Texas Health and Human Services Digest: June 18, 2020

  • Twitter
  • Facebook
  • Google+
  • Linkedin

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

June 23, 2020

June 25, 2020

June 26, 2020

June 30, 2020

The Administrative Procedure Act (Texas Government Code, Chapter 2001(link is external)) 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.

The Administrative Procedure Act (Texas Government Code, Chapter 2001(link is external)) 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.

No rules are presently available for public comment.

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
Repeal of Title 40, Chapter 109, Subchapter C, Specialized Telecommunications Assistance Program, and new Title 26, Chapter 360, Subchapter C, Specialized Telecommunications Assistance Program#18R061Bryant Robinson6/18/207/2/20
Title 26, Chapter 744, 746, & 747 Minimum Standards for School Age and Before or After School Programs, Child-Care Centers, & Child-Care Homes#20R024HHSC Child Care Regulation6/17/207/1/20
Title 26, Chapter 742 Minimum Standards for Listed Family Homes#20R021HHSC Child Care Regulation6/15/206/29/20
Title 26, Chapter 303 Preadmission Screening and Resident Review (PASSR)#20R049Lisa Habbit6/12/206/26/20

 

The Influenza information has recently been updated and is now available.

Long-Term Care Hospital (LTCH) Provider Preview Reports have been updated and are now available.  The data contained within the Preview Reports is based on quality data submitted by LTCHs between Quarter 1 – 2019 and Quarter 4 – 2019 and reflects what will be published on LTCH Compare during the September 2020 refresh of the website. Providers have until July 18, 2020 to review their performance data. Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate. Beginning with the September 2020 refresh, CMS will publicly display three new measures on the LTCH Compare website. For more information:

LTCH Quality Reporting Public Reporting webpage, LTCH Compare

Inpatient Rehabilitation Facility (IRF) Provider Preview Reports have been updated and are now available.  The data contained within the Preview Reports is based on quality data submitted by IRFs between Quarter 1 – 2019 and Quarter 4 – 2019 and reflects what will be published on IRF Compare during the September 2020 refresh of the website. Providers have until July 18, 2020 to review their performance data. Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate.  Beginning with the September 2020 refresh, CMS will publicly display six new measures on the IRF Compare website. For more information: IRF Quality Public Reporting webpage, IRF Compare

Registration is open for the 2020 Texas Oral Health Virtual Conference. Complex medical issues are best addressed by inter-professional teams. All providers on the team benefit from inter-professional education. Explore timely health topics that foster collaboration among all types of providers including:

  • Sugar, sugar everywhere:  A panel discussion on the harmful effects of sugar and what we can do about it. (Have you ever referred a patient to a dietitian?)
  • Dental Considerations for Individuals with Autism
  • Syphilis, the great masquerader…what to look for and why (Do you know it’s on the rise in Texas?)
  • Oropharyngeal Cancer:  Are you prepared to manage patients before, during, and after treatment?
  • Developing an Effective Health Communication Campaign – Lessons Learned from the Community Water Fluoridation Project
  • Integration of Oral Health and Primary Care Practice:  Take the First Step!
  • DSHS Dental Director Update: What does the new decade hold for oral health?

To access registration and view the conference schedule, course descriptions and speaker information, please visit: https://www.texasoralhealthconference.com/schedule.html. Continuing education credit for multiple disciplines will be provided for this event.

Texas Health and Human Services is accepting comments from stakeholders on the following draft rules. The comment period ends July 2, 2020.

  • Texas Health and Human Services Commission Title 40, Part 2, Chapter 109, Subchapter C, Specialized Telecommunications Assistance Program repeal, and new Texas Health and Human Services Commission Title 26, Part 1, Chapter 360, Subchapter C, Specialized Telecommunications Assistance Program. Comments can be emailed to Bryant Robinson.

Questions can be emailed to HHS Rules Coordination OfficeVisit the HHS Rulemaking website for more information. See the above rules comment schedule.

Many people who contract COVID-19 have only a mild illness, or sometimes no symptoms at all. But others develop respiratory failure that requires oxygen support or even a ventilator to help them recover [1]. It’s clear that this happens more often in men than in women, as well as in people who are older or who have chronic health conditions. But why does respiratory failure also sometimes occur in people who are young and seemingly healthy?

A new study suggests that part of the answer to this question may be found in the genes that each one of us carries [2]. While more research is needed to pinpoint the precise underlying genes and mechanisms responsible, a recent genome-wide association (GWAS) study, just published in the New England Journal of Medicine, finds that gene variants in two regions of the human genome are associated with severe COVID-19 and correspondingly carry a greater risk of COVID-19-related death.

The two stretches of DNA implicated as harboring risks for severe COVID-19 are known to carry some intriguing genes, including one that determines blood type and others that play various roles in the immune system. In fact, the findings suggest that people with blood type A face a 50 percent greater risk of needing oxygen support or a ventilator should they become infected with the novel coronavirus. In contrast, people with blood type O appear to have about a 50 percent reduced risk of severe COVID-19.

These new findings—the first to identify statistically significant susceptibility genes for the severity of COVID-19—come from a large research effort led by Andre Franke, a scientist at Christian-Albrecht-University, Kiel, Germany, along with Tom Karlsen, Oslo University Hospital Rikshospitalet, Norway. Their study included 1,980 people undergoing treatment for severe COVID-19 and respiratory failure at seven medical centers in Italy and Spain.

In search of gene variants that might play a role in the severe illness, the team analyzed patient genome data for more than 8.5 million so-called single-nucleotide polymorphisms, or SNPs. The vast majority of these single “letter” nucleotide substitutions found all across the genome are of no health significance, but they can help to pinpoint the locations of gene variants that turn up more often in association with particular traits or conditions—in this case, COVID-19-related respiratory failure. To find them, the researchers compared SNPs in people with severe COVID-19 to those in more than 1,200 healthy blood donors from the same population groups.

The analysis identified two places that turned up significantly more often in the individuals with severe COVID-19 than in the healthy folks. One of them is found on chromosome 3 and covers a cluster of six genes with potentially relevant functions. For instance, this portion of the genome encodes a transporter protein known to interact with angiotensin converting enzyme 2 (ACE2), the surface receptor that allows the novel coronavirus that causes COVID-19, SARS-CoV-2, to bind to and infect human cells. It also encodes a collection of chemokine receptors, which play a role in the immune response in the airways of our lungs.

The other association signal popped up on chromosome 9, right over the area of the genome that determines blood type. Whether you are classified as an A, B, AB, or O blood type, depends on how your genes instruct your blood cells to produce (or not produce) a certain set of proteins. The researchers did find evidence suggesting a relationship between blood type and COVID-19 risk. They noted that this area also includes a genetic variant associated with increased levels of interleukin-6, which plays a role in inflammation and may have implications for COVID-19 as well.

These findings, completed in two months under very difficult clinical conditions, clearly warrant further study to understand the implications more fully. Indeed, Franke, Karlsen, and many of their colleagues are part of the COVID-19 Host Genetics Initiative, an ongoing international collaborative effort to learn the genetic determinants of COVID-19 susceptibility, severity, and outcomes. Some NIH research groups are taking part in the initiative, and they recently launched a study to look for informative gene variants in 5,000 COVID-19 patients in the United States and Canada.

The hope is that these and other findings yet to come will point the way to a more thorough understanding of the biology of COVID-19. They also suggest that a genetic test and a person’s blood type might provide useful tools for identifying those who may be at greater risk of serious illness.

CPRIT announces the release of one (1) RFA for the Academic Research program. The complete RFA and instructions detailing applicable deadlines and requirements are available in the Apply for Funding section of CPRIT’s website.

Research Training Awards
The application period is July 8, 2020 through October 28, 2020. Proposals must be submitted through CPRIT’s online grant application system.

Research Training Awards (RFA-R-21.1 RTA)
This RFA solicits applications for integrated institutional research training programs to support promising individuals who seek specialized training in the area of cancer research. The goals of the Research Training Awards are to attract outstanding predoctoral (e.g. PhD, DNS or MD/PhD), and postdoctoral trainees committed to pursuing a career in basic, population-based, translational, or clinical cancer research; to expand the skills and expertise of trainees to promote the next generation of investigators and leaders in cancer research; to position most trainees for independent research careers; and to support the development of high-quality, innovative, and creative research that, if successful, could provide the basis for a significant impact on cancer prevention, detection, and/or treatment. Successful applicant institutions are expected to provide trainees with broad access to research opportunities across disciplinary lines and to maintain high standards for intellectual rigor and creativity.

Coronavirus Updates and Resources
COVID-19 has led to outbreaks of respiratory illness in the US. The number of reported cases continues to increase. Providers of all types care for some of the most vulnerable Texans. It is important to stay up to date with all guidance and recommendations from the CDC, HHSC, DSHS and other reliable sources. Below are key resources for providers.
CDC

HHSC

DSHS

NF Special Infection Control Assessments
Special Infection Control Assessment teams began conducting on-site assessments at NFs on June 11. This helped identify infection control concerns and provide immediate recommendations and guidance on infection control practices and mitigation strategies.
More information is available on the NF Special Infection Control Assessments page.

FDA The FDA has issued a letter to health care providers concerning certain filtering face piece respirators manufactured in China. These respirators may not provide adequate respiratory protection to health care workers exposed to COVID-19, based on performance testing conducted by the CDC’s National Institute for Occupational Safety and Health. The following links provide additional information.

Centers for Medicare and Medicaid Services CMS issued an Interim Final Rule on May 6, 2020. It requires NFs to report data about COVID-19 using the CDC’s National Healthcare Safety Network COVID-19 LTC Facility Module. The data reported includes:

  • Suspected and confirmed COVID-19 infections among residents and staff
  • Total deaths and deaths related to COVID-19 among residents and staff
  • PPE and hand hygiene supplies
  • Access to COVID-19 testing
  • Staffing shortages
  • Ventilator capacity and supplies

CMS has published preliminary nursing home data reported by NFs to NHSN.

CMS has also added findings of nursing facility COVID-19 Infection Control Surveys to the Nursing Home Compare Website.

Center for Excellence in Aging Services and Long-Term Care
The Center for Excellence in Aging Services and Long-Term Care is a partnership between HHSC and The University of Texas at Austin School of Nursing. The Center offers a web-based platform for the delivery of best practices. The focus is on geriatrics and disabilities. The content on the website has been adapted to meet the educational needs of a variety of professionals who provide care to people residing in long-term care facilities. Registration is free.
Phase V: Infection Control is now available and includes an interactive review of the key concepts of infection prevention and control in long-term care facilities.
The Center has also hosted several webinars related to COVID-19:

The Center is seeking nominations for health care providers at the CNA, LVN, RN, and APRN levels who have provided excellent person-centered care to people living in NFs or SNFs.

Visit the Center’s website for more information, including the nomination criteria and process. Nominations close June 30, 2020 at noon.

Civil Monetary Penalty Funds Available for Purchase of Communication Devices
All NFs are encouraged to apply for up to $3000 in federal CMP funds per facility. These funds are to buy communication devices to aid in connecting residents with their loved ones during the COVID-19 pandemic. Use awarded funds for items such as tablets, webcams, headphones and certain accessories.

Submit completed applications to the CMP Mailbox.

Guidance to NFs on Coordination with Managed Care Organizations
NF providers are contractually required to inform a member’s MCO service coordinator of certain changes, including:

  • Diagnosis of COVID-19
  • Member has left the NF
  • Member requests to return to the community

Find complete information on the TMHP document (PDF).

Combining more healthy lifestyle behaviors was associated with substantially lower risk for Alzheimer’s disease in a study that included data from nearly 3,000 research participants. Those who adhered to four or all of the five specified healthy behaviors were found to have a 60% lower risk of Alzheimer’s. The behaviors were physical activity, not smoking, light-to-moderate alcohol consumption, a high-quality diet, and cognitive activities. Funded by the National Institute on Aging (NIA), part of the National Institutes of Health, this research was published in the June 17, 2020, online issue of Neurology, the medical journal of the American Academy of Neurology.

The research team reviewed data from two NIA-funded longitudinal study populations: The Chicago Health and Aging Project (CHAP)(link is external) and the Memory and Aging Project (MAP)(link is external). They selected participants from those studies who had data available on their diet, lifestyle factors, genetics, and clinical assessments for Alzheimer’s disease. The resulting data pool included 1,845 participants from CHAP and 920 from MAP.
The researchers scored each participant based on five healthy lifestyle factors, all of which have important health benefits:

  • At least 150 minutes per week of moderate- to vigorous-intensity physical activity – Physical activity is an important part of healthy aging.
  • Not smoking – Established research has confirmed that even in people 60 or older who have been smoking for decades, quitting will improve health.
  • Light-to-moderate alcohol consumption – Limiting use of alcohol may help cognitive health.
  • A high-quality, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, which combines the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diet – The MIND diet focuses on plant-based foods linked to dementia prevention.
  • Engagement in late-life cognitive activities – Being intellectually engaged by keeping the mind active may benefit the brain.

The research team then compared the scores with outcomes of clinical diagnosis of Alzheimer’s in the CHAP and MAP participants. Lead author of the paper, Klodian Dhana, M.D., Ph.D., assistant professor at Rush University Medical Center, emphasized that the combination of healthy lifestyle factors is key. He wrote that compared to participants with no or one healthy lifestyle factors, the risk of Alzheimer’s was 37% lower in those with two to three, and 60% lower in those with four to five healthy lifestyle factors.

2017 research review and report commissioned by NIA concluded that evidence on lifestyle factors such as increasing physical activity, along with blood pressure management and cognitive training, is “encouraging although inconclusive” for preventing Alzheimer’s. Since then, more research has emerged, such as the SPRINT MIND trial, which suggests intensive blood pressure control may slow age-related brain damage, and new trials have launched. For example:

  • The NIA-funded MIND Diet Intervention to Prevent Alzheimer’s Disease is an interventional clinical trial comparing parallel groups with two different diets. An NIA-funded collaboration between Rush University and Harvard T.H. Chan School of Public Health and Brigham & Women’s Hospital (grant number R01AG052583). MIND has enrolled more than 600 participants and is ongoing with an anticipated completion date in 2021.

The U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is a multisite randomized clinical trial designed to evaluate whether lifestyle interventions — including the MIND diet — may protect cognitive function in older adults who are at increased risk for cognitive decline. NIA is funding the imagingneurovascular, and sleep ancillary studies of POINTER.

NIA is currently funding more than 230 active clinical trials on Alzheimer’s and related dementias. Of those, more than 100 are nondrug interventions, such as exercise, diet, cognitive training, sleep, or combination therapies. People interested in participating in clinical trials can find more information on the NIA website.