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December 2016 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 3 Comprehensive Health Center (CHC)

CHCs or physician-operated clinics are funded by federal grants. To apply for participation in Texas Medicaid, they must be certified and participate as health centers under Medicare (Title XVIII).
CHC claims are paid according to each center’s encounter rates as established by CMS. Medicaid payments to CHCs are limited to Medicare deductible or coinsurance according to current guidelines. CHC providers that supply laboratory services in an office setting must comply with the rules and regulations for the Clinical Laboratory Improvement Amendments (CLIA). Providers that do not comply with CLIA are not reimbursed for laboratory services.
Refer to:
Subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA)” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks).
Subsection 2.7, “Medicare Crossover Claim Reimbursement” (Vol.1 General Information).
Section 1: Provider Enrollment and Responsibilities (Vol. 1, General Information).
Section 4, “Federally Qualified Health Center (FQHC),” in this Handbook.
Section 7, “Rural Health Clinic,” in this Handbook.

Texas Medicaid & Healthcare Partnership
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