How you can help TMC make a difference

Lori NaborsAbout TMC

Become a member…become part of the solution

Texas Medicaid Coalition is a grass-roots organization with members who have various levels of expertise related to Medicaid MDS assessments, reimbursement, medical necessity, LTCMI forms, PASRR processes, utilization reviews, permanent medical necessity, audits and the appeal processes.

If you are interested in sharing information with peers, identifying Medicaid system problems and working with others to resolve issues…YOUR VOICE is needed. Membership applications can be completed online at www.medicaidtx.org. Membership is FREE!

Alone we can do so little; together we can do so much.Helen Keller

TMC’s current Texas Medicaid priorities

TMC is currently discussing the following issues during monthly meetings with DADS and the OIG:

  • ADL coding
  • Utilization Review processes
  • MCO updates and processes
  • PL1 process during CHOW
  • Utilization Review appeal process
  • Permanent Medical Necessity
  • RN signature dates matching on MDS and LTCMI
  • TAC/RAI rule clarifications

TMC has also entered into talks with the DADS PASRR Department to arrange monthly meetings. The goal is to have a forum to address PASRR issues on a routine basis. Current PASRR issues include:

  • PL1 process during the CHOW
  • Guidance for providers when issues arise with the Local Authority
  • Clarification related to requirements for notification to the Local Authority when therapy is delivered

Updates for progress made will be posted on the TMC website and discussed during the monthly TMC conference calls. Please join the monthly conference calls to receive information on updates and pending issues. Joining the conference call is open to anyone who wants to attend and membership is FREE! Membership applications can be completed here.

The importance of Resident Assessment Coordinators (RAC-CT) in Texas Medicaid

Facility leadership

Resident Assessment Coordinators are in the spotlight for producing the facility MDS reimbursement rates. As RAC nurses, you have great responsibilities and huge accountability for the revenue generated. This revenue helps facilitate adequate staffing, obtain necessary equipment needed to care for residents and provide excellent care for our elderly population.

It is also your duty to lead against all odds! A nurse who can fill out an MDS assessment can be found anywhere but those who work the assessment process to produce accurate assessments with payment levels based on the care being delivered are priceless to a facility.

Be a LEADER! One voice, one person, one example…can make a difference.

Information sharing

RAC nurses are very aware of the problems they face both at the facility level and working with the rules of the RAI Manual and TAC codes. The long-term care industry historically has been very closed to sharing information between facilities. TMC believes that sharing information gives one voice the power to be heard.

TMC will be delivering education opportunities through credible sources with topics being determined by listening to those who are on the “front lines” daily. Information sharing and updates will be reported during monthly conference calls with opportunities for questions and discussion for each topic.

Progress has already been made in several areas due to sharing information. Monthly meetings are being held with the OIG, DADS and PASRR Leaders to discuss the issues related to the Medicaid MDS processes. The Utilization Review issues experienced by Texas Providers have been shared with TMC members and addressed during these meetings. Some issues have been resolved while others are still being discussed.

A leader is one who knows the way, goes the way and shows the way!John C. Maxwell