DADS released 12 information and provider letters:
DBMD:
HHSC approved new payment rates for Employment Assistance and Supported Employment in the DBMD waiver program effective, February 1, 2011: Employment Assistance $33.44; Supported Employment $33.44. (Letter)
NF Administrators, Social Workers, and Rehabilitation Therapy staff:
DADS clarified the provision of specialized services to Medicaid-eligible nursing facility residents and Preadmission Screening and Resident Review (PASRR). To be eligible for specialized services, a Medicaid recipient must: be Medicaid eligible for NF care; reside in a Medicaid-certified NF; and have an approved PASRR. (Letter)
Home Health Agencies Seeking Medicare Certification:
DADS seeks clarification from these providers on three questions previously published in PL #07-17. (Letter)
Hospice Agencies Seeking Medicare Certification:
DADS seeks clarification from these providers on three questions previously published in PL #07-17. (Letter)
CBA, CWP, and MDCP providers:
HHSC approved new payments for these providers, effective February 1, 2011. See the new rates at the HHSC Payment Rates site. (Letter)
HCS and TxHmL:
HHSC approved new per diem payment rates HCS and TxHmL providers, effective February 1, 2011. Click on the links to access the rates, and download the letter here.
Local MR authorities, TxHmL, and CDS agencies:
DADS implement new cost ceilings for TxHmL, effective September 1, 2010 (letter):
| Service Category Limits and Individual Plan of Care Cost Ceiling Community Living Service Category | $13,600 |
| Professional and Technical Services Category | $3,400 |
| Annual Total Cost Ceiling | $17,000 |
TxHmL, HCS, MR authorities, and CDSAs:
DADS will no longer notify the provider, MRA, or CDSA of the approval or denial of an individual’s enrollment, transfer, or termination of services by mail, fax, or e-mail. Notification will continue to be mailed to the individual’s address listed in the CARE system. (Letter)
CDSAs:
DADS issued this letter to provide guidance for revising CDS employer budgets related to rate reductions in several programs. An excerpt:
Service Plan Changes
For service plan changes for CBA and CWP out-of-home respite, DADS case managers will be requesting from the CDSAs, in writing, the total amount of funds and number of units of out-of-home respite used from the beginning of the individual service plan period through January 31, 2011. Case managers will use this information to update the service plan and Service Authorization System (SAS) Service Plan and Service Authorization records.
For HCS and TxHml, CDS service authorizations have been automatically converted to the new rates by the CARE system. Therefore, CDSAs do not need a new service authorization from the HCS or TxHmL service coordinators before adjusting the CDS budget workbook.
CDS Employer Budget Workbooks Adjustments
The CDS employer will not be required to complete a new budget workbook to adjust for the February 1, 2011 rate decrease. The employer or CDSA may write in the authorized changes on the current budget workbook. On page 2 of the budget workbook, mark through the old rate and write in the new rate and the re-calculated amount remaining for that service in the current year budget. Both the employer and the CDSA representative must sign a new approval page (page 1) and write “rate decrease” on the new approval page. If there is a decrease in an employee’s hourly pay or benefits, the CDS employer must complete a new Form 1730, Wage and Benefits Plan.
Program for the All-Inclusive Care for the Elderly providers:
DADS informed the PACE organizations of procedural changes for processing enrollments, disenrollments and any changes in a participant’s Medicaid/Medicare status. Effective February 1, 2011, the DADS Community Services regional staff will begin entering data into the Service Authorization System for PACE participants. (Letter)
Program of All-Inclusive Care for the Elderly Organizations:
DADS informed these organizations about a recent change in the LTC Online Portal. DADS implemented version 3.0 in October, and this version includes an edit that won’t allow the MN/LOC assessment to be completely entered into the LTC Online Portal if the physician answers N (no) to question S7a, which must be answered for the initial enrollment only:
“Did an MD/DO certify that this individual requires nursing facility services or alternative community based services under the supervision of an MD/DO? ”
Download the letter for more information.
NF contractors:
DADS provided guidance for NFs related to routine handling of funds associated with Incurred Medical Expenses. (Letter)
