The Texas Department of Aging and Disability Services reminds providers that in fiscal year 2007, any claims remaining from fiscal year 2004 become miscellaneous and won't be paid through the standard Claims Management System payment process. If the service dates on a claim are earlier than two previous fiscal years and the current year, it is dubbed "miscellaneous." For more information, download the letter here. … [Read more...] about Provider Letter: New Fiscal Year — Reminder
Pennsylvania to Require PACE Seniors to Enroll in Medicare Drug Plans
Pennsylvania will require low-income seniors currently enrolled in the PACE prescription drug assistance program to enroll in Medicare Part D. (Medical News Today) PACE covers drug costs not covered by Medicare. The state sent letters to Pace enrollees to inform them about their new Medicare plans. Beneficiaries will have 10 days to object to the state's recommendations. After 10 days, the state will enroll beneficiaries in the recommended plans automatically. Apparently, PACE participants … [Read more...] about Pennsylvania to Require PACE Seniors to Enroll in Medicare Drug Plans
Texas Register Updates; New OIG Report
The Texas Health and Human Services Commission (HHSC) recently adopted amendments to §371.204 and §371.208, relating the Hospital Screening Criteria for Texas Medical Review Program (TMRP), Tax Equity and Fiscal Responsibility Act (TEFRA), and LoneSTAR Select II Contract Reviews and Appeals Related to Utilization Review Department Review Decisions. For more information, see this section of the July 14 Texas Register. The Board of Nurse Examiners will review and consider whether to re-adopt, … [Read more...] about Texas Register Updates; New OIG Report
An Interview With Andy Kessler
Earlier this month, I wrote a post about a new book entitled The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor written by Andy Kessler. Today, I had the opportunity to interview Andy as my guest while sitting in as a guest host for my friend Mychal Massie on his show, Straight Talk, which plays on Right Talk Radio. John, at Right Talk, graciously allowed me to download the show in order to reproduce it here. I thank John and Right Talk for giving me … [Read more...] about An Interview With Andy Kessler
Provider Letter: More Licensure and Medicare Certification Delays
In a letter that replaces PL #06-08, the Texas Department of Aging and Disability Services (DADS) alerted Home and Community Support Services Agencies (HCSSA) to expect more delays for initial licensure and Medicare certification. Region 6 (Houston Regional Office) and Region 3 (Arlington Regional Office) could see delays of up to a year. In the updated letter, DADS added or changed information about the process. For example, providers must request initial licensure at least six months … [Read more...] about Provider Letter: More Licensure and Medicare Certification Delays
CMS Revises Guidance for Coverage Determinations
In an effort to help make sure patients are getting appropriate care, the Centers for Medicare and Medicaid Services (CMS) revised guidance for national coverage determinations (NCDs), according to the news release. As a condition of payment, providers must develop and capture additional patient information to supplement standard claims. CMS Administrator Mark B. McClellan said, "Our goal is to speed access to valuable new technologies, and to promote the effective use of those technologies … [Read more...] about CMS Revises Guidance for Coverage Determinations
Medicare Part D Costly and Burdensome for Nursing Home Providers
Pharmaceutical representatives testified before Congress earlier this month about the administrative burden placed on long term care providers, particularly nursing homes, by Medicare Part D, the new prescription drug program. They also said providers are losing money because of the program. The new drug program was created to give seniors more choices, but it seems to be offering conflicting and confusing choices. For example, Long Term Care Pharmacy Alliance executive director Paul Baldwin … [Read more...] about Medicare Part D Costly and Burdensome for Nursing Home Providers
Provider Letter: Repeal of 40 TAC Criminal History Check
The Texas Department of Aging and Disability Services (DADS) informs all facilities covered by the Health and Safety Code (HSC) that 40 Texas Administrative Code, Chapter 76, Criminal History Check of Employees in Facilities for Care of the Aged and Persons with Disabilities, will be repealed, effective June 1, 2006. The provision was repealed because DADS currently requires facilities to comply with Chapter 250 of the HSC. According to the rule, certain elderly and disabled care facilities … [Read more...] about Provider Letter: Repeal of 40 TAC Criminal History Check
Provider Letter: 211 System
The Texas Department of Aging and Disability Services (DADS) has issued a provider letter (July 17) to Home and Community Support Services Agencies (HCSSA) and Adult Day Care Facilities (ADC) on using the 211 system. The 211 system is a telephone number that connects callers to local health and human services agencies. People looking for social service assistance for food, housing, education, legal help, child care, physical and mental health, financial support, transportation, or emergencies … [Read more...] about Provider Letter: 211 System
Bush Administration Relaxes Proof of Citizenship Requirement
The Bush Administration has backtracked on its commitment to require Medicaid recipients to show proof of citizenship to continue receiving benefits. At least eight million people will be exempted from the requirement because they established citizenship when they applied for Medicare or Supplemental Security Income. Is "established" the same as "proved"? Did the Medicare and Supplemental Security Income recipients show documentation or simply check a box? Last week I wrote that the new … [Read more...] about Bush Administration Relaxes Proof of Citizenship Requirement