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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 3. Certified Nurse Midwife (CNM) : 3.1 Provider Enrollment

3.1 Provider Enrollment
To enroll in Texas Medicaid, a CNM must be licensed as a registered nurse and as an advanced practice registered nurse (APRN) by the Texas Board of Nursing (BON), and be authorized to practice as a nurse-midwife. A registered nurse under the multistate licensure compact may be licensed in another state but certified as an APRN for the state of Texas by the Texas BON. Texas Medicaid accepts a signed letter of certification from the Texas BON as documentation of appropriate licensure and certification for enrollment.
Refer to:
The Texas Department of State Health Services (DSHS) website at www.dshs.state.tx.us/famplan for information about family planning and the locations of family planning clinics that receive Title V, X, or XX funding from DSHS.
Providers cannot be enrolled if their license is due to expire within 30 days; a current license must be submitted.
All providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendments (CLIA). Providers not complying with CLIA are not reimbursed for laboratory services.
All APRNs (including CNMs, CRNAs, CNSs, and NPs) are enrolled within the categories of practice as determined by the Texas BON. CNSs and NPs must enroll as an APRN; CNMs and CRNAs may enroll using their specific titles.
A CNM must identify the licensed physician or group of physicians with whom there is an arrangement for referral and consultation if medical complications arise. The collaborating physician does not have to be a participating provider in Texas Medicaid. According to TAC, §354.1252 (3), if the collaborating physician or group is not a participating provider in Texas Medicaid, the CNM must inform clients of their potential financial responsibility. If the arrangement is changed or canceled, the CNM must notify Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment in writing within two weeks after the change or cancellation.
CNMs are encouraged to participate in or make referrals to family planning agencies.
Refer to:
Section 1: Provider Enrollment and Responsibilities (Vol. 1, General Information) for more information about enrollment in Texas Medicaid.
Subsection 5.2, “Enrollment,” in the Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information about enrollment in the THSteps Program.
Subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA),” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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