SECTION 260.357. Non-Billable Time and Activities

A program provider must not bill for and HHSC does not reimburse for:

(1) services provided to an individual before HHSC's approval of the individual's request for enrollment in the DBMD Program;

(2) supervision of service providers unless providing delegated tasks;

(3) phone calls, text messages, emails, letters, or meetings with HHSC or community resources that do not directly address an individual's services;

(4) administrative meetings or staff meetings;

(5) in-service training, general training, continuing education, or conferences;

(6) employee conferences or evaluations;

(7) filing claims for services;

(8) traveling to and from an individual's residence, except when a day habilitation, transportation provided as a residential habilitation activity, or in-home respite service provider is transporting the individual;

(9) processing paperwork or completing records or reports;

(10) services not included on an approved IPC;

(11) services that are mutually exclusive;

(12) other services and activities not authorized, permitted, or allowed under this chapter;

(13) routine care and supervision that a family member is legally obligated to provide;

(14) activities or supervision for which a payment is made by a source other than Medicaid;

(15) room and board;

(16) any expense related to providing transportation provided as a residential habilitation activity, nursing, out-of-home respite in a camp, case management, adaptive aids, intervener services, or CFC PAS/HAB outside the program provider's contracted service delivery area, including costs for transportation or lodging;

(17) transportation provided as a residential habilitation activity, nursing, out-of-home respite in a camp, case management, adaptive aids, intervener services, or CFC PAS/HAB provided to an individual outside the program provider's contracted service delivery area if the individual has received services outside the program provider's contracted service delivery during a period of more than 60 consecutive days;

(18) two or more services provided at the same time by the same service provider; or

(19) an item or service provided to an individual at the request of the individual or LAR that is not a reimbursable item in the DBMD Program.

Source Note: The provisions of this §260.357 adopted to be effective February 26, 2023, 48 TexReg 896