Revision 15-2; Effective October 30, 2015

 

1100 General Information and Statutory Requirements

Revision 12-1; Effective February 10, 2012

 

Department of Aging and Disability Services (DADS) rules at 40 TAC §9.573 set forth requirements for Texas Home Living (TxHmL) Program providers to receive payment for TxHmL Program services. Specifically, 40 TAC §9.573(a)(4) requires a program provider to prepare and submit service claims in accordance with the TxHmL Program Billing Guidelines. Also, Sections II. H. and II. T. of the TxHmL Program Provider Agreement requires program providers to comply with the TxHmL Program Billing Guidelines. In addition, 40 TAC §9.573(a)(11) sets forth circumstances under which a program provider will not be paid or Medicaid payments will be recouped from the program provider.

 

1200 Service Components

Revision 15-2; Effective October 30, 2015

 

The TxHmL Program consists of the following service components:

  • professional therapies, which consist of the following subcomponents:
    • audiology services,
    • dietary services,
    • occupational therapy services,
    • physical therapy services,
    • behavioral support services, and
    • speech and language pathology services;
  • day habilitation;
  • registered nursing;
  • licensed vocational nursing;
  • specialized registered nursing;
  • specialized licensed vocational nursing;
  • community support (transportation);
  • respite;
  • supported employment;
  • employment assistance;
  • adaptive aids;
  • minor home modifications; and
  • dental treatment.

 

1300 Billing and Payment Reviews

Revision 12-1; Effective February 10, 2012

 

Billing and payment reviews are conducted to determine if a program provider has complied with DADS rules and these billing guidelines. Billing and payment reviews and residential visits are distinct from the reviews described in 40 TAC §9.576, which are performed to determine a program provider's compliance with the program certification principles contained in 40 TAC §9.578-9.579. Appendix I, Billing and Payment Review Protocol, describes how billing and payment reviews are conducted.