Texas Health and Human Services Digest: January 8, 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 8, 2021

January 11, 2021

January 12, 2021

January 13, 2021

January 15, 2021

January 21, 2021

January 22, 2021

January 25, 2021

January 26, 2021

January 27, 2021

January 29, 2021

February 5, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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
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.
TitleProject No.ContactComment Start DateComment End Date
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
Title 25, Chapter 295, Subchapter I, Texas Environmental Lead Reduction#21R034DSHS Environmental Hazards Branch1/4/211/19/21
Title 26, Chapter 551, Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions#19R072HHS Policy, Rules and Training1/4/211/19/21

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 DatePacket UpdatedDocuments
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

Physician Fee Schedule Update. On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS):

  • Provided a 3.75% increase in MPFS payments for CY 2021
  • Suspended the 2% payment adjustment (sequestration) through March 31, 2021
  • Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
  • Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024

CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) webpage.

Home Health Value-Based Purchasing (HHVBP) Model Expansion. The U.S. Department of Health and Human Services (HHS) is announcing that HHS Secretary, Alex M. Azar, II, has approved the expansion of the Home Health Value-Based Purchasing (HHVBP) Model. The HHVBP expansion would be implemented through rulemaking no earlier than January 1, 2022.

Tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the HHVBP Model began its first performance year in 2016. The CMS Office of the Actuary has certified, based on its independent assessment of the model’s performance over the first three years of the Model, that an expansion would reduce, or not result in any increase in, net Medicare spending.

The Secretary has also determined that an expansion of the HHVBP Model would likely improve quality of care for Medicare beneficiaries, without denying or limiting coverage or provision of benefits to Medicare beneficiaries. These combined determinations, coupled with the actuarial certification, meet the criteria set by Section 1115A(c) of the Affordable Care Act to allow the Secretary to expand the model through rulemaking.

For more information, please visit https://innovation.cms.gov/innovation-models/home-health-value-based-purchasing-model. For questions please call the helpdesk at (844) 280-5628 or email HHVBPquestions@cms.hhs.gov.

NIST Digital Identities 800-63-3 Requirements

What is happening?

The Office of Information Technology (OIT) understands that guidance will come from the Department of Health and Human Services (DHHS) to the Information Security & Privacy Group (OIT/ISPG), and then to all of CMS about compliance to the new National Institute of Standards and Technology (NIST) Digital Identity Guidelines 800-63-3 that will have significant changes to the following:

Multifactor Authentication (MFA); and

Identity Proofing.

Who does this affect?

This applies to all CMS identity management verification systems/processes, including Identity Management (IDM).

**Note: This communication and any future changes are completely unrelated to and have no impact on the IDM Migration effort that is currently underway.**

What are the potential changes?

1. MFA: Under the previous NIST guidelines, Level of Assurance (LOA) 2 users were not required to complete MFA during authentication (i.e., entering a user name and password) to access their respective system(s). This is the current process that is used today. The new NIST Digital Identity Guidelines will require all users (i.e., LOA2 and LOA3) to complete MFA during authentication into their respective system(s). OIT anticipates that this change would not occur any earlier than 2022/2023.

For reference, this is how CMS populations are currently categorized using the LOAs:

LOA 1Shell account that does not require identity proofing or MFA.
LOA 2Federally Facilitated Marketplace (FFM) Consumers and some other CMS applications that have roles in LOA2. Identity proofing is required to set up an account, no MFA required at log in.
LOA 3Providers/Professionals & Help Desk users. Identity proofing is required to set up an account, MFA is required at log in.
LOA 4No users in EIDM

2. Identity Proofing: under the previous NIST Guidelines, LOA2 and LOA3 users were required to answer knowledge based questions also known as “out of wallet questions” to set up an account. This is the current process that is used today. The new NIST Digital Identity Guidelines remove knowledge based questions in favor of document verification (i.e., a “selfie,” picture of a government issued identification, and financial or document information [e.g., SSN, utility bill, phone number, driver’s license number, etc.]) . Please see the graphic below that depicts the transition of LOA users into the new NIST Identity Assurance Levels (IALs). Therefore, all IAL2 users will be required to provide a selfie and document verification to be successfully identity proofed in order to create an account. OIT anticipates that this change would not occur any earlier than 2022/2023.

What are the next steps?
There is a provision in NIST 800-63-3 that empowers an agency to create their own IAL2 risk based alternative solution in the event that the “selfie” and document verification method is too restrictive. OIT is currently investigating this option.

OIT conducted some market and product research and identified vendors that appear to meet the new NIST IAL2 requirements for identity proofing. As we continue to investigate, other vendors may come to light and a future procurement may occur. We are scheduling demos with five vendors after the EIDM to IDM migration is complete (i.e., after mid-February). We encourage participation in these demos so that CMS components can understand the impacts of these changes that may occur to identity proofing in the future. Additional information about the demos is forthcoming via GovDelivery notifications.

Please contact IDMQuestions@cms.hhs.gov should you have any questions or need assistance.

CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies. The Centers for Medicare & Medicaid Services (CMS) issued guidance to state health officials designed to drive the adoption of strategies that address the social determinants of health (SDOH) in Medicaid and the Children’s Health Insurance Program (CHIP) so states can further improve beneficiary health outcomes, reduce health disparities, and lower overall costs in Medicaid and CHIP.  SDOH describe the range of social, environmental, and economic factors that can influence health status—conditions that can often have a greater impact on health outcomes than the actual delivery of health services. The new guidance describes how states can leverage existing flexibilities under federal law to tackle adverse health outcomes that can be impacted by SDOH and supports states with designing programs, benefits, and services that can more effectively improve population health and reduce the cost of caring for our nation’s most vulnerable and high-risk populations.

To view the Opportunities in Medicaid and CHIP to Address Social Determinants of Health letter, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho21001.pdf

Read the full release.

Updated Centers for Disease Control 2019 Suicide Mortality. The National Action Alliance for Suicide Prevention (Action Alliance) has released information on the updated data by the Centers for Disease control and Prevention’s National Center for Health Statistics on the decline of suicide rates for the first time in 15 years.

Here in Texas, the age-adjusted suicide death rate decreased from 13.7 deaths per 100,000 population to 13.4 deaths per 100,000 population.  This still accounted for 3,887 deaths among Texans. While the death rate decreased among many groups, the rate increased for those 15 to 24 years of age from 14.3 deaths per 100,000 population to 15.2 deaths per 100,000 population, for those who are Black from 7.1 deaths per 100,000 population to 7.4 deaths per 100,000 population, and slightly for those Hispanic from 7.6 deaths per 100,000 population to 7.7 deaths per 100,000 population.

A media statement from Action Alliance discussing the decline in suicide deaths is available online at action_alliance_statement_2019_cdc_mortality_data.pdf (theactionalliance.org).

If you have any questions, email suicide.prevention@hhs.texas.gov.

Federal Fiscal Year 2021 Payment Rates for Medicaid Community Hospice Adopted (IL 2021-02). The Texas Health and Human Services Commission approved rate changes for the Medicaid Community Hospice program. The payment rates are effective retroactive to Oct. 1, 2020.

HHSC has published IL 2021-02 Federal Fiscal Year 2021 Payment Rates for Medicaid Community Hospice (PDF).

The increased payment rates were calculated per federal regulations on payment for hospice care. This is in Title 42 of the Code of Federal Regulations, Part 418, Subpart G. Furthermore, 42 CFR 418.306(c) requires that Medicaid hospice payment rates are adjusted every federal fiscal year. Adjustments were made using data issued by the Centers for Medicare and Medicaid Services.

Access the approved payment rates effective Oct.1, 2020 here.

REMINDER: Drug Utilization Review Board Applications Due January 15. If you’re interested in the statewide Drug Utilization Review Program for Medicaid, you may want to apply to be a member of the Drug Utilization Review Board. But act quickly as applications are due Jan. 15!

Click here to learn more and apply.

January HCS Provider Certification Principle Webinars. The following webinars are a repeat of last year’s HCS and TxHmL Certification Principles series. Each webinar will cover a certification principle or principles outlined in TAC Title 40 Chapter 9 and will include examples of program provider violations.

Certification Principle 9.172: Mission, Development and Philosophy of Program Operations/Top Ten Deficiencies for HCS and TxHmL
This webinar is part of the WSC Certification Principles training series. This presentation will cover the requirements detailed in TAC §9.172 and the top ten deficiencies for program providers.
Jan. 26
2-5 p.m.
Register for the webinar.

Comprehensive Nursing Assessment
This webinar is part of the WSC Certification Principles training series. This presentation will go over the requirements for the Comprehensive Nursing Assessment
Jan. 28
9-12 p.m.
Register for the webinar.

GL 20-5003 Required Training on Human Trafficking for Licensed Chemical Dependency Counselors (HB 2059-86R) Available Online. GL 20-5003 relating to the required human trafficking prevention training for certain health care practitioners has been posted.

This letter instructs licensed chemical dependency counselors (LCDCs) providing direct patient care to complete a training course on identifying and assisting victims of human trafficking as a condition of registration permit or license renewal.

Please read the letter at the below link and if you have questions, contact HCR_PRT@hhs.texas.gov.

Read the letter.

Informal Comments on Draft Rules Due 1/22 on Diagnostic Assessment. Texas Health and Human Services Commission is accepting informal comments from stakeholders on the following draft rules. The comment period ends January 22, 2021.

  • Texas Health and Human Services Commission Title 26, Part 1, Chapter 304, Diagnostic Assessment. Comments can be emailed to Lisa Habbit.

Questions can be emailed to HHS Rules Coordination Office.

Read more.

Jan. 7 Recording of HCS and TxHmL Administrative Penalties and Amelioration Available. A recording of the Jan. 7, 2021 HCS and TxHmL Administrative Penalties and Amelioration webinar is available for those unable to attend.

Listen to the webinar recording here.

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

Human Trafficking Prevention Month 2021. January is Human Trafficking Prevention Month and National Human Trafficking Awareness Day is January 11. DFPS and its partners are hosting a variety of events throughout the month. Below are some great ways to get involved.

Wear Blue Day
On Monday, January 11, 2021 you are invited to take photos of friends, family, colleagues, and yourself while wearing blue clothing, and then share those photos on social media – Facebook, Twitter, Instagram. Use #WearBlueDay. Tag DFPS in your post by using the handle @TexasDFPS and please email your photos to HumanTrafficking@dfps.state.tx.us

Wear Blue Day is part of the Department of Homeland Security’s Blue Campaign to combat human trafficking. Homeland Security works with law enforcement and organizations like DFPS to protect the basic right of freedom and bring to justice those who exploit human lives.

Learn More: TexasEndHumanTrafficking.org

#LightTheWayEndHumanTrafficking

GRACE Week of Prayer to End Human Trafficking
January 11-17, 2021
The Governor’s Response Against Child Exploitation (GRACE) is encouraging faith communities across Texas to unite in prayer, become better educated about human trafficking, and find opportunities to prevent exploitation and support survivors. Watch and share this video invitation from First Lady Cecilia Abbott

Join First Lady Cecilia Abbott, DFPS Commissioner Jaime Masters, and a variety of faith leaders in a Facebook Live Launch Event on Monday, January 11th from 6:00pm to 6:30pm.

You can use #TXPraysToEndHT on social media to share your support for the Week of Prayer to End Human Trafficking. Please view and share GRACE’s Week of Prayer Facebook page, Instagram photo, and Twitter post about this weeklong initiative.

Texas Blue Sand Project     
Please join the Texas Attorney General’s Office during Human Trafficking Awareness Month in its Blue Sand Project—a great outdoor project and free way to get involved in the movement to end this heinous crime. Get blue sand from your local craft store, spread it around to fill in the cracks of the sidewalk, post a photo and tag it with #TXBlueSandProject. 

Texas ranks second in human trafficking cases nationwide. Help us send the message that this crime will not be tolerated in Texas. We can prevent victims from falling through the cracks if we all take the time to educate ourselves about the warning signs of trafficking.

For more information, please visit the Texas Attorney General’s website or email:humantrafficking@oag.texas.gov.