Medicaid Provider Enrollment Texas Health and Human Services

Table of Content

• LiveHealth Online ― quick and easy access to care
• Texas Disability Mentoring Day
• Medicaid CHIP Data Analytics Unit Quarterly Report of Activities SFY 2021, Q4
• LTC-only Providers Enrolling Through Provider Enrollment and Management System (PEMS)
• The Cost of Home Care vs. Other Types of Care
• State-by-State Medicaid For Home Care Everything You Want To Know
• HCBS Settings Rule

The national average of $5,148 is about $550 more per month than the state average. These requirements affect Medicaid, Healthy Texas Women and the Children with Special Health Care Needs Services Program only. However, these requirements don’t apply to out-of-network providers who order, refer or prescribe only for managed care members.

Home Health Care cannot be provided in nursing facilities or inpatient mental health/substance abuse treatment facilities. Personal care and non-licensed in-home care providers are not allowable services. The STAR-PLUS waiver gives Texas seniors access to a variety of services and supports, including home modifications and help with basic activities of daily living. If you qualify for STAR+PLUS, you’ll work with a service coordinator to determine which services are a good match for your needs. STAR+PLUS also covers respite care, which gives caregivers a short break to relax and take care of their own needs. If your caregiver needs a short break, you may be able to use the STAR+PLUS waiver to hire someone to help you while they’re gone.

LiveHealth Online ― quick and easy access to care

A new applicant that wants to obtain a contract to provide Texas Health and Human Services LTC Medicaid services must enroll in Texas Medicaid. In March 2014, the Centers for Medicare and Medicaid Services issued the federal HCBS Settings Rule which added requirements for settings where Medicaid HCBS are provided. Income is counted differently when only one spouse applies for Regular Medicaid; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Covid-19 stimulus checks and Holocaust restitution payments do not count as income and have no impact on Medicaid eligibility. 1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance.

Our focus is to help you get the care and services you need to make a difference in your life. The state is one of eleven, and by far the largest, that has never accepted the expanded Medicaid coverage offered by the Affordable Care Act, commonly known as Obamacare. Before the pandemic, Texas’s rate of children without medical coverage was 12.7 percent. In addition, all ordering, referring or prescribing providers must enroll in Texas Medicaid as participating providers. MCO LTSS providers may obtain an application by submitting a request to MCO_LTSS_Provider_Re- The request must include the provider's business name, tax identification number, taxonomy and National Provider Identifier. Applicants must enroll in Texas Medicaid through TMHP do not have to enroll through HHSC; however, these applicants must mail HHSC a copy of TMHP's notification letter as proof of enrollment.

Texas Disability Mentoring Day

One such alternative, made possible by the Affordable Care Act, is the Community First Choice option. CFC allows states to offer in-home personal attendant services to assist with one’s activities of daily living and instrumental activities of daily living . Examples include help with grooming, mobility, toiletry, preparing meals, light housecleaning, etc. for persons who would otherwise require placement in nursing homes. At the time of this writing, nine states have implemented the CFC option. These states are Alaska, California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington.

2) Community First Choice Program – An entitlement program that, in addition to personal care, provides in-home support, such as meal preparation, medical alert services, and light housework. This program allows for self-direction, meaning program participants can hire the caregiver of their choosing, including some relatives, to provide them with personal care assistance. 3) Regular Medicaid / Elderly and People with Disabilities – This is an entitlement program; Persons who meet the eligibility requirements are guaranteed program benefits.

Medicaid CHIP Data Analytics Unit Quarterly Report of Activities SFY 2021, Q4

When only one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of the applicant spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance from the applicant spouse to prevent spousal impoverishment. If a non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse to bring their income up to this level.

Texas Health and Human Services is responsible for regulating home care providers in Texas. The regulations are outlined in Title 2 of the Texas Health and Safety Code. THHS monitors compliance with the rules to ensure seniors and disabled adults receive appropriate care. To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible. 3) Primary Home Care – This is another program that provides for personal care in the home. Like Community First Choice, program participants can choose their caregivers, which includes the ability to select family members.

HCS program providers should be prepared for 3-person residences and 4-person residences assessments. HCS program providers should notify HH/CC service providers of the ongoing assessment process. HHSC and TMHP staff may reach out directly to schedule an on-site visit or alert you of required follow-up action to achieve full compliance. The client is not stable enough to be cared for outside of the acute care setting as determined by the agency and the client's primary medical care provider. Language assistance must be provided to individuals who have limited English proficiency and/or other communication needs at no cost to them in order to facilitate timely access to all health care and services.

All home health care workers employed by agencies that participate in Medicaid and/or Medicare must be fully vaccinated against SARS-CoV-2 to prevent the spread of COVID-19. This is based on a rule issued by the Centers for Medicare & Medicaid Services, a federal agency. State officials challenged the legality of the rule, but a district court dismissed the case on January 20, 2022. Texas doesn’t have any vaccination-related mandates for home care or home health care workers employed by agencies that don’t participate in Medicare and Medicaid.

The Cost of Home Care vs. Other Types of Care

With regular state Medicaid, also called original Medicaid and classic Medicaid, the federal government requires that states make home health benefits available to those in need. Personal care assistance (help with bathing, dressing, eating and other non-medical care) in the home, which is not federally mandated, is also offered by many states’ regular Medicaid plans. “Home care” may extend to a variety of settings outside of one’s own personal home.

Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s look back rule. When “spending down”, it is best to keep documentation of how assets were spent as evidence the look back period was not violated. For Texas residents, 65 and over, who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA.

For home exemption, the Medicaid applicant must live in the home or have intent to return and have a home equity interest no greater than $636,000 . Equity interest is the value of the home, minus any outstanding debt, in which the Medicaid applicant owns. If the applicant has a spouse living in the home, it is exempt regardless of where the applicant lives and their home equity interest.