Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 211 - DAY ACTIVITY AND HEALTH SERVICES (DAHS) CONTRACTUAL REQUIREMENTS
Section 211.210 - Financial Errors
Universal Citation: 26 TX Admin Code ยง 211.210
Current through Reg. 49, No. 38; September 20, 2024
(a) In the absence of acceptable secondary documentation, financial errors include the errors described in this section.
(1) The DAHS
facility is reimbursed for services, but DADS Daily Attendance and Daily
Transportation Record form is missing for the period for which services are
reimbursed. DADS applies the error to the total number of units reimbursed for
the billing period.
(2) The DAHS
facility is reimbursed for units that exceed the units recorded on DADS Daily
Attendance and Daily Transportation Record form. DADS applies the error to the
total number of units reimbursed in excess of the units recorded.
(3) The DAHS facility is reimbursed for units
of service and the client did not receive services or was Medicaid ineligible
(not applicable to Title XX clients). DADS applies the error to the total
number of units reimbursed for the days the client did not receive services or
was Medicaid ineligible.
(b) Corrections of critical omissions or errors in DAHS facility documentation must be postmarked or date stamped as received by DADS within 14 days after the regional nurse mails DADS Notification of Critical Omissions/Errors in Required Documentation form to the DAHS facility. If the DAHS facility fails to meet this time frame:
(1) the date of prior approval can be no
earlier than the postmark or DADS-stamped date on the corrected documentation;
or
(2) DADS may refer the
individual to another DAHS facility of the individual's choice.
(A) If there is space in another DAHS
facility, the regional nurse notifies the case manager by the next workday to
give the individual or individual's family/representative the option to be
referred to another DAHS facility.
(B) The case manager will contact the
individual within three workdays after being notified by the regional nurse and
refer the individual to another DAHS facility, if the individual or the
individual's family/representative prefers this option.
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