Regulations

Federal Regulatory Information

The Interpretive Guidelines serve to interpret and clarify the Conditions of Participation (CoPs) for home health agencies. The guidelines define or explain the relevant statute and regulations and do not impose any requirements that are not otherwise set forth in statute or regulation. 

Regulatory Links

  • Home Health Agency Center (HHAC)
  • Home Health Regulations Conditions of Participation (CoPs)
  • Medicare Learning Network Articles (MLN Matters)
  • Outcome and Assessment Information Set (OASIS)
  • Home Health Prospective Payment System (PPS)
  • Internet Only Manuals (IOMs)
  • Transmittals used to communicate new or changed policies or procedures from CMS

 Home Health Statute (Laws)

 Palmetto GBA 

  • JM Home Health and Hospice – contains links to Claims issues log, ICD-10 resources, LCDs and coverage articles, Medicare Advisories, Medicare forms and more.

Quick Links

Enrollment, Participation and Certification

Home Health Face-to-Face

Fraud and Abuse

CBSA/HHRG/LUPA Rates and Calculations








Resources

Health & Human Services Commission (HHSC)

Medicaid Health Partnership Provider Page (TMHP)
  • Texas Medicaid Provider Procedural Manual. This manual is a comprehensive guide for Texas Medicaid providers. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, dental, and children’s health services.
  • Online Fee Lookup. This page will allow you to lookup the fee schedules for Texas Medicaid, Department of State Health Services (DSHS) Family Planning Program, (DSHS) Primary Health Care Program, (DSHS) Expanded Primary Health Care Program and the Children with Special Health Care Needs (CSHCN) Services Program. Users can search for fee information for specific codes. To use a general fee schedule, Medicaid providers can click Static Fee Schedules.
  • Federal Medicaid Re-enrollment or Re-verification. Texas Medicaid must comply with federal regulations which require all providers to revalidate their enrollment information every three to five years. In accordance with this mandate, the Centers for Medicare & Medicaid Services (CMS) require that states complete the initial re-enrollment of all providers by March 24, 2016. For Texas Medicaid, any provider enrolled before January 1, 2013, must be fully re-enrolled by March 24, 2016. Providers can begin this process immediately.
  • TMHP Learning Management System (LMS). The TMHP LMS is available to all providers and includes computer-based-training (CBT) documents, webinars, and provider workshop materials. To access the LMS, providers must register and obtain a username. Click here to access the “How to register for the LMS” job aid. The LMS allows providers to: View the course catalog; Enroll in courses; View enrollments; View LMS Resources

Texas Regulatory Information

Texas Health and Human Services (HHS)

The Texas Health and Human Services (HHS) licenses, certifies and surveys home and community support services agencies (HCSSAs) for compliance with state and federal laws and regulations. Through these regulatory activities, HHS protects Texas citizens receiving home health, hospice and personal assistance services. 

Texas Administrative Code

Texas Family Code

Texas Health and Safety Code

Texas Human Resources Code

Texas Occupations Code



Department of Family and Protective Services (DFPS)

DFPS has a central place to report abuse, neglect and exploitation. Per licensing standards for HCSSA rule 97.249, If an agency has cause to believe that a client served by the agency has been abused, neglected, or exploited by an agency employee, the agency must report the information immediately (within 24 hours) to DFPS AND HHS at (800) 458-9858.

  • Provider Self-Reporting. Licensed or certified HHS providers must notify the agency if someone in their care has been or may be physically or mentally abused, neglected or exploited.
  • Employee Misconduct Registry. The purpose of the Employee Misconduct Registry (EMR) is to ensure that unlicensed personnel who commit acts of abuse, neglect, exploitation, misappropriation, or misconduct against residents and consumers are denied employment in HHS-regulated facilities and agencies.  All HHS regulated agencies must search the EMR prior to the first face to face contact of the unlicensed personnel with the client.

Programs

  • Community Attendant Services (CAS)
  • Community Living Assistance and Support Services (CLASS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Family Care (FC)
  • Home and Community-based Services (HCS)
  • Medically Dependent Children's Program (MDCP)
  • Primary Home Care (PHC)
  • STAR+PLUS
  • STAR Kids
  • Community First Choice (CFC) HHS

Resources

Hospice Regulatory Information

Hospice is specialized type of care for those facing a life-limiting illness, their families and their caregivers. Hospice care addresses the patient's physical, emotional, social and spiritual needs. Hospice care also helps the patient's family caregivers.

Federal

Wage Index Files and Medicaid Payment Rates
Enrollment, Participation, and Certification
 Hospice Face-to-Face
  • Hospice Face-to-Face Guidance PowerPoint
  • Update on Physician Signature Requirement and Face-to-Face Encounter Requirements PDF
  • Hospice Face-to-Face encounter FAQs
Fraud & Abuse

State

DADS Provider Resources

How to Become a Hospice Provider

State & Federal Statutes and Rules

Hospice Training Requirement

Medicaid Hospice Program Standards Handbook


Department of State Health Services (DSHS)
The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service is Medicaid's comprehensive preventive child health service for individuals from birth through 20 years of age. In Texas, EPSDT is known as Texas Health Steps (THSteps), which includes the preventive care components, or Early and Periodic Screening (EPS), of the total EPSDT service. In addition, medically necessary health-care services are provided to children and adolescents enrolled in THSteps even if the service is not available under the state’s Medicaid plan to the rest of the Medicaid population. In Texas, these additional services are available through the Comprehensive Care Program (CCP).