I live in Texas too and I have noticed the increase in pending denials. I had one recently that after picking the chart apart, correcting the LTCMI, calling the TMHP nurse three times it was sent back to the doctor and denied. They told me my next step would be to send a letter from the doctor saying why he needed LTC. It finally was approved. If they need a note from the doctor why do we spend our time assessing and doing the MDS. This patient seemed like a slam dunk for MN. He was under 60 years old and they are getting really bad about wanting to deny them. Our LTC has quite a few people from their 30's to 60's. I spend a lot of time on the MDS to begin with then they want us to sweat blood! It makes me look harder about accepting residents that might not qualify. It does not help our census and doe not help these people that need our services.