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.
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
- Palliative Care Interdisciplinary Advisory Council (PCIAC) Agenda
- This meeting will be webcast: Mental Health Condition and Substance Use Disorder (MHCSUD) Parity Workgroup Agenda
January 27, 2021
- This meeting will be webcast: Joint Committee on Access and Forensic Services (JCAFS) Agenda
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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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.
Only includes the month of December.
New Measures Under Consideration Mark a Milestone for CMS’s Reimagined Quality Strategy to Increase Digital Innovation and Reduce Burden. The Centers for Medicare & Medicaid Services (CMS) today unveiled its 2020 list of quality and efficiency measures under consideration. Quality measures are tools the agency uses to collect data from providers on the effectiveness, safety, efficiency, and timeliness of care beneficiaries receive. Every year, CMS evaluates all measures in its programs, proposing to remove those that have become less relevant and proposing new measures that may be more meaningful based on review by external health care experts. This year, almost all of the measures proposed would be collected digitally, meaning information comes from claims and other electronic sources, and would not require doctors to retrieve data manually. As a signal for CMS’s broader direction as the agency puts patients over paperwork in the push for quality and innovation, the 2020 list of measures under consideration represents “a first” on several important fronts, particularly where digital innovation and reducing administrative burden are concerned.
For more information or to review the 2020 list of measures under consideration, please visit: https://www.cms.gov/files/document/measures-under-consideration-list-2020-report.pdf.
Important Updates on the Hospice Quality Reporting Program (HQRP). Swingtech sends informational messages to hospices related to the Quality Reporting Program (QRP) on a quarterly basis. Their latest outreach communication can be found on the HQRP Requirements and Best Practices webpage. If you want to receive Swingtech’s quarterly emails, then add or update the email addresses to which these messages are sent by sending an email to QRPHelp@swingtech.com. Be sure to include your facility name and CMS Certification Number (CCN) along with any requested updates.
REMINDER – Deadline Approaching: CMS is announcing the Request for Application (RFA) open period (November 19, 2020 to January 3, 2021) for the Value in Opioid Use Disorder Treatment (ViT) Initiative. The Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (Innovation Center) is announcing the Request for Application (RFA) for a new initiative that aims to increase access to opioid use disorder (OUD) treatment services to eligible Medicare Fee-For-Service (FFS) beneficiaries, including those dually eligible for Medicare and Medicaid. This is one of a number of new initiatives required under The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act). The statute makes available $10,000,000 each of fiscal years 2021-2024 for demonstration payments.
Value in Opioid Use Disorder Treatment (Value in Treatment) is a four-year demonstration that creates two new payments to participating providers: 1) a per beneficiary per month care management fee (CMF) and 2) a performance-based incentive payment. These new payments will be made in addition to the OUD treatment services Medicare currently covers.
Value in Treatment participants may use these payments to furnish certain patient-centered OUD treatment services and have a reasonable expectation of improving or maintaining the health or overall function of participating beneficiaries.
The demonstration is open to a wide range of eligible participants, including:
- Individual physicians
- Group practices comprised of at least one physician or Nurse Practitioner
- Hospital outpatient departments
- Federally qualified health centers
- Rural health clinics
- Community mental health centers
- Certified community behavioral health clinics (CCBHCs)
- Opioid treatment programs (OTPs)
- Critical Access Hospitals (CAHs)
CMS encourages eligible participants to apply to the demonstration from November 19, 2020 to January 3, 2021. Selected participants are expected to implement the demonstration by April 1st, 2021, at which point demonstration payments will also start.
For more information, and to access the Request for Application (RFA), please visit: https://innovation.cms.gov/innovation-models/value-in-treatment-demonstration
Check Your Initial 2021 MIPS Eligibility on the QPP Website. You can now use the updated Quality Payment Program Participation Status Tool to check on your initial 2021 eligibility for the Merit-based Incentive Payment System (MIPS).
Just enter your National Provider Identifier, or NPI, to find out whether you need to participate in MIPS during the 2021 performance year.
Low-Volume Threshold Requirements
To be eligible to participate in MIPS in 2021, you must:
- Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS); AND
- Furnish covered professional services to more than 200 Medicare Part B beneficiaries; AND
- Provide more than 200 covered professional services under the PFS.
If you do not exceed all 3 of the above criteria for the 2021 performance year, you are excluded from MIPS. However, you have the opportunity to opt-in to MIPS and receive a payment adjustment if you meet or exceed 1 or 2, but not all, of the low-volume threshold criteria. Alternatively, you may choose to voluntarily report to MIPS and not receive a payment adjustment if you do not meet any of the low-volume threshold criteria or if you meet some, but not all, of the criteria.
Please note, beginning in 2021, the Centers for Medicare & Medicaid Services (CMS) will evaluate the low-volume threshold for MIPS Alternative Payment Model (APM) participants at the individual or group level, just as it does for participants who are not in MIPS APMs. CMS will no longer evaluate APM Entities for the low-volume threshold.
New Participation Option: APM Performance Pathway (APP). Beginning in 2021 the APM Performance Pathway (APP) is a new reporting framework, complementary to the MIPS Value Pathways (MVP). The APP is available only to participants in MIPS APMs and can be reported by the individual eligible clinician, group, or APM Entity.
Find Out Today. Find out whether you’re eligible for MIPS today. Prepare now to earn a positive payment adjustment in 2023 for your 2021 performance.
Note: The tool will be updated with Qualifying APM Participant (QP) status at a later time. Additionally, we will update the tool in late 2021 to indicate final MIPS eligibility.
For More Information
- Visit the How MIPS Eligibility is Determined webpage on the Quality Payment Program website.
- View the 2021 MIPS Eligibility Decision Tree.
- For more information on the APP, view 2021 APP Infographic and the 2021 APP Fact Sheet.
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, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET. We also encourage you to contact us earlier in the year, as response times often increase with heavier demand as the March 31 data submission deadline approaches.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
MIPS Low-Volume Threshold Criteria for 2020 and Participating Through the Opt-In or Voluntary Reporting Options. Clinicians and groups are excluded from the Merit-based Incentive Payment System (MIPS) for 2020 if they:
- Billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the 2 determination periods (October 1, 2018 – September 30, 2019 or October 1, 2019 – September 30, 2020); OR
- Provided care to 200 or fewer Part B-enrolled patients during either of the 2 determination periods; OR
- Provided 200 or fewer covered professional services professional services to Part B patients during either of the 2 determination periods.
In order to be eligible for MIPS, a clinician or group must exceed all 3 criteria listed above. You can check the Quality Payment Program (QPP) Participation Status Tool to view your final 2020 eligibility status for MIPS.
Participation Options for Clinicians and Groups Not Eligible for MIPS
Clinicians and groups who are not eligible for MIPS can still choose to report data to MIPS:
- Make an Election to Opt-in or Voluntarily Report: Clinicians and groups who are identified as “opt-in eligible” on the QPP Participation Status Tool have exceeded 1 or 2 of the low-volume threshold criteria noted above and have at least 1 clinician who:
- Is identified as a MIPS eligible clinician type on Medicare Part B claims;
- Enrolled in Medicare before 2020;
- Is not a QP; and
- Is not a participant in one or more MIPS APM entities, all of which are below the low-volume threshold.
These clinicians and groups can make an election to:
- Opt-in to MIPS. You will receive a MIPS payment adjustment (positive, negative or neutral).
- Voluntarily Report. You will not receive a MIPS payment adjustment.
- Note: Once made, your election is binding and irreversible. (No election is required if you don’t want to report data to MIPS.)
- Voluntarily Report (no election required): Clinicians and groups who are excluded from MIPS and are not “opt-in eligible” because they fall below all 3 of the low-volume threshold criteria may choose to voluntarily report data to MIPS and will not receive a MIPS payment adjustment.
Before reporting data, opt-in eligible clinicians and groups will need to complete an election to opt-in or voluntarily report in MIPS by signing in to qpp.cms.gov. Qualified Registries and Qualified Clinician Data Registries (QCDRs) can also submit elections on behalf of clinicians and groups. Elections can be made once the 2020 MIPS submission period opens on January 4, 2021.
For More Information
- Visit the Reporting Options Overview Webpage on the Quality Payment Program website.
- Check out the 2020 MIPS Opt-In Reporting and Election Process Toolkit.
Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
- Redesign of Medicare Supplier Directory Improves Beneficiary Decision-making
- Proposed Updates to Coverage Policy for Autologous Blood-Derived Products for Chronic Non-Healing Wounds
- Open Payments: Review & Dispute Data by December 31
- Hospital Price Transparency: Requirements Effective January 1
- DMEPOS Competitive Bidding Program: Round 2021 Begins January 1
- Clinics/Group Practices & Certain Other Suppliers: Revised CMS-855B Required January 4
- Acute Hospital Care at Home: Increasing Capacity through Hospital without Walls Program
- Orthoses Referring Providers: Comparative Billing Report in December
- National Correct Coding Initiative Medicare Policy Manual: Annual Update
- FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
- Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable Charge
- Promoting Interoperability Call: Audio Recording & Transcript
- Physician Fee Schedule Call: Audio Recording & Transcript
Connecting People With Data. The Centers for Medicare & Medicaid Services (CMS) released our annual update to the Drug Spending Dashboards with data for 2019. The dashboards focus on average spending per dosage unit for prescription drugs in the Medicaid, Medicare Part B, and Medicare Part D programs, and track the change in average spending per dosage unit over time. Information is presented in an interactive web-based tool, so researchers and consumers can easily sort the data to identify trends.
In addition, CMS released our annual update to the Medicare Part B Discarded Drug Units Report with data for 2019. CMS requires all physicians, hospitals, and other providers submitting Medicare Part B drugs claims to report any discarded amount of a single use vial or other single use package drug on its claim for reimbursement. This report presents data on spending for discarded drug units covered under Medicare Part B.
To view the Drug Spending Dashboards and the Discarded Drug Units Report see: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/index
Centers for Medicare & Medicaid Services (CMS) Measures Management System Update.
Measure Management and You: A monthly bulletin about clinical quality measurement resources and opportunities | December 2020 [Volume 5, Edition 9]
What’s New with the Measures Management System (MMS)
Announcement: Please join CMS on January 27 from 2:00 p.m. – 3:00 p.m., ET, for its bimonthly MMS Information Session series. The presentation for this session is titled Maximizing Efficiency of Information Gathering with the De Novo Measure Scan (DNMS) Tool. Click here to register for the MMS Information Session
In Case You Missed It: The recording of CMS’ November MMS Information Session titled Updated CMS Resources: A Look at the New Care Compare and MMS Blueprint Package is now available online. Click here to watch the recording. This webinar provides details about recent CMS developments including the release of a new Care Compare tool on Medicare.gov and the MMS Blueprint package, which features a streamlined CMS MMS Blueprint and a quality measures guide titled Quality Measures: How They Are Developed, Used, & Maintained (Quality Measures 101).
Announcements: Stay Up to Date
Announcement: The Department of Health and Human Services (HHS) proposed an unprecedented regulatory reform through retrospective reviews to ensure regulations are making appropriate impacts. In this media release, HHS lauded CMS’ recent review that reduced the number of Medicare quality measures by eighteen percent since 2017. Click here to learn more
Announcement: The Office of the National Coordinator for Health Information Technology (ONC) released the final 2020-2025 Federal Health IT Strategic Plan. The Plan defines a set of goals, objectives, and strategies that guide the federal government in supporting the access, exchange, and use of electronic health information to connect healthcare with health data. Click here to learn more
New Features Available: CMS continues to modernize the Hospital Quality Reporting (HQR) system for electronic clinical quality measures (eCQMs). The system now features clearer descriptions of measures and an improved Denominator Declaration navigational screen. Click here to learn more
In Case You Missed It: CMS’ Medicaid and CHIP Program System (MACPro) released a five-part video series providing an update on quality measures reporting in federal fiscal year 2020. These videos were recorded during the October 14 presentation.
- Quality Measures Reporting FFY 2020 State Update (Part 1 of 5)
- Quality Measures Reporting FFY 2020 State Update (Part 2 of 5)
- Quality Measures Reporting FFY 2020 State Update (Part 3 of 5)
- Quality Measures Reporting FFY 2020 State Update (Part 4 of 5)
- Quality Measures Reporting FFY 2020 State Update (Part 5 of 5)
Get Involved: Upcoming Events
- Virtual Event: 2021 Virtual HL7 Fast Healthcare Interoperability Resources (FHIR) Connectathon from January 13-15
- Virtual Event: 2021 CMS Quality Conference from March 2-3
Public Comment: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program (Mental Health/Substance Use Care)
- The public comment period closes on December 23, 2020
Federal Register: Medicare Program; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy Issues and Level II of the Healthcare Common Procedure Coding System (HCPCS)
- The public comment period closes on January 4, 2021
TEP: Development of Measure for Patient Receipt of Key Information Following an Outpatient Procedure
- The public comment period closes on January 15, 2021
TEP: Development, Reevaluation, and Implementation of Outpatient Outcome and Efficiency Measures
- The public comment period closes on January 15, 2021
National Quality Forum (NQF) Event Calendar
Interested in providing feedback on measures under consideration for NQF endorsement? The NQF event calendar includes details about current and upcoming comment periods as well as information about upcoming meetings.
Stay In Touch
Have questions or suggestions? We’re here to help!
- Contact MMS Support
Now Available: Direct Contracting Model Financial Reconciliation webinar slides and audio for the Global and Professional Options. The Center for Medicare and Medicaid Innovation (Innovation Center) recently presented a webinar to the Direct Contracting Model Participants on financial reconciliation. This webinar covered the details of the financial reconciliation process for determining shared savings / losses for a Direct Contracting Entity (DCE) including the calculation of final Performance Year (PY) benchmarks and expenditures, the application of stop-loss and risk corridors, and other adjustments.
The slides and audio recording are now available on the Direct Contracting website.
We encourage you to monitor the Direct Contracting website (https://innovation.cms.gov/innovation-models/direct-contracting-model-options) for future updates. Please contact our help desk with any questions/comments – DPC@cms.hhs.gov.
Infant opioid withdrawal therapy varies widely by treatment site. Medical care for newborn infants who were exposed to opioids in the womb varied widely across 30 hospitals nationwide, according to a study funded by the National Institutes of Health. The study authors say that the findings underscore the need for clinical trials to determine the most effective treatments. Read the release.
Study links metabolic syndrome to higher cardiovascular risk in patients with psoriasis. Psoriasis, a chronic inflammatory skin disease, has long been known to increase the risk of cardiovascular disease, which includes heart attack and stroke. Now, researchers have identified a key culprit: the presence of metabolic syndrome (MetSyn), a condition that includes obesity, diabetes, high cholesterol, and hypertension, and is highly prevalent among psoriasis patients.
The findings, which could lead to new ways to help prevent cardiovascular disease among people with psoriasis, appear online today in the Journal of the American Association of Dermatology (JAAD). The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
Read the release.
HHSC Adopts Joint Committee on Access and Forensic Services Rules. The Health and Human Services Commission (HHSC) adopts rules in Title 1, Texas Administrative Code (TAC), Chapter 351, Subchapter B, Division 1, Section 351.841, relating to the Joint Committee on Access and Forensic Services (JCAFS).
The JCAFS rules align with reporting requirements in statute, update the membership and terms of officers, and correct the abolition date for the committee. The JCAFS rules are effective December 22, 2020 and can be viewed online:
Addition of Seclusion as a Critical Incident in CLASS and DBMD. The HHSC CLASS/DBMD Notification of Critical Incidents form is revised to include seclusion.
Community Living Assistance and Support Services case management agencies, CLASS direct service agencies and Deaf Blind with Multiple Disabilities program providers are now required to report seclusion of people to HHSC as a critical incident. Providers must report seclusion through the critical incident process laid out in CLASS Appendix XIII and DBMD Appendix IX.
CLASS CMAs, CLASS DSAs and DBMD program providers must continue to report seclusion to the Department of Family and Protective Services. Report suspected abuse, neglect or exploitation to DFPS immediately, but no later than 24 hours after having knowledge or suspicion as directed in §45.708, §45.810 and §42.410.
- Pharmacy Provider Revalidation Frequently Asked Questions Updated
- July 2020 Preferred Drug List Revised Dec. 16
- Preferred Drug List Update Coming Jan. 28
Comments on Proposed Rules Due 1/25/21 on Physician Directed Payment Program. Texas Health and Human Services Commission is accepting comments from stakeholders on the following proposed rules, which are now posted in the Texas Register. The comment period ends January 25, 2021.
- Texas Health and Human Services Title 1, Part 15, Chapter 353, Subchapter O, Sections 353.1309 and 353.1311, concerning Physician Directed Payment Program. Comments can be emailed to HHSC.
Questions can be emailed to HHS Rules Coordination Office.
Visit the HHS Rulemaking website for more information.
HHSC Proposes Rules for New Physicians’ Directed Payment Program. The Health and Human Services Commission (HHSC) is accepting comments on proposed new §353.1309, concerning Texas Incentives for Physicians and Professional Services, and proposed new §353.1311, concerning Quality Metrics for the Texas Incentives for Physician and Professional Services Program. The proposed rules are published in the December 25, 2020 issue of the Texas Register.
HHSC is proposing these new rules to align with its ongoing efforts to transition away from the Delivery System Reform Incentive Payment (DSRIP) program and the Network Access Improvement Program (NAIP).
Proposed New Rules Describe Enhanced Medicaid Physician Reimbursement. Currently, Texas’ Medicaid physician payments made through either the fee-for-service or managed care models, may not cover all Medicaid allowable costs for physician and professional services. Proposed new §353.1309 establishes the Texas Incentives for Physician and Professional Services (TIPPS) program and describes the circumstances under which HHSC will direct a Medicaid managed care organization (MCO) to provide enhanced reimbursement to physician practice groups in the MCO’s network in a participating service delivery area for the provision of physician and professional services. Proposed new §353.1311 describes the quality metrics and performance requirements associated with TIPPS.
HHSC Requests Comments on Proposed New Rules. HHSC is accepting public comments on the proposed rules until January 25, 2021. A public hearing is scheduled for January 11, 2021, at 11:30 a.m. (CST) to receive public comments on the proposal. Persons interested in attending may register for the public hearing here. You may also submit written comments via email to: RAD_1115_Waiver_Finance@hhsc.state.tx.us.
HHSC Accepting Comments on Proposed Rules. Texas Health and Human Services Commission (HHSC) is accepting comments from stakeholders on the following proposed rules, which are now posted in the Texas Register. The comment period ends January 19, 2021
- Texas Health and Human Services Title 26, Part 1, Chapter 280, Pediatric Teleconnectivity Resource Program for Rural Texas. Comments can be emailed to HHS Rules Coordination Office.
- Texas Health and Human Services Title 25, Part 1, Chapter 411, Subchapter M repeal and new Title 26, Part 1, Chapter 306, Subchapter B, concerning Standards of Care in Crisis Stabilization Units. Comments can be emailed to HHS Rules Coordination Office.
- Texas Health and Human Services Title 40, Part 2, Chapter 109, Subchapter C repeal and new Title 26, Part 1, Chapter 360 Subchapter C, concerning Specialized Telecommunications Assistance Program. Comments can be emailed to Bryant Robinson.
- Texas Health and Human Services Title 25, Part 1, Chapters 133, 135, 137, 139, and 229, and Title 26, Part 1, Chapters 506, 507, 509, 510, and 564, concerning Medical and Health Care Billing. Comments can be emailed to HHS Policy, Rules and Training.
- Texas Health and Human Services Title 26, Part 1, Chapter 558, Licensing Standards for Home and Community Support Services Agencies. Comments can be emailed to Joyce Stamatis.
- Texas Health and Human Services Title 26, Part 1, Chapters 744, 746, 747, 748, and 749, Minimum Standards for School-Age and Before or After-School Programs, Child-Care Centers, Child-Care Homes, General Residential Operations, and Child-Placing Agencies. Comments can be emailed to Aimee Belden.
- Texas Health and Human Services Title 26, Part 1, Chapter 745, Licensing, and Chapter 748, Minimum Standards for General Residential Operations. Comments can be emailed to Gerry Williams.
Dec. 23 Updates on DataLogic Vesta EVV System Outage. DataLogic, Texas Medicaid and Healthcare Partnership, and HHSC are developing technical assistance and guidance to help reduce administrative burden to Vesta users for EVV visits that occurred during the Vesta EVV system outage between Dec. 5 and Dec. 10.
HHSC recommends program providers, financial management services agencies, and consumer directed services employers continue focusing their efforts on visits in the Vesta EVV system that occurred before Dec. 5 and after Dec. 10.
Vesta users can refer to:
- The Vesta EVV website for frequently asked questions and updates about the outage.
- The DataLogic’s Vesta EVV System Outage Impacts article for updates about the impact to claim submissions and the EVV Portal.
HHSC will continue to provide updates and additional guidance.
DSHS Accepting Comments on Proposed Rules. Texas Department of State Health Services is accepting comments from stakeholders on the following proposed rules, which are now posted in the Texas Register. The comment period ends January 19, 2021.
- Department of State Health Services Title 25, Part 1, Chapter 217, Subchapters A and B, concerning Milk and Diary. Comments can be emailed to DSHS Milk and Diary Unit.
DSHS Flu Surveillance Activity Report Update. This information has recently been updated and is now available.
Children Waiting for Adoption. See the latest children who were added to or updated in the Texas Adoption Resource Exchange (TARE).