The following information was obtained from the April 25 issue of the Texas Register:

Adopted Rules

The Texas Health and Human Services Commission (HHSC) adopted amendments to §§19.208, 19.214, and 19.2112, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification, which will update terminology and state agency names and correct rule cross-references to reflect changes from health and human services agencies consolidations in 2004 and to make sections consistent with other DADS rules.

For more information, see the relevant section of the Texas Register.

HHSC also adopted amendments to §§94.2, 94.3, and 94.9 - 94.11 in Chapter 94, Nurse Aides, which will allow the Nurse Aide Registry to deem a nurse aide to be unemployable based on a finding that the nurse aide is listed as unemployable in the Employee Misconduct Registry.

For more information, see the relevant section of the Texas Register.

The Texas Department of Aging and Disability Services (DADS) released a provider and information letter, and announced joint training sessions:

• Family Council Provisions in Senate Bill (SB) 131, 80th Legislature, Regular Session, 2007 (Replaces PL 08-03)

DADS informed Nursing Facilities that the DADS Council has approved proposed rules for implementation of the provisions of SB 131 related to family councils on December 12, 2007. You may download the letter and a four-page questions and answers attachment.

• DADS Information Letter No. 08-58: Money Follows the Person CBA Demonstration Service; Overnight Companion Services (OCS) [replaces Information Letter 08-43]

In a three-page letter to Home and Community Support Services Agency Community Based Alternatives Providers in Cameron, Hidalgo and Willacy Counties, DADS informed these providers about a new MFP Demonstration Service called Overnight Companion Services (OCS). The letter contains information about authorizing and billing for OCS.

DADS has announced joint training sessions for Nursing Facility administrators, direct care staff, surveyors, and anyone with an interest in long-term care planning:

Dates and locations:
June 24, 2008 - Arlington
June 26, 2008 - Austin
August 14, 2008 - San Antonio

See this section of the web site for more information.

The Texas Department of Aging and Disability Services (DADS) has released two provider and two information letters:

• Guidelines for Reporting Incidents (replaces PL 1999-34)

In a provider letter, DADS notified ICFs/MR about changes in the guidelines for reporting incidents to DADS, effective immediately. The revised guidelines supersede guidelines dated October 1, 1999, for licensed ICFs/MR. Download the five-page letter for more information.

• Expired Licenses (replaces PL 05-49)

DADS informed All Assisted Living Facilities, Adult Day Care Facilities, Nursing Facilities, Home and Community Support Services Agencies, and ICFs/MR, about facility and agency license renewals. Holders must file a renewal application to prevent expiration. Download the provider letter for more information.

• Economic Stimulus Payments — Filing Deadline Extended to October 15, 2008

In a letter to Nursing Facility, Intermediate Care Facilities/Mental Retardation, and Community Program Providers, DADS provided information about the filing extension for the Economic Stimulus rebate. An excerpt from the letter:

Many individuals served by the Department of Aging and Disability Services (DADS) who do not have a federal tax filing requirement and do not usually file an income tax return may be eligible for a rebate through the Economic Stimulus Payment program. These people will need to file a 2007 Income Tax Return to be eligible for the rebate.

The Internal Revenue Service (IRS) has extended the deadline to file IRS Form 1040A so eligible individuals may qualify for a rebate payment through the Economic Stimulus Payment program.

For more information, download the letter.

• Customized Power Wheelchairs Added as Medicaid Nursing Facility Program Service; Additional Information Provided

DADS informed Nursing Facilities about obtaining a Customized Power Wheelchair for an eligible recipient. The 11-page letter and attachment contains details about eligibility requirements, process for requesting, submission, approval process, and other important information. Download the letter and attachment here.

The Centers for Medicare and Medicaid Services (CMS) announced a new rule that would reduce funding for inpatient rehabilitation facilities in fiscal year 2009. According to CQ Health Beat (via Kaiser Network), the $20 million reduction, required by Congress, would prevent a cut to Medicare physicians payments. The same legislation reauthorizes the State Children’s Health Insurance Program (SCHIP).

In other SCHIP news, the Government Accountability Office (GAO) contends that the Bush administration violated federal law when it prevented states from expanding SCHIP, because it did not follow the rule-making process. (Kaiser Network)

Comments from Senators John Rockefeller and Olympia Snowe, who requested the GAO opinion:

“The directive is a bold-faced attempt to subvert the law and prevent states from implementing their plans to provide health insurance coverage to millions of uninsured children nationwide,” Rockefeller said in a statement (CQ Today, 4/18). Snowe said, “CMS chose to circumvent the rules and go their own way,” adding that “this is clearly the wrong approach” (CongressDaily, 4/18). Rockefeller and Snowe in a release wrote, “CMS now has a critical choice to make: rescind the rule or continue to spend taxpayer money defending a growing list of lawsuits it is unlikely to win” (AP/Lexington Herald-Leader, 4/19).

You may download the report summary or full opinion.

The following information was obtained from the April 18 issue of the Texas Register:

Proposed Rules

The Texas Health and Human Services Commission (HHSC) has proposed to amend §355.8061, concerning payment for hospital services and §355.8069, concerning supplemental payments to certain rural public hospitals, in Title 1 of the Texas Administrative Code (TAC), Part 15, Chapter 355, Subchapter J, Division 4, Medicaid Hospital Services. The amendment would make changes to the Non-State-Owned Rural Public Hospital supplemental payment program.

See the relevant section of the Texas Register for more information.

The Texas Department of Aging and Disability Services (DADS) has proposed to amend 19 sections of the code, including those pertaining to Medicaid-certified facilities, the Medicaid hospice program, and the Medicaid Waiver program. Follow this link, and scroll down to read details in each section.

Adopted Rules

HHSC has adopted an amendment to §358.432, concerning Home Equity Treatment and adopts a new §358.444, concerning Medicaid Treatment of Qualified Long-Term Care Partnership Program Insurance Policies, which implements a Long-Term Care Partnership Program to enable individuals who purchase certain approved private long-term care insurance policies to have a dollar-for-dollar exclusion of their resources in an amount equal to the insurance benefits paid on behalf of the individual in determining eligibility for medical assistance.

See the relevant section of the Texas Register for more information.

DADS has adopted a new §19.2614, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification without changes to the proposed text published in the January 18, 2008, issue of the Texas Register (33 TexReg 521), which will allow a nursing facility to procure a customized power wheelchair for a Medicaid-eligible nursing facility resident.

See the relevant section of the Texas Register for more information.

The following information was obtained from the April 11 issue of the Texas Register:

Open Meetings and Notices

The Texas Health and Human Services Commission (HHSC) has announced a hearing on proposed state-owned veterans nursing facility payment rates. The hearing is scheduled for May 6, 2008, at 9 a.m., in the Permian Basin Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.

HHSC will conduct a public rate hearing to receive comment on proposed Medicaid payment rates for Freestanding Psychiatric Facilities. The hearing is scheduled for April 23, 2008, at 9 a.m. in the Lone Star Conference Room of the Braker Center, Building H, at 11209 Metric Boulevard, Austin, Texas 78758-4021.

HHSC has announced its intent to submit Transmittal Number 08-001, Amendment Number 805, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. An excerpt:

The purpose of this amendment is to initiate a process by which the State will pay managed care organizations who have entered into a Medicare Risk Product Agreement with the Centers for Medicare and Medicaid Services (CMS), referred to as a “Medicare Advantage Health Plan,” or “MA Health Plan,” a monthly capitated payment in exchange for the MA Health Plan’s payment of the cost sharing obligations to health care service providers attributable to dual eligible members enrolled in the MA Health Plan’s Medicare risk product.

For details on where to send public comments for the hearings and information about the amendment, see the relevant section of the Texas Register.

The Texas Department of Aging and Disability Services (DADS) has released a provider and an information letter:

• License Periods and License Renewal Requirements (HCSSAs) [replaces PL 08-06]

DADS informed HCSSAs that beginning May 1, 2008, it will transmit license renewal notices, application forms, and license renewal instructions to current licensees at least 120 days prior to expiration of the current license. Contact the Professional and Technical Review Branch of the Licensing and Credentialing Section at (512) 438-2630 with questions. For more information, download the two-page letter.

• Daily Claims Processing for ICF/MR Service Group 6 Providers

DADS informed ICF/MR Providers, Service Group 6, that all such providers will be able to submit Service Group 6 claims any day of the week, effective April 22, 2008. For more information, call DADS Provider Claims Services (PCS) Provider Hotline at 512-438-2200, Option 1. You may download the letter here.

A 10 percent reduction in reimbursements for Medicare physicians could be delayed for 18 months, if Democratic Congressman Max Baucus’s plan is successful. (Kaiser Network)

Medicare physicians will see their reimbursements cut by 10 percent beginning July 1, 2008. Under Baucus’s plan, the cut would be delayed until 2010, and reimbursement rates would be raised by 1.1 percent. He also wants to increase and link reimbursements for primary care physicians (PCP) to quality of care.

The Medicare Payment Advisory Commission, an independent government agency that advises Congress about Medicare issues, believes that a pay increase for PCPs will “bolster the number of PCPs, who receive relatively lower salaries than specialists, causing fewer medical students to choose primary care…”

In other Medicare news, a survey released by the Pharmaceutical Care Management Association (PMCA) revealed that reducing the time in which Medicare prescription drug reimbursements must be made would limit the ability to detect fraud. From the Kaiser Network:

For the survey, PCMA interviewed dozens of industry experts responsible for pharmacy audits and fraud investigations and found that fraud schemes have become more complicated and more difficult to detect. Experts maintain that waste, fraud and abuse in pharmacy claims accounts for 1% of medication costs, which could translate to hundreds of millions of dollars in unnecessary costs for the Medicare prescription drug benefit, PCMA said.

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

• TILEs to RUGs Training Information

DADS informed Nursing Facility Providers, Hospice Providers, Community Based Alternatives Home and Community Support Services Agencies, Consolidated Waiver Programs, Program of All-Inclusive Care for the Elderly, State of Texas Access Reform Plus, and Integrated Care Management Providers about the transition from Texas Index for Level of Effort (TILE) to the federal Resource Utilization Group (RUG-III). Transition will occur on September 1, 2008.

DADS is offering online training to providers. Download the two-page letter for more information.

• Money Follows the Person CBA Demonstration Service; Overnight Companion Services (OCS)

DADS informed Home and Community Support Services Agency Community Based Alternatives Providers in Cameron, Hidalgo and Willacy Counties, about new services in The Money Follows the Person (MFP) initiative. An excerpt of the three-page letter:

Effective May 1, 2008, eligible CBA MFP Demonstration participants residing in Cameron, Hidalgo and Willacy counties may access a new demonstration service, overnight companion services (OCS), to assist in their relocation from institutional to community living. OCS will be offered annually to up to 20 participants. OCS provide 8-12 consecutive hours during a 24 hour period of available, direct support and assistance in the individual’s home during normal sleeping hours, not restricted to normal nighttime hours.

For more details, download the letter.

The following information was obtained from the April 4 issue of the Texas Register:

Notices and Public Hearing

The Texas Health and Human Services Commission (HHSC) has issued a correction to a public notice about its intent to submit Transmittal Number 08-000, Amendment Number 804, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act in the February 1, 2008, issue of the Texas Register (33 TexReg 1001). The correct notice reads:

HHSC announced its intent to submit Transmittal Number 08-006, Amendment Number 810, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendment is effective February 1, 2008.

Additionally, HHSC issued a notice that it adopted the following per diem reimbursement rates:

Large State-Operated ICF/MR Facilities-Medicaid Only clients

Proposed interim daily rate: $381.26

Large State-Operated ICF/MR Facilities - Dual-eligible Medicaid/Medicare clients

Proposed interim daily rate: $365.09

HHSC will hold a public hearing on April 22, 2008, at 9 a.m. to receive public comment on proposed payment rates for Supported Employment and Employment Assistance Services in the Deaf-Blind with Multiple Disabilities (DBMD) Program waiver. For more information on the notices and the public hearing, see the relevant section of the Texas Register, and scroll down for each entry.

Adopted Rules

HHSC has adopted an amendment to §355.8063, Reimbursement Methodology for Inpatient Hospital Services, which updates the Medicaid reimbursement methodology for freestanding psychiatric facilities, effective January 1, 2008. See the relevant section of the Texas Register for details.

The Texas Board of Nursing has adopted an amendment to 22 Texas Administrative Code §223.1 (Fees). See the relevant section of the Texas Register for more information.