Texas Register Table of Contents
Governor
Proclamations Re:
Proclamation 41-3947, concerning the COVID-19 response.
TO ALL TO WHOM THESE PRESENTS SHALL COME:
WHEREAS, 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 COVID-19 poses an imminent threat of disaster for all counties in the State of Texas; and
WHEREAS, in each subsequent month effective through today, I have issued proclamations renewing the disaster declaration for all Texas counties; and
WHEREAS, pursuant to the Texas Disaster Act of 1975, I have issued a series of executive orders and suspensions of Texas laws aimed at protecting the health and safety of Texans, ensuring uniformity throughout the State, and achieving the least restrictive means of combatting the evolving threat posed by COVID-19; and
WHEREAS, Executive Orders GA-13, GA-37, GA-38, GA-39, and GA-40 remain in effect with “the force and effect of law” under Section 418.012 of the Texas Government Code; and
WHEREAS, ending the disaster declaration would terminate the executive orders that protect Texans’ freedom by suspending the power of local governments to require masks, compel vaccinations, and close businesses; and
WHEREAS, I intend to keep these executive orders and suspensions in place until the Legislature can enact laws this session to prohibit local governments from imposing restrictions like mask mandates and vaccine mandates; and
WHEREAS, renewing the disaster declaration in no way infringes on the rights or liberties of any law-abiding Texans; and
WHEREAS, under the Texas Disaster Act of 1975, a state of disaster continues to exist in all counties during Texas’s successful economic recovery from COVID-19;
NOW, THEREFORE, in accordance with the authority vested in me by Section 418.014 of the Texas Government Code, I do hereby renew the disaster proclamation for all counties in Texas.
Texas Health and Human Services Commission
Proposed Rules Re:
New 1 TAC §§353.1501 – 353.1506, concerning the establishment of policies and procedures that allow a Medicaid managed care organization (MCO) to conduct assessments and provide care coordination services using telecommunications and information technology
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER R. TELECOMMUNICATIONS IN MANAGED CARE SERVICE COORDINATION AND ASSESSMENTS
1 TAC §§353.1501 – 353.1506
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §353.1501, concerning Purpose; §353.1502, concerning Definitions; §353.1503, concerning Use of Telecommunications in Assessments; §353.1504, concerning Use of Telecommunications in Service Coordination and Service Management; §353.1505, concerning Additional Requirements for Assessments and Service Coordination in STAR+PLUS and STAR Kids; and §353.1506, concerning Additional Requirements for Assessments and Service Management in STAR Health in new Subchapter R, concerning Telecommunications in Managed Care Service Coordination and Assessments.
BACKGROUND AND PURPOSE
The proposed new rules implement Texas Government Code §533.039, as added by House Bill (H.B.) 4, 87th Texas Legislature, Regular Session, 2021. Section 533.039 of the Texas Government Code requires HHSC to establish by rule policies and procedures that allow a Medicaid managed care organization (MCO) to conduct assessments and provide care coordination services using telecommunications and information technology, to the extent permitted by federal law.
During rule development, HHSC considered a number of factors, including the following statutorily-required considerations: (1) the extent to which a managed care organization determines using the telecommunications or information technology is appropriate; (2) whether the recipient requests an assessment or service coordination visit using telecommunications or information technology; (3) whether the recipient consents to the use of telecommunications or information technology; (4) the feasibility of conducting in-person visits during a public health emergency or natural disaster; and (5) whether HHSC finds the use of telecommunications or information technology is appropriate under the circumstances.
HHSC consulted with the Centers for Medicare & Medicaid Services (CMS) for guidance related to the implementation of H.B. 4. CMS advised that Texas must deploy an assessment method that is adequate to develop a person-centered plan that meets the requirements in the Code of Federal Regulations (CFR) Title 42 §441.301(c)(2). CMS further advised that Texas must meet the health and welfare assurances in 42 CFR §441.302 for each waiver participant and determine if its assessment tools require in-person visual observations.
SECTION-BY-SECTION SUMMARY
- Proposed new §353.1501 affirms that the purpose of the rules in new Subchapter R is to establish requirements for the use of telecommunications in Medicaid managed care for service coordination and assessments conducted by MCOs who contract with HHSC.
- Proposed new §353.1502 contains definitions for terms used in new Subchapter R.
- Proposed new §353.1503 details requirements applicable to assessments. MCOs must conduct initial assessments and annual reassessments using HHSC-developed tools in-person, including tools for STAR+PLUS Home and Community Based Services eligibility, STAR Kids (Screening and Assessment Instrument), and STAR Health for Medically Dependent Children Program eligibility (Screening and Assessment Instrument). In STAR+PLUS, STAR Kids, and STAR Health, initial and annual functional reassessments using HHSC-developed tools for services such as personal assistance services, personal care services, and Community First Choice must also be conducted in person. Change in condition assessments that require or potentially require a change in the Resource Utilization Group (RUG) level must be conducted in person. For change in condition assessments that do not require or potentially require a change in the RUG level, the MCO may offer members a choice of audio-visual communication in place of in-person, if the MCO obtains and documents verbal consent.
- Proposed new §353.1504 details requirements applicable to service coordination or service management. Members of the STAR+PLUS program who are designated at levels 1 or 2 for service coordination must receive at least one in-person service coordination visit per year. Similarly, all STAR Kids members must receive at least one in-person service coordination visit per year. An in-person assessment in STAR+PLUS and STAR Kids, as required in proposed new §353.1503, satisfies the annual in-person service coordination visit required for level 1 and 2 members in STAR+PLUS and the annual in-person service coordination visit in STAR Kids. MCOs may offer members in STAR+PLUS and STAR Kids a choice of audio-visual communication for service coordination in place of an in-person visit if no assessment is occurring. The proposed rules specify requirements around audio-visual service coordination, including the responsibility of the MCO to obtain and document member or member legally authorized representative verbal approval for the use of audio-visual communication during a service coordination visit. STAR Health MCOs may offer a choice of audio-visual or telephonic communication service management in place of an in-person visit if no assessment is occurring.
- Proposed new §353.1505 contains additional requirements related to assessments and service coordination in STAR+PLUS and STAR Kids. Information technology, including text or email, may not be used as the sole means of conducting an assessment or service coordination, but may supplement audio-visual or in-person assessments. HHSC may also require an MCO to discontinue service coordination or assessments using telecommunications on a case-by-case basis, if HHSC determines that the discontinuation is in the best interest of the member. The proposed rule contains requirements for an MCO to obtain verbal consent for audio-visual communication in place of an in-person visit and allows an MCO to use their discretion on how to document verbal consent, but requires the MCO to produce the documentation of verbal consent for audit and compliance purposes. The proposed rule requires an MCO to honor a member’s request for in-person service coordination or assessments unless HHSC issues direction to MCOs during a declared state of disaster that service coordination or assessments must be conducted using audio-only communication or audio-visual communication due to the specific nature of a governor declared disaster.
- Proposed new §353.1506 contains additional requirements related to assessments and service management in STAR Health. The proposed new rule contains requirements similar to the requirements in proposed new §353.1505 for STAR+PLUS and STAR Kids. The proposed rule allows an MCO to use their discretion on how to document verbal consent, but requires the MCO to produce the documentation of verbal consent for audit and compliance purposes. The proposed rule requires an MCO to honor a member’s request for in-person service coordination or assessments unless HHSC issues direction to MCOs during a declared state of disaster that service management or assessments must be conducted using audio-only communication or audio-visual communication due to the specific nature of a governor declared disaster.
Adopted Rules Re:
Amending 1 TAC §377.107, removing an outdated reference to the Internal Revenue Code relating to the HHSC contract with Texas Court Appointed Special Advocates (CASA).
CHAPTER 377. CHILDREN’S ADVOCACY PROGRAMS
SUBCHAPTER B. STANDARDS OF OPERATION FOR LOCAL COURT-APPOINTED VOLUNTEER ADVOCATE PROGRAMS
1 TAC §377.107
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §377.107, concerning Contract with Statewide Volunteer Advocate Organization. The amendment to §377.107 is adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5550). The rule will not be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to comply with Senate Bill (S.B.) 1156, 87th Legislature, Regular Session, 2021, which requires HHSC to remove the requirement for the statewide organization for the volunteer advocate for children program to be designated as a supporting organization under §509(a)(3) of the Internal Revenue Code.
Texas Department of State Health Services
Adopted Rules Re:
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER K. HOSPITAL LEVEL OF CARE DESIGNATIONS FOR MATERNAL CARE
25 TAC §§133.201 – 133.211
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §133.201, concerning Purpose; §133.202, concerning Definitions; §133.203, concerning General Requirements; §133.204, concerning the Designation Process; §133.205, concerning Program Requirements; §133.206, concerning Maternal Designation Level I; §133.207, concerning Maternal Designation Level II; §133.208, concerning Maternal Designation Level III; §133.209, concerning Maternal Designation Level IV; §133.210, concerning the Survey Team; and new §133.211 concerning the Perinatal Care Regions.
The amendments to §§133.202 – 133.210 are adopted with changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3888) and the sections will be republished. Sections 133.201 and 133.211 are adopted without changes and will not be republished.
BACKGROUND AND JUSTIFICATION
The adoption updates the content and processes with the advances and practices since the rules were adopted in 2018. Senate Bill (S.B.) 749, 86thLegislature, Regular Session, 2019, amended Texas Health and Safety Code, Chapter 241. S.B. 749 requires language specific to waiver agreements, a three-person appeal panel for designation reviews, and language specific to telemedicine and telehealth be integrated into the maternal rules.
House Bill (H.B.) 1164, 87th Legislature, Regular Session, 2021, amended Texas Health and Safety Code, Chapter 241. H.B. 1164 added statutes concerning patient safety practices for placenta accreta spectrum disorder (PASD) in hospitals with maternal levels of care designation. As part of the standards for designation, hospitals must implement patient safety practices for screening, evaluation, diagnosis, treatment, management, and reporting of PASD for all maternal patients and integrate these measures into their maternal Quality Assessment and Performance Improvement (QAPI) Plan.
DSHS worked in collaboration with the Perinatal Advisory Council’s (PAC) subcommittee assigned to address the PASD patient safety practices. The PAC used data collected by DSHS in its analysis and recommendations. The PAC considered recommendations and publications of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, including the publication “Guidelines for Perinatal Care.” The PAC reviewed guidelines by the Society of Maternal-Fetal Medicine, the geographic and varied needs of citizens of this state, and the patient safety practices adopted under Texas Health and Safety Code §241.1837. The PAC and DSHS solicited comments from physicians who practice in the evaluation, diagnosis, treatment, and management of placenta accreta spectrum disorder; other health professionals who practice in the evaluation, diagnosis, treatment, and management of placenta accreta spectrum disorder; health researchers with expertise in placenta accreta spectrum disorder; representatives of patient advocacy organizations; and other interested persons during the rule development.
A similar PAC subcommittee addressed the rule language specific to integrating the telehealth and telemedicine into the maternal rules.
The PAC formed a workgroup to collaborate with DSHS staff to review the comments received and determine the most appropriate language to ensure the health and safety of pregnant patients and prevent any unnecessary burden on the facilities providing maternal care.
In Addition Re:
Licensing Actions for Radioactive Materials
For more information, please visit this week’s edition of the Texas Register 47 Tex Reg 9068.
Licensing Actions for Radioactive Materials
For more information, please visit this week’s edition of the Texas Register 47 Tex Reg 9075.