SECTION 355.8021. Reimbursement Methodology for Home Health Services

(a) Authorized home health nursing and aide services provided to eligible Medicaid recipients are reimbursed the lesser of the billed amount or the Medicaid reimbursement rate established by HHSC.

(b) HHSC reviews the fees for nursing and aide services at least once every two years based upon:

(1) analysis of the Centers for Medicare & Medicaid Services fees for the same or similar services;

(2) analysis of Medicaid fees for the same or similar services in other states; and

(3) analysis of fees paid under commercial insurance for the same or similar services.

(c) HHSC may use data sources or methodologies other than those listed in subsection (b) of this section to establish Medicaid fees for home health services when HHSC determines that the methodologies in subsection (b) of this section are unreasonable or insufficient.

(d) Reimbursement for Physical, Occupational, and Speech Therapy Services is described in §355.8097 of this title (relating to Reimbursement for Physical, Occupational, and Speech Therapy Services).

(e) Fees for home health services will be adjusted within available funding as described in §355.201 of this title (relating to Establishment and Adjustment of Reimbursement Rates by the Health and Human Services Commission).

Source Note: The provisions of this §355.8021 adopted to be effective December 1, 2017, 42 TexReg 5431