DADS released 12 information letters.
CBA HCSSA:
HCSSAs must follow the procedures listed in the letter when the DADS case manager notifies them that an applicant’s initial medical necessity determination assessment has expired, effective August 1, 2013. (Letter)
DADS reminded providers that the adopted rules that include limits on the amount of certain services an individual may receive and a process for DADS to grant an exception to those limits expire on August 31, 2013. (Letter)
MDCP HCSSA:
DADS updated its policy regarding rounding time increments when billing for respite and flexible family support services (formerly adjunct support services) MDCP. (Letter)
CLASS and Financial Management Services Agencies:
DADS reminded providers that the adopted rules that include limits on the amount of certain services an individual may receive and a process for DADS to grant an exception to those limits expire on August 31, 2013. (Letter)
HCS, Financial Management Services Agencies, and Local Authorities:
DADS reminded providers that the adopted rules that include limits on the amount of certain services an individual may receive and a process for DADS to grant an exception to those limits expire on August 31, 2013. (Letter)
MDCP:
DADS reminded providers that the adopted rules that include limits on the amount of certain services an individual may receive and a process for DADS to grant an exception to those limits expire on August 31, 2013. (Letter)
Medicaid Hospice:
DADS informed all Texas Medicaid Hospice providers that effective August 1, 2013, all Medicaid Hospice physicians must perform a face-to-face assessment for each individual enrolled in the Texas Medicaid Hospice program to determine continued eligibility for hospice care. (Letter)
Excerpt of second letter:
In accordance with Title 40 Texas Administration Code (TAC), Chapter 30, §30.16 and §30.18, an individual or the individual’s representative may revoke the individual’s election of Hospice services at any time and may then elect to receive Hospice services later as long as the individual meets eligibility requirements. However, it is not appropriate to revoke Hospice services to receive aggressive or curative treatments and then re-elect Hospice services once aggressive or curative treatments are provided.
Excerpt of third letter:
Pursuant to Title 40 of the Texas Administrative Code (TAC), Chapter §19.1926, Medicaid Hospice Services, and 42 Code of Federal Regulations (CFR) §418.112 Condition of Participation: Hospice providers that provide Hospice care to residents of Skilled Nursing Facilities/Nursing Facilities (SNF/NF) or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) must have a written agreement with the SNF/NF or ICF/IID facility that specifies the provision of Medicaid Hospice services in the facility. The agreement must be signed by authorized representatives of the Hospice provider and the SNF/NF or ICF/IID before the provision of Hospice services. The written agreement must include, at a minimum, all the requirements specified in these two regulations.
DADS reminded these providers that hospice enrollment for individuals in managed care is the same as for individuals in traditional, fee for service Medicaid. (Letter)
Community/State (Service Group 5) ICF/IID:
DADS reminded providers that any claims for services performed during Fiscal Year 2011 (September 1, 2010 – August 31, 2011) that are received by the TMHP after noon, August 13, 2013, will be processed as Miscellaneous, and cannot be paid through the standard payment process. (Letter)
AFC, AL, CAS, CBA, CLASS, CDA, CMPAS, DAHS, DBMD, ERS, FC, HDM, Hospice, Non-State (Service Group 6) ICF/IDD, Local Authorities, MDCP, NF, PHC, PACE, Special Services to Persons with Disabilities, and Transition Assistance Services:
DADS reminded providers that any claims for services performed during Fiscal Year 2011 (September 1, 2010 – August 31, 2011) that are received by the TMHP after noon, August 13, 2013, will be processed as Miscellaneous, and cannot be paid through the standard payment process. (Letter)
