Revision 13-0; Effective September 3, 2013

 

 

5100 Billing and Claims

Revision 13-0; Effective September 3, 2013

 

5110 Billing and Claims Payment, Rule

Revision 13-0; Effective September 3, 2013

 

40 Texas Administrative Code, §55.41.

Rule §55.41, regarding reimbursement of two consecutive failed delivery of meals, is applicable unless otherwise stated. See Section 4300, Service Requirements, Rule, for billing exception.

 

5120 Claims and Payment Information

Revision 13-0; Effective September 3, 2013

 

A provider agency may access information about, or request assistance with, claims and payments through the Texas Medicaid and Healthcare Partnership (TMHP) website on the Provider for Long Term Care Web page.

 

5200 Rate Setting

Revision 13-0; Effective September 3, 2013

 

5210 HHSC Rate Analysis

Revision 13-0; Effective September 3, 2013

 

A provider agency may access rate information at the Health and Human Services Commission
(HHSC) Rate Analysis website.

 

5220 Reimbursement Methodology for Home-Delivered Meals, Rule

Revision 13-0; Effective September 3, 2013

 

1 Texas Administrative Code §355.511.

See Appendix III, Cost Determination Process, for information.

 

5230 Budget-Based Rate Negotiation

Revision 13-0; Effective September 3, 2013

 

The Department of Aging and Disability Services (DADS) posts budget-based rate negotiation documents and detailed instructions on the Home-Delivered Meals (HDM) provider page at FFY Budget Negotiation. A provider agency may also access that information at the HDM home page.

A provider agency must use these documents during budget-based rate negotiations with the DADS contract manager to develop a per meal unit rate for the upcoming Federal Fiscal Year (FFY). In addition, a provider agency that is a common provider will be contacted by its Area Agency on Aging (AAA) to negotiate per meal unit rates for those meals. AAAs and DADS continue to jointly negotiate budgets and rates for common providers.

DADS contract managers and provider agencies, as applicable, will review projected expenses for the coming FFY in conjunction with final budget numbers for the most current completed fiscal year and apply cost allocation methodology and cost principles to arrive at the appropriate per meal unit rate for the upcoming FFY. The contract specific rate cannot exceed the unit reimbursement rate established by the Texas Health and Human Services Commission.

For additional information on delivery of fewer than five hot meals per week, see Section 4310, Waiver Request.