Form 3074-TMHP January 2006 Texas Medicaid and Healthcare Partnership Use Only 1. Hospice Provider Name 2. Provider Address (Street or P.O. Box, City, State, Zip) 4. Correction (check if applicable) 5. Recipient Name (Last, First, Middle) 6. DADS Medicaid No. Social Security No. Election/Start Date 10. The rules under the Texas Administrative Code are Medicaid Hospice Provider Manual. 6 IL 2012-39 – The Texas Department of Aging and Disability Services Apr 18, 2012 Medicaid Hospice Program (Replaces Provider Letter #02-06) Texas Medicaid Hospice.

Section 1000, IntroductionRevision 11-1; Effective May 11, 20111100 Role of the Texas Department of Aging and Disability Services (DADS)Revision 08-1; Effective November 12, 2008DADS staff work directly with Medicaid hospice providers in the following areas:. Conduct audits on contracts with hospice providers. Issue Medicaid contracts to hospice providers that have met the Medicaid contract requirements. Authorize hospice services based on the receipt of the individual's required hospice eligibility documents. Section 2000, ContractsRevision 06-2; Effective December 12, 20062100 Medicaid ContractRevision 06-2; Effective December 12, 2006Hospice providers must apply to DADS to participate as a Medicaid hospice provider.

Only a provider with a fully executed, current Medicaid contract with DADS may receive state and federal reimbursement for services to Medicaid and dually eligible individuals on hospice. The Medicaid contract is considered an open-ended contract.The same legal business entity that applied for the Medicare hospice certification applies for Medicaid contracts.

DADS Community Services Contracts will enter into a contract with the provider upon completion of the application. Providers must meet the requirements specified in 40 Texas Administrative Code (TAC), Contracting for Community Care Services, and 40 TAC, Medicaid Hospice Program.2200 Advertising and Solicitation of IndividualsRevision 06-2; Effective December 12, 2006DADS may investigate complaints of solicitation of coerced individuals. Validated complaints may lead to adverse actions. Such actions may lead to termination of the provider's contract. Section 3000, EligibilityRevision 09-1; Effective February 27, 20093100 Recipient Financial EligibilityRevision 06-2; Effective December 12, 2006The purpose of this subsection is to provide hospice staff with a basic understanding of Medicaid eligibility determinations for general discussions with families, nursing facility (NF) staff, hospital staff and other service providers. However, Health and Human Services Commission (HHSC) Medicaid eligibility (ME) staff are the experts in this area. Consult ME staff and keep them informed on all issues related to the eligibility of an applicant or recipient.The Social Security Administration (SSA) through Supplemental Security Income (SSI) or HHSC determines if an individual is eligible for Medicaid.

Hospice is only one program that can be paid by Medicaid. Some Medicaid recipients are not eligible for nursing facility (NF) services or for the home and community-based waiver services, because of transferred assets (that is, recipient deletes name from joint bank account, transfers home to a relative, etc.). Not all Medicaid recipients are eligible for all Medicaid services. Each individual Medicaid service has certain criteria that must be met in order to qualify.The ME determination process for non-SSI eligible individuals begins when an application is submitted to HHSC ME. The process involves an investigation of the applicant's financial status, proof of citizenship, and ends with a decision of approval or denial. If an institutionalized applicant or one who seeks home and community-based waiver services is determined eligible, the ME staff determines the amount of income he must apply toward the cost of his care (copay).

Denial of Medicaid eligibility may be appealed through a request to the HHSC ME staff.Determining Medicaid eligibility may be a complex and lengthy process that varies with each applicant. ME staff must complete the process within 45 days, except in unusual situations. Payment does not begin until DADS establishes a record of eligibility in its central computer.HHSC staff use, Notification of Eligibility - Regular Medicaid Benefits, to inform the recipient and the hospice provider of the individual's eligibility for Medicaid benefits and the initial amount of copay, if applicable. HHSC Form H4808, Notice of Change in Applied Income/Notice of Denial of Medical Assistance, is used for subsequent denials and copay adjustments. The hospice provider receives these and any other appropriate eligibility forms directly from HHSC ME staff.When an individual is a full vendor SSI Medicaid recipient and receives Medicaid hospice services in an NF or ICF/MR-RC, the hospice provider is responsible for notifying SSA. SSA must have this information so the SSI payment to the recipient can be reduced to $30 a month, which is the federal benefit rate (FBR) for an institutionalized individual.ME staff determine financial eligibility for medical assistance only (MAO). Eligibility determination is a complex procedure— do not attempt to advise applicants, recipients or their families.

Direct any questions about a recipient's eligibility for Medicaid benefits to the ME staff at HHSC. The following information is intended to be a guide for referral of individuals to ME staff.HHSC issues Form H3087, Medicaid Identification, to eligible Medicaid recipients each month. This card ensures that the recipient, whose name appears on it, is eligible for services for the specific dates indicated on the card. Individuals may be eligible if they meet certain income and resource requirements. Section 4000, Billing and PaymentRevision 11-1; Effective May 11, 20114100 General InformationRevision 11-1; Effective May 11, 2011A provider must have a DADS Medicaid contract to receive Medicaid payment for hospice services. DADS pays the Medicaid hospice provider at periodic intervals, depending on when the provider bills for approved services.

Payments are based on the hospice care setting applicable to the type and intensity of hospice services provided to the Medicaid hospice recipient for that day.DADS Provider Claims Services authorizes hospice services, according to department, state and federal regulations, for contracted providers that furnish Medicaid services to DADS consumers. Provider Claims Services does not develop program policy, but is responsible for applying established policy when performing the authorization for reimbursement function.Payment for hospice services is controlled by receipt of information. Section 5000, Reimbursement RatesRevision 06-2; Effective December 12, 20065100 General InformationRevision 05-1; Effective December 2, 2005The Medicaid Hospice Program establishes and pays prospective hospice per diem rates that are no lower than the Medicare Hospice Program rates (Part A of Title XVIII of the Social Security Act). Medicaid rates are calculated on a yearly basis, based on information provided by the Centers for Medicare & Medicaid Services. The Medicaid hospice per diem rates are calculated by using the Medicare hospice methodology, but adjusted to disregard cost offsets allowed for Medicare deductibles and coinsurance amounts. HHSC does not apply or follow Medicare hospice rate freezes. Retroactive adjustments are not allowed other than for the.

application of the cap on overall Medicaid hospice payments,. limitation on payments for inpatient care days, and. recoupment of inaccurate payments made to providers.The rates are effective from October 1 through September 30 of each federal fiscal year.5200 Hospice Per Diem RatesRevision 06-2; Effective December 12, 2006The Medicaid program pays one of four per diem rates. Rates are paid for any particular hospice day based on the hospice care setting (of a Medicaid only recipient) applicable to the type and intensity of the hospice services provided for that day. The four Medicaid per diem rates are:. routine home care,.

continuous home care,. inpatient respite care, and. general inpatient care.DADS pays one of the per diem rates for each day an individual on Medicaid hospice qualifies for the Medicaid Hospice Program, regardless of the volume of services provided on any given day.The following table identifies the services that can be billed for individuals on DADS Medicaid hospice based on their eligibility type and residence.

Section 6000, Hospice Care in Long Term Care FacilitiesRevision 08-1; Effective November 12, 2008A Medicaid recipient may elect to receive hospice care in any long term care facility such as a nursing facility (NF), intermediate care facility for persons with mental retardation or related conditions (ICF/MR-RC), or hospital. Long term care facilities must comply with all requirements for participation in the Medicaid and Medicare programs that apply to the facility.

Long term care facilities do not have to participate in the hospice program; however, if a resident expresses a desire to participate in hospice and the facility does not contract with hospice providers, the facility should assist the resident in locating a facility that is willing to participate in the hospice program. The hospice rules and policies are similar for all long term care facilities, with some variances because of licensing requirements and payment rates.6100 Agreements with Long Term Care FacilitiesRevision 06-2; Effective December 12, 2006A hospice provider must enter into an agreement with a long term care facility that is interested in participating in the hospice program. Section 9000, Community ServicesRevision 05-1; Effective December 2, 2005Individuals who receive hospice care and reside in the community may be eligible to use community services.

Contracted providers in the community, such as home health and community support services agencies, furnish services not related to the terminal illness. The following items describe the types of community services available in most areas. Contact local Department of Aging and Disability Services (DADS) offices for more information.9100 Non-Medicaid Community Care ServicesRevision 05-1; Effective December 2, 20059110 Adult Foster Care (AFC)Revision 05-1; Effective December 2, 2005Adult foster care (AFC) provides a 24-hour living arrangement with supervision in an adult foster home for consumers who, because of physical, mental, or emotional limitations, are unable to function independently in their own homes.Providers of AFC must live in the household and share a common living area with consumers.

With the exception of family members, no more than three adults may live in the foster home unless it is licensed by DADS.Services may include minimal help with personal care, help with activities of daily living, and provision of, or arrangement for, transportation. The consumer pays the provider for room and board.9120 Client Managed Personal Attendant Services (CMPAS)Revision 05-1; Effective December 2, 2005Personal assistant services are provided to consumers with physical disabilities who are mentally competent and willing to supervise their attendant or who have someone who can provide the personal assistant’s supervision. Consumers interview, select, train and supervise their personal assistants. Licensed personal assistance services agencies determine client eligibility; the care needed; develop a pool of potential personal assistants; and provide emergency back-up personal assistants. Services include: personal assistance services and additional services may include health-related tasks prescribed by a physician.9130 Day Activity and Health Services (DAHS) Title XXRevision 05-1; Effective December 2, 2005Day Activity and Health Services (DAHS) facilities provide daytime services Monday through Friday to consumers residing in the community to provide an alternative to placement in NFs and other institutions.

Services are designed to address the physical, mental, medical, and social needs of consumers. Services include:.

noon meal and snacks,. nursing and personal care,. physical rehabilitation,. social, educational and recreational activities, and. transportation.9140 Emergency Response Services (ERS)Revision 05-1; Effective December 2, 2005Emergency Response Services (ERS) provides an electronic monitoring system to functionally impaired adults who live alone or are socially isolated in the community. In an emergency, the consumer can press a call button to signal for help.

Torrent under the dome season 1 episode 9 full. Lyra's quest for a grabbed companion reveals a vile plot including taken kids and transforms into a journey to comprehend a secretive wonder called Residue. In The Unpretentious Blade, she is joined on her adventure by Will, a kid who has a blade that can cut windows between universes. Episode: 320 MB episodeAbout series Earth Jensen comes all the way back from school one day to locate a baffling box with his name on it outside his front entryway. As Lyra learns reality with regards to her folks and her forecasted fate, the two youngsters are up to speed in a war against heavenly powers that extends crosswise over numerous universes and prompts an exciting end in The Golden Spyglass.

Revision 08-1; Effective November 12, 2008CARE Form System (3618, 3619, and 3652)800-727-5436Distribution (fax)512-438-3548Facility Enrollment512-438-2630Hospice Complaints800-458-9858ICF/MR-RC Complaint Hotline800-458-9858Medicaid Fraud888-752-4888Medicaid Hospice512-438-3015Nursing Home Hotline800-458-9858Protective and Regulatory Hotline (PRS)800-252-5400Provider Claims Services512-438-2200Texas Medicaid and Healthcare Partnership-Long Term Care800-626-4117Vendor Drug Hotline800-435-4165.

All providers who receive federal funds from HHS for the provision of Medicaid/CHIP services are obligated to make language services available to those with Limited English Proficiency (LEP) under Title VI of the Civil Rights Act and Section 504 of the Rehab Act of 1973. However, language interpretation services are not classified as mandatory 1905 services.States are not required to reimburse providers for the cost of language services, nor are they required to claim related costs to Medicaid/CHIP.

States may consider the cost of language services to be included in the regular rate of reimbursement for the underlying direct service. In those cases, Medicaid/CHIP providers are still obligated to provide language services to those with LEP and bear the costs for doing so.

Still, states do have the option to claim Medicaid reimbursement for the cost of interpretation services, either as medical-assistance related expenditures or as administration.