Data Reimbursement Newsletter

This summer, THCA and THCA members sat on the HHSC QIPP Year 3 stakeholder workgroup which was charged with objectives to increase participation for the QIPP Y3 program and expand quality measures to further improve program outcomes with additional focus on staffing. The workgroup concluded earlier this month with consensus of the following overarching parameters for recommendations to HHSC including an estimated participation eligibility that triples over QIPP Year 2:

• Lower Private Eligibility Threshold – 65% Medicaid Days
• Expanded NSGO relationship criteria
• Expanded QAPI monthly component
• Developed the new monthly Staffing & Workforce Development component
• Modified CMS 5 Star QM’s
• Developed a new NSGO component for Infection Control

Your calls to 2-1-1 can be redirected to more appropriate staff for questions regarding your Medicaid pending applications. When contacting 2-1-1, simply mention that you are a ‘Medicaid provider’ and this will trigger the representative to escalate your call to an HHSC staff member that has been trained to handle provider calls and has access to additional information and notes.

HHSC has an assigned staff member as the agency liaison for each Nursing Facility in Texas. This Facility Contact list includes escalation points for the Facility Contact, their Supervisor, and the Program Manager that oversees the area.

 Medicaid Recertification List

To better support and plan for Medicaid recertifications in your building, your HHSC Facility Contact will provide you a listing of all Medicaid renewal dates upon request (reach out to your Facility Contact to obtain this list).

Over the past year, HHSC Rate Analysis has been piloting cost report reform for certain providers to move to a once-per-biennium cost report submission, rather than an annual submission. The pilot has been perceived by HHSC and other providers as being very successful in reducing administrative burden on providers as well as on the agency.  HHSC is planning to expand this initiative to move all providers to every-other-year cost reporting which would have nursing facilities scheduled for cost report submission in 2019 and then accountability reports to be submitted in “off” years.