prevention and control programs.

340B Drug Pricing Program (340B Program) – The federal Health Resources and Service Administration (HRSA) 340B Drug Pricing Program, which reduces the cost of covered outpatient drugs for certain federally supported entities and eligible health care organizations.

Centers for Disease Control and Prevention (CDC) – Agency of the U.S. Department of Health and Human Services that has funding agreements with state, local, and territorial STD programs for STD prevention and control projects. The TIPP receives Public Health Service Act Section 318 funds from CDC.

Clinical STD Services – Direct sexual health care, including laboratory testing, physical exams, treatment for STDs, referral, and client education.

Essential Community Provider (ECP) – Providers serving predominately low-income, medically underserved people defined in Section 340B(a)(4) of the Public Health Service (PHS) Act and entities described in Section 1927(c)(1)(D)(I)(IV) of the Social Security Act (SSA) (also known as safety net providers).

In-Kind Support – Non-cash contributions provided by TIPP that directly benefit a TIPP clinic partner. In-kind contributions purchased with 318 funds consist of GC or CT testing supplies, GC or CT laboratory support, technical assistance, quality audits, and resources for training (based on the HRSA FAQs regarding in-kind contributions).

Procedures of Collaboration (POC) – A collaborative agreement between the TIPP AA and TIPP clinic partners guiding and defining the relationship, expectations, and roles and responsibilities.
 
Texas Department of State Health Services (DSHS) – Agency responsible for administering CDC 318 funds that support the TIPP.

Texas Infertility Prevention Project (TIPP) – A state project funded by the CDC with 318 funds; a partnership between the DSHS HIV/STD Prevention and Care Unit, the DSHS Pharmacy Branch, and the DSHS Laboratory Services Section. TIPP furnishes GC and CT screening supplies and laboratory services, medications (medications obtained from the DSHS Pharmacy Branch do not qualify as 318 in-kind contributions for 340B) training, and technical assistance to ECPs to serve specific target populations to prevent and control STDs.

TIPP Administrative Agency (TIPP AA) – The agency contracted by the DSHS HIV/STD Prevention and Care Unit to administer TIPP and work with DSHS TIPP Leadership to coordinate oversight of TIPP.

Uninsured – A client who experiences any circumstance which might influence or restrict access to necessary preventive health care services or medication. Circumstances might include insurance privacy concerns, the financial burden due to high deductibles or co-pays, the inability to receive timely treatment, or a circumstance in which a disease intervention specialist (DIS) identifies a partner of a contact through partner services.
 

3.0 People and Organizations Affected

• TIPP Administrative Agency (AA)
• TIPP Clinic Partners
• DSHS TIPP Leadership
   

4.0 Responsibilities

TIPP clinic partners:

• Comply with TIPP policies and the TIPP POC.

The TIPP AA:

• Tracks the availability of TIPP funds to add new TIPP clinic partners.
• Determines the applicant’s eligibility for TIPP with 5.1 Project Core Criteria.
• Identifies and assesses the suitability of potential TIPP clinic partners.
• Submits a list of eligible TIPP clinic partner locations to DSHS TIPP leadership once a year.
• Trains and orients new and existing TIPP clinic partners.
• Provides technical assistance to ensure TIPP clinic partners comply with TIPP POC.
• Periodically monitors TIPP clinic partners to assess the quality of care and program compliance.
• Conducts clinical and administrative audits.

DSHS TIPP Leadership:

• Provides project oversight.
• Approves the initiation and continuation of TIPP clinic partners.
   

5.0 Policy

Only providers who deliver clinical services to diagnose and treat STDs and meet project criteria (see 5.1 Project Core Criteria) are eligible for consideration as a TIPP clinic partner.
 

5.1 Project Core Criteria

A TIPP clinic partner must meet the following core criteria:

• Be a Texas local health department, community-based clinic, sexual health, family planning, or other essential community provider (ECP).
• Provide clinical STD services.
• Submit CT and GC specimens to a public health lab or a private lab with whom the TIPP AA has or can obtain a memorandum of agreement.
• Follow current CDC Sexually Transmitted Infection Treatment Guidelines for screening, treatment, follow-up, partner management, and prevention and risk reduction messages.
• Have policies, procedures, and standing delegation orders for testing, treatment, follow-up, referral, and client education.
• Have an organizational mission aligned with the TIPP mission.
• Agree to follow TIPP Procedures of Collaboration.
• Have a level of morbidity and demonstrate an unmet need for TIPP services in the program’s service population and area.
• Comply with Texas Administrative Code Title 1, Part 15, Chapter 382, Subchapter A, Healthy Texas Women, Rule §382.17 Health-Care Providers, (b)-(d).
   

5.2 Requests to Participate in the TIPP

The TIPP AA periodically accepts clinic requests to participate in the TIPP. The TIPP AA and DSHS TIPP leadership evaluate requests annually.
 

5.3 TIPP Applicant Review Process

When a clinic submits a request, the TIPP AA determines if funds are available. If funds are available, the TIPP AA evaluates the request based on the eligibility criteria in 5.1 Project Core Criteria.

If the TIPP has an existing clinic partner in the applicant’s service area, the TIPP AA and DSHS TIPP leadership may decline to enroll the applicant even if it meets all core criteria. Once per year, the TIPP AA notifies applicants of the review results.
 

5.4 Resources Available to TIPP Clinic Partners

TIPP clinic partners do not receive direct financial assistance. They receive in-kind resources from the TIPP:

• GC and CT amplified technology test kits purchased by DSHS to use with clients who meet TIPP screening criteria,
• GC and CT laboratory processing for specimens from clients who meet TIPP screening criteria,
• Medications to treat GC and CT (Medications obtained from the DSHS Pharmacy Branch do not qualify as 318 in-kind contributions for 340B.),
• Training, technical assistance, and programmatic consultation via telephone, written correspondence, webinars, meetings, and site visits, and
• Administrative and clinical audits to ensure policies, procedures, and practices comply with TIPP policies and TIPP POC. 

TIPP clinic partners only use allocated GC and CT testing supplies for uninsured people.
 

5.5 Responsibilities of TIPP Clinic Partners

When DSHS accepts a TIPP applicant, the applicant must agree to abide by the requirements in the TIPP POC, which the TIPP AA maintains.
 

5.6 Continuation and Discontinuation of TIPP Participation

TIPP clinic partners do not need to re-enroll. Once accepted, they continue to receive in-kind resources unless:

• Clinical and administrative reviews demonstrate the clinic partner is not following TIPP policy or the TIPP POC.
• Data indicates the clinic partner is not serving a high-morbidity population.
• DSHS has limited project funding, which requires a reduction or discontinuation of in-kind support.
• The TIPP clinic partner decides to separate from TIPP. 

TIPP clinic partners receive a written notice from the TIPP AA 90 days before separation from the TIPP.
 

5.7 Limits of TIPP Collaboration

Collaboration with the TIPP does not provide automatic access to the 340B Drug Pricing Program. TIPP clinic partners may qualify for program participation but must comply with all requirements of the 340B Program
 

6.0 Revision History

Date	Action	Section
7/19/2023	Annual review and update (all sections). Removed underinsured definition and replaced it with uninsured definition (Section 2.0). Updated project core criteria (Section 5.1) to remove city/county jails and juvenile detention centers. Updated requirement on TIPP AA sharing applicant review results once per year (Section 5.3).	All, 3.0, 5.1, 5.3
8/20/2019	Added TIPP partner project criteria; added definition of underinsured and specified use of in-kind testing supplies for uninsured/underinsured individuals per STD PCHD NOFO requirement, removed Procedures Collaboration	-
9/1/2017	Changed "TB/HIV/STD Unit" to "TB/HIV/STD Section" to reflect new program designation	-
11/2/2015	This is a new policy	All