DADS released one information and two provider letters. CLASS CSA, CLASS, DSA, HCS, TxHmL, CDA, and Local Authorities: DADS is expanding utilization management and review activities for its Medicaid community entitlement and waiver programs, effective January 1, 2012. (Letter) ADC, ALF, HCSSA, ICF/ID, and NF: Beginning March 1, 2012, if the name of an applicant or associated person is listed in a health and human services agency record of adverse licensing, DADS may deny the person's … [Read more...] about IL and PLs: Adverse Licensing, Crime Reporting
TX Register Update: Specialty Drugs
The following information was obtained from the January 27 issue of the Texas Register. HHSC proposed new §354.1853, Specialty Drugs, which provides a definition and criteria for specialty drugs. An excerpt: Section 1.02(d), Senate Bill 7, 82nd Legislature, First Called Session, 2011, amends Texas Government Code §533.005(a) by adding paragraph (23)(G) to require Medicaid managed care organizations (MCOs) and subcontracted pharmacy benefit managers (PBMs) to adopt policies and procedures for … [Read more...] about TX Register Update: Specialty Drugs
ILs: Nursing Changes
DADS released three information letters. HCS and TxHmL: These providers must be in compliance with nursing changes by January 1, 2012, with the following requirements: HCS and TxHmL program providers must be in compliance by January 1, 2012 with the following requirements: • All licensed vocational nurses (LVNs) must be clinically supervised by a registered nurse (RN). • Program providers must have a written plan and schedule to complete an initial comprehensive nursing assessment for … [Read more...] about ILs: Nursing Changes
TX Register Updates: Feb. 15 Hearing, Emergency Rules
The following information was obtained from the January 20 issue of the Texas Register. Public Notices HHSC will hold a public hearing on February 15, 2012, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; payment rates for annual Healthcare Common Procedure Coding System; and Medicaid payment rates for the Medicaid Biennial Calendar Fee Review. The hearing will be held Lone Star Conference Room. For … [Read more...] about TX Register Updates: Feb. 15 Hearing, Emergency Rules
IL and PLs: Inappropriately Placed Residents
DADS released one information and two provider letters. Assistant Living Facilities: The legislature has made changes to the process of removing an inappropriately placed resident. An excerpt: An inappropriately placed resident is a resident who was appropriate when admitted to the ALF, but whose condition has changed. All residents must be appropriate for the ALF licensure type when admitted to the facility. After admission, if the resident’s condition changes, the resident may no longer … [Read more...] about IL and PLs: Inappropriately Placed Residents
Medicare/Medicaid News Around the Web
MedPAC, a group that advises Congress on Medicare, recommends an overhaul in the way skilled nursing homes are reimbursed. "Congress also should direct HHS to cut payments to skilled nursing facilities with relatively high risk-adjusted rehospitalization rates for their Medicare-covered skilled nursing facility stays." - McKnight's Raising the age of Medicare eligibility. "Medicare provides health insurance to almost everyone who is 65 or older. If the eligibility age was raised above 65, … [Read more...] about Medicare/Medicaid News Around the Web
Three Year Old Denied Kidney Transplant because She is Special Needs
So this is what they think of the clients of providers of care for the developmentally disabled. Does it all come back to this? … [Read more...] about Three Year Old Denied Kidney Transplant because She is Special Needs
TX Register Updates: Military Spouses, Denying Licenses
The following information appeared in the January 13 issue of the Texas Register. Public Notices HHSC adopted a new per diem payment rate for the Tyler state-owned veterans nursing facility: $237.00. HHSC intends to submit to CMS a request to amend the Youth Empowerment Services waiver to expand the geographical area of the waiver to include Tarrant County in addition to Bexar and Travis Counties. See the Texas Register for more information. Proposed Rules HHCS proposes to amend … [Read more...] about TX Register Updates: Military Spouses, Denying Licenses
DADS News Alerts: Rescinded ‘Your Texas Benefits’ Letter
DADS released several news alerts. An excerpt: -- DADS and the Board of Nursing will delay full implementation of the pilot program for the HCS and TxHmL waiver programs and all ICF/ID with capacities of 13 or fewer beds until March 1, 2012. -- Providers with a Quality Improvement Evaluation System account to submit MDS data or view CASPER reports should now update their account and follow the process to ensure they continue to receive critical CMS alerts. -- Revised forms 4116-MHM-AA … [Read more...] about DADS News Alerts: Rescinded ‘Your Texas Benefits’ Letter
ILs and PLs: COLA Delay, ICF/ID Changes
DADS released three information and three provider letters: Community Care for the Aged and Disabled RC providers, CBA, AL/RC, and AFC: CMS recently announced a 3.6 percent COLA increase in federal benefits. Because of late receipt of this news, HHSC will not implement the increase until February 1, 2012. (Letter) NF, ICF, HCS, and TxHmL: HHSC will delay the COLA increase in Retirement, Survivors and Disability Insurance, Supplemental Security Income, and Medicare Part A and B … [Read more...] about ILs and PLs: COLA Delay, ICF/ID Changes
