Texas Register Updates: Community Relations Repeals, Nursing Facility Amendments, Etc.

Updates from the December 22 edition of the Texas Register include the repeal of 40 TAC §§7.301 through 7.311 and §§7.313 through 7.316, concerning community relations, amendments to nursing facilities licensure and Medicaid certification requirement provisions, health and human services agencies licensing remedies, amendments to sections dealing with licensing standards for assisted living facilities, and [...]

Few Legal Protections for Home Health Workers

An Iowa University law professor conducted a study of home health care workers and found that they have few legal protections. (Medical News Today) It’s more difficult to regulate employment inside a private home, and home health care workers don’t seem to be a high priority for agencies like the Occupational Safety and Health Administration. [...]

Provider Letters: Electronic Notifications and Travel Reimbursement Rates

In a letter dated December 18, the Texas Department for Aging and Disability Services (DADS) notified all assisted living, adult day care, home and community support service agencies, immediate care, and nursing facilities about a change in program notifications. DADS has been providing program notifications online effective October 1, 2006. Notifications will no longer be [...]

National Provider Identifier

A National Provider Identifier (NPI) is a 10-digit number used to identify providers under the 1996 Health Insurance Portability and Accountability Act (HIPAA). According to the Centers for Medicare and Medicaid Services, there are only 151 days left to comply with the NPI requirement. From the site: If you are a health care provider who [...]

Pharmacists Face Reduced Medicaid Reimbursements

Pharmacists may see their Medicaid reimbursements reduced if a proposed new rule becomes a reality. The Kaiser Network reports (via the New York Times) that the Bush administration proposed a rule that would save the government $8.4 billion over the next five years. This would allow the government to offer drug discounts to beneficiaries similar [...]

Provider Letter: Medicaid Estate Recovery Program

In a provider letter to nursing facilities dated December 18, the Department of Aging and Disability Services (DADS) asked these facilities for help with providing personal representative information to the Medicaid Estate Recovery Program. Although some providers fill out the personal representative information request form, others do not. From the letter: The expectation is that [...]

Provider Letter: Payment Disallowed for Date of Death During a Medicare Co-insurance Stay

The Department of Health and Human Services has notified nursing facilities that in some cases, Medicaid is improperly billed and therefore pays for the date of death that occurs during a Medicare Part A skilled nursing facility stay in error. This determination was made after a review of the Texas Medicaid Long Term Care payments [...]

Physicians Medicare Reimbursement Reduction Reversed

Physicians receiving Medicare reimbursements will get a reprieve. Before adjourning last week, Congress passed a bill that will reverse a 5.1 percent reduction in reimbursement. (Kaiser Network) Reimbursement rates will remain at their current levels, and physicians who report quality-of-care data will get a 1.5 percent increase. Back in September, one lawmaker, House Ways and [...]

Survey Says Most U.S. Residents Favor Government Price Negotiations

A survey conducted by the Kaiser Family Foundation showed that 85 percent of U.S. residents favor government price negotiations for Medicare prescription drugs. The federal government currently is prohibited from negotiating drug prices or establishing a list of preferred drugs. (Kaiser Network) According to the survey, 92 percent of Democrats, 85 percent of Independents and [...]

Private Lawsuits Under the False Claims Act

The recent decision in United States v. Regence Blue Cross (10th Cir 12/05/2006) illustrates the power of qui tam, or private, civil lawsuits under the False Claims Act (FCA). Under the FCA, an action can be commenced either by the United States itself, or as a “qui tam” action, by a private person acting “for [...]

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