| (a) Vendor payment will be made based upon the nursing
facility administrator's or the administrative designee's approval
of the Nursing Care Statement.
(b) Vendor payment will be made at periodic intervals
but not less than once per month for services rendered during the
previous billing period.
(c) The vendor payment for an entire month will be
in accordance with the number of calendar days in the month.
(d) Vendor payment for time periods of less than an
entire calendar month shall be made in accordance with the number
of days care was provided beginning with the effective date on the
Notification of Recipient Medical Necessity Determination and/or Vendor
Payment Plan.
(e) Days are defined as 24-hour periods extending from
midnight to midnight. Payment is computed in terms of whole days,
even though the recipient may have been in a nursing facility only
a fractional part of the day of entrance. (See §19.2601(e) of
this title (relating to Vendor Payment (Items and Services Included)).
(f) Vendor payment will be made in terms of daily rates.
(g) The recipient must have the status of a certified
recipient, must have been determined to be in need of nursing facility
care, and must be physically located in a Medicaid-certified bed of
a facility at the time the service is rendered in order for the facility
to receive payment for the service.
(h) The Texas Department of Human Services (DHS) will
owe the facility no interest on payments not made within the time
limits provided in these rules, the provider contract, or Chapter
2251 of the Government Code when the delay is the result of a bona
fide dispute between DHS and the facility over compliance with the
terms and conditions of the Medicaid program or is the result of other
rules, laws or contract terms authorizing the withholding or nonpayment.
|
| Source Note: The provisions of this §554.2604 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective August 1, 2000, 25 TexReg 6779; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
