Source: https://www.txnmhospice.org/2019/03/28/regulatory-updates-3-28-19/
Timestamp: 2019-04-26 06:20:31+00:00

Document:
This final rule amends the regulation governing State Medicaid Fraud Control Units (MFCUs or Units). The rule incorporates statutory changes affecting the Units as well as policy and practice changes that have occurred since the regulation was initially issued in 1978. These changes include a recognition of OIG’s delegated authority; Unit authority, functions, and responsibilities; disallowances; and issues related to organization, prosecutorial authority, staffing, recertification, and the Units’ relationship with Medicaid agencies. The rule is designed to assist the MFCUs in understanding their authorities and responsibilities under the grant program, clarify the flexibilities the MFCUs have to operate their programs, and reduce administrative burden, where appropriate, by eliminating duplicative and unnecessary reporting requirements. For more information, go to: https://www.govinfo.gov/content/pkg/FR-2019-03-22/html/2019-05362.htm.
The Texas Health and Human Services Commission (HHSC) proposes amendments to §371.1305, concerning Preliminary Investigation, and §371.1307, concerning Full Investigation. HHSC also proposes new §371.1312, concerning Recipient Investigations.
The Texas Government Code §531.102(p) was added by Senate Bill (S.B.) 207, 85th Legislature, 2017 to require HHSC and the Office of Inspector General (OIG) to adopt rules establishing criteria for opening, prioritizing, and closing cases. Accordingly, HHSC and OIG adopted rule §371.1305, which established the criteria mandated by the statute. In its report to the 85th Legislature in February 2017, the Sunset Commission noted agency implementation as partially complete and recommended that OIG adopt rules relating to prioritizing recipient cases and guiding field investigators in closing cases.
Formalize criteria for prioritizing and closing cases.
Delineate inclusive lists of specific criteria that will be considered by investigators when they consider whether a particular preliminary, full-scale, or recipient investigation should be closed. In the case of preliminary investigations, investigators also consider this criteria when deciding whether a case should be pursued as a full-scale investigation.
Requires that recipient cases be prioritized according to the highest potential for recovery and federal timeliness requirements.
These proposed amendments do not change OIG’s approach to opening, closing, and prioritizing investigations, they only provide more detail as to the criteria that the agency’s investigators apply when they evaluate a recipient case or whether a case should be closed.
Proposed amendment to §371.1305 adds a new section (e), which delineates an inclusive list of criteria that OIG may consider when determining whether to close a preliminary investigation. The current section (e) is relettered to section (f), and current section (f) is relettered to section (g).
Proposed amendment to §371.1307 adds a new section (b), which delineates an inclusive list of criteria that OIG may consider when determining whether to close a full-scale investigation. Sections have been relettered.
Proposed new §371.1312 delineates a list of factors OIG considers when prioritizing recipient cases, as well as an inclusive list of criteria that OIG may consider when determining whether to close a recipient case.
PECOS is an online Medicare enrollment system. CMS has updated the FAQ and contact information.
Contact information, go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243418.html?DLPage=1&DLEntries=10&DLFilter=technic&DLSort=0&DLSortDir=descending.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers from all Medicare cards by April 2019. A new, randomly generated Medicare Beneficiary Identifier, or MBI, is replacing the SSN-based HICN. The new MBI is noticeably different than the HICN. The MBI hyphens on the card are for illustration purposes: don’t include the hyphens or spaces on transactions. The MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. CMS excludes these letters to avoid confusion when differentiating some letters and numbers. CMS revised this article on March 6, 2019, to add language that the MBI look-up tool can be used to obtain an MBI even for patients in a Medicare Advantage Plan. All other information remains the same.
A fact sheet discussing the transition to the MBI and the new cards is available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/ Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf.
The Medicare Beneficiary Identifier (MBI) Lookup tool allows providers to use our secure eServices online portal to obtain the new MBI number when patients do not present their Medicare card. If you do not already have access, sign up at: https://www.onlineproviderservices.com/ecx_improvev2/initLogin.do for access to eServices to use the tool. To read this article, go to: https://www.palmettogba.com/Palmetto/Providers.Nsf/files/April_2019_JMHHH_Medicare_Advisory_Final.pdf/$File/April_2019_JMHHH_Medicare_Advisory_Final.pdf.
Hospice provider preview report: Review Hospice Item Set (HIS) quality measure results from the third quarter of 2017 to the second quarter of 2018.
Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey provider preview report: Review facility-level CAHPS survey results from the third quarter of 2016 to the second quarter of 2018.
Palmetto has released the fee schedule based on the CY 2019 Medicare Physician Fee Schedule (MPFS) Final Rule. The fees are effective January 1, 2019. To access, go to: https://www.palmettogba.com/palmetto/providers.nsf/ls/JM%20Home%20Health%20and%20Hospice~BANNCR5423?opendocument&utm_source=JMHHHL&utm_campaign=JMHHHLs&utm_medium=email.
The Medicaid hospice rates were posted to the HHSC rate setting website. You can access them at: https://rad.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2019/10-2019-hospice-rates.pdf.
As a reminder, Hospice providers seeking eligibility information can pull Medicaid Eligibility and Service Authorization Verification (MESAV) using any of the following field combinations through TexMedConnect. This service can be accessed 24 hours a day, 7 days a week.
For more information on TexMedConnect and utilizing MESAV, call the TMHP Long Term Care Help Desk at 1-800-626-4117, Option 1. You can access this notification at: file:///C:/Users/Acer/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/KRBT6N81/Reminder%20Eligibility%20Information%20for%20Hospice%20Providers.pdf.

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