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

In a letter to Home and Community-Based Services (HCS) and Texas Home Living Providers, DADS provided guidance related to the review of DPS criminal history reports retrieved from the DPS secure web site. These reports are confidential and are intended for the exclusive use of the requesting provider. Download the six-page letter for more information.

DADS informed Home and Community Support Services Agencies (HCSSAs) providers of its authority to issue two-year HCSSA licenses and to eliminate late renewal of a license during the 90 days after its expiration. Download the letter for more information.

DADS clarified to HCSSAs information regarding tuberculosis (TB) testing requirements for HCSSAs. For example, there’s no regulatory requirement for HCSSAs to conduct employee TB screenings. For details, download the letter.

In letters to all licensed providers covered by Health & Safety Code Chapter 250, all unlicensed ICF/MRs, and all State Mental Retardation Facilities, DADS provided guidance and clarification related to the review of DPS criminal history reports by DADS Regulatory Services surveyors. Download all three letters here, here, and here.

The following information was obtained from the October 24 Texas Register:

Public Hearings

The Texas Health and Human Services Commission (HHSC) will hold public hearings on November 17, 2008, at 1:30 p.m. to receive public comment on the proposed Medicaid payment rates for several procedures and services, including Hysteroscopy with Endometrial Ablation surgery, Texas Health Steps, and Vision Devices. Beginning with this link, scroll down to read about all nine procedures and services and where to send written comments.

Proposed Rules

HHSC proposes to amend §355.509, Reimbursement Methodology for Residential Care Program, under Title 1, Part 15, Chapter 355, Subchapter E, to establish the reimbursement methodology for the Residential Care (RC) program. Specifically, it revises the rule to excuse a RC provider from submitting a cost report if the provider’s total number of Residential Care billable days of service is 366 or fewer during the provider’s fiscal year. See the relevant section of the Texas Register for more information.

HHSC proposes on behalf of the Texas Department of Aging and Disability Services (DADS) to amend the following sections: Mental Retardation Authority Responsibilities, Nursing Facility Administrators, and Contracting to Provide Primary Home Care. See this section of the Texas Register, and scroll down to read each entry.

Adopted Rules

HHSC has adopted amendments to §355.105, concerning General Reporting and Documentation Requirements, Methods, and Procedures, to establish cost reporting and documentation requirements, methods, and procedures for DADS programs for which HHSC administers rates. For details, see the relevant section of the Texas Register.

The Los Angeles Times concludes a three-part series on the health insurance system with an article that highlights the friction between providers and insurance companies. Collecting what’s owed can get expensive, as any business owner can attest. But when insurance companies delay and/or deny payments, it can effect patient care.

The Times found that consolidation of insurance companies has “created de facto monopolies,” which makes collection even more difficult. The top 10 insurance companies covered 27 percent of insured people 20 years ago. Today, four companies, including Aetna and Cigna, cover over 85 million people. This gives insurance companies leverage when deciding what to pay and what to deny and providers little power to negotiate. Consequently, doctors turn away patients and/or opt out of insurance networks. Patients end up caught up in the billing wars.

Given the rising cost of health care, development of new medical technology, and advancements in treatments, the problem likely will get worse before it improves.

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

In a letter to ICF/MR providers, DADS provided information and instructions regarding the role and responsibilities of ICF/MR Providers to maintain current and accurate ICF/MR Provider Characteristics in CARE Screen 683. This includes information on the number of vacant beds, the age ranges and genders of persons served, facility staff training, wheelchair accessibility, staff to resident ratios, and medication administration options at the facility. See the relevant web page, and download the letter for details.

DADS clarified in a letter to HCS and TxHmL providers rules in relation to the current BON statutes and rules that impact service delivery in the HCS and TxHmL waiver programs. BON rules are available here. For more information, download the two-page letter.

The Texas Department of Aging and Disability Services (DADS) released three information letters:

DADS notified DAHS in the ICM service areas about procedures for determining service initiation time frames for eligible ICM members. An excerpt:

Current DAHS program rules in §98.205(a) stipulate that the DAHS facility must initiate services within seven days of the begin date on Form 2101, Authorization for Community Care Services. The Texas Department of Aging and Disability Services (DADS) has learned that DAHS providers in the ICM service areas do not consistently receive Form 2101 in a timeframe that allows for service initiation within seven days of the authorized begin date.

Download the two-page letter for more information.

DADS informed NF and ICF/MR providers that the National Telecommunications and Information Administration is providing $40 coupons for individuals residing in NFs and ICFs/MR to offset the cost of purchasing a digital converter box. Download the letter for details.

DADS notified community service providers that it has developed a new Consumer Rights Booklet for several community service programs. Download the letter for a list of these programs and to how to obtain additional copies of the booklet.

According to a report released by the Centers for Medicare and Medicaid Services (CMS) last week, state and federal Medicaid spending will total $339 billion in 2008 and reach $674 billion by 2017. (Kaiser Network)

Why will Medicaid costs rise at a rate of 7.9 percent annually? Factors like the increased number of insured people and medical services, better and more complex care, and wage increases and inflation in the medical sector account for the rising rate.

Additionally, the number of people in the workforce is not keeping up with our ability to fund health care. Our country’s demand for more and better care must be balanced with our limited ability to privately and publicly fund this care.

Download CMS’s 40-page report in PDF.

The Wall Street Journal reports that a gap in Medicare coverage makes the hospital-to-home care swap more difficult.

Under “home-infusion therapy,” patients can receive cost-effective care in their own homes and forgo lengthy hospital stays. But Medicare doesn’t fully cover home-infusion therapy. For instance, the list of intravenous drugs has grown, and patients can get these treatments at home. Home drug administering costs between $150 and $200 a day, as opposed to $1,500 to $2,500 a day in hospitals.

Insurance companies know a cost-effective program when they see one, and many fully cover home-infusion care. Medicare Part D, however, covers only the cost of intravenous drugs. It does not cover pharmacy and nursing services, supplies, and other features that account for about half the cost of home-infusion therapy.

Part D is a drug program, so it makes sense on some level that non-drug supplies and services won’t be covered. But Russell Bodoff, president of the National Home Infusion Association, says Medicare could save money by paying for more services under home-infusion therapy.

The association commissioned a study that estimated the cost of legislation requiring Medicare Part D to cover home-infusion services: $1.5 billion over 10 years, offset by a savings of $7.4 billion, if 10 percent of infusion therapy patients receive care at home.

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

DADS informed FC and HDM providers that it has allotted funds to provide FC and HDM services to a limited number of Hurricane Ike evacuees temporarily residing in shelters hotels, or homes. For details, download the two-page letter.

DADS notified Nursing Facility providers of the TILEs to RUGs “hold harmless” feature, which is intended to ensure that no Texas Medicaid nursing facility receives a lower average Medicaid per diem payment under RUGs in state fiscal year 2009 than it received under TILE in FY 2008. Download the three-page letter for more information.

DADS informed CBA providers that the Centers for Medicare and Medicaid Services approved DADS’s request to establish a separate dental services category in the CBA program. The letter does not apply to Integrated Care Management waiver providers. Download the four-page letter for details.

The following information was obtained from the October 10 issue of the Texas Register:

Adopted Rules

The Texas Board of Nursing has adopted amendments under the following sections: General Provisions, Vocational Nursing Education, Professional Nursing Education, Licensure, Peer Assistance And Practice, and Fees. Among the amendments’ purposes:

See the relevant section of the Texas Register and scroll down to read each entry.

Public Notices

The Texas Health and Human Services Commission has adopted a new per diem Medicaid payment rate for the Truman Smith Children’s Care Center in the amount of $200.80, effective September 1, 2008. See the relevant section of the Texas Register for details.

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

The Texas Medicaid Hospice Program Standards Handbook has been revised to reflect Texas Index for Level of Effort to Resource Utilization Group changes. For more information, download the letter.

DADS notified Community Based Alternatives (CBA), Home and Community Support Services Agencies (HCSSA), and Primary Home Care Provider Agencies that it’s repealing the rule at §49.43, which was implemented in the early 1980s to expedite claims for eligible provider agencies delivering personal assistance services. For more information, download the letter.

In a letter to CBA, HCSSAs, Integrated Care Management Providers, Consolidated Waiver Program Providers, Deaf-Blind with Multiple Disabilities Providers, Primary Home Care Providers, and Service Responsibility Options Providers, DADS followed up a previous letter concerning the Office of Inspector General Review of Personal Assistance Services. DADS will implement changes to clarify duplicate billing assumptions. Download the two-page letter for more information.

In a letter to Home and Community-based Services (HCS) Providers and Texas Home Living (TxHmL) Program Providers, DADS clarified the professional disciplines considered qualified providers of behavioral support services in the HCS and TxHmL Programs. For more information, download the letter.