Texas Health and Human Services Digest: June 24, 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


In response to the 2019 Coronavirus (COVID-19) public health emergency, the Centers for Medicare & Medicaid Services (CMS) is announcing flexibilities for clinicians participating in the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) in 2020:

  • Clinicians significantly impacted by the public health emergency may submit an Extreme & Uncontrollable Circumstances Application to reweight any or all of the MIPS performance categories. Those requesting relief via the application will need to provide a justification of how their practice has been significantly impacted by the public health emergency.
  • Reminder: In April, CMS added a new COVID-19 clinical trials improvement activity. There are two ways MIPS eligible clinicians or groups can receive credit for this new improvement activity:
    • A clinician may participate in a COVID-19 clinical trial and have those data entered into a data platform for that study; or
    • A clinician participating in the care of COVID-19 patients may submit clinical COVID-19 patient data to a clinical data registry for purposes of future study.

For More Information

Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.

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

These flexibilities, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

The Centers for Medicare & Medicaid Services (CMS) is calling for a renewed national commitment to value-based care based on Medicare claims data that provides an early snapshot of the impact of the coronavirus disease 2019 (COVID-19) pandemic on the Medicare population.  The data shows that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and confirms long-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations.

The data released today includes the total number of reported COVID-19 cases and hospitalizations among Medicare beneficiaries between January 1 and May 16, 2020. The snapshot breaks down COVID-19 cases and hospitalizations for Medicare beneficiaries by state, race/ethnicity, age, gender, dual eligibility for Medicare and Medicaid, and urban/rural locations. The new data show that more than 325,000 Medicare beneficiaries had a diagnosis of COVID-19 between January 1 and May 16, 2020. This translates to 518 COVID-19 cases per 100,000 Medicare beneficiaries. The data also indicate that nearly 110,000 Medicare beneficiaries were hospitalized for COVID-19-releated treatment, which equals 175 COVID-19 hospitalizations per 100,000 Medicare beneficiaries.

Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites. The disparities presented in the snapshot go beyond race/ethnicity and suggest the impact of social determinants of health, particularly socio-economic status.

Other key data points:

  • End-stage renal disease (ESRD) patients (individuals with chronic kidney disease undergoing dialysis) had the highest rate of hospitalization among all Medicare beneficiaries, with 1,341 hospitalizations per 100,000 beneficiaries. Patients with ESRD are also more likely to have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure.
  • The second highest rate was among beneficiaries enrolled in both Medicare and Medicaid (also known as “dual eligible”), with 473 hospitalizations per 100,000 beneficiaries.
  • Among racial/ethnic groups, Blacks had the highest hospitalization rate, with 465 per 100,000. Hispanics had 258 hospitalizations per 100,000. Asians had 187 per 100,000 and whites had 123 per 100,000.
  • Beneficiaries living in rural areas have fewer cases and were hospitalized at a lower rate than those living in urban/suburban areas (57 versus 205 hospitalizations per 100,000).

The snapshot also shows that besides higher hospitalization rates, beneficiaries enrolled in both Medicaid and Medicare have a higher infection rate of COVID-19, with 1,406 cases per 100,000 beneficiaries. By comparison, the coronavirus infection rate for beneficiaries enrolled only in Medicare is 325 cases per 100,000. The rate of COVID-19 cases for dual eligible individuals is higher across all age, sex, and race/ethnicity groups. Previous research has shown that these individuals experience high rates of chronic illness, with many having long-term care needs and social risk factors that can lead to poor health outcomes.

Given the complexity of these disparities, any solution requires a multi-sectoral approach that includes federal, state, and local governments, community based organizations, and private industry. One piece of this is the increased implementation of a value-based system that rewards providers for keeping patients healthy and gives consumers the information about disease prevention and outcomes needed to help make healthcare choices on the basis of quality.

Additionally, CMS is encouraging states to double down on efforts to protect low income seniors and look at the data and determine what resources are available, both locally and federally, to improve this disparity of health outcomes. CMS has identified a range of operational opportunities for states to improve care for dually eligible individuals and a variety of models that states can participate in that focus on improving the quality and cost of care for individuals who are concurrently enrolled in Medicaid and Medicare.

The Center for Medicaid and Children’s Health Insurance Program (CHIP) Services is developing guidance for states on new opportunities to adopt innovative, value-based payment design and implement strategies to address social determinants of health for their beneficiaries, including those who are dually-eligible for Medicare and Medicaid. In addition to these ongoing efforts and programs, the CMS Office of Minority Health will be holding a series of listening sessions with key stakeholders responsible for providing care to racial and ethnic minorities. These listening sessions are intended to help refine the ongoing outreach and work by CMS to improve future efforts on this issue.

CMS typically releases Medicare claims information on an annual basis when there are more complete claims and encounter data. However, as part of the agency’s efforts to provide data transparency during the pandemic and ensure the public has this vital information as soon as it is available, CMS is releasing this preliminary data now. The data will be updated on a monthly basis as more claims and encounter records are received. CMS anticipates releasing similar information on Medicaid beneficiaries in the future.

Governor Greg Abbott has appointed Cortney Jones and Enrique Mata to the Family and Protective Services Council for terms set to expire on February 1, 2025. The council is charged with studying and making recommendations to the commissioner regarding the management and operation of the Department of Family and Protective Services.

Cortney Jones of Austin is the Founder and Executive Director of Change 1, a community based organization that collaborates with local agencies and individuals dedicated to foster care alumni success. In addition, she is a motivational speaker and previously worked for Child Protective Services. She is a member of the Child Welfare Race Equity Collaborative Advisory Committee and the Texas Court Appointed Special Advocates (CASA) Public Policy and Communications committees. She is a former board member of Adoption Knowledge Affiliates and Head Start Child Inc. and a former member of the Supreme Court of Texas Children’s Commission Foster Care School Discipline Committee. She previously served on the National Foster Care Youth and Alumni Policy Council, and served as a field instructor with the University of Texas’ School of Social Work. Cortney received a Bachelor in Social Work from Texas A&M University-Commerce and a Master in Social Work from Texas State University.

Enrique Mata of El Paso is a Senior Program Officer with Paso del Norte Health Foundation. He has more than 20 years of experience in health philanthropy including designing, implementing, and evaluating multi-million dollar initiatives. He is also certified as an advanced public health nurse and advanced nurse executive by the American Nurses Credentialing Center. He is a member of the American Nurses Association, Sigma Theta Tau Nursing Honor Society, and The University of Texas at El Paso Alumni Association. He serves on the UT El Paso School of Nursing Advisory Board, The El Paso Behavioral Health Consortium, and the El Paso 211 Advisory Board. Mata received a Bachelor of Science in Nursing from UT El Paso and a Master of Science in Public Health from Walden University.

The Texas Health and Human Services Commission today announced the recipients of the 2019 Innovators in Aging award, which highlights individuals and organizations that have positive impacts on the lives of older Texans.

According to the Texas Demographic Center, the population of Texans who are older than 65 is expected to exceed 9 million people within the next 30 years. With that population expanding, more innovation is needed to meet its needs. Texas HHSC is recognizing seven organizations and individuals that have developed and carried out new ideas that help older adults stay healthy, connected and informed.
The 2019 Innovators in Aging award recipients are:

  • Active for Life® at the Texas A&M Center for Population Health and Aging: Active for Life® addresses the critical issue of translating research into practice in meeting the needs of older adults, by connecting partners and stakeholders that help older adults become active members of their health care team.
  • AGE of Central Texas and Blanton Museum of Art: This unique partnership offers an accessible opportunity for people living with early memory loss and their caregivers to have an interactive museum experience, promoting connection between the older adult with dementia and their caregiver.
  • Caring in Action: Caring in Action pairs volunteers with residents of nursing or assisted living facilities through The Holiday Project and shares HHSC Age Well Live Well resources through the Activity Professionals of Texas Networking Group. The initiative connects people of all ages, faiths, and backgrounds through volunteering and engagement.
  • Jim Jonson and The Medicare Puzzle: The Medicare Puzzle is a 50-minute video that provides an overview of the Medicare system and a detailed breakdown of its requirements and protocols. The information is presented by Jim Jonson, a volunteer Benefits Counselor at the Alamo Area Agency on Aging for 14 years.
  • Laura Golden and Cheyenne Rhodes of My Health My Resources of Tarrant County: Golden and Ms. Rhodes are part of the clinical care team at the My Health My Resources of Tarrant County that created and successfully implemented a person-centered, dementia-friendly intervention for adults with intellectual and developmental disabilities and dementia.
  • Texas Elder Abuse and Mistreatment Institute for their work on the Forensic Assessment Center Network-Adult Division program: The FACN-Adult Division program uses telehealth to connect geriatric and forensic mistreatment experts with Adult Protective Services and HHSC provider investigation specialists to help them address the safety and well-being of vulnerable adults in Texas.
  • The Texas Tech University Health Sciences Center Garrison Institute on Aging: The Garrison Institute on Aging is a collaborative initiative aiming to advance healthy aging through innovative research, education, and community outreach. The institute also offers RSVP, a Healthy Aging Lecture Series, and the Care Partner Academy, a caregiver support group.

All recipients of the Innovators in Aging award were nominated by their communities. This is the second year of the award program. More information about it is available here. Texas residents can also dial 2-1-1 to learn about programs and services for older adults.

(See schedule provided above.) Texas Health and Human Services is accepting comments from stakeholders on the following draft rules. The comment period ends July 7, 2020.

  • Texas Health and Human Services Commission Title 26, Chapter 558 Licensing Standards for Home and Community Support Services Agencies. Comments can be emailed to HHSC Policy, Rules, and Training.

Questions can be emailed to HHS Rules Coordination Office.
Visit the HHS Rulemaking website for more information.

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 an audit conducted by our team, new educational resources and information about our updated website.

OIG audits El Paso provider’s security controls
The OIG conducted an audit to assess the design and effectiveness of selected security controls over confidential HHS system information stored and processed by the provider as well as its business continuity and disaster recovery planning for selected activities. Read the report.

OIG develops SNAP pamphlets for clients, retailers
The OIG has created new pamphlets in English and Spanish to help clients properly apply for Supplemental Nutrition Assistance Program (SNAP) benefits and advise retailers how to spot potential misuse of SNAP. Read the client pamphletRead the retailer pamphlet.

OIG website has new look
The OIG website (ReportTexasFraud.com) has been updated with a refreshed home page, more prominent links to our exclusions list and fraud reporting forms and other enhancements to improve readability. See how it looks.

The Texas Department of State Health Services (DSHS) is distributing 368 additional cases of the antiviral drug remdesivir to 142 hospitals across the state of Texas. These cases have been provided to DSHS through the U.S. Department of Health and Human Services. This is the fifth round of distribution from the federal government. At 368 cases, enough to treat approximately 1,472 patients, this is the largest distribution so far and brings the total cases distributed to Texas hospitals by DSHS to 977.

Remdesivir has shown promise in early trials in speeding up the recovery time among hospitalized COVID-19 patients. Using a five-day average of hospitalization data, DSHS used county weighting of the number of COVID positive patients in hospitals to determine the number of remdesivir cases per county. Children’s hospitals are eligible this round due to the powder formulation of the medication. Additionally, because use of a limited supply is prioritized towards severely ill patients in facilities with ICUs, hospitals without ICU beds were excluded from the distribution

Medical staff at each hospital will determine how the drug will be used, though it must be prescribed in accordance with the Food and Drug Administration’s Emergency Use Authorization, allowing for the treatment of suspected or confirmed COVID-19 in adults and children hospitalized with severe disease, such as those in intensive care. Preliminary results from a clinical trial showed the average recovery time among patients who received remdesivir was 11 days versus 15 days with a placebo. The supply is part of a donation from drug maker Gilead.