Hospice providers:

DADS sent a corrected letter that notifies these providers that they can bill for ventilator services provided to residents in nursing facilities. In the attached letter, the corrections are indicated in red. (Letter)

Day Activity Health Services providers:

DADS determined that either an LVN or an RN can complete and sign the Form 3050 (DAHS Health Assessment/Individual Service Plan) when it is used for assessment in a Day Activity Health Services program. An LVN is not required to obtain the co-signature of an RN, and an RN is not required to sign the medication section of the Form 3050 in a DAHS facility. (Letter)

HCS, ICF/MR, TxHmL:

DADS informed these providers about proposed changes to TAC rules governing fiscal accountability for the ICF/MR and HCS programs and the Attendant Compensation Rate Enhancement for the ICF/MR, HCS and TxHmL programs. An excerpt:

“Fiscal accountability requires all ICF/MR and HCS providers to meet certain spending requirements for a broad range of staff. Providers and the Health and Human Services Commission (HHSC) have both expressed concerns that the current fiscal accountability system is not sustainable over the long term. In response to these concerns, the 81st Legislature authorized HHSC to discontinue fiscal accountability spending requirements contingent upon the implementation of a rate enhancement system or other appropriate financial performance standards through the 2010-11 General Appropriations Act (S.B. 1, Article II, Health and Human Services Commission, Rider 67).”

Medicaid Hospice Providers:

HHSC recently approved rate changes for the Medicaid Hospice Program for Federal Fiscal Year 2010, effective October 1, 2009. See new rates on this web page. The adjustment will be retroactive, so providers don’t have to do anything, unless repayment fails. In that case, they’ll need to re-bill the denied claims. (Letter)

ICF/MR:

DADS announced the Employment Services Training and Technical Assistance Initiative. The purpose is to improve employment outcomes for individuals to whom you provide services. See this web page for more information.

DADS will host regular webinars on topics related to employment for people with disabilities, which will be held from September 2009 through May 2010, on the first Thursday of the month from 10 a.m. – 11 a.m. (Letter)

HCSSAs: All Medicare-approved home health agencies or those seeking approval under Medicare must comply with Outcome and Assessment Information Set (OASIS)-C requirements. Download the patient classification table here and the letter here.

HCS, TxHmL, and CDSAs: HHSC approved new payment rates for these programs, effective September 1, available at the HHSC Rate Analysis web page and TxHmL web page. Download the letter for additional links.

CDSAs, HCS, and TxHmL: DADS provided guidance to these programs for revising CDS employer budgets and for filing claims as a result of CARE system changes implemented for rate increases in the HCS and TxHmL programs. (Letter)

Hospice Providers: DADS notified hospice providers that they can bill for ventilator services provided to residents in nursing facilities. (Letter):

Service Code 4 = Ventilator Services
Bill Code – N0500
Partial Ventilator Services = CPT Code 94567
Revenue Code = 0659

Bill Code – N0501
Full Ventilator Services = CPT Code 94004
Revenue Code = 0659

Reimbursement Rates
August 1, 2009 = Full Ventilator Services = $116.28
August 1, 2009 = Partial Ventilator Services = $46.51
September 1, 2009 and forward = Full Ventilator Services = $118.84
September 1, 2009 and forward = Partial Ventilator Services = $47.54

Public Notices

HHSC has adopted new Medicaid per diem payment rates for the nursing facility program operated DADS, effective September 1, 2009:

• Base Rates by RUG
• Add-on Rates by Enhancement Level
• Liability Insurance

See the relevant section of the Texas Register for more information.

HHSC will hold a public hearing on October 20, 2009, at 9:00 a.m. to receive public comment on proposed rates for Hospice routine home, continuous home, inpatient respite, and general inpatient care, in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas.

The briefing package will be available on October 5, 2009. Request a copy by contacting Meisha Scott by telephone (512) 491-1445, fax (512) 491-1998, or e-mail Meisha.Scott@hhsc.state.tx.us. Send written comments to Ms. Scott by 5 p.m. the day of the hearing.

Proposed Rules

The Texas Medical Board proposed amendments to 14 sections of the code:

• Licensure
• Physician Registration
• Criminal History Evaluation Letters
• Postgraduate Training Permits
• Temporary And Limited Licenses
• Physician Profiles
• Telemedicine
• Fees, Penalties And Forms
• Investigations
• Procedural Rules
• Disciplinary Guidelines
• Office-Based Anesthesia Services And Pain Management Clinics
• Standing Delegation Orders
• Non-Certified Radiologic Technicians

Screen 573 allows ICFs/MR to monitor compliance with RLO. The screen’s new function is to identify individuals in each queried component code that have not received a RLO due to being a new admission. These individuals will show as “Not Found” on Screen 573. A vendor will place a hold on payments to facilities until all reviews are updated and completed. (Letter)

HCS, MRAs, and CDSAs: DADS implemented in CARE new nursing categories and new rates for specialized therapies, effective September 1. DADS will run retroactive reimbursement processes for providers affected by the implementation delay.

The four new nursing categories are NUR, NUL, NURS, and NULS. Rates will be implemented in physical therapy, occupational therapy, speech and language pathology, behavioral support, audiology services, and dietary services. You may find the new fee schedule here. (Letter)

HHSC adopted new per diem payment rates for NFs, the hospice program in NFs, and the swing bed program, effective September 1. These program providers can access rates here. (Letter)

DBMD and CDSAs: DADS will implement support consultation as an optional service component for individuals participating in the CDS service delivery option, effective October 1. Case managers are responsible for informing those who select the CDS option that support consultation is available. Attached to the letter are charts for DBMD waiver program FY 2010 payment rates. (Letter)

• ICF/MR Group 5
• ICF/MR Group 6
• HCS and TxHml
• Community Services, Nursing Facility, and Therapy Providers

DADS informed community-based ICF/MR providers of the initiation of adverse actions that may be taken by DADS against providers that don’t comply with the Review of Living Options process, including requirements for planning and documentation. (Letter)

DADS announced that the ICF/MR Provider & Surveyor Conference will be held on November 3 and 4, 2009, in Austin. DADS will offer a Direct Care track again this year. Registration begins September 1, 2009. (Letter)

DADS explained to MRAs, HCS, and TxHmL program providers the process of submitting a Medicaid application or redetermination packet to the Medicaid Eligibility for the Elderly and People with Disabilities section of HHSC on behalf of an individual. (Letter)

DADS informed HCS providers that it will conduct annual unannounced visits to all three-person and four-person HCS residences in which supervised living or residential support is provided. These visits include HCS foster/companion care homes. (Letter)

DADS reminds HCS providers that in order for the DADS Waiver Survey and Certification to conduct annual, unannounced residential visits, HCS Program providers must enter and maintain accurate information in the CARE system. (Letter)

DADS issued a letter to HCS, CDSAs, and MRAs about changes to the HCS program, which include changes to the nursing service component and HCS billing program guidelines. (Letter)

DADS informed CLASS, CMA, and DBMD providers about changes related to an applicant’s or an individual’s request for a fair hearing in the Texas Integrated Eligibility Redesign System. (Letter)

DADS encourages PHC providers to continue submitting Form 2101, Authorization for Community Care Services, with Form 3052, Practitioner’s Statement of Medical Need. (Letter)

DADS provided CARE instructions for TxHmL providers. The user guide has been updated to reflect the changes. (Letter)

The U.S. Department of Health and Human Services is collecting information on evacuation plans for facilities located along the Texas coast. The department asks nursing and assisted living facilities in the following counties to fill out this survey: Aransas, Brazoria, Brooks, Calhoun, Cameron, Chambers, Ft. Bend, Galveston, Harris, Hidalgo, Jackson, Jefferson, Jim Wells, Kenedy, Kleberg, Liberty, Matagorda, Nueces, Orange, Refugio, San Patricio, Victoria, Wharton, and Willacy. (Letter)

• Emergency Preparedness Reminder

DADS reminded all Adult Day Care Facilities, Assisted Living Facilities, Home and Community Support Service Agencies, Intermediate Care Facilities for Persons with Mental Retardation or Related Conditions, and Nursing Facilities to review their emergency preparedness and response plans and available resources in the event of an emergency. Hurricane season is June 1 through November 30. Download the letter for more information.

• Implementation of Medicaid Hospice Rates Revised for Wage Index

DADS informed Medicaid Hospice providers that the Texas Health and Human Services Commission has updated the payment rates for the Medicaid Hospice program because of the American Recovery and Reinvestment Act of 2009. New rates are retroactively effective from October 1, 2008. See rate changes on this web page, and download the letter for details.

• Integrated Care Management (ICM) 1915(c) Waiver Rules, Adaptive Aids, Minor Home Modification and Medical Supplies Processes (Replaces IL 2008-47)

DADS sent a letter to ICM Waiver providers informing them about operational processes for accessing adaptive aids, medical supplies and minor home modifications. The five-page letter and attachment summarizes the revised steps for purchasing these items.

• TV Converter Box Program Update

DADS issued a provider letter to all DADS service providers that contains updated information on the transition from analog broadcasts to digital television. Download the two-page letter for details.

• Provider Screening of Employees, Subcontractors for Excluded Persons

DADS has asked all community service providers to review a letter sent by the Centers for Medicare and Medicaid Services reminding states to direct providers of Medicaid reimbursed services to screen employees and subcontractors employees for excluded persons. Download the seven-page letter and attachment here.

• Clarification of the Provision and Billing of Hospice Services for Medicaid Nursing Facility Residents

In a letter to Hospice and Nursing Facility providers, DADS clarified the billing of hospice services for Medicaid-eligible nursing facility residents. Download the letter for more information.

• Community Services Medical Necessity (MN) and Level of Care (LOC) Assessment for PACE Participants Residing in Nursing Facilities (NFs)

DADS served notice to PACE providers about MN/LOC assessments and billing for participants whose permanent residence is a Medicaid NF. PACE submits assessments to the Texas Medicaid Healthcare Partnership every year, and the organization is responsible for making payments to NFs for each PACE resident. Download the letter for more information.

• Submission of the Hospice Election, Form 3071, and Physician Certification of Terminal Illness, Form 3074

In a letter to Medicaid Hospice providers, DADS presented an updated list of regional contacts for the submission of hospice election and certification forms to DADS Long Term Services and Support Regional Staff, Texas Medicaid and Healthcare Partnership, and the Health and Human Services Commission Medicaid Eligibility for Persons with Disabilities staff. Download the letter and five-page list of contacts.

• Medicaid Hospice Physician Rate Changes

In a second letter to Medicaid Hospice providers, DADS informed them about approved rate changes for the Medicaid Hospice program for FY 2009, effective January 1, 2009. See this page for fee schedule amounts. Hospice providers can find more information on this web page and download the letter here.