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44.2 Provider Responsibilities
If approved to bill as a TB clinic under Texas Medicaid, the provider must adhere to the following requirements:
• Be a facility that is not an administrative, organizational, or financial part of a hospital, but is organized and operated to provide medical care to outpatients.
•Comply with all applicable federal, state, and local laws and regulations.
•Employ or have a contract or formal arrangement with a licensed physician (doctor of medicine [M.D.] or doctor of osteopathy [D.O.]) who is responsible for providing medical direction and supervision over all services provided to the clinic's clients. To meet this requirement, a physician must see the client at least once, prescribe the type of care provided and, if the services are not limited by the prescription, periodically review the need for continued care.
•Adhere to the guidelines issued by HHSC, under the authority of the Texas Health and Safety Code, and ensure that services are consistent with the recommendations of the American Thoracic Society and the Centers for Disease Control and Prevention (CDC). For more information, visit the website at www.cdc.gov/tb/pubs/mmwr/maj_guide.htm.
•Ensure that services provided to each client are commensurate with the client's medical needs based on the client's assessment/evaluation, diagnostic studies, plan of care, and physician direction. These services must be documented in the client's medical records.
•Be enrolled and approved for participation in Texas Medicaid.
•Sign a written provider agreement with HHSC or its designee. By signing the agreement, the provider of TB-related clinic services agrees to comply with the terms of the agreement and all requirements of Texas Medicaid including regulations, rules, handbooks, standards, and guidelines published by HHSC or its designee.
•Bill for services covered by Texas Medicaid in the manner and format prescribed by HHSC or its designee.
•Be organized and operated to provide TB-related services, which include, but are not limited to, the covered services as indicated in "Benefits and Limitations" .
•Not provide services within a skilled nursing facility (SNF), intermediate care facility (ICF), or intermediate care facility for the mentally retarded (ICF-MR).
Refer to: "Provider Enrollment" for more information.
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