Texas Health and Human Services Digest: December 30, 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.

January 6, 2021

January 8, 2021

January 12, 2021

January 13, 2021

January 21, 2021

January 26, 2021

January 27, 2021

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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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 353, Subchapter O, Sections 353.1309 and 353.1311, concerning Physician Directed Payment Program#21R028: Physician Directed Payment ProgramHHSC1/25/21
Title 26, Chapter 748, Minimum Standards for General Residential Operations#20R039: Legislative and Other Updates to Chapters 745 and 748Gerry Williams1/19/21
Title 25, Chapters 133, 135, 137, 139, and 229, concerning Medical and Health Care Billing#20R045: Medical and Health Care BillingHHS Policy, Rules and Training1/19/21
Title 26, Chapters 506, 507, 509, 510, and 564, concerning Medical and Health Care Billing#20R045: Medical and Health Care BillingHHS Policy, Rules and Training1/19/21
Title 25, Chapter 217, Subchapters A and B, concerning Milk and Diary#20R051: Milk and DairyDSHS Milk and Dairy Unit1/19/21
Title 26, Chapter 280, Pediatric Teleconnectivity Resource Program for Rural Texas#20R081: Pediatric Teleconnectivity Resource Program for Rural TexasHHS Rules Coordination Office1/19/21
Title 40, Chapter 109, Subchapter C repeal, concerning Specialized Telecommunications Assistance Program#18R061: Specialized Telecommunications Assistance ProgramBryant Robinson1/19/21
Title 26, Chapter 360 Subchapter C, concerning Specialized Telecommunications Assistance Program#18R061: Specialized Telecommunications Assistance ProgramBryant Robinson1/19/21
Title 25, Chapter 411, Subchapter M repeal, concerning Standards of Care in Crisis Stabilization Units#18R040: Standards of Care in Crisis Stabilization UnitsHHS Rules Coordination Office1/19/21
Title 26, Chapter 306, Subchapter B, concerning Standards of Care in Crisis Stabilization Units#18R040: Standards of Care in Crisis Stabilization UnitsHHS Rules Coordination Office1/19/21
Title 26, Chapter 558, Licensing Standards for Home and Community Support Services Agencies#19R069: Legislative Implementation and TULIP Process UpdateJoyce Stamatis1/19/21
Title 26, Chapter 744, Minimum Standards for School-Age and Before or After-School Programs#20R026: Regulation of Child-Care FacilitiesAimee Belden1/19/21
Title 26, Chapter 746, Minimum Standards for Child-Care Centers#20R026: Regulation of Child-Care FacilitiesAimee Belden1/19/21
Title 26, Chapters 747, 748, & 749, Minimum Standards for Child-Care Homes, General Residential Operations, and Child-Placing Agencies#20R026: Regulation of Child-Care FacilitiesAimee Belden1/19/21
Title 26, Chapter 745, Licensing#20R039: Legislative and Other Updates to Chapters 745 and 748Gerry Williams1/19/21

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. 

2021 Schedule
As HHSC has received a waiver to Rate Hearing Requirements, there will not be a rate hearing conducted on many of these rates.

TitleProposed Effective DatePacket UpdatedDocuments
Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In MedicaidSeptember 01, 2021Notice 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 CareMarch 01, 2021Notice 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, 2021Notice 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, 2021Notice 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, 2021Notice 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, 2021Notice 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, 2021Notice 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, 2021Notice 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 ReviewMarch 01, 2021Biennial 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, 2021Notice 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

Reminder: 2021 Virtual Group Election Period for MIPS Closes on December 31. To form a virtual group for the 2021 Merit-based Incentive Payment System (MIPS) performance year, an election must be submitted to CMS via e-mail by tomorrow, December 31, 2020 (11:59 p.m. Eastern Time).

NOTE: A virtual group must submit an election to CMS for each performance year that it intends to participate in MIPS as a virtual group (as required by statute). If your virtual group was approved for the 2020 MIPS performance year and intends to participate in MIPS as a virtual group for the 2021 MIPS performance year, your virtual group is still required to submit an election to CMS for the 2021 MIPS performance year between October 1, 2020 and December 31, 2020 (11:59 p.m. Eastern Time).

What Is a Virtual Group?
A virtual group is a combination of 2 or more Taxpayer Identification Numbers (TINs) consisting of the following:

  • Solo practitioners who are MIPS eligible (a solo practitioner is defined as the only clinician in a practice); and/or
  • Groups that have 10 or fewer clinicians (at least one clinician within the group must be MIPS eligible). A group is considered to be an entire single TIN.

A virtual group has the flexibility to determine its own makeup.  A solo practitioner or group can only participate in one virtual group during the performance year.

What Are the Advantages of Participating in a Virtual Group?
Participating in MIPS as a virtual group has the following advantages:

  • Can increase performance volume in order to be reliably measured; and
  • Provides an opportunity for members of a virtual group to collaborate, share resources, and potentially increase performance under MIPS.

What Is the Virtual Group Election Process?
The following highlights key items that a virtual group needs to complete prior to the submission of an election:

  • Establish a formal written agreement between each TIN within the virtual group (see Agreement Sample Template in the Virtual Group Election Process Guide within the 2021 Virtual Group Toolkit).
  • Identify an official virtual group representative.

The following outlines the elements that need to be included in an election:

  • Acknowledgement that a formal written agreement has been established between each TIN within the virtual group.
  • The name and contact information for the official virtual group representative.
  • The name and TIN for each practice, and all associated National Provider Identifiers (NPIs) under each TIN.

Once complete, the virtual group must submit the election via e-mail to CMS at MIPS_VirtualGroups@cms.hhs.gov by 11:59 p.m. Eastern Time tomorrow (see Election E-mail Sample in the Virtual Group Election Process Guide within the 2021 Virtual Group Toolkit).

For further information regarding virtual group participation in MIPS, virtual group reporting requirements, the election process, checklists for virtual groups to consider, and sample templates, download the 2021 Virtual Group Toolkit.

Need Help?

  • 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.
  • Connect with your local technical assistance organization. We provide no-cost technical assistance to small, underserved, and rural practices to help you successfully participate in the Quality Payment Program.

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

In order to help ETC Model Participants prepare for the ETC Model, CMS is providing the ETC Beneficiary Notification Form in Spanish (PDF).

ETC Participants are not required to use the translated version. This form serves to better assist the ETC Beneficiary population.

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

Disclaimer: The contents of this communication do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This communication is intended only to provide clarity to the public regarding existing requirements under the law.

Preparing for Program Year 2021 Data Collection. As you prepare for the upcoming 2021 data collection, we would like to reminder you of available resources and the upcoming program expansion details.

Beginning January 1, 2021 the Open Payments program expansion will go into effect. This expansion includes additional Open Payments reporting requirements as well as updates to the Nature of Payment categories. The program is impacted in the following ways:

  • The definition of a “covered recipient” is expanded to include five additional provider types: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists (including anesthesiologist assistants), and certified nurse midwives. This is in response to statutory changes included in the SUPPORT Act.
  • Standardization of data on reported products by adding reporting requirements for the ‘device identifier’ component of the unique device identifier for devices and medical supplies.
  • The Nature of Payment categories will include three new categories: debt forgiveness, long-term medical supply or device loan, and acquisitions. In addition, the two categories related to education programs will be combined into one

The following resources for Program Year 2021 data collection are available on the Open Payments Resources Page:

  • PY2021 and Onwards 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. This version is for use with the 2021 data collection and submission. It provides specifications for reporting data on the newly added covered recipient types, updated device reporting requirements and updated nature of payment categories.
  • PY2021 and Onwards 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.
  • Open Payments Physician and Non-Physician Practitioner Taxonomy Code List: This list has all of the accepted physician taxonomy codes and can be used to report physician and non-physician practitioner specialties. If a covered recipient’s National Plan and Provider Enumeration System (NPPES) profile does not contain any of the specialties on the Open Physician and Non-Physician Practitioner Taxonomy Code List, the reporting entity may provide an alternative code from that list
  • 2021 Reporting Cycle Teaching Hospital List: A list of all teaching hospitals that are reportable for the purposes of Open Payments for 2021.
  • Preliminary Non-Physician Practitioner List (PnPPL): Similar to the Validated Physician List, the PnPPL represents a subset of reportable providers. This is designed to help reporting entities pre-validate their data prior to data submission. This includes identifying information for providers registered in CMS systems. The PnPPL is available for download within the Open Payments System.
  • Preliminary Medical Device and Medical Supply Reference Data: This preliminary reference data includes medical device and medical supply names and Primary Device Identifier Information for all the medical device and medical supplies listed in the Food and Drug Administration (FDA) Global Unique Device Identification Database Directory (GUDID) through June 30, 2020. This dataset is preliminary and provided to support Program Year 2021 data collection. An active list of devices is located on the Access GUDID website at https://accessgudid.nlm.nih.gov/download. An instructions document is available, which provides details about the use of the Device Name and Primary Device Identifier (PDI) dataset. In addition to the resources listed above, visit the Changes for Reporting Entities page to stay up to date on the latest program expansion information and resources.

Submit questions to the Help Desk via email at openpayments@cms.hhs.gov or by calling  1-855-326-8366, Monday through Friday, from 9:00 a.m. to 5:00 p.m. (ET), excluding Federal holidays.

Visit the Resources page on the Open Payments website for many of the above resources.

The Help Desk refers media inquiries to CMS’ Press Office for response.

New Group Health Plan (GHP) Correspondence Cover Sheet Now Available. A new Group Health Plan (GHP) Correspondence Cover Sheet is available for use in the Download section of the Group Health Plan Recovery page. This cover sheet should be used when sending GHP recovery related correspondence to the Commercial Repayment Center (CRC).

CHART Model Community Transformation Track Application Deadline Extension. The Centers for Medicare & Medicaid Services (CMS) will extend the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline by one month to March 16, 2021.

This extension is in response to feedback received from stakeholders, including comments about the challenges of preparing an application during the coronavirus disease 2019 (COVID-19) public health emergency. Extending the application deadline will allow interested applicants additional time to prepare their applications.

The Community Transformation Track will provide up-front funding to up to 15 rural communities across the country. The rural communities will be awarded seed money to work with health care providers and payers across the community to design systems of care that improve access to high quality care that is sustainable and value-based.

For more information about the Community Transformation Track Notice of Funding Opportunity (NOFO) or the CHART Model, please visit: https://innovation.cms.gov/innovation-models/chart-model.
The NOFO has been updated with new application and performance period dates and is posted at https://www.grants.gov/web/grants/view-opportunity.html?oppId=329062

EVV Claims Matching Update for CLASS CFC PAS/HAB. On Jan. 1, 2021, Community Living Assistance and Support Services direct service agencies and financial management services agencies submitting claims for Community First Choice Personal Attendant Services/Habilitation services must ensure an Electronic Visit Verification visit transaction that supports the claim is accepted into the EVV Portal before the claim is submitted, or the claim will be denied.

As a reminder, HHSC extended the EVV practice period through Dec. 31. During the practice period, claims for CFC PAS/HAB services receive informational-only claims matching results and are not denied for EVV.

DSAs and FMSAs can follow the Best Practices to Avoid EVV Claim Mismatches (PDF) to ensure a claim is entered correctly and not denied for EVV when the practice period ends.

Email questions to HHSC EVV.

EVV Proprietary System Registration Ends Jan. 11, 2021. Program providers and financial management services agencies that want to use an Electronic Visit Verification proprietary system have until Jan. 11, 2021, to register for an opportunity to get HHSC approval in 2021. To register, complete the EVV Proprietary System Request Form (PDF) and submit the form by email to TMHP.

HHSC will allow up to six program providers and FMSAs to register for the Readiness Review session below. A program provider or FMSA must have a developed and compliant proprietary system which meets all HHSC requirements by the Readiness Review begin date.

Readiness Review Session 2

  • Registration cutoff date: Jan. 11, 2021
  • Planning meeting with registered providers and FMSAs: Jan. 19, 2021
  • Connectivity Checkpoint with Texas Medicaid and Healthcare Partnership: May 17, 2021
  • Readiness Review begin date: May 31, 2021
  • System go-live date: Aug. 27, 2021

Visit the TMHP EVV Proprietary Systems website for more information about HHSC’s requirements for using an EVV proprietary system and the Readiness Review session.

Email HHSC EVV for policy questions.

EVV Policy Update: 90 Day Visit Maintenance Temporary Policy. HHSC posted the Electronic Visit Verification Temporary 90 Day Visit Maintenance Policy (PDF) on the HHS EVV webpage. The policy:

  • Is effective on Jan. 1, 2021.
  • Applies to all program providers, financial management services agencies and Consumer Directed Services employers required to use EVV.
  • Allows 90 days to complete visit maintenance, instead of the standard 60 days, for visits with dates of service from Jan. 1, 2021–March 31, 2021.
  • Gives Cures Act program providers, FMSAs and CDS employers required to use EVV beginning Jan. 1, 2021, more time to familiarize themselves with the EVV system and the visit maintenance process.

As a reminder, program providers currently required to use EVV have 180 days to complete visit maintenance for visits with dates of service from March 21, 2020–Dec. 31, 2020, as described in the Temporary EVV Policies for COVID-19 (PDF).

Contact your payer with policy questions or email HHSC EVV.

DSHS Flu Surveillance Activity Report Update. This information has recently been updated and is now available.

DSHS Laboratory – Microbiological Sciences Branch Notice. Starting January 1, 2021, the Texas DSHS Austin Laboratory will no longer be providing
the following testing services:

  • Rubella Virus, IgM
  • Ehrlichia IFA
  • Q-Fever, IgG

If specimens for the above assays are received at the DSHS Austin Laboratory on or
after January 1, 2021, laboratory staff will contact the submitter to decide how the
laboratory may proceed with the specimens from the options below:

  1. Option 1 ─ Ship the specimens back to the submitter; no shipping charges; the

submitter may choose this option if they wish to submit the specimens to a
commercial laboratory that provides testing with an expected turnaround time of 5-6 days.

  1. Option 2 ─ Cancel the test and appropriately discard the specimens.
  2. Option 3 ─ Forward the specimens to the CDC (Centers for Disease Control and

Prevention) for testing; no shipping charges; testing at the CDC has a projected
turnaround time of 10 days for Rubella IgM and 6 weeks for Ehrlichia IgG and Q-Fever IgG.

Please contact the DSHS Microbiology laboratory with any questions at
Lab.Microbiology@dshs.texas.gov.