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

• TILEs to RUGs Training Information

DADS informed Nursing Facility Providers, Hospice Providers, Community Based Alternatives Home and Community Support Services Agencies, Consolidated Waiver Programs, Program of All-Inclusive Care for the Elderly, State of Texas Access Reform Plus, and Integrated Care Management Providers about the transition from Texas Index for Level of Effort (TILE) to the federal Resource Utilization Group (RUG-III). Transition will occur on September 1, 2008.

DADS is offering online training to providers. Download the two-page letter for more information.

• Money Follows the Person CBA Demonstration Service; Overnight Companion Services (OCS)

DADS informed Home and Community Support Services Agency Community Based Alternatives Providers in Cameron, Hidalgo and Willacy Counties, about new services in The Money Follows the Person (MFP) initiative. An excerpt of the three-page letter:

Effective May 1, 2008, eligible CBA MFP Demonstration participants residing in Cameron, Hidalgo and Willacy counties may access a new demonstration service, overnight companion services (OCS), to assist in their relocation from institutional to community living. OCS will be offered annually to up to 20 participants. OCS provide 8-12 consecutive hours during a 24 hour period of available, direct support and assistance in the individual’s home during normal sleeping hours, not restricted to normal nighttime hours.

For more details, download the letter.

According to a recent Government Accountability Office (GAO) report, Medicare Advantage (MA) plans can cost more than traditional Medicare for certain services like home health care, nursing homes, and certain hospital stays. (Kaiser Network)

Under MA plans, the government pays a subsidy to private insurance companies to offer such plans, whose purpose is to keep premiums very low. In light of the GAO’s findings, the Centers for Medicare and Medicaid Services announced that it will collect additional data on private MA plans.

Democrat and House Ways and Means Health Subcommittee Chair Peter Stark and other members of his party believe reimbursement reductions are in order. “I see no reason that they have to be grossly overpaid and under-regulated.”

Republican Rep. Dave Camp (pictured above) didn’t hold back in his criticism of the report. “Clearly it’s a fake report with fake conclusions, and we’re having a fake hearing on it so we can all run to the media and make certain pronouncements…The report only looks at hypothetical beneficiaries, who use only certain types of services and enroll in a narrow selection of plans.”

Go to the GAO’s web site to download the 12-page report and/or read the abstract.

Since December 11, the Texas Department of Aging and Disability Services (DADS) has issued provider and information letters to the following:

Nursing Facilities

• Authority to Make Health Care Decisions (letter)
• Rules and Regulations Concerning Provider Continuing In-service Education for Certified Nurse Aides (letter)

Home and Community Support Services Agencies

• Medicare Treatment Consent Requirements (letter)

Primary Home Care and Community Attendant Services Providers

• Supervisory Visit Requirements (letter)

Home and Community-based Services Providers, Texas Home Living Providers, and Mental Retardation Authorities

• Transfer and Billing information related to the Client Assignment and Registration System conversion for the implementation of Consumer Directed Services (letter)

Most Providers

• Second Notice of Tentative DADS Payment System Downtime for All Payments including those to Long Term Care Providers (letter)

As of September 1, 2007, a change has been effected in the Texas Health & Safety Code regarding transport of patients by stretcher:

SECTION 14. (a) Subsection (a), Section 773.004, Health
and Safety Code, is amended to read as follows:
(a) This chapter does not apply to:
(1) [a ground transfer vehicle and staff used to
transport a patient who is under a physician’s care between medical
facilities or between a medical facility and a private residence,
unless it is medically necessary to transport the patient using a
stretcher;
[(2)] air transfer that does not advertise as an
ambulance service and that is not licensed by the department;
(2) [] the use of ground or air transfer vehicles
to transport sick or injured persons in a casualty situation that
exceeds the basic vehicular capacity or capability of emergency
medical services providers in the area;
(3) [(4)] an industrial ambulance; or
(4) [(5)] a physician, registered nurse, or other
health care practitioner licensed by this state unless the health
care practitioner staffs an emergency medical services vehicle
regularly.
(b) Section 773.041, Health and Safety Code, is amended by
adding Subsection (a-1) to read as follows:

(a-1) A person may not transport a patient by stretcher in a
vehicle unless the person holds a license as an emergency medical
services provider issued by the department in accordance with this
chapter. For purposes of this subsection, “person” means an
individual, corporation, organization, government, governmental
subdivision or agency, business, trust, partnership, association,
or any other legal entity.

(c) Not later than May 1, 2008, the executive commissioner
of the Health and Human Services Commission shall adopt the rules
necessary to implement the changes in law made by this section to
Chapter 773, Health and Safety Code.

As the Bill Analysis demonstrates, this does away with the exemption for transport between medical facilities or medical facility and home, and requires a license as an emergency medical services provider issued by the Department of State Health Services (DSHS). I’ll update this when the rules come out.

The Texas Department of Aging and Disability Services (DADS) informed Community Living Assistance and Support Services (CLASS), Case Management Agencies, and Direct Services Agencies that before CLASS enrollment can be finalized, an applicant’s enrollment in other community service programs, including Personal Care Services, must end.

For more information, download the letter here.

In a provider letter to Home and Community Support Services Agencies (HCSSA), DADS clarified the Informal Review of Deficiencies (IRoD) process (formerly known as the Informal Review of Violations).

The IRoD, an informal, administrative process, applies to all licensed and Medicare-certified HCSSA. For more information, download the four-page letter here.

The Texas Department of Aging and Disability Services (DADS) issued a provider letter to Nursing Facilities and Hospitals Seeking Medicare Certification for a Skilled Nursing Care Unit to inform them about new policy documents issued by the Centers for Medicare and Medicaid Services (CMS) regarding workload prioritization on initial certification surveys.

Attached to the two-page letter is a two-page Q&A memo. Download the letter and attachment here for more information.

CMS published the final Calendar Year 2008 Medicare Home Health Prospective Payment System (PPS) rule on August 29, 2007. This final rule requires changes to Outcome and Assessment Information Set (OASIS-B1) data set, and DADS notified Medicare-certified Home Health Agencies of these changes. See the OASIS-B1 page for more information. You may download the provider letter here.

The Texas Department of Aging and Disability Services (DADS) notified all Long Term Services and Supports Providers about tentative plans for late-January Health and Human Services Commission system changes that will affect all claim payments. Because of a system upgrade, claims will not be paid between January 24 and February 6, 2008. For more information, download the letter here.

DADS notified Home and Community-based Services (HCS), Texas Home Living (TxHmL) Service Providers, and Mental Retardation Authorities about training on the Consumer Directed Services (CDS) option. CDS is scheduled to be implemented in early 2008. For a list of training dates and locations, download the letter here.

DADS informed HCS and TxHmL providers that there will be no claims payment processing on December 21, 2007, because of state holiday closures on December 24, 25, and 26, 2007. The processing schedule will resume on December 28, 2007. Download the letter for more information.

The Texas Department of Aging and Disability Services (DADS) informed all Home and Community-based Services (HSC) and Texas Home Living Program (TxHmL) Contractors about a new policy that seeks to ensure these contractors comply with Deficit Reduction Act of 2005 (Section 6032) requirements to educate employees, contractors, and agents about federal and state fraud and false claims laws, and whistleblower protections laws, effective January 1, 2007.

The policy applies to HSC and TxHmL contractors that meet or exceed $5 million in annual Medicaid payments. For more information, download the four-page letter here.

The Texas Department of Aging and Disability Services (DADS) issued a letter to Community Based Alternatives and Assisted Living/Residential Care Providers to inform them about Personal Care 3 Reimbursement Rates. These rates became effective on September 1, 2007. For more details, download the letter here.

DADS informed the Medically Dependent Children Program and Home and Community Support Service Agencies about increases in provider rates. New rates and billing codes can be accessed here and here. Download the information letter here.

In a provider letter to all Medicare- and/or Medicaid-Participating Nursing Facilities, DADS clarified Life Safety Code Enforcement Guidelines. Specifically, federal nursing home regulations at 42 Code of Federal Regulations Part 488, Subpart F, are applicable to Life Safety Code surveys as well as health surveys. For information on the process to be used in applying the enforcement regulations, download the letter here.

There has been a rate increase for providers of Home and Community-based Services and Texas Home Living Waiver Services, effective September 1, 2007. See the new rates here and here. You may download the letter for more information.

In a letter to Nursing Facilities, the Texas Department of Aging and Disability Services (DADS) alerted these providers to changes in the code required by Senate Bill 344, passed by the 80th Legislature, Regular Session, 2007. Changes to Section 242.0336, Temporary Change of Ownership (CHOW) License, include:

• The Department of Aging and Disability Services (DADS) may not issue a temporary NF CHOW license prior to the 31st day after receiving (1) the application from the CHOW license applicant and (2) written notification from the current license holder of the license holder’s intent to transfer operation of the facility to the license applicant.
• If DADS does not receive the CHOW application and the written notification from the current license holder at least 30 days prior to the CHOW effective date requested in the application, the effective date of the temporary NF CHOW license is the 31st day after the date DADS receives both the application and the written notification from the current license holder.
• DADS is required to issue or deny a temporary NF CHOW license no later than the 31st day after receipt of the completed application.

Download the letter to read about other changes.

DADS informed Home and Community-Based Services Providers, Texas Home Living Program Providers, Community Living Assistance and Support Services Providers, Case Management Agencies, Direct Services Agencies, and Deaf Blind Multiple Disabilities Providers that new convictions barring employment were added to the Health and Safety Code Chapter 250.

For more information about these additions, download the letter here.