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Increased RCC for Rural Health Hospitals Effective September 1, 2025

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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 September 1, 2025, House Bill 18 (HB 18) from the 89th Legislative Regular Session increased the ratio of cost to charge (RCC) for rural health hospitals. HB 18 added an additional 0.60% to the calculated RCC (not to exceed 100%).

Texas Medicaid will reprocess any affected claims that were submitted with dates of service from September 1, 2025, through September 30, 2025. If there were overpayments, Texas Medicaid may recoup funds from future payments, and that will be reflected on Remittance and Status (R&S) reports.

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