The following information was obtained from the January 18 issue of the Texas Register. Adopted Rules HHSC adopted an amendment to §357.17, Types of Hearings, which states that a client receiving Medicaid services through an MCO must exhaust the MCO's expedited appeals process before requesting an expedited fair hearing from HHSC unless the MCO has not sent a timely response to the request or the MCO has denied the request. HHSC adopted new §390.1, Definitions, and §390.2, Standards … [Read more...] about TX Register Updates: Types of Hearings, Rural Health
IL/News Alerts: Cost Avoidance Project, New MOA
NF, Hospice, ICF/IID: DADS provided a status of the implementation of the Cost Avoidance Project. An excerpt: Release 1: Implemented August 2012 This release implemented new operations processes for validating insurance information on file for Long Term Care (LTC) individuals at Texas Medicaid & Healthcare Partnership (TMHP). This release provides phone support to providers requiring assistance with Other Insurance (OI) information on file for individuals in their facilities. Release … [Read more...] about IL/News Alerts: Cost Avoidance Project, New MOA
TX Register Updates: Notice Correction, Medical Board Changes
The following information appeared in the January 11 issue of the Texas Register. Public Notice Correction HHSC published a correction to an intent to submit an amendment to the Texas State Plan for Medical Assistance. An excerpt: The announcement incorrectly described the fiscal impact of the proposed state plan amendment. The correct fiscal impact is as follows: The proposed amendment is estimated to result in an additional annual aggregate expenditure of $21,300,000 for the … [Read more...] about TX Register Updates: Notice Correction, Medical Board Changes
State Insurance Exchanges Approved
CMS reports that the U.S. Department of Health and Human Services (HHS) has conditionally approved health insurances exchanges in California, Hawaii, Idaho, Nevada, New Mexico, Vermont, and Utah. "States across the country are working to implement the health care law and build a marketplace that works for their residents,” Secretary Kathleen Sebelius said. "In ten months, consumers in all fifty states will have access to a new marketplace where they will be able to easily purchase affordable, … [Read more...] about State Insurance Exchanges Approved
TX Register Updates: NPI Changes
The following information was obtained from the January 4 issue of the Texas Register. HHSC adopted amendments to §354.1001, Claim Information Requirements, and §354.1121, Definitions. The changes require, among other things, the claim for services or supplies to include the name and associated NPI of the performing provider, the referring or ordering provider, and the supervising provider, if the referring or ordering provider is acting under the direction or supervision of another provider … [Read more...] about TX Register Updates: NPI Changes
ILs/News Alert: Cost Reports, MDS Data
2012 Cost Report and Cost Report Training Requirements for (in PDF): CBA HCSSA, CLASS CMA and DSA, and PHC HCS, TxHmL, and ICF/IID CBA AL, DAHS, DBMD, NF, and RC MDS 3.0 update Everyone with a Quality Improvement Evaluation System (QIES) account to submit MDS data and view CASPER reports should now update their account. Be sure all MDS Coordinators, Swing Bed Coordinators, and any other corporate and provider staff who have a QIES account follow this process to ensure they … [Read more...] about ILs/News Alert: Cost Reports, MDS Data
Medicaid/Medicare News Around the Web
"The US Centers for Medicare & Medicaid Services (CMS) may be duplicating efforts and paying for the same services under multiple programs to test new payment and treatment delivery models, the US Government Accountability Office (GAO) said in a recent report. Better coordination among the programs is needed to prevent the inefficient use of federal resources, GAO said." – Medcape Medical News "In all, Medicare is rewarding 1,557 hospitals with more money and reducing payments to 1,427 … [Read more...] about Medicaid/Medicare News Around the Web
TX Register Updates: 1/11/13 Hearing, Medical Board Changes
The following information was obtained from December 28 issue of the Texas Register. Public Hearing and Notice HHSC will hold a public hearing on Friday, January 11, 2013, at 1:30 p.m. to receive comment on proposed Medicaid payment methodology for cost sharing payments for Medicare services provided to dual eligibles. The hearing will be held in the Lone Star Conference Room. HHSC intends to submit Transmittal Number 13-001 to the Texas State Plan for Medical Assistance, which would … [Read more...] about TX Register Updates: 1/11/13 Hearing, Medical Board Changes
TX Register Updates: Affordable Care Act, Nursing Changes
The following information was obtained from the December 21 issue of the Texas Register. Public Notices HHSC intends to submit to the Texas State Plan for Medical Assistance an amendment that would update the fee schedules in the current state plan by including fees for new services and by modifying fees for existing services. HHSC intends to submit to CMS a request to amend the Texas Healthcare Transformation Quality Improvement Program waiver program. An excerpt: The 82nd Texas … [Read more...] about TX Register Updates: Affordable Care Act, Nursing Changes
Medicare and Medicaid Court Decisions
Medicare recipients with chronic conditions can no longer be turned down for home health services provided by skilled nurses and therapists, according to a recent settlement between the federal government and consumer advocates. Home care and other long term care providers benefit as well. An excerpt: To receive this coverage, patients must meet specific requirements. First, a doctor must prescribe care from a nurse or therapist. Patients in skilled-nursing facilities also must demonstrate a … [Read more...] about Medicare and Medicaid Court Decisions
