The Texas Health and Human Services Commission (HHSC) has adopted an amendment to the Medicaid Managed Care section of the rules. The amendment updates the definition of Value-added Services. Pursuant to Senate Bill 10, HHSC is to “actively encourage” HHSC-contracted Medicare managed organizations to offer value-added benefits.
HHSC also adopted an amendment regarding the Consumer Directed Services (CDS) Payment Option, Reimbursement Rates Chapter. The U.S. Department of Health and Human Services directed Texas to revise the reimbursement methodology for CDS agencies.
HHSC adopted additional amendments to the Hearings, Texas Health Steps Comprehensive Care Program, And State Children’s Health Insurance Program sections. For more information about the amendments, see the relevant sections of the August 24 Texas Register.
The Kaiser Network reports Medicare is spending more on preventive services and screenings, according to the Centers for Medicare and Medicare Services (CMS). This isn’t news, but it’s interesting to note that fewer than 10 percent of beneficiaries receive preventive screenings and immunizations recommended by health care professionals.
In other Medicare news, CMS has issued a final rule that prohibit doctors from conflict-of-interest referrals. They can longer refer patients for services in which they or members of their immediate family have a financial interest. For more information, see the news release.
Additionally, CMS recently proposed a rule to revise requirements that ambulatory surgical centers (ASCs) must meet if billing Medicare for services to beneficiaries. The change would reflect “contemporary standards of practice in the ASC community, as well as recommendations from the HHS Inspector General.” See the news release for more information.
The Texas Department of Aging and Disability Services (DADS) informed Community Services Waiver Providers about the increase in individual cost limits for six Medicaid waiver programs operated by DADS. The three-page August 20 letter includes of a breakdown of cost limits for such programs as the Consolidated Waiver Program and the Deaf-Blind with Multiple Disabilities Program.
You may download the letter here.
In an August 24 provider letter to Assisted Living Facilities, Adult Day Care Facilities, Intermediate Care Facilities for Persons With Mental Retardation or a Related Condition, Nursing Facilities, and Home and Community Support Services Agencies, DADS included a list of new convictions barring employment, which were added to the code pursuant to state House and Senate bills.
Download the letter for more information.
The Board of Nurse Examiners has proposed amendments to delete obsolete portions of rules pertaining to Practice and Procedure. The proposed amendments were reviewed by the Board’s Eligibility and Disciplinary Task Force on July 13, 2007, and the Board and task force recommended approval. For more information, see the relevant section of the August 17 Texas Register.
The Board also proposed a new rule pertaining to Licensure, Peer Assistance and Practice. Read more about this proposed new rule here.
The Texas Health and Human Services Commission (HHSC) has adopted amendments to §354.1003, Time Limits for Submitted Claims. The amendment requires School Health and Related Services claims to be submitted within 365 days from the date of service or 95 days after the end of the state fiscal year, whichever comes first. See the relevant section of the August 17 Texas Register for more information.
HHSC has issued notices for two public hearings and several notices of intent to submit amendments to the code. Begin at this link and scroll down for information about proposed Medicaid payment rates for 2007 annual procedure codes relating to physician-administered drugs and biologicals and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, proposed Medicaid payment rates for a Sign Language Interpreter Procedure Code, and public notices.
Medicare will no longer pay for “treating preventable errors, injuries and infections that occur in hospitals,” according to the New York Times. Such preventable errors include leaving a sponge or other object inside a patient during surgery and giving a patient the wrong blood.
Such a policy obviously will put pressure on hospitals to get it right the first time (which they should be doing anyway), or they won’t get paid. An excerpt:
Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case.
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.
One state, Michigan, has had spectacular success with systematic efforts to reduce infection rates in intensive care units.
Medicare will publish the new rules this week.
On August 15, the Department of Aging and Disability Services (DADS) issued an information letter to Nursing Facility Administrators and Hospice Directors about the approval of new per diem payment rates for the Nursing Facility Program (NF), the Hospice Program in NFs, and the Swing Bed Program, effective September 1, 2007 through August 31, 2008. Download the letter here for more information.
In an August 16 letter, DADS informed Title XIX and Title XX Home Delivered Meals (HDM) Providers about documents they must use during uniform rate negotiations for Federal Fiscal Year (FFY) 2008 (October 1, 2007 - September 30, 2008). Information can be found on the HDM Program provider page. For more information, download the letter here.
On August 15, DADS issued a letter and a four-page attachment to Home and Community Support Services Agencies (HCSSA) to inform them about the HCSSA survey process. Download the letter and attachment here.
In a provider letter to Nursing Facility, Assisted Living Facilities, and Intermediate Care Facility for Persons with Mental Retardation Providers, dated August 17, DADS asked that they begin updating their vacancy information daily on the Facility Inventory, Vacancy, and Evacuation Status web site, at http://fives.dads.state.tx.us/, until further notice. DADS issued this notice because Hurricane Dean might enter the Gulf of Mexico this week. Download the letter here for more information.
Last week, the Texas Department of Aging and Disability Services issued several information letters regarding revised notices for fiscal year 2007 cutoff dates. Please click on the links below to download the letters:
- Community Services Providers, Nursing Facility Providers, Therapy Providers
- Home and Community-Based Service and Texas Home Living Waiver Providers
- Intermediate Care Facilities for Persons with Mental Retardation or Related Conditions (ICF/MR) Providers - Service Group 5
- ICF/MR Providers - Service Group 6
Another Washington-based think tank has cropped up. According to the Kaiser Network, a group of doctors, pharmacies, health insurers and others have formed an organization to help reduce medication errors.
The new organization will dedicate itself to promoting “best practices for the use of electronic prescribing technology that links physicians, pharmacists and patients.”
“Because medication nonadherence is estimated to account for between 10% to 20% of hospital admissions and adds up to $100 billion a year to health care costs in the U.S. alone, innovations related to e-prescription and improving patients’ success in taking medications as prescribed have the potential to greatly improve both clinical and economic outcomes,” said Bern Shen, director of strategic planning at the Intel Digital Health Group.
There are two tropical storms presently aimed at the Texas Coast. Here is the latest on Tropical Storm Erin:
Here is its projected path:
In the Gulf of Mexico, Tropical depression Five took shape last night, and has been upgraded to Tropical Storm Erin at 10 am CT moving northwest toward the southeastern Texas Coast.
Conditions appear favorable for Tropical Storm Erin to be a flooding rain threat into Friday night.
The current forecast track brings this system into the southern Texas Coast on Thursday, but the impacts will be felt along all of the Texas Coast, from Brownsville, through Corpus Christi and Houston, to Lake Charles, LA.
Tropical Storm Dean is a potential threat:
Meanwhile, our second area of concern, Tropical Storm Dean (60 mph), continues to move quickly west in the Atlantic.
Dean is forecast to become a hurricane by Thursday night or early Friday, and should be threatening the Lesser Antilles as early as Friday. From there, Dean should continue west-northwestward into the Caribbean.
It is too early to tell what, if any, impacts Dean will have on the United States.
Here is Dean’s potential path:
I spoke with someone at DADS today. By next Monday, the Governor’s Division of Emergency Management should be tracking Tropical Storm Dean (which may be a hurricane by then), so keep up with information from that site. Also, providers should be checking with Regional Offices for regulatory questions about evacuations, etc.