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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.4 Presumptive Eligibility (PE) : Qualified Provider Enrollment
To be eligible as a qualified provider for PE determinations the following federal requirements must be met. The provider must:
Provide outpatient hospital services, RHC services, or clinic services furnished by or under the direction of a physician without regard to whether the clinic is administered by a physician (includes family planning clinics).
The Commodity Supplemental Food Program of the Agriculture and Consumer Protection Act of 1973
The Indian Health Service must be a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination and Education Assistance Act. Indian Health Service providers can refer to Section 1: Provider Enrollment and Responsibilities (Vol. 1, General Information) for more information about the enrollment procedures for Texas Medicaid.
Family planning agency providers may be eligible to enroll as PE providers. To enroll as a qualified provider for PE, the provider must request a Presumptive Eligibility Qualified Provider Enrollment Packet from the following address:
Attn: Texas Works
Presumptive Eligibility Program
PO Box 149030
Mail Code W‑323
Austin, TX 78714‑9030
Before final approval as a qualified PE provider, an operating plan must be developed with the regional HHSC client self-support regional director’s office. The rules for PE identify minimal agreements that must be included in this plan.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.