If an applicant is determined to be eligible and in need of
nursing facility care, the effective date of vendor coverage is either
the date the individual entered the facility, the date of application,
or the date the need for nursing facility care was established, whichever
date is the latest.
(1) Once the effective date is established, the Texas
Department of Human Services (DHS), through the contract agreement
with the facility, sets the acceptable rates for services.
(2) If the facility charges the applicant an amount
over the recognized monthly rate set by DHS, the difference must be
refunded to the recipient or the responsible party.
(3) Private pay individuals living in Medicaid certified
nursing facilities, or distinct parts, who do not receive SSI cash
benefits may be eligible for "Three months prior" vendor payments.
(See §19.2408 of this title (relating to Retroactive Medical
Necessity Determinations)).
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| Source Note: The provisions of this §554.2605 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 |
