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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.2 Client Limited Program : Selection of Designated Provider and Pharmacy
Selection of Designated Provider and Pharmacy
Texas Medicaid fee-for-service clients identified for limited status can participate in the selection of one primary care provider, primary care pharmacy, or both from a list of participating Medicaid providers. Eligible providers cannot be under administrative action, sanction, or investigation. In general, the designated primary care provider’s specialty is general practice, family practice, or internal medicine. Other specialty providers may be selected on a case-by-case basis. Primary care providers can include, but are not limited to: a physician, physician assistant, physician group, advanced practice nurse, outpatient clinic, rural health clinic (RHC), or federally qualified health center (FQHC).
If the client does not select a primary care provider or primary care pharmacy, HHSC selects one for the client.
When a candidate for the designated provider is determined, HHSC contacts the provider by letter. If the provider agrees to be the designated provider, HHSC sends letters of confirmation to the designated provider and the client confirming the name of the client, primary care provider or primary care pharmacy, and the effective date of the limited arrangement.

Texas Medicaid & Healthcare Partnership
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