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Avoiding HCS and TxHmL Overpayment of Services

Last updated on 9/8/2022

Effective January 2, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care (IPC) that overlap the May 1 implementation of the new process for submitting Home and Community-based Services (HCS) and Texas Home Living (TxHmL) forms and claims. On a quarterly basis, TMHP will calculate all services that have been paid through the Client Assignment and Registration system (CARE) and TMHP and will recoup services that exceed the authorized IPC amount.

To avoid overpayments and recoupments, providers, local intellectual or developmental disability authorities (LIDDAs), consumer-directed services (CDS), and financial management services agencies (FMSAs) should ensure that:

  • IPC and Intellectual Disability or Related Condition report (ID/RC) with an effective date prior to May 1, 2022, which were not entered into the CARE system before close of business on April 6, 2022, are entered into both systems.
  • IPC forms are corrected in a timely fashion to avoid incorrect data on Medicaid Eligibility Service Authorization Verification (MESAV).
  • Claims with dates of service through April 30, 2022, are submitted in CARE. Claims with dates of service beginning May 1, 2022, are submitted in TMHP.
  • Units and dollar amounts are correct before submitting claims. See Clarification of Billing Units for HCS and TxHmL Hourly Services.

Providers should continue to use the CARE screen C73-Service Delivery by Provider (PAID) and TMHP’s MESAVs to ensure that services are being updated and billed correctly.

For questions regarding Individual Plan of Service Forms 3608 and 8582, contact the Intellectual and Developmental Disability (IDD) Utilization Review (UR) message line at 512-438-5055.

For questions regarding CARE claims with dates of service through April 30, 2022, contact HHS Field Support for HCS and TxHmL at 800-214-4175, Option 2.

For questions regarding TMHP claims with dates of service beginning May 1, 2022, contact the TMHP LTC Help Desk at 800-626-4117, Option 1.

For questions about facilitating payment to the Texas Health and Human Services Commission (HHSC) for outstanding negative claims, contact HHSC Provider Recoupments and Holds at 512-438-2200, Option 3.