(a) Criteria. Subject to the specifications, conditions,
requirements, and limitations established by the Texas Health and
Human Services Commission (HHSC), the Texas Medicaid Program will
reimburse a licensed midwife (LM) for a service in accordance with
provisions of the state plan only if:
(1) the LM is licensed and approved by the Texas Midwifery
Board under Chapter 203 of the Occupations Code and 22 TAC Chapter
831 (relating to Midwifery);
(2) the LM who performs the service is enrolled in
and approved for participation in the Texas Medicaid Program;
(3) the service:
(A) is consistent with rules and protocols promulgated
by the Texas Midwifery Board or other appropriate state licensing
authority;
(B) is provided in a freestanding birthing center that
is licensed under Chapter 244 of the Health and Safety Code and approved
by HHSC to participate in the Texas Medicaid Program; and
(C) is within the LM's scope of practice, as defined
by state law and permitted by the freestanding birthing center;
(4) the service is one of the following:
(A) prenatal care;
(B) labor and delivery;
(C) postpartum care immediately following delivery
and until discharge or transfer from the freestanding birthing center;
or
(D) newborn care immediately following delivery and
until discharge or transfer from the freestanding birthing center;
and
(5) the service is not duplicative of any other service
charged to the Texas Medicaid Program.
(b) Reimbursement restrictions.
(1) HHSC does not reimburse an LM for conducting childbirth
education classes.
(2) HHSC reimburses only the LM actually performing
the covered service.
(c) Referral physician or group.
(1) Upon enrollment in the Texas Medicaid program,
an LM must inform HHSC in writing of the identity of a licensed physician
or group of physicians (the "referral physician or group") with whom
the LM has arranged for referral and consultation in the event of
medical complications and submit a letter from the licensed physician
or physician group affirming that agreement. For purposes of this
section, "consultation" means discussion of patient status, care,
and management.
(2) If the arrangement changes or if the LM selects
a new referral physician or group, the LM must, within ten business
days of the change or new selection, notify HHSC in writing of the
new referral physician or group's identity and submit a letter from
the licensed physician or physician group affirming that agreement.
(3) If the referral physician or group is not participating
in the Texas Medicaid Program, the LM must inform recipients of their
potential financial responsibility according to the requirements of
the Texas Medicaid Program applicable to all Medicaid providers.
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