April 2024 Newsletter

Happy Spring & Happy Easter!

April puts spirit of youth in everything, as Spring shows what God can do with a drab and dirty world.

Let’s spring into Spring/Summer with a DiagnosTEX in-person CE conference! Come join the fun!

Thursday evening, we will have an optional pre-course start to the conference, with an extra 2-hour discussion on puree foods and thickeners. This will be at our office in North Richland Hills. Friday will be 6-hour CE course on Dysphagia across the spectrum with break-out sessions on peds and adults. Stay tuned for details.

Get prepared! It’s getting close…………..MAY is Better Speech and Hearing Month is next month

Be prepared next month, we need to educate now more than ever! The May event provides opportunities to raise awareness. ASHA has many resources to help you celebrate BHSM every day. www.asha.org . Some good educational material to share can also be found in the DiagnosTEX Bookstore and the Barium Barista Clinical Cafe at www.dysphagiadiagnostex.com. Check it out!

• ABOVE and BEYOND - By: Ronda Polansky M.S. CCC-SLP
  Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation. Over 30 handouts on specific disorders in dysphagia in ONE location to use in your practice, plus a resource section for SLP’s on cranial nerve testing, pharyngeal exercises, and treatment techniques. A need to have booklet in your therapy bag!!
  Cost: $20.00. (plus, S&H).
  
  
• An SLP Should NEVER Lose Their Voice: Advocate for Proper Dysphagia Evaluations
  Material to assist in educating Physicians, Administrators, Nurses and other Medical Professionals on Dysphagia and Modified Barium Swallow Studies.
  
  
• What You Can Not See at Bedside (DVD or jump drive)
  Copies of MBSS studies for education of staff and families on various disorders and clear episodes of penetrations and aspirations.
  Cost - $20.00 (plus S & H).
  
  
• Anatomy Clipboards
  A must have for daily anatomy education!
  Cost - $10.00

Dysphagia Cookbook
We want to also give a shout out to the recipe book authored by those at Simply Thick, a must have for those on altered diets! Modern Dysphagia Cooking – Laurie Berger, Paul Haefner, John Holahan, and Nancy Yezzi. Very well done with dysphagia patients and their caregivers in mind.

DiagnosTEX Outpatient Clinic
Seeing adult and pediatric patients in office in North Richland Hills on Mondays and Fridays! See website for more details or call the office at 817-514-6271. Personalized service at its best!

New Prohibition on COVID-19 Vaccination Requirements in Texas
Effective February 6, 2024, Texas employers in the private sector are prohibited from requiring their employees, job applicants, contractors, or applicants for contract positions to be vaccinated against COVID-19 and from subjecting such individuals to adverse treatment due to their unvaccinated status. SB 7 contains an adverse action exception for certain health care facilities, health care providers, and physicians. SB 7 allows certain health care facilities, health care providers, or physicians to “establish and enforce a reasonable policy that includes requiring the use of protective medical equipment by an individual who is an employee or contractor of the facility, provider, or physician and who is not vaccinated against COVID-19 based on the level of risk the individual presents to patients from the individual’s routine and direct exposure to patients.

Medicare Advantage Plans are not following Medicare Guidelines as established by the 2024 CMS ruling. We know this personally and we have heard this from many of the facilities we service, about 3 day stays instead of the 100. Refer to the following link: https://www.aha.org/frequently-asked-questions-faqs/2024-02-07-cms-faqs-2024-medicare-advantage-rule

Question:
Can an MA organization deny admission of a patient to a post-acute care facility from an acute care hospital if it’s ordered by their physician and the patient meets the coverage criteria for admission into that facility?

Answer:
No, if a patient is being discharged from an acute care hospital to a post-acute care facility that would be covered under Traditional Medicare and the patient’s attending physician orders post-acute care in the specific type of facility (i.e., Skilled Nursing Facility (SNF), Long Term Care Hospital (LTCH)) and the patient meets all applicable Medicare coverage criteria for admission into that facility type, the MA organization cannot deny admission to that post-acute setting and/or redirect the care to a different setting. In the context of post-acute care services furnished in a particular setting, MA organizations may only deny a request for Medicare covered post-acute care services if the MA organization determines that the Traditional Medicare coverage criteria (e.g., for SNF care in §§ 409.30-409.36) or internal coverage criteria when applicable and 7 authorized by § 422.101(b) for the services cannot be satisfied in that particular setting. We explained this clearly as part of the proposal that we adopted in the final rule. 88 FR 22189. We reiterate here that MA organizations may only deny a request for Medicare covered post-acute care services in a particular setting if the MA organization determines that the Traditional Medicare coverage criteria or internal coverage criteria (when applicable and authorized by § 422.101(b)) for the services cannot be satisfied in that particular setting. However, MA plans are permitted to offer coverage of alternatives to Medicare covered post-acute care services in a particular setting and an enrollee is permitted to elect different treatment. The requirement for MA plans to cover all basic benefits consistent with Traditional Medicare coverage criteria does not prohibit discussions with the enrollee of other treatment options that are covered by the MA plan. However, the flexibility for MA plans to cover and deliver care in cost-effective approaches does not replace the obligation for MA plans to cover all basic benefits consistent with the established coverage criteria for Traditional Medicare. MA organizations may only terminate coverage for post-acute care services based on coverage criteria that are specified in § 422.101(b) or (c), which include medical necessity. An algorithm or software tool may be used to assist MA plans in predicting a length of stay, but that prediction alone must not be used as the basis to terminate post-acute care services; the patient must no longer meet the level of care requirements needed for the post-acute care at the time the services are being terminated, which can only be determined by re assessing the individual patient’s condition prior to issuing the notice of termination of services. An MA organization’s decision to terminate post-acute care services and discharge a patient from a home health agency (HHA), skilled nursing facility (SNF), or comprehensive outpatient rehabilitation facilities (CORF) is an organization determination and is appealable in accordance with rules in §§ 422.624 and 422.626.4 The specific expedited appeal process applicable to such terminations of provider services provides that the burden of proof rests with the MA organization to demonstrate that termination of coverage is the correct decision, either on the basis of medical necessity, or based on other Medicare coverage policies, and that the MA organization must supply a specific and detailed explanation why services are either no longer reasonable and necessary or are no longer covered, including a description of the applicable coverage criteria and rules. 42 CFR § 422.626(c) and (e).

Cyber Attack on Healthcare!
The nation’s largest clearinghouse is still struggling to recover from a cyberattack reported more than three weeks ago, leaving hospitals and medical providers across the country cash-strapped and frustrated. The ransomware attack on UnitedHealth that has disrupted payments to U.S. doctors and healthcare facilities nationwide for a month, has taken an especially harsh toll on the community health centers that serve more than 30 million poor and uninsured patients. The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and Deputy Secretary Andrea Palm, led a convening of health care community leaders – joined by White House Domestic Policy Advisor Neera Tanden, White House Deputy National Security Advisor (DNSA) for Cyber and Emerging Technologies Anne Neuberger, and others from the federal government – to discuss concrete actions and potential cybersecurity rules that would impose financial consequences for healthcare organizations that don't have a certain baseline of cybersecurity readiness in place. Health and Human Services' Office for Civil Rights announced on March 13 that it has opened an investigation into the hack to determine if protected health information was breached and to assess Change Healthcare's and UHG's compliance with HIPAA rules. The breakdown at Change, the result of a ransomware attack, snapped an essential backbone of the healthcare industry, causing cash flow crises for hospitals, clinics, and doctor’s practices across the country, which are still struggling to submit reimbursement paperwork to insurers. This situation was as close to a collapse of the US Healthcare system as there has ever been.