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7.7.21.4 Out-of-Network Hospitals
An out-of-network hospital is one that is not contracted to provide services to PCCM clients:
• Out-of-network hospitals are reimbursed only for inpatient services provided to PCCM clients as the result of an emergency admission. Inpatient services are reimbursed at the rate paid by the Texas Medicaid fee-for-service program.
•Reimbursement for emergency treatment will be made at the current Medicaid rates.
Hospitals that are not contracted with PCCM are reimbursed according to Texas Medicaid fee-for-service rates.
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