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 Services; §353.411, Accessibility of Services; §353.413, Managed Care Benefits and … [Read more...] about Texas Register Publishes Changes to Medicaid Managed Care and Other Services
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 guidelines for sufficient emergency training in 2004-2005. However, nursing homes didn't always follow the plans. For example, 5 of the … [Read more...] about OIG Releases Report on Nursing Homes’ Response to Hurricanes
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 exempts the first $25,000. For more information, visit on Medicaid estate recovery in Texas, visit the estate recovery program … [Read more...] about Georgia’s $100,000 Medicaid Estate Exemption Fails
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. Attached to the letter are the amended 40 TAC sections. You may download the six-page document here. … [Read more...] about Provider Letter: New Rules for Permanency Planning
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 taking this into consideration, hospice still makes a significant difference in keeping people out of the hospital … [Read more...] about Hospice Care Reduces End-of-Life Hospitalization
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 that don't have access to the new system can mail hardcopies to Provider Claims Services. The PCS fax lines will be … [Read more...] about Provider Letters: Alerts for Hospice and Nursing Facilities
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 facilities no longer needs "active treatment services" (standard W 198). To read about these options, download the letter here. In … [Read more...] about Provider Letters: Alerts for ICF-MR/RC Facilities
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 new rule, see this section of the July 21 Texas Register. HHSC has extended comment periods and issued hearing notices for two proposed amendments of … [Read more...] about Texas Register Publishes New Rule, Hearing Notices
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 the federal government should be responsible for long term care of the elderly, while the states focus on "acute care for those under 65." … [Read more...] about Former HHS Chief Says Feds Should Be Responsible for Medicaid Long Term Care
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 the Centers for Medicare and Medicaid Services (CMS), reimbursement cuts will be smaller and phased in over three years. Groups like AdvaMed, which … [Read more...] about Bush Administration Scales Back Medicare Reimbursement Cuts