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RULE §354.1371Tuberculosis Clinic Benefits and Limitations

(a) Covered tuberculosis (TB)-related clinic benefits shall include:

  (1) physician and non-physician examination, consultation and evaluation, including counseling and education services on risks, transmission, prevention, and treatment of TB;

  (2) diagnostic and evaluation services and procedures which:

    (A) permit the presumptive diagnosis of TB;

    (B) confirm the presence of infection; and

    (C) monitor and assess recipient compliance and drug toxicity;

  (3) prescription drugs; and

  (4) monitoring recipient compliance and completion of regimes of prescribed drugs including direct observation of recipient intake of prescribed drugs.

(b) TB clinics shall:

  (1) be a facility that is not an administrative, organizational, or financial part of a hospital, but is organized and operated to provide medical care to outpatients;

  (2) be organized and operated to provide TB-related services and have the facilities and resources available to provide any or all of the covered services;

  (3) comply with all applicable federal, state and local laws and regulations;

  (4) employ or have a contract or formal arrangement with a licensed physician (Medical Doctor or Doctor of Osteopathy) who is responsible for providing medical direction and supervision over all services provided to the clinic's patients. To meet this requirement, physician services must be provided to the clinic's patients at least once every 90 days to prescribe the type of care provided, and, if the services are not limited by the prescription, to periodically review the need for continued care;

  (5) comply with any guidelines issued by the department, and ensure that services are consistent with the published recommendations of the American Thoracic Society and the Centers for Disease Control and Prevention;

  (6) maintain complete and accurate medical records of each recipient's care and treatment and accurately document all services provided and the medical necessity for the services;

  (7) be qualified, approved and enrolled in the Texas Medical Assistance Program (Medicaid) and sign a written Medicaid Provider Agreement with the department or its designee;

  (8) agree to comply with all other provisions and requirements contained in the current Texas Medicaid Provider Procedures Manual and as updated on a bimonthly basis by the Medicaid Bulletin;

  (9) submit claims for services using the claims filing procedures established by the department or its designee. All claims are subject to review for medical necessity; and

  (10) not provide services within a skilled nursing facility (SNF), intermediate care facility (ICF), or intermediate care facility for the mentally retarded (ICF-MR).

Source Note: The provisions of this §354.1371 adopted to be effective November 22, 1996, 21 TexReg 11596; amended to be effective December 28, 1998, 23 TexReg 13076; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective June 30, 2010, 35 TexReg 5522; amended to be effective November 25, 2015, 40 TexReg 8200

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