HHSC is marking another significant milestone in the expansion of Medicaid managed care. As of March 1, people covered by Medicaid who are eligible for STAR+PLUS and live in a nursing facility will get their basic health services and long-term care services through STAR+PLUS. People who get both Medicaid and Medicare (dual eligible) will continue to get their basic health services through Medicare and their long-term care services through STAR+PLUS Medicaid. With this most recent … [Read more...] about Nursing facility residents latest to get services through STAR+PLUS
Upcoming HHSC Meetings & Events in Austin
March 13, 2015 10 a.m. — Austin Consumer Direction Workgroup March 16, 2015 8 a.m. — Austin Intellectual and Developmental Disability System Redesign Advisory Committee - Transition to Managed Care Sub-Committee Meeting Visit us at Garlo Ward, PC … [Read more...] about Upcoming HHSC Meetings & Events in Austin
2015 Upper Payment Limit (UPL) Program
The enrollment period for non-state government-owned Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) providers that would like to participate in Quarters 1 and 2 of the 2015 Upper Payment Limit (UPL) program, covering October 1, 2014 – March 31, 2015, closes on March 13, 2015. There is no “roll-over” enrollment. If you wish to enroll in Quarter 1 and 2, you must complete all forms, regardless if you completed them for the 2014 UPL … [Read more...] about 2015 Upper Payment Limit (UPL) Program
DADS and CBS and Tx Home Living Behavioral Support Service Provider Policy Training
Department of Aging and Disability Services Home and Community-based Services and Texas Home Living Behavioral Support Service Provider Policy Training DADS' letter announced the release of the Department of Aging and Disability Services (DADS) Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Behavioral Support Service Provider Policy Training and to inform program providers of the deadline by which service providers of behavioral supports must complete the DADS approved … [Read more...] about DADS and CBS and Tx Home Living Behavioral Support Service Provider Policy Training
Processing of Custom Power Wheelchair, Durable Medical Equipment, and Goal-Directed Therapy (Rehabilitative Services) Prior Authorization Requests
Processing of Custom Power Wheelchair, Durable Medical Equipment, and Goal-Directed Therapy (Rehabilitative Services) Prior Authorization Requests DADS published an information letter as a follow-up to the Claims Forwarding, Dental Billing, and Other Changes Related to the Nursing Facility Transition to Managed Care Long Term Care news article which was posted to TMHP.com on February 5, 2015. The news article indicated the Department of Aging and Disability Services (DADS) would provide … [Read more...] about Processing of Custom Power Wheelchair, Durable Medical Equipment, and Goal-Directed Therapy (Rehabilitative Services) Prior Authorization Requests
Requirement to Submit Request for Dental Evaluation
DADS notified case management agencies (CMAs) and direct services agencies (DSAs) of changes regarding submission of documents for dental services to receive an evaluation for a dental treatment plan in the Community Living Assistance and Support Services (CLASS) program. Currently, sections 2310, 2320, and 2330 of the CLASS Provider Manual require the CMA to include a completed Form 3660 with the individual plan of care (IPC) if dental treatment including an evaluation to develop a dental … [Read more...] about Requirement to Submit Request for Dental Evaluation
CMS Strengthens Five Star Quality Rating System for Nursing Homes
CMS Strengthens Five Star Quality Rating System for Nursing Homes The Centers for Medicare & Medicaid Services (CMS) strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one. Today’s announcement also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, … [Read more...] about CMS Strengthens Five Star Quality Rating System for Nursing Homes
CMS proposes 2016 payment and policy updates for Medicare Health and Drug Plans
Proposed policies continue Secretary’s initiative tying Medicare payments to value and maintain stability of Medicare Advantage program The Centers for Medicare and Medicaid Services (CMS) today released proposed changes for the coming year for the Medicare Advantage (MA) and Part D Prescription Drug Programs that will advance Health and Human Services Secretary Sylvia M. Burwell’s vision of building a better, smarter health care system and moving the Medicare program, and the health care … [Read more...] about CMS proposes 2016 payment and policy updates for Medicare Health and Drug Plans
Nursing Facility Managed Care Transition: Selection of a Managed Care Organization Required by Individuals Receiving Hospice Services
Hospice services will continue to be provided under Medicaid fee-for-service (FFS) after nursing facility (NF) services transition to managed care effective March 1, 2015. There will be no change in the way hospice services are delivered or billed. However, NF residents receiving hospice services will be required to choose a STAR+PLUS health plan, if they are 21 or older, are eligible for Medicaid, and meet STAR+PLUS criteria. This requirement includes Medicaid-only and dually-eligible … [Read more...] about Nursing Facility Managed Care Transition: Selection of a Managed Care Organization Required by Individuals Receiving Hospice Services
Nursing Facility Managed Care Transition: Medicaid Managed Care and Service Coordination
This letter provides information regarding service coordination, a key feature of the STAR+PLUS Medicaid managed care program. Service coordination is a benefit offered to all STAR+PLUS members. In the nursing facility (NF), managed care organization (MCO) service coordinators (SCs) will partner with NF staff to ensure each member’s care is integrated and coordinated to avoid preventable hospital admissions, readmissions and emergency room visits. Each MCO will have a SC (who can be a … [Read more...] about Nursing Facility Managed Care Transition: Medicaid Managed Care and Service Coordination
