CSHCN 2008 > Physician > Enrollment

24.1 Enrollment

24.1.1 Independent Practices

To enroll in the CSHCN Services Program as a physician (doctor of medicine [MD] and doctor of osteopathy [DO]) or as a doctor of podiatric medicine [DPM]), physicians must be licensed by the licensing board of their profession to practice in Texas. Physicians may enroll as a CSHCN Services Program provider by completing the provider enrollment application available through the TMHP-CSHCN Services Program. Physicians and podiatrists must be actively enrolled as a Medicaid provider before enrolling in the CSHCN Services Program. Out-of-state physicians must meet all these conditions, and be located in the United States, within 50 miles of the Texas state border.

Important: CSHCN Services Program providers are responsible for knowing, understanding, and complying with the laws, administrative rules, and policies of the CSHCN Services Program and the Texas Medicaid Program.

By enrolling in the CSHCN Services Program, providers are charged not only with knowledge of the adopted CSHCN Services Program agency rules published in Title 25 of the Texas Administrative Code (TAC), but also with knowledge of the adopted Medicaid agency rules published in Title 1 of the TAC, Part 15, and specifically including the fraud and abuse provisions contained in Chapter 371.

CSHCN Services Program providers also are required to comply with all applicable laws, administrative rules, and policies that apply to their professions. Specifically, it is a violation of program rules when a provider fails to provide health-care services or items to recipients in accordance with accepted medical community standards and standards that govern occupations, as explained in 1 TAC §371.1617(a)(6)(A) for Medicaid providers, which also applies to CSHCN Services Program providers as set forth in 25 TAC §38.6(b)(1). Accordingly, CSHCN Services Program providers can be subject to sanctions for failure to, at all times, deliver health-care items and services to recipients in full accordance with all applicable licensure and certification requirements. These include, without limitation, requirements related to documentation and record maintenance, such that a CSHCN Services Program provider can be subject to sanctions for failure to create and maintain all records required by his/her profession, as well as those required by the CSHCN Services Program and the Texas Medicaid Program.

Refer to: Section 3.1, "Provider Enrollment," on page 3-2 for more detailed information about CSHCN Services Program provider enrollment procedures.