Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,854
2821-2988 p. ; 28 cm.View a full description of this periodical.
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27.9. Applicant Qualifications.
(a) The minimum qualifications for a Case Management for
Children and Pregnant Women applicant are:
(1) completion and approval of an application for Case
Management for Children and Pregnant Women as defined in 27.1 of
this title (relating to Definitions);
(2) agreeing to comply with the department rules, policies
and procedures on Case Management for Children and Pregnant
Women and the applicable statutory provisions;
(3) agreeing to comply with applicable state and federal
laws governing participation of providers in the Medicaid program; and
(4) employment of case managers with the following qual-
ifications:
(A) Registered nurse (with a diploma, an associate's,
bachelor's or advanced degree) or Social Worker (with bachelor's or
advanced degree), currently licensed by the respective Texas licensure
board and whose license is not temporary or provisional in nature; and
(B) possessing two years of cumulative paid full-time
work experience or two years of supervised, full-time educational in-
ternship/practicum experience in the past ten years with children, up
to age 21, and/or pregnant women. Experience must include assessing
the psychosocial and health needs of and making community referrals
for these populations.
(5) agreeing to comply with all licensure requirements of
the case manager(s) respective state licensure/examining boards in-
cluding the obligation to report all suspected child abuse/neglect; and
(6) knowledge of and coordination with providers of health
and health-related services and other active community resources.
(b) A case manager employed in an approved Targeted Case
Management for Pregnant Women and Infants or Texas Health Steps
Medical Case Management agency at the time of implementation of
these rules but who does not meet the licensure, educational and/or
experience requirements outlined in subsection (a)(4)(A) and (B) of
this section, is eligible to continue to provide case management services
until the case manager leaves the employ of that agency unless state
licensure law does not allow the case manager to provide the services.
(c) An applicant under investigation or being sanctioned by the
department or any other State of Texas or Federal Governmental agency
will not be approved as a case management provider.
27.11. Case Management Provider Requirements.
In order to remain a Case Management Provider, an individual or
agency must:
(1) comply with applicable state and federal laws and reg-
ulations governing participation of providers in the Medicaid program;
(2) maintain provider status with the department;
(3) develop and maintain a system for Case Management
for Children and Pregnant Women services incorporating the following
elements:
(A) Case Management for Children and Pregnant
Women services in locations convenient for the eligible recipient to
facilitate face-to-face contact;
(B) Provision of Case Management for Children and
Pregnant Women services in order to assist eligible recipients in ac-
cessing necessary medical, social, educational, and other services;
(C) a comprehensive resource directory, updated at
least annually, which contains the names, addresses, and telephonenumbers of providers of health and health-related services including,
but not limited to: physicians; other primary care providers; Early
Childhood Intervention (ECI); Children with Special Health Care
Needs (CSHCN); Special Supplemental Nutrition Program for
Women, Infants and Children (WIC); rehabilitation services; the Med-
icaid Medical Transportation Program (MTP); the Texas Information
and Referral Network, and locally active community services;
(D) an internal quality assurance plan that includes, but
is not limited to, chart reviews and staff observation;
(E) a current list of opened and closed client records;
(F) an accounts receivable system through which billed
claims will be tracked and matched with paid claims and client records
to assure claims are billed and paid for correct dates of service, were
billed with appropriate procedure codes and are not duplicative of other
claims for the same client;
(G) outreach activities that assure individualized refer-
rals. The following activities may impede client choice and therefore
are prohibited:
(i) door to door, telephone or other cold-call market-
ing or solicitation of clients by providers;
(ii) the distribution of materials to Case Manage-
ment for Children and Pregnant Women recipients that can reasonably
be interpreted as intended to market the provider's services;
(iii) the distribution of any false or materially
misleading materials to Case Management for Children and Pregnant
Women recipients;
(iv) obtaining lists of Medicaid clients without a spe-
cific referral;
(v) offering incentives for enrollment into case man-
agement services; and/or
(vi) entering into exclusive referral relationships
with referral sources.
(4) assure Case Management for Children and Pregnant
Women services will be provided by approved case managers who
meet the qualifications defined in 27.9 and 27.11 of this title
(relating to Applicant Qualifications and Case Management Provider
Requirements);
(5) assure that approved case managers:
(A) have received department-approved education
and training regarding Case Management for Children and Pregnant
Women;
(B) have the opportunity to participate in appropriate
Medicaid, case management and THSteps workshops, seminars, and
training;
(C) assume responsibility for all Case Management for
Children and Pregnant Women services they provide to eligible recip-
ients, including services by their designated support staff;
(D) participate in relevant motion or cost studies;
(E) agree to permit the department or its designee
access to the Case Management for Children and Pregnant Women
provider's records, and permit direct observation of case management
activities for the purpose of determining the provider's suitability
to continue participation as a Case Management for Children and
Pregnant Women provider; and28 TexReg 2854 April 4, 2003 Texas Register
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Texas. Secretary of State. Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003, periodical, April 4, 2003; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth101027/m1/33/: accessed May 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.