(a) Criteria. Subject to the specifications, conditions, requirements, and limitations established by the Texas Health and Human Services Commission (HHSC), the Texas Medicaid Program will reimburse a licensed midwife (LM) for a service in accordance with provisions of the state plan only if:
  (1) the LM is licensed and approved by the Texas Midwifery Board under Chapter 203 of the Occupations Code and 22 TAC Chapter 831 (relating to Midwifery);
  (2) the LM who performs the service is enrolled in and approved for participation in the Texas Medicaid Program;
  (3) the service:
    (A) is consistent with rules and protocols promulgated by the Texas Midwifery Board or other appropriate state licensing authority;
    (B) is provided in a freestanding birthing center that is licensed under Chapter 244 of the Health and Safety Code and approved by HHSC to participate in the Texas Medicaid Program; and
    (C) is within the LM's scope of practice, as defined by state law and permitted by the freestanding birthing center;
  (4) the service is one of the following:
    (A) prenatal care;
    (B) labor and delivery;
    (C) postpartum care immediately following delivery and until discharge or transfer from the freestanding birthing center; or
    (D) newborn care immediately following delivery and until discharge or transfer from the freestanding birthing center; and
  (5) the service is not duplicative of any other service charged to the Texas Medicaid Program.
(b) Reimbursement restrictions.
  (1) HHSC does not reimburse an LM for conducting childbirth education classes.
  (2) HHSC reimburses only the LM actually performing the covered service.
(c) Referral physician or group.
  (1) Upon enrollment in the Texas Medicaid program, an LM must inform HHSC in writing of the identity of a licensed physician or group of physicians (the "referral physician or group") with whom the LM has arranged for referral and consultation in the event of medical complications and submit a letter from the licensed physician or physician group affirming that agreement. For purposes of this section, "consultation" means discussion of patient status, care, and management.
  (2) If the arrangement changes or if the LM selects a new referral physician or group, the LM must, within ten business days of the change or new selection, notify HHSC in writing of the new referral physician or group's identity and submit a letter from the licensed physician or physician group affirming that agreement.
  (3) If the referral physician or group is not participating in the Texas Medicaid Program, the LM must inform recipients of their potential financial responsibility according to the requirements of the Texas Medicaid Program applicable to all Medicaid providers.

Source Note: The provisions of this §354.1253 adopted to be effective January 1, 2013, 37 TexReg 9769