Texas Health and Human Services Digest: December 2, 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 2, 2020

December 3, 2020

December 4, 2020

December 7, 2020

December 8, 2020

December 9, 2020

December 10, 2020

December 11, 2020

December 14, 2020

December 15, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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
Title 1, Chapter 355, Subchapter J, Division 11, Section 355.8201, Waiver Payments to Hospitals for Uncompensated Care#21R012: Uncompensated Care Secondary Reconciliation for DYs 6-8HHSC12/7/20

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

Radiation Oncology Model Delay. On October 21, 2020, CMS announced its intent to delay the RO Model start date to July 1, 2021 through rulemaking.  This delay is included in the 2021 Hospital Outpatient Prospective Payment (OPPS) Final Rule (CMS-1736-FC) as an interim final rule with comment period (CMS-1736-IFC).

The following Limited Data Set (LDS) files are now available to request:

  • 2021 Hospital Outpatient Prospective Payment System (OPPS) Final
  • 2021 OPPS Partial Hospitalization Program Final
  • 2021 Ambulatory Surgical Center (ASC) Final

To request these files, please see the instructions on the CMS Data Use Agreement (DUA) website.

For more information about CMS LDS files, please see the LDS File Listing website.

Trump Administration Finalizes Policies to Give Medicare Beneficiaries More Choices around Surgery. Today, the Centers for Medicare & Medicaid Services (CMS) is finalizing policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules will increase value for Medicare beneficiaries and reflect the agency’s efforts to transform the healthcare delivery system through competition and innovation. These changes implement the Trump Administration’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, and will take effect on January 1, 2021.

Read the full release.

Reminder: Upcoming MIPS Important Dates and Deadlines. The Centers for Medicare & Medicaid Services (CMS) would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:

  • December 31 – 2020 Promoting Interoperability Hardship Exception Application period closes. Clinicians, groups, and virtual groups who believe they are eligible for this exception may apply, and if approved, will qualify for a re-weighting of the MIPS Promoting Interoperability performance category. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will also be added to the QPP Participation Status Tool (note: may not appear in the tool until the submission window opens in 2021).
  • December 31 – 2021 virtual group election period closes. Solo practitioners and groups with 10 or fewer clinicians (including at least one MIPS eligible clinician) who want to participate in MIPS as a virtual group for the 2021 performance year must submit their election to CMS.
  • January 4, 2021 – 2020 MIPS performance year data submission window opens.
  • February 1, 2021 – 2020 Extreme and Uncontrollable Circumstances Application period closes. Clinicians, groups, and virtual groups who believe they are eligible for this exception may apply, and if approved, will qualify for a re-weighting of one or more MIPS performance categories. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will be added to the QPP Participation Status Tool.
    • New: CMS has finalized that for the 2020 performance year, Alternative Payment Model (APM) Entities may submit Extreme and Uncontrollable Circumstances applications as a result of COVID-19. For more information about the impact of COVID-19 on Quality Payment Program participation, see the Quality Payment Program COVID-19 Response webpage.
  • March 1, 2021 – Deadline for CMS to receive 2020 claims for the Quality performance category. Claims must be received by CMS within 60 days of the end of the performance period. Deadline dates vary to submit claims to the MACs. Check with the MACs for more specific instructions.
  • March 31, 2021 – 2020 MIPS performance year data submission window closes.

For More Information
To learn more, visit the QPP website and access the following resources:

Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov
To receive assistance more quickly, please consider calling during non-peak hours—before 10 a.m. and after 2 p.m. Eastern Time.

  • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

CMS Finalizes Proposal to Allow APM Entities to Submit Applications for the Extreme and Uncontrollable Circumstances Exception and Extends Deadline to February 1. In the 2021 Medicare Physician Fee Schedule (PFS) Final Rule, CMS has finalized its previous proposal to allow Alternative Payment Model (APM) Entities to submit an application to reweight Merit-based Incentive Payment System (MIPS) performance categories as a result of extreme and uncontrollable circumstances. In addition, CMS has extended the application deadline to February 1, 2021.

If an APM Entity’s application is approved, that APM Entity will receive a final score equal to the performance threshold for the 2020 MIPS performance year, and the MIPS eligible clinicians in the APM Entity group would receive a neutral payment adjustment in 2022.

Who is Eligible to Submit an Application?
APM Entities affected by extreme and uncontrollable circumstances in the following models are able to submit an application:

  • Medicare Shared Saving Program (SSP)
  • Next Generation ACO Model
  • Vermont Medicare ACO Model
  • Comprehensive Primary Care Plus (CPC+)
  • Comprehensive ESRD Care (CEC)
  • Bundled Payments for Care Improvement (BPCI)
  • Oncology Care Model (OCM)
  • Maryland Primary Care Program
  • Independence at Home Demonstration

What are the Application Requirements?
Unlike those who choose to apply as individual clinicians, groups, or virtual groups, APM Entities must apply to reweight all MIPS performance categories to 0%. Additionally, 75% of the MIPS eligible clinicians in the APM Entity must qualify for reweighting in the MIPS Promoting Interoperability performance category. They may qualify automatically or through a MIPS Promoting Interoperability Hardship Exception Application (due December 31, 2020).

CMS does not require APM Entities to submit documentation with their applications. However, APM Entities should retain documentation of the circumstances supporting their application for their own records in the event they are selected by CMS for data validation or an audit.

When are Applications Due?
Applications are due to CMS by Monday, February 1, 2021 at 8:00 p.m. ET.

How do I Apply?
You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application. For more information on HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide.

Once you register for a HARP account, sign in to qpp.cms.gov, select “Exceptions Applications” on the left-hand navigation, select “Add New Exception,” and select “Extreme and Uncontrollable Circumstances Exception.”

How do I Know if I’m Approved?
If you submit an application, then you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but it may not appear in the tool until the submission window is open in 2021.

Will Submitting Data Void the Exception?
Data submitted for an APM Entity will not override performance category reweighting from an approved application. This differs from the policy for individual, group, and virtual group applications.

Will an Approved Application Affect Model-Specific Reporting Requirements?
If an APM Entity’s application is approved, the approval would only affect MIPS reporting, and that APM Entity would still be required to meet its model-specific reporting requirements.

For More Information

Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.

  • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients. On December 1, CMS released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The rule allows non-physician practitioners to provide the care they were trained and licensed to give, cutting red tape so health care professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. This final rule takes steps to further implement President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors including prioritizing the expansion of proven alternatives like telehealth.

Read the release.

For More Information:

CMS Releases 2021 Final Rule for the Quality Payment Program. The Centers for Medicare & Medicaid Services (CMS) published the final policies for the 2021 performance year of the Quality Payment Program (QPP) via the Medicare Physician Fee Schedule (PFS) Final Rule.

Note: As with other rules, CMS is publishing this final rule to meet the legal requirements to update Medicare payment policies in the PFS on an annual basis. In recognition of the 2019 Coronavirus (COVID-19) public health emergency and limited capacity of healthcare providers to review and provide comment on extensive proposals, CMS has limited annual rulemaking required by statute to focus primarily on essential policies, including Medicare payment to providers, as well as changes that reduce burden and may help providers in the COVID-19 response.

2021 QPP Final Rule Highlights
The key policies included for Quality Payment Program include:

  • Beginning Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) implementation in 2022
  • Keeping the performance threshold at 60 points for 2021
  • Revising performance category weights for Quality (decreases from 45% to 40%) and Cost (increases from 15% to 20%)
  • Extending the use of the CMS Web Interface as a collection and submission type for reporting MIPS quality measures in 2021 and sunsetting the option beginning with 2022
  • Sunsetting the APM Scoring Standard and allowing MIPS eligible clinicians in APMs the option to participate in MIPS and submit data at the individual, group, virtual group or APM Entity level
  • Updating third party intermediary approval criteria as well as remedial action and termination criteria

CMS Finalizes New APM Performance Pathway for 2021
Based on stakeholder feedback, CMS will implement the APM Performance Pathway (or APP) in 2021. The APM will be:

  • Complementary to MVPs, composed of a fixed set of measures for each performance category
  • Available as an option only for MIPS eligible clinicians in MIPS APMs
  • Reported by individual eligible clinicians, groups, or APM Entities

Performance category weights under the APP will be: 50% for Quality, 30% for Promoting Interoperability, 20% for Improvement Activities, and 0% for Cost.

Complex Patient Bonus COVID-19 Update in 2020
The final rule also increases the complex patient bonus from a 5- to 10-point maximum for clinicians, groups, virtual groups, and APM Entities for the 2020 performance year only to offset the additional complexity of their patient population due to COVID-19.

Final Rule Webinar Details
CMS will host a webinar on Wednesday December 9, 2020 to provide an overview of the final rule for the 2021 performance year. During this webinar, CMS will answer questions from attendees at time permits.

For More Information
To learn more about the PFS Final Rule and the 2021 Quality Payment Program finalized policies, review the following resources:

  • Press Release – Provides additional details regarding today’s announcement
  • QPP 2021 Final Rule Resources Zip File – Contains the following:
    • Fact Sheet and Table – Offers an overview of the QPP final rule policies for 2021; table compares these policies to the requirements for 2020
    • Frequently Asked Questions (FAQs) – Addresses the frequently asked questions for the 2021 QPP final rule policies
    • CMS MVP Submission Template – Provides instructions and a template that stakeholders should use to submit an MVP candidate for consideration.

Questions
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov.

  • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

Demolition Completion, Construction Begins on New, State-of-the-Art Austin State Hospital. Construction crews have completed demolition of vacant buildings on the Austin State Hospital campus to make way for the construction of a 240-bed standalone replacement hospital, the Texas Health and Human Services Commission announced today.

HHSC is partnering with Dell Medical School at The University of Texas at Austin to redesign and construct the new 380,000 square-foot hospital.

The total cost budgeted for the new hospital is approximately $305 million. The Texas Legislature and Gov. Greg Abbott have already approved $180.5 million in funding for the design and initial construction of the replacement hospital. The $124 million for the remainder of the project is pending legislative approval.

Construction crews are building the hospital on the existing 80-acre ASH campus. The new hospital will have private rooms for each patient and natural light throughout the building to promote recovery. There will be ten, 24-bed units, that each have therapy rooms, classrooms, exercise rooms, an arts and crafts room, and other therapy spaces.

The main level’s first floor will feature social interaction spaces including a café, gym, music and art room, chapel and salon. Outside, there will be basketball and volleyball courts and walking trails to relieve stress and anxiety.

This new hospital is part of a $745 million investment from Texas lawmakers and Gov. Abbott for the construction and renovation of state psychiatric hospitals in Austin, Kerrville, Rusk and San Antonio, as well as a new hospital in Houston. Combined, the construction projects at the hospitals will add at least 350 new inpatient psychiatric beds in Texas within the next four years.

Officials and construction crews broke ground on the new hospital in October 2019. It is scheduled to open in June 2023. For more information about state hospital construction projects throughout the state, visit the Changes to the State Hospital System page on the HHSC website.

Austin State Hospital, which has been operating since 1861, is the oldest psychiatric hospital in Texas. The Old Main Building, a Texas Historic Landmark, will remain intact.

Visuals. New video and images are available, including produced video of the project, downloadable b-roll and pictures of the ongoing construction, and video sound bites from Parker LaCombe, the director of peer support at Austin State Hospital, and Dr. Strakowski, associate vice president for Regional Mental Health at Dell Medical School.

At this time, to protect the health and safety of patients and staff during the COVID-19 pandemic, non-essential visitors are not allowed on campus.

About Austin State HospitalAustin State Hospital provides inpatient psychiatric care to adults, adolescents and children. The hospital also provides competency restoration services for people who have been determined incompetent to stand trial and long-term treatment for individuals who have been found not guilty by reason of insanity. Austin State Hospital served 705 patients in fiscal year 2020. It is among 10 state hospitals that HHSC operates for people with mental illness.

Webinar: Injury Prevention in Infants and Children During the Holidays. Join the HHSC Office of Disability Prevention for Children and Safe Kids Austin on Dec. 3, 2020, from 10-11 a.m. for a webinar on preventing injuries in infants and children during the holidays. While the holidays are a time for joy and celebration for many, injuries and deaths due to toys, decorations and other causes are all too frequent. Presenters will address these issues, as well as practical tips and resources aimed at promoting infant and child safety.

This webinar is intended for parents and providers who work with families and others caring for infants and children throughout the state.

What: “Infant and Children Injury Prevention During the Holidays” webinar
Who: Parents and people who work with families and children
When: Dec. 3, 2020, 10-11 a.m. Central Time

Presenters include:

  • Jay Smith, project manager for the Office of Disability Prevention for Children, Health and Human Services Commission
  • Carlee McConnell, Safe Kids Austin coordinator, Trauma Department, Dell Children’s Medical Center in Austin

Register for the “Injury Prevention in Infants and Children During the Holidays”

After registering, participants will receive a confirmation email explaining how to join the webinar. For questions, email Jay Smith at jay.smith@hhsc.state.tx.us or call 512-438-4715.

Informal Comments on Draft Rules Due 12/16 on End Stage Renal Disease Facilities. Texas Health and Human Services Commission is accepting informal comments from stakeholders on the following draft rule. The comment period ends December 16, 2020.

  • Texas Health and Human Services Commission Title 26, Part 1, Chapter 507, End State Renal Disease Facilities. Comments can be emailed to HHS Policy, Rules and Training.

Questions can be emailed to HHS Rules Coordination Office.
Visit the HHS Rulemaking website for more information.

Read more.