The following information was obtained from the January 2 issue of the Texas Register:

The Texas Health and Human Services Commission (HHSC) has proposed to repeal 1 TAC §354.1430, concerning Definitions; §354.1432, concerning Benefits and Limitations; and §354.1434, concerning Requirements for Telemedicine Providers, and to replace the repealed rules with proposed new 1 TAC §354.1430, concerning Definitions, and §354.1432, concerning Benefits and Limitations, under Chapter 354, Subchapter A. HHSC also proposes to repeal 1 TAC §355.7001, concerning Telemedicine Services Reimbursement, and to replace it with new 1 TAC §355.7001, concerning Telemedicine Services Reimbursement.

The proposed changes would remove the limitations on the location of the distant site, expand the options for distant site locations and the distant site provider base, and other changes. See the relevant section of the Texas Register for details about the proposed changes.

The Texas Department of Aging and Disability Services (DADS) released two information letters:

• RUGs Information Requiring Special Attention

DADS issued an information letter to Nursing Facility providers to share questions that require special attention. DADS provided four questions and responses in a three-page letter. Example:

Question 4: When calling PCS, what type of calls can be escalated to the supervisor?
Response: A delay in the processing of the form which will cause the form or the claim to be out of compliance may be escalated to PCS; for example:

• A pending denial or denial of a client who has already established permanent Medical Necessity
• The 3618/3619/3652 PC E form or claim may be nearing the 12-month rule

Download the letter for details.

• Money Follows the Person (MFP) Community Based Alternatives (CBA) Demonstration Service: Overnight Companion Services (OCS) Available Through the Consumer Directed Services (CDS) Option

Last July, DADS implemented a new pilot service called OCS for CBA MFP demonstration participants in Cameron, Hidalgo and Willacy counties. Up to 20 people can participate in OCS every year. Eligible individuals can receive OCS through the CDS Option, effective January 15, 2009. Download the three-page letter for more information.

The following information was obtained from the December 26 issue of the Texas Register:

Adopted Rules

The Texas Board of Nursing (BON) adopted an amendment to 22 TAC §211.6, pertaining to Committees of the Board, which adds language to the rule reflecting the establishment of the Eligibility and Disciplinary Advisory Committee, which was known as the Eligibility and Disciplinary Committee Task Force. BON also adopted amendments to 22 TAC §217.16, relating to Minor Incidents, which provide clarification and consistency in BON’s current “minor incident” rule and BON’s nursing peer review rules at 22 TAC §217.19 and §217.20.

For more information on the amendments, see the relevant section of the Texas Register.

The Texas Health and Human Services Commission (HHSC) adopted amendments to §41.307 and §41.407, in Chapter 41, Consumer Directed Services Option. The changes update the Texas Department of Aging and Disability Service’s rules to reflect the HHSC Rate Analysis Department’s revised rate setting methodology approved by the Centers for Medicare and Medicaid Services.

HHSC also adopted new §§43.1 - 43.4, 43.11 - 43.19, 43.21, 43.22, 43.31 - 43.33, 43.41, 43.42, 43.51, 43.61, and 43.71, in Chapter 43, Service Responsibility Option. These new sections govern the service responsibility option. See the relevant section of the Texas Register for details about the amendments.

Public Notices

HHSC intends to submit a series of amendments to the Texas State Plan for Medical Assistance, whose effective date is January 1, 2009. The amendments deal with revising reimbursement methodology for Intermediate Care Facilities for Persons with Mental Retardation and the Texas Medicaid State Plan, and extending Medicaid coverage to working individuals with disabilities whose earnings are too high for them to qualify for regular Medicaid.

See the relevant section of the Texas Register for more information about these public notices.

In the previous entry, I mentioned DADS’s new Five Star Rating System for nursing homes. These facilities will be rated on health inspections, staffing, and quality. Kaiser Network is reporting than nursing facility industry experts say the new system is stricter in some states than others, which may result in better facilities in certain states.

About 22 percent of almost 16,000 nursing facilities received the lowest rating, and 12 percent received the highest. National Citizen’s Coalition for Nursing Home Reform calls the survey unreliable and that poorly performing facilities can achieve high ratings.

American Health Care Association president said Bruce Yarwood said, “We believe that customer satisfaction…is a superior indicator” than self-reported surveys.

Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services said the new ratings system “should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision.”

The Texas Department and Aging and Disability Services (DADS) notified Community Living Assistance and Support Services (CLASS) providers that Form 8604, the Transition Assistance Services (TAS) Assessment and Authorization, has been replaced by Form 3621-A, CLASS Transition Assistance Services. See the TAS handbook for more information.

DADS is offering new forms for programs like Deaf/Blind with Multiple Disabilities, Home and Community-based Services, and Intermediate Care Facilities for Persons with Mental Retardation. Access new forms here.

DADS has launched the Five Star Rating System on the Nursing Home Compare Website. Nursing homes will be rated on such measures as health inspections, staffing, and quality. Log in to state services to see the preview. Check the Nursing Home Compare page for more information,

Effective December 2, 2008, the Centers for Medicare and Medicaid Services has revised Hospice Conditions of Participation (CoPs) to comply with new conditions found at 42 Code of Federal Regulations, Part 418. See the revised CoPs here (PDF).

DADS has issued follow-up information for criminal history record requests for HCS and TxHmL program applicants who attended the Pre-Application Orientation on December 8. And finally, DADS will conduct orientations on the proposed new contract and fiscal compliance monitoring tools in regions 4, 5, and 6 the week of January 5-9, 2009.

For details about each news alert, click this link and scroll down to read each entry.

The Texas Department of Aging and Disability Services (DADS) released two information letters:

• Service Authorization Notification for Emergency Dental Services

DADS informed Nursing Facility providers about a change in the notification process for clients receiving authorizations for Emergency Dental Services, effective December 11. DADS will no longer send a fax notification to providers when the service authorization(s) have been approved for Emergency Dental Services. Download the letter for more information.

• Service Authorization Notification for Durable Medical Equipment

DADS informed Intermediate Care Facilities for Persons with Mental Retardation or a Related Condition (Service Group 6) providers about a change in the notification process for clients receiving authorizations for Durable Medical Equipment (DMEs), effective December 11. DADS will no longer send a fax notification to providers when the service authorization(s) have been approved for DMEs. Download the letter for details.

Last summer, President George W. Bush vetoed a bill that would have halted a 10.6 percent Medicare physicians pay cut. Democrats proposed to reduce payments to Medicare Advantage (MA) plans to fund the physicians pay cut.

President Bush reportedly vetoed the bill because it would “harm beneficiaries by taking private health plan options away from them” and urged Congress to send him a bill “that reduces the growth in Medicare spending, increases competition and efficiency, implements principles of value-driven health care, and appropriately offsets increases in physician spending.”

The Wall Street Journal reports that President-Elect Barack Obama probably will try to resurrect the proposal to reduce payments to MAs as well as change Medicare Part D. From the article:

With the economy in a recession and Democrats with a bigger majority in Congress, it may be easier for them to achieve their goals. President-elect Barack Obama talked about cutting “excessive subsidies” to those plans during the presidential campaign. Senate Finance Chairman Max Baucus (D., Mont.) said he wanted to address “overpayments” to private insurers in his blueprint on health-care reform.
…
Democrats also are aiming to change elements of the drug benefit, such as the coverage gap known as the doughnut hole. Mr. Obama, Mr. Stark and others are also keen on getting the government the power to negotiate for drug prices, something it can’t do.

The following information was obtained from the December 12 issue of the Texas Register:

The Texas Health and Human Services Commission (HHSC) intends to submit an amendment to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would comply with the Centers for Medicaid and Medicare Services final rule to further align the Medicaid definition of “outpatient services” to the Medicare definition. For information on obtaining a copy of the proposed amendment, see the relevant section of the Texas Register.

HHSC seeks public comments on its estimate and methodology for determining the Temporary Assistance for Needy Families Program caseload reduction credit for Federal Fiscal Year 2009. The methodology and the estimated caseload reduction credit is posted here. See the relevant section of the Texas Register for more information.

The Medicare Payment Advisory Commission (MedPAC) has recommended that hospitals receive full market basket Medicare payment increases in fiscal year 2010. (Kaiser Network)

Among the proposals is a 1.6 percent payment increase recommendation for long term care hospitals based on quality of care delivered. A final vote will come in January. MedPAC advises Congress on Medicare issues.

In other Medicare news, Kaiser reports that close to 133,000 beneficiaries in Tennessee have not taken advantage of Part D, the prescription drug program, despite not being covered by other drug programs. Reasons? Possibly lack of knowledge, confusion, can’t afford it, etc. We can assume Tennessee is not the only state where large numbers of eligible beneficiaries have not signed up for Part D.

Open enrollment for Medicare Part D began on November 15th and ends on December 31st. There’s a one percent penalty for every month beneficiaries wait to enroll after the deadline.

The Centers for Medicare and Medicaid Services recently revised the existing Hospice Conditions of Participation. Effective December 2, 2008, hospices must meet the revised conditions of participation (CoPs), found at 42 Code of Federal Regulations, Part 418, to participate in Medicare and Medicaid programs. Download a PDF copy of the revised CoPs.

For more information, see alert #306.

Please see the DADS alert about its Christmas/New Year Processing Schedule.

DADS staff will conduct orientations on the proposed new contract and fiscal compliance monitoring tools in regions 4, 5, and 6 during the week of January 5 through 9. Contractors in other regions received these sessions in September and October. See alert #305.