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 23 - FEDERALLY QUALIFIED HEALTH CENTER SERVICES
Section 354.1321 - Benefits and Limitations
Universal Citation: 1 TX Admin Code ยง 354.1321
Current through Reg. 49, No. 38; September 20, 2024
(a) Effective for services on or after April 1, 1990, and subject to the specifications, conditions, limitations, and requirements established by the Texas Department of Health (department), federally qualified health center (FQHC) services are available to eligible Medicaid recipients.
(b) Covered services are limited to:
(1) services as described in the Social
Security Act, §1861(aa)(1)(A)-(C); and
(2) other ambulatory services covered by the
Texas Medical Assistance Program when provided by other enrolled
providers.
(c) Covered services provided by an FQHC must be reasonable and medically necessary as determined by the department or its designee.
(d) When furnished to a patient of the FQHC, medically necessary services include:
(1)
physician services;
(2) physician
assistant services;
(3) nurse
practitioner services;
(4) clinical
psychologist services;
(5) clinical
social worker services;
(6)
services and supplies incident to such services as would otherwise be covered
if furnished by a physician or as an incident to a physician's
services;
(7) visiting nurse
services to a homebound individual, in the case of those FQHCs that are located
in an area that has a shortage of home health agencies as determined by the
state survey agency; and
(8) any
other ambulatory service offered by an FQHC and that is otherwise included in
the Title XIX Medicaid state plan.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
