Become part of the solution to Texas Medicaid problems

Lori NaborsAbout TMC

Long-term care providers in Texas are faced with many challenges. In the world of MDS 3.0, there are no exceptions. Since we have evolved into a RUG-based payment system for Texas Medicaid, we have found ourselves facing many challenges.

TMC faces the challenges

RUG reviews began in 2010, looking retrospectively at MDS coding and supporting documentation. RUG reviews have sparked many concerns for providers, often leaving us with more questions than answers.

Many of us were left very frustrated and realized that we shared similar concerns. We came together and formed the Texas Medicaid Coalition. We sought to clarify the rules for ADL coding and other RUG-related issues.

Since the dawning of TMC, we have now seen a significant decline in ADL coding issues and improved RUG review outcomes across the state.

2015 brings new challenges

As we continue our journey into 2015 and Phase 3 of RUG reviews, we are still challenged with uncertainties.

As members of TMC, we collaboratively work to identify areas of uncertainties and concerns that we can take to the table for discussion with the OIG and DADS, working toward solutions to unveil clear definitions of rules and guidance for all of us who work in long-term care.

Your voice matters

As a TMC member, you become part of a solution, as your voice speaks for all providers in Texas and helps us all be prepared for what 2015 brings in an ever-changing industry.