SECTION 371.5. Providers

(a) Health care providers must be enrolled in Texas Medicaid in order to apply as providers and be reimbursed for services provided in the Breast and Cervical Cancer Services (BCCS) Program, except in very limited circumstances.

(b) If the Texas Health and Human Services Commission (HHSC) is unable to locate a sufficient number of eligible providers offering services in a certain region, HHSC may compensate other local providers for the provision of breast and cervical cancer screening and diagnostic services. Methodologies for determining if a certain region has a sufficient number of eligible providers may include:

(1) estimated number of clients in need;

(2) amount of funds available for allocation;

(3) service capacity of the proposed provider for the provision of breast and cervical cancer screening and diagnostic services;

(4) distance and/or time clients must travel to receive services; and

(5) any other relevant factors HHSC deems relevant for determining provider access.

(c) Upon request, BCCS Program providers must provide HHSC or its designee with all information HHSC or its designee requires to determine the provider's compliance with the program requirements.

(d) If HHSC or its designee determines that a BCCS Program provider fails to comply with this section, HHSC or its designee will disqualify the provider from the BCCS Program.

(e) If a BCCS Program provider is disqualified, HHSC or its designee will take appropriate action to:

(1) assist a BCCS client to find an alternative provider; and

(2) recoup any funds paid to the disqualified provider for BCCS services performed during the period of disqualification.

Source Note: The provisions of this §371.5 adopted to be effective July 1, 1992, 17 TexReg 3983; amended to be effective May 23, 2002, 27 TexReg 4355; amended to be effective June 27, 2007, 32 TexReg 3847; amended to be effective September 1, 2016, 41 TexReg 6500; transferred effective December 1, 2021, as published in the Texas Register November 5, 2021, 46 TexReg 7643; amended to be effective March 20, 2023, 48 TexReg 1563