NF Administrators:

DADS Quality Assurance and Improvement unit is conducting the annual Nursing Facility Quality Review evaluations of care delivered to nursing facility residents. DADS has contracted with Nurse Aide Competency Evaluation Service Plus Foundation, Inc., to conduct the 2010 evaluations of individuals residing in nursing facilities. (Letter)

ICF/MR:

DADS clarified the transportation requirements related to Supported Employment in the ICF/MR program. Among other things ICF/MR providers must not charge an individual or require him to spend his own money for items and services that are the program provider’s responsibility, which are included in the ICF/MR Program daily reimbursement rate. (Letter)

MDCP:

Because of changes to the daily nursing facility reimbursement rates, MDCP Individual Plan of Care cost limits were recalculated, and some MDCP participants’ Individual Plans of Care will need to be changed. Providers with affected participants will receive an updated service authorization form and Form 2412. (Letter)

ICF/MR, NF Administrators, and Contractor CEOs:

DADS reminded providers of the deadline to request a review of findings from an Adult Protective Services Mental Health Mental Retardation investigation, which is the 30th calendar day from the day the report was signed and dated by the investigator. (Letter)

Public Notices

HHSC announced a contract award valued at $163,915 to Health Management Associates, to provide consulting services to HHSC regarding a pilot to serve people with intellectual and development disabilities.

HHSC intends to submit to CMS an amendment to the HCS, which would increase the number of people to be served in the HCS waiver program and the reimbursement rates for some of the services.

HHSC also intends to submit amendments to the Texas State Plan for Medical Assistance, which would modify the reimbursement methodologies in the Texas Medicaid State Plan as a result of Medicaid fee changes for Physicians and Certain Other Practitioners, Durable Medical Equipment, and Vision Services.

For more information about each notice, see the relevant section of the Texas Register.

Proposed Rules

The Texas Medical Board proposes to amend several sections: Acupuncture, Procedural Rules, Compliance Program, Disciplinary Guidelines, Office-Based Anesthesia Programs, and Pain Management Clinics, and Unlicensed Practice.

See the Texas Register for details.

Withdrawn Rules

The Texas Medical Board has withdrawn the emergency adoption of §180.4, which appeared in the November 20, 2009, issue of the Texas Register (34 TexReg 8091). See the Texas Register for details.

Adopted Rules

HHSC adopted an amendment to §351.3, concerning Purpose, Task and Duration of Advisory Committees, under Title 1, Part 15, Chapter 351 of the Texas Administrative Code, which describes two new HHSC advisory committees: the Advisory Committee on Qualifications for Health Care Translators and Interpreter and the Electronic Health Information Exchange System Advisory Committee.

For more information, see the relevant section of the Texas Register.

The Texas Medical Board adopted new §180.4, concerning Operation of Program. The Board asked stakeholders for comments, and those comments were incorporated into the proposed rules. The new §180.4 establishes the requirements for eligibility, referrals, drug-testing, and fees for the Physician Health Program. See the Texas Register for more information.

The article mentions a story we blogged about last month. To deal with a potential budget shortfall, Governor Rick Perry, Lieutenant Governor David Dewhurst, and House Speaker Joe Straus asked HHSC to reduce Medicaid spending by five percent. HHSC Commissioner Tom Suehs offered a list of reductions worth $304 million.

The Texas Tribune notes that last month’s proposed reductions would mean a one percent decrease for nursing care and a two percent cut for long term care, hospice, and similar providers.

“We can’t afford to serve as many people as we have historically,” said Baptist Memorial Executive Director Patrick Crump. “We can’t afford to take another cut from where we are right now and continue to provide to the same number of people at the same level.”

As Medicaid providers are underfunded now, more cuts likely would impact providers’ ability to hire or maintain current levels of staffing. Those seemingly small cuts would result in fewer available beds and a loss of as much as $200,000 annually for some facilities.

Tim Graves, president and CEO of the Texas Health Care Association in Austin, wrote a letter to the editor of the Dallas Morning News about the impact of the cuts. “We believe that before we engage in discussions about cutting Texas seniors’ key Medicaid-financed programs, we must absolutely look first at the fact facilities are already dealing with a state and federal funding environment that squeezes their collective ability to recruit and retain high-quality direct-care staff.”

Texas was ranked fourth nationally for Medicaid underfunding in 2009, according to the American Health Care Association.

CBA, CBA Assisted Living/Residential Care, CLASS, DAHS, ICF/MR, ICM, HCS, NFs, PHC, RC, and TxHmL providers:

The HHSC Rate Analysis Department has posted mandatory cost reporting and cost report training for 2009 information on its web site. The final session of the 2009 cost report training is scheduled for March 9-10, 2010. Providers must make sure the preparer has completed cost report training. HHSC RAD must receive all 2009 cost reports no later than March 31, 2010. (Letter)

HCS and MRA providers:

DADS proposed rules at 40 TAC Chapter 9, Subchapter D, that will transfer the case management function from HCS Program providers to MRAs as required by the 2010-2011 General Appropriations Act (Article II, Special Provisions, Section 48, Senate Bill 1, 81st Legislature, Regular Session, 2009). See the proposed rules here.

DADS anticipates that a final version of these rules will be adopted in April or May of 2010 and effective June 1, 2010. (Letter)

DBMD providers:

DADS clarified its expectations regarding DBMD providers’ training responsibilities in the following areas:

Reporting Abuse, Neglect and Exploitation: Program providers are responsible to make sure those receiving DBMD services and the LAR are told at enrollment and every year how to report abuse, neglect, and exploitation, effective March 1.

Annual Provider Selection: Providers must begin completing the DADS Provider Selection Determination Form (Form 1576) with the individual and LAR every year to verify that provider choice is offered, effective March 1.

Medical Transportation: Individuals seeking medical transportation through Medicaid must access non-waiver resources before requesting services through the waiver. Call 1-877-633-8747 for this service.

Billing for Assisted Living and Day Habilitation: “Some individuals in the DBMD waiver receive services in a 24-hour residential setting provided as licensed home health assisted living (service code 19E) or as licensed assisted living (service code 19) and also attend day habilitation (service code 10). In such instances, the provider must bill the assisted living as 18-hour assisted living (service code 19F) on the days in which the program provider is also billing for the individual’s participation in day habilitation (service code 10). Individuals receiving day habilitation are not receiving 24 hour care during the time they are away from the residence. If services are currently on the ISP as 24 hour care, (service code 19E or 19) and the individual is receiving day habilitation (service code 10), the DBMD provider must complete an ISP amendment to place those units under 18-hour assisted living (service code 19F) for those days the individual is receiving day habilitation (service code 10).” (Letter)

Proposed Rules

HHSC proposes to amend several sections of the code, including Nursing Facility Administrators, Nursing Facility Requirements For Licensure And Medicaid Certification, Medicaid Waiver Program For People Who Are Deaf Blind With Multiple Disabilities, DBMD Program, Enrollment Process, and Transfer Between Program Providers. See the relevant section of the Texas Register and scroll down for more information about proposed changes.

Adopted Rules

HHSC adopted an amendment to §372.410, concerning allowable deductions from countable income in SNAP, in Chapter 372, Temporary Assistance for Needy Families and Supplemental Nutrition Assistance Programs, which consolidates and simplifies HHSC’s Supplemental Nutrition Assistance Program shelter utility policies to allow HHSC staff to serve clients with greater efficiency and fewer errors. See the relevant section of the Texas Register for more information.

The Texas Medical Board adopted amendments to §175.5, concerning Payment of Fees or Penalties, which will allow the Board to offer refunds to applicants who withdraw their applications within 45 days of initial application.

The Board also adopted amendments to §187.14, concerning Informal Resolution of Disciplinary Issues Against a Licensee, which will amend the composition and functions of the Quality Assurance Committee that reviews investigated complaints filed with the Board.

For more information about both changes, see the relevant section of the Texas Register.

Hospice providers – billing instructions update:

DADS informed hospice providers that they will use modifier U4 in the Modifier 4 location, along with Modifier U3 (Level of Care 1) in the Modifier 2 location, on the Medicaid Institutional Claim when billing hospice services for residents of State Supported Living Centers who are Medicare eligible, effective February 1. (Letter)

All CLASS providers:

DADS clarified information in IL 08-123, Behavioral Support Services. An excerpt of the letter:

“The CLASS waiver application defines Behavioral Support services as providing specialized interventions to assist an individual to decrease maladaptive behaviors that prevent or interfere with inclusion in community life.

“An individual must receive a behavioral assessment prior to implementation of behavioral support services. CLASS state office will authorize up to six hours for the assessment. The assessment must specify the behaviors that prevent the individual’s participation in community life.”

Proposed Rules

HHSC proposes to amend Subchapter B, Definitions, §19.101, concerning definitions; Subchapter D, Facility Construction, §19.330, concerning construction and initial survey of completed construction; and new §19.220, concerning expedited life safety code and physical plant inspection fees, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification.

The changes would require DADS to give nursing facilities the option of obtaining an expedited Life Safety Code inspection and to authorize DADS to charge a fee based on the size and type of institution to recover the cost of the expedited inspection, and DADS proposed changes to comply. See the relevant section of the Texas Register for details about the proposed changes.

Public Hearing and Notice

Proposed Rules