| (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.
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