|(a) The board may hold an application for consideration
until the end of the fiscal year if funds are available, upon receipt
of a physician's written statement of intent to provide the required
Medicaid or Texas Women's Health Program service levels during the
anticipated year of service.
(b) The source of data to be used in determining required
service levels will be Medicaid HMO encounter data.
(c) The method for determining required service levels
will be stated in the board's Memorandum of Understanding with the
Texas Health and Human Services Commission. Required service levels
will be based on the Medicaid Managed Care client counts statewide
for each eligible primary care specialty, including obstetrics/gynecology
and geriatrics, over a period of one year, thus taking into account
variations among these specialties in the number of unduplicated clients.
(d) Any physician applying for loan repayment on the
basis of services to Medicaid or Texas Women's Health Program enrollees
must use his/her own TPI or NPI and must be the rendering physician
for claims/encounters submitted to Texas Medicaid Health Partner (TMHP).
(e) If the administrative data provided by TMHP for
the physician's TPI or NPI do not confirm that the physician met the
required service levels during the year of service following the application
date, the physician must submit a Claims Affidavit and specified data
from the clinic's internal billing system, in the format requested
by the board, for review by the HHSC, to receive further consideration
for loan repayment.
|Source Note: The provisions of this §23.68 adopted to be effective February 22, 2016, 41 TexReg 1231; transferred effective December 15, 2016, as published in the Texas Register November 25, 2016, 41 TexReg 9341