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COVID-19 Non-Risk Payment Reimbursement Criteria

In response to the COVID-19 public health emergency and the guidance provided by the Centers for Medicare and Medicaid Services (CMS), the Texas Health and Human Services Commission (HHSC) is making non-risk payments (NRP) to reimburse managed care organizations (MCOs) for certain COVID-19 related services.

Consistent with CMS guidance and the elimination of certain pandemic-related HCPCS codes, HHSC has added and removed vaccine administration and drug treatment codes from the non-risk payment process for COVID-19 reimbursement criteria. HHSC previously moved COVID-19 costs into the MCO capitation rates effective for dates of service on or after Sept. 1, 2023. HHSC’s NRP COVID-19 reimbursement will end Aug. 31.

Reference the updated COVID-19 Non-Risk Payment Reimbursement Criteria (PDF) [ [link removed] ] found on the HHSC Disaster Response Information for Providers webpage [ [link removed] ].

















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