27 Nov 2020

Texas Register November 27, 2020 Volume: 45 Number: 48

by | posted in: Governor, Texas Board of Nursing, Texas Board of Physical Therapy Examiners, Texas Department of Insurance, Texas Department of State Health Services, Texas Department on Aging and Disability Services, Texas Health and Human Services Commission |

Texas Register Table of Contents

Governor

 

Notices

Proclamation 41-3782: Renewing the disaster proclamation for all Texas counties in response to COVID-19

OVERVIEWIn accordance with the authority vested by Section 418.014 of the Texas Government Code, Governor renews the disaster proclamation for all counties in Texas in response to COVID-19.Pursuant to Section 418.017, Governor authorizes the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster.Pursuant to Section 418.016, any regulatory statute prescribing the procedures for conduct of state business or any order or rule of a state agency that would in any way prevent, hinder, or delay necessary action in coping with this disaster shall be suspended upon written approval of the Office of the Governor. However, to the extent that the enforcement of any state statute or administrative rule regarding contracting or procurement would impede any state agency’s emergency response that is necessary to cope with this declared disaster,Governor suspends such statutes and rules for the duration of this declared disaster for that limited purpose.BACKGROUND AND JUSTIFICATION Governor’s rationale for issuing Proclamation 41-3782 is listed in this week’s edition of the Texas Register (45 Tex Reg 8429). 

Texas Health and Human Services Commission

Emergency Rule

Renewing emergency rule 26 TAC §306.1351 to allow virtual delivery of behavioral health services during the COVID-19 crisis

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEMSUBCHAPTER Z. EMERGENCY RULEMAKING26 TAC §306.1351OVERVIEWThe Health and Human Services Commission is renewing the effectiveness of emergency new §306.1351 for a 60-day period. The text of the emergency rule was originally published in the August 7, 2020, issue of the Texas Register (45 TexReg 5461).HHSC is renewing the effectiveness of 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 private physical space for certain in-person interactions, such as the use of a telephone or video-conferencing; and 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.BACKGROUND AND JUSTIFICATION 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 these emergency rules for Behavioral Health Services in response to COVID-19.As authorized by Government Code, §2001.034, the Commission may adopt an emergency rule without prior notice or hearing if it finds that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Government Code, §2001.034, may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

Texas Department on Aging and Disability Services

Emergency Rule

Renewing the emergency amendment to 40 TAC §30.14, allowing physicians to virtually conduct face-to-face assessments for Medicaid hospice re-certification

CHAPTER 30. MEDICAID HOSPICE PROGRAMSUBCHAPTER B. ELIGIBILITY REQUIREMENTS40 TAC §30.14OVERVIEWThe Department of Aging and Disability Services is renewing the effectiveness of emergency amended §30.14 for a 60-day period. The text of the emergency rule was originally published in the July 31, 2020, issue of the Texas Register (45 TexReg 5265).The emergency amendment to §30.14(e) allows a hospice physician or hospice advanced practice registered nurse to conduct a face-to-face assessment of an individual as a telemedicine medical service, as defined in Texas Government Code §531.001(8), if the sole purpose of the assessment is for hospice recertification. 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. The Commission 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.

Texas Health and Human Services Commission

Proposed Rules

Amending 1 TAC §393.1 to update dispute resolution procedures for Nursing Facilities and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions

CHAPTER 393. INFORMAL DISPUTE RESOLUTION AND INFORMAL RECONSIDERATION1 TAC §393.1OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §393.1, concerning Informal Dispute Resolution for Nursing Facilities and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID).SUMMARY OF CHANGES A detailed summary of changes made by the amendments to §393.1 is included in this week’s edition of the Texas Register (45 Tex Reg 8437). BACKGROUND AND JUSTIFICATIONThe purpose of the amendment to §393.1 is to comply with Senate Bill (S.B.) 304, 84th Legislature, Regular Session, 2015, which modified §531.058 Texas Government Code by requiring HHSC to contract with a disinterested non-profit organization to perform Informal Dispute Resolution (IDR) reviews for nursing facilities. To foster consistency, all three facility types IDR serves were included in the procurement. Additionally, amendments to this rule also align with House Bill (H.B.) 2025, 85th Legislature, Regular Session, 2017, which modified Texas Health and Safety Code Chapters 242, 247, and 252. H.B. 2025 required a system to be developed to record and track the severity and scope of licensure violations for Intermediate Care Facilities (ICF/IIDs) and Assisted Living Facilities (ALFs).

Texas Health and Human Services Commission

Proposed Rules

New 1 TAC §393.3, establishing dispute resolution procedures for Texas Home Living and Home and Community-based Service providers

CHAPTER 393. INFORMAL DISPUTE RESOLUTION AND INFORMAL RECONSIDERATION1 TAC §393.3OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §393.3 concerning Informal Dispute Resolution for Texas Home Living and Home and Community-based Service providers.SECTION SUMMARY Proposed new §393.3(a) establishes the new IDR process for HCS and TxHmL waiver providers. Subsections 393.3(b)-(f) establish timeframes for submitting IDR materials, and subsection (g) describes potential outcomes of an IDR. Limitations in the IDR process are described in subsection (h). Subsection (i) states the necessary information the IDR Department must receive from the State survey agency to process an IDR request. Subsections (j)-(l) discuss the timelines for receiving additional information in IDR, and the requirements for sharing information with all parties. The prohibition against ex parte communications is described at (m).Subsections (n)-(p) discuss the availability of IDR conferences to the provider, the deadline by which an IDR conference must occur, and the requirements for the IDR conferences. The deadline by which an IDR must be completed is stated at (q). Subsection (r) requires that timeframes in the IDR process be computed in accordance with Texas Government Code §311.014. The requirement for IDR participants to comply with operating procedures is discussed at (s). Subsection (t) permits the State survey agency to revise an IDR recommendation should it violate a federal law, regulation, or State of Texas rule. Last, subsection (u) complies with the legislative mandate by H.B. 2590 to contract the IDR function to a disinterested organization.BACKGROUND AND JUSTIFICATIONThe purpose of the new §393.3 is to comply with H.B. 2590, 85th Legislature, Regular Session, 2017, which modified Human Resources Code by adding a new section §161.0892. This new section directs HHSC to establish and outsource an IDR process for Texas Home Living (TxHmL) and Home and Community-based Service (HCS) providers.

Texas Board of Nursing

Proposed Rules

Amending 22 TAC §217.23 to update exceptions to the balance billing prohibition for out-of-network providers and establish new dispute resolution procedures

CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE22 TAC §217.23OVERVIEWThe Texas Board of Nursing (Board) proposes amendments to §217.23, relating to Balance Billing Dispute Resolution.SUMMARY OF CHANGES A detailed summary of changes made by the amendments to §217.23 is included in this week’s edition of the Texas Register (45 Tex Reg 8454). BACKGROUND AND JUSTIFICATION The proposed amendments are necessary to implement changes to the Insurance Code, effectuated by the passage of Senate Bill (SB) 1264 during the 86th Legislative Session, effective September 1, 2019. In order to protect consumers, SB 1264 prohibits balance billing by many out of network providers, except in a narrow set of circumstances. Additionally, SB 1264 authorizes a new dispute resolution process for claim disputes between out of network providers and health benefit plan issuers and administrators.The proposed amendments are necessary to implement the new requirements of SB 1264 and mirror the Department’s adopted rules.

Texas Board of Physical Therapy Examiners

Proposed Rules

Amending 22 TAC §337.1 to update disclosure requirements for licensees who provide physical therapy services through non-traditional means

CHAPTER 337. DISPLAY OF LICENSE22 TAC §337.1The Texas Board of Physical Therapy Examiners proposes amending 22 Texas Administrative Code (TAC) §337.1. Display of License.The amendment is proposed to require licensees who provide physical therapy services through telehealth, home visits, or other non-traditional modes to provide information on accessing the board’s online license verification system.

Texas Board of Physical Therapy Examiners

Proposed Rules

Amending 22 TAC §337.2 to require licensees who provide physical therapy services through non-traditional means to provide disclosure on dispute resolution

CHAPTER 337. DISPLAY OF LICENSE22 TAC §337.2The Texas Board of Physical Therapy Examiners proposes amending 22 Texas Administrative Code (TAC) §337.2, concerning Consumer Information Sign.The amendment is proposed to require licensees who provide physical therapy services through telehealth, home visits, or other non-traditional modes to provide information on directing complaints regarding non-compliance with the Texas Physical Therapy Practice Act/Rules to the Texas Board of Physical Therapy Examiners.

Texas Board of Physical Therapy Examiners

Proposed Rules

Amending 22 TAC §341.3 to update requirements for the Continuing Competence program

CHAPTER 341. LICENSE RENEWAL22 TAC §341.3The Texas Board of Physical Therapy Examiners proposes amending 22 Texas Administrative Code (TAC) §341.3, Qualifying Continuing Competence Activities.The amendments are proposed to clarify the documentation required for continuing competence approval of college or university courses in paragraph (2); to update language for completion of a residency or fellowship and required hours for mentorship of a resident or fellow to align with the standards set forth by the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) in paragraph (5)(C) and (D); and to add paragraph (7) which provides a means for licensees to claim continuing competence credit for engaging in non-work related voluntary charity care.

Texas Department of Insurance

Proposed Rules

Amending 28 TAC §180.1 to update requirements for physician peer reviews, utilization reviews, and independent reviews of health care services

PART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS’ COMPENSATIONCHAPTER 180. MONITORING AND ENFORCEMENTSUBCHAPTER A. GENERAL RULES FOR ENFORCEMENT28 TAC §180.1OVERVIEWThe Texas Department of Insurance, Division of Workers’ Compensation (DWC) proposes an amendment to §180.1, Definitions. SUMMARY OF CHANGES Amended §180.1(4) adds to the definition of appropriate credentials the language from Labor Code §408.0043(c) that requires a physician who performs a peer review, utilization review, or independent review of health care services to have the same or similar specialty as the physician that requests or performs the health care services. The amendment is limited to certain reviews of physician-requested or physician-provided health care services by physicians performing utilization review, independent review, or peer reviews. The amendment does not alter the appropriate credentials for utilization review, independent review, or peer review of health care services requested or provided by other types of health care providers. BACKGROUND AND JUSTIFICATIONThe purpose of this amendment is to align the rule with Texas Labor Code §408.0043, Professional Specialty Certification Required for Certain Review, as amended by Senate Bill (SB) 1742, 86th Legislature, Regular Session (2019), effective September 1, 2019. The Legislature added subparagraph (c) to §408.0043 to require that when a health care service is requested, ordered, provided, or to be provided by a physician, a physician performing a peer review, utilization review, or independent review must be of the same or a similar specialty as that physician.

Texas Health and Human Services Commission

Adopted Rules

Amending 1 TAC §354.1729 to revise definitions related to the Delivery System Reform Incentive Payment Program for DY 9-10

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER D. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAMDIVISION 8. DSRIP PROGRAM DEMONSTRATION YEARS 9-101 TAC §354.1729OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1729, concerning Definitions. The amendments are adopted without changes to the proposed text as published in the July 17, 2020, issue of the Texas Register (45 TexReg 4857). These rules will not be republished.The amendment to §354.1729 revises the definitions of the terms “encounter” and “innovative measure.” The amendment also deletes the definition of the term “quality improvement collaborative activity,” as there are no quality improvement collaborative activities for DY9-10.BACKGROUND AND JUSTIFICATION On December 21, 2017, the Centers for Medicare & Medicaid Services (CMS) approved extending the Medicaid demonstration waiver entitled “Texas Healthcare Transformation and Quality Improvement Program” for an additional five years. The Delivery System Reform Incentive Payment (DSRIP) program is included in this waiver and provides incentive payments to participating Medicaid providers, primarily for improving their performance on selected health outcome measures. Even though the Transformation Waiver was approved for five more years, CMS approved DSRIP funding only for an additional four years (demonstration years [DYs] 7-10).Texas DSRIP for DYs 7-10 is governed by the Program Funding and Mechanics (PFM) Protocol, the Measure Bundle Protocol (MBP), and associated rules. HHSC negotiates the protocols with CMS and adopts rules reflecting the CMS-approved protocols. During the approval process for the protocols for DYs 9-10, CMS required certain changes to both the state’s PFM protocol proposal and the MBP proposal. Once these changes were made by HHSC, CMS approved both protocols on September 17, 2019. The amendments being adopted reflect the final versions of the PFM protocol and MBP approved by CMS.

Texas Health and Human Services Commission

Adopted Rules

Amending 1 TAC §354.1735 to update requirements for submitting a RHP plan to the Delivery System Reform Incentive Payment Program for DY 9-10

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER D. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAMDIVISION 8. DSRIP PROGRAM DEMONSTRATION YEARS 9-101 TAC §354.1735OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1735, concerning Participants. The amendments are adopted without changes to the proposed text as published in the July 17, 2020, issue of the Texas Register (45 TexReg 4857). These rules will not be republished.The amendment to §354.1735 clarifies that anchors are required to hold at least one public meeting prior to submitting the Regional Healthcare Partnership (RHP) plan update for DY9-10 to HHSC, as specified in the PFM Protocol.BACKGROUND AND JUSTIFICATION On December 21, 2017, the Centers for Medicare & Medicaid Services (CMS) approved extending the Medicaid demonstration waiver entitled “Texas Healthcare Transformation and Quality Improvement Program” for an additional five years. The Delivery System Reform Incentive Payment (DSRIP) program is included in this waiver and provides incentive payments to participating Medicaid providers, primarily for improving their performance on selected health outcome measures. Even though the Transformation Waiver was approved for five more years, CMS approved DSRIP funding only for an additional four years (demonstration years [DYs] 7-10).Texas DSRIP for DYs 7-10 is governed by the Program Funding and Mechanics (PFM) Protocol, the Measure Bundle Protocol (MBP), and associated rules. HHSC negotiates the protocols with CMS and adopts rules reflecting the CMS-approved protocols. During the approval process for the protocols for DYs 9-10, CMS required certain changes to both the state’s PFM protocol proposal and the MBP proposal. Once these changes were made by HHSC, CMS approved both protocols on September 17, 2019. The amendments being adopted reflect the final versions of the PFM protocol and MBP approved by CMS.

Texas Health and Human Services Commission

Adopted Rules

Amending 1 TAC §354.1737 to remove duplicative language concerning RHP plans within the Delivery System Reform Incentive Payment Program for DY 9-10

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER D. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAMDIVISION 8. DSRIP PROGRAM DEMONSTRATION YEARS 9-101 TAC §354.1737OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1737, concerning RHP Plan Update for DY9-10. The amendments are adopted without changes to the proposed text as published in the July 17, 2020, issue of the Texas Register (45 TexReg 4857). These rules will not be republished.The amendment to §354.1737 adds references to provisions that are being added to another section It also deletes the requirement that the RHP Plan Update for DY9-10 include for each performer the related strategies associated with each of the performer’s Category C Measure Bundles for DY7-8 that the performer implemented in DY7-8.BACKGROUND AND JUSTIFICATION On December 21, 2017, the Centers for Medicare & Medicaid Services (CMS) approved extending the Medicaid demonstration waiver entitled “Texas Healthcare Transformation and Quality Improvement Program” for an additional five years. The Delivery System Reform Incentive Payment (DSRIP) program is included in this waiver and provides incentive payments to participating Medicaid providers, primarily for improving their performance on selected health outcome measures. Even though the Transformation Waiver was approved for five more years, CMS approved DSRIP funding only for an additional four years (demonstration years [DYs] 7-10).Texas DSRIP for DYs 7-10 is governed by the Program Funding and Mechanics (PFM) Protocol, the Measure Bundle Protocol (MBP), and associated rules. HHSC negotiates the protocols with CMS and adopts rules reflecting the CMS-approved protocols. During the approval process for the protocols for DYs 9-10, CMS required certain changes to both the state’s PFM protocol proposal and the MBP proposal. Once these changes were made by HHSC, CMS approved both protocols on September 17, 2019. The amendments being adopted reflect the final versions of the PFM protocol and MBP approved by CMS.

Texas Health and Human Services Commission

Adopted Rules

Amending 1 TAC §354.1753 to update Category C requirements for performers within the Delivery System Reform Incentive Payment Program for DY 9-10

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER D. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAMDIVISION 8. DSRIP PROGRAM DEMONSTRATION YEARS 9-101 TAC §354.1753OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1753, concerning Category C Requirements for Performers. The amendments are adopted without changes to the proposed text as published in the July 17, 2020, issue of the Texas Register (45 TexReg 4857). These rules will not be republished.The amendment to §354.1753 makes numerous changes, the most significant being: 1) it prohibits performers from carrying forward achievement of a measure’s DY10 goal achievement milestone to Performance Year 5; and 2) it changes the pay for performance measures’ DY9-10 milestone valuations from those in the PFM protocol proposal HHSC submitted to CMS on January 3, 2019, back to those that were in effect in DY7-8.BACKGROUND AND JUSTIFICATION On December 21, 2017, the Centers for Medicare & Medicaid Services (CMS) approved extending the Medicaid demonstration waiver entitled “Texas Healthcare Transformation and Quality Improvement Program” for an additional five years. The Delivery System Reform Incentive Payment (DSRIP) program is included in this waiver and provides incentive payments to participating Medicaid providers, primarily for improving their performance on selected health outcome measures. Even though the Transformation Waiver was approved for five more years, CMS approved DSRIP funding only for an additional four years (demonstration years [DYs] 7-10).Texas DSRIP for DYs 7-10 is governed by the Program Funding and Mechanics (PFM) Protocol, the Measure Bundle Protocol (MBP), and associated rules. HHSC negotiates the protocols with CMS and adopts rules reflecting the CMS-approved protocols. During the approval process for the protocols for DYs 9-10, CMS required certain changes to both the state’s PFM protocol proposal and the MBP proposal. Once these changes were made by HHSC, CMS approved both protocols on September 17, 2019. The amendments being adopted reflect the final versions of the PFM protocol and MBP approved by CMS.

Texas Health and Human Services Commission

Adopted Rules

Amending 1 TAC §354.1757 to provide a financial incentive for hospital safety within the Delivery System Reform Incentive Payment Program for DY 9-10

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER D. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAMDIVISION 8. DSRIP PROGRAM DEMONSTRATION YEARS 9-101 TAC §354.1757OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1757, concerning Disbursement of Funds. The amendments are adopted without changes to the proposed text as published in the July 17, 2020, issue of the Texas Register (45 TexReg 4857). These rules will not be republished.The amendment to §354.1757 makes the goal achievement milestone for a hospital safety measure with perfect performance at baseline eligible for full payment for maintenance of high performance if certain conditions are met.BACKGROUND AND JUSTIFICATION On December 21, 2017, the Centers for Medicare & Medicaid Services (CMS) approved extending the Medicaid demonstration waiver entitled “Texas Healthcare Transformation and Quality Improvement Program” for an additional five years. The Delivery System Reform Incentive Payment (DSRIP) program is included in this waiver and provides incentive payments to participating Medicaid providers, primarily for improving their performance on selected health outcome measures. Even though the Transformation Waiver was approved for five more years, CMS approved DSRIP funding only for an additional four years (demonstration years [DYs] 7-10).Texas DSRIP for DYs 7-10 is governed by the Program Funding and Mechanics (PFM) Protocol, the Measure Bundle Protocol (MBP), and associated rules. HHSC negotiates the protocols with CMS and adopts rules reflecting the CMS-approved protocols. During the approval process for the protocols for DYs 9-10, CMS required certain changes to both the state’s PFM protocol proposal and the MBP proposal. Once these changes were made by HHSC, CMS approved both protocols on September 17, 2019. The amendments being adopted reflect the final versions of the PFM protocol and MBP approved by CMS.

Texas Department of State Health Services

Adopted Rules

Repealing 25 TAC §85.1 as part of a chapter reorganization clarifying procedures for local health authorities to request public health data

CHAPTER 85. HEALTH AUTHORITIESSUBCHAPTER A. LOCAL PUBLIC HEALTH25 TAC §85.1OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts the repeal of §85.1, concerning Health Authorities. BACKGROUND AND JUSTIFICATION The adoption complies with House Bill 3704, 86th Legislature, Regular Session, 2019, which added Texas Health and Safety Code, §1001.089(e). The new law requires DSHS to establish a review process for a local public health entity that requests public health data maintained by DSHS. The review process applies to public health data requests for which there is not an existing agreement to share data. The adopted new rule allows DSHS to enter into an agreement with a local public health entity to share public health data that are necessary to fulfill its essential public health services in compliance with federal and state law.The adopted rules also reorganize the structure of the chapter and define terms to improve clarity. The adopted rules also serve as the four-year review of rules in compliance with Texas Government Code, §2001.039.

Texas Department of State Health Services

Adopted Rules

New 25 TAC §§85.1, 85.3, 85.4, established as part of a chapter reorganization clarifying procedures for local health authorities to request public health data

CHAPTER 85. LOCAL PUBLIC HEALTH25 TAC §§85.1, 85.3, 85.4OVERVIEWThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts new §85.1, concerning Definitions; new §85.3, concerning Health Authorities; and new §85.4, concerning Public Health Data Review Process.BACKGROUND AND JUSTIFICATION The adoption complies with House Bill 3704, 86th Legislature, Regular Session, 2019, which added Texas Health and Safety Code, §1001.089(e). The new law requires DSHS to establish a review process for a local public health entity that requests public health data maintained by DSHS. The review process applies to public health data requests for which there is not an existing agreement to share data. The adopted new rule allows DSHS to enter into an agreement with a local public health entity to share public health data that are necessary to fulfill its essential public health services in compliance with federal and state law.The adopted rules also reorganize the structure of the chapter and define terms to improve clarity. The adopted rules also serve as the four-year review of rules in compliance with Texas Government Code, §2001.039.

Texas Health and Human Services Commission

Adopted Rules

New 26 TAC §370.1, requiring healthcare practitioners to complete human trafficking prevention training

CHAPTER 370. HUMAN TRAFFICKING RESOURCE CENTER26 TAC §370.1OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts new §370.1, concerning Human Trafficking Prevention Training Requirements. The new §370.1 is adopted with changes to the proposed text as published in the August 14, 2020, issue of the Texas Register (45 TexReg 5594). This rule will be republished.BACKGROUND AND JUSTIFICATION The new section is necessary to comply with Texas Occupations Code, §§116.001, 116.002, and 116.003, which require HHSC to approve, post, and update a list of human trafficking prevention training courses for certain health care practitioners.HHSC adopts the new rule as the result of House Bill (H.B.) 2059, 86th Legislature, Regular Session, 2019. H.B. 2059 requires the Executive Commissioner to approve training courses on human trafficking prevention, including at least one that is available without charge. It also requires the Executive Commissioner to post the list of approved training courses on the agency website and to update the list of approved trainings as necessary. The bill requires an HHSC rule to define the time allowed for health care practitioners to successfully complete a training course from the approved list.

Texas Department of Insurance

Adopted Rules

TDI will conduct an official rule review of 28 TAC Chapter 26 (Employer-Related Health Benefit Plan Regulations) and Chapter 33 (Continuing Care Providers), among others

OVERVIEWThe Texas Department of Insurance (TDI), under Texas Government Code §2001.039, will review and consider for readoption the following chapters of 28 Texas Administrative Code Part 1:Chapter 5 (relating to Property and Casualty Insurance); Chapter 6 (relating to Captive Insurance);Chapter 7 (relating to Corporate and Financial Regulation);Chapter 9 (relating to Title Insurance); Chapter 13 (relating to Miscellaneous Insurers and Other Regulated Entities);Chapter 19 (relating to Licensing and Regulation of Insurance Professionals); Chapter 21 (relating to Trade Practices); Chapter 22 (relating to Privacy); Chapter 25 (relating to Insurance Premium Finance); Chapter 26 (relating to Employer-Related Health Benefit Plan Regulations); Chapter 28 (relating to Supervision and Conservation); Chapter 33 (relating to Continuing Care Providers); and Chapter 34 (relating to State Fire Marshal). The current versions of Chapter 11 (relating to Health Maintenance Organizations), and Chapter 15 (relating to Surplus Lines Insurance), were both adopted within the past four years, so it is not necessary to include them in the current review of rules.PUBLIC COMMENT TDI will consider any written comments on the rule review that are received by TDI no later than 5:00 p.m., central time, on December 28, 2020. Send your comments to ChiefClerk@tdi.texas.gov; or to the Office of the Chief Clerk, MC 112-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.

Texas Health and Human Services Commission

In Addition

Notice of Public Hearing on the Proposed Long-Term Care Plan for Individuals with Intellectual Disabilities and Related Conditions for FY 2022-2023

OVERVIEWThe Health and Human Services Commission (HHSC) will conduct an online public hearing on Tuesday, December 1, 2020, at 11:00 a.m. Central Standard Time to receive public testimony regarding the proposed Long-Term Care Plan for Individuals with Intellectual Disabilities and Related Conditions for Fiscal Years 2022-2023 (the proposed LTC Plan).HHSC is required by Texas Health and Safety Code §533A.062 to develop a proposed plan on long-term care for persons with an intellectual disability biennially. Section 533A.062(a) and (b) sets out the scope of the plan.Anyone may request a free copy of the proposed LTC Plan by contacting the HHSC Quality Reporting Unit by email at LtcSearch@hhsc.state.tx.us.HEARING DETAILSThis hearing will be conducted online only. To join the meeting, go to https://attendee.gotowebinar.com/register/8294335699565713167.PUBLIC COMMENT HHSC welcomes public comments pertaining to the proposed LTC Plan during the public hearing. If you would like to register to provide oral comments at the hearing, please go to: https://attendee.gotowebinar.com/register/8294335699565713167. After registering, you will receive a confirmation email containing information about joining the webinar. Registration will be open until the start of the online public hearing.Public comments may also be submitted in writing by e-mail to LtcSearch@hhsc.state.tx.us up to, but no later than, 5:00 p.m. Central Standard Time on December 1, 2020. Written comments may be read aloud during the meeting by HHSC staff, and copies will be provided to HHSC staff for review.

Texas Health and Human Services Commission

In Addition

HHSC plans to request a “Fast Track” extension for the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver

OVERVIEWThe Health and Human Services Commission (HHSC) announces its intent to submit the following to the Centers for Medicare & Medicaid Services (CMS):The Health and Human Services Commission (HHSC) plans to submit a “Fast Track” extension application to the Centers for Medicare & Medicaid Services (CMS) for the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver under section 1115 of the Social Security Act. The extension request is for 5 years, which will allow the 1115 waiver authority to run through 2027.BACKGROUND AND JUSTIFICATION The requested extension will allow Texas continued flexibility to pursue the goals of the existing 1115 waiver: expand risk-based managed care to new populations and services; support the development and maintenance of a coordinated care delivery system; improve outcomes while containing cost growth; and transition to quality-based payment systems across managed care and providers. The extension will also create financial stability for Texas Medicaid providers, as HHSC works to transition the valuable work identified through Delivery System Reform Incentive Payment (DSRIP) innovations. The extension years better align the DSRIP transition timeline with the overall goals to create a sustainable program. There are no significant policy changes requested under this extension application.Since 2011 when the waiver was initially approved, the managed care model in Texas has been expanded statewide and includes more services under capitation. Today, Texas serves over four million Texans through Medicaid and CHIP programs, and 95% are covered under the Medicaid managed care model. This request to extend preserves the innovations, collaboration, and improved value of care through a continuous five-year extension of our current demonstration period.

Texas Health and Human Services Commission

Adopted Rules

HHSC will submit a series of requests to CMS to allow Medicaid MCOs to provide all non-emergency medical transportation for Medicaid managed care members

OVERVIEWThe Health and Human Services Commission (HHSC) announces its intent to submit the following to the Centers for Medicare & Medicaid Services (CMS):Amendment to the Texas State Plan for Medical Assistance under Title XIX of the Social Security ActAmendment to the Texas Healthcare Transformation Quality Improvement Program (THTQIP) demonstration waiver under section 1115 of the Social Security Act.Termination of the TX-24 MTO Nonemergency Transportation waiver under section 1915(b) of the Social Security ActTermination of the TX-26 Fee-For-Service Selective Contracting Program under section 1915(b)(4) of the Social Security ActInitial application for a new Fee-For-Service Selective Contracting Program under section 1915(b)(4) of the Social Security ActThe proposed effective date for these amendments and initial waiver is June 1, 2021. The proposed effective date for the two terminations is May 31, 2021.BACKGROUND AND JUSTIFICATION The purpose of these amendments, terminations and initial application is to implement changes required by House Bill (HB) 1576, 86th Texas Legislature, Regular Session, 2019. HB 1576 requires Medicaid managed care organizations (MCOs) to provide all nonemergency medical transportation (NEMT) services for Medicaid managed care members. HB 1576 also requires MCOs to provide NEMT demand response transportation services for certain trips requested with less than 48-hours’ notice and increases opportunities for transportation network companies (TNCs) to provide demand response transportation services. Finally, HB 1576 maintains the Medical Transportation Program (MTP) to serve the remaining fee-for-service (FFS) Medicaid population. Services for the FFS population will mirror those offered through managed care, including the changes described in this paragraph.

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