The following information was obtained from the August 15 and August 22 issues of the Texas Register:

Adopted Rules

HHSC adopted amendments to §355.307, Reimbursement Setting Methodology, §355.308, Direct Care Staff Rate Component, and §355.311 Medicaid Reimbursement Rates for State Veterans Homes, which will establish the reimbursement methodology for the Nursing Facility program, including Medicaid reimbursement rates for state veteran’s homes. See the relevant section of the Texas Register for details.

HHSC adopted a new §354.1189, concerning the implementation of an acute care Medicaid billing coordination system. The new section will implement §531.02413, Government Code, Billing Coordination System. This section will require HHSC to put into practice an acute care Medicaid billing coordination system for the fee-for-service and primary care case management delivery models. See the relevant section of the Texas Register for more information.

HHSC also adopts amendments to §355.8061, concerning payment for hospital services, and §355.8069, concerning supplemental payments to certain rural public hospitals, in Title 1, Part 15, Chapter 355, Subchapter J, Division 4, concerning Medicaid Hospital Services. The amendments 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.

Public Notices

HHSC intends to submit to the Centers for Medicare and Medicaid Services an amendment to the Community Living Assistance and Support Services (CLASS) waiver program, which sets the waiver cost limit for an individual in the CLASS program at 200 percent of the cost of serving similar individuals in an Intermediate Care Facility for Individuals with Mental Retardation. See the relevant section of the Texas Register for more information.

On September 1, 2008, changes within Appendix PP of the State Operations Manual become effective. The changes involve deleting F326 and incorporating that tag’s guidance into F325 and deleting F370 and incorporating it into F371. However, the changes are voluminous compared to what exists now.

You may find the changes here, comprising 58 pages. The old sections are here and here.

The changes concern nutrition, therapeutic diets, approved food sources and food sanitation. Be ready.

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

• Specialized Services and Rehabilitative Services in the Medicaid Nursing Facility Program

The Texas Department of Health and Human Services and DADS informed Nursing Facility and Therapy Providers contracted with DADS that the Texas Medicaid Program can reimburse only nursing facilities - not outside therapy providers - for specialized and rehabilitative services delivered to Medicaid clients residing in a nursing facility. Download the two-page letter for more information.

• Behavioral Support Services

DADS informed all Community Living Assistance and Support Services Providers that effective September 1, 2008, the previously labeled service type “Psychological Services” will change to “Behavioral Support.” From the letter:

Board-certified Behavior Analysts (BCBA) have been added to the list of qualified providers able to provide this service. Psychological Services may continue to be provided by previously qualified providers and billed as Behavioral Support.

You may download the letter here.

The Kaiser Family Foundation has released a report on the costs and consequences of the Medicare Part D coverage gap in 2007.

The coverage gap, also called the “doughnut hole,” is the period of time during the year when a beneficiary is not covered and is responsible for paying drug costs out of pocket.

The Kaiser study “quantifies…the number of Medicare Part D plan enrollees in 2007″ who reached the doughnut hole. The study does not include low-income beneficiaries who received subsidies.

According to the study, one in four Part D enrollees reached the coverage gap last year. Kaiser extrapolated that 3.4 million beneficiaries reached the doughnut hole and faced paying the full cost of their prescription drugs. This resulted in some beneficiaries altering their use during the gap. For example, 15 percent stopped taking drugs for their conditions and 5 percent used different drugs.

Download the 38-page report (PDF).

The Centers for Medicare and Medicaid Services (CMS) announced last week that a pilot pay-for-performance program, which pays doctors based on quality of care, has lowered costs “in some cases” and improved quality of care for patients with congestive heart failure, coronary artery disease, and diabetes.

According to CMS, four of the 10 groups participating in the program reduced costs to patients and CMS spending by $17.4 million.

Kerry Weems, acting administrator for CMS, said, “We are paying for better outcomes and we are getting higher quality and more value for the Medicare dollar. And these results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians.”

The Centers for Medicare and Medicaid Services (CMS) has announced that payment rates for nursing homes will increase by $780 million next year. (Source)

The payment increase (3.4 percent) is the result of a recalibration of the annual market basket calculation. CMS acting administrator Kerry Weems said CMS was “committed to providing high quality care to those in skilled nursing facilities and to paying those facilities properly for that care” and assures that CMS will continue evaluating the data for future adjustments.

In other Medicare news, CMS reports that costs for Medicare Part D are lower than expected. The average monthly premium for Part D will be $28 in 2009, about 37 percent lower than projected when Part D was established in 2003. (Source)

CMS reports that beneficiaries are satisfied with the program. A survey conducted by Harris Interactive also found that a majority of beneficiaries were satisfied with the program.

The Texas Department of Aging and Disability Services (DADS) issued ten information letters between August 1st through the 14th:

• Home Delivered Meals Rate Setting Procedures for Federal Fiscal Year 2009 (two-page letter)
• Changes to the Quality Assurance Fee Program for ICF/MR Providers (three-page letter)
• Wheelchair Requests for Nursing Facility Residents (two-page letter)
• Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (two-page letter)
• Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (ICF/MR Providers, Service Group 6) (two-page letter)
• Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (ICF/MR Providers, Service Group 5) (two-page letter)
• Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (HCS and TxHmL) (two-page letter)
• Expansion of the Consumer Directed Services Option to Nursing and Professional Therapies-New Form 3671-C Alternate and Revised 3671-B (two-page letter)
• Billing for Specialized Nursing — Interim Procedure (two-page letter)
• Revision of Living Options Client Assignment and REgistry Screen and Additional Review Responsibilities (two-page letter)

The following information was obtained from the August 8 issue of the Texas Register:

Public Hearings

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on August 25, 2008, at 1:30 p.m., to receive public comment on 440 proposed Medicaid payment rates for physician-administered drugs and biologicals and 10 proposed Medicaid payment rates for durable medical equipment covering the Augmentive Communication Devices. See the relevant section of the Texas Register for meeting location.

Proposed Rules

The Texas Board of Nursing proposes amendments to the following sections:

• General Provisions
• Vocational Nursing Education
• Professional Nursing Education
• Licensure, Peer Assistance And Practice
• Advanced Practice Nurses
• Fees

For details about the amendments, follow this link and scroll down to read each entry.

On behalf of the Texas Department of Aging and Disability Services (DADS), HHSC proposes amendments to §19.208, concerning renewal procedures; and §19.216, concerning license fees, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification.

HHSC also proposes amendments to §§97.245 - 97.247, 97.249, 97.250, 97.282, 97.283, 97.501, 97.507, 97.525, and 97.527, concerning staffing policies, personnel records, verification of employability of unlicensed persons, reportable conduct, investigations, client conduct and responsibility and client rights, advance directives, survey frequency, agency cooperation with a survey, survey procedures, and post-survey procedures; new §97.502 and §97.602, concerning state agency investigations of complaints and self-reported incidents and administrative penalties; and the repeal of §97.602, concerning administrative penalties, in Chapter 97, Licensing Standards for Home and Community Support Services Agencies.

Follow this link and scroll down for information about both entries.

Adopted Rules

HHSC adopts the repeal of §352.10, concerning Quality Assurance Fee for the Home and Community-based Services and Community Living Assistance and Support Services, and adopts an amendment to §355.114, concerning Consumer Directed Services Payment Option. See the relevant sections of the Texas Register for more information.

DADS has issued a public notice about procuring services by Area Agencies on Aging. Download the list of area agencies here (PDF - seven pages), and see the relevant section of the Texas Register for more information.

Medicare Part D isn’t even three years old, and a lawmaker already wants to replace it.

Congressman Dennis Kucinich, a Democrat from Ohio, introduced a measure that would replace Medicare Part D with a new program ostensibly to lower costs. According to the bill, Medicare would negotiate directly with drug companies for prescription drug discounts and do away with co-payments, premiums, and deductibles. (CQ Politics)

In a statement, Kucinich said, “The privatized drug plan has been given a chance and, as predicted, it has failed. There is no reason for us to keep throwing money at a bad idea when we know we can save taxpayers billions of dollars and give seniors the medication they need.”

Drugs bought through Part D cost 30 percent more than drugs bought through Medicaid.

Part D beneficiaries themselves don’t seem to have problems with the drug program. According to a Harris Interactive study, 87 percent of beneficiaries said they were “happy” with the plan, and three-quarters said the plan helped them save money.

The following information was obtained from the August 1 of the Texas Register:

Public Hearings

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on August 18, 2008, at 1:30 p.m. to receive public comment on the proposed increase in Medicaid payment rates for seven procedure codes, including Breast Brachytherapy and THSteps Therapeutic Dental Services. Follow this link and scroll down to read each entry.

Proposed Rules

On behalf of the Department of Aging and Disability Services, HHSC proposes several changes to the rules in the following sections:

• Mental Retardation Authority Responsibilities
• Pilot Program To Increase The Use Of Advance Directives In Nursing Facilities And Intermediate Care Facilities For Persons With Mental Retardation
• Consumer Directed Services Option
• Service Responsibility Option
• Client Managed Personal Attendant Services Co-Payment Determination
• Intermediate Care Facilities For Persons With Mental Retardation Or Related Conditions
• Licensing Standards For Assisted Living Facilities

For details about proposed amendments and repeals, follow this link and scroll down to read entries for each section.

Withdrawn Rules

The Texas Medical Board has withdrawn proposed amendments to §182.8, concerning Expert Panel and §193.6, concerning Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses. See the relevant section of the Texas Register for more information.

Adopted Rules

The Texas Medical Board has adopted amendments to the following sections:

• General Provisions
• Licensure
• Physician Registration
• Authority Of Physicians To Supply Drugs
• Postgraduate Training Permits
• Temporary And Limited Licenses
• Surgical Assistants
• Standing Delegation Orders

For details about proposed amendments, follow this link and scroll down to read entries for each section.

HHSC adopted amendments to §§19.101, 19.403, 19.701, 19.2004, and new §19.706, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification. See the relevant section of the Texas Register for more information about the changes.

HHSC has issued a series of public notices, which includes correcting a typographical error in the Public Notice regarding HHSC’s intent to submit an amendment to the Texas State Plan for Medical Assistance and a notice of intent to renew a consultant contract. Follow this link and scroll down to read each entry.