1 Tex. Admin. Code § 354.1301 - Benefits and Limitations
(a) Anesthesia
services provided by a Certified Registered Nurse Anesthetist (CRNA) are
covered by the Texas Medical Assistance Program and are subject to the
specifications, conditions, requirements, and limitations specified in this
section and established by the Texas Health and Human Services Commission
(HHSC) or its designee.
(b) To be
payable, the services must be:
(1) Provided
by a CRNA practicing in accordance with the Nursing Practice Act and the rules
and regulations promulgated by the Board of Nurse Examiners;
(2) Reasonable and medically necessary as
determined by HHSC or its designee;
(3) Ordered and supervised by a physician (MD
or DO), dentist, or podiatrist, to the extent allowed by state law, who must be
licensed in the state in which he or she practices; and
(4) Provided under one of the following
conditions:
(A) No physician anesthesiologist
is on the medical staff of the facility where the services are
provided;
(B) As determined in
accordance with the policies of the facility in which the services are
provided, no physician anesthesiologist is available to provide the
services;
(C) The physician,
dentist, or podiatrist performing the procedure requiring the services
specifically requests the services of a CRNA;
(D) The eligible recipient requiring the
services specifically requests the services of a CRNA;
(E) The CRNA is scheduled or assigned to
provide the services in accordance with policies of the facility in which the
services are provided; or
(F) The
services are provided by the CRNA in connection with a medical
emergency.
(c) The Texas Medical Assistance Program will
not reimburse the CRNA for equipment or supplies. Equipment and supplies are
the responsibility of the facility in which the CRNA services are provided. If
the equipment and supplies are covered and reimbursable by the Texas Medical
Assistance Program, payment may be made to the facility if the facility is
approved for participation in the Texas Medical Assistance Program. The basis
and amount of reimbursement depends on the reimbursement methodology utilized
by the Texas Medical Assistance Program for the services and providers
involved.
(d) The scope of this
section is limited to reimbursement policy for anesthesia services under the
Texas Medical Assistance Program. Nothing contained in this section shall be
construed to modify, supersede, or otherwise affect any other existing federal
or state law or regulation or institutional practice regarding the
administration of anesthesia.
(e)
Reimbursement for covered CRNA services may be made to the CRNA actually
performing the services or, provided that federal requirements related to
reassignment of claims are met, to a hospital, physician, dentist, podiatrist,
group practice, or ambulatory surgical center with which the CRNA has an
employment or contractual relationship.
(f) Physician reimbursement for supervision
of CRNAs is governed by the Health and Human Service Commission's policies
regarding physician services.
(g)
HHSC or its designee reimburses Texas Medical Assistance Program allowable CRNA
services only when the services are submitted for payment under a CRNA provider
number.
Notes
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