OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION

Transcription

1 OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION HOSTED BY Health and Human Services Commission Office of Inspector General Texas Department of Aging and Disability Services ATTENDEES Health and Human Services Commission Office of Inspector General Texas Department of Aging and Disabilities Services Texas Health Care Association Leading Age Texas Medicaid Coalition And Other Nursing Facility Providers PURPOSE To promote an exchange and dialogue regarding Nursing Facility Reviews between and among the attendees. The group will meet periodically to discuss nursing facilities and to obtain stakeholder input. The discussions at these stakeholder meetings are for informational purposes only and are not binding on the Health and Human Services Commission Office of Inspector General and the Texas Department of Aging and Disability Services or its representatives. March 24, :00 a.m. - noon Texas Juvenile Justice Department Metric Blvd., Building H Lone Star Conference Room Austin, TX I. Welcome I Introduction Ill. Restorative Resource Utilization Group (RUG) Increases during Reviews

2 IV. Encoding Period V. Computer Access OIG Exit Break 10:15-10:30 V VI Long Term Care Medicaid Information (LTCMI) Dx Coding X. Wrap-Up I Conclusion June 23, :00 a.m. - noon Texas Department of Aging and Disability Services 701 West 51 st Street Public Hearing Room #125 Austin, TX I. Welcome / Introduction I IV. Reconsideration Review Process and Appeals ADLs and Supporting Documentation A. ADL documentation completed by CNAs B. ADL documents and flow sheets as the sole source of ADL coding support. Monthly Summary and 60% rule for ADLs V. How long will extrapolations not be applied to MDS 3.0 URs? Concerning documentation on a grid where multiple staff document care (ADL flow Sheet, Medication Administration Records, etc.). If the document contains staff initials but not full signature, is a Master Signature log acceptable as a means to clearly identify the staff member who provided the care to meet TAC requirements.

3 V VI Restorative A. Training Requirements B. Clarification regarding restorative for improvement Respiratory therapy training guidelines RUG Increases during reviews X. OIG Exit XI. Break 10:15 10:30 X XI XIV. XV. X XV Dx Coding Off-site records: Is it possible to obtain all pages of the review when records are off-site? Reconsideration and formal appeal timeframes: Extension of time Review process when a Nurse Reviewer is unable to substantiate a RUG Will there be or has there been any information posted on the OIG website in relationship to the outcome of these stakeholder meetings? Wrap-up / Conclusion September 22, :00 a.m. - noon Texas Department of Aging and Disability Services 701 West 51st Street Public Hearing Room #125 Austin, TX I. Introductions and Logistics of the Meeting I Providers use of MDS 2.0 coding key instead of MDS 3.0 coding key for ADL self-performance and ADL Support Forwarding UR Letters to Other Parties Avoiding HIPAA Violations

4 IV. RN Signatures LTCMI / MDS A. Reviewer s guidance for default on next reviews B. Penalties V. ADL Documentation - CMS ADL workgroup updates Break 10:15 10:30 V VI Restorative A. Discussion for guidance on interpretation of restorative nursing program B. Definition of measureable goals A. PMN B. TMHP C. Denials RUG Review Cycles - Criteria for facilities selection Overview of the Appeal Process X. Conclusion / Wrap-up December 15, :00 p.m. 4:00 p.m. Texas Juvenile Justice Department Metric Blvd. Building H Lone Star Conference Room Austin, TX I. Introductions and Logistics of the Meeting I RN Signatures LTCM/ MDS A. Will the OIG consider not making this a payment item as long as facilities can provide evidence that the RN signing the MDS and the RN on the LTCMI have a valid RN license and RUG training certification? ADL coding (for Cheryl Shiffer) A. CMS ADL workgroup updates B. Why does the algorithm conflict with the written rules? C. Has CMS discussed changing the rule of three so that the MDS can be coded extensive assistance when there is a

5 combination of three or more episodes of total dependence and weight bearing support even though the rule of three might have been met at a lower level? IV. A. Please provide an update regarding the Medical Necessity review process B. How will Permanent be reviewed? V. RUG Review Cycles A. Has every facility gone through a RUG UR? TMC has received feedback from some non-profit facilities that state they have never had a UR. B. Can you review the criteria for facility selection? UR Recoupment Process A. What is the process for Recoupment on RUGs when the claim is in reconsideration or formal appeal? B. How does the OIG determine responsibility when there has been a CHOW during the review period? C. How does the recoupment process work for Closed Facilities? Break 2:30-2:45 V VI Will DADS consider using A1900 as the date of admission to MCD, instead of A1600? MDS Survey A. Can DADS provide a detailed overview of this process? B. Can providers be trained on this process? In some cases, UR Nurse Reviewers are telling providers that they are not allowed to look at documentation prior to handing it over to the reviewers. Can you provide TAC reference that supports this requirement? X. New Appeal Language XI. Address to Send Appeals to DADS X Need for Quarterly Meetings in 2015 XI Conclusion / Wrap-up Contact: Sandra Ging, Office of Inspector General, P. O. Box 85200, Austin, TX , sandra.ging@hhsc.state.tx.us

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