DADS released two information letters and several news alerts:
All contracted NFs:
DADS informed these providers they should stop using Form 3618 – Resident Transaction Notice, when a resident elects hospice and chooses to remain in the facility. When the hospice provider submits Form 3071 – Recipient Election/Cancellation/Discharge Notice, the NF service authorization will automatically close out to eliminate the possibility of duplicative payments. (Letter)
CBAs, CDSAs, DAHS, PHC, and CMPAS:
DADS updated IL11-08 on the expansion of the STAR+PLUS program in the Harris, Bexar, Nueces, Travis, and Jefferson county service areas beginning September 1, 2011. An excerpt:
Harris and Jefferson Service Area Operations – Evercare Enrollment Suspension
In the Harris and Jefferson county service areas, the Texas Health and Human Services Commission (HHSC) has placed Evercare on an enrollment suspension. While Evercare’s enrollment is suspended, members who are enrolled in Medicaid managed care residing in the Harris and Jefferson county service areas will be enrolled in Amerigroup or Molina. HHSC will re-evaluate Evercare’s enrollment suspension later this fall.
Impact of Evercare Enrollment Suspension: STAR+PLUS Enrollment
As a result of the Evercare enrollment suspension, members enrolled in Medicaid managed care residing in the Harris and Jefferson county service areas who previously selected Evercare as their managed care organization (MCO) to begin on September 1, 2011, will be transferred to Amerigroup or Molina. Current STAR+PLUS members of Evercare will continue to receive their services the same way they do currently.
Impact of Evercare Enrollment Suspension: DADS Long-term Services and Supports (LTSS) Individuals
Individuals receiving Supplemental Security Income (SSI) or SSI-related Medicaid who are enrolled in the STAR+PLUS program include those currently authorized by the Department of Aging and Disability Services (DADS) to receive Community-based Alternatives (CBA) waiver services, Client-Managed Personal Assistance Services (CMPAS), Primary Home Care (PHC), and Title XIX Day Activity and Health Services (DAHS). As a result of the Evercare enrollment suspension, members residing in the Harris and Jefferson county service areas who selected long-term services and supports (LTSS) providers that only contracted with Evercare will need to select LTSS providers who have contracted with Amerigroup or Molina.
— PowerPoint presentations for the July 25 CLASS quarterly webinar and the July 19 CLASS Fair Hearings Processes are available here.
— The 2011 Home Health and Hospice Care Nurse Staffing Survey will be available online through August 5, 2011.
— Texas requires that providers fill in item Z0250 in the MDS 3.0, but a third of providers are sending blank values. Others are submitting the wrong RUG in Z0250. Providers should set their Z0250 RUG configuration to RUG-IV, 48 group, version 1.00, index maximizing, and case mix index set F01 – Research 48 Group Strive. See this page for details.
— CMS posted the final SNF PPS rule for FY 2012 in the Federal Register (PDF).
— In response to comments in the recent CBA stakeholder meeting, DADS and HHSC will propose a single rate for personal assistant services to replace the proposed two rate category model as initially proposed: $11.20 per hour.
— HHSC adopted amendments to §97.256, Emergency Preparedness Planning and Implementation and §97.602, Administrative Penalties.
— HHSC adopted amendments to §9.1921 in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification, to requires a nursing facility to upload to the DADS web site a statement of all facility requirements involving resident rights and responsibilities not in the general statement of resident rights and responsibilities given to a resident upon admission.
— HHSC adopted an amendment to §98.42, concerning safety, in Subchapter C, Facility Construction Procedures, and new §98.64, concerning emergency preparedness and response, in Subchapter D, Licensure and Program Requirements, in Chapter 98, Adult Day Care and Day Activity and Health Services Requirements. The changes are in response to challenges faced during recent hurricane seasons and adds requirements relating to National Fire Protection Association standards.
— HHSC adopted new §19.326, concerning safety operations, in Subchapter D, Facility Construction, and the repeal of existing §19.326, concerning safety operations; and new §19.1914, concerning emergency preparedness and response, in Subchapter T, Administration, and the repeal of existing §19.1914, concerning disaster and emergency preparedness, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification.
The changes add requirements for ensuring residents’ health, safety, and well-being during disasters.
See the news alert page for details about each update.
