1 Tex. Admin. Code § 355.8021 - Reimbursement Methodology for Home Health Services
(a) Authorized home health nursing and aide
services provided to eligible Medicaid recipients are reimbursed the lesser of
the billed amount or the Medicaid reimbursement rate established by
HHSC.
(b) HHSC reviews the fees for
nursing and aide services at least once every two years based upon:
(1) analysis of the Centers for Medicare
& Medicaid Services fees for the same or similar services;
(2) analysis of Medicaid fees for the same or
similar services in other states; and
(3) analysis of fees paid under commercial
insurance for the same or similar services.
(c) HHSC may use data sources or
methodologies other than those listed in subsection (b) of this section to
establish Medicaid fees for home health services when HHSC determines that the
methodologies in subsection (b) of this section are unreasonable or
insufficient.
(d) Reimbursement for
Physical, Occupational, and Speech Therapy Services is described in §
355.8097 of this title (relating to
Reimbursement for Physical, Occupational, and Speech Therapy
Services).
(e) Fees for home health
services will be adjusted within available funding as described in §
355.201 of this title (relating to
Establishment and Adjustment of Reimbursement Rates by the Health and Human
Services Commission).
Notes
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