Specifically, 40 TAC 9.170(d) requires a program provider to prepare and submit service claims in accordance with the HCS Program Billing Guidelines. of the Home and Community-based Services Billing Guidelines and the Texas Home Living Billing Guidelines. 1, Item c and No. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Individual applications are subject to eligibility requirements. https://attendee.gotowebinar.com/recording/4225828217950682891, For a copy of the handouts, you can email: Shelley.Gusky01@hhs.texas.gov, Administrative Penalties and Amelioration. Texas Health & Human Services Commission. A summary of the revisions can be found onpage 25 of the CFC (PDF),page 146 of the HCS (PDF)andpage 122 of the TxHmL (PDF). IL 2022-36is posted on the HHS webpage for Home and Community-based Services, Texas Home Living, local intellectual and developmental disability authority, and financial management services agency program providers. To clarify, as of June 15, 2020, Survey Operations is resuming some survey activity such as complaints with lower priorities, and possibly some licensure and certification surveys. End Users do not act for or on behalf of the CMS. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT. 2021 Rules Manual and Fees. This information about reimbursement methodologies and acceptable billing practices may help health care providers bill claims more accurately to reduce delays in . These policies are guidelines only and do not constitute a benefit determination, medical advice, guarantee of payment, plan preauthorization, an Explanation of Benefits or a contract. This information about reimbursement methodologies and acceptable billing practices may help health care providers bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information. interacting by video conference with an individual who has a medical need for licensed vocational nursing, including: observing administration of medication; and conducting a focused assessment of the individual's health status; at the time an individual receives medication from a pharmacy, ensuring the accuracy of: the type and amount of medication; and the dosage instructions; http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4471.2, Specific Requirements Licensed Vocational Nursing Billable Activity (cont.) Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (Humana Entities). They must follow: The HCS file extension indicates to your device which app can open the file. (This fee is non-refundable as allowed by state). Billable Services In The HCS Program(For HCS) Part IV of the Care Coordination Series (Be sure to attend Part V: Requesting AAs/MHMs /DE Funding on August 3rd, 2023!) Here is the link to the HCS BGs: https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/resources/hcs/hcs-billing-guidelines.pdf, Billable Services In The HCS Program(For HCS) Part IV of the Care Coordination Series (Be sure to attend Part V: Requesting AAs/MHMs /DE Funding on August 3rd, 2023!) This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. CDT is a trademark of the ADA. Revision 22-1 is effective May 2. The scope of this license is determined by the ADA, the copyright holder. No medical necessity shown when residential staff calls nurse to administer over the counter medication to individual No medical necessity for follow-up phone call Billing for services without Face-to-Face, Telephone or Video conferencing contact Providing any activity not requiring a nursing license One note used for multiple service events No Progress Note, Residential Assistance http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4500, Specific Requirements Residential Assistance Residential Location Own Home/Family Home if no foster/companion care, residential support or supervised living is provided to the individual Foster/Companion Care is not owned or leased by the program provider, a service provider provides care to the individual; and the care provider and the individual have the same address http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4530, Specific Requirements Residential Assistance Residential Location 3-Person Home the individuals residence is a 3-person residence and a service provider provides residential support or supervised living to the individual 4-person Home the individuals residence is a 4-person residence and a service provider provides residential support or supervised living to the individual (one must be RSS) http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4530, Supported Home Living http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4540, Specific Requirements Supported Home Living Billable Activity Interacting face-to-face with the individual: to assist with activities of daily living to assist with ambulation and mobility to reinforce counseling and therapy subcomponents to assist with administration of medication or tasks delegated by an RN to conduct habilitation activities to secure transportation for the individual to supervise the individuals safety and security interactions regarding an incident directly affecting the individual's health or safety; performing allowable non-face-to-face activities participating in a service planning team meeting; participating in the development of an implementation plan; and participating in the development of an IPC. HHSC Long-term Care Regulation has publishedPL 20-55 Administrative Penalty Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program Providers (PDF). Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers must use theHCS and TxHmL Bill Code Crosswalkstarting May 1, 2022 to submit claims for all services. Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc. New Mexico: Humana group dental and vision plans are insured by Humana Insurance Company. interacting face-to-face or speaking by telephone with a pharmacist or representative of a health insurance provider, including the Social Security Administration, about an individual's insurance benefits for medication if the registered nurse justifies, in writing, the need for the registered nurse to perform the activity; instructing a service provider, except a service provider of registered nursing or specialized registered nursing, on a topic that is specific to an individual such as choking risks for an individual who has cerebral palsy; supervising a licensed vocational nurse regarding an individual's nursing services or health status; instructing, supervising or verifying the competency of an unlicensed person in the performance of a task delegated in accordance with rules of the Texas Board of Nursing at 22 TAC, Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) or the Human Resources Code, 161.091-.093, as applicable; http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4420, Specific Requirements Registered Nursing Billable Activity (cont.) Individualized Skills and Socialization Provider Training, Resources for Long-Term Care Providers home, Access and Intake Services Community Options book (PDF), Realistic job previews for direct support workers. A recording of the Jan. 5, 2021, HCS and TxHmL Changes to Survey Process and Hold Harmless Period Overview webinar is available for those unable to attend. https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/HCS%20Provider%20User%20Guide.pdf. The letter has been revised to include information for how HCS and TxHmL program providers can file a complaint regarding a surveyor, how to report survey inconsistencies related to the interpretation and application of regulations and rules, and to provide updated contact information for Long-term Care Regulatory HCS and TxHmL regional program staff. Participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, the program provider must use the out-of-home bill codes below with the modifiers KX and CR. Also, Sections II. A NYS DMV Driver's License or a NYS DMV Non-driver Photo ID is necessary to apply. at the time an individual receives medication from a pharmacy, ensuring the accuracy of: the type and amount of medication; and the dosage instructions; researching medical information for an individual who has a medical need for registered nursing, including: reviewing documents, except for a written service log or written summary log of a service component as described in Section 3820, to evaluate the quality and effectiveness of the medical treatment the individual is receiving; and completing a comprehensive assessment; http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4420, Specific Requirements Registered Nursing Billable Activity (cont.) HHSC is temporarily waiving certain requirements in Section 3710, 4381.3, 4381.7(6) and 4381.7(7) of the HCS Billing Guidelines and TxHmL Guidelines. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. HCS BILLING GUIDELINES. HCS and TxHmL Stakeholders can now comment to the HCS, TxHmL and CFC Billing Guidelines by July 18, 2021 about the proposed revisions: Proposed Billing Requirements. Participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, the program provider must use the out-of-home bill codes below with the modifiers KX and CR.. February 23, 2022. In the event of a dispute, the policy as written in English is considered the controlling authority. U.S. GOVERNMENT RIGHTS. Applications are available at the American Dental Association web site, http://www.ADA.org. HCS Billing Guidelines Training; HCS Applicant Examinations; HCS/TxHmL Applicant Training; TxHmL Applicant Examinations; Web-based training; Resources for Long-Term Care Providers home; HHS resources. This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. HHSC Releases Guidance Booklet for HCS/TxHmL Providers, https://register.gotowebinar.com/recording/recordingView?webinarKey=3385319749029434640®istrantEmail=javasbja%40gmail.com, Recording of Clarification of Administrative Penalties and Related Processes Webinar Available, Letter: PL 20-55 Administrative Penalties HCS & TxHmL, Hold Harmless Period & Administrative Penalties & Amelioration, 3708-A HCS and TxHmL Amelioration Request, CFC Billing Requirements for HCS and TxHmL Program Providers (PDF), Provider Letter 2021-07, Informal Dispute Resolution (PDF), PL 2020-01, How to File a Complaint Regarding a Surveyor and Report Survey Inconsistencies (PDF), https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/waiver-survey-certification-wsc-provider-portal, PL 20-55 Administrative Penalty Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program Providers (PDF). https://apps.hhs.texas.gov/providers/communications/2020/letters/IL2020-19.pdf. Temporary Change in HCS and TxHmL Policy for Service Providers of Respite and CFC PAS/HAB HCS and TxHmL Billing Guidelines Section 4660(1) and CFC Billing Billable Services In The HCS Program(For HCS) Part IV of the Care Coordination Series (Be sure to attend Part V: Requesting AAs/MHMs /DE Funding on August 3rd, 2023!) Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). The ADA does no t directly or indirectly practice medicine or dispense dental services. Texas HHSC is temporarily waiving certain requirements in Section 3710, 4381.3, 4381.7(6) and 4381.7(7) of the Home and Community-based Services Billing Guidelines and the Texas Home Living Billing Guidelines. T. of the HCS Program Provider Agreement require program providers to comply with the HCS Program Billing Guidelines. H. and II. The PL provides guidance to providers on the rules regarding administrative penalties. HCS BILLING GUIDELINES You can find the newest version on the DADS website: http://www.dads.state.tx.us/handbooks/hcsbg/. 4. HCS Program provider capable of delivering the full array of HCS Program service components. bill. To provide clarity in the interim, the Appendix III Conversion Table has been updated to be a standalone document. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4260, Common Errors No begin and/or end times No location of service provided Reviewing or creating service delivery records Family paying for rate differential No Progress Note, Day Habilitation http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4300, Specific Requirements Day Habilitation Billable Activity The only billable activities for the day habilitation service component are: interacting face-to-face with an individual to assist the individual in achieving objectives to: acquire, retain or improve self-help skills, socialization skills or adaptive skills that are necessary to for the individual to successfully reside, integrate and participate in the community; reinforce a skill taught in school, specialized therapies; and develop opportunities for employment in the community (for example, completing a job application, assessing employment skills and training on employment-related issues); transporting an individual between settings at which day habilitation is provided to the individual; assisting an individual with his or her personal care activities if the individual cannot perform such activities without assistance; participating in a service planning team meeting; participating in the development of an implementation plan; and participating in the development of an IPC. If you have purchased an association plan, an association fee may also apply. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4720, SpecificRequirements Examples of Activities Not Billable under SE The following are examples of activities that are not billable for the supported employment service component: interacting with an individual prior to the individual's employment; conducting employment interest assessments, assisting with or arranging interviews, and completing job applications; interacting with an individual when the individual is not on duty; and transporting an individual to a job interview. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. The CFC Billing Guidelines contain the requirements for Home and Community based-Services (HCS) and Texas Home Living (TxHmL) program providers to be paid for a CFC service, including: 1. service documentation requirements; 2. service claim requirements; 3. restrictions regarding submission of claims; 4. billable and non-billable activities; and 5. T. of the HCS Program Provider Agreement require program providers to comply with the HCS Program Billing Requirements. E/M Introductory Guidelines related to Hospital Inpatient and Observation Care Services codes 99221-99223, 99231-99239, Consultations codes 99242-99245, 99252-99255, Emergency Department Services codes 99281-99285, Nursing Facility Services codes 99304-99310, 99315, 99316, Home or 1 .3 . No other regular survey activities have begun for HCS/TxHmL programs. learning outcomes. If you do not agree to the terms and conditions, you may not access or use the software. General Requirements Applicable Service Components Specialized Therapies Audiology; dietary; occupational therapy; physical therapy; behavioral support; social work; and speech and language pathology. 5. Claims may be affected by other factors, such as state and federal laws and regulations, provider contract terms and our professional judgment. A recording of the March 16, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend. PFD develops payment rates or rate ceilings in accordance with these rules and agency policy guidelines. The HCS, TxHml, and CFC billing guidelines have been updated effective September 1, 2020. intangible, Billing - . Create stunning presentation online in just 3 steps. HHSC Publishes Revision 22-1 of the HCS and TxHmL Program Billing Requirements, CFC Billing Requirements, Home and Community-based Services Program Billing Requirements (PDF), Texas Home Living Program Billing Requirements (PDF), Community First Choice Billing Requirements for HCS and TxHmL Program Providers (PDF). See page two for the current policy under Sections 4320 and 3710. ALL rights reserved. module 3 medicaid rules developed by mary askew, healthcare consultant. Before sharing sensitive information, make sure youre on an official government site. Humana has full and final discretionary authority for their interpretation and application. HCS and TxHmL providers must use the HCS and TxHmL Bill Code Crosswalk starting May 1, 2022 to submit claims for all services. We will be reviewing these in our "Billable Services-HCS-2020" webinar on Sept. 21st, 2020. Contact the HCS Policy Box with questions. WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. For questions about billing guides, contact Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. IL 2022-32is posted on the HHS webpage for Home and Community-based Services, Texas Home Living, local intellectual and developmental disability authority, and financial management services agency program providers. CPT is a registered trademark of American Medical Association. The program provider employs and retains service . Home and Community-based Services Program Billing Requirements (PDF) module 2 medicare rules developed by mary askew, healthcare consultant. module 1 background developed by mary askew, healthcare consultant. TEXAS HOME LIVING (TxHmL) WAIVER PROGRAM PAYMENT RATES EFFECTIVE MARCH 1, 2022 Payment Rate Services Eligible for Rate Enhancement Attendant Compensation All revisions are outlined in the Revision 22-1 Section of each document. host home/companion care to provide day habilitation to the individual at the same time the service provider provides residential support supervised living, or host home/companion care to the individual. You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. All rights reserved. 2, Item c), a program provider must have written documentation to support a service claim for specialized therapies that: meets the requirements set forth in Section 3800, Written Documentation; includes the exact time the service event began and the exact time the service event ended documented by the service provider making the written service log; and for any activity performed by multiple service providers at the same time for the same individual, includes a written justification in the individual's implementation plan for the use of multiple service providers. Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., Humana Medical Plan of Utah, Humana Health Benefit Plan of Louisiana, Inc., CompBenefits Company, CompBenefits Insurance Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., or DentiCare, Inc. (DBA CompBenefits). General Information Department of Aging and Disability Services (DADS) rules at 40 TAC 9.170 set forth requirements for Home and Community-based Services (HCS) Program providers to receive payment for HCS Program services. prepared by: d. ross patrick, md lsuhsc - shreveport. Is there any material outlining how to register for an EDI account? Activities Not Listed in Section 4220 Any activity not described in Section 4220, Billable Activity, is not billable for the specialized therapies service component. Guidelines on the recent updates will help providers create consistent processes to reduce errors and reimbursement delays. HHSC Publishes Revision 21-3 of the HCS and TxHmL Program Billing Requirements and CFC Billing Requirements. Requests can be made by emailing the Billing and Payment unit at hcs.txhml.bpr@hhsc.state.tx.us OR by calling the unit hotline at 512-438-5359. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4471.2, Specific Requirements Specialized Registered and Licensed Vocational Nursing Follow respective sections only for an individual who has a tracheostomy or is dependent on a ventilator. This replaces IL 2022-28. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4760, Common Errors Training not occurring at the job site Pre-vocational training No Progress Note, Nursing http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4400, Specific Requirements Registered Nursing Billable Activity The only billable activities for the registered nursing service component are: interacting face-to-face with an individual who has a medical need for registered nursing, including: preparing and administering medication or treatment ordered by a physician, podiatrist or dentist; assisting or observing administration of medication; and assessing the individual's health status, including conducting a focused assessment or a comprehensive assessment; speaking by telephone with an individual who has a medical need for registered nursing, including assessing the individual's health status; interacting by video conference with an individual who has a medical need for registered nursing, including: observing administration of medication; and assessing the individual's health status, including conducting a focused assessment or a comprehensive assessment; http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4420, Specific Requirements Registered Nursing Billable Activity (cont.)
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