Texas Health and Human Services Digest: December 4, 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 4, 2020

December 7, 2020

December 8, 2020

December 9, 2020

December 10, 2020

December 11, 2020

December 14, 2020

December 15, 2020

December 16, 2020

December 22, 2020

Proposed Rules
Formal Comments via the Texas Register
To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State. Interested parties then can review and comment on the proposed rule. The Secretary of State publishes a new issue of the Texas Register each Friday.

The Administrative Procedure Act (Texas Government Code, Chapter 2001) requires the notice published in the Texas Register to include a brief explanation of the proposed rule and a request for comments from any interested person. The notice also includes instructions for submitting comments regarding the rule to the agency, including the date by which comments must be submitted. Agencies must give interested persons “a reasonable opportunity” to submit comments. The public comment period begins on the day after the notice of a proposed rule is published in the Texas Register and lasts for a minimum of 30 calendar days.

Below is a list of proposed rules that have been published in the Texas Register. The proposed rules that are published in the Texas Register are open for public comment until the end of the comment period.

TitleProject No., DescriptionContactComment End Date
Title 1, Chapter 393, Informal Dispute Resolution and Informal Reconsideration#20R093: Informal Dispute ResolutionAllison Levee12/28/20
Title 26, Chapter 746, Minimum Standards for Child-Care Centers#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 26, Chapter 747, Minimum Standards for Child-Care Homes#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 25, Section 133.48, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 25, Section 135.26, Reporting Requirements, and Section 135.27, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 26, Section 510.47, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 26, Chapter 742, Minimum Standards for Listed Family Homes#20R021: Listed Family HomesHHS Child Care Regulation12/21/20
Title 26, Chapter 744, Minimum Standards for School Age and Before or After School Programs#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
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

CMS Announces New Model to Advance Regional Value-Based Care in Medicare. The Centers for Medicare & Medicaid Services announced a new and transformative voluntary payment model that builds on CMS’ focus to deliver Medicare beneficiaries value through better care and improved quality. The Geographic Direct Contracting Model (the “Model”) will test an approach to improving health outcomes and reducing the cost of care for Medicare beneficiaries in multiple regions and communities across the country. Through the model, participants will take responsibility for beneficiaries’ health outcomes, giving participants a direct incentive to improve care across entire geographic regions. Within each region, organizations with experience in risk-sharing arrangements and population health will partner with health care providers and community organizations to better coordinate care.

Beneficiaries in the model will maintain all of their existing Original Medicare benefits, including the ability to see any provider they choose. Beneficiaries may also receive enhanced benefits, including additional telehealth services, easier access to home care, access to skilled nursing care without having to stay in a hospital for three days, and concurrent hospice and curative care. Participants will also have the ability to reduce beneficiary cost sharing for Medicare Part A and Part B services as well as offer beneficiaries a Part B premium subsidy. Lower out-of-pocket costs will allow participants to encourage beneficiaries to seek high-value care while maintaining the freedom and choice beneficiaries have in the Original Medicare program. While providers and participants may choose to voluntarily enter into value-based arrangements, the Model will not change how Medicare-enrolled providers care for beneficiaries in Original Medicare today.

Read the release.

For more information, please visit: https://www.cms.gov/newsroom/fact-sheets/geographic-direct-contracting-model-geo

2018 Provider Payment and Utilization Data Now Available! Today, the Centers for Medicare & Medicaid Services released our annual update to the Medicare Provider Utilization and Payment Public Use Files (PUFs) with data for 2018. These PUFs summarize utilization and payments for procedures, services, and prescription drugs provided to Medicare beneficiaries. Today’s update includes the following files:

  • Inpatient Hospital
  • Outpatient Hospital
  • Post-Acute Care and Hospice
  • Physician and Other Supplier
  • Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies
  • Part D Prescriber

The 2018 data and all previous years of the PUFs are available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week Four
November 22 – November 28, 2020
In Week Four of the 2021 Open Enrollment period, 523,020 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

As a reminder, New Jersey and Pennsylvania transitioned to their own State-based Exchange platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections or 7% of all plan selections during the 2020 Open Enrollment Period. These enrollees’ selections will not appear in our figures until we announce the State-based Exchange plan selections.

Read the release.

2018 Quality Payment Program Performance Information is Now Available on Medicare Care Compare and in the Provider Data Catalog. The Centers for Medicare & Medicaid Services (CMS) has added new performance information to the Doctors & Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC), the successor websites to Physician Compare and the Physician Compare Downloadable Database.

Medicare patients and caregivers can use the Care Compare website to search for and compare doctors, clinicians and groups who are enrolled in Medicare. Publicly reporting 2018 Quality Payment Program performance helps empower patients to select and access the right care from the right provider.

Specifically, the 2018 Quality Payment Program performance information on Care Compare clinician and group profile pages includes:

  • 77 MIPS quality measures reported by clinicians and displayed as measure-level star ratings on their profile pages;
  • 84 MIPS quality measures reported by groups and displayed as measure-level star ratings on group profile pages;
  • 7 Consumer Assessment for Healthcare Providers and Systems (CAHPS) for MIPS summary survey score measures displayed as top-box percent performance scores on group profile pages;
  • 9 Qualified Clinical Data Registry (QCDR) quality measures reported by individual doctors and clinicians displayed as star ratings on their profile pages; and
  • 9 Qualified Clinical Data Registry (QCDR) quality measures reported by groups displayed as star ratings on group profile pages.

Additionally, for the first time in Performance Year (PY) 2018:

  • 13 Promoting Interoperability (PI) measures are reported as star ratings on clinician profile pages for individuals and groups;
  • 10 PI attestations are reported as a checkmark on clinician and group profile pages;
  • 113 Improvement Activity (IA) attestations are reported as checkmarks on clinician and group profile pages; and
  • PY 2018 aggregate MIPS performance information is reported in the

The 2018 Medicare Shared Savings Program and Next Generation Accountable Care Organization (ACO) performance information is publicly reported on Care Compare ACO profile pages and in the PDC.
Visit the Physician Compare Initiative page for details about the 2018 Quality Payment Program performance information that has been added to Care Compare profile pages for MIPS doctors and clinicians:

If you have any questions about public reporting for doctors and clinicians, please contact us at PhysicianCompare-Helpdesk@AcumenLLC.com.

Important! Physician Compare has sunset as of December 1, 2020, but you’ll still be able to find the same information about doctors and clinicians and other health care providers on Care Compare on Medicare.gov. The Provider Data Catalog on CMS.gov also makes it easier for you to search and download our publicly reported data. Start using these tools today.

Register Today for Webinar: 2018 Quality Payment Program Performance Information is Now Available on Medicare Care Compare and in the Provider Data Catalog. CMS is hosting a one-hour webinar on the 2018 Quality Payment Program performance information recently published on the Doctors & Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC), the successor websites to Physician Compare and the Physician Compare Downloadable Database. The webinar will include a live question and answer session and discuss the 2018 doctor and clinician performance information recently added to Care Compare profile pages and in the PDC.

Register today. The webinar will be conducted at the following time:

Registration ends on December 16, 2020, at 8:00 PM ET / 5:00 PM PT. We look forward to meeting you there.

If you have any questions about public reporting for doctors and clinicians on Care Compare, visit the Physician Compare Initiative page or contact us at PhysicianCompare-Helpdesk@AcumenLLC.com.

Important! Physician Compare has sunset as of December 1, 2020, but you’ll still be able to find the same information about doctors and clinicians and other health care providers on Care Compare on Medicare.gov. The Provider Data Catalog on CMS.gov also makes it easier for you to search and download our publicly reported data. Start using these tools today.

Reminder: Extended Deadline to Update Your Billing Info by December 13 for Your APM Incentive Payment
Reminder: Certain Clinicians Need to Update Their Billing Information by December 13 to Receive Their APM Incentive Payment
The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website includes 2020 Alternative Payment Model (APM) Incentive Payment details. To access information on the incentive amount and organization paid, clinicians and surrogates can log in to the QPP website using their HARP credentials. In order to receive payments, certain clinicians will need to verify their Medicare billing information by December 13, 2020.

Many eligible clinicians who were Qualifying APM Participants (QPs) based on their 2018 performance began receiving their 2020 5% APM Incentive Payments last month. If you have already received your payment, you do not need to do anything.

CMS also posted a new 2020 APM Incentive Payment Fact Sheet to explain:

  • Who is eligible to receive an APM incentive payment in 2020
  • How CMS determines your 2020 APM Incentive Payment
  • Frequently asked questions and answers

Who Needs to Verify Their Medicare Billing Information?
If you have not received a payment and find your name on this public notice, you will need to verify your Medicare billing information.

NOTE: If you do not verify your Medicare billing information by December 13, 2020, CMS will not be able to issue your APM Incentive Payment.

For more information, review the QP Public Notice File for Payment Year 2020 Excel Spreadsheet and supporting forms in the 2020 QP Notice for APM Incentive Payment zip file. The spreadsheet will indicate which form you need to submit—the IP Form and/or 588 Form—in order to verify your Medicare billing information.

Questions?
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.

HHS Finalizes Good Guidance Practices Rule and Issues Advisory Opinion Regarding Compliance with Notice-and-Comment Obligations. The Department of Health and Human Services (HHS) finalized a Good Guidance Practices rule to help ensure that the public receives appropriate notice of new guidance documents and that HHS guidance documents do not impose obligations on regulated parties that are not already reflected in statutes or regulations. This final rule implements Executive Order 13891 and is part of a broader regulatory reform initiative within HHS.

The Good Guidance Practices regulation clarifies HHS’s obligations under the Administrative Procedure Act and enhances how HHS issues and maintains guidance documents. The rule requires all guidance documents issued after the rule’s effective date to self-identify as “guidance,” carry a disclaimer indicating that the contents of the document generally cannot impose binding new obligations that exceed requirements set forth in statutes or regulations, and include certain information designed to ensure transparency and uniformity across guidance documents, including citations to any statutory and/or regulatory provisions that the guidance document is interpreting or applying. Guidance documents that qualify as “significant guidance documents” can only be issued after a public notice-and-comment period. HHS must include all of its guidance documents in a single, searchable guidance repository, which is located at HHS.gov/Guidance.  Any historical guidance document not posted to the guidance repository by the effective date of the rule will be considered rescinded.

The Good Guidance Practices regulation additionally creates a petition process, which gives interested parties an opportunity to petition HHS to correct unlawful guidance. Today, HHS also announced the withdrawal of a guidance document that was identified, in response to a Request for Information, as unlawfully purporting to impose binding obligations. As the announcement, available here – PDF, explains, HHS encourages interested parties in the future to bring similar matters to the Department’s attention by utilizing the petition process. More information about how to submit a petition is available on HHS.gov/Guidance.

The withdrawn guidance document was also inconsistent with the Supreme Court’s decision last year in Azar v. Allina Health Services, 139 S. Ct. 1804 (2019). The HHS Office of the General Counsel (OGC) today released an advisory opinion providing guidance around the steps HHS is taking to comply with this Supreme Court decision. In Allina, the Supreme Court determined that HHS must use notice-and-comment rulemaking in certain circumstances, even where the Administrative Procedure Act does not require such rulemaking. The OGC Allina advisory opinion, available here – PDF, clarifies what the public can expect HHS to do in order to satisfy Allina’s requirements regarding notice-and-comment rulemaking.

To view the final rule, please visit https://www.hhs.gov/sites/default/files/hhs-eo-13891-final-rule.pdf – PDF

High-dose influenza vaccine shows no additional benefit for heart disease patients. High-dose influenza (commonly known as flu) vaccines are no better than regular-dose influenza vaccines in reducing deaths and hospitalizations among patients with underlying heart disease, according to a large study publishing in JAMA. The results do not change well-established findings about the value of an annual influenza vaccine for persons with heart disease and other chronic illnesses, and do not change the recommendation for an annual influenza vaccine for most people.

The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, and appears online on December 4.

Read the release.

NIH researchers link cases of ALS and FTD to a mutation associated with Huntington’s disease. A study led by researchers at the National Institutes of Health has made a surprising connection between frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS), two disorders of the nervous system, and the genetic mutation normally understood to cause Huntington’s disease.

This large, international project, which included a collaboration between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA), opens a potentially new avenue for diagnosing and treating some individuals with FTD or ALS.

Several neurological disorders have been linked to “repeat expansions,” a type of mutation that results in abnormal repetition of certain DNA building blocks. For example, Huntington’s disease occurs when a sequence of three DNA building blocks that make up the gene for a protein called huntingtin repeats many more times than normal. These repeats can be used to predict whether someone will develop the illness and even when their symptoms are likely to appear, because the more repeats in the gene, the earlier the onset of disease.

Read the release.

New updates to federal guidelines revamp asthma management. The National Institutes of Health today announced 19 recommendations in six key areas of asthma diagnosis, management and treatment. The new guidance, published in the Journal of Allergy and Clinical Immunology, represents the first updates to federal comprehensive asthma management and treatment guidelines in more than a decade, and focuses on tailored treatment interventions for specific age groups based on disease severity using inhaled corticosteroids, long-acting antimuscarinic antagonists, immunotherapy, indoor allergen mitigation, fractional exhaled nitric oxide testing, and bronchial thermoplasty. The recommendations are based on systematic reviews conducted by the Agency for Healthcare Research and Quality and input from National Asthma Education Prevention Program (NAEPP) participant organizations, medical experts, and the public.

The National Heart, Lung, and Blood Institute (NHLBI), part of NIH, coordinates the NAEPP Coordinating Committee (NAEPPCC) and the 19-member expert panel working group which developed the 2020 Focused Updates to the Asthma Management Guidelines: A Report from The National Asthma Education and Prevention Program Expert Panel Working Group.

Read the release.

Texas Health & Human Services Commission Executive Council meeting. The Texas Health and Human Services Commission Executive Council will meet on Dec. 08, 2020 at 2:00 p.m. CST. Due to the COVID-19 pandemic, this meeting will be conducted virtually using Microsoft Teams only.  There is not a physical location for this meeting. Click here to view the agendaTexas Insight will be covering this meeting.

HHSC Announce Extension of Emergency SNAP Benefits for December 2020. Governor Greg Abbott announced that the Texas Health and Human Services Commission (HHSC) will provide approximately $204 million in emergency Supplemental Nutrition Assistance Program (SNAP) food benefits for the month of December as the state continues to respond to the COVID-19 pandemic.

The emergency December allotments are in addition to the almost $1.7 billion in benefits previously provided to Texans between April and November. HHSC received federal approval from the U.S. Department of Agriculture (USDA) to extend the maximum, allowable amount of SNAP benefits to recipients based on family size.

Administered by HHSC, SNAP is a federal program that provides food assistance to approximately 1.7 million eligible low-income families and individuals in Texas.

Texans in need can apply for benefits, including SNAP and Medicaid, at YourTexasBenefits.com or use the Your Texas Benefits mobile app to manage their benefits.

The following new reports have been posted on the Reports and Presentations page:

December 2020

To see a list of all reports and presentations go to the Reports and Presentations page.

HCS and TxHmL Program Providers Required to Select an EVV Vendor. Effective Jan. 1, HHSC will require HCS and TxHmL program providers to use EVV for the following services:

  • Community First Choice Personal Assistance Services/Habilitation (CFC PAS/HAB)
  • In-Home Respite
  • In-Home Day Habilitation (Own Home or Family Home only)

HCS and TxHmL program providers are required to select an EVV vendor and complete EVV training to meet the Jan.1 deadlines. The requirement to select an EVV vendor and complete training applies to all contracted HCS and TxHmL program providers.

Beginning Jan. 1, 2020, service claims for CFC PAS/HAB will be denied by the claims adjudication system and not paid by HHSC if the program provider has not onboarded with an EVV vendor.

Read IL 20-07 (PDF) for more information about selecting an EVV vendor and completing training to be EVV-compliant by the Jan. 1 deadline.

Email EVV if you have questions about EVV requirement.

EVV Policy Updates Effective Dec. 1. The following electronic visit verification policy updates are effective Dec. 1 and have been posted in the Policy section of the HHS EVV website.

EVV Reason Code Policy (PDF)

The revised policy replaces the EVV Reason Code and Required Free Text Policy and describes the requirements for using reason codes when completing visit maintenance in the EVV system.

EVV Reports Policy (PDF)

The revised policy includes the EVV Claim Match Reconciliation Report in the EVV Portal and the following additional standard reports in the EVV system:

  • EVV Attendant History Report
  • EVV Clock In/Clock Out Usage Report
  • EVV Reason Code Usage and Free Text Report
  • EVV Units of Service Summary Report

Email HHSC EVV with your questions.