TMPPM 2008 > Texas Medicaid Services > Certified Nurse-Midwife (CNM) > Enrollment

14.1 Enrollment

To enroll in the Texas Medicaid Program, a CNM must be a licensed registered nurse recognized by the Texas Board of Nursing (BON) as an advanced practice nurse (APN) in nurse-midwifery and certified by the American College of Nurse-Midwives. A current copy of the provider's American College of Nurse-Midwives Certificate must be submitted with the Medicaid provider enrollment application. A CNM must also be enrolled as a Medicare provider.

Providers cannot be enrolled if their license is due to expire within 30 days; a current license must be submitted.

Refer to: The Department of State Health Services (DSHS) website at www.dshs.state.tx.us
/famplan for information about family planning and the locations of family planning clinics receiving Title V, X, or XX funding from DSHS.

CNMs must use their individual provider identifier to bill for services they provide to Medicaid clients.

All providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendments (CLIA). Providers not complying with CLIA are not reimbursed for laboratory services.

A CNM must identify the licensed physician or group of physicians with whom there is an arrangement for referral and consultation if medical complications arise. The collaborating physician does not have to be a participating provider in the Texas Medicaid Program. If the arrange-ment is changed or canceled, the CNM must notify TMHP Provider Enrollment in writing within two weeks after the change or cancellation.

CNMs are encouraged to participate in or make referrals to family planning agencies.

CNMs may enroll as providers of Texas Health Steps (THSteps) medical check ups for newborns younger than two months of age and adolescent females. Specific information may be found in the THSteps section of this manual.

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 Title 1 Texas Administrative Code (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.

"Provider Enrollment" for more information about enrollment in the THSteps Program.

"Clinical Laboratory Improvement Amendments (CLIA)" .

"Family Planning Services" on page 20-1.