Texas Register Table of Contents
- 1 Health and Human Services Commission
- 2 Texas Optometry Board
- 2.0.1 Proposed Rules Re:
- 2.0.1.1 Amending 22 TAC §273.5 to update rules concerning Clinical Instruction and Practice – Limited License for Clinical Faculty.
- 2.0.1.2 New 22 TAC §277.13, outlining the investigation process for all complaints received by the agency resulting from the treatment of glaucoma after September 1, 2021.
- 2.0.1.3 New 22 TAC §277.14, describing the selection process for the Case Review Consultant and Expert Panel for complaints resulting from glaucoma treatment.
- 2.0.2 Withdrawn Rules Re:
- 2.0.2.1 Withdrawing 22 TAC §277.13, which concerned the preliminary evaluation and official investigation process for all complaints received by the agency related to the treatment of glaucoma after September 1, 2021.
- 2.0.2.2 Withdrawing 22 TAC §277.14, which outlined the selection process for the Case Review Consultant and Expert Panel.
- 2.0.2.3 Withdrawing 22 TAC §277.15, which described the disciplinary action process and public reporting of data related to jurisdictional complaints received related to the treatment of glaucoma after September 1, 2021.
- 2.0.1 Proposed Rules Re:
Health and Human Services Commission
Emergency Rules Re:
New 26 TAC §500.1, allow a currently licensed hospital to operate certain off-site inpatient facilities without obtaining a new license.
CHAPTER 500. COVID-19 EMERGENCY HEALTH CARE FACILITY LICENSING
SUBCHAPTER A. HOSPITALS
26 TAC §500.1
OVERVIEW
The 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 §500.1, concerning an emergency rule to allow hospitals to treat and house patients more effectively in response to COVID-19.
HHSC is adopting an 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 Executive Commissioner 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 rule for Hospital Off-Site Facilities in Response to COVID-19.
To allow operation of additional off-site facilities, this emergency rule also allows a waiver of the requirement for off-site facilities to be open or licensed within the past 36 months, at HHSC’s discretion.
This emergency rule also temporarily permits a currently licensed hospital to designate a specific part of its hospital for use as an off-site facility by another hospital, and to allow another currently licensed hospital to apply to use the first hospital’s designated hospital space as an off-site facility for inpatient care.
Adopted Rules Re:
Amending 1 TAC §355.8095 to allow Aging and Disability Resource Centers (ADRCs) the opportunity to participate in the Medicaid Administrative Claiming (MAC) program.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 5. GENERAL ADMINISTRATION
1 TAC §355.8095
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.8095, concerning Medicaid Administrative Claiming Program. The amendment to §355.8095 is adopted without changes to the proposed text as published in the September 17, 2021, issue of the Texas Register (46 TexReg 6006). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to allow Aging and Disability Resource Centers (ADRCs) the opportunity to participate in the Medicaid Administrative Claiming (MAC) program. MAC is a joint federal-state funded program authorized by the Centers for Medicare & Medicaid Services (CMS) which provides reimbursement for the costs of Medicaid administrative activities that refer eligible or potentially eligible Medicaid recipients to appropriate Medicaid and health-related services. HHSC serves as a pass-through entity to administer these federal funds. MAC in Texas currently provides funding for school districts, mental health programs/programs serving individuals with intellectual and developmental disabilities, local health departments/districts, and early childhood intervention programs. Access to this reimbursement opportunity allows ADRCs a mechanism to better serve the healthcare needs of Medicaid beneficiaries.
The rule change also amends a statement regarding costs allowable for submission through a MAC claim to better reflect the staff requirements for cost reporting, as per the CMS-approved Time Study Implementation Guide.
In Addition Re:
Public Notice – Children and Pregnant Women (CPW)
OVERVIEW
The Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the Texas Healthcare Transformation and 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 September 1, 2022.
This amendment will add the CPW benefit to the list of services delivered through managed care.
BACKGROUND AND JUSTIFICATION
House Bill 133, 87th Legislature, Regular Session, 2021 directs HHSC to transition the Case Management for Children and Pregnant Women (CPW) Medicaid benefit from fee-for-service to managed care for members enrolled in managed care. CPW is currently provided only in fee-for-service Medicaid and provides case management services to assist certain individuals in gaining access to needed medical, social, educational, and other services. Pursuant to this proposed amendment, Texas Medicaid managed care organizations (MCOs) will contract with and reimburse providers for billable case management services.
This amendment will further the demonstration objectives of expanding risk-based managed care to new populations and services and support the development and maintenance of a coordinated care delivery system.
The amendment allows this Medicaid benefit to be included in the managed care delivery system under the authority of the Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver.
The amendment also encourages the maintenance of a coordinated care delivery system through coordination of case management services that are available to a beneficiary. For example, MCO service coordinators and CPW providers enrolled in the MCO’s provider network will be better able to share case documentation such as the beneficiary’s service plan and health screenings to assess medical, social, and educational needs. In addition, the MCOs will have more visibility of prior authorization requests and reimbursement of the benefit among their members and may identify opportunities for MCO service coordinators to provide service coordination or collaborate and coordinate with the CPW provider.
The Center for Medicare and Medicaid Services (CMS)-approved 1115 evaluation design focusing on demonstration years 7-11 culminates in a Draft Evaluation Report due March 31, 2024, as required by STC 86. The amendment may influence evaluation measures on overall demonstration costs, but potential impacts will be negligible. As a result, the overall evaluation findings will not be meaningfully impacted by the amendment.
HHSC determined not to include any evaluation questions, hypotheses, or measures on the CPW benefit in the revised 1115 evaluation design focusing on demonstration years 10-19, as required by STC 82 as the amendment will have no impact on beneficiaries. However, the state will direct the external evaluator to interpret and present pertinent findings within the context of this amendment as necessary.
This amendment will not have an impact on enrollment and will not result in cost sharing for beneficiaries.
CPW is available for high-risk pregnant women of any age and children age 20 and younger with a health condition or health risk. A CPW provider must be a licensed registered nurse or licensed social worker. Services include: 1) an authorized face-to-face comprehensive visit with the client and their family to perform a family needs assessment and develop a service plan to address the client’s unmet needs; and 2) authorized face-to-face or telephone follow-up visits to assist the client and family with obtaining the necessary services until their needs are met.
Public Notice – Texas Healthcare Transformation and Quality Improvement Program (THTQIP) Waiver
OVERVIEW
The Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the Texas Healthcare Transformation and 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 September 1, 2022.
BACKGROUND AND JUSTIFICATION
In response to House Bill 2822, 87th Legislative Session, 2021, an amendment to the THTQIP 1115 waiver is needed for the Vendor Drug Program to exempt all adults age 18 and older in Medicaid from preferred drug list prior authorizations for drugs in the antipsychotic class under certain circumstances.
The CMS-approved 1115 evaluation design focusing on demonstration years 7 – 11 culminates in a Draft Evaluation Report due March 31, 2024, as required by STC 86. The amendment may influence a limited set of evaluation measures, but potential impacts will be negligible as the amendment will be implemented in the final month of demonstration year 11. As a result, the overall evaluation findings will not be meaningfully impacted by the amendment.
HHSC determined not to include any evaluation questions, hypotheses, or measures related to the PDL PA exemption for antipsychotic drugs in the revised 1115 evaluation design focusing on demonstration years 10 – 19, as required by STC 82. However, the state will direct the external evaluator to interpret and present pertinent findings within the context of this amendment as necessary.
This amendment will not impact enrollment and there will not be beneficiary cost-sharing.
This amendment will not result in any changes to the formulary.
This amendment does not affect the authority of a pharmacist to dispense the generic equivalent or interchangeable biological product of a prescription drug.
This amendment does not affect any drug utilization review requirements prescribed by state or federal law.
This amendment does not affect clinical prior authorization edits to preferred and nonpreferred antipsychotic drug prescriptions.
PROPOSED CHANGES
This amendment proposes to increase access to effective antipsychotic medication by reducing barriers to care through the elimination of preferred drug list prior authorizations for adults age 18 and older in Medicaid which furthers the demonstration’s objective of improving outcomes while containing cost growth long-term. HHSC is requesting that CMS waive Section 1902(a)(10)(B) of the Social Security Act as well as 42 C.F.R. 440.240 related to comparability of services to the extent necessary to enable the state to vary the amount, duration, and scope of services to allow only adults age 18 or over access to any drug of the antipsychotic class on the Medicaid formulary without requiring a Preferred Drug List (PDL) prior authorization (PA) in certain circumstances.
The proposed change would allow individuals age 18 and over to bypass the PDL and PA, subject to federal law on maximum dosage limits and commission rules on drug quantity limits, when the patient has previously been prescribed:
- a 14-day trial of a preferred antipsychotic drug within the past year which was unsuccessful; or
- a nonpreferred antipsychotic drug and the prescription is for the purpose of drug dosage titration, given a prior authorization was already obtained; or
- a nonpreferred antipsychotic drug and the prescription modifies the dosage, dosage frequency, or both, of the drug as part of the same treatment for which the drug was previously prescribed, given a prior authorization was already obtained.
Public Notice – Texas State Plan Amendment to Allow Advanced Telecommunications for Physicians’ and Dentists’ Services
OVERVIEW
The Texas Health and Human Services Commission (HHSC) announces its intent to submit an amendment to the Texas State Plan to allow the use of advanced telecommunications for Physicians’ and Dentists’ Services under Title XIX of the Social Security Act. The proposed amendment is effective February 1, 2022.
BACKGROUND AND JUSTIFICATION
The purpose of this amendment, Transmittal Number 22-0005, seeks to ensure that Medicaid recipients, child health plan program enrollees, and other individuals receiving benefits under a public benefits program administered by HHSC, regardless of the delivery model, have the option to receive certain services using advanced telecommunications.
Interested parties may obtain additional information and/or a free copy of the proposed amendments by contacting Shae James, State Plan Coordinator, by mail at the Health and Human Services Commission, P.O. Box 13247, Mail Code H-600, Austin, Texas 78711; or by email at Medicaid_Chip_SPA_Inquiries@hhsc.state.tx.us. Copies of proposed amendment will be available for review at the local county offices of HHSC, (which were formerly the local offices of Texas Department of Aging and Disability Services).
Texas Optometry Board
Proposed Rules Re:
Amending 22 TAC §273.5 to update rules concerning Clinical Instruction and Practice – Limited License for Clinical Faculty.
CHAPTER 273. GENERAL RULES
22 TAC §273.5
OVERVIEW
The Texas Optometry Board (Board) proposes amendments to §273.5, concerning Clinical Instruction and Practice – Limited License for Clinical Faculty.
The proposal amends §273.5(a)(1) by replacing “Council on Optometric Education of the American Optometric Association (COEAOA)” with “Accreditation Council on Optometric Education (ACOE)”. The proposal also amends §273.5(g)(1) – (2) by removing the “in-state” college of optometry requirement. Additional amendments also clarify the intent of the rule.
New 22 TAC §277.13, outlining the investigation process for all complaints received by the agency resulting from the treatment of glaucoma after September 1, 2021.
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.13
OVERVIEW
The Texas Optometry Board (TOB) proposes new §277.13, concerning Complaints Resulting from Glaucoma Treatment – Investigation Process. A version of this rule was originally proposed in the December 10, 2021, issue of the Texas Register (46 Tex Reg 8305). The Board met on February 25, 2022, to consider comments received. At the February 25, 2022, meeting, the Board made significant changes to the proposed rule and voted unanimously to propose the rule again. The previously published version of this rule has been withdrawn and the notice of withdrawal is published elsewhere in this issue of the Texas Register.
BACKGROUND AND JUSTIFICATION
This rule is being proposed pursuant to SB 993 of the 87th Regular Legislative Session. This new rule sets forth the investigation process for all complaints received by the agency resulting from the treatment of glaucoma after September 1, 2021. Senate Bill 993 required collaboration with the Texas Medical Board and all input received to date has been considered and included by the TOB for the proposal of this rule.
New 22 TAC §277.14, describing the selection process for the Case Review Consultant and Expert Panel for complaints resulting from glaucoma treatment.
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.14
OVERVIEW
The Texas Optometry Board proposes new §277.14, concerning Complaints Resulting From Glaucoma Treatment – Use of Case Review Consultant and Expert Panel. A version of this rule was originally proposed in the December 10, 2021, Texas Register (46 Tex Reg 8307). The previously published version of this rule has been withdrawn and the notice of withdrawal is published elsewhere in this issue of the Texas Register.
BACKGROUND AND JUSTIFICATION
This rule is being proposed pursuant to SB 993 of the 87th Regular Legislative Session. This new rule sets forth the selection process for the Case Review Consultant and Expert Panel as required by SB 993 of the 87th Regular Legislative Session. Senate Bill 993 required collaboration with the Texas Medical Board and all input received to date has been considered and included by the Texas Optometry Board for the proposal of this new rule.
Withdrawn Rules Re:
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.13
OVERVIEW
The Texas Optometry Board withdraws proposed new §277.13, which appeared in the December 10, 2021, issue of the Texas Register (46 Tex Reg 8305).
Withdrawing 22 TAC §277.14, which outlined the selection process for the Case Review Consultant and Expert Panel.
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.14
OVERVIEW
The Texas Optometry Board withdraws proposed new §277.14, which appeared in the December 10, 2021, issue of the Texas Register (46 Tex Reg 8307).
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.15
OVERVIEW
The Texas Optometry Board withdraws proposed new §277.15, which appeared in the December 10, 2021, issue of the Texas Register (46 Tex Reg 8308).