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DADS Provider Alerts — Texas Home Living (TxHmL)

STAR+PLUS Training in Fort Worth for Providers of Services to Individuals with Intellectual and Developmental Disabilities

Beginning September 1, 2014, certain individuals with intellectual and developmental disabilities (IDD) who are covered by Medicaid will receive their basic medical services, or acute care, through a STAR+PLUS managed care health plan.  The Texas Health and Human Services Commission (HHSC) is holding provider trainings across the state to educate providers who serve individuals with IDD on STAR+PLUS managed care and what changes to expect.

Training for providers in the Tarrant service area will be held on September 2, 2014.

Providers of Home and Community Based Services (HCS), Texas Home Living (TxHmL), Deaf-Blind with Multiple Disabilities (DBMD) and Community Living Assistance and Support Services (CLASS) as well as representatives from Intermediate Care Facilities for individuals with Intellectual Disabilities or Related Conditions (ICF-IID) are strongly encouraged to attend this training session to get the latest information on the transition to managed care for their clients.

Additional information on the training can be found at: http://www.hhsc.state.tx.us/news/meetings/2014/090214-stare-plus-iddpt-fort-worth.shtml

Tarrant service area managed care organizations will be present to answer questions.

You can learn more about the expansion of managed care here: http://www.hhsc.state.tx.us/medicaid/managed-care/mmc.shtml.

(8/22/2014)

Reminder Regarding Nurse Database for Nurses Participating in the Licensed Vocational Nurse (LVN) On-Call Pilot

This alert applies to:

  • Home and Community-Based Services;
  • Texas Home Living; and
  • Intermediate Care Facilities for Individuals with an Intellectual Disability With a Capacity of 13 or Fewer Beds

As stated in the Texas Department of Aging and Disability Services (DADS) Information Letter 14-46 and Provider Letter 14-03, DADS is updating the nurse database for participation in the LVN On-Call Pilot.  All LVNs and registered nurses who are participating in the pilot must access the database at https://www.surveymonkey.com/s/Y337KY2 to update their information. Participation in the pilot must be documented by September 8, 2014. Nurses who have not completed their entry in the database by the due date will be considered ineligible for continued participation in the pilot. To complete the database, the LVN must have access to documentation of the dates of completion of the required training.

DADS requests that all providers ensure that their nurses receive a copy of this alert and update their information in the database within the designated time frame.

For more information on the LVN On-Call Pilot Program, please visit the Nursing Services Changes website at http://www.dads.state.tx.us/providers/nschanges/index.cfm.

If you have any questions regarding the information in this alert, please contact the DADS Waiver Survey and Certification unit at 512-438-4163 or an ICF/IID policy specialist in the Regulatory Services Policy, Rules and Curriculum Development unit at 512-438-3161.

(8/20/2014)

Texas Board of Nursing (BON) Documentation Webinar

The Department of Aging and Disability Services and the BON are issuing this alert to inform all licensed vocational nurses (LVNs), registered nurses (RNs) and facility administrators who are from the following program providers and are participating in the LVN On-Call Pilot Program that they are required to view a pre-recorded webinar from the BON regarding nursing documentation.

  • Texas Home Living program providers
  • Home and Community-based Services program providers
  • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (with a capacity of 13 or fewer beds)

The purpose of this webinar is to identify the important requirements within the standards of nursing practice that, when implemented, result in complete nursing documentation. By using appropriate nursing documentation, webinar participants will be able to:

  • accurately reflect the nursing care provided; and
  • comply with BON licensure regulations.

LVNs and RNs can view the pre-recorded webinar free of charge at any time by visiting http://www.bon.texas.gov/webinar-document/.

  • To start the webinar video, place your curser on the grayed-lined rectangle in the upper-left side of the black box. The rectangle will then turn white.
  • Left click in the white rectangle and the webinar will begin to play.
  • Please note that you may view the webinar on a personal computer or a Macintosh computer. However, if you view the webinar on a mobile device (e.g., smartphone, tablet and I-Pad), there will be audio but no video.

If you have any questions regarding this webinar, please contact the BON at workshops@bon.texas.gov or call (512) 305-6844.

For more information on the LVN On-call Pilot Program, please visit the Nursing Services Changes website at http://www.dads.state.tx.us/providers/nschanges/index.cfm.

(8/20/2014)

Steps to Alleviate Delays in Filling Needed Prescriptions for Individuals Affected by the STAR+PLUS Managed Care Expansion of Acute Care Services

Effective September 1, 2014, STAR+PLUS services for acute care only will be expanded to include some individuals who have Intellectual or Developmental Disabilities (IDD) and live in an Intermediate Care Facility for Individuals with Intellectual Disability or Related Conditions (ICF-IID) or who receive services through one of the following IDD waivers: Community Living Assistance Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS) or Texas Home Living (TxHmL).

To ensure individuals experience no delays in receiving necessary medications, particularly in the first weeks following the September 1, 2014 transition, here are some proactive steps for you, as a provider, and your families to take to avoid any possible delay.

  1. Prior to September 1, 2014, individuals are encouraged to refill any currently prescribed and authorized medication using the individual's current Medicaid card.
  2. If an individual takes a medication that has previously needed a prior authorization, is in excess of the usual dosage or is a non-preferred medication (whether or not on the Preferred Drug List), contact the managed care organization (MCO) after September 1, 2014.  Explain that the individual is currently prescribed the medication and ask what documentation (prior doctor's orders, reasons for the medication, etc.) you need to provide the MCO to expedite authorization for the drug to avoid delays in obtaining it after September 1, 2014. Be aware that:
    • Although prior authorization (PA) is required for non-preferred medications and medications subject to restrictions for clinical reasons, MCOs are required to follow certain requirements to ensure continuity of care for clients. The MCOs must ensure that an individual receiving medications through an approved PA continue to receive the medications for 90 calendar days after the September 1, 2014 expansion or until the expiration date of the PA, whichever is shorter.
    • Prior Authorization call center phone numbers vary by health plan. The Prescriber Assistance Chart identifies prior authorization and member call center phone numbers for each health plan where you can verify if a medication needs a prior authorization. Please use the member call center number.
    • A 72-hour emergency supply of a prescribed drug must be provided when a medication is needed without delay and prior authorization is not available.
(8/19/2014)

Stakeholder Feedback Sought Regarding DRAFT Changes to the Home and Community-based Services (HCS) Billing Guidelines and for the Texas Home Living (TxHmL) Billing Guidelines

The Texas Department of Aging and Disability Services (DADS) is seeking stakeholder feedback regarding proposed changes to the Home and Community-based Services (HCS) billing guidelines and for the Texas Home Living (TxHmL) billing guidelines to add definitions, billable/non-billable activities, and changes to employment assistance and supported employment. Additional edits to both the HCS and TxHmL billing guidelines include:

  • adding licensed social workers and counselors to the list of qualified providers for behavioral supports;
  • adding clarification for all nursing components;
  • removing employment services from day habilitation billable activities;
  • adding clarification regarding the restriction from the provision of two services at the same time;
  • adding exception for the provision of supported home living and day habilitation at the same time;
  • adding requirement that respite is only used in non-routine circumstances; and
  • adding camps as allowable out of home respite setting.

In addition, the following edits apply to the HCS billing guidelines only:

  • adding requirements that program provider must own or lease a home where residential support and/or supervised living services is provided;
  • adding requirements that two shifts must be documented per calendar day for residential support services; and
  • adding that the service provider can live in a residence with spouse in a four person residence.

DADS is seeking stakeholder feedback by COB Monday, August 18th, 2014. Feedback can be sent to txhml@dads.state.tx.us.

(8/12/2014)

Chapter 49, Contracting for Community Services Webinar

The Department of Aging and Disability Services (DADS) is hosting three webinars on the proposed Chapter 49, Contracting for Community Services, rule revisions:

August 18, 2014 from 1:30 p.m. until 4 p.m.
Space is limited.
Reserve your Webinar Seat Now at:
https://www1.gotomeeting.com/register/415951600

August 21, 2014 from 1:30 p.m. until 4 p.m.
Space is limited.
Reserve your Webinar Seat Now at:
https://www1.gotomeeting.com/register/322963073

August 26, 2014 from 1:30 p.m. until 4 p.m.
Space is limited.
Reserve your Webinar Seat Now at:
https://www1.gotomeeting.com/register/361402737

With webinars, you may choose to listen to the audio portion of the presentations by using your computer speakers. A phone line will also be available for those who may have a need to call in. Please be aware that attendees who choose the phone option may be subject to long distance phone charges.

After registering, you will receive a confirmation email containing information about joining the webinar.

System Requirements
PC-based attendees:
Required: Windows® 8, 7, Vista, XP or 2003 Server
Mac®-based attendees:
Required: Mac OS® X 10.6 or newer
Mobile attendees
Required: iPhone®, iPad®, Android™ phone or Android tablet

Please contact Kathie Carleton-Morales at Kathie.Carleton-Morales@dads.state.tx.us if you have any questions about the upcoming webinar.

(8/11/2014)

Database for Nurses Participating in the LVN On-Call Pilot for HCS, TxHmL and ICF/IIDs With a Capacity of 13 or Fewer Beds

As state in the Texas Department of Aging and Disability Services (DADS) stated in Information Letter 14-46 and Provider Letter 14-03, DADS is updating the nurse database for participation in the LVN On-Call Pilot. All LVNs and registered nurses who are participating in the pilot must access the database at https://www.surveymonkey.com/s/Y337KY2 to update their information. Participation in the pilot must be documented by September 8, 2014. Nurses who have not completed their entry in the database by the due date will be considered ineligible for continued participation in the pilot. To complete the database, the LVN must have access to documentation of the dates of completion of the required training.

DADS requests that all providers ensure that their nurses receive a copy of this alert and update their information in the database within the designated time frame.

For more information on the LVN On-Call Pilot Program, please visit the Nursing Services Changes website at http://www.dads.state.tx.us/providers/nschanges/index.cfm.

If you have any questions regarding the information in this alert, please contact the DADS Waiver Survey and Certification unit at 512-438-4163 or an ICF/IID policy specialist in the Regulatory Services Policy, Rules and Curriculum Development unit at 512-438-3161.

(8/8/2014)

Community First Choice Alert - Managed Care Organizations Outreach to the Department of Aging and Disability Services Intellectual and Developmental Disabilities Waiver Providers

Senate Bill 7 (S.B. 7), 83rd Legislature, Regular Session, 2013 requires the Health and Human Services Commission (HHSC) to implement a cost-effective option for basic attendant and habilitation services for people with disabilities who are eligible for Medicaid, including those in managed care.

A federal option, called Community First Choice (CFC), allows states to provide home and community-based attendant services and supports to individuals with disabilities who qualify for Medicaid as part of the state plan.

S.B. 7 requires managed care organizations (MCOs) that contract with HHSC for the provision of CFC attendant and habilitation services under the STAR+PLUS and STAR Health Medicaid managed care program to include the Department of Aging and Disability Services (DADS) Intellectual and Developmental Disabilities (IDD) waiver providers in their provider networks for the provision of basic attendant and habilitation services.

MCOs will be reaching out to the following DADS providers to offer them an opportunity to contract to provide CFC state plan services:

  • Community Living Assistance and Support Services (CLASS) Direct Services Agencies licensed as a Home and Community Support Services Agency (HCSSA)
  • Deaf Blind with Multiple Disabilities (DBMD), HCSSAs
  • Home and Community-based Services (HCS) certified providers
  • Texas Home Living (TxHmL) certified providers

Individuals already receiving services through a 1915(c) waiver will continue to receive those services as they do today from their existing providers.

Information regarding CFC can be accessed at the following link:
http://www.hhsc.state.tx.us/medicaid/managed-care/community-first-choice/

Questions about CFC can be submitted to HHSC by indicating “CFC” in the subject line at: Managed_Care_Initiatives@hhsc.state.tx.us.

HHSC is working on a process to collect questions and will be responding to the questions as more information is available through a Frequently Asked Questions (FAQ) document.

(8/6/2014)

Frequently Asked Questions List Published: Maintaining Continuous Eligibility for Individuals Enrolled in DADS IDD Programs

The Texas Department of Aging and Disability Services (DADS) has published a Frequently Asked Questions (FAQ) list. The list is a collection of questions received from participants of program specific webinars and trainings hosted by DADS regarding maintaining continuous Level of Care (LOC) eligibility and/or Individual Plan of Care (IPC) authorizations and financial eligibility (Medicaid) for the IDD programs to avoid impacting STAR+PLUS acute care eligibility for individuals at the time of the Medicaid managed care transition scheduled for Sept. 1, 2014. Some questions were also collected by email and phone conversations. This document will be updated with additional questions and answers as needed throughout the transition period.

To view the FAQ list, you can click here or go to the specific website for a desired IDD program listed below and click on the “Medicaid Managed Care Resources” navigation button located in the menu on the left of the page; then click on the “DADS FAQ List” link.

Waiver Programs

Facility-based Programs

(7/31/2014)

Health Insurance Premium Payment (HIPP) Program

The Health Insurance Premium Payment (HIPP) program is a Medicaid program that reimburses eligible individuals for their share of an employer-sponsored health insurance premium payment.

To qualify for HIPP, an employee must either be Medicaid eligible or have a family member who is Medicaid eligible.  A client who is in Medicaid managed care can be considered for enrollment in HIPP. However, if they qualify for HIPP enrollment, they cannot stay enrolled in Medicaid managed care, with the exception of STAR+PLUS clients.

STAR+PLUS and HIPP
To ensure access to long-term services and supports, individuals enrolled in, or eligible for, the STAR+PLUS program may receive coverage through Medicaid and HIPP. Although clients will need to select a Medicaid-enrolled primary care provider (PCP) under STAR+PLUS, clients can continue to see the PCP and specialists they currently see through their employer-sponsored insurance. (Designation of a STAR+PLUS PCP will not impact designation of PCPs under employer-sponsored insurance) The client is responsible for all associated cost sharing related to their employer-sponsored insurance:

  1. for non-Medicaid covered benefits, or
  2. if the PCP and specialists they see are not Medicaid-enrolled providers.

Beginning on September 1, 2014, some individuals enrolled in a 1915© waiver for individuals with intellectual and developmental disabilities (IDD) or residing in a community-based intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) will begin receiving their acute care services, such as doctor's visits and prescription drugs, through the STAR+PLUS program. The 1915© IDD waivers are Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS) and Texas Home Living (TxHmL). These individuals may also be enrolled in HIPP. Under these circumstances:

  • HIPP will reimburse clients for employer-sponsored insurance premiums,
  • STAR+PLUS MCOs will cover cost-sharing related to the employer-sponsored insurance for Medicaid-covered services provided by a Medicaid provider,
  • STAR+PLUS MCOs also will cover Medicaid-covered acute care services provided by a Medicaid provider not available through the employer sponsored insurance, and
  • The IDD waivers and ICFs-IID will provide long-term services and supports.

STAR and HIPP
Clients enrolled in STAR may apply for HIPP, and if found eligible for HIPP, the client will be disenrolled from STAR.

HIPP Coverage
The HIPP program may pay for clients and their family members to get employer-sponsored health insurance benefits if it is determined to be cost effective.

Medicaid-eligible HIPP enrollees do not have to pay out-of-pocket deductibles, co-payments, or co-insurance for health care services that Medicaid covers when seeing a provider that accepts Medicaid. Instead, Medicaid reimburses providers for these expenses. HIPP enrollees who are not Medicaid-eligible must pay deductibles, co-payments, and co-insurance required under the employer-sponsored insurance policy. Additionally, if a Medicaid-eligible HIPP enrollee needs a Medicaid-covered service that is not covered by their employer-sponsored insurance plan, Medicaid will provide this service at no cost to the enrollee as long as the services are provided by an enrolled Medicaid provider.

Additional information about the HIPP program is available at www.getHIPPTexas.com. Questions and concerns with HIPP enrollment should be directed to the HIPP helpline at 1-800-440-0493.

(7/25/2014)

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