The Texas Department of Health and Human Services (HHSC) issued a correction to a notice of a public hearing on proposed Medicaid payment rates for Home and Community-based Services and Texas Home Living waiver programs, which appeared in the July 20 Texas Register. The hearing date has been changed from August 7, 2007, at 9:00 a.m. to August 14, 2007, at 3:30 p.m. The scope of the hearing has been expanded to include proposed rates for the Consolidated Waiver Program - Supported Employment, 24-Hour Residential Habilitation, and Family Surrogate Services.
To read the corrected notice, see the relevant section of the July 27 Texas Register.
HHSC has announced a series of public hearings on proposed payment rate changes for various programs. Beginning at this link, scroll down to read all notices.
To read public notices about HHSC’s intent to submit various transmittal and amendment numbers, visit this link.
In a letter dated July 19, the Texas Department of Aging and Disability Services (DADS) informed Nursing Facilities, Community Based Alternatives, Home and Community Support Services Agencies, Hospice Providers, Program of All Inclusive Care for the Elderly Providers, and Consolidated Waiver Program Providers that beginning August 12, the Texas Medicaid & Healthcare Partnership (TMHP) will verify nurse licensure with the Texas Board of Nursing (TBON) for both the Director of Nurses (DON) and the Assessor signing the Client Assessment, Review and Evaluation (CARE) Form 3652-A for all purpose codes.
Download the letter here for more information.
In a July 20 information letter, DADS notified contracted providers about a calculation error in the Enrollment Worksheets for the state fiscal year (SFY) 2008 Nursing Facility Direct Care Staff Enhancement Open Enrollment. The error could result in inaccurate results in your calculations. The correct worksheets can be found here. Download the letter here.
In an information letter dated June 23, DADS informed Home and Community-Based Services Program Providers and Texas Home Living Program Providers about the new Retroactive Rate Adjustment and Cost Ceiling Adjustment, effective June 1. For more information, download the letter here.
Last week, the U.S. House of Representatives approved an amendment to block a rule proposed by the Centers for Medicare and Medicaid Services (CMS) that would have reduced Medicare inpatient hospital reimbursements in FY 2008 by 2.4 percent. (Kaiser Network)
CMS apparently anticipates that hospitals will bill Medicare for services that reimburse at higher rates “in response to changes that would link payments with the severity of the illnesses of patients.” The proposed rule to reduce reimbursements would offset this expected behavior.
Republican Rep. Jerry Weller said CMS seeks to “punish the hospitals before they’ve done anything wrong.”
The Texas Health and Human Services Commission (HHSC) proposed amendments to §§2.101 - 2.103 and 2.105 - 2.112, and the repeal of §§2.104 and 2.113 - 2.115, Chapter 2, Mental Retardation Authority Responsibilities, Subchapter C, Charges for Community Services. From the Texas Register:
Because they originated at the Texas Department of Mental Health and Mental Retardation, the rules in Chapter 2, Subchapter C, currently contain references to both mental health and mental retardation services. The purpose of the proposal is to eliminate references related to mental health issues and tailor the remaining rule language exclusively to mental retardation services.
For more information on the proposed changes and where to send comments, see the relevant section of the July 13 Texas Register.
HHSC proposed an amendment to §97.527, concerning post-survey procedures, in Chapter 97, Licensing Standards for Home and Community Support Services Agencies, which will update the time frames and procedures that a home and community support services agency must follow to request an informal review of deficiencies. Additionally, the amendment will allow an agency submitting an IRoD request form more time to submit a rebuttal letter and supporting documentation.
For more information on the proposed changes and where to send comments, see the relevant section of the July 13 Texas Register.
In a letter dated July 16, the Department of Aging and Disability Services (DADS) informed Nursing Facilities about procedural changes in the Provider Claims Service Unit.
It will now take 7-10 business days to process requests, whether the request has been submitted by telephone or e-mail. For more information, download the letter here.
In a letter dated July 17, DADS reminded Nursing Facilities, Community Services Providers, Therapy Providers, and ICF/MR Service Groups 5 & 6 Providers to avoid Miscellaneous claims in the new fiscal year by submitting claims for work done in FY05 no later than 12 p.m. on Wednesday, August 15. Those submitted after that will be processed as Miscellaneous and can’t be paid through the standard payment process. For more information, download the letter here.
DADS issued a similar reminder to Home and Community-Based Service Providers and Texas Home Living Waiver Providers. You may download the letter here.
In a letter dated July 6, the Department of Aging and Disability Services (DADS) informed Home and Community-based Services Program Providers, Texas Home Living Program Providers, and Executive Directors of Mental Retardation Authorities that the Prevention and Management of Aggressive Behavior (PMAB) training curriculum owned by the state of Texas is not available to train employees of private providers.
PMAB training is available for personnel working on state mental retardation facilities or state hospitals, and in some cases, for employees of community mental health/mental retardation centers. You may download the letter here.
In a letter dated July 12, DADS informed All Nursing Facility Administrators that the current letter updates Provider Letter #04-18, issued on June 18, 2004, regarding the Promoting Independence Initiative. For more information, download the letter here.
In a letter dated July 12, DADS informed Community Living Assistance and Support Services (CLASS), Case Management Agencies and Direct Services Agencies, and Consumer Directed Services Agencies that effective June 1, 2007, new rates for the CLASS program were implemented. The rate changes have been entered into the Long Term Care Provider System. You may download the letter here for more information.
Two Democratic senators are considering more regulations for the health care industry.
Senators Herb Kohl and Claire McCaskill, members of the Senate Special Committee on Aging, are set to discuss what should be done about drug companies giving gifts to physicians, which they say may “compromise physicians’ medical judgment by putting their financial interest ahead of the welfare of their patients.” (Kaiser Network)
Drug company representatives visit hospitals with drug samples, sometimes bearing gifts. Is this a big enough problem to justify more regulations?
Reimbursement Rates
The Texas Health and Human Services Commission (HHSC) has proposed to amend §355.114, Consumer Directed Services Payment Option, in its Reimbursement Rates.
The reimbursement methodology for Consumer Directed Services (CDS) allocates a flat fee of the total payment rate for each CDS hour of service without regard for total payment. The amendment would change the rate to one that reflected the CDS Agency’s actual level of effort providing support services. See the relevant section of the July 6 Texas Register for more information.
Hearings
HHSC proposes to amend §357.305, concerning Administrative Review of Fair Hearing Decisions, and to promulgate new Subchapter R, concerning Judicial and Administrative Review of Hearings, §§357.701 - 357.703. The proposed rule would help implement new statutory requirements. See the relevant section of the July 6 Texas Register for more information.
Medicaid Eligibility
HHSC proposes to amend the administrative code to allow a $20 exclusion of unearned or earned income from an individual’s monthly income in determining an individual’s eligibility for community attendant services. See the relevant section of the July 6 Texas Register for more information.
State Children’s Health Insurance Program
HHSC proposes to amend the following rules under Chapter 370, State Children’s Health Insurance program: §370.4, Definitions; §370.20, Application Availability and File Date; §370.22, Completion of Telephone Applications; §370.43, Citizenship and Residency; §370.44, Income and Assets; §370.46, Waiting Period; §370.51, Deadline and Method for Requesting Review; §370.52, Disposition of a Request for Review; §370.303, Completion of Enrollment; §370.307, Continuous Enrollment Period, §370.325, Cost-Sharing Cap; and §370.401, Perinates.
The proposed rule amendments are designed to make changes to eligibility and cost sharing policy and procedures. See the relevant section of the July 6 Texas Register for more information.
The Texas Health and Human Services Commission (HHSC) has proposed to amend §353.2, Definitions, to update the definition of value-added services. An excerpt:
The current rule states that value-added services must be health care services. To align the rule with S.B. 10 and planned contract changes for value-added services, the proposed amendment states that value-added services may be health care services or positive incentives that promote healthy lifestyles and improve health outcomes.
The public hearing was held on July 11, but you may still send written comments to Shirley Stanford, Program Specialist VI in the Medicaid/CHIP Division, by mail to the HHSC, P.O. Box 85200, MC H312, Austin, Texas 78708-5200, by fax to (512) 491-1972, or by e-mail to shirley.stanford@hhsc.state.tx.us, within 30 days of the publication of the proposed rule change. See the relevant section of the July 6 Texas Register for more information.
The Texas Health and Human Services Commission (HHSC) announced three public hearings in the June 29 Texas Register.
July 17 – HHSC will hold a public hearing to receive comments on proposed rate increases for providers of 24-Hour Residential Child Care (RCC) services. The meeting will be held on July 17 at 1:30 p.m. in the Lone Star Conference Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas. For information on how to receive briefing packages and where to send comments, see the relevant section of the Texas Register.
July 18 – HHSC will hold a public hearing to receive comments on proposed rate increases for the following community care programs and services operated by the Department of Aging and Disability Services (DADS): Consumer Directed Services Agency (CDSA); Community-Based Alternatives (CBA) Waiver Program and CBA Assisted Living/Residential Care (AL/RC); Community Living Assistance and Support Services (CLASS); Medically Dependent Children Program (MDCP); Residential Care (RC); Emergency Response Services (ERS); Home-Delivered Meals; Primary Home Care (PHC); Day Activity and Health Services (DAHS); Deaf-Blind Multiple Disabilities Waiver (DB-MD); and Community Care for Aged and Disabled Adult Foster Care (CCAD AFC).
The meeting will be held on July 18 at 9 a.m. in the Lone Star Conference Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas. For information on how to receive briefing packages and where to send comments, see the relevant section of the Texas Register.
July 19 – HHSC will hold a public hearing to receive comments on the proposed Medicaid Standard Dollar Amount (SDA) payment rates for state-owned, teaching hospitals. The meeting will be held on July 19 at 8 a.m. in the Lone Star Conference Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas. For information on how to receive briefing packages and where to send comments, see the relevant section of the Texas Register.