The Texas Department of Aging and Disability Services (DADS) has released four information letters and one provider letter:
- Initial HCSSA Administrator Training Approval
In a seven-page letter to Home and Community Support Services Agencies (HCSSAs), DADS described the initial process for becoming a DADS-approved provider of HCSSA training for administrators and alternative administrators, and to get listed as a provider. For details about administrator requirements, download the letter.
- Critical Incident Reporting
DADS reiterated the critical incident reporting requirement in Section II of the program Provider Agreement for Home and Community-based Service and Texas Home Living Program Providers. From the letter:
Providers must enter critical incident data in CARE screen 686 no later than 30 days from the end of the month being reported. If there are no critical incidents have occurred during a month, the provider will enter a zero (0) into the CARE screen for each critical incident category for that month.
For more information about the requirement, download the letter and five-page attachment.
- Submission of the Hospice Election Form 3071 and Physician Certification of Terminal Illness Form 3074
DADS informed Medicaid Hospice Providers about an updated list of regional contacts for the submission of hospice election and certification forms to Community Services, Texas Medicaid and Healthcare Partnership, and Health and Human Services Commission Medicaid Eligibility staff. Download the letter for details.
- Changes to IBM Mainframe Security Settings
DADS informed Community Intermediate Care Facilities for Persons with Mental Retardation that IBM Mainframe password composition and history requirements have changed, effective June 8, 2008. Download the letter for details about the new password requirement.
DADS also informed Home and Community-Based Services Program Providers and Texas Home Living Program Providers about IBM Mainframe password change requirements, effective June 8, 2008. Download the letter for details.
Lawmakers on Capitol Hill continue to debate and discuss Medicare issues. This week, the House Ways and Means Health Subcommittee held a hearing to discuss the competitive bidding program for durable medical equipment. (Kaiser Network)
Durable equipment includes prosthetics, orthotics, and other tools, and the Centers for Medicare and Medicare Services is tasked with selecting suppliers based on bids. The program will expand to 70 additional Metropolitan Statistical Areas in 2009. An excerpt:
Subcommittee Chair Pete Stark (D-Calif.) said that the hearing will address concerns from durable medical equipment suppliers and advocates for Medicare beneficiaries that the program is “not working as well as it is supposed to” (CQ HealthBeat, 5/5).
According to Stark, the hearing will allow lawmakers to determine whether the program requires revisions before the scheduled expansion in 2009 (Edney, CongressDaily, 5/6). Stark said, “I’d like to see the whole thing scrapped.” He added that Congress likely will take action to revise the program, with only the “question of whether we’ll do it in 2008 or 2009.” The House Small Business Committee plans to hold a hearing on the program later this month (Wilde Mathews, Wall Street Journal, 5/6).
In other Medicare news, lobbyists continue their efforts to convince Congress to delay a 10.6 percent reimbursement fee cut for Medicare physicians, although Senate action on the issue might be pushed back. (Kaiser Network)
Other matters, such as an Iraq war spending bill and bill that would delay new Medicare regulations, will push the physician fee cut issue down the priority list, according to an AARP spokesperson.
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 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.
A 10 percent reduction in reimbursements for Medicare physicians could be delayed for 18 months, if Democratic Congressman Max Baucus’s plan is successful. (Kaiser Network)
Medicare physicians will see their reimbursements cut by 10 percent beginning July 1, 2008. Under Baucus’s plan, the cut would be delayed until 2010, and reimbursement rates would be raised by 1.1 percent. He also wants to increase and link reimbursements for primary care physicians (PCP) to quality of care.
The Medicare Payment Advisory Commission, an independent government agency that advises Congress about Medicare issues, believes that a pay increase for PCPs will “bolster the number of PCPs, who receive relatively lower salaries than specialists, causing fewer medical students to choose primary care…”
In other Medicare news, a survey released by the Pharmaceutical Care Management Association (PMCA) revealed that reducing the time in which Medicare prescription drug reimbursements must be made would limit the ability to detect fraud. From the Kaiser Network:
For the survey, PCMA interviewed dozens of industry experts responsible for pharmacy audits and fraud investigations and found that fraud schemes have become more complicated and more difficult to detect. Experts maintain that waste, fraud and abuse in pharmacy claims accounts for 1% of medication costs, which could translate to hundreds of millions of dollars in unnecessary costs for the Medicare prescription drug benefit, PCMA said.
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.
As you may recall, the Bush administration has proposed to cut spending on programs like Medicaid, including reducing physician reimbursements. A coalition of local governments and providers in California plans to file a lawsuit to stop these cuts. (Kaiser Network)
San Francisco Mayor Gavin Newsom said that a proposed 10 percent reimbursement reduction could serve as a disincentive to doctors treating patients in Medi-Cal, California’s Medicaid program. He fears patients will seek treatment in hospital emergency rooms, which are already overburdened. The lawsuit, if filed, would claim that Medicaid cuts would unfairly transfer responsibility for coverage to local governments that fund public hospitals.
Governor Arnold Schwarzenegger’s administration said the reduced reimbursement rate is not a long-term solution but one that would ensure beneficiaries remain covered.
The following information was obtained from the March 7 issue of the Texas Register:
Open Meetings
The Texas Department of Aging and Disability Services (DADS) will hold a public hearing to receive comments about the External/Internal Assessment, which will be included in the Texas Health and Human Service System Strategic Plan for Fiscal Year (FY) 2009-2013. The hearing will take place on Tuesday, March 18, 2008, at 4:00 p.m., in the Winters Building Public Hearing Room at 701 W. 51st Street, Austin, Travis County, Texas 78751.
Additionally, DADS will hold a Pre-Application Orientation for individuals seeking to participate as a contractor in the Home and Community-based Services and/or the Texas Home Living Medicaid Waiver Programs on June 9, 2008. Visit the relevant section of the Texas Register for more information about both meetings.
The Texas Department of Health and Human Services Commission intends to submit Amendment 800, Transmittal Number TX 07-041, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. For more information, see the relevant section of the Texas Register.
Proposed Rules
The Texas Medical Board has proposed a series of amendments concerning the following sections: Supervision of Medical School Students, Physician Advertising, Physician Profiles, and Voluntary Relinquishment or Surrender of a Medical License. See the relevant section of the Texas Register for more information.
Withdrawn Rules
The Texas Medical Board has withdrawn proposed amendments to §162.1, concerning Supervision of Medical Students. Follow the link for more information.
Adopted Rules
The Texas Medical Board has adopted amendments to several sections of the code, including General Provisions, Physician Registration, and Reinstatement And Reissuance sections. See the relevant section of the Texas Register and scroll down for more information.
Although President George W. Bush twice vetoed bills that would have expanded the State Children’s Health Insurance Program (SCHIP), Democrats in the House of Representatives are still trying to find ways to expand the program. (Kaiser Network)
Last week, Charles Rangel, chair of the House Ways and Means Committee, said the House budget reconciliation bill would include provisions to expand SCHIP and stop a 10 percent Medicare physician payment reduction. The measure would increase SCHIP funding by $50 billion and delay the physician payment cut for two years.
The National Governors Association has gone on record to oppose the Bush administration’s proposal to shift more Medicaid costs to the states. (Kaiser Network)
The shift reportedly will save $15 billion over five years. One change under the new rules is that states no longer will be allowed to use Medicaid funds to help pay for physician training. The administration contends there’s “no explicit authorization under the Medicaid statute to subsidize the training of physicians.” This change reportedly will save $1.8 billion over five years.
Additionally, hospitals and nursing homes will see new limits on Medicaid payments. At least two Republican governors are publicly critical of the plan.
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