TMPPM 2008 > Texas Medicaid Services > Genetic Services > Enrollment

22.1 Enrollment

A provider of genetic services who wishes to enroll in the Texas Medicaid Program must complete the required Medicaid provider enrollment application forms and enter into a written agreement with HHSC. Texas Medicaid provider enrollment forms are available from TMHP, and may be downloaded at www.tmhp.com. Completed applications are submitted to:

Texas Medicaid & Healthcare Partnership
Provider Enrollment
PO Box 200795
Austin, TX 78720

Prior to enrollment, applicant qualifications for the provision of genetic services are verified and approved by the Department of State Health Services (DSHS). Verification and approval are administered through the Health Screening & Case Management Unit, 1-512-458-7111, ext. 2193. Basic contract requirements are as follows:

•The provider's medical director must be a clinical geneticist (doctor of medicine [MD] or doctor of osteopathy [DO]) who is licensed by the Texas Medical Board and who is board eligible/certified by the American Board of Medical Geneticists (ABMG).

•The provider must use a team of professionals to provide genetic evaluative, diagnostic, and counseling services. The team rendering the services must consist of professional staff including a clinical geneticist (MD or DO) and at least one of the following: nurse, social worker, medical geneticist (PhD), or genetic counselor.

Upon DSHS approval, TMHP issues a provider identifier number and a performing provider identifier for the provision of genetic services.

A provider cannot be enrolled if his or her license is due to expire within 30 days; a current license must be submitted.

Important: All providers are required to read and comply with Section 1, Provider Enrollment and Responsibilities. In addition to required compliance with all requirements specific to the Texas Medicaid Program, it is a violation of Texas Medicaid Program rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in 1 TAC §371.1617(a)(6)(A). Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to the Texas Medicaid Program, providers can also be subject to Texas Medicaid Program sanctions for failure, at all times, to deliver health-care items and services to Medicaid clients in full accordance with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.

Refer to: "Provider Enrollment" for more information about enrollment procedures.