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December 2016 Texas Medicaid Provider Procedures Manual

Section 1: Provider Enrollment and Responsibilities : 1.1 Provider Enrollment and Reenrollment : 1.1.9 Required Enrollment Forms : Physician’s Letter of Agreement
Upon initial enrollment and upon revalidation, Certified Nurse Midwife (CNM) or Licensed Midwife (LM) providers must complete and submit to TMHP with the Medicaid provider enrollment application the Physician’s Letter of Agreement affirming the CNM’s supervising physician arrangement or the LM’s referring or consulting physician arrangement.
According to HHSC rules, 1 TAC §354.1253(c), and 1 TAC §354.1252(3), CNM providers and LM providers are required to inform HHSC in writing of the identity of a licensed physician or group of physicians with whom the CNM or LM has arranged for referral and consultation in the event of medical complications. For purposes of this rule, “consultation” means discussion of patient status, care, and management.
A separate agreement must be submitted for each physician with whom an arrangement is made. This agreement must be signed by the CNM or LM and the physician.
A new agreement must also be completed and submitted to TMHP when a new arrangement is made and when changes to an arrangement are made.
Refer to:

Texas Medicaid & Healthcare Partnership
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