Tex. HHSC Medicaid Hospice Provider Manual § 4520

Revision 06-2; Effective December 12, 2006

In addition to the per diem rate, the Medicaid Hospice Program pays providers according to customary and reasonable Medicaid physician charges. The program pays for direct patient care services provided to Medicaid hospice recipients by physicians who are on staff with the provider. The Medicaid Hospice Program does not pay when a physician provides patient care services on a volunteer basis or when physician services are provided by physicians who are not on staff with the Medicaid hospice provider. Physician payment amounts through the Medicaid Hospice Program are included in the Medicaid hospice cap amount, which varies each federal fiscal year. All claims for higher amounts are reduced to the Texas Medicaid Reimbursement Methodology (TMRM) amounts for physician services.

A provider is responsible for managing all physician services for inclusion in the hospice plan of care and to ensure physicians are paid on a timely basis. The Medicaid hospice provider has a liability to pay hospice physicians for physician services rendered.

The Texas Medicaid Program, through TMHP, makes payments directly to non-hospice physicians for physician services furnished to Medicaid hospice recipients. TMHP pays regardless of hospice status. TMHP Medicaid payment amounts to non-hospice physicians are not counted in the Medicaid Hospice Program cap.