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2012 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 8. Tuberculosis Services : 8.4 Provider Responsibilities

8.4 Provider Responsibilities
If approved to submit claims as a TB clinic under Texas Medicaid, the provider must adhere to the following requirements:
Employ or have a contract or formal arrangement with a licensed physician (doctor of medicine [M.D.] or doctor of osteopathy [D.O.]) who is responsible for providing medical direction and supervision over all services provided to the clinic’s clients. To meet this requirement, a physician must see the client at least once every 90 days to prescribe the type of care provided and, if the services are not limited by the prescription, periodically review the need for continued care.
Adhere to the guidelines issued by HHSC, under the authority of the Texas Health and Safety Code, and ensure that services are consistent with the recommendations of the American Thoracic Society and the Centers for Disease Control and Prevention (CDC). For more information, visit the website at www.cdc.gov/tb/default.htm.
Maintain complete and accurate medical records of each recipient’s care and treatment and accurately document all services provided and the medical necessity for the services.
Ensure that services provided to each client are commensurate with the client’s medical needs based on the client’s assessment/evaluation, diagnostic studies, plan of care, and physician direction. These services must be documented in the client’s medical records.
Sign a written provider agreement with HHSC or its designee. By signing the agreement, the provider of TB‑related clinic services agrees to comply with the terms of the agreement and all requirements of Texas Medicaid including regulations, rules, handbooks, standards, and guidelines published by HHSC or its designee.
Refer to:
Subsection 1.1, “Provider Enrollment” in Section 1, “Provider Enrollment and Responsibilities” (Vol. 1, General Information) for more information.

Texas Medicaid & Healthcare Partnership
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