THCA

Volume XXXI, Number 8
August 2016

THCA Meets with HHSC on Eligibility Issues

THCA’s Data / Reimbursement Committee recently met with Health and Human Services Commission (HHSC) staff regarding timely processing of Medicaid eligibility. The committee learned that the agency had modified its business model somewhat in order to streamline the process. Of note:

According to HHSC, the agency’s business model has been updated to process eligibility more quickly. In an attempt to increase efficiency, the policy is to no longer accept phone calls.

Providers can fax problem eligibility cases, with the case number, to HHSC at 877-477-2839. (Initial feedback from some THCA member facilities indicates that this is working fairly well).

Last year, Medicaid eligibility determinations would come through fairly consistently throughout the month with about 30% in the final week of the month. With the change in the agency’s business model, this year about half of the approvals are coming in the final week (generally between the 20th and the 24th).

Each nursing facility will have a designated person to contact for problem cases. (THCA has provided HHSC with a list of its member facilities and the agency is currently trying to determine if it can amend that listing with designated contacts for each facility. If the agency can successfully do this, THCA will immediately post this information on the members-only section of its web site and notify membership that this information is available).