Texas Register Publishes Changes to Medicaid Managed Care and Other Services

Texas Health and Human Services Commission (HHSC) has adopted new rules that affect various provisions of Chapter 353 Medicaid Managed Care. The following rules are amended (from the August 25 Texas Register): §353.2, Definitions; §353.3, Experience Rebate in the Managed Care Program; §353.403, Enrollment; §353.405, Marketing; §353.407, Requirements of Health Maintenance Organizations; §353.409, Scope of [...]

OIG Releases Report on Nursing Homes’ Response to Hurricanes

The Office of Inspector General (OIG) of the U.S. Department Health and Human Services has released a report titled, “Nursing Home Emergency Preparedness and Response During Recent Hurricanes.” OIG reviewed 20 nursing homes for the study. According to the report, 94 percent of nursing homes met government guidelines for emergency plans, and 80 percent met [...]

Georgia’s $100,000 Medicaid Estate Exemption Fails

Citing the figure as “somewhat excessive,” the Centers for Medicare and Medicaid Services rejected Georgia’s attempt to raise the state’s Medicaid estate recovery exemption from $25,000 to $100,000. (Medical News Today) To offset the costs of nursing home care, states are required by federal law to recover money from a beneficiary’s estate. Current Georgia law [...]

Provider Letter: New Rules for Permanency Planning

Nursing facilities will be subject to new rules related to permanency planning, effective September 1, 2006. The amended sections of 40 Texas Administrative Code (TAC) Chapter 19 (§19.802 and §19.805) reflect changes made by the legislature concerning the annual review of a child’s comprehensive care plan and the involvement of a child’s legally authorized representative. [...]

Hospice Care Reduces End-of-Life Hospitalization

According to a new study published by Health Services Research, nursing home residents receiving hospice care reduce their chances of hospitalization by half compared to those who don’t receive hospice care. From SeniorJournal.com: People who choose hospice, which focuses on comfort instead of cure, tend to refuse aggressive end-of-life treatment anyway, Gozalo said. But even [...]

Provider Letters: Alerts for Hospice and Nursing Facilities

Last week the Texas Department of Aging and Disability Services (DADS) issued provider letters for hospice and nursing facilities, and community services and therapy providers: August 9 – DADS reminded hospice and nursing facilities that the current DOS-based form system is being upgraded to a web-based system called LTC Online Portal, effective August 21. Providers [...]

Provider Letters: Alerts for ICF-MR/RC Facilities

There were several new provider letters issued last week for Intermediate Care Facilities for Persons with Mental Retardation or a Related Condition (ICF-MR/RC). In an August 3 provider letter, the Texas Department of Aging and Disability Services (DADS) described providers’ options when an ICF-MR/RC survey team determines that a person living in one of these [...]

Texas Register Publishes New Rule, Hearing Notices

The Texas Health and Human Services Commission (HHSC) adopted §354.1450, which governs auditing of Medicaid providers. HHSC must notify providers of an upcoming audit no later than seven days before the field portion of the audit starts. If a pharmacy is being audited, HHSC must notify the pharmacy’s corporate office. For more information on the [...]

Former HHS Chief Says Feds Should Be Responsible for Medicaid Long Term Care

The federal government and the states currently share responsibility for Medicaid long term care. Tommy Thompson, former U.S. Health and Human Services secretary, says that should change in light of the approaching retirement of the baby boomers. Medicaid is already burdening the states, and it will get worse in the next few years. Thompson believes [...]

Bush Administration Scales Back Medicare Reimbursement Cuts

Over the last few months, medical device makers and lawmakers have pressured the Bush administration to rethink a proposed rule that would have cut Medicare reimbursements for implanted cardiac devices by up to 30 percent in an effort to close loopholes used by specialty hospitals. The lobbying efforts worked. Under the final rule issued by [...]

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