SECTION 98.211. Billing and Payment

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(a) The method of payment is a unit of authorized service and is defined as half a day. One unit of service constitutes three hours but less than six hours of covered services provided by the DAHS facility. Six hours or more of service constitutes two units of service. Time spent in approved transportation provided by the DAHS facility shall be counted in the unit of service.
(b) The DAHS facility is not entitled to payment if:
(1) the DAHS facility fails to submit prior approval forms or supporting documentation to the regional nurse within the required time frames for DAHS facility initiated referrals;
(2) the DAHS facility did not maintain the staff-client ratio for one or more days;
(3) the DAHS facility exceeded its license capacity; or
(4) the DAHS facility's monthly claims do not correspond to the DAHS facility's service authorizations and DADS' Daily Attendance/Daily Transportation Record form.

Source Note: The provisions of this §98.211 adopted to be effective May 1, 1999, 24 TexReg 3100; amended to be effective April 1, 2007, 32 TexReg 1749

                    
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