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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 1. ADMINISTRATION |
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PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION |
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CHAPTER 355. REIMBURSEMENT RATES |
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SUBCHAPTER J. PURCHASED HEALTH SERVICES |
| DIVISION 1. MEDICAID VISION CARE PROGRAM |
| § 355.8001. Reimbursement for Vision Care Services |
| DIVISION 2. MEDICAID HOME HEALTH PROGRAM |
| § 355.8021. Reimbursement Methodology for Home Health Services |
| § 355.8023. Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) |
| DIVISION 3. PHYSICIAN SERVICES |
| § 355.8041. Recipient-Initiated Second Opinions |
| DIVISION 4. MEDICAID HOSPITAL SERVICES |
| § 355.8052. Inpatient Hospital Reimbursement |
| § 355.8056. State-Owned Teaching Hospital Reimbursement Methodology |
| § 355.8058. Inpatient Direct Graduate Medical Education (GME) Reimbursement |
| § 355.8060. Reimbursement Methodology for Freestanding Psychiatric Facilities |
| § 355.8061. Outpatient Hospital Reimbursement |
| § 355.8065. Disproportionate Share Hospital Reimbursement Methodology |
| § 355.8066. State Payment Cap and Hospital-Specific Limit Methodology |
| § 355.8070. Hospital Augmented Reimbursement Program |
| DIVISION 5. GENERAL ADMINISTRATION |
| § 355.8085. Reimbursement Methodology for Physicians and Other Practitioners |
| § 355.8087. In-Home Total Parenteral Hyperalimentation Services |
| § 355.8089. In-home Respiratory Therapy Services for Ventilator-Dependent Persons |
| § 355.8091. Reimbursement to Licensed Professional Counselors, Licensed Clinical Social Workers, and Licensed Marriage and Family Therapists |
| § 355.8093. Reimbursement Methodology for Physician Assistants |
| § 355.8095. Medicaid Administrative Claiming Program |
| § 355.8097. Reimbursement Methodology for Physical, Occupational, and Speech Therapy Services |
| DIVISION 6. RURAL HEALTH CLINICS |
| § 355.8101. Rural Health Clinics Reimbursement |
| DIVISION 7. AMBULATORY SURGICAL CENTERS |
| § 355.8121. Reimbursement to Ambulatory Surgical Centers |
| DIVISION 8. HEARING AID SERVICES |
| § 355.8141. Reimbursement for Hearing Aid Services |
| DIVISION 9. MIDWIVES |
| § 355.8161. Reimbursement Methodology for Midwife Services |
| DIVISION 10. BIRTHING CENTER SERVICES |
| § 355.8181. Birthing Center Reimbursement |
| DIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT |
| § 355.8200. Retained Funds for the Uncompensated Care Program |
| § 355.8201. Waiver Payments to Hospitals for Uncompensated Care |
| § 355.8202. Waiver Payments to Physician Group Practices for Uncompensated Care |
| § 355.8203. Delivery System Reform Incentive Payments |
| § 355.8204. Funding for DSRIP Monitoring Program |
| § 355.8205. Delivery System Reform Incentive Payments for Demonstration Years 7-8 |
| § 355.8206. Funding for DSRIP Monitoring Program for Demonstration Years 7-8 |
| § 355.8208. Waiver Payments to Publicly-Owned Dental Providers for Uncompensated Charity Care |
| § 355.8210. Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care |
| § 355.8212. Waiver Payments to Hospitals for Uncompensated Charity Care |
| § 355.8214. Waiver Payments to Physician Group Practices for Uncompensated Charity Care |
| § 355.8215. Public Health Provider - Charity Care Program (PHP-CCP) |
| § 355.8216. Delivery System Reform Incentive Payments for Demonstration Years 9-10 |
| § 355.8217. Payments to Public Health Providers for Charity Care |
| § 355.8218. Funding for DSRIP Monitoring Program for Demonstration Years 9-10 |
| DIVISION 12. CERTIFIED REGISTERED NURSE ANESTHETISTS AND ANESTHESIOLOGIST ASSISTANTS |
| § 355.8221. Reimbursement Methodology |
| DIVISION 13. CHEMICAL DEPENDENCY TREATMENT FACILITY SERVICES |
| § 355.8241. Reimbursement Methodology for Chemical Dependency Treatment Facilities |
| DIVISION 14. FEDERALLY QUALIFIED HEALTH CENTER SERVICES |
| § 355.8261. Federally Qualified Health Center Services Reimbursement |
| DIVISION 15. NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS |
| § 355.8281. Reimbursement Methodology for Nurse Practitioners and Clinical Nurse Specialists |
| DIVISION 17. LONESTAR SELECT CONTRACTING PROGRAM |
| § 355.8321. LoneSTAR Select Contracting Process for Inpatient Hospital Services |
| DIVISION 19. MEDICAID MANAGED CARE: STANDARDS FOR THE STATE OF TEXAS ACCESS REFORM (STAR) |
| § 355.8361. Rates and Payment Structures |
| DIVISION 20. CASE MANAGEMENT FOR CHILDREN WHO ARE BLIND AND VISUALLY IMPAIRED |
| DIVISION 21. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN |
| § 355.8401. Reimbursement Methodology for Case Management for Children and Pregnant Women |
| DIVISION 22. REIMBURSEMENT METHODOLOGY FOR THE EARLY CHILDHOOD INTERVENTION PROGRAM |
| § 355.8421. Reimbursement for Case Management Services for Infants and Toddlers with Developmental Disabilities |
| § 355.8422. Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities |
| DIVISION 23. EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) |
| § 355.8441. Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services |
| § 355.8443. Reimbursement Methodology for School Health and Related Services (SHARS) |
| § 355.8445. Reimbursement for Environmental Lead Investigations |
| DIVISION 24. EPSDT: EYEGLASS PROGRAM |
| § 355.8461. Reimbursement |
| DIVISION 28. PHARMACY SERVICES: REIMBURSEMENT |
| § 355.8541. Legend and Nonlegend Medications |
| § 355.8542. Drug Price Effective Date |
| § 355.8543. Nonlegend Drug Restrictions |
| § 355.8544. Usual and Customary Prices |
| § 355.8546. Brand-Name Drugs |
| § 355.8547. Reimbursement for Compound Prescriptions |
| § 355.8548. 340B Covered Entities |
| § 355.8549. Reimbursement to Hospitals and Physicians Who Dispense Drugs |
| § 355.8550. Third-Party Resources |
| § 355.8551. Professional Dispensing Fee |
| DIVISION 29. MEDICAL TRANSPORTATION |
| § 355.8561. Billing |
| DIVISION 30. FAMILY PLANNING |
| § 355.8581. Reimbursement Methodology for Family Planning Services |
| DIVISION 31. AMBULANCE SERVICES |
| § 355.8600. Reimbursement Methodology for Ambulance Services |
| DIVISION 32. CLINICAL LABORATORY SERVICES |
| § 355.8610. Reimbursement for Clinical Laboratory Services |
| DIVISION 33. INDIAN HEALTH SERVICES |
| § 355.8620. Reimbursement Methodology for Services Provided in Indian Health Service and Tribal Facilities |
| DIVISION 34. WOMEN'S HEALTH PROGRAM |
| § 355.8641. Reimbursement Methodology for the Women's Health Program |
| DIVISION 35. RENAL DIALYSIS SERVICES |
| § 355.8660. Renal Dialysis Reimbursement |