Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 352 - MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAM PROVIDER ENROLLMENT
Section 352.13 - Medicare Certification or Enrollment in Medicare
Universal Citation: 1 TX Admin Code ยง 352.13
Current through Reg. 49, No. 38; September 20, 2024
(a) To participate in Medicaid or CHIP, an applicant or re-enrolling provider must be actively enrolled in Medicare or certified by Medicare (if applicable), or both, unless otherwise specified by HHSC or its designee or specifically exempted in subsection (b) of this section.
(b) HHSC or its designee, in its sole discretion, may exempt an applicant or re-enrolling provider from subsection (a) of this section if:
(1) the
type of practice or service is not covered by Medicare;
(2) an HHSC rule or other state agency's rule
expressly exempts an applicant or re-enrolling provider from Medicare
enrollment or Medicare certification; or
(3) the applicant's or re-enrolling
provider's exclusion from participating in Medicaid or CHIP will prevent
recipients from having access to needed medical services.
(c) This section is applicable only to applicants or re-enrolling providers that:
(1) have not been terminated or excluded from
Medicare, any other state's medical assistance program, or CHIP; and
(2) meet the requirements in §
RSA
352.5 of this chapter (relating to Provider
Enrollment Requirements).
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