Recent News

TMHP - Updates to PEMS Effective November 22, 2024

By Jennifer Elder posted Dec 13,2024
Members, TMHP released THIS NOTICE late Friday. The notice details changes that have been implemented in the PEMS system to assist providers, most specifically surrounding NPI and Taxonomy information. These changes were effective November 22, 2024, and include: PEMS National Provider Identifier (NPI/Taxonomy Information Page) Updates The NPI Taxonomy Information page STATUS field will be renamed "NPPES Status" to align with the source of the NPI Taxonomy Information provided by the National Plan and Provider Enumeration System (NPPES). The information that is displayed on this page reflects the provider's NPI status in the NPPES NPI Registry ...

IMPORTANT!! Great News!! TMHP Extends Revalidation Due Dates and Plans Retroactive Enrollment Period Effective Dates

By Jennifer Elder posted Dec 13,2024
Members, Late Friday, TMHP released THIS NOTICE which details their planned actions to assist providers who have been negatively impacted by the revalidation process. Effective December 13, 2024, providers will receive an additional 180 calendar days to complete revalidations PEMS . TMHP and HHSC are also developing a process to address enrollment gaps for providers that have been disenrolled for failing to revalidate timely. These flexibilities are currently planned to last through May 31, 2025. Per the notice, PEMS will automatically add 180 calendar days to the revalidation due date. This will be reflected in the Revalidation Due Dates found ...

OIG issues Special Fraud Warning re: Marketing Practices involving Medicare Advantage

By Jennifer Elder posted Dec 13,2024
Members, The OIG has issued a Special Fraud Alert warning about marketing schemes involving the Medicare Advantage program. This has been a concerning issue for many of you, especially during Open Enrollment. Per the report, the OIG has identified marketing practices involving questionable payments and referrals between Medicare Advantage plans, health care professionals (HCP's), and third-party marketers such as agents and brokers and have determined that these practices are misleading to some Medicare enrollees in regard to choosing specific health plans or health care providers that may not meet the enrollees' needs. The report also ...

CMS - New NOMNC/DENC Forms Required January 1, 2025

By Jennifer Elder posted Dec 13,2024
Members, The OMB has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123), and the Detailed Explanation of Non-Coverage (DENC, CMS-10124). The renewed notices contain updates which are applicable only to Medicare Advantage enrollees; see new notices HERE . You will use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025. Please let us know if you have any questions. Jennifer Elder

HHSC: EVV Claims Matching Bypass from Jan. 1 to March 31

By Jessica Boston posted Jan 30,2024
Members: As you may recall, TAHC&H met with HHSC Commissioner Young, Representative Richard Raymond, and their dedicated teams to address pressing issues surrounding Electronic Visit Verification (EVV) for providers and vendors. In that meeting, TAHC&H recommended that HHSC work with CMS to continue to allow providers to pass claims through the system, giving them visit error data on the back end. Please see below for an update from HHSC that authorizes EVV claims matching bypass from Jan. 1 to March 31, 2024. Please don't hesitate to let us know if you have any questions. ...

NATIONAL CIVILITY MONTH

By Jenn Merket posted Sep 07,2023
Below is an important contribution from the DEI Committee. AUGUST WAS NATIONAL CIVILITY MONTH People being civil to others makes the world a whole lot better and is the key focus of National Civility Month. This holiday was founded to help the world remember to treat others how we wish to be treated — with kindness, empathy, and respect. While researching this holiday, my initial thought was, "why do we need this holiday; shouldn't civility be the norm?" But then I watched the news, and it was crystal clear that the world needed a reminder. The Pandemic and isolation, coupled with the loss of life, income, ...

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

By Jennifer Elder posted Feb 22,2023
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 ...

CMS - Expanded HHVBP On-Demand Video “First Performance Year Quick Guide” Available Now

By Jennifer Elder posted Jan 18,2023
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 ...

Palmetto/CMS - January 2023 Common Working File Dark Days

By Jennifer Elder posted Dec 07,2022
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 ...

CMS - NOW AVAILABLE – Final OASIS-E Instrument and OASIS-E Changes from Draft to Final Instrument & Manual

By Jennifer Elder posted Dec 07,2022
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.

HHSC - OASIS-E Training for Clinicians Slated for December

By Jennifer Elder posted Dec 07,2022
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 ...

HHSC - The Star Kids Handbook has been revised effective December 1, 2022

By Jennifer Elder posted Dec 07,2022
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 .

DBMD/HCS/TxHmL - HHSC Publishes Payment Rates for Individualized Skills and Socialization Services Effective Jan. 1, 2023

By Jennifer Elder posted Dec 07,2022
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 ...

HHSC – HCS and TxHmL Providers – Reminder of Overpayment of Services

By Jennifer Elder posted Nov 17,2022
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 ...

CMS - NOW AVAILABLE IN QIES - Preview Reports for the February 2023 Refresh

By Jennifer Elder posted Nov 09,2022
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 ...

CDC - Revised COVID-19 Healthcare Personnel Guidance

By Jennifer Elder posted Oct 05,2022
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 ...

CMS - Expanded Home Health VBP Model Newsletter – September 2022

By Jennifer Elder posted Oct 05,2022
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 ...

HHSC - Medicaid Hospice Provider Webinar Slated for Aug. 17

By Jennifer Elder posted Aug 10,2022
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 ...

HHSC has Published Fiscal Year 2022 Cutoff Date for Year-end Closeout Processing

By Jennifer Elder posted Aug 10,2022
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, ...

House Bill 4 Telecommunications Comments and Responses Available for Comment

By Jennifer Elder posted Aug 10,2022
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 ...