Information Letter No. 14-81 addresses the impact of the carve-in of acute medical careservices into managed care for certain persons enrolled in the Home and Community-basedServices (HCS) or Texas Home Living (TxHmL) programs as required by Senate Bill (SB)7 (83rd Legislature, Regular Session, 2013) and the impact the carve-in will have onexpectations for program providers, including compliance with program rules as describedin Texas Administrative Code (TAC), Chapter 9, Subchapter D for HCS … [Read more...] about Program Provider Responsibilities Regarding Acute Care Services
Request for Medical Service Planning Documents for Individuals Residing in ICF/IID
DADS has issued Information Letter 14-40 / Provider Letter 14-15 regarding the Expansion of Medicaid Managed Care Acute Care Services – Request for Medical Service Planning Documents for Individuals Residing in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions. In accordance with the provisions of Senate Bill 7, 83rd Texas Legislature, Regular Session, 2013, an eligible individual residing in an Intermediate Care Facility for Individuals with … [Read more...] about Request for Medical Service Planning Documents for Individuals Residing in ICF/IID
Restrictions on the Provision of Services by a Legally Responsible Person
DADS has issued Information Letter 14-39 titled Restrictions on the Provision of Services by a Legally Responsible Person - The purpose of this information letter (IL) is to inform Deaf Blind with Multiple Disabilities (DBMD) providers and Financial Management Services Agencies (FMSAs) of restrictions regarding the provision of services by a legally responsible person. FMSAs must inform Consumer Directed Services (CDS) employers about the information provided in this letter. The Centers … [Read more...] about Restrictions on the Provision of Services by a Legally Responsible Person
Expansion of Medicaid Acute Care Services – Role of STAR+PLUS Acute Care Service Coordinator in Long-term Support Services Planning
Information Letter 14-38 outlines the Role of STAR+PLUS Acute Care Service Coordinator in Long-term Support Services Planning. In accordance with the provisions of Senate Bill 7, 83rd Texas Legislature, Regular Session, 2013, certain individuals residing in an Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Condition (ICF/IID) or receiving long-term services and support (LTSS) through the Home and Community-based Services (HCS), Texas Home Living … [Read more...] about Expansion of Medicaid Acute Care Services – Role of STAR+PLUS Acute Care Service Coordinator in Long-term Support Services Planning
Exceptions to Managed Care Expansion
DADS has issued Information Letter 14-37 stating… Effective September 1, 2014, acute care services (e.g., physician visits, prescriptions) for some residents of non-state operated intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) will change from fee for service to managed care. Individuals who enroll into the STAR+PLUS program will receive acute care services through STAR+PLUS, with two exceptions as described below. Behavioral … [Read more...] about Exceptions to Managed Care Expansion
Information Letter No. 14-34 REVISED Children and Young Adults Receiving Services in the Medically Dependent Children Program voluntarily enrolled in the STAR program in the Medicaid Rural Service Areas will be Transferred Back to Fee-For-Service
Information Letter No. 14-34 REVISED Children and Young Adults Receiving Services in the Medically Dependent Children Program voluntarily enrolled in the STAR program in the Medicaid Rural Service Areas will be Transferred Back to Fee-For-Service This information letter is revised to clarify that it is applicable to children and young adults who are in the Medically Dependent Children Program (MDCP) and who voluntarily enrolled in the STAR program in the Medicaid Rural Service Areas (MRSAs). … [Read more...] about Information Letter No. 14-34 REVISED Children and Young Adults Receiving Services in the Medically Dependent Children Program voluntarily enrolled in the STAR program in the Medicaid Rural Service Areas will be Transferred Back to Fee-For-Service
Preadmission Screening and Resident Review Minimum Data Set Long Term Care Medicaid Information Rejections
The purpose of Information Letter No. 14-33 is to inform Medicaid-certified nursing facilities (NFs) of an important update to the Long Term Care (LTC) Online Portal and Preadmission Screening and Resident Review (PASRR). The federal PASRR process requires Medicaid-certified NFs to evaluate an individual who may have an intellectual disability (ID), developmental disability (DD), or a mental illness (MI). The PASRR Level I (PL1) Screening Form is designed to identify persons who are suspected … [Read more...] about Preadmission Screening and Resident Review Minimum Data Set Long Term Care Medicaid Information Rejections
HHSC Cancels Xerox Medicaid Contract
The Texas Health and Human Services Commission (HHSC) today notified Xerox Corp. that the state is terminating the company's Medicaid claims administration contract for cause after Xerox staff approved thousands of requests for braces that weren't medically necessary. News Release … [Read more...] about HHSC Cancels Xerox Medicaid Contract
TEXAS STATE MEDICAID FRAUD CONTROL UNIT: 2013 ONSITE REVIEW
TEXAS STATE MEDICAID FRAUD CONTROL UNIT: 2013 ONSITE REVIEW OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements. For fiscal years (FYs) 2010 through 2012, the Texas Unit reported recoveries of … [Read more...] about TEXAS STATE MEDICAID FRAUD CONTROL UNIT: 2013 ONSITE REVIEW
Proposed HHSC amendments seek to update Medicaid reimbursement
PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION CHAPTER 355. REIMBURSEMENT RATES. HHSC proposes to amend §355.7001, concerning Reimbursement Methodology for Telemedicine and §355.8085, concerning Reimbursement Methodology for Physicians; and proposes the repeal of §355.8081, concerning Reimbursement Methodology for Laboratory and X-ray Services, Radiation Therapy, Physical Therapists' Services, Physician Services, Podiatry Services, Chiropractic Services, Optometric Services, Ambulance … [Read more...] about Proposed HHSC amendments seek to update Medicaid reimbursement
