TMPPM 2010 > Gynecological and Reproductive Health, Obstetrics, and Family Planning Services Handbook > Medicaid Title XIX family planning services > Title XIX Provider Enrollment


3. Medicaid Title XIX family planning services

3.1 Title XIX Provider Enrollment

The following guidelines and exceptions apply for family planning providers:

Physicians who wish to provide Texas Medicaid obstetric and gynecological (OB-GYN) services are allowed to bypass Medicare enrollment and obtain a Medicaid-only provider identifier for OB-GYN services regardless of provider specialty.

Federally qualified health centers (FQHCs) do not need to apply for a separate physician or agency number. FQHCs must use their NPI, the appropriate benefit code as applicable, and the family planning procedure codes in this section.

Rural health clinics (RHCs) must use their National Provider Identifier (NPI), the appropriate benefit code as applicable, and the appropriate modifier and place of service as outlined in this section. An RHC can also apply for enrollment as a family planning agency.

Family planning agencies must apply for enrollment with TMHP to receive an agency provider identifier. To be enrolled in Texas Medicaid, family planning agencies must meet the following requirements:

Complete an agency enrollment application.

Ensure that all services are furnished by, prescribed by, or provided under the direction of a licensed physician in accordance with the Texas Medical Board or Texas BON.

Have a medical director who is a physician currently licensed to practice medicine in Texas, and submit a current copy of the medical director's physician license.

Have an established record of performance in the provision of both medical and educational/counseling family planning services as verified through client records, established clinic hours, and clinic site locations.

Provide family planning services in accordance with DSHS standards of client care for family planning agencies.

Be approved for family planning services by the DSHS Family Planning Program.

The effective date for participation is the date an approved provider agreement with Medicaid is established and the provider is assigned a Medicaid provider identifier.

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

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 Texas Medicaid, it is a violation of Texas Medicaid 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 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 Texas Medicaid, providers can also be subject to Texas Medicaid 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: Section 1: Provider Enrollment and Responsibilities (Vol. 1, General Information) for more information about enrollment procedures.

Subsection 6.3.6, "Benefit Code" in Section 6, "Claims Filing", (Vol.1, General Information) for more information about benefit codes.

Texas Medicaid & Healthcare Partnership
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