Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter A - PURCHASED HEALTH SERVICES
Division 11 - GENERAL ADMINISTRATION
Section 354.1190 - Medicaid Provider Database

Universal Citation: 1 TX Admin Code ยง 354.1190

Current through Reg. 49, No. 38; September 20, 2024

(a) The Medicaid Provider Database is an electronic, searchable, Internet-based database of all participating providers in the Medicaid program.

(1) Definitions
(A) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(B) "Health care provider" means a person, other than a physician, who:
(i) is licensed or otherwise authorized to provide a health care service in this state including:
(I) a pharmacist, dentist, optometrist, mental health counselor, social worker, advanced practice nurse, physician assistant, or durable medical equipment supplier; or

(II) a pharmacy, hospital, or other institution organization;

(ii) is wholly owned or controlled by:
(I) a health care provider or a group of health care providers described by clause (i) of this subparagraph;

(II) one or more hospitals and physicians, including a physician-hospital organization;

(iii) is a professional association of physicians organized under the Texas Professional Association Law, as described by § RSA 1.008, Business Organizations Code;

(iv) is an approved nonprofit health corporation certified under Chapter 162, Occupations Code;

(v) is a medical and dental unit, as defined by § RSA 61.003, Education code, a medical school, as defined by § RSA 61.501, Education Code, or a health science center described by Subchapter K, Chapter 74, Education Code, that employs or contracts with physicians to teach or provide medical services, or employs physicians and contracts with physicians in a practice plan; or

(vi) is another person wholly owned by physicians.

(C) "Managed care plan" has the meaning assigned by § RSA 533.001, Government Code.

(D) "Participating provider" means a physician or health care provider who provides Medicaid services, including a physician or health care provider who contracts or otherwise agrees with a managed care organization to provide Medicaid services.

(E) "Physician" means an individual licensed to practice medicine in this state.

(F) "Recipient" means a recipient of medical assistance.

(2) Required Elements.
(A) The database includes each participating provider's:
(i) name;

(ii) Specialty;

(iii) Location;

(iv) Office hours (including any office hours outside of regular business hours);

(v) Telephone number;

(vi) a list of the Medicaid services offered by the provider; and

(vii) any waiver program or other program within the Medicaid program in which the provider is a participant, including the Texas Health Steps Program (THSteps).

(B) The database includes whether the provider:
(i) is accepting new recipients, and if applicable, the managed care organization(s) or managed care plan(s) under which new recipients are being accepted;

(ii) has any practice limitations, including specific age range limitations; and

(iii) speaks any languages other than English.

(b) The database allows a person to search a managed care organization by name and by participating provider within each of the managed care plans offered by that managed care organization. The database also allows a participating provider to electronically assess and change or update his/her information.

(c) The database is available and accessible to each participating provider and each recipient.

(d) The database will be updated continually and at least once a month.

(e) There are no fees associated with accessing the information or for making information available on the provider database either directly or indirectly for either the provider or the recipient.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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