Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter J - MEDICAID THIRD PARTY RECOVERY
Division 6 - BILLING AND PAYMENT GUIDELINES
Section 354.2355 - Long Term Care Providers
Universal Citation: 1 TX Admin Code ยง 354.2355
Current through Reg. 49, No. 38; September 20, 2024
(a) A nursing facility, home health services provider, or any other similar long-term care services provider that is Medicare certified must:
(1) seek reimbursement from Medicare before
billing the Medicaid program for health care items or services provided to an
individual who is eligible to receive similar services under the Medicare
program; and
(2) as directed by
HHSC, appeal Medicare claim denials for payment.
(b) A nursing facility, home health services provider, or any other similar long-term care services provider that is Medicare certified is not required to seek reimbursement from Medicare before billing the Medicaid program for a person who is:
(1) Medicare eligible; and
(2) has been determined as not being
homebound.
(c) For health care items or services in subsection (a) of this section, a payment or denial remittance from Medicare is required prior to Medicaid considering payment.
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