DADS informed the following providers that in addition to an initial Nurse Aide Registry and the Employee Misconduct Registry search, they must search both registries every year for unlicensed employees and volunteers whose duties include face-to-face contact with clients, effective September 1, and document and keep a record of the searches:

• Adult Day Care
• Assisted Living Facilities
• HCSSA
• ICF/MR
• Nursing Facilities

Assisted Living Facilities:

DADS informed these providers about changes to changes to Texas Health and Safety Code §247.002 in response to HB 216, 81st Legislature. An excerpt:

Texas Administrative Code (TAC), Title 40, Part 1, Chapter 92, §92.11(a)(1), Criteria for Licensing, effective September 1, 2010, states:

(a) A person must be licensed to establish or operate an assisted living facility in Texas.

(1) An assisted living facility is an establishment that:

(A) furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment;

(B) provides:

(i) personal care services;

(ii) administration of medication by a person licensed or otherwise authorized in this state to administer the medication; or

(iii) services described in clauses (i) and (ii) of this subparagraph; and

(C) may provide assistance with or supervision of the administration of medication.

NF Administrators:

In response to Senate Bill 806, 81st Legislature, Regular Session 2009, HHSC adopted changes that will, among other things, add the conviction of an offense listed in Health and Safety Code, §250.006, to the list of offenses that may bar an administrator from employment in a facility or applicant from obtaining an initial license. (Letter)

Medically Dependent Children Program providers:

DADS reminded MDCP providers that all unlicensed attendants must receive orientation to tasks specific to the MDCP individual in the MDCP individual’s place of residence before providing services. (Letter)

• Future Of Primary Care? Some Say ‘Medical Home’

• Midlevel Providers Fill Primary Care Doctors’ Shoes

Public Notices

HHSC withdrew its intent to submit Amendment 944, Transmittal Number TX 10-051, to the Texas State Plan for Medical Assistance, which would have proposed to cover certain pharmacy supplies as part of the home health benefit provided by a licensed pharmacy provider.

HHSC intends to submit amendments to the Texas State Plan for Medical Assistance, which would require HHSC to rebase acute care hospital rates within available funds.

Finally, HB 216, 81st Legislature, Regular Session, 2009, created Health and Safety Code Chapter 254, Boarding Home Facilities, directs HHSC to develop and publish model standards for the operation of boarding home facilities relating to construction and remodeling of boarding homes, and other provisions.

See the Texas Register for more information.

Adopted Rules

HHSC adopted amendments to §355.7101, concerning Cost Determination Process, and §355.7103, concerning Rate-Setting Methodology for 24-Hour Residential Child-Care Reimbursements, which will update and standardize the Department of Family and Protective Services (DFPS) facility-type language references in HHSC rules to current DFPS usage.

HHSC adopted an amendment to §370.401, concerning Perinates, in Chapter 370, State Children’s Health Insurance Program, which provides the Children’s Health Insurance Program Perinatal coverage to newborn children whose household income is above 185 percent of the Federal Poverty Level.

HHSC adopted amendments to §379.502, concerning preparing, providing, and serving food to residents; and §379.716, concerning DFPS licensing for shelter centers, in Chapter 379, Family Violence Program. The changes update the name of food benefits formerly known as food stands to reflect the current term, and to implement SB 68, which amended the code to require DFPS licensure of a child-care facility in a temporary shelter, including a family violence shelter center, that provides care for children temporarily residing in the shelter.

See the Texas Register for more information.

On DADS behalf, HHSC adopted amendments to the code concerning the following sections:

• 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

• Per diem payment rates NFs and hospice directors, effective September 1, 2010, can be found here.

• Per diem payment rates for ICFs/MR, effective September 1, 2010, can be found here.

CLASS and DBMD providers:

DADS informed these providers that effective September 1, 2010, it will not allow providers to be paid for more than 24 hours of service in a 24-hour day. Claims submitted for more than 24-hour units in a 24-hour day will be denied payment. (Letter)

In the age of lower reimbursement rates, specializing may be a more attractive option for medical students than going into primary care. Would a solo practice trend encourage more medical students to enter into the field and hang out their own shingles?

NPR is running a three-part series on primary care physicians going solo. An excerpt of part one:

Conventional wisdom is that the age-old model of a single doctor serving patients out of a small office is rapidly going extinct. Doctors need to evolve or die. That means fancy new computerized medical systems and bigger groups to handle the overhead.

But Cathy Crute wants to get one thing straight from the get-go: She is not a dinosaur.

“No, no. I think patients love a small practice,” she says from her rather Spartan office. “My receptionist can recognize a lot of patients’ voices over the phone. They know who they’re talking to every time. They don’t have to go through a whole chain of command.”

And the patients in the waiting room of her Portland, Maine, office seem to agree with that assessment.

“I just think it’s better service to come to the same person all the time and have one person overlooking you,” says Laurie Warhol, from nearby Waterboro. She’s been coming to Crute for more than a decade. “I think they know you better. They know your problems better. You don’t have to remind them of everything all the time.”

Patient Mike Greenleaf says he likes not just the doctor, but the entire atmosphere of the practice. “The staff’s great, and they know you on an individual basis. And it just makes you feel that much better than if you just go sit in a room full of people and have someone call your name that doesn’t know you,” he said.

• The definition of “licensed health professional” has been moved to 40 TAC §19.101(56), from 40 TAC §19.101(57);
• The DADS Paid Feeding Assistant Training curriculum is available on the Regulatory Services Credentialing web page at the following url: http://www.dads.state.tx.us/providers/NF/credentialing/NATCEP/feedingassistant.pdf (98-page PDF)

Public Notices

HHSC proposes new Medicaid per diem reimbursement rates for the Truman W. Smith Children’s Care Center ($219.69 ) and DADS-operated/state-operated ICFs/MR (small $603.64; large Medicaid-only: $537.41; large dual-eligible Medicaid/Medicare: $516.23).

See the Texas Register for more information.

HHSC intends to submit Transmittal Number 10-050, Amendment Number 943, to the Texas State Plan for Medical Assistance, which would add concurrent hospice care and treatment services for individuals younger than 21.

HHSC intends to submit an amendment to SCHIP, which would add concurrent hospice care and treatment services for SCHIP members.

Finally, HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance, which would modify the reimbursement methodology in the State Plan for Nursing Facilities to delete the statement that the payment rates for the pediatric care facility class of service will be equal to the payment rates in effect on August 31, 2009, plus 2.79 percent effective, September 1, 2010.

See the Texas Register for more information.

Proposed Rules

The Texas Board of Nursing proposes to amend §217.6 (relating to Failure to Renew License) and §217.9 (relating to Inactive Status), and the reasons for the changes include clarifying existing requirements that apply to the reactivation of an expired (delinquent) or inactive nursing license, and specifying the new requirements that will apply to the reactivation of an expired (delinquent) or inactive nursing license.

See the Texas Register for more information.

Public Notices

HHSC intends to submit to CMS a waiver amendment for the State of Texas Access Reform Program, a Managed Care waiver program under the authority of §1915(b) of the Social Security Act. The amendment would add new benefits for the proposed substance use disorder treatment services, including those provided in residential settings.

HHSC is anticipating expanding the STAR+PLUS 1915(b) and two 1915(c) waivers to the area currently part of Integrated Care Management 1915(c) waiver services. HHSC is submitting ICM 1915(c) waiver renewals in the unlikely event STAR+PLUS expansion is delayed beyond the anticipated start date of February 1, 2011.

HHSC announced the release of its Request for Proposals (RFP) for consulting services for RFP 529-11-0009, to procure a consultant to assist HHSC with the design, development, implementation and management of healthcare reform in accordance with the specifications contained in this RFP.

See the Texas Register for more information.

Proposed Rules

The Texas Board of Nursing proposes to amend §216.1 (relating to Definitions) and §216.3 (relating to Requirements), necessary to advance the Board’s comprehensive approach to continuing competency in nursing. An excerpt:

The proposed amendments to §216.1 and §216.3 are intended to supplement the rules that were adopted by the Board in August, 2009. The adopted rules allow a nurse to choose among three methods of demonstrating his or her continuing competency for each two-year licensing period. Under existing §216.3(a), a nurse may complete 20 contact hours of continuing education. Under existing §216.3(b), a nurse may achieve, maintain, or renew an approved national nursing certification in the nurse’s area of practice. Finally, under existing §216.5, a nurse may attend an academic course that meets certain, prescribed criteria. The proposed amendments to §216.1 and §216.3 build upon this groundwork by requiring a nurse who chooses to complete continuing education courses to complete courses in his or her area of practice.

See the Texas Register for more information.

Adopted Rules

HHSC adopted an amendment to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology, which, deletes language in the rule that describes references to the DSH 2010 program year. Additionally, the change removes restrictive language under the definition of  ”dually eligible patient.”

HHSC also adopted an amendment to §355.8068, concerning Supplemental Payments to Certain Urban Hospitals, which allows a governmental entity that didn’t provide the maximum intergovernmental transfer amount in any of the first three quarters of a fiscal year to fund the remaining amount up to this maximum with the final fourth quarter intergovernmental transfer of that fiscal year.

HHSC adopted an amendment to §355.8101, concerning Rural Health Clinics Reimbursement and §355.8261, concerning Federally Qualified Health Center Services Reimbursement, to update the Medicaid reimbursement methodology for both.

See the Texas Register for more information.

Hospice:

Hospice providers are responsible for know the Medicare and Medicaid eligibility for a hospice client. An excerpt:

The DADS rule for Medicaid Hospice Payments and Limitations at 40 TAC §30.60(h) states:

(h) Third-party resources. Medicaid pays only after all third-party resources have been used.

In accordance with 40 TAC §30.60(h), it is the responsibility of the hospice provider to be aware of a client’s eligibility for Medicare Part A when a client elects hospice. Additionally the hospice provider is responsible for being aware of any Medicare Part A eligibility for the client through the entire hospice period of care to avoid recoupment of Medicaid payments of hospice services covered by Medicare.

Subsequently, if the hospice provider bills Medicaid for services when the client is Medicare eligible, Medicaid services will be recouped. Clients enrolled in Medicare who have service authorizations for Service Codes 1 and 30 will be cancelled effective the date of Medicare enrollment and any Medicaid paid services for the Service Codes 1 and 30 for the time period covered by Medicare will be recouped by DADS. Hospice providers will be given the opportunity to dispute the recoupment of the hospice services by providing documentation concerning Medicare enrollment dates and/or denials of billings to Medicare for the services in question. Upon receipt of the documentation, DADS will evaluate the denial and circumstances to determine the Medicaid liability.

States are required to provide hospice care concurrently with treatment services for individuals under 21 enrolled in SCHIP. Effective August 1, 2010, a family electing to receive hospice care for such an individual is no longer required to waive treatment for the terminal illness. (Letter)

NFs:

DADS reminded these providers they’re required to submit copies of all Form 3618 Resident Transaction Notices and Form 3619 Medicare/Skilled Nursing Facility Patient Transaction Notices to the appropriate HHSC Medicaid Eligibility for the Elderly and People with Disabilities  specialist.  (Letter)