DADS released two information letters:

• Amended Process for Individual Plan of Care (IPC) Entry in the Client Assignment and Registration (CARE) System for Nursing and Respite Services in the HCS and TxHmL Programs

DADS informed Consumer Directed Services Agencies, HCS and TxHmL Program providers, and Mental Retardation Authorities providers that IPC renewals entered into the CARE system with an effective date of September 1, 2009, or after, will not have nursing or daily respite services available for selection in the CARE system in preparation for the system transition occurring September 1, 2009, effective July 1. Download the two-page letter for details.

• Clarification That Time Using Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BIPAP) Devices Cannot Be Counted as Time to Request Reimbursement for Ventilator/Respirator

DADS informed Community Based Alternatives Home and Community Support Services Agencies (HCSSA), Integrated Care Management Waiver HCSSAs, Consolidated Waiver Program HCSSAs, and Programs of All-Inclusive Care for the Elderly providers that effective with the posting of the letter, providers completing the Medical Necessity/Level of Care assessment must not include the use of a CRAP or BIPAP device under Field S6b. For instructions, download the letter.

Public Notices and Hearings

The Texas Health and Human Services Commission (HHSC) adopted the following per day payment rates for the state-owned veterans nursing facilities for fiscal year (FY) 2009, effective September 1, 2008: Big Spring, $133.00; Bonham, $133.00; Floresville, $133.00; Temple, $133.00; McAllen, $133.00; El Paso, $133.00 and Amarillo, $133.00. Effective March 1, 2009 the rates adopted are: Big Spring, $136.00; Bonham, $136.00; Floresville, $136.00; Temple, $136.00; McAllen, $136.00; El Paso, $136.00 and Amarillo, $136.00.

HHSC will hold a public hearing on July 13, 2009, at 10:00 a.m. to receive public comment on rate increases for the 24-Hour Residential Child Care program operated by the Department of Family and Protective Services. The hearing will be held in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.

HHSC will submit an amendment to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would adjust payment rates for the Nursing Facility Program. HHSC will also submit an amendment to adjust payment rates for the Intermediate Care Facilities for Persons with Mental Retardation Program

Follow this link and scroll down to read about each entry.

Proposed Rules

HHSC proposes to amend §355.8081, Payments for Laboratory and X-ray Services, Radiation Therapy, Physical Therapists’ Services, Physician Services, Podiatry Services, Chiropractic Services, Optometric Services, Ambulance Services, Dentists’ Services, and Psychologists’ Services, under Title 1, Part 15, Chapter 355, Subchapter J, Division 5 of the Texas Administrative Code. The amendments would add Medicaid reimbursement for services provided by a licensed psychological associate under the direct supervision of a licensed psychologist. See the relevant section of the Texas Register for details.

Adopted Rules

HHSC adopts the repeal of Chapter 357, Subchapters A, D, E, F, G, and H and adopts a new Chapter 357, Subchapter A. The repeal and amendment would provide clarification on required procedural rules that direct the conduct of client fair hearings. See the relevant section of the Texas Register for details.

The salary cut would have saved the state $98 million in 2009 and 2010.

In other provider news, the Supreme Court ruled that California’s Medicaid providers may challenge the state’s proposed cuts to provider fees, upholding a federal court’s ruling.

Earlier this month, we reported that the Texas Senate had approved a bill to increase enrollment in the State Children’s Health Insurance Program, raising the income eligibility limits from $44,000 to $66,000 for a family of four. An additional 80,000 uninsured children would be covered.

Public Hearings and Notices

The Texas Health and Human Services Commission (HHSC) will hold a public hearing on July 15, 2009, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for Early and Periodic Screening, Diagnosis, and Treatment Personal Care Services for Type of Service (TOS) 1, Ambulance Services, and Certified Nurse Midwife services in a birthing center for types of service (TOS) 1 and 2.

The hearing will be held in the Lone Star Conference Room of HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas. See the relevant section of the Texas Register for details.

HHSC intends to submit amendments to the Texas State Plan for Medical Assistance, which would modify the reimbursement methodologies in the Texas Medicaid State Plan as a result of Medicaid fee changes for Ambulance Services Texas Health Steps and Personal Care Services.

HHSC also intends to submit an amendment to the Texas State Plan for Medical Assistance, which would modify the reimbursement methodologies in the Texas Medicaid State Plan as a result of Medicaid fee changes for Tuberculosis Clinic Services.

See the relevant section of the Texas Register for details.

Proposed Rules

HHSC proposed to amend §355.8061, Payment for Hospital Services, and §355.8063, Reimbursement Methodology for Inpatient Hospital Services. The changes would consolidate and update the inpatient and outpatient supplemental payment rule language for eligible publicly-owned or -affiliated urban hospitals. For more information, see the relevant section of the Texas Register.

Withdrawn Rules

The Texas Medical Board withdrew proposed amendments to §§174.1, 174.2, 174.4, 174.6 and §190.8. See the relevant section for details.

Adopted Rules

The Texas Medical Board adopted amendments for the following sections: Supervision Of Medical School Students, Medical Records, Physician Profiles, and Disciplinary Guidelines. Follow this link and scroll down to read amendments to each section.

AUSTIN – Toby Simmons’ disabilities were so severe that he couldn’t breathe or swallow without help. For the first two decades of his life, he received around-the-clock nursing care in his foster mother’s home.

But when he turned 21 and aged out of the children’s health program that paid for the care, the state said it was too costly to keep him at home. The state’s solution? An institution.

Simmons’ foster mother saw another answer: a provision that lawmakers created two years ago to keep people like Simmons at home. But despite her pleas – and warnings from Simmons’ longtime doctor that he was too fragile to live in an institution – the state denied the funding. He moved to a Killeen-area nursing home in May, and within 24 hours, he was dead. It’s still unclear why.

Lawmakers designed the provision to keep medically fragile people from being forced into lower-cost nursing homes or state schools when they would be safer in their own homes. But disability rights advocates say that state officials have interpreted it so narrowly that almost no one can qualify.

What is another way the State can skirt the law mentioned in the above quote? How about putting the providers who care for people like Toby out of business for bogus reasons? Do you think that might be happening?

Medical home coordinator Dr. Trevor Rabie said, “Many patients feel that if they go to a specialist or sub-specialist for each aspect of their medical care, that they’re actually improving their medical care. But then there’s no coordination and no one really looking at the patient as a whole, and that’s the real crux of the medical home.”

Medical homes may cut down on appointment wait times. At the clinic mentioned in the story, patients can attend health care talks and work out on “senior-friendly” exercise machines. Rabie said he hopes the clinic will be able to add specialists like a dietician or an exercise physiologist to the program.

Under the cost-cutting plan, the drug industry would pay for half the Medicare drug’s price when it’s not covered by the gap under Part D.

Over 10 years, pharmaceutical companies will sacrifice $80 billion by covering a larger share of brand-name prescription drug costs. The health care industry has been surprisingly flexible (or complicit, depending on your point of view) in accommodating the president’s government health care proposal.

According to WSJ, 46 million Americans are uninsured.

• TMHP Remittance and Status (R&S) Report Information

In a letter to DADS Long Term Care Services and Supports providers, DADS emphasized the importance and usefulness of the TMHP (R&S) Report:

“Providers that do not reconcile their R&S Reports may be billing incorrectly, which can result in audits and penalties. Providers should ensure not only that all billing is accurate, but also that any problems associated with the claim are resolved within the 12-month filing limitation. Repayment of invalid or inappropriate recoupments not resolved within 12 months is subject to the 12-month filing limitation.”

Download the two-page letter for more information.

• Form 2032 - Escheatment of Consumer Funds

DADS informed Nursing Facilities, Intermediate Care Facilities for Persons with Mental Retardation, Assisted Living Facilities, and Residential Care Adult Foster Care that DADS posted Form 2032 to the web site for immediate download. For more information, download the two-page letter.

• Provider fee

DADS informed Transition Assistance Services (TAS) providers that the $158.28 provider fee is not included in the $2,500 per consumer when calculating the total cost of TAS items. Download the letter for more information.

• Home Delivered Meals (HDM) Rate Setting Procedures for Federal Fiscal Year (FFY) 2010

DADS has posted budget-based rate negotiation documents on the HDM provider page for Title XIX and Title XX HDM providers: “FFY 2010 Budget Negotiation“:

Download the two-page letter for details.

• Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program (TxHmL) providers and Consumer Directed Services Agencies (CDSAs) to Maintain Current Information in the Client Assignment and Registration (CARE) System

In a letter to HCS and TxHmL Program providers and CDSAs, DADS clarified procedures for waiver program providers and CDSAs to inform DADS of changes regarding addresses, telephone numbers, and personnel; individuals’ addresses; and changes in waiver contract areas.

Download the two-page letter for more information.

• Amended Process for Individual Plans of Care (IPCs) and Claims Submission in the Client Assignment and Registration (CARE) System for Respite Services in the HCS and TxHmL Programs

DADS informed CDSAs, HCS Program and TxHmL Program providers, and Mental Retardation Authorities that DADS is amending the process for entering IPCs and submitting claims for respite services in the CARE system for the HCS and TxHmL Programs. Download the two-page letter.