| (a) Nursing facilities may collect from the recipient
only the applied income that is specified on the recipient's payment
plan forms, except when that amount exceeds the monthly vendor rate.
In this event, the facility may collect only an applied-income amount
equal to the maximum monthly Medicaid vendor rate.
(b) If a payment plan appears incorrect, the facility
administrator should contact the local Texas Department of Human Services
(DHS) worker to correct the plan. Even if a recipient's income increases,
the administrator must not collect an increased payment until the
plan is changed. The administrator should not collect an increased
payment in anticipation of a payment plan increase.
(c) If an admitted recipient does not have a payment
plan, the administrator should contact the local worker for help in
determining how much applied income is owed. If the forthcoming forms
indicate a lesser payment, the administrator should refund the excess
immediately and notify the worker.
(d) Facilities that collect payments (part applied
income, part Medicaid) in excess of the vendor rate are in violation
of DHS regulations and of Public Law 95-142 which makes "solicitation
of supplementation" a felony.
(e) Regional DHS staff must report any violations.
If an investigation shows that the facility has violated this standard,
a recommendation for withholding vendor payments, contract termination,
referral to the courts, or other contract action may be made.
(f) The nursing facility must refund the recipient's
prorated applied income money when the recipient has paid in advance
for the full month and is discharged from the facility any time during
the month. The facility must make the refund within 30 calendar days
from and including the date of discharge, even when vendor payment
has not been received from DHS.
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| Source Note: The provisions of this §554.2316 adopted to be effective May 1, 1995, 20 TexReg 2393; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
