SECTION 355.8241. Reimbursement Methodology for Chemical Dependency Treatment Facilities

(a) Subject to the specifications, conditions, limitations, and requirements established by the Health and Human Services Commission (HHSC), payment for covered chemical dependency treatment facility services provided by a participating chemical dependency treatment facility (CDTF) is limited to the lesser of the provider's customary charge or the maximum allowable fee established by HHSC.

(b) A CDTF must bill for the covered services that it provides. Services provided by an attending physician or laboratory will be reimbursed separately. The CDTF must be enrolled and approved for participation in the Medicaid program at the time the services are provided.

(c) HHSC will conduct periodic rate reviews and will update the Medicaid CDTF fee schedule as needed. HHSC may adjust rates based on an analysis of:

(1) the Centers for Medicare and Medicaid Services fees for similar services;

(2) Medicaid fees paid by other states;

(3) a survey of costs reported by CDTFs;

(4) data provided by the United States Department of Labor;

(5) previous Medicaid payments for Medicaid-reimbursable CDTF services; or

(6) a combination of sources described in paragraphs (1) - (5) of this subsection.

Source Note: The provisions of this §355.8241 adopted to be effective July 1, 1990, 15 TexReg 3431; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 1997, as published in the Texas Register December 11, 1998, 23 TexReg 12660; amended to be effective November 22, 2011, 36 TexReg 7859