The following information was obtained from the May 2 issue of the Texas Register:
Open Meetings
The Texas Health and Human Services Commission (HHSC) will hold a series public hearings on May 19, 20, and 23 concerning Medicaid reimbursement rates for various providers. For times and locations, please follow this link and scroll down for more information about each hearing.
Proposed Rules
HHSC has proposed to repeal §352.10, Quality Assurance Fee for the Home and Community-based Services and Community Living Assistance and Support Services waiver programs, under Title 1, Part 15, Chapter 352.
HHSC also proposed amendments to §355.105, concerning General Reporting and Documentation Requirements, Methods, and Procedures, which would establish cost reporting and documentation requirements, methods and procedures for all Department of Aging and Disability Services programs for which the HHSC administers rates. For more information about both proposed rules, see the relevant section of the Texas Register.
The Texas Board of Nursing has proposed to amend 22 Texas Administrative Code §213.12 regarding Witness Fees and Expenses, which would allow a witness who has been subpoenaed by the Board or a party to a proceeding of the Board’s to receive adequate reimbursement for their mileage. The Board also proposes to amend 22 Texas Administrative Code §223.1 regarding Fees, to reduce the renewal fees for Registered and Vocational Nurses from $67 to $65 and from $58 to $55, because of a $4.75 reduction in the fee for an FBI fingerprint-based criminal background check and the increased income from a higher number of RNs and LVNs renewing their licenses.
See the relevant section of the Texas Register for more information.
Adopted Rules
HHSC has adopted new §355.310, concerning the reimbursement methodology for customized power wheelchairs and associated physical or occupational therapy evaluations for qualified Texas nursing facility residents. The new rule lays out the reimbursement methodology.
The Texas Board of Nursing had adopted the repeal of 22 Texas Administrative Code §217.19 (Incident-Based Nursing Peer Review), and §217.20 (Safe Harbor Peer Review for Nurses), because of changes to the peer review process. See the relevant section of the Texas Register for more information.
The Texas Department of Aging and Disability Services (DADS) released three new information letters:
- Helpful Nursing Facility Provider Information for the TILEs to RUGs Transition
DADS informed Nursing Facility and Hospice Providers about the September 1, 2008, transition from the Texas Index for Level of Effort (TILE) to the federal Resource Utilization Group (RUG). DADS says it is essential for providers to monitor future updates on the Texas Medicaid & Healthcare Partnership website at www.tmhp.com or the DADS Provider Communications website:
http://www.dads.state.tx.us/providers/communications/index.cfm
Download the four-page letter and attachment for more information.
- Helpful Community Services Provider Information for the TILEs to RUGs Transition
In a letter to 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, DADS informed these providers about the September 1, 2008, transition from the Texas Index for Level of Effort (TILE) to the federal Resource Utilization Group (RUG). Download the letter for more information.
- Provider Clarification to Rule §9.223, Review of Living Options
DADS clarified the responsibilities for Intermediate Care Facility for Persons with Mental Retardation Providers and Mental Retardation Authorities under Rule §9.223, Review of Living Options in a two-page letter. You may find the rule here.
According to DADS, providers must discuss living options with each individual and legally authorized representative, and document the discussion. For more information, download the letter.
The Bush administration has agreed to a moratorium on two of seven proposed Medicaid rules, which include limiting Medicaid reimbursements to hospitals and nursing homes run by state and local governments, so lawmakers can discuss and agree to changes. (Medical News Today)
As you may recall, the administration proposed to limit physician reimbursement rates and stopped the expansion of Medicaid programs like the State Children’s Health Insurance Program.
According to U.S. Department of Health and Human Services secretary Mike Leavitt, President Bush would veto any bill that places a moratorium on all seven rules.
“We’re trying to put a package together where the five would remain and we would extend [graduate medical education funding] and [intergovernmental transfers to public hospitals] for a period where we tried to find a solution…We would defer the implementation until August, and if we’re not able to do that, it would be deferred until March.”
The following information was obtained from the April 25 issue of the Texas Register:
Adopted Rules
The Texas Health and Human Services Commission (HHSC) adopted amendments to §§19.208, 19.214, and 19.2112, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification, which will update terminology and state agency names and correct rule cross-references to reflect changes from health and human services agencies consolidations in 2004 and to make sections consistent with other DADS rules.
For more information, see the relevant section of the Texas Register.
HHSC also adopted amendments to §§94.2, 94.3, and 94.9 - 94.11 in Chapter 94, Nurse Aides, which will allow the Nurse Aide Registry to deem a nurse aide to be unemployable based on a finding that the nurse aide is listed as unemployable in the Employee Misconduct Registry.
For more information, see the relevant section of the Texas Register.
The Texas Department of Aging and Disability Services (DADS) has released two provider and two information letters:
- Guidelines for Reporting Incidents (replaces PL 1999-34)
In a provider letter, DADS notified ICFs/MR about changes in the guidelines for reporting incidents to DADS, effective immediately. The revised guidelines supersede guidelines dated October 1, 1999, for licensed ICFs/MR. Download the five-page letter for more information.
- Expired Licenses (replaces PL 05-49)
DADS informed All Assisted Living Facilities, Adult Day Care Facilities, Nursing Facilities, Home and Community Support Services Agencies, and ICFs/MR, about facility and agency license renewals. Holders must file a renewal application to prevent expiration. Download the provider letter for more information.
- Economic Stimulus Payments — Filing Deadline Extended to October 15, 2008
In a letter to Nursing Facility, Intermediate Care Facilities/Mental Retardation, and Community Program Providers, DADS provided information about the filing extension for the Economic Stimulus rebate. An excerpt from the letter:
Many individuals served by the Department of Aging and Disability Services (DADS) who do not have a federal tax filing requirement and do not usually file an income tax return may be eligible for a rebate through the Economic Stimulus Payment program. These people will need to file a 2007 Income Tax Return to be eligible for the rebate.
The Internal Revenue Service (IRS) has extended the deadline to file IRS Form 1040A so eligible individuals may qualify for a rebate payment through the Economic Stimulus Payment program.
For more information, download the letter.
- Customized Power Wheelchairs Added as Medicaid Nursing Facility Program Service; Additional Information Provided
DADS informed Nursing Facilities about obtaining a Customized Power Wheelchair for an eligible recipient. The 11-page letter and attachment contains details about eligibility requirements, process for requesting, submission, approval process, and other important information. Download the letter and attachment here.
The Centers for Medicare and Medicaid Services (CMS) announced a new rule that would reduce funding for inpatient rehabilitation facilities in fiscal year 2009. According to CQ Health Beat (via Kaiser Network), the $20 million reduction, required by Congress, would prevent a cut to Medicare physicians payments. The same legislation reauthorizes the State Children’s Health Insurance Program (SCHIP).
In other SCHIP news, the Government Accountability Office (GAO) contends that the Bush administration violated federal law when it prevented states from expanding SCHIP, because it did not follow the rule-making process. (Kaiser Network)
Comments from Senators John Rockefeller and Olympia Snowe, who requested the GAO opinion:
“The directive is a bold-faced attempt to subvert the law and prevent states from implementing their plans to provide health insurance coverage to millions of uninsured children nationwide,” Rockefeller said in a statement (CQ Today, 4/18). Snowe said, “CMS chose to circumvent the rules and go their own way,” adding that “this is clearly the wrong approach” (CongressDaily, 4/18). Rockefeller and Snowe in a release wrote, “CMS now has a critical choice to make: rescind the rule or continue to spend taxpayer money defending a growing list of lawsuits it is unlikely to win” (AP/Lexington Herald-Leader, 4/19).
You may download the report summary or full opinion.
The following information was obtained from the April 18 issue of the Texas Register:
Proposed Rules
The Texas Health and Human Services Commission (HHSC) has proposed to amend §355.8061, concerning payment for hospital services and §355.8069, concerning supplemental payments to certain rural public hospitals, in Title 1 of the Texas Administrative Code (TAC), Part 15, Chapter 355, Subchapter J, Division 4, Medicaid Hospital Services. The amendment 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.
The Texas Department of Aging and Disability Services (DADS) has proposed to amend 19 sections of the code, including those pertaining to Medicaid-certified facilities, the Medicaid hospice program, and the Medicaid Waiver program. Follow this link, and scroll down to read details in each section.
Adopted Rules
HHSC has adopted an amendment to §358.432, concerning Home Equity Treatment and adopts a new §358.444, concerning Medicaid Treatment of Qualified Long-Term Care Partnership Program Insurance Policies, which implements a Long-Term Care Partnership Program to enable individuals who purchase certain approved private long-term care insurance policies to have a dollar-for-dollar exclusion of their resources in an amount equal to the insurance benefits paid on behalf of the individual in determining eligibility for medical assistance.
See the relevant section of the Texas Register for more information.
DADS has adopted a new §19.2614, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification without changes to the proposed text published in the January 18, 2008, issue of the Texas Register (33 TexReg 521), which will allow a nursing facility to procure a customized power wheelchair for a Medicaid-eligible nursing facility resident.
See the relevant section of the Texas Register for more information.
The following information was obtained from the April 11 issue of the Texas Register:
Open Meetings and Notices
The Texas Health and Human Services Commission (HHSC) has announced a hearing on proposed state-owned veterans nursing facility payment rates. The hearing is scheduled for May 6, 2008, at 9 a.m., in the Permian Basin Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.
HHSC will conduct a public rate hearing to receive comment on proposed Medicaid payment rates for Freestanding Psychiatric Facilities. The hearing is scheduled for April 23, 2008, at 9 a.m. in the Lone Star Conference Room of the Braker Center, Building H, at 11209 Metric Boulevard, Austin, Texas 78758-4021.
HHSC has announced its intent to submit Transmittal Number 08-001, Amendment Number 805, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. An excerpt:
The purpose of this amendment is to initiate a process by which the State will pay managed care organizations who have entered into a Medicare Risk Product Agreement with the Centers for Medicare and Medicaid Services (CMS), referred to as a “Medicare Advantage Health Plan,” or “MA Health Plan,” a monthly capitated payment in exchange for the MA Health Plan’s payment of the cost sharing obligations to health care service providers attributable to dual eligible members enrolled in the MA Health Plan’s Medicare risk product.
For details on where to send public comments for the hearings and information about the amendment, see the relevant section of the Texas Register.
The following information was obtained from the April 4 issue of the Texas Register:
Notices and Public Hearing
The Texas Health and Human Services Commission (HHSC) has issued a correction to a public notice about its intent to submit Transmittal Number 08-000, Amendment Number 804, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act in the February 1, 2008, issue of the Texas Register (33 TexReg 1001). The correct notice reads:
HHSC announced its intent to submit Transmittal Number 08-006, Amendment Number 810, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendment is effective February 1, 2008.
Additionally, HHSC issued a notice that it adopted the following per diem reimbursement rates:
Large State-Operated ICF/MR Facilities-Medicaid Only clients
Proposed interim daily rate: $381.26
Large State-Operated ICF/MR Facilities - Dual-eligible Medicaid/Medicare clients
Proposed interim daily rate: $365.09
HHSC will hold a public hearing on April 22, 2008, at 9 a.m. to receive public comment on proposed payment rates for Supported Employment and Employment Assistance Services in the Deaf-Blind with Multiple Disabilities (DBMD) Program waiver. For more information on the notices and the public hearing, see the relevant section of the Texas Register, and scroll down for each entry.
Adopted Rules
HHSC has adopted an amendment to §355.8063, Reimbursement Methodology for Inpatient Hospital Services, which updates the Medicaid reimbursement methodology for freestanding psychiatric facilities, effective January 1, 2008. See the relevant section of the Texas Register for details.
The Texas Board of Nursing has adopted an amendment to 22 Texas Administrative Code §223.1 (Fees). See the relevant section of the Texas Register for more information.
According to the Sacramento Bee (via Medical News Today), California has not been complying with a law that requires the Medi-Cal director to review physician reimbursement rates every year.
According to Sandra Shewry, director of the California Department of Health Care Services, the 1976 law is obsolete, passed when health care spending “made up a smaller portion of the state budget and the health department made annual recommendations for adjustments in the rates.” The review requirement was intended to keep reimbursement rates competitive.
Apparently, current rates are not competitive. Medi-Cal reimbursement rates for physicians are the lowest of any state Medicaid program, according to the California Medical Association. Last month, a coalition of local governments and providers in California announced an intent to file a lawsuit to stop a proposed 10 percent reimbursement rate cut for physicians under the Medi-Cal program.
Also see California Coalition Will File Suit to Stop Medicaid Cuts.