SECTION 354.2355. Long Term Care Providers  


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  • (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 services provided to an individual who is eligible to receive similar services under the Medicare program.

    (2) as directed by the Commission, 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 services in subsection (a) of this section, a payment or denial remittance from Medicare is required prior to Medicaid considering payment.

Source Note: The provisions of this §354.2355 adopted to be effective March 28, 2004, 29 TexReg 2867