Texas Health and Human Services Digest: December 16, 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 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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

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

2020 Schedule

TitleProposed Effective DatePacket UpdatedDocuments
Notice of Adjustments to Fees, Rates or Charges for Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates Related to Coronavirus Disease 2019 (COVID-19) Vaccine AdministrationDecember 11, 2020 Notice of Adjustments to Fees, Rates or Charges for Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates Related to Coronavirus Disease 2019 (COVID-19) Vaccine Administration
12-11-2020-hcpcs-update-covid-19-vaccine-admin-rate-info.pdf

2021 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

Now Available: Updated 2021 CMS QRDA I Schematron for Hospital Quality Reporting. The Centers for Medicare & Medicaid Services (CMS) has posted an updated 2021 CMS Quality Reporting Document Architecture (QRDA) Category I Schematron for Hospital Quality Reporting. The Schematron provides technical instructions for eligible hospitals and critical access hospitals (CAHs) to report electronic clinical quality measures (eCQMs) for the calendar year 2021 reporting period for the:

  • Hospital Inpatient Quality Reporting Program
  • Medicare and Medicaid Promoting Interoperability Programs for Eligible Hospitals and CAHs

The change to the 2021 CMS QRDA I Schematron is:

  • An assertion rule has been added to the Schematron that will allow only one Encounter Diagnosis QDM template with a rank attribute equal to 1, to indicate the principal diagnosis, within an Encounter Performed template. This enforcement is in alignment with guidance provided in section 3.19 in the QRDA I STU Release 5.2 Implementation Guide with errata, which states “When there are multiple diagnoses, only one diagnosis should be identified as principal diagnosis.”

Additional QRDA-Related Resources:

CMS Office of the Actuary Releases 2019 National Health Expenditures. Total national healthcare spending in 2019 grew 4.6%, which was similar to the 4.7% growth in 2018 and the average annual growth since 2016 of 4.5%, according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published today ahead of print by Health Affairs.

This report includes health expenditure data though 2019 and therefore does not include any of the effects of the coronavirus disease 2019 (COVID-19) pandemic on health care spending.

Future reports for 2020 forward will measure health expenditures based on the latest available data and will reflect the impacts of the pandemic on total health care spending as well as on the distribution of spending among the services, payers, and sponsors of health care.

The share of the economy devoted to health spending was relatively stable in 2019, at 17.7% compared with a 17.6% share in 2018. The 4.6% growth in healthcare expenditures was faster than the 4.0% overall economic growth as measured by Gross Domestic Product (GDP) in 2019. The growth in total national healthcare expenditures in 2019 reached $3.8 trillion, or $11,582 per person, up from 2018 when total national health expenditures were $3.6 trillion, or $11,129 per person.

Spending for personal health care, which includes health care goods and services, accounted for 84% of total health care spending in 2019 and increased 5.2%, a faster rate than the 4.1% it increased in 2018.  The faster growth in personal health care spending was driven largely by growth for hospital care, retail prescription drugs, and physician and clinical services.

Offsetting the faster growth in personal health care spending was a decline in the net cost of health insurance, which includes nonmedical expenses such as administrative costs, taxes, and underwriting gains or losses.  The net cost of health insurance declined 3.8% in 2019 largely because of a suspension of the health insurance providers’ tax.

  • Private health insurance spending (31% of total health care spending) increased 3.7% to $1.2 trillion in 2019, which was slower than the 5.6% rate of growth in 2018. The deceleration in overall private health insurance spending growth was driven by a 7.9% decline in the net cost of private health insurance that was primarily the result of the suspension of the health insurance tax in 2019. Private health insurance enrollment increased slightly in 2019, by 0.5%, as enrollment in employer-sponsored insurance increased 0.7%.
  • Medicare spending (21% of total health care spending) grew 6.7% to reach $799.4 billion in 2019, which was slightly faster than the 6.3 % growth in 2018. The acceleration in 2019 reflected faster growth in Medicare private health plan spending (39% of total Medicare expenditures in 2019), which increased 14.5% following growth of 12.6% in 2018. Growth in fee-for-service Medicare expenditures slowed in 2019, increasing 2.2% compared to 3.0% growth in 2018. Overall, Medicare enrollment growth was steady in 2019, increasing 2.6%—the same rate as in 2018.
  • Medicaid spending (16% of total health care spending) increased 2.9% in 2019 to reach $613.5 billion. This was similar to the 3.1% rate of growth in 2018.  This relatively steady growth was influenced by faster spending growth for most goods and services and a decline in the net cost of insurance—a decline that was in part due to the health insurance tax moratorium in 2019.   In 2018 and 2019, Medicaid enrollment was estimated to have decreased 0.9% and 1.5%, respectively.
  • Out-of-pocket spending (11% of total health care spending at $406.5 billion in 2019) includes direct consumer payments such as copayments, deductibles, and spending not covered by insurance.  Out-of-pocket spending grew 4.6% in 2019, which was faster than the 3.8% growth in 2018.

Health care spending growth was faster in 2019 for the three largest goods and service categories – hospital care, physician and clinical services, and retail prescription drugs.

  • Hospital spending (31% of total health care spending) growth accelerated in 2019, increasing 6.2% to $1.2 trillion compared to 4.2% growth in 2018. The faster growth in 2019 was driven by faster growth in non-price factors (such as the use and intensity of services), which increased 4.2% in 2019 compared to 1.8% in 2018, while growth in hospital prices grew more slowly, increasing 2.0% after growth of 2.4% in 2018. Growth in all three major payers of hospital care (private health insurance, Medicare, and Medicaid) accelerated in 2019.
  • Physician and clinical services spending (20% of total health care spending) increased 4.6% to $772.1 billion in 2019, which was faster than the rate of growth in 2018 of 4.0%. Non-price factors were the largest contributor to the acceleration in physician and clinical services expenditures, as prices increased 0.8% in 2019, or at about the same rate as in 2018.
  • Retail prescription drug spending (10% of total health care spending) increased 5.7% in 2019 to $369.7 billion, accelerating from growth of 3.8% in 2018. Faster growth in use, or the number of prescriptions dispensed, contributed to the acceleration in total retail prescription drug spending, as prices for prescription drugs declined for the second consecutive year in a row, decreasing by 0.4% in 2019 after falling by 1.0% in 2018.

Additional highlights from the report include:

Sponsors of Healthcare include estimates of spending by the businesses, households, other private funds and governments that are responsible for financing, or sponsoring, health care payments. Expenditures in these areas follow:

  • Federal government’s spending on health care increased 5.8% in 2019, up slightly from a rate of 5.4% in 2018.  The faster growth in 2019 was driven mainly by federal general revenue and Medicare net trust fund expenditures that increased 9.4% in 2019 after growth of 6.1% in 2018.
  • Private businesses’ health care spending grew more slowly in 2019, increasing 3.7% compared to growth of 5.7% in 2018. This slower growth was driven largely by a deceleration in private businesses’ contributions to employer-sponsored private health insurance premiums.
  • Household’s health care spending increased 4.5% in 2019 compared to 4.8% growth in 2018. Out-of-pocket spending and contributions to employer-sponsored private health insurance premiums accounted for almost two-thirds of household spending in 2019 (38% and 27%, respectively).

Previous vintages of the National Health Expenditure estimates have been revised to reflect the most recent and up-to-date source data that is available.

The 2019 National Health Expenditures data and supporting information will appear on the CMS website at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Study finds surge of teen vaping levels off, but remains high in early 2020. Findings released today from the most recent Monitoring the Future (MTF) survey of substance use behaviors and related attitudes among teens in the United States indicate that levels of nicotine and marijuana vaping did not increase from 2019 to early 2020, although they remain high. The annual MTF survey is conducted by the University of Michigan’s Institute for Social Research, Ann Arbor, and is funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

In the four years since the survey began including questions on nicotine and marijuana vaping, use of these substances among teens have increased to markedly high levels From 2017 to 2019, the percentage of teenagers who said they vaped nicotine in the past 12 months roughly doubled for eighth graders from 7.5% to 16.5%, for 10th graders from 15.8% to 30.7%, and for 12th graders from 18.8% to 35.3%. In 2020, the rates held steady at a respective 16.6%, 30.7%, and 34.5%. However, somewhat encouragingly, daily, or near daily (20 occasions in the past 30 days), nicotine vaping declined among 10th and 12th graders from 2019 to 2020, by close to half — from 6.8% to 3.6% in 10th grade and from 11.6% to 5.3% in 12th grade.

Read the release.

Surgical and drug treatment options lead to similar outcomes for diabetic eye disease. Surgical and injectable drug approaches are equally effective for treatment of bleeding inside the eye from proliferative diabetic retinopathy (PDR), according to a National Eye Institute (NEI)-supported clinical study from the DRCR Retina Network (DRCR.net(link is external)). A consequence of diabetes, PDR involves the growth of new, abnormal blood vessels in the light-sensing retina. These blood vessels are prone to bleeding into the gel-like vitreous that fills the eye, causing vision loss. NEI is part of the National Institutes of Health.

Researchers compared anti-vascular endothelial growth factor (VEGF) eye injections versus removal of blood via vitrectomy surgery and laser photocoagulation. Both treatments improved central vision for the majority of participants, although approximately one-third of the participants needed both anti-VEGF injections and surgery. The findings will help guide treatment for people with bleeding in the eye from PDR. The results were published in the Journal of the American Medical Association.

Read the release.

Urgent Reminder for CLASS and DBMD SPT Meetings by Jan. 1, 2021. CLASS and DBMD program providers must start holding renewal SPT meetings before Jan. 1, 2021. This is to develop renewal individual plans of care and renewal documentation effective on Jan. 1, 2021, and to avoid future billing issues.

Complete renewal SPT meetings:

  • Before the end of the IPC effective period
  • By telehealth for ID/RC assessments and phone or telehealth for IPCs

IL 20-46, Renewal of ID/RC Assessments and IPCs and Requirements for Revised IPCs and Transfer IPCs (PDF), provide requirements and allowances.

If SPT meetings are not completed before Jan. 1, 2021 for plans that expire on Dec. 31, 2020, billing for services cannot occur before the date of the SPT meeting. This is because the renewal IPC effective date cannot be dated before the SPT meeting date.

Dec. 15 Recording of Certification Principles: Abuse, Neglect and Exploitation Webinar for HCS and TxHmL Providers Available. A recording of the December 15, 2020, Certification Principles: Abuse, Neglect and Exploitation webinar for HCS and TxHmL providers is available for those unable to attend.

View the webinar recording here.

Family and Youth Success Program Request for Feedback (RFF). The Prevention and Early Intervention (PEI) division is seeking feedback regarding the Family and Youth Success (FAYS) (formerly STAR) Program.

FAYS is the longest-standing statewide prevention grant program administered by PEI. FAYS addresses family conflict and everyday struggles while promoting strong families and youth resilience.

This RFF seeks feedback from all stakeholders on the following areas in addition to any other feedback on the program.

  • Geographic Service Areas
  • Payment Methodology
  • Community Strengths and Needs Assessment
  • Virtual and Phone Services
  • Program Quality

Additional information and feedback forms
for the RFF can be found here: 

Request for Feedback

PEI welcomes written responses and comments to the Request for Feedback by January 29, 2021 at 2:00 P.M. Central Time.