Medicaid Payment Rates

Medicaid Payment RatesAs you know, the CMS Medicaid hospice payment rates memo was released on September 1, 2015. Therequirements reflect the Medicare final rule which was published on August 6, 2015. The rule changesimplement several items:? Payment methodology for routine home care (RHC) – beginning January 1, 2016 the RHC rateswill be implemented; a higher base payment for the first 60 days of care and a reduced rate forthe days thereafter.? Service Intensity Add-on – this is payment for … [Read more...]

HHSC – Learning Collaborative Summit

HHSC has posted information on the August 27th - 28th Statewide Learning Collaborative Summit, including the livestream link and agenda, on the Dates and Deadlines page. Visit us at Garlo Ward, PC … [Read more...]

Interpretation of Medical Assistance Only Codes

DADS published an information letter  to provide assistance to service coordinators, case managers, and program providers on how to identify an individual’s Medicaid type program (TP) and to identify if a certified Medicaid TP is categorized as Medical Assistance Only (MAO).Individuals certified for MAO Medicaid by the Health and Human Services Commission (HHSC) receiving Community First Choice (CFC) services through a 1915(c) Waiver Program must meet eligibility requirements stated in 42 Code … [Read more...]

Medicaid Hospice – Changes in Procedures

DADS issues a letter to inform Texas Medicaid Hospice providers of updates to the Form3071, Individual Election/Cancellation/Update, and Form 3074, The Physician Certification ofTerminal Illness, and the coinciding instructions for those forms. As a reminder, per InformationLetter 14-50, effective July 1, 2014, Form 3071 and Form 3074 must be submitted electronicallyon the Texas Medicaid and Healthcare Partnership (TMHP) Long-Term Care (LTC) Portal. Paperforms will no longer be accepted by TMHP; … [Read more...]

Information on Ebola Virus for Providers of Services to Individuals in the Department of Aging and Disability Services Programs

DADS information letter provides information on the Ebola virus that providers may use to help ensure the health and safety of staff members and individuals receiving services. The Department of Aging and Disability Services encourages its providers to take reasonable precautions to ensure their employees are not exposed to a symptomatic person by knowing how Ebola is transmitted and its symptoms. An individual will not contract Ebola if he has not had exposure to an individual with Ebola or … [Read more...]

IL and News Alerts: 3/31 Webinar, Postponed NF Resident Move

DADS released one information letter. CBA and FMSA: HHSC approved new payment rates for the CBA waiver program, effective March 1, 2014. You can access these rates at the HHSC Rate Analysis site. (Letter) --  DADS notified all CLASS CMA and DSA that Form 3591, CLASS IPC/IDRC Cover Sheet, is available. Providers must use this form as a cover sheet when submitting an ID/RC assessment or PC packet to DADS, beginning April 1, 2014. --  DADS has postponed moving NF resident into STAR+PLUS … [Read more...]

LTC News: Court Reverses Medicaid Ruling

"The Arkansas Supreme Court tossed out a $1.2 billion judgment against Johnson & Johnson on Thursday, reversing a lower court verdict that found the drug maker engaged in fraudulent tactics when marketing the antipsychotic drug Risperdal." - Associated Press "Lawmakers in both houses of Congress have unveiled a draft bill calling for post-acute care providers to furnish standard assessment data, with the goals of enabling better quality oversight and driving Medicare payment reform." - … [Read more...]

TX Register Updates: Reimbursement Changes

The following information was obtained from the Texas Register. Public Notices HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act to update the fee schedules in the current state plan for: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; Early and Periodic Screening, Diagnosis, and Treatment Services; and Physicians and Other Practitioners. HHSC intends to submit an amendment to update the fee … [Read more...]

LTC News: NF Inspections, Post-acute Care

--  "Federal efforts to strengthen inspections of the nation's nursing homes are gaining momentum after a government probe uncovered instances of substandard care." - Kaiser News --  "The Centers for Medicare & Medicaid Services sees the upcoming Quality Assurance & Performance Improvement guidelines, not harsher penalties, as the way to reduce adverse events in post-acute care, officials said on an Open Door Forum call Thursday [March 6]." - McKnight's --  "About 22% of Medicare … [Read more...]

ILs: Billing Codes, Hospice Discussions

DADS released four information letters. NF: DADS notified these providers of correct billing codes for a Customized Manual Wheelchair, effective March 1, 2014. (Letter) HCS and TxHmL: The Waiver Survey and Certification unit of DADS will allow HCS and TxHmL providers to request an informal review of the findings in a draft report of a review conducted in accordance with DADS rule at 40 TAC §9.185 and §9.577, effective March 1, 2014. (Letter) Medicaid Hospice: An excerpt: It has come … [Read more...]