Provider Letter No. 17-22 - Quality service reviews (QSRs) of the implementation of policies, procedures, and improvements relating to the Pre-admission Screening and Resident Review Process (PASRR) will be conducted and the process will continue with Texas Health and Human Services (HHS) staff. HHS QSR staff will continue to conduct QSRs of nursing facilities, community-based Medicaid service providers, and Local IDD Authorities (LIDDAs) that provide service coordination and other services … [Read more...] about Latest Pre-admission Screening and Resident Review – Quality Service Reviews
CMS & CBO Report different numbers on possible effect of AHCA in the healthcare market
The Republican led U.S. House of Representatives approved the American Health Care Act of 2017 last may and now the Office of the Chief Actuary of the Centers for Medicare and Medicaid Services released its report on the Estimated Financial Effect of the “AHCA .” According to reports from the Health Affairs Organization:"The headline from the Actuary’s report that is likely to receive the most attention is that the CMS Actuary sees the AHCA as increasing the uninsured by 4 million for 2018/2019 … [Read more...] about CMS & CBO Report different numbers on possible effect of AHCA in the healthcare market
Ban on nursing home arbitration agreement officially lifted by CMS.
Ban on nursing home arbitration agreement officially lifted by CMS.Upheld by the Centers for Medicare & Medicaid Services under the Trump Administration, according to reports, the ban on nursing home arbitration clauses has been lifted. CMS Issued the 'Proposed Revision Requirements for Long-Term Care Facilities’ Arbitration Agreements on its website. Obama-era regulation previously stopped nursing homes from forcing patients and their families to sign binding arbitration agreements, … [Read more...] about Ban on nursing home arbitration agreement officially lifted by CMS.
Medicaid Managed Care Fraud and the New Rule
The final rule has been recently issued. Suffice it to say that it is long and complicated. Expect increased enforcement and prosecutor scrutiny. I will write a series of articles trying to parse out the complexities, risks and best practices in the coming months. In the meantime, read the 2016 OIG Work Plan for the purpose of your compliance plans. … [Read more...] about Medicaid Managed Care Fraud and the New Rule
Medicaid Payment Rates
Medicaid Payment RatesAs you know, the CMS Medicaid hospice payment rates memo was released on September 1, 2015. Therequirements reflect the Medicare final rule which was published on August 6, 2015. The rule changesimplement several items:? Payment methodology for routine home care (RHC) – beginning January 1, 2016 the RHC rateswill be implemented; a higher base payment for the first 60 days of care and a reduced rate forthe days thereafter.? Service Intensity Add-on – this is payment for … [Read more...] about Medicaid Payment Rates
HHSC – Learning Collaborative Summit
HHSC has posted information on the August 27th - 28th Statewide Learning Collaborative Summit, including the livestream link and agenda, on the Dates and Deadlines page. Visit us at Garlo Ward, PC … [Read more...] about HHSC – Learning Collaborative Summit
Interpretation of Medical Assistance Only Codes
DADS published an information letter to provide assistance to service coordinators, case managers, and program providers on how to identify an individual’s Medicaid type program (TP) and to identify if a certified Medicaid TP is categorized as Medical Assistance Only (MAO).Individuals certified for MAO Medicaid by the Health and Human Services Commission (HHSC) receiving Community First Choice (CFC) services through a 1915(c) Waiver Program must meet eligibility requirements stated in 42 Code … [Read more...] about Interpretation of Medical Assistance Only Codes
Medicaid Hospice – Changes in Procedures
DADS issues a letter to inform Texas Medicaid Hospice providers of updates to the Form3071, Individual Election/Cancellation/Update, and Form 3074, The Physician Certification ofTerminal Illness, and the coinciding instructions for those forms. As a reminder, per InformationLetter 14-50, effective July 1, 2014, Form 3071 and Form 3074 must be submitted electronicallyon the Texas Medicaid and Healthcare Partnership (TMHP) Long-Term Care (LTC) Portal. Paperforms will no longer be accepted by TMHP; … [Read more...] about Medicaid Hospice – Changes in Procedures
Information on Ebola Virus for Providers of Services to Individuals in the Department of Aging and Disability Services Programs
DADS information letter provides information on the Ebola virus that providers may use to help ensure the health and safety of staff members and individuals receiving services. The Department of Aging and Disability Services encourages its providers to take reasonable precautions to ensure their employees are not exposed to a symptomatic person by knowing how Ebola is transmitted and its symptoms. An individual will not contract Ebola if he has not had exposure to an individual with Ebola or … [Read more...] about Information on Ebola Virus for Providers of Services to Individuals in the Department of Aging and Disability Services Programs
IL and News Alerts: 3/31 Webinar, Postponed NF Resident Move
DADS released one information letter. CBA and FMSA: HHSC approved new payment rates for the CBA waiver program, effective March 1, 2014. You can access these rates at the HHSC Rate Analysis site. (Letter) -- DADS notified all CLASS CMA and DSA that Form 3591, CLASS IPC/IDRC Cover Sheet, is available. Providers must use this form as a cover sheet when submitting an ID/RC assessment or PC packet to DADS, beginning April 1, 2014. -- DADS has postponed moving NF resident into STAR+PLUS … [Read more...] about IL and News Alerts: 3/31 Webinar, Postponed NF Resident Move