Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Future Scope
Future Scope: Enterprise Data Warehouse / Business Intelligence Solution
The Enterprise Data Warehouse / Business Intelligence (EDW/BI) Solution will be designed with
the flexibility to incorporate additional data sources and expand the capacity, performance, and
functionality through services rendered to accommodate potential future scope, while still
ensuring integrity of the long term architectural vision. This document provides information
relating to potential additional Functional Requirements, Source Systems, Data Sources, and
Services or Software intended to enhance EDW functionalities in the future. The Cost Proposal
for the EDW/BI Solution for this RFP should not include any pricing for potential future scope.
As specified in the Project Overview (Section 1.6.2.) of the EDW/BI Request for Proposal (RFP),
the Respondent's Solution will have the capacity and flexibility to acquire additional data
sources and perform all future functions and services as a part of the Future Scope. Table 1 Potential Additional Functional Requirements, within this document, lists the potential additional
Functional Requirements that will be supported through the implementation of Future Scope
functionality into the Solution.
Future Scope additional services will include but may not be limited to buying additional
hardware, software, adding additional data sources, enhancing the Solution's functionality,
improving the system's scalability, and providing services that are within the scope of this RFP
and any awarded Contract.
Within the HHS Enterprise are additional source systems that are out-of-scope for the Solution's
initial development but which offer data that can enhance views of health care services and
histories. These systems typically contain transactions related to Medicaid clients (or services
provided to them) but which are overseen by the following agencies outside HHSC:
Texas Department of Aging and Disability Services (DADS)
Texas Department of Assistive and Rehabilitative Services (DARS)
Texas Department of Family and Protective Services (DFPS)
Texas Department of State Health Services (DSHS)
A list of potential additional source systems within the HHS Enterprise in provided in Table 2 Potential Additional Source Systems of this document. It should be noted that recommendations
from the recent Sunset Advisory Commission Report (October 2014) are expected to create
many requirements for additional data integration across current agency boundaries.
In addition, the EDW will be able to obtain these additional sources of data and services in order
to support and extend the comprehensiveness of data collections previously established. As
the maturity of health care information increases across Texas, there will likely be opportunities
to enhance Medicaid client history information with transaction data arising from clinical systems
where Medicaid client receive treatment. Integrating clinically relevant data into the EDW that
was previously unavailable within administrative data sets in HHSC (claims or encounter
transactions) will offer new potential opportunities to measure and track Medicaid client
outcomes. For example, supplementing the EDW data from electronic health records (EHRs)
can fill information gaps related to services for Medicaid clients, both inside and outside their
periods of Medicaid eligibility. Lists of potential additional data sources and additional services
are provided in Table 3 – Potential Additional Data SourcesTable 3 and Table 4 – Additional
Services or Software for Data Connectivity, respectively, in this document.
1
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Future Scope
EDW Future Scope: Potential Additional Functional Requirements
The following potential additional functional requirements, listed in Table 1 below, are provided
to Respondents in order to provide information concerning the expected long term development
strategy of the EDW. These requirements are outside the scope of this RFP. However, it is
expected that the Solution should be able to be modified and enhanced to accommodate future
objectives. Additional functional requirements assessment and alignment of EDW capabilities to
business objectives are expected to be necessary before future projects can begin. Note that
additional details about each requirement are included in Appendix A: Detailed Functional
Requirements – Potential Future Scope in this document.
Table 1 - Potential Additional Functional Requirements
FR ID
Functional Requirement Description
FR015
Use Vital Statistics to notify business units of client life changes
FR018
Integrate DSHS registries with client records.
FR076
Implement enterprise view across agencies of case management
portfolio.
Determine availability in comparable programs (Medicaid).
FR003
FR006
FR021
FR041
FR043
FR020
Monitor [cost] impact of migration between programs and services
(including both internal and external as available).
Integrate service data from the All Payers data (Texas Healthcare
Information Collection (THCIC) Data).
Expose streams of care episodes that cross programs or departments
or agencies.
Assess comparable services within and across all agencies.
Incorporate public health strategy program data (e.g., immunizations,
smoking cessation).
Stage
Topic/Domain
Client, Provider, and
Enrollment Visibility
Client, Provider, and
Enrollment Visibility
Client, Provider, and
Enrollment Visibility
Client, Provider, and
Enrollment Visibility
Service Delivery
Client
Service Delivery
Client
Service Delivery
Services
Service Delivery
Service Delivery
(Episodes of Care)
Services
Client
Client
Case
Program
Program
FR061
Provide a single view of Medicaid services across programs/agencies.
Service Delivery
(Episodes of Care)
Continuity
FR078
Compare client outcomes across case management programs.
Service Delivery
Services
FR028
Identify people without health insurance.
Client Historical
Information
Client
FR066
Integrate Vendor drug by incorporating drugs prescribed through
private insurance providers.
Client Historical
Information
Continuity
FR067b
Integrate health data from private insurers.
Client Historical
Information
Continuity
FR068
Integrate data about veterans who are also clients from the Veterans
Administration
Client Historical
Information
Client
2
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Future Scope
EDW Future Scope: Potential Additional Source Systems
The following Table 2 lists the potential additional Source Systems for the EDW that are
identified for future scope and are provided to Respondents in order to provide information
concerning the expected long term development strategy of the EDW. These potential additional
source systems are outside the scope of this RFP. However, it is expected that the Solution
should be able to be modified and enhanced to accommodate future objectives. All of these
data sources are within HHS agencies.
Table 2 - Potential Additional Source Systems
System
Count
Agency
1
DADS
2
3
EDW Source
Systems
Source
System Name
Source System Description
CARES
Compliance,
Assessment,
Reporting, and
Enforcement
System
Supports regulation of long-term
care facilities to ensure that all
federal and state regulations are
met. This is the primary state
system used by regulatory
services staff. The system
includes Wafer and CARES
Reporting interfaces.
Sybase
7
DADS
CMS ICF/MR
PRV PMT
Intermediate
Care Facilities
for Persons with
Mental
Retardation
Provider
Payment
System
DADS Claims Management
System’s ICF/MR Provider
Payment System– calculates
provider payments and federal
funds requests, performs HIPAA
reconciliation, and retains
supporting client-level claim data
for audit and reporting purposes.
Oracle
10
DADS
CSIL
Community
Services
Interest List
Community Services Interest List
(CSIL) is a web-based
application for keeping track of
individuals waiting to receive
services in various Community
Care programs. CSIL replaces
the manual tracking systems
used by different community
care programs.
Oracle
1
3
Database
Type
System
Size (Gb,
as of Jan
2014)
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
System
Count
Agency
4
5
Future Scope
EDW Source
Systems
Source
System Name
Source System Description
DADS
HCS PRV PMT
Home and
Communitybased Services
Provider
Payment
System
Home and Community-based
Services Provider Payment
(HCS PRV PMT) system
calculates provider payments
and federal funds requests,
performs HIPAA reconciliation,
and retains supporting clientlevel claim data for audit and
reporting purposes. Interfaces
with HCS, MARS/G Accounts
Payable, and General Ledger.
Oracle
50
DADS
HCSSA
DADS licenses, certifies and
surveys Home and Community
Support Services Agencies
(HCSSAs) for compliance with
state and federal laws and
regulations.
Oracle
1
The Client Assignment and
Registration System (CARE)
system is the central client
database for Mental Health (MH)
and Mental Retardation (MR)
(DSHS and DADS) components
of HHSC. It contains MR Data (&
MR History) along with MH Data
(& History), including services
provided in State Supported
Living Centers (SSLCs). Also
includes data for HCS, ICF/MR
and TxHML programs.
Mainframe
MODEL
204
7
Home and
Community
Support
Services
Agencies
6
DADS
MR CARE
MR Client
Assignment and
Registration
System
4
Database
Type
System
Size (Gb,
as of Jan
2014)
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
EDW Source
Systems
Future Scope
System
Count
Agency
Source
System Name
Source System Description
7
DADS
SAS
Service
Authorization
System
Service Authorization System
(SAS) accepts and maintains
information about an individual’s
authorization for services. State
staff or a contracted provider
authorizes specific service
arrays for individual clients
before a provider can
successfully bill for services. An
authorization provides service
information such as: type of
service, Level of Service (LOS),
authorized service period (time
frames), co-payment, and
specific rates. Service Groups,
Service Codes, and the
authorized LOS drive system
functionality, determining the
programs and services for which
an individual is authorized.
DADS CMS Service
Authorization System (SAS)
database is the primary
repository of service information
for all individuals enrolled in
DADS Long Term Care (LTC)
programs. An electronic file of
SAS data is transmitted to
TMHP daily for claims
adjudication processing.
Oracle
8
DADS
TxHML
Texas Home
Living
This program provides selected
essential services and supports
to people with intellectual and
developmental disabilities that
live in their family homes or their
own homes.
Mainframe
5
Database
Type
System
Size (Gb,
as of Jan
2014)
220
7
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
EDW Source
Systems
Future Scope
System
Count
Agency
Source
System Name
Source System Description
9
DARS
TKIDS
Texas Kids
Intervention
Data System
Texas Kids Intervention Data
System (TKIDS) is a consumer
tracking system for Early
Childhood Intervention (ECI).
The system is used to collect
data on services provided to
children, birth to age 3 with
disabilities or developmental
delays, and their families. TKIDS
also has a reporting application
attached.
Oracle
38
10
DFPS
IMPACT
Information
Management
Protecting
Adults and
Children in
Texas
IMPACT is a case management
system that tracks Adult
Protective Services (APS), Child
Care Licensing (CCL) and Child
Protective Services (CPS)
program activities related to
Reports of Abuse/Neglect,
Investigations of Abuse/Neglect
and Exploitation, delivery of
services to clients including inhome services, foster care,
eligibility determination, and
billing.
Oracle
1,126
6
Database
Type
System
Size (Gb,
as of Jan
2014)
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
System
Count
Agency
11
DSHS
EDW Source
Systems
ASKIT
Future Scope
Source
System Name
Source System Description
Automated
System for
Kidney
Information
Tracking
Automated System for Kidney
Health Information Tracking
(ASKIT) provides patient and
provider information for the
Kidney Health Care Program
(KHC) and their contracted
providers. Checks client
Medicaid information via both
real-time and batch interfaces
with the Centralized Billing
System. Receives matching
Medicare Part D data from U.S.
Centers for Medicare and
Medicaid Services (CMS);
imports and exports files with
contracted drug claims
processor.
7
Database
Type
Sybase
5.3.2
System
Size (Gb,
as of Jan
2014)
25
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
System
Count
Agency
12
DSHS
EDW Source
Systems
CMBHS
Future Scope
Source
System Name
Source System Description
Clinical
Management
for Behavioral
Health Services
Data
Warehouse
Clinical Management for
Behavioral Health Services
(CMBHS) is a web-based clinical
record keeping system for statecontracted community mental
health and substance abuse
service providers. CMBHS is an
electronic health record system
that merges legacy automated
health management systems
from the former Texas
Department of Mental Health
and Mental Retardation
(TDMHMR) and the former
Texas Commission on Alcohol
and Drug Abuse (TCADA). In
addition to an electronic health
record, CMBHS also serves as a
clinical tool which includes
diagnostic and treatment plan
capabilities. CMBHS supports
data exchange across
contracted substance abuse
service providers and between
DSHS and other state agencies
to coordinate care. The CMBHS
system combines the electronic
health recordkeeping
requirements for both mental
health and substance abuse
treatment providers in a single
system.
8
Database
Type
Oracle
10g
System
Size (Gb,
as of Jan
2014)
328
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
EDW Source
Systems
Future Scope
System
Count
Agency
Source
System Name
Source System Description
13
DSHS
CMIS – CSHCN
Case
Management
Information
System –
Children with
Special Health
Care Needs
This system is used to determine
and maintain client eligibility for
the Children with Special Health
Care Needs (CSHCN) program.
Processes authorizations for
services and payment of claims.
Provides eligibility information to
TMHP, TxDOT and the HHSCVendor Drug (VDP) Program’s
contracted claims processor.
Receives payment, provider,
authorization, reconciliation and
manifestation information from
TMHP and the HHSC-Vendor
Drug Program’s contracted
claims processor.
MS
Access
2000
6
14
DSHS
CPW Provider
Children and
Pregnant
Women
Provider
Children & Pregnant Women
(CPW) is a system that provides
case management for children &
pregnant women and where
CPW providers complete and
submit prior authorization
requests for services.
SQL
SERVER
2008R2
1
15
DSHS
CRS
Client Record
System
Client Record System (CRS) is
the primary client management
system for State Supported
Living Centers and Hospitals. It
consists of admitting, discharge,
transfer and billing functions as
well as a full suite of electronic
medical record modules for
treatment planning, assessment,
orders, dietary management,
and incident tracking.
Cache
16
DSHS
IMD
Institutions for
Mental
Diseases
IMD MSIS Claims Processing.
Medicaid claims documentation
for state hospitals to be reported
to HHSC MSIS System.
Sybase
ASE 12.5
9
Database
Type
System
Size (Gb,
as of Jan
2014)
250
1
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
EDW Source
Systems
Future Scope
System
Count
Agency
Source
System Name
Source System Description
17
DSHS
ImmTrac
Texas
Immunization
Registry
Texas Immunization Registry.
ImmTrac is a central automated
statewide immunization tracking
registry that records
immunizations administered to
citizens in the State of Texas.
Except for disaster-related
information, consent must be
obtained for records to be
retained in the registry.
SYBASE
15.0.3
71
18
DSHS
NBS/LIMS
Newborn
Screening
(NBS) /
Laboratory
Information
Management
System (LIMS)
Newborn Screening (NBS)
Laboratory Information
Management System (LIMS)
contains patient, provider &
laboratory test results
information for genetic &
metabolic disease testing. –
Microsoft
SQL
Server
2000
1,024
19
DSHS
Orchard (Harvest)
Harvest
Harvest Laboratory operational
information system for state
hospitals contains patient
information for the clinical
chemistry portion of the
laboratory. Tests include lead
testing, hemoglobin red blood
cell count, syphilis, glucose
testing, cholesterol testing, and
hemoglobinopathies
Microsoft
SQL
Server
30
20
DSHS
TER
Texas
Electronic
Registrar
Texas Electronic Registrar
system tracks birth, death, and
marriage certifications and
customer service requests for
vital records transactions.
Oracle
11.0.2.3
266
21
DSHS
THCIC
Texas Health
Care
Information
Council
Health Care Data Collection
System (HCDCS). Collection,
auditing and warehousing of
hospital discharge data and
outpatient surgical and
radiological procedure data.
DSHS
LINK
10
Database
Type
System
Size (Gb,
as of Jan
2014)
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
System
Count
Agency
EDW Source
Systems
22
DSHS
THSteps
23
DSHS
24
25
Future Scope
Source
System Name
Source System Description
Database
Type
System
Size (Gb,
as of Jan
2014)
Texas Health
Steps
Texas Health Steps (THSteps) is
the Early Periodic Screening,
Diagnosis, and Treatment
(EPSDT) program for Texas
Medicaid. THSteps provides
preventive health care services
at regular and periodic intervals
to Medicaid clients who are from
birth through 20 years of age.
This system supports in part
MMIS and is funded by Title XIX.
SQL
Server
2008, R2
85
TWICES
Texas-Wide
Integrated
Client
Encounter
System
Integrated case management
across all DSHS program
SQL
SERVER
2008R2
50
HHSC
ESSFDW(CAPPS
Employee Data,
HHSAS Financial
Data)
Enterprise
Support
Services
Financial Data
Warehouse
Data Warehouse holds the
CAPPS employees data and
HHSAS Financial data for all
HHS agencies
Oracle
9.2.0
HHSC
HEART
HHS Enterprise
Administrative
Reporting and
Tracking
System
–This system tracks external
customer complaints, issues,
and resolutions for compliance
with SB 1563.‘
Sybase
11
102
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
EDW Source
Systems
Future Scope
System
Count
Agency
Source
System Name
Source System Description
26
HHSC
Medicare Buy-In
Medicare BuyIn
Medicare Buy-in system
identifies and report individuals
who are eligible for Medicare
Buy-In to CMS. This would
benefit individuals from saving a
substantial amount of money on
their income when they no
longer pay for their Medicare
premium. This also benefits the
State when it buy-in an
individual’s Medicare premium
because Medicare will pay for
their medical claims; therefore
the State’s liability to pay
Medicaid can be reduced.
Oracle
95
27
HHSC
MEHIS
Medicaid
Eligibility and
Health
Information
Services
The Medicaid Eligibility and
Health Information System
(MEHIS) replaced paper
Medicaid identification forms
with a permanent plastic card,
automates eligibility
verification, provides an
electronic health record for all
Medicaid clients, and establish a
foundation for future health
information exchange.
Oracle
1,228
12
Database
Type
System
Size (Gb,
as of Jan
2014)
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
System
Count
Agency
EDW Source
Systems
28
HHSC
NorthSTAR
29
HHSC
NPPS
Future Scope
Source
System Name
Source System Description
Database
Type
System
Size (Gb,
as of Jan
2014)
NorthSTAR
The NorthSTAR operational
system provides for the
identification and enrollment of
consumers into the NorthSTAR
behavioral managed care
initiative. Custom developed
Mainframe system. Interfaces
with CARE and with Medicaid
eligibility data. Sends enrollment
and eligibility data to the
enrollment broker (Maximus), to
the NorthSTAR and Mental
Retardation and Behavioral
Health Outpatient Data
Warehouse (MBOW) and to the
managed care organization
(Value Options).
Mainframe
28
NorthSTAR
Premium
Payable
System
NPPS calculates provider
payments and federal funds
requests, and retains supporting
client-level claim data for audit
and reporting purposes.
Oracle
100
13
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Future Scope
EDW Future Scope: Potential Additional Data Sources
The following Table 3 lists potential additional data sources currently considered relevant to
potential future development and are provided to Respondents in order to provide information
concerning the expected long term development strategy of the EDW. These potential additional
data sources are outside the scope of this RFP. However, it is expected that the Solution should
be able to be modified and enhanced to accommodate future objectives. This list includes
reference data sources, data mapping/translation utilities, external system data (i.e. within
Federal and commercial systems) and internal system data sources (i.e. additional HHS
systems not previously integrated in earlier projects or listed above).
Table 3 – Potential Additional Data Sources
Purpose
Name
Category
Provisioning
Mode
Stage
Rationale
External
Data
Automated Survey Processing
Environment (ASPEN)
Federal
Data
Client,
Provider,
and
Enrollment
Visibility
Survey processing
and data exchange
between DADS and
CMS (including
deficiency plans for
Medicaid providers).
Internal
Data
Resiliency and Disease
Management (RDM)
State –
DSHS
Data
Client,
Provider,
and
Enrollment
Visibility
A primary aim of
RDM is to ensure
the provision of
interventions with
empirical support to
eliminate or manage
symptoms and
promote recovery
from psychiatric
disorders
Internal
Data
Supplemental Nutrition
Assistance Program (SNAP)
State –
HHSC
Data
Client,
Provider,
and
Enrollment
Visibility
Provides additional
program information
for Medicaid clients
eligible for SNAP
Internal
Data
Service Utilization and Review
System (SURS)
State - OIG
Data
Client,
Provider,
and
Enrollment
Visibility
Utilization review of
Medicaid providers
by the HHSC Office
of the Inspector
General
Internal
Data
Temporary Assistance for Needy
Families (TANF)
State –
HHSC
Data
Client,
Provider,
and
Provides additional
program information
for Medicaid clients
14
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Purpose
Name
Future Scope
Category
Provisioning
Mode
Stage
Rationale
Enrollment
Visibility
eligible for TANF
Reference
Case Management CrossReference
State –
Custom (BM)
Data
Client,
Provider,
and
Enrollment
Visibility
Provides maintained
descriptions and
program attribution
for all HHS case
management
programs.
Reference
Functional Assessment Codes
and Descriptions
State
Data
Client,
Provider,
and
Enrollment
Visibility
Reference data for
functional, medical,
or psychiatric
assessments across
the enterprise.
Internal /
External
Data
Provider Structure with
Employees
Solution
Data
Client,
Provider,
and
Enrollment
Visibility
Required for
functions relating to
provider facilities.
Provider businessto-business and
organization/group
ownership
information does not
reside (or is
incompletely
described) in HHS
systems.
Reference
Service Authorization Codes and
Descriptions
State
Data
Client,
Provider,
and
Enrollment
Visibility
Reference data for
authorizations
across the HHS
enterprise.
External
Data
Outcome and Assessment
Information Set (OASIS)
Federal
Data
Service
Delivery
LTC assessment
and incident data
shared between
Federal system and
CARES.
Reference
Public Assistance Reporting
Information System (PARIS)
Federal
Data
Service
Delivery
Current use is within
DADS to identify
military veterans
who are in both VA
and Texas Medicaid
15
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Purpose
Name
Future Scope
Category
Provisioning
Mode
Stage
Rationale
systems.
Reference
Systematized Nomenclature of
Medicine (SNOMED) (D Axis)
Codes and Descriptions
Solution
Data
Service
Delivery
Universal reference
set expected to
describe many
healthcare service
transactions
available in the
future via HIE. Not
currently used in
HHSC services or
payment systems.
External
Data
Prescription Drug Point-of-Sale
Data
Solution
Data
Drug
Integration
Point-of-sale data to
supplement
prescription data in
Vendor Drug
system.
Internal
Data
Insurance Third Party Payer Data
State
Data
Client
Historical
Information
Existing third party
payer information in
Compass21 (TPR,
etc.)
External
Data
Insurance Brokerage Data
Solution
Data
Client
Historical
Information
Source(s) needed to
supplement payer or
coverage histories
for Medicaid clients.
Link
HIX
State
Data
Client
Historical
Information
Source(s) needed to
supplement payer or
coverage histories
for Medicaid clients.
Internal
Data
DSHS Nutrition, Physical Activity,
and Obesity Prevention (NPAOP)
State
Data
Client
Historical
Information
Program information
and data for a DSHS
program known to
impact Medicaid
clients
Internal
Data
DSHS Tobacco Prevention and
Control (TPC)
State
Data
Client
Historical
Information
Program information
and data for a DSHS
program known to
impact Medicaid
clients
If the required data is not yet available in the EDW, the EDW may potentially be required to acquire the necessary data
16
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Purpose
Name
Future Scope
Category
Provisioning
Mode
Stage
Rationale
from sources specified by HHSC-OIG (current list of MFADS sources is listed below) for online inquiry access to these data
via universes to be built by HHSC-OIG within the MFADS sandbox of the EDW.
Internal
Data
HHSC Medicaid Claims
Administrator Contractor
 Adjudicated acute care
claims, adjudicated
Medicare crossover claims,
encounters, and code tables
State
Data
MFADS
Currently used by
MFADS program.
State
Data
MFADS
Currently used by
MFADS program.
State –
HHSC
Data
MFADS
Currently used by
MFADS program.
 Provider File – provider
identification data and code
tables
 Reference Files – To include
but not limited to Diagnosis
Related Group, Diagnosis
Code, Procedure Codes,
and code tables
 Client File – Client eligibility
data and code tables (data
originates from HHSC
SAVERR or HHSC TIERS
systems)
 HHSC Eligibility Recon
Extract – Client eligibility
reconciliation extract
 Adjudicated Claims data and
code tables
 Provider/Vendor/contract
data and code tables
 Reference files and code
tables
Internal
Data
HHSC Vendor Drug Claims
Processing Contractor
 Adjudicated Claims data and
code tables
 Reference data to include
pharmacy, pharmacy
address, pharmacy type,
National Drug Code (NDC),
and lock-in
Internal
Data
HHSC Medical Transportation
(provides non-emergency
transportation services)
 Authorization data
17
Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Purpose
Internal
Data
Name
DADS Long Term Care
(LTC)/Claims Management
System (CMS)
 LTC adjudicated claims data
and code tables
Future Scope
Category
Provisioning
Mode
Stage
Rationale
State
Data
MFADS
Currently used by
MFADS program.
 LTC authorizations data and
code tables
 LTC facility assessment data
and code tables
 LTC provider data from the
LTC Provider Subsystem
 LTC facility data from the
Long Term Care Regulatory
Client Assessment Resident
Evaluation System (CARES)
which contains facility
demographic, ownership,
licensure, and certification,
sanctions, and other similar
data
Internal
Data
HHSC SAVERR/TIERS Eligibility
Recon
 Eligibility Recon Extract –
Client eligibility
reconsiderations extract
State
Data
MFADS
Currently used by
MFADS program.
Internal
Data
HHSC/DSHS Texas Health Steps
(THSteps)
 THSteps medical screening
laboratory data and code
tables
State
Data
MFADS
Currently used by
MFADS program.
 THSteps newborn screening
data and code table
Internal
Data
DSHS Bureau of Vital Statistics
(BVS)
 BVS deaths data and code
tables
State
Data
MFADS
Currently used by
MFADS program.
Internal /
External
Data
Texas State Licensing Board
(external data – currently
obtained by MFADS from HHSC
Medicaid Claims Administrator
Contractor)
 Dental provider licensing
data and code tables
State
Data
MFADS
Currently used by
MFADS program.
 Medical Doctor/Doctor of
Osteopathic Medicine
(MD/DO) provider licensing
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Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Purpose
Name
Future Scope
Category
Provisioning
Mode
Stage
Rationale
data and code tables
 Board of Nurse Examiners
Registered Nurse (RN)
licensing data
 Board of Nurse Examiners
Licensed Vocational Nurse
(LVN) licensing data
 Board of Nurse Examiners
Advanced Practice
Registered Nurse (APRN)
licensing data
External
Data
SSA Death Master File –
obtained via subscription, monthly
download accessible through
Social Security Death Master File
Monthly Download Service
(External Web Site)
Federal
Data
MFADS
Currently used by
MFADS program.
Definitions
Purpose: Classification of data sources (Acquisition, Collections, Conformance, External Data, Identity, Internal Data, Link,
Mapping, Reference, Translation)
Category: Proposed method by which the reference data will be provisioned or generated when required in the future.
Solution – Contractor’s Solution will incorporate The potential additional data source when required in the future
through the EDW Change Order process.
Federal, State, Other – HHSC will be responsible for subscription of the additional data sources that the
Contractor will include in the Solution’s data acquisition, when required in the future through the EDW Change
Order process.
Provisioning Mode: Potential or expected format of data source (Data, Software)
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Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Future Scope
EDW Future Scope: Potential Additional Services or Software for Data Connectivity
The following Table 4 lists potential additional services or software for data connectivity
requirement, currently considered relevant to potential future development and are provided to
Respondents in order to provide information concerning the expected long term development
strategy of the EDW. These potential additional services or software requirements are outside
the scope of this RFP. However, it is expected that the Solution should be able to be modified
and enhanced to accommodate future objectives.
Table 4 – Additional Services or Software for Data Connectivity
Purpose
Name
Category
Provisioning
Mode
Stage
Rationale
Reference
Dartmouth Atlas
Solution
Data/Software
Service
Delivery
Medicare utilization
measurement and
reference via
geographic regions
for comparative
benchmarking
Mapping
Drugs to Diagnosis
[External]
Solution
Data/Software
Drug
Integration
Required to relate
diagnosis events
available in HIE or
other external
systems within
episodes of care.
Mapping
Drugs to
Procedure
[External]
Solution
Data/Software
Drug
Integration
Required to relate
diagnosis events
available in HIE or
other external
systems within
episodes of care.
Acquisition
Electronic Medical
Records (EMR)
Parser
Solution
Software
Client
Historical
Information
Needed to integrate
transaction data from
future HIE system(s)
Link
HIE
Solution
Data/Software
Client
Historical
Information
Needed to integrate
transaction data from
future HIE system(s)
Mapping
Alignment of I Data
Elements
Solution
Software
Client
Historical
Information
Needed to integrate
transaction data from
future HIE system(s)
Definitions
Purpose: Classification of data sources (Acquisition, Collections, Conformance, External Data, Identity, Internal Data, Link,
Mapping, Reference, Translation)
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Texas Health and Human Services Commission
EDW/BI Solution RFP No. 529-16-0001
Purpose
Name
Category
Future Scope
Provisioning
Mode
Stage
Rationale
Category: Proposed method by which the reference data will be provisioned or generated when required in the future.
Solution – Contractor’s Solution will incorporate the potential additional services or software when required in
the future through the EDW Change Order process.
Provisioning Mode: Potential or expected format of data source (Data, Software)
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Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
Appendix A – Detailed Functional Requirements – Potential Future Scope
FR ID
FR015
Functional Requirement:
Use Vital Statistics to notify business units of client life changes.
Stage:
Client, Provider, and Enrollment Visibility
Description:
This requires integrations to vital statistics records at DSHS or other external
governmental entity records that track births, deaths or other major life changes. The
intent is to pass data concerning these changes to the EDW to enable early
identification of changes that may impact client eligibility for services.
Potential User Groups:
DADS Budget Analysts
MH Inpatient Services
DSHS Center for Health Statistics
THSteps
LTC Analysts
HHSC Operations Support (Managed Care)
People who need clean addresses for mailings
MITA Business Processes: Determine Eligibility
Disenroll Member
Enroll Member
Inquire Member Eligibility
Manage Member Information
Member Management (ME)
Member Management (ME)
Member Management (ME)
Member Management (ME)
Member Management (ME)
FR ID
FR076
Functional Requirement:
Implement enterprise view across agencies of case management portfolio.
Stage:
Client, Provider, and Enrollment Visibility
Description:
The EDW will enable users to view the array of services available clients in the
various programs funded by Medicaid.
Potential User Groups:
Strategic Decision Support
DADS Budget Analysts
MITA Business Processes: Develop and Maintain Benefits Package
Develop and Maintain Program Policy
Manage Program Information
Manage Case
22
Program Management (PG)
Program Management (PG)
Program Management (PG)
Program Integrity Management (PI)
Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
FR ID
FR041
Functional Requirement:
Expose streams of care episodes that cross programs or departments or agencies
Stage:
Service Delivery (Episodes of Care)
Description:
The Vendor will be able to identify episodes of care that involve more than one
program, department or agency. For instance, if a long term care client receives
acute care services. This requires Episodes of Care.
Potential User Groups:
Office of the Medical Director
HHSC Operations Support (Managed Care)
LTC Analysts
Strategic Decision Support
DADS Budget Analysts
TMHP
Vendor Drug Program
MITA Business Processes: Manage Member Information
Generate Financial and Program Analysis
Manage Program Information
Perform Population and Member Outreach
Develop and Maintain Program Policy
Establish Case
Manage Medicaid Population Health
Manage Registry
Member Management (ME)
Program Management (PG)
Program Management (PG)
Member Management (ME)
Program Management (PG)
Care Management (CM)
Care Management (CM)
Care Management (CM)
FR ID
FR003
Functional Requirement:
Determine availability in comparable programs (Medicaid)
Stage:
Client, Provider, and Enrollment Visibility
Description:
Comparable programs are those programs with similar eligibility requirements and
service offerings. This requirement supports analysis of comparable programs from
several perspectives. This analysis may support case management activities by
identifying comparable programs with interest lists or available openings for new
clients. The requirements also support examination of any differences in access and
utilization to determine causes and/or approaches to optimize service delivery.
Potential User Groups:
DADS Budget Analysts
Strategic Decision Support
THSteps
LTC Analysts
HHSC Operations Support (Managed Care)
DFPS Analysts
MITA Business Processes: Manage Program Information
Maintain Benefits-Reference Information
23
Program Management (PG)
Program Management (PG)
Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
FR ID
FR006
Functional Requirement:
Monitor cost impact of migration between programs and services (including both
internal and external as available)
Stage:
Service Delivery (Episodes of Care)
Description:
Clients may move from one program or service to another throughout their tenure in
HHS services. This migration makes it difficult to provide continuity of care to
Medicaid clients and may lead to increased health risks. Further, frequent movement
may add to the cost of client services. EDW will be able to track these movements
and the costs associated with the move (i.e., costs for services in program A versus
cost in program B). The EDW will support analysis of reasons for frequent migration,
services authorized and received through each program and the costs for the service.
Potential User Groups:
HHSC Operations Support (Managed Care)
DADS Budget Analysts
Strategic Decision Support
System Forecasting
LTC Analysts
HHSC Actuarial Analysis
HHSC Rate Analysts
Vendor Drug Program
Office of the Medical Director
MITA Business Processes: Disenroll Member
Enroll Member
Authorize Referral
Authorize Service
Price Claim-Value Encounter
Prepare Capitation Premium Payments
Member Management (ME)
Member Management (ME)
Operations Management (OM)
Operations Management (OM)
Operations Management (OM)
Operations Management (OM)
FR ID
FR021
Functional Requirement:
Integrate service data from the All Payers database (THCIC).
Stage:
Service Delivery (Episodes of Care)
Description:
DSHS manages the Health Care Information Council and its All Payers database.
The Vendor will identify tables and elements from the All Payers database and
include these into episodes in the EDW. This specifically includes items such as
hospital discharge data, including present-on-admission indicators.
Potential User Groups:
DSHS Center for Health Statistics
Office of the Medical Director
MITA Business Processes: Price Claim-Value Encounter
Operations Management (OM)
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Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
Prepare Home and Community Based Services
Payment
Operations Management (OM)
FR ID
FR043
Functional Requirement:
Assess comparable services within and across all agencies
Stage:
Service Delivery (Episodes of Care)
Description:
In the current environment, there is little visibility from program to program,
particularly when these programs are managed by separate agencies. The EDW will
support the ability to identify programs that are comparable, both within an agency
and across the enterprise of five separate agencies. This functionality gives the HHS
enterprise the ability to compare programs to identify unnecessary duplication of
services, exam disparity in reimbursement rates and make appropriate referrals for
clients. This requires Episodes of Care.
Potential User Groups:
Office of the Medical Director
Strategic Decision Support
DADS Budget Analysts
LTC Analysts
DSHS Center for Health Statistics
ECI Analysts
HHSC Operations Support (Managed Care)
Vendor Drug Program
TMHP
MH Inpatient Services
THSteps
MITA Business Processes: Develop and Maintain Benefits Package
Develop and Maintain Program Policy
Manage Program Information
Program Management (PG)
Program Management (PG)
Program Management (PG)
FR ID
FR061
Functional Requirement:
Provide a single view of Medicaid services across programs/agencies.
Stage:
Service Delivery (Episodes of Care)
Description:
This functionality requires access to claim, encounter and provider data necessary to
track all of the programs and HHS agencies that provide a particular service. For
each agency or program, the EDW will be able to aggregate all services provided to
create a comprehensive view of all services within the agency or program. This
requires Episodes of Care.
Potential User Groups:
Strategic Decision Support
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Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
DADS Budget Analysts
System Forecasting
LTC Analysts
HHSC Rate Analysts
HHSC Actuarial Analysis
HHSC Operations Support (Managed Care)
Vendor Drug Program
Office of the Medical Director
THSteps
MH Inpatient Services
DFPS Analysts
MITA Business Processes: Manage Member Information
Manage Provider Information
Price Claim-Value Encounter
Prepare Capitation Premium Payments
Prepare Home and Community Based Services
Payment
Member Management (ME)
Provider Management (PM)
Operations Management (OM)
Operations Management (OM)
Operations Management (OM)
FR ID
FR067b
Functional Requirement:
Integrate health data from private insurers
Stage:
Client Historical Information
Description:
HHS agencies have some data related to private insurance coverage for Medicaid
clients. External sources of coverage and treatment data (e.g. HIX, HIE, insurance
and claims clearinghouses) can be integrated to provide more complete data regarding
continuity of care and continuity of coverage for periods when clients were outside
Medicaid.
Potential User Groups:
DADS Budget Analysts
System Forecasting
Strategic Decision Support
TMHP
THSteps
LTC Analysts
HHSC Operations Support (Managed Care)
Office of the Medical Director
DFPS Analysts
ECI Analysts
MITA Business Processes: Manage Member Information
Establish Business Relationship
Manage Business Relationship
26
Member Management (ME)
Business Relationship
Management (BR)
Business Relationship
Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
Management (BR)
FR ID
FR068
Functional Requirement:
Integrate data about veterans who are also clients from the VA
Stage:
Client Historical Information
Description:
A new interface will need to be built to bring in data from external systems (such as
PARIS) with the VA for sharing data related to individuals who receive both VA and
HHS services. The VA data will be integrated to the EDW to enable identification of
clients receiving both types of service and improve coordination of services.
Potential User Groups:
System Forecasting
Strategic Decision Support
DADS Budget Analysts
LTC Analysts
HHSC Operations Support (Managed Care)
Office of the Medical Director
MITA Business Processes: Manage Member Information
Establish Business Relationship
Manage Business Relationship
Member Management (ME)
Business Relationship
Management (BR)
Business Relationship
Management (BR)
FR ID
FR018
Functional Requirement:
Integrate DSHS registries with client records.
Stage:
Client, Provider, and Enrollment Visibility
Description:
DSHS maintains several public health registries (i.e., cancer registry). Integration of
registry data with the EDW will enable identification of public health trends in the
Medicaid client population and ensure more accurate reporting of Medicaid client
status to the appropriate registry.
Potential User Groups:
DSHS Center for Health Statistics
Office of the Medical Director
LTC Analysts
MITA Business Processes: Determine Eligibility
Inquire Member Eligibility
Manage Member Information
Member Management (ME)
Member Management (ME)
Member Management (ME)
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Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
FR ID
FR020
Functional Requirement:
Incorporate public health strategy program data, e.g., immunizations, smoking
Stage:
Service Delivery (Episodes of Care)
Description:
The Vendor shall integrate to source systems that track public health strategies such
as the immunization tracking system. The intent is to ensure that both the public
health strategy programs and the EDW contain current, accurate information for
Potential User Groups:
DSHS Center for Health Statistics
Office of the Medical Director
MITA Business Processes: Develop Agency Goals and Objectives
Develop and Maintain Program Policy
Manage Member Information
Perform Population and Member Outreach
Program Management (PG)
Program Management (PG)
Member Management (ME)
Member Management (ME)
FR ID
FR066
Functional Requirement:
Integrate Vendor drug by incorporating drugs prescribed through private insurance
providers.
Stage:
Client Historical Information
Description:
The Vendor will integrate with subscription services that provide visibility to drug
prescribed through private insurance. This will provide a complete view into a cli’nt's
drug history. This will require Episodes of Care.
Potential User Groups:
Vendor Drug Program
MH Inpatient Services
Office of the Medical Director
MEHIS Analysts
MITA Business Processes: Manage Member Information
Authorize Service
Member Management (ME)
Operations Management (OM)
FR ID
FR028
Functional Requirement:
Identify people without health insurance.
Stage:
Client Historical Information
Description:
This functionality requires integrate to HIXs and is a future requirement. The intent is
to obtain prior health insurance coverage spans through HIXs and/or insurance brokerage
subscription data once these are implemented state-wide.
Potential User Groups:
Office of the Medical Director
System Forecasting
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Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
MITA Business Processes: Perform Population and Member Outreach
Member Management (ME)
FR ID
FR078
Functional Requirement:
Compare client outcomes across case management programs.
Stage:
Client Historical Information
Description:
HHS agencies need to be able to assess the efficacy and effectiveness of case
management programs. As outcomes for comprehensive case management is
identified and tracked, the EDW will include outcome data to support this analysis.
This requires Episodes of Care.
Potential User Groups:
LTC Analysts
HHSC Operations Support (Managed Care)
Office of the Medical Director
Strategic Decision Support
MITA Business Processes: Develop and Maintain Benefits Package
Develop and Maintain Program Policy
Manage Program Information
Manage Case
Manage Member Information
Inquire Member Eligibility
29
Program Management (PG)
Program Management (PG)
Program Management (PG)
Program Integrity Management (PI)
Member Management (ME)
Member Management (ME)
Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
Appendix B – Glossary for Additional Future Scope Acronyms and Terms
The following Table 5 lists the additional expansion of Acronyms within this Future Scope
document that is not previously provided in Exhibit A – Glossary document of the Procurement
Library.
Table 5 - Additional Acronyms
Acronym
Expansion
APRN
Advanced Practice Registered Nurse
APS
Adult Protective Services
ASKIT
Automated System for Kidney Health Information Tracking
ASPEN
Automated Survey Processing Equipment
BR
Medicaid Information Technology Architecture acronym for Business Relationship
Management Business Process
BVS
Bureau of Vital Statistics
CARE
Client Assignment and Registration System
CARES
Compliance, Assessment, Reporting, and Enforcement System
CCL
Child Care Licensing
CM
Medicaid Information Technology Architecture acronym for Care Management
Business Process
CMBHS
Clinical Management for Behavioral Health Services Data Warehouse
CMIS
Case Management Information System
CPS
Child Protective Services
CPW
Children and Pregnant Women
CRS
Client Record System
CSHCN
Children with Special Health Care Needs
CSIL
Community Services Interest List
DADS
Texas Department of Aging and Disability Services
DARS
Texas Department of Assistive and Rehabilitative Services
DFPS
Texas Department of Family and Protective Services
DO
Doctor of Osteopathic Medicine
DSHS
Texas Department of State Health Services
ECI
Early Childhood Intervention
EHR
Electronic Health Records
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Future Scope
Acronym
Expansion
EMR
Electronic Medical Records
EPSDT
Early Periodic Screening, Diagnosis, and Treatment
HCDCS
Health Care Data Collection System
HCS
Home and Community-based Services
HCSSA
Home and Community Support Services Agencies
HEART
HHS Enterprise Administrative Reporting and Tracking System
HHSAS
Health and Human Services Accounting System
HIE
Health Information Exchange
HIT
Health Information Technology
HIX
Health Insurance Exchange
ICF-MR or
Intermediate Care Facilities for Persons with Mental Retardation
ICF/MR
IMD
Institutions for Mental Diseases
ImmTrac
Texas Immunization Registry
IMPACT
Information Management Protecting Adults and Children in Texas
KHC
Kidney Health Care Program
LIMS
Laboratory Information Management System
LOS
Level of Service
LVN
Licensed Vocational Nurse
MARs
Medication Administration Records
MBOW
Mental Retardation and Behavioral Health Outpatient Data Warehouse
MD
Medical Doctor
ME
Medicaid Information Technology Architecture acronym for Member Management
Business Process
MEHIS
Texas Medicaid Eligibility and Health Information Services
MH
Mental Health
MR
Mental Retardation
MR CARE
Mental Retardation Client Assignment and Registration System
MSIS
Medicaid Statistical Information System
NBS
Newborn Screening
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Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Future Scope
Acronym
Expansion
NDC
National Drug Code
NPOAP
Nutrition, Physical Activity, and Obesity Prevent
NPPS
NorthSTAR Premium Payment System
OASIS
Outcome and Assessment Information Set
OM
Medicaid Information Technology Architecture acronym for Operations Management
Business Process
PARIS
Public Assistance Reporting Information System
PG
Medicaid Information Technology Architecture acronym for Program Management
Business Process
PM
Medicaid Information Technology Architecture acronym for Provider Management
Business Process
PRV PMT
Provider Payment
RDM
Resiliency and Disease Management
RN
Registered Nurse
SAS
Service Authorization System
SAVERR
System of Application, Verification, Eligibility, Referral and Reporting
SNOMED
Systematized Nomenclature of Medicine
SSLCs
State Supported Living Centers
SURS
Service Utilization Review System
TCADA
Texas Commission on Alcohol and Drug Abuse
TDMHMR
Texas Department of Mental Health and Mental Retardation
TER
Texas Electronic Registrar
THCIC
Texas Health Care Information Collection
THSteps
Texas Health Steps
TKIDS
Texas Kids Intervention Data System
TPC
Tobacco Prevention and Control
TWICES
Texas Wide Integrated Client Encounter System
TxDOT
Texas Department of Transportation
TxHML
Texas Home Living
VDP
Vendor Drug Program
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EDW/BI Solution - RFP No. 529-16-0001
Future Scope
The following Table 6 lists the additional brief definition of Terms within this Future Scope
document that is not previously provided in Exhibit A – Glossary document of the Procurement
Library.
Table 6 - Additional Term Definitions
Term
Brief Definition
Dartmouth Atlas
Refers to the Dartmouth Atlas of Health Care organization that provides
benchmark for geographic mapping of how medical resources are
distributed and used in the United States, assisting policymakers, the
media, health care analysts and others improve their understanding of
health care systems.
Electronic Health
Records (EHR)
Means a collection of electronic health information about an individual
patient. It is a record in digital format that is theoretically capable of being
shared across different health care settings.
Electronic Medical
Record (EMR)
Means a computerized medical record created in an organization that
delivers care, such as a hospital or physician's office. Electronic medical
records tend to be a part of a local stand-alone health information system
that allows storage, retrieval and modification of records.
Health Information
Exchange (HIE)
Means the mobilization of healthcare information electronically across
organizations within a region, community or hospital system.
Health Information
Technology (HIT)
Means the umbrella framework to describe the comprehensive
management of health information across computerized systems and its
secure exchange between consumers, providers, government and quality
entities, and insurers.
Health Insurance
Exchange (HIX)
Means the set of state-regulated and standardized health care plans in the
United States, from which individuals may purchase health insurance
eligible for federal subsidies.
Medicaid Eligibility and
Health Information
Services (MEHIS)
Refers to the application system that positions HHSC to respond to the
emerging and anticipated health information technology initiatives that will
foster improved continuity of care, increased communication with clients
and providers, expanded data for healthcare analytics, and better health
outcomes over time.
Medicaid Statistical
Information System
(MSIS)
Prior to Federal fiscal year 1999, the Medical Statistical Information System
(MSIS) were a voluntary program and those states participating in the MSIS
project provided data tapes from their claims processing systems to the
Centers for Medicare & Medicaid Services (CMS) in lieu of the hard-copy
statistical 2082 tables. However, in accordance with the Balanced Budget
Act (BBA) of 1997, all claims processed are submitted electronically
through MSIS.
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Future Scope
Term
Brief Definition
Supplemental Nutrition
Assistance Program
(SNAP)
Means the program that provides financial assistance for food purchasing
to low- and no-income people and families in Texas.
Temporary Assistance
for Needy Families
(TANF)
Means the federal assistance program administered by HHSC that provides
temporary assistance for needy families in Texas.
34