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31.3 Benefits and Limitations
MSCs are those medical services provided by registered nurses (RNs) and determined with or by a licensed physician to be reasonable and medically necessary for the care of a pregnant adolescent or woman during the prenatal period and subsequent 60-day postpartum period. MSC benefits do not include deliveries.
Covered clinic services include, but are not necessarily limited to: risk assessment, medical services, specific laboratory or screening services, case coordination/outreach, nutritional counseling, psychosocial counseling, family planning counseling, and client education about maternal and child health.
Medical services must be furnished on an outpatient basis by the physician, nurse practitioner, physician's assistant, or licensed professional nurse under the physician's supervision, and must be within the staff's scope of practice or licensure as defined by state law. Although the physician does not necessarily have to be present at the clinic when services are provided, the physician must assume professional responsibility for the medical services provided at the clinic, and ensure through approval of the plan of care (POC) that the services are medically appropriate. The physician must spend as much time in the clinic as is necessary to ensure that clients are receiving medical services in a safe and efficient manner in accordance with accepted standards of medical practice.
The physician must see each client as soon as possible after she enters the MSC care and prescribe or approve the POC. The POC must be based on a risk assessment completed by the physician or licensed, professional clinic staff. MSCs must follow the procedures outlined throughout this manual. All service, frequency, and documentation requirements are applicable.
A minimum level of service must be provided by enrolled MSC providers to all Texas Medicaid clients as follows.
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