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.

Public Notices

HHSC intends to submit to CMS a request to amend the Non-Emergency Medical Transportation waiver program, which would add Colorado, Erath, Palo Pinto, and Somerville counties to the waiver to realign the counties in the full-risk broker model areas that impact the waiver. Jasper, Newton, Polk, San Jacinto, and Tyler counties will be removed.

Adopted reimbursement rates for large, state-operated ICFs/MR and for small, state-operated ICFs/MR: $582.57 and $562.13. See the Texas Register for more information about both notices.

Proposed Rules

The Texas Board of Nursing proposed to amend §217.6, Failure to Renew License, which would simplify the licensure process for military spouse applicants without compromising the safety of the public. An excerpt:

First, the Board has determined that military spouse applicants should not be required to pay the late fees and fines normally required for reactivating an expired or delinquent license. Because military spouses are often transferred from state to state with little notice, the Board has determined that the purpose of the late fees and fines, which is to encourage a licensee’s timely renewal, is not applicable in such situations. As such, the proposal exempts military spouse applicants from paying these late fees and fines. However, only those military spouse applicants who submit a reactivation application to the Board in paper form will be exempt from paying these late fees and fines. This is because the Board’s online system is unable to process applications that are not accompanied by full payment of the late fees and fines normally required for the reactivation of an expired or delinquent license. Because the Board is unable to alter its online system at this time, the proposed amendments specifically require the reactivation application to be submitted in paper form in order for a military spouse applicant to receive this exemption.

Second, in compliance with the provisions of SB 1733, the Board has determined that military spouse applicants who have practiced nursing in another jurisdiction within the four years immediately preceding a reactivation application are exempt from completing 20 contact hours of continuing education. This exemption not only allows these applicants to demonstrate their competency to practice through alternative means, as mandated by SB 1733, but it also protects the health and safety of the public by ensuring that an applicant has recently practiced nursing in another jurisdiction and is a safe and competent practitioner.

Withdrawn Rules

The Texas Medical Board has withdrawn the proposed amendments to §192.1 and §192.2, and new §§198.1 – 198.3. See the Texas Register for details.

Adopted Rules

The Texas Medical Board adopted changes to several sections of the code:

• Licensure
• Reinstatement And Reissuance
• Temporary And Limited Licenses
• Fees And Penalties
• Complaints
• Surgical Assistants
• Pain Management Clinics

On DADS’ behalf, HHSC adopted changes to several sections of the code:

• Mental Retardation Services–Medicaid State Operating Agency Responsibilities
• Nursing Facility Administrators
• Community Living Assistance And Support Services
• Community Care For Aged And Disabled
• Medically Dependent Children Program
• Nurse Aides
• Medication Aides–Program Requirements

Rule Review

The Texas Medical Board adopted the review of  Chapter 163, Licensure, §§163.1, 163.2, 163.4 – 163.11 and 163.13, and adopted amendments to §§163.1, 163.2, 163.6, 163.7 and 163.11.

The board also adopted the review of Chapter 167, Reinstatement and Reissuance, §§167.1 – 167.8, pursuant to the Texas Government Code, §2001.039 and adopted amendments to §167.8. For details, see the Texas Register.

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)

–  On November 3, 2011, from 12:30-2 p.m. CT, CMS will host a National Provider Call on “Skilled Nursing Facility Prospective Payment System (PPS) Minimum Data Set (MDS) 3.0 and Resource Utilization Group-Version 4 (RUG-IV) Policies and Clarifications.” Registration is required to attend this call.

–  HHSC is expanding the STAR+PLUS Medicaid managed care delivery system into the Lubbock, El Paso, and Hidalgo service areas and will discontinue enrolling providers for HCSSA, CDS, AL/RC, AFC, and ERS (all for CBA) contracts.

–  DADS provided responses to FAQs received during the CLASS Monitoring Tools Webinar held on October 5, 2011.

–  DADS will hold two public work sessions on Thursday, November 17, 2011, in the John H. Winters Public Hearing Room, 701 W. 51st Street, Austin, to discuss ideas for reducing administrative costs in HCS, TxHmL, and ICF programs. An excerpt:

DADS welcomes your ideas for reducing administrative cost and requirements in these programs. To facilitate discussion, please complete and return one or more of the linked Microsoft Word forms by 5:00 p.m., Friday, November 4, 2011. DADS will compile the ideas and review them during the work sessions:

• Ideas for HCS program
• Ideas for TxHmL program
• Ideas for ICF program

Please complete and return your survey(s) to DADS by 5:00 p.m. on Friday, November 4, 2011, using one of the following methods:

• send an email to jose.saenz@dads.state.tx.us with the subject line of Ideas for Reducing Administrative Requirements;
• send to Jose Chema Saenz, Manager, Stakeholder Relations Unit, CCEA, DADS, MC W-623, P.O. Box 149030, Austin, Texas 78714-9030; or
• send a fax to 512-438-3884 with attention to Jose Chema Saenz, DADS Stakeholder Relations.

See the news alert page for more information.

Public Notices

HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance, which would add categorical determinations to the Preadmission Screening and Resident Review (PASRR) program. HHSC intends to submit an amendment that would define the PASRR Level II evaluation and identify specialized services available only to PASRR-eligible individuals.

Finally, HHSC intends to submit to CMS a request to renew the TxHmL waiver program. For more information about each notice, see the Texas Register.

Proposed Rules

HHSC proposed to amend the following sections of the code:

• 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
• Licensing Standards For Home And Community Support Services Agencies
• Adult Day Care And Day Activity And Health Services Requirements
• Denial Or Refusal Of License

1.  A concise statement of the specific actions or determinations disputed;
2. A recommended resolution; and
3. Any supporting documentation relevant to the dispute.

Provider Letter 11-11 further states that if a provider is disputing a cost report adjustment, the provider must include a description of the cost report item they are disputing, what they believe the correct value of the item should be, why they believe this, and supporting documentation (such as payroll records, timesheets, canceled checks, etc.). If a provider is submitting a correction to a cost report, the provider must include a description of the cost report item they are correcting, what they believe the correct value of the item should be, why they believe this, and documentation that supports their corrected value (see above for examples).

Prior to September 1, 2011, if a provider submitted an informal review request that did not meet these requirements, HHSC would accept the request for review and request the additional information through a certified mailing, giving the interested party an additional 15 days to provide the information. Garlo Ward has prepared and submitted numerous informal review requests for clients over the years. We have always included a detailed description of the cost report line items disputed, with a thorough explanation of our recommended resolution per line item and attached all available and applicable supporting documents.

As noted above, as of September 1, 2011, requests for informal review that do not include the required information will be denied and not subject to further appeal. Meaning, providers will no longer get a second chance to make up for a deficient informal review request. Don’t let this happen to you! Garlo Ward can help you gather the information necessary and draft a request for informal review that meets the rule requirements.

Public Hearings and Notice

HHSC will hold a public hearing on October 27, 2011, at 9 a.m. to receive public comment on proposed rates for Hospice routine home, continuous home, inpatient respite, and general inpatient care, to be held in the Lone Star Conference Room.

HHSC intends to submit transmittal number 11-055 to the Texas State Plan for Medical Assistance, which would establish the Recovery Audit Contractor Program. For more information about the hearing and the amendment, see the Texas Register.

DADS will hold a public hearing on October 18, 2011, at 8:30 a.m. to receive public comment on proposed amendments and new sections to Chapter 9, Subchapter D, the HCS program; Chapter 45, the CLASS program; Chapter 48, Subchapter J, the CBA program; and the MDCP program. The hearing will be held in the Public Hearing Room of the John H. Winters Building, 701 W. 51st Street, Austin. For details, see the Texas Register.

Proposed Rules

HHSC proposes to amend §355.8620, Reimbursement Methodology for Outpatient Services, which would add inpatient services to the type provided by the Indian Health Service or a to a tribe that will be reimbursed. See the Texas Register for more information.

The Texas Medical Board proposes to amend §173.1, Profile Contents; and §173.3, Physician-Initiated Updates. An excerpt:

The amendment to §173.1 clarifies what utilization review services are subject to reporting on a physician’s profile and specifically excludes the reporting of utilization review provided in relation to worker’s compensation claims.

The amendment to §173.3 clarifies that changes in address to be reported to the Board by physicians within 30 days of their occurrence, applies to both mailing and practice address changes.

The board also proposes to amend §175.1, Application and Administrative Fees; §175.2, Registration and Renewal Fees; and §175.5, Payment of Fees or Penalties. An excerpt:

The amendment to §175.1 removes all language relating to surcharges as this term is used only for internal agency purposes and its removal eliminates confusion; increases the application fee for physician-in-training permits used to complete rotations in Texas by $1 due to fee increases set by the Department of Information Resources; and sets the fee at $18 for the processing of Physician/Physician Assistant Jointly-Owned Entity Annual Reports.

The amendment to §175.2 removes all language relating to surcharges as this term is used only for internal agency purposes and its removal eliminates confusion.

The amendment to §175.5 provides that additional fees shall be incurred by individuals who renew their applications online or through hard-copy, depending on the format.

• On DADS’ Behalf

HHSC proposes changes to the code in the following sections:

• Mental Retardation Services–Medicaid State Operating Agency Responsibilities
• Nursing Facility Administrators
• Community Living Assistance And Support Services
• Community Care For Aged And Disabled
• Medically Dependent Children Program
• Licensing Standards For Assisted Living Facilities
• Nurse Aides
• Medication Aides–Program Requirements

Adopted Rules

HHSC adopted §354.1042, concerning home health supplies provided by a pharmacy, and new §354.1877, concerning quantity limitations; and the repeal of Subchapter W concerning pharmacy limitations, which consists of §354.3047, concerning quantity limitations, and §354.3092, concerning review and evaluation.

Among other things, the changes would allow pharmacies enrolled in the Medicaid Vendor Drug Program to provide a limited set of basic home health supplies commonly found in pharmacies without requiring enrollment as a DME provider. See the Texas Register for details.

The Texas Board of Nursing adopted an amendment to §223.1, Fees, which increases the renewal fee for a professional nursing license by $8; the new fee is $73 every two years. See the Texas Register for more information.

• On DADS’ Behalf

HHSC adopted amendments to §§11.2 – 11.4, concerning definitions, quality assurance fee determination methodology, and required reports, in Chapter 11, Quality Assurance Fee. The changes are adopted to require ICF/MR providers to pay a quality assurance fee for all days of paid leave on a monthly basis and exclude durable medical equipment claims from total revenue calculations. For more information, see the Texas Register.

Proposed Rule Review

The Texas Medical Board proposes to review Chapter 173, Physician Profiles, §§173.1 – 173.5 and 173.7; and The Chapter 175, Fees and Penalties, §§175.1 – 175.3 and 175.5. This same Texas Register proposes amendments to §173.1 and §173.3; and §§175.1, 175.2 and 175.5. See the Texas Register for contact information.