Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.
The Texas Legislature has allocated funds to increase outpatient reimbursement rates for rural hospitals (Senate Bill 1, Article II, Rider 8[f], 88th Legislature, Regular Session 2023).
As of September 1, 2023, there will be a 40% increase (not to exceed 100%) to the uncapped outpatient ratio of cost to charges (RCC). The policy of no payouts and no recoupments due to cost settlements remains in effect.
For more information, call the TMHP Contact Center at 800-925-9126.