SECTION 354.2355. Long Term Care Providers

(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 health care items or services provided to an individual who is eligible to receive similar services under the Medicare program; and

(2) as directed by HHSC, 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 health care items or 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; amended to be effective February 22, 2024, 49 TexReg 855