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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3 Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.1 General Information : 3.1.1 Reimbursement Limitations

3.1.1
For clients who are 21 years of age and older, Texas Medicaid reimbursement for acute care inpatient hospital services is limited to $200,000 per client, per benefit year (November 1 through October 31). Claims are reviewed retrospectively, and payments that exceed $200,000 are recouped.
This $200,000 limitation does not apply to the following:
For clients who are 20 years of age and younger, dollar limitations do not apply.

Texas Medicaid & Healthcare Partnership
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