Texas Health and Human Services Digest: July 28, 2020

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Previous meetings have made alternative arrangements like phone-in capability or have been canceled. These meetings are on the calendar as of today.

July 29, 2020

July 30, 2020

July 31, 2020

August 4, 2020

August 5, 2020

August 6, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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.

Project No.,
Comment End Date
Title 1, Chapter 370, Subchapter G, Standards for CHIP Managed Care#19R057: CHIP Appeals ProcessHHS Rules Coordination Office8/24/20
Title 40, Chapter 51, Medically Dependent Children Program#18R006: Repeal of MDCP Rules in Title 40HHS Rules Coordination Office8/24/20
Title 25, Chapter 265, General Sanitation#19R043: Public Swimming Pools and SpasDSHS Consumer Protection Division8/24/20
Title 1, Chapter 354, Subchapter D, Division 8 DSRIP Program Demonstration Years 9-10#19R067: Delivery System Reform Incentive Payment (DSRIP) Program DY 9-10HHS Texas Healthcare Transformation and Quality Improvement Program8/17/20
Title 26, Chapter 567 Certificate of Public Advantage#20R041: Certificate of Public Advantage (COPA)HHS Health Care Regulation’s Policy, Rules, and Training8/10/20
Title 25, Chapter 98, Subchapter C, Division 2 Advisory Committee#20R052: Texas HIV Medication Advisory CommitteeDSHS HIV-STD Program8/10/20
Title 26, Chapter 746, Subchapter B, Division 2 Required Notification#20R025: Annual Reporting of Employees Leaving Child-Care CentersHHS Child Care Regulation8/10/20

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.

The following are draft rules on which HHS is accepting informal public or stakeholder input. All rules are posted in MS Word format unless otherwise noted.

TitleProject No.ContactComment Start DateComment End Date
Title 26, Chapter 745 Licensing, Subchapters A, C, D, and L, and Chapter 748 Minimum Standards for General Residential Operations#20R039HHS Child Care Regulation7/15/207/29/20
Title 25, Chapter 217, Subchapter A, Grade Specifications and Requirements for Milk, and Subchapter B, Grade A Raw Milk and Raw Milk Products#20R051DSHS Milk and Dairy Unit7/14/207/28/20

Falls can be serious, even deadly, for older adults. Each year, about 3 million adults 65 and older are treated in emergency departments nationwide for serious injuries from a fall. These injuries can result in disability and reduced quality of life. Fear of falling can lead older adults to be less physically and socially active.

Several factors can increase fall risk. Aging often brings changes to eyesight and reflexes. Muscle weakness, problems with balance, and foot problems can also increase the likelihood of a fall. Certain medications can contribute by causing dizziness and confusion. But falls are often preventable. Researchers have been studying strategies to prevent serious fall injuries among older adults.

A new study tested a fall injury intervention tailored to individuals and administered by specially trained nurses. The trial, called Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), was funded by NIH’s National Institute on Aging (NIA) and the nonprofit Patient-Centered Outcomes Research Institute. Findings were published in the New England Journal of Medicine on July 9, 2020.

More than 5,400 participants, aged 70 and older, were enrolled at 86 primary care practices across 10 U.S. health care systems. The older adults who took part had been injured from a fall, had fallen at least two times in the previous year, or were afraid of falling because of difficulty walking or balancing.

The volunteers were first screened for fall injury risk factors. These included issues with walking and balance, falling hazards in the home, vision problems, problems with feet or shoes, weakened bones, certain medications, and low blood pressure when standing up.

Half the practices were randomly selected to use the tailored fall prevention plan. Specially trained nurses helped them to identify their risk factors and work to reduce one to three of them.

The other practices served as the control group. Participants received an informational pamphlet on falls and were encouraged to discuss fall prevention with their primary care doctors, who also received the risk factor screening results.

The researchers measured the length of time to the first serious fall injury. After a participant reported a serious injury, it was verified at the practice or through health records. The team looked at the intervention’s effectiveness over 20 months or more.

The overall rate of serious fall injuries in the trial was much lower (about 5%) than the team expected. While they hoped the fall prevention plan would reduce serious injuries, there was little difference in the rate of serious fall injuries between the two groups.

Past studies have shown that many falls in older adults can be prevented. Researchers will continue to explore the most effective ways to minimize serious fall injuries.

The Texas Health and Human Services Commission announced today construction is underway on a $30.5 million project at Kerrville State Hospital to create a 70-bed maximum-security unit.

“This project is an investment in the community and in the patients we serve,” said Tim Bray, Texas HHS Associate Commissioner for State Hospitals. “This state-of-the-art unit will support us as we continue providing the very best inpatient psychiatric care to people with mental illness.”

Construction crews are transforming two vacant buildings on campus into a maximum-security forensic unit. The new unit will add 70 beds to the hospital’s existing 220-bed capacity.

This project is part of the $745 million investment from the Texas Legislature and Gov. Greg Abbott for the construction and renovation of state psychiatric hospitals in Austin, Kerrville, Rusk and San Antonio, as well as a new hospital in Houston.

“I am proud to have supported efforts to provide a much-needed expansion to the Kerrville State Hospital,” said State Sen. Dawn Buckingham. “This project is important for the community and will benefit many citizens in Kerrville and surrounding areas.”

The new unit is expected to be completed by September 2021. When finished, Kerrville State Hospital will become the third state hospital in Texas to offer maximum-security beds. North Texas State Hospital-Vernon and Rusk State Hospital are also psychiatric care facilities that serve patients in a maximum-security setting.

Health officials anticipate 260 new jobs will be created at Kerrville State Hospital after construction is complete and the new unit opens. New jobs will include direct care staff such as psychiatric nursing assistants, nurses, psychiatrists, psychologists, social workers and support service positions for the kitchen, laundry, maintenance, and security areas.

“It is exciting to think about this expansion of the Kerrville State Hospital,” said Kerrville Mayor Bill Blackburn. “In addition to the good jobs that will be welcomed by the people of Kerrville, I think of the good care the patients here will find at the hospital. My father spent the last four years of his life at the Kerrville State Hospital, and he was well cared for.”

At this time, to protect the health and safety of patients and staff during the COVID-19 pandemic, non-essential visitors are not allowed on campus. We are providing links to the published video, downloadable b-roll and pictures of the initial phase of construction, as well as video sound bites from Mike Maples, HHSC Deputy Executive Commissioner of the Health and Specialty Care System.

For more information about state hospital construction projects throughout the state, visit the Changes to the State Hospital System page on the HHS website.

About Kerrville State Hospital
Kerrville State Hospital, which is about 50 miles Northwest of San Antonio, provides inpatient psychiatric services for patients on a forensic commitment, which includes people who have been ruled incompetent to stand trial or found not guilty by reason of insanity. The hospital serves approximately 250 patients annually. Kerrville State Hospital is among 10 state hospitals that HHSC operates for people with mental health disorders.

The reference to PL 19-16 has been updated to accurately reflect PL 19-17.
The following are HHSC’s requirements for care facilities to report resident deaths to HHSC, including deaths from COVID-19.

  • Nursing facilities must report:
    • Any resident death that happen in the facility or of residents who die within 24 hours of transfer to a hospital. The facility must report these deaths to HHSC via TULIP within 10 working days of the last day of the month in which a death occurs.
    • All deaths under unusual circumstances to Complaint and Incident Intake within 24 hours. See PL 19-17.
  • Assisted living facilities and day activity and health services facilities must report any death of unknown cause to Complaint and Incident Intake within 24 hours. See:
    • PL 19-23 (assisted living facility)
    • PL 15-14 (day activity and health services).
  • Intermediate care facilities must report all deaths to Complaint and Incident Intake within one hour. See:
  • In-patient hospices must report unexpected deaths related to using restraint or seclusion (see 26 Texas Administrative Code §558.871(n)(link is external)). The in-patient hospice must report these deaths to Complaint and Incident Intake within 24 hours of knowledge of the client’s death.
  • Prescribed Pediatric Extended Care Centers must report a minor’s death that happens in the center or of any minor who dies within 24 hours of transfer from the center to the hospital to Complaint Incident Intake. See 26 TAC §550.905(link is external).
  • Home and Community-based Services and Texas Home Living Program Providers must report all deaths of people receiving HCS or TxHmL services to HHSC by the end of the next business day following the death or the program provider’s learning of the death. See IL 12-28.

Note: If the death may have been from abuse, neglect or exploitation, more reporting requirements may exist.

The Texas Commission of Licensing and Regulation adopts amendments to the Dyslexia Therapy program rules at 16 Texas Administrative Code, Chapter 120, §120.26. The adopted rules implement House Bill 2059, 86th Legislature, Regular Session (2019), which requires human trafficking prevention training for health care practitioners prior to the renewal of a license.

The adoption justification was published in the July 24, 2020, issue of the Texas Register (45 TexReg 5191). The updated rule chapter will be made available upon its effective date of August 1, 2020.