The following information was obtained from the June 20 issue of the Texas Register:
The Texas Health and Human Services Commission adopted the repeal of §355.454, concerning Frequency of Reporting Costs and an amendment to §355.457, concerning Fiscal Accountability, in its Reimbursement Rates Chapter.
The updates will “clarify and formalize requirements related to required documentation and allowable costs, add procedures for determining recoupments when a provider fails to submit a cost report, and formalize procedures for allowing providers with control of multiple component codes in the program to request to aggregate their reports for purposes of determining compliance with spending requirements.”
See the relevant section of the Texas Register for more information.
The Texas Board of Nursing has adopted an amendment to §213.12 (Witness Fees and Expenses), which will allow a subpoenaed witness to receive adequate mileage reimbursement. See the relevant section of the Texas Register for more information.
The Texas Department of Aging and Disability Services (DADS) issued two information letters:
- Compliance with Texas Government Code Section 531.164(h) related to Search for Parent or Guardian of a Child
In a letter to Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) and Nursing Facility (NF) Providers, DADS reminded them of the requirements related to Search for Parent or Guardian of a Child. Reference Provider Letter #06-33, dated August 18, 2006, to NFs or to Provider Letter #06-34, dated August 30, 2006, to ICFs/MR of this codified requirement. Download the letter for more information.
- Clarification of Provider Role when Individuals Receiving Waiver Services are Admitted for Inpatient Psychiatric Treatment
In a letter to Home and Community-based Services Providers, Texas Home Living Program Providers, and Mental Retardation Authorities, DADS clarified its expectations regarding a program provider’s responsibilities when an individual receiving waiver services is admitted to a state hospital or other mental health facility for behavior or psychiatric stabilization. Download the letter for more information about these responsibilities.
Yesterday, the House of Representatives “overwhelmingly” passed a bill that would stop a 10.6 percent Medicare physicians pay cut, which is scheduled to go into effect on July 1. (Associated Press)
The House passed the measure by a vote of 355-59, despite a potential presidential veto. Democrats want to fund the delayed cut by decreasing funding to Medicare Advantage (MA) plans, and President Bush has threatened to veto any bill that cuts funding to MAs.
In any case, the House-passed bill can’t move forward unless and until the Senate passes its version of the bill. Earlier this month, Democrats in the Senate failed to garner the 60 votes needed to invoke cloture and begin debate on its version of the bill.
The battle continues.
Beneficiaries of Medicaid can continue buying prescription drugs at a low cost once they become eligible for Medicare, according to a class action lawsuit settlement. (Kaiser Network)
The Centers for Medicare and Medicaid Services (CMS) announced the settlement last week. The lawsuit was filed on behalf of 6.2 million “dual eligible” Medicaid beneficiaries. Under the 2003 Medicare law, dual eligibles are supposed to receive assistance for buying prescription drugs, but beneficiaries were charged up to $75 or more, as opposed to co-payments of fewer than $5, because agencies, insurers, and pharmacies didn’t share information about beneficiaries’ low-income status.
As part of the settlement, agencies and companies will share this information, with time limits placed on submitting names and processing claims.
The Texas Department of Aging and Disability Services (DADS) released two information letters and two provider letters:
- Service Provision Requirements for all HCS Program Providers
In a two-page letter to Home and Community-based Services (HCS) and Mental Retardation Authorities (MRA), DADS clarified existing HCS Program rules concerning service provision requirements for HCS Program providers. Download the letter for more information.
- Clarification of Provider Role when Individuals Receiving Waiver
In a three-page letter to HCS, Texas Home Living Program Providers, and MRAs, DADS clarified its expectations regarding a program provider’s responsibilities when an individual receiving waiver services is admitted to a state hospital or other mental health facility for behavior or psychiatric stabilization. Download the letter for details.
- Therapy Facility Registration — Executive Council of Physical Therapy and Occupational Therapy Examiners Services (ECPTOTE) are Admitted for Inpatient Psychiatric Treatment
DADS issued a provider letter to Nursing Facilities and Assisted Living Facilities to inform them that if they provide outpatient PT or OT services, they must register with ECPTOTE as an “OT and/or PT therapy facility” in accordance with the OT and/or PT therapy facility registration provisions of §453.213 and §454.215 of the Texas Occupations Code and the Texas Administrative Code, Title 22, Part 16, Chapter 347, and Title 40, Part 12, Chapter 376. For more information, download the letter.
- Unlicensed Locations Operated by a Licensed Assisted Living Facility Owner
DADS informed Assisted Living Facilities about the legal consequences of a licensed assisted living facility owner operating in unlicensed locations. An excerpt:
DADS may take appropriate remedies against licensed assisted living facilities operating in violation of Chapter 247. Additionally, DADS may refer an unlicensed assisted living facility operating in violation of Chapter 247 to the Office of the Attorney General or local prosecuting attorney for injunctive relief and/or civil penalties.
Download the two-page letter for more information.
The following information was obtained from the June 13 issue of the Texas Register:
The Texas Department of Aging and Disability Services (DADS) will hold a public hearing at 3 p.m. on June 23, 2008, to accept public testimony regarding the draft Report Update for State Mental Retardation Facilities for Fiscal Years 2008-2009. The hearing will take place in the Winters Building Public Hearing Room at 701 W. 51st Street, Austin, Texas. To find out where to send written comments, see the relevant section of the Texas Register.
Last week, Democrats in the Senate did not get the 60 votes needed to invoke cloture and begin debate on a measure that would delay a 10.6 percent Medicare physicians fee cut for 18 months. (Kaiser Network)
As I mentioned before, Democrats in both houses of Congress are trying to delay the cut, which goes into effect on July 1, 2008. The Bush administration seeks to reduce funding to Medicare and Medicaid programs and will veto any bill that proposes to cut funding to Medicare Advantage (MA) plans, a private program. Democrats intend to fund the physicians fee cut by reducing funding to MAs.
Democratic senator Max Baucus told The Hill: “We all know what this vote [against cloture and debate] was about, and it wasn’t about what’s best for American seniors. The White House doesn’t want overpaid private plans in Medicare to lose a single dime.”
Whether private Medicare plans are overpaid or not, the issue will continue to divide an already contentious Congress.
Previous posts:
The Texas Department of Aging and Disability Services (DADS) released four information letters:
- Addition of Specialized Nursing Services to the DBMD Program
DADS informed Deaf-Blind Multiple Disabilities (DBMD) Providers that it will implement specialized nursing services and associated rates in the DBMD Program. The codes and rates are:
Licensed Vocational Nurse (LVN) - 13A - $29.69 per hour
Registered Nurse (RN) - 13B - $43.39 per hour
Specialized Nursing (RN) - 13C - $49.90 per hour
Specialized Nursing (LVN) - 13D - $34.14 per hour
Download the letter for more information.
- MDS Software Changes for TILEs to RUGs Transition
DADS informed Nursing Facility and Hospice Providers about the transition from the Texas Index for Level of Effort (TILE) to the federal Resource Utilization Group (RUG), scheduled for September 1, 2008. To help with the transition, providers should monitor the Texas Medicaid & Healthcare Partnership web site. Download the three-page letter for further details.
- RUGs Readiness for Nursing Facility and Hospice Providers — NEW INFORMATION
In another letter to Nursing Facility and Hospice Providers, DADS provided new information about the TILE to RUG transition scheduled for September 1. Download the six-page letter, which answers commonly asked questions.
- RUGs Readiness for Community Services Providers — NEW INFORMATION
DADS informed Community Based Alternatives Home and Community Support Services Agency Providers, Consolidated Waiver Program Home and Community Support Services Agency Providers, Program of All-Inclusive Care for the Elderly Providers, State of Texas Access Reform Plus Providers, and Integrated Care Management/1915(c) Waiver Home and Community Support Services Agency Providers about steps they need to take to prepare for the September 1 transition from TILE to RUG. The five-page letter includes commonly asked questions and answers. An excerpt:
1. What does our agency need to do to get ready for the TILEs to RUGs change?
Issues involving Form 3652-A data should be resolved by August 25, 2008, because the LTC Online Portal will be unavailable August 25-31, 2008. Reviewing MESAV (Medicaid Eligibility Service Authorization Verification) and/or the Remittance and Status (R&S) Report will clarify whether any records are missing, identify any gaps in payment or services, explain the reason for a denied claim, etc. During this portal downtime, providers can obtain forms status information by contacting the TMHP Call Center/Help Desk at 1/800-626-4117, option 1 (see item 3 below).
To avoid delays in payment, please allow sufficient time to take care of any issues in order to insure that your forms are processed prior to the RUG transition on September 1, 2008.
The following information was obtained from the June 6 issue of the Texas Register:
Public Notices
The Texas Health and Human Services Commission has announced its intent to release Request for Proposals (RFP No. 529-08-0180) to secure the services of a qualified vendor to assist the state in completing the Medicaid Information Technology Architecture (MITA) State-Self Assessment, the gap analysis and the to-be MITA roadmap. HHSC seeks to contract with a single qualified consultant to fulfill the requirements of the RFP. Contact information:
Elizabeth Ward, Purchaser
Texas Health and Human Services Commission
Enterprise Contracts and Procurement Services (ECPS) Department
909 West 45th Street; Building 1
Mail Code: 2020
Austin, Texas 78751
Telephone: (512) 206-5540
Fax: (512) 206-5475
E-mail: elizabeth.ward@hhsc.state.tx.us
See the relevant section of the Texas Register for more information.
Proposed Rule
The Texas Board of Nursing has proposed to amend 22 Texas Administrative Code §217.20 (Safe Harbor Peer Review) to correct the name of the section title, changing it from “Safe Harbor Peer Review” to “Safe Harbor Peer Review for Nurses and Whistleblower Protections.” For information on where to send written comments or concerns, see the relevant section of the Texas Register.
Although President Bush has proposed to reduce funding to programs like Medicare and Medicaid, both houses of Congress have other plans.
Last week, the House of Representatives voted to approve a $3.1 trillion FY 2009 budget that excludes President Bush’s proposed Medicare and Medicaid program cuts. (Kaiser Network)
Kaiser reports (via the Washington Post) that Democrats may wait until the new administration to pass spending bills to avoid the current president’s veto. Meanwhile, Democrats in the Senate are trying to stop a 10 percent cut in Medicare physicians fees. The cut is scheduled to go into effect on July 1, 2008.
As I reported last week, Democrats propose to cut funding to Medicare Advantage (MA) plans, which they claim are “overpaid and damaging to traditional Medicare,” to offset the budget bill. U.S. Department of Health and Human Services secretary Mike Leavitt said President Bush will veto any bill that reduces payments to MA plans.