SECTION 352.13. Medicare Certification or Enrollment in Medicare

(a) To participate in Medicaid or CHIP, an applicant or re-enrolling provider must be actively enrolled in Medicare or certified by Medicare (if applicable), or both, unless otherwise specified by HHSC or its designee or specifically exempted in subsection (b) of this section.

(b) HHSC or its designee, in its sole discretion, may exempt an applicant or re-enrolling provider from subsection (a) of this section if:

(1) the type of practice or service is not covered by Medicare;

(2) an HHSC rule or other state agency's rule expressly exempts an applicant or re-enrolling provider from Medicare enrollment or Medicare certification; or

(3) the applicant's or re-enrolling provider's exclusion from participating in Medicaid or CHIP will prevent recipients from having access to needed medical services.

(c) This section is applicable only to applicants or re-enrolling providers that:

(1) have not been terminated or excluded from Medicare, any other state's medical assistance program, or CHIP; and

(2) meet the requirements in §352.5 of this chapter (relating to Provider Enrollment Requirements).

Source Note: The provisions of this §352.13 adopted to be effective December 31, 2012, 37 TexReg 9899