Appendix II, Cost Limit for Purchased Services
Revision 17-1; Effective March 15, 2017
Under state law, the Texas Health and Human Services Commission may not purchase alternate care for an individual when the cost per day of the care exceeds the cost per day in a nursing facility. Few combinations of Community Care for Aged and Disabled (CCAD) services even approach this cost. However, case managers must be careful when authorizing maximum levels of personal attendant services along with another CCAD service.
To determine rates for services that vary by region or contract (for instance, Family Care, Emergency Response Services or Home-Delivered Meals), the highest allowable rate is used. To ensure the correct amount of services are purchased, contact the regional contract manager to obtain the actual unit rate in a specific region.
When an individual receives multiple services, contact the regional contract manager to:
- obtain current unit rates that apply to the services authorized; and
- determine the total cost of services to ensure that the nursing facility average is not exceeded.