Texas Health and Human Services Digest: November 13, 2020

  • Twitter
  • Facebook
  • Google+
  • Linkedin

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.

November 13, 2020

November 16, 2020

November 17, 2020

November 18, 2020

November 19, 2020

November 20, 2020

November 30, 2020

December 11, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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.

TitleProject No., DescriptionContactComment End Date
Title 1, Chapter 355, Subchapter J, Division 14, Section 355.8261, Federally Qualified Health Center Services Reimbursement#21R008: Federally Qualified Health Center Services ReimbursementHHS Provider Finance Department12/14/20
Title 1, Chapter 355, Subchapter J, Division 11, Section 355.8201, Waiver Payments to Hospitals for Uncompensated Care#21R012: Uncompensated Care Secondary Reconciliation for DYs 6-8HHSC12/7/20
Repeal of Title 25, Chapter 415, Subchapter C, Use and Maintenance of Department of State Health Services/Department of Aging and Disability Services Drug Formulary#19R052: HHSC Psychiatric Drug FormularyHHS Health and Specialty Care11/23/20
Repeal of Title 40, Chapter 5, Subchapter C, Use and Maintenance of Drug Formulary#19R052: HHSC Psychiatric Drug FormularyHHS Health and Specialty Care11/23/20
New Title 26, Chapter 306, Subchapter G, Use and Maintenance of the Health and Human Services Commission Psychiatric Drug Formulary, Sections 306.351 – 306.360#19R052: HHSC Psychiatric Drug FormularyHHS Health and Specialty Care11/23/20
Title 1, Chapter 355, Subchapter B, Establishment and Adjustment of Reimbursement Rates for Medicaid, Section 355.205#21R015: Rate Increase Attestation Process COVID-19HHS Provider Finance Department11/23/20
Repeal of Title 1, Chapter 383, Interstate Compact on Mental Health and Mental Retardation#19R065: Interstate Compact CoordinationHHS Health and Specialty Care11/16/20
New Title 26, Chapter 903, Interstate Compact on Mental Health and Intellectual and Developmental Disabilities#19R065: Interstate Compact CoordinationHHS Health and Specialty Care11/16/20
Title 1, Chapter 354, Subchapter A, Division 1, Section 354.1003, Time Limits for Submitted Claims#20R006: Claims Payment Deadlines ExceptionsHHS Rules Coordination Office11/16/20
Title 25, Chapter 40, Subchapter D, concerning Maintenance and Administration of Asthma Medication#20R019: Asthma MedicationDSHS School Health Program11/16/20
Title 25, Chapter 40, Subchapters B and C, concerning Epinephrine Auto-Injector Policies in Certain Entities and Youth Facilities#20R018: Epinephrine Policies in Certain Entities and Youth FacilitiesDSHS School Health Program11/16/20

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 1, Chapter 351, Section 351.805, State Medicaid Managed Care Advisory Committee#20R108HHS Medicaid/CHIP Services11/5/2011/19/20
Title 1, Chapter 354, Subchapter F, Division 8, Drug Utilization Review Board#21R007John Pepin10/30/2011/13/20
Title 26, Chapter 561, Employee Misconduct Registry (EMR)#19R045HHS Policy, Rules and Training10/30/2011/13/20

Take Action Against Diabetes. The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) is recognizing National Diabetes Month in November. According to the Centers for Disease Control and Prevention (CDC), an estimated 34 million people in the United States have diabetes, and 1 in 5 of them don’t know they have it. Diabetes occurs because of the body’s inability to produce insulin, the hormone that regulates blood sugar levels. If the body doesn’t make enough insulin, sugar can’t get into the cells and blood sugar levels can rise. High blood sugar can lead to health problems including heart disease, kidney disease, stroke, and blindness.

CMS has added a new “Insulin Savings” filter on Medicare Plan Finder to display plans that will offer the capped out-of-pocket costs for insulin. Beneficiaries use the Medicare Plan Finder to view plan options and look for a participating plan in their area that covers their insulin at no more than a $35 monthly copay.

Diabetes is an important issue to CMS OMH because racial and ethnic minorities are at a higher risk of developing diabetes. Many who are diagnosed experience challenges managing their diabetes and are more likely to experience complications. Several factors including lack of access to health care, quality of care received, and socioeconomic status are all barriers to preventing diabetes and having effective diabetes management once diagnosed.

Below are several additional resources that can help health care professionals, patients, and their families manage diabetes:
Consumer Resources

Partner Resources:

To learn more about CMS OMH and to download resources, please visit https://go.cms.gov/omh or contact us at OMH@cms.hhs.gov.

New Section 111 Non-Group Health Plan Alert Available. A new technical alert titled Revisions to Section 111 Edits to no Longer Cause Record to Reject is now available in the Downloads section of the NGHP Alerts page on CMS.gov.

New Section 111 Group Health Plan Alert Available. A new technical alert titled Field Requirement Changes for Prescription Drug Reporting Fields on the MSP and Non-MSP Input File is now available in the Downloads section of the GHP Alerts page on CMS.gov.

Updated Non-Group Health Plan User Guide is Now Available. An updated version of the Non-Group Health Plan (NGHP) User Guide is now available in the Downloads section of the NGHP User Guide page on CMS.gov. Please see chapter 1 for a summary of changes.

Updated Group Health Plan User Guide is Now Available. An updated version of the Group Health Plan (GHP) User Guide is now Available in the Downloads section the GHP User Guide page on CMS.gov.  Please see chapter 1 for a summary of changes.

CMS Data Element Library Updates. The DEL has been updated to include the following:
New and Updated CMS content

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week 1, November 1-November 7, 2020. In week one of the 2021 Open Enrollment period, 818,365 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

As a reminder, New Jersey and Pennsylvania transitioned to their own SBE platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections last year, accounting for 7% percent of all plan selections.  These enrollees’ selections will not appear in our figures until we announce the State-based Marketplace plan selections.

Definitions and details on the data are included in the glossary.
HealthCare.gov Platform Snapshot

HealthCare.gov Platform SnapshotWeek 1: November 1 – 7
Plan Selections818,365
New Consumers173,344
Consumers Renewing Coverage645,021
Consumers on Applications Submitted1,461,189
Call Center Volume510,487
Calls with Spanish Speaking Representative41,514
HealthCare.gov Users3,132,427
CuidadoDeSalud.gov Users105,800
Window Shopping HealthCare.gov Users211,633
Window Shopping CuidadoDeSalud.gov Users10,952

Glossary
Plan Selections: The cumulative metric represents the total number of people who have submitted an application and selected a plan, net of any cancellations from a consumer or cancellations from an insurer that have occurred to date. The weekly metric represents the net change in the number of non-cancelled plan sections over the period covered by the report.

Plan selections will not include those consumers who are automatically re-enrolled into a plan.
To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not report the number of effectuated enrollments.

New Consumers: A consumer is considered to be a new consumer if they did not have 2020 Exchange coverage through December 31, 2020, and had a 2021 plan selection.

Renewing Consumers: A consumer is considered to be a renewing consumer if they have 2020 Exchange coverage through December 31, 2020, and either actively select the same plan or a new plan for 2021.

Exchange: Generally, this report refers to 36 states that use the HealthCare.gov platform for the 2021 benefit year. The states using the HealthCare.gov platform for the individual market Exchange are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

HealthCare.gov States: The 36 states that use the HealthCare.gov platform for the 2021 benefit year, including the Federally-facilitated Exchange and some State-based Exchanges.

Consumers on Applications Submitted: This includes a consumer who is on a completed application submitted to the Exchange using the HealthCare.gov platform. If determined eligible for Exchange coverage, a consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people on a submitted application (rather than the total number of submitted applications).

Enhanced direct enrollment (EDE): The pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This pathway allows CMS to partner with the private sector to provide a user-friendly enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center. Applications and plan selection made through the EDE channel are included in the overall metrics presented above.

Call Center Volume: The total number of calls received by the call center for the 36 states that use the HealthCare.gov platform for the 2021 benefit year over the time period covered by the snapshot. Calls with Spanish speaking representatives are not included.

Calls with Spanish Speaking Representative: The total number of calls received by the call center for the 36 states that use the HealthCare.gov platform for the 2021 benefit year over the time period covered by the snapshot where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.

New Resources are Now Available on the QPP Resource Library. The Centers for Medicare & Medicaid Services (CMS) has posted many new Quality Payment Program (QPP) resources to the QPP Resource Library:

2020 Merit-based Incentive Payment System (MIPS) User Guides: These guides provide details on a variety of topics to help clinicians understand the MIPS 2020 performance period requirements. The guides cover the following:

2020 MIPS Measure Specialty Guides: These guides provide a detailed sample of measures and activities for the 2020 MIPS performance categories relevant to various eligible specialists. Each guide explains how measures and activities are applicable to the individual specialty, includes the weight of each performance category for the MIPS Final Score, and provides information about submitting data.

All guides posted in 2019 have been updated for the 2020 performance period. Additionally, CMS has finalized the following new guides:

The guides can be found in the QPP Resource Library by using the drop down menu “Resource Type” and sorting by “Specialty Guides.”

2020 CMS Web Interface Quick Start Guide: This guide shares information to help stakeholders understand and report their data via the CMS Web Interface.

2020 Quality Measures List with Telehealth Guidance: This resource provides a list of quality measures that currently include telehealth for the 2020 performance period.

2020 CAHPS for MIPS Approved Survey Vendors: This resource contains the list and contact information of survey vendors who are approved to administer the CAHPS for MIPS Survey for 2020.

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, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. Eastern Time (ET).

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

Reminder: 2021 Virtual Group Election Period for MIPS Closes on 12/31. To form a virtual group for the 2021 Merit-based Incentive Payment System (MIPS) performance year, an election must be submitted to CMS via e-mail by December 31, 2020 (11:59 p.m. Eastern Time).

NOTE: A virtual group must submit an election to CMS for each performance year that it intends to participate in MIPS as a virtual group (as required by statute). If your virtual group was approved for the 2020 MIPS performance year and intends to participate in MIPS as a virtual group for the 2021 MIPS performance year, your virtual group is still required to submit an election to CMS for the 2021 MIPS performance year between October 1, 2020 and December 31, 2020 (11:59 p.m. Eastern Time).

What Is a Virtual Group?
A virtual group is a combination of 2 or more Taxpayer Identification Numbers (TINs) consisting of the following:

  • Solo practitioners who are MIPS eligible (a solo practitioner is defined as the only clinician in a practice); and/or
  • Groups that have 10 or fewer clinicians (at least one clinician within the group must be MIPS eligible). A group is considered to be an entire single TIN.

A virtual group has the flexibility to determine its own makeup.  A solo practitioner or group can only participate in one virtual group during the performance year.

What Are the Advantages of Participating in a Virtual Group?
Participating in MIPS as a virtual group has the following advantages:

  • Can increase performance volume in order to be reliably measured; and
  • Provides an opportunity for members of a virtual group to collaborate, share resources, and potentially increase performance under MIPS.

What Is the Virtual Group Election Process?
The following highlights key items that a virtual group needs to complete prior to the submission of an election:

  • Establish a formal written agreement between each TIN within the virtual group (see Agreement Sample Template in the Virtual Group Election Process Guide within the 2021 Virtual Group Toolkit).
  • Identify an official virtual group representative.

The following outlines the elements that need to be included in an election:

  • Acknowledgement that a formal written agreement has been established between each TIN within the virtual group.
  • The name and contact information for the official virtual group representative.
  • The name and TIN for each practice, and all associated National Provider Identifiers (NPIs) under each TIN.

Once complete, the virtual group must submit the election via e-mail to CMS at MIPS_VirtualGroups@cms.hhs.gov by 11:59 p.m. Eastern Time on December 31, 2020 (see Election E-mail Sample in the Virtual Group Election Process Guide within the 2021 Virtual Group Toolkit).

For further information regarding virtual group participation in MIPS, virtual group reporting requirements, the election process, checklists for virtual groups to consider, and sample templates, download the 2021 Virtual Group Toolkit.
Need Help?

  • 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 a.m. and after 2 p.m. Eastern Time.
    • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
  • Connect with your local technical assistance organization. We provide no-cost technical assistance to small, underserved, and rural practices to help you successfully participate in the Quality Payment Program.

Cardiac arrest treatment that uses life support machine boosts survival. Using a life support machine to replicate the functions of the heart and lungs significantly improved the survival of people who suffered from out-of-hospital cardiac arrest, according to a new study published today in The Lancet(link is external). The treatment program involving the life support machine called extracorporeal membrane oxygenation (ECMO) proved so much more effective than the standard treatment for this usually fatal condition that the trial was stopped early after enrolling just 30 of the expected 165 patients.

The study, known as the Advanced Reperfusion Strategies for Refractory Cardiac Arrest (ARREST) trial, was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. It found that using ECMO as part of a broader program of care for cardiac arrest resulted in the survival of six of 14 patients compared with just one of 15 patients receiving standard treatment. Standard care for cardiac arrest typically includes cardiopulmonary resuscitation (CPR), defibrillation, intubation, and intravenous medications.

Approximately 340,000 people die of cardiac arrest each year in the United States. The condition occurs when the heart suddenly stops beating. There is no blood flow to the body, including the heart and brain. Immediate emergency treatment is essential to prevent death, but standard treatments are only marginally effective. Less than 10% of people who suffer a cardiac arrest survive. Some cardiac arrest patients do not respond to any standard cardiac arrest treatments. The ARREST investigators, led by Demetris Yannopoulos, M.D., a cardiologist and professor of medicine at the Center for Resuscitation Medicine at the University of Minnesota Medical School in Minneapolis, hypothesized that this was because these patients had severe and extensive blockages in the arteries to their heart. To find out what approach might help cardiac arrest patients, the ARREST trial compared standard treatment with treatment with ECMO as soon as possible in 30 people who suffered a cardiac arrest. The average age was 61, and 25 of the 30 patients were men.

The ECMO machine connects to a patient by tubes inserted in an artery and vein in the groin. The machine pulls blood out of the patient’s body, pumps it through a part of the machine that acts as an artificial lung, and then returns it back to the body. This gives doctors time to stabilize the patient and, if suitable, clear any blockages in the arteries of the heart.

Six of the 14 people in ARREST who received ECMO (one of the ECMO patients declined to be included in the study) survived to hospital discharge compared with only one of the 15 who received standard treatment. At three and six months after hospital discharge, all six people who received ECMO were alive and well compared with none of the patients who received standard treatment. The investigators noted that the substantial improvement in survival among those treated with ECMO was due to the full team-based program of care implemented around it, not ECMO alone. That team program included protocols for emergency medical services to identify patients who might benefit most from it, rapid transport to a hospital, rapid communication with an ECMO center to mobilize experienced operators who do a high volume of ECMO procedures, and protocols for care after the patient is resuscitated. ECMO was only one part of this treatment plan.

Read the full release.

HHSC Showcases Construction Progress at Rusk State Hospital. Construction crews are busy at work on a nearly $200 million project to build a modern 227,000 square-foot patient complex and replace the administration building at Rusk State Hospital, the Texas Health and Human Services Commission announced today.

Crews recently placed the last beam atop the administration building and are on track to complete 50 percent of the building by February 2021. The construction team has also completed demolition work at the site of the new patient complex and have begun laying plumbing and installing electrical infrastructure.

The patient complex will include a 100-bed maximum-security unit and a 100-bed non-maximum-security unit. This project will also include the construction of a new administration building.

This project is part of a $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. Combined, the construction projects at the hospitals will add at least 350 new inpatient psychiatric beds in Texas within the next four years.

The three-story, 227,368 square-foot patient complex features single-person rooms, the use of natural light throughout patient rooms and common areas, and outdoor spaces to promote recovery and healing. The first floor will have social interaction spaces such as a movie theater, salon, café, library, gym and a music therapy room. The second and third floors will hold the patient units, an exercise room, group therapy rooms and classrooms. Outside, there will be secure courtyards and walking trails, as well as basketball and volleyball courts. The new two-story administration building is 18,900 square feet and will accommodate the administration department and IT staff.

The patient building is expected to open in February 2023, and the administration building is scheduled to open in November 2021. For more information about state hospital construction projects throughout the state, visit the Changes to the State Hospital System page on the HHS website.

Visuals
New video and images are available, including produced video of the project, downloadable B-roll and pictures of the ongoing construction, and video sound bites from Terina McIntyre, HHSC director of State Hospital Operations.
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.

About Rusk State Hospital
Rusk State Hospital provides competency restoration services for individuals on forensic commitments who have been determined incompetent to stand trial or found not guilty by reason of insanity, as well as inpatient psychiatric services to individuals with mental illness who are at risk of harming themselves or others and may require longer-term inpatient treatment. The hospital serves approximately 580 patients each year. Rusk is among 10 state hospitals that HHSC operates for people with mental illness.

OIG Update. Thank you for subscribing to OIG Updates – a monthly newsletter from the Texas Health and Human Services Office of Inspector (OIG). The OIG promotes the health and safety of Texans by protecting the integrity of state health and human services delivery. We are pleased to provide you with an update about the OIG’s work to fight fraud, waste and abuse. Within this email, you’ll find hyperlinks to recent agency news.

Defendant sentenced in SNAP fraud case. Sentencing continues in a benefits trafficking case that produced criminal charges against 62 defendants. Read how the OIG’s EBT Trafficking Unit partnered with local law enforcement on the investigation.

OIG releases Fraud Hotline results. The OIG Fraud Hotline answered 7,827 calls during the fourth quarter of fiscal year 2020, with an average wait time of 44 seconds. Learn more about the types of calls the hotline received.

OIG audits pharmacy benefit manager. OIG auditors recommended improvements to ensure the pharmacy benefit manager complies with contract requirements. Click here to read the full report.

HHSC Requests Comments on Draft DBMD Waiver Amendment 7. The Texas Health and Human Services Commission is accepting comments on the draft of the Deaf Blind with Multiple Disabilities Program Services Waiver Amendment 7. The changes to the amendment can be found on Page 2 of the draft of DBMD Waiver Amendment 7 (PDF). Comments will be accepted until November 22, 2020. Email your comments to dbmdpolicy@hhsc.state.tx.us.

Comments on Proposed Rule Due 12/14 on Federally Qualified Health Center Services Reimbursement. Texas Health and Human Services Commission is accepting comments from stakeholders on the following proposed rule, which is now posted in the Texas Register. The comment period ends December 14, 2020.

  • Texas Health and Human Services Title 1, Chapter 355, Subchapter J, Division 14, Section 355.8261, Federally Qualified Health Center Services Reimbursement. Comments can be emailed to HHS Provider Finance Department.

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

Read more.

The following new report has been posted on the Reports and Presentations page:

November 2020

To see a list of all reports and presentations go to the Reports and Presentations page.

The following dashboards have been added to our website:

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