Texas Register Table of Contents
- 1 Governor
- 2 Governor
- 3 Texas Health and Human Services Commission
- 4 Texas Medical Disclosure Panel
- 5 Texas Department of Insurance
- 6 Texas Department of Insurance
- 7 Texas Department of Insurance
- 8 Texas Health and Human Services Commission
- 9 Texas Health and Human Services Commission
- 10 Texas Department of Insurance
- 11 Texas Health and Human Services Commission
- 12 Texas Health and Human Services Commission
- 13 Advisory Board of Athletic Trainers
- 14 Texas Health and Human Services Commission
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Governor
Appointments
Governor appoints Sylvia Hernandez Kauffman as the Inspector General for Health and Human Services
Appointments for April 12, 2021Appointed as the Inspector General for Health and Human Services, for a term to expire February 1, 2022, Sylvia Hernandez Kauffman of Austin, Texas (Ms. Kauffman is being reappointed).
Governor
In Addition
Governor reappoints three members to the Texas Board of Respiratory Care
Appointments for April 12, 2021Appointed to the Texas Board of Respiratory Care, for terms to expire February 1, 2027: Timothy R. “Tim” Chappell, M.D. of Plano, Texas (Dr. Chappell is being reappointed);Sam G. “Gregg” Marshall, Ph.D. of Round Rock, Texas (Mr. Marshall is being reappointed);Kandace D. “Kandi” Pool of San Angelo, Texas (Ms. Pool is being reappointed).
Texas Health and Human Services Commission
Emergency Rule
New 26 TAC §500.21, updating operational requirements at End Stage Renal Disease Facilities to reduce barriers to treatment for dialysis patients
CHAPTER 500. COVID-19 EMEGENCY HEALTH CARE FACILITY LICENSINGSUBCHAPTER B. END STAGE RENAL DISEASE FACILITIES26 TAC §500.21OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 500 COVID-19 Emergency Health Care Facility Licensing, new §500.21, concerning an emergency rule in response to COVID-19 in order to update and continue the regulatory requirements for end stage renal disease (ESRD) facilities to reduce barriers to treatment during the COVID-19 pandemic.HHSC is adopting this emergency rule to reduce barriers to treatment for dialysis patients by updating ESRD facility regulatory guidelines regarding staffing ratios, in-home visits, telemedicine, incident reporting, and education and training requirements for staff.BACKGROUND AND JUSTIFICATION As authorized by Texas Government Code §2001.034, HHSC may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.The purpose of the emergency rulemaking is to support the Governor’s March 13, 2020 proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. HHSC accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this rule for ESRD Facility Requirements During the COVID-19 Pandemic.
Texas Medical Disclosure Panel
Proposed Rules
Amending 25 TAC §601.2 to modify the list of risks and hazards that must be disclosed for certain cardiovascular and respiratory procedures
CHAPTER 601. INFORMED CONSENT25 TAC §601.2OVERVIEWThe Texas Medical Disclosure Panel (Panel) proposes amendments to §601.2, concerning Procedures Requiring Full Disclosure of Specific Risks and Hazards–List A. Proposed amendments to §601.2 modify the list of procedures and risks and hazards in subsection (b) regarding the cardiovascular system and subsection (o) regarding respiratory system treatments and procedures. BACKGROUND AND JUSTIFICATION These amendments are proposed in accordance with Texas Civil Practice and Remedies Code §74.102, which requires the Panel to determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to their patients or persons authorized to consent for their patients and to establish the general form and substance of such disclosure. Section 601.2 contains the List A procedures requiring disclosure of specific risks and hazards to patients before being undertaken; §601.3 contains the List B procedures for which no disclosure of specific risks and hazards is required.
Texas Department of Insurance
Proposed Rules
Amending 28 TAC §3.5701 to require that health insurers retain certain statistical data
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIESSUBCHAPTER FF. CREDIT LIFE AND CREDIT ACCIDENT AND HEALTH INSURANCEDIVISION 7. EXPERIENCE CALL28 TAC §3.5701OVERVIEWThe Texas Department of Insurance (TDI) proposes to amend 28 TAC §3.5701, concerning statistical data and annual experience calls. SUMMARY OF CHANGES The amendments to §3.5701 add language to specify that insurers writing credit life insurance and accident and health insurance in Texas must keep statistical data for no less than five years and provide it to TDI upon request in a format specified by the Commissioner when requested, remove references to TDI’s mailing address and required forms, and remove the word “annual” when describing calls for credit call reports. The amendments add a new subsection (c), regarding calculations and work papers, stating that calculations and work papers will now be retained and made available upon the Commissioner’s request in the same manner as other credit life and accident and health insurance experience data. Proposed new subsection (c) is similar to current §3.5702(b), which is proposed for repeal. The amendments also capitalize “Commissioner” and change “if” to “whether” to adhere to current agency style.BACKGROUND AND JUSTIFICATION The current credit call rules found in 28 TAC §3.5701 and §3.5702 require insurers writing credit life insurance and accident and health insurance in Texas to send statistical and experience data to the TDI Life & Health Actuarial Office (LHAO) on an annual basis. However, there is no further administrative or statutory requirement that LHAO use the data.The amendments to §3.5701 and the repeal of §3.5702 would change the requirement to provide that credit call data instead be kept by each company and simply be made available upon TDI’s request. So rather than imposing an annual data reporting requirement, TDI will only request the data if the Commissioner needs it to determine whether rates are reasonable in relation to benefits afforded by a given policy contract together with appropriate expenses.The amendments and repeal would (1) streamline TDI resources and data management and (2) remove a reporting burden on companies, while still providing a process to preserve relevant data.
Texas Department of Insurance
Proposed Rules
Repealing 28 TAC §3.5702 to remove duplicative provisions requiring health insurers to report certain statistical data
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIESSUBCHAPTER FF. CREDIT LIFE AND CREDIT ACCIDENT AND HEALTH INSURANCEDIVISION 7. EXPERIENCE CALL28 TAC §3.5702OVERVIEWThe Texas Department of Insurance (TDI) proposes to repeal 28 TAC §3.2702, concerning instructions for preparing forms.The repeal of §3.5702 removes a section made obsolete by the amendments in §3.5701. The forms, filing instructions, and calculations described in §3.5702(a) and (b) are unnecessary, because any data will now be retained and made available upon the Commissioner’s request in the same manner as other credit life and accident and health insurance experience data. Figure: 28 TAC §3.5702(a) is unnecessary, because it lists the reporting forms, which will no longer be used. Finally, subsection (c) is unnecessary, because it details requirements to submit experience data that will be addressed under proposed amendments to §3.5701.BACKGROUND AND JUSTIFICATION The current credit call rules found in 28 TAC §3.5701 and §3.5702 require insurers writing credit life insurance and accident and health insurance in Texas to send statistical and experience data to the TDI Life & Health Actuarial Office (LHAO) on an annual basis. However, there is no further administrative or statutory requirement that LHAO use the data.The amendments to §3.5701 and the repeal of §3.5702 would change the requirement to provide that credit call data instead be kept by each company and simply be made available upon TDI’s request. So rather than imposing an annual data reporting requirement, TDI will only request the data if the Commissioner needs it to determine whether rates are reasonable in relation to benefits afforded by a given policy contract together with appropriate expenses.The amendments and repeal would (1) streamline TDI resources and data management and (2) remove a reporting burden on companies, while still providing a process to preserve relevant data.
Texas Department of Insurance
Proposed Rules
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIESSUBCHAPTER T. MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES28 TAC §3.3307OVERVIEWThe Texas Department of Insurance (TDI) proposes to amend 28 TAC §3.3307, concerning loss ratio standards and refund or credit of premiums.BACKGROUND AND JUSTIFICATION The current Medicare Supplement Data Call rule in 28 TAC §3.3307(f) requires Medicare supplement individual or group policy issuers to annually submit to TDI their refund or credit calculations on Medicare supplement insurance policies, to document the calculations they must make each year in determining any need to refund premiums to policyholders. TDI’s Actuarial Data Team currently collects this calculation data; however, there is no further requirement on the team to subsequently use it. This results in a depletion of TDI manpower and resources to create a large repository of frequently unused data.Amendments to §3.3307 would change the requirement to provide the data to TDI, to simply provide that issuers keep the data and make it available to TDI upon request. This change will ease this potentially costly burden on issuers, as they would no longer be required to annually file their calculations with TDI, while maintaining TDI’s access to that data when needed. Insurers would keep the calculations on file and make them available should the Commissioner need that information to review trends in loss ratio standards and refund or credit of premiums in the interest of consumer protection and market fairness.
Texas Health and Human Services Commission
Adopted Rules
New 1 TAC §353.1315 and §353.1317, updating payment provisions for rural health clinics within Medicaid MCO networks
CHAPTER 353. MEDICAID MANAGED CARESUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES1 TAC §353.1315, §353.1317OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts new §353.1315, concerning Rural Access to Primary and Preventive Services Program and new §353.1317, concerning Quality Metrics for Rural Access to Primary and Preventive Services Program.BACKGROUND AND JUSTIFICATION The purpose of the new rules is to describe the circumstances under which HHSC will direct a Medicaid managed care organization (MCO) to provide a uniform dollar amount in the form of prospective monthly payments and rate increases to rural health clinics (RHCs) in the MCO’s network in a participating service delivery area (SDA) for the provision of general medical services and tied to quality measurement. The rules also describe the methodology used by HHSC to determine the amounts of the payments and rate increases.HHSC is adopting these new rules as part of the new programs developed to transition from the Delivery System Reform Incentive Payment (DSRIP) program. HHSC anticipates that the increased payments to RHCs will support access to services, promote better health outcomes, and increase focus on improving quality goals of the Texas Medicaid program. Additional information about the new initiative is included in this week’s edition of the Texas Register (46 Tex Reg 2717).
Texas Health and Human Services Commission
Adopted Rules
Amending 1 TAC §355.8600 to establish enhanced supplemental payments for certain ambulance service providers
CHAPTER 355. REIMBURSEMENT RATESSUBCHAPTER J. PURCHASED HEALTH SERVICESDIVISION 31. AMBULANCE SERVICES1 TAC §355.8600OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.8600, concerning Reimbursement Methodology for Ambulance Services.BACKGROUND AND JUSTIFICATION The amendment to §355.8600 establishes enhanced supplemental payments to publicly owned ground emergency ambulance service providers. Publicly owned ground emergency ambulance providers currently receive fee-for-service payments to cover uncompensated care costs. Subject to approval by the Centers for Medicare and Medicaid Services, the amendment will make publicly owned ground emergency ambulance providers eligible for additional payments for services up to the average rate payable by commercial insurers for those same services.
Texas Department of Insurance
Adopted Rules
Amending 28 TAC §3.1 and §3.5 to remove references to “prepaid legal services” in rules governing life, accident, and health insurance and annuities
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIESSUBCHAPTER A. SUBMISSION REQUIREMENTS FOR FILINGS AND DEPARTMENTAL ACTIONS RELATED TO SUCH FILINGS28 TAC §3.1, §3.5OVERVIEWThe Commissioner of Insurance adopts amendments to 28 TAC §3.1 and §3.5, relating to life, accident, and health insurance and annuities.BACKGROUND AND JUSTIFICATION The amended sections are necessary to remove references to “prepaid legal services,” which is comprised of both for-profit legal services, which were removed from TDI’s regulation by Senate Bill 597, 78th Legislature, 2003 (SB 597), and nonprofit legal services, which were removed from TDI’s regulation by Senate Bill 1623, 86th Legislature, 2019 (SB 1623).
Texas Health and Human Services Commission
In Addition
Correction of error in the publication of adopted new 26 TAC §564.28, which implemented restrictions on certain out-of-network billing practices for substance-use disorder treatment facilities
The Health and Human Services Commission (HHSC) proposed new 26 TAC §564.28 in the December 18, 2020, issue of the Texas Register (45 TexReg 9108). The new rule was adopted in the April 9, 2021 issue of the Texas Register (46 TexReg 2435).Due to an error by HHSC, the rule was published in the incorrect subchapter. The rule should be included in Subchapter C (Operational Requirements), not Subchapter B (Licensing Requirements).
Texas Health and Human Services Commission
In Addition
HHSC will conduct a public hearing on proposed Medicaid payment rates for the special review of Medical Transportation Program
OVERVIEWThe Texas Health and Human Services Commission (HHSC) will conduct a public hearing on May 4, 2021, at 9:00 a.m., to receive comment on proposed Medicaid payment rates for the Medical Transportation Program (MTP). THE PROPOSALThe payment rates for MTP are proposed to be effective June 1, 2021.A briefing packet describing the proposed payment rates will be made available at https://rad.hhs.texas.gov/rate-packets on or after April 23, 2021. Interested parties may obtain a copy of the briefing packet on or after that date by contacting Provider Finance by telephone at (512) 730-7401; by fax at (512) 730-7475; or by e-mail at PFDAcuteCare@hhsc.state.tx.us.HEARING DETAILSDue to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. Registration for the HHSC Public Rate Hearing for MTP to be held on May 4, 2021, 9:00 a.m. CDT can be found using the following link:https://attendee.gotowebinar.com/register/9158923477462333451PUBLIC COMMENTSWritten comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5 p.m. the day of the hearing. Written comments may be sent by U.S. mail, overnight mail, email, or fax to addresses listed in this week’s edition of the Texas Register (46 Tex Reg 2856).
Advisory Board of Athletic Trainers
In Addition
HHSC requests waivers of certain EVV claim requirements for services rendered during Winter Storm Uri
OVERVIEWDue to a statewide emergency resulting from Winter Storm Uri, the Health and Human Services Commission (HHSC) submitted a request to the Centers for Medicare and Medicaid Services (CMS) to amend the waiver application for the following waivers through an Appendix K: • Deaf Blind with Multiple Disabilities (DBMD); • Youth Empowerment Services (YES); • Texas Home Living (TxHmL); • Home and Community-based Services (HCS); and • Medically Dependent Children Program (MDCP).HHSC administers the above waiver programs under the authority of §1915(c) of the Social Security Act. The proposed effective date for the amendment is February 10, 2021, with an end date of February 24, 2021.BACKGROUND AND JUSTIFICATIONThe DBMD, YES, TxHmL, HCS, and MDCP waivers require that a claim for an EVV-required service (“EVV claim”) be denied if critical data elements on the EVV claim don’t match the EVV visit transaction. HHSC is requesting a waiver of this requirement so that the claims matching process will be temporarily suspended, allowing HHSC or the managed care organization in the MDCP waiver to pay an EVV claim for a date of service during the period of February 10, 2021 to February 24, 2021 that doesn’t match the EVV visit transaction. The claims matching process compares an EVV visit transaction to an EVV claim of a provider or financial management services agency prior to the payment of the claim.A temporary suspension of the claims matching process would allow providers and financial management services agencies to receive payment while they collect and manually enter EVV visit transactions that could not be entered during the storm. HHSC is not requesting that CMS waive the requirement that providers use the EVV system to document service delivery.Although the EVV systems remained functional throughout the disaster, massive power and communication network outages prevented some service providers from using the EVV systems to clock in and out in real time, resulting in a backlog of manual entries for program providers, financial management services agencies, and consumer directed services employers.CMS has determined that public notice requirements normally applicable under 1915(c) do not apply to information contained in an Appendix K. Therefore, states applying for §1915(c) Appendix K amendments are not required to conduct a public notice and input process.
Texas Health and Human Services Commission
In Addition
HHSC plans to submit amendment to the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver (effective October 1, 2021)
OVERVIEWThe Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver under section 1115 of the Social Security Act. The current waiver is approved through September 2030. The proposed effective date for this amendment is October 1, 2021.PROPOSED CHANGESSpecifically, SB 1096 removes all the Preferred Drug List (PDL) prior authorizations (PAs) for all members of the STAR Kids program except those PAs based on evidence-based clinical criteria and nationally recognized peer-reviewed information, and those PAs designed to minimize waste, fraud, or abuse. This amendment will not result in any changes to the formulary. This amendment will give a member the opportunity to be prescribed any drug whether there is preferred or non-preferred status although a member will not have access to drugs not covered by Medicaid.HHSC is proposing to waive requirements in 42 CFR §440.240, related to comparability of services for groups, because only members of the STAR Kids program will be allowed this option. 42 CFR §440.240 requires the services available to any categorically needy beneficiary under the plan are not less in amount, duration, and scope than those services available to a medically needy beneficiary; and the services must be available to any individual in the following groups are equal in amount, duration, and scope for all beneficiaries within the group: (1) The categorically needy and (2) A covered medically needy group.
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