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 22, 2020
- This meeting will be webcast: Toxic Substances Coordinating Committee (TSCC) Agenda
January 6, 2021
- This meeting will be webcast: STAR Kids Managed Care Advisory Committee Agenda
January 12, 2021
- This meeting will be webcast: Nursing Facility Payment Methodology Advisory Committee (NF-PMAC) Agenda
January 13, 2021
- This meeting will be webcast: Early Childhood Intervention (ECI) Advisory Committee Agenda
January 26, 2021
- This meeting will be webcast: Mental Health Condition and Substance Use Disorder (MHCSUD) Parity Workgroup Agenda
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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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.
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 rules available for comment.
2020 Schedule
| Title | Proposed Effective Date | Packet Updated | Documents |
|---|---|---|---|
| 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 | December 18, 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 12-18-2020-hcpcs-update-covid-19-vaccine-admin-rate-info.pdf | |
| 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 | December 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
| Title | Proposed Effective Date | Packet Updated | Documents |
|---|---|---|---|
| Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In Medicaid | September 01, 2021 | Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In Medicaid 09-01-2021-prospective-reimbursement-rural-hospitals-in-medicaid.pdfNotice 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 Care | March 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 Update | March 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 Radiosurgery | March 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 Cartridge | March 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 Tomosynthesis | March 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 Policy | March 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.pdfNotice 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 Review | March 01, 2021 | Biennial Calendar Fee Review 03-2021-biennialcalendarfeereview.pdfBiennial Calendar Fee Review Attachments 03-2021-biennialcalendarfeereview-att.zip | |
| Notice of Adjustments to Fees, Rates or Charges for Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates Related to Coronavirus Disease 2019 (COVID-19) | January 01, 2021 | Notice of Adjustments to Fees, Rates or Charges for Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates Related to Coronavirus Disease 2019 (COVID-19) 01-01-2021-notice-adjfeesratescharges-hcpcs-covid19.pdf |
CMS Issues Final Rule to Empower States, Manufacturers, and Private Payers to Create New Payment Methods for Innovative New Therapies Based on Patient Outcomes – The Final Rule updates provisions to promote value-based payment for prescription drugs, while furthering the Trump Administration’s efforts to combat the opioid crisis. Today the Centers for Medicare & Medicaid Services (CMS) finalized regulatory changes to modernize Medicaid prescription drug purchasing and propel payment innovation by providing states, private payers and manufacturers more flexibility to enter into value-based purchasing (VBP) arrangements for prescription drugs.
By law, state Medicaid agencies are entitled to manufacturer rebates for the prescription drugs provided to Medicaid beneficiaries, which is operationalized by drug manufacturers reporting their “best price” to CMS for brand name drugs, and providing rebates to the federal and state governments under the Medicaid Drug Rebate Program (MDRP). Many insurers are experimenting with value-based payment approaches due to the proliferation of new therapies coming to market today that fight disease in an entirely new way, which could not have been imagined at the start of the MDRP 30 years ago. The potentially transformative impact of these new therapies has prompted insurers, including Medicaid, to rethink innovative payment approaches.
Under current regulations, prescription drug manufacturers face challenges accounting for VBP arrangements in their Medicaid best price reporting to CMS. This has the unintended consequence of hindering providers, insurers and prescription drug manufacturers in their efforts to develop innovative payment models for new drug therapies and other innovative treatments. Current regulations also discourage payers and manufacturers from designing new payment arrangements based on the value their product may provide.
With the new flexibilities under this final rule, manufacturers will be more willing to negotiate with payers, including Medicaid, with drug pricing being driven by the value of their drug to the individual patient. This is significant, especially in the era of new genetic-based treatments which may initially be expensive, yet in the long run offer significant value to the patient and payer. Payers will be able to negotiate prices with manufacturers for these genetic-based treatments based upon outcomes and evidence-based measures such as reduced hospitalizations, lab visits, and physician office visits, ensuring that if such measures fail to support the value of a drug, the payer is not held accountable for the full price.
A Fact Sheet on the Final Rule can be viewed at: https://www.cms.gov/newsroom/fact-sheets/establishing-minimum-standards-medicaid-state-drug-utilization-review-dur-and-supporting-value-based-0
The Final Rule can be viewed at: https://www.cms.gov/files/document/122120-cms-2482-f-medicaid-dur-ofr-master-webposting-508.pdf
CMS Proposes Updates to Coverage Policy for Autologous Blood-Derived Products for Chronic Non-Healing Wounds – Proposal ends coverage with evidence development for platelet rich plasma for the treatment of chronic, non-healing diabetic, venous, and pressure wounds. The Centers for Medicare & Medicaid Services (CMS) proposed to update the coverage policy for Autologous Blood-Derived Products for Chronic Non-Healing Wounds. Specifically, CMS is proposing to update coverage of platelet rich plasma (PRP) for the treatment of chronic non-healing diabetic, venous, and pressure wounds. PRP is a blood-derived product prepared from the patient’s own blood to be used as a wound covering in the management of chronic wounds. PRP is currently covered under the Coverage with Evidence Development (CED) pathway for the treatment of chronic, non-healing diabetic, venous, and pressure wounds when beneficiaries are enrolled in a clinical study. The proposed NCD issued today would eliminate the CED requirement and nationally covers platelet rich plasma for the treatment of chronic non-healing diabetic wounds. The proposal also would provide for coverage determinations for PRP for all other chronic non-healing wounds to be made by local Medicare Administrative Contractors.
CMS is seeking comments on the proposed national coverage determination. All public comments may be submitted at https://www.cms.gov/medicare-coverage-database/indexes/nca-open-for-public-comment-index.aspx. A final decision will be issued no later than 60 days after the conclusion of the 30-day public comment period.
To read the proposed decision, visit the CMS website at: https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=300
Upcoming Program Year 2020 Data Submission
Program Year 2020 Data Submission and System Availability
The Centers for Medicare & Medicaid Services (CMS) would like to remind reporting entities of resources available for reference when preparing for the upcoming Program Year 2020 Data Submission.
The Open Payments System will be unavailable Friday January 22, 2021 through Friday January 29, 2021 due to system updates for the upcoming data submission. Please keep this system outage in mind when planning your organization’s annual recertification activities.
Short-term system outages for routine maintenance may occur during evening or weekend hours. For best system availability and performance, we recommend that you access the Open Payments system during regular business hours.
Program Year 2020 Data Submission Resources
- Preliminary Validated Physician List (VPL): We encourage reporting entities to utilize the provided physician list to validate profile information. The VPL is designed to minimize matching errors during data submission and eliminate any inconsistencies in the data. Use this preliminary version for pre-validation of physician identifying information. You must be registered in the Open Payments system and affiliated with a reporting entity in order to access and download the VPL and the accompanying instructions document. Access to the VPL will be unavailable during the scheduled system outages.
There are two versions of the VPL, one containing physicians who have a National Provider Identifier (NPI) and one containing physicians who do not have an NPI.
The VPL containing Physicians with NPIs includes:
- Variations of physician first/ last name
- National Provider Identifiers (NPIs)
- State License Numbers
The VPL containing physicians without NPIs includes:
- Variations on physician’s first/ last name
- State License Numbers and associated primary provider types
The VPL zip file includes a supplement file for each reportable program year that includes inactive licenses for each physician for that corresponding program year.
The VPL Supplement File per Program Year with Inactive Licenses includes:
- Variations of physician first/ last name
- National Provider Identifiers (NPIs)
- State License Numbers and primary type associated with the license
The final version of the VPL will be released in early 2021 before data submission begins.
Additional Data Submission Resources
- PY2016-2020 Submission Mapping Document: This document serves as a data dictionary for the three types of reports (General, Research, and Ownership/ Investment Interest) submitted to Open Payments. It also shows the connection between data elements in the data submission specifications to specific data fields in character-separated value (CSV) sample files. Please note that there are multiple versions of the Submission Mapping Document depending on the reporting year.
- PY2016-2020 Sample Submission CSV Files: These files can be used to check formatting of data submitted through bulk file uploads. Please note that for both general and research payments, there are multiple versions of the Sample Submission CSV files depending on the reporting year.
- Error Code Key: A list of all error codes generated by the Open Payments system for records with validation errors, and guidance on how to correct the error. The Error Code Key is updated to include an additional error code, E-9054 ‘Related Product Indicator’.
- Physician Taxonomy Code List: This list has all of the accepted physician taxonomy codes and can be used to report physician specialty. If a covered recipient physician’s National Plan and Provider Enumeration System (NPPES) profile does not contain any of the specialties on the Open Payments Physician Taxonomy Code List, the reporting entity may provide an alternative code from that list.
December 31, 2020 Deadline Reminder
Corrections to records in response to active disputes can be made through December 31, 2020 in order to be included in the January Data Refresh.
Questions – Contact the Live Help Desk
For more information about Open Payments, please visit the Open Payments website.
If you have any questions, you can submit an email to the Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is available by calling 1-855-326-8366, (TTY Line: 1-844-649-2766) Monday through Friday, from 9:00 a.m. to 5:00 p.m. (ET), excluding Federal holidays.
Register for the January 12 Webinar on Medicare Promoting Interoperability Program Requirements for 2021. The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on Tuesday, January 12 at 1:00 p.m. ET to discuss program requirements for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program in 2021.
During this webinar, CMS subject matter experts will discuss the following:
- Electronic health record (EHR) reporting requirements
- 2015 Edition Certified EHR Technology requirements
- Objectives, measures, and scoring
- Electronic clinical quality measure changes
- Important dates and additional resources
CMS subject matter experts will answer questions at the end of the webinar as time permits.
Webinar Details
- Title: 2021 Medicare Promoting Interoperability Program Webinar
- Date: Tuesday, January 12, 2021
- Time: 1:00 – 2:30 p.m. ET
- Registration link: https://app.webinar.net/lAoPyL0yNE9
For More Information
For more information, please visit the Promoting Interoperability Programs website or email CMSQualityTeam@ketchum.com.
Reston Ebolavirus spreads efficiently in pigs. Reston ebolavirus (RESTV) should be considered a livestock pathogen with potential to affect other mammals, including people, according to National Institutes of Health scientists. The caution comes from a study published in Proceedings of the National Academy of Sciences in which the scientists found that experimental piglets infected with RESTV developed severe respiratory disease and shed the virus from the upper respiratory tract. RESTV can infect humans but is not known to cause disease. Now the scientists express concern that pigs could serve as an “interim or amplifying host for ebolaviruses.”
“The emergence of RESTV in pigs is a wake-up call as transmission into humans through direct contact with pigs or the food chain is a possibility,” they state in their study report. Scientists from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) conducted the work at Rocky Mountain Laboratories in Hamilton, Montana.
The following new reports have been posted on the Reports and Presentations page:
December2020
- Interoperability for Texas: Powering Health 2020
- Annual Report on Quality Measures and Value Based Payments 2020
- Texas Medicaid and CHIP Reference Guide, Thirteenth Edition (Pink Book)
- Report on the Mental Health for Veterans Grant Program, 2020
- Annual Federal Funds Report – Fiscal Year 2020
- Statewide Initiatives to Improve Quality of Maternal Health Care 2020
- Implementation of Acute Care Services and Long-term Services and Supports System Redesign for Individuals with an Intellectual or Developmental Disability – 2020
To see a list of all reports and presentations go to the Reports and Presentations page.
Upcoming HCS and TXHmL Webinars
Hold Harmless Period Overview
This webinar will cover the “Hold Harmless” period for the new survey process for HCS and TxHmL.
Jan 5, 2021
2 p.m. – 4 p.m.
Register for the webinar.
Administrative Penalties and Amelioration
This webinar will review the new survey process for HCS and TxHmL which begins on March 1, 2021 and will include and overview of administrative penalties and amelioration.
Jan 7, 2021
1 p.m. – 4 p.m.
Register for the webinar.
Cures Act EVV: Preparing for Jan. 1, 2021 Implementation. HHSC will require Electronic Visit Verification for all Medicaid personal care services beginning on Jan. 1, 2021. This requirement is mandated by the federal 21st Century Cures Act. If HHSC does not comply, Texas will lose federal funding for Medicaid services.
Beginning Jan. 1, 2021:
- Document all delivery visits for an EVV-required service in the EVV system. EVV-required services on the Programs, Services, and Service Delivery Options Required to Use EVV (PDF) document.
- An EVV-required service claim will be paid only if:
- The EVV visit transaction that supports the claim is accepted into the EVV Portal before claim submission.
- The claim receives an “EVV01 – EVV Match” result code in the EVV Portal after the claims matching process is performed.
Program providers and financial management services agencies must complete the following before Jan. 1, 2021, to avoid impacts to EVV claims payment:
- EVV system onboarding. This includes system setup and training.
- If an EVV vendor system is selected from the state vendor pool, the EVV vendor provides the training. Refer to the TMHP EVV Vendors webpage for more information about EVV vendors and their contact information.
- If an EVV proprietary system is selected, the program provider or FMSA handles system training.
- EVV training requirements outlined in the Cures Act EVV: Training Requirements Checklists (PDF).
- Document all visits for EVV-required services in the EVV system.
CDS employers must complete the following before Jan. 1, 2021, to avoid delays in payment to their CDS employees:
- Form 1722, Employers Selection for Electronic Visit Verification Responsibilities. Submit the signed form to their FMSA, which is the company that helps with CDS employee payroll.
- EVV system onboarding. CDS employers can contact their FMSA to complete onboarding and schedule training.
- EVV training requirements outlined in the Cures Act EVV: Training Requirements Checklists (PDF).
- Employees must start documenting all visits for EVV-required services in the EVV system.
HHSC is providing the following support to program providers, FMSAs, and CDS employers. This is to reduce impacts to claims payment and payment to CDS employees as they adjust to the new EVV requirements.
- If a visit is not captured through an electronic verification method, enter the visit manually into the EVV system and confirm acceptance into the EVV Portal to avoid claim denials. Instructions for manually entering a visit are posted in the following locations:
- DataLogic/Vesta EVV system.
- First Data/AuthentiCare EVV system in the “Custom Links” section.
- HHSC has published Best Practices to Avoid EVV Claim Mismatches (PDF) to help program providers and FMSAs ensure a claim is not denied for reasons related to EVV.
- HHSC has issued the 90 Day Visit Maintenance Temporary Policy (PDF). extending the time to complete visit maintenance for dates of service between Jan. 1, 2021 and March 31, 2021.
- An EVV compliance grace period will be applied for one year to all Cures Act EVV Expansion services with dates of service between Jan. 1, 2021 and Dec. 31, 2021 for the compliance measures listed in EVV Compliance Oversight Reviews Policy (PDF).
The EVV Contact Information Guides provide points of contact for EVV-related questions and issues:
- CDS Employer EVV Contact Information Guide (PDF)
- Program Provider and FMSA Contact Information Guide (PDF)
Visit the HHS EVV website for more information
DFPS Launches Get Parenting Tips Campaign. The Texas Department of Family and Protective Services (DFPS) is offering a new website filled with free tips and expert advice to help parents navigate the many challenges of child rearing – from pregnancy through the teen years.
GetParentingTips.com contains 30 original articles, authored by experts in a variety of fields as well as in-house articles based on authoritative sources and the latest research. Articles are grouped by child age, parents, and popular topics. DFPS will publish new articles every month to explore additional topics. The website and the campaign’s You Tube channel also feature many videos, including some that share the perspectives of other parents on issues like managing parenting stress.
“Never have parents needed support more than they do now due to COVID-19,” said Sasha Rasco, DFPS Associate Commissioner for Prevention and Early Intervention. “While several articles are specific to the pandemic, all the information on the website can help reduce the stress that parents are experiencing – now and in future years as well.”
GetParentingTips.com is not about getting kids to eat their vegetables. It focuses on information, coping tips, and strategies that help parents navigate both common and difficult situations. It tries to answer the question, “I’ve tried that, now what?
For parents who need more than information, the website also directs them to local programs that can support them.
To help parents find the website, DFPS is investing $52,000 a month in online advertising from now through August 31, 2020, which is the end of the state fiscal year. The campaign also has a Facebook page (Facebook.com/GetParentingTips) and will use social media to spread the word and share tips and resources.