SECTION 363.213. Ordering Physician Responsibilities

(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 examination or treatment to the participant within 30 days before the start of PPECC services;

(2) providing a signed prescription or written, dated physician’s order for PPECC services within 30 calendar days before the participant’s start of services, which is valid through the initial authorization period and complies with requirements contained in the Texas Medicaid Provider Procedures Manual;

(3) providing a signed prescription or written, dated physician’s order for each PPECC authorization period, once the initial prescription or order is no longer valid;

(4) performing a face-to-face evaluation of the participant each year;

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

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

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

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

Source Note: The provisions of this §363.213 adopted to be effective November 1, 2016, 41 TexReg 8284