19 Tex. Admin. Code § 23.68 - Applications Based on Services to Medicaid or Texas Women's Health Program Enrollees
(a) The
Coordinating Board may hold an application for consideration until the end of
the fiscal year if funds are available.
(b) The source of data to be used in
determining required service levels will be Medicaid HMO encounter data
provided by the Health and Human Services Commission.
(c) The method for determining required
service levels will be stated in the Coordinating 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 assistance 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 Coordinating Board for review by the HHSC, to receive
further consideration for loan repayment assistance.
Notes
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