CMS Strengthens Five Star Quality Rating System for Nursing Homes The Centers for Medicare & Medicaid Services (CMS) strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one. Today’s announcement also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, … [Read more...] about CMS Strengthens Five Star Quality Rating System for Nursing Homes
CMS proposes 2016 payment and policy updates for Medicare Health and Drug Plans
Proposed policies continue Secretary’s initiative tying Medicare payments to value and maintain stability of Medicare Advantage program The Centers for Medicare and Medicaid Services (CMS) today released proposed changes for the coming year for the Medicare Advantage (MA) and Part D Prescription Drug Programs that will advance Health and Human Services Secretary Sylvia M. Burwell’s vision of building a better, smarter health care system and moving the Medicare program, and the health care … [Read more...] about CMS proposes 2016 payment and policy updates for Medicare Health and Drug Plans
Nursing Facility Managed Care Transition: Selection of a Managed Care Organization Required by Individuals Receiving Hospice Services
Hospice services will continue to be provided under Medicaid fee-for-service (FFS) after nursing facility (NF) services transition to managed care effective March 1, 2015. There will be no change in the way hospice services are delivered or billed. However, NF residents receiving hospice services will be required to choose a STAR+PLUS health plan, if they are 21 or older, are eligible for Medicaid, and meet STAR+PLUS criteria. This requirement includes Medicaid-only and dually-eligible … [Read more...] about Nursing Facility Managed Care Transition: Selection of a Managed Care Organization Required by Individuals Receiving Hospice Services
Nursing Facility Managed Care Transition: Medicaid Managed Care and Service Coordination
This letter provides information regarding service coordination, a key feature of the STAR+PLUS Medicaid managed care program. Service coordination is a benefit offered to all STAR+PLUS members. In the nursing facility (NF), managed care organization (MCO) service coordinators (SCs) will partner with NF staff to ensure each member’s care is integrated and coordinated to avoid preventable hospital admissions, readmissions and emergency room visits. Each MCO will have a SC (who can be a … [Read more...] about Nursing Facility Managed Care Transition: Medicaid Managed Care and Service Coordination
Minimum Payment Amount Program (MPAP) Period Two
The Texas Health and Human Services Commission (HHSC) reminds providers that Enrollment for Period Two of the Minimum Payment Amounts Program (MPAP), covering September 1, 2015 – August 31, 2016, for certain non-state government-owned nursing facility providers closes on February 28, 2015. There is no “roll-over” enrollment. If you wish to enroll in Period Two, you must complete all forms for Period Two, regardless if you completed them for Period One or not. To qualify for period two of this … [Read more...] about Minimum Payment Amount Program (MPAP) Period Two
Nursing Facilities – Claims with Other Insurance Liability
Senate Bill 7, 83rd Legislature, Regular Session, 2013, directs the Health and Human Services Commission to deliver nursing facility services through the STAR+PLUS managed care model. Effective March 1, 2015, STAR+PLUS Managed Care Organizations (MCOs) will provide services to most Medicaid residents in a nursing facility. Currently, nursing facilities must verify on all claims if a Medicaid resident has other insurance, and must bill the other insurance carrier before billing … [Read more...] about Nursing Facilities – Claims with Other Insurance Liability
DADS Releases Final HCBS Statewide Transition Plan
DADS submitted the Home and Community Based Services (HCBS) Statewide Transition Plan in December 2014. The final plan is now available on the DADS website. Approval from CMS for the HCBS Statewide Transition Plan is pending. In March 2014, CMS issued rules designed to ensure that people receiving Medicaid services through home and community based services have full access to the benefits of community living, including receiving services in the most integrated setting. The HCBS rules are … [Read more...] about DADS Releases Final HCBS Statewide Transition Plan
Medicaid Hospice – Changes in Procedures
DADS issues a letter to inform Texas Medicaid Hospice providers of updates to the Form3071, Individual Election/Cancellation/Update, and Form 3074, The Physician Certification ofTerminal Illness, and the coinciding instructions for those forms. As a reminder, per InformationLetter 14-50, effective July 1, 2014, Form 3071 and Form 3074 must be submitted electronicallyon the Texas Medicaid and Healthcare Partnership (TMHP) Long-Term Care (LTC) Portal. Paperforms will no longer be accepted by TMHP; … [Read more...] about Medicaid Hospice – Changes in Procedures
Nursing Facility Trainings Slated for Texarkana in February 2015
Nursing facility providers are invited to 2 trainings in February at the Health and Human Services Commission (HHSC) in Texarkana, TX. Dates and topics are listed below. Providers can register at: http://www.dads.state.tx.us/providers/training/jointtraining.cfm Feb. 178:30 a.m.- 4:30 p.m.AND Feb 188:30 a.m. - 12:30 p.m.Understanding the Survey and Enforcement Processes for Nursing Facilities Feb. 198:30 a.m. - 5 p.m.Culture Change: Transforming Care within the Regulations Visit us … [Read more...] about Nursing Facility Trainings Slated for Texarkana in February 2015
Managed Care Webinar Recordings
The Texas Health and Human Services Commission recently presented a series of webinars on the managed care transition that will happen March 1, 2015. DADS stakeholders can view recordings of previous events or register to attend February events. Community First Choice Recorded webinar Meeting handouts in PDF CFC website Register for the next webinar Dual Demonstration Project Recorded webinar Meeting handouts in PDF Dual Demonstration website Register for the next … [Read more...] about Managed Care Webinar Recordings
