OIG Audits & Inspections: Update

by | Oct 28, 2025

October 28th, 2025 OIG Beginning Auditing of Cost Reports If you attended the Office of Inspector General (OIG) session at PPAT’s 28th Annual Conference you may recall Susan Biles, OIG, stating that the OIG’s FY 2026 Work Plan would include auditing HCS/TxHmL cost reports. We have received updated information since their presentation at PPAT, as a result of some of the inquiries during the session.   Some providers have already began receiving requests...

Rider 56:  Appropriate Care Settings for Individuals with Severe and Persistent Mental Illness and Co-Occurring Conditions Study 

by | Oct 27, 2025

October 27th, 2025 HHSC Rider 56 (89th Texas Legislature):  According to HHSC, it’s in the beginning stages of implementation but plans to engage stakeholders in the process in early January as well as publish a communication about the Rider and related implementation plans. Rider 56:  Appropriate Care Settings for Individuals with Severe and Persistent Mental Illness and Co-Occurring Conditions Study.   Out of funds appropriated in Strategy D.2.5, Community...

ICAP Scoring Software Update

by | Oct 27, 2025

October 27th, 2025 ICAP Software:   HHSC reported that the University of Minnesota has acquired the publishing rights to the ICAP from Riverside Publishing.  The University intends to make ‘massive’ revisions to the ICAP which should be completed in the next 4 years. Currently, the University has made ‘technical’ changes to the instructions, which it plans to test before moving forward with other changes.  The University will also make the...

Cameras In Private Areas (HCS Program): Update

by | Oct 23, 2025

October 23rd, 2025 HCS Program & Cameras in Private Areas:  HHSC Medicaid division sent Regulatory staff at HHSC an email informing them that “CMS thinks there’s a privacy concern regarding cameras being allowed in private areas (even if justifications are in place), and that CMS will no longer permit this practice.” According to HHSC, currently, there are no HCS rules specific to this matter.  HHSC stated that more details will be...

Change in IDD Waiver Cost Limits

by | Oct 23, 2025

October 23rd, 2025 New cost limits for the IDD waivers are as follows: For DBMD and CLASS, HHSC updated the individual cost limits from $114,736.07 to $149,774. For TxHmL, HHSC updated the individual cost limit from: $17,000 to $31,684. For HCS, HHSC updated the individual cost limit based on level of need (LON) as described below: Intermittent (LON 1), Limited (LON 5), and Extensive (LON 8) The amount is increasing from $167,468 to $169,182. Pervasive (LON 6) The...