SECTION 354.1321. Benefits and Limitations

(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.

Source Note: The provisions of this §354.1321 adopted to be effective August 1, 1990, 15 TexReg 4120; amended to be effective July 24, 1991, 16 TexReg 3872; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561