Texas Health and Human Services Digest: November 30, 2020

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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 30, 2020

December 1, 2020

December 2, 2020

December 3, 2020

December 4, 2020

December 7, 2020

December 8, 2020

December 9, 2020

December 10, 2020

December 11, 2020

December 14, 2020

December 15, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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 393, Informal Dispute Resolution and Informal Reconsideration#20R093: Informal Dispute ResolutionAllison Levee12/28/20
Title 26, Chapter 746, Minimum Standards for Child-Care Centers#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 26, Chapter 747, Minimum Standards for Child-Care Homes#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
Title 25, Section 133.48, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 25, Section 135.26, Reporting Requirements, and Section 135.27, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 26, Section 510.47, Patient Safety Program repeal#20R010: Medical Error ReportingHHS Policy, Rules and Training12/21/20
Title 26, Chapter 742, Minimum Standards for Listed Family Homes#20R021: Listed Family HomesHHS Child Care Regulation12/21/20
Title 26, Chapter 744, Minimum Standards for School Age and Before or After School Programs#20R024: Physical Activity, Nutrition, and Screen Time for Licensed Day Care and Registered HomesHHS Child Care Regulation12/21/20
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

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.

There are currently no draft rules available for comment.

December 2020 CMS Preclusion List Published. The monthly CMS Preclusion List has been published. Feel free to contact PreclusionList@cms.hhs.gov if you have any questions or concerns.
Thank you,

CMS Preclusion List Team

New Alert. An Alert titled 2021 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards or Other Payments has been added to the Downloads section of the Non-Group Health Plan Recovery page on CMS.gov.

Applicability of Reporting Requirements for Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, and Skilled Nursing Facilities Affected by the Hurricane Laura. The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to home health agencies, hospices, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities located in areas affected by Hurricane Laura due to the devastating impact of the storm.

For further information about these exceptions, please check the downloads section on the program-specific web pages:

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week Three
November 15 – November 21, 2020
In Week Three of the 2021 Open Enrollment period, 758,421 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 State-based Exchange platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections or 7% of all plan selections during the 2020 Open Enrollment Period. These enrollees’ selections will not appear in our figures until we announce the State-based Exchange plan selections.

Definitions and details on the data are included in the glossary.

HealthCare.gov Platform Snapshot

HealthCare.gov Platform SnapshotWeek 3: Nov. 15-21Cumulative:  Nov. 1-21
Plan Selections758,421 2,380,527
New Consumers177,644 521,272
Consumers Renewing Coverage580,777 1,859,255
Consumers on Applications Submitted1,044,1423,722,817
Call Center Volume484,8041,543,340
Calls with Spanish Speaking Representative34,886117,312
HealthCare.gov Users2,842,7768,195,718
CuidadoDeSalud.gov Users95,535273,766
Window Shopping HealthCare.gov Users164,808521,961
Window Shopping CuidadoDeSalud.gov Users9,71922,670

HealthCare.gov State-by-State Snapshot 
The state-by-state Snapshot provides cumulative individual market plan selections for the 36 states with Exchanges using the HealthCare.gov platform for the 2021 benefit year. Cumulative individual plan selections for the states using the HealthCare.gov platform include:

 StateCumulative Plan Selections November 1-21

Read the release.

CMS Finalizes Policy that will Increase the Number of Available Lifesavings Organs by Holding Organ Procurement Organizations Accountable through Transparency and Competition. The Centers for Medicare & Medicaid Services (CMS) is finalizing a rule that is designed to increase the supply of lifesaving organs available for transplant in the United States by requiring that the organizations responsible for organ procurement be transparent in their performance, highlighting the best and worst performers, and requiring them to compete on their ability to successfully facilitate transplants.

The rule enacts sweeping reform of the Medicare Conditions for Coverage (CfCs) for Organ Procurement Organizations (OPOs). OPOs, which are entities that seek organs for the 113,000 Americans on waitlists, must meet minimum quality measure thresholds in the CfCs to receive Medicare and Medicaid payment. The current measures are based on self-reported data and disincentivize OPOs from aggressively seeking any and all available organs. The rule creates new measures designed to hold OPOs accountable for seeking – and ensuring transplant of – as many organs as possible, and the calculation of the measures is based on objective data. The rule is designed to increase the number of organs available for transplant, helping tackle one of the longstanding problems in the organ transplant system, namely that the need for organs greatly exceeds the supply. Indeed, as the capstone of President Trump’s July 2019 Executive Order on Advancing American Kidney Health, the rule is the last of a long list of Trump Administration actions designed to increase the supply of donated organs for Americans on waitlists for lifesaving transplants.

Read the release.


For a fact sheet on the final rule (CMS-3380-F), please visit: https://www.cms.gov/newsroom/fact-sheets/organ-procurement-organization-opo-conditions-coverage-final-rule-revisions-outcome-measures-opos

To view the final rule (CMS-3380-F), please visit: https://www.cms.gov/files/document/112020-opo-final-rule-cms-3380-f.pdf

Interoperability and Patient Access Final Rule Call — December 9, 2020
Wednesday, December 9, 2020 from 1:30 to 3:00 pm ET

On May 1, CMS released the Interoperability and Patient Access final rule, listing ways to give patients better access to their health information. Using data exchange through secure Application Programming Interfaces (APIs), we took a first step in making health information more available to patients and moving toward greater interoperability across the health care system. This approach to data exchange will allow patients to make informed decisions and reduce burden on payers and providers.
During this call, we’ll answer your questions about implementing these policies:

  • Public reporting and information blocking – targeting late 2020/early 2021
  • Provider digital contact information in the National Plan and Provider Enumeration System – targeting March, 2021
  • Revisions to the Conditions of Participation (CoPs) of for hospitals and critical access hospitals – effective April 30, 2021
  • Patient Access API – enforced after July 1, 2021
  • Provider Directory API – enforced after July 1, 2021
  • Payer-to-payer data exchange – effective January 1, 2022
  • Improving the dual eligible experience – effective April 1, 2022

Visit the Interoperability webpage for more information about the final rule and to find resources.

Target Audience: All Medicare Fee-for-Service providers, payers, and industry-wide stakeholders.

CMS Updates



Claims, Pricers & Codes


MLN Matters® Articles


ICD-10 MS-DRGs Version 38.1 Effective January 1, 2021. In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective January 1, 2021.  In addition, the Centers for Medicare & Medicaid Services (CMS) is implementing 21 new procedure codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), also effective January 01, 2021.

The ICD-10 MS-DRG V38.1 Grouper Software, Definitions Manual Table of Contents, and the Definitions of Medicare Code Edits V38.1 manual to accommodate these new diagnosis and procedure codes, effective for discharges on or after January 01, 2021 will be available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.html

The Index and Tabular Addenda for the new diagnosis codes will be made available via the CDC website at: https://www.cdc.gov/nchs/icd/icd10cm.htm

NIH announces restructured HIV clinical trials networks. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, today announced the clinical investigators and institutions that will lead four NIH HIV clinical trials networks over the next seven years to conduct the innovative, efficient clinical research needed to accelerate progress against the HIV pandemic. NIAID also awarded grants to 35 U.S. and international institutions selected as HIV clinical trials units (CTUs). NIAID and co-funding NIH Institutes intend to provide approximately $375.3 million in the first year to support the networks.

The process of refining the NIH HIV clinical trials networks began in 2017 and involved extensive consultations with researchers, clinicians, advocates, people with or at risk of HIV, and other stakeholders. The new, streamlined network structure will reduce administrative and oversight costs, allowing more funds to be allocated to clinical trials to advance four key areas of research emphasis: HIV prevention; HIV vaccines; HIV/AIDS adult therapeutics; and HIV/AIDS maternal, adolescent and pediatric therapeutics. The networks also have the flexibility to leverage their infrastructure to rapidly respond to emerging infectious diseases, such as coronavirus disease 2019 (COVID-19).

The new structure includes one network that will focus on development of a safe, effective and durable preventive HIV vaccine, and one that will work to advance an array of non-vaccine HIV prevention products and strategies to meet the needs and preferences of diverse populations worldwide. Two therapeutics networks will develop and evaluate potential new treatments and cure strategies for HIV and HIV-related complications and co-infections. One of these networks will focus on adults, while the other will focus on infants, children, adolescents, and pregnant and postpartum women. HIV prevention and vaccine research for the maternal, pediatric and adolescent populations will be led by the HIV prevention and vaccine networks, with assistance from the therapeutics network focused on these populations.

The four networks will direct, coordinate and conduct NIH-funded clinical research worldwide in close collaboration with one another, NIAID, other partner NIH Institutes and Centers, industry and non-governmental research organizations. Each network is led by a leadership and operations center (LOC) and includes a laboratory center (LC) and a statistical and data management center (SDMC).

Read the full release.

Digital Breast Tomosynthesis Policy Comments and Responses Posted. Stakeholder comments and HHSC responses have been posted for the Telemonitoring Services draft policy:

The documents are posted on the Medicaid Medical and Dental Policy page.
Email MCDmedicalbenefitspolicycomment@hhsc.state.tx.us with questions.

HHSC Publishes Administrative Penalty Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program Providers (PL 20-55). HHSC Long-term Care Regulation has published PL 20-55 – Administrative Penalty Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program Providers (PDF). The PL provides guidance to providers on the rules regarding administrative penalties.

The following new reports have 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.

HCS and TxHmL CARE Service Authorization instructions for EVV. HCS and TxHmL are required to manually enter each individual’s service authorization in the EVV Vendor System.

Providers can find instructions here on how to find their service authorizations in CARE.

If additional assistance is needed after the service authorization is obtained, program providers can contact their EVV vendor for further instructions.

1115 TRANSFORMATION WAIVER UPDATE. The Health and Human Services Commission (HHSC) announces its intent to submit a “Fast Track” extension application to the Centers for Medicare & Medicaid Services (CMS) for the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver under section 1115 of the Social Security Act. The extension request is for 5 years, which will provide the 1115 waiver authority through September 30, 2027.

The requested extension will allow Texas continued flexibility to pursue the goals of the existing 1115 waiver:

  • expand risk-based managed care to new populations and services;
  • support the development and maintenance of a coordinated care delivery system;
  • improve outcomes while containing cost growth; and
  • transition to quality-based payment systems across managed care and providers.

The extension will also create financial stability for Texas Medicaid providers, as HHSC works to transition the valuable work identified through Delivery System Reform Incentive Payment (DSRIP) innovations. The extension better aligns the DSRIP transition timeline with the overall goals to create a sustainable program. There are no significant policy changes requested under this extension application.

Under the “Fast Track” extension, CMS seeks to align the review process with timelines typically used for decisions on requests like a State Plan Amendment, or 90 days.

Public Health Emergency. Responding to the public health emergency has put pressure on the state’s health care system.  Therefore, this application also requests that the Secretary exercise his authority under 42 CFR § 431.416(g) to waive certain notice procedures in order to expedite a decision. Approval of this “Fast Track” extension will sustain the achievements of the demonstration and support the needs of beneficiaries and Texans.

Visit here for more detailed information about the extension application.

1115 Waiver – Public Hearing
December 7, 2020 at 2:00 PM CST by registering at the link below:
Members of the public throughout the State have an opportunity to provide comments via this webinar.
Register here to attend this webinar.

HHSC Executive Council Meeting for Public Comment
December 8, 2020, at 2:00PM CST
Register here to provide public comment.
Click here to attend the meeting.

Written Comments
Written comments will be accepted until December 27, 2020 and can be emailed to Texas Medicaid Waivers.

December HCS Provider Certification Principle Webinars. These webinars are part of our WSC certification principles training series.

Quality Assurance
Learn more about certification principle 9.178 and quality assurance for HCS providers.
Dec. 3 2020, 1 p.m.
Register for the webinar.
Rights of Individuals
This webinar will cover TAC 9.173, Rights of Individuals.
Dec. 10, 2020, 2 p.m.
Register for the webinar.
Abuse, Neglect and Exploitation
Learn more about provider requirements regarding abuse, neglect and exploitation.
Dec. 15, 2020, 2 p.m.
Register for the webinar.
Service Delivery
This webinar will cover TAC 9.174, Service Delivery for HCS providers.
Dec. 17, 2020, 10 a.m.
Register for the webinar.

Comments on Proposed Rules Due 12/28 on Informal Dispute Resolution
Texas Health and Human Services Commission is accepting comments from stakeholders on the following proposed rules, which are now posted in the Texas Register. The comment period ends December 28, 2020.

  • Texas Health and Human Services Title 1, Part 15, Chapter 393, Informal Dispute Resolution and Informal Reconsideration. Comments can be emailed to Allison Levee.

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

Read more.

Children Waiting for Adoption. See the latest children who were added to or updated in the Texas Adoption Resource Exchange (TARE).

The following TCR products are now available on our website.

  • Cancer in Texas 2020 — This annual report provides an overview of the cancer burden in Texas. This year, the report includes a special section on cancer in the oldest old (ages 85 years and older).
  • Alcohol-Associated Cancers in Texas — This web report provides an overview of how overweight and obesity affect cancer risk. It includes incidence rates and incidence rate trends in Texas for eight associated cancers.
  • Cancer in the Oldest Old in Texas — This web report provides an overview of cancer in Texans ages 85 years and older. It includes incidence and mortality rates and five-year relative survival rates.

A web report on tobacco-associated cancers will be added to our website soon.

If you have any questions or comments, please visit the “Contact TCR” webpage for a list of who to contact.