Kaiser Health News reports on an study with expected findings: when times are hard, hospitals expand into affluent areas. In other words, hospitals seek more private-injured individuals. They also buy private practices in those areas and build more emergency services. The Texas Tribune reports that lawmakers will include drug reimbursements in the expanding Medicaid managed care, which they believe will save over $100 million. Included in the story is an interactive map that shows access … [Read more...] about Provider News Around the Web
DADS News Alerts: MDS, Provider Meetings
DADS has issued about over a dozen news alerts since March 28. An excerpt beginning on the second page: -- DADS reminded providers that when a nursing home or swing bed facility completes an MDS 3.0 "discharge assessment-return anticipated", and the resident does not return to the facility within 30 days, no further action is required. -- Case management for children and pregnant women is a Texas Medicaid benefit for eligible children birth to age 20 with a health condition or health … [Read more...] about DADS News Alerts: MDS, Provider Meetings
TX Register Updates: Employee Vaccines, SSLC Staff Training
The following information was obtained from the April 6 issue of the Texas Register: Public Notices HHSC intends to submit to CMS a request for MDCP and CBA waiver program renewals. HHSC also intends to submit transmittal number 12-007, which would add tobacco cessation counseling services for pregnant women, and transmittal number 12-001, which would update the Medicaid State Plan section titled "Section One - Single State Agency Organization" to include current information on agency … [Read more...] about TX Register Updates: Employee Vaccines, SSLC Staff Training
Primary Care, Medicaid News
The shortage of primary care physicians and primary care in general has been widely reported. According to the Texas Tribune, for example, the federal government has declared Harris County a primary care physician shortage zone. The health care reform law will result in millions more Texans on the Medicaid rolls. Who will treat them? CMS announced a program to alleviate some of the pressure. The initiative will provide funds to hospitals to increase training for advanced practice registered … [Read more...] about Primary Care, Medicaid News
ILs/PL: Rule Reminders for HCS and TxHmL
DADS released three information letters and one provider letter: NFs: DADS notified NFs that the compliance date for the Automated External Defibrillator Requirement has been extended to September 1, 2014. (Letter) HCS and TxHmL: DADS rules require these providers to include in an individual's implementation plan a list outcomes and to document the progress or lack of progress toward the outcomes. Completing sample logs in the billing guidelines might not fulfill this requirement. … [Read more...] about ILs/PL: Rule Reminders for HCS and TxHmL
TX Register Updates: May 15 Medicaid Payment Hearing
The following information was obtained from the March 30 issue of the Texas Register: HHSC will hold a public hearing on May 15, 2012, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for third quarter 2011 Healthcare Common Procedure Coding System; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies - "E Codes"; Doctor of Dentistry Services in an Ambulatory Surgical Center/Hospital Ambulatory Surgical Center, Evoked Response Tests and Neuromuscular Procedures, … [Read more...] about TX Register Updates: May 15 Medicaid Payment Hearing
Health Care and the Supreme Court
Texas Tribune reporter Thanh Tan is writing a series of articles on the Patient Protection and Affordable Care Act case currently before the U.S. Supreme Court. Texas is one of the states that filed suit against the federal government challenging the law, particularly the individual mandate, as unconstitutional. The Texas Tribune published a story (which includes a video) on how the law affects physicians. An excerpt: While a ruling on the constitutionality of the new health care reforms … [Read more...] about Health Care and the Supreme Court
ILs/PL: LTC Claim Errors, Criminal History Checks
DADS released two information letters and one provider letter: AFC, ALF, CBA, CLASS, DAHS, HDM, Hospice, ICF/ID, NF, PACE, and other providers: Last year, LTC CMS processed over 15 million claims, which included 423,185 rejected claims and 456,967 denied claims. DADS provided guidelines to deal with the most common errors that delay LTC provider claim processing and payment An excerpt: Rejected Claims A rejected claim fails initial system edits, and is returned to the provider for … [Read more...] about ILs/PL: LTC Claim Errors, Criminal History Checks
TX Register Updates: Reimbursement Rates
The following information was obtained from the March 23 issue of the Texas Register: HHSC adopted amendments to §355.105, General Reporting and Documentation Requirements, Methods, and Procedures; §355.112, Attendant Compensation Rate Enhancement; §355.308, concerning Direct Care Staff Rate Component; §355.503, Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential … [Read more...] about TX Register Updates: Reimbursement Rates
DADS News Alerts: MDS 3.0 Updates, DADS 1915(c) Training
-- A Medical Necessity and Level of Care Item by Item Guide is scheduled for release on April 1, 2012. This is the link (PDF) to the November 2011 Item by Item Guide: . Effective April 1, 2012 it will link to the April revision. -- An MDS 3.0 RAI Manual (v1.08) Errata document labeled "MDS 3.0 RAI Manual (v1.08) Errata_March_12_2012" has been posted in the Downloads section of the MDS 3.0 Training page. -- Providers using MDS 3.0 for nursing homes and swing beds: "[M]ay ignore warning … [Read more...] about DADS News Alerts: MDS 3.0 Updates, DADS 1915(c) Training
