Texas Department of Aging and Disability Services
Claims Management
Advisory Council Meeting
August 13, 2008
Welcome/Introductions – Maria Garcia Montoya, Chair, DADS Claims Support
General Updates & Announcements – Maria Montoya, DADS

Membership – Members are requested to email DADS when there are changes to the CMS
Advisory Council membership list, which is posted on the LTC homepage at
http://www.tmhp.com/LTC Programs/: click on CMS Advisory Council Meeting Minutes.

Follow-up Items –
 Linking Contracts. Procedures for linking CLASS contracts were published in the May 2008
Council meeting notes, which are published on the LTC homepage at the address above.
General instructions for all providers were published on Page 12 of the August 2008 LTC
Provider Bulletin.
 Printing the R&S Report. Three options for printing Remittance and Status Reports were
published in the May Council meeting notes and on Page 11 of the August 2008 Bulletin.
 TexMedConnect Implementation. This NPI-compliant replacement for TDHconnect was
successfully implemented on May 24, 2008; all LTC providers are now billing through
TexMedConnect.

Information Letters – DADS has published a number of CMS-related Information Letters since the
May 14, 2008, Council meeting, including those listed below; all DADS Information Letters are
posted at http://www.dads.state.tx.us/providers/communications/letters.cfm:
 CPWC. Letter No. 2008-98, Wheelchair Requests for Nursing Facility (NF) Residents, clarifies
the definition of Customized Power Wheelchairs (CPWC) for NF residents because providers
were sending requests which did not meet this definition to TMHP (the Texas Medicaid &
Healthcare Partnership)
 Year-end/Miscellaneous Claims Processing. Several letters involving the year-end /
miscellaneous claims cutoff information have been published, including #2008-65; 2008-66;
2008-67; 2008-68; and 2008-69.
Letter No. 2008-66 Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing
informed Community Services, Nursing Facility, and Therapy providers of the following claims
processing cutoff times:
 NOON August 15, 2008, Miscellaneous Claims cutoff date
 NOON August 26, 2008, Fiscal Year (FY) 2008 claims processing cutoff date
 5:00 p.m. FY08 deadline for TMHP to receive paper claims.
 August 2, 2008, the earliest FY09 Comptroller payment date

August 2008 LTC Provider Bulletin – The latest Long Term Care Provider Bulletin is available on
the LTC page of the TMHP website, http://www.tmhp.com/LTC Programs/, with information on the
upcoming September 1, 2008, conversion from the Texas Index for Level of Effort (TILE) to the
Resource Utilization Group (RUG), as well as the items mentioned above regarding linking
contracts and the three options for printing R&S Reports.
http://www.tmhp.com
8/13/08 CMS Advisory Council Meeting - Page 1 of 6

CBA Claims – DADS has been researching information received in an August 12, 2008, email
regarding claims rejecting for individuals in Community Based Alternatives (CBA) when they have
not yet been converted to NF Medicaid. Preliminary research indicates this is being caused by
front-end system edits when the system has not yet received the new Medicaid co-insurance
information. The timing has to be worked out between the nursing facility and Medicare. Research
is continuing and Maria will email Tom the additional information.
Texas Index for Level of Effort (TILE) to Resource Utilization Group (RUG) Conversion
Project – Trish Risley, DADS Claims Support
This project is in the final push for implementation on September 1, 2008. Trish provided the following
updates regarding concurrent project tracks:

Rulemaking Track – Providers have asked when the Utilization Review process will begin for
Minimum Data Set (MDS). There will continue to be a 16-month retrospective review, just as TILE
reviews are handled today; MDS reviews will be done after the TILE reviews expire.
 DADS Rules – Adopted August 8, 2008, to be effective September 1, 2008.
 HHSC Rate Analysis Rules – Adopted in August to be effective September 1, 2008.
 OIG Rules – The HHSC Office of Inspector General (OIG) rule changes were published in the
July 4, 2008, issue of the Texas Register. It is anticipated these rules will go into effect in midSeptember 2008.

Training Track – Online and instructor-led training will be offered. These are different types of
instruction and attending one will not provide the information you will need to learn by attending the
other.
1. LTC Online Portal Workshops – These workshops are offered through TMHP. All LTC
workshop materials are available on the LTC homepage.
 NF/Hospice Workshops. The remaining RUGs workshops for NF/Hospice providers include
an online session being conducted on August 25, as well as workshops the last week of
August in Austin, Corpus Christi, Houston/Cypress, and Dallas.
 Community Services/Waivers Workshops. There are three more RUGs workshops for
providers of Waivers services that are being conducted this week (August 13, 14, and 15),
with an online session scheduled for August 18.
In addition, TMHP will host the following two post-implementation RUGs Q&A sessions for
providers to raise questions they have after RUGs have been in effect for 2-3 weeks, and to
hear the answers to questions other providers are asking. To participate, providers must preregister online at http://www.tmhp.com/C18/Workshops/default.aspx or use the links provided
below. See pages 7-8 in the August 2008 Bulletin for additional information about these RUG
Conference Call/Webinar sessions:
 September 15, 2008: LTC RUG/MDS NF/Hospice Q and A Conference Call
 September 22, 2008: LTC RUG Community Waiver Q and A Conference Call
2. Online TSU RUG Training – Online RUG training for registered nurses who complete medical
assessments has been available online since April 1. [Note: Also see Chris Mayfield’s remarks
later in this document regarding automated licensure verification being implemented at the same
time as the RUGs project.] So far about 1831 people have registered for the course available
through Texas State University http://www.txstate.edu/continuinged/programs/RUG-Training.html.
 NF: There are currently 1100 registered; 739 people have completed the course. This
training is required for registered nurses who sign in Section R2a of the MDS Assessment
http://www.tmhp.com
8/13/08 CMS Advisory Council Meeting - Page 2 of 6
that the assessment is complete; however, DADS encourages others who participate in the
assessment process to take this RUGs training also. Effective September 1, 2008, nurses
cannot submit the MDS LTC MI (Medical Information) Section S data if they have not
completed this course. Licensed Vocational Nurses (LVNs) can participate in the training
but federal Resident Assessment Instrument (RAI) guidelines require a registered nurse
(RN) to sign the certification completion.
 Waivers: Currently 192 people have completed the course. In order to sign MDS forms the
following are required to take the Online RUG training offered through TSU:
 Home Health Agency RN – for Community Based Alternatives (CBA) and Community
Waiver Program (CWP)
 PACE RN – for the Program of All-Inclusive Care for the Elderly (PACE)
 Health Maintenance Organization (HMO) RN or Home Health Agency RN – for
STAR+PLUS and Integrated Care Management (ICM) programs
 DADS RN – for Medically Dependent Children Program (MDCP)
3. Online TILE Training – This training will continue for another year because providers could
have some Purpose Code Es through August 2009. This means they need to have a TILE
nurse certified to approve these PC E’s. The training continues to be available online at the
following TSU link: http://www.txstate.edu/continuinged/programs/tile_program.html

Transition Track – Information providers need to prepare for the September 1, 2008, transition is
available online for easy reference.

RUGs website. DADS publishes as much project information as possible at
http://www.dads.state.tx.us/providers/TILEstoRUGs to help providers know what to do and
when to do it. This RUGs site includes:
 RUGs Information Letters. This site includes links to all related DADS Information
Letters, which is a good area to look over.
 RUGs FAQs. A link to frequently-asked questions (FAQs) is on the left side of the
screen – another useful area to monitor.
 RUG Rates. The TEXAS MEDICAID CASE MIX INDEX SET AND RATES includes three
sections:
 Texas Medicaid CMI Set & Raven Instructions – For NFs only, the table is
followed (on Page 3) by written instructions for adding the Texas Case Mix
Index Set to your RAVEN software. The inclusion of the Texas Case Mix Index
Set provides the information your software system needs to calculate your
Texas Medicaid RUG for you. This software is recommended to help your
software stay current, but is not required; it is a convenience available from the
federal Centers for Medicare and Medicaid Services (CMS) to let facilities know
if their software is out of date with the State MDS database. If you use other
third-party software to submit your MDS, contact your vendors for assistance in
adding the Texas Case Mix Index Set. Use of this optional task will assist you in
understanding how your client will fall into the RUG categories. The optional
RUG is calculated and transmitted to the State MDS database. When the RUG
is received along with the MDS assessment into the State database any
discrepancies will be indicated on your validation report.
 Texas Medicaid Nursing Facility RUG Rates – Includes NF 2009 HHSC payment
rates for NFs
 Texas Medicaid Community Services RUG Rates – The Community Services Rates
are located on the TILEs to RUGs website.
http://www.tmhp.com
8/13/08 CMS Advisory Council Meeting - Page 3 of 6


LTC Provider Bulletin. The August 2008 issue was mailed last week. This issue includes lots of
information about the transition from TILEs to RUGs so it is important to review that also. LTC
Provider Bulletins are posted on the LTC homepage of TMHP.com.
Procedure for Transition – Note that there are no changes in the way providers bill claims; National
Revenue codes remain the same.

Nursing Facilities. Beginning September 1, NFs have the option of when to transition, although
it must be done no later than November 30, 2008, either by submitting the next regularly
scheduled MDS assessment or by submitting an MDS quarterly assessment [note that this offcycle submission will adjust the cycle]. The next MESAVs will show RUG levels rather than
TILEs. Note that when a client who currently is on TILE levels transitions to RUG (groups), the
RUG should be entered as a second line item; going forward it would all be on one line. There
is a three-month transition for Nursing Facilities; within 50 days all clients will have an
assessment of some type.

Community Services Waiver Program Providers. For Community Services, providers will
transition at the point when they submit the Medical Necessity and Level of Care Assessment
(MNLOC) upon the Individual Service Plan (ISP) renewal. If there is a significant change in the
client condition, they can submit the MNLOC and the client will be transitioned at that time from
a TILE to a RUG. Community Services providers have up to one year to transition, through
August 31, 2009.

In response to a question, Trish confirmed that the change from TILEs to RUGs will be effective
as of the R2b signature date, rather than at the beginning of the following month as is done
now.

Automation Next Steps. The LTC Online Portal will be unavailable August 24-31, 2008, while
the systems are being converted. This means providers cannot enter Forms 3618, 3619, 3652A, 3071 or 3074. NFs can only submit Purpose Code E 3652 forms; all other Purpose Codes
will be locked from submission. The LTC Online Portal is scheduled to be available for use
effective September 1, 2008.
Effective September 1, MDSs will be pulled on a routine basis (hourly) throughout the day and
will be available for providers to push forward.
TexMedConnect – Chris Mayfield, TMHP Technology Team
TMHP enhancements to TexMedConnect are in the design phase, with proposals being prioritized by
DADS. Two releases are planned: one in the late fall or early winter, and another in January or
February 2009.
Possible changes include:

Looking at the overall R&S Report solution TMHP has provided in order to define improvements

Offering something like true batch functionality for MESAV and CSI reports
Members suggested the ability to select items to be extracted from total results, but learned it is not
possible to do a batch MESAV across multiple accounts.
Since the May meeting of this group, TMHP clarified and posted information on the three types of R&S
Report access on http://www.tmhp.com/ltc Programs/: click on TexMedConnect Claim/Payment Information—
R&S Options, located on the top of the right column.
http://www.tmhp.com
8/13/08 CMS Advisory Council Meeting - Page 4 of 6
Nurse licensure verification will be implemented effective September 1, 2008. For additional
information, refer to the following July 29, 2008, DADS Information Letters:
 No. 2008-100, Verification of Nurse Licensure with the Texas Board of Nursing for Nursing
Facility and Hospice Providers
 No. 2008-101, Verification of Nurse Licensure with the Texas Board of Nursing for Community
Services Providers / Health Plan Organizations
Note: Information on this change was addressed in the TILEs to RUGs LTC workshops TMHP
conducted for NF/Hospice and Community Services/Waivers providers this summer.
Integrated Care Management (ICM) – Lena Brown-Owens, DADS
Lena is in a new position as the Provider Services – Community Services Manager, and introduced one
of her staff, Carolyn Pou, who is now responsible for ICM in DADS. Lena referred providers to the ICM
update published in the August 2008 LTC Provider Bulletin. She also mentioned that the following two
recent DADS Information Letters on ICM are being revised:


No. 2008-08, Integrated Care Management (ICM) Program: Appeal, Fair Hearing and Complaint
Coordination – operational changes are being incorporated. The revised information letter
number will be 2008-112.
No. 2008-47, ICM 1915(c) Waiver Rules, Adaptive Aids, Minor Home Modification and Medical
Supplies Processes – operational changes related to forms completion service authorizations
are being incorporated. The revised information letter number will be 2008-119.
Lena also provided the following contact information:


The email box for providers to report issues is HPO_ICM@hhsc.state.tx.us
Providers should report service coordinator, authorization, or other customer service issues
directly to HHSC by contacting Heather Powell at 512/491-1333 or
Heather.Powell@hhsc.state.tx.us
Procedures are being developed to eliminate a timing disconnect which has recently caused questions
regarding communications involving approved authorizations. Clients have been receiving the State’s
notice of authorization approval when the authorization may not yet have been processed. DADS is
responsible for sending the notice of authorization approval to the consumer, and Evercare is
responsible for sending the notice of authorization approval to the provider agency. However, those
notices are sometimes not being sent at the same time. If providers are contacted by customers who
indicated that they have been approved but those providers have not yet received a notice of
authorization approval from Evercare, the provider should first contact their Evercare service
coordinator. If they are not successful in receiving a response from the service coordinator, they should
contact HHSC [see Heather’s contact information, above]. If the issue is still not resolved or there is no
response from HHSC, providers should contact Carolyn Pou, 512/438-3169,
Carolyn.pou@dads.state.tx.us or Lena Brown-Owens, 512/438-5609,
lena.brownowens@dads.state.tx.us.
STAR+PLUS
Maria reported that DJ Johnson was unable to attend today’s meeting and will be scheduled on the
November 12 agenda to provide a STAR+PLUS update.
http://www.tmhp.com
8/13/08 CMS Advisory Council Meeting - Page 5 of 6
Tentative Agenda for November 12, 2008, Advisory Council Meeting
 General Updates
 STAR+PLUS Update
 TILEs to RUGs
 Integrated Care Management
 Contact Maria.Montoya@dads.state.tx.us to add any other items to this agenda
Planned Council Meetings - 10:00 – 12:00 (unless otherwise announced)
▪
Dates:
Wednesday, November 12, 2008
Wednesday, February 11, 2009
Wednesday, May 13, 2009
Wednesday, August 12, 2009
▪
Location:
Meet in the lobby of TMHP offices:
12365 A (Building 9) Riata Trace Way Parkway
Austin, Tx 78727
http://www.tmhp.com
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