CLASS CSA, CLASS, DSA, HCS, TxHmL, CDA, and Local Authorities:

DADS is expanding utilization management and review activities for its Medicaid community entitlement and waiver programs, effective January 1, 2012. (Letter)

ADC, ALF, HCSSA, ICF/ID, and NF:

Beginning March 1, 2012, if the name of an applicant or associated person is listed in a health and human services agency record of adverse licensing, DADS may deny the person’s application for a license or renewal. (Letter)

Hospice, ICF/ID, and NF:

DADS clarified how to apply CMS S&C Letter 11-30-NH in the context of DADS’ current incident reporting requirements. An excerpt:

Here are some points of guidance with regard to applying the provisions of S&C 11-30-NH in the context of DADS’ current incident reporting requirements:

• Section 1150B requires reporting of “any reasonable suspicion of a crime” to at least one local law enforcement agency of jurisdiction and to DADS. Reports to DADS (and the Department of Family and Protective Services, if appropriate) must also be made in accordance with current reporting guidelines as outlined in Provider Letter 06-12 and 40 TAC §97.249 (Hospice), Provider Letter 06-43 (NF), Provider Letter 09-02 (non-licensed ICF/ID) and Provider Letter 10-24 (licensed ICF/ID).

• Facilities, per page 3 of S&C 11-30, should coordinate with local law enforcement entities to determine what actions are considered crimes within their political jurisdiction. In the event more than one local law enforcement entity may have jurisdiction, such as a local police or sheriff’s department, DADS recommends facilities confirm which law enforcement entity should receive reports. DADS also recommends that owners, operators, employees, managers, agents or contractors of facilities and agencies review the Texas Penal Code, in particular the offenses in Chapters 22 (Assaultive Offenses), 31 (Theft) and 32 (Fraud). The Texas Penal Code is available on the Texas Legislature’s website at http://www.statutes.legis.state.tx.us/. Incidents of abuse, neglect and exploitation reported to law enforcement may result in a criminal investigation for one or more of the offenses in Chapters 22, 31 or 32.

HCS and TxHmL:

These providers must be in compliance with nursing changes by January 1, 2012, with the following requirements:

HCS and TxHmL program providers must be in compliance by January 1, 2012 with the following requirements:

• All licensed vocational nurses (LVNs) must be clinically supervised by a registered nurse (RN).

• Program providers must have a written plan and schedule to complete an initial comprehensive nursing assessment for all individuals enrolled in HCS.

HCS and TxHmL program providers must be in compliance by March 1, 2012 with the following requirements:

• LVNs participating in the pilot project may perform on-call services by telephone only if all conditions for pilot participation have been met. On-call services are defined as providing telephone services any time of the day or night to make an assessment by phone of non-urgent, urgent, and emergency conditions or issues an individual may experience. On-call services also includes providing instructions to an unlicensed person over the phone regarding a condition.

• LVNs who are not participating in the pilot project cannot provide on-call services.

HCS and TxHmL program providers must be in compliance by May 1, 2012 with the following requirements:

• Data reflecting nursing on-call services for March 1, 2012 and thereafter must be entered into the Client Assignment and Registration System (CARE). A separate information letter will be posted outlining the reporting requirements in CARE.

HCS:

An RN may exempt an HCS foster/companion care provider from the Board of Nursing definition of unlicensed person if the specified conditions are met. You will find the information at Question 5 on the FAQs page. (Letter)

CBA HCSSAs:

CBA nursing assessments will be required twice a year instead of four times a year, effective January 20, 2012. (Letter)

– DADS and the Board of Nursing will delay full implementation of the pilot program for the HCS and TxHmL waiver programs and all ICF/ID with capacities of 13 or fewer beds until March 1, 2012.

–  Providers with a Quality Improvement Evaluation System account to submit MDS data or view CASPER reports should now update their account and follow the process to ensure they continue to receive critical CMS alerts.

– Revised forms 4116-MHM-AA and 4116-Dental for HCS/TxHmL dated September 2011 must be used. Older versions will no longer be processed.

–  DADS has rescinded Information Letter No. 11-155: “Health and Human Services Commission Form H3087 Replaced by ‘Your Texas Benefits’ Medicaid Card” on January 3, 2012, because it contained outdated information. Current provider information on “Your Texas Benefits” Medicaid card is found here.

See the news alert page for details on these and other entries.

Community Care for the Aged and Disabled RC providers, CBA, AL/RC, and AFC:

CMS recently announced a 3.6 percent COLA increase in federal benefits. Because of late receipt of this news, HHSC will not implement the increase until February 1, 2012. (Letter)

NF, ICF, HCS, and TxHmL:

HHSC will delay the COLA increase in Retirement, Survivors and Disability Insurance, Supplemental Security Income, and Medicare Part A and B premium amounts to February 1, 2012. (Letter)

HCSSA w/ DADS contract:

DADS released the results of a joint streamlining project (with Access and Intake, Contract Oversight and Support, and Regulatory Services) conducted during fiscal year 2011. An excerpt:

We are pleased to report that DADS identified several opportunities to increase coordination or eliminate duplication and has changed policies and procedures accordingly. Those changes are as follows: Several items reviewed during Regulatory surveys will no longer be reviewed by contract managers, including:

• Several items reviewed during Regulatory surveys will no longer be reviewed by contract managers, including:

o verification that providers document, investigate and resolve complaints reported to the provider;

o verification that individuals are informed of their rights and how to file complaints;

o verification that providers are conducting criminal history checks on unlicensed attendants;

o evidence of provider compliance in delivering seldom-used therapies;

o evidence of supervisory visits; and

o verification that interdisciplinary team meetings were convened in required timeframes.

Hospice, ICF/ID, and NF:

DADS clarified how to apply CMS Survey and Certification letter provisions in the context of the DADS’s current incident reporting requirements. (Letter)

All ICF/ID:

DADS informed providers that some Board of Nursing rules are more specific to the practice of professional nursing in Texas and may be viewed as more restrictive than the ICF/ID federal regulations. Providers must comply with the more stringent rules. (Letter)

All ICF/ID:

DADS clarified the Board of Nursing’s position on an LVN providing on-call telephones services to individuals in the ICF/ID program:

The BON defines on-call telephone services as “providing telephone services anytime of the day to handle non-urgent, urgent and emergent conditions an individual may experience; and making a telephone assessment and providing instructions to an unlicensed person over the phone regarding that condition.” The BON has determined LVNs providing on-call services to individuals in the ICF/ID program to be out of the LVN’s scope of practice. (Letter)

CLASS CSAs, CLASS DSAs, and CDSAs:

Effective January 1, 2012, a CMA and DSA can bill for pre-enrollment assessment activities on the same day. (Letter)

ICF/MRs:

DADS issued this letter to guide providers on using video surveillance cameras to monitor common areas. An excerpt:

There is no state rule or federal requirement that specifically addresses the use of video surveillance cameras in ICFs/ID; however, 42 Code of Federal Regulations (CFR) §483.420(a) (W122), §483.420(a)(5) (W127), §483.420(a)(7) (W129 and W130) and §483.420(a)(9) (W133) require an ICF/ID to protect the privacy and rights of the individuals who reside in the facility. When an ICF/ID chooses to use video surveillance cameras to monitor common areas, it must:

1. Obtain approval before implementation from the facility’s specially constituted committee (SCC). 42 CFR §483.440(f)(3) (W262) requires the facility’s SCC (sometimes referred to by CMS as the Human Rights Committee or the Constituted Advisory Committee) to review and approve programs and practices that might involve risks to individual rights before implementation. This is intended to ensure individual’s rights are fully protected. Therefore, the facility’s video surveillance camera policies and procedures must be reviewed and approved by its SCC before cameras may be installed.

• Cost reporting information for CBA HCSS, CLASS CMA/DSA, and PHC

• Cost reporting information for HCS, ICF/MR, and TxHmL

• Cost reporting information for Adult Day Care, ALRC, CBACCAD, DBMD, NF, and RC

DAHS:

DADS clarified procedures for documenting information on Form 3682, DAHS Daily Transportation Record, and the activities DAHS facility may bill as part of transportation services. (Letter)

CDS for PHC, CAS, and FC:

DADS is adjusting the calculation of the Annual Service Plan for PHC, CAS and FC to be consistent with calculations made by the Service Authorization System. (Letter)

All Community Services 1915(c) Waiver providers:

An excerpt:

In accordance with Section 3309 of the Affordable Care Act, effective January 1, 2012, individuals receiving Medicaid 1915(c) waiver services and enrolled in a Medicare Part D prescription drug plan (PDP), will no longer be responsible for Medicare Part D prescription co-payments. This change will impact individuals enrolled in Community Based Alternatives (CBA), Community Living Assistance and Support Services (CLASS), Medically Dependent Children Program (MDCP), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS) and Texas Home Living (TxHmL).

If an individual, as described above, is asked to make a co-payment for a Part D prescription after December 31, 2011, the individual (or the individual’s guardian) should inform his or her prescription drug plan (PDP) that he or she is receiving waiver services. The individual should provide documentation to the PDP confirming enrollment in a waiver. The PDP must forward the documentation to the Centers for Medicare & Medicaid Services (CMS) for use in updating its systems.

This earlier letter appears to be a duplicate of the above.

The proposed rules:

• Amend the definition of “line item” - With the recent rollout of HHSC’s web-based State of Texas Automated Information Reporting System (“STAIRS”), the meaning of the term has become somewhat obsolete. A web-based system does not rely on “lines” as does a paper-based system or HHSC’s more recent database system.  HHSC’s clarification covers the use of the term by defining “line item” as, “A specific informational, statistical, revenue or expense data element in a cost report.”
• Remove the term “auditor” -   Cost report desk reviews are generally completed by HHSC Office of Inspector General audit staff. However, HHSC intends to modify its cost report audit process to focus more audit resources on high-risk cost reports.  Consequently, both audit and non-audit HHSC staff would be making exclusions or adjustments to a cost report or finalizing those adjustments. Therefore, HHSC proposes removing the word “auditor” from §355.107(a).

The MCAC recommended approval of the rules for publication. Next, HHSC will present the proposed rules to the DADS Agency Council on November 30, 2011. The proposed rules are expected to be published in February 2012, with publication of the adopted rule May 2012 and an effective date of approximately June 2012.

Most LTC providers:

HIPAA rules mandate that all Electronic Data Interchange (EDI) transactions must use EDI Version 5010. CMS has extended the December 31, 2011, compliance deadline until April 1, 2012. (Letter)

ICF/MR:

DADS reminds providers of their responsibility to maintain current and accurate information in ICF/MR Provider Characteristics using Client Assignment and Registration Screen 683 and the instructions for entering information (Letter)

–  CBA and HCSSAs: DADS has revised the following forms (to be used by January 2, 2012) to remove requisition fees:

• Form 3671-D, Minor Home Modification, and Instructions have been updated
• Form 3672-E, Adaptive Aids and Medical Supplies, and Instructions have been updated
• Form 3671-H, Dental Services, and Instructions have been updated.

– DADS recently hosted a HSC billing guidelines webinar, but providers requested face-to-face training. In response, DADS will host several on-site training sessions. For training dates and registration (required), see the HSC training sessions page.

DADS made three changes to the HDM Contract Compliance and Fiscal Monitoring Tool. An excerpt:

Meal Delivery within the Required Timeframes

An HDM provider or subcontractor performing meal delivery must monitor each meal delivery route annually to verify meals are delivered within the required timeframes. Documentation of monitoring must include the route name/number, the date of the monitoring, and the times of the first and last meal deliveries. The applicable rule references are 40 TAC §55.27, 40 TAC §85.302, and 40 TAC §49.31.

Providers and subcontractors must complete and document monitoring of all meal delivery routes by February 29, 2012. During contract monitoring, contract staff will request a list of all of the provider/subcontractor meal delivery routes and select a sample for review. Contract monitorings that begin on May 1, 2012, and later will review route monitoring documentation for compliance with these requirements.

– DADS provided a link to the current Medicaid event calendar for consumer outreach events for STAR+PLUS expansion into the Lubbock, El Paso, and Hidalgo service areas. For more information, follow this link: http://www.hhsc.state.tx.us/medicaid/MMC/El-Paso-Lubbock.shtml.

–  DADS notified HCS and TxHmL providers about a change in adaptive aid and minor home modification requisition fee policies and possible adjustments to an individual’s Individual Plan of Care. An excerpt:

Due to the recent cost-containment initiative and revisions that have been made to the Home and Community-based Service Guidelines and Texas Home Living Guidelines, requisition fees on some IPCs dated on or after 12/1/2011 are currently set higher than the program limits allow in the Client Assignment and REgistration system (CARE). The Department of Aging and Disability Services (DADS) is working to resolve this issue. Individuals with requisition fees included on their current IPCs that are over the allowable limits will be adjusted to the appropriately calculated amount on 12/1/2011.

–  The DADS Culture Change survey will be available through December 8, 2011.

–  DADS changed the service code for behavioral support available in the CLASS program from SVC 14 to SVC 43A, retroactive to November 1. 2011.

See the news alert page for details about each update.

CAS, CBA, FC, and PHC providers:

Regarding personal attendant services, the attendant may not directly transport the individual receiving the services. He may arrange for transportation, accompany the individual when using public transportation, or meet the individual at the location. (Letter)

ICF/MR (excluding state-supported living centers):

DADS will conduct mortality reviews for deaths that occurred on September 1, 2011 and later for decedents who lived in ICF/MR facilities when they died or if they died within 90 days of discharge. (Letter)

CLASS Case Management and CDAs:

DADS is removing hydrotherapy from the list of specialized therapies available in the CLASS program. (Letter)

HCS, CDSA, and Local Authorities:

An excerpt of the Cost Containment Initiative Update:

In Information Letter No. 11-82, dated September 8, 2011, the Department of Aging and Disability Services (DADS) notified providers and local authorities of cost containment measures effective December 1, 2011, for the Home and Community-based Services (HCS) Program. The letter addressed new service limits for selected HCS Program services and the process for requesting an exception to a service limit.

Second Level Review

In response to stakeholder feedback, DADS has implemented a second level review as part of the cost containment initiative for a:

• service for which DADS first level review indicates there should be a denial of the service limit exception; and

• voluntary service reduction request based on a new service limit.

MDCP and HCSSA:

Cost Containment Initiative Update

All NF Administrators and PACE providers:

The Texas legislature authorized the PACE program as a community-based service option under the Money Follows the Person policy. For more information about the PACE program: http://www.dads.state.tx.us/services/faqs-fact/pace.html. Current PACE sites include El Paso, Lubbock, and Amarillo. (Letter)