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Reminder: Billing In-Home Respite Services in CLASS and DBMD Programs

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The Texas Health and Human Services Commission (HHSC) reminds Community Living Assistance and Support Services (CLASS) and Deaf Blind with Multiple Disabilities (DBMD) program providers that they must bill for in-home respite services in accordance with the unit of service breakdown tables listed in the CLASS and DBMD provider manuals and as outlined below.

This applies to the following billing combinations:

ProgramService GroupService CodeBill Code
CLASS211G0100 – In-Home Respite - DSA
DBMD1611G0100 – In-Home Respite

Billing Requirements

Following the CLASS Provider Manual Section 7610 Billing Units of Respite Service and DBMD Provider Manual Section 11410 Billing Units of Respite Service, program providers must convert service time to units of service, submit billing according to the table below, and must have a matching accepted Electronic Visit Verification (EVV) visit transaction in the EVV Aggregator for the date of service being billed.

Service TimeUnit of Service
1 hour of service= 1/24 unit (.04)
2 hours of service= 2/24 unit (.08)
3 hours of service= 3/24 unit (.12)
4 hours of service= 4/24 unit (.17)
5 hours of service= 5/24 unit (.21)
6 hours of service= 6/24 unit (.25)
7 hours of service= 7/24 unit (.29)
8 hours of service= 8/24 unit (.33)
9 hours of service= 9/24 unit (.37)
10 hours of service= 10/24 unit (.42)
11 hours of service= 11/24 unit (.46)
12 hours of service= 12/24 unit (.50)
13 hours of service= 13/24 unit (.54)
14 hours of service= 14/24 unit (.58)
15 hours of service= 15/24 unit (.62)
16 hours of service= 16/24 unit (.67)
17 hours of service= 17/24 unit (.71)
18 hours of service= 18/24 unit (.75)
19 hours of service= 19/24 unit (.79)
20 hours of service= 20/24 unit (.83)
21 hours of service= 21/24 unit (.87)
22 hours of service= 22/24 unit (.92)
23 hours of service= 23/24 unit (.96)
24 hours of service= 24/24 unit (1.0)

For partial units billed, the units would be follows:

  • 15 minutes = .01
  • 30 minutes = .02
  • 45 minutes = .03

Example: If a service provider worked 2 hours and 15 minutes, the program provider would enter .09 units when billing their claim in TexMedConnect or through Electronic Data Interchange (EDI). If a provider bills 2.25 units in TexMedConnect or through EDI without dividing by 24 hours, this will result in an overpayment which may be recouped.

Resources

Long-term Care (LTC) Bill Code Crosswalk (Excel)

EVV Personal Care Services Bill Code Table - version 12.1 (Excel)

Contact

Please email your questions regarding this reminder to your program below:

For EVV questions, contact HHSC EVV Operations.