The Texas Department of Aging and Disability Services reminds providers that in fiscal year 2007, any claims remaining from fiscal year 2004 become miscellaneous and won’t be paid through the standard Claims Management System payment process.

If the service dates on a claim are earlier than two previous fiscal years and the current year, it is dubbed “miscellaneous.” For more information, download the letter here.

Pennsylvania will require low-income seniors currently enrolled in the PACE prescription drug assistance program to enroll in Medicare Part D. (Medical News Today)

PACE covers drug costs not covered by Medicare. The state sent letters to Pace enrollees to inform them about their new Medicare plans. Beneficiaries will have 10 days to object to the state’s recommendations. After 10 days, the state will enroll beneficiaries in the recommended plans automatically.

Apparently, PACE participants had the option of not enrolling in Medicare drug plans, but officials “changed their minds,” said PACE director Tom Snedden. From the Pittsburgh Post-Gazette:

“It’s not in their best interest to opt out,” Mr. Snedden said of enrollees, noting that many should see little, if any, change in their prescription drug coverage by joining a Part D plan.

He acknowledged concerns that the state, which plans to save millions of dollars a year by merging the federal and state drug programs, could save much less if many enrollees decided not to join Part D.

The Texas Health and Human Services Commission (HHSC) recently adopted amendments to §371.204 and §371.208, relating the Hospital Screening Criteria for Texas Medical Review Program (TMRP), Tax Equity and Fiscal Responsibility Act (TEFRA), and LoneSTAR Select II Contract Reviews and Appeals Related to Utilization Review Department Review Decisions. For more information, see this section of the July 14 Texas Register.

The Board of Nurse Examiners will review and consider whether to re-adopt, re-adopt with amendments, or repeal Title 22 of the Texas Administrative Code, Part 11, Chapter 211, relating to General Provisions. See this section of the July 14 Texas Register for more information.

The Office of the Inspector General within HHSC has released a report on efforts to stop Medicaid fraud, waste, and abuse, titled Joint Semi-Annual Interagency Coordination Report.

Earlier this month, I wrote a post about a new book entitled The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor written by Andy Kessler. Today, I had the opportunity to interview Andy as my guest while sitting in as a guest host for my friend Mychal Massie on his show, Straight Talk, which plays on Right Talk Radio. John, at Right Talk, graciously allowed me to download the show in order to reproduce it here. I thank John and Right Talk for giving me permission to air the show at Garlo Ward.

Andy Kessler does a great job on the show and he has some really good insight and information about trends in medical technology and how it will impact us in the future. I also had the chance to read his book and highly recommend it. It’s informative, easy to read and quite humorous. Here is a really good review of the book from the Wall Street Journal.

So, I urge you to click on the little symbol below and listen to the show. It lasts about an hour and is well worth it.

In a letter that replaces PL #06-08, the Texas Department of Aging and Disability Services (DADS) alerted Home and Community Support Services Agencies (HCSSA) to expect more delays for initial licensure and Medicare certification. Region 6 (Houston Regional Office) and Region 3 (Arlington Regional Office) could see delays of up to a year.

In the updated letter, DADS added or changed information about the process. For example, providers must request initial licensure at least six months before the license expiration date and notify regional HCSSA program managers if they fall below the required census level for initial certification survey (10 patients served with 7 active).

You may download the letter here.

In an effort to help make sure patients are getting appropriate care, the Centers for Medicare and Medicaid Services (CMS) revised guidance for national coverage determinations (NCDs), according to the news release. As a condition of payment, providers must develop and capture additional patient information to supplement standard claims.

CMS Administrator Mark B. McClellan said, “Our goal is to speed access to valuable new technologies, and to promote the effective use of those technologies by providing patients and doctors with better medical evidence.”

Guidance documents help the public understand how and why CMS decides to cover certain items and services. The agency solicited feedback on its draft guidance document and considered this information while developing the revised guidance document, focusing on the public’s concerns about a process called Coverage with Evidence Development (CED). To learn more about NCDs and CEDs, visit the Medicare Coverage Center page.

Pharmaceutical representatives testified before Congress earlier this month about the administrative burden placed on long term care providers, particularly nursing homes, by Medicare Part D, the new prescription drug program. They also said providers are losing money because of the program.

The new drug program was created to give seniors more choices, but it seems to be offering conflicting and confusing choices. For example, Long Term Care Pharmacy Alliance executive director Paul Baldwin testified that in some cases, medications previously covered were no longer covered under Part D.

As a result, pharmacies have to absorb the costs of those prescriptions. Pharmacies and nursing homes end up paying for the drugs because they can’t legally deny medications to recipients and residents. Additionally, Medicare beneficiaries who were automatically enrolled in Part D on January 1 found themselves in multiple drug plans for which they received little information.

Baldwin and other representatives offered suggestions they said would ease the burden and bring down costs. Nursing homes currently are not allowed to advise patients on choosing plans. These facilities should be allowed to discuss options with patients and guide them to plans with the necessary covered drugs.

Providers and recipients seeking help from the Centers for Medicare and Medicaid Services (CMS) often received the wrong information about which prescription drug plans were appropriate, which I blogged about here. In May, the Government Accountability Office issued a 32-page report (PDF) about CMS’s customer service. According to CMS, it is trying to fix the problems.

Sources: United Press International and Axcess News

The Texas Department of Aging and Disability Services (DADS) informs all facilities covered by the Health and Safety Code (HSC) that 40 Texas Administrative Code, Chapter 76, Criminal History Check of Employees in Facilities for Care of the Aged and Persons with Disabilities, will be repealed, effective June 1, 2006.

The provision was repealed because DADS currently requires facilities to comply with Chapter 250 of the HSC. According to the rule, certain elderly and disabled care facilities must check the criminal history of employees and applicants through the Texas Department of Public Safety.

You may download the letter (July 17) here.

The Texas Department of Aging and Disability Services (DADS) has issued a provider letter (July 17) to Home and Community Support Services Agencies (HCSSA) and Adult Day Care Facilities (ADC) on using the 211 system.

The 211 system is a telephone number that connects callers to local health and human services agencies. People looking for social service assistance for food, housing, education, legal help, child care, physical and mental health, financial support, transportation, or emergencies can dial 2-1-1 and speak with trained professionals who will refer them to the appropriate agencies.

The Texas Health and Human Services Commission, Texas Alliance of Information and Referral Systems, and various community-based organizations collaborate to provide this service.

DADS requires that HCSSAs and ADCs have written plans for disaster preparedness, including triage, evacuation, sheltering, etc. You may download the letter here.

The Bush Administration has backtracked on its commitment to require Medicaid recipients to show proof of citizenship to continue receiving benefits. At least eight million people will be exempted from the requirement because they established citizenship when they applied for Medicare or Supplemental Security Income.

Is “established” the same as “proved”? Did the Medicare and Supplemental Security Income recipients show documentation or simply check a box?

Last week I wrote that the new law went into effect on July 1. Last month “anti-poverty” groups filed a class-action lawsuit in the U.S. District Court in Chicago, contending that the citizenship requirement violates recipients’ constitutional rights. Last week, a federal judge held hearings on the matter. Some speculate this is why the rules were relaxed.

The Kaiser Family Foundation has published a fact sheet (PDF) with information on the new law and how it will affect Medicaid beneficiaries and the states. The states of New York, Georgia, Montana, and New Hampshire already have proof of citizenship policies in place.

Kaiser published a study on New York’s 30-year-old proof of citizenship requirement. You may download the 30-page report, Citizenship Documentation Requirements in the Deficit Reduction Act of 2005: Lessons from New York (PDF).

Sources: New York Times and Reuters