Recent News

Medicaid/CHIP – Important Reminder – Medicaid Continuous Enrollment Flexibility Ends on March 31, 2023

By Jennifer Elder posted 28 days ago
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Members,   As a reminder,  the Medicaid Continuous Enrollment flexibility is ending on March 31, 2023 .  Some beneficiaries may need to submit a new application, and some will only have to complete a renewal packet. Beneficiaries will receive a notice or a request for information from HHSC that may include completing an application or renewal form, or a request to provide additional verification. It's important to help patients watch for these notices and educate on actions that need to be taken  to prevent loss of coverage and/or significant gaps in coverage  after March 31, 2023.  These notices are mailed in a yellow envelope that says Action ...
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CMS - Expanded HHVBP On-Demand Video “First Performance Year Quick Guide” Available Now

By Jennifer Elder posted Jan 18,2023
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Members, The CMS HHVBP Technical Assistance team has created an on-demand video to assist home health providers with a review of what to expect in the first performance year of the expanded HHVBP Model.  The video,  "First Performance Year Quick Guide",  is now available on the   Expanded HHVBP Model webpage   under Quality Improvement .    Please see the full notice from CMS below.   First Performance Year Quick Guide To provide home health agencies (HHAs) with a review of what to expect in the first performance year of the expanded ...
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Palmetto/CMS - January 2023 Common Working File Dark Days

By Jennifer Elder posted Dec 07,2022
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Members, For the upcoming January 2023 Release, the Common Working File (CWF) will be observing Dark Days starting Friday, December 30, 2022, through Sunday, January 1, 2023.  Monday, January 2, 2023, is the observed New Year’s Day holiday with no cycles running in production.  The Dark Days are needed to ensure the completion of weekly, monthly and quarterly processing and the installation of the January 2022 release.  The Dark Days will not affect your ability to access beneficiary eligibility, claim status or other information through Palmetto GBA’s eServices portal. During this time, claims will not be sent to CWF. During the Dark Days, the Interactive ...
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CMS - NOW AVAILABLE – Final OASIS-E Instrument and OASIS-E Changes from Draft to Final Instrument & Manual

By Jennifer Elder posted Dec 07,2022
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Members, CMS has released the final OASIS-E instrument, effective January 1, 2023. The instrument is available in the  Downloads  section on the   OASIS Data Sets   page. A log of changes from the draft to final instrument is available   HERE ,  and the final User Manual is available in the  Downloads  section on the   OASIS Users Manuals   page.
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HHSC - OASIS-E Training for Clinicians Slated for December

By Jennifer Elder posted Dec 07,2022
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Members, Please see the below notice from HHSC regarding upcoming scheduled OASIS-E training for clinicians.  Please make sure you register yourself and applicable staff members for the training to ensure you are prepared for the upcoming transition effective January 1, 2023. OASIS-E TRAINING FOR CLINICIANS SLATED FOR DECEMBER This training is for registered nurses, physical, occupational and speech therapists who collect OASIS data. This three-part webinar series provides foundational guidance on transition to the OASIS-E data set and will cover the new OASIS-E Items ...
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HHSC - The Star Kids Handbook has been revised effective December 1, 2022

By Jennifer Elder posted Dec 07,2022
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Members, Please see the revised Star Kids Handbook in the notice below.  The revisions are effective December 1, 2022. THE STAR KIDS HANDBOOK (SKH) HAS BEEN REVISED. The Star Kids Handbook revision updates Sections 1000, 2000, 3000, 4000, 5000, 6000, 7000 and Appendix III. This revision is effective Dec. 1, 2022.  Click the link to see the updates .
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DBMD/HCS/TxHmL - HHSC Publishes Payment Rates for Individualized Skills and Socialization Services Effective Jan. 1, 2023

By Jennifer Elder posted Dec 07,2022
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Members, Please see the below notice published by HHSC regarding the payment rates for Individualized Skills and Socialization Services.  These rates will be effective January 1, 2023.  See the full notice below and share the information with applicable staff. HHSC PUBLISHES PAYMENT RATES FOR INDIVIDUALIZED SKILLS AND SOCIALIZATION SERVICES EFFECTIVE JAN. 1, 2023 The Texas Health and Human Services Commission (HHSC) has approved payment rates for Individualized Skills and Socialization in the Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services ...
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HHSC – HCS and TxHmL Providers – Reminder of Overpayment of Services

By Jennifer Elder posted Nov 17,2022
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Members, As a reminder, effective January 2, 2023, TMHP will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims. On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount. Read the full alert HERE . HCS refers to Home and Community Based Services Program (HCS) , not Home and Community Support Services Agencies (HCSSA) .  If you do ...
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CMS - NOW AVAILABLE IN QIES - Preview Reports for the February 2023 Refresh

By Jennifer Elder posted Nov 09,2022
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Members, Please see the below notice released this morning by CMS.  The notices advises providers that the CASPER Preview Reports for the February 2023 refresh are now available.  Please review the notice for additional details and share the information with applicable staff.   NOW AVAILABLE IN QIES - Preview Reports for the February 2023 Refresh Providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. Once released in CASPER, providers will have 30 ...
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CDC - Revised COVID-19 Healthcare Personnel Guidance

By Jennifer Elder posted Oct 05,2022
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Members, The CDC has issued revised guidance related to COVID-19 and Healthcare Personnel.  Please see below for summary of changes. 1. The   Infection Control Guidance for Healthcare Personnel   now eliminates the consideration of vaccination status of health care workers when determining next steps in the event of new symptoms or exposure, (ex: screening, quarantine, or additional precautions needed). The CDC no longer recommends masking and/or other source control for employees who are seeing patients in  low risk  COVID-19 areas, saying "When SARS-CoV-2   Community Transmission   levels are  not  high, healthcare facilities ...
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CMS - Expanded Home Health VBP Model Newsletter – September 2022

By Jennifer Elder posted Oct 05,2022
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Members, Please see the below HHVBP Newsletter published by CMS this morning.  The newsletter provides the latest information related to the nationwide expansion Home Health Value Based Purchasing, which will be implemented nationwide January 1, 2023.  Our   Fall Conference   will provide detailed education on HHVBP, including  changes you need to make  to successfully implement the Value Based Purchasing Model,  how to navigate  the model's complexity and  understand financial impacts , and a speaker who will share  real life experiences and data on how the initial nine states faired during the original implementation in 2016 .  Please make sure you ...
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HHSC - Medicaid Hospice Provider Webinar Slated for Aug. 17

By Jennifer Elder posted Aug 10,2022
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Members, Please see the following notice just released by HHSC.  The notice is for Medicaid Hospice providers and details an upcoming webinar on August 17 th  to review the new rules in TAC Chapter 266.  The link to register for the webinar is in the notice below. MEDICAID HOSPICE PROVIDER WEBINAR SLATED FOR AUG. 17 HHSC will host an informational webinar on Aug. 17 for hospice providers to review the newly implemented Medicaid Hospice Program rules found in Texas Administrative Code Title 26, Chapter 266, effective July 26. Wednesday, Aug. 17 1–2:30 p.m. Register ...
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HHSC has Published Fiscal Year 2022 Cutoff Date for Year-end Closeout Processing

By Jennifer Elder posted Aug 10,2022
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Members, Please see the below notice just released by HHSC.  The notice directs providers to IL 2022-43, which details important claims processing cutoff dates for Fiscal Year 2022. Please see the entire notice and link to the information letter below.   HHSC HAS PUBLISHED FISCAL YEAR 2022 CUTOFF DATE FOR YEAR-END CLOSEOUT PROCESSING IL 2022-43  is posted on the Adult Foster Care Providers, Assisted Living Facilities, Community Attendant Services Providers, Community Living Assistance and Support Services Providers, Consumer Managed Personal Attendant Services Providers, ...
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House Bill 4 Telecommunications Comments and Responses Available for Comment

By Jennifer Elder posted Aug 10,2022
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Members, Please see the below notice just released from HHSC.  The notice shares public comments and HHSC responses to those comments related to the HB 4 draft policies, which were previously posted for public comment. HB 4 (87th Legislative Session, 2021) allows covered services through telemedicine, telehealth and audio-only delivery if clinically appropriate and cost effective. Please see the entire notice below. HOUSE BILL 4 TELECOMMUNICATIONS COMMENTS AND RESPONSES AVAILABLE FOR COMMENT In alignment with   HB 4 (87th Legislative Session, 2021), HHSC has developed ...
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Happy National Nurse's Month from TAHC&H

By Helen Carrillo posted May 06,2022
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National Nurses Week begins each year on Nurses Day, May 6 th   and ends on May 12th, Florence Nightingale's birthday. This year the American Nurses Association (ANA) is recognizing May as Nurses Month. During National Nurses Week, we honor and celebrate the extraordinary men and women who have devoted themselves to ensuring Texans receive care in their homes. Nurses have been challenged in the past few years in the delivery of care to our patients and have shone brightly once again.  The contributions our nurses have made to the health and wellbeing of our most vulnerable Texans has been exponentially magnified. ANA is recognizing a  month-long celebration ...
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The Connection between PDGM Value-Based Therapy Management and Agency Success

By Helen Carrillo posted Mar 29,2022
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The installation of PDGM in 2020 rewired the Home Health care production and delivery model under the Impact Act's Volume to Value (V2V) reforms. The V2V specifics of the HH reforms address traditional areas of the previous PPS Model that failed to produce increased outcomes. OASIS accuracy, splitting the 60-day certification period, and reduced payments for Community-based referrals were all included in the Patient-Driven Groupings Model. But the changes to HH Rehab services were the most impactful, as Providers found that the value of the patient episodes were no longer defined by the number of rehab visits on the case. Prior to PDGM's installation, most ...
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HHSC - Emergency Rule vs. CDC Guidance Clarification

By Jennifer Elder posted Jan 14,2022
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Members, Yesterday, January 11, 2022, TAHCH met with HHSC regarding HCSSA staffing shortages and the contradictions and inconsistencies between the revised CDC guidance for   Managing HCP   and   Mitigating Staffing Shortages , and the   HHSC emergency rule   and   HHSC provider FAQ's .  We pointed out the growing need for HCSSA agencies to implement contingency (when a shortage is anticipated) or crisis (when a shortage is occurring) level staffing shortage plans and how providers are conflicted about whether to follow the CDC guidance or risk being non-compliant with the HHSC emergency rule due to the 14 day contact screening criteria and no allowance ...
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HHSC - TMHP COVID-19 Guidance for New and Initial Medicaid Prior Authorizations

By Jennifer Elder posted Aug 27,2021
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To help ensure continuity of care during the COVID-19 response, HHSC has directed TMHP to move forward with processing new and initial prior authorization requests, including recertification requests, by relaxing document submission timeframes for providers if they are unable to provide certain required documentation during the COVID-19 emergency. This direction will remain in effect through September 30, 2021. HHSC will provide more information if there are changes. This guidance applies to all state plan services, including: Acute care services Long-term services and supports Personal assistance services Personal care services ...
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TMHP - Prior Authorization Forms Are Being Updated Effective September 1, 2021

By Jennifer Elder posted Aug 27,2021
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Members, Please see the following information from TMHP regarding Prior Authorization Forms Updates .  You can access the notice from the TMHP website HERE . "Prior Authorization Forms Are Being Updated Effective September 1, 2021 Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Effective ...
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OSHA ETS – Medical Removal and MRP Benefits Update – August 25, 2021

By Jennifer Elder posted Aug 27,2021
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We understand that there is a great deal of confusion related to the OSHA ETS medical removal and MRP benefits.  We are aggressively advocating for clarification and that additional employee requirements be added to the ETS to protect home care providers against those employees that choose to act fraudulently.  For now, in an effort to reduce confusion regarding the medical removal and MRP benefit requirements of the OSHA ETS, we have put together the below information: An employer is required to remove an employee from the workplace when the employer knows that the employee: Is COVID-19 positive, meaning that the employee was confirmed positive ...
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