Recent News

Medicare: Latest Strike Force Enforcement Actions

By Marissa Machado posted 17 days ago
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Dear Members, Below are their most recent cases. Just want to bring these to your attention for knowledge and learning purposes:  The Medicare Fraud Strike Force Teams harness data analytics and the combined resources of Federal, State, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse. First established in March 2007, Strike Force teams currently operate in the following areas: Miami, Florida; Los Angeles, California; Detroit, Michigan; Houston, Texas ; Brooklyn, New York; Baton Rouge and New Orleans, Louisiana; Tampa and Orlando, Florida; Chicago, Illinois; Dallas, Texas; Washington, D.C.; Newark, New Jersey/Philadelphia, ...
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Health Advisory: CDC reminds clinicians to have a high suspicion for influenza & provides recommendation for rapid antiviral treatment of high-risk patients

By Marissa Machado posted 19 days ago
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On March 28th, the Centers for Disease Control and Prevention (CDC) issued a * health advisory to notify clinicians that influenza activity remains high in the United States, with an increasing proportion of activity due to influenza A(H3N2) viruses, continued circulation of influenza A(H1N1) viruses, and low levels of influenza B viruses. The Health Alert Network (HAN) advisory states that influenza should be considered as a possible diagnosis for patients with respiratory illness while local influenza activity remains elevated and widespread, and the season is likely to last several more weeks (see CDC FluView report for details:  https://www.cdc.gov/flu/weekly/index.htm ...
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Gavel to Gavel

By Helen Carrillo posted 26 days ago
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(March 22, 2019) This past Wednesday, the Senate unanimously passed a package of bills which would provide $1.8 billion in Hurricane Harvey relief and flood prevention funding. SB 6 , SB 7 , & SB 8 – all top priorities of Lieutenant Governor Patrick – will together create a disaster response plan for local officials, a statewide flood plan, and a flood project ‘resiliency fund.’ The bills now head for consideration in the House, where a 2018-2019 supplemental spending bill, which includes Hurricane Harvey spending, is set on the calendar for next Wednesday.   Meanwhile in the House, the House Appropriations Committee approved HB 1 , a budget including ...
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TAHC&H Testifies in Support of Home Telemonitoring

By Helen Carrillo posted Mar 20,2019
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On Tuesday, March 19 th , TAHC&H director of Government Relations and Regulatory Affairs, Sarah Mills testified in support of HB 1063, by Representative Four Price.  Additionally, on Wednesday, March 20 th , we will also testify on a similar bill in the House Public Health committee, HB 1738, by Representative Ryan Guillen.  Background In 2011 the Texas Legislature passed SB 293 (Watson, Davis) relating to telemedicine medical services, telehealth services, and home telemonitoring services provided to certain Medicaid recipients.  The bill authorized the Texas Health and Human Services Commission (HHSC) to establish a statewide program ...
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ACHC Accreditation workshops coming to Texas

By Becky Campbell posted Mar 07,2019
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Accreditation Commission for Health Care, Inc. (ACHC) is hosting a hospice and home health accreditation workshop in Dallas on April 9 – 10 th ! Specifically created for organizations seeking accreditation for the first time or those experienced in the accreditation process, this workshop provides an in-depth look at pre-survey preparation, key steps to having a successful on-site survey, and how to complete important post-survey components. Each attendee will receive the  ACHC Accreditation Guide to Success  workbook along with a copy of the ACHC Home Health Accreditation Standards for FREE, which will be used as the primary learning instruments during ...
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The Good. The Bad. The Internet.

By Becky Campbell posted Mar 06,2019
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I was doing member touch base calls this morning and got a surprise when one of our dearest members was questioning the reason for a non-response.  Apparently they submitted an inquiry to Regulatory from the TAHC&H website that wasn’t answered. After a bit of digging we discovered that the email address used to send regulatory questions posed by members was no longer accepting emails from our website. Just a note to let y’all know it is fixed – click here to access the online form… or you can use the old-fashioned method and give us a call! Take care - Beck
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MEDICARE: Informative Article on Enhanced Oversight of New HHAs by CMS

By Heather Kennedy posted Feb 27,2019
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Dear Members,  Please enjoy this article by Elizabeth E. Hogue, Esq. describing the enhanced oversight of new Medicare home health providers by CMS. *********************************** CMS Announces Enhanced Oversight of New Providers The Centers for Medicare and Medicaid (CMS) issued MLN Matters Number SE19005 on February 15, 2019, which says that new home health agencies (HHAs) will be placed into provisional periods of enhanced oversight effective immediately, including non-payment or suppression of Requests for Advance Payment (RAPs). In the MLN Matters article, CMS first points out the Affordable Care Act (ACA) provides statutory authority ...
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Understanding Patient Expectations for Home Health and Virtual Care

By Becky Campbell posted Feb 22,2019
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Patient Preferences Generally, patients prefer home health care options as they would prefer to recover at home instead of in a hospital bed or busy healthcare setting as the home setting is more comfortable for one’s well-being and convenient for being able to return to one’s day-to-day schedule.  Leveraging patients’ preferences for the care setting is beneficial.  The Alliance for Home Health Quality and Innovation (AHHQI) contends that patients who are receiving care in their preferred location are more likely to adhere to care management plans, improving their overall health while preventing avoidable readmissions and costs. Patient expectations in ...
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Gavel to Gavel

By Helen Carrillo posted Feb 18,2019
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(Feb 15, 2019) This week, the Texas Legislature began considering two major bills relating to Governor Abbott’s emergency items: Senate Bill 10 and Senate Bill 2. On Tuesday, February 12, the Senate Health and Human Services Committee considered Senate Bill 10, which creates the Texas Mental Health Care Consortium. Once created, the Mental Health Care Consortium will leverage the expertise of health-related institutions to bolster mental health options for Texas children and adolescents. The Committee discussed issues relating to the reliance on medicine as a primary treatment of mental illness and the stigma surrounding the connection between mental health patients ...
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MEDICAID: MDCP Medical Necessity Denial Attachment added to STAR Kids Handbook

By Heather Kennedy posted Feb 11,2019
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Dear Members,  Please note that HHSC has added an appendix to the STAR Kids Program Support Unit Operational Procedures Handbook for the denial of medical necessity in the Medically Dependent Children's Program (MDCP). Appendix XXVII explains the eligibility requirements for MDCP and describes the client's right to an appeal process; this update makes this information available to clients in both English and Spanish. STAR Kids was implemented statewide in November 2016 to serve Medicaid clients with disabilities aged 20 and younger as a result of   S.B. 7, 83rd Legislature, Regular Session 2013 , which directed HHSC to implement cost-savings measures ...
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Gavel to Gavel

By Helen Carrillo posted Feb 11,2019
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(Feb. 08, 2019) - Governor Gregg Abbott’s State of the State address this week celebrated Texas tenacity and encouraged the Legislature to continue their efforts to “… fulfill the promise of Texas”. In his address, Governor Abbott declared several emergency items for the 86th legislative session including: school finance reform, property tax reform, school safety reform, mental health funding and Hurricane Harvey relief. As emergency items, these issues are no longer limited by the Texas Constitution’s prohibition of passing legislation in the first sixty days of session. The Governor’s speech also highlighted funding for anti-human-trafficking and anti-gang ...
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MEDICAID: EVV News; MEDsys Visit Maintenance, Recoupment Policy Guidance

By Heather Kennedy posted Feb 09,2019
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Dear Members,  This week, HHSC announced that providers may request visit maintenance be opened on historical MEDsys data in order to make corrections beginning February 11, 2019 . Providers will not be able to create new MEDsys visits as a result of the transition to DataLogic for EVV. HHSC has set the following rules and deadlines for these changes: Providers have 60 business days from Feb. 11 to request visit maintenance be unlocked from the appropriate payer. DataLogic has 60 business days from the received approval date from the payer to open visit maintenance to make the approved changes and export the changes to the payer. Managed Care ...
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MEDICAID: HHS Discontinues Handbooks, Refers to SOS

By Heather Kennedy posted Feb 06,2019
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Dear Members,  This week, HHSC announced via Provider Letter PL 19-02  that they will no longer maintain handbooks with Rules in them, referring instead to the Secretary of State (SOS) website where the online version of the Texas Administrative Code may be found. Downloadable, searchable copies of the Rules may be requested from the SOS, as described in the provider letter; HHSC will no longer provide this service. PL 19-02 states that HHSC will no longer maintain handbooks containing these Rules: Day Activity and Health Services Requirements, 40 TAC Chapter 98 Denial or Refusal of License, 26 TAC Chapter 560 Employee Misconduct Registry ...
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RCTCLearn.Net to host Coordinator Training

By Becky Campbell posted Feb 04,2019
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Wednesday, February 13 th , 2019 at 11:00 a.m. CST (12:00 p.m. EST, 10:00 a.m. MST, 9:00 a.m. PST) RCTCLEARN.NET will again be hosting webinars for agencies or training coordinators new to o the program or/and new to the My CEU tool for tracking course completions.  The webinars provide an excellent opportunity to learn about the new features on the system as well as discuss ideas on how to introduce or re-introduce the programs.   While designed for new users, they may also be beneficial for existing agencies and training coordinators as well.  Webinars typically last around 15 minutes or a little longer depending on user questions. Click here to ...
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Gavel to Gavel

By Helen Carrillo posted Feb 04,2019
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This week in Texas politics was highlighted by Governor Greg Abbott, Lieutenant Governor Dan Patrick, and Speaker of the House Dennis Bonnen’s unveiling of a united proposal to curb property tax growth on Thursday. The proposal, which has been introduced in both the House and the Senate, caps the annual growth of local property taxes from 8% to 2.5%. Under the new legislation, if local government entities – such as counties, cities, and school districts – wish to exceed the cap, they must first get voter approval through what’s called a rollback election. With property taxes high on the agenda, this legislation is expected to be center stage for this legislative ...
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MEDICARE: New Enrollment Application Reduces Administrative Burden

By Heather Kennedy posted Feb 01,2019
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Dear Members,  CMS has announced that they received approval for a new Medicare Enrollment Application in December 2018, the CMS-855I . CMS believes this new version of the application will simplify the process for providers by offering the following changes: Expanding instructions for individual and group affiliations to simplify reporting;  Making it optional to list a contact person; Adding electronic storage information for those who no longer keep paper records; and Creating a more logical data flow. This application is available for use effective immediately. Thank you!
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MEDICAID: State Medicaid Managed Care Advisory Committee Meeting Feb 25

By Heather Kennedy posted Feb 01,2019
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Dear Members,   The   State Medicaid Managed Care Advisory Committee   will meet on Monday, February 25, 2019, 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. Austin ,   TX  ...
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MEDICAID: EVV Tool Kit Module 2 Now Available from HHSC

By Heather Kennedy posted Feb 01,2019
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Dear Members,  HHSC has posted Module 2 of its Electronic Visit Verification (EVV) Tool Kit for use by contracted providers, Consumer Directed Services (CDS) employers, and Financial Management Services Agencies (FMSAs) who will be transitioning into the EVV program as part of the Commission's implementation of the 21st Century Cures Act . This module will be presented in two parts; part one covers the roles and responsibilities of participants in the EVV program. HHSC's EVV Operations team provides Tool Kit updates on the 1st and 22nd of each month.  Please mark your calendars for their live webinar on Friday, February 22, 2019, from 1:00 pm to 3:00 pm ...
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Employers: You May Be Required to Post OSHA's Summary of Work-Related Injuries and Illnesses

By Heather Kennedy posted Jan 28,2019
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Dear Members, Please be advised that, as employers, you may be required by the Occupational Safety and Health Administration (OSHA) to post a summary of work-related illnesses and injuries in a location viewable by the public for calendar year 2018 from February 1, 2019 until April 30, 2019. Home health care services (NAICS code 6216) are on the list of industries who must report work-related illnesses and injuries to OSHA, and post a summary of these via the 300A (Summary of Work-Related Injuries and Illnesses), unless they meet the requirement for an exemption based on small size (10 or fewer employees in the entire company).  Members are encourage ...
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MEDICAID: Discussion from the STAR Kids Stakeholder Workgroup Meeting January 22, 2019

By Heather Kennedy posted Jan 28,2019
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Dear Members, On January 22, TAHC&H staff attended the quarterly meeting of the HHSC STAR Kids Stakeholder Workgroup. The group discussed many of the same issues raised during the STAR Kids Managed Care Advisory Committee meeting earlier this month, including: HHSC’s Pay for Quality Initiative Preferred Provider Agreements Access to Care, Therapy Waiting Lists HHSC’s Pay for Quality Initiative HHSC’s Denbigh Shelton presented the Commission’s proposed Pay for Quality Program measures for the STAR Kids program, explaining that 3% of the MCO’s capitation will be at risk for recoupment if these requirements are not met. One workgroup ...
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