Provider Letter PL 2018-20 (Replaces PL 13-04 and PL 18-07) This letter gives directives to the following provider types: Assisted Living Facilities (ALFs), Day Activity and HealthnServices (DAHS) Facilities, Home and Community Support Services Agencies (HCSSAs), Intermediate Care Facilities for Individuals with an Intellectual Disability (ICFs/IID), Prescribed Pediatric Extended Care Centers (PPECs) Nursing Facilities (NFs) A provider (as listed above) must include in an initial … [Read more...] about Provider Letter Regarding Incident Reporting Requirements
Medicare and Medicaid Programs – CMS, HSS Proposed Regulatory Provisions Fact Sheet
Today the Centers for Medicare & Medicaid Services (CMS), in order to promote Medicaid and Medicare program efficiency, transparency, and burden reduction, proposed new rules that revise the applicable conditions of participation (CoPs) for providers and conditions for coverage (CfCs). The link of this rule will be republished in the Federal Register on Sept. 20. According to the fact sheet summary excerpt: This proposed rule would reform Medicare regulations that are identified as … [Read more...] about Medicare and Medicaid Programs – CMS, HSS Proposed Regulatory Provisions Fact Sheet
Proposed Veterans Medical Marijuana Safe Harbor Act could Legalize Cannabis for Military
As the growing population of military veterans seek access and rights to use medical cannabis to treat PTSD, chronic pain and other mental and physical war wounds, new legislation has now been filed by two Democratic senators (Senator Brian Schatz (D-HI) and Senator Bill Nelson (D-FL) that aims to basically legalize medical marijuana for them and let government physicians enable them to have access to it. According to reports, the Veterans Medical Marijuana Safe Harbor Act, would allow veterans … [Read more...] about Proposed Veterans Medical Marijuana Safe Harbor Act could Legalize Cannabis for Military
CMS authorizes increase of $340 million in Hospice payments for FY 2019
Many families and health care providers are debating whether the Centers for Medicare and Medicaid Services, which runs Medicare (CMS) and Congress are doing enough to implement processes to protect patients and their families from hospice providers who may be exploiting the service. Recently, CMS finalized a $340 Million/ 1.8 percent increase in Hospice payments for Medicare Hospice providers. According to reports, the Office of Inspector General (OIG) at HHS synthesized 10 years of … [Read more...] about CMS authorizes increase of $340 million in Hospice payments for FY 2019
$434 Million in Financial Payments Improperly Issued by CMS to Insurers
In a new report by The HHS Office of Inspector General, the Centers for Medicare & Medicaid Services (CMS) was found to have wrongly funded $434.4 million in financial assistance payments to qualified health plan (QHPs) issuers for 461,127 policies. The audit revealed that the improperly authorized funding occurred in 2014, the first year the ACA law’s health insurance marketplaces went online. According to the report, CMS relied on insurers to verify that their enrollees were confirmed and … [Read more...] about $434 Million in Financial Payments Improperly Issued by CMS to Insurers
Proposed Rule for Permanent Risk Adjustment Program for 2018
A new Centers for Medicare & Medicaid Services (CMS) Press release details the proposed additional rule to address risk adjustment program for the 2018 benefit year. The rule would give payers the ability to receive 2018 risk adjustment payments by resolving legal contentions of the program’s operation and give CMS the ability to issue risk adjustment payments without interruptions for the current plan year. According to reports the risk adjustment payments also reimburse health insurers … [Read more...] about Proposed Rule for Permanent Risk Adjustment Program for 2018
Technical Memoranda (TM) concerning prescribed Life Safety Code (LSC) standards for ALFs
Provider Letter 18-11 - Technical Memoranda (TM) concerning prescribed Life Safety Code (LSC) standards for ALFs to be responsible for reviewing the LSC TM and complying with the guidance provided therein. The LSC is a set of fire protection requirements designed to provide a reasonable degree of safety at Assisted Living Facilities. It covers construction, protection, and operational features designed to provide safety from fire, smoke, and panic. According to the letter and 2.0 Policy … [Read more...] about Technical Memoranda (TM) concerning prescribed Life Safety Code (LSC) standards for ALFs
Preparing for the Upcoming Fiscal Year 2018 Fee-for-Service Claims Billing Closeout
Information Letter No. 18-06 : This letter addresses preparation for the August 31, 2018, end of fiscal year closeout. Providers must promptly submit claims to be paid by the Health and Human Services Commission (HHSC) for any unbilled services. Any problems associated with the claims are resolved within the 12-month filing limitation. The letter directly addresses the following: Adult Foster Care Providers Assisted Living Facilities Community Attendant Services Providers Community … [Read more...] about Preparing for the Upcoming Fiscal Year 2018 Fee-for-Service Claims Billing Closeout
Amended Nursing Peer Review Committee (NPRC) Requirements and a State Agency’s Duty to Report
PL 18-06 - Long-Term Care Regulatory Provider Letter (PL) The Texas Health and Human Services Commission released the provider letter to nursing providers (ALF, DAHS, HCSSA, ICF/IID, and Nursing Facilities) the letter details that House Bill (HB) 3296, 85th Legislature, Regular Session, 2017, amended Texas Occupations Code §303.0015, regarding the establishment of a NPRC. Additionally, this letter clarifies the process a surveyor from the Texas Health and Human Services Commission (HHSC) … [Read more...] about Amended Nursing Peer Review Committee (NPRC) Requirements and a State Agency’s Duty to Report
New Requirements for Rehabilitative Services and Nursing Facility Specialized Services
PL 18-01 (NF) -Last September 10, 2017, the Health and Human Services Commission (HHSC) added new rules and amended and deleted rules in Texas Administrative Code (TAC), Title 40, Part 1, Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification. The Provider letter describes new requirements related to rehabilitative services and nursing facility (NF) specialized services and the provider responsibilities that arise from the new rules. Among many new rules and for … [Read more...] about New Requirements for Rehabilitative Services and Nursing Facility Specialized Services
