The Texas Department of Aging and Disability Services (DADS) issued six information letters: Addition of Supported Employment and Employment Assistance to the Deaf-Blind Multiple Disabilities (DBMD) Program and a Change in the Behavior Communication Specialist Service DADS informed DBMD Providers that it will implement Supported Employment and Employment Assistance services in the DBMD Program, effective September 1. Service codes and rates (per hour) for both services: Supported … [Read more...] about Information Letters: Changes in Deaf-Blind Multiple Disabilities Program, Etc.
Texas Register Updates: Medicaid Hearing Aid Services, Etc.
The following information was obtained from the August 29 issue of the Texas Register: Proposed Rules The Texas Health and Human Services Commission (HHSC) proposes to amend §354.1231, Benefits and Limitations; §354.1233, Requirements for Hearing Aid Services; and §354.1235, Requirements for Provider Participation, in Title 1, Part 15, Chapter 354, Subchapter A, Division 15, related to Medicaid hearing aid services. The amended rules would better align Medicaid rules with current … [Read more...] about Texas Register Updates: Medicaid Hearing Aid Services, Etc.
OIG: Medicare Overpaid for New Generic Drugs
According to the Office of Inspector General (OIG) of the Department of Health and Human Services, Medicare overpaid for prescription drugs with new generic versions, because of delays in updating its pricing formula. (Kaiser Network) For example, Medicare overpaid $6.5 million for the cancer drug irinotecan. A generic version was approved, but new generic prices were not integrated right away. Medicare paid $126 a dose, although generic prices averaged $41. According to the 20-page … [Read more...] about OIG: Medicare Overpaid for New Generic Drugs
Texas Register Updates: Reimbursement Methodology for NFs, Etc.
The following information was obtained from the August 15 and August 22 issues of the Texas Register: Adopted Rules HHSC adopted amendments to §355.307, Reimbursement Setting Methodology, §355.308, Direct Care Staff Rate Component, and §355.311 Medicaid Reimbursement Rates for State Veterans Homes, which will establish the reimbursement methodology for the Nursing Facility program, including Medicaid reimbursement rates for state veteran's homes. See the relevant section of the Texas … [Read more...] about Texas Register Updates: Reimbursement Methodology for NFs, Etc.
Are You Ready for the Latest Changes to the SOM? Tags 325 and 371
On September 1, 2008, changes within Appendix PP of the State Operations Manual become effective. The changes involve deleting F326 and incorporating that tag's guidance into F325 and deleting F370 and incorporating it into F371. However, the changes are voluminous compared to what exists now. You may find the changes here, comprising 58 pages. The old sections are here and here. The changes concern nutrition, therapeutic diets, approved food sources and food sanitation. Be ready. … [Read more...] about Are You Ready for the Latest Changes to the SOM? Tags 325 and 371
Information Letters: Texas Medicaid Reimbursements, Etc.
The Texas Department of Aging and Disability Services (DADS) issued two information letters: Specialized Services and Rehabilitative Services in the Medicaid Nursing Facility Program The Texas Department of Health and Human Services and DADS informed Nursing Facility and Therapy Providers contracted with DADS that the Texas Medicaid Program can reimburse only nursing facilities - not outside therapy providers - for specialized and rehabilitative services delivered to Medicaid clients … [Read more...] about Information Letters: Texas Medicaid Reimbursements, Etc.
State of the Medicare Coverage Gap in 2007
The Kaiser Family Foundation has released a report on the costs and consequences of the Medicare Part D coverage gap in 2007. The coverage gap, also called the "doughnut hole," is the period of time during the year when a beneficiary is not covered and is responsible for paying drug costs out of pocket. The Kaiser study "quantifies…the number of Medicare Part D plan enrollees in 2007" who reached the doughnut hole. The study does not include low-income beneficiaries who received … [Read more...] about State of the Medicare Coverage Gap in 2007
CMS Reports Pay-for-Performance Pilot Success
The Centers for Medicare and Medicaid Services (CMS) announced last week that a pilot pay-for-performance program, which pays doctors based on quality of care, has lowered costs "in some cases" and improved quality of care for patients with congestive heart failure, coronary artery disease, and diabetes. According to CMS, four of the 10 groups participating in the program reduced costs to patients and CMS spending by $17.4 million. Kerry Weems, acting administrator for CMS, said, "We are … [Read more...] about CMS Reports Pay-for-Performance Pilot Success
Medicare Raises Nursing Home Payments; Part D Costs Lower Than Expected
The Centers for Medicare and Medicaid Services (CMS) has announced that payment rates for nursing homes will increase by $780 million next year. (Source) The payment increase (3.4 percent) is the result of a recalibration of the annual market basket calculation. CMS acting administrator Kerry Weems said CMS was "committed to providing high quality care to those in skilled nursing facilities and to paying those facilities properly for that care" and assures that CMS will continue evaluating … [Read more...] about Medicare Raises Nursing Home Payments; Part D Costs Lower Than Expected
Information Letters: Claim Cutoff Dates, Etc.
The Texas Department of Aging and Disability Services (DADS) issued ten information letters between August 1st through the 14th: Home Delivered Meals Rate Setting Procedures for Federal Fiscal Year 2009 (two-page letter) Changes to the Quality Assurance Fee Program for ICF/MR Providers (three-page letter) Wheelchair Requests for Nursing Facility Residents (two-page letter) Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing (two-page letter) Cutoff Dates for … [Read more...] about Information Letters: Claim Cutoff Dates, Etc.
