DADS released two information letters. CBA, MDCP, CLASS, CMA, DFMD, HCS, and TxHmL: Beginning May 17, individuals enrolled in the 1915(c) waiver programs and eligible for STAR in the Medicaid Rural Service Area will receive a packet of information with instructions on how to choose their medical plan and primary care provider. (Letter) Title XIX and Title XX Home Delivered Meals: DADS has posted budget-based rate negotiation documents and detailed instructions on the HDM provider … [Read more...] about ILs: Medicaid RSA, HDM
TX Register Updates: Consultant, Medicare Equalization
The following information was obtained from the April 27 issue of the Texas Register. HHSC has entered into a sole source agreement for consulting services for May 15, 2012. The consultant will, among other things, assist HHSC in meeting standards and requirements of the waiver under section 1115 of the Social Security Act. HHSC intends to submit transmittal number 12-022 to the Texas State Plan for Medical Assistance, which would exempt services provided by psychologists, psychiatrists, … [Read more...] about TX Register Updates: Consultant, Medicare Equalization
Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
Since October 2008, the Centers for Medicare and Medicaid Services ("CMS") have not paid hospitals for certain hospital-acquired conditions. That is, CMS will not pay for certain conditions that were not present in the patient upon admission. The conditions are, as designated by CMS, conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been … [Read more...] about Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
Social Media and Your Health Care Organization
A new study on social media and health care shows that more than 1, 200 hospitals participate on 4,200 social networking sites. Social media is changing the nature of healthcare interaction, and health care organizations that ignore this virtual environment may be missing opportunities to engage consumers. From a marketing perspective, health care organizations and small businesses should seize the opportunities to capitalize on social media. However, social media in health care is not … [Read more...] about Social Media and Your Health Care Organization
DADS News Alerts: Medicare Part A Clarification, Meetings
-- CMS posted a second errata for the MDS 3.0 RAI Manual. The two PDF files: MDS 3.0 RAI Manual (v1.08) Errata v3 MDS 3.0 RAI Manual (v1.08) Errata v4 -- CMS staff clarification of a Medicare Part A stay -- When such a resident is discharged: [T]he Assessment Reference Date (ARD) of a scheduled Medicare Prospective Payment System (PPS) assessment may be adjusted to the day the resident is discharged only when the ARD for the scheduled PPS assessment was set prior to the day of … [Read more...] about DADS News Alerts: Medicare Part A Clarification, Meetings
ILs: Medicaid Hospice
DADS released four information letters: CLASS: DADS has changed the monitoring review period in conjunction with implementing new contract and fiscal compliance monitoring tools for CLASS CMAs and DSAs. (Letter) Medicaid Hospice: DADS will begin identifying the overall aggregate payments made to hospice providers during each hospice cap period using claims paid in State fiscal year 2010. (Letter) Medicaid Hospice and NF: DADS clarified which provider is responsible for billing … [Read more...] about ILs: Medicaid Hospice
TX Register Updates: Dual Eligibles, TANF, and SNAP
The following information was obtained from the April 20 issue of the Texas Register. Proposed Rules HHSC proposes to amend §354.1143, Coordination of Medicaid with Medicare Parts A, B, and C, which would authorize HHSC to make higher cost-sharing payments for dual eligibles for certain services if HHSC determines it's necessary to ensure adequate access or that it would be more cost-effective. For details, see the Texas Register. HHSC also proposed to amend §355.8065, Disproportionate … [Read more...] about TX Register Updates: Dual Eligibles, TANF, and SNAP
DADS News Alerts: Upcoming Meetings/Webinar
DADS has issued several alerts since April 10. An excerpt: -- A CLASS Stakeholder Quarterly Webinar is scheduled for April 24, 2012, from 1-2:30 p.m. Register here. -- STAR program training in Wichita Falls has been rescheduled for April 25 for 1915 (c) Waiver Program providers. Please see the March 16 bulletin titled, "Training Schedule for Providers of DADS 1915(c) Waiver Programs concerning the STAR program in the Medicaid Rural Service Area" for the updated information. -- Region … [Read more...] about DADS News Alerts: Upcoming Meetings/Webinar
ILs/PLs: LTC Payment, DFPS Investigations
DADS released three information and two provider letters: CBA and HCSSA (revised letter): DADS case managers will add a dental buffer up to a maximum of $400 to each CBA initial ISP and annual reassessment, unless the amount of the buffer will cause the ISP to exceed the cost limit, effective April 19. (Letter) AFC, ALF, CBA, CLASS, CMPAS, DBMD, HDM, MDCP, PACE, TAS, and other providers: An excerpt on how to check for LTC claim payment information: Personal Needs Allowance … [Read more...] about ILs/PLs: LTC Payment, DFPS Investigations
TX Register Updates: Contract Awards, Medicare Billing Prohibition
The following information was obtained from the April 13 Texas Register: Public Notices HHSC announced several contract awards. See the Texas Register for a listing of the companies. HHSC intends to submit transmittal number 12-010, which would convert the reimbursement methodology for non-emergency medical transportation services from fee-for-service to full risk capitation in the following designated counties: Collin, Dallas, Denton, Ellis, Hood, Hunt, Johnson, Kaufman, Navarro, … [Read more...] about TX Register Updates: Contract Awards, Medicare Billing Prohibition
