Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 21 - CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
Section 355.8401 - Reimbursement Methodology for Case Management for Children and Pregnant Women
Universal Citation: 1 TX Admin Code ยง 355.8401
Current through Reg. 49, No. 38; September 20, 2024
(a) Qualified providers. Payments are made to qualified providers delivering case management services to Medicaid-eligible individuals who are eligible for Case Management for Children and Pregnant Women according to Department of State Health Services (DSHS) rules at 25 TAC Chapter 27 (relating to Case Management for Children and Pregnant Women).
(b) Unit of service. Case Management for Children and Pregnant Women services are limited to one contact per day per client. Qualified providers are reimbursed based on a prospective and uniform statewide rate for the following types of services:
(1) comprehensive visit;
(2) face-to-face case management visit;
and
(3) telephone case management
visit.
(c) Rate methodology.
(1) The Health and Human
Services Commission determines Case Management for Children and Pregnant Women
rates by modeling a rate for similar case management activities and using
relevant costs and fees that provide information related to case management
services for children and high risk pregnant women. HHSC will utilize the cost
and fee survey data compiled as a basis for updating the reimbursement rate.
Total reported costs are projected from the historical reporting period to the
prospective rate period.
(2) The
reimbursement methodology for Case Management for Children and Pregnant Women
services is also governed by §
RSA
355.108 of this chapter (relating to
Determination of Inflation Indices) and §
RSA
355.109 of this chapter (relating to
Adjusting Reimbursement When New Legislation, Regulations, or Economic Factors
Affect Costs).
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