This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:44 GMT

TITLE 26 - HEALTH AND HUMAN SERVICES
PART 1 - HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 270 - CONTRACTING TO PROVIDE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
SUBCHAPTER 270.22.html - null
SECTION/RULE §270.22 - Medicaid Capitation Payments

(a) The provider agency must accept the Medicaid capitation payment as payment in full for all services to a Medicaid eligible client.(b) If the client is also a Medicare beneficiary, the Centers for Medicare and Medicaid Services will also pay a Medicare capitation payment to the provider agency.(c) An exception to subsection (a) of this section occurs when a client enters a nursing facility and the client has applied income. To receive this exception:(1) the provider agency must collect the client's applied income, unless the purpose of the stay is for the client to receive respite care; and(2) the applied income must be determined in accordance with §§15.100, 15.450, 15.501-15.503, and 15.506 of this title (relating to Definitions; General Principles Concerning Income; Vendor Living Arrangements; Allowable Deductions; Protection of Spousal Income and Resources; and Mandatory Payroll Deductions from Earned Income).

Source Note: The provisions of this §270.22 adopted to be effective March 24, 2004, 29 TexReg 2923; transferred effective July 31, 2024, as published in the July 5, 2024, issue of the Texas Register, 49 TexReg 4933.

View Official Rule