DADS informed the following providers that in addition to an initial Nurse Aide Registry and the Employee Misconduct Registry search, they must search both registries every year for unlicensed employees and volunteers whose duties include face-to-face contact with clients, effective September 1, and document and keep a record of the searches:

• Adult Day Care
• Assisted Living Facilities
• HCSSA
• ICF/MR
• Nursing Facilities

Assisted Living Facilities:

DADS informed these providers about changes to changes to Texas Health and Safety Code §247.002 in response to HB 216, 81st Legislature. An excerpt:

Texas Administrative Code (TAC), Title 40, Part 1, Chapter 92, §92.11(a)(1), Criteria for Licensing, effective September 1, 2010, states:

(a) A person must be licensed to establish or operate an assisted living facility in Texas.

(1) An assisted living facility is an establishment that:

(A) furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment;

(B) provides:

(i) personal care services;

(ii) administration of medication by a person licensed or otherwise authorized in this state to administer the medication; or

(iii) services described in clauses (i) and (ii) of this subparagraph; and

(C) may provide assistance with or supervision of the administration of medication.

NF Administrators:

In response to Senate Bill 806, 81st Legislature, Regular Session 2009, HHSC adopted changes that will, among other things, add the conviction of an offense listed in Health and Safety Code, §250.006, to the list of offenses that may bar an administrator from employment in a facility or applicant from obtaining an initial license. (Letter)

Medically Dependent Children Program providers:

DADS reminded MDCP providers that all unlicensed attendants must receive orientation to tasks specific to the MDCP individual in the MDCP individual’s place of residence before providing services. (Letter)

Public Notices

HHSC withdrew its intent to submit Amendment 944, Transmittal Number TX 10-051, to the Texas State Plan for Medical Assistance, which would have proposed to cover certain pharmacy supplies as part of the home health benefit provided by a licensed pharmacy provider.

HHSC intends to submit amendments to the Texas State Plan for Medical Assistance, which would require HHSC to rebase acute care hospital rates within available funds.

Finally, HB 216, 81st Legislature, Regular Session, 2009, created Health and Safety Code Chapter 254, Boarding Home Facilities, directs HHSC to develop and publish model standards for the operation of boarding home facilities relating to construction and remodeling of boarding homes, and other provisions.

See the Texas Register for more information.

Adopted Rules

HHSC adopted amendments to §355.7101, concerning Cost Determination Process, and §355.7103, concerning Rate-Setting Methodology for 24-Hour Residential Child-Care Reimbursements, which will update and standardize the Department of Family and Protective Services (DFPS) facility-type language references in HHSC rules to current DFPS usage.

HHSC adopted an amendment to §370.401, concerning Perinates, in Chapter 370, State Children’s Health Insurance Program, which provides the Children’s Health Insurance Program Perinatal coverage to newborn children whose household income is above 185 percent of the Federal Poverty Level.

HHSC adopted amendments to §379.502, concerning preparing, providing, and serving food to residents; and §379.716, concerning DFPS licensing for shelter centers, in Chapter 379, Family Violence Program. The changes update the name of food benefits formerly known as food stands to reflect the current term, and to implement SB 68, which amended the code to require DFPS licensure of a child-care facility in a temporary shelter, including a family violence shelter center, that provides care for children temporarily residing in the shelter.

See the Texas Register for more information.

On DADS behalf, HHSC adopted amendments to the code concerning the following sections:

• Intermediate Care Facilities For Persons With Mental Retardation Or Related Conditions

• Licensing Standards For Assisted Living Facilities

• Licensing Standards For Home And Community Support Services Agencies

Public Hearing and Notices

HHSC will hold a public hearing on June 15, 2010, at 1 p.m., to receive public comment on proposed payment rates for the state-owned veterans nursing facilities, to be held  in the Permian Basin Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.

HHSC intends to submit Transmittal Number 10-022, Amendment Number 915, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would establish limitations on estate recovery mandated by section 115 of the Medicare Improvements for Patients and Providers Act of 2008, Publ. Law 110-275.

HHSC intends to submit to CMS a request to renew the STAR+PLUS program. See the Texas Register for more information about the hearing and notices.

Proposed Rules

HHSC proposes to amend Title 1, Part 15, Chapter 354, Subchapter A, Division 5, by adding new §354.1063, Preventable Adverse Events. Among the changes: reimbursement for physician services associated with preventable adverse events that occur in the hospital setting will be denied or reduced.

HHSC also proposes to add a new §354.1071, Additional Claim Information Requirements, and §354.7072, Authorized Inpatient Hospital Services, in Title 1, Part 15, Chapter 354, Subchapter A, Division 6, relating to present-on-admission requirements, preventable adverse events, and potentially preventable readmissions. Among the changes: a new §354.1070 that defines “present on admission,” “preventable adverse event,” and “potentially preventable readmission.”

See the relevant section of the Texas Register for details about the proposed changes and where to send written comments

The Texas Medical Board proposes to amend §§185.4, 185.7, 185.16, 185.22, and new §185.27, concerning Physician Assistants. Changes include deleting inaccurate language and providing clarifying language that the rule applies to determinations on active practice; and providing that a PA Board may revoke a temporary license when necessary. See the Texas Register for details.

HHSC proposes on DADS’ behalf to amend §90.3, concerning definitions, §90.11, concerning criteria for licensing, and §90.17, concerning criteria for denying a license or renewal of a license, in Chapter 90, ICFs/MR or Related Conditions. Changes include deleting definitions of the terms “affiliate,” “person with a disclosable interest,” and “manager” and adds a definition for “controlling person” to be consistent with the changes made by SB 806. A definition of “license holder” is also added for clarification.

See the Texas Register for more information.

Withdrawn Rules

HHSC adopted the repeal and replacement of §355.746, concerning Reimbursement Methodology for Mental Retardation Service Coordination, without changes to the proposed text as published in the April 2, 2010, issue of the Texas Register (35 TexReg 2695) and will not be republished. See the Texas Register for more information.

Adopted Rules

DADS adopted changes to five sections of the code:

• Mental Retardation Authority Responsibilities
• Mental Retardation Services–Medicaid State Operating Agency Responsibilities
• Nursing Facility Requirements For Licensure And Medicaid Certification
• Intermediate Care Facilities For Persons With Mental Retardation Or Related Conditions
• Licensing Standards For Assisted Living Facilities

Assisted Living Facilities:

DADS clarified a resident’s use of an assistive device. An excerpt:

1) The ALF must complete a comprehensive functional assessment that is specific to a resident and provide care to the resident according to the resident’s individual service plan based on the results of the comprehensive assessment, as specified in 40 Texas Administrative Code (TAC) §92.41(c);

2) The ALF must ensure that all staff members are competent to provide personal care as specified in 40 TAC §92.41(a)(4). If providing personal care involves the use of assistive devices, the ALF must document staff training and competency related to the use of the device…

ICFs/MR and NFs:

DADS reminded these providers of the requirement to submit a Facility Resident Death Report, DADS Form 5300. They are required to submit the report within 10 working days after the last day of the month in which a resident dies or in which a resident dies within 24 hours after being admitted. (Letter)

CLASS providers:

On May 15, the Medicaid Eligibility Service Authorization Verification will replace the Individual Plan of Care (IPC) as the official notification that the IPC is approved. An excerpt:

“CLASS providers should access a MESAV within 15 business days, not including a two business-day mailing period, from submission to the CLASS Program in the DADS Provider Services Office. MESAV information can only be requested for three consecutive months when the dates requested are within the service authorization period. For example, if an IPC with an authorization period from March 1, 2010, through February 28, 2011, is submitted to DADS Provider Services on February 16, 2010, a MESAV can be requested on March 1, 2010, for authorization information from March through May 2010. Errors found in the MESAV can be faxed (using current procedures) to PCS for immediate resolution. Changes are made retroactive to the begin date of the approved IPC.”

HCS and TxHmL providers:

DADS will implement dental treatment requisition fees for HCS and TxHmL providers, effective June 1. The maximum amount provided for an individual is $1,000 per IPC. Included in the letter is a table of fees. (Letter)

Adult Foster Care, Assisted Living/Residential Care, and Out-of-Home Respite providers:

DADS is implementing a revised contract bed amendment processes for the increase to add beds that were previously under contract and the decrease of contracted beds through attrition, effective with the information letter’s publication. DADS revised Form 3681-A, Community Services Application-Addendum A, and Form 3254-B, Community Services Contract Assisted Living/Residential Care (AL/RC), Out-of-Home Respite (OHR) and Adult Foster Care (AFC)-Bed Amendment Only. (Letter)

You may download the forms here.

ICFs/MR, CLASS, Deaf Blind/Multiple Disability, TxHmL, and HCS providers:

DADS invited these providers to participate in a voluntary training needs assessment survey for input regarding their training needs and barriers to those needs. (Letter)

Adult Day Care Facilities, Assisted Living Facilities, HCSSAs, ICFs/MR, and NFs:

DADS reminded these providers that the DADS Regulatory Services division no longer distributes printed program notifications to service providers. There are two options available to you to receive Regulatory Services notifications: 1) regularly visit Resources for DADS service providers; and 2) sign up to receive free e-mail notifications on the DADS website. Click the tab “E-mail Updates” and follow instructions. (Letter)

HCS:

DADS is attempting to make timeframe requirements for submission of service claims in the HCS and TxHmL programs consistent with other DADS-administered programs. HCS and TxHmL providers requirements are being modified. An excerpt:

An HCS and TxHmL program provider must submit a clean claim for a service component to the state Medicaid claims administrator no later than twelve months after the last day of the month in which the service component was provided.

The definition of a “clean claim” is, in accordance with the Code of Federal Regulations, Title 42, §447.45(b), a service submitted by a program provider for a service delivered to an individual that can be processed without obtaining additional information from the provider of the service or from a third party.

HCS:

DADS reminds these providers that in accordance with 40 TAC §711.1001, the perpetrator or alleged perpetrator of abuse, neglect, or exploitation is not permitted to request a review of the finding or methodology used to conduct a Department of Family and Protective Services investigation. Only the administrator or contractor chief executive officer of the HCS or TxHmL provider may do so. (Letter)

Licensed Type E Assisted Living Facilities:

Effective September 1, 2010, the Texas legislature repeals Section 247.030, Health and Safety Code, which means Type E will no longer be a licensing option for ALFs. DADS will continue to mail licensing renewal packets to Type E facilities until May 1, 2010 (Letter)

CBAs, Consolidated Waiver Program, and ICM Waiver HCSSAs:

DADS clarified to these providers that HCSSAs are not required to complete the Medical Necessity and Level of Care assessment as part of the pre-enrollment assessment for NF residents. (Letter)

Medicaid Hospice Providers:

DADS updated the list of regional contacts for hospice election and certification submissions to DADS Long Term Services and Supports regional staff, Texas Medicaid and Healthcare Partnership, and HHSC Medicaid Eligibility staff. (Letter with four-page contact list)

NFs:

Effective April 3, 2010, DADS will implement an enhancement to the DADS Service Authorization System to allow payment for a nursing facility resident who transfers to a new facility. The enhancement will authorize payment to the NF providing services to residents. (Letter)

Type C Assisted Living Facilities:

DADS will implement the use of revised Form 3736 (Application for State License to Operate a Type C Assisted Living Facility), effective April 1, which will be available on the DADS web site starting March 15, 2010. The new application forms will apply to initial and change of ownership licenses with an effective date of May 1, 2010, or later. (Letter)

Adult Day Care Facilities, Assisted Living Facilities (Except Type C Facilities), and ICFs/MR:

DADS will implement the use of Form 3720 (Application for State License to Operate a Long-Term Care Facility), effective April 1, which will be available on the DADS website starting March 15, 2010. The new application forms will apply to initial and change of ownership licenses with an effective date of May 1, 2010, or later. (Letter)

NFs:

DADS will implement the use of  3720N (Nursing Facility Application), effective April 1, which will be available on the DADS website starting March 15, 2010. The new application forms will apply to initial and change of ownership licenses with an effective date of May 1, 2010, or later. (Letter)

CBA, CBA Assisted Living/Residential Care, CLASS, DAHS, ICF/MR, ICM, HCS, NFs, PHC, RC, and TxHmL providers:

The HHSC Rate Analysis Department has posted mandatory cost reporting and cost report training for 2009 information on its web site. The final session of the 2009 cost report training is scheduled for March 9-10, 2010. Providers must make sure the preparer has completed cost report training. HHSC RAD must receive all 2009 cost reports no later than March 31, 2010. (Letter)

HCS and MRA providers:

DADS proposed rules at 40 TAC Chapter 9, Subchapter D, that will transfer the case management function from HCS Program providers to MRAs as required by the 2010-2011 General Appropriations Act (Article II, Special Provisions, Section 48, Senate Bill 1, 81st Legislature, Regular Session, 2009). See the proposed rules here.

DADS anticipates that a final version of these rules will be adopted in April or May of 2010 and effective June 1, 2010. (Letter)

DBMD providers:

DADS clarified its expectations regarding DBMD providers’ training responsibilities in the following areas:

Reporting Abuse, Neglect and Exploitation: Program providers are responsible to make sure those receiving DBMD services and the LAR are told at enrollment and every year how to report abuse, neglect, and exploitation, effective March 1.

Annual Provider Selection: Providers must begin completing the DADS Provider Selection Determination Form (Form 1576) with the individual and LAR every year to verify that provider choice is offered, effective March 1.

Medical Transportation: Individuals seeking medical transportation through Medicaid must access non-waiver resources before requesting services through the waiver. Call 1-877-633-8747 for this service.

Billing for Assisted Living and Day Habilitation: “Some individuals in the DBMD waiver receive services in a 24-hour residential setting provided as licensed home health assisted living (service code 19E) or as licensed assisted living (service code 19) and also attend day habilitation (service code 10). In such instances, the provider must bill the assisted living as 18-hour assisted living (service code 19F) on the days in which the program provider is also billing for the individual’s participation in day habilitation (service code 10). Individuals receiving day habilitation are not receiving 24 hour care during the time they are away from the residence. If services are currently on the ISP as 24 hour care, (service code 19E or 19) and the individual is receiving day habilitation (service code 10), the DBMD provider must complete an ISP amendment to place those units under 18-hour assisted living (service code 19F) for those days the individual is receiving day habilitation (service code 10).” (Letter)

DADS proposes to transfer case management function, currently performed by HCS program providers, to Mental Retardation Authorities, as required by the 2010-2011 General Appropriations Act, effective June 1, 2010. (Letter)

An excerpt:

“Effective the date of this letter, a program provider is not required to provide case management using only employees of the program provider (that is, a program provider could use a qualified contractor to provide case management). If a program provider chooses not to provide case management using only employees, however, the program provider must ensure that at least one of the following service components is provided using only employees: residential support, supervised living, supported home living, day habilitation, supported employment, or respite.”

CBA, CBA Assisted Living/Residential Care, CLASS, DAHS, ICF/MR, HCS, NF, PHC, RC, and TxHmL providers:

HHSC Rate Analysis Department has posted information on its web site regarding mandatory cost reporting and cost report training for 2009. See the HHSC RAD web site for details. (Letter)