The Texas Department of Aging and Disability Services (DADS) released five information letters:
- Payment Rates for DADS Community Programs
DADS informed Community Service Providers that the Texas Health and Human Services Commission (HHSC) has approved a rate increase to recognize the impact of the increase in the federal minimum wage on certain provider types, effective August 1, 2008. The rates are posted on the HHSC Rate Analysis website.
Download the letter and seven-page attachment here.
- Unavailability of the Texas Medicaid and Healthcare Partnership Long-Term Care (LTC) Online Portal — August 25 - 31, 2008 (Note: letter revised 7/30/2008)
In a letter to Medicaid Nursing Facility Providers, DADS reminded them that as part of the transition from the Texas Index of Level of Effort to Resource Utilization Group, the LTC Online Portal will be unavailable for Forms 3652-A, 3618 and 3619 entries and inquiries from August 25 through August 31, 2008. Download the letter for more information.
Congress is considering the Fairness in Nursing Home Arbitration Act of 2008, which make pre-admission arbitration agreements invalid and unenforceable. The House Judiciary Subcommittee on Commercial Law and Administrative Law just approved the bill and refused amendments which would prevent it from being applied retroactively, among other things.
Specifically, the bill:
…requires that agreements to arbitrate nursing home disputes be made after the dispute has arisen and not at the time of admittance into the home. While the new Act does not prohibit arbitration in nursing home disputes, it does prevent a nursing home corporation—which typically has greater bargaining power–from forcing residents and their families into arbitration via a non-negotiable contract that was forced on the resident prior to the dispute. The Act also ensures arbitration occurs on a voluntary basis and is not forced.
According to a report released by the House Committee on Oversight and Government Reform, Medicare Part D paid about 30 percent more for prescription drugs in the program’s first two years than Medicaid would have paid for the same drugs. This has cost the program about $3.7 billion. (Kaiser Network)
Drug company Johnson & Johnson received a whopping $615 million more from Part D than it would have received from Medicaid.
Lawmakers already are trying to fix the problem. Congressman Henry Waxman, Democrat from California and committee chair, said he’ll introduce a measure to require the drug benefit to pay only what Medicaid would have paid for dual eligible coverage. Republicans and Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services, said Part D gives beneficiaries more choices than Medicaid.
You may download the 15-page report here (PDF).
Under the 2003 Medicare law, the president is required to propose a savings bill if Medicare trustees warn two consecutive years that the program will draw 45 percent of funding from the general government revenue. (Kaiser Network)
Last Thursday, the U.S. House of Representatives voted 231-184 to delay the president’s “trigger” bill for the rest of the 110th Congress. Democrats said they changed the rule, because the 45 percent threshold is “arbitrary” and would reduce Medicare spending or shift costs to beneficiaries. Republicans, on the other hand, are concerned about controlling Medicare spending.
Mike Leavitt, Secretary of the U.S. Department of Health and Human Services, said, “The Congressional Budget Office may have determined that budget gimmicks contained in Medicare legislation passed last week meet the technical requirements of the trigger law. But parliamentary sleight of hand will do nothing to resolve the enormous financial challenges presented by Medicare in the future.”
The following information was obtained from the July 25 issue of the Texas Register:
Adopted Rules
The Texas Health and Human Services Commission (HHSC) has adopted a new §355.8054, concerning Children’s Hospital Reimbursement Methodology, which will separate the Medicaid reimbursement methodologies for children’s hospitals into a stand-alone rule to clarify definitions, processes, and timing related to children’s hospital reimbursement. See the relevant section of the Texas Register for more information.
The Texas Board of Nursing adopted without changes an amendment to 22 Texas Administrative Code §217.20 (Safe Harbor Peer Review), which corrects the name of the title to this section. When the rule was originally adopted and published in the May 2, 2008, issue of the Texas Register (33 TexReg 3632), the title was “Safe Harbor Peer Review,” but it should have been “Safe Harbor Peer Review for Nurses and Whistleblower Protections.” See the relevant section of the Texas Register for more information.
Public Notices
HHSC published a notice that corrects a previous notice. The previous notice regarding an amendment to the Women’s Health Program (WHP) incorrectly stated that HHSC was requesting an October 1, 2008, effective date. The correct date is November 1.
HHSC announced an intent to submit an amendment to the Centers for Medicare and Medicaid Services regarding the Integrated Care Management (ICM) 1915(c) waiver. The amendment would allow the Texas Department of Aging and Disability Services to grant an exemption to the $5,000 annual dental service limit up to $10,000 annually.
HHSC announced an intent to submit an amendment to the Texas State Plan for Medical Assistance, which would add language to the state plan that identifies the HHSC website at which providers can access fee schedules and rates and adds a statement regarding the difference in fees and rates related to government providers and private providers.
HHSC announced an intent to submit an amendment to the Texas State Plan for Medical Assistance, which would adjust payment rates for the Day Activity and Health Services programs to increase attendant compensation as necessary to comply with the new federal minimum wage that will increase $0.70 from the current $5.85 per hour to $6.55 per hour on July 24, 2008.
HHSC announced an intent to submit an amendment to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would adjust payment rates for the Primary Home Care program to increase attendant compensation as necessary to comply with the new federal minimum wage that will increase $0.70 from the current $5.85 per hour to $6.55 per hour on July 24, 2008.
For details about each notice, follow this link and scroll down to read each entry.
The Texas Department of Aging and Disability Services (DADS) released four information letters:
- Criminal History, Employee Misconduct Registry and Nurse Aide Registry Checks
In a letter to Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers, DADS clarified existing HCS and TxHmL program rules regarding concerning background checks required for all employees of an HCS or TxHmL program provider. They must check the Nurse Aide Registry and Employee Misconduct Registry and complete a criminal history check for all applicants for employment, contractors and employees of the program provider whose duties involve or would involve direct contact with an individual who receives services from the provider. Download the letter for more information.
- Written Notification to an Individual or Legally Authorized Representative (LAR) of the Denial of a Level of Need (LON) Assignment
DADS advised HCS and Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) Providers that effective July 15, 2008, DADS will send written notification to an individual receiving HCS or ICF/MR services or their LAR when DADS denies a LON assignment for the individual. Download the letter for more information.
- Consumer Directed Services (CDS) Option Policy Clarifications and Notification of a Revision to the HCS and MRA User Guides
In a letter to HCS and TxHmL Providers, Mental Retardation Authorities (MRAs), and Consumer Directed Services Agencies, DADS clarified information regarding CDS and notified program providers and MRAs of a revision to the HCS and MRA User Guides relating to Client Assignment and Registration System (CARE) screens C06 and L06. Download the six-page letter for more information.
- Nursing Facility (NF) Services Provided to Integrated Care Management (ICM) Participants
DADS informed NF Providers that the ICM program began on February 1, 2008 in the Dallas and Tarrant service areas and clarified policy and procedures for NF services provided to ICM participants. Download the four-page letter for details.
If a physician adopts e-prescribing technology in 2009 and 2010, he/she will receive a 2 percent bonus in Medicare payments. Those who don’t will see reductions in reimbursements. (Kaiser Network)
Contained in the bill that delays a 10.6 percent Medicare reimbursement rate cut are details of an electronic prescribing incentive program, which is designed to save money and reduce drug-related errors. The program will begin on January 1, 2009.
Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services (CMS), says each physician will have to pay $3,000 to adopt the technology and pay between $80 and $400 a month to run the system.
In other CMS news, a new proposal would limit the practice of “lock-in pricing,” used by pharmacy benefit managers (PBM). This practice can increase costs for beneficiaries enrolled in Medicare Part D and cause them to fall into the “donut hole” coverage gap quicker than they normally would. An excerpt:
Under lock-in pricing, PBMs charge a higher rate to insurers with whom they have contracted to administer their drug benefit than what they pay pharmacies to dispense the drugs to beneficiaries, according to the Journal. The PBMs then keep the difference.
According to CMS, about 19 percent of drug plans use lock-in-pricing.
The following information was obtained from the July 18 issue of the Texas Register:
The Texas Health and Human Services Commission (HHSC) has proposed the repeal of §§371.212 - 371.214 and new §371.212 and §371.214, because of a typographical error in the fax number listed in the Public Comment section of the preamble of the proposal. The correct fax number is (512) 833-6487.
HHSC has adopted the following interim per diem reimbursement rate for small, state-operated Intermediate Care Facilities for Persons with Mental Retardation, including facilities operated by the Texas Department of Aging and Disability Services: $340.99. The final rate is effective September 1, 2007.
The HHSC, Office of Inspector General, will hold a public hearing on August 1, 2008, to receive comments on the proposed repeal of §§371.212 - 371.214 and proposed new §371.212 and §371.214 of Title 1, Part 15, Chapter 371, Subchapter C of the Texas Administrative Code.
Finally, HHSC has announced its intent to submit Transmittal Number 08-013, Amendment Number 817, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would assure CMS that the State of Texas complies with the Medicaid Integrity Program, outlined in sections 1936 and 1902(a)(69) of the Social Security Act.
For details about these four announcements, see the relevant section of the Texas Register, and scroll down to read each entry.
Things are moving fast. As we mentioned last week, President George W. Bush was set to veto a bill that would halt a 10.6 percent Medicare physicians pay cut. Yesterday, the president vetoed the bill, despite the bill passing both houses of Congress by veto-proof margins in recent weeks.
President Bush wrote that he vetoed the bill because it would “harm beneficiaries by taking private health plan options away from them,” and urged Congress to send him a bill “that reduces the growth in Medicare spending, increases competition and efficiency, implements principles of value-driven health care, and appropriately offsets increases in physician spending.” (Source)
The same day the president vetoed the bill, Congress overrode his veto. The measure stopped the reimbursement rate cut and will give physicians a 1.1 percent increase in 2009. (Source)
According to the Centers for Medicare and Medicaid Services (CMS), private auditors have recovered close to $700 million in improper Medicare payments to providers in six states, including New York, California, and Florida.
Eighty-five percent of overpayments was collected from inpatient hospitals, six percent from inpatient rehab facilities, and four percent from outpatient hospital providers.
CMS pays private auditors a portion of Medicare payments found to be “improper.” Is this a conflict of interest? At any rate, auditors reviewed $317 billion in Medicare claims and found that overpayments accounted for $992.7 million of the improper payments and underpayments accounted for $38 million; however, providers were able to successfully challenge 4.6 percent of those payments.