Texas Department of Aging and Disability Services
Home and Community-based Services (HCS) Program Billing Guidelines
Revision: 14-1
Effective: March 21, 2014

Section 1000

Introduction

1100  General Information and Statutory Requirements

Revision 10-1; Effective June 1, 2010

Department of Aging and Disability Services (DADS) rules at 40 TAC §9.170 set forth requirements for Home and Community-based Services (HCS) Program providers to receive payment for HCS Program services. Specifically, 40 TAC §9.170(d) requires a program provider to prepare and submit service claims in accordance with the HCS Program Billing Guidelines. Also, Sections II. H. and II. T. of the HCS Program Provider Agreement require program providers to comply with the HCS Program Billing Guidelines. In addition, 40 TAC §9.170(k) sets forth circumstances under which a program provider will not be paid or Medicaid payments will be recouped from the program provider.

1200  Service Components

Revision 14-1; Effective March 21, 2014

The HCS Program consists of the following service components:

  • professional therapies, which consist of the following subcomponents:
    • audiology services,
    • dietary services,
    • occupational therapy services,
    • physical therapy services,
    • behavioral support services,
    • social work services,
    • speech and language pathology services; and
    • cognitive rehabilitation therapy;
  • day habilitation;
  • registered nursing;
  • licensed vocational nursing;
  • specialized registered nursing;
  • specialized licensed vocational nursing;
  • residential assistance, which consists of the following subcomponents:
    • host home/companion care,
    • residential support,
    • supervised living, and
    • supported home living;
  • respite;
  • supported employment;
  • employment assistance;
  • adaptive aids;
  • minor home modifications; and
  • dental treatment.

1300  Billing and Payment Reviews

Revision 10-1; Effective June 1, 2010

Billing and payment reviews are conducted to determine if a program provider has complied with DADS rules and these billing guidelines. Billing and payment reviews and residential visits are distinct from the reviews described in 40 TAC §9.171, which are performed to determine a program providerís compliance with the program certification principles contained in 40 TAC §§9.172-9.179. Appendix I, Billing and Payment Review Protocol, describes how billing and payment reviews are conducted.