Private Providers
Calm Amid Uncertainty
Association of Texas
IDD System Redesign!
19th Annual Fall Conference
Sunset?
84 Session?
STAR+PLUS!
th
November 12-14, 2014
DoubleTree Hotel ● Austin, Texas
Managed Care!
WEDNESDAY, November 12, 2014
8:15 am to Noon:
PPAT Member Meeting and Annual Board Elections
Noon to 1:30 pm:
Lunch on Your Own
1:30 pm to 2:30 pm:
Welcome & Opening Session
The Future of Medicaid, Surprise Speaker -- You Will Not Be
Disappointed!
2:30 pm to 3:00 pm
Break Service in Exhibit Hall
3:00 pm to 5:00 pm:
Federal and State Initiatives: Community First Choice
Option & More, Speakers TBA
5:00 pm to 7:30 pm:
Welcoming Reception & Silent Auction
A time to relax, visit with colleagues and friends and first chance to bid on the silent auction items.
Hors D’oeuvres and Cash Bar
1
THURSDAY, November 13, 2014
7:00 am to 8:15 am:
Breakfast Buffet with Exhibitors
8:30 am to 10:15 am:
Concurrent Sessions
Session A1: MCOs Are Now In Our World: Time To Work Together, MCO Representatives
(Amerigroup, Cigna, Molina, Superior & United); Gary Jessee, Deputy Director, Medicaid Managed
Care Operations, HHSC; and Debbie Little Smith, Program Management, HHSC Medicaid/CHIP
Session B1: Regulatory Year In Review, Joanalys B. Smith, Attorney at Law, Smith &
Associates
She's baaack! For eight years now (probably longer), Ms. Smith will review survey and certification
issues and other regulatory matters you need to know about. This year she will discuss
discretionary sanctions, zero rejection, housing issues, acceptance problems, guardianship conflicts
and new survey rules.
Session C1: Friday's at DADS, Representatives from DADS' Policy and Innovation, Access &
Intake and Regulatory Divisions
This session will discuss the efforts of the IDD System Improvement Workgroup and catch you up
on initiatives in progress such as... the federal HCBS regulations governing Residential Settings;
the High Needs Medical Project; Transition Assistance Services, changes to Critical Incident
Reporting, changes in the Medicaid Eligibility Reauthorization process, etc. Opportunity for Q & A
will be offered.
10:15 am to 10:45 am
Break Service in Exhibit Hall
10:45 am to Noon:
Concurrent Sessions
Session A2: Becoming a STAR+PLUS LTSS Provider: The Credentialing Process,
MCO Representatives (Amerigroup, Cigna, Molina, Superior & United); Gary Jessee, Deputy
Director, Medicaid Managed Care Operations, HHSC; and Debbie Little Smith, Program
Management, HHSC Medicaid/CHIP
Session B2: Contract Enforcement; What New Chapter 49 Really Means To Your
Operations, Joanalys B. Smith, Attorney at Law, Smith & Associates
This session expands on the Year in Regulatory Review session to focus on the new contract
enforcement regulations under Chapter 49 and the related regulations under Chapter 9 governing
HCS and TxHmL. Combined, these newly adopted regulations have significantly altered the
certification and contracting processes particularly as they relate to provider compliance
expectations, enforcement and termination actions and appeal processes. Join Ms. Smith as she
walks you through these changes.
Session C2: Making the Most of Your Day: How to Angle for Success, Michelle Garcia,
Psy.D., Clinical Psychologist, Michelle Garcia, Psy.D. & Associates
Are you feeling overwhelmed and like the work you do is hard with rewards few and far between?
If yes, then join Dr. Garcia for this uplifting presentation. Not only will it prove to be a fun time, but
you will also learn valuable tips, including: making your job more enjoyable, feeling more
confident, and being more successful at seeing change in the individuals you serve.
12:00 pm to 1:15 pm
Lunch on Your Own
2
1:15 pm to 2:45 pm:
Concurrent Sessions
Session A3: Successful Implementation of the HCS/TxHmL Billing & Payment Guidelines,
Willie Mae Jones, Manager, Billing & Payment, DADS and Others TBA.
Although it's been several years since significant revisions to the Billing Guidelines (2011 to be
exact), there have been four (4) revision notices over the past year with a total of 82 revisions
thus far. While true that not all of the revisions have posed challenges in implementation and
compliance, many have, such as the provision of day habilitation in host homes and the recent
changes in respite services. And let's not forget the nursing billing guidelines which many, if not
all, providers still clamor for changes to allow more billable units of services. Speakers will not only
review the 2014 changes, but discuss the most frequently cited billing issues found during audits
and answer your questions.
Session B3: Reimbursement & Cost Reporting Requirements: HHSC Expectations,
Victor Perez, Director, Long-Term Services & Supports - Rate Analysis, HHSC; Elena Hudson,
ICF/IID Rate Analyst, HHSC; and Maria Ebenhoeh, HCS/TxHmL Rate Analyst, HHSC
If you're not aware, changes in analysts in the HHSC Rate Analysis office have occurred. While
meeting the new Director and analysts offers no guarantee of a pass on submitting your cost
report, a review of the reimbursement and cost reporting requirements may reduce any time now
spent on completing your cost reports, responding to questions, justifying expenses, etc., etc., etc.
In addition to reviewing reimbursement-related requirements, attendees will also receive an update
on the Section 52 Project; i.e., HHSC's efforts in responding to Section 52, Article II, Special
Provisions for all Health and Human Services Agencies of the 2014-15 General Appropriations Act,
S.B. 1, 83rd Legislature, Regular Session, related to determining the impact of the employer
mandate in the Affordable Care Act on Medicaid long-term care providers, and, if available,
reimbursement rate related information in HHSC's Consolidated Budget.
Session C3: Consequences of Expired LOCs and/or IPCs under STAR+PLUS,
Jerri Ward, Attorney at Law, Garlo Ward, P.C.
2:45 pm to 3:15 pm
Break Service in Exhibit Hall
3:15 pm to 4:45 pm:
Concurrent Sessions
Session A4: Best Practices: Nursing Care in Community-Based IDD Programs, Diane
Moore, BSN, RN, CDDN and Co-owner, Innovative Outcomes, Inc. (ICF & HCS provider) and Grace
White, MSN, RN, APHN-BC, Director Of Nursing, MHMR of Tarrant County
Since passage of SB 1857 (Zaffirini-82nd Session) and its implementation in the ICF/IID and
HCS/TxHmL programs in early 2012, changes to the LVN On-Call Pilot Protocol and some of the
rules and forms have occurred. These changes have not, however affected the practice of nursing;
i.e., how nursing services are provided. Unfortunately, sometimes state agency regulatory
expectations, not to mention other factors, have a way of 'getting in the way of' ensuring safe
nursing. The most frequently cited nursing deficiencies in the ICF/IID and HCS/TxHmL programs
and recent random sample reviews of the LVN On-Call Pilot program evidence, in part, how easy it
is to sometimes unintentionally get off course. This session, conducted by two leaders in the field
of nursing in the IDD service system, will put you back on course. Not only will Ms. Moore and Ms.
White provide you best practice tips in providing safe and quality nursing care, they will provide
you the tools to achieve such while also meeting regulatory expectations.
3
Session B4: Effective Cost Reporting Tips & Related Tax Issues, Mark Dickson, CPA, Mason
Warner & Company, P.C.
Two years (very long years) have passed since we've discussed the cost reporting process.
While the cost reporting process and requirements have not significantly changed, neither have the
headaches that result in preparing the reports and responding to questions from auditors. Join
Mark, a highly experienced cost report preparer and CPA, as he provides his insight on a wide
range of topics that directly impact Medicaid Providers. Topics to be covered include Cost Report
and Wage Enhancement changes / issues, Texas Franchise Tax issues and Federal Tax issues
related to Medicaid Providers.
Session C4: Transitions from SSLCs to the Community: Making It Work, Scott M.
Schalchlin, Assistant Commissioner, State Supported Living Centers (SSLCs), DADS and Sandy
Ray, Programs, SSLCs, DADS
Since the 2009 DOJ and State of Texas settlement agreement there has been heightened attention
on SSLCs. This attention resulted in more focused efforts on developing effective 'census
management' strategies. Over the past year, transition (or, census management) efforts have
been stepped up. This includes stepped up efforts in resolving barriers that have heretofore
sometimes 'slowed' or 'precluded' placements. In this session attendees will be provided an
overview of (and the impetus behind) these efforts and have the opportunity to provide feedback
on barriers encountered when they have been selected as the service provider and offer
suggestions on how to ensure placements are successful.
5:15 pm to 7:00 pm
Happy Hour and Silent
Hall to make one last bid. Appetizers and Cash Bar
Auction Closing – Join us in the Exhibit
FRIDAY, November 14, 2014
8:30 am to 10:00 am:
Concurrent Sessions
Session A1: Nursing Services in ICFs/IID & HCS/TxHmL: BON and Agency Regulations
& Expectations, Frequently Cited Deficiencies, the LVN On-Call Pilot, Etc., Melinda G
Hester, RN, DNP, Lead Nursing Consultant for Practice, Texas Board of Nursing; Jill Jenkins, Waiver
Survey & Certification Regulatory Services, DADS; Barbara Blankenship, ICF/IID Policy, Regulatory
Services; Elizabeth Jones, Consumer Directed Services, DADS
Yesterday you had the opportunity to review and discuss best practice tips in nursing care and
techniques to avoid problems with non-compliance in providing health care. Today you'll have the
opportunity to hear from the regulators -- the BON and DADS. Not only will nursing requirements
and frequently cited principles and regulations be reviewed, but recent changes to the LVN On-Call
Pilot, findings of the random sample reviews and nursing under the Consumer Directed Services
(CDS) option will also be discussed. Time for Q&A will also be available.
Session B1: Employment First: SB 1226 (83rd R) Task Force, State Initiatives &
Services, Etc., Roger Webb, Executive Director, Texas Council for Developmental Disabilities and
Chair, DADS Employment First Task Force, and DARS, DADS and Self-Advocate Representatives
4
Session C1: Special Olympics and Texercise – Collaborating for Health, Mike Sullivan,
Director of Families and Outreach, Special Olympics Texas, and Chelsea Couch, Texercise Program
Specialist, DADS
If you have not attended a session conducted by Mike before, you don't know what you're missing.
And FYI.... come early as seats go fast. This year Mike is teaming up with Ms. Couch, Department
of Aging and Disability Services (DADS). Together they will share details of the partnership
between Special Olympics and DADS and how their respective health programs are being used to
effectively to engage people in the community and group homes in wellness activities. The session
will discuss the variety of fitness activities available through the Special Olympics and DADS
Texercise program.
10:00 am to 10:15 pm
Break Service
10:15 am to Noon:
CLOSING SESSION
Session A3: Preparing for the 84th Session: Appropriations Bill, Sunset Commission
Recommendations, Updates to SB 7 (Nelson-83rd Session) & More, Speakers TBA
5