SECTION 23.68. Applications Based on Services to Medicaid or Texas Women's Health Program Enrollees

(a) The board may hold an application for consideration until the end of the fiscal year if funds are available, upon receipt of a physician's written statement of intent to provide the required Medicaid or Texas Women's Health Program service levels during the anticipated year of service.

(b) The source of data to be used in determining required service levels will be Medicaid HMO encounter data.

(c) The method for determining required service levels will be stated in the 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 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 board, for review by the HHSC, to receive further consideration for loan repayment.

Source Note: The provisions of this §23.68 adopted to be effective February 22, 2016, 41 TexReg 1231; transferred effective December 15, 2016, as published in the Texas Register November 25, 2016, 41 TexReg 9341