Texas Register January 29, 2021 Volume: 46 Number: 5

Governor

 

Appointments

Governor appoints seven new members to the Texas Medical Board District Three Review Committee

Appointments for January 14, 2021Appointed to the Texas Medical Board District Three Review Committee, for terms to expire January 15, 2022:Celeste Caballero, M.D. of Lubbock, Texas (replacing Jayaram B. “Jay” Naidu, M.D. of Odessa, whose term expired);Mindi L. McLain of Amarillo, Texas (replacing Nancy Seliger of Amarillo, whose term expired).Appointed to the Texas Medical Board District Three Review Committee, for terms to expire January 15, 2024: Ogechika K. “Oge” Alozie, M.D. of El Paso, Texas (replacing Surendra Kumar Varma, MD. of Lubbock, whose term expired).Taylor A. Gillig of Arlington, Texas (replacing David W. Miller, Ph.D. of Abilene, whose term expired).Gabrielle H. Rich, D.O. of Big Spring, Texas (replacing John S. Scott, Jr., D.O. of Keller, whose term expired).Appointed to the Texas Medical Board District Three Review Committee, for terms to expire January 15, 2026:Michael N. Burley of Southlake, Texas (replacing Betty Lou “Penny” Angelo of Midland, whose term expired).Sharmila Dissanaike, M.D. of Lubbock, Texas (replacing John P. McKinley, M.D. of Amarillo, whose term expired).

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Governor

Appointments

Governor appoints six new members to the Texas Medical Board District Four Review Committee

Appointments for January 14, 2021Appointed to the Texas Medical Board District Four Review Committee, for terms to expire January 15, 2022Ada L. Booth, M.D. of Corpus Christi, Texas (replacing Leah Raye Mabry, M.D. of San Antonio, whose term expired);Walton “Boyd” Bush, Jr., Ed.D. of Bee Cave, Texas (replacing James Hinton Dickerson, Jr. of New Braunfels, whose term expired).Appointed to the Texas Medical Board District Four Review Committee, for terms to expire January 15, 2024:Leanne Burnett, M.D. of Fresno, Texas (replacing Richard K. Newman, M.D. of San Antonio, whose term expired);Phillip W. “Phil” Worley of Hebbronville, Texas (replacing Annette P. Raggette of Austin, whose term expired).Appointed to the Texas Medical Board District Four Review Committee, for terms to expire January 15, 2026:Ruth Villarreal of Mission, Texas (replacing Phillip W. “Phil” Worley of Hebbronville, whose term expired);Andrew J. “Jimmy” Widmer, M.D. of Belton, Texas (replacing Robert E. “Hoot” Hootkins, MD., Ph.D. of Austin, whose term expired).

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Governor

Appointments

Governor appoints new member and reappoints one existing member to the Advisory Council on Emergency Medical Services

Appointments for January 19, 2021Appointed to the Advisory Council on Emergency Medical Services, for terms to expire January 1, 2026:James M. “Mike” DeLoach of Littlefield, Texas (Judge Deloach is being reappointed);Della M. Johnson of Mesquite, Texas (replacing Jorie D. Klein of Dallas, whose term expired).

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Texas Medical Board

Emergency Rule

Amending 22 TAC §187.2 and §187.6 to the use of videoconference in conducting Board investigations

CHAPTER 187. PROCEDURAL RULESSUBCHAPTER A. GENERAL PROVISIONS AND DEFINITIONS22 TAC §187.2, §187.6OVERVIEWThe Texas Medical Board (Board) adopts, on an emergency basis, amendments to 22 TAC §§187.2(6) and 187.6, relating to “Definitions” and “Appearances Personally or by Representative.” The amendments are effective immediately upon filing.The emergency amendment to §187.2(6) adds a definition of “appear/appearance” and the amendments to §187.6 are conforming amendments to incorporate consistent usage of the term “appear” and “appearance.”BACKGROUND AND EXPLANATION There is currently a sharp increase in COVID-19 cases in certain areas of Texas. Further, the COVID-19 cases and hospitalizations continue to increase in Texas and there is possibly a more transmissible variant that has been identified. Thus, the emergency amendment is necessary to facilitate safe continuity of operations of the Texas Medical Board with respect to resolution of complaint investigations. These complaint investigations and disciplinary process comprise essential functions of the Board. The Board currently has approximately 175 cases postponed. The emergency amendment will provide the Board with the ability to implement maximum safety measures mitigating against the spread of COVID-19.Pursuant to §2001.034 and §2001.036(a)(2) of the Texas Government Code, the emergency amendment is adopted on an emergency basis and with an expedited effective date because an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. The emergency amendment will eliminate potential unnecessary exposure to COVID-19 for agency staff, gubernatorial appointees (including physicians and other health professionals), complainants (including patients and/or family members), licensees, and their representatives when addressing complaints through Informal Show Compliance Proceedings and Settlement Conferences (ISC).In order to comply with public health officials’ recommendations about how to protect against the spread of COVID-19, the emergency rules provide a means of providing maximum safety measures (virtually eliminating potential exposure) when conducting statutorily required ISCs regarding alleged violations of the Medical Practice Act and other applicable laws. In addition, the rules eliminate unnecessary expenditure of state funds during a time of decreased state revenue. The rules also provide adequate means for licensees and their representatives to respond to and address alleged violations of laws regarding the practice of medicine through the statutory ISC process.

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Texas Health and Human Services Commission

Emergency Rule

New 26 TAC §306.1351, establishing flexible procedures for the behavioral health delivery system in response to COVID-19

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEMSUBCHAPTER Z. EMERGENCY RULEMAKING26 TAC §306.1351OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 306 Behavioral Health Delivery System, new §306.1351, concerning an emergency rule in response to COVID-19, in order to reduce the risk of transmission of COVID-19, and to ensure continuity of services for individuals receiving community-based mental health services.HHSC is adopting this emergency rule to establish flexibility of certain requirements to: allow alternative methods other than face-to-face contact or in-person interactions, such as the use of telehealth, telemedicine, video-conferencing, or telephonic methods; allow virtual platforms instead of a specific physical space or in-person interactions, such as the use of a telephone or videoconferencing; allow a child or adolescent participating in the YES Waiver Program to reside with another responsible adult as the child or adolescent may not be residing with his or her legally authorized representative due to COVID-19 if the Centers for Medicare & Medicaid Services approves HHSC’s request for activation of Appendix; and rules under Title 25, Part 1 and Title 26, Part 1 of the TAC that require staff training through face-to-face or in person or a specific physical space or on site.BACKGROUND AND JUSTIFICATION As authorized by Texas Government Code §2001.034, the Commission 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 renewal on December 6, 2020 of the 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 emergency rulemaking in response to COVID-19.

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Texas Health and Human Services Commission

Emergency Rule

Renewing 26 TAC §500.1, which allows certain licensed hospitals to operate an off-site inpatient facility without obtaining a new license during the COVID-19 crisis

CHAPTER 500. COVID-19 EMERGENCY HEALTH CARE FACILITY LICENSINGSUBCHAPTER A. HOSPITALS26 TAC §500.1OVERVIEWThe Health and Human Services Commission is renewing the effectiveness of emergency new §500.1 for a 60-day period. The text of the emergency rule was originally published in the October 2, 2020, issue of the Texas Register (45 TexReg 6833).HHSC is renewing this emergency rule to allow a currently licensed hospital to operate an off-site inpatient facility without obtaining a new license at: (1) another type of facility currently licensed or licensed within the past 36 months or a facility pending licensure that has passed its final architectural review inspection, such as an ambulatory surgical center, an assisted living facility, a freestanding emergency medical care facility, an inpatient hospice unit, a mental hospital, or a nursing facility; (2) an outpatient facility operated by the hospital; (3) a formerly licensed hospital that closed within the past 36 months or a hospital pending licensure that has passed its final architectural review inspection; (4) a hospital exempt from licensure; and (5) a mobile, transportable, or relocatable unit.BACKGROUND AND JUSTIFICATION As authorized by Texas Government Code §2001.034, the Commission 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. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this emergency rule for Hospital Off-Site Facilities in Response to COVID-19.

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Texas Department on Aging and Disability Services

Emergency Rule

Amending 40 TAC §30.14 to allow assessments for continued Medicaid eligibility to be conducted using telemedicine

CHAPTER 30. MEDICAID HOSPICE PROGRAMSUBCHAPTER B. MEDICAID HOSPICE PROGRAM40 TAC §30.14OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 40 Texas Administrative Code, Chapter 30, Medicaid Hospice Program, an amendment to §30.14(e), concerning an emergency rule in response to COVID-19 in order to allow determination of an individual’s continued eligibility for hospice care for a period of care after the initial period through a telemedicine medical service. HHSC is adopting this emergency amendment to §30.14(e) to allow a hospice physician or hospice advanced practice registered nurse to determine an individual’s continued eligibility for hospice care for a period of care, after the initial period, through a telemedicine medical service, as defined in Texas Government Code §531.001(8). This amendment will reduce the risk of transmitting COVID-19.BACKGROUND AND JUSTIFICATION As authorized by Texas Government Code §2001.034, the Commission 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 emergency amendment to §30.14, concerning Certification of Terminal Illness and Record Maintenance.

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Texas Health and Human Services Commission

Proposed Rules

Amending 1 TAC §353.1315 and §353.1317 to establish when a Medicaid MCO must provide a uniform dollar amount in the form of prospective monthly payments and rate increases for certain rural health services

CHAPTER 353. MEDICAID MANAGED CARESUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES1 TAC §353.1315, §353.1317OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes 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 proposed 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 for certain services tied to quality measurement to rural health clinics (RHCs) in the MCO’s network in a participating service delivery area (SDA) for the provision of general medical services. The proposed rules also describe the methodology used by HHSC to determine the amounts of the payments and rate increases.HHSC is proposing 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.RHCs provide access to primary and preventive care and chronic disease management to rural residents and help to avoid potentially preventable emergency departments visits and hospitalizations, which increase Medicaid costs. The program’s quality objectives are supported by the results from the DSRIP Transition Best Practices Workgroup, particularly related to measures tracking improvement in primary care related services..In May 2016, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that allows a state to direct expenditures under its contract with an MCO under certain limited circumstances. Under the federal rule, a state may direct an MCO to raise rates for a class of providers of a particular service by a uniform dollar amount or percentage, or as a performance incentive, subject to approval of the contract arrangements by CMS. To obtain approval, the arrangements must be based on the utilization and delivery of services; direct expenditures equally, and using the same terms of performance, for a class of providers of a particular service; advance at least one of the goals and objectives of the state’s managed care quality strategy and have an evaluation plan to measure the effectiveness of the arrangements at doing so; not condition provider participation on an intergovernmental transfer (IGT); and not be automatically renewed.These proposed rules authorize HHSC to use IGTs from non-state governmental entities to support managed care capitation payment increases in one or more SDAs. Each MCO within the SDA would then be contractually required by the state to provide a uniform dollar amount in the form of a prospective monthly payment and a percentage rate increase for certain services for RHCs.

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Texas Health and Human Services Commission

Proposed Rules

Amending 1 TAC §353.1320 and §353.1322 to establish when a Medicaid MCO must provide a uniform dollar amount in the form of prospective monthly payments and rate increases for certain behavioral health services

CHAPTER 353. MEDICAID MANAGED CARESUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES1 TAC §353.1320, §353.1322OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §353.1320, concerning Directed Payment Program for Behavioral Health Services; and new §353.1322, concerning Quality Metrics for the Directed Payment Program for Behavioral Health Services.BACKGROUND AND JUSTIFICATION The purpose of the proposed new rules is to describe the circumstances under which HHSC will direct a Medicaid managed care organization (MCO) to provide a uniform percentage rate increase and a uniform dollar increase in the form of prospective monthly payments to community mental health centers (CMHCs) in the MCO’s network in a participating service delivery area (SDA) for the provision of services by CMHCs. The proposed rules also describe the methodology used by HHSC to determine the amounts of the rate and dollar increases.HHSC is encouraging CMHCs to earn certification as Certified Community Behavioral Health Clinics (CCBHC) to implement processes and delivery of care that are consistent with the CCBHC model. Currently, Medicaid payments to CMHCs that are either CCBHC entities or in the process of getting certified, made through either the fee-for-service (FFS) or managed care models, may not cover all costs of Medicaid allowable services provided by CMHCs. HHSC is proposing these rules to establish a new program developed under the Delivery System Reform Incentive Payment program (DSRIP) Transition Plan.HHSC anticipates that the increased payments to participating CMHCs will sustain access to services, promote better health outcomes, and increase focus on improving quality goals that are established as part of the Texas Medicaid program.In May 2016, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that allows a state to direct expenditures under its contract with MCOs under certain limited circumstances. Under the federal rule, a state may direct an MCO to raise rates for a class of providers of a particular service by a uniform dollar amount or percentage, or as a performance incentive, subject to approval of the contract arrangements by CMS. To obtain approval, the arrangements must be based on the utilization and delivery of services; direct expenditures equally, and using the same terms of performance, for a class of providers of a particular service; advance at least one of the goals and objectives of the state’s Medicaid quality strategy and have an evaluation plan to measure the effectiveness of the arrangements at doing so; not condition provider participation on an intergovernmental transfer (IGT); and not be automatically renewed.These proposed rules authorize HHSC to use IGTs from sponsoring governmental entities to support MCO capitation payment increases in one or more SDAs. Each MCO within the SDA would then be contractually required by the state to increase payments by a uniform percentage and dollar amount for the applicable component, respectively, for one or more classes of CMHCs that provide services within the SDA.

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Texas Health and Human Services Commission

Proposed Rules

Replacing current 26 TAC, Chapter 553 with new Chapter 553 to update and clarify licensing procedures for Assisted Living Facilities

OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Title 26, Texas Administrative Code (TAC), Chapter 553, Licensing Standards for Assisted Living Facilities, in its entirety. In its place, HHSC proposed new 26 TAC, Chapter 553. SECTION-BY-SECTION SUMMARY A detailed summary of the provisions included in proposed new 26 TAC, Chapter 553 is included in this week’s edition of the Texas Register (46 Tex Reg 708).BACKGROUND AND JUSTIFICATION The purpose of the proposal is to implement changes made to the Texas Health and Safety Code, Chapters 81 and 247 by House Bill (H.B.) 823, 1848, and 3329, 86th Legislature, Regular Session, 2019. H.B. 823 implements an expedited inspection process that allows an applicant for an assisted living facility license, or renewal of a license, to obtain an on-site health inspection not later than the 21st day after the date the request is made. H.B. 1848 amends the requirements of a long-term care facility’s infection prevention and control program to include monitoring of key infectious agents, including multidrug-resistant organisms and procedures for making rapid influenza diagnostic tests available to facility residents. H.B. 3329 amends the meaning of a long-term care facility to state that a facility may provide health maintenance activities, as defined by the Texas Board of Nursing.This proposal amends the licensure process to reflect the transition from paper applications to the use of the online licensure portal, called Texas Unified Licensure Information Portal (TULIP), and clarifies other processes relating to licensure. The proposal reorganizes the chapter in order that topics in the rules are easier to locate and provisions on related subjects are grouped together to facilitate navigation within the rules. The proposal also updates rule references throughout the chapter in response to the administrative transfer of the chapter from 40 TAC, Chapter 92, to 26 TAC, Chapter 553. The proposal also updates the agency name throughout the chapter from the Department of Aging and Disability Services (DADS) to HHSC.

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Texas Department of Insurance

Adopted Rules

The Division of Workers’ Compensation amends 28 TAC §133.307 to allow the electronic submission of Medical Fee Dispute Resolution requests

CHAPTER 133. GENERAL MEDICAL PROVISIONSSUBCHAPTER D. DISPUTE OF MEDICAL BILLS28 TAC §133.307OVERVIEWThe Texas Department of Insurance, Division of Workers’ Compensation (DWC or division) adopts amendments to 28 TAC §133.307 (concerning MDR of Fee Disputes) to allow health care providers and pharmacy processing agents to electronically submit requests for medical fee dispute resolution (MFDR). The amendments are adopted with one change to the proposed text published in the October 9, 2020, issue of the Texas Register (45 TexReg 7207). The rule will be republished. The effective date of these amendments, as described in §133.307(a)(4), will be February 22, 2021.SECTION-BY-SECTION SUMMARYA detailed summary of changes made by the amendments is included in this week’s edition of the Texas Register (46 Tex Reg 827).BACKGROUND AND JUSTIFICATION Section 133.307 applies to a request to DWC for MFDR as authorized by the Texas Workers’ Compensation Act. It was last amended in 2012. Currently, requestors can submit MFDR requests by mail and hand-delivery. Injured employees may also submit requests by fax. The amendments are necessary to allow electronic transmission in the form and manner described in 28 TAC §102.5 (concerning General Rules for Written Communications to and from the Commission) to increase convenience and reduce costs associated with fee disputes. As provided by §102.5(h), “Electronic transmission is defined as transmission of information by facsimile, electronic mail, electronic data interchange or any other similar method and does not include telephonic communication.”Under these amendments, electronic filing will be accepted through fax, secure file transfer protocol (SFTP), or encrypted email. About 70% of the MFDR requests DWC receives are submitted by 15 entities. Moving those requests to electronic transmission should significantly reduce the time and costs spent managing paper mail.

Texas Health and Human Services Commission

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Long Acting Reversible Contraceptives (LARCs) Fee Review

OVERVIEWThe Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 5, 2021, at 9:00 a.m., to receive comment on proposed Medicaid payment rates for the Long Acting Reversible Contraceptives (LARCs) Fee Review updates.ADDITIONAL INFORMATION A briefing packet describing the proposed payments rates will be available at https://rad.hhs.texas.gov/rate-packets on or after January 26, 2021. Interested parties may obtain a copy of the briefing packet prior to the hearing by contacting Provider Finance by telephone at (512) 730-7401; by fax at (512) 730-7475; or by e-mail at RADAcuteCare@hhsc.state.tx.us. The briefing packet will also be available at the public hearing.HEARING DETAILS Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. Please register for the HHSC Public Rate Hearing for the Long Acting Reversible Contraceptives (LARCs) Fee Review updates to be held on February 5, 2021 9:00 a.m. CST at: https://attendee.gotowebinar.com/register/8996719121083795470The meeting will be archived and can be accessed on demand at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.PUBLIC COMMENT Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing. Written comments may be sent to addresses provided in this week’s edition of the Texas Register (46 Tex Reg 871). 

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Texas Health and Human Services Commission

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medical Transportation Program (MTP) Fee Review

OVERVIEWThe Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 5, 2021, at 9:00 a.m., to receive comment on proposed Medicaid payment rates for the MTP Fee Review updates.ADDITIONAL INFORMATIONA briefing packet describing the proposed payments rates will be available at https://rad.hhs.texas.gov/rate-packets on or after January 26, 2021. Interested parties may obtain a copy of the briefing packet prior to the hearing by contacting Provider Finance by telephone at (512) 730-7401; by fax at (512) 730-7475; or by e-mail at RADAcuteCare@hhsc.state.tx.us. The briefing packet will also be available at the public hearing.HEARING DETAILS Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. Please register for the HHSC Public Rate Hearing for the MTP Fee Review updates to be held on February 5, 2021, 9:00 a.m. CST, at: https://attendee.gotowebinar.com/register/8996719121083795470. The meeting will be archived and can be accessed on demand at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.PUBLIC COMMENT Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing. Written comments may be sent to addresses provided in this week’s edition of the Texas Register (46 Tex Reg 871). 

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Texas Health and Human Services Commission

In Addition

Notice of Public Hearing on Proposed Payment Rates for HCBS – Adult Mental Health Supported Home Living and YES Waiver In-Home Respite

OVERVIEWThe Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 17, 2021, at 9:00 a.m., to receive public comments on the proposed payment rates for Home and Community-Based Services – Adult Mental Health (HCBS-AMH) Supported Home Living (SHL) and Youth Empowerment Services (YES) Waiver In-Home Respite.HHSC proposes to convert the HCBS-AMH SHL hourly payment rate to a 15-minute rate of $5.60, effective April 1, 2021, and convert the YES Waiver In-Home Respite rate to a 15-minute rate of $5.22. Transitioning of the HCBS-AMH SHL and YES Waiver In-home Respite rates to 15 minutes is necessary to implement electronic visit verification.ADDITIONAL INFORMATIONA briefing packet describing the proposed payment rates will be available at https://rad.hhs.texas.gov/proposed-rate-packets on or after January 22, 2021. Interested parties may obtain a copy of the briefing packet before the hearing by contacting the HHSC Provider Finance Department by telephone at (512) 424-6637; by fax at (512) 730-7475; or by e-mail at RAD-LTSS@hhsc.state.tx.us.HEARING DETAILS Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. Physical entry to the hearing will not be permitted. To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance using the following link: https://attendee.gotowebinar.com/register/8087644007720282127.The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements. HHSC will archive the public hearing; the archive can be accessed on demand after the hearing at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings.PUBLIC COMMENT Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing. Written comments may be sent to addresses provided in this week’s edition of the Texas Register (46 Tex Reg 872). 

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Texas Health and Human Services Commission

In Addition

HHSC plan to submit an amendment to the Texas State Plan for Medical Assistance

OVERVIEWThe Texas Health and Human Services Commission (HHSC) announces its intent to submit an amendment to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The amendment is proposed to be effective February 1, 2021.The proposed amendment will remove language related to the assignment of a rate for a new Federally Qualified Health Center that was added effective September 1, 2020.ADDITIONAL INFORMATIONInterested parties may obtain a copy of the proposed amendment and/or additional information about the amendment by contacting Cynthia Henderson, State Plan Coordinator, by mail at the Texas Health and Human Services Commission, P.O. Box 13247, Mail Code H-600, Austin, Texas 78711; by telephone at (512) 428-1932; by facsimile at (512) 730-7472; or by email at Medicaid_Chip_SPA_Inquiries@hhsc.state.tx.us. Copies of the proposed amendment will be available for review at the local county offices of HHSC, (which were formerly the local offices of the Department of Aging and Disability Services).PUBLIC COMMENT Written comments about the proposed amendment and/or requests to review comments may be sent to addresses provided in this week’s edition of the Texas Register (46 Tex Reg 872). 

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Texas Department of State Health Services

In Addition

DSHS has posted decisions either confirming or denying limited-liability status for twenty-three nonprofit hospitals

The Hospital Survey Program in the Center for Health Statistics, Texas Department of State Health Services, has completed its analysis of hospital data for the purpose of certifying nonprofit hospitals or hospital systems for limited liability in accordance with Texas Health and Safety Code, §311.0456. Twenty-three hospitals requested certification in accordance with §311.0456, each of the requesting hospitals will be notified, by mail, on the determination of whether certification requirements were met. The certification issued under Texas Health and Safety Code, §311.0456, to a nonprofit hospital or hospital system takes effect on December 31, 2020, and expires on the anniversary of that date.DSHS’ final decisions are posted in this week’s edition of the Texas Register (46 Tex Reg 873). 

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Texas Department of State Health Services

In Addition

DSHS declines to adopt modifications to the definitions of “Tetrahydrocannabinols” and “Marihuana Extract” in the Schedules of Controlled Substances

FEDERAL ACTION On August 21, 2020, the Acting Administrator of the Drug Enforcement Administration (DEA) issued an interim final rule making four conforming changes to DEA’s existing scheduling regulations. The interim final rule was published in the Federal Register, Volume 85, Number 163, pages 51639-51645 and was effective August 21, 2020. Pursuant to Section 481.034(g), as amended by the 75th Legislature, of the Texas Controlled Substances Act, Health and Safety Code, Chapter 481, the commissioner may object during the 30-day period beginning on the day after the date of publication in the Federal Register of a final order designating a substance as controlled or deleting a substance from the schedules.The interim final rule modifies 21 CFR 1308.11(d)(31) by adding language stating that the definition of “Tetrahydrocannabinols” does not include “any material, compound, mixture or preparation that falls within the definition of hemp set forth in 7 U.S.C 1639o.”The interim final rule modifies 21 CFR 1308.11(d)(58) by stating that the definition of “Marihuana Extract” is limited to extracts “containing greater than 0.3 percent delta-9-tetrahydrocannabinol on a dry weight basis.”STATE ACTION In the capacity as Commissioner of the Texas Department of State Health Services, John Hellerstedt, M.D., objected to the modifications of the two definitions to the extent that the definitions allow for the presence or addition of tetrahydrocannabinols aside from the presence of delta-9-tetrahydrocannabinol. Multiple tetrahydrocannabinol isomers and variants may have pharmacological or psychoactive properties.On September 18, 2020, the Commissioner notified the public of his objection. Pursuant to Section 481.034(g), on October 6, 2020, the Commissioner held a hearing to allow public comment with respect to the objection. Zero comments were received during the hearing and zero written comments were received by October 8, 2020.Therefore, the modifications of the two definitions above are not adopted.

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