(a) Facilities must abide by Public Law 95-142 related
to Medicare/Medicaid antifraud and abuse amendments.
(b) Participation will be limited to providers of services
who accept, as payment in full, the amounts paid in accordance with
the fee structure approved by the Texas Department of Human Services
(DHS).
(c) Providers who have a contract with DHS and who
solicit contributions, donations, or gifts from Medicaid recipients
or family members will be in noncompliance with federal requirements.
(d) The facility must inform Medicaid recipients and
their families that their right to nursing facility services is not
contingent upon contributions. The facility must give copies of this
notice to the recipient, and either the responsible party or family
representative.
(e) If a recipient, family member, guardian, or other
interested party does make a free-will contribution, the nursing facility
administrator executes a statement for signature by both the contributor
and the administrator. It will state that the services provided to
any Medicaid recipient in the nursing facility are not predicated
upon contributions and that the gifts are free-will contributions.
(f) When a provider accepts federal and/or state funds
for items or services delivered which are not reimbursed within the
per diem, the facility must document:
(1) that the type of item or service is ordered by
the physician;
(2) that the item or service has not been billed to
more than one payor source; and
(3) that the recipient actually received the item or
service.
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Source Note: The provisions of this §554.2606 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 |