DADS is hosting Town Hall Meetings throughout the state this summer to provide an opportunity for DADS consumers and family members, service providers and the public to learn more about the Consumer Directed Services (CDS) service delivery option available in many Texas programs. Currently, only 2% of HCS programs (OHFH) and 4% of TxHmL Programs utilize consumer directed services (CDS). Providers and public welcome. Schedule 7/27: Longview, Texas 7/29: Fort Worth, Texas 8/12: Austin, … [Read more...] about Upcoming CDS Town Hall Meetings
Changes to TxHmL Critical Incident Reporting (CARE)
TxHmL providers report to DADS through the CARE system and the required reporting information has changed (SB 325). Providers must begin collecting data in compliance with the new requirements on August 1, 2009. Providers must now report the total number of medication errors, serious injuries, behavior plans authorizing restraint, emergency restraints used (including type of restraint), individuals requiring emergency restraints, and restraint related injuries. For more information please see … [Read more...] about Changes to TxHmL Critical Incident Reporting (CARE)
Medicare Fraud Strike Force in Texas
According to the Houston Chronicle, there's a federal Medicare fraud strike force on the loose in Texas. The article highlights a number of Houston-area clinics committing Medicare fraud. Medicare fraud in the U.S. last year totaled $2.35 billion. There were 575 health fraud criminal actions and 342 civil actions filed. The task force has reduced identification of Medicare fraud from months to days, thanks to improved technology. Justice Department spokeswoman Melissa Schwartz said, "There … [Read more...] about Medicare Fraud Strike Force in Texas
Obtacles to Keeping the Medically Fragile at Home
The State claims that it does not force those who age out of the children's health care plan into institutional care. It looks to me that the State certainly does do that and in a recent case, it appears that a young man died because of it. AUSTIN – Toby Simmons' disabilities were so severe that he couldn't breathe or swallow without help. For the first two decades of his life, he received around-the-clock nursing care in his foster mother's home. But when he turned 21 and aged out … [Read more...] about Obtacles to Keeping the Medically Fragile at Home
GAO: Fraud and Abuse Increased Medicare Home Health Services Spending
According to a new Government Accountability Office (GAO) report, Medicare fraud and abuse by home health care providers resulted in a 44 percent increase in spending over five years. (Kaiser Network) The GAO reviewed home health care payments from 2002 to 2006 and found that the number of Medicare beneficiaries increased 17 percent and spending reached $13 billion. The increases were caused by some providers exaggerating medical conditions and other providers billing the government for … [Read more...] about GAO: Fraud and Abuse Increased Medicare Home Health Services Spending
Legislative Bills Get Public Hearings, Sent to Committee
Last month, I published a post with a list of bills introduced in the 81st Legislative Session that impact providers. Some of these bills have been scheduled for public hearings and referred to committees. Click on the links to find out the present status of the bills: HB 5 - Relating to the elimination of smoking in all workplaces and public places; providing penalties. HB 67 - Relating to a medical assistance buy-in program for children with certain developmental disabilities. HB 87 … [Read more...] about Legislative Bills Get Public Hearings, Sent to Committee
MedPAC’s 2009 Report to Congress
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, released its 2009 report to Congress. The report includes payment policy recommendations for nine payment systems: hospital inpatient, hospital outpatient, physicians, ambulatory surgical center, outpatient dialysis, skilled nursing, home health, inpatient rehabilitation facilities, and long-term care hospitals. From the press release: FEE-FOR-SERVICE PAYMENT UPDATE … [Read more...] about MedPAC’s 2009 Report to Congress
Home Care Group Develops Medicare Anti-Fraud Plan
The Kaiser Network reports that the American Association for Homecare presented a 13-point plan on preventing Medicare fraud and abuse related to durable medical equipment. According to the group's plan, suppliers of home durable medical equipment would be subject to site inspections, and contract renewal would be contingent on these inspections. Also required under the plan would be a six-month trial period, an anti-fraud office, and stronger penalties and fines for fraud and … [Read more...] about Home Care Group Develops Medicare Anti-Fraud Plan
Medicaid and Protection of Spouse’s Income and Assets
Late last month, there was a disturbing article in The New York Times regarding Medicaid and the protection of a spouse's income and assets when the Medicaid beneficiary lives at home rather than in a nursing home. According to the article, one state Health Department spokesman said the following: “They’re saying if you put your spouse in a nursing home, you’re going to get to keep more income than if you keep your spouse out of a nursing home,†said Mark L. Kissinger, deputy … [Read more...] about Medicaid and Protection of Spouse’s Income and Assets
Smaller Reimbursements for Home Health Agencies
According to the Kaiser Network, MedPAC has recommended reducing Medicare reimbursements to home health agencies by 5.5 percent from FY 2009 levels and increasing payments to long term care hospitals and dialysis centers. MedPAC, which advises Congress on Medicare issues, will send a report to the legislative body in March. The report will also contain a recommendation to change home health agency reimbursement rates in 2011 "to account for the average cost of care, develop studies to … [Read more...] about Smaller Reimbursements for Home Health Agencies