DADS released six information letters, including three for nursing facilities.
NFs:
DADS reminded NFs that Texas Government Code section 531.153 requires that providers develop a permanency plan for an individual under age 22 who resides in an institution. Section 531.154 also requires a nursing facility to notify, within three days of a child’s admission to the facility: DADS, the community resource coordination group, the local office of Early Childhood Intervention, and the local school district where the facility is located. (Letter)
DADS informed NFs that certain specific requirements must be met before DADS can authorize the ACD system request for purchase by the NF and before the provider can be reimbursed for the ACD system and related services. These providers must use Form 8730. (Letter)
NFs must submit, within 72 hours of admission or discharge, DADS Form 3618, Resident Transaction Notice. Impact on providers: timely and accurate Form 3618 submission updates the payment system to reflect appropriate service dates and resident eligibility. (Letter)
ICF/MR:
DADS informs these providers that certain specific requirements must be met before DADS can authorize the ACD system request for purchase by the ICF/MR provider and before the provider can be reimbursed for the ACD system and related services. These providers must use Form 8728. (Letter)
CLASS, CMA, CBA, HCSSAs, CWP, DBMD, and ICMW:
Because there have been several instances where providers have been billed and paid for over 24 hours of nursing services during a 24-hour period, DADS has implemented changes to the automated Claims Management System to prevent further instances. An excerpt from the letter:
“Effective December 1, 2009, DADS will implement a CMS edit that will prohibit providers from billing for more than 24 hours of nursing services within a 24-hour day. The affected nursing service codes are 13, 13A, 13B, 13C, and 13D, 13AW, 13AY, 13BW, 13BY, 13CW, 13CY, 13DW, and 13DY. ”
CBA and HCSSAs:
DADS will authorize liquid nutritional supplements such as Ensure, Boost, Resource, Jevity, Glucerna, and Arginaid when HCSSAs provide documentation that these supplements are medically necessary to meet the needs of the individual. The new procedures apply to new Individual Service Plans and new requests for nutritional supplements received on or after the posting date of the letter.
