(a) To participate in Medicaid or CHIP, an applicant
or re-enrolling provider must be actively enrolled in Medicare or
certified by Medicare (if applicable), or both, unless otherwise specified
by HHSC or its designee or specifically exempted in subsection (b)
of this section.
(b) HHSC or its designee, in its sole discretion, may
exempt an applicant or re-enrolling provider from subsection (a) of
this section if:
(1) the type of practice or service is not covered
(2) an HHSC rule or other state agency's rule expressly
exempts an applicant or re-enrolling provider from Medicare enrollment
or Medicare certification; or
(3) the applicant's or re-enrolling provider's exclusion
from participating in Medicaid or CHIP will prevent recipients from
having access to needed medical services.
(c) This section is applicable only to applicants or
re-enrolling providers that:
(1) have not been terminated or excluded from Medicare,
any other state's medical assistance program, or CHIP; and
(2) meet the requirements in §352.5 of this chapter
(relating to Provider Enrollment Requirements).
Source Note: The provisions of this §352.13 adopted to be effective December 31, 2012, 37 TexReg 9899