Source: http://www.taop.org/medicare--medicaid-updates.html
Timestamp: 2017-12-17 07:51:32
Document Index: 374827220

Matched Legal Cases: ['§352', '§352', '§352', '§352', '§352', 'art 455', 'art 15']

TAOP Annual Meeting 2018
CMS Finalizes Rule Creating Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items (CMS 6050-F)
February 4, 2015 - TX Medicaid Amendments to Rules Affecting the Enrollment of Practice Locations
This email is to inform you that the Health and Human Services Commission (HHSC) will be presenting proposed amendments at the February 18, 2016 Medical Advisory Committee and the February 26, 2016 HHSC Council. The proposed amendments affect the following rules under 1 TAC Chapter 352:
· RULE §352.3 Definitions
· RULE §352.7 Applying for Enrollment
· RULE §352.9 Screening Levels
· RULE §352.21 Duty to Report Changes
The proposed amendments clarify that certain provider types (including Medicaid providers also enrolled in Medicare) may use a Provider Information Change (PIC) form to add a new practice location to the provider’s enrollment at TMHP, in lieu of submitting a completed application for each new practice location (see current 1 TAC §352.7). The proposed amendments have been expedited to ensure that providers can continue to use PIC forms to add new practice locations, as appropriate, prior to the ACA-mandated re-enrollment deadline (see 42 CFR Part 455, Subpart E, for relevant federal requirements).
These changes will reduce the administrative burden associated with the addition of new practice locations for many providers.
It is also HHSC’s intent to expand the use of PIC forms to add practice locations in lieu of a completed application for providers that are Medicaid-enrolled only (providers with no Medicare enrollment) and identified as “limited-risk” under the Affordable Care Act.
There will be associated technology changes that will impact the timeline with which limited-risk provider will be able to use the PIC form to add practice locations. More information will be provided on those changes soon.
To ensure practice locations are enrolled in compliance with state and federal rules, while limiting the administrative burden for providers, these amendments revise rule provisions to require one enrollment application for each provider and all applicable application fees, and then leverage available Medicare data to ensure practice locations not included in the initial enrollment application are screened and validated.
Any enrollment changes such as the selection of a new provider type or change in ownership will still require submission of a completed application.
The proposed amendments will occur concurrently with amendments proposed for Title 1, Part 15, Chapter 371, Subchapter E, concerning Provider Disclosure and Screening.
The proposed changes to Chapter 371 are posted for comment in the Texas Register and can be found here:
http://www.sos.state.tx.us/texreg/archive/January292016/Proposed%20Rules/1.ADMINISTRATION.html#3
Please follow the directions at that link to provide comment regarding any amendments to Chapter 371.
Questions or feedback related to the attached proposed amendments for Chapter 352 may be addressed to the individual identified below. As of publication of these amendments in the Texas Register there will be a formal 30 day comment period.
Alexander Melis, MSSW
Acute Care Policy Development
Texas Medicaid/CHIP Division
Voice: (512) 462-6270
Email: alex.melis@hhsc.state.tx.us
February 2, 2016 - TX Medicaid Request for Feedback
Dear Texas Medicaid Stakeholder –
Please see attached an amendment to Texas Administrative Code (TAC) that will be heard at the May meeting of the Medical Care Advisory Committee. The rule relates to exceptions to the 24-month payment deadline, and the TAC is being updated to correspond with what is currently listed in the Texas Medicaid Provider Procedures Manual (TMPPM). Below is the language from the TMPPM, and the attached is what is proposed for the TAC.
Current TMPPM language:
7.3.1.4 Exceptions to the 24-Month Payment Deadline
HHSC shall consider exceptions to the 24-month claims payment deadline for the situations listed below. The final decision about whether a claim falls within one of the following exceptions will be made by HHSC.
• Claims for providers with retroactive adjustments who are reimbursed under a retrospective payment system.
• Claims paid within six months from the Medicare paid date.
• Claims from providers under investigation for fraud or abuse.
• Claims paid at any time in accordance with a court order, to carry out hearing decisions or agency corrective actions taken to resolve a dispute, or to extend the benefits of a hearing decision, corrective action, or court order to others in the same situation as those directly affected by it.
If you have any comments regarding this change, we would appreciate your feedback by February 15, 2016. Thanks so much!
tac_24_month_claims_payment.docx
NAAOP Responds to White House Reply to "WE THE PEOPLE" Petition on Proposed Medicare Coverage Restrictions for Lower Limb ProsthesesPRESS STATEMENT
Washington, D.C.-The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) issued its response today to the White House's "initial" reply to the "We the People" petition requesting the President to rescind the draft Medicare Local Coverage Determination for Lower Limb Prostheses (DL 33787). The White House response to the petition was posted October 16th.
While not a substantive reply to the petition's request, the White House acknowledged that it will provide an "update" in the future. The White House's initial response mentions that "HHS has met with stakeholders on this important issue, and both CMS and its contractors understand the questions that have been raised about access to the right prosthetic care – including related technologies – for Medicare beneficiaries." It also states that "CMS wants to make clear that they're committed to providing high quality care to all Medicare beneficiaries."
Peter W. Thomas, NAAOP General Counsel, noted that, "While we would have preferred a final answer instructing the DME MACs to rescind the draft LCD, we are encouraged that the White House recognized the need to publicly respond and provide this initial update. NAAOP will continue to work with CMS and the White House and press the issue by educating legislators and government officials to achieve the outcome both Medicare beneficiaries with limb loss and privately-insured amputees in the United States deserve."
David McGill, NAAOP President, added, "After attracting over 100,000 signatures in 17 days, witnessing the prosthetic and orthotic community submit thousands of public comments, and participating in both an amputee protest and a high-level meeting with CMS and HHS officials, we cannot hide our disappointment that the draft LCD has not yet been rescinded. But we take CMS at its word that they understand the concerns we have raised and look forward to working with them to achieve a good outcome for patients, their families, and the providers who serve them. NAAOP will recommit itself to advocacy work on this vital issue."
Rescission of the draft LCD is critical because it lacks virtually any clinical or medical evidence to support its proposals while other payers look to it for guidance. United Healthcare has already discontinued coverage of suction socket technology by referencing the draft Medicare policy. "NAAOP believes strongly that the public must be offered another opportunity to comment on the final LCD when it is announced. The draft LCD was so fundamentally flawed that the next iteration must be considered a draft subject to public comment," stated McGill.
Most people think that once you become eligible for Medicare,
all of the coverage and payment problems that are pervasive in the private health insurance industry magically disappear.
But in fact, Medicare focuses significant energy on reducing inappropriate payments and overpayments to healthcare providers.
With this background, recent guidance from Medicare should be of interest to all amputees who are Medicare beneficiaries.
The OIG Report In 2011, the Office of the Inspector General published a report that summarized its review of payments made by Medicare to prosthetists of lower-limb prostheses. The OIG concluded that Medicare inappropriately paid $43 million for lower-limb prosthetic claims that did not meet the established requirements for payment, such as missing information about the patient's ability to walk or prosthetic devices that were medically unnecessary because the patient's functional level did not correspond to the device delivered. The OIG identified an additional $61 million in claims for patients who had no record of a visit with their referring physician in the previous 5 years.
Medicare's Response As a result of the OIG report, Medicare instructed the contractors who process all Medicare prosthetic claims to more closely scrutinize what prosthetists submit. In September 2011, these contractors sent out “Dear Physician” letters – letters to remind prescribing doctors of their responsibility to thoroughly document an amputee’s condition in their medical records. At the same time, various auditing entities that Medicare contracts with dramatically ramped up their reviews of lower-limb prosthetic claims.
What does this mean for the consumer? Many prosthetists have responded to these developments by insisting on seeing a copy of the doctors’ medical records before proceeding with the delivery of a prosthesis. This can result in delivery delays for Medicare beneficiaries. The Amputee Coalition has anecdotal evidence that some doctors simply refuse to provide the detailed information set forth in the “Dear Physician” letters because of the administrative burden it places on them, which forces patients to find new physicians who are willing to do the necessary paperwork. Some prosthetists are actively educating their patients about these requirements and having the patients go to their doctors to insist on appropriate documentation prior to delivery.
What can you do? Be an informed and active consumer and help your prosthetist and doctor to get it right. The Amputee Coalition has developed a letter that outlines what documentation Medicare needs to have in the medical record to support payment for your prosthesis.
Prior to 2005, TMHP’s policy was to only provide coverage for cranial remolding orthoses for use after surgery for cranial deformities, including craniosynostosis. In 2007, vested stakeholders (physicians, providers, national/state associations, parent support groups, etc) petitioned TMHP to include benefits coverage for cranial remolding orthoses used in the treatment of deformational plagiocephaly. Effective May 1, 2007 (Texas Medicaid Bulletin, No. 204), TMHP expanded benefits coverage for cranial remolding orthoses to include the diagnosis of deformational plagiocephaly if key medical guidelines were met. December 13, 2011 - TMHP posted a notice on their website stating that benefit coverage for deformational plagiocephaly using cranial remolding orthoses will terminate effective February 1, 2012.
Action – Request TMHP to postpone this policy as less than two months notice does not give vested stakeholders enough time to comment on these important benefit changes that will severely restrict access for TX Medicaid patients.
Action – Request that TMHP to continue to provide coverage for cranial remolding orthoses as additional clinical studies further substantiate medical necessity for the treatment of deformational plagiocephaly along with position/consensus papers from the AAP.
Action – Forward this information to physicians, orthotists and other allied health care professionals and request them to use this template as a guideline to send an email/letter to TMHP as soon as possible.
tmhp_letter_template.docx
_December 12, 2011
Registration Now Open for DMEPOS Competitive Bidding (CMS Message 201112-03)
Registration is now open and available to all suppliers interested in participating in the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. When bidding opens, suppliers will need to submit their bids using the DMEPOS on-line bidding system (DBidS). To help ensure bid security and privacy, suppliers interested in bidding must first register all employees that will enter information in DBidS to obtain a user ID and password through the Individuals Authorized Access to CMS Computer Services (IACS) system. Only supplier employees that have a user ID and password will be able to access DBidS; suppliers that do not register will not be able to bid.
If you are a supplier interested in bidding, register now - don't wait. Designate one authorized official (AO) listed on the CMS-855S enrollment form to act as your AO for registration purposes. The AO must register for a user ID and password first and must approve other supplier employees' requests to register. After an AO successfully registers, the AO may designate other authorized officials on the CMS-855S to serve as backup authorized officials (BAO). The AO and BAOs can designate other supplier employees as end users (EU). BAOs and EUs must also register for a user ID and password to be able to use the on-line bidding system. The name, date of birth, and Social Security number (SSN) of the AO and BAOs must match exactly with what is on file with the National Supplier Clearinghouse to register successfully.
We strongly urge all AOs to register no later than December 22, 2011 to ensure that BAOs and EUs have time to register before bidding begins. We recommend that BAOs register no later than January 12, 2012 so that they will be able to assist AOs with approving EU registration. Registration will close on February 9, 2012 at 9 p.m. prevailing Eastern Time - no AOs, BAOs, or EUs can register after registration closes.
To register, go to the Competitive Bidding Implementation Contractor (CBIC) website and click on "REGISTRATION IS OPEN" above the Registration Clock on the home page. Please review the IACS Reference Guide posted on the website for step-by-step instructions on registration. You will also find a registration checklist and Quick Step guides on the CBIC website. If you have any questions about the registration process, please contact the CBIC Customer Service Center at 1-877-577-5331.
The CBIC is the official information source for bidders. All suppliers interested in bidding are urged to sign up for E-mail Updates on the home page of the CBIC website. For information about Round 2 and the national mail-order competition, including bidder education materials, please refer to the resources located under Bidding Suppliers: Round 2 & National Mail-Order on the CBIC website.
_Received November 11, 2011
Dear Association: There has been an article posted regarding changes that are up and coming for your association members. I have attached the link to the article, available on www.tmhp.com, in an effort to ensure your members are educated and take the appropriate actions. Please feel free to share the information. The highlight of the article is bulleted below:
S.B. 874, 82nd Legislature, Regular Session, 2011, requires the Texas Health and Human Services Commission (HHSC) to establish and implement separate provider types for prosthetist and orthotist providers for purposes of enrollment and reimbursement in Texas Medicaid.
In accordance with this requirement, currently-enrolled orthotist and prosthetist providers that are currently-enrolled as durable medical equipment (DME) providers will be required to re-enroll in Texas Medicaid beginning December 19, 2011.
Please feel free to contact me if you have any questions related to this article.
ACS/Texas Medicaid and Healthcare Partnership (TMHP)
(512) 506-7707
andrea.daniell@tmhp.com