Monthly Archives - February 2018

Managing allergic rhinitis

Below are medication recommendations for treating allergic rhinitis. All recommendations are available to Texas Children’s Health Plan members without prior authorization! Oral Antihistamines: Oral cetirizine or loratadine (once daily) offers relief for itchy eyes/nose/throat and congestion. Available in liquid and tablet formulations. Cetirizine can be prescribed in patients as young as 6 months of age whereas loratadine is only approved in patients 2 years of age and older. Headache and drowsiness are the most common side effects. If side effects [...]

QVAR HFA Metered Dose Inhaler is Going off of the Market

With little if any notice to providers, TEVA has decided to stop selling the QVAR HFA Metered Dose inhaler in the US. They have replaced it with a QVAR RediHaler, which is a breath actuated inhaler that CANNOT be used with a spacer (valved holding chamber) device. Young children and disabled children who cannot take a deep breath in and hold it will not be able to use the RediHaler device.   Patients who are used to or prefer to [...]

Provider Alert! LTSS Provider Enrollment

Attention:  Update for LTSS Providers Subject: Provider Enrollment HHSC has begun the Affordable Care Act Managed Care Organization (MCO) Long Term Services & Supports (LTSS) provider enrollment process.  The MCO LTSS providers we are targeting are: assigned an Atypical Provider Identifier (API) by HHSC, do not have an active Texas Provider Identifier (TPI) for the same provider type to bill TMHP for acute care services and do not have an active DADS Medicaid contract. HHSC requests LTSS providers to be notified of [...]

Diabetes Gift Card Available to Adult Texas Children’s Health Plan Members

If you currently treat an adult Texas Children’s Health Plan member (18 years or older) with diabetes, they can receive up to 3 $20 gift cards upon completion of each of the following: Annual diabetic eye exam OR Biannual HbA1c blood test (every 6 months) OR Maintain an under 8 HbA1c blood result every 6 months

Provider Alert! FMSA Training

Attention:  Financial Management Services Agencies (FMSA) Subject:  Training Opportunity Tuesday, March 6, 2018 10:00 a.m. – 12:00 p.m. CT Register now https://register.gotowebinar.com/register/2237295444263992834 All current contracted FMSAs with a managed care organization or HHSC must attend this mandatory training. This training is a condensed version of HHSC’s FMSA enrollment training and: Includes an overview of the consumer directed services option Reviews CDS roles and responsibilities Has been tailored to meet the needs of FMSAs that have recently hired new staff or just need to refresh their knowledge Email questions to [...]

Be a HEDIS Hero

The National Committee for Quality Assurance (NCQA) is a non-profit organization that measures the quality of healthcare across large populations. NCQA does this through its Health Effectiveness and Data Set, also known as HEDIS. HEDIS measures are a set of evidence-based standards that Texas Children’s Health Plan is committed to improving upon in order to provide the best care for our members. Making changes across your patient population is easier than you think! In fact, you can become a HEDIS [...]

Provider Alert! Therapy Wait List

Subject:  Therapy Providers Effective 1/15/2018, HHSC formally required MCOs to report on access issues specific to all therapy modalities (PT, OT, ST). In the future, if Texas Children’s Health Plan (TCHP) should receive a member complaint specific to access to care, TCHP will follow-up with each therapy provider. If a wait list is identified, each provider will be required to submit detailed information for each member waiting for care. The information will need to be populated in a specified template, [...]

ADHD Provider Tool Kit: Evaluation and Diagnosis Resources

What is it? The ADHD Provider Tool Kit is the online Texas Children’s Health Plan resource for a wide range of relevant material to assist the diagnosis, treatment, and management of patients with ADHD and their families. The goal is to provide information sources for providers who frequently see patients with this diagnosis. Evaluation and Diagnosis Current DSM-5 criteria are listed. Symptoms fall into two primary clusters: Inattention and Hyperactivity/Impulsivity. Helpful tips regarding age-specific differences are listed to assist diagnosis in child [...]

Provider Alert! Uniform Hospital Rate Increase Program (UHRIP)

Attn: STAR HOSPITAL SERVICES RE: Uniform Hospital Rate Increase Program (UHRIP) Dear Provider, The Texas Health and Human Services Commission (HHSC) has received approval from the Centers for Medicare and Medicaid Services to implement the Uniform Hospital Rate Increase Program (UHRIP) for hospital services effective March 1, 2018 for Harris and Jefferson Service Delivery Areas (SDAs).  State-owned hospitals and institutions for mental diseases are excluded from the program. Texas Children’s Health Plan (TCHP) will be sending a Letter of Agreement to all eligible [...]