Newborn Screening Benefits Program

Contractors Providing Benefits

The Department of State Health Services (DSHS) works with contractors to provide newborn screening benefits and services to eligible clients in Texas using Newborn Screening Program (NBS) Benefits. To provide these approved services and benefits, contractors are required to understand and be knowledgeable of terminology, eligibility screening requirements and processes as well as comply with specific federal and state laws and procedures. 

The NBS Benefits Contractor Procedures Manual and Supplement Benefits Lists provide important information to contractors. NBS Benefits reimburses enrolled providers for the provision of specified services to eligible clients in accordance with the NBS Program rules. 

Contractor Manual 

The contractor manual describes benefit provider qualifications, the client eligibility process, and billing and reimbursement. The supplements to the manual are separately posted to allow for ease of updating as needed. 

• NBS Benefits Contractor Procedures Manual (through 8/31/2024)
• NBS Benefits Contractor Procedures Manual (effective 9/1/2024)
• Contractor Manual Supplement – Laboratory Services
• Contractor Manual Supplement – Allowable Benefits List

Eligibility Requirements

NOTE: NBS Benefits is a payer of last resort. This means that all applicants first must apply for Medicaid, Children's Health Insurance Program (CHIP), and Children with Special Health Care Needs (CSHCN) before applying for NBS Benefits.

Infants, children, and adults are prioritized by need as funds are available and meet the following:

• Have income at or below 350% of Federal Poverty Income Level
• Are diagnosed with disorder identified by Newborn Screening Program
• Are a bona fide resident of the State of Texas
• Have an annual renewal review
• Are ineligible for other programs providing the same services such as:
  • Medicaid recipients
  • Children with Special Health Care Needs (eligible if on waiting list)
  • Children’s Health Insurance (CHIP) program
  • CHIP Perinatal
  • Title V Genetic Services
  • Private Insurance

Benefits Provided

• Dietary supplements, metabolic foods (formulas), and low-protein foods 
• Medications
• Vitamins
• Confirmatory testing, evaluation, and follow-up care
• Reimbursement to specialists for telephone consults 

Eligible Providers  

• Medical geneticists and clinics
• Centers specializing in metabolic, endocrine and hematological disorders
• Laboratories that provide confirmatory testing
• Pharmacies that provide vitamins, medications, dietary supplements (metabolic foods)
• Manufacturers or retailers of medical foods that provide low-protein foods, formulas, dietary supplements, and vitamins

Newborn Screening Program Benefits Forms

Eligibility Forms 

• Applicant Packet 
• Benefits Application for Services 
• Prescription Request Form (New/Add/Change)
• Presumptive Eligibility Application 
• Prior Approval Request Form 
• Statement of Applicant’s Rights And Responsibilities
• Waiver of Ineligibility 

Monthly Billing and Report Forms  

• State of Texas Purchase Voucher (Word)
• Monthly Billing – Low-Protein Foods 
• Monthly Billing – Pharmacy/Medical Foods Provider

Optional Forms

• Low Protein Foods Approval Request (New Items/Prices)
• Statement of Self-Employment Income
• Employment Verification – Release of Information
• Request for Information

Questions? 

Email nbsbenefits@dshs.texas.gov if you have questions about NBS program benefits or need open enrollment information.