1. (a) TDMHMR will pay to non-state-operated facilities modeled rates that will vary by class of facility and a client's level-of-need.
2. (b) The non-state operated facility modeled rates include payment for both residential and day program services. Individuals receive medical and dental services through the Medicaid identification card. Any medical expenses other than covered services are the responsibility of the provider.

3. (c) With a limit of $5,000 per client per year, TDMHMR will pay a provider for the actual cost of a client's durable medical equipment if:

   1. (1) the cost of the equipment exceeds $1,000;
   2. (2) the facility receives approval from TDMHMR to purchase the equipment;
   3. (3) the provider submits a voucher to TDMHMR for the cost of the equipment; and
   4. (4) the client is eligible for Medicare benefits and the provider has submitted a Medicare claim and received a response to the claim prior to requesting payment from TDMHMR.
4. (d) There are modeled rates for each level of need for each class of non-state operated facilities.

Source Note:The provisions of this §355.455 adopted to be effective March 25, 1997, 22 TexReg 2760; transferred effective September 1, 1997, as published in the Texas Register December 26, 1997, 22 TexReg 12748.