Texas Health and Human Services Digest: November 6, 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 6, 2020

November 9, 2020

November 10, 2020

November 12, 2020

November 13, 2020

November 16, 2020

November 17, 2020

November 18, 2020

November 19, 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To let the public know about a rulemaking action – such as new, amended or repealed rules – HHS publishes a notice in the Texas Register, a publication of the Texas Secretary of State.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 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

2021 Medicare Part B Premiums Remain Steady. Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2021 monthly Medicare Parts A and B premiums, deductibles, and coinsurance amounts in which the Medicare Part B monthly premium remains steady. This news comes as Medicare Open Enrollment started on October 15, 2020 running through December 7, 2020, and follows the announcement that Medicare Advantage (or private Medicare health plans) and Part D prescription drug plan premiums are at historic lows, with hundreds of Medicare Advantage and Part D plans now offering $35 monthly co-pays for insulin starting in January 2021.

Medicare Part B Premiums/Deductibles. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

The standard monthly premium for Medicare Part B enrollees will be $148.50 in 2021, an increase of $3.90 from $144.60 in 2020. Recent legislation signed by President Trump significantly dampens the 2021 Medicare Part B premium increase that would have occurred given the estimated growth in Medicare spending next year. Medicare spending is estimated to grow due to people seeking care they may have delayed during the COVID-19 public health emergency, availability of more COVID-19 treatments, and availability of COVID-19 vaccines (for which CMS recently announced that there would be no out-of-pocket costs for seniors).

CMS also announced that the annual deductible for Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from $198 in 2020.

Medicare Part A Premiums/Deductibles. Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,484 in 2021, an increase of $76 from $1,408 in 2020.

Medicare Open Enrollment. Medicare beneficiaries can choose to enroll in fee-for-service Original Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans (Medicare Part D) are already finalized and are unaffected by this announcement.

During the ongoing Medicare Open Enrollment – which began on October 15, 2020 and ends December 7, 2020, more than 60 million Medicare beneficiaries can compare coverage options like Original Medicare (Part A and Part B) and Medicare Advantage, and choose health and prescription drug plans for 2021. Medicare health and drug plan costs and covered benefits can change from year-to-year. CMS urges Medicare beneficiaries to review their coverage choices and decide on the options that best meet their health needs. Over the past three years, CMS has made it easier for seniors to compare and enroll in Medicare coverage. The redesigned Medicare Plan Finder makes it easier for beneficiaries to:

  • Compare pricing between Original Medicare, Medicare Advantage plans, Medicare prescription drug plans (Medicare Part D), and Medicare Supplemental Insurance (Medigap) policies;
  • Compare coverage options on their smartphones and tablets;
  • Compare up to three Medicare Part D drug plans or three Medicare Advantage plans side-by-side;
  • Get plan costs and benefits, including which Medicare Advantage plans offer extra benefits;
  • Build a personal drug list and find Medicare Part D prescription drug coverage that best meets their needs.

Highlights for 2021 Open Enrollment include:

  • A 34 percent decrease in average monthly premiums for Medicare Advantage plans since 2017. This is the lowest average monthly premium since 2007. Beneficiaries in some states, including Alabama, Nevada, Michigan, and Kentucky, will see decreases of over 50 percent in average Medicare Advantage premiums.
  • More than 4,800 Medicare Advantage plans are offered for 2021, compared to about 2,700 in 2017. Similarly, more Medicare Part D plans are available, and the average basic Part D premium has dropped 12 percent since 2017.
  • Medicare beneficiaries can join a prescription drug plan that will offer many types of insulin at a maximum copayment of $35 for a 30-day supply. More than 1,600 Medicare Advantage and Part D prescription drug plans are participating in the Part D Senior Savings Model for 2021. People who enroll in a participating plan could save up to an estimated $446 a year in out-of-pocket costs on insulin. 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 can 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.
  • Free, personalized counseling on Medicare options is also available through the nonprofit State Health Insurance Assistance Program, or by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

For a fact sheet on the 2021 Medicare Parts A & B premiums and deductibles, please visit: https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles

For more information on the 2021 Medicare Parts A and B premiums and deductibles (CMS-8074-N, CMS-8075-N, CMS-8076-N), please visit:

The Deadline for Critical Access Hospitals to Submit their Medicare Promoting Interoperability Program Hardship Exception Application is Monday, November 30. The Centers for Medicare & Medicaid Services (CMS) requires that all critical access hospitals (CAHs) use 2015 Edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Programs. CMS mandates downward payment adjustments be applied to CAHs that are not meaningful users of CEHRT.

CAHs may be exempt from Medicare penalties if they can show that compliance with the requirement for being a meaningful EHR user would result in a significant hardship. To be considered for an exemption, CAHs must complete a hardship exception application and provide proof of hardship. If approved, the hardship exception is valid for only one payment adjustment year. CAHs would need to submit a new application for subsequent years and in no case may a CAH be granted an exception for more than five years.

The application for CAHs is available online as a web-based application and can be found here. Previously registered users should already have account access, and new users can create an account by visiting QualityNet and selecting “Register”.
Hardship Exception Application Details

  • You may now submit hardship applications electronically here.
  • If an electronic submission is not possible, you may verbally submit your application over the phone by calling the QualityNet Help Desk at (866) 288-8912.
  • The deadline for CAHs to submit an application is November 30, 2020.

For More Information. For more information about payment adjustments and hardship information, click here. For more information on the Promoting Interoperability Programs, visit the Promoting Interoperability Programs website.

Inhalant Drugs: Bill Correctly. An Office of Inspector General (OIG) report found that CMS improperly paid suppliers for inhalation drugs. Review the Provider Compliance Tips for Nebulizers and Related Drugs (PDF) fact sheet to help you bill correctly. Additional resources:

Hospital Price Transparency: Requirements Effective January 1
In 2 months, each hospital operating in the United States is required to provide clear, accessible pricing information online about the items and services they provide in 2 ways:

  • Comprehensive machine-readable file with all items and services
  • Display of shoppable services in a consumer-friendly format

Is your organization prepared to be compliant? Visit the new Hospital Price Transparency website for resources to help you prepare:

SNF Quality Reporting Program: October Refresh. The October refresh of Skilled Nursing Facility (SNF) Quality Reporting data is available. Visit the Nursing Home Compare website, Care Compare website, and Provider Data Catalog to view the data.

For More Information:

Flu Shots: Each Visit is an Opportunity. Flu shots are free for your Medicare patients if you accept assignment. Medicare Part B covers 1 flu shot per flu season and additional flu shots if medically necessary.

Every patient visit is an opportunity to promote the flu shot. The CDC recommends annual flu shots for everyone 6 months and older.
For More Information:

SNF Quality Reporting Program: Confusion Assessment Method Video Tutorial. CMS released a video tutorial for the Skilled Nursing Facility (SNF) Quality Reporting Program on the Confusion Assessment Method (CAM©) cognitive assessment. Learn about:

  • Standardized data assessment guidance strategies
  • Accurate coding using live-action resident scenarios

This video tutorial is 25 minutes. Visit the Training webpage for more information.

SNF Quality Reporting Program: Brief Interview for Mental Status Video Tutorial. CMS released a video tutorial for the Skilled Nursing Facility (SNF) Quality Reporting Program on the Brief Interview for Mental Status (BIMS) cognitive assessment. Learn about:

  • Standardized data assessment guidance strategies
  • Accurate coding using live-action patient/resident scenarios

This video tutorial is 22 minutes. Visit the Training webpage for more information.

NIH researchers identify gene in mice that controls food cravings, desire to exercise. National Institutes of Health researchers have discovered a gene in mice that controls the craving for fatty and sugary foods and the desire to exercise. The gene, Prkar2a, is highly expressed in the habenula, a tiny brain region involved in responses to pain, stress, anxiety, sleep and reward. The findings could inform future research to prevent obesity and its accompanying risks for cardiovascular disease and diabetes. The study was conducted by Edra London, Ph.D., a staff scientist in the section on endocrinology and genetics at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and colleagues. It appears in JCI Insight.

Prkar2a contains the information needed to make two subunits — molecular components — of the enzyme protein kinase A. Enzymes speed up chemical reactions, either helping to combine smaller molecules into larger molecules, or to break down larger molecules into smaller ones. Protein kinase A is the central enzyme that speeds reactions inside cells in many species. In a previous study, the NICHD team found that despite being fed a high fat diet, mice lacking functioning copies of Prkar2a were less likely to become obese than wild type mice with normally functioning Prkar2a.

The researchers determined that Prkar2a-negative mice ate less high-fat food than their counterparts, not only when given unlimited access to the food, but also after a fast. Similarly, the Prkar2a negative mice also drank less of a sugar solution than the wild type mice. The Prkar2a-negative mice were also more inclined to exercise, running 2-3 times longer than wild type mice on a treadmill. Female Prkar2a-negative mice were less inclined to consume high fat foods than Prkar2-negative males, while Prkar2-negative males showed less preference for the sugar solution than Prkar2-negative females.

The gut trains the immune system to protect the brain. The membranes surrounding our brains are in a never-ending battle against deadly infections, as germs constantly try to elude watchful immune cells and sneak past a special protective barrier called the meninges. In a study involving mice and human autopsy tissue, researchers at the National Institutes of Health and Cambridge University have shown that some of these immune cells are trained to fight these infections by first spending time in the gut.

The central nervous system (CNS) is protected from pathogens both by a three-membrane barrier called the meninges and by immune cells within those membranes. The CNS is also walled off from the rest of the body by specialized blood vessels that are tightly sealed by the blood brain barrier. This is not the case, however, in the dura mater, the outermost layer of the meninges. Blood vessels in this compartment are not sealed, and large venous structures, referred to as the sinuses, carry slow moving blood back to the heart. The combination of slow blood flow and proximity to the brain requires strong immune protection to stop potential infections in their tracks.

In this study, Dr. McGavern’s team worked with researchers in a lab led by Menna R. Clatworthy, M.D., Ph.D., University of Cambridge, UK to look at what immune cell types reside in the outer layers of the meninges of mice and humans. What they discovered was rather surprising: there were many immune cells previously educated to make antibodies against specific microbes. These antibody-producing cells, called IgA cells, are typically found in other barriers such as the mucous membranes of the bronchial tree of the lungs and gut.

Read the full release.

Informal Comments on Draft Rule Due 11/19 on State Medicaid Managed Care Advisory Committee. Texas Health and Human Services Commission is accepting informal comments from stakeholders on the following draft rule. The comment period ends November 19, 2020.

  • Texas Health and Human Services Commission Title 1, Part 15, Chapter 351, Section 351.805, State Medicaid Managed Care Advisory Committee. Comments can be emailed to HHS Medicaid/CHIP Services.

Questions can be emailed to HHS Rules Coordination Office.

Visit the HHS Rulemaking website for more information.

HHSC Provider Reimbursement Rate Tables Published. The Health and Human Services Commission (HHSC) Provider Finance Department (PFD) is responsible for setting Medicaid and other reimbursement rates for other state programs.

Provider reimbursement rate tables have been published and are available at the Provider Finance Department website. These rate tables historically were included in the “Consolidated Budget Report” which is no longer required.

The rate tables contain overall percent rate changes required to recognize increases/decreases in costs incurred by providers based on various established methodologies. The estimated fiscal impact of a one percent rate change can be used to estimate most of the fiscal impact to the state for each one percent rate increase or decrease in provider reimbursement.

In addition to the rate tables, information is provided on several specific rate issues, including supplemental payment programs, hospital inpatient rates, nursing facility financing, long-term services and supports and compensation for attendant workers.

Vendor Drug Program Updates

October Drug Utilization Review Board Summary. The Texas Drug Utilization Review Board held its quarterly meeting in Oct. to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of the meeting is now available. The next meeting is scheduled for Friday, Jan. 22.
Other updates

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.

Comments on Proposed Rules Due 12/7 on Uncompensated Care Secondary Reconciliation for DYs 6-8. 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 7, 2020.

  • Texas Health and Human Services Title 1, Part 15, Chapter 355, Subchapter J, Division 11, Section 355.8201, Waiver Payments to Hospitals for Uncompensated Care. Comments can be emailed to HHSC.

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

Deadline to Apply for Federal COVID-19 Relief Fund for Providers is Today, Nov. 6. HHSC reminds Medicaid and CHIP providers that the deadline to apply for the CARES Act Provider Relief Fund is today, Nov. 6.

Read more