Long Island Care at Home vs. Coke, a federal case concerning home health worker compensation, got its second hearing before the U.S. Supreme Court on April 16, 2007. Before the justices: the validity of a longstanding Department of Labor regulation regarding “companionship services†provided by third parties (read: home health agencies) “to the care of the elderly or infirm.†Coke’s attorneys argued that Congress understood the terms "domestic service employment," as used in the … [Read more...] about U.S. SUPREME COURT HEARS ARGUMENT ON HOME HEALTH WORKER EXEMPTION UNDER WAGE AND HOUR LAWS.
DADS Mandates Employer Implemented Policies Addressing Fraud and False Claims Laws, Including Whistleblower Protections
DADS issued Information Letter 07-50 on May 10, 2007, requiring all Home and Community-Based (HCS) and Texas Home Living (TxHmL) Providers educate employees, contractors, and agents about federal and state fraud and false claims laws, and the whistleblower protections available under those laws. The mandate comes from the employee educational requirements under Section 6032 of the Federal Deficit Reduction Act (DRA) of 2005. Specifically, effective January 1, 2007, all providers who receive or … [Read more...] about DADS Mandates Employer Implemented Policies Addressing Fraud and False Claims Laws, Including Whistleblower Protections
Cooperation Key to Nursing Home Quality Improvements
Mary Ousley, past chair of the American Health Care Association, which represents long term care providers, testified before a congressional committee last week about the long term care profession’s experience with the Omnibus Budget Reconciliation Act of 1987 (OBRA ‘87). OBRA '87 is considered landmark legislation because it established many nursing home oversight rules in place today. Ousley said that in order to improve nursing facilities, providers, regulators, and consumers must … [Read more...] about Cooperation Key to Nursing Home Quality Improvements
Provider Letters: Minimizing Claim Rejections, Life Safety Code, Etc.
May 1 The Texas Department of Aging and Disability Services (DADS) sent an informational letter to long term care providers about what they can do to minimize claim rejections. Attached to the two-page letter is a two-page chart titled, “Common Reasons Claims Deny.†Download the letter and chart here. May 7 All home and community-based services waiver program providers will be required to comply with the 2006 National Fire Protection Association (NFPA) 101 Life Safety Code, … [Read more...] about Provider Letters: Minimizing Claim Rejections, Life Safety Code, Etc.
Provider Letters: National Provider Identifier and Criminal History Checks
April 27 The Texas Department of Aging and Disability Services (DADS) informed nursing facilities, community services, ICF/MR, and therapy providers about the National Provider Identifier (NPI) reporting process. An NPI is a 10-digit number used to identify health care providers. To prevent delays in billing, all providers that contract with DADS are required to report an NPI or Atypical Provider Identifier to DADS before June 1, 2007. For more information, download the letter here. May … [Read more...] about Provider Letters: National Provider Identifier and Criminal History Checks
Texas Register: MCOs, SHARS, Reimbursement, and PCS
The Texas Health and Human Services Commission (HHSC) proposed a new rule that would require Medicaid Managed Care Organizations (MCO) disease management care programs to have performance measures that are comparable to the Medicaid fee-for-service/Primary Care Case Management disease management program. Additionally, MCOs must demonstrate an ability to manage complex diseases among Medicaid recipients. A public hearing will be held on May 17, 2007, from 9-10 a.m. in the HHSC Lone Star … [Read more...] about Texas Register: MCOs, SHARS, Reimbursement, and PCS
STAR+PLUS Clients Letter and Fire Authority Memo
In a letter dated April 26, the Texas Department of Aging and Disability Services informed nursing facility providers new to the STAR+PLUS program about the program’s enrollment procedures and assured them that effective January 1, 2007, the STAR+PLUS enrollment will not impact the nursing facility process. For more information, download the letter here. The Centers for Medicare and Medicaid Services released a memo dated April 20 to state survey agency directors concerning “Permitted … [Read more...] about STAR+PLUS Clients Letter and Fire Authority Memo
Long Term Care Providers Face More Medicare Reimbursement Cuts
Providers receiving Medicare reimbursements could see more reductions in reimbursements by 2011, the Kaiser Network reports. Under the 2005 Tax Increase Prevention and Reconciliation Act, which President Bush signed into law in 2006, the federal government will be required to withhold three percent of payments to business that pay taxes and contract with the government. This law will significantly affect providers that depend on Medicare reimbursements to operate. Lawmakers are working to … [Read more...] about Long Term Care Providers Face More Medicare Reimbursement Cuts
Medicare Prescription Drug Negotiation Bill Stalls in Senate
Earlier this month, the U.S. House of Representatives passed a bill that would require the government to negotiate Medicare Part D prescription drug prices with drug companies. (See Congress Debates Medicare Part D Drug Price Negotiating) Last week, the measure failed to receive enough for votes for a floor debate in the Senate. (Medical News Today) Those who oppose the bill fear that requiring the government to negotiate instead of allowing the market to dictate drug prices will stifle drug … [Read more...] about Medicare Prescription Drug Negotiation Bill Stalls in Senate
Texas Register Upate: Internet Posting of Sanctions Imposed for Contractual Violations
The Texas Health and Human Services Commission (HHSC) adopted a rule regarding Internet Posting of Sanctions Imposed for Contractual Violations. HHSC is authorized to impose sanctions against a Medicaid managed care organization for failing to comply with contract terms. During the 30-day comment period, HHSC received one comment: Comment: HHSC received a comment from DSHS, in which the commenter suggested adding language to §353.5(a), General Provisions, indicating the rule only … [Read more...] about Texas Register Upate: Internet Posting of Sanctions Imposed for Contractual Violations
