Texas Health and Human Services Digest: January 20, 2021

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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 20, 2021

January 21, 2021

January 22, 2021

January 25, 2021

January 26, 2021

January 27, 2021

January 29, 2021

February 5, 2021

February 17, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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 25, Chapter 411, Subchapter J, Standards of Care and Treatment in Psychiatric Hospitals#20R008: Voluntary Admission for Psychological ServicesHHS Policy, Rules and Training2/1/21
Title 26, Chapter 568, Standards of Care and Treatment in Psychiatric Hospitals#20R008: Voluntary Admission for Psychological ServicesHHS Policy, Rules and Training2/1/21
Title 25, Chapter 289, Subchapter E, Section 289.233, Radiation Control Regulations for Veterinary Radiation Machines#20R030: Veterinary Radiation MachinesDSHS Consumer Protection Division2/1/21
Title 26, Chapter 368, Intellectual and Developmental Disabilities (IDD) Habilitative Specialized Services#20R055: IDD Habilitative Specialized ServicesHHS IDD Services2/1/21
Title 1, Chapter 353, Sections 353.1305, 353.1306, and 353.1307, concerning Uniform Hospital Rate Increase Program#21R027: Uniform Hospital Rate Increase ProgramHHSC2/1/21
Title 1, Chapter 353, Subchapter O, Sections 353.1309 and 353.1311, concerning Physician Directed Payment Program#21R028: Physician Directed Payment ProgramHHSC1/25/21

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.
TitleProject No.ContactComment Start DateComment End Date
Title 26, Chapter 554, Nursing Facility Requirements for Licensure and Medicaid Certification#21R041Kayla Lail1/21/211/28/21
Title 1, Chapter 353, Subchapter Q, Process to Recoup Certain Overpayments#20R082Marina Hench1/14/211/27/21
Title 26, Chapter 925, Research Involving Health and Human Services Commission Services#20R104HHSC Health and Specialty Care System1/11/211/25/21
Title 26, Chapter 304, Diagnostic Assessment#20R124Lisa Habbit1/8/211/22/21

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 Date
Packet
Updated
Documents
Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In MedicaidSeptember 01, 2021 Notice Of Proposed Prospective Reimbursement For Rural Hospitals Participating In Medicaid
09-01-2021-prospective-reimbursement-rural-hospitals-in-medicaid.pdf

Notice 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, 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 UpdateMarch 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 RadiosurgeryMarch 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 CartridgeMarch 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 TomosynthesisMarch 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 PolicyMarch 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.pdf

Notice 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, 2021 Biennial Calendar Fee Review
03-2021-biennialcalendarfeereview.pdf

Biennial 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) High Throughput TestingJanuary 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) High Throughput Testing
01-01-2021-notice-adjfees-hcpcs-covid19-highthrouhput-testing.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)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

Part D Payment Modernization (PDM) Model Application Process for Calendar Year 2022. CMS released the Calendar Year (CY) 2022 Request for Applications (RFA) (PDF) for the Part D Payment Modernization (PDM) Model.

In order to address the high list price and high beneficiary out-of-pocket costs of prescription drugs, CMS is testing the impact of an updated Medicare Part D payment structure focused on the catastrophic phase of the Part D benefit. For CY 2022, the PDM Model is being updated with the following changes to better enable Part D sponsors to help beneficiaries manage costs, as well in light of the changes to the discount safe harbor to the Federal anti-kickback statute that removes protection for certain reductions in price in connection with the sale or purchase of prescription pharmaceutical products from pharmaceutical manufacturers to Part D sponsors that will take effect on January 1, 2022:

  1. Part D Formulary Flexibilities: CMS will test new Part D formulary flexibilities to improve alignment of Part D formularies with other pharmacy benefit designs in the commercial and individual markets, while still maintaining broad access to drugs at lower costs. Specifically, all of the existing, comprehensive Part D formulary checks and enrollee protections other than the protected class requirement and two-drugs per class requirement, including the coverage determination and appeal process and other Part D formulary requirements, will remain in place and provide safeguards to ensure beneficiaries retain access to the Part D prescription drugs they need. In addition, each Part D sponsor that applies to implement the formulary flexibilities will be required to provide an enhanced transition process for enrollees affected by proposed formulary changes for drugs in the protected classes. This transition process must include both proactive outreach to current enrollees and an extended transition supply that provides for multiple temporary fills for new enrollees and current enrollees who have not been able to switch to a formulary medication or complete the coverage determination process.
  2. Removal of downside Model risk for CY 2022: CMS will not apply the current 10 percent downside Model risk for Part D sponsors participating in the Model in CY 2022. CMS intends to apply 10 percent downside Model risk in CY 2023 and for the duration of the model thereafter

Interested Part D sponsors should submit a non-binding Notice of Intent (PDF) to apply by March 1, 2021. A timely and complete NOI is required for Part D sponsors who intend to submit a formal PDM Model application. More information about the NOI process is available in the CY 2022 Request for Applications (RFA) (PDF) and at the PDM Model webpage. If interest in the Model exceeds a certain amount, CMS would restrict participation to certain PDP regions. If CMS decides to limit participation to certain PDP regions, CMS will communicate (prior to the application go-live date) eligible PDP regions and an explanation of the selection methodology to Part D sponsors that submitted complete NOIs by the due date.

For those Part D sponsors that submit an NOI, CY 2022 Applications for the PDM Model are due on Friday, April 16, 2021 by 11:59 PM PDT, and the application portal will go live by March 23, 2021. A link to the CY 2022 PDM Application will be posted on the PDM Model webpage.

The CY 2022 PDM Model overview webinar will be held on February 3, 2021, from 4:00-5:00 PM EST. Registration is now open.

For further information, please visit the PDM Model webpage. You can also contact the model team at PartDPaymentModel@cms.hhs.gov.

CMS Updates the CMS Program Statistics with 2019 Data. The Centers for Medicare & Medicaid Services (CMS) released our annual update to the CMS Program Statistics with data for 2019.  The CMS Program Statistics presents detailed summary statistics on Medicare populations, utilization, and expenditures, as well as counts for Medicare-certified institutional and non-institutional providers.

Today’s release also includes new tables presenting utilization and expenditures by Medicare Part D coverage phase.

To view the CMS Program Statistics data see: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/index.html

All of the above data assets are also catalogued on Healthdata.gov:  http://www.healthdata.gov/dataset/search

The Data Navigator development team welcomes your feedback. Write to us at DataNavigator@cms.hhs.gov .

Paving the Way to Equity: A Progress Report. In 2015, the Centers for Medicare & Medicaid Services (CMS) developed the first-ever CMS Equity Plan for Improving Quality in Medicare (CMS Equity Plan for Medicare), which outlined CMS‘s path to help advance health equity by improving the quality of care provided to minority and other underserved Medicare beneficiaries. This plan provided an action-oriented, results-driven path for achieving health equity by focusing on populations that experience disproportionately high burdens of disease, worse quality of care, and barriers to accessing care – specifically, racial and ethnic minorities, sexual and gender minorities, people with disabilities, and individuals living in rural areas.

Today, CMS is excited to release an update on the past five years of work on this plan. Click here to read Paving the Way to Equity:  A Progress Report.

This progress report describes key ways CMS has demonstrated progress on the Path to Equity between 2015 and 2021, including 1) increasing understanding and awareness of disparities; 2) developing and disseminating solutions to achieve health equity; and 3) implementing sustainable actions to achieve health equity.

In the future, CMS will continue to implement sustainable actions across its programs and policies to achieve health equity among Medicare beneficiaries, and will explore new opportunities across all of its programs and policies. This work, and all of the work of the CMS Equity Plan, will maintain a focus on ensuring CMS programs and policies are designed to help organizations across the health care continuum work together to reduce disparities and achieve health equity for CMS beneficiaries nationwide. Visit our website to learn more about the CMS Equity Plan for Medicare.

Centers for Medicare & Medicaid Services (CMS) Measures Management System Update.

WHAT’S NEW WITH THE MEASURES MANAGEMENT SYSTEM (MMS)
MMS Information Session:  Join us January 27, 2021 from 2 p.m. – 3 p.m. (ET) for the MMS Information Session Maximizing Efficiency of Information Gathering with the De Novo Measure Scan (DNMS) Tool! The purpose of this webinar is to review efficient ways to search biomedical literature to support the development of new clinical quality measures using the Environmental Scan Support Tool (ESST)’s De Novo Measure Scan (DNMS) feature. The presenters will conduct a demonstration of the DNMS feature and explain the hows and whys of information gathering for new measure development and respecification. The ESST is publicly accessible on the CMS Measures Inventory Tool (CMIT) website. Click here to register for the MMS Information Session

Announcement: On January 18, 2021, CMS expanded access to several CMIT features, including the ESST and the DNMS, which allows users to use structured search terms to build a new measure concept. Those interested in using these valuable quality measurement tools can now gain access by creating a free user account on the CMIT site. Register for a CMIT user account here

Introducing CMS MERIT: CMS is pleased to announce the upcoming launch of the CMS Measures Under Consideration Entry/Review Information Tool (CMS MERIT) on January 29, 2021. CMS MERIT offers several features that enhance the Measures Under Consideration (MUC) List entry and review process for CMS’s pre-rulemaking process. Developers wishing to submit measures for CMS consideration in certain CMS programs, as required under the ACA, will use CMS MERIT for their submissions in 2021. Visit https://cmsmerit.cms.gov/ starting January 29 to explore this new tool.

  • An introductory webinar that highlights CMS MERIT functionality and features will be held at 2:00 p.m. (ET) Thursday, February 18, 2021. Register for the webinar here

ANNOUNCEMENTS: STAY UP TO DATE
Announcement: CMS proposed new rules to address prior authorization and reduce burden on providers, giving them more time to focus on their patients and provide better quality care. Click here to read more about these proposed rules

Announcement: CMS launched its new Hospital Quality Reporting (HQR) platform. The site features advanced security, simple submissions, reliable calculations, intuitive interfaces, and a modern infrastructure. Click here to learn more about this new platform

Announcement:  An updated 2021 CMS Quality Reporting Document Architecture (QRDA) Category I Schematron for Hospital Quality Reporting (HQR) is now available. Click here to download the updated ZIP file

Announcement:  CMS updated the 2021 CMS Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals to include the list of electronic clinical quality measures (eCQMs) finalized by CMS for the CY 2021 Performance Period based on the CY 2021 Physician Fee Schedule Final Rule released on December 1, 2020. Click here to read more about this update

In Case You Missed It: The National Quality Forum (NQF) convened a multistakeholder Technical Expert Panel (TEP), as a part of a contract with the Centers for Medicare and Medicaid Services (CMS), to guide the identification of challenges that impact the development, endorsement, and implementation of healthcare performance measures that use EHR data and recommend actions for mitigating those challenges. The Final Recommendation Report is now accessible through the project page.

In Case You Missed It: CMS published a short video on the new QualityNet Question and Answer tool showing how to access the tool, browse and search features, how to ask a new question, and how to get reports on previously asked questions. Click here to watch the video

GET INVOLVED: UPCOMING EVENTS
Webinar: Quality Reporting for Hospital Outpatient Departments and Ambulatory Surgical Centers: CY 2021 Program Finalized Proposals on January 27
Learn more about this event

STAKEHOLDER ENGAGEMENT OPPORTUNITIES
Public CommentTechnical Expert Panels (TEP), and Federal Register Rule Comment
Public Comment: MACRA Episode-Based Cost Measures: Wave 4 Measure Development

TEP: Practitioner Level Measurement of Effective Access to Kidney Transplantation

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.

Qualifying APM Participant (QP) Threshold Update. On December 27, 2020, the Consolidated Appropriations Act, 2021 was signed into law. Under this law, the Quality Payment Program’s Qualifying Alternative Payment Model (APM) Participant (QP) thresholds for payment years 2023 and 2024 — performance years 2021 and 2022 — are frozen at 50% for the payment amount threshold and 35% for the patient count threshold for performance years 2021 and 2022.

The partial QP thresholds have also been frozen at the same levels used for the 2022 payment year and 2020 performance year.

Performance Year202020212022
Payment Year202220232024
QP Payment Amount Threshold50%50%50%
QP Patient Count Threshold35%35%35%

As a reminder, if you qualify as a QP, you may be eligible for the 5% Alternative Payment Model incentive payment and be exempt from participating in Merit-based Incentive Payment System (MIPS).

How do I know if I am a QP in 2021?
CMS will use three snapshot dates—March 31, June 30, and August 31, 2021, to review data to make 2021 QP determinations. CMS will make determinations approximately 4 months after the end of each snapshot date, at which point you will be able to check the Quality Payment Program Participation Status Tool for updates to your APM status.

How do I know if I’m required to participate in MIPS in 2021?
If you are MIPS eligible and not determined to be a QP or a Partial QP, you will be required to participate in MIPS in 2021 and will receive a MIPS Final Score and payment adjustment. To learn more about MIPS, visit qpp.cms.gov.
For more information

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

An Audit Report on Selected Contracting Functions at the Health and Human Services Commission. The Health and Human Services Commission (Commission) improved its administration of certain contracting functions since a series of prior audit reports. However, it continued to have weaknesses in certain planning, procurement, and vendor selection functions. Specifically, for the contracts tested, the Commission:

  • Did not accurately screen all vendor proposals for compliance with its solicitation requirements.
  • Did not perform required vendor compliance verifications adequately or within required time frames.
  • Did not perform proper planning to re-procure one of the contracts tested.
  • Did not obtain all required certifications and disclosures from employees involved in procuring and managing its contracts.

Evaluating Vendor Proposals. To strengthen its procurement processes, the Commission implemented a quality control function for evaluating vendor proposals. As a result, the Commission’s final scores and rankings supported its award decisions for the contracts tested.

Use of SCOR. The Commission did not use its System of Contract Operation and Reporting (SCOR) as intended to manage the contracts tested.

STAIRS Contract. Although the Commission did not use SCOR as required, it effectively managed its contract for the support and maintenance of the State of Texas Automated Information Reporting System through other mechanisms.

 Jump to Overall Conclusion.

HHSC OIG Update. Welcome to OIG Update – a monthly newsletter from the Texas Health and Human Services Office of Inspector General (OIG). This newsletter highlights some of the OIG’s recent efforts in detecting, preventing and deterring fraud, waste and abuse in the delivery of Texas health and human services programs. Within this email, you’ll find hyperlinks to recent agency news.

Hospice executive sentenced to prison for health care fraud
The owner of a Texas chain of hospice companies was sentenced to 20 years in federal prison for his role in a $150 million health care scheme. Read more about this case on the OIG’s website.

OIG recovered $95 million in the first quarter
The OIG published its first Quarterly Report for fiscal year 2021. The agency recovered more than $95 million. In addition, nearly $81 million was identified for potential future recoveries, and another nearly $41 million was achieved in cost avoidance. The report available here summarizes the excellent work performed by the agency during the past three months.

OIG reviews program integrity in value-based purchasing
The OIG has identified program integrity considerations when implementing value-based purchasing. Click here to learn how the OIG is ensuring tax dollars are spent appropriately.

DSHS RSV Data Update. This information has recently been updated and is now available.

Family and Youth Success Program Request for Feedback (RFF)

CORRECTION NOTICE. The original Request for Feedback document had a non-working email address; the email has been corrected. If you attempted to send feedback before, please resubmit to PEIContracting@dfps.state.tx.us

The Prevention and Early Intervention (PEI) division is seeking feedback regarding the Family and Youth Success (FAYS) (formerly STAR) Program.

FAYS is the longest-standing statewide prevention grant program administered by PEI. FAYS addresses family conflict and everyday struggles while promoting strong families and youth resilience.

This RFF seeks feedback from all stakeholders on the following areas in addition to any other feedback on the program.

  • Geographic Service Areas
  • Payment Methodology
  • Community Strengths and Needs Assessment
  • Virtual and Phone Services
  • Program Quality

Additional information and feedback forms for the RFF can be found here: 

REQUEST FOR FEEDBACK

PEI welcomes written responses and comments to the Request for Feedback by January 29, 2021 at 2:00 P.M. Central Time.