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4.3.5.2 Qualified Provider Enrollment
To be eligible as a qualified provider for PE determinations the following federal requirements must be met. The provider must:
• Be an eligible Medicaid provider.
•Provide outpatient hospital services, RHC services, or clinic services furnished by or under the direction of a physician without regard to whether the clinic is administered by a physician (includes family planning clinics).
•Receive funds from or participate in one of the following:
•The migrant health centers.
•Community health centers.
•The Stewart McKinney Act (homeless).
•Maternal and Child Health Services Block Grant Program.
•The Indian Self-Determination and Education Assistance Act.
•Special Supplemental Food Program for Women, Infants, and Children (WIC).
•The Commodity Supplemental Food Program of the Agriculture and Consumer Protection Act of 1973.
•A state perinatal program (including family planning programs).
•The Indian Health Service must be a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination and Education Assistance Act. Indian Health Service providers can refer to "Provider Enrollment" for more information about the enrollment procedures for the Texas Medicaid Program.
•Be determined by HHSC to be capable of making PE determinations.
Family planning agency providers may be eligible to enroll as PE providers. To enroll as a qualified provider for PE, the provider must request a Presumptive Eligibility Qualified Provider Enrollment Packet from the following address:
HHSC
Attn: Texas Works
Presumptive Eligibility Program
PO Box 149030
Mail Code W-323
Austin, TX 78714-9030
Before final approval as a qualified PE provider, an operating plan must be developed with the regional HHSC client self-support regional director's office. The rules for PE identify minimal agreements that must be included in this plan.
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