A program provider must not bill for and HHSC does not reimburse
for:
(1) services provided to an individual before HHSC's
approval of the individual's request for enrollment in the DBMD Program;
(2) supervision of service providers unless providing
delegated tasks;
(3) phone calls, text messages, emails, letters, or
meetings with HHSC or community resources that do not directly address
an individual's services;
(4) administrative meetings or staff meetings;
(5) in-service training, general training, continuing
education, or conferences;
(6) employee conferences or evaluations;
(7) filing claims for services;
(8) traveling to and from an individual's residence,
except when a day habilitation, transportation provided as a residential
habilitation activity, or in-home respite service provider is transporting
the individual;
(9) processing paperwork or completing records or reports;
(10) services not included on an approved IPC;
(11) services that are mutually exclusive;
(12) other services and activities not authorized,
permitted, or allowed under this chapter;
(13) routine care and supervision that a family member
is legally obligated to provide;
(14) activities or supervision for which a payment
is made by a source other than Medicaid;
(15) room and board;
(16) any expense related to providing transportation
provided as a residential habilitation activity, nursing, out-of-home
respite in a camp, case management, adaptive aids, intervener services,
or CFC PAS/HAB outside the program provider's contracted service delivery
area, including costs for transportation or lodging;
(17) transportation provided as a residential habilitation
activity, nursing, out-of-home respite in a camp, case management,
adaptive aids, intervener services, or CFC PAS/HAB provided to an
individual outside the program provider's contracted service delivery
area if the individual has received services outside the program provider's
contracted service delivery during a period of more than 60 consecutive
days;
(18) two or more services provided at the same time
by the same service provider; or
(19) an item or service provided to an individual at
the request of the individual or LAR that is not a reimbursable item
in the DBMD Program.
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