Texas Register Updates: Reimbursement Methodology for NFs, Etc.

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 [...]

Are You Ready for the Latest Changes to the SOM? Tags 325 and 371

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. [...]

Information Letters: Texas Medicaid Reimbursements, Etc.

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 [...]

State of the Medicare Coverage Gap in 2007

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 [...]

CMS Reports Pay-for-Performance Pilot Success

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 [...]

Medicare Raises Nursing Home Payments; Part D Costs Lower Than Expected

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 [...]

Information Letters: Claim Cutoff Dates, Etc.

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 [...]

Texas Register Updates: Board of Nursing Amendments, Etc.

The following information was obtained from the August 8 issue of the Texas Register:
Public Hearings
The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on August 25, 2008, at 1:30 p.m., to receive public comment on 440 proposed Medicaid payment rates for physician-administered drugs and biologicals and 10 proposed Medicaid payment rates [...]

Replace Medicare Part D?

Medicare Part D isn’t even three years old, and a lawmaker already wants to replace it.
Congressman Dennis Kucinich, a Democrat from Ohio, introduced a measure that would replace Medicare Part D with a new program ostensibly to lower costs. According to the bill, Medicare would negotiate directly with drug companies for prescription drug discounts and [...]

Texas Register Updates: Medicaid Payment Rates, Etc.

The following information was obtained from the August 1 of the Texas Register:
Public Hearings
The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on August 18, 2008, at 1:30 p.m. to receive public comment on the proposed increase in Medicaid payment rates for seven procedure codes, including Breast Brachytherapy and THSteps Therapeutic [...]

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