Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter A - PURCHASED HEALTH SERVICES › Division 18 - MATERNITY CLINIC SERVICES › Section 354.1271 - Benefits and Limitations

Current through Reg. 49, No. 28; July 12, 2024
(a) Subject to the
					 specifications, conditions, limitations, and requirements established by the
					 Texas Health and Human Services Commission (HHSC) or its designee, maternity
					 clinic services are those clinic services determined by a licensed physician
					 (MD or DO) to be reasonable and medically necessary for the care of a pregnant
					 female (patient) during the patient's prenatal period and postpartum period.
					 The physician prescribing the services must be employed by or have a
					 contractual agreement/formal arrangement with the clinic to assume professional
					 responsibility for the services provided to the clinic's patients.
(b) The physician must see each patient and
					 prescribe or approve each patient's plan of care. The physician must base the
					 plan of care on a risk assessment completed by the physician or by licensed,
					 professional clinic staff. The assessment must be based on findings obtained
					 through a health history, laboratory/screening services, and a physical
					 examination. HHSC or its designee establishes the criteria for assessing the
					 patient's risk. The level of services provided to the patient must be
					 commensurate with the risk assessment. Services must be provided on site or
					 through referral or other formal arrangement to patients experiencing a normal
					 pregnancy and to patients whose pregnancy places them at risk.
(c) Covered services must be furnished on an
					 outpatient basis by the physician or by licensed, professional clinic staff
					 under the direction of the physician. The physician and professional clinic
					 staff must be licensed by the state in which the services are rendered.
					 Services provided by the professional clinic staff must be within staff's scope
					 of practice or licensure as defined by state law.
(d) Covered clinic services include, but are
					 not necessarily limited to, risk assessment, medical services,
					 laboratory/screening services, case coordination/outreach, nutritional
					 counseling, psychosocial counseling, family planning counseling, and patient
					 education regarding maternal and child health.
(e) Although the physician does not
					 necessarily have to be present at the clinic when covered services are
					 provided, the physician must assume professional responsibility for the
					 services provided at the clinic and must ensure through approval of the plan of
					 care that the services are medically appropriate. The physician must spend as
					 much time in the clinic as is necessary to ensure that patients are receiving
					 services in a safe and efficient manner in accordance with accepted standards
					 of medical practice.
(f) Clinics
					 must have arrangements for referral of non-stress test (NST), sonography, and
					 amniocentesis for high-risk patients.