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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook : 1 General Information

1 General Information
The information in this handbook is intended for gynecological, obstetrics, and Texas Medicaid Title XIX family planning providers. The handbook provides information about Texas Medicaid’s benefits, policies, and procedures that are applicable to these service providers.
All providers are required to read and comply with Section 1: Provider Enrollment and Responsibilities. In addition to required compliance with all requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide healthcare services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1659. Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to Texas Medicaid, providers can also be subject to Texas Medicaid sanctions for failure, at all times, to deliver healthcare items and services to Medicaid clients in full accordance with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.
Refer to:
The Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information about providing services to Texas Medicaid/Texas Health Steps (THSteps) clients.
“Section 1: Provider Enrollment and Responsibilities” (Vol. 1, General Information).
“Texas Medicaid Administration” in “Preliminary Information” (Vol. 1, General Information).
Refer to:
The Women’s Health Services Handbook (Vol. 2, Provider Handbooks) for information about Health and Human Services Commission (HHSC) programs providing women’s health services.
This handbook contains information about Texas Medicaid fee-for-service benefits. For information about managed care benefits, providers can refer to the Medicaid Managed Care Handbook.
Managed care carve-out services are administered as fee-for-service benefits. A list of all carve-out services is available in the Medicaid Managed Care Handbook.
Refer to:
Section 9, “* Carve-Out Services” in the Medicaid Managed Care Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.