Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter A - PURCHASED HEALTH SERVICES
Division 3 - MEDICAID HOME HEALTH SERVICES
Section 354.1041 - Benefits for Medicare/Medicaid Recipients
Universal Citation: 1 TX Admin Code ยง 354.1041
Current through Reg. 49, No. 38; September 20, 2024
For recipients who are eligible for both Medicare and Medicaid (dual eligible), Medicare is the primary payor.
(1) Medicaid will pay the Medicare deductible and coinsurance subject to the limitations described in § RSA 354.1143 of this subchapter (relating to Coordination of Medicaid with Medicare Parts A, B, and C) for qualified recipients of home health services.
(2) Eligible recipients who have exhausted their home health benefits under Medicare are not entitled to receive all home health services under the Medicaid program. Home health aide services, DME, supplies, or appliances may be a covered service if:
(A) an eligible Medicaid recipient enrolled
in Medicare does not qualify for home health services under Medicare because
skilled nursing care, physical therapy, speech therapy or occupational therapy
is not an essential element of the recipient's treatment plan; and/or
(B) the medical supplies, equipment, or
appliances for use in the eligible recipient's place of residence are not
otherwise available as a Medicare Part B benefit.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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