Texas Health and Human Services Digest: November 2, 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 2, 2020

November 3, 2020

November 4, 2020

November 5, 2020

November 6, 2020

November 10, 2020

November 12, 2020

November 13, 2020

November 16, 2020

November 17, 2020

November 18, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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
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 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
Title 26, Chapter 749, Minimum Standards for Child-Placing Agencies, concerning Legislative changes#20R101HHS Child Care Regulation10/19/2011/2/20

H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020.

The bill would

  • Create an additional Medicare benefit option, coverage of the cost of immunosuppressive drugs, for kidney transplant patients who have no other health insurance or drug coverage
  • Charge beneficiaries a premium for the new drug-only benefit

Estimated budgetary effects would primarily stem from

  • Premiums paid by beneficiaries who enroll in the new drug-only coverage
  • New spending for prescription drugs for beneficiaries who enroll
  • Reduced spending on other Medicare services

Areas of significant uncertainty include

  • The number of beneficiaries who would enroll in the new benefit

Bill Summary. H.R. 5334 would create a new, limited benefit under Medicare that would cover a portion of the cost of immunosuppressive drugs for people who have had a kidney transplant but whose post-transplant coverage under Medicare has ended. To be eligible, a beneficiary would need to have no other source of health insurance or drug coverage. Enrollees would pay a premium for the coverage.

Estimated Federal Cost. The costs of the legislation fall within budget function 570 (Medicare).

Read the full release.

The following Limited Data Set (LDS) files are now available:

  • 2020 2nd Quarter Master Beneficiary Summary File (MBSF)
  • 2020 2nd Quarter Carrier
  • 2020 2nd Quarter Durable Medical Equipment (DME)
  • 2020 2nd Quarter Home Health
  • 2020 2nd Quarter Hospice
  • 2020 2nd Quarter Inpatient
  • 2020 2nd Quarter Outpatient
  • 2020 2nd Quarter Skilled Nursing Facility (SNF)

To request these files, please see the instructions on the CMS Data Use Agreement (DUA) website.

For more information about CMS LDS files, please see the LDS File Listing website.

Reminder: Upcoming MIPS Important Dates and Deadlines. The Centers for Medicare & Medicaid Services (CMS) would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:

  • December 31 – 2020 Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Exception Applications Clinicians, groups, and virtual groups who believe they are eligible for these exceptions may apply, and if approved, will qualify for a re-weighting of one or more MIPS performance categories. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will also be added to the QPP Participation Status Tool but may not appear in the tool until the submission window opens in 2021.
    • Note: CMS has proposed for the 2020 performance year to allow Alternative Payment Model (APM) Entities to submit Extreme and Uncontrollable Circumstances applications as a result of COVID-19. For more information about the impact of COVID-19 on Quality Payment Program participation, see the Quality Payment Program COVID-19 Response webpage.
  • December 31 – 2021 virtual group election period closes. Solo practitioners and groups with 10 or fewer clinicians (including at least one MIPS eligible clinician) who want to participate in MIPS as a virtual group for the 2021 performance year must submit their election to CMS.
  • January 4, 2021 – 2020 MIPS performance year data submission window opens.
  • March 1, 2021 – Deadline for CMS to receive 2020 claims for the Quality performance category. Claims must be received by CMS within 60 days of the end of the performance period. Deadline dates vary to submit claims to the MACs . Check with the MACs for more specific instructions.
  • March 31, 2021 – 2020 MIPS performance year data submission window closes.

For More Information
To learn more, visit the QPP website and access the following resources:

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.

CMS Releases Toolkit to Accelerate State Efforts to Rebalance Long-term Care Systems and Enhance Home and Community-Based Services for Eligible Medicaid Beneficiaries. The Trump Administration and Centers for Medicare & Medicaid Services (CMS) are delivering on their commitment to foster innovation in Medicaid by providing states with new tools to help beneficiaries return home from institutional settings without sacrificing safety or quality of care. CMS launched a new toolkit designed for state Medicaid agencies to strengthen their infrastructure and develop robust home and community-based services (HCBS) for eligible beneficiaries. This toolkit is the latest in a series of CMS efforts to promote high quality, person-centered HCBS to safely transition older adults and individuals with disabilities back to their homes and communities, and decrease reliance on nursing home care.

The toolkit provides states with examples of innovative state models and best practices to rebalance their long-term services and supports (LTSS) programs to expand the use of HCBS over institutional services. LTSS enables millions of Americans, including children, individuals with disabilities, and older adults, to have their care needs met in a variety of settings, which are often more cost-effective than traditional institutional settings. As the primary funder of LTSS nationally, Medicaid plays an important role in supporting state efforts to achieve a more equitable balance between the share of spending and use of services and supports delivered in individuals’ homes and communities as compared to institutional care.

States continue to be at the forefront of innovation in designing new models for the delivery and financing of LTSS. CMS supports state efforts to help older adults and people with disabilities to access care and services at home and in other community settings, so they may live their lives with as much dignity and independence as possible. CMS is committed to helping states to strengthen and enhance their LTSS systems, and ensure that Medicaid beneficiaries receive high quality, cost-effective, person-centered services in the setting of their choice.

For further information, visit: https://www.medicaid.gov/medicaid/long-term-services-supports/downloads/ltss-rebalancing-toolkit.pdf

To view the fact sheet on Long-term Services and Supports (LTSS) Rebalancing Toolkit, visit: https://www.cms.gov/newsroom/fact-sheets/long-term-services-and-supports-ltss-rebalancing-toolkit-fact-sheet

CMS Provides Transparency on Cost and Quality in State Medicaid and CHIP Programs – 2020 Scorecard continues to build upon a new era of accountability in Medicaid and Children’s Health Insurance Program. The Centers for Medicare & Medicaid Services (CMS) released the third annual update to its Medicaid and Children’s Health Insurance Program (CHIP) Scorecard. The Scorecard is the signature Medicaid accountability initiative that highlights state and federal performance on the administration and health outcomes of the Medicaid and CHIP programs that collectively account for approximately $600 billion in annual spending and serve over 74 million Americans. For the first time, the Scorecard now provides identified per capita spending data across all states, highlighting variation in program costs alongside the quality and performance data. First released in 2018, the Medicaid and CHIP (MAC) Scorecard is a key part of President Trump’s efforts to ensure greater transparency and accountability of the nation’s largest health coverage programs.

This year’s release builds on the success of the previous Scorecards with a variety of updates and improvements for users, including the debut of a new way to view state-specific data on the Medicaid.gov State Profile “Quality of Care” section.  CMS has also improved the overall design and navigation across the 2020 MAC Scorecard to enhance the user experience.

The Scorecard includes healthcare quality measures of asthma medication management for children and adults as well as a measure of follow-up care for adults after an emergency department visit for mental illness. It also contains new administrative accountability measures including CMS and state approval times for managed care contract reviews; and CMS approval times for enhanced federal funding to support states’ eligibility, enrollment and information technology systems.

The 2020 Scorecard provides per capita expenditure data across all states. For the 2018 T-MSIS based per capita expenditure data, seventeen states had a high level of data usability, and an additional eleven states showed a moderate level of data usability.  The remaining states fell into the category of having a low level of data usability. The median per capita expenditures, based on CMS calculations, for all states in 2018 is $8,126, with a range of $1,807 in Puerto Rico to $14,387 in North Dakota.[1]

This year, new data were added to the MAC Scorecard’s National Context page.  For example, these new data show the percentage of each state’s population that is enrolled in Medicaid, which ranges from 9.0% to 36.3 % and that nationally, about half of those enrolled in Medicaid and CHIP are children. The National Context page also has new data on the national percentage of beneficiaries enrolled in Medicaid and CHIP by eligibility group and the national rate of improper payments in Medicaid and CHIP.

Further, the national context now provides information on the percentage of Medicaid beneficiaries currently enrolled in Medicare (i.e., dually eligible beneficiaries); the percentage of dually eligible beneficiaries in programs that integrate the delivery of Medicare and Medicaid benefits; and the approval status for states’ transition plans for home and community-based services. For example, nearly half of all states (23) have a Medicaid population where 11.8%-24.2% are dually eligible beneficiaries and 36 states now enroll dually eligible beneficiaries in integrated care programs. The addition of these new data in the Scorecard help to further underscore the importance of understanding the dually-eligible population’s role in the Medicaid program.

Read the full release.

To view the 2020 MAC Scorecard, please visit: https://www.medicaid.gov/state-overviews/scorecard/index.html

For more information pertaining to the 2020 MAC Scorecard, please visit:

Governor Abbott Appoints Four to Rehabilitation Council of Texas. Governor Greg Abbott has appointed Emily Robinson and reappointed Erin “Amanda” Bowdoin, Lindsey Geeslin, and Rodrick D. Robinson to the Rehabilitation Council of Texas for terms set to expire on October 29, 2023. The council partners with the Texas Workforce Commission to advocate for people with disabilities in the vocational rehabilitation process.

Emily Robinson of Pflugerville is an Educational Program Specialist at the Texas Education Agency. She is a member of Texas Association of the Deaf. Robinson received a Bachelor of Arts in Communications Sciences and Disorders and a Master of Science in Education of the Deaf and Hard of Hearing from Texas Woman’s University.

Erin “Amanda” Bowdoin of Forney is a certified teacher of the visually impaired and a braillist for Mesquite ISD. She is a member of the Association of Texas Professional Educators and of the Council for Exceptional Children. Bowdoin received a Bachelor of Arts in Elementary Education from Texas A&M University-Commerce and a Master of Education in Special Education specializing in visual impairment from Stephen F. Austin University.

Lindsey Geeslin of Waco is Sales Manager for Lhoist North America. She is a member of the Texas Workforce Investment Council, the Texas Masonry Council, and volunteers her time to the Waco Community through the Heart O’ Texas Fair and Rodeo & Extraco Events Center. Geeslin received a Bachelor of Science in Agriculture Business and Management from Texas State University.

Rodrick D. Robinson of McKinney is founder and CEO of New Life Medical Equipment. He is a member of the Baylor Scott & White McKinney Medical Center Board of Trustees, the McKinney Airport Advisory Committee, and the McKinney Comprehensive Plan Committee. Additionally, he is an ordained Deacon at First McKinney Baptist Church and student mentor for McKinney ISD. Robinson received a Bachelor of Business Administration in Entrepreneurship and Strategic Management from the University of North Texas in Denton.

LTC Provider Bulletin Now Available. The November 2020 Long-Term Care (LTC) Provider Bulletin has been published on the LTC homepage on TMHP.com.

Visit the TMHP LTC homepage regularly for news, reminders, training opportunities, and other important program updates.

For questions, see the Provider Resources section of the bulletin.

Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Review – 11/13/2020. Due to the declared state of disaster stemming from COVID-19, the rate hearing scheduled for Friday, November 13, 2020 will be conducted online only.

Please register for the HHSC Public Rate Hearing for Medicaid Calendar Fee Review, HCPCS Updates, and Medical Policy Updates to be held on November 13, 2020 9:00 AM CST. After registering, you will receive a confirmation email containing information about joining the webinar.

The rate hearing packets for the public rate hearing scheduled for Friday, November 13, 2020, at 9:00 a.m. were posted on the Health and Human Services Commission (HHSC) Provider Finance Website on October 30, 2020 with the proposed effective dates of January 1, 2020 and March 1, 2021.

The hearing will be for the purpose of receiving public testimony on the following proposed Medicaid Rates:
Proposed to be Effective January 1, 2020
Biennial Calendar Fee Review:

  1. Indian Health Services

Proposed to be Effective March 1, 2021:
Biennial Calendar Fee Review:

  1. Anesthesia
  2. Ambulatory Surgical Center (ASC)/Hospital Based ASC
  3. Birthing Centers
  4. Clinical Laboratories
  5. Clinical Laboratories Gapfill
  6. G Codes
  7. General and Integumentary System Surgery
  8. Nervous System Surgery
  9. Orthotic Procedures and Devices
  10. PAD Non-Oncology
  11. PAD Oncology
  12. PAD Vaccines
  13. NDCX List

Colorectal Cancer Screening Medical Policy Review

  1. Colorectal Cancer Screening

Digital Breast Tomography Medical Policy Review

  1. Digital Breast Tomography
  2. Digital Breast Tomography (Hospitals)

Stereotactic Radiosurgery Medical Policy Review

  1. Stereotactic Radiosurgery

Wound Care Medical Policy Review

  1. Wound Care Applications
  2. Wound Care Ambulatory Surgical Center – Hospital Based ASC
  3. Wound Care Q Codes

Telemonitoring Medical Policy Review

  1. Telemonitoring

Nutritional (Enteral) Products, Supplies, and Equipment – Home Health & CCP: Immobilized Lipase Cartridge Medical Policy Review

  1. Nutritional (Enteral) Products, Supplies, and Equipment – Home Health & CCP: Immobilized Lipase Cartridge

Quarterly Healthcare Common Procedure Coding System Updates

  3. TOS 1 HCPCS
  4. TOS 2 HCPCS
  5. TOS 4 HCPCS
  6. TOS 4 HCPCS Hospital and Rural Outpatient Imaging

The notice for the rate hearing was published in the October 23, 2020, issue of the Texas Register, and is currently available on the HHSC website. As indicated in the notice and the rate hearing packets, written comments regarding the proposed payment rates may be submitted instead of, or in addition to, oral testimony until 5 p.m. the day of the hearing. Written comments may be sent by U.S. mail, overnight mail, special delivery mail, fax or email, as follows:

U.S. Mail:
Texas Health and Human Services Commission
Attention: Provider Finance, Mail Code H-400
P.O. Box 149030
Austin, Texas 78714-9030

Overnight mail or special delivery mail:
Texas Health and Human Services Commission
Attention: Provider Finance, Mail Code H-400
Brown-Heatly Building
4900 North Lamar Boulevard
Austin, Texas 78751

Phone number for package delivery: 512-730-7401
Fax: Attention: Provider Finance at 512-730-7475

Persons with disabilities who wish to attend the hearing and require auxiliary aids or services should contact Provider Finance at (512) 730-7401 at least 72 hours before the hearing so appropriate arrangements can be made.

Preferred Communication. During the current state of disaster due to COVID-19, physical forms of communication are checked with less frequency than during normal business operations. For quickest response, and to help curb the possible transmission of infection, please turn to e-mail or phone if possible for communication with HHSC related to this rate hearing.

Please forward this information to providers and organizations in your programs as appropriate.

Diabetes news you can use: November is National Diabetes Awareness Month and November 14 is World Diabetes Day! It is a month to consider personal care plans that help manage blood glucose levels, encourage healthy eating habits, support mental health and prepare for emergencies. View free resources, tips, and toolkits.

Tools and Resources

Diabetes Friendly Recipes

How to shop smart for health coverage. When looking for health insurance, know your needs; ask questions; compare plans; and avoid scams. Watch video