Texas Health and Human Services Digest: June 23, 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.

June 25, 2020

June 26, 2020

June 29, 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
Title 26, Chapter 558 Licensing Standards for Home and Community Support Services Agencies#19R069HHSC Policy, Rules, and Training6/23/207/7/20
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


Challenge seeks online tool to help socially isolated Americans connect and engage. Today, the Administration for Community Living (ACL) and the Office of the Assistant Secretary for Health launched the MENTAL Health Challenge to combat the social isolation and loneliness that older adults, people with disabilities and veterans often experience.  A total of $750,000 in prizes will be awarded for development of an easy-to-use online system that offers recommendations for programs, activities and resources that can help users connect to others and engage in the community, based on their individual needs, interests and abilities. The winning system will be announced and demonstrated in January 2021 at CES, an annual trade show produced by the Consumer Technology Association. It ultimately will become the centerpiece of a national public awareness campaign.

Social disconnection has enormous health consequences. Social isolation has been found to be as harmful to a person’s health as smoking 15 cigarettes a day, and people who are socially isolated or lonely face higher risk of hospitalization; depression, anxiety and suicide; heart failure and stroke; dementia; and even premature death. Not surprisingly, a recent analysis found that Medicare spends an additional $6.7 billion every year on enrollees who are socially isolated.

For a variety of reasons, older adults, people with disabilities, and veterans are more likely to be socially isolated and to report feeling lonely. Nearly a quarter of Americans who are 65 or older have few social relationships or infrequent social contact with others, and more than 40 percent of people 60 and older report feeling lonely. In one small study, people with disabilities were more than three times more likely to report feelings of loneliness than people without disabilities. Veterans report higher rates of loneliness than civilians, particularly if they have functional limitations or have experienced traumatic events, and loneliness has been cited as the top risk factor for suicidal ideation in veterans.

The number of older adults is projected to almost double by the year 2060, the population of people with disabilities also is growing, and 22 veterans die by suicide every day. There is a clear and critical need to help all three connect with others and engage in their communities. This is particularly true when normal social interaction is limited due to a crisis like the COVID-19 pandemic.

Supporting partners for the Mobilizing and Empowering the Nation and Technology to Address Loneliness & social isolation (MENTAL) Health Innovation Challenge include the Federal Communications Commission (FCC) and the Department of Veterans Affairs. The Challenge was coordinated by the White House Office of Science and Technology Policy.

More information about the MENTAL Health Innovation Challenge, including deadlines and evaluation criteria, can be found at ACL.gov/challenge and at https://www.challenge.gov/challenge/MENTAL-health-social-isolation-challenge.

About the partners for MENTAL Health Innovation Challenge:

  • The Administration for Community Living (ACL) was created around the fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities. By funding services and supports provided by networks of community-based organizations, and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans.
  • The Office of the Assistant Secretary for Health oversees the Department’s key public health offices and programs, a number of Presidential and Secretarial advisory committees, 10 regional health offices across the nation, the Office of the Surgeon General, and the U.S. Public Health Service Commissioned Corps.
  • In 1976, Congress established the White House Office of Science and Technology Policy to provide the President and others within the Executive Office of the President with advice on the scientific, engineering, and technological aspects of the economy, national security, homeland security, health, foreign relations, the environment, and the technological recovery and use of resources, among other topics.
  • The mission of the U.S. Department of Veterans Affairs (VA) is to fulfill President Lincoln’s promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans. Within the VA, the Veterans Health Administration is the largest integrated health care network in the United States, with 1,255 health care facilities serving nine million enrolled veterans each year.
  • The Federal Communications Commission regulates interstate and international communications by radio, television, wire, satellite, and cable in all 50 states, the District of Columbia and U.S. territories. An independent U.S. government agency overseen by Congress, the Commission is the federal agency responsible for implementing and enforcing America’s communications law and regulations.

Read the full release here.

This draft is entitled “Platelet-Rich Plasma for Wound Care in the Medicare Population“. If you are interested in reviewing this document, please visit: http://www.ahrq.gov/research/findings/ta/index.html. The document will be available for review from 9:00 am on June 23, 2020 to 5:00 pm on July 14, 2020. If you have any questions, please contact epc@ahrq.hhs.gov.

New office to continue agency’s work of reducing regulatory burden to allow providers to focus on patients instead of paperwork and reducing health care costs. Today, the Centers for Medicare & Medicaid Services (CMS) is announcing the creation of the Office of Burden Reduction and Health Informatics to unify the agency’s efforts to reduce regulatory and administrative burden and to further the goal of putting patients first. The new office is an outgrowth of the agency’s Patients over Paperwork (PoP) Initiative, which is the cornerstone of CMS’s ongoing efforts to implement President Trump’s 2017 executive order to “Cut the Red Tape” and eliminate duplicative, unnecessary, and excessively costly requirements and regulations. This announcement permanently embeds a culture of burden reduction across all platforms of CMS agency operations.

CMS’s burden reduction work began three years ago with the launch of our PoP Initiative, which has focused on reducing unnecessary regulatory burden, in order to allow providers to concentrate on their primary mission: patient care. The results are expected to save providers and clinicians $6.6 billion and 42 million unnecessary burden hours through 2021. As part of our efforts to date, CMS has heard from over 2,500 providers, clinicians, administrative staff, health care leaders, beneficiaries and their support teams through 158 site visits and listening sessions. Through more than 10 Requests for Information (RFI) combined with stakeholder interviews, CMS also has over 15,000 comments to assist us in our burden reduction efforts.

These efforts have yielded significant results:

  • Removed unnecessary, obsolete, or excessively burdensome conditions of participation for hospitals and other healthcare providers saving an estimated 4.4 million hours of time previously spent on paperwork with an overall total projected savings to providers of $800 million annually.[1]
  • Removed 235 data elements from 33 items on the Outcomes and Assessment Information Set (OASIS) assessment instrument for home health.
  • Established within the Quality Payment Program (QPP), a consolidated data submission experience for the different performance categories of the Merit-based Incentive Payment System (MIPS) so that clinicians no longer need to submit data in multiple systems.
  • Eliminated 79 measures, through modernizing proposals to advance our Meaningful Measures Initiative, resulting in projected savings of $128 million and an anticipated reduction of 3.3 million burden hours through 2020.
  • Implemented changes resulting in faster processing of state requests to make program or benefit changes to their respective Medicaid programs through the state plan amendment (SPA) and section 1915 waiver review process.

Read the full release here.

National Institutes of Health investigators and colleagues have discovered that when the immune system first responds to infectious agents such as viruses or bacteria, a natural brake on the response prevents overactivation. Their new study in mBio describes this brake and the way pathogens such as SARS-CoV-2, the virus that causes COVID-19, turn it on. Their finding provides a potential target for an immunotherapy that might be applied to a wide range of infectious diseases.

When a cell senses an infectious agent with molecules called pathogen recognition receptors, part of its response is to increase cell surface expression of a molecule called CD47, otherwise known as the “don’t eat me” signal. Increased CD47 expression dampens the ability of cells called macrophages, the immune system’s first responders, to engulf infected cells and further stimulate the immune response. Upregulation of CD47 on cells was observed for diverse types of infections including those caused by mouse retroviruses, lymphocytic choriomeningitis virus, LaCrosse virus, SARS CoV-2, and by the bacteria Borrelia burgdorferi and Salmonella enterica typhi.

By blocking CD47-mediated signaling with antibodies in mice infected with lymphocytic choriomeningitis virus, the authors demonstrated they could enhance the speed of pathogen clearance. Furthermore, knocking out the CD47 gene in mice improved their ability to control M. tuberculosis infections and significantly prolonged their survival.  In addition, retrospective studies of cells and plasma from people infected with hepatitis C virus indicated that humans also upregulate CD47.  In these studies, inflammatory cytokine stimuli and direct infection both promoted increased CD47 expression.

This highly collaborative research project involved 14 different institutions and was led by scientists from NIH’s National Institute of Allergy and Infectious Diseases in Hamilton, Montana, and Stanford University in Stanford, California. The findings open the possibility of using CD47 blockade as a new immunotherapeutic to treat a wide range of different infections. “There may be circumstances where host responses need boosting and CD47 represents a novel target for host-directed therapies in such cases,” the scientists write, mentioning SARS-CoV-2, HIV, HPV and Ebola virus among several possibilities.

Read the full release here.

Results from NIH-funded study could lead to improvements in diagnosis and treatment. Polycystic ovary syndrome (PCOS), an infertility disorder affecting at least 15% of reproductive-age women, may have at least two different subtypes, suggests a study funded by the National Institutes of Health. The findings could provide important information on the possible causes of PCOS and for developing more effective ways to treat the condition. The study appears in PLOS Medicine and was funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Institute of Diabetes and Digestive and Kidney Diseases.

PCOS(link is external) is characterized by irregular or missing menstrual periods (due to lack of or infrequent ovulation), high levels of androgens (male hormones) and small cysts on the ovaries. Women with PCOS are also at higher risk of diabetes and heart disease.

The current study analyzed the genes of nearly 900 women who had irregular menstrual periods. Researchers categorized them according to their body mass index (BMI) and levels of glucose, insulin and reproductive hormones, including androgens. Their analysis revealed two PCOS subtypes, each associated with distinct groups of gene variants. The reproductive subtype, about 23%, had higher levels of luteinizing hormone (LH), a pituitary hormone that regulates the ovaries, and sex hormone binding globulin (SHBG), a protein that transports estrogen and androgens. This subtype also tended to have a lower BMI and lower insulin levels than the others.

The metabolic group, roughly 37%, had a higher BMI, higher glucose and insulin levels and lower levels of SHBG and LH. The remaining women had no clear combinations of traits but had a greater frequency of gene variants associated with PCOS, suggesting that this group may be distinct from the others. Understanding the genes underlying these subtypes may yield new ways to diagnose PCOS and develop personalized treatments.

The study was conducted by Andrea Dunaif, M.D., of the Mount Sinai Health System in New York City, and colleagues.

Read the full release here.

Volunteers Sent More Than 900 Letters to Residents and Patients.
State supported living centers and state hospitals across Texas are using pen pal programs to help their residents and patients stay connected with their communities during the pandemic.

“As part of our dedication to provide the best care possible at state hospitals and state supported living centers, our staff has developed unique ways to help residents and patients cope with feelings of isolation caused by the pandemic,” said Mike Maples, HHS deputy executive commissioner for the Health and Specialty Care System. “With the newly created pen pal programs, people receiving care in our facilities have been able to maintain social interactions with volunteers.”

Residents of living centers include people with intellectual and developmental disabilities, and patients of state hospitals include people with mental health issues. Socialization is an important part of maintaining good mental health. Due to COVID-19, group activities, communal dining and visits with relatives and volunteers have been limited to prevent the spread of the virus.

Pen pal programs at several state hospitals and state supported living centers allow members of the community to send encouraging letters and cards to residents and patients. Volunteers can send positive messages, drawings, or stories about what they are doing for fun. Volunteers throughout Texas have already sent more than 900 cards and letters, and some have received responses as part of the program, which facility staff help to coordinate.

People who are interested in volunteering can fill out a volunteer application here. For information about how to join the pen pal program, e-mail VolunteerHHSC@hhsc.state.tx.us to learn about the participating facilities which include Austin State Hospital, Austin State Supported Living Center, Richmond State Supported Living Center and San Antonio State Hospital.

About State Hospitals and State Supported Living Centers
Texas Health and Human Services operates 10 state hospitals and 13 state supported living centers in Texas. State hospitals provide inpatient psychiatric care to adults, children and adolescents. State supported living centers provide residential treatment and training services to people with intellectual and developmental disabilities who are medically fragile or who have behavioral issues.