 |
Texas Administrative Code (Last Updated: March 27,2024) |
 |
TITLE 1. ADMINISTRATION |
|
|
PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION |
|
|
CHAPTER 354. MEDICAID HEALTH SERVICES |
|
|
SUBCHAPTER A. PURCHASED HEALTH SERVICES |
| DIVISION 1. MEDICAID PROCEDURES FOR PROVIDERS |
| § 354.1001. Claim Information Requirements |
| § 354.1002. Compliance with Civil Rights Act |
| § 354.1003. Time Limits for Submitted Claims |
| § 354.1004. Retention of Records |
| § 354.1005. Unauthorized Charges |
| DIVISION 2. MEDICAID VISION CARE PROGRAM |
| § 354.1015. Benefits and Limitations |
| § 354.1017. Specifications for Eyewear |
| § 354.1021. Additional Claims Information Requirements |
| § 354.1023. Optometric Services Provider |
| § 354.1025. Competitive Procurement of Vision Care Services |
| DIVISION 3. MEDICAID HOME HEALTH SERVICES |
| § 354.1031. General |
| § 354.1033. Provider Participation Requirements |
| § 354.1035. Recipient Qualifications for Home Health Services |
| § 354.1037. Written Plan of Care |
| § 354.1039. Benefits and Limitations of Home Health Services |
| § 354.1040. Requirements for Wheeled Mobility Systems |
| § 354.1041. Benefits for Medicare/Medicaid Recipients |
| § 354.1042. Supplies Provided by a Pharmacy |
| § 354.1043. Competitive Procurement of Durable Medical Equipment (DME) and Supplies |
| DIVISION 4. MEDICAID CHIROPRACTIC SERVICES |
| § 354.1051. Additional Claim Information Requirements |
| § 354.1052. Authorized Chiropractic Services |
| DIVISION 5. PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES |
| § 354.1060. Definitions |
| § 354.1061. Additional Claim Information Requirements |
| § 354.1062. Authorized Physician Services |
| § 354.1063. Preventable Adverse Events |
| § 354.1064. Anesthesiologist Assistant Conditions of Participation |
| § 354.1065. Anesthesiologist Assistant Benefits and Limitations |
| § 354.1066. Physician Assistant Conditions of Participation |
| § 354.1067. Physician Assistant Benefits and Limitations |
| § 354.1069. Sign Language Interpreter Services |
| DIVISION 6. HOSPITAL SERVICES |
| § 354.1070. Definitions |
| § 354.1071. Additional Claim Information Requirements |
| § 354.1072. Authorized Inpatient Hospital Services |
| § 354.1073. Authorized Outpatient Hospital Services |
| § 354.1075. Hospitalization (Dental Care Only) for Individuals under Age 21 Years |
| § 354.1077. Provider Participation Requirements |
| DIVISION 7. LABORATORY, X-RAY, AND RADIATION THERAPY |
| § 354.1091. Additional Claim Information Requirements |
| § 354.1092. Authorized Services |
| DIVISION 8. PODIATRY SERVICES |
| § 354.1101. Additional Claim Information Requirements |
| § 354.1102. Authorized Podiatry Services |
| DIVISION 9. AMBULANCE SERVICES |
| § 354.1111. Definitions |
| § 354.1113. Additional Claim Information Requirements |
| § 354.1115. Authorized Ambulance Services |
| DIVISION 10. DEFINITIONS |
| § 354.1121. Definitions |
| DIVISION 11. GENERAL ADMINISTRATION |
| § 354.1131. Payments to Eligible Providers |
| § 354.1133. Parental Accompaniment Requirement |
| § 354.1135. Claims Procedures |
| § 354.1137. Review of Questionable Claims |
| § 354.1139. Verification of Cost Data |
| § 354.1141. Notification to Eligible Providers |
| § 354.1143. Coordination of Medicaid with Medicare Parts A, B, and C |
| § 354.1145. Nonliability |
| § 354.1147. Medicaid Fee Schedule |
| § 354.1149. Exclusions and Limitations |
| § 354.1151. Freedom of Choice |
| § 354.1153. Subrogation |
| § 354.1155. Confidentiality of Information |
| § 354.1157. Potential Fraud, Program Abuse, and Other Misutilization |
| § 354.1159. Utilization Review |
| § 354.1161. Provider Re-enrollment or Provider Contract or Agreement Modification |
| § 354.1163. Fair Hearings |
| § 354.1165. Free Services for Recipients |
| § 354.1167. Reimbursement for Abortions |
| § 354.1169. Ectopic Pregnancy |
| § 354.1171. Use of Drugs or Devices to Prevent Implantation of the Fertilized Ovum |
| § 354.1175. Organ Transplants |
| § 354.1181. Provider Compliance with the Clinical Laboratory Improvement Amendments of 1988 |
| § 354.1183. Provider Compliance with the Mammography Quality Standards Act of 1992 |
| § 354.1185. Provider Compliance with Durable Medical Equipment (DME) Certification Requirements |
| § 354.1186. Requirements for the Health Passport |
| § 354.1187. Responsibilities of Third-Party Billing Vendors |
| § 354.1189. Acute Care Medicaid Billing Coordination System |
| § 354.1190. Medicaid Provider Database |
| DIVISION 12. RURAL HEALTH CLINICS |
| § 354.1201. Authorized Services by Rural Health Clinics |
| § 354.1202. Conditions for Payments to Rural Health Clinics |
| § 354.1203. Relationship of Recipient's Treating Physician to Rural Health Clinics |
| DIVISION 13. AMBULATORY SURGICAL CENTERS |
| § 354.1211. Conditions for Participation |
| § 354.1212. Services and Limitations |
| DIVISION 14. DENTISTS' SERVICES |
| § 354.1221. Authorized Dentists' Services |
| DIVISION 15. HEARING AID SERVICES |
| § 354.1231. Benefits and Limitations |
| § 354.1233. Requirements for Hearing Aid Services |
| § 354.1235. Requirements for Provider Participation |
| DIVISION 16. MIDWIFE SERVICES |
| § 354.1251. Benefits and Limitations |
| § 354.1252. Certified Nurse Midwife: Conditions for Participation |
| § 354.1253. Licensed Midwife: Conditions for Participation |
| DIVISION 17. BIRTHING CENTER SERVICES |
| § 354.1261. Benefits and Limitations |
| § 354.1262. Conditions for Participation |
| DIVISION 18. MATERNITY CLINIC SERVICES |
| § 354.1271. Benefits and Limitations |
| § 354.1272. Conditions for Participation |
| § 354.1275. Monitoring |
| DIVISION 19. PSYCHOLOGISTS' SERVICES |
| § 354.1281. Benefits and Limitations |
| § 354.1282. Conditions of Participation |
| DIVISION 20. PHYSICAL THERAPISTS' SERVICES |
| § 354.1291. Benefits and Limitations |
| § 354.1292. Conditions for Participation |
| DIVISION 21. CERTIFIED REGISTERED NURSE ANESTHETISTS' SERVICES |
| § 354.1301. Benefits and Limitations |
| § 354.1302. Conditions for Participation |
| DIVISION 22. SUBSTANCE ABUSE AND DEPENDENCY TREATMENT SERVICES |
| § 354.1311. Benefits and Limitations |
| § 354.1312. Conditions for Participation |
| DIVISION 23. FEDERALLY QUALIFIED HEALTH CENTER SERVICES |
| § 354.1321. Benefits and Limitations |
| § 354.1322. Provider Participation Requirements |
| § 354.1323. Reviews/Appeals |
| DIVISION 24. NURSE PRACTITIONER AND CLINICAL NURSE SPECIALIST SERVICES |
| § 354.1331. Benefits and Limitations |
| § 354.1332. Conditions for Participation |
| DIVISION 25. SCHOOL HEALTH AND RELATED SERVICES |
| § 354.1341. Benefits and Limitations |
| § 354.1342. Conditions for Participation |
| DIVISION 26. COORDINATED CARE |
| § 354.1351. Coordinated Care Pilot Project |
| DIVISION 27. COMMUNITY FIRST CHOICE |
| § 354.1360. Purpose |
| § 354.1361. Definitions |
| § 354.1362. Eligibility |
| § 354.1363. Assessment |
| § 354.1364. Services and Limitations |
| § 354.1365. Provider Qualifications |
| § 354.1366. Consumer Directed Services and Service Responsibility Option |
| § 354.1367. Person-Centered Service Plan |
| § 354.1368. Fair Hearing |
| § 354.1369. Attendant Base Wage |
| DIVISION 28. TUBERCULOSIS |
| § 354.1371. Tuberculosis Clinic Benefits and Limitations |
| DIVISION 29. LICENSED PROFESSIONAL COUNSELORS, LICENSED CLINICAL SOCIAL WORKERS, AND LICENSED MARRIAGE AND FAMILY THERAPISTS |
| § 354.1381. Benefits and Limitations |
| § 354.1382. Conditions for Participation |
| DIVISION 30. IN-HOME TOTAL PARENTERAL HYPERALIMENTATION SERVICES |
| § 354.1391. In-home Total Parenteral Hyperalimentation Services |
| DIVISION 31. IN-HOME RESPIRATORY THERAPY SERVICES FOR VENTILATOR-DEPENDENT PERSONS |
| § 354.1401. In-home Respiratory Therapy Services for Ventilator-Dependent Persons |
| DIVISION 32. TEXAS MEDICAID WELLNESS PROGRAM |
| § 354.1415. Vendor Requirements and Conditions for Participation |
| § 354.1416. Eligibility Criteria |
| § 354.1417. Definitions for Wellness Services |
| DIVISION 33. ADVANCED TELECOMMUNICATIONS SERVICES |
| § 354.1430. Definitions |
| § 354.1432. Telemedicine and Telehealth Benefits and Limitations |
| § 354.1434. Home Telemonitoring Benefits and Limitations |
| § 354.1435. Provision of Behavioral Health Services through an Audio-Only Platform |
| § 354.1436. Provision of Non-behavioral Health Services Using an Audio-only Platform |
| DIVISION 34. OUT-OF-STATE SERVICES |
| § 354.1440. Medical Care or Services Provided to Medicaid Recipients Outside of Texas |
| DIVISION 35. REIMBURSEMENT ADJUSTMENTS FOR POTENTIALLY PREVENTABLE EVENTS |
| § 354.1445. Potentially Preventable Readmissions |
| § 354.1446. Potentially Preventable Complications |