|(a) For the purposes of this subchapter, "pharmacy
provider" means a provider of outpatient pharmacy services enrolled
in the Medicaid program.
(b) Any pharmacy who has a current license or registration
with the Texas State Board of Pharmacy or is licensed under the laws
of another state and is free from any pharmacy board restriction may
apply to become a pharmacy provider. Prescribing practitioners who
are authorized and licensed to practice the healing arts, as defined
and limited by federal and state laws, and choose to provide their
own pharmaceuticals may also apply to become pharmacy providers.
(c) Except as stated in §354.1809 of this title
(relating to Termination of Participation), Chapter 352 of this title
(relating to Medicaid and Children's Health Insurance Program Provider
Enrollment), and Chapter 371 of this title (relating to Medicaid and
Other Health and Human Services Fraud and Abuse Program Integrity),
the Health and Human Services Commission (HHSC) and its designee maintain
open enrollment for in-state pharmacies licensed as Class A or C by
the Texas State Board of Pharmacy. Pharmacies holding any other class
of pharmacy license may be subject to special application procedures.
(d) A pharmacy must be enrolled as a pharmacy provider
to participate as a provider in the Children's Health Insurance Program
(CHIP), the Kidney Health Care (KHC) program, or the Children with
Special Health Care Needs (CSHCN) program.
(e) A pharmacy does not have to be enrolled in the
Medicare program to dispense covered outpatient drugs or certain supplies
as defined in §354.1042 of this title (relating to Supplies Provided
by a Pharmacy) to clients enrolled in the Medicaid program.
(f) A pharmacy that fills prescriptions for Medicaid
clients on behalf of an enrolled Medicaid pharmacy that submits Medicaid
claims (e.g., a central fill pharmacy or a pharmacy that provides
medication fulfillment services) may be required to enroll in accordance
with Chapters 352 and 371 of this title and is subject to other participation
requirements in this division, including §354.1807 of this division
(relating to Access to Records).
(g) A pharmacy applying for enrollment as a pharmacy
provider is subject to the enrollment and application requirements
in Chapters 352 and 371 of this title.
(h) Claims are subject to post-payment review for compliance
with state and federal laws and regulations and HHSC policy. Reimbursement
paid to a pharmacy provider for claims that do not comply may be subject
to recoupment of overpayment.
(i) HHSC may enter into special negotiated reimbursement
arrangements with other state or local entities, such as a Department
of State Health Services hospital, to maximize federal financial participation
in state or locally funded programs. If a state or local entity is
unwilling to participate in such an arrangement, a contract or agreement
may be denied.
|Source Note: The provisions of this §354.1801 adopted to be effective November 16, 1987, 12 TexReg 3553; amended to be effective August 1, 1990, 15 TexReg 3860; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4562; amended to be effective June 19, 2003, 28 TexReg 4541; amended to be effective December 31, 2012, 37 TexReg 9905