Case Management for Children and Pregnant Women (CPW) Carve-In and Provider Professional Liability Insurance

September 15, 2022

Reminder

For dates of services on or after September 1, 2022, House Bill 133, 87^th Legislature, Regular Session 2021, requires Case Management for Children and Pregnant Women (CPW) services to transition to Blue Cross and Blue Shield of Texas (BCBSTX).  We will be responsible for managing the delivery of CPW services to Medicaid members from birth through age 20, or pregnant women, and to contract and credential with CPW providers.

New Information

Health and Human Services Commission (HHSC) has provided guidance below and written exceptions regarding provider credentialing requirements related to professional liability insurance, including malpractice insurance for CPW providers.

Guidance

• The National Committee for Quality Assurance (NCQ) and Utilization Review Accreditation Commission (URAC) require BCBSTX to require our network providers to attest to the status of their professional liability insurance with the National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC).
  • NCQA allows providers to attest to having $0 of professional liability insurance, which equates to the provider not having professional liability insurance.
  • URAC allows the professional liability insurance requirement not to impact the ability of BCBSTX to be accredited.
  • NCQA and URAC do not require malpractice insurance.
    

HHSC Written Exception:

1. HHSC will continue to enforce the contract requirement that CPW providers must maintain professional liability insurance. Although CPW providers are providing a non-clinical service like case management where diagnosing or clinical treatment is not in scope of the CPW service, a CPW provider may be subject to situations that arise when delivering a Medicaid covered benefit, such as failure to provide services agreed upon by the member and the CPW provider or professional oversights, in which professional liability insurance coverage is important.
2. A CPW provider is not required to obtain malpractice insurance.
3. A CPW provider can have up to six months after completing contracting and credentialing with BCBSTX to obtain the professional liability insurance.
4. Effective immediately are HHSC’s written exceptions 1, 2, and 3 described above.

 Questions

Providers, for questions or additional information, please:

• Contact your BCBSTX Medicaid Network team at 1-855-212-1615, or
• Submit via email to Texas Medicaid Network Department