31.1 EnrollmentTo enroll in the Texas Medicaid Program, MSCs must ensure that the provider providing the services is employed by or has a contractual agreement or formal arrangement with the clinic to assume professional responsibility for the services provided to clinic clients. To meet this requirement, a provider 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. Medicare certification is not a prerequisite for MSC enrollment. A current copy of the supervising practitioner's physician license must be submitted at the time of enrollment. An MSC must be a facility that is:
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• An MSC wanting to bill and receive reimbursement for case management services to high-risk pregnant adolescents, women, and infants must meet the eligibility criteria specified in "Case Management for Children and Pregnant Women (CPW)" . To bill and receive reimbursement for family planning services, family planning agencies, providers, advanced practice nurses (APNs), or physicians assistants (PAs) must use their provider identifier. To bill and receive reimbursement for laboratory procedures, an MSC must meet the requirements for an independent laboratory. 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. 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. |
Not an administrative, organizational, or financial part of a hospital.
