Did You Miss The Last HCS & TxHmL Town Hall Meeting?

by | Apr 14, 2023

April 14th, 2023

April 12, 2023 town hall meeting

  • April topics included:
    • Using the Provider Location Update (PLU) Form for moves/updates
    • Entering Individualized Skills and Socialization in TMHP
    • Highlighting Individualized Skills and Socialization Available Resources
  • Questions and Answers – HCS/TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding the LTC Online Portal for HCS and TxHmL.

You can register for the recorded session at: https://register.gotowebinar.com/register/91533672855255893

PDF handout

The next meeting is May 10, 2023.  We will keep you posted on registration for this webinar.

Next session they will discuss the “Enrollment Process” and Location Code Issues

 

Some highlights during the April 13th, 2023 Town Hall Session: 

Use the Frequently Asked Questions document:
Frequently Asked Questions Home and Community-based Services (HCS)
Texas Home Living (TxHmL) Waiver Programs

 

2022 Cost Reporting:

➢WHERE: 2022 Cost Report Units of Service Information for HCS and TxHmL Programs

➢HOW: 2022 Cost Report Units of Service Tool Information for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs

➢WHO: Contact PFD-LTSS@hhs.texas.gov or (737) 867-7817, if there are questions after reviewing the above notifications

▪Refer to the HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 19 notification for updates including avoiding overbilling for service components limited to 1 unit per day, valid IMT suspension reasons for temporary discharge and billable units on IPC form accommodation for leap year.

Accessing and Using Your Remittance and Status (R&S) Reports
❑ Web R&S (Portal*) report remains available for 90 days after posting. After 90 days, reports are automatically removed from the website and are no longer available to the user.
❑ ER&S report can be downloaded from the FTP server up to 30 days after the report is posted. Once downloaded, it is no longer available for other users. Previously downloaded reports can be recovered by calling the TMHP EDI Help Desk at 888-863-3638, option 4. Turnaround time is by two weeks. Providers can also contact the EDI Help Desk to get credentials to access the FTP server.

❑ BEST PRACTICE: Download and reconcile R&S Reports on a weekly basis, as a claim is reported only once in the Non-Pending section of the R&S Report, after it is finalized.

 

Purpose of PLU Form  (Provider Location Update)

1)To Add location:•Used to create a location. •The address of the new location should not be the same as any existing location codes.  •Location codes must be unique.
2) To Update location: •Only the Location Type and Location effective date is updateable. •The effective date can be changed to a future date but not for today’s date.

3) To End location: •Used when the location does not have any residents and needs to be closed.  •Ensure all individuals have been assigned to a new location before ending a location. If a service location is ended by the provider, it cannot be reopened.  •The provider must add the ended location as a new location to reopen it.

 

 

Avoiding delays in billing when submitting forms for transferred clients

BEST PRACTICE: Review the data auto-populated on the subsequent form (especially the Program Provider section) to ensure that the correct provider is displayed.

 

Common Location Submission Issues

1. When creating a location, the wrong location effective date was entered on the form, and the form moved to ‘Processed/Complete’ status.
a)To correct this:
•Do not end that location and try to add it again.
•Instead, submit a new PLU with the action type ‘Update Location’ to change the effective date.

b)In the event you are still not able to change the effective date, then, you can reach out to UR if this was related to a renewal/ revision. Or reach out to PES if it was related to a transfer.

 

2. Handling PLU forms that are in ‘Pending Dads Review’ status. •Just like any other forms in this status, HHSC will need additional documentation.

For PLU, supplemental documentation must be submitted by email to Survey Operations at HCSFourPersonResidenceRequests@hhs.Texas.gov

 

3. Location Capacity issues with submitted forms:

•Best practice is to check the location Capacity.
•To look for the location capacity information you will use CARE Screen C84 to get the general information.

•This will prevent the forms from being stuck for a long time till the verification is complete.

ISS Info

For information on Provider Training, Webinars, Resources, and more
see:
•Texas Health and Human Services Individualized Skills and Socialization website

•Send HCS/TxHmL/DBMD Policy Individualized Skills and Socialization
Questions to: HCSPolicy@hhs.Texas.gov , TxHmLPolicy@hhs.Texas.gov ,or DBMDPolicy@hhs.Texas.gov

•Send Licensure Policy and Rules Questions to:
LTCRPolicy@hhs.Texas.gov

 

Things to know before billing ISS:
1) You will be authorized for 1,560 hours (max) during an IPC year.
2) Can only bill up to six hours per calendar day.
3) Can only bill five days per calendar day.  (Although you can trade out weekend days for equal amount of weekdays, i.e. Mon, Tues, Weds. Sat and Sun.)
4) Cannot date span on claims.
5) Must use HCPCS code H2014 and bill per hour.
6) Use the bill code crosswalk to see the codes and modifiers needed for the particular Individualized Skills and Socialization service.
7) Rate information can be found at this website Long term Services & Supports |Provider Finance Department (texas.gov)   Select the appropriate Service from the left side menu.

 

 

ISS Units

•Individual Skills and Socialization is an hourly unit, max 1560

•260 DH days= 1560 ISS hrs

•1560 (max) covers the extra day for Leap Year

 

 

As of January 1, 2023, you will automatically get Individualized Skills and Socialization
authorization if you were already getting day habilitation authorization.
•This information can be verified on the MESAV.
•These units for individualized skills and socialization will not be visible on the current
IPC form nor on the dashboard until a revision or renewal IPC is entered.

Any new IPC forms submitted with the effective date on or after 3-1-2023, will have the Individualized Skills and Socialization service (23 or 23V) and not Day Hab (10C) service in the drop-down list.
•If submitting an IPC transfer which has Day Hab and the effective date is on or after 3-1-2023,

You will first need to submit a Revision IPC to end Day Hab.) Once the revision is in a ‘Processed/Complete’ status, then the Transfer IPC can be submitted.

 

Tips for data entry

•Editing an auto-authorization on a revision
•Select Revise IPC
•On Prov/Ind tab, select – begin date, end date, residential type and implementation dates in the drop-down menus

•Make changes on IPC/Cost tab

 

Prorating

•Determine how many days have already been used for dayhab
•Subtract that from 260 (or the number of days requested for dayhab)
260 –55 (days utilized) = 205
•Multiply remaining days by 6 to determine how many hours needed of Individual Skills and Socialization

205 X 6 = 1230