Long-Term Care

LTC Provider Bulletin, No. 84 November 2020

Long-Term Care

Provider Bulletin

Trending Now 2

COVID-19 Updates and Resources .........................................................................2

Cures Act EVV Expansion for Medicaid Personal Care Services .............................................3

Training and Events 4

Updated Electronic Visit Verication Training Requirements Checklists .....................................4

Update - 2020 Quality in Long-Term Care Conference ......................................................4

Joint Training Opportunities ..............................................................................5

Online Training Courses Now Available in the HHS Learning Portal .........................................6

Computer-Based Training on the Texas Medicaid & Healthcare Partnership Learning Management System ..7

Webinars Available for Nursing Facility, Hospice, Community Services Waiver Programs Providers,

and MCOs ...............................................................................................8

Reminder for Resource Utilization Group Training Requirements ...........................................8

Reminders 9

Quality Assurance Performance Improvement (QAPI) and Resident Safety – Roadmap to Quality ............9

Eligibility Information Available for Hospice Providers .....................................................9

Local Authority Evaluator Process to Search and Access Form Types .......................................10

Claims Identied for Potential Recoupment Reports Available ............................................ 11

Visit the Texas Nursing Facility Quality Improvement Coalition Facebook Page ............................. 11

Proper Handling of Medicaid Overpayments by LTC Fee-for-Service Providers .............................12

Long-Term Care Home Page on TMHP.com ..............................................................13

Provider Resources 14

Provider Relations Representatives ......................................................................14

TMHP LTC Contact Information ..........................................................................15

Electronic Visit Verication (EVV) Contact Information ....................................................16

MCO EVV Contact Information ...........................................................................18

Electronic MDS Submissions Contact Information ........................................................19

HHSC Contact Information ..............................................................................19

Acronyms In This Issue ..................................................................................23

Use of the American Medical Association’s (AMA) copyrighted Current Procedural Terminology

(CPT) is allowed in this publication with the following disclosure: “Current Procedural

schedules, basic units, relative values, or related listings are included in CPT. e AMA assumes

no liability for the data contained herein. Applicable Federal Acquisition Regula tion System/

Department of Defense Regulation System (FARS/DFARS) restrictions apply to gov ernment use.”

e American Dental Association requires the following copyright notice in all publications

containing Current Dental Terminology (CDT) codes: “Current Dental Terminology (including

T N

LTC Provider Bulletin, No. 84 2 November 2020

Trending Now

COVID-19 Updates and Resources

e Quality Monitoring Program (QMP) continues to support nursing facilities (NFs) as

they care for the people living in their facilities, through both telephonic and on-site visits.

It is important for all providers to stay up-to-date with all guidance and recommendations

from the CDC, HHSC, and DSHS. Below are key resources for providers:

HHSC

• HHSC COVID-19 Provider Resources

• COVID-19 Response for Nursing Facilities

Texas Department of State Health Services

• Hospitals and Healthcare Professionals

• COVID-19 Dashboard

Centers for Disease Control and Prevention

• Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes

• Preparing for COVID-19 in Nursing Homes

• NHSN LTCF COVID-19 Module

• Infection Control Guidance for Healthcare Professionals about COVID-19

• Discontinuation of Transmission-Based Precautions for Patients with COVID-19

• Criteria for Return to Work for Healthcare Personnel with Suspected or

Conrmed COVID-19

• Optimizing Supply of PPE and Other Equipment During Shortages

• Sequence for Donning and Dong PPE

For questions, or to receive assistance from a QMP sta member, email QMP@hhsc.state.

tx.us or your assigned Technical Assistance Advisor. n

Need Help Navigating the

LTC Online Portal?

Need Help Navigating the

LTC Online Portal?

Click HERE to access the LTC Online

Portal Basics Computer Based Training (CBT)*

*Login Required

LTC Provider Bulletin, No. 84 3 November 2020

Trending Now

Cures Act EVV Expansion for Medicaid

Personal Care Services

By January 1, 2021, Texas Health and Human Services Commission (HHSC) will implement the 21st

Century Cures Act Electronic Visit Verication (EVV) requirement for Medicaid personal care services not

currently required to use EVV by state law. HHSC already requires EVV for about 90 percent of Medicaid

personal care services.

To conrm if a Medicaid personal care service is subject to the Cures Act EVV requirement, refer to pages

1-2 of Programs and Service Delivery Options Required to Use EVV.

Updated Cures Act EVV Expansion Timeline

roughout the 2020 calendar year, program providers and nancial management services agencies

(FMSAs) must take action to meet the EVV start date by January 1, 2021. Refer to the Cures Act EVV

Expansion Timeline on the HHS 21

Century Cures Act EVV web page for more information and next

steps.

EVV Practice Period

From July 1, 2020, through November 30, 2020, an EVV practice period will allow program providers and

FMSAs impacted by the 21st Century Cures Act to practice using the EVV system, EVV Portal, and EVV

claims matching. Consumer directed services (CDS) employers can practice using the EVV system.

Note: EVV claims will not be denied for a mismatch during the practice period.

Beginning December 1, 2020, all service visits for an EVV-required service must be captured in the EVV

system. Claims that don’t have a matching EVV visit transaction in the EVV Portal will be denied.

Refer to the May 22 article for more information about the practice period. n

T  E

LTC Provider Bulletin, No. 84 4 November 2020

Training and Events

Updated Electronic Visit Verication

Training Requirements Checklists

Per HHSC policy, program providers currently required to use EVV by state law must

complete EVV policy and EVV Portal training annually. To help meet these annual

training requirements, the Existing EVV: Training Requirements Checklists have been

updated with more detailed information about training for program providers and service

attendants using an EVV vendor system from the state EVV vendor pool, or an EVV

proprietary system.

Additional Training Resources

Program providers may also refer to the HHSC EVV website and the TMHP EVV website

for job aids, quick reference guides, the EVV Tool Kit, and webinar presentations about

EVV policy, the EVV Portal, and EVV claims submission and billing.

Questions? Email Electronic_Visit_Verication@hhsc.state.tx.us or refer to the EVV

Contact Information Guide for a complete list of topics and points of contact for

EVV-related questions and issues. n

Update - 2020 Quality in Long-Term

Care Conference

Due to the COVID-19 pandemic, Health and Human Services made the decision to move

forward with an online Quality in Long-Term Care conference.

e conference presentations are available on the HHS Learning Portal, and can be

accessed through August 2021. To obtain a certicate of completion, participants must

view the selected presentation(s), and complete the associated learning quizzes and course

evaluations. e certicate, noting any continuing education hours awarded, can be

downloaded from the HHS Learning Portal.

In June 2020, the Texas Nurses Association ended the practice of reviewing and approving

continuing education for nurses. HHS received approval to award continuing education

credit through the Louisiana State Nurses Association (LSNA), an Accredited Approver

through the American Nurses Credentialing Center. Continuing education hours awarded

through the LSNA will be accepted by the Texas Board of Nursing.

Questions can be emailed to QMP@hhsc.state.tx.us. n

Joint Training

Opportunities

Health and Human Services

Commission Education

Services provides a variety

of training sessions by

webinar for both providers

and surveyors. e training

calendar is updated

frequently. n

Dr. Tracie Harrison

Coronavirus (COVID-19)

For information about this rapidly

evolving situation, check the

website at TMHP.com by clicking

below.

www.tmhp.com/topics/covid-19

LTC Provider Bulletin, No. 84 5 November 2020

Training and Events

Center for Excellence in Aging Services

and Long-Term Care

e Center for Excellence in Aging Services and Long-Term Care

(Center) is a partnership between the Health and Human Services

Commission and the University of Texas at Austin School of Nursing.

e Center oers a web-based platform for the delivery of best

practices, with a focus on geriatrics and disabilities. e content

on the website has been adapted to meet the educational needs of a

variety of professionals who provide care to residents of long-term

care facilities in Texas.

Under the leadership of Dr. Tracie Harrison, the Center is an

educational platform for the delivery of geriatric and disability best

practices to providers of long-term care. Phase V - Infection Control

is now available and includes an interactive review of the key concepts

of infection prevention and control in long-term care facilities.

e Center has recently hosted several webinars related to COVID-19:

• Hearing Loss, Communication and Mental Health

• COVID-19 in Black America

• Infection Control and COVID-19 in LTC

Visit the Center for Excellence in Aging Services and Long-Term Care website for more information.

Registration is free. n

LTC Provider Bulletin, No. 84 6 November 2020

Training and Events

Online Training Courses Now Available in

the HHS Learning Portal

Four online training opportunities are now available through the HHS Learning Portal:

• Feeding Assistant Training - is curriculum was developed for use by participants in a feeding

assistant training class and includes both instructor-led and online components. e goal is for residents

to receive more assistance with eating and drinking to help reduce the incidence of unplanned weight

loss and dehydration. is course must be taught by a licensed health professional (physician; physician

assistant; nurse practitioner; physical, speech, or occupational therapist; pharmacist; physical or occupa-

tional therapy assistant; registered professional nurse; licensed vocational nurse; licensed dietitian;

or licensed social worker) or registered dietician, and participants must demonstrate safe feeding

techniques by performing two feedings in the Module 9 Practicum under the observation of a licensed

nurse.

• Advanced CNA Academy – iscomprehensive, ve-module online coursewill provide nursing facility

stawith thorough and sustainable education, information, and resources related to the Advanced

Certied Nursing Assistant (CNA). Individual modules examine the role of the CNA in providing

quality care, nursing facility rules and regulations, quality care for geriatric residents and residents

with intellectual and/or developmental disabilities or mental illnesses, the role of CNAs in supporting

resident assessments, and the safety and well-being of residents. Both a nal exam and a training survey

are required as part of the course. is online course has been approved for 6.0 hours of continuing

education credit by HHSC for CNAs. HHSC is an approved provider of continuing education credits for

CNAs as governed by 26 TAC Chapter 556, Section 556.9(3)(C).

• PASRR in the Nursing Facility – A new online Preadmission Screening and Resident Review (PASRR)

course for nursing facility (NF) sta is now available. is nine-module, comprehensive online course

will provide thorough and sustainable education, information, and resources that are needed to

successfully complete all NF responsibilities related to the PASRR process. In addition, this training

will detail the complexities of caring for residents with intellectual or developmental disabilities, mental

illness, or both. is course has been approved for 7.0 hours of continuing education credit by HHSC

for the following professions: licensed social worker, licensed professional counselor, licensed marriage

and family therapist, licensed nursing facility administrators, nursing facility activity directors, qualied

intellectual disability professionals, certied nurse aides, and licensed psychology professionals.

• Meaningful Engagement to Enhance Quality of Life – Designed for nursing facility activity directors,

licensed nurses, certied nurse aides, and ancillary sta, this online training explains evidence-based

best practices to help sta develop meaningful and relevant person-centered activity programs and

implement individualized activities that reect each resident’s preferences, customary habits, and

lifestyle. is online course has been approved for 4.0 hours of continuing education credit by HHSC for

the following professions: CNAs and nursing facility activity directors.

To take these courses, visit the HHS Learning Portal and create a secure user account. Aer creating

your account, navigate the portal to nd the course, or use the course links provided above.

Email questions to QMP@hhsc.state.tx.us. n

LTC Provider Bulletin, No. 84 7 November 2020

Training and Events

Computer-Based Training on the Texas

Medicaid & Healthcare Partnership

Learning Management System

e following long-term care (LTC)-specic computer-based training (CBT) courses are currently

available on the Texas Medicaid & Healthcare Partnership (TMHP) Learning Management System

(LMS):

LTC Online Portal Basics

is interactive CBT provides a basic overview of the LTC Online Portal, including information about

creating an administrator account, and an overview of the features of the blue navigational bar and

the yellow Form Actions bar. Demonstrations and simulations appear throughout the CBT to provide

opportunities for an interactive experience.

TexMedConnect for Long-Term Care (LTC)

Providers

is CBT demonstrates eective navigation and use of

the LTC TexMedConnect web application. Providers

will learn how to:

• Log in to TexMedConnect.

• Verify a client’s eligibility.

• Enter, save, and adjust dierent types of claims.

• Export Claim Data.

• Find the status of a claim.

• View Remittance and Status (R&S) Reports.

Accessing the TMHP LMS

e TMHP LMS can be accessed through the TMHP

website or directly at http://learn.tmhp.com.

Users must have a user name and password to access CBTs and LTC webinar recordings in the LMS.

To obtain a user name and password, providers must create an account by clicking the Don’t have an

account? Sign up here. link on the LMS home page. Aer creating an account, providers can access all

available training materials in the LMS.

For questions about the LTC training CBTs and webinars, call the TMHP Help Desk/Call Center at

800-626-4117 or 800-727-5436. For LMS login or access issues, email TMHP Learning Management

System (LMS) support at TMHPTrainingSupport@tmhp.com. n

The TMHP Learning

Management System

(LMS) has a number of

online trainings that

LTC providers will find

helpful.

LTC Provider Bulletin, No. 84 8 November 2020

Training and Events

Webinars Available for Nursing Facility,

Hospice, Community Services Waiver

Programs Providers, and MCOs

Long-term care (LTC) training sessions are available in webinar format. LTC providers are able to take

advantage of live, online training webinars, as well as replays of those webinars, that cover topics relevant

to tasks performed on the LTC Online Portal. ese webinars target nursing facility (NF) and hospice

providers, Community Services Waiver Programs providers, and managed care organizations (MCOs).

e webinars that are currently oered include:

• LTC Community Services Waiver Programs Webinar - Provides information that assists Community

Services Waiver providers with using the LTC Online Portal to complete and submit the Medical

Necessity and Level of Care (MN/LOC) Assessment

• LTC Form 3618: Resident Transaction Notice and Form 3619: Medicare/Skilled Nursing Facility Patient

Transaction Notice Webinar

• LTC Nursing Facility Minimum Data Set (MDS) Assessment and Long-Term Care Medicaid

Information (LTCMI) Webinar

• LTC Nursing Facility PASRR Webinar, Part 1

• LTC Nursing Facility PASRR Webinar, Part 2

• LTC Hospice Form 3071 Election/Cancellation/Discharge Notice and 3074 Physician Certication of

Terminal Illness Webinar

For a list of webinar descriptions, upcoming broadcast dates, registration links, recordings of past webinars,

and Q&A documents, visit the TMHP Learning Management System (LMS) at https://learn.tmhp.com. n

Reminder for Resource Utilization Group

Training Requirements

Providers are reminded that Resource Utilization Group (RUG) training is required for registered nurses

(RNs) who sign assessments as complete. RNs must successfully complete the required RUG training

to be able to submit Minimum Data Set (MDS) and Medical Necessity and Level of Care (MN/LOC)

Assessments on the Long-Term Care Online Portal. Training is valid for two years and must be renewed by

completing the online RUG training oered by Texas State University.

It can take from two to seven business days to process and report completion of RUG training from Texas

State University to the Texas Medicaid & Healthcare Partnership (TMHP), depending on current volume of

enrollments and completions.

To register for the RUG training, or for more information, visit www.txstate.edu/continuinged/CE-Online/

RUG-Training.html. n

LTC Provider Bulletin, No. 84 9 November 2020

Reminders

R

Quality Assurance Performance

Improvement (QAPI) and Resident

Safety – Roadmap to Quality

Although the regional conferences have ended, the HHS Quality Monitoring Program will

continue to oer support for NFs as they work on improving their QAPI programs. Nursing

facilities can also request reviews of their QAPI plans. For individual consultation regarding

your facility’s QAPI program, contact Sheila Shepherd, MSN, RN, by email, by phone

512-438-5577, or by text 850-867-8669. n

Eligibility Information Available for

Hospice Providers

As a reminder, hospice providers seeking eligibility information can pull Medicaid

Eligibility and Service Authorization Verication (MESAV) using any of the following eld

combinations through TexMedConnect. is service can be accessed 24 hours a day, 7 days

a week.

• Medicaid/Client No. and Last Name

• Medicaid/Client No. and Date of Birth

• Medicaid/Client No. and Social Security Number

• Social Security Number and Last Name

• Social Security Number and Date of Birth (DOB)

• Last Name, First Name, and DOB

Listed below are the most common eligibility types that are valid for hospice services:

Program Type Coverage Code

Type 12, 11 P

Type 13, 51 R

Type 01, 03, 07, 08, 09, 10, 14, 15, 18, 19, 20, 21, 22,

29, 37, 40, 43, 44, 45, 46, 47, 48, 55, 61, 63, 67

R or P

For more information on TexMedConnect and utilizing MESAV, call the TMHP

Long-Term Care Help Desk at 800-626-4117, Option 1. n

Search Criteria

Combinations:

1. Medicaid Number

2. Social Security number (SSN)

and person’s last name

3. SSN and date of birth (DOB)

4. DOB, person’s rst name, and

person’s last name.

LTC Provider Bulletin, No. 84 10 November 2020

Reminders

Local Authority Evaluator Process to

Search and Access Form Types

Beginning April 23, 2020, some Local Authority (LA) users at each center gained the ability to search

and access additional form types to aid with completing a Preadmission Screening and Resident Review

(PASRR) Evaluation (PE) using the Power Search function

on the Long-Term Care (LTC) Online Portal.

To perform these searches, the LA users MUST request a

NEW LTC Online Portal user name (dierent from their

current one) from their center’s system administrator. e

system administrator is required to enter a unique email

address for each LTC Online Portal user name due to Health

Insurance Portability and Accountability Act (HIPAA)

restrictions.erefore, a new email address needs to be

requested from the IT contact at the LA before the system

administrator can create the new LTC Online Portal user

name for the new access permission. When creating the new

LTC Online Portal user name, the system administrator

MUST grant the LA Evaluator prole/security permission

ONLY.Following this procedure will ensure that the ability

to search and access additional form types for a specic

person will be available for the new user name.

Note: e system administrator may decide to create one LTC Online Portal user name with the

new access permission that can be shared among multiple LA users, which would reduce the number

of unique email addresses that need to be created.For those who added this permission to their

traditional LA LTC Online Portal user name and experienced issues,you will need to remove the LA

Evaluator prole/security permission from this traditional LA user name.en follow the instructions

above to create the new user name with only the LA Evaluator prole/security permission.

Once the new user name is available, the user will then need to enter one of the following valid search

criteria combinations to access forms:

• Medicaid Number; OR

• Social Security number (SSN) and person’s last name; OR

• SSN and date of birth (DOB); OR

• DOB, person’s rst name, and person’s last name.

Note: If users enter invalid search criteria combinations, they will receive an error message and no

forms will be returned. Forms returned using the correct identifying information will be view-only

(not editable) but can be printed.

For more information, call the TMHP Long-Term Care Help Desk at 800-626-4117, Option 1. n

LTC Provider Bulletin, No. 84 11 November 2020

Reminders

Claims Identied for Potential

Recoupment Reports Available

Providers are reminded that TMHP generates the Claims Identied for Potential Recoupment

(CIPR) Provider Report on a weekly basis, and TMHP maintains each CIPR Provider Report for six

months aer it is generated. Reviewing the CIPR Provider Report regularly helps providers avoid

unexpected recoupments. e CIPR Provider Report lists claims that have been identied for potential

recoupment as a result of TMHP identifying new or changed long-term care-relevant insurance

policies for clients with paid claims during the policy coverage period. e CIPR Provider Report lists

potentially impacted claims and the insurance company information for the corresponding long-term

care-relevant policy.

For each claim identied on the CIPR Provider Report, providers must le a claim with the appropriate

third-party insurance for the services previously paid by Medicaid. Aer receiving the response from

the third-party insurance, providers must then adjust the claim listed on the CIPR Provider Report and

include the Other Insurance (OI) Disposition information received from the third-party insurance. For

more information about OI billing information, consult the Long-Term Care User Guide for TexMed-

Connect beginning on page 102. e User Guide provides information on how to submit a claim,

adjusting claims, viewing Other Insurance on the Medicaid Eligibility and Service Authorization

Verication (MESAV), and how to ll out the Other Insurance/Finish Tab section of the claim.

A claim will continuously appear on the CIPR Provider Report until it is adjusted with a valid OI

disposition reason. If a claim identied on the CIPR Provider Report is not adjusted within 120 days

from the date the claim rst appeared on the CIPR Provider Report, then the Health and Human

Services Commission (HHSC) will recoup the previously paid claim.

Contact Information

For questions about submission of long-term care fee-for-service claims and adjustments, call the

TMHP Long-Term Care (LTC) Help Desk at 800-626-4117, Option 1.

For questions about Other Insurance information, including OI updates and OI MESAV discrepancies,

call the TMHP LTC Help Desk at 800-626-4117, Option 6. n

Visit the Texas Nursing Facility Quality

Improvement Coalition Facebook Page

e Quality Monitoring Program (QMP) and the TMF Quality Improvement Organization continue to

collaborate on the Texas Nursing Facility Quality Improvement Coalition Facebook page. Many great

resources and educational opportunities are shared on this Facebook page, designed to improve the

quality of care and quality of life for all people residing in a Texas nursing facility. In addition, this page

is a means of communicating updates on current and future initiatives.

Like and follow the Texas Nursing Facility Quality Improvement Coalition Facebook page today! n

LTC Provider Bulletin, No. 84 12 November 2020

Reminders

Proper Handling of Medicaid Overpayments

by LTC Fee-for-Service Providers

It is important for providers to follow proper procedures when a Medicaid overpayment has been

discovered. e correct way to refund money to the Health and Human Services Commission (HHSC)

for a long-term care (LTC) fee-for-service (FFS) Medicaid overpayment always starts with a claim

adjustment.

Claim adjustments that have processed to Approved-to-pay (A) status will automatically refund money

to HHSC by reducing payments for future billing. Claims that process to Transferred (T) status will

require repayment by check or by deduction; deductions are set up by HHSC Provider Recoupments

and Holds. If the adjustment claim processes to T status or the provider is no longer submitting

new LTC FFS claims to oset the negative balance, then the provider should call HHSC Provider

Recoupments and Holds to determine the appropriate method for returning the money. Providers

should always contact HHSC Provider Recoupments and Holds before submitting a check for an

overpayment.

ings to remember:

• To return an LTC FFS Medicaid overpayment to HHSC, providers should always process an

adjustment claim in TexMedConnect or via their third-party submitter. Some examples of

overpayments requiring an adjustment claim include:

◦ Original paid claim was billed with too many units of service.

◦ Original paid claim did not properly report LTC-relevant Other Insurance payments or coverage.

◦ Original paid claim was billed with the wrong revenue code and/or Healthcare Common

Procedure Coding System (HCPCS) code.

• If submitted properly, LTC FFS claim adjustments to return money to HHSC will not deny for the

one-year claim ling deadline edit (Explanation of Benets [EOB] F0250).

◦ LTC FFS claim adjustments must include a negative claim detail to oset the original paid claim

and a new claim detail to repay the claim at the correct (lower) amount. e net total of the

adjustment claim must be negative.

• Providers SHOULD NOT use TMHP Form F0079 Texas Medicaid Refund Information Form to

report LTC FFS overpayments. is form is exclusively used for acute care claims.

Contact Information:

Entity What they can do…

TMHP LTC Help Desk

800-626-4117, Option 1

• Assist with ling an adjustment claim

• Assist with understanding the provider’s Remittance

and Status (R&S) Report

LTC Provider Bulletin, No. 84 13 November 2020

Reminders

Entity What they can do…

HHSC Provider Recoupments and

Holds

512-438-2200, Option 3

• Provide the current outstanding balance aer

adjustment claims are processed

• Facilitate payment to HHSC for outstanding negative T

claims by provider check or deduction

• Facilitate payment to HHSC for an outstanding negative

balance (A or T claims) by provider check or deduction

from an associated contract when the provider is no

longer billing new LTC FFS claims

Long-Term Care Home Page on TMHP.com

Long-term care (LTC) has its own dedicated section on TMHP.com. All the content found under

Long-Term Care at tmhp.com is up-to-date information and resources such as news articles, LTC

Provider Bulletins, User Guides, and webinar information and registration.

Additionally, there are links to the dierent Texas Medicaid & Healthcare Partnership (TMHP)

applications such as TexMedConnect, the LTC Online Portal, the Learning Management System (LMS),

and the ability to search all of TMHP.com.

To locate the Long-Term Care page, click Programs at the top of tmhp.com, and then select Long-Term

Care (LTC) from the drop-down box.

e Long-Term Care home page features recent news articles by category and news articles that have

been posted within the last seven days. At the top of the Long-Term Care home page, there is a link to

the LTC Online Portal. A link to TexMedConnect can be found on the home page of tmhp.com. Both

of these links require a user name and password.

On the le-hand side, there are links to:

• Provider Bulletins, with links to recent Long-Term Care Provider Bulletins.

• Provider Education, which includes a link to the LMS, where providers can nd multimedia training

content, recorded webinars and associated question and answer (Q&A) documents, User Guides,

and the TMHP YouTube channel.

• Reference Material, including General Information, User Guides, and Frequently Asked Questions.

• Forms, and form instructions, which includes the various downloadable forms needed by long-term

care providers.

Providers are encouraged to frequently visit TMHP.com for the latest news and information. n

Shared Counties

Are Shaded White.

Shared Counties

Are Shaded White.

ANDERSON

ANDREWS

ANGELINA

ARANSAS

ARCHER

ARMSTRONG

ATASCOSA

AUSTIN

BAILEY

BANDERA

BASTROP

BAYLOR

BEE

BELL

BEXAR

BLANCO

BORDEN

BOSQUE

BOWIE

BRAZORIA

BRAZOS

BREWSTER

BRISCOE

BROOKS

BROWN

BURLESON

BURNET

CALDWELL

CALHOUN

CALLAHAN

CAMERON

CAMP

CARSON

CASS

CASTRO

CHAMBERS

CHEROKEE

CHILDRESS

CLAY

COCHRAN

COKE

COLEMAN

COLLIN

COLLINGSWORTH

COLORADO

COMAL

COMANCHE

CONCHO

COOKE

CORYELL

COTTLE

CRANE

CROCKETT

CROSBY

CULBERSON

DALLAM

DALLAS

DAWSON

DEAF SMITH

DE LTA

DENTON

DE WITT

DICKENS

DIMMIT

DONLEY

DUVAL

EASTLAND

ECTOR

EDWARDS

ELLIS

EL PASO

ERATH

FALLS

FANNIN

FAYETTE

FISHER

FLOYD

FOARD

FORT

BEND

FRANKLIN

FREESTONE

FRIO

GAINES

GALVESTON

GARZA

GILLESPIE

GLASSCOCK

GOLIAD

GONZALES

GRAY

GRAYSON

GREGG

GRIMES

GUADALUPE

HALE

HALL

HAMILTON

HANSFORD

HARDEMAN

HARDIN

HARRIS

HARRISON

HARTLEY

HASKELL

HAYS

HEMPHILL

HENDERSON

HIDALGO

HILL

HOCKLEY

HOOD

HOPKINS

HOUSTON

HOWARD

HUDSPETH

HUNT

HUTCHINSON

IRION

JACK

JACKSON

JASPER

JEFF DAVIS

JEFFERSON

JIM HOGG

JIM

WELLS

JOHNSON

JONES

KARNES

KAUFMAN

KENDALL

KENEDY

KENT

KERR

KIMBLE

KING

KINNEY

KLEBERG

KNOX

LAMAR

LAMB

LAMPASAS

LA SALLE

LAVACA

LEE

LEON

LIBERTY

LIMESTONE

LIPSCOMB

LIVE OAK

LLANO

LOVING

LUBBOCK

LYNN

MCCULLOCH

MCLENNAN

MCMULLEN

MADISON

MARION

MARTIN

MASON

MATAGORDA

MAVERICK

MEDINA

MENARD

MIDLAND

MILAM

MILLS

MITCHELL

MONTAGUE

MONTGOMERY

MOORE

MORRIS

MOTLEY

NACOGDOCHES

NAVARRO

NEWTON

NOLAN

NUECES

OCHILTREE

OLDHAM

ORANGE

PALO PINTO

PANOLA

PARKER

PARMER

PECOS

POLK

POTTER

PRESIDIO

RAINS

RANDALL

REAGAN

REAL

RED RIVER

REEVES

REFUGIO

ROBERTS

ROBERTSON

ROCKWALL

RUNNELS

RUSK

SABINE

SAN

AUGUSTINE

SAN

JACINTO

SAN PATRICIO

SAN SABA

SCHLEICHER

SCURRY

SHACKLEFORD

SHELBY

SHERMAN

SMITH

SOMERVELL

STARR

STEPHENS

STERLING

STONEWALL

SUTTON

SWISHER

TARRANT

TAYLOR

TERRELL

TERRY

THROCKMORTON

TITUS

TOM

GREEN

TRAVIS

TRINITY

TYLER

UPSHUR

UPTON

UVALDE

VAL VERDE

VAN

ZANDT

VICTORIA

WALKER

WALLER

WARD

WASHINGTON

WEBB

WHARTON

WHEELER

WICHITA

WILBARGER

WILLACY

WILLIAMSON

WILSON

WINKLER

WISE

WOOD

YOAKUM

YOUNG

ZA PATA

ZAVALA

LTC Provider Bulletin, No. 84 14 November 2020

Provider Resources

Provider Relations Representatives

When Long-Term Care (LTC) providers need help, the Texas

Medicaid & Healthcare Partnership (TMHP) is the main

resource for general inquiries about claim rejections/denials

and how to use automated TMHP provider systems (the LTC

Online Portal and TexMedConnect).

Providers can call TMHP at 800-925-9126

with questions and to request on-site visits

to address particular areas of provider concern.

TMHP webinars for LTC Community Services

Waiver Programs and nursing facility (NF)/Hospice

providers are also oered specically for LTC providers.

e map on this page, and the table below, indicate TMHP provider

relations representatives and the areas they serve. Additional information,

including a regional listing by county, is available on the TMHP website at

www.tmhp.com/Pages/SupportServices/PSS_Reg_Support.aspx.

Territory Regional Area Representative

1 Amarillo, Childress, Lubbock Kendra Davila

2 Midland, Odessa, San Angelo Stacey Jolly

3 Alpine, El Paso, Van Horn Isaac Romero

4 Carrizo Springs, Del Rio, Eagle Pass, Kerrville, San Antonio Jacob Vasquez

5 Brownsville, Harlingen, Laredo, McAllen Yvonne Garza-Garcia

6 Corpus Christi, San Antonio, Victoria Araceli Wright

7 Austin, Bastrop, San Marcos Josh Haley

8 Abilene, Wichita Falls Brooke Livingston

9 Corsicana, Dallas, Denton, Fort Worth, Grayson Vanessa Whitley-Parker

10 North Dallas Jaime Vasquez

11 Bryan College Station, Houston Christopher Morales

12 Beaumont, Galveston, Nacogdoches Ebony Brown

13 Houston, Katy Israel Barco

14 Longview, Marshall, Palestine, Northeast Texas Carrita Mitchell

15 Killeen, Temple, Waco Korey Reeder

*Bexar, Dallas, Harris, and Williamson Counties are shared by 2 or more provider representatives.

ese counties are divided by ZIP Codes. Refer to the TMHP website at www.tmhp.com for the assigned repre-

sentative to contact in each ZIP Code.

nnn

TMHP LTC Contact Information

e Texas Medicaid & Healthcare Partnership (TMHP) Call Center/Help Desk operates Monday

through Friday from 7:00 a.m. to 7:00 p.m., Central Time (excluding TMHP-recognized holidays).

When calling the TMHP Call Center/Help Desk, providers are prompted to enter their 9-digit

Long-Term Care (LTC) provider number using the telephone keypad. When the 9-digit LTC provider

number is entered on the telephone keypad, the TMHP Call Center/Help Desk system automatically

populates the TMHP representative’s screen with that provider’s specic information, such as name and

telephone number.

Providers should have their 4-digit Vendor/Facility or Site Identication number available for calls

about Forms 3618 and 3619, Minimum Data Set (MDS), Medical Necessity and Level of Care (MN/

LOC) Assessment, and Preadmission Screening and Resident Review (PASRR).

Providers must have a Medicaid or Social Security number and a medical chart or documentation for

inquiries about a specic person.

For questions, providers should call the TMHP Call Center/Help Desk at the following telephone numbers:

• Austin local telephone number at 512-335-4729.

• Toll free telephone number (outside Austin) at 800-626-4117 or 800-727-5436.

Aer dialing the phone numbers above, Choose Option 1: Customer service/general inquiry for

questions about:

• General inquiries.

• Using TexMedConnect.

• Claim adjustments.

• Claim status inquiries.

• Claim history.

• Claim rejection and denials.

• Understanding Remittance and Status (R&S) Reports.

• Forms.

• Forms 3071 and 3074.

• Forms 3618 and 3619.

• Resource Utilization Group (RUG) levels.

• Minimum Data Set (MDS).

• LTC Medicaid Information (LTCMI).

• Medical Necessity and Level of Care (MN/LOC) assessment.

• PASRR Level 1 Screening, PASRR Evaluation, and PASRR Specialized Services submission status

messages.

LTC Provider Bulletin, No. 84 15 November 2020

Provider Resources

Choose Option 2: To speak with a nurse about:

• Medical necessity.

• Custom Powered Wheelchair Form 3076.

• Forms pending denial.

• Medical necessity denial letters.

Choose Option 3: Technical Support for questions about:

• TexMedConnect – technical issues, account access, portal issues.

• Modem and telecommunication issues.

• Processing provider agreements.

• Verifying that system screens are functioning.

• American National Standards Institute (ANSI) ASC X12 specications, testing, and transmission.

• Getting Electronic Data Interchange (EDI) assistance from soware developers.

• EDI and connectivity.

• LTC Online Portal, including technical issues, account access, portal issues.

Choose Option 5: Request fair hearing for questions about:

• Individual appeals.

• Individual fair hearing requests.

• Appeal guidelines.

Choose Option 6 for questions about LTC other insurance information and updates.

Choose Option 7 to repeat this message.

Electronic Visit Verication (EVV) Contact Information

For questions about Claims, providers should call the TMHP EDI Helpdesk at: 888-863-3638,

Option 4, including questions about:

• Electronic Data Interchange (EDI) – Submitting Claims for EVV.

• Claim Rejections (excluding Long-Term Care [LTC] claim rejections with error code F, RJ, and/or AC).

For questions about EVV Claims Processing, contact the entity that pays or denies your claims (i.e., the

managed care organization [MCO]. See page 18 for a list of MCO phone numbers).

For questions about EVV Claims Processing that are specic to TMHP call:

• LTC: 800-626-4117, Option 1, then Option 6.

• Acute Care: 800-925-9126, Option 7.

LTC Provider Bulletin, No. 84 16 November 2020

Provider Resources

For EVV general complaints questions, contact:

• HHSC Program Providers email: Electronic_Visit_Verication@hhsc.state.tx.us.

• MCO Program Providers at your MCO’s EVV mailbox (See page 18).

For questions about MCO complaints, email: HHSC Managed Care Compliance and Operations at:

HPM_Comp[email protected]te.tx.us.

For questions about EVV Vendor complaints, email the TMHP EVV mailbox at: EVV@tmhp.com.

If you have questions about policy and compliance, contact:

For general EVV questions about policy and compliance, email the HHSC EVV Operations mailbox at:

Electronic_Visit_Verication@hhsc.state.tx.us. Questions may include:

• Rules.

• Programs and Services Required to Use EVV.

• e 21st Century Cures Act.

For general questions about EVV policy and compliance reviews, contact HHSC Program Providers at:

Electronic_Visit_Veri[email protected]te.tx.us or the MCO Program Providers at your MCO’s EVV mailbox

(See page 18 for a list of email addresses). Questions may include:

• Allowable Phone Identication and Recoupment.

• Compliance Oversight.

• Reason Codes.

• EVV Usage.

• Policy and Requirements.

• EVV Reports and Understanding EVV Reports.

• Visit Maintenance and Unlock Request Policy.

• Reason Codes.

For questions about the EVV Portal, email the TMHP EVV mailbox at

EVV@tmhp.com or contact the EVV Vendor (See EVV Vendor list on page 18). Questions may include:

• General Support.

• EVV Provider Onboarding.

• EVV Reports in the Vendor System.

• EVV Visit Transactions – Includes Accepted and/or Rejected EVV Visit Transactions.

For questions about TexMedConnect and Electronic Data Interchange call the TMHP EDI Helpdesk at:

888-863-3638, Option 4. Questions may include:

• File Submission Errors.

LTC Provider Bulletin, No. 84 17 November 2020

Provider Resources

• Form Processing (i.e., EDI Agreement, TPA, and TPAEF).

• PIMS Assistance.

• Submitter IDs – Creation and Modication.

• TexMedConnect and EDI – Account Setup, Submitting Claims for EVV.

For questions about training on the EVV Vendor System, contact the EVV Vendor (See EVV Vendor

list on page 18). Questions may include:

• General questions.

• Accessing Reports.

• EVV Clock In and Clock Out Methods.

• Making Corrections through Visit Maintenance.

For questions about TMHP Systems training, email questions to the TMHP EVV mailbox at:

EVV@tmhp.com.

Note: For non-system-related EVV Policy questions email the HHSC Program Providers at:

Electronic_Visit_Veri[email protected]te.tx.us or the MCO Program Providers at your MCO’s EVV mailbox

(See below for a list of email addresses). Questions may include:

• EVV Portal and EVV Standard Reports.

• Claims submission.

EVV Vendor list

DataLogic Software, Inc./Vesta:

Phone: 844-880-2400

Email: info@vestaevv.com

First Data Government Solutions/AuthentiCare:

Phone: 877-829-2002

Email: AuthenticareTXSupport@rstdata.com

MCO EVV Contact Information

Contact Information for MCOs.

Name of MCO Phone Email

Aetna 844-787-5437 evvmailbo[email protected]

Amerigroup 800-454-3730 TXEVVSupport@amerigroup.com

Blue Cross Blue Shield 877-784-6802 BCBSTX_EVV_Question[email protected]

Children’s Medical Center Health Plan 800-947-4969 cmchpevv@childrens.com

Cigna-Health Spring 877-653-0331 providerrelation[email protected]m

Community First Health 855-607-7827 cpevv@cp.com

LTC Provider Bulletin, No. 84 18 November 2020

Provider Resources

Name of MCO Phone Email

Cook Children’s Health Plan 800-964-2247 CCHPE[email protected]rg

Driscoll Children’s Health Plan 877-324-7543 evvquestions@dchstx.org

Molina Healthcare of Texas 866-449-6849 mhtxevv@molinahealthcare.com

Superior Health Plan 877-391-5921 SHP.EVV@superiorhealthplan.com

Texas Children’s Health Plan 800-731-8527 EVVGrou[email protected]rg

United Health Group 888-887-9003 [email protected]

Electronic MDS Submissions Contact Information

If you have questions about electronic Minimum Data Set (MDS) submissions, contact the QIES

Technical Support Oce (QTSO) at help@qtso.com or 800-339-9313.

HHSC Contact Information

e following is HHSC contact information for questions listed.

If you have questions about the 12-month rule, contact:

• Community Services - Community Services Contract Manager.

• Institutional Services (NFs)—Provider Claims Services: 512-438-2200, Option 1.

• IDD Services—Provider Claims Services: 512-438-2200, Option 1.

If you have questions about Community Services contract enrollment:

• Email: hhseopcm@hhsc.state.tx.us

• Voice mail: 512-438-3550.

If you have questions about Hospice services contract enrollment:

• Email: IDDWaiverContractEnrollmen[email protected].tx.us

If you have questions about ICF/IID and nursing facility contract enrollment, call 512-438-2630.

If you have questions about Days paid and services paid information for cost reports, use TexMed-

Connect to submit a batch of CSIs.

If you have questions about Rate Analysis contacts visit this website:

https://rad.hhs.texas.gov/long-term-services-supports/contact-list. Contact information is listed by subject.

If you have questions about how to prepare a cost report (forms and instructions) and approved rates posted,

visit this website: rad.hhs.texas.gov/long-term-services-supports then select the appropriate program.

If you have questions about how to sign up for, or obtain direct deposit, or how to sign up for electronic

funds transfer, call Accounting at: 512-438-2410.

If you have questions about how to obtain IRS Form 1099-Miscellaneous Income, call Accounting at:

512-438-3189.

LTC Provider Bulletin, No. 84 19 November 2020

Provider Resources

If you have questions about Medicaid eligibility, applied income, and name changes, contact a Medicaid

for the Elderly and People With Disabilities (MEPD) worker, or the Integrated Eligibility and Enrollment

(IEE) Call Center at telephone number 2-1-1 or visit the website: https://yourtexasbenets.hhsc.texas.gov/.

If you have questions about PASRR policy and rules, email PASRR.Support@hhsc.state.tx.us.

Note: When emailing the PASRR mailbox, do not include the person’s identifying information; instead,

send the Document Locator Number (DLN), so PASRR staff can find the form.

For additional learning opportunities, information, and forms, visit: https://hhs.texas.gov/doing-business-

hhs/provider-portals/long-term-care-providers/resources/preadmission-screening-resident-review-pasrr.

If you have questions about Payment Issues (If payment has not been received aer more than 10 days

from the date of billing), call the HHSC Payment Processing Hotline at: 512-438-2410.

If you have questions about Personal Needs Allowance (PNA), call Provider Claims Services at:

512-438-2200, Option 2.

If you have questions about PASRR Quality Service Review, call a PASRR Quality Service Review

Program Manager at: 512-438-5413.

If you have Targeted Case Management Service Authorization questions for Local Intellectual and

Developmental Disability Authorities (LIDDAs), contact the HHSC Regional Claims Management

Coordinator at website: https://hhs.texas.gov/about-hhs/nd-us/community-services-regional-contacts.

If you have questions about Service Authorization questions for Guardianship Program, call the HHSC

Oce of Guardianship at: 512-438-2843.

If you have questions about Deductions and provider-on-hold questions for Institutional Services

(nursing facilities), contact the HHSC Regional Claims Management Coordinator at website:

https://hhs.texas.gov/about-hhs/nd-us/community-services-regional-contacts or Institutional Services

(NFs)—HHSC Provider Recoupments and Holds at: 512-438-2200, Option 3.

If you have questions about Deductions and provider-on-hold questions for Community Services, call

the Community Services Contract Manager or IDD Services at: 512-438-4722.

If you have questions about Invalid or inappropriate recoupments for nursing facilities and Hospice

services, call HHSC Provider Recoupments and Holds at: 512-438-2200, Option 3.

If you have questions about Status of warrant/direct deposit aer a claim has been transmitted to

Accounting (scal) by TMHP, visit the Comptroller’s website at: www.window.state.tx.us.

Choose the State-to-Vendor-Payment Info-Online-Search link or call Accounting at: 512-438-2410.

When calling Accounting, provide the Provider/contract number assigned by HHSC.

Note: Allow 5-7 business days for processing of claims before verifying payment information.

If you have questions about Texas State University Resource Utilization Group (RUG) training, call the

Oce of Continuing Education Online course at: 512-245-7118 or visit the website at:

www.txstate.edu/continuinged.

If you have questions about Long-Term Care (LTC) Provider Recoupments and Holds (PRH) including

torts and trusts and/or annuities for which the state is the residual beneciary, call PRH at: 512-438-2200,

Option 3.

LTC Provider Bulletin, No. 84 20 November 2020

Provider Resources

For Questions about Community Care for the Aged and Disabled Programs

(CCAD), Community Living Assistance and Support Services (CLASS), Deaf

Blind with Multiple Disabilities (DBMD), Medically Dependent Children

Program (MDCP), Home and Community-based Services (HCS), Texas Home

Living Waiver (TxHmL), and Hospice Programs

If you have questions about CLASS Program Policy, call 512-438-5077, 877-438-5658 or email

ClassPolic[email protected].tx.us.

For questions about HCS Program Policy, call 512-438-4478 or email HCSP[email protected].

For questions about MDCP Program Policy, call 512-438-3501, 877-438-5658, or email

MDCPp[email protected]s.

For questions about TxHmL Program Policy, call 512-438-4639 or email TxHmlPolicy@hhsc.state.tx.us.

For questions about DBMD Program Policy, call 512-438-2622, 877-438-5658, or email

dbmdp[email protected].

For questions about CCAD nancial or functional eligibility criteria or CCAD service authorization

issues, contact the caseworker.

Note: For more contact information visit:

https://hhs.texas.gov/about-hhs/nd-us/community-services-regional-contacts.

For questions about CCAD Program policies and procedures, email CCADPolicy@hhsc.state.tx.us.

For Hospice policy questions, email: HospiceP[email protected]ate.tx.us.

For questions about Hospice Program service authorization issues, call Provider Claims Services at:

512-438-2200, Option 1.

For questions about Home and Community-based Services (HCS) and Texas Home Living Waiver

(TxHmL) billing and payment reviews, call the Billing and Payment Hotline at: 512-438-5359 or email: HCS.

TxHml.BP[email protected]s.

For questions about policy for HCS TxHmL, email: H[email protected].tx.us or

Tx[email protected].tx.us.

For questions about HCS, TxHmL, CLASS, or DBMD Program Enrollment/Utilization Review (PE/UR):

Intellectual Disability-Related Conditions (ID/RC) Assessment Purpose Codes, Level of Need, Level of Care,

and Individual Plan of Care (IPC), call HCS or TxHmL at: 512-438-5055 or Fax: 512-438-4249.

Call CLASS or DBMD at: 512-438-4896 or Fax: 512-438-5135.

For questions about Vendor Holds for HCS/TxHmL, call 512-438-3234 or email:

IDDWaiverContractEnrollment@hhsc.state.tx.us.

For questions about Individual Rights (individual/family complaints concerning LIDDA, HCS, and

TxHmL), call IDD Ombudsman at 800-252-8154 or email: Omb[email protected]te.tx.us. Learn more

about the IDD Ombudsman at https://hhs.texas.gov/idd-help.

For questions about invalid or inappropriate CCAD recoupments, call HHSC Provider Recoupments and

Holds at: 512-438-2200, Option 3.

LTC Provider Bulletin, No. 84 21 November 2020

Provider Resources

Intermediate Care Facility/Facilities for Individuals with an Intellectual

Disability or Related Conditions (ICF/IID) and Nursing Facility Programs

If you have questions about the HHS Quality Monitoring Program, email: Q[email protected]s.

For questions about Payment information for cost reports or a Quality assurance fee (QAF), call

512-424-6552.

For questions about Health and Human Services Commission Network (HHSCN) connection problems,

call 512-438-4720 or 888-952-4357.

For questions about ICF/IID durable medical equipment (DME), DME authorizations, Home and

Community-Based Services (HCS), Texas Home Living Waiver (TxHmL), home modications, adaptive

aids, and dental services approvals, call Provider Claims Services at: 512-438-2200, Option 5.

For questions about ICF/IID/Residential Care (RC) Individual Movement Form IMT/service authori-

zation, call Provider Claims Services at: 512-438-2200, Option 1.

For Client Assessment Registration (CARE) System Help Desk for ICF/IID, call 888-952-4357.

Request HHSC Field Support sta.

For questions about Program enrollment/Utilization Review (PE/UR), Intellectual Disability-Related

Conditions (ID/RC) Assessment Purpose Codes, Level of Need, Level of Care, and Individual Plan of

Care (IPC), call 512-438-5055 or Fax: 512-438-4249.

For questions about Provider contracts and vendor holds for ICF/IID or Provider access to ICF/IID

CARE system, call 512-438-2630.

For questions about MDS 3.0, MDS Purpose Code E, and Forms 3618 and 3619 missing/incorrect

information, call Provider Claims Services at: 512-438-2200, Option 1.

For questions about Rehabilitation and specialized therapy/emergency dental/Customized Power

Wheelchair (CPWC) service authorizations, call Provider Claims Services at: 512-438-2200, Option 6, or

Fax: 512-438-2302.

For questions about Service authorizations for nursing facilities, call Provider Claims Services at:

512-438-2200, Option 1 or Fax: 512-438-2301.

For questions about invalid or inappropriate recoupments for ICF/IIDs, call the HHSC Help Desk at:

512-438-4720 or 800-214-4175.

For questions about Consumer Rights and Services, call Consumer Rights and Services at: 800-458-9858,

email: ciicom[email protected]te.tx.us, or visit the website at: https://hhs.texas.gov/about-hhs/your-rights/

consumer-rights-services.

nnn

LTC Provider Bulletin, No. 84 22 November 2020

Provider Resources

Acronyms In This Issue

Acronym Denition

AMA American Medical Association

ANSI American National Standards Institute

CARE Client Assessment Registration

CBT Computer-Based Training

CCAD Community Care for Aged and Disabled Programs

CDS Consumer Directed Services

CDT Current Dental Terminology

CIPR Claims Identied for Potential Recoupment

CNA Certied Nursing Assistant

CLASS Community Living Assistance and Support Services

CPT Current Procedural Terminology

CPWC Customized Power Wheelchair

DBMD Deaf Blind with Multiple Disabilities

DLN Document Locator Number

DME Durable Medical Equipment

DOB Date of Birth

EDI Electronic Data Interchange

EOB Explanation of Benets

EVV Electronic Visit Verication

FARS/DFARS Federal Acquisition Regulations System/Department of Defense Regulation System

FFS Fee-For-Service

FMSA Financial Management Services Agency

HCPCS Healthcare Common Procedure Coding System

HCS Home and Community-Based Services

HHSC Health and Human Services Commission

HHSCN Health and Human Services Commission Network

HIPAA Health Insurance Portability and Accountability Act

ICF/IID Intermediate Care Facility for Individuals with an Intellectual Disability

ID/RC Intellectual Disability - Related Condition

IEE Integrated Eligibility and Enrollment

IPC Individual Plan of Care

LA Local Authority

LIDDA Local Intellectual and Developmental Disability Authority

LMS Learning Management System

LSNA Louisiana State Nurses Association

LTC Long-Term Care

LTCMI Long-Term Care Medicaid Information

MCO Managed Care Organization

LTC Provider Bulletin, No. 84 23 November 2020

Provider Resources

Acronym Denition

MDCP Medically Dependent Children’s Program

MDS Minimum Data Set

MEPD Medicaid for the Elderly and People With Disabilities

MESAV Medicaid Eligibility and Service Authorization Verication

MN/LOC Medical Necessity and Level of Care

NF Nursing Facility

OI Other Insurance

PASRR Preadmission Screening and Resident Review

PE PASRR Evaluation

PE/UR Program Enrollment/Utilization Review

PNA Personal Needs Allowance

PRH Provider Recoupments and Holds

Q&A Question and Answer

QAF Quality Assurance Fee

QAPI Quality Assurance, Performance Improvement

QMP Quality Monitoring Program

QTSO QIES Technical Support Oce

R&S Remittance and Status

RC Residential Care

RN Registered Nurse

RUG Resource Utilization Group

SSN Social Security Number

TMHP Texas Medicaid & Healthcare Partnership

TxHmL Texas Home Living Waiver

nnn

LTC Provider Bulletin, No. 84 24 November 2020

Provider Resources