DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Annual Update of the HHS Poverty Guidelines–This notice provides an update of the Department of Health and Human Services (HHS) poverty guidelines to account for last calendar year’s increase in prices as measured by the Consumer Price Index. The guidelines in this 2019 notice reflect the 2.4 percent price increase between calendar years 2017 and 2018. After this inflation adjustment, the guidelines are rounded and adjusted to standardize the differences between family sizes. For more information, go to: https://www.govinfo.gov/content/pkg/FR-2019-02-01/html/2019-00621.htm.
TITLE 22. EXAMINING BOARDS PART 34. TEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS CHAPTER 781. SOCIAL WORKER LICENSURE–The Texas State Board of Social Worker Examiners (board) proposes amendments to §§781.402, 781.405, and 781.413, and repeal and new of §§781.505, 781.509, and 781.603, concerning the licensure and regulation of social workers. The proposed amendments to the rules eliminate the Advanced Practitioner specialty recognition and clarifies requirements for supervision towards licensure, modify the board processing times for applications, and provide a more detailed timeline for participants in the Alternate Method of Examining Competency program. The new rules modify requirements regarding inactive status, continuing education, and the process for complaints, aligned to recommendations set forth by the Sunset Advisory Commission. The amendments to §781.402 will provide specific requirements regarding Licensed Master Social Workers practicing towards Licensed Clinical Social Worker requirements, and remove existing language relating to the Advanced Practitioner specialty recognition. The amendments to §781.405 modifies processing times for applications from 15 working days to 30 working days. The amendments to §781.413 detail more specific guidelines for participants in the Alternative Method of Examining Competency program. For more information, go to: https://www.sos.state.tx.us/texreg/archive/February12019/Proposed%20Rules/22.EXAMINING%20BOARDS.html#6.
Federal News and Information
Common Working File (CWF) Provider Queries National Provider Identifier (NPI) and Submitter Identification (ID) Verification
Change Request (CR) 10983 announces that the Common Working File (CWF) will require verification of the National Provider Identifier (NPI) and Submitter Identification (ID) similar to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) when Medicare Part A providers request Medicare beneficiary eligibility and entitlement data via the CWF provider inquiry screens. This article was revised on January 29, 2019, to reflect an updated Change Request that removed the July 2019 verification effective and implementation dates. To access CR 10983, go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10983.pdf.
Hospice reminder ~ Texas providers cannot utilize a physician assistance as an attending physician until licensure rules have been amended to reflect federal law.
Designated Hospice Attending Physicians
Effective January 1, 2019, Medicare beneficiaries electing the hospice benefit can select physician assistants (PAs) as their attending physicians. According to Change Request (CR) 10517 physician assistants (PAs) are now “recognized as designated hospice attending physicians, in addition to physicians and nurse practitioners (NPs).” Prior to January 1, 2019, only physicians and nurse practitioners (NPs) were allowed as hospice attending physicians. CR 10517 provides the following updates in the Medicare Benefit Policy Manual (Pub. 100-02, Chapter 9 – Coverage of Hospice Services Under Hospital Insurance. This information can be accessed at:
- Change Request (CR) 10517: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R246BP.pdf.
- Medicare Benefit Policy Manual Chapter 9 – Coverage of Hospice Services Under Hospital Insurance: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R246BP.pdf.
Texas News and Information
Health and Human Services Commission (HHSC)
Handbooks Discontinued; Instructions for Requesting Rules
HHSC will NO LONGER maintain rules at its website! Provider letter 19-02 Handbooks Discontinued; Instructions for Requesting Rules contains instructions for using the SOS website to request a rule chapter or subchapter.
- Go to the SOS’s Public Document Request page: http://texreg.sos.state.tx.us/public/pub_doc_request$.startup
- Click on “Agency” corresponding to the appropriate title of the TAC
- Click on “Chapters” corresponding to the appropriate agency name
- Click on “Chapter Request” or, “Subchapters”
- Type in your email address and click “Submit Document Request” on the Chapter Request or Subchapter Request form
It should not take more than a few minutes to obtain the requested rules. For more detailed instructions, go to: https://apps.hhs.texas.gov/providers/communications/2019/letters/PL2019-02.pdf
Texas Medicaid Healthcare Partnership (TMHP)
~Medicaid Hospice, double check Service Group 8
Reminder: Upcoming Changes to Long Term Care Submission of 837 Professional, 837 Institutional and 837 Dental Claims
The current Health and Human Services Commission (HHSC) Long Term Care (LTC) Bill Code Crosswalk allows providers to submit claims with:
- Skipped modifiers (skipped modifier scenarios are defined as any record on the HHSC LTC Billing Code Crosswalk table where a modifier is required and any preceding modifier position[s] is not required or entered).
- Same modifier value in multiple modifier positions on the same Detail Service Line.
Beginning February 1, 2019, to maintain compliance with the Health Insurance Portability and Accountability Act (HIPAA), HHSC and TMHP will implement changes that will no longer allow Duplicate Modifiers and Skipped Modifiers to be submitted on the Same Detail Service Line. As a result, the following changes will be made:
HHSC LTC Bill Code Crosswalk
Updates will be made to the HHSC LTC Bill Code Crosswalk to require that modifiers start in position 1 and any subsequent modifier value will not be the same (duplicate). Note that these Bill Code Crosswalk records will be retroactively changed. Any claims submitted beginning February 1, 2019, will be required to use the updated crosswalk (irrespective of the Date of Service on the claim).
Some of the records used for Electronic Visit Verification (EVV) fee-for-service claims have been updated in this Bill Code Crosswalk.
Click the link below for the published crosswalk:
For detailed information on Claims Entry, Submission of Claims, EDI and other information go to:
TMHP Long Term Care Provider Bulletin
The February 2019 LTC Provider Bulletin has been posted on TMHP.com. Topics covered are: PASRR, LTC Bill Code Crosswalk, changes to the Medicaid hospice forms submission, Medicaid overpayments, webinars and much more. To view the most current edition online, go to: