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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 Program Forms

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

Nursing Facility

Community Waiver Programs

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

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

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  TexMedConnect Claim/Payment Information—R&S Options
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  Nursing Facility and Hospice Provider Training
  LTC Waiver Programs (includes CBA, CWB, and PACE)
  LTC TexMedConnect Workbook
  LTC RUG/MDS Nursing Facility/Hospice TILE to RUG Training Materials (updated)
  LTC RUG Workshop for Community Waivers (updated)
  LTC Webinar Evaluation
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 LTC Online Portal Access
 News
Labor Day Holiday
Information posted August 28, 2008: TMHP will observe the Labor Day holiday on September 1, 2008. The LTC help desk staff will be available to assist providers beginning September 2, 2008 at 7:00 A.M. Please refer to the LTC RUG training materials on tmhp.com and the Frequently Asked Questions document at http://www.dads.state.tx.us/providers/TILEStoRugs/ .
RUG Update Information for LTC Community Waivers Providers
Information posted August 22, 2008: The following RUG Update Information is being posted for LTC Community Waivers Providers. Medical Determination on Significant Changes: This is to clarify that Medical Necessity (MN) determinations will not be done on MN & LOC significant changes submitted by Waiver Program providers through the LTC Online Portal effective September 1, 2008. Physician’s Signature Required: Providers are being reminded that although the current MN and LOC Assessment form does not include a place for a physician signature, a physician’s signature is required on all initial MN and LOC assessments. BC1 RUG Value: BC1 RUG Value is considered to be a default value. Default RUG BC1 is assigned because the system is unable to calculate actual RUG based on the assessment submitted. Community Service waivers have 14 days to correct an assessment or inactivate the form and submit a new one.
LTC Portal Downtime
Information posted August 22, 2008: The TMHP Long Term Care Online Portal will be unavailable from Monday, 8/25/08 starting at 12 am until Monday, 9/1/08 at 12 am for the TILES to RUGS transition. We apologize for this inconvenience. To check the status of a previously submitted form, please contact the TMHP Call Center / Help Desk at 1-800-626-4117 or 1-800-727-5436 option 1.
Attention: DADS LTC Waiver Program Providers Using Form 3652
Information posted August 15, 2008: TILEs to RUGs Transition Information - DADS strongly encourages all initial assessments requiring a physician’s signature conducted on or after August 15, 2008, be completed using the new RUG MNLOC form and then submitted after September 1. DADS also recommends that other assessments (not requiring a physician’s signature) conducted on or after August 21 be completed on the RUG MNLOC form and submitted after September 1. This will prevent having to conduct duplicate assessments if the Form 3652 cannot process through TMHP for some reason. If a Form 3652 cannot be processed before August 25 for any reason, and that is the only form that you have, then you must complete a second assessment using the RUG MNLOC form and submit that after September 1.
CMS Advisory Council Directory
Information posted August 13, 2008: The LTC Claims Management System Advisory Council membership list has been updated. The CMS Advisory Council meets quarterly to discuss upcoming changes and projects affecting users of the DADS Claims Management System. Notes from Council meetings are posted on TMHP.com under "CMS Advisory Council Meeting Minutes." Click on the title to access this document.
Fiscal Year-end Cutoff Processing
Information posted August 8, 2008: DADS has published Information Letters 2008-66; 2008-67; and 2008-68, Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing, to inform providers of important August 2008 processing cutoff dates. Please refer to the appropriate letter for details: #2008-66 is addressed to Community Services, Nursing Facility and Therapy Providers; #2008-67 pertains to ICF/MR SG5 Providers; #2008-68 supplies dates for ICF/MR SG6 Providers.
Updated TILEs to RUGs Training Materials Available
Information posted August 6, 2008: Updated information from the summer Nursing Facility/Hospice and Community Waiver Workshops is now available. This updated information includes corrections to both the Nursing Facility/Hospice and Community Waiver Quick Reference Guides as well as corrections and clarifications to the information contained in the Nursing Facility/Hospice and Community Waiver Workbooks. The information can be found by clicking on the appropriate link under the “LTC Online Portal Training Materials” section of the LTC Webpage.
Duplicate LTC Electronic Remittance and Status (R&S) Reports
Information posted August 5, 2008: Long Term Care Third-Party Submitters may notice duplicate copies of their August 2, 2008, LTC Electronic Remittance and Status (R&S) report available in their folder. These additional copies can be ignored.
Long Term Care Information Letters No. 08-88 and 08-94
Information posted August 1, 2008: Information Letters regarding TILEs to RUGs Billing Information are now available. The following Information Letters provide updated RUGs Billing information for Nursing Facility/Hospice (#2008-88) and (#2008-94) CBA HCSSA, CWP, PACE, STAR+PLUS, and ICM providers. Click on the title for links to the Information Letters.
Claims Engine and Long Term Care Systems Maintenance Scheduled For August, 2008
Information posted August 1, 2008: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on August 10, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. * Interactive Eligibility Verification through AIS, the TMHP website, TexMedConnect, or EDI. * Interactive Claims Submission through TexMedConnect or EDI.
Long Term Care Information Letters No. 08-100 and 08-101
Information posted July 31, 2008: Information letters regarding Nurse Licensure Verification. The following Information Letters provide information for Verification of Nurse Licensure with the Texas Board of Nursing for Nursing Facility and Hospice Providers and for Verification of Nurse Licensure with the Texas Board of Nursing for Community Services Providers/Health Plan Organizations. Click on the title for links to the Information Letters.
August 2008 Long Term Bulletin No. 35
Information posted July 31, 2008: The August 2008 Long Term Bulletin No. 35 is now available. Click the title to view the bulletin.
Long Term Care Information Letter No. 2008-111
Information posted July 29, 2008: DADS has issued the following Information Letter for all Medicaid Nursing Facility Providers: Information Letter No. 2008-111 -- Unavailability of the Texas Medicaid and Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal -- August 25 - 28, 2008 Click on the title to link to the Information Letter.
Workshops Schedules Affected Due to Hurricane Dolly
Information posted July 22, 2008: The Long Term Care workshops scheduled for Corpus Christi on July 23, 2008 (LTC RUG for Community Waiver) and July 24, 2008 (LTC TexMed Connect) will go on as scheduled. The Long Term Care TexMed Connect workshops scheduled for Harlingen on July 22 and McAllen on July 23 have been cancelled and rescheduled. Providers registered for the workshops were automatically registered for the new dates. Click on the title to view the details.
RUGs Workshop Materials Available for Community Services Providers
Information posted July 17, 2008: The Resource Utilization Group (RUGs) training materials notice below is for providers in the following Community Services programs:Community Based Alternatives (CBA) Home and Community Support Services Agency (HCSSA), Consolidated Waiver Program (CWP) Home and Community Support Services Agency (HCSSA), Program of All-Inclusive Care for the Elderly (PACE), State of Texas Access Reform Plus (STAR+PLUS), Integrated Care Management (ICM) /1915(c) Waiver Home and Community Support Services Agency (HCSSA). Click on the title for more information.
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