10 Apr 2020

Texas Register April 10, 2020 Volume: 45 Number: 15

by | posted in: Governor, Texas Council for Developmental Disabilities, Texas Department of Family Protective Services, Texas Department of Insurance, Texas Department of State Health Services, Texas Health and Human Services Commission |

Texas Register Table of Contents

Governor

 

Notices

Executive Order GA-11: Airport screening and self-quarantine measures during the COVID-19 disaster

OVERVIEWI, Greg Abbott, Governor of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby order the following on a statewide basis effective at noon on March 28, 2020:Quarantine after airport arrival from certain destinations:Every person who enters the State of Texas as the final destination through an airport, from a point of origin or point of last departure in New York, New Jersey, Connecticut, or the City of New Orleans, or in any other state or city as may be proclaimed hereafter, shall be subject to mandatory self-quarantine for a period of 14 days from the time of entry into Texas or the duration of the person’s presence in Texas, whichever is shorter. Each person covered under this order to self-quarantine shall be responsible for all associated costs, including transportation, lodging, food, and medical care.Exception:This order to self-quarantine shall not apply to people traveling in connection with military service, emergency response, health response, or critical-infrastructure functions, as may be determined by the Texas Division of Emergency Management. Specific procedures which a “covered person” must follow:A covered person shall use a form prescribed by the Texas Department of Public Safety (DPS) to designate a quarantine location in Texas, such as a residence or a hotel, and provide a full name, date of birth, home address, telephone number, and driver license or passport information. DPS Troopers, or other approved peace officers, shall collect a completed form from each covered person immediately upon disembarking and verify it against the person’s driver license or passport.Providing false information on this form is a criminal offense under Section 37.10 of the Texas Penal Code. Questions about this form should be directed to DPS at (800) 525-5555.A covered person shall proceed directly from the airport to the designated quarantine location entered on the DPS form. Any covered person exhibiting symptoms of COVID-19 shall be escorted to the designated quarantine location by a DPS Trooper.A covered person shall remain in the designated quarantine location for a period of 14 days or the duration of the person’s presence in Texas, whichever is shorter, leaving only to seek medical care or to depart from Texas. During that period, a covered person shall not allow visitors into or out of the designated quarantine location, other than a health department employee, physician, or healthcare provider, and shall not visit any public spaces.DPS Special Agents will conduct unannounced visits to designated quarantine locations to verify compliance by confirming the physical presence of covered persons. Any failure to comply with this order to self-quarantine shall be a criminal offense punishable by a fine not to exceed $1,000, confinement in jail for a term not to exceed 180 days, or both.This executive order shall remain in effect and in full force until modified, amended, rescinded, or superseded by the governor.BACKGROUND AND JUSTIFICATIONThe Governor’s rationale for issuing Executive Order GA-11 is listed in this week’s edition of the Texas Register. 

Governor

Notices

Executive Order GA-12: Roadway screening and self-quarantine measures during the COVID-19 disaster

OVERVIEWI, Greg Abbott, Governor of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby order the following on a statewide basis effective at noon on March 30, 2020:Quarantine after entry through roadways from certain destinations:Every person who enters the State of Texas through roadways from Louisiana, or from any other state as may be proclaimed hereafter, shall be subject to mandatory self-quarantine for a period of 14 days from the time of entry into Texas or the duration of the person’s presence in Texas, whichever is shorter. Each person covered by this order to self-quarantine shall be responsible for all associated costs, including transportation, lodging, food, and medical care.Exception:This order to self-quarantine shall not apply to people traveling in connection with commercial activity, military service, emergency response, health response, or critical-infrastructure functions, as may be determined by the Texas Division of Emergency Management.Specific procedures which a “covered person” must follow: The Texas Department of Public Safety (DPS) shall enforce this executive order along the Texas-Louisiana border. Using a form to be prescribed by DPS, each covered person shall designate a quarantine location in Texas, such as a residence or a hotel, and provide a full name, date of birth, home address, telephone number, and driver license or passport information. DPS Troopers, or other approved peace officers, will collect a completed form from a covered person and verify it against the person’s driver license or passport. Providing false information on this form is a criminal offense under Section 37.10 of the Texas Penal Code. Questions about this form should be directed to DPS by calling (800) 525-5555.A covered person shall proceed directly to the designated quarantine location entered on the DPS form. Any covered person exhibiting symptoms of COVID-19 shall be escorted to the designated quarantine location by a DPS Trooper.A covered person shall remain in the designated quarantine location for a period of 14 days or the duration of the person’s presence in Texas, whichever is shorter, leaving only to seek medical care or to depart from Texas. During that period, a covered person shall not allow visitors into or out of the designated quarantine location, other than a health department employee, physician, or health care provider, and shall not visit any public spaces.DPS Special Agents will conduct unannounced visits to designated quarantine locations to verify compliance by confirming the physical presence of covered persons. Any failure to comply with this order to self-quarantine shall be a criminal offense punishable by a fine not to exceed $1,000, confinement in jail for a term not to exceed 180 days, or both.This executive order shall remain in effect and in full force until modified, amended, rescinded, or superseded by the governor.BACKGROUND AND JUSTIFICATIONThe Governor’s rationale for issuing Executive Order GA-12 is listed in this week’s edition of the Texas Register. 

Governor

Notices

Executive Order GA-14: Statewide continuity of essential services and activities during the COVID-19 disaster

OVERVIEWI, Greg Abbott, Governor of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby order the following on a statewide basis effective 12:01 a.m. on April 2, 2020, and continuing through April 30, 2020, subject to extension based on the status of COVID-19 in Texas and the recommendations of the CDC and the White House Coronavirus Task Force:In accordance with guidance from DSHS Commissioner Dr. Hellerstedt, and to achieve the goals established by the President to reduce the spread of COVID-19, every person in Texas shall, except where necessary to provide or obtain essential services, minimize social gatherings and minimize in-person contact with people who are not in the same household.In accordance with the Guidelines from the President and the CDC, people shall avoid eating or drinking at bars, restaurants, and food courts, or visiting gyms, massage establishments, tattoo studios, piercing studios, or cosmetology salons; provided, however, that the use of drive-thru, pickup, or delivery options for food and drinks is allowed and highly encouraged throughout the limited duration of this executive order.In accordance with the Guidelines from the President and the CDC, people shall not visit nursing homes, state supported living centers, assisted living facilities, or long-term care facilities unless to provide critical assistance as determined through guidance from the Texas Health and Human Services Commission.In accordance with the Guidelines from the President and the CDC, schools shall remain temporarily closed to in-person classroom attendance and shall not recommence before May 4, 2020.”Essential services”:”Essential services” shall consist of everything listed by the U.S. Department of Homeland Security in its Guidance on the Essential Critical Infrastructure Workforce, Version 2.0, plus religious services conducted in churches, congregations, and houses of worship. Other essential services may be added to this list with the approval of the Texas Division of Emergency Management (TDEM). TDEM shall maintain an online list of essential services, as specified in this executive order and in any approved additions. Requests for additions should be directed to TDEM at EssentialServices@tdem.texas.gov or by visiting www.tdem.texas.gov/essentialservices.In providing or obtaining essential services, people and businesses should follow the Guidelines from the President and the CDC by practicing good hygiene, environmental cleanliness, and sanitation, implementing social distancing, and working from home if possible. In particular, all services should be provided through remote telework from home unless they are essential services that cannot be provided through remote telework. If religious services cannot be conducted from home or through remote services, they should be conducted consistent with the Guidelines from the President and the CDC by practicing good hygiene, environmental cleanliness, and sanitation, and by implementing social distancing to prevent the spread of COVID-19.This executive order does not prohibit people from accessing essential services or engaging in essential daily activities, such as going to the grocery store or gas station, providing or obtaining other essential services, visiting parks, hunting or fishing, or engaging in physical activity like jogging or bicycling, so long as the necessary precautions are maintained to reduce the transmission of COVID-19 and to minimize in-person contact with people who are not in the same household.Cooperation with other legislation and orders:This executive order shall supersede any conflicting order issued by local officials in response to the COVID-19 disaster, but only to the extent that such a local order restricts essential services allowed by this executive order or allows gatherings prohibited by this executive order. I hereby suspend Sections 418.1015(b) and 418.108 of the Texas Government Code, Chapter 81, Subchapter E of the Texas Health and Safety Code, and any other relevant statutes, to the extent necessary to ensure that local officials do not impose restrictions inconsistent with this executive order, provided that local officials may enforce this executive order as well as local restrictions that are consistent with this executive order.This executive order supersedes Executive Order GA-08, but not Executive Orders GA-09, GA-10, GA-11, GA-12, or GA-13, and shall remain in effect and in full force until April 30, 2020, unless it is modified, amended, rescinded, or superseded by the governor.BACKGROUND AND JUSTIFICATIONThe Governor’s rationale for issuing Executive Order GA-14 is listed in this week’s edition of the Texas Register. 

Governor

Notices

Proclamation 41-3725: Additional states and cities to be covered under Executive Order GA-11’s airport screening and quarantine measures

OVERVIEWNOW, THEREFORE, I, Greg Abbott, Governor of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby add the following states and cities, effective at noon on March 30, 2020, to the list set forth in Executive Order GA-11:State of CaliforniaState of LouisianaState of WashingtonCity of Atlanta, GeorgiaCity of Chicago, IllinoisCity of Detroit, MichiganCity of Miami, FloridaThis proclamation shall remain in effect and in full force for as long as Executive Order GA-11 is in effect and in full force, unless otherwise modified, amended, rescinded, or superseded by the governor.BACKGROUND AND JUSTIFICATIONWHEREAS, I, Greg Abbott, Governor of Texas, issued a disaster proclamation on March 13, 2020, certifying under Section 418.014 of the Texas Government Code that the novel coronavirus (COVID-19) poses an imminent threat of disaster for all counties in the State of Texas; andWHEREAS, on March 26, 2020, Executive Order GA-11 imposed a mandatory self-quarantine of 14 days for air travelers flying to Texas from certain areas experiencing substantial community spread of COVID-19; andWHEREAS, Executive Order GA-11 provided that additional states or cities could be added to that mandatory self-quarantine by proclamation thereafter.

Texas Department of Insurance

Emergency Rule

New 28 TAC §35.2, requiring TDI-regulated health plans to honor new prescription benefit procedures in order to ensure enrollees access to medications during the COVID-19 crisis

CHAPTER 35. EMERGENCY RULESSUBCHAPTER A. COVID-19 EMERGENCY RULES28 TAC §35.2OVERVIEWThe Commissioner of Insurance adopts new 28 TAC §35.2, concerning Pharmacy Benefits, on an emergency basis, effective immediately. The emergency adoption is necessary to ensure that enrollees in TDI-regulated plans have access to the medications they need while limiting their exposure to public places during the COVID‑19 pandemic.The new rule limits exposure to public places by limiting trips to the pharmacy and preventing unnecessary physical contact: Under the rule, health benefit plans will be required to cover up to a 90-day additional supply of prescription drugs regardless of when the drug was last dispensed. This applies only to situations in which a prescribing health professional has determined that the additional supply is appropriate. The rule does not affect laws limiting dispensation of certain drug classes or affect a pharmacy’s ability to limit dispensation to ensure availability of a drug. In an effort to limit physical exposure, the new rule also prevents plans from requiring signature at the point of delivery of a prescription drug unless the signature is otherwise required by law or refusing payment solely on the grounds that the drug was delivered by a local pharmacy to the enrollee.The new rule puts protections in place for enrollees who are unable to reasonably locate a prescribed drug due to supply chain issues:Health benefit plans will be required to cover prescription drugs from out-of-network pharmacies at no additional copayment, coinsurance, or other cost sharing when the enrollee cannot reasonably obtain them from an in-network pharmacy. The rule also requires health benefit plans to make alternative drugs available on-formulary or in the same preferred tier when an on-formulary or preferred drug is unavailable due to shortage or lack of distribution. If the alternative drug is substantially equivalent to the originally-prescribed drug, plans may not require prior authorization for the alternative drug. Health plans may assist enrollees in locating pharmacies to fulfill prescriptions in-network with on-formulary or preferred drugs, but the new rule prohibits health benefit plans from requiring the enrollee to travel more than 30 miles or visit multiple pharmacies.BACKGROUND AND PURPOSEThe new rule prevents disruptions in access to potentially critical prescription drugs due to difficulty seeing prescribing health professionals or delays in obtaining prior authorization by requiring plans to extend established prior authorization approvals. Routine appointments are often being postponed due to social distancing efforts, and enrollees may also experience fewer available appointments with their prescribing health professional. Health plans have already inquired about extending certain timelines out of concerns about staffing shortages caused by the pandemic. The intent of the rule is that plans would update their computer systems to reflect a 90-day extension of prior authorization approvals for qualifying prescription drugs in advance of a refill request. The provision ensures that enrollees’ access to maintenance medications is not at risk due to decreased access to their prescribing health professionals or shortages of staff that may be experienced by plan administrators and cause prior authorization delays during the pandemic.This emergency rule does not affect the authority of the prescribing health professional and will be in effect for a limited amount of time. The rule relies on the discretion and duty of care of the prescribing health professional to ensure the health and safety of the enrollee and provides for the delivery of prescription drugs that the health professional has determined that the enrollee needs.

Texas Health and Human Services Commission

Proposed Rules

Amending 1 TAC §355.8201 to detail calculation and distribution methods for reimbursing unspent Uncompensated Care funding to hospitals

CHAPTER 355. REIMBURSEMENT RATESSUBCHAPTER J. PURCHASED HEALTH SERVICESDIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT1 TAC §355.8201OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to 1 TAC §355.8201, concerning Waiver Payments to Hospitals for Uncompensated Care.The proposed amendment to §355.8201 adds new §355.8201(g)(8), which includes language to describe the methodology HHSC will use to calculate and distribute payments to hospitals made after January 1, 2020, using the unspent funds for Uncompensated Care (UC) program years 2014 through 2017. The proposed amendment also details the basis for each hospital’s payment allocation. All providers participating in the UC program are eligible to receive a payment allocation except for state hospitals, physician group practices, and ambulance and dental providers.BACKGROUND AND JUSTIFICATIONFederal action:The hospital specific limit (HSL) is a limit on the amount of payments a hospital may receive for care to Medicaid and low-income uninsured patients. In Texas during the program years at issue, two types of HSLs existed for hospitals that participated in the Disproportionate Share Hospital and UC programs: an interim HSL and a final HSL. The interim HSL is defined by HHSC and the final HSL is described in federal law. The interim HSL is calculated in the payment year for DSH and UC to determine payment amounts using historical Medicaid and uninsured data. The final HSL is calculated two years after the payment year using actual data to determine whether hospitals were overpaid.In 2010, the Centers for Medicare & Medicaid Services (CMS) promulgated a series of Frequently Asked Questions (FAQs) relating to the calculation of the final HSL. FAQ 33 stated that, when calculating the HSL, full payments from commercial insurers should offset the costs of providing care to Medicaid beneficiaries who also had commercial insurance.In December 2018, after engaging in federal litigation that enjoined CMS from promulgating FAQ 33, CMS withdrew FAQ 33 and related FAQ 34 and communicated this decision in a published bulletin that also provided additional commentary on its expectations of implementing this change. Specifically, CMS noted that it would accept revised DSH audits covering hospital services furnished before June 2, 2017, and that the costs reflected in these audits would not be offset by other insurance and Medicare payments.State action: In December 2011, HHSC received federal approval for an 1115 demonstration waiver that would allow HHSC to expand Medicaid managed care statewide and preserve supplemental Medicaid funding received under the Upper Payment Limit (UPL) program. Under the 1115 waiver, HHSC established the Delivery System Reform Incentive Payment (DSRIP) and UC funding pools.The 1115 waiver approval required supplemental payments made during the first demonstration year of the waiver to be included in the UC pool cap. CMS determined that HHSC did not include UPL supplemental payments made in November 2011 and December 2011 (prior to the 1115 waiver approval) and, as such, this resulted in an overpayment in UC pool funding for the first demonstration year. CMS determined the total overpayment, known as the “UPL obligation,” was approximately $480.8 million, and that the obligation would have to be offset against the UC pool for the first five demonstration years of the waiver.To date, HHSC has used recoupments totaling approximately $138.4 million to help offset the obligation, instead of redistributing the recoupments to other providers. As a result, the remaining UPL obligation is estimated at $342.4 million.

Texas Department of Family Protective Services

Proposed Rules

Amending 40 TAC §700.1003 to expand the definition of “designated caregiver” for a child in DFPS conservatorship

CHAPTER 700. CHILD PROTECTIVE SERVICESSUBCHAPTER J. ASSISTANCE PROGRAMS FOR RELATIVES AND OTHER CAREGIVERSDIVISION 1. RELATIVE AND OTHER DESIGNATED CAREGIVER PROGRAM40 TAC §700.1003OVERVIEWThe Department of Family and Protective Services (DFPS) proposes an amendment to §700.1003, in Chapter 700, concerning Child Protective Services.The proposed amendment of §700.1003 expands the statutory definition of a “designated caregiver” to also include an individual with a longstanding and significant relationship to the family of a child that is in DFPS conservatorship.BACKGROUND AND PURPOSEThe purpose of the rule change is to comply with House Bill (HB) 3390, which was enacted into law by the 86th Texas Legislature and became effective immediately on June 14, 2019. HB 3390, among other things, amends Family Code Section 264.751, regarding the definitions pertaining to the Relative and Other Designated Caregiver (RODC) Program, or Kinship Program, to expand the statutory definition of a “designated caregiver” to also include an individual with a longstanding and significant relationship to the family of a child that is in DFPS conservatorship. Current statute and agency rule limits the definition to an individual with a longstanding and significant relationship with the child only.HB 3390 requires rules necessary for implementation to be adopted as soon as practicable after the effective date.

Texas Department of State Health Services

Adopted Rules

Amending 25 TAC §§13.1-13.2 and repealing §13.3 to update application criteria for the J-1 Visa Waiver Program in order to recruit physicians to underserved areas

CHAPTER 13. HEALTH PLANNING AND RESOURCE DEVELOPMENTSUBCHAPTER A. RECRUITMENT OF PHYSICIANS TO UNDERSERVED AREAS25 TAC §13.1, §13.2, §13.3The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §13.1 (Priorities for Waiver Recommendations) and §13.2 (Application Fee) and adopts the repeal of §13.3 (Other Federal or State Requirements). The amendment to §13.1 is adopted with changes to the proposed text as published in the November 29, 2019, issue of the Texas Register (44 TexReg 7311). This rule will be republished. The amendment to §13.2 and repeal of §13.3 are adopted without changes to the proposed text as published in the November 29, 2019, issue of the Texas Register (44 TexReg 7311). These rules will not be republished.BACKGROUND AND JUSTIFICATIONThe Texas Conrad 30 J-1 Visa Waiver Program recommends up to 30 foreign medical graduates (physicians) each year to receive a waiver of the J-1 visa requirement to return home for two years. In exchange for this waiver, the physician must provide medical care for three years in an underserved area. The rules covering this program describe application prioritization criteria, application fees, and the refund policy for those fees.The amendments and repeal clarify the criteria used to prioritize applications; update references to the website; clarify the application fee process and refund policy; correct a grammatical error; remove a section as unnecessary; and serve as the four-year review of rules required by Texas Government Code, §2001.039.

Texas Council for Developmental Disabilities

In Addition

Council requests applications for funding from culturally diverse groups that provide services to developmentally disabled individuals

OVERVIEWThe Texas Council for Developmental Disabilities (TCDD) announces the availability of funds for groups of people who belong to traditionally underserved racial or ethnic groups and who are providing services and supports to people with developmental disabilities (DD) of the same race or ethnicity. Groups applying for these grants focus on improving access to culturally competent supports and services. Projects will support people who are black/African American, Hispanic/Latino, Asian, and Native American to change the systems that provide supports and services for people with DD so they may serve all people in culturally responsive ways. Projects will also assist people who have DD and are black/African American, Hispanic/Latino, Asian, or Native American to have better access to services and supports that meet their needs. Finally, projects will inform TCDD’s future advocacy work, long range planning, and grant project development.FUNDINGTCDD has approved funding for up to $10,000 for up to 12 months. Funds available for these projects are provided to TCDD by the U.S. Department of Health and Human Services, Administration on Disabilities, pursuant to the Developmental Disabilities Assistance and Bill of Rights Act. Funding for the project is dependent on the results of a review process established by TCDD and on the availability of funds. Non-federal matching funds of at least 10% of the total project costs are required for projects in federally designated poverty areas. Non-federal matching funds of at least 25% of total project costs are required for projects in other areas.APPLICATION PROCESSAdditional information concerning this Request for Applications (RFA) and TCDD is available at https://tcdd.texas.gov/grants-rfas/funding-available-for-grants/. All questions pertaining to this RFA should be directed in writing to TCDD via email at apply@tcdd.texas.gov or via telephone at (512) 437-5432.Proposals must be submitted through https://tcdd.smapply.org/prog/lst/ and will be reviewed by TCDD according to the following schedule: applications received by 5:00 p.m. on June 22, 2020, may be reviewed at the August 2020 Council meeting; applications received by 5:00 p.m. on September 14, 2020, may be reviewed at the November 2020 Council meeting; applications received by 5:00 p.m. on December 14, 2020, may be reviewed at the February 2021 Council meeting; applications received by 5:00 p.m. on March 15, 2021, may be reviewed at the May 2021 Council meeting. Proposals will not be accepted outside of these due dates.

Texas Council for Developmental Disabilities

In Addition

Council requests applications for funding to build the organizational capacity of local self-advocacy groups

OVERVIEWThe Texas Council for Developmental Disabilities (TCDD) announces the availability of funds for projects to build the organizational capacity of local self-advocacy groups to become more established in their communities, create partnerships, conduct formal activities, and ultimately expand their role and impact. The groups will identify and achieve at least one major activity that will put them in a position to pursue more significant activities and/or grants. Applications must, at the very least, include a self-advocacy group as one of the co-applicants.FUNDINGTCDD has approved funding for up to 10 projects for up to $15,000 for up to 12 months. Funds available for these projects are provided to TCDD by the U.S. Department of Health and Human Services, Administration on Disabilities, pursuant to the Developmental Disabilities Assistance and Bill of Rights Act. Funding for the project is dependent on the results of a review process established by TCDD and on the availability of funds. Non-federal matching funds of at least 10% of the total project costs are required for projects in federally designated poverty areas. Non-federal matching funds of at least 25% of total project costs are required for projects in other areas.APPLICATION PROCESSAdditional information concerning this Request for Applications (RFA) and TCDD is available at https://tcdd.texas.gov/grants-rfas/funding-available-for-grants/. All questions pertaining to this RFA should be directed in writing to TCDD via email at apply@tcdd.texas.gov or via telephone at (512) 437-5432.Proposals must be submitted through https://tcdd.smapply.org/prog/lst/ and will be reviewed by TCDD according to the following schedule: applications received by 5:00 p.m. on June 22, 2020, may be reviewed at the August 2020 Council meeting; applications received by 5:00 p.m. on September 14, 2020, may be reviewed at the November 2020 Council meeting; applications received by 5:00 p.m. on December 14, 2020, may be reviewed at the February 2021 Council meeting; applications received by 5:00 p.m. on March 15, 2021, may be reviewed at the May 2021 Council meeting. Proposals will not be accepted outside of these due dates.

Texas Council for Developmental Disabilities

In Addition

Council requests applications for funding to promote community inclusion of developmentally disabled individuals

OVERVIEWThe Texas Council for Developmental Disabilities (TCDD) announces the availability of funds for organizations to develop projects that will identify and address barriers to full community inclusion faced by people with disabilities. To address the identified barrier, projects may either replicate best practices or develop unique and innovative ideas. At the conclusion of the projects, grantees will demonstrate how people with disabilities in their community are more included in education, employment, or social activities. The goal of community inclusion mini-grants is to produce short- and/or long-term systems change. Applications can include solutions to typical barriers, barriers that have developed due to the COVID-19 situation, or both.FUNDINGTCDD has approved funding for up to 10 projects for up to $15,000 for up to 12 months. Funds available for these projects are provided to TCDD by the U.S. Department of Health and Human Services, Administration on Disabilities, pursuant to the Developmental Disabilities Assistance and Bill of Rights Act. Funding for the project is dependent on the results of a review process established by TCDD and on the availability of funds. Non-federal matching funds of at least 10% of the total project costs are required for projects in federally designated poverty areas. Non-federal matching funds of at least 25% of total project costs are required for projects in other areas.APPLICATION PROCESSAdditional information concerning this Request for Applications (RFA) and TCDD is available at https://tcdd.texas.gov/grants-rfas/funding-available-for-grants/. All questions pertaining to this RFA should be directed in writing to TCDD via email at apply@tcdd.texas.gov or via telephone at (512) 437-5432.Proposals must be submitted through https://tcdd.smapply.org/prog/lst/ and will be reviewed by TCDD according to the following schedule: applications received by 5:00 p.m. on June 22, 2020, may be reviewed at the August 2020 Council meeting; applications received by 5:00 p.m. on September 14, 2020, may be reviewed at the November 2020 Council meeting; applications received by 5:00 p.m. on December 14, 2020, may be reviewed at the February 2021 Council meeting; applications received by 5:00 p.m. on March 15, 2021, may be reviewed at the May 2021 Council meeting. Proposals will not be accepted outside of these due dates.

Texas Council for Developmental Disabilities

In Addition

Council requests applications for funding to promote access to meaningful work and community engagement for developmentally disabled individuals

OVERVIEWThe Texas Council for Developmental Disabilities (TCDD) announces the availability of funds for service providers and other organizations in Texas to develop innovative methods to support people with developmental disabilities (DD) to find and keep the meaningful work they want and to have self-directed purposeful options for community engagement during the day when not working.The intent of offering funding for the project described in this Request for Applications (RFA) is to develop and/or pilot strategies that will enhance traditional program models that result in a self-directed meaningful day that include an individual’s wants and needs for improved community access and integration. Also, projects could develop new and innovative ways for people with DD to secure meaningful employment and/or to engage in community-integrated activities when they aren’t working. Grantees will document the development, implementation, barriers and successes of their projects and activities, as well as survey the individuals served in this project. Applications can include solutions to typical barriers, barriers that have developed due to the COVID-19 situation, or both.Applicants will identify the specific activities to be conducted to reach identified goals. Examples are provided in the RFA. TCDD grant funds cannot be used for activities that are currently paid for by other sources. The project’s activities should be able to be shared with other providers and organizations around the state to improve person-centered outcomes.FUNDINGTCDD has approved funding for up to 10 projects for up to $15,000 per organization for one year. Funds available for these projects are provided to TCDD by the U.S. Department of Health and Human Services, Administration on Disabilities, pursuant to the Developmental Disabilities Assistance and Bill of Rights Act. Funding for the project is dependent on the results of a review process established by TCDD and on the availability of funds. Non-federal matching funds of at least 10% of the total project costs are required for projects in federally designated poverty areas. Non-federal matching funds of at least 25% of total project costs are required for projects in other areas.APPLICATION PROCESSAdditional information concerning this Request for Applications (RFA) and TCDD is available at https://tcdd.texas.gov/grants-rfas/funding-available-for-grants/. All questions pertaining to this RFA should be directed in writing to TCDD via email at apply@tcdd.texas.gov or via telephone at (512) 437-5432.Proposals must be submitted through https://tcdd.smapply.org/prog/lst/ and will be reviewed by TCDD according to the following schedule: applications received by 5:00 p.m. on June 22, 2020, may be reviewed at the August 2020 Council meeting; applications received by 5:00 p.m. on September 14, 2020, may be reviewed at the November 2020 Council meeting; applications received by 5:00 p.m. on December 14, 2020, may be reviewed at the February 2021 Council meeting; applications received by 5:00 p.m. on March 15, 2021, may be reviewed at the May 2021 Council meeting. Proposals will not be accepted outside of these due dates.

Texas Health and Human Services Commission

In Addition

Public Notice: Amendment to the Community Living Assistance and Support Services (CLASS) Waiver

OVERVIEWThe Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request to amend the Community Living Assistance and Support Services (CLASS) waiver administered under section 1915(c) of the Social Security Act. CMS has approved this waiver through August 31, 2024. The proposed effective date for the amendment is August 31, 2020.The CLASS waiver, provides community-based services and supports to eligible individuals who have a related condition as an alternative to an intermediate care facility for individuals with intellectual disabilities or a related condition. CLASS waiver services are intended to enhance an individual’s integration into the community, maintain or improve the individual’s independent functioning and quality of life, and prevent the individual’s admission to an institution. Services and supports should supplement, rather than replace, those available from other sources. These changes will not have an impact on cost neutrality of the CLASS waiver program.SECTION-BY-SECTION SUMMARYAppendix D: Removing performance measure D.e.2 and renumbering D.e.3 to D.e.2.Appendix E: Increasing the amount that may be included in a consumer-directed services budget for employer-related support activities.Appendix G: Changing the data source for performance measure G.a.4.Revising performance measure G.a.11 to achieve more accurate reporting.Revising performance measure G.c.1 to achieve more accurate reporting. Also changing the data source and sampling approach for performance measure G.c.1.

Texas Health and Human Services Commission

In Addition

Public Notice: Amendment to the Deaf Blind with Multiple Disabilities (DBMD) Waiver

OVERVIEWThe Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request to amend the Deaf Blind with Multiple Disabilities (DBMD) waiver administered under section 1915(c) of the Social Security Act. CMS has approved this waiver through February 28, 2023. The proposed effective date for the amendment is August 31, 2020.The DBMD waiver program serves individuals with legal blindness, deafness, or a condition that leads to deaf-blindness, and at least one additional disability that limits functional abilities. The program serves individuals in the community who would otherwise require care in an intermediate care facility for individuals with intellectual disability or a related condition. These changes will not have an impact on cost neutrality of the DBMD waiver program.SECTION-BY-SECTION SUMMARYAppendix D:Removing performance measure D.e.2 and renumbering D.e.3 to D.e.2.Appendix E:Setting a limit on the amount that may be included in a consumer-directed services budget for employer-related support activities.Appendix G:Changing the data source for performance measure G.a.4.Revising performance measure G.a.11 to achieve more accurate reporting. Also changing the data source and sampling approach for performance measure G.a.11.Appendix I:Adding a description of electronic visit verification.

Texas Health and Human Services Commission

In Addition

Public Notice: Amendment to the Home and Community-based Services (HCS) Waiver

OVERVIEWThe Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request to amend the Home and Community-based Services (HCS) waiver administered under section 1915(c) of the Social Security Act. CMS has approved this waiver through August 31, 2023. The proposed effective date for the amendment is August 31, 2020.The HCS waiver program provides services and supports to individuals with intellectual disabilities who live in their own homes, in the home of a family member, or in another community setting such as a small three-person or four-person residence operated by an HCS program provider.SECTION-BY-SECTION SUMMARYAppendix B:Updated the reserved capacity totals for certain target groups for waiver years two and three.Updated the Point in Time (PIT)/Factor C for waiver year two.Appendix C:Added requirement for program providers to receive a score of at least 85 percent on a provider competency exam as part of program provider enrollment.Removed performance measure C.a.3 and renumbered performance measures C.a.4 and C.a.5 relating to qualified providers.Added language regarding the imposition of administrative penalties as an additional method of remediation for program providers who do not comply with HCS rules.Clarified language regarding the date in a plan of correction by which a program provider must complete corrective action and the survey process for verification of correction action.Removed language regarding program providers receiving reimbursement for a payment made toward a deductible, co-payment, or denied service for a professional therapy covered by a third-party resource.Appendix D:Added language regarding the imposition of administrative penalties as an additional method of remediation for program providers who do not comply with HCS rules.Clarified language regarding the date in a plan of correction by which a program provider must complete corrective action and the survey process for verification of correction action.Renumbered performance measures D.e.2 and D.e.3 relating to the adequacy of service plans.Appendix E:Increased the amount that may be included in a consumer-directed services budget for employer-related support activities.Appendix F:Replaced references to CRS/CRID with “IDD Ombudsman” to reflect organizational changes at HHSC and described the IDD Ombudsman complaint investigation process.Appendix G:Added language regarding imposition of administrative penalties as an additional method of remediation for program providers who do not comply with HCS rules.Clarified language regarding the date in a plan of correction by which a program provider must complete corrective action and the survey process for verification of correction action.Replaced references to CRS/CRID with “IDD Ombudsman” to reflect organizational changes at HHSC and described the IDD Ombudsman complaint investigation process.Appendix I:Added requirement for program providers and financial management service agencies to use electronic visit verification for certain services and included description of process to monitor compliance with EVV requirements.Appendix J:Update the Point In Time/Factor C for waiver year two through five to demonstrate cost neutrality.

Texas Health and Human Services Commission

In Addition

Public Notice: Amendment to the Medically Dependent Children Program

OVERVIEWThe Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request to amend the Medically Dependent Children Program (MDCP) waiver administered under section 1915(c) of the Social Security Act. CMS has approved this waiver through August 31, 2022. The proposed effective date for the amendment is August 31, 2020.The MDCP waiver provides home and community-based services to persons under age 21 who are medically fragile through the STAR Kids and STAR Health programs and meet the requirements for nursing facility care. Services include respite, adaptive aids, minor home modifications, employment assistance, supported employment, financial management services, transition assistance services, and flexible family support services. Texas uses the MDCP waiver to provide services to Texans in the least restrictive environment possible. These environments include the individual’s or a family member’s home, or a Child Protective Services foster care home which can meet the individual’s complex medical needs.SECTION-BY-SECTION SUMMARYGeneral changes:Replaced the term “foster home” with “agency foster home” to reflect a change in state law.Expanded Consumer Directed Services per Texas House Bill (H.B.) 4533, 86th Legislative Session (2019).Appendix C:Updated the frequency of data collection/generation and added clarifying language to the following performance measures C.a.1, C.a.2, C.b.1, C.b.2 relating to qualified providers.Appendix D:Updated the following performance measures D.a.1, D.a.2, D.a.3, D.d.1, D.e.2 relating to the adequacy of service plans.Remove performance measure D.b.1 per CMS guidance.Add performance measure D.e.3.Appendix E:Increased the amount that may be included in a consumer-directed services budget for employer-related support activities.Appendix G:Update the frequency of data analysis for performance measure G.b.1 to “quarterly” and “continuously and ongoing.”Appendix I:Added language that Electronic Visit Verification is being utilized.Appendix J:Update the Factor C and Point In Time (PIT) numbers for waiver year three through waiver year five to demonstrate cost neutrality.These changes will not have an impact on cost neutrality of the MDCP waiver program.

Texas Health and Human Services Commission

In Addition

Public Notice: Amendment to the Texas Home Living (TxHmL) Waiver Program

OVERVIEWThe Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request for an amendment to the Texas Home Living (TxHmL) waiver program, a waiver implemented under the authority of section 1915(c) of the Social Security Act. CMS has approved this waiver through February 28, 2022. The proposed effective date for this amendment is August 31, 2020.TxHmL provides services and supports to individuals with intellectual disabilities who live in their own homes or in the home of a family member. Services and supports are intended to enhance quality of life, functional independence, and health and well-being in continued community-based living and to enhance, rather than replace, existing informal or formal supports and resources. Services include day habilitation, respite, supported employment, financial management services, support consultation, adaptive aids, audiology services, behavioral support, community support, dental treatment, dietary service, employment assistance, minor home modifications, occupational therapy services, physical therapy services, nursing, and speech-language pathology.SECTION-BY-SECTION SUMMARYAppendix B:Removed Breast and Cervical Cancer eligibility group.Added Medicaid Buy-In Children as an eligibility group served in the TxHmL Program.Appendix C:Removed performance measure C.a.3 and renumbered performance measures C.a.4 and C.a.5.Clarified language regarding the date in a plan of correction by which a program provider must complete corrective action and the survey process for verification of correction action.Appendix D:Clarified language regarding the date in a plan of correction by which a program provider must complete corrective action and the survey process for verification of correction action.Renumbered performance measures D.e.2 and D.e.3 relating to the adequacy of service plans.Appendix E:Increased the amount that may be included in a consumer-directed services budget for employer-related support activities.Appendix F:Replaced references to CRS/CRID with “IDD Ombudsman” to reflect organizational changes at HHSC and described the IDD Ombudsman complaint investigation process.Appendix G:Clarified language regarding the date in a plan of correction by which a program provider must complete corrective action and the survey process for verification of correction action.Replaced references to CRS/CRID with “IDD Ombudsman” to reflect organizational changes at HHSC and described the IDD Ombudsman complaint investigation process.Appendix I:Added requirement for program providers and financial management service agencies to use electronic visit verification for certain services and included description of process to monitor compliance with EVV requirements.

Texas Health and Human Services Commission

In Addition

Public Notice – Texas State Plan for Medical Assistance Amendments

OVERVIEWThe Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments are effective April 1, 2020.The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for the following:Ambulance Services;Ambulatory Surgical Centers;Birthing Center Facility Services;Case Management Services;Certified Pediatric Nurse Practitioners and Certified Family Nurse Practitioners;Certified Registered Nurse Anesthetists and Anesthesiologist Assistants;Chemical Dependency Treatment Facility Services;Clinical Diagnostic Laboratory Services;Community First Choice Services;Community Attendant Services;Day Activity and Health Services;Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS);Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT);Family Planning Services;Federally Qualified Health Centers;Graduate Medical Education;Hearing Aids and Audiometric Evaluations;Home Health Services;Hospice Services;Indian Health Services;Inpatient Hospital Services;Intermediate Care Facility Services;Licensed Clinical Social Worker Services;Licensed Professional Counselor Services;Licensed Marriage and Family Therapist Services;Medical Transportation;Nursing Facility Services;Outpatient Hospital Services;Personal Care Services;Physicians and Other Practitioners;Physician Assistants;Prescribed Pediatric Extended Care Centers;Primary Home Care services;Private Duty Nursing Services;Programs of All-Inclusive Care for the Elderly services;Rehabilitative Services;Renal Dialysis Facilities;Rural Health Clinics; andVision Care Services.Further detail on specific reimbursement rates and percentage changes is available on the HHSC Rate Analysis website under the proposed effective date at: http://rad.hhs.texas.gov/rate-packets.RATE HEARINGHHSC will conduct a public hearing for the proposed rate changes. Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only; no physical entry to the hearing will be permitted. For information on the date, time, and how to access the hearing, please continue to monitor the HHSC website at https://hhs.texas.gov/about-hhs/communications-events/meetings-events. Once available, information about the proposed rate changes and the hearing will also be published in a subsequent issue of the Texas Register at http://www.sos.state.tx.us/texreg/index.shtml.

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