The Texas Department of Aging and Disability Services (DADS) issued six information letters:
- Addition of Supported Employment and Employment Assistance to the Deaf-Blind Multiple Disabilities (DBMD) Program and a Change in the Behavior Communication Specialist Service
DADS informed DBMD Providers that it will implement Supported Employment and Employment Assistance services in the DBMD Program, effective September 1. Service codes and rates (per hour) for both services: Supported Employment Service code 37 $28.21 and Employment Assistance Service code 54 $28.21. Download the two-page letter for more information.
- Request for Waiver of Requirement to Deliver Meals Fewer than Five Days a Week
A provider of Title XIX and Title XX Home Delivered Meals may request a waiver of the program requirement to deliver a hot meal five days a week if the provider determines that such a delivery schedule is not feasible for certain individuals within the provider’s contracted service area. Download the two-page letter for more information.
- Assisted Living/Residential Care (AL/RC) and Resource Utilization Groups (RUG) for Attendant Compensation Rate Enhancement Program
DADS informed Community Based Alternatives and Integrated Care Management AL/RC Providers that effective September 1, 2008, it will replace the TILE score with the RUG score and will assign consumers to one of the six reimbursement levels based on their RUG score. Download the three-page letter for more information.
The following information was obtained from the August 29 issue of the Texas Register:
Proposed Rules
The Texas Health and Human Services Commission (HHSC) proposes to amend §354.1231, Benefits and Limitations; §354.1233, Requirements for Hearing Aid Services; and §354.1235, Requirements for Provider Participation, in Title 1, Part 15, Chapter 354, Subchapter A, Division 15, related to Medicaid hearing aid services. The amended rules would better align Medicaid rules with current hearing aid technology and standards of care to clarify rule content. For more information, see the relevant section of the Texas Register.
Adopted Rules
HHSC has adopted an amendment to §355.503, Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs, which establishes the reimbursement methodology. For more information, see the relevant section of the Texas Register.
On behalf of the Texas Department of Aging and Disability Services (DADS), HHSC adopted amendments to 15 sections, including Nursing Facility Requirements For Licensure And Medicaid Certification, Medicaid Hospice Program, and Use Of General Revenue For Services Exceeding The Individual Cost Limit Of A Waiver Program. Follow this link and scroll to read each entry.
Public Notices
DADS will hold a Pre-Application Orientation (PAO) for people who want to participate as contractors in the Home and Community-based Services or the Texas Home Living Medicaid Waiver Programs or both. Register at the PAO application web page beginning Friday, September 5, 2008, through Friday, November 7, 2008. Mail the completed and signed form to the following address:
Department of Aging and Disability Services
Community Services Contracts, Attn: Patsy Haralson
P.O. Box 149030, MC: W-517
Austin, TX 78714-9030
For more information, see the relevant section of the Texas Register.
According to the Office of Inspector General (OIG) of the Department of Health and Human Services, Medicare overpaid for prescription drugs with new generic versions, because of delays in updating its pricing formula. (Kaiser Network)
For example, Medicare overpaid $6.5 million for the cancer drug irinotecan. A generic version was approved, but new generic prices were not integrated right away. Medicare paid $126 a dose, although generic prices averaged $41.
According to the 20-page report (PDF), Medicare probably is overpaying for other prescription drugs. The OIG suggests, among other things, that Medicare find a way to rectify price discrepancies in a more timely fashion.
The following information was obtained from the August 15 and August 22 issues of the Texas Register:
Adopted Rules
HHSC adopted amendments to §355.307, Reimbursement Setting Methodology, §355.308, Direct Care Staff Rate Component, and §355.311 Medicaid Reimbursement Rates for State Veterans Homes, which will establish the reimbursement methodology for the Nursing Facility program, including Medicaid reimbursement rates for state veteran’s homes. See the relevant section of the Texas Register for details.
HHSC adopted a new §354.1189, concerning the implementation of an acute care Medicaid billing coordination system. The new section will implement §531.02413, Government Code, Billing Coordination System. This section will require HHSC to put into practice an acute care Medicaid billing coordination system for the fee-for-service and primary care case management delivery models. See the relevant section of the Texas Register for more information.
HHSC also adopts amendments to §355.8061, concerning payment for hospital services, and §355.8069, concerning supplemental payments to certain rural public hospitals, in Title 1, Part 15, Chapter 355, Subchapter J, Division 4, concerning Medicaid Hospital Services. The amendments 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.
Public Notices
HHSC intends to submit to the Centers for Medicare and Medicaid Services an amendment to the Community Living Assistance and Support Services (CLASS) waiver program, which sets the waiver cost limit for an individual in the CLASS program at 200 percent of the cost of serving similar individuals in an Intermediate Care Facility for Individuals with Mental Retardation. See the relevant section of the Texas Register for more information.
On September 1, 2008, changes within Appendix PP of the State Operations Manual become effective. The changes involve deleting F326 and incorporating that tag’s guidance into F325 and deleting F370 and incorporating it into F371. However, the changes are voluminous compared to what exists now.
You may find the changes here, comprising 58 pages. The old sections are here and here.
The changes concern nutrition, therapeutic diets, approved food sources and food sanitation. Be ready.
The Texas Department of Aging and Disability Services (DADS) issued two information letters:
- Specialized Services and Rehabilitative Services in the Medicaid Nursing Facility Program
The Texas Department of Health and Human Services and DADS informed Nursing Facility and Therapy Providers contracted with DADS that the Texas Medicaid Program can reimburse only nursing facilities - not outside therapy providers - for specialized and rehabilitative services delivered to Medicaid clients residing in a nursing facility. Download the two-page letter for more information.
- Behavioral Support Services
DADS informed all Community Living Assistance and Support Services Providers that effective September 1, 2008, the previously labeled service type “Psychological Services” will change to “Behavioral Support.” From the letter:
Board-certified Behavior Analysts (BCBA) have been added to the list of qualified providers able to provide this service. Psychological Services may continue to be provided by previously qualified providers and billed as Behavioral Support.
You may download the letter here.
The Kaiser Family Foundation has released a report on the costs and consequences of the Medicare Part D coverage gap in 2007.
The coverage gap, also called the “doughnut hole,” is the period of time during the year when a beneficiary is not covered and is responsible for paying drug costs out of pocket.
The Kaiser study “quantifies…the number of Medicare Part D plan enrollees in 2007″ who reached the doughnut hole. The study does not include low-income beneficiaries who received subsidies.
According to the study, one in four Part D enrollees reached the coverage gap last year. Kaiser extrapolated that 3.4 million beneficiaries reached the doughnut hole and faced paying the full cost of their prescription drugs. This resulted in some beneficiaries altering their use during the gap. For example, 15 percent stopped taking drugs for their conditions and 5 percent used different drugs.
Download the 38-page report (PDF).
The Centers for Medicare and Medicaid Services (CMS) announced last week that a pilot pay-for-performance program, which pays doctors based on quality of care, has lowered costs “in some cases” and improved quality of care for patients with congestive heart failure, coronary artery disease, and diabetes.
According to CMS, four of the 10 groups participating in the program reduced costs to patients and CMS spending by $17.4 million.
Kerry Weems, acting administrator for CMS, said, “We are paying for better outcomes and we are getting higher quality and more value for the Medicare dollar. And these results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians.”
The Centers for Medicare and Medicaid Services (CMS) has announced that payment rates for nursing homes will increase by $780 million next year. (Source)
The payment increase (3.4 percent) is the result of a recalibration of the annual market basket calculation. CMS acting administrator Kerry Weems said CMS was “committed to providing high quality care to those in skilled nursing facilities and to paying those facilities properly for that care” and assures that CMS will continue evaluating the data for future adjustments.
In other Medicare news, CMS reports that costs for Medicare Part D are lower than expected. The average monthly premium for Part D will be $28 in 2009, about 37 percent lower than projected when Part D was established in 2003. (Source)
CMS reports that beneficiaries are satisfied with the program. A survey conducted by Harris Interactive also found that a majority of beneficiaries were satisfied with the program.
The Texas Department of Aging and Disability Services (DADS) issued ten information letters between August 1st through the 14th:
- Home Delivered Meals Rate Setting Procedures for Federal Fiscal Year 2009 (two-page letter)
- Changes to the Quality Assurance Fee Program for ICF/MR Providers (three-page letter)
- Wheelchair Requests for Nursing Facility Residents (two-page letter)
- Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (two-page letter)
- Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (ICF/MR Providers, Service Group 6) (two-page letter)
- Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (ICF/MR Providers, Service Group 5) (two-page letter)
- Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (HCS and TxHmL) (two-page letter)
- Expansion of the Consumer Directed Services Option to Nursing and Professional Therapies-New Form 3671-C Alternate and Revised 3671-B (two-page letter)
- Billing for Specialized Nursing — Interim Procedure (two-page letter)
- Revision of Living Options Client Assignment and REgistry Screen and Additional Review Responsibilities (two-page letter)