Texas Health and Human Services Digest: August 19, 2020

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Previous meetings have made alternative arrangements like phone-in capability or have been canceled. These meetings are on the calendar as of today.

August 20, 2020

August 21, 2020

August 24, 2020

August 25, 2020

August 26, 2020

August 31, 2020

September 1, 2020

September 10, 2020

Proposed Rules
Formal Comments via the Texas Register
To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State. Interested parties then can review and comment on the proposed rule. The Secretary of State publishes a new issue of the Texas Register each Friday.

The Administrative Procedure Act (Texas Government Code, Chapter 2001) requires the notice published in the Texas Register to include a brief explanation of the proposed rule and a request for comments from any interested person. The notice also includes instructions for submitting comments regarding the rule to the agency, including the date by which comments must be submitted. Agencies must give interested persons “a reasonable opportunity” to submit comments. The public comment period begins on the day after the notice of a proposed rule is published in the Texas Register and lasts for a minimum of 30 calendar days.

Below is a list of proposed rules that have been published in the Texas Register. The proposed rules that are published in the Texas Register are open for public comment until the end of the comment period.

Project No.,
Comment End Date
Title 26, Part 1, Chapter 370, Human Trafficking Resource Center#20R034: Human Trafficking Prevention Training RequirementsHHS Rules Coordination Office9/14/20
Title 25, Chapter 37, Subchapter S, Newborn Hearing Screening#19R073: Newborn Hearing ScreeningDSHS Newborn Screening Unit9/8/20
Title 25, Chapter 73, Laboratories, and Title 25, Chapter 218, Subchapter A, Evaluation of Milk Laboratories, and Subchapter B, Evaluation of Shellfish Laboratories#19R014: Evaluation of Milk and Shellfish LaboratoriesDSHS Milk and
Dairy Unit
Title 1, Chapter 370, Subchapter G, Standards for CHIP Managed Care#19R057: CHIP Appeals ProcessHHS Rules Coordination Office8/24/20
Title 40, Chapter 51, Medically Dependent Children Program#18R006: Repeal of MDCP Rules in Title 40HHS Rules Coordination Office8/24/20
Title 25, Chapter 265, General Sanitation#19R043: Public Swimming Pools and SpasDSHS Consumer Protection Division8/24/20

Draft Rules Informal Comments

Informal opportunities to comment occur before a rule is published in the Texas Register. HHS staff may solicit informal public and stakeholder input by:

  • inviting stakeholders to submit comments on potential rule changes during rule development.
  • sharing a draft rule with stakeholders for review.
  • using existing HHS advisory committees to comment on rules.

There are currently no draft rules available for comment.

TitleProject No.ContactComment Start DateComment End Date
Repeal of Title 26, Chapter 555, Subchapter B, Requirements for Licensure, and updated Title 26, Chapter 555, Subchapters A – D, relating to Requirements for Nursing Facility Administrators#18R057Bridney Jones8/18/208/25/20

Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. The data contained within the Preview Reports is based on quality data submitted by SNFs between Q1 2019 – Q4 2019 (1/01/19 – 12/31/19) (for assessment-based measures) and Q4 2017 and Q3 2019 (10/01/17 – 9/30/19) (for claims-based measures). The data reflects what will be published on Nursing Home Compare during the October 2020 refresh of the website.  Providers have until August 30, 2020 to review their performance data. Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate.

Beginning with the October 2020 refresh, CMS will publicly display six new measures on the Nursing Home Compare website:

  • Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury,
  • Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC SNF QRP,
  • Application of IRF Functional Outcome Measure: Change in Self-Care (NQF #2633),
  • Application of IRF Functional Outcome Measure: Change in Mobility (NQF #2634),
  • Application of IRF Functional Outcome Measure: Discharge Self-Care Score (NQF #2635), and
  • Application of IRF Functional Outcome Measure: Discharge Mobility Score (NQF #2636)

SNF performance data for these measures will be included for the first time on this preview report.

The following existing measures will continue to be reported as part of the October 2020 refresh

  • Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay),
  • Application of Percent of Long-Term Care Hospital (LTCH) Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function,
  • Medicare Spending Per Beneficiary – PAC SNF QRP,
  • Discharge to Community – PAC SNF QRP, and
  • Potentially Preventable 30-Day Post-Discharge Readmission Measure – SNF QRP

We are implementing the annual refresh of the SNF QRP claims-based measures during the October 2020 refresh of NH Compare. The annual refresh will include updates to the Medicare Spending per Beneficiary (MSPB), Discharge to Community (DTC) measure, and the Potentially Preventable Readmissions (PPR) measure.

The Centers for Medicare & Medicaid Services (CMS) wants to remind you that the end of the 2021 Merit-Based Incentive Payment System (MIPS) Self-Nomination period is September 1, 2020 at 8 p.m. Eastern Time (ET). The Self-Nomination Tool on the QPP website will lock at the deadline and additional edits will not be permitted.

Please ensure that your 2021 MIPS Self-Nomination Form is complete and click the Submit for Review button before the deadline in the Self-Nomination tool on the Quality Payment Program website.

You can only submit the Self-Nomination Form for review after all required fields are complete on each tab. Each tab has a Vertical Progress Indicator on the left side of the form that shows your progress. A green checkmark shows you’ve completed the tab, and the Submit for Review button becomes enabled. Once you’ve selected the Submit for Review button, the Vendor Landing page will list your self-nomination with the nomination status In Self-Nomination Review.

The Centers for Medicare and Medicaid Service (CMS) wants to make you aware of a recent Drug Safety Communication from the Food & Drug Administration (FDA). The FDA announced it now requires labeling for opioid pain medicine and medicine to treat OUD be updated to recommend that as a routine part of prescribing these medicines, health care professionals should discuss the availability of the overdose reversal drug naloxone with patients and caregivers, both when beginning and renewing treatment.

Additionally, the labeling changes recommend that health care professionals consider prescribing naloxone to patients who are prescribed opioid pain medicines and who are at increased risk of opioid overdose, including those who are also taking benzodiazepines or other medicines that depress the central nervous system; those who have a history of OUD; and those who have experienced a prior opioid overdose.  A naloxone prescription should also be considered for patients prescribed opioids who have household members, including children, or other close contacts at risk for accidental ingestion or opioid overdose.

We encourage you to share this information with your members as soon as possible.

On Monday August 10, 2020, CMS updated the AUC website to announce that the Educational and Operations Testing Period, during which there are not payment penalties, has been extended through 2021. This update is included at the top of the page with the green border: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program.

We do not have further information to share at this time, but as new information becomes available it will be accessible via the Outreach and Education page of the AUC website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/OandE.

Announcement: CMS is pleased to extend an open invitation to the public to attend its upcoming webinar titled Understanding Clinical Quality Measures: How CMS is Modernizing its Approach to Digital Measurement. The webinar will provide an engaging and informative overview of quality measurement, the unique features of electronic clinical quality measures (eCQMs) and future plans for digitization. Additionally, the presentation will address burden reduction, measure reporting considerations, as well as provide information about key resources. The webinar will be offered twice in September on Tuesday, September 15, 2020,  from 2:00 p.m. – 3:00 p.m., ET (Register here), and Thursday, September 17, 2020, from 3:00 p.m. – 4:00 p.m., ET (Register here). For questions about the webinar, please contact MMSSupport@battelle.org.

Announcement: Trump Administration Announces New Resources to Protect Nursing Home Residents Against COVID-19. Click here to learn more.

Announcement: Updated eCQM Specifications and eCQM Materials for 2021 Reporting Now Available. Click here to learn more.

Announcement: Guidance on Allowance of Telehealth Encounters in eCQMs Now Available. Click here to learn more.

ICYMI—National Health Quality Roadmap: Representing the work from government and private sector quality experts, the roadmap outlines develop strategies for improving the Federal Government’s administration of the healthcare quality enterprise, providing details for establishing, adopting, and publishing common quality measurements; aligning inpatient and outpatient measures; and eliminating low-value or counterproductive measures. While the COVID-19 pandemic will impact project timelines, HHS is nevertheless committed to implementing the programs outlined, with the intent of improving the healthcare quality enterprise for the benefit of the American people. Learn more about the National Health Quality Roadmap.

HIGHIGHT—Social Risk and Medicare’s Value-Based Purchasing Programs Second Report to Congress: As required by the IMPACT Act, the second Report to Congress examines the effect of individuals’ social risk factors on quality measures, resource use, and other measures under the Medicare program, as well as analyses of the effects of Medicare’s current value-based payment programs on providers serving socially at-risk beneficiaries and simulations of potential policy options to address these issues. Learn more about ASPE’s Report to Congress.
Resource: 2021 MIPS Self-Nomination Application Demo Webinar.

Multifocal contact lenses slow myopia progression in children. Children who wore multifocal contact lenses had slower progression of their myopia, or nearsightedness, over three years.

Blood tests show promise for early Alzheimer’s diagnosis. Blood levels of a protein called ptau217 were associated with damage to the brain caused by Alzheimer’s disease, and may one day help diagnose disease before symptoms appear.

Today, we are releasing the detailed instructions for the submission of Legislative Appropriations Requests (LAR) for the 2022-2023 biennium. These instructions are posted on the websites of the Legislative Budget Board (LBB) and the Office of the Governor. You may begin the process of entering data into the Automated Budget and Evaluation System of Texas (ABEST). Please contact your assigned LBB analyst if you have further questions. As the Comptroller of Public Accounts recently stated, the current economic outlook “carries an unprecedented amount of uncertainty.” While we have immense faith that the Texas economy will recover and continue leading the nation, this uncertainty further demonstrates that the state must maintain its commitment to fiscal restraint. We appreciate the efforts your entities have made in the current fiscal biennium to minimize spending that did not impact services or necessitate reductions in force when possible. All state entities will be required to submit an LAR with a base funding amount equal to your adjusted 2020-2021 base. Some agencies that were exempted from the 5 percent reduction in the 2020- 2021 appropriations years will be provided adjusted baseline numbers for purposes of the 2022- 2023 LAR. Any request above that base level, including a restoration of reductions, should be included as an exceptional item. 2022-2023 Biennium Legislative Appropriations Requests August 18, 2020 Exceptions to the baseline request limitation include amounts necessary to:

  • maintain funding for the Foundation School Program under current law;
  • satisfy debt service requirements for bond authorizations;
  • maintain funding at fiscal year 2021 budgeted levels plus amounts necessary to cover the impact of payroll growth for state pension systems and employee group benefits (not including payroll contributions made by state agencies and institutions of higher education for retirement and group health insurance), though group benefit modifications may be considered;
  • maintain current benefits and eligibility in Medicaid programs, the Children’s Health Insurance Program, foster care programs, the adoption subsidies programs, and the permanency care assistance program (baseline requests for these programs should include amounts sufficient for projected caseload growth);
  • maintain funding for programs serving individuals with intellectual or developmental disabilities;
  • maintain funding for Child Protective Services; and
  • maintain funding for the Department of Public Safety.

We will continue to work with Comptroller Hegar to closely monitor the economy and state revenues.

To prepare for the possibility of reduced state revenues in the upcoming session, each entity shall provide additional information about existing programs, listing the top priorities for the entity, and how a reduction in the specific program would impair an entity from fulfilling its core mission. Thank you for your dedicated service to Texas. While the future carries significant uncertainty, we know that by working together we can ensure the State will continue to provide core government functions and a high level of customer service. We look forward to working with you in preparation for the 87th Legislative Session.

The following documents will be helpful in understanding this exceptional budget request process for this exceptional time.

Welcome to OIG Update – a monthly newsletter from the Texas Health and Human Services Office of Inspector General (OIG). This newsletter highlights some of the OIG’s recent efforts in detecting, preventing and deterring fraud, waste and abuse in the delivery of Texas health and human services programs. Within this email, you’ll find hyperlinks to our Fraud Hotline performance and audits conducted by our team.

Fraud Hotline results released. The OIG’s Fraud Hotline continued to take calls during the third quarter while working remotely, answering 5,491 calls. Read more about the hotline’s work.

OIG conducts audit of local government council. The audit determined whether contract controls ensured the local developmental and disability authority coordinated services to enrollees, monitored service delivery, reported general revenue expenses according to contract requirements and documented paid encounters. Read the report.

OIG audit finds $50,728 in overpayments to DME provider. The audit evaluated whether there was valid authorization and evidence of delivery of fee-for-service durable medical equipment (DME) and supplies associated with Medicaid claims submitted by and paid to the provider. Read the report.

Texas Health and Human Services is accepting comments from stakeholders on the following draft rules. The comment period ends August 25, 2020.

  • Texas Health and Human Services Commission Title 26, Part 1, Chapter 555, Subchapter B, Requirements for Licensure repeal, and updated Title 26, Chapter 555, Subchapters A – D, relating to Requirements for Nursing Facility Administrators. Comments can be emailed to Bridney Jones.

Questions can be emailed to HHS Rules Coordination Office.

The Texas State Board of Social Worker Examiners is an independent licensing board administratively attached to the Texas Health and Human Services Commission (HHSC). The Board, as an independent entity, maintains a management structure and decision-making authority separate from HHSC. This message is an official communication from the Texas State Board of Social Worker Examiners.

The Texas State Board of Examiners of Professional Counselors is an independent licensing board administratively attached to the Texas Health and Human Services Commission (HHSC). The Board, as an independent entity, maintains a management structure and decision-making authority separate from HHSC. This message is an official communication from the Texas State Board of Examiners of Professional Counselors.

The Texas State Board of Examiners of Marriage and Family Therapists is an independent licensing board administratively attached to the Texas Health and Human Services Commission (HHSC). The Board, as an independent entity, maintains a management structure and decision-making authority separate from HHSC. This message is an official communication from the Texas State Board of Examiners of Marriage and Family Therapists.

The Council on Sex Offender Treatment is an independent licensing board administratively attached to the Texas Health and Human Services Commission (HHSC). The Council, as an independent entity, maintains a management structure and decision-making authority separate from HHSC. This message is an official communication from the Council on Sex Offender Treatment.

The 86th Texas Legislature introduced Texas Occupations Code, Chapter 116, Training Course on Human Trafficking Prevention, which requires a health care practitioner to successfully complete an HHSC-approved Human Trafficking Prevention training course as a condition for renewal of a license on or after September 1, 2020. Information about the HHS-Approved Human Trafficking Course is available on HHSC’s Health Care Practitioner Human Trafficking Training webpage.

HHSC has posted the following new and revised Electronic Visit Verification policies, effective Aug. 1.

The information is on the HHS EVV website and is for program providers, financial management services agencies and consumer directed services employers.

New Policies

  • Data Collection Policy (PDF)
    • The Data Collection Policy replaces the EVV Data Elements Policy. It requires an EVV system to verify critical data elements relating to the delivery of a Medicaid personal care service as required by Texas Government Code §531.024172.
  • Service Authorization Policy (PDF)
    • Requires program providers and FMSAs to enter and maintain current service authorizations in the EVV system for each member receiving a service required to use EVV.

Revised Policies

  • EVV System Selection Policy (PDF)
    • The System Selection Policy replaces the EVV Vendor Selection Policy. It now includes the EVV proprietary system option and updated requirements for selecting an EVV system.
  • EVV System Transfer Policy (PDF)
    • The System Transfer Policy replaces the EVV Vendor Transfer Policy. It provides requirements for transferring from one EVV system to another.
  • Training Policy (revised)
    • Requires program providers, FMSAs and CDS employers to complete EVV training prior to using an EVV system, and then annually.

Website Updates

The Forms section of the HHS EVV home page has been removed. The:

  • Visit Maintenance Unlock Request has moved to the new EVV Visit Maintenance section to make it easier to locate.
  • EVV Rights and Responsibilities for fee-for-service and managed care have moved to the new Rights and Responsibilities section.

Email questions to HHSC EVV.

Sullivan to step down as Insurance Commissioner. Kent Sullivan has notified Governor Abbott that he will resign as Texas Insurance Commissioner in September to return to the private sector. Sullivan became head of the Texas Department of Insurance in October 2017 and has led a major modernization effort in his three years at the agency. Read more.

TDI modernization. In October 2017, Kent Sullivan became Insurance Commissioner, and TDI began a top-to-bottom review to improve services and modernize. Today, the agency answers calls, processes licenses, and resolves consumer complaints faster. Read more about our efforts and the results.