Figure: 1 TAC 355

Health & Human Services Commission--Medicaid Reimbursement Rate Rules Transfer
Legend
TDH--Tex. Dep't of Health
DPRS-Tex. Dep't of Protective & Regulatory Services		 ECI--Interagency Council for Early Childhood Intervention      TRC--Tex. Rehabilitation Com'n
     MHMR--Tex. Dep't of Mental Health & Mental Retardation
Agency Former Citation Caption New Citation Duplicate
Title
 Ch. Subch Sec. Title Ch. Subch. Division Sec.
TDH 25 29 B 29.103 Reimbursement for Optometric
Services		 1 355 J.
Purchased
Health
Services		 1. Medicaid Vision Care
Program		 355.8001 Yes
TDH 25 29 D 29.307 Reimbursement Methodology for
Home Health Services		 1 355 J 2. Medicaid Home
Health Program		 355.8021 Yes
TDH 25 29 F 29.503 Recipient-Initiated Second Opinions 1 355 J 3. Physician Services 355.8041 Yes
TDH 25 29 G 29.601 Payment for Hospital Services 1 355 J 4. Hospital Services 355.8061 No
TDH 25 29 G 29.606 Reimbursement Methodology for
Inpatient Hospital Services		 1 355 J 4. Hospital Services 355.8063 No
TDH 25 29 G 29.609 Additional Reimbursement to
Disproportionate Share Hospitals		 1 355 J 4. Hospital Services 355.8065 No
TDH 25 29 G 29.610 Disproportionate Share Hospital
Reimbursement Methodology		 1 355 J 4. Hospital Services 355.8067 No
TDH 25 29 L 29.1102 Payment for Laboratory and X-ray
Services, Radiation Therapy
Physical Therapists' Services
Physician Services, Podiatry
Services, Chiropractic Services
Optometric Services, Ambulance
Services, Dentists Services and
Psychologists' Services		 1 355 J 5. General
Administration		 355.8081 No
TDH 25 29 L 29.1103 Medical Care Provided Outside of
Texas in Another State of the United
States		 1 355 J 5. General
Administration		 355.8083 Yes
TDH 25 29 L 29.1104 Texas Medicaid Reimbursement
Methodology (TMRM)		 1 355 J 5. General
Administration		 355.8085 No
TDH 25 29 L 29.1126 In-home Total Parenteral
Hyperalimentation Services		 1 355 J 5. General
Administration		 355.8087 Yes
TDH 25 29 L 29.1127 In-home Respiratory Therapy
Services for Ventilator-Dependent
Persons		 1 355 J 5. General
Administration		 355.8089 Yes
TDH 25 29 M 29.1203 Reimbursement 1 355 J 6. Rural Health Clinics 355.8101 No
TDH 25 29 N 29.1303 Reimbursement 1 355 J 7. Ambulatory Surgical
Centers		 355.8121 No
TDH 25 29 P 29.1504 Reimbursement for Hearing Aid
Services		 1 355 J 8. Hearing Aid Services 355.8141 Yes
TDH 25 29 Q 29.1603 Reimbursement 1 355 J 9. Nurse-Midwife
Services		 355.8161 Yes
TDH 25 29 R 29.1703 Reimbursement 1 355 J 10. Birthing Center
Services		 355.8181 Yes
TDH 25 29 S 29.1803 Reimbursement 1 355 J 11. Maternity Services 355.8201 Yes
TDH 25 29 V 29.2103 Reimbursement 1 355 J 12. Certified Registered
Nurse-Anesthetists'
Services		 355.8221 Yes
TDH 25 29 W 29.2203 Reimbursement 1 355 J 13. Chemical
Dependency Treatment
Facility Services		 355.8241 No
TDH 25 29 Y 29.2403 Reimbursement 1 355 J 14. Federally Qualified
Health Center Services		 355.8261 No
TDH 25 29 Z 29.2503 Reimbursement 1 355 J 15. Certified Family
Nurse Practitioner and
Pediatric Nurse
Practitioner		 355.8281 No
TDH 25 29 AA 29.2603 Reimbursement 1 355 J 16. School Health and
Related Services		 355.8301 No
TDH 25 29 CC 29.2801 LoneSTAR Select Contracting
Process for Inpatient Hospital
Services		 1 355 J 17. LoneSTAR Select
Contracting Program		 355.8321 Yes
TDH 25 29 DD 29.2902 Reimbursement Methodology 1 355 J 18. Tuberculosis 355.8341 No
TDH 25 30 B 30.31 Rates and Payment Structures 1 355 J 19. Medicaid Managed
Care: Standards for the
Statge of Texas Access
Reform (STAR)		 355.8361 No
TDH 25 32 A 32.106 Case Management Reimbursement
Methodology		 1 355 J 20. Case Management
for Children who are
Blind and Visually
Impaired		 355.8381 No
TDH 25 32 C 32.306 Case Management Reimbursement
Methodology		 1 355 J 21. Case Management
for High-risk Pregnant
Women and High-risk
Infants		 355.8401 No
TDH 25 32 D 32.501 General Reimbursement Information 1 355 J 22. Reimbursement
Methodology for the
Early Childhood
Intervention Program		 355.8421 No
TDH 25 32 D 32.502 Cost Reporting Procedures 1 355 J 22. Reimbursement
Methodology for the
Early Childhood
Intervention Program		 355.8422 No
TDH 25 32 D 32.503 Reimbursement Rate Determination 1 355 J 22. Reimbursement
Methodology for the
Early Childhood
Intervention Program		 355.8423 No
TDH 25 32 D 32.504 Allowable Cost Information 1 355 J 22. Reimbursement
Methodology for the
Early Childhood
Intervention Program		 355.8424 No
TDH 25 32 D 32.505 List of Allowable Costs 1 355 J 22. Reimbursement
Methodology for the
Early Childhood
Intervention Program		 355.8425 No
TDH 25 32 D 32.506 List of Unallowable Costs 1 355 J 22. Reimbursement
Methodology for the
Early Childhood
Intervention Program		 355.8426 No
TDH 25 33 E 33.140 Early and Periodic Screening,
Diagnosis, and Treatment
Comprehensive Care Program
Providers (EPSDT-CCP)		 1 355 J 23. Early and Periodic
Screening, Diagnosis,
and Treatment (EPSDT):
Medical Phase		 355.8441 No
TDH 25 33 I 33.404 Reimbursement 1 355 J 24. EPSDT: Eyeglass
Program		 355.8461 No
TDH 25 33 J 33.507 THSteps Medical Case Management
Reimbursement Methodology		 1 355 J 25. EPSDT: Texas
HealthSteps Medical
Case Management		 355.8481 No
TDH 25 34 F 34.4 Reimbursement Methodology for the
Medically Dependent Children
Program, a §1915(c) Home and
Community-Based Waiver Program		 1 355 J 27. Waiver Program for
Medically Dependent
Children		 355.8521 No
TDH 25 35 F 35.601 Legend and Nonlegend Medication 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8541 No
TDH 25 35 F 35.602 Price Changes 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8542 No
TDH 25 35 F 35.603 Nonlegend Drug Restrictions 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8543 No
TDH 25 35 F 35.604 Usual and Customary Prices 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8544 No
TDH 25 35 F 35.605 Texas Maximum Allowable Cost 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8545 No
TDH 25 35 F 35.606 Brand-Name Drugs 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8546 No
TDH 25 35 F 35.607 Reimbursement for Compound
Prescriptions		 1 355 J 28: Pharmacy Services:
Reimbursement		 355.8547 No
TDH 25 35 F 35.608 Hospitals, Nursing Homes and
Government Institutions		 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8548 No
TDH 25 35 F 35.609 Reimbursement to Hospitals and
Physicians Who Dispense Drugs		 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8549 No
TDH 25 35 F 35.610 Third-Party Resources 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8550 No
TDH 25 35 F 35.611 Dispensing Fee 1 355 J 28. Pharmacy Services:
Reimbursement		 355.8551 No
TDH 25 40   40.401 Billing 1 3551 J 29. Medical
Transportation		 355.8561 No
TDH 25 56 D 56.401 Purchased Counseling and
Educational Services		 1 355 J 30. Family Planning:
Purchased Services		 355.8581 Yes
TDH 25 56 D 56.402 Medical Services 1 355 J 30. Family Planning:
Purchased Services		 355.8582 Yes
TDH 25 56 D 56.403 Elective Sterilization 1 355 J 30. Family Planning:
Purchased Services		 355.8583 Yes
TDH 25 56 D 56.404 Maximum Rates and Specific Codes 1 355 J 30. Family Planning:
Purchased Services		 355.8584 Yes
MHMR 25 409 I 409.364 Rehabilitative Services For Persons
With Mental Illness: Rehabilitative
Services Reimbursement
Methodology		 1 355 F   355.781 Yes
MHMR 25 409 J 409.365 Right To Appeal 1 355 F   355.783 Yes
ECI 25 621   621.123 Reimbursable Services 1 355 M
Miscellan-
eous
Medicaid
Programs		 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9001 Yes
ECI 25 621   621.129 General Reimbursement Information 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9002 No
ECI 25 621   621.130 Methodology 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9003 No
ECI 25 621   621.131 Cost Reporting Procedures 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9004 No
ECI 25 621   621.132 Basic Objectives and Criteria for
Desk Review of Cost Reports		 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9005 No
ECI 25 621   621.133 Notification 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9006 No
ECI 25 621   621.134 Reimbursement Rate Determination 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9007 No
ECI 25 621   621.135 Determinaton of Inflation Indices 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9008 No
ECI 25 621   621.136 Adjusting Rates when New
Legislation, Regulations or
Economic Factors Affect Costs		 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9009 No
ECI 25 621   621.137 Allowable Cost Information 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9010 No
ECI 25 621   621.138 List of Allowable Costs 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9012 No
ECI 25 621   621.139 List of Unallowable Costs 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9013 No
ECI 25 621   621.140 Reviews and Administrative
Hearings		 1 355 M 1. Early Childhood
Intervention: Case
Management Services
for Infants and Toddlers
with Developmental
Disabilities		 355.9014 Yes
TRC 40 111   111.12 Cost Report 1 355 M 2. Medicaid Waiver
Program for People with
Deaf-blindness and
Multiple Disabilities		 355.9021 Yes
TRC 40 111   111.14 Reimbursement Methodology for
Community-based Services
Provided to People Who are Deaf-
Blind with Multiple Disabilities		 1 355 M 2. Medicaid Waiver
Program for People with
Deaf-blindness and
Multiple Disabilities		 355.9022 No
DPRS 40 708   708.5 Reimbursement for Services 1 355 M 3. Medicaid Targeted
Case Management
Program		 355.9041 No