The Texas Health and Human Services Commission has adopted amendments to 1 TAC §353.4 regarding Managed Care Organization requirements concerning out-of-network providers.
Nursing facility services were carved into Medicaid managed care effective March 1, 2015. As a result of this change, HHSC is amending and adding rule language consistent with managed care contract requirements related to managed care reimbursement of out-of-network nursing facility services.
Additionally, HHSC is taking this opportunity to amend and add new language related to out-of-network emergency transport and other authorized out-of-network services. Also, this rule amendment makes clarifying changes to managed care out-of-network usage standards and reporting.
The effective date for the adopted amendments is May 2.
HHSC has also adopted amendments to 1 TAC Chapter 352 regarding, definitions, applying for enrollment, screening levels, and duty to report changes. The amended rules allow Medicaid providers to add a practice location to their Medicaid enrollment with a minimized administrative burden.
The effective date for the adopted amendments is May 2.