The following information was obtained from the March 21 issue of the Texas Register:

Public Notices

The Texas Health and Human Services Commission has announced its intent to submit the state’s application for a renewal of the Texas Waiver for Home and Community-Based Services (HCS waiver) and Amendment 808, Transmittal Number TX 08-004, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. See the relevant section of the Texas Register for details.

As you may recall, the Bush administration has proposed to cut spending on programs like Medicaid, including reducing physician reimbursements. A coalition of local governments and providers in California plans to file a lawsuit to stop these cuts. (Kaiser Network)

San Francisco Mayor Gavin Newsom said that a proposed 10 percent reimbursement reduction could serve as a disincentive to doctors treating patients in Medi-Cal, California’s Medicaid program. He fears patients will seek treatment in hospital emergency rooms, which are already overburdened. The lawsuit, if filed, would claim that Medicaid cuts would unfairly transfer responsibility for coverage to local governments that fund public hospitals.

Governor Arnold Schwarzenegger’s administration said the reduced reimbursement rate is not a long-term solution but one that would ensure beneficiaries remain covered.

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

• Revised Coordination and Notification Process for Vocational Rehabilitation and Supported Employment Services

DADS informed Home and Community-based Services Program Providers, Texas Home Living Program Providers, Community Living and Support Services Program Providers, Deaf Blind and Multiple Disabilities Program Providers, Executive Directors of Mental Retardation Authorities, Superintendents of State Mental Retardation Facilities, and Intermediate Care Facilities for the Mentally Retarded and Related Conditions Program Providers about the revised process to inform individuals and providers of an individual’s eligibility status for employment services. Download the three-page letter for more information.

• Medicaid Hospice Continuous Home Care Per Diem

DADS informed Medicaid hospice providers that effective April 25, 2008, submitted claims for continuous home care will be electronically edited on the quantity billed. For more information, download the letter.

• Implementation of Money Follows the Person Demonstration (Demonstration); Referral of Nursing Facility Residents to Relocation Contractors; and Responsibilities of Relocation Contractors under the Demonstration

In an information letter to relocation contractors, DADS summarized recent policy changes related to the Demonstration, referral of nursing facility residents to relocation contractors, and the relocation contractor responsibilities under the Demonstration. For more details on policy changes, download the letter.

The Kaiser Network recently highlighted a story from the Wall Street Journal about fraud in private sector Medicare and Medicaid managed care plans. (Kaiser Network)

In the 1990s, the federal government moved more Medicare and Medicaid beneficiaries to managed care plans in the private sector to reduce costs. Although some believed the private sector would have incentives to conduct business ethically and prevent fraud, others believe a new kind of fraud has cropped up. An excerpt:

The Journal reports that traditional fraud prevention for government programs consisted of “policing doctors, hospitals, dialysis centers and the like to catch overcharges or billing for treatment never provided.” However, according to the Journal, “[m]anaged care fraudsters profit by … shortchanging patients or physicians to cut costs while collecting preset fees from the government,” as well as by “refus[ing] to enroll unhealthy people, skimp[ing] on paying doctors or deny[ing] patients care.” Regulators say “they are realizing they must become more attuned to more-complex scams carried out by sophisticated corporations,” the Journal reports.

The following information was obtained from the March 14 issue of the Texas Register:

Open Meetings

The Texas Health and Human Services Commission (HHSC) will hold a hearing on Medicaid payment rates for various procedure codes, including Lung Volume Reduction and eye surgery. The hearing will be held on March 31, 2008, at 1:30 p.m. in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas. Visit the relevant section of the Texas Register for more information about the hearing.

HHSC will also hold a hearing on a proposed payment rate for reconstruction of polydactylous digit, soft tissue and bone provided by Ambulatory Surgical Centers and Hospital Ambulatory Surgical Centers services. For more information, see the relevant section of the Texas Register.

The Texas Department of Aging and Disability Services (DADS) issued three new information letters:

Clarification of Roles and Responsibilities for Relocation Contractors in the ICM Program Service Areas – DADS issued a three-page letter to Integrated Care Management Providers and DADS Relocation Contractors in the ICM Program Service Areas about these contractors’ roles and responsibilities in the program. Download the letter for more information.

Consumer Directed Services Town Hall Meetings – DADS informed Home and Community-based Services, Texas Home Living Service Providers, Mental Retardation Authorities, Community Living Assistance and Support Services Case Managers, Deaf-Blind with Multiple Disabilities Providers, and Consumer Directed Services Agencies about town hall meetings hosted by DADS. The two-page letter, which you may download here, includes a list of meetings with dates, times, and locations.

Rate Changes Due to March 2008 Annual Cost of Living Adjustments (COLA) – DADS reminded Community Care for the Aged and Disabled (CCAD), Residential Care (RC) Providers, Community Based Alternatives (CBA), Assisted Living/Residential Care (AL/RC) Providers, Consolidated Waiver Program (CWP), and Assisted Living/Residential Care (AL/RC) Providers about COLA rate changes approved by the Texas Health and Human Services Commission, effective March 1, 2008. You may access new RC and AL/RC rates here and CWP rates here.

Download the letter for more information.

The following information was obtained from the March 7 issue of the Texas Register:

Open Meetings

The Texas Department of Aging and Disability Services (DADS) will hold a public hearing to receive comments about the External/Internal Assessment, which will be included in the Texas Health and Human Service System Strategic Plan for Fiscal Year (FY) 2009-2013. The hearing will take place on Tuesday, March 18, 2008, at 4:00 p.m., in the Winters Building Public Hearing Room at 701 W. 51st Street, Austin, Travis County, Texas 78751.

Additionally, DADS will hold a Pre-Application Orientation for individuals seeking to participate as a contractor in the Home and Community-based Services and/or the Texas Home Living Medicaid Waiver Programs on June 9, 2008. Visit the relevant section of the Texas Register for more information about both meetings.

The Texas Department of Health and Human Services Commission intends to submit Amendment 800, Transmittal Number TX 07-041, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. For more information, see the relevant section of the Texas Register.

Proposed Rules

The Texas Medical Board has proposed a series of amendments concerning the following sections: Supervision of Medical School Students, Physician Advertising, Physician Profiles, and Voluntary Relinquishment or Surrender of a Medical License. See the relevant section of the Texas Register for more information.

Withdrawn Rules

The Texas Medical Board has withdrawn proposed amendments to §162.1, concerning Supervision of Medical Students. Follow the link for more information.

Adopted Rules

The Texas Medical Board has adopted amendments to several sections of the code, including General Provisions, Physician Registration, and Reinstatement And Reissuance sections. See the relevant section of the Texas Register and scroll down for more information.

Five executives of National Century Financial Enterprises, a finance company which bought accounts receivables of small hospitals and nursing homes, have been convicted by a federal jury of wire and securities fraud. The company went bankrupt in 2002 and the executives were accused of hiding losses from shareholders by moving money around in accounts and keeping two sets of books.

Here is the defense attorneys’ position:

Attorneys for the five defendants said prosecutors took the company’s activities out of context by showing jurors only a tiny slice of National Century’s operations.

That’s what federal prosecutors do in some of the cases which criminalize bad business decisions. They also threaten defendants into testifying against their cohorts:

The government’s star witness, former executive vice president Sherry Gibson, testified last month that the company kept two sets of books, one for public consumption filled with false information, the other that showed the firm’s actual shortfalls. Gibson is one of four former National Century executives who previously pleaded guilty to fraud charges and have cooperated with the government.

So it’s really rich when the Feds turn around and prosecute someone on the other side for witness tampering:

Missing from the trial has been National Century’s former president and chief executive, Lance Poulsen, a chief target of the government’s allegations.

Before his own trial on the fraud charges in August, Poulsen is scheduled for a trial Monday before Marbley on charges of witness tampering.

He’s accused of offering to pay a witness for testimony. Well, what is the Federal government doing when it threatens witnesses with long jail sentences and then offers less time for their testimony? Do you think they always get the truth out of witnesses with that tactic?

In an effort to retain tax cuts and tax breaks proposed by President George W. Bush, congressional Republicans have proposed a fiscal year 2009 budget that would cut Medicare and Medicaid spending. (Kaiser Network)

In anticipation of the Bush administration’s tax cuts expiring at the end of 2010, Democrats have proposed a budget of $3 trillion to fund domestic programs. Yesterday, both sides of the aisle began debating competing budget proposals.

In other Medicaid news, a hospital coalition has filed suit in federal court to prevent the implementation of Medicaid rule changes that would reduce payment to “safety-net” hospitals by $5 billion over five years. From the Kaiser Network:

The rule would limit federal Medicaid payments to so that they would not exceed the cost of providing care. The rule change would apply to hospitals funded by local governments. However, the hospitals argue that the cuts would make it more difficult for public hospitals to offset the cost of treating the uninsured by increasing Medicaid charges.

A spokesman for the Centers for Medicare and Medicaid Services said the Bush administration’s rule would “bring greater transparency to the financing of the Medicaid program.” Hospital groups involved in the lawsuit include the American Hospital Association and the National Association of Public Hospitals and Health Systems.

In response to stakeholder concerns about the implementation of Family Council Provisions in SB 131, the Texas Department of Aging and Disability Services (DADS) issued a provider letter to Nursing Facilities with an attached list of questions and answers. You may download the five-page letter and attachment here.

DADS also released three information letters:

• Nursing Services Billing – DADS informed Community Living Assistance and Support Services Providers that it has implemented an interim process for provider billing until service codes for Licensed Vocational Nursing and Registered Nursing can be updated. You may download the letter here.
• DADS NPI Implementation – DADS informed All Long Term Services and Supports Providers that May 23, 2008, marks the end of the State of Texas contingency period for National Provider Identifier compliance. The previous date was February 29, 2008. Download the letter for more information.
• Nursing Facility Payment Rates for Rehabilitative and Specialized Services - The Texas Health and Human Services Commission has approved new Medicaid payment rates for the Nursing Facility Rehabilitative and Specialized Services Program, effective March 1, 2008. The information letter includes a table of new statewide payment rates.