26 Tex. Admin. Code § 270.22 - Medicaid Capitation Payments
(a) The
provider agency must accept the Medicaid capitation payment as payment in full
for all services to a Medicaid eligible client.
(b) If the client is also a Medicare
beneficiary, the Centers for Medicare and Medicaid Services will also pay a
Medicare capitation payment to the provider agency.
(c) An exception to subsection (a) of this
section occurs when a client enters a nursing facility and the client has
applied income. To receive this exception:
(1) the provider agency must collect the
client's applied income, unless the purpose of the stay is for the client to
receive respite care; and
(2) the
applied income must be determined in accordance with §§15.100,
15.450, 15.501-15.503, and 15.506 of this title (relating to Definitions;
General Principles Concerning Income; Vendor Living Arrangements; Allowable
Deductions; Protection of Spousal Income and Resources; and Mandatory Payroll
Deductions from Earned Income).
Notes
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