Long Term Care Program

The Texas Department of Aging and Disability Services (DADS) administers programs providing LTC Services and Institutional Care to eligible clients. The Texas Medicaid & Healthcare Partnership (TMHP) LTC team supports the LTC provider community in submitting claims through the Claims Management System (CMS). TMHP also supports providers as they submit Client Assessment Review and Evaluation (CARE) forms through the CARE Forms System. Additionally TMHP assists providers with Minimum Data Set (MDS) System automation.

The TMHP LTC help desk provides customer-oriented support to providers and State staff on paper and electronic submission of LTC claims. Support on the CARE Forms System is offered through determination of medical necessity and level of care for clients who are Medicaid eligible and meet the medical necessity requirements of admission into a nursing facility or a cost-effective alternative to institutionalization. Assistance to providers on the MDS System includes transmitting/correcting assessments, running/obtaining reports, understanding error messages, obtaining IDs/passwords and setting up Netscape.

DADS administers programs ensuring eligible Medicaid and other qualifying clients receive the care and living assistance needed.

LTC Program Resources on the TMHP website

• LTC User Manual for Paper Submitters
• LTC Bulletins
• LTC Information Letters
• LTC Reference Codes
• 3652 CARE Form Information
• Provider Help Information
• CMS Advisory Council Meeting Minutes
• Register for a workshop

LTC Program Forms

• 1290 - NPI Long Term Care Form
• Instructions 1290- Long Term Care Claim Form
• 3071-Recipient Election/Cancellation/Discharge Notice
• 3074-Physician Certification of Terminal Illness Notice
• 3618-Resident Transaction Notice Form
• Instructions/Key for 3618-Resident Transaction Notice Form
• 3619- Medicare/ SNF Patient Transaction Notice
• 3652-A Client Assessment, Review and Evaluation (Care)

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LTC Program Forms (Effective September 1, 2008 with implementation of TILEs to RUGs)

Nursing Facility

• 3618 - Resident Transaction Notice
• 3618 – Resident Transaction Notice Instructions
• 3619 – Medicare / SNF Patient Transaction Notice
• 3619 – Medicare / SNF Patient Transaction Notice Instructions
• Federal MDS Assessments (CMS)
• Federal MDS Assessment Instructions  
  refer to RAI User's Manual then RAI Chapter 3
• Federal MDS Assessment Schedule for RAI  
  refer to RAI User's Manual then RAI Chapter 2
• LTCMI – Nursing Facility
• LTCMI – Nursing Facility Instructions
• PASARR Screening
• PASARR Screening Instructions

Community Waiver Programs

• Medical Necessity and Level of Care Assessment
• Medical Necessity and Level of Care Assessment Instructions

3652-A CARE Form Purpose E (Completed September 1, 2008 – August 24, 2009)

• 3652-A CARE Form
• 3652-A CARE Form Purpose Code E Instructions

LTC Program Contact Information:

• General Inquiry (LTC claims and Nursing Facility forms): 1-800-727-5436/1-800-626-4117 Option #1
• Speak to Nursing Facility Nurse: 1-800-727-5436/1-800-626-4117 Option #2
• Technical Related Questions: 1-800-727-5436/1-800-626-4117 Option #3
• Schedule Fair Hearing: 1-800-727-5436/1-800-626-4117 Option #5
• Helpful Contact Information

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LTC Program Helpful Links

• Texas Department of Aging and Disability Services (DADS)
• Client Assessment, Review and Evaluation (CARE) Instructions
• Long Term Care Nursing Facilities Policies
• Texas Department of State Health Services (DSHS)
• Health and Human Services Commission (HHSC)
• Centers for Medicare and Medicaid Services (CMS)
• LTC Bill Code Crosswalk on the DADS website
• Tile Calculator Software on HHSC website
• Texas County Codes

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