TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > THSteps Medical and Dental Administrative Information

43.1.4 Provider Enrollment

Providers cannot be enrolled if their professional license is due to expire within 30 days of application. Facility providers must submit a current copy of the supervising practitioner's license. To provide Medicaid services, each nurse practitioner (NP) must be licensed as a registered nurse (RN) and recognized as an advanced practice nurse (APN) by the Texas Board of Nursing (BON).

To enroll in the THSteps program, providers must be enrolled in the Texas Medicaid Program, and meet one of the following requirements:

•Physicians (doctor of medicine [MD] and doctor of osteopathy [DO]) currently licensed in the state where the service is provided.

•Health-care providers or facilities (public or private) capable of performing the required medical check up procedures under a physician's direction, such as regional and local health departments, family planning clinics, migrant health clinics, community-based hospitals and clinics, maternity clinics, rural health clinics (RHCs), federally qualified health centers (FQHCs), home health agencies, and school districts. In the case of a clinic, a physician is not required to be present in the clinic at all times during the hours of operation; however, a physician must assume responsibility for the clinic's operation.

•Family and pediatric nurse practitioners enrolled independently.

•Certified nurse-midwives (CNMs) enrolled as providers of THSteps medical check ups for newborns younger than 2 months of age and adolescent females.

•Women's health-care nurse practitioners enrolled as providers of THSteps medical check ups for adolescent females.

•Adult nurse practitioners enrolled as providers of THSteps check ups for adolescents.

•Physician assistants (PAs) may enroll independently as THSteps medical providers. It is recommended that PAs have expertise or additional education in the areas of comprehensive pediatric assessment.

Residents may provide medical check ups in a teaching facility under the personal guidance of the attending staff as long as the facility's medical staff by-laws and requirements of the Graduate Medical Education (GME) Program are met, and the attending physician has determined the intern or resident to be competent in performing these functions. THSteps does not require the supervising physician to examine the client as long as these conditions are met.

An RN may not enroll independently, but may perform THSteps medical check ups only under the supervision of a physician. The physician ensures that the RN has appropriate training and adequate skills for performing the procedures for which they are responsible.

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 information about enrollment procedures.