RULE §60.22 Medicaid Capitation Payments


Published: 2015

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(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 §60.22 adopted to be effective March 24, 2004, 29 TexReg 2923