Section 354.2355 - Long Term Care Providers(a) A nursing facility, home health services provider, or any other similar long-term care services provider that is Medicare certified must: (1) seek reimbursement from Medicare before billing the Medicaid program for health care items or services provided to an individual who is eligible to receive similar services under the Medicare program; and(2) as directed by HHSC, appeal Medicare claim denials for payment.(b) A nursing facility, home health services provider, or any other similar long-term care services provider that is Medicare certified is not required to seek reimbursement from Medicare before billing the Medicaid program for a person who is: (1) Medicare eligible; and(2) has been determined as not being homebound.(c) For health care items or services in subsection (a) of this section, a payment or denial remittance from Medicare is required prior to Medicaid considering payment.1 Tex. Admin. Code § 354.2355
The provisions of this §354.2355 adopted to be effective March 28, 2004, 29 TexReg 2867; Amended by Texas Register, Volume 49, Number 07, February 16, 2024, TexReg 0858, eff. 2/22/2024