The following information was obtained from the September 26 issue of the Texas Register:
The Texas Health and Human Services Commission announced its intent to submit Amendment 20 to the Texas State Plan for the State Children’s Health Insurance Program (SCHIP) under Title XXI of the Social Security Act, effective October 1, 2008. The amendment would exempt people who did temporary work for the Census Bureau from including this income to determine Medicaid and Temporary Assistance to Needy Families programs eligibility. See the relevant section of the Texas Register for more information.
On Wednesday, October 1, TAHSA is hosting its first webinar training. In the comfort of your office or home, you can learn about coming trends in technology in long term care.
You may register by going here.
Earlier this month, the Kaiser Network reported that House Democrats were considering a bill to add billions more in Medicaid reimbursements as part of a second economic stimulus package they’d hoped to pass before Congress adjourns this month. Kaiser reported late last week that House Democrats proposed a package of $61 billion (some sources report $56 billion), with $13 billion set aside for Medicaid.
Their counterparts in the Senate proposed a $56.2 billion package that would provide additional funding for Medicaid, but Senate Republicans blocked the measure. They contend the package is too expensive and won’t stimulate the economy.
Will bailout bill debates derail further action on the stimulus bills? Most likely.
The following information was obtained from the September 19 issue of the Texas Register:
Proposed Rules
The Texas Medical Board has proposed amendments to nine sections of the rules, including Medical Records, Authority of Physicians to Buy Drugs, Complaints, and Investigations. Follow this link and scroll down to read each entry.
The Texas Health and Human Services Commission (HHSC) proposed to amend §97.3, concerning license fees; §97.17, concerning application procedures for a renewal license; §97.25, concerning application procedures and requirements for change of ownership; and §97.31, concerning time frames for processing and issuing a license, in Chapter 97, Licensing Standards for Home and Community Support Services Agencies.
The amendments would implement portions of Senate Bill 1318, 80th Legislature, Regular Session, 2007, which, in part, amended Texas Health and Safety Code, §142.0105.
HHSC also proposes to amend §98.15, concerning renewal procedures and qualifications; §98.21, concerning license fees; and §98.82, concerning determinations and actions pursuant to inspections; and proposes new §98.63, concerning peer review, in Chapter 98, Adult Day Care and Day Activity and Health Services Requirements. The amendments would implement portions of Senate Bill 1318, 80th Legislature, Regular Session, 2007. See the relevant section of the Texas Register for details on the proposed amendments.
Adopted Rules
HHSC has adopted an amendment to §354.1863, Prescription Requirements, under Title 1, Part 15, Chapter 354, Subchapter F, Division 4, relating to the new federal requirement that written prescriptions for covered outpatient drugs for Medicaid recipients must be executed on tamper-resistant prescription pads. The Centers for Medicare and Medicaid Services issued implementation guidance to State Medicaid Directors.
HHSC adopted amendments to §372.2, concerning the meaning of words and terms used in the chapter; §372.404, concerning income HHSC counts when determining eligibility for Temporary Assistance for Needy Families (TANF); §372.753, concerning the difference in determining eligibility for the TANF State Program (TANF-SP) as compared to the TANF Program; and §372.754, concerning the difference in determining the amount of benefits in TANF-SP as compared to the TANF Program. The amendments reflect changes authorizing HHSC and the Attorney General to increase monthly child support payments.
See the relevant section of the Texas Register for more information about the amendments.
Public Notices
HHSC has adopted new per diem payment rates for the nursing facility program operated by the Texas Department of Aging and Disability Services. HHSC also announced its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, to reflect Medicaid fee changes for services provided by doctors and other practitioners, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, and Family Planning Services. See the relevant section of the Texas Register for more information.
The Texas Department of Aging and Disability Services (DADS) issued two provider and three information letters:
- Survey About Vehicles Used for Transportation of Individuals
DADS requested that Assisted Living Facilities (ALFs) participate in a survey of providers regarding vehicles used to provide transportation of individuals enrolled in DADS programs. The deadline is October 1, 2008. Here is a direct link to the survey. Download the letter for more information.
- Regulatory Compliance Issues Related to Hurricane Ike
DADS informed Intermediate Care Facilities for Persons with Mental Retardation or a Related Condition, Nursing Facilities (NFs), ALFs, Adult Day Care Providers, and Home and Community Support Services Agencies of its flexibility in regulatory and enforcement programs to accommodate the emergency needs of consumers and providers in the wake of Hurricane Ike. Download the two-page letter for more information.
- Consumer Directed Services (CDS) and Dental Service Adjustments
DADS informed Deaf Blind with Multiple Disabilities Providers (DBMD) and CDS Agencies that effective October 1, 2008, the DBMD program will implement the new Financial Management Services reimbursement methodology adopted by the Texas Health and Human Services Commission for the CDS option. Download the two-page letter for more information.
- Requesting Providers to Complete Online Survey Relating to Transportation Practices
DADS requests that Home and Community-based Services Providers and Texas Home Living Program Providers complete an online survey relating to transportation practices. The deadline is October 3, 2008. View the survey here, and download the letter here.
- NF Enhanced Direct Care Staff Rate — State Fiscal Year 2009 Optional Worksheets Incorporating Both TILEs and RUGs
DADS notified NF providers that it posted Rate Analysis website optional worksheets for use in estimating compliance with Staffing and Spending Requirements under the Enhanced Direct Care Staff Rate for SFY 2009. Download the two-page letter for more information.
Last year, the Congressional Budget Office estimated that Medicaid spending would increase by $10 billion from 2008 to 2012 and by $23 billion from 2008 to 2017, under a so-called comprehensive immigration reform bill that failed to pass Congress.
Three years earlier, the Government Accountability Office reported that the cost of caring for illegal aliens is difficult to track, for obvious reasons. Those in the country in violation of U.S. immigration law can and likely do use phony or stolen Social Security numbers. Many are treated in emergency rooms and “forget” to leave Social Security numbers. (Kaiser Network)
A professor of health care policy noted that “uncompensated care” for illegal aliens may be much lower than perceived. In 2000, $1.1 billion in government money was spent on illegal aliens for health care, according to RAND. Total spending on illegal aliens was about $6.5 billion. The study also claims illegal aliens use fewer services because they have no health insurance, are generally in better health, lack English skills, and fear deportation.
In related news, a federal program that reimburses states that provide medical care to illegal aliens will expire by the end of this month. Hospitals in the border state of Arizona have asked Congress to renew the program.
The Kaiser Network wrote about a Washington Post story on how hospitals are dealing with nursing shortages.
While nurses can command top salaries because of shortages, some providers are luring them by streamlining paperwork, implementing technology, and giving nurses more authority. Hospitals have figured out that financial incentives and perks have unintended consequences. Some nurses work long enough to collect the money and perks, then leave. An excerpt:
Inova Fairfax recently introduced a state-of-the-art data system — consisting of video monitors and other equipment that track the vital signs of intensive care patients — to reduce the amount of time nurses spend filling out paperwork. It also has established a concierge that offers such services as dry cleaning, movie tickets and car detailing for busy nurses trying to juggle their professional and personal lives.
Inova is part of a nationwide movement. These days, nurses at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., for instance, set their own schedule and have a say in what type of equipment should be purchased and whether patient-staff ratios need to be adjusted.
Baby boomer nurses are set to retire, and things could get crucial by 2025 when open nursing jobs may reach a million. Ironically, more baby boomers will need nursing services by then.
The Texas Department of Aging and Disability Services (DADS) issued three information letters:
- Utilization Review of Individual Service Plans (ISPs)
DADS sent a letter to Deaf Blind with Multiple Disabilities Providers with an attachment that provides specific information regarding utilization review thresholds. These providers developed criteria to fully implement this review requirement, effective November 1, 2008. Download the letter and attachment here.
- Reminder — Fiscal Year 2008 (FY08) Critical Incident Data Completion
DADS reminded Intermediate Care Facilities for Persons with Mental Retardation of the requirement to complete the Critical Incident Data as it pertains to their facilities for FY08. Unreported data for FY08 should be entered no later than October 3, 2008. For more information, download the two-page letter.
- Notification of the Availability of Revised Individual Plan of Care (IPC) Forms
DADS informed Home and Community-based Services (HCS) Providers, Texas Home Living (TxHmL) Program Providers, and Mental Retardation Authorities that revised IPC forms are available on the DADS web site at:
Download the letter for more information.
Democrats in Congress may give states billions more in Medicaid reimbursements as part of a second economic stimulus package they hope to pass before Congress adjourns this month. (Kaiser Network)
Proponents seek to make sure recipients aren’t “kicked out” of the Medicaid program and the State Children’s Health Insurance Program and may require states to agree not to cut eligibility. At the same time, proponents aim to deal with budget deficits, which 29 states will face in 2009. As a result, some of these states will cut health care spending.
In other Medicaid news, two prominent Democrats sent a letter to President Bush, advising him to reject a Medicaid regulation they say would result in $350 million in lost funding for 400,000 recipients in New York. (Kaiser Network)
Senators Hillary Clinton and Chuck Schumer wrote that the law “would have an unacceptable impact on care and treatment for the low-income families that are in the greatest need of specialized health care services.”
The Bush administration contends the regulation is designed to prevent Medicaid reimbursements for abuses in the system. Jeff Nelligan, spokesman for the Centers for Medicare and Medicaid Services, said, “This rule enhances the integrity of the Medicaid program, ensuring that the services provided [to] our Medicaid recipients are effective and that taxpayers are receiving the full value of the funds spent on Medicaid…”
The Texas Department of Aging and Disability Services (DADS) issued one provider letter and two information letters:
- Facility Inventory, Vacancy and Evacuation Status (FIVES) Application
DADS reminded all provider types that DADS wants facilities to update their number of vacancies and evacuation information in the FIVES application every day during the five days before and after a hurricane. Visit the FIVES web page, and download the provider letter here.
- Notification of documentation required to show compliance with Occupations Code, §301.353 and 22 Texas Administrative Code (TAC), Chapter 217, §217.11(2)
DADS notified Medically Dependent Children Program (MDCP) Independent Licensed Vocational Nurse Providers that they are required to present documents that show compliance with Occupations Code, §301.353 and 22 TAC, Chapter 217, §217.11(2). Any licensed vocational nurse who contracts DADS to provide services to individuals in MDCP must submit Form 2404, effective September 4, 2008. Download the letter for more information.
- Utilization Review of Individual Service Plans (ISPs)
DADS informed Community Living Assistance and Support Services (CLASS) Providers that DADS is required by the Texas Legislature to “employ utilization management and utilization review practices as necessary to ensure that the appropriate scope and level of services are provided to individuals receiving services in 1915(c) waivers.”
Consequently, CLASS staff will be required to review ISPs with costs over 100 percent “of the estimated annualized per capita cost of providing services in an Intermediate Care Facilities Serving Persons with Mental Retardation or a Related Condition (ICF/MR) to an individual qualifying for an ICF/MR Level of Care VIII, which is $57,368.04.”
Download the two-page letter for more information.