DADS released two provider and three information letters:
ALL HCSSAs:
The code requires a HCSSA to provide DADS with written notification at least 30 days before adding or deleting a category of service to its license. DADS approves or denies the addition of a category within 30 days after receipt, and the HCSSA must not provide the services until it receives written approval. (Letter)
All Medicaid-certified NFs:
— To make monthly Medicaid occupancy reporting easier and more accurate, DADS revised Form 3645. Attached to the letter are instructions for completing the form. DADS prefers that providers submit the form electronically.
— Effective June 15, 2011, DADS won’t cite a Medicaid-certified nursing facility for a TAC 40, §19.405(a) rule violation (Additional Requirements for Trust Funds in Medicaid-certified Facilities) if the word “trustee” is not used in the title of an account containing residents’ funds. (Letter)
NFs, Hospice, Community Services, ICF/MR Community/State (Service Group) 5, and ICF/MR Non-state (Service Group 6):
DADS reminds providers to promptly submit claims for unbilled services in light of the August 31, 2011, end of the state fiscal year. An excerpt:
12-month filing rule – Providers should ensure not only that billing is current for all services provided, but also that any problems associated with the claims are resolved within the 12-month filing limitation.
Remittance & Status (R&S) Reports – Especially as the new state fiscal year approaches, providers should be particularly diligent in reviewing their R&S Reports to ensure recoupments on paid claims are valid. Any invalid recoupments for FY 2009 services (services provided September 1, 2008, through August 31, 2009) should be brought to the attention of state office staff immediately so providers can re-bill for these services prior to this year’s August cutoff date for submitting claims prior to the new state fiscal year. If rebilled after the August cutoff date, the claim becomes a “miscellaneous claim.” For additional information on receiving and using R&S Reports, refer to the Important TexMedConnect Reference Information article in the latest LTC Provider Bulletin.
Miscellaneous claims – Miscellaneous claims occur when the service dates are earlier than two prior fiscal years plus the current fiscal year. Claims for services that are less than eight years old and/or claims that total less than $50,000 owed to a single legal entity are paid on a first-come, first-served basis using funds appropriated during each legislative session. Miscellaneous claims over $50,000 and/or for services more than eight years old cannot be paid except as a special line item in the state budget.
CBA HCSSAs:
HCSSAs can no longer use a NF Medical Necessity to certify a Money Follows the Person CBA applicant. Instead, they must complete an initial MN/LOC Assessment. (Letter)
