SECTION 47.89. Reimbursement

(a) Billing requirements. A provider must not bill HHSC for:

(1) more hours than an individual's weekly authorization, except when services are delivered as described in §47.63(b)(2) of this chapter (relating to Service Delivery);

(2) services delivered in a licensed facility, if the facility is required by the license to provide those services;

(3) services provided outside the contracted service delivery area except if provided in compliance with §47.63(e) of this chapter; and

(4) services or tasks that duplicate any services or tasks provided to the individual by another source.

(b) Hourly rate. A provider must agree to accept the hourly rate authorized by HHSC.

(c) Documentation. A provider must maintain the documentation described in this chapter to be eligible for reimbursement.

(d) Rounding. A provider must bill HHSC for services in quarter-hour increments, rounding up to the next quarter-hour if the actual time worked is eight minutes or more, and rounding down to the previous quarter hour if the actual time worked is less than eight minutes.

(e) Allowable tasks. A provider must bill HHSC only for the tasks described in §47.41 of this chapter (relating to Allowable Tasks).

Source Note: The provisions of this §47.89 adopted to be effective June 1, 2004, 29 TexReg 5113; amended to be effective June 1, 2009, 34 TexReg 2802; amended to be effective October 1, 2013, 38 TexReg 6621; amended to be effective September 1, 2014, 39 TexReg 6635; amended to be effective October 1, 2019, 44 TexReg 5138