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In a press release today from HHS, Secretary Kathleen Sebelius announced that HHS will initiate a process to postpone the compliance date by which certain health entities have to comply with ICD-10. The press release can be found below.
Press Release: HHS Announces Intent to Delay ICD-10 Compliance Date
As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).
The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.
“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”
ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.
Please visit the ICD-10 website for the latest news and resources from CMS.
In response to financial limitations as well as increased scrutiny at the federal level with regard to the provision of publicly funded vaccines, DSHS has made several changes to vaccines policies in the state. Most notable changes are in regard to patient eligibility for TVFC vaccine, and include the following:
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Children who have private insurance that covers vaccines will no longer be eligible for low cost vaccines in public health department clinics, but instead will be referred to their medical home for immunization services.
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DSHS has adopted the federal eligibility criteria for defining "underinsured" children. The federal criteria include children whose commercial (private) insurance does not cover one or more vaccines or whose insurance caps vaccine coverage at a certain amount (once that amount has been reached, the child is considered underinsured). Underinsured children will continue to receive immunizations from their medical home, Federally-Qualified Health Centers (FQHC), and Rural Health Centers (RHC). Additionally, in early 2012, DSHS will pursue delegation agreements with FQHCs and RHCs that should result in public health clinics also being able to serve underinsured children. Insured children with vaccine coverage who have high copays or deductibles are no longer considered underinsured and are not eligible for TVFC vaccines.
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Individuals who begin a vaccine series at age 18 or younger (and TVFC-eligible), may only finish that series at public health clinics that are Adult Vaccine Safety Net (ASN) providers (typically the public health department), provided the series is completed prior to their 20th birthday. Historically providers have been able to vaccinate these individuals at any TVFC enrolled site.
To read the full memo, as well as to access information about the new standardized forms to be used
to support this revised TVFC policy, please visit: http://txpeds.org/webfm_send/1637.
Changes have also been made to the Adult Vaccine Safety Net program, and those details can be seen at: http://txpeds.org/webfm_send/1639.
Thanks to a unified outcry from the physician community, CMS has announced that they will reverse their previous decision and will be publishing RVUs for CPT Code 96110 (developmental screening).
CMS has published 0.29 total RVUs and revised the code status indicator for 96110 from "X" (Statutory Exclusion) to "N" (Noncovered Service), which now allows non-Medicare payers that cover developmental screening, and base payment on Medicare RBRVS, to continue to do so. For additional details, please see the CMS Bulletin announcing this decision.
Effective December 1st, there are several changes to to benefits for Texas Health Steps preventive medical checkups of which providers should be aware. For complete details, please see the TMHP Medicaid Bulletin.
Effective November 1, 2011, Pfizer has increased their price for Prevnar-13 to $120.20* per dose. In November and December, providers can purchase PCV-13 at the previous cost of $113.40 per dose. Account specific purchase options will be calculated by reviewing purchase history for Prevnar-13. Providers will be eligible to purchase up to 100% of their average monthly purchase history from April 2011 – September 2011. To qualify for this offer, November orders must have a requested delivery date of November 30, 2011 or earlier. December orders must have a requested delivery date of December 29, 2011 or earlier. November and December monthly purchase options cannot be combined and must ship within the respective month. All orders with a requested delivery date after December 29, 2011 will be at the new price of $120.20, regardless of when the order was placed.
You may order above the purchase option in either month; however, the new price of $120.20 per dose will apply. You may place as many orders as you would like in either month, up to your purchase option, at the previous price of $113.40 per dose. Any orders currently in the system prior to November 1st that are above your purchase option will be automatically canceled.
Pfizer provides flexible payment options for vaccines to qualified customers, including individual doctors (Trade Class 01), freestanding dispensaries (Trade Class 07), and doctors in group practices (Trade Class 31). These options include 90 day payment terms with a 2% net discount on invoiced and credit card orders.
For questions regarding purchase options, please contact your Pfizer Vaccines Territory Manager or call Customer Service at 1-800-666-7248.
* A federally mandated excise tax of $0.75 per dose will be added to the standard price.
HHSC has announced tentative award contracts for Medicaid, CHIP, and dental managed care services effective March 1, 2012. Below you will find maps of the new service areas, as well as information on the managed care organizations that will be serving each area.
Service Area Maps:
STAR Service Areas and Medicaid Rural Service Area (MRSA)
Medicaid Rural Service Area Regions
STAR+PLUS Service Area
CHIP Service Areas
MCO Provider Representative Contact Information
The prescription drug benefit will also be included in CHIP and Medicaid managed care effective March 1, 2012. Prescription drug benefits will no longer be paid through HHSC's Vendor Drug Program, but managed care organizations will use the same state drug formulary as Medicaid fee-for-service.
HHSC will be hosting a series of provider trainings in the Managed Care Expansion service delivery areas. These meetings will allow HHSC to present information on managed care and providers will be given an opportunity to ask questions relevant to Medicaid and CHIP services.
There is no cost to attend these trainings. Trainings will be conducted in select cities across the state between September and November 2011 in half-day segments.
For additional information please visit the HHSC Medicaid managed care initiatives webpage at: http://www.hhsc.state.tx.us/medicaid/MMC.shtml.
More info is also available through the TMHP webpage at: http://www.tmhp.com/Pages/PCCM/PCCM_Home.aspx.
The recent World Breastfeeding Week, focusing on communication as a vital component to encouraging breastfeeding, generated a lot of great discussion and information related to promoting this practice. Below are some items of particular interest:
- Breastfeeding support is included in the new ACA guidelines that require health plans to cover certain preventive services for women. Coverage for comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment are specifically named among a variety of women’s health services. For more information, see the HRSA guidelines available online.
- The CDC has recently released their 2011 Breastfeeding Report Card. To see how Texas stacks up to other states and the national average on a variety of indicators related to breastfeeding and support for breastfeeding, please visit: http://www.cdc.gov/breastfeeding/pdf/2011BreastfeedingReportCard.pdf.
- An online broadcast hosted by the University of Albany School of Public Health, Breastfeeding and the New Media, provided tools to help moms who use smart phones easily track their feedings. See below for more details on “apps” for parents and physicians to help promote breastfeeding, as well as information on additional web resources of interest.
Breastfeeding "Apps"
iPhone users: Nursing Tracker
Android users: Breastfeeding Tabulator,
Apps from the Massachusetts Coalition for Breastfeeding which may benefit both healthcare providers and mothers can be found at: http://massbreastfeeding.org/index.php/2009/breastfeeding-management/.
Resources for Parents
La Leche League International: http://www.llli.org/
Women’s Health.gov: http://www.womenshealth.gov/
Breastfeeding.com: http://www.breastfeeding.com/
Loving Support: http://www.lovingsupport.org/
Resources for Providers
Academy of Breastfeeding Medicine: http://www.bfmed.org/
This site includes 23 protocols related to caring for breast feeding mothers and infants that may be of particular interest: http://www.bfmed.org/Resources/Protocols.aspx
LACTMed: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
App (for iPhone and Android): http://toxnet.nlm.nih.gov/help/lactmedapp.htm
Beginning September 1, 2011, specific developmental and autism screening tools will be required by Texas Health Steps.
In September 2009, Texas Health Steps (THSteps) providers began receiving additional reimbursement for THSteps medical checkups when using the following standardized screening tools: Ages and Stages Questionnaire (ASQ), Ages and Stages Questionnaire: Social Emotional (ASQ:SE), Parents Evaluation of Developmental Status (PEDS), and the Modified Checklist for Autism in Toddlers (M-CHAT). This is a reminder that effective September 1, 2011, these tools MUST be used at the ages specified in the table below for a THSteps medical checkup to be considered complete. The additional reimbursement for use of these specific tools will continue to be available. THSteps originally notified providers of this requirement in 2009 when the policy allowing the additional reimbursement became effective.
The Preventive Care Medical Checkup policy implemented September 1, 2009, and outlined these specific recommended ages and tools:
| Ages | Developmental Screening Tool | Autism Screening Tool | ||
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9 months |
ASQ or PEDS |
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| 12 months |
ASQ or PEDS |
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| 18 months | ASQ or PEDS | M-CHAT | ||
| 24 months |
ASQ or PEDS Note: May be completed at 30 months if not completed at 24 months or with provider or parental concern. |
M-CHAT (only if the screening is not completed at 18 months, or with provider or parental concerns) | ||
| 3 years | ASQ, ASQ:SE, or PEDS | |||
| 4 years | ASQ, ASQ:SE, or PEDS |
Providers may submit CPT code 96110 for reimbursement for use of these tools. Modifier U6 must be used for autism screening.
The American Academy of Pediatrics (AAP) states that early identification of developmental disorders is critical to the well-being of children and their families. Developmental screening is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health-care professionals.
AAP, the American Academy of Neurology (AAN), the Child Neurology Society, and other organizations rate the ASQ and PEDS as high quality developmental screening tools. The ASQ, PEDS and M-CHAT all fulfill AAN criteria related to national standardization, reliability, validation against criterion diagnostic tests and accuracy.
More details on these tools and information on integrating the tools into the physician’s practice can be found in the THSteps Online Provider Education module “Using Developmental Screening Tools” at www.txhealthsteps.com. In addition, a “Screening Implementation Worksheet” with practice set-up information is available at Developmental Behavioral Pediatrics Online (www.DbPeds.org). Applying the AAP’s “Developmental Surveillance and Screening Algorithm with a Pediatric Preventive Care Visit” can also help integrate developmental surveillance and screening into practice settings.
For additional information on the THSteps policy, please contact Mindy Schroeder, BSN, RN, Nurse Consultant, Texas Health Steps, Department of State Health Services, at 512.458.7111 x 2102 or via email at mindy.schroeder@dshs.state.tx.us.
In the past two weeks, a child in Houston and two adults in Fort Worth were diagnosed with the measles. Although these cases are believed to have been exposed at an event in Florida, community spread may have occurred from these or other unreported cases. Additionally, the City of Lubbock Health Department is following up on an out of state resident with measles who was seen in a local emergency room. Because of these cases, all healthcare providers in Texas are asked to consider measles in the differential diagnosis of febrile rash illness.
Measles (rubeola) is a highly contagious febrile rash illness caused by a paramyxovirus transmitted via the respiratory route. The incubation period averages 10-12 days, and 14 days from exposure to rash onset (range 7 -18 days). The prodrome generally lasts 2-4 days and is characterized by fever, increasing in stepwise fashion and often peaking at 103°-105°F. Fever is followed by the onset of cough, coryza, and/or conjunctivitis. Koplik spots are considered to be pathognomonic for measles and appear as punctate blue-white spots on the bright red background of the buccal mucosa, occurring 1-2 days before rash to 1-2 days afterwards. The measles rash is a maculopapular eruption that begins at the hairline and gradually proceeds to face and upper neck and from there downward and outward. The maculopapular lesions are generally discrete but may become confluent. Other symptoms of measles include anorexia, diarrhea (especially in infants), and generalized lymphadenopathy. Complications can include otitis media, pneumonia, encephalitis, seizures and death.
A case of measles must be reported immediately to the state or local health department. Do not wait for laboratory confirmation to report the patient. Laboratory testing for measles includes a serological assay for measles IgM and viral isolation (usually from a throat swab). The state or local health department can provide information and assistance on laboratory testing at the DSHS lab or other labs.
If you suspect a patient has the measles, the following steps should be taken:
1. Isolate the patient. In a hospital setting, negative air pressure rooms are recommended.
2. All visitors and staff working with the patient should use airborne precautions.
3. Obtain diagnostic specimens.
4. Report the patient to the health department.
For additional information about this message please contact Rachel Wiseman, (512) 458-7111 extension 2632.
Effective September 1, 2011, Primary Care Case Management (PCCM) Medicaid clients in 28 of the counties contiguous to existing State of Texas Access Reform (STAR) and STAR+PLUS service areas will no longer have PCCM as an option for Medicaid-covered health care services, and they will be transitioned from PCCM to the STAR program or STAR+PLUS Medicaid Managed Care Program. For more details on which counties will be impacted by this change as well as HMO key contact information, please visit the TMHP website.
HHSC is hosting a series of meetings in counties affected by this change to present information to acute care providers about the STAR and STAR+PLUS programs. HMOs will also be in attendance to answer questions and provide contracting information. For a calendar of meetings, please visit: http://www.tmhp.com/TMHP_File_Library/PCCM/STAR%20Expansion%20Training%20Calendar.pdf. For complete details on the expansion on the expansion and important provider information, please go to http://www.tmhp.com/Pages/PCCM/STAR_Expansion.aspx or contact Diane Eberhart at diane.eberhart@hhsc.state.tx.us.
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News
In a press release today from HHS, Secretary Kathleen Sebelius announced that HHS will initiate a process to postpone the compliance date by which certain health entities have...
In response to financial limitations as well as increased scrutiny at the federal level with regard to the provision of publicly funded vaccines, DSHS has made several changes...
Thanks to a unified outcry from the physician community, CMS has announced that they will reverse their previous decision and will be publishing RVUs for CPT Code 96110 (...