Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 363 - TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM
Subchapter B - PRESCRIBED PEDIATRIC EXTENDED CARE CENTER SERVICES
Section 363.213 - Ordering Physician Responsibilities

Universal Citation: 1 TX Admin Code § 363.213

Current through Reg. 50, No. 13; March 28, 2025

(a) An ordering physician in an employment or contractual relationship with a PPECC cannot provide the required physician's order unless the physician has a therapeutic relationship with and ongoing clinical knowledge of the participant.

(b) The ordering physician's responsibilities include:

(1) providing an in person examination or treatment to the participant within 30 calendar days before the start of PPECC services unless the physician waives this examination because:
(A) a diagnosis has already been established by the physician;

(B) the participant is under the continuing care and medical supervision of the physician; and

(C) the physician has stated in writing that an examination of the participant 30 calendar days prior to admission is not medically necessary;

(2) if a physician waives an examination in accordance with subsection (b)(1) of this section:
(A) the physician must examine the participant in person within 365 calendar days after the date of the participant's last examination; and

(B) the physician and PPECC must maintain documentation of the waived examination and the information described in subsection (b)(1) of this section in the participant's medical record;

(3) providing a written, signed, and dated order prescribing PPECC services within 30 calendar days before the participant's start of services;

(4) providing specific, written, signed, and dated physician orders for PPECC services which is valid through the initial authorization period and complies with requirements contained in the Texas Medicaid Provider Procedures Manual;

(5) providing specific, written, signed, and dated physician orders for each PPECC authorization period, once the initial order is no longer valid;

(6) performing an in person evaluation of the participant each year;

(7) reviewing, approving, signing, and dating a plan of care (POC), and any other documentation required for service prior authorization, including any updates or changes;

(8) affirming in writing that PPECC services are medically necessary for the participant;

(9) affirming in writing that the participant's medical condition is sufficiently stable to permit safe delivery of PPECC services as described in the POC;

(10) affirming in writing that the participant's medical condition is stable and the type of provider, a registered nurse, licensed vocational nurse, or direct care staff, that must be present on the PPECC transportation vehicle as indicated in the POC; and

(11) providing continuing care to and medical supervision of the participant.

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