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Update to Hospital-Based Ambulatory Surgical Centers Cost Settlement Package

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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.

Effective June 1, 2023, hospital-based ambulatory surgical centers (HASCs) switched from the previous reimbursement model to a strict maximum fee methodology. Beginning April 1, 2025, the cost settlement package sent to Texas Medicaid HASC facilities will reflect this change.

The update will exclude some HASC information from the cost settlement details. Information on Worksheet E, Part C of the cost report (Centers for Medicare & Medicaid Services Form 2552), is excluded.

Note: This update is only for reporting purposes and will not have any financial impact on HASC facilities.

For more information, call the TMHP Contact Center at 800-925-9126.