In a letter dated May 22, 2006, the Texas Department of Aging and Disability Services (DADS) advised nursing facilities about new rules in Title 40 of the Texas Administrative Code, effective June 1.

The new rules relate to the definition of restraints, frequency of use, notification of restraint use and seclusion to patients’ legal representatives, etc. You may download the letter and the 25-page attachment (relevant TAC) here.

DADS issued a similar letter to intermediate care facilities for patients with mental retardation or a related condition and assisted living facilities. The letters cite different sections of TAC, so you may want to read all relevant rules. You may download the intermediate facilities letter and the 19-page attachment here.

For assisted living facilities, download the letter and the 31-page attachment here.

Monday, June 5 update: DADS has issued revised letters to nursing, assisted living, and intermediate care facilities about new rules on patient restraint and seclusion.

Concerned about executives’ salaries and perks, the Senate Committee on Finance has asked the Centers for Medicare and Medicaid Services (CMS) to investigate Medicare Quality Improvement Organizations (QIOs) for effectiveness and improprieties. (Medical News Today)

The call for an investigation was likely prompted by the American Health Quality Association’s request for more funding and broadened responsibilities. According to the Kaiser Network, CMS currently pays $300 million per year to QIOs to “investigate beneficiary complaints, evaluate quality and work with physicians and hospitals to improve care.” QIOs also work to ensure Medicare pays only for medically necessary services.

In related news, the American Health Care Association and National Center for Assisted Living have announced they have joined the Pharmacy Quality Alliance in an effort to bolster their collective voice in shaping long term care pharmacy policies.

You may recall previous posts about Medicare’s potential coverage of the artificial spinal disk Charite. As late as February, the Centers for Medicare and Medicaid (CMS) wanted to deny coverage for the surgery. CMS allowed a 30-day comment period, and at the time, the chances of coverage didn’t look promising.

According to Johnson & Johnson, the company that manufactures the disk, Medicare will allow its local medical directors to approve coverage for beneficiaries under 60. From the New York Times article cited by Medical News Today:

J&J, through its DePuy unit, is the only device maker with an artificial disc on the U.S. market after gaining approval to sell its product, called Charite, in October 2004.

Doctors have been slow to embrace the product, however, after the Medicare federal health insurance program last year denied J&J’s request to provide national coverage for it…J&J on Tuesday said Medicare agreed to allow its local medical directors to approve paying for the device in beneficiaries under the age of 60, a decision the company believes will open the door to better coverage among private insurers.

CMS previously denied coverage because clinical trial data failed to show the surgery to implant the disk was “reasonable and necessary.” The article doesn’t explain why CMS had a change of heart, and CMS has not issued a statement on this matter.

In a letter dated May 19, the Texas Department of Aging and Disability Services reminds freestanding inpatient hospices about patient safety during disasters. All Home and Community Support Services Agencies are bound by law to have a written policy for “publicly known natural disaster preparedness for clients receiving services.”

Inpatient hospices must also have an evacuation plan and periodically rehearse this plan with staff. Freestanding inpatient hospices are also required to have written plans for evacuation in case of fire.

You may download the letter here.

The deadline to sign up for Medicare’s prescription drug program has come and gone, but a bipartisan group of politicians is pushing to eliminate the late fee for beneficiaries who missed the deadline. The next open enrollment period begins in November. (Kaiser Network)

Department of Health and Human Services Secretary Mike Leavitt wants Congress to wait until final enrollment numbers are determined before passing the legislation. I agree.

The proposed legislation would cost taxpayers $18 million to help beneficiaries sign up, although a final count has yet to be determined. How did they arrive at that figure? Politicians are presuming that those who didn’t sign up were confused about the drug plan. That may not be the case at all.

See also Bipartisan Senate Group Seeks to Lift Late Fee on Medicare Drug Plan

At least one state wants Medicaid beneficiaries to take responsibility for their own care strongly enough to put incentives in place. West Virginia proposed and the feds approved a plan for “personal responsibility contracts.” (Medical News Today)

To receive credits for health care services, beneficiaries must choose a primary care provider - a “medical home” - and take measures to stay healthy and improve health by taking medications, attending doctors appointments and exercising. Beneficiaries build up credits in a “healthy rewards account” for optional services. Those who don’t meet the goals will have benefits and coverage reduced.

The personal responsibility contracts will probably help reduce costs associated with unnecessary and preventable treatment. From the Charleston Daily Mail:

[W]ith federal pressure to curtail Medicaid costs, the redesign also relies on “care coordination.” Recipients must seek prior approval for outpatient surgery and other procedures.

With about one-fourth of its 1.8 million people relying on Medicaid for their health care, West Virginia spent $2.3 billion in state and matching federal funds on the program in 2005.

“I just know that there’s always never enough,” Manchin said. “We want desperately to get this program under control.”

The American Health Care Association and the National Center for Assisted Living issued a statement about the U.S. Senate’s rejection of the Medical Care Access Protection Act, a bill that would have implemented health care liability reforms.

Long term care providers have had to reduce patients’ access to certain services because of the high costs of medical liability insurance caused by expensive litigation. The Medical Care Access Protection Act (PDF) was designed to reform the system by reducing punitive damages, attorneys’ fees, etc., while still protecting patients.

From the statement:

“We will continue to work with the Bush Administration and members of the U.S. Senate and House to pass a bill to help stop the problem of resources being directed away from patient care to pay for higher lawsuit costs. This is negatively impacting our ability to sustain nursing home care quality gains, and we regret Senate supporters were unable to muster sufficient backing to pass the Ensign bill.”

Also see Business groups to keep pushing malpractice reform.

On April 24, the Department of Labor (DOL) published its semiannual regulatory agenda promising to issue revisions to the Family and Medical Leave Act (FMLA). The DOL set a deadline for June, 2006 for publishing the revisions. Of course, the DOL has already set and passed numerous dates for the proposed FMLA revisions. We will continue to monitor this issue.

In a letter dated May 12, the Texas Department of Aging and Disability Services (DADS) asked providers to participate in an online survey for joint training courses. Based on the survey, DADS will assess the needs of nursing, assisted living, adult day care, and intermediate care facilities when developing joint training courses for long term care providers.

According to the letter, there is no fee to take the confidential survey, which will be accessible for the next 60 days, starting today. You may download the letter here.

In a move designed to reduce out-of-pocket expenses for beneficiaries and save the money for the Medicare program, the Centers for Medicare and Medicaid Services (CMS) is seeking to open up bidding for durable medical equipment.

From the press release:

“We intend to implement these DME competitive reforms to get savings for beneficiaries and taxpayers, while maintaining and improving quality,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “This is another way in which Medicare is now using competition to bring lower-cost, up-to-date care to our beneficiaries.”

The new competitive acquisition program, which is required by the Medicare Modernization Act of 2003 (MMA), would replace the current DMEPOS fee schedule payment amounts for selected items in select areas.

Medical News Today links to a number of reactions. For instance, the Washington Post provides a decent analysis. Also see the Kaiser Network’s comments. The American Association for Homecare doesn’t like the proposed rule, citing concerns about reduced patient choice and the effect on small long term providers.

I believe opening up the process to competition will help lower costs because it will force companies to improve products and offer them at affordable prices. Tom Ryan, AAHomecare Chair and CEO of Homecare Concepts, would disagree with my assessment. He says:

“The reality is some durable medical equipment items have already been set by the government at a price below what the market would set. If a provider cannot bid above a mandated below-market fee ceiling, how does that accomplish the wonders that CMS advertises, which is to ‘harness marketplace dynamics to create incentives for suppliers to provide quality items’? The touted cost savings and market-driven benefits of this restrictive contracting program are unrealistic.”

If you’re a provider and regular reader, I’d like to know what you think about the proposed rules.