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CPW Services and Provider Professional Liability Insurance
Date: January 17, 2025
Attention: Case Management for Children and Pregnant Women (CPW) Providers
Call to action: The purpose of this communication is to offer additional guidance about Health and Human Services (HHSC’s) policy regarding provider-credentialing requirements related to professional liability insurance, including malpractice insurance, for CPW providers.
Background: House Bill 133, 87th Legislature, Regular Session, 2021, requires Case Management for CPW services to transition to a Medicaid managed care delivery model. This change only impacts Medicaid MCOs with members birth through age 20 or pregnant women.The implementation date of this change was September 1, 2022.
How this impacts providers: Additional HHSC guidance regarding provider credentialing requirements related to professional liability insurance, including malpractice insurance, for CPW providers are as follows:
Policy: UMCM Chapter 16.1,Medicaid and CHIP Contract Operational Guidance, Section 16.7.5.20: “In accordance with managed care contract requirements, Texas Children’s Health Plan (TCHP) /MCO must maintain on its own or cause CPW Providers to maintain professional liability insurance. However, an MCO must allow new CPW Provider types six months after completing contracting and credentialing with an MCO before causing them to obtain professional liability insurance. TCHP/MCO is not required to obtain professional liability insurance on behalf of the CPW Provider during the six months after the CPW Provider completes contracting and credentialing with an MCO. A CPW Provider is not required to obtain malpractice insurance.”
Explanation of Policy: To “maintain professional liability insurance” a CPW provider must attest to the status of their professional liability insurance in the TCHP/MCO contracting/credentialing application.
A CPW provider can attest to any amount, even if the amount is $0.
If a CPW provider attests to $0, this means the provider does not hold professional liability insurance, which is allowable by the National Committee for Quality Assurance (NCQA) and still meets the HHSC and MCO requirements.
However, HHSC requires Medicaid MCOs/TCHP to maintain information on the professional liability insurance status for its providers. TCHP/ MCO must allow new CPW provider types that choose to maintain professional liability insurance, six months after completing contracting and credentialing with an MCO before CPW providers must report their professional liability insurance status.
While malpractice insurance is a type of professional liability insurance, a CPW provider is not required to obtain malpractice insurance.
Next step for Providers: CPW Providers are strongly advised to follow the guidance outlined above regarding credentialing requirements related to professional liability insurance.
