Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 276 - CONTRACTING TO PROVIDE ASSISTED LIVING AND RESIDENTIAL CARE SERVICES
Subchapter B - PROVIDER CONTRACTS
Section 276.21 - Reimbursement
Current through Reg. 50, No. 13; March 28, 2025
(a) A unit of service is one billable day of authorized service delivered to a client.
(b) The unit rate reimbursed by the Department of Aging and Disability Services (DADS) includes any copayment. The combined reimbursement from DADS and the client or the client's representative for the required services described in § 46.41 of this chapter (relating to Required Services) must not exceed the unit rate plus room and board specified for each type of setting. The unit rate does not include charges for services described in § 46.15 of this chapter (relating to Additional Services and Fees).
(c) The facility must deduct the copayment amount from reimbursement claims submitted to DADS.
(d) The facility must not bill DADS for the day of discharge, unless the discharge is due to the death of the client.
(e) The facility must bill the double occupancy (Residential Care Apartment) rate for clients in the single occupancy (Assisted Living Apartment) setting who request double occupancy.
(f) The facility must bill DADS for the balance of the bedhold charge for any clients whose daily copayment is less than the maximum bedhold charge allowed by DADS.
(g) The facility may bill DADS for emergency care provided to clients for:
(h) The facility must not bill for services provided before or after the authorized effective dates for CBA AL or Community Care for Aged and Disabled (CCAD) Residential Care (RC) services, as those dates are determined by DADS.
(i) When the facility requests a level of care reset, the facility may bill DADS at the new payment rate effective the date of the new assessment. The facility may request only two level of care resets during each calendar year for each CBA client for the following time periods:
(j) CCAD RC services will be reimbursed at the double occupancy rate, regardless of the actual occupancy.