HCS Billing Guideline Revisions, Aug. 29, 2011
Department of Aging
and Disability Services
Billing and Payment
Misti J. Ackermann
Billing and Payment Review Process
Types of Reviews
- Routine
- Special
- On-Site
- Desk
On-Site Reviews
- Can be special or
routine
- Routine occurs every 2
years
- Special are conducted
after a referral or billing
anomaly
Desk Reviews
- Can be special or
routine
- Routine occurs every 2
years
- Special are conducted
after a referral or billing
anomaly
HCS Billing Guideline Revision An Overview of Major Changes
2011 Billing Guidelines
Guidelines: http://www.dads.state.tx.us/handbooks/hcsbg/index.htm
Guideline Changes: http://www.dads.state.tx.us/handbooks/hcsbg/rmemo/11-1.htm
Changes to Billing Guidelines
Section 2000 - Definition Changes
- Competitive Employment: Employment that pays an individual
at or above the greater of
(A) the applicable minimum wage; or
(B) the prevailing wage paid to individuals without disabilities performing the
same or similar work.
- Comprehensive Assessment: An extensive evaluation of an
individual's health status that:
(A) addresses anticipated changes in the conditions of the individual as well as emergent changes in the individual's health status;
(B) recognizes changes to previous conditions of the individual;
(C) synthesizes the biological, psychological, spiritual and social aspects of
the individual's condition;
(D) collects information regarding the individual's health status;
(E) analyzes information collected about the individual's health status to make
nursing diagnoses and independent decisions regarding nursing services
provided to the individual;
(F) plans nursing interventions and evaluates the need for different
interventions; and
(G) determines the need to communicate and consult with other service
providers or other persons who provide supports to the individual.
- Focused Assessment: An appraisal of an individual's current
health status that
(A) contributes to a comprehensive assessment conducted by a registered
nurse,
(B) collects information regarding the individual's health status, and
(C) determines the appropriate health care professionals or other persons who
need the information and when the information should be provided.
- Integrated Employment: Employment at a work site at which an individual routinely interacts with people without disabilities other
than the individual's work site supervisor or service providers.
Section 3000
- Clarification of Relative, Guardian or
Managing Conservator requirements
- Division of Time Between Individuals
- Service Coordination & Day Habilitation
- Written Documentation for non-nursing
services (See Next Slide)
Section 3800 - Written Service Log
A written service log must:
- be written after the service is provided;
- for service components or subcomponents with a 15-minute unit of
service, as listed in Item 3510, 15-Minute Unit of Service:
- include:
- a description or list of activities performed by the service
provider and the individual that evidences the performance of
one or more of the billable activities described in Section 4000
for the particular service component or subcomponent being
claimed; and
- a brief description of the location of the service event, as
described in Item 3610 (see No. 1), such as the address or
name of business; and
- be supported by information that justifies the length of the service event,
as described in Item 3610, 15-minute Unit of Service (see No. 1), such
as an explanation in the written service log or implementation plan of
why a billable activity took more time than typically required to complete;
- for service components or subcomponents with a daily unit of service, as
listed in Item 3520, Daily Unit of Service, include:
- a description or list of activities performed by the service provider
and the individual that evidences the performance of the billable
activities described in Section 4000 for the particular service
component or subcomponent being claimed; or
- for foster/companion care, residential support and supervised living,
if the individual was not available to receive services, an explanation
for the unavailability; be made within reasonable time after the
activity being documented is provided; and
- include the signature and title of the service provider making the written
service log.
Section 3800 - Written Summary Log
A written summary log must:
- be written after services have been provided;
- include information that identifies the individual for whom the
written summary log is made;
- include a general description or list of activities performed
during the calendar week in which the service component or
subcomponent was provided;
- be made within a reasonable time after the week being
documented; and
- include the signature and title of the service provider making the
written summary log.
Unusual Incidents or Progress Toward Objectives (Written Service& Summary Logs)
The description of the activities in a written service log or written summary
log must include a description of any unusual incident that occurs such as a
seizure, illness or behavioral outburst, and any action taken by the service provider in response to the incident.
Section 4000
- Specialized Therapies
- Definitions
- Video Conference
- Day Habilitation
- In-Home Exception
- Time Change
- Supported Employment Dual Billing Removal
- Nursing (See Next Slides)
- Residential Services (See Next Slides)
- Respite
- Supported Employment
Section 4400 - Nursing Services
- Registered Nursing
- Focused & Comprehensive Assessments
- Medication Review
- Insurance Provider Communication
- Supervising LVN (RN can only bill)
- Licensed Vocational Nursing
- Focused Assessments
- Medication Review
- Insurance Provider Communication
Section 4500 - Residential Services
- Foster Care & Supervised Living
- Residential Support Services
- Service Provider Shifts
- Off Duty Requirement
- No Shifts of More than 24 Hours
- Supported Home Living
- Safety & Supervision
- No Volunteer Hour Limit
Section 6000
- Adaptive Aids
- Prior Approval Removal
- Authorization for Payment Requirements
- Minor Home Modifications
- Prior Approval Removal
- Authorization for Payment Requirements
Other Changes
- Guideline Format
- Billing and Payment Review Process
- Form Updates
- 2122 Service Delivery Log with Written Narrative/Written Summary
- 2123 Adaptive Aid/Minor Home Modification Request for Prior Approval
- 2124 Community Support Transportation Log
- 4116-Dental Dental Summary Sheet
- 4116-MHM-A Minor Home Modification/Adaptive Aids Summary Sheet
- 4117 HCS Supported Employment Service Delivery Log
- 4118 HCS Respite Service Delivery Log
- 4119 HCS Residential Support Services (RSS) and Supervised Living
(SL)
- 4120 HCS Day Habilitation (DH)
- 4121 HCS Supported Home Living
Recent Questions Regarding Changes:
When can we start using the checklists?
These are effective 9/1/11. You may begin using them
at that time.
Will the CDSAs be made aware of the new
forms and requirements?
Yes.
Will the CDS individuals be able to utilize these
checklists for documentation? Will CDSA's be
held accountable for these guidelines?
Yes. The CDS individuals may utilize checklists, as
well. All rules and requirements for the HCS program
must be followed regardless of the enrollment in the
CDS option.
DADS Contacts
| Name |
Phone Number |
E-Mail Address |
| Misti J. Ackermann, Manager |
(512) 438-4934 |
Misti.ackermann@dads.state.tx.us |
| Vivian Griffor, Team Leader |
(512) 438-3593 |
Vivian.griffor@dads.state.tx.us |
| Willie Mae Jones, Team Leader |
(512) 438-3607 |
Willie.jones.2@dads.state.tx.us |
| D. Sam Montgomery, Team Leader |
(512) 438-3577 |
David.montgomery@dads.state.tx.us |
| Virginia (Vicki) Sifuentes, Team Leader |
(512) 438-4974 |
Virginla.sifuentes@dads.state.tx.us |
| Julia Solis, Team Leader |
(512) 438-4679 |
JuIla.solis@dads.state.tx.us |
| Nathan Berridge, Team Leader |
(512) 438-5120 |
Nathan.berridge@dads.state.tx.us |
| Karri Henager, Program Specialist |
(512) 438-5949 |
Karri.henager@dads.state.tx.us |
| Jeff Rehagen, Program Specialist |
(512) 438-4966 |
Jeffrey.rehagen@dads.state.tx.us |
| Stephanie Santos-Vela, Program Specialist |
(512) 438-3573 |
Stephanie.santos-vela@dads.state.tx.us |
| Nikolaos Vekris, Program Specialist |
(512) 438-5706 |
Nikolaos.vekris@dads.state.tx.us |
| Billing and Payment Hotline |
(512) 438-5359 |
HCS.TxHmL.bpr@dads.state.tx.us |
| Fax |
(512) 438-2695 |
|
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Updated:
May 3, 2013
