Long Term Care - TMHP
Long Term CareProvider BulletinLTC Provider Bulletin, No. 73February 2018What’s new2Expanded Capabilities for Third-Party Software Vendors in Support of PASRR NFSS AuthorizationRequests Beginning March 24, 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2What Does it Take to be the Best Nurse or Nurse Assistant in Long Term Care?. . . . . . . . . . . . . . . . . . . . . . . 3Expanded Comment Field on MN/LOC Assessment Available December 9, 2017. . . . . . . . . . . . . . . . . . . . . 3New Card for Medicare Clients after April 1, 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4In This Corner5Center for Excellence in Long Term Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Reminder: Claims Identified for Potential Recoupment (CIPR) Reports Available . . . . . . . . . . . . . . . . . . . . . 6Proper Handling of Medicaid Overpayments by LTC Fee-for-Service Providers. . . . . . . . . . . . . . . . . . . . . . . 7Register Now for the Transition to Practice for Nurses in the Nursing Facility Setting Academy . . . . . . 8Register Now - Texas OASIS HCBS Dementia Training Academy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Register Now - PASRR in the Nursing Facility: Putting the Pieces Together. . . . . . . . . . . . . . . . . . . . . . . . . 10Save the Date! 2018 Geriatric Symposium – Texas Taking the Next Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Advanced Person-Centered Behavior Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11NOSH: Nurses Optimizing Supportive Handfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Updates13Webinars Available for Nursing Facility, Hospice, Community Services Waiver Programs Providers,and MCOs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Long Term Care Home Page on TMHP.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Visit the Texas Nursing Facility Quality Improvement Coalition Facebook page . . . . . . . . . . . . . . . . . . . . . 15Reminders16Computer-Based Training (CBT) on the Texas Medicaid & Healthcare Partnership LearningManagement System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Preadmission Screening and Resident Review (PASRR) Training Available. . . . . . . . . . . . . . . . . . . . . . . . . . 17Reminder for Resource Utilization Group Training Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Provider ResourcesProvider Relations Representatives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TMHP LTC Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Electronic MDS Submissions Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HHSC/DADS Contact Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Acronyms In This Issue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181819202024
What s NewExpanded Capabilities for Third-Party SoftwareVendors in Support of PASRR NFSS AuthorizationRequests Beginning March 24, 2018Beginning March 24, 2018, expanded capabilities will be available to third-partysoftware vendors (TPSV) to make changes to Authorization Requests forPreadmission Screening and Resident Review (PASRR) Nursing FacilitySpecialized Services (NFSS) forms on behalf of Nursing Facility (NF) providersthat use TPSV software. Expanding the capabilities for TPSV to supportthe NFSS is in response to requests from Nursing Facilities. Providers mayreference the article, “NFSS on the TMHP LTC Online Portal,” which waspublished on the TMHP website on July 18, 2017.What’s newTPSVs will be able to make the following changes after a PASRR NFSS form hasbeen submitted via Electronic Data Interchange (EDI): Add Notes: A TPSV will be able to add notes to an NFSS Form that will bedisplayed in either the Form History or PASRR Transaction ID (PTID) Historyon behalf of NF providers using their software. Update NFSS PTID: An NF will have the ability to make allowable changesto data fields on the NFSS as a result of using the update PTID functionusing their TPSV software. Change NFSS PTID Status: NFs will be able to change the status of NFSSPTID after it has been submitted. TPSVs will be able to change the status ofan NFSS PTID on behalf of a provider as follows: From ‘Pending Denial’ to ‘Pending State Review’ From ‘Pending NF Receipt’ to ‘Pending State Confirmation’ From ‘Provider Action Required’ to ‘Submit to SAS’Should your TPSV not provide these expanded capabilities, NF staff must stillbe prepared to submit and access the NFSS form directly on the LTC OnlinePortal to perform the necessary actions to request specialized services for theirPASRR-positive residents.NFs are encouraged to work with their TPSVs to ensure functionality of the LTCOnline Portal enhancements is available.For more information, contact your TPSV.LTC Provider Bulletin, No. 73CPT only copyright 2017 American Medical Association. All rights reserved.2nFebruary 2018
What s NewWhat Does it Take to be the Best Nurse or NurseAssistant in Long Term Care?The Center for Excellence in Long Term Care is seeking nominations for the “Nursing AtIts Best Award.” This is an opportunity to recognize and share with others the outstandingwork performed by nursing staff every day in long term care settings across Texas.Nominations will be accepted for CNAs, LVNs, RNs, and APRNs who have providedexcellent person-centered care to residents in a long term care setting, particularly in askilled Nursing Facility or nursing home. The nominee must meet the following criteria: Work in a long term care setting in Texas Must be at least a year in position Demonstrates past or present person-centered careAward winners will receive a certificate and will also be featuredon the Center for Excellence in Long Term Care website andsocial media pages. In addition, the winners will have theopportunity to have the Center for Excellence in Long Term Careconduct a continuing education workshop at their facility.Submit a written nomination of 250 words or less, telling us whyyour nominee deserves to win this award. Nominations for thefirst awards will close March 9, 2018, and the winners will benotified on April 11, 2018. Awards will be presented quarterly;any submissions received after March 9 will be held andreviewed during the next award cycle.For more information, visit the Center for Excellence website atwww.utlongtermcarenurse.com/best-award. nExpanded Comment Field on MN/LOC Assessment AvailableDecember 9, 2017Effective December 9, 2017, the comment field in the Medical Necessity Level ofCare (MN/LOC) Assessment form was expanded. Providers are now able to enterup to 1,500 characters in the expanded field. The expansion allows providers toadd supplemental or clarifying information in the comments field.For more information, call the Long Term Care Help Desk at 1-800-626-4117,Option 1. nLTC Provider Bulletin, No. 73CPT only copyright 2017 American Medical Association. All rights reserved.3February 2018
What s NewNew Card for Medicare Clients after April 1, 2018In accordance with the Medicare Access and CHIP Reauthorization Act of 2015, the SocialSecurity Number (SSN)-based Health Insurance Claim Number (HICN) will be replacedwith a new Medicare Beneficiary Identifier (MBI).Beginning April 1, 2018, Medicare beneficiaries will be issued new Medicare ID cards withMBIs in the following format: 11 digits in length; Position 1 must be numeric values 1 to 9; Position 4, 7, 10, and 11 must be numeric values 0 to 9; Position 2, 5, 8, and 9 must be alphabetic values A thru Z (minus S, L, O, I, B, Z); and Position 3 and 6 must be alphanumeric values either 0 thru 9 or A thru Z (minus S, L,O, I, B, Z).(Note: only upper case alphabetic characters)Effective April 1, 2018, the MBI can be submitted as the Medicare Number on thefollowing forms on the Long Term Care (LTC) Online Portal:¾¾ Medical Necessity and Level of Care Assessment (Waiver 3.0) form¾¾ Resident Transaction Notice (3618) form¾¾ Medicare/SNF Patient Transaction Notice (3619) form¾¾ Physician Certification of Terminal Illness (3074) form¾¾ Intellectual Disability/Related Condition Assessment (8578) form¾¾ STAR Kids Screening and Assessment (SK-SAI) form¾¾ PASRR Level 1 Screening (PL1) form¾¾ PASRR Evaluation (PE) formThese forms will no longer accept the HICN as the Medicare Number beginningJanuary 1, 2020.For more information, visit the Centers for Medicare & Medicaid Services website.nUse of the American Medical Association’s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication withthe following disclosure: “Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All rights reserved.No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data containedherein. Applicable Federal Acquisition Regula tion System/Department of Defense Regulation System (FARS/DFARS) restrictions apply togov ernment use.”The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT)codes: “Current Dental Terminology (including procedure codes, nomenclature, descriptors, and other data contained therein) is copyright 2017 American Dental Association. All Rights Reserved. Applicable FARS/DFARS apply.”LTC Provider Bulletin, No. 73CPT only copyright 2017 American Medical Association. All rights reserved.4February 2018
In This CornerCenter for Excellence in Long Term CareThe Center for Excellence in Long Term Care (Center) is a partnership betweenthe Texas Health and Human Services Commission (HHSC) and the Universityof Texas at Austin School of Nursing. The Center offers a web-based platformfor the delivery of best practices, with a focus on geriatrics and disabilities.The content on the website has been adapted to meet the educational needsof a variety of professionals who provide care to residents of long term carefacilities in Texas.Under the leadership of Dr. Tracie Harrison, the Center is an educationalplatform for the delivery of geriatric and disability best practices to providers ofgeriatric care. Phases I through III are now available.In This CornerPhase I: Improving Dementia CarePhase I includes online modules that promote best practices to improve servicedelivery and positive outcomes for residents with dementia.Topics include: The needs and experiences of people with dementia; The needs and experiences of family and friends of people with dementia; Current treatment options; and State and national trends in the use of antipsychotic medications.Phase II: Geriatric Nursing Specialty EducationThe objective of the Geriatric Nursing Specialty Education training program isto provide education, best practices, and clinical guidelines that will be used totransition nurses in geriatric care, specifically to the long term care settings.Topics include: Dementia and dementia care; Pharmacological related considerations; Systematic review of the geriatric patient; and Overview of long term care settings, including regulatory oversight.Phase III: Geriatric Transition to PracticeThe modules in Phase III focus on the learning needs of nurses (both LVNs andRNs) who are entering the long term care setting for the first time.Visit the Center for Excellence in Long Term Care atwww.utlongtermcarenurse.com. Registration is free.LTC Provider Bulletin, No. 73CPT only copyright 2017 American Medical Association. All rights reserved.5nFebruary 2018
In This CornerReminder: Claims Identified for Potential Recoupment(CIPR) Reports AvailableProviders are reminded that TMHP generates the ClaimsIdentified for Potential Recoupment (CIPR) Provider Reporton a weekly basis and TMHP maintains each CIPR ProviderReport for six months after it is generated. Reviewing the CIPRProvider Report regularly helps providers avoid unexpectedrecoupments. The CIPR Provider Report lists claims that havebeen identified for potential recoupment as a result of TMHPidentifying new or changed long term care relevant insurancepolicies for clients with paid claims during the policy coverageperiod. The CIPR Provider Report lists potentially impactedclaims and the insurance company information for thecorresponding long term care relevant policy.Provider reports areavailable for NursingFacilities, HospiceProviders, andIntermediate CareFacilities for Individualswith an IntellectualDisability or relatedconditionsFor each claim identified on the CIPR Provider Report, providersmust file a claim with the appropriate third-party insurance forthe services previously paid by Medicaid. After receivingthe response from the third-party insurance, providers mustthen adjust the claim listed on the CIPR Provider Report, and include the Other Insurance(OI) Disposition information received from the third-party insurance. For more informationabout OI billing information, consult the TexMedConnect Long Term Care User Guide.A claim will continuously appear on the CIPR Provider Report until it is adjusted witha valid OI disposition reason. If a claim identified on the CIPR Provider Report is notadjusted within 120 days from the date the claim first appeared on the CIPR ProviderReport, then the Health and Human Services Commission (HHSC) will recoup thepreviously paid claim.Useful Links:Accessing R&S and CIPR Reports from the Website – This PDF provides instructions forlocating, viewing, downloading, and printing the CIPR Provider Report.TexMedConnect Long Term Care User Guide – The User Guide provides informationon how to submit a claim, adjusting claims, viewing Other Insurance on the MedicaidEligibility and Service Authorization Verification (MESAV), and how to fill out the OtherInsurance/Finish Tab section of the claim.Contact InformationFor questions about submission of long term care fee-for-service claims and adjustments,call the TMHP Long Term Care (LTC) Help Desk at 1-800-626-4117, Option 1.For questions about Other Insurance information, including OI updates and OI MESAVdiscrepancies, call the TMHP LTC Help Desk at 1-800-626-4117, Option 6. nLTC Provider Bulletin, No. 73CPT only copyright 2017 American Medical Association. All rights reserved.6February 2018
In This CornerProper Handling of Medicaid Overpayments by LTCFee-for-Service ProvidersIt is important for providers to follow proper procedures when a Medicaid overpaymenthas been discovered. The correct way to refund money to the Health and HumanServices Commission (HHSC) for a long term care (LTC) fee-for-service (FFS) Medicaidoverpayment always starts with a claim adjustment.Claim adjustments that have processed toApproved-to-pay (A) status will automaticallyProviders should always contactrefund money to HHSC by reducing payments forHHSC Provider Recoupmentsfuture billing. Claims that process to Transferred(T) status will require repayment by check or byand Holds before submitting adeduction; deductions are set up by HHSC Providercheck for an overpayment.Recoupments and Holds. If the adjustmentclaim processes to T status or the provider is nolonger submitting new LTC FFS claims to offsetthe negative balance, then the provider should call HHSC Provider Recoupments andHolds to determine the appropriate method for returning the money. Providers shouldalways contact HHSC Provider Recoupments and Holds before submitting a check for anoverpayment.Things to remember: To return a LTC FFS Medicaid overpayment to HHSC, providers should always processan adjustment claim in TexMedConnect or via their third-party submitter. Someexamples of overpayments requiring an adjustment claim include: Original paid claim was billed with too many units of service. Original paid claim did not properly report LTC-relevant Other Insurance payments orcoverage. Original paid claim was billed with the wrong revenue code and/or HealthcareCommon Procedure Coding System (HCPCS) code. If submitted properly, LTC FFS claim adjustments to return money to HHSC will notdeny for the one year claim filing deadline edit (Explanation of Benefits [EOB] F0250). LTC FFS claim adjustments must include a negative claim detail to offset the originalpaid claim and a new claim detail to repay the claim at the correct (lower) amount.The net total of the adjustment claim must be negative. Providers SHOULD NOT use TMHP Form F0079 “Texas Medicaid Refund InformationForm” to report LTC FFS overpayments. This form is exclusively used for acute careclaims.LTC Provider Bulletin, No. 73CPT only copyright 2017 American Medical Association. All rights reserved.7February 2018
In This CornerContact Information:EntityHHSC Provider Recoupmentsand HoldsWhat they can do Provide the current outstanding balance afteradjustment claims are processed Facilitate payment to HHSC for outstandingnegative T claims by provider check or deduction Facilitate payment to HHSC for an outstandingnegative balance (with claim status A or T) byprovider check or deduction from an associatedcontract when the provider is no longer billingnew LTC FFS claims Assist with filing an adjustment claim Assist with understanding the provider’sRemittance and Status (R&S) Report512-438-2200, Option 3TMHP LTC Help Desk1-800-626-4117, Option 1 Register Now for the Transition to Practice for Nursesin the Nursing Facility Setting AcademyRegistration is still available for the final Transition to Practice Academy regionalconference. This training opportunity will help newly graduated nurses or those new tothe Nursing Facility setting increase their knowledge and readiness to practice. Participating nurses will gain valuable resources and takeaways that support their transitionand prepare nurses to offer the highest possible level of care to Nursing Facilityresidents. Visit the registration website for more information or to register for theTransition to Practice Academy in San Antonio on February 28-March 1, 2018.For more information email QMP@hhsc.state.tx.us.nNeed He
LTC Provider ulletin o 3 Februar 218 Long Term Care Provider Bulletin What’s new 2 Expanded Capabilities for Third-Party Software Vendors in Support of PASRR NFSS Authorization
Texas Medicaid EDI Connectivity Guide Texas Medicaid Proprietary & Confidential Page 7 of 29 Last Updated: 10/27/2021 3 Technology Requirements 3.1 Telecommunications TMHP supports the TMHP virtual private network (VPN) Client, using a high-speed internet connection, to connect to the TMHP network.
Select Long-Term Care Occupations, Pooled 2003-2013. 27. UCSF Health Workforce Research Center on Long-Term Care Research Report 6 Entry and Exit of Workers in Long-Term Care Executive Summary In the past decade, the health care industry, and long-term care (LTC) in particular, saw substantial job growth. In anticipation of growing demand .
insurance called Qualified Long-Term Care Insurance. This regulation is intended to provide requirements for all long-term care insurance contracts, including qualified long-term care insurance contracts, as defined in the NAIC Long-Term Care Insurance Model Act and by Section 7702B(b) of the Internal Revenue Code of 1986, as amended.
Coding will mirror TMHP (Texas Medicaid and Healthcare Partnership) guidelines found in the most current Texas Medicaid Provider Procedures Manual Access the current procedures manual at www.TMHP.com, click on “providers” and then click on “Reference Material” National Drug
Long Term Care and Personal Care Homes FINANCIAL SUBSIDY APPLICATION FOR: PERSONAL CARE HOME LONG TERM CARE . Financial Assessment Officer - Eastern Health Long Term Care 760 Topsail Road - Business Side, Mount Pearl, NL A1N 3J5 Tel: (709) 752-4361 Fax: (709) 752-4740 .
into long-term health care benefit plans. Conversely, Medicaid expenses on long-term health care services for residents may be offset by similar amounts (as aforementioned) annually. This is about 5.07-5.78 percent of the Medicaid long-term care appropriations for Nursing Home Careor 2.99-3.40 percent of the total Medicaid Long Term
CPT ONLY - COPYRIGHT 2016 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED. 2.7.17 Reimbursement. DME and expendable medical supplies are reimbursed in accordance with 1 TAC §355.8441. See the applicable fee schedule on the TMHP website at www.tmhp.com. Providers may be reimbursed
Account to access Provider Information on the website. Providers who create a TMHP User Account have a responsibility to administer access to the secure pages of the portal containing protected health information (PHI) that is linked to their National Provider Identifier (NPI) or other provider numbers. Each provider number will be controlled .
