Texas Health and Human Services Digest: December 11, 2020

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From HHSC: While every effort has been made to offer an accurate and current listing of meeting agendas and events on this calendar, the information has been compiled from a variety of sources and is subject to change without notice to the user.

December 11, 2020

December 14, 2020

December 15, 2020

December 16, 2020

December 22, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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.

TitleProject No., DescriptionContactComment End Date
Title 1, Chapter 393, Informal Dispute Resolution and Informal Reconsideration#20R093: Informal Dispute ResolutionAllison Levee12/28/20
Title 26, Chapter 746, Minimum Standards for Child-Care Centers#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 26, Chapter 747, Minimum Standards for Child-Care Homes#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 25, Section 133.48, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 25, Section 135.26, Reporting Requirements, and Section 135.27, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 26, Section 510.47, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 26, Chapter 742, Minimum Standards for Listed Family Homes#20R021: Listed Family HomesHHS Child Care Regulation12/21/20
Title 26, Chapter 744, Minimum Standards for School Age and Before or After School Programs#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 1, Chapter 355, Subchapter J, Division 14, Section 355.8261, Federally Qualified Health Center Services Reimbursement#21R008: Federally Qualified Health Center Services ReimbursementHHS Provider Finance Department12/14/20

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.
TitleProject No.ContactComment Start DateComment End Date
Title 26, Chapter 507, End Stage Renal Disease Facilities#19R008HHS Policy, Rules and Training12/2/2012/16/20

2021 Consideration Schedule

TitleProposed Effective DatePacket UpdatedDocuments
Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In MedicaidSeptember 01, 2021 Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In Medicaid
09-01-2021-prospective-reimbursement-rural-hospitals-in-medicaid.pdf

Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In Medicaid Attachment
09-01-2021-prospective-reimbursement-rural-hospitals-in-medicaid-attch-rate-vis.pdf

Notice of Proposed Adjustments to Fees, Rates or Charges for Wound CareMarch 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Wound Care
03-2021-policy-woundcare.pdf
Notice of Proposed Adjustments to Fees, Rates or Charges for Telemonitoring UpdateMarch 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Telemonitoring Update
03-2021-policy-telemonitoring.pdf
Notice of Proposed Adjustments to Fees, Rates or Charges for Stereotactic RadiosurgeryMarch 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Stereotactic Radiosurgery
03-2021-policy-stereotactic-radiosurgery.pdf
Notice of Proposed Adjustments to Fees, Rates or Charges for Nutritional (Enteral) Products, Supplies, and Equipment – Home Health & CCP: Immobilized Lipase CartridgeMarch 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Nutritional (Enteral) Products, Supplies, and Equipment – Home Health & CCP: Immobilized Lipase Cartridge
03-2021-policy-nutrional-prod-sup-equip.pdf
Notice of Proposed Adjustments to Fees, Rates or Charges for Digital Breast TomosynthesisMarch 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Digital Breast Tomosynthesis
03-2021-policy-dbt.pdf
Notice of Proposed Adjustments to Fees, Rates or Charges for Colorectal Cancer Screening PolicyMarch 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Colorectal Cancer Screening Policy
03-2021-policy-colorectal-cancer-screen.pdf
Notice of Proposed Adjustments to Fees, Rates or Charges for Healthcare Common Procedure Coding System (HCPCS)March 01, 2021 Notice of Proposed Adjustments to Fees, Rates or Charges for Healthcare Common Procedure Coding System (HCPCS)
03-2021-policy-hcpcs.pdf

Notice of Proposed Adjustments to Fees, Rates or Charges for Healthcare Common Procedure Coding System (HCPCS) Attachments
03-2021-policy-hcpcs-att.zip

Biennial Calendar Fee ReviewMarch 01, 2021 Biennial Calendar Fee Review
03-2021-biennialcalendarfeereview.pdf

Biennial Calendar Fee Review Attachments
03-2021-biennialcalendarfeereview-att.zip

HHSC: Dates Announced for Federal COVID-19 Vaccination Program for Long-Term Care Staff, Residents. The State of Texas will participate in the Pharmacy Partnership for Long-Term Care Program, a federal program to vaccinate residents and staff of long-term care facilities against COVID-19. The program is free of charge to facilities and sends staff and Pfizer vaccines from partnering Walgreens and CVS locations to these facilities to vaccinate residents and staff who volunteer to participate.

The first vaccines included in this program will be provided to pharmacies the week of December 21, 2020, and the program will begin December 28, 2020.

Long-term care facilities that have not enrolled in the pharmacy program may choose to enroll with the Texas Department of State Health Services’ Immunization Program to receive vaccines and vaccinate their own staff and residents or partner with a local pharmacy or other vaccine provider.

Read more here.

DSHS: COVID Update.
Public Health

Hospitals & Healthcare Professionals

Executive Order GA-32 | Orden ejecutiva GA-32

COVID-19 Testing Information

DSHS: Texas adds probable cases, antigen test positivity rate to data dashboard. The Texas Department of State Health Services today will update the COVID-19 data dashboard to include additional data and to simplify the layout to improve functionality.

DSHS is adding case counts for probable cases statewide and by county. Probable cases are those identified through antigen testing or a combination of symptoms and a known exposure without a more likely diagnosis. Reporting probable cases allows Texans to see a more complete picture of how COVID-19 is affecting Texas since both confirmed and probable cases represent active infections. For that reason, they will be included in the estimates of active and recovered cases.

In addition to the probable case counts, DSHS is adding a positivity rate for antigen tests. This positivity rate, based on when people were tested, aligns with the most reliable positivity rate for molecular tests. These positivity rates, which show the percentage of tests taken in a given period that are positive, provide a consistent view of the severity of the pandemic over time because they most closely reflect the conditions when people were tested.

The configuration of the dashboard will change to improve performance. Some tabs will be combined, and users will be able to toggle between confirmed and probable cases, fatalities, and active and recovered estimates by county on a single tab. Case and fatality demographics will also be consolidated onto one tab.

After several months of posting three positivity rates for molecular tests, as previously announced, DSHS will retire the rates based on when lab results were reported to the state and the legacy rate which used the number of new confirmed COVID-19 cases over seven days divided by the number of new molecular test results over the same period.

ESRD Treatment Choices Model Webinar Materials, Additional Resources Posted. CMS has released the final rule for the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD, while reducing Medicare expenditures and preserving or enhancing the quality of care furnished to beneficiaries with ESRD. The Model will begin on January 1, 2021.

In order to help ETC Model Participants prepare for the ETC Model, CMS hosted an introductory webinar on Wednesday, December 9, 2020. The webinar provided an overview of the ETC Model, including:

  • Participant selection
  • The Home Dialysis Payment Adjustment
  • The Performance Payment Adjustment
  • The ETC Model timeline, including the timing of payment adjustments
  • Information about how to communicate with CMS about the ETC Model.

CMS posted the slides, recording, and transcript of the webinar to the ETC Model website. Other materials posted to the Model website include the following:

For more information about the ETC Model, please visit the ETC Model website. You can also find more information about the ETC Model in the Specialty Care Models To Improve Quality of Care and Reduce Expenditures Final Rule, CMS-5527-F. The Final Rule is available in the Federal Register. For any questions, please email the ETC Model team at ETC-CMMI@cms.hhs.gov.

CMS Proposes New Rules to Address Prior Authorization and Reduce Burden on Patients and Providers. Under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve the electronic exchange of health care data among payers, providers, and patients, and streamline processes related to prior authorization to reduce burden on providers and patients. By both increasing data flow, and reducing burden, this proposed rule would give providers more time to focus on their patients, and provide better quality care.

The COVID-19 pandemic has shone a harsh light on many longstanding inefficiencies in the health care system—including the lack of data sharing and access. Today’s proposed rule aims to improve this for patients navigating care. The proposed rule would build on the Trump Administration’s Interoperability and Patient Access final rule published by the CMS in May.

The rule would require payers in Medicaid, CHIP and QHP programs to build application programming interfaces (APIs) to support data exchange and prior authorization. APIs allow two systems, or a payer’s system and a third-party app, to communicate and share data electronically  Payers would be required to implement and maintain these APIs using the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The FHIR standard is an innovative technology solution that helps bridge the gaps between systems so both systems can understand and use the data they exchange.

On behalf of HHS, the Office of the National Coordinator for Health IT (ONC) is also proposing to adopt certain standards through an HHS rider on the CMS proposed rule.

Read the release.

To read more on the importance of these proposed changes, please visit CMS Administrator Seema Verma’s blog post here: https://www.cms.gov/blog/reducing-provider-and-patient-burden-and-promoting-patients-electronic-access-health-information

The proposed rule is available to review today at: https://www.cms.gov/files/document/121020-reducing-provider-and-patient-burden-cms-9123-p.pdf The comment period will close on January 4, 2021.

For a copy of the Fact Sheet, visit: https://www.cms.gov/newsroom/fact-sheets/reducing-provider-and-patient-burden-improving-prior-authorization-processes-and-promoting-patients

For more information on the CMS proposed rule, please visit: https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index

Changes to Texas Administrative Code Chapter References for HHS System. As part of the transformation of the Health and Human Services (HHS) system, rule chapters are being relocated in the Texas Administrative Code (TAC).
Effective January 15, 2021, rules in:

  • 40 TAC Social Services Assistance, Part 1, Department of Aging and Disability Services, Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification

Will be transferred to:

  • 26 TAC Health and Human Services, Part 1, Texas Health and Human Services Commission, Chapter 554, Nursing Facility Requirements for Licensure and Medicaid Certification.

The table below outlines recent rule transfers.

Rule TitleCurrent TACNew TAC
Basis and Scope40 TAC 19, Sub A26 TAC 554, Sub A
Definitions40 TAC 19, Sub B26 TAC 554,  Sub B
Nursing Facility Licensure Application Process40 TAC 19, Sub C26 TAC 554, Sub C
Facility Construction40 TAC 19, Sub D26 TAC 554, Sub D
General Provisions40 TAC 19, Sub D, Div 126 TAC 554, Sub D, Div 1
Facilities Licensed Before September 11, 200340 TAC 19, Sub D, Div 226 TAC 554, Sub D, Div 2
Provisions Applicable to All Facilities40 TAC 19, Sub D, Div 326 TAC 554, Sub D, Div 3
Construction and Initial Survey40 TAC 19, Sub D, Div 426 TAC 554, Sub D, Div 4
Facilities Licensed on or After September 11, 2003 and Before April 2, 201840 TAC 19, Sub D, Div 526 TAC 554, Sub D, Div 5
Plan Review40 TAC 19, Sub D, Div 626 TAC 554, Sub D, Div 6
Small House and Household Facilities40 TAC 19, Sub D, Div 726 TAC 554, Sub D, Div 7
Building Rehabilitation40 TAC 19, Sub D, Div 826 TAC 554, Sub D, Div 8
Facilities Licensed on or After April 2, 201840 TAC 19, Sub D, Div 926 TAC 554, Sub D, Div 9
Resident Rights40 TAC 19, Sub E26 TAC 554, Sub E
Admission, Transfer, and discharge Rights in Medicaid-Certified Facilities40 TAC 19, Sub F26 TAC 554, Sub F
Freedom From Abuse, Neglect, and Exploitation40 TAC 19, Sub G26 TAC 554, Sub G
Quality of Life40 TAC 19, Sub H26 TAC 554, Sub H
Resident Assessment40 TAC 19, Sub I26 TAC 554, Sub I
Quality of Care40 TAC 19, Sub J26 TAC 554, Sub J
Nursing Services40 TAC 19, Sub K26 TAC 554, Sub K
Food and Nutrition Services40 TAC 19, Sub L26 TAC 554, Sub L
Physician Services40 TAC 19, Sub M26 TAC 554, Sub M
Rehabilitative Services40 TAC 19, Sub N26 TAC 554, Sub N
Dental Services40 TAC 19, Sub O26 TAC 554, Sub O
Pharmacy Services40 TAC 19, Sub P26 TAC 554, Sub P
Infection Control40 TAC 19, Sub Q26 TAC 554, Sub Q
Physical Plant and Environment40 TAC 19, Sub R26 TAC 554, Sub R
Administration40 TAC 19, Sub T26 TAC 554, Sub T
Inspections, Surveys, and Visits40 TAC 19, Sub U26 TAC 554, Sub U
Enforcement40 TAC 19, Sub V26 TAC 554, Sub V
Enforcement Generally40 TAC 19, Sub V, Div 126 TAC 554, Sub V, Div 1
Licensing Remedies40 TAC 19, Sub V, Div 226 TAC 554, Sub V, Div 2
Remedies in Medicaid-Certified Facilities40 TAC 19, Sub V, Div 326 TAC 554, Sub V, Div 3
Certification of Facilities for Care of Persons with Alzheimer’s Disease and related Disorders40 TAC 19, Sub W26 TAC 554, Sub W
Requirements for Medicaid-Certified Facilities40 TAC 19, Sub X26 TAC 554, Sub X
Medical Necessity Determinations40 TAC 19, Sub Y26 TAC 554, Sub Y
Vendor Payment40 TAC 19, Sub AA26 TAC 554, Sub AA
Nursing Facility Responsibilities Related to Preadmission Screening and Resident Review (PASRR)40 TAC 19, Sub BB26 TAC 554, Sub BB
General Provisions40 TAC 19, Sub BB, Div 126 TAC 554, Sub BB, Div 1
Nursing Facility Responsibilities40 TAC 19, Sub BB, Div 226 TAC 554, Sub BB, Div 2
Nursing Facility Specialized Services for Designated Residents40 TAC 19, Sub BB, Div 326 TAC 554, Sub BB, Div 3

You will need to refer to the new TAC chapters after January 15, 2021. All letters, memoranda, and other guidance remain in effect while HHSC updates outdated references. The rule transfer notice was posted in the December 11, 2020, issue of the Texas Register.

If you have questions about these administrative moves, email the Rules Coordination Office.

Read more.

Influenza Update. This information has recently been updated and is now available.

DSHS Legislative Information. The following reports have been finalized and posted to the DSHS Legislative Information page:

All 2020 DSHS Legislative Mandated Reports can be found here and will be posted as they are submitted to the Legislature.  For reports prepared for previous sessions, see the Archived Reports and Presentations page.

DSHS Texas Birth Defects.  The Texas Birth Defects Monitor Volume 26 is now available on the Texas Birth Defects Epidemiology and Surveillance Branch’s website here.  This volume includes topics such as:

  • Case Management Partnership with Regional Specialized Health and Social Services: A Closer Look at Down Syndrome
  • Updated Data from the Texas Birth Defects Registry, 2012-2017
  • Critical Congenital Heart Defect Mortality

For comments and questions, please send an email to BirthDefects@dshs.texas.gov.