These policies are not intended to address every claim situation. 1, Item c and No. These are scheduled for publication by Sept. 1. copy. They are located on the Long-term Care . This replaces IL 2022-32. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4220, SpecificRequirements Not Billable as Specialized Therapies The following are examples of activities that are not billable for the specialized therapies service component: providing services outside the scope of the service provider's practice; providing services that are performed by a service coordinator or were performed by a former case manager; scheduling an appointment; transporting an individual; traveling or waiting to provide a specialized therapies subcomponent; training or interacting about general topics unrelated to a specific individual, such as principles of behavior management, or general use and maintenance of an adaptive aid or equipment; creating written documentation as described in Section 4260; reviewing a written narrative or written summary of a service component as described in Section 3820; and http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4230, SpecificRequirements Not Billable as Specialized Therapies The following are examples of activities that are not billable for the specialized therapies service component (continued): interacting with: a staff person who is not a service provider; or a service provider of any nursing service component (registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies, if not during a service planning team meeting or during the development of an IPC or an implementation plan. Respite Supported Employment Adaptive Aids Minor Home Modifications Dental Treatments http://www.dads.state.tx.us/handbooks/hcsbg/3000/3000.htm#sec3100, Specialized Therapies http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4200, Specific Requirements Specialized Therapies Audiology services Dietary services Occupational therapy services Physical therapy services Psychology services Social work services Speech and language pathology services http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4200, Specific Requirements Specialized Therapies Billable Activity The only billable activities for the specialized therapies service component are: interacting face-to-face or by video conference or speaking by telephone with an individual, based on the specialized therapies subcomponent provided, to conduct assessments or provide services within the scope of the service provider's practice; interacting face-to-face or by video conference or speaking by telephone with a person regarding a specialized therapies subcomponent provided to an individual, but not with: a staff person who is not a service provider; or a service provider of any nursing service component (registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing), or specialized therapies; writing an individualized treatment plan for an individual's specialized therapies which, for behavioral support services, is a behavior support plan; reviewing documents, except for a written narrative or written summary of a service component as described in Section 3820, to evaluate the quality and effectiveness of an individual's specialized therapies; http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4220, Specific Requirements Specialized Therapies Billable Activity training the following persons on how to provide specialized therapies treatment, including how to document the provision of treatment: a service provider of foster/companion care, residential support, supervised living, supported home living, day habilitation, respite, supported employment or employment assistance; or a person other than a service provider who is involved in serving an individual; reviewing documents in preparation for the training described in the bullet above; participating in a service planning team meeting; participating in the development of an implementation plan; participating in the development of an IPC; and http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4220, Specific Requirements Specialized Therapies Billable Activity for behavioral support services, in addition to the activities listed above: assessing the targeted behavior so that a behavior support plan may be developed; training of and consulting with an individual, family member or other persons involved in the individual's care regarding the implementation of the behavior support plan; monitoring and evaluating the effectiveness of the behavior support plan; modifying, as necessary, the behavior support plan based on the monitoring and evaluation of the plan's effectiveness; and educating an individual, family members or other persons involved in the individual's care about the techniques to use in assisting the individual to control maladaptive or socially unacceptable behaviors exhibited by the individual. This replaces IL 2022-28. T. of the HCS Program Provider Agreement require program providers to comply with the HCS Program Billing Guidelines. Also, Sections II. HHSC Publishes Revision 21-3 of the HCS and TxHmL Program Billing Requirements and CFC Billing Requirements. HCS program providers may, if an individual in the HCS Program is receiving day habilitation in the individuals temporary or permanent residence, allow the individuals service provider of residential support, supervised living, or. Specific Requirements Nursing Unit of Service 15 Minute of Service A service claim cannot be made for a fraction of a unit of service Accumulation of Service Times Can be accumulated for nursing provided to one individual on a single calendar day http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4450, Common Errors Billing for creating and reviewing service records. electronically submit billing, make inquiries, and enter an individual's information. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. We will be reviewing these in our Billable Services-HCS-2020 webinar on Sept. 21st, 2020. 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. These policies are made available to provide information on certain Humana claims payment processes. HCS Billing Guidelines Revised-Sept. 2020. module 3 medicaid rules developed by mary askew, healthcare consultant. Get powerful tools for managing your contents. A recording of the March 19, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend. HCS Rules, Manuals & Fees. 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. All rights reserved. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. HHSC revised PL 2021-26 to reflect updates to the HCS or TxHmL Program Manager and Assistant Regional Director contact list. Texas Health & Human Services Commission. The extension for temporary policy for In-Home DH goes through June 30th, 2022 now. Register for the webinar. Copyright 2016-2023. The Health Care Services cost containment calculations for the 2021 Rule Set are posted below. You have the updated ppt. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. You can find the newest version on the DADS website:. Provider Marketing Guidelines; Provider Relations; Rate and Code Updates; TexMedConnect and My Account Guides; Quick Reference Guides; Contact; My Account; Provider; Client/Cliente; Search Search . The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. HCS Billing Guidelines Training. 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. H. and II. 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. TEXAS HOME LIVING (TxHmL) WAIVER PROGRAM PAYMENT RATES EFFECTIVE MARCH 1, 2022 Payment Rate Services Eligible for Rate Enhancement Attendant Compensation The HCS and TxHmL Bill Code Crosswalk includes new bill codes for the services that require electronic visit verification. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. The .gov means its official. HHSC has published a revision to this guidance inIL 2022-36 In-Home Day Habilitation Information for Program Providers for COVID-19 (PDF). For HCS program providers: Providing out-of-home day habilitation or in-home day habilitation in a host home or companion care setting, program providers must use the out-of-home day habilitation bill codes. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements. [Content_Types].xml ( ]k0F#VQF^r+*q"/;S[gU. CPT only copyright 2022 American Medical Association. Thanks. For more information please contact Meghan Jones to register: meghanjones.tx@gmail.com If you attended the recent Billable Nursing Services training in August (Part I and II) we did add these to your handouts at the time of the training. 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. In conjunction with these training opportunities, HHSC has developed acomprehensive guidance booklet (PDF)that captures the training content in a user-friendly format. Enrollment and Transfer IPCs. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. CPT is a registered trademark of American Medical Association. Texas Fee-for-Service HCS Rates - Page 3 of 19. CMS-1500 (08-05) Billing Guidelines - . These policies are made available to provide information on certain Humana claims payment processes. 2021 Rules Manual and Fees. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4471.3. Humana group life plans are offered by Humana Insurance Company or Humana Insurance Company of Kentucky. This information about reimbursement methodologies and acceptable billing practices may help health care providers bill claims more accurately to reduce delays in . TMHP revisions. Claims may be affected by other factors, such as state and federal laws and regulations, provider contract terms and our professional judgment. In-person training on the HCS Billing Guidelines is available upon request. Children's Health Insurance Program (CHIP). For a link to the recording of this session and a copy of the handouts, you can email: Shelley.Gusky01@hhs.texas.gov. 5. The HCS and TxHmL Bill Code Crosswalk includes new bill codes for the services that require electronic visit verification. Residential Assistance Foster/Companion Care; Residential Support; Supervised Living; and Supported Home Living. The Billing Requirements are located on theLong-term Care Providers webpageandHandbooks webpageand are outlined below: Section 4 ofHouse Bill 3720, 87th Legislature, Regular Session, 2021, requires HHSC to develop guidelines for regulatory staff and providers regarding the imposition of administrative penalties. The scope of this license is determined by the ADA, the copyright holder. Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. These policies are not intended to address every claim situation. interacting face-to-face or by video conference or speaking by telephone with a person regarding the health status of an individual, but not with: a staff person who is not a service provider; or a service provider of any nursing service component (registered nursing, licensed vocational nursing, specialized registered nursing or specialized licensed vocational nursing) or specialized therapies; 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 licensed vocational nurse justifies, in writing, the need for the licensed vocational nurse to perform the activity; http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4471.2, Specific Requirements Licensed Vocational Nursing Billable Activity (cont.) instructing a service provider, except a service provider of registered nursing or specialized registered nursing, on a topic specific to an individual such as choking risks for an individual who has cerebral palsy; participating in a service planning team meeting; participating in the development of an implementation plan; and participating in the development of an IPC. of the Home and Community-based Services Billing Guidelines and the Texas Home Living Billing Guidelines. A minimum one-year, initial contract period may be required for some dental and vision plans, excluding Dental Savings Plus. All rights reserved. http://www.dads.state.tx.us/handbooks/hcsbg/4000/4000.htm#sec4370, Common Errors Individual sleeping Not signing individual out of Day Habilitation for other services provided (NU, SHL, etc.) Provider Fiscal Compliance. participating in a service planning team meeting; participating in the development of an implementation plan; and participating in the development of an IPC. Also, Sections II. 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 CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611.
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