Subject |
Statutes |
Rule/s |
Nurse-Midwife Services
Benefits and Limitations
Conditions for Participation Reimbursement
|
§531.021, Texas Government Code |
1 TAC §354.1251
1TAC §354.1252
1TAC §355.8161 |
CRNA Services
Benefits and Limitations
Conditions for Participation Reimbursement
|
§531.021, Texas Government Code |
1 TAC §354.1301
1TAC §354.1302
1TAC §355.8221 |
NP and CNS Services
Benefits and Limitations
Conditions for Participation Reimbursement
|
§531.021, Texas Government Code |
1 TAC §354.1331
1TAC §354.1332
1TAC §355.8181 |
Permits physicians to bill for Medicaid services provided by a CNM, CNS or NP and receive 100%. Per Medicaid Provider Manual, the physician should ut the modifier "SA". |
§532.021, Texas Government Code |
1 TAC §354.1062 |
HHSC requires managed care companies that contract with HHSC to provide Medicaid services to include APNs as primary care providers. |
§533.005(a) (13), Texas Government Code |
N/A |
Home Health Agencies may not accept a plan of care from an APN, e.g. APNs may not order initial home health services for Medicaid clients. |
N/A |
1 TAC §354.1037(a) |
Orders/referrals for Medicaid patients for the following services must be ordered by a physician: laboratory and radiology, physical therapy, and durable medical equipment |
N/A
§531.2116-§531.2175, Texas Government Code
§32.057(c)(2), Texas Human Resources Code |
1 TAC §354.1091
1 TAC §354.1291(b)(4)&(c)
1 TAC §354.1039(4)(A)&(i)
1 TAC §354.1430
1 TAC §354.1415(a)(4) |
