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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 6 Licensed Midwife (LM) : 6.1 Provider Enrollment

6.1
To enroll in Texas Medicaid, an LM must be licensed as a midwife by the Texas Midwifery Board.
Providers cannot be enrolled if their license is due to expire within 30 days; a current license must be submitted.
An LM must identify the licensed physician or group of physicians with whom there is an arrangement for referral and consultation if medical complications arise. Upon initial enrollment and upon re-enrollment, the LM must complete and submit to TMHP, along with the Texas Medicaid Provider Enrollment Application, the Physician’s Letter of Agreement form that affirms the LM’s referring or consulting physician arrangement. A separate letter of agreement must be submitted for each physician or group of physicians with whom an arrangement is made. This agreement must be signed by the LM and the physician.
If the arrangement is changed or canceled, the LM must notify TMHP Provider Enrollment in writing and a new letter of agreement must be completed and submitted to TMHP within 10 business days after the change or cancellation.
The referral physician or group does not have to be a participating provider in Texas Medicaid. According to TAC, §354.1253(c), if the referral physician or group is not a participating provider in Texas Medicaid, the LM must inform clients of their potential financial responsibility.
Refer to:
Section 1: Provider Enrollment and Responsibilities (Vol. 1, General Information) for more information about enrollment in Texas Medicaid.

Texas Medicaid & Healthcare Partnership
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