Section 11000, Billing/Record Keeping Requirements

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Revision 20-2; Effective October 9, 2020

 

11100 Billing DBMD and CFC Services

Revision 20-2; Effective October 9, 2020
 

The following Deaf Blind with Multiple Disabilities (DBMD) and Community First Choice (CFC) services are available to an individual enrolled in the DBMD program:

  • Adaptive Aids
  • Audiology
  • Behavioral Support
  • Case Management
  • Chore Services
  • CFC Emergency Response Services (ERS)
  • CFC Personal Assistance Services/Habilitation (PAS/HAB)
  • Day Habilitation
  • Dental Treatment
    • Services
    • Sedation
  • Dietary Services
  • Employment Assistance
  • Intervener Services
    • Intervener    
    • Intervener I
    • Intervener II
    • Intervener III
  • Minor Home Modifications
  • Nursing Services
    • Licensed Vocational Nurse
    • Specialized Nursing (LVN)
    • Registered Nurse
    • Specialized Nursing (RN)
  • Occupational Therapy
  • Orientation and Mobility
  • Physical Therapy
  • Residential Services
    • Licensed Assisted Living Services
    • Licensed Home Health Assisted Living
  • Respite:
    • In-Home
    • Out-of-Home
  • Speech, Hearing and Language Therapy
  • Supported Employment
  • Transition Assistance Services
  • Transportation-Residential Habilitation
  • Services for individuals who choose the Consumer Directed Services (CDS) option:
    • Financial Management Services or CFC Financial Management Services
    • Support Consultation or CFC Support Consultation

A DBMD program provider must bill for a DBMD service or CFC service in accordance with 40 Texas Administrative Code (TAC) Chapter 42. Some services are defined in 40 TAC §42.103, Definitions. DBMD services are also described in Appendix C of the DBMD Waiver Application.

A DBMD service or CFC service provided to an individual must be recorded as a distinct event by each service provider. A service provider must document services provided, except for adaptive aids, dental treatment, minor home modifications, CFC ERS and CFC Support Management on Form 6503, DBMD Summary of Services Delivered, or via the Electronic Visit Verification (EVV) System.

A service provider must complete Form 6503 according to the form’s instructions.  

A program provider must ensure that after a service provider makes the last entry on Form 6503, a staff person other than the service provider signs and dates the form as a timekeeper as verification of accuracy of the information on the form.

For DBMD services requiring EVV, providers must follow EVV billing requirements for relevant claims. Providers may refer to HHSC’s EVV website for more information.

Current rates for DBMD services may be found at: https://rad.hhs.texas.gov/long-term-services-supports/deaf-blind-multiple-disabilities-waiver-dbmd.

 

11200 Billable Units

Revision 20-2; Effective October 9, 2020

 

A program provider or financial management services agency (FMSA) bills for a DBMD or CFC service using billable units that are based on the time spent providing the service or the cost incurred for the service.

 

11210 Services Unit Measurements

Revision 20-2; Effective October 9, 2020

 

The following chart shows which DBMD and CFC services use a billable unit based on time.

Service Billable Unit
Audiology one hour
Behavioral Support one hour
Case Management one hour
Chore Services one hour
CFC Personal Assistance Services/Habilitation (PAS/HAB) one hour
Day Habilitation Services one hour
Dietary Services one hour
Employment Assistance one hour
Intervener Services  
Intervener one hour
Intervener I one hour
Intervener II one hour
Intervener III one hour
Nursing Services  
Licensed Vocational Nurse one hour
Specialized Nursing (LVN) one hour
Registered Nursing one hour
Specialized Nursing (RN) one hour
Occupational Therapy one hour
Orientation and Mobility one hour
Physical Therapy one hour
Residential Services  
Licensed Assisted Living Services one hour (no partial units)
Licensed Home Health Assisted Living one hour (no partial units)
18-Hour Assisted Living one hour (no partial units)
Respite  
In-Home Respite 24 hours
Out-of-Home Respite 24 hours
Speech, Hearing and Language Therapy one hour
Supported Employment one hour
Transportation-Residential Habilitation one hour

The following services are billed using the cost of the service, along with any allowable requisition fees:

  • Adaptive Aids
  • Minor Home Modifications
  • Dental Treatment
  • Transition Assistance Services

 

11300 Determining Billable Units for an Hourly Service

Revision 20-2; Effective October 9, 2020

 

For a service that has a billable unit of one hour, a program provider must determine the billable units using the amount of time that a service provider spent providing the service in accordance with the table below.

Service Time Billable Unit(s) of Service
Less than 8 minutes 0.00
At least 8 minutes, but less than 23 minutes  0.25
At least 23 minutes, but less than 38 minutes 0.50
At least 38 minutes, but less than 53 minutes 0.75
At least 53 minutes, but less than 1 hour 8 minutes 1.00
At least 1 hour 8 minutes, but less than 1 hour 23 minutes 1.25
At least 1 hour 23 minutes, but less than 1 hour 38 minutes 1.50
At least 1 hour 38 minutes, but less than 1 hour 53 minutes 1.75
At least 1 hour 53 minutes, but less than 2 hours 8 minutes 2.00
At least 2 hours 8 minutes, but less than 2 hours 23 minutes 2.25
At least 2 hours 23 minutes, but less than 2 hours 38 minutes 2.50
At least 2 hours 38 minutes, but less than 2 hours 53 minutes 2.75
At least 2 hours 53 minutes, but less than 3 hours 8 minutes 3.00
At least 3 hours 8 minutes, but less than 3 hours 23 minutes 3.25
At least 3 hours 23 minutes, but less than 3 hours 38 minutes 3.50
At least 3 hours 38 minutes, but less than 3 hours 53 minutes 3.75
At least 3 hours 53 minutes, but less than 4 hours 8 minutes 4.00
At least 4 hours 8 minutes, but less than 4 hours 23 minutes 4.25
At least 4 hours 23 minutes, but less than 4 hours 38 minutes 4.50
At least 4 hours 38 minutes, but less than 4 hours 53 minutes 4.75
At least 4 hours 53 minutes, but less than 5 hours 8 minutes 5.00
At least 5 hours 8 minutes, but less than 5 hours 23 minutes 5.25
At least 5 hours 23 minutes, but less than 5 hours 38 minutes 5.50
At least 5 hours 38 minutes, but less than 5 hours 53 minutes 5.75
At least 5 hours 53 minutes, but less than 6 hours 8 minutes 6.00
At least 6 hours 8 minutes, but less than 6 hours 23 minutes 6.25
At least 6 hours 23 minutes, but less than 6 hours 38 minutes 6.50
At least 6 hours 38 minutes, but less than 6 hours 53 minutes 6.75
At least 6 hours 53 minutes, but less than 7 hours 8 minutes 7.00
At least 7 hours 8 minutes, but less than 7 hours 23 minutes 7.25
At least 7 hours 23 minutes, but less than 7 hours 38 minutes 7.50
At least 7 hours 38 minutes, but less than 7 hours 53 minutes 7.75
At least 7 hours 53 minutes, but less than 8 hours 8 minutes 8.00
At least 8 hours 8 minutes, but less than 8 hours 23 minutes 8.25
At least 8 hours 23 minutes, but less than 8 hours 38 minutes 8.50
At least 8 hours 38 minutes, but less than 8 hours 53 minutes 8.75
At least 8 hours 53 minutes, but less than 9 hours 8 minutes 9.00
At least 9 hours 8 minutes, but less than 9 hours 23 minutes 9.25
At least 9 hours 23 minutes, but less than 9 hours 38 minutes 9.50
At least 9 hours 38 minutes, but less than 9 hours 53 minutes 9.75
At least 9 hours 53 minutes, but less than 10 hours 8 minutes 10.00
At least 10 hours 8 minutes, but less than 10 hours 23 minutes 10.25
At least 10 hours 23 minutes, but less than 10 hours 38 minutes 10.50
At least 10 hours 38 minutes, but less than 10 hours 53 minutes 10.75
At least 10 hours 53 minutes, but less than 11 hours 8 minutes 11.00
At least 11 hours 8 minutes, but less than 11 hours 23 minutes 11.25
At least 11 hours 23 minutes, but less than 11 hours 38 minutes 11.50
At least 11 hours 38 minutes, but less than 11 hours 53 minutes 11.75
At least 11 hours 53 minutes, but less than 12 hours 8 minutes 12.00
At least 12 hours 8 minutes, but less than 12 hours 23 minutes 12.25
At least 12 hours 23 minutes, but less than 12 hours 38 minutes 12.50
At least 12 hours 38 minutes, but less than 12 hours 53 minutes 12.75
At least 12 hours 53 minutes, but less than 13 hours 8 minutes 13.00
At least 13 hours 8 minutes, but less than 13 hours 23 minutes 13.25
At least 13 hours 23 minutes, but less than 13 hours 38 minutes 13.50
At least 13 hours 38 minutes, but less than 13 hours 53 minutes 13.75
At least 13 hours 53 minutes, but less than 14 hours 8 minutes 14.00
At least 14 hours 8 minutes, but less than 14 hours 23 minutes 14.25
At least 14 hours 23 minutes, but less than 14 hours 38 minutes 14.50
At least 14 hours 38 minutes, but less than 14 hours 53 minutes 14.75
At least 14 hours 53 minutes, but less than 15 hours 8 minutes 15.00
At least 15 hours 8 minutes, but less than 15 hours 23 minutes 15.25
At least 15 hours 23 minutes, but less than 15 hours 38 minutes 15.50
At least 15 hours 38 minutes, but less than 15 hours 53 minutes 15.75
At least 15 hours 53 minutes, but less than 16 hours 8 minutes 16.00
At least 16 hours 8 minutes, but less than 16 hours 23 minutes 16.25
At least 16 hours 23 minutes, but less than 16 hours 38 minutes 16.50
At least 16 hours 38 minutes, but less than 16 hours 53 minutes 16.75
At least 16 hours 53 minutes, but less than 17 hours 8 minutes 17.00
At least 17 hours 8 minutes, but less than 17 hours 23 minutes 17.25
At least 17 hours 23 minutes, but less than 17 hours 38 minutes 17.50
At least 17 hours 38 minutes, but less than 17 hours 53 minutes 17.75
At least 17 hours 53 minutes, but less than 18 hours 8 minutes 18.00
At least 18 hours 8 minutes, but less than 18 hours 23 minutes 18.25
At least 18 hours 23 minutes, but less than 18 hours 38 minutes 18.50
At least 18 hours 38 minutes, but less than 18 hours 53 minutes 18.75
At least 18 hours 53 minutes, but less than 19 hours 8 minutes 19.00
At least 19 hours 8 minutes, but less than 19 hours 23 minutes 19.25
At least 19 hours 23 minutes, but less than 19 hours 38 minutes 19.50
At least 19 hours 38 minutes, but less than 19 hours 53 minutes 19.75
At least 19 hours 53 minutes, but less than 20 hours 8 minutes 20.00
At least 20 hours 8 minutes, but less than 20 hours 23 minutes 20.25
At least 20 hours 23 minutes, but less than 20 hours 38 minutes 20.50
At least 20 hours 38 minutes, but less than 20 hours 53 minutes 20.75
At least 20 hours 53 minutes, but less than 21 hours 8 minutes 21.00
At least 21 hours 8 minutes, but less than 21 hours 23 minutes 21.25
At least 21 hours 23 minutes, but less than 21 hours 38 minutes 21.50
At least 21 hours 38 minutes, but less than 21 hours 53 minutes 21.75
At least 21 hours 53 minutes, but less than 22 hours 8 minutes 22.00
At least 22 hours 8 minutes, but less than 22 hours 23 minutes 22.25
At least 22 hours 23 minutes, but less than 22 hours 38 minutes 22.50
At least 22 hours 38 minutes, but less than 22 hours 53 minutes 22.75
At least 22 hours 53 minutes, but less than 23 hours 8 minutes 23.00
At least 23 hours 8 minutes, but less than 23 hours 23 minutes 23.25
At least 23 hours 23 minutes, but less than 23 hours 38 minutes 23.50
At least 23 hours 38 minutes, but less than 23 hours 53 minutes 23.75
At least 23 hours 53 minutes, but less than 24 hours 8 minutes 24.00

 

11310 Determining Billable Units for Multiple Service Events

Revision 20-2; Effective October 9, 2020

 

For a service with a billable unit of one hour, if there is more than one service event of the same service in a calendar month, a program provider must determine total billable units for the month by determining the billable units for each service event and adding the billable units together.

Example:

Service Provider Time Service Begins Time Service Ends Duration of Service Event Billable Units
Service Provider A 8:00 a.m. 4:05 p.m. 8 hours 5 minutes 8.00 
Service Provider B 4:45 p.m. 6:07 p.m. 1 hour 22 minutes 1.25
Service Provider B 8:50 p.m. 11:01 p.m. 2 hours 11 minutes 2.25
Total Billable Units       11.50

 

11320 Determining Billable Units for More than One Service Provider or More than One Individual

Revision 20-2; Effective October 9, 2020

 

If a service with a billable unit of one hour is provided during the same time period by more than one service provider to more than one individual, or both, a program provider must use the following formula to calculate the billable units by multiplying the number of service providers by the time spent providing the service, and dividing the result by the number of individuals being provided the service.

Number of service providers x Time spent providing the service ÷ Number of individuals being provided service = Billable units
Examples:            
Two service providers x 1 hour ÷ 1 individual = 2 billable units
One service provider x 1 hour ÷ 2 individuals = 1/2 (0.5) billable unit per individual
One service provider x 1 hour ÷ 3 individuals = 1/3 (0.33) billable unit oer individual
Two service providers x 1 hour ÷ 3 individuals = 2/3 (0.67) billable unit per individual

 

11400 Determining Billable Units for Respite

Revision 20-2; Effective October 9, 2020

 

The billable unit of service for respite is defined as a 24-hour period. A program provider must determine billable units of respite in accordance with the table below, using the amount of time that an individual received respite.

Examples:

One individual in a respite setting for 24 hours = 1 billable unit
Two individuals in a respite setting for 24 hours = 1 billable unit per individual
Three individuals in a respite setting for 24 hours = 1 billable unit per individual

 

11410 Billing Units of Respite Service

Revision 20-2; Effective October 9, 2020

 

Partial units of respite are calculated as follows:

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)

A program provider determines billable units of respite separately for each individual. The number of billable units of respite are not affected by the number of other individuals or service providers in a respite setting at the same time.

Examples:

Respite provided to one individual for 24 hours by one service provider = 1 billable unit
Respite provided to two individuals for 12 hours by one service provider = 0.5 billable unit per individual
Respite provide to three individuals for 24 hours by two service providers = 1 billable unit per individual