Appendix III, Expedited Payment System

Revision 04-1; Effective June 1, 2004

Purpose

  • To request expedited payment.
  • To liquidate expedited payment.

Requesting Expedited Payment

Follow procedures below to request expedited payment through the paper claims process.

Note: Expedited payment is available only to community-based alternative services, family care, and primary home care agencies that offer personal assistance services.

Complete Form 1290 in the usual manner but enter 80% of the pervious month's reimbursement as the expedited payment amount.

Claim Requirements

Mail the expedited payment claim (Form 1290) by the 20th of the service month. (Example: The service month is September; mail the expedited payment claim by September 20th).

Liquidating (Reconciliating) Expedited Payment

After the first of the month after the service month, submit a regular detailed claim, using Form 1290 for each client for the previous month. On Form 1290, indicate the amount of the claim, including the expedited payment. CMS deducts the expedited payment from the claim and pays you the difference. If the claim submitted does not completely reconcile, then CMS takes 100% of the claim. CMS waits until another claim comes in to reduce the difference.

You must reconcile the expedited payment by the 25th of the month. Example: The service month is September; expedited payment claim is submitted September 20th; reconciliation must be done by the 25th of October. If you do not reconcile by the date the ceiling is posted for the next expedited payment (usually after the 25th of the month), you will not receive the next expedited payment.

If your expedited payment is not liquidated by the date the ceiling is posted for the next payment, you WILL NOT receive the next expedited payment.

If your expedited payment claim is rejected, Form 1290 is returned to you. Complete a new Form 1290.

The liquidation of the expedited payment does not begin until the receipt of the regular detailed claim for the month covered by the expedited payment.

Sanctions

Providers who do not comply with the reconciliation requirements will not receive an expedited payment for at least one month. For providers who have continuous problems billing for expedited payment, DHS retains the right to cancel participation in the expedited billing system.

Appendix IV-A, Reimbursement Methodology for Primary Home Care Services and Family Care Services

Revision 05-1; Effective February 1, 2005

§355.5902 Reimbursement Methodology for Primary Home Care

This rule is available on the Secretary of State's Texas Administrative Code website at
http://texreg.sos.state.tx.us/public/readtac$ext.viewtac.

To access Texas Health and Human Services Commission rules, click on Title 1, Administration, then Part 15. Click on Chapter 355, Reimbursement Rates, then Subchapter G, Telemedicine Services and Other Community-Based Services, to access this rule.

Appendix X, Information Letters

Revision 04-1; Effective June 1, 2004

Information letters regarding Primary Home Care Services are located at:
dads.state.tx.us/providers/communications/letters.cfm

Appendix XIII, Abuse, Neglect, and Exploitation Training and Competency Test

Revision 19-3; Effective October 18, 2019

1. Requirement to Train Staff Members, Service Providers and Volunteers

As required by program rule, a program provider must ensure their staff members, service providers and volunteers are:

  1. trained on:
    • acts that constitute abuse, neglect and exploitation;
    • signs and symptoms of abuse, neglect and exploitation; and
    • methods to prevent abuse, neglect and exploitation; and
  2. knowledgeable of:
    • acts that constitute abuse, neglect and exploitation;
    • signs and symptoms of abuse, neglect and exploitation; and
    • methods to prevent abuse, neglect and exploitation; and
  3. instructed to report to the Department of Family and Protective Services (DFPS) immediately, but not later than 24 hours, after having knowledge or suspicion that an individual has been, or is being, abused, neglected or exploited by:
  4. provided with these instructions described in paragraph c of this section, in writing.

2. Optional Computer-Based Training and Competency Test

A program provider has the option of having their staff members, service providers and volunteers complete HHSC’s ANE Competency Training. The completion of the computer-based training by employees, agents and subcontractors meets the requirement in Section 1a of this appendix.

If staff members, service providers and volunteers complete HHSC’s ANE Competency Final Test, they must receive a score of at least 80 percent.

The completion of the competency test by staff members, service providers and volunteers meets the requirement in Section 1b of this appendix.

Staff members, service providers and volunteers must first sign up on the Learning Portal to have access to HHSC approved trainings, including this ANE training, entitled ANE Competency Training and Exam (online). The ANE training is found in Medicaid Long Term Services and Supports Training under the Health and Human Services Commission Courses tab.

Link to the Learning Portal homepage: learningportal.hhs.texas.gov/.

3. Documentation Requirements

Program providers must maintain records documenting staff members, service providers and volunteers have received training on ANE. If using HHSC’s ANE Competency Training as evidence of ANE training, the program provider must maintain a copy of the certificate generated from HHSC’s ANE Competency Final Test for each staff member, service provider and volunteer. The program provider must maintain training records in accordance with 40 Texas Administrative Code §49.307 Record Retention and Disposition.