DADS released a provider letter and posted several news alerts: Assisted Living: The legislature added Section 247.007 to the HSC, which requires all assisted living facilities to comply with requirements for reporting and investigating ANE. (Letter) -- DADS has revised Form 3626, Request for an Exception of Service Limit, to address frequent questions from CLASS providers on how to accurately calculate service amounts. -- DADS will host a webinar on the proposed new contract and … [Read more...] about PL and News Alerts: ANE Reporting, Nursing Training Sessions
MedPAC Recommends Reduce Payments to Specialists
American Medical News reports that MedPAC, which advises Congress on Medicare, recommended significant cuts to specialists to prevent such cuts for primary care physicians. An excerpt: The Medicare Payment Advisory Commission has drafted recommendations to Congress that would block a 29.5% pay cut scheduled for 2012 and future across-the-board Medicare rate reductions, but the plan would pay for the changes by lowering rates for nonprimary care services. Supporters of the proposal said it could … [Read more...] about MedPAC Recommends Reduce Payments to Specialists
TX Register Updates: STD Coverage, Cost Finding
The following information was obtained from the September 23 issue of the Texas Register: Public Notice HHSC intends to submit to CMS a request for extension for renewal of the Women's Health Program demonstration waiver to add treatment of sexually transmitted diseases to coverage. See the Texas Register for more information. Adopted Rules HHSC adopted amendments to §355.457, Cost Finding Methodology, which establishes the cost finding methodology for the ICF/MR program. HHSC also … [Read more...] about TX Register Updates: STD Coverage, Cost Finding
ILs and PL: AFC Clients, Mortality Review
DADS released two provider and three information letters. Licensed Type C ALs: DADS will conduct a two-year review of licensed Type C assisted living facilities that no longer serve adult foster care (AFC) clients, effective September 14, 2011, which replaces the assessment completed by the AFC contract specialist when the services were provided to those clients. Use Form 1123, Review of Assisted Living Facility Type C. (Letter) HCSSAs: Attached to this letter is a five-page document … [Read more...] about ILs and PL: AFC Clients, Mortality Review
DADS Alerts: Long Term Care Changes in Texas
Every week, DADS issues important news alerts for providers. Here are four of the nine alerts posted since September 2: DADS added a new section to its web site: Culture Change in Texas Long-term Care. The MDS Privacy Act Statement is available in Spanish in the MDS 3.0 RAI Manual. "Effective for dates of service or dates of discharge (services) on or after October 1, 2013, Medicaid fee-for-service, Medicaid managed care, Primary Care Case Management (PCCM), family planning … [Read more...] about DADS Alerts: Long Term Care Changes in Texas
TX Register Updates: Medical Board Changes
The following information was obtained from the September 16 issue of the Texas Register: Public Notice HHSC intends to submit transmittal number 11-045 to the Texas State Plan for Medical Assistance, which would limit payments for Medicare Part B services provided to dual eligibles to no more than the Medicaid payment amount for the same service, with the exception of dialysis services. See the Texas Register for more information. Proposed Rules The Texas Medical Board proposed … [Read more...] about TX Register Updates: Medical Board Changes
Medicaid Managed Care Expansion
Expanding managed care is one way Texas hopes to save money. One of ten states with specific expansion plans, Texas seeks to find a balance between cost reduction and quality care as the health care reform law, which will increase the Medicaid rolls, goes into effect. An excerpt from Kaiser Health News: Nearly every state uses managed care to some extent, and as of October 2010, about 66 percent of Medicaid enrollees were in managed-care plans of some type, according to the survey. That … [Read more...] about Medicaid Managed Care Expansion
ILs and PL: Weather-Related Closures, New Service Limits
DADS released one provider and six information letters: Adult Day Care, AL, HCSSAs, ICFs/MR, and NFs: CMS and DADS don't consider inclement weather-related or emergency state office closures to be state or federal holidays. Please submit any TAC- or federal code-required reports or other documents within the specified time frame, regardless closures. (Letter) CLASS Case Management and DSAs, HCS, CWP, and CDSAs: DADS will end the CWP on December 31, 2011, because it is no longer cost … [Read more...] about ILs and PL: Weather-Related Closures, New Service Limits
TX Register Updates: Medical Board Fees, Cease and Desist Orders
The following was obtained from the September 9 issue of the Texas Register: Public Notices HHSC adopted new per diem payment rates for the non-state operated ICF/MR, which can be found here. HHSC also intends to submit amendments to the Texas State Plan for Medical Assistance to modify the reimbursement methodologies as a result of Medicaid fee adjustments for: Durable Medical Equipment Prosthetics, Orthotics, and Supplies; Early Periodic Screening, Diagnosis and Treatment; Physicians and … [Read more...] about TX Register Updates: Medical Board Fees, Cease and Desist Orders
Primary Care Physicians Seek CMS Committee Changes
The Wall Street Journal reports that the American Academy of Family Physicians (AAFP), which represents primacy care doctors, has asked CMS to change the way its Relative Value Scale Update Committee (RUC) calculates Medicare reimbursements—which it says places a higher value specialists' work—and to add more members who represent primary care groups. A group of primary care physicians is suing CMS. An excerpt: "I think the whole thing needs to be replaced," said Paul Fischer, a doctor who … [Read more...] about Primary Care Physicians Seek CMS Committee Changes
