Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009 Page: 5,455
5445-5614 p. ; 28 cm.View a full description of this periodical.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
(A) an institution for tuberculosis;[ in a mental institu-
tion, or in]
(B) the hospital or nursing sections of institutions for
the mentally retarded; or
(C) an institution for mental disease if the patient is be-
tween the ages of 22 and 64;
(2) special shoes or other supportive devices for the feet
and[,] ambulation aids (except as provided for in the home health ser-
vices program)[, immunizations (except for influenza and pneumonia
immunizations determined to be medically necessary by the depart-
ment or its designee), or occupational therapy (except provided for
under other rules in this chapter)];
(3) any services provided by military medical facilities, ex-
cept: [for]
(A) those military hospitals enrolled to provide inpa-
tient emergency services,[,]
(B) Veterans Administration facilities [,] or
(C) United States Public Health Service hospitals;
(4) care and treatment related to any condition covered by
[for which benefits are provided er available under the] workmen's
compensation laws;
(5) care, treatment, or other services by a doctor of den-
tistry unless: [dental surgery, doctor of medical dentistry, or doctor
of dental medicine, including services related to teeth or structures di-
rectly supporting the teeth r ther services by a dentist
(A) the recipient's dental diagnosis is causally related to
a life-threatening medical condition; or [except aS described and lim-
ited under 29-402 of title (relating to Authorized Dentists' Ser
vices);]
(B) the treatment is [unless] specifically authorized by
the Health and Human Services Commission (HHSC) [department] or
its designee; [or]
(C-) unless services are specifically authorized under
the Early and Periodic Screening, Diagnosis, and Treatment Program
(EPSD-T.]
{(6) eyeglasses and examinations for the prescription and
fitting thereof, except a provided in this chapter;]
(6) [(-7)] any care or services to the extent that a benefit is
paid or payable under Medicare;
(7) [(8)] any services or supplies provided [delivered] to an
individual before the effective date of designation by HHSC [the de-
partment] as an eligible recipient or after the effective date of denial as
an eligible recipient except orthodontic services that are authorized and
initiated while the recipient is eligible for Medicaid may be continued
for 36 months after a recipient is no longer Medicaid eligible;
(8) [(9)] any services or supplies provided in connection
with cosmetic surgery except as required for the prompt repair of ac-
cidental injury or for improvement of the functioning of a malformed
body member [or when specially authorized by the department];
(9) immunizations specifically for travel to or from foreign
countries. Immunizations included on the immunization schedule ap-
proved by the Advisory Committee on Immunization Practices (ACIP)
are a benefit unless an immunization is specifically excluded by HHSC;[(10) any services OF supplies provided in connection with
a routine physical examination except a otherwise provided in this
(10) [(44-] any services provided by an immediate relative
of the eligible recipient or member of the eligible recipient's household
except for personal care services;
[(1-2) any services O supplies which are not reasonable and
necessary Xfor the diagnosis or treatment of illness of injury OeF to ir-
prove the functioning f a malformed body member, except cosmeti
surgery, when speially authorized by the department, unless otherwise
specifically provided in this chapter;]
(11) [(4-3)] custodial care;
[(14) any services Or supplies provided to an individual af-
ter a fi nder utilization review procedure that suth services or
supplies are not medically necessary;]
[(1.5) whole blood o packed red cells, except as provided
n thise hapterf
(12) [(4-6)] any services or supplies provided outside of the
United States, except for deductible and coinsurance portions of Medi-
care benefits as provided for in this chapter;
(13) [(4-7)] any services or supplies not provided for in this
chapter;
(14) [(-1-8] any services or supplies not provided for in this
chapter for:
(A) the treatment of flat foot conditions and the pre-
scription of supportive devices therefor;
(B) the treatment of subluxations of the foot; or
(C) routine foot care (including the cutting or removal
of corns, warts, or calluses, the trimming of nails, and other routine
hygiene care);
[(t19) any par enteration provided onan t-
patient hospital basis or as an in-home service without prior authoriza-
tion from the department's health insuring agent, nor to any outpatient
lhyperalimentation administered as a nutritional supplement
(15) [(20)] any medical and remedial care, services, and
supplies provided to a hospital inpatient [by practitioners, providers,
Or suppliers] after total hospitalization-related expenditures under the
Medicaid [Texas Medical Assistance] Program reach $200,000 per re-
cipient, per 12-month benefit period unless the services are exempted
by subparagraphs (A) - (C) of this paragraph. [, except as specified
in 29.1125 of this title (relating to Organ Transplants), except as
otherwise spe ifi4ed by the department as directed by -the department's
board. This limit kdoes iot apply to medically necessary services pro-
vided to an inpatient 4ess than age one includingg inpatients under age
one who are admitted to and remain in a hospital past their first birth-
day). This limit so does not apply to physician (MI r DO) services
as defined in Title X. X laTws and reg latiow s tav.] For the
purposes of this limit, "12-month benefit period" means 12 consecu-
tive months beginning November 1 of each year and ending October
31 of the next year. The limit applies to hospitalization-related services
while the recipient is a hospital inpatient regardless of where the ser-
vices are provided,[ regardless of] how soon[,] within the 12-month
period[,] the limit is reached,[-] and [regardless of] how many hospital
stays are involved. For the purposes of this limit, HHSC or its designee
[the department's agent] processes and pays claims, if payable, in order
of receipt. The services exempted from the $200,000 limit are: [.]PROPOSED RULES August 14, 2009
34 TexReg 5455
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
Texas. Secretary of State. Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009, periodical, August 14, 2009; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth90865/m1/10/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.