The Texas Department of Aging and Disability Services (DADS) issued one provider and three information letters:
- Community Services Medical Necessity (MN) and Level of Care Assessment (LOC) — Resource Utilization Group Value “BC1″
DADS notified Home and Community Support Services Agencies for Community-Based Alternatives, Consolidated Waiver Program, Integrated Care Management, and Program for the All Inclusive Care for the Elderly that it implemented a recent change in look-back periods for several fields as a result of providers obtaining a “BC1” value on Community Services MN and LOC assessments. Download the two-page letter for more information.
- 15-Passenger Van Warnings
In a letter to All Assisted Living Facilities, Adult Day Care Facilities, Nursing Facilities, and Intermediate Care Facilities for Persons with Mental Retardation or a Related Condition, DADS provided information about the risks associated with failing to use seatbelts in 15-passenger vans, fully loading them, not properly inflating their tires, as well as steps providers can take to help diminish risks. See the safety information located at the National Highway Traffic Safety Administration’s New Safety Advisory on 15-Passenger Vans Issued web page, and download the three-page letter.
- Client Abuse and Neglect Reporting System (CANRS)
DADS informed Texas Home Living and Home and Community-based Services providers that it’s making CANRS available to them so DADS can conduct pre-employment screenings of employees to find confirmed allegations of abuse, neglect, and exploitation while employed at State Schools, State Hospitals, and State Centers. Download the letter for more information.
- Medicaid Hospice per Diem and Medicaid Hospice Cap
DADS informed Medicaid Hospice Providers of approved rate changes for the Medicaid hospice program for FY 2009, effective October 1. The new cap is $22,386.15. See the new rates here and download the letter here.
From 2004 to 2007, Medicaid paid almost $198 million for over 100 unapproved prescription drugs. (Source)
Although the drugs have been on the market for decades, they haven’t been assessed by the Food and Drug Administration (FDA) for safety or effectiveness. About two percent of drugs sold in the United States have not been approved by the FDA. The agency developed tighter restrictions on drugs in the 1960s.
Critics say the FDA must compile a complete list of unapproved drugs, so that Medicaid and private insurers don’t end up paying for them. Herb Kuhn of Medicaid said, “I think this is something we ought to look at very hard, and we ought to fix it…It raises a whole set of questions, not only in terms of safety, but in the efficiency of the program — to make sure we are getting the right set of services for beneficiaries.”
In other Medicaid news, the AP reports that Idaho’s Medicaid eligibility system contains thousands of errors, because there’s no coordination between the automated computer system used to determine eligibility and the one used to process payments. (Source)
An excerpt:
According to the audit, “The last completed reconciliation was for a 13-month period and contained 23,240 errors.” More than 1,500 errors were corrected within five weeks, but more than 21,600 remained. “Based on these numbers, we estimate 400 errors and only 300 corrections occur each week, resulting in approximately 100 new errors that will not be corrected.”
A spokesperson from Idaho’s Department of Health and Welfare said the audit was based on old information.
The following information was obtained from the November 14 issue of the Texas Register:
Public Notices
The Texas Health and Human Services Commission (HHSC) will hold a public hearing on December 3, 2008, at 9:00 a.m. to receive public comment on proposed payment rates for the assisted living/residential care services under the Community Based Alternatives program, ICM Assisted Living/Residential Care program, assisted living/residential care services under the Consolidated Waiver program, Community Based Alternatives Personal Care III services, and Residential Care program.
HHSC will hold a public hearing on December 3, 2008, at 9:30 a.m. to receive public comment on proposed rates for Adjunct and Respite Nursing in the Consumer Directed Services (CDS) option in the Medically Dependent Children Program operated by the Texas Department of Aging and Disability Services (DADS). At 10 a.m. in the same location, HHSC will receive public comment on the proposed rates for Overnight Companion Services under the CDS option in the Community Based Alternatives Waiver program operated by DADS.
For more information about all three public hearings, follow this link and scroll down to read each entry.
The Texas Board of Nursing (BON) requests information from law firms or attorneys interested in representing the BON in occupational license disciplinary hearings before the State Office of Administrative Hearings. For information on the subject matter and where and how to respond, see the relevant section of the Texas Register. The deadline for responding is no later than 5:00 p.m., November 28, 2008.
Proposed Rules
BON has proposed to amend 22 TAC §211.6, pertaining to Committees of the Board. The amendment would add to the rule reflecting the establishment of the Eligibility and Disciplinary Advisory Committee, formerly known as the Eligibility and Disciplinary Committee Task Force. BON also proposes to amend 22 TAC §217.16 relating to Minor Incidents, which would provide clarification and consistency in its current “minor incident” rule with the board’s nursing peer review rules located at 22 TAC §217.19 and §217.20.
For more information about the proposed rules and where to send public comments, see the relevant section of the Texas Register.
Adopted Rules
BON adopted amendments to §221.4 and §221.6 and the repeal of §221.5, concerning Advanced Practice Nurses. The amendments and repeal align 22 TAC Chapter 221 with Chapter 305 of the Nursing Practice Act (the Advanced Practice Registered Nurse Compact) and national standards. See the relevant section of the Texas Register for details.
The Texas Department of Aging and Disability Services (DADS) released an information and a provider letter:
- Data Entry Training Class for Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) providers
DADS informed HSC and TxHmL program providers about a monthly Data Entry Training Class for 2009. The two-day class focuses on the Client Assignment and Registration System data entry, policies, and procedures of the HCS and TxHmL Waiver programs. Download the letter and two-page attachment for dates and times.
- Physical Examinations in Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR)
DADS provided guidance and clarification to ICFs/MR regarding annual physical examinations. ICFs/MR must provide or obtain preventative and general care as well as an annual physical examination for each individual. See the letter for details.
The state of California is considering temporarily stopping enrollment in the State Children’s Health Insurance Program (SCHIP) to avoid a $17.2 million deficit that will be caused by a glut of “new clients.” The state in general faces an $11.2 billion deficit. (Source)
Over 900,000 children in California receive health care through the program. The enrollment freeze would protect benefits for current enrollees and manage costs of the program. Lesley Cummings, executive director for the state’s Managed Risk Medical Insurance Board, which made the recommendation, said the freeze would go into effect on December 18.
“If the board does not cap enrollment, it would have to take other, more drastic actions later,” Cummings said. “Capping enrollment, rather than eliminating coverage that a child currently has, seems the preferable path…”
Throughout 2008, Democrats and Republicans in Congress debated and passed bills that would have expanded SCHIP. President George Bush vetoed at least two versions of the bills, citing concerns that better-off families who could afford private insurance would enroll in the program, depriving low-income children of coverage.
We have a new feature for the blog. We will be doing interviews with various people in the long term care profession about issues such as technology and associated products, legislative developments and regulatory and other legal issues on a regular basis.
Today, I present our first podcast on a technology which has been newly adapted to long term care, voice activated documentation. I interview Jim Shearon of Vocollect and AccuNurse as well as Rose Ireland of TAHSA on this subject. Please go the the icon below and click on it and the player will appear.
The Texas Department of Aging and Disability Services (DADS) released eight information letters:
- New Provider Workflow Process for Nursing Facilities (NF) and Hospices
In a letter to NFs and hospice providers, DADS informed them about the “Provider Action Required” status displayed for a form in the LTC Online Portal. The form history will include a detailed descriptive message that informs the provider of the error and will indicate what actions are required to correct or update the form for continued processing. Download the letter for more information.
- Specialized Services and Rehabilitative Services in the Medicaid Nursing Facility Program
DADS informed NFs that beginning November 1, 2008, it will only reimburse a nursing facility for specialized and rehabilitative services delivered to an eligible Medicaid recipient residing in a Medicaid nursing facility. Download the three-page letter and chart for more information.
- New Provider Workflow Process for Community Waiver Providers
DADS informed Community Based Alternatives, Home and Community Support Services Agencies (HSC), Consolidated Waiver Programs, Program of All-Inclusive Care for the Elderly, State of Texas Access Reform Plus, and Integrated Care Management providers that it will implement system enhancements to the Texas Medicaid & Healthcare Partnership Long Term Care Online Portal to include a Provider Workflow. Download the letter for details.
The following information was obtained from the November 7 issue of the Texas Register:
The Texas Health and Human Services Commission (HHSC) will hold a public hearing on November 25, 2008, at 1:30 p.m., to receive public comment on proposed Medicaid payment rates for electric patient lifts related to Home Health Mobility Aids medical policy changes, in the Lone Star Conference Room of HHSC, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas.
Proposed rates under consideration:
- L-E0635: Current Rate = $121.76, Proposed Rate = $122.36; J-E0635: Current Rate = $1,565.42, Proposed Rate = $1,223.60; and J-E0635-TG (enhanced features): Current Rate = Not a Benefit; Proposed Rate = Manually Priced.
HHSC will hold a public hearing on November 21, 2008, at 1 p.m., to receive public comment regarding a proposed amendment to 1 TAC §355.8052, Inpatient Hospital Reimbursement, whose purpose is to clarify that the intent of the fiscal year 2009 rebasing is contingent on the federal approval and implementation of the Medicaid Reform Waiver and availability of state funds for that purpose.
The public meeting will be held in the Lone Star Conference Room, in Building H of the Braker Center, at 11209 Metric Boulevard, Austin, Texas.
HHSC has issued a public notice announcing its intent submit an amendment to the Medically Dependent Children Program waiver, which is a Medicaid Home and Community-Based Services waiver under the authority of §1915(c) of the Social Security Act.
For more information about the two hearings and the public notice, follow this link and scroll down to read each entry.
Earlier this year, the Bush administration sought to prevent the expansion of the State Children’s Health Insurance Program (SCHIP). The president twice vetoed versions of the bill that would have expanded the program amid concerns that parents who could afford private insurance would seek coverage under SCHIP, depriving low-income children of coverage.
Unable to override a presidential veto, Democrats decided to not pursue efforts to renew and expand SCHIP. With a Democrat in the White House and larger majority in Congress, the tide has turned. Last week, Speaker of the House Nancy Pelosi said that the Democrat-majority Congress would seek to pass measures blocked by the Bush administration, including the expansion of SCHIP and using taxpayers’ money to fund embryonic stem cell research. (Congress Daily)
The new Congress will decide whether to attach legislation to renew and expand SCHIP to a larger bill or draft a separate bill.
Incidentally, the Government Accountability Office recently studied the issue and concluded the administration violated federal law when it prevented states from expanding SCHIP, because it did not follow the rule-making process.
The following information was obtained from the October 31 issue of the Texas Register:
Public Hearings
The Texas Health and Human Services Commission (HHSC) will hold a public hearing on November 17, 2008, at 1:30 p.m., to receive public comment on proposed Medicaid payment rates for maternity service clinics, in the Lone Star Conference Room of HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.
HHSC will hold a public rate hearing on November 21, 2008, at 9:00 a.m., to receive public comment on proposed Medicaid payment rates for Rural Health Clinics and Federally Qualified Health Clinics. The hearing will take place in the Palo Duro Canyon Conference Room of the Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.
HHSC announced its intent to submit an amendment to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would modify the reimbursement methodology in the Texas Medicaid State Plan for clinical diagnostic laboratory services.
For more information about both hearings and the intent to submit announcement, follow this link and scroll down to read each entry.
Proposed Rules
The Texas Medical Board proposes amendments to six sections of the rules: Licensure, Physician Registration, Temporary And Limited Licenses, Physician Profiles, Physician Assistants, and Procedural Rules. For more information about the proposed rules for each section, see the relevant section of the Texas Register.
Withdrawn Rules
The Texas Medical Board has withdrawn the proposed amendment to §187.18.