Monday’s testimony confirmed Gov. Rick Perry’s warning that Medicaid costs represent a major challenge to the state budget, and he called for lawmakers to get the program under control. But lawmakers are likely to have a hard time finding enough cuts in services and cost-savings to balance the budget when they meet again next year. The total shortfall could amount to more than $10 billion without significant changes to the program.

Last year, the Legislature cut about $15 billion in state spending and roughly $12 billion in services to balance the two-year budget. Medicaid represents about 20 percent of the state budget, and for every $1 Texas spends on the program, the federal government matches $1.47 to help cover the costs, many mandated by federal law.

According to the story, elderly and disabled Medicaid patients who go to the ER account for a third of Medicaid spending. The obvious solution would be to keep these recipients out of ERs and lessen the need for such care. Even so, providers in Texas will see reimbursement cuts.

California’s budget woes are well known, and these woes are felt by the long term health care industry. Reuters reports that state’s new budget includes cuts Medi-Cal, the state’s Medicaid program, and to nursing homes and home care services.

–  The Board of Nursing is hosting a webinar titled “The LVN Scope of Practice: What Every LVN, RN and Employer Should Know.” Registration information (PDF):

Webinars will be held from 11a.m. to Noon on the following days:
Friday, June 29, 2012, (deadline for registration is Friday, June 22, 2012)
Friday, Aug. 24, 2012 (deadline for registration is Friday, Aug. 17, 2012)
Friday, Oct. 5, 2012 (deadline for registration is Friday, Sept. 28, 2012)

–  DADS is expanding UMR activities to include review of DAHS, effective June 1, 2012. DAHS providers may submit comments on the following:

Utilization review questions (PDF) planned for DAHS, and
Document Request form (PDF). Utilization review staff will use the form to request documents from the DAHS facility.

–  DADS will hold an AL/ADC provider meting for Regions 4 and 5 only on June 27, 2012, from 2-4 p.m. at the University of Texas at Tyler’s Ornelas Activity Center, 3402 Old Omen Road in Tyler. Registration deadline is June 15, 2012: https://www.surveymonkey.com/s/XNGJ3VS

–  DADS is soliciting volunteers to participate in Release 1 testing of the Single Service Authorization System (SSAS). Please visit the SSAS web site for more information.

–  DADS is hosting the annual ICF/ID provider and surveyor conference for ICF/ID, direct support staff, DADS ICF/ID Regulatory staff, and other professionals who work with ICF/ID individuals.

August 29 & 30, 2012
Commons Conference Center
J.J. Pickle Research Campus
10100 Burnet Road
Austin, Texas

See the news alert page for more updates.

Public Hearings and Notice

HHSC will hold a public hearing to receive comments on the regional healthcare partnership, on May 17, 2012, from 1:30-4:30 p.m. in the Brown-Heatly Building, Public Hearing Room, 4900 North Lamar Boulevard in Austin.

HHSC will hold a second public hearing to receive comments on proposed changes to the administrative rule codified in 1 TAC §355.8065, Disproportionate Share Hospital Reimbursement Methodology, on May 18, 2012, beginning at 9 a.m. at William B. Travis State Office Building, 1701 N. Congress Avenue, Room 1-111 in Austin.

HHSC will hold a public hearing to receive comments on the proposed new rule §354.1451, Medicaid Recovery Audit Contractor Program, on May 22, 2012, from 10-11 a.m. in the Lone Star Conference Room, 11209 Metric Boulevard, Building in Austin.

HHSC will hold a public hearing to receive comment the HHS System Draft Strategic Plan for 2013 – 2017, on May 23, 2012, from 11-2 p.m. in the Family Services Center, Training Room, 901 Avenue B in Brownwood.

HHSC will hold a public hearing on the draft 2013 – 2017 Strategic Plan, on May 30, 2012, from 11-2 p.m., in the CentroMed Southside Medical Encino Ballroom, 3750 Commercial Ave, San Antonio.

CORRECTION:

This public notice contains a correction to a Texas Health and Human Services Commission’s public notice published in the April 27, 2012, issue of the Texas Register (37 TexReg 3241). The earlier notice did not note that the referenced state plan amendment also would clarify language related to the payment of cost-sharing for renal dialysis crossover claims.

The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number 12-022 to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The requested effective date for the proposed amendment is May 1, 2012.

For more information about these hearings, including where to send comments, see the Texas Register.

Adopted Rules

The Texas Medical Board adopted an amendment to §171.3, Physician-in-Training Permits, which provides that physician-in-training permit holders may do internal moonlighting under limited conditions.

The board also adopted amendments to §192.1, Definitions and §192.2, Provision of Anesthesia Services in Outpatient Settings, which, among other things, add the definition for the American Safety and Heath Institute (ASHI) and amend language to recognize ASHI as an approved BLS and Advanced Cardiac Life Support certifier.

Finally, the board adopted amendments to §195.2, Certification of Pain Management Clinics, which, among other things, remove the rehearing process for applicants denied pain management clinic certification by the Board. See the Texas Register for more information.

Adopted Rule Reviews

The Texas Medical Board adopted the review of Chapter 192, Office-Based Anesthesia Services, §§192.1 – 192.6.

Elizaitis noted that state surveyors have also honed in on matters of resident dignity, and surveyors are citing facilities when nurses and CNAs fail to knock on a resident’s door before entering. She stated that facility operators must know the survey process inside and out, and should share such information regarding surveyors and survey operations with residents and family members.

The webinar is available with free registration on the McKnight’s Online Expo website. Garlo Ward has additional material available on its website regarding recent changes to CMS Survey Enforcement and Penalties, including practical tips regarding the survey process.

Michelle Rowan, president of a market research firm that released a report about the booming business, attributes high profits to a growing senior population and home health care company owners working out of their homes to keep down overhead costs.

Some health care workers typically are low-paid, but the industry is worried that potential mandatory overtime and minimum wage requirements will price home health care beyond the reach of seniors who need it. An excerpt:

Home care representatives have appeared before Congress to argue that overtime pay would force them to charge seniors more — and that home care workers already make minimum wage and above.

One of the industry’s leading companies, Home Instead Senior Care, spent at least $362,000 in 2011 fighting the proposal.

Sheila McMackin, president of the National Private Duty Association, said her group has asked the Labor Department to consider that home care often includes overnight care, and seniors won’t be able to afford that if workers receive overtime.

Some private home health care companies accept Medicare and Medicaid, but they face the same issues as other providers: low reimbursement rates.

ICFs/ID with Capacity of 13 or Fewer Beds:

DADS clarified the enforcement schedule for implementing HRC §§161.091 – 161.096 and informed providers of the required elements of the comprehensive nursing assessment for an LVN to provide on-call services or an unlicensed staff member to administer medications. (Letter)

All contracted NFs:

DADS informed providers they must submit Form 3618 – Resident Transaction Notice when an individual living in a nursing facility elects hospice and continues to reside in the nursing facility, effective May 15. (Letter)

HSC, TxHmL, and ICF/ID:

DADS reminded providers that they’re required to submit financial and statistical information through a 2011 Cost Report for each contract held with DADS. (Letter)

Emergency Rules

For 60 days, HHSC is renewing the effectiveness of the adoption of new §355.8201 and §355.8202.

Proposed Rules

HHSC proposed to amend §353.2, definitions; and §353.403, enrollment and disenrollment; and proposes new Subchapter K, consisting of §353.1001 and §353.1003, Children’s Medicaid Dental Services, in Chapter 353, Medicaid Managed Care. The changes would describe the default assignment process for dental homes.

HHSC also proposed new §355.314, Supplemental Payments to Non-State Government-Owned Nursing Facilities, which would establish the methodology for determination and payment of supplemental UPL payments for non-state government-owned NFs.

Finally, HHSC proposes to amend §370.4, definitions, §370.301, CHIP enrollment packet, and §370.303, completion of enrollment, in Chapter 370, State Children’s Health Insurance Program. The changes would describe the default assignment process for dental homes. For more information about these changes, see the Texas Register.

The Texas Medical Board proposed to amend several sections of the code:

• Licensure – §§163.2, 163.4 and 163.5, Licensure, which among other things would set out medical graduation requirements for 5th pathway applicants to be consistent with rules relating to other types of applicants for full licensure.
• Physician Registration – §166.1, Physician Registration, and §166.3, Retired Physician Exception, which among other things would provide that a physician will not be eligible for a registration permit if the physician has violated §170.002 or Chapter 171.
• Temporary And Limited Licenses – §§172.8, 172.15, and 172.16,  Temporary and Limited Licenses, which among other things would provide that applicants for Faculty Temporary Licenses will be determined ineligible for FTLs based on the same reasons for ineligibility for full licensure.
• Business Organizations – §177.5, Special Requirements for 162.001(b) Health Organizations, which would require non-profit health organizations to adopt and enforce policies to ensure that physicians employed by the organization exercise independent medical judgment.
• Disciplinary Guidelines – §190.8, Violation Guidelines, which would add that the board will take disciplinary action if the physician violates §170.002 or Chapter 171, Texas Health and Safety Code.

Withdrawn Rules

The Texas Medical Board withdrew the proposed amendments to §163.2 and §163.5, which appeared in the March 9, 2012, issue of the Texas Register.

Adopted Rules

HHSC adopted new §354.1853, Specialty Drugs, which adds a section to require MCOs and subcontracted PBMs to adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that are consistent with rules adopted by the Executive Commissioner. HHSC also adopted amendments to §355.101, Introduction, and §355.107, Notification of Exclusions and Adjustments, which adopts a formal definition for the term “line item” and eliminates a reference to auditors. See the Texas Register for details.

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

• Physician Registration – §166.2, Continuing Medical Education, which provides that physicians who treat tick-borne diseases should complete relevant CME as required by Senate Bill 1360.
• Fees And Penalties – §175.5, Payment of Fees or Penalties, to clarify that additional fees for hard-copy registrations are only for renewal purposes and not initial applications for licensure.
• Complaints – §178.3, Complaint Procedure Notification, which changes language related to required notice posting by autopsy facilities to refer to “persons” rather than “physicians” and adds two new figures to subsection (d).
• Physician Assistants – §185.4, Procedural Rules for Licensure Applicants, to provide grounds for the license application extensions for those on file with the board for over a year and allows for an alternative licensure process for military spouses.
• Procedural Rules – §187.13, Informal Board Proceedings Relating to Licensure Eligibility, which changes the appeal process for denied licensure applicants or approved for licensure under an agreed order or remedial plan.
• Disciplinary Guidelines – §190.15, Aggravating and Mitigating Factors, which provides that mitigating factors in a matter before the board where a licensee has violated the Medical Practice Act don’t require the board to dismiss the case.

–  DADS will hold a meeting for Region 6 only NFs on June 22, 2012, from 1-4 p.m. at the United Way of Greater Houston, Auditorium, 50 Waugh Drive, Houston. Register here before June 8.

–  DADS will issue an RFP to re-procure CMPAS in existing catchment areas. DADS hopes to have the new contracts in place no later than August 31, 2012. The web link for the RFP for the CMPAS procurement will be available as soon as possible on the Electronic State Business Daily.

–  DADS released “Physical and Behavioral Health Services in the Home and Community-Based Services (HCS) and Community Living Assistance and Support Services (CLASS) Medicaid Waiver Programs (PDF).”

CBA, MDCP, CLASS, CMA, DFMD, HCS, and TxHmL:

Beginning May 17, individuals enrolled in the 1915(c) waiver programs and eligible for STAR in the Medicaid Rural Service Area will receive a packet of information with instructions on how to choose their medical plan and primary care provider. (Letter)

Title XIX and Title XX Home Delivered Meals:

DADS has posted budget-based rate negotiation documents and detailed instructions on the HDM  provider page at “Federal Fiscal Year (FFY) 2013 Budget Negotiation.” (Letter)

HHSC has entered into a sole source agreement for consulting services for May 15, 2012. The consultant will, among other things, assist HHSC in meeting standards and requirements of the waiver under section 1115 of the Social Security Act.

HHSC intends to submit transmittal number 12-022 to the Texas State Plan for Medical Assistance, which would exempt services provided by psychologists, psychiatrists, licensed clinical social workers, and specific services related to the transport of portable x-ray equipment and personnel from Medicare Equalization. See the Texas Register for details about both notices.