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2810 Fee-for-Service Reimbursement
Revision 25-3; Effective Sept.1, 2025
Client data must be entered in Med-IT® no later than 45 days after each service was provided. The fee-for-service component of funding pays for direct medical services on a fee-for-service basis. Each grantee is responsible for determining a person’s eligibility for clinical services. HHSC reimburses grantees on a fee-for-service basis for services that have been provided to eligible clients. Grantees must continue to provide services to established clients and submit claims for client services even after the grant funding limit has been met.
Grantees must file claims electronically through the Med-IT® system. Those claims must be filed within the following time frames:
- Initial claims submission must be submitted within 45 days of the date of service on the claim. If the 45th day falls on a weekend or holiday, the filing deadline is extended until the next business day.
- All claims must be submitted and processed within 60 days after the end of the grant period.
- All claims must continue to be billed even after the grant funding limit has been met.
Grantees may contact Med-IT® Helpdesk for questions about claims and payment status.
HHSC reviews BCCS services and procedures grantee submits electronically to HHSC for processing.
Reimbursable Codes
Fee-for-service reimbursement is limited to a prescribed set of procedure codes approved by BCCS. The approved list of reimbursable codes is in Med-IT® and referenced in the BCCS Appendix VI, BCCS Billing Guideline. Grantees may email the BCCS Program to request more services be added to the program by requesting a Topic Nomination Form.
Grantees may submit claims for a person’s office visits that reflect different levels of service for new and established people. A new person is defined as one who has not received clinical services at the grantee’s clinics during the previous three years. The level of services, which determines the procedure code to be billed for that client visit, is indicated by a combination of factors such as the complexity of the problem addressed, and the time spent with the client by clinic providers. The American Medical Association (AMA) publishes materials related to Current Procedural Terminology (CPT) coding that includes guidance on office visit codes (Evaluation and Management Services).
2820 Cost Reimbursement
Revision 25-3; Effective Sept.1, 2025
Cost Reimbursement provides funds to grantees that support the overall outcomes of clients served through BCCS Fee-for-Service. These funds must be used for support services that enhance BCCS Fee-for-Service client service delivery. Cost reimbursement awards must be used for client travel and may also be used for categories listed below per state and federal requirements.
Costs must be reasonable, allowable and already allocated, and may be assessed against any of the following optional categories the grantee identifies during its budget development process:
- Administrative Personnel
- Personnel Travel
- Equipment
- Supplies
- Contractual
- Other allowable direct costs not listed in any previous categories.
Grantees may request reimbursement for costs by submitting a monthly voucher packet for expenses outlined in a categorical budget approved by HHSC, as required for categorical cost reimbursement. Supporting documentation must be submitted with each voucher packet. HHSC will provide grantees with a personalized voucher packet and Financial Status Report (FSR) form at the beginning of each grant year. Grantees must submit the monthly voucher packet and the quarterly FSR to the designated email address on the forms.
- B-13X Form Budget Category monthly expenditures, program income and non-HHSC funding;
- Form 4116, Authorization for Expenditures;
- data management form Required Data Collection; and
- supporting documentation, such as a general ledger, must be submitted monthly with each voucher packet.
Categorical Budget Revisions
HHSC, at its sole discretion, may approve fund transfers between categories within the approved budget workbook upon a grantee’s written request. The request must include a detailed explanation that supports the need for the fund transfer. The grantee must seek HHSC’s written approval before making any fund transfers. Visit the Texas Grant Management Standards (TxGMS), Statewide Procurement Division, Version 2 for more information. Grantees must submit a revised budget to HHSC for review any time a budget revision is made.