DBMD case management rate change from hourly to monthly
The 2024-2025 General Appropriations Act, House Bill 1, 88th Legislature, Regular Session, 2023 (Article II, HHSC, Rider 29) authorized changes to case management services in the Deaf Blind with Multiple Disabilities (DBMD) program.
These changes are expected to improve efficiency for providers and to reflect service delivery more accurately. Rider 29 streamlines the case management billing process by allowing DBMD providers to receive a monthly fee, instead of an hourly fee, for case management services. This change does not impact the billable activities for case management.
Rate amount and effective date
The DBMD case management monthly rate of $251.30 will be effective on Sept. 1, 2023.
Development and submission of Individual Plan of Care
Updates to Form 6500, “DBMD and CFC – Individual Plan of Care (IPC)” and Form 6500-T, “IPC Service Delivery Transfer Worksheet” will become available on Sept. 1, 2023. The updated versions of these forms include both Service Code 12 (Case Management – hourly) with an end date of Aug. 31, 2023 and Service Code 12D (Case Management – monthly) with a start date of Sept. 1, 2023. Service Planning Teams (SPT) must use these forms for the development and submission of an IPC. Additional DBMD form updates will be forthcoming.
DBMD providers who are developing an IPC with an effective date of Sept. 1, 2023, or later must reflect one unit of Service Code 12D (Case Management – monthly) for each month remaining in the IPC period. Program providers are not required to revise Service Code 12 (Case Management – hourly) on IPCs submitted to HHSC prior to Sept. 1, 2023.
Billing activities for Service Code 12 after Sept. 1, 2023
Case management service code 12 will no longer be a Medicaid billable service in the DBMD program for dates of service beginning Sept. 1, 2023. Providers will need to use service code 12D to bill case management, effective Sept. 1, 2023, and going forward.
Providers may bill case management claims with a date of service prior to Sept. 1, 2023, under service code 12. The new case management service code, 12D, has been assigned a monthly rate and cannot be billed as an hourly rate.
For questions regarding policy changes, please email DBMD Policy. For questions regarding IPC changes and submissions to HHSC, please call 512-438-4896. For questions regarding rates, please email the Provider Finance Department.