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 6 - HOSPITAL SERVICES
Section 354.1072 - Authorized Inpatient Hospital Services

(1) Duration of care. Except as otherwise specified in § RSA 354.1175 of this subchapter (relating to Organ Transplants), when an eligible recipient is confined as an inpatient in a Title XIX hospital, or a Title XVIII or XIX out-of-state hospital approved for participation, the Health and Human Services Commission (HHSC) or its designee pays for medically necessary inpatient hospital services actually furnished to the recipient during the first 30 days of each Title XIX spell of illness. The Title XIX spell-of-illness limitations are waived for medically necessary inpatient services provided to recipients less than age twenty one. The services are subject to the utilization review requirements of the Texas Medical Assistance (Medicaid) Program.

(2) Benefits for inpatient hospital care. The hospital services for which benefits are provided under paragraph (1) of this subsection consist of the following:

(3) HHSC will impose reimbursement denials or reductions for potentially preventable events and preventable adverse events as defined in §354.1070 of this division (relating to Definitions).

(4) HHSC will categorize patients based on severity of illness, risk of mortality and other criteria defined by HHSC or its designee to identify potentially preventable events as defined in §354.1070 of this division and apply corresponding reimbursement adjustments as described in Division 35 of this subchapter (relating to Reimbursement Adjustment for Potentially Preventable Events).

(1) Except as provided in paragraph (2) of this subsection, a hospital or any entity that is wholly owned or wholly operated by a hospital must include in its inpatient charges the cost of all reimbursable services provided by the hospital to a patient on the date of admission and during the three calendar days immediately preceding the date of the patient's admission, if the services are:

(2) A hospital that is not a "subsection (d) hospital" as defined in Social Security Act §1886(d)(1)(B) (RSA 1396ww(d)(1)(B)) must include in its charges the cost of services described in paragraph (1) of this subsection provided by the hospital to a patient during the one calendar day immediately preceding the date of admission. Hospitals that are not "subsection (d) hospitals" include children's, psychiatric, and rehabilitation hospitals.