HHSC – Sunset and the Transition of the State Agencies under HHSC; Vision of HHS Transformation

Health and Human Services Commission (HHSC)  Acting on direction from the Texas Legislature, the health and human services agencies have startedactivities that lay the groundwork for transformation of the health and human services system. Thefollowing information was taken from the HHSC Connection. Contrary to what some might believe, the 84th Texas Legislature did not approve beginning-to-endinstructions for how the health and human services agencies should reorganize. Yes, … [Read more...]

ICD 10; what to do with difficult submissions

 As you know, ICD 10 begins October 1, 2015. CMS MLN released information to providers on claimsubmission alternatives when you have difficulties submitting ICD-10 claims due to being unable tocomplete necessary systems changes or having issues with billing software, vendor(s), orclearinghouse(s). The article states that the following claims submission alternatives are available: Freebilling software, provider internet portals, direct data entry (DDE), and paper claims. Each … [Read more...]

Medicaid Payment Rates

Medicaid Payment RatesAs you know, the CMS Medicaid hospice payment rates memo was released on September 1, 2015. Therequirements reflect the Medicare final rule which was published on August 6, 2015. The rule changesimplement several items:? Payment methodology for routine home care (RHC) – beginning January 1, 2016 the RHC rateswill be implemented; a higher base payment for the first 60 days of care and a reduced rate forthe days thereafter.? Service Intensity Add-on – this is payment for … [Read more...]

Adventist Health – To Pay $118MM

Adventist Health System has agreed to pay $118.7 million to settle a whistleblower lawsuit that alleges the Florida-based company paid kickbacks to doctors in exchange for referrals.The 2012 lawsuit alleges Adventist, which operates skilled nursing facilities, rehabilitation facilities, hospitals and other healthcare facilities in 10 states, gave physicians bonuses and increased salaries, and allowed them to overbill, in exchange for referring their patients to Adventist facilities. The suit was … [Read more...]

SNF aide, 77, pleads guilty to rape, faces $15 million fine if abuses again

A former employee of a Minneapolis nursing home pleaded guilty this week to chargesthat he raped a resident who suffered from dementia. He also agreed to an unusual settlement that would require him to pay $15 million to the victim's estate if he is convicted again.George Sumo Kpingbah, 77, was working as an aide at Walker Methodist Health Center when he was found abusing an 83-year-old resident by a nurse on her rounds in December 2014. A Department of Health investigation found the facility … [Read more...]

HCS Dental Limit Increased to $2000/year 9/1 Documents You Need to Proceed

Information Letter No. 2015-51 - Service Limit Increase for Dental Treatment in the Home and Community-based Services ProgramAddressed to:Home and Community-Based Services (HCS) ProvidersLocal Intellectual and Developmental Disability AuthoritiesHome and Community-based Services (HCS) Program Billing Guidelines09/01/2015 05:30 AM CDT Dental Limit Increase Questions about Dental Requisition Fees?Check page 2 of "HCS Rates Effective September 1, 2015."Visit us at Garlo Ward, PC … [Read more...]

Revised HCS, CLASS, DBMD, TxHmL Forms –  Includes HCS Transportation, TAS, and Pre-Enrollment Minor Home Modifications

 DADS has published the following revised forms related to transportation, transition assistance services (HCS only), and pre-enrollment minor home modifications (HCS only). Please begin using the current versions of these forms during the service planning process. As the agency continues to release new or revised forms, providers will be notified.Revised forms:Form 3595 - IPP Service ReviewForm 3598 - Individual Transportation PlanForm 3608 - Individual Plan of Care (IPC) - HCS/CFCForm … [Read more...]

EVV Delay in Compliance Penalties

 The Health and Human Services Commission (HHSC), Department of Aging and Disability Services (DADS), and Managed Care Organizations (MCOs) recognize the continued system challenges faced by providers in using the Electronic Visit Verification (EVV) system. While all required providers are expected to fully utilize EVV, the respective payors (HHSC, MCOs and DADS) have agreed to not impose penalties around compliance levels at this time. HHSC will issue detailed guidance on compliance for … [Read more...]

HHSC Seeks Input on Workgroups, Councils Structure

HHSC Seeks Input on Workgroups, Councils Structure The Texas Health and Human Services Commission (HHSC) is asking for comments on existing advisory committees. In response to approved Sunset legislation, HHSC conducted a comprehensive analysis of 132 existing advisory committees. This analysis, along with stakeholder input, will be used to determine the future advisory committee structure. Comments should be emailed to HHSAdvisoryCommittees@hhsc.state.tx.us by close of businessSept. 25.Some of … [Read more...]

Medicaid Re-enrollment Website Launched

All provider types must re-enroll by March 24, 2016DADS Medicaid providers that render services either through Medicaid managed care organizations or traditional fee-for-service Medicaid are required to revalidate their information every 3-5 years. In Texas, the deadline for the next re-enrollment is March 24, 2016.To help providers better understand this process, DADS has created a Texas Medicaid LTSS Provider Re-enrollment website at http://www.dads.state.tx.us/providers/mpre/. The site … [Read more...]