Friday, March 18, 2016

ASC provider Enrollment - Texas Medicaid


To enroll in Texas Medicaid, an ambulatory surgical center (ASC) must do the following:

• Meet and comply with applicable state and federal laws, rules, regulations, and provisions of the state plan under Title XIX of the Social Security Act

• Be enrolled in Medicare

• Meet and comply with state licensure requirements for ASCs

Providers cannot be enrolled if their license is due to expire within 30 days; a current license must be submitted.

An out-of-state provider may enroll in Texas Medicaid if it is the customary or general practice for clients in a particular locality to use medical resources in another state. An out-of-state provider located within 50 miles of the Texas border is automatically considered to meet this criterion.
All providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendments (CLIA). Only providers complying with CLIA may be reimbursed for laboratory services.

Important: All providers are required to read and comply with Section 1, Provider Enrollment and Responsibilities.

In addition to required compliance with all requirements specific to Texas Medicaid, it is a violation of Texas Medicaid rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1617(a)(6)(A).

Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to Texas Medicaid, providers can also be subject to Texas Medicaid sanctions for failure, at all times, to deliver health-care items and services to Medicaid clients in full accordance
with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.

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