Recent News

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Preparing for work this morning, television news on in the background, I heard a familiar name – Tyson Murphy.   Tyson is a relatively new TAHC&H Member, however seems to have jumped in with both feet, so yes my ears perked up! I heard "Until they are completely filled, our work is not done."   He is involved in the Be a Santa to a Senior, a program through Home Instead Senior Care, is in its fifteenth year in Central Texas.   The company saw a 50 percent spike this December in the number of older Texans who filled out gift requests to be placed in three Walmart stores in Williamson and Travis counties. Nearly a thousand people put their wishes on ...
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Dear Members, Palmetto GBA’s Medical Review staff initiated TPE Probe review edits for providers identified through data analysis demonstrating high risk for improper payment. Providers have been offered education throughout and upon completion of the Probe 1 TPE review. Current Probe 1 Home Health TPE Results for the period from October 1, 2017 to September 30, 2018, are as follows: Home Health Probes Processed October 1, 2017 to September 30, 2018 Number of Providers with Edit Effectiveness Performed from Oct. 1, 2017 – Sept. 30, 2018 Providers Compliant Completed/Removed from Edit Providers Non-Compliant Progressing ...
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​ Dear Members, Last week, I attended an HHSC eligibility and enrollment workgroup meeting to discuss issues that were raised when TAHC&H, MCOs, providers, and other stakeholders met with Rep. Richard Raymond in mid-November. Rep. Raymond serves as the Chair of the Human Services Committee , and serves on the Health & Human Services Transition and Oversight Committee . Ongoing Improvement Initiatives To begin, state staff gave an update on various initiatives they have implemented to improve their data and processes for eligibility determination and client enrollment since 2016. These include: A real-time Social Security Number ...
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Dear Members, The next quarterly meeting of the State Medicaid Managed Care Advisory Committee will be held on Wednesday, December 12, 2018, at 1:00 pm. This committee provides recommendations and ongoing input to HHSC on the operation of Medicaid managed care throughout the state of Texas. The committee also guides policy related to Medicaid managed care, and serves as the central source for stakeholder input to HHSC. Webcasting is available for this meeting, or you may attend in person. This meeting will be held at: Health and Human Services Commission Brown-Heatly Building, Public Hearing Room 4900 North Lamar Blvd. ...
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Dear Members,  Palmetto GBA will be hosting free teleconferences on the Targeted Probe and Educate (TPE) Program in 2019. These sessions offer providers valuable opportunities to ask Palmetto's Medical Review Subject Matter Experts questions about TPE findings. Mark your calendars for these sessions beginning in Spring 2019! Medical Review Hot Topic Targeted Probe and Educate Teleconferences Date March 4, 2019 June 3, 2019 September 3, 2019 December 2, 2019 Time 1:00 p.m. -2:00 p.m. CT 1:00 p.m. -2:00 p.m. CT 1:00 p.m. -2:00 p.m. CT 1:00 p.m. -2:00 p.m. CT Participation Number (877) 789-3907 (877) ...
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UPDATED: CAHPS Hospice Survey Response Rate: The CAHPS Hospice Survey response rate for the upcoming public reporting period second quarter of 2016 through the first quarter of 2018 (04/01/2016 through 3/31/2018) is 33%, which is the same as the response rate for the current public reporting period, first quarter of 2016 through the fourth quarter of 2017 (1/01/2016 through 12/31/2017). For details regarding the formula that CMS uses to calculate the survey response rate, please see the CAHPS Hospice Survey Quality Assurance Guidelines, Version 5.0, available at:   http://www.hospicecahpssurvey.org/en/quality-assurance-guidelines/ .  UPDATED: Case-Mix ...
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Dear Members, Some of you may have noticed recent changes in your payments for Primary Home Care (PHC) and/or Community Living Assistance and Support Services (CLASS) attendant services.  Near the start of each state Fiscal Year, HHSC posts updated attendant rate enhancement information for participating providers. An overview of this enhancement for community care providers is available on HHSC Rate Analysis’ Long-term Services and Supports website . Providers must enroll each year to participate.  In mid-October, HHSC sent awards letters to participating providers and posted the SFY 2019 rate awards levels to their website . Providers may use their ...
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Dear Members,  Please be advised that both Texas state and federal offices will be closed on Wednesday, December 5, 2018, in observance of a Day of Mourning following the passing of President George Herbert Walker Bush. Governor Abbott has issued an Executive Order directing the closure of state offices on December 5 and flying of flags at half-staff over state buildings and the capitol for the month of December. Governor Abbott has also encouraged Texas businesses to fly their flags at half-staff until December 31, 2018, as well. Payments for claims that would have been issued on December 5 will be processed on December 6, as a result; claim processing ...
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Dear Members, We know that many of you are currently dealing with Additional Documentation Requests (ADRs) from the Centers for Medicare & Medicaid Services (CMS) as a result of Targeted Probe and Educate (TPE) audits. TPE audits are intended to improve provider billing practices by reducing errors in claims submission, thereby reducing claim denials and appeals, but we understand that the ADRs that often result are difficult and time-consuming, as well. The Targeted Probe and Educate Process Agencies with high error rates in their claims or billing/utilization practices that differ significantly from their peers are identified via data analytics ...
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Dear Members, Please mark your calendars for some important public meetings during the first week of December! Texas Council on Consumer Direction Meeting December 4, 2018, 10:00 a.m. Webcasting is available for this meeting, or you may attend in person. The meeting will be held at: Health and Human Services Commission  Brown-Heatly Building, Public Hearing Room 4900 North Lamar Blvd. Austin, TX 78751  The agenda for this quarterly meeting includes a presentation on Applied Self-Direction, reports on STAR Kids, STAR+PLUS, and Consumer Directed Services (CDS) policy, Electronic Visit Verification (EVV), and 2018 legislative appropriations ...
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The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to share the following updates: Training Opportunity: Palliative Care for Older Adults Dually Eligible for Medicare and Medicaid Date/Time: Wednesday, December 5, 2018 from 12:00-1:30pm (EDT) Register here: https://www.resourcesforintegratedcare.com/GeriatricCompetentCare/2018_GCC_Webinar/Palliative_Care Older adults who are in the advanced stage of an illness or nearing the end of life may experience physical or emotional distress, fragmented care delivery, and barriers to effective communication. Palliative care aims to address ...
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Dear Members,  As TAHC&H continues to work with the state on the Electronic Visit Verification (EVV) program via regular workgroup discussions and issues as they arise on a case-by-case basis, we are pleased to share with you EVV-related news as we receive it.  Today, HHSC advised that they are working with the Texas Medicaid and Healthcare Partnership (TMHP) to evaluate the possibility of expanding the pool of EVV vendors in the future, to allow providers a choice when additional programs are added to the EVV requirements as part of the 21st Century Cures Act .  If HHSC and TMHP determine that this is a viable option, new vendors might be available ...
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​Dear Members, There’s a lot going on at the Centers for Medicare and Medicaid Services (CMS), including rate and fee changes, and updates to information for hospice providers. Here is the latest news for licensed and certified agencies: Home Health Prospective Payment System (HH PPS) Rate Update for 2019 If you are a home health agency billing Medicare Administrative Contractors (MACs), please be advised that CMS has completed its annual update to the Prospective Payment System rates and case-mix weights for home health services for calendar year 2019. Rates for services to Medicare beneficiaries in rural areas will be increased, as well. Please refer ...
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Each month the Home Health Quality Improvement National Campaign (HHQI) recognizes an agency that is active in the HHQI National Campaign and is closest to the national, risk-adjusted ACH 20th percentile and/or the national, risk-adjusted Oral Medication Improvement 80th percentile (or better).    This month, HHQI recognizes Paradigm HomeCare of Tyler, Texas for their dedication to improving home health quality.  Congratulations Paradigm for your dedication to quality
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Dear Members, The U.S. Department of Labor's Houston District Office will be hosting an educational event on the Payroll Audit Independent Determination (PAID) program on December 6, 2018 from 10:00 am to 12:00 pm at Houston Community College, 5601 West Loop South Houston, TX 77081.   The event is free to the general public, but registration is required as space is limited. The PAID program expedites resolution of inadvertent minimum wage and overtime violations under the Fair Labor Standards Act, and provides a framework for employers to proactively resolve those violations without litigation.  A high ranking DOL official and a representative from the ...
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Dear Members,  In preparation for the implementation of the 21st Century Cures Act and the restructuring of the current Electronic Visit Verification (EVV) program , HHSC has asked for provider participation in an online survey to gauge interest in the possibility of using a proprietary EVV system in the future. This survey is being administered by HHSC and the Texas Medicaid and Healthcare Partnership (TMHP), and will be available online until 5:00 p.m. (Central time) on November 21, 2018. For questions regarding the survey or the EVV program, please contact HHSC EVV Operations .
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Dear Members, HHSC has issued a notice for users transitioning from the MEDsys Electronic Visit Verification (EVV) system to DataLogic Vesta that access to MEDsys data will become read-only effective December 17, 2018.  Read-only access will include the following HHS EVV Standard Reports, available as a CSV or PDF: EVV Visit Log Units of Service Summary Attendant or Nurse Providing Services Provider Agency/FMSA List Contract List EVV Compliance Plan Summary EVV Compliance Plan Daily EVV Compliance Snapshot Report Reason Code Free Text Reason Code Use Unsent EVV Visit Report Please note: The following HHSC EVV Standard reports ...
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Dear Members,  ​ HHSC has issued a reminder  to Community Attendant Services (CAS) and Primary Home Care (PHC) providers to maintain all required documents in individual files. Providers must ensure: The practitioner’s statement and the initial service delivery plan are in the individual’s file if the provider completed the pre-initiation activity. Any documentation of changes is in the subsequent service delivery plan. Individual file requirements in Title 40 Texas Administrative Code, Chapter 47, Contracting to Provide Primary Home Care are described below: TAC  §47.45  identifies pre-initiation activities as: conducting an evaluation, ...
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​Dear Members,  HHSC has published an  Electronic Visit Verification (EVV) Provider Policy Handbook as an online resource for providers using the EVV system.   EVV is a computer-based system used to electronically verify the occurrence of authorized personal attendant service visits by documenting the precise time a service delivery visit begins and ends. For questions about the EVV program and/or the Provider Policy Handbook, please email HHSC at: Electronic_Visit_Verification@hhsc.state.tx.us . 
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Dear Members, TAHC&H has recently learned that the state will no longer accept paper application forms for initial, renewal, or licensure changes. These activities must now be submitted to HHSC/DADS via the TULIP system for all provider types regulated by long-term care regulatory services, including Home and Community Support Services Agencies (HCSSAs). TULIP is an electronic system designed to increase the efficiency of the licensure process by: Making all licensure applications electronic, including those for initial licenses, renewals and changes of ownership Accepting electronic payments Providing immediate access to the status of licensure ...
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