Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Section 270.22 - Medicaid Capitation Payments
Universal Citation: 26 TX Admin Code ยง 270.22
Current through Reg. 49, No. 38; September 20, 2024
(a) The provider agency must accept the Medicaid capitation payment as payment in full for all services to a Medicaid eligible client.
(b) If the client is also a Medicare beneficiary, the Centers for Medicare and Medicaid Services will also pay a Medicare capitation payment to the provider agency.
(c) An exception to subsection (a) of this section occurs when a client enters a nursing facility and the client has applied income. To receive this exception:
(1) the provider agency must collect the
client's applied income, unless the purpose of the stay is for the client to
receive respite care; and
(2) the
applied income must be determined in accordance with §§15.100,
15.450, 15.501-15.503, and 15.506 of this title (relating to Definitions;
General Principles Concerning Income; Vendor Living Arrangements; Allowable
Deductions; Protection of Spousal Income and Resources; and Mandatory Payroll
Deductions from Earned Income).
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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