Texas Hospital Association

Health Care Advocate: June 22, 2022

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Advocacy News 
If you have questions or comments about the articles below, please contact [email protected].

Governor Signs the Last of THA’s Bills into Law

The last trickle of legislative news comes after the June 18 bill veto deadline as Gov. Abbott signed Senate Bill 25 and SB 1624 into law on Sunday.

Sen. Lois Kolkhorst’s (R-Brenham) SB 25 provides support for postsecondary nursing education including funding for grant, scholarship, and loan repayment programs. SB 25 also expands eligibility for loan repayment programs to nurses who serve as part-time faculty and extends the Nursing Innovation Grant Program until 2027, as that program was set to expire this year. The legislation seeks to address a lingering vulnerability in the hospital workforce, which essentially left 64% of hospitals to operate at reduced services due to staff shortages. THA has long advocated for improving the nursing pipeline to help alleviate historic workforce challenges in health care that were exacerbated by the pandemic. The bill went into effect immediately after signing.

SB 1624 by Sen. Judith Zaffirini (D-Laredo) will clarify the process for determining and reviewing guardianship for individuals as well as improving emergency detention procedures for severe mental health issues. THA was in favor of the bill’s requirement for the state to implement a process to electronically apply and receive approval for emergency detention orders. The bill will be effective in September and is a vital step in the modernization of mental health care services and speeding up the emergency detention order process. (Jennifer Banda, J.D./Sara González/Cameron Duncan, J.D./Carrie Kroll)

New: Read THA’s End-Of-Session Report

As Capitol activity starts to wind down, THA has released its end-of-session report featuring a round-up of legislative items impacting hospitals during the 88th session. The report provides key insights into the policies shaping the Texas health care environment, including THA’s efforts to dismantle problematic bills aimed at hospitals. Among other topics, the end-of-session report discusses outcomes related to:

  • Workforce;
  • Coverage;
  • Budget;
  • End-of-life care;
  • Insurance; and
  • Public health and safety.

Read an overview of the end-of-session report in The Scope. To look back at weekly session coverage, THA’s Cap Recap continues to be available. The end-of-session report is viewable and downloadable on the THA website. (Jennifer Banda, J.D.)

DSHS Finalizes Neonatal Facility Designation Rules

The Texas Department of State Health Services has issued final rules adopting amendments to the rules for Hospital Level of Care Designations for Neonatal Care. According to HHSC, the adoption “updates the content and processes with the advances and practices since these rules were adopted in 2016.” Senate Bill 749 from the 86th Legislature amended the Texas Health and Safety Code by adding language about waiver agreements, a three-person appeal panel for designation reviews, and language about telemedicine and telehealth into the neonatal rules. In addition, the Perinatal Advisory Council (PAC) provided DSHS with recommendations designed to clarify parts of the rules.

The recommendations include the use of prearranged consultative agreements using telemedicine technology, and consideration of a waiver agreement for facilities that cannot meet a specific designation requirement. The recommendations further define the process for the three-person appeal panel, clarify that pediatric echocardiography should be completed in a time consistent with standards of professional practice, and should include national accredited organizations providing resuscitation courses.

DSHS received comments on the proposed rules from 35 commenters, including THA. Many of THA’s comments were incorporated into the final rule, including the removal of language that would have allowed access to medical peer review information by surveyors; requiring facilities to reject surveyors with a known conflict of interest (THA requested the addition of “known”); aligning the rule language relating to waiver requests with statutory language; and incorporating THA’s requested changes related to response times for certain radiology and surgical services, and the availability of a dietician.

The adopted rules are effective on June 24. (Steve Wohleb, J.D.)

HHSC Proposes Rural Emergency Hospital Rules

The Texas Health and Human Services Commission has issued proposed rules related to the licensing and operation of a “limited services rural hospital” (LSRH). In 2019, the Texas Legislature enacted Senate Bill 1621, which added Subchapter K to the Texas Hospital Licensing Law. SB 1621 was passed in anticipation of Congress creating a category of Medicare-eligible rural facilities to which rural hospitals could be converted. Congress passed the federal Consolidated Appropriations Act, 2021, which became law on Dec. 27, 2020, and required the Centers for Medicare & Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation (COPs) for REHs effective Jan. 1, 2023. While they go by different names, the federal REH designation and the state-based LSRH designation refer to the same type of facility.

HHSC commenced the approval process for LSRHs under emergency rules adopted shortly after the federal COPs went into effect. The proposed rules incorporate similar details as the COPs and closely mirror draft rules that THA commented on in March and are similar in structure to the existing rules for operating a general or special hospital. More specifically, the proposed rules address:

  • The procedures for obtaining an LSRH license;
  • The standards for LSRH functions and services;
  • Patient rights;
  • Discrimination or retaliation prohibitions;
  • Patient transfer requirements;
  • Reporting guidelines for abuse and neglect
  • Standards for voluntary agreements;
  • Inspection and investigation procedures;
  • Enforcement standards;
  • Fire prevention and protection requirements;
  • General safety standards; physical plant and construction requirements; and
  • Standards for processing documents.

THA is reviewing the scope of the proposed rule and will provide comments to HHSC as necessary, particularly in areas where HHSC failed to incorporate changes requested in THA’s prior comment letter. The comment deadline for the proposed rules is July 18. (Steve Wohleb, J.D.)

DSHS Urges Hospital Awareness of Fungal Meningitis

This week, members of the Texas Department of State Health Services (DSHS) epidemiology team met with THA staff to discuss developments in the ongoing fungal meningitis outbreak related to procedures in Mexico. DSHS requested THA’s help in disseminating updates on the outbreak, including interim guidance for diagnostic testing and treatment from the Centers for Disease Control and Prevention (CDC).

Through their investigation, public health authorities have linked the outbreak of fungal meningitis to people who received procedures under epidural anesthesia at River Side Surgical Center or Clinica K-3 in Matamoros, Mexico between Jan. 1, and May 13, 2023. The CDC recommends diagnostic testing of symptomatic and asymptomatic patients that were exposed regardless of the invasive lumbar puncture procedure. This recommendation is due to the possible latency of symptom onset when it comes to fungal meningitis and the high fatality potential of the disease. The CDC also provides a snapshot of evaluation and treatment for fungal meningitis.

The CDC has additional resources on its website, including a webinar explaining the interim guidance, and a social media toolkit hospitals and providers can use to raise awareness in their communities and ensure exposed individuals seek care. (Erika Ramirez/Carrie Kroll)

Cybersecurity Advisory Cautions Hospitals Against Ransomware

In light of new malicious cyber activity, an advisory was issued warning health care facilities, government agencies and corporations about a critical security flaw in the MOVEit Transfer tool. Hospitals are recommended to take mitigation actions to reduce risk and protect against cybersecurity threats, including keeping systems up to date, maintaining data backup plans and sharing the federal advisory with their IT teams.

Specific mitigation steps can be found on the MOVEit Transfer advisory, or through the Federal Burau of Investigation (FBI)/Cybersecurity and Infrastructure Security Agency’s (CISA) alert. Reports about ransomware incidents should be made to a local FBI office, the FBI Internet Crime Complaint Center, or CISA. (Fernando Martinez)

HHSC to Hold Medicaid Rate Hearing on Women’s Health Surgeries, Rural Hospital Services

The Texas Health and Human Services Commission will hold a public hearing on July 11 at 9:00 a.m. CDT to receive comments on proposed Medicaid rates for:

  • Ambulance services;
  • Birth and women’s Health services;
  • Evaluation and management;
  • Private duty nursing;
  • Personal care services; and
  • Rural hospital inpatient and outpatient services.

Rate packets will be posted on the HHSC Provider Finance webpage no later than June 30, 2023. The hearing and rate packets will present details on rate enhancements funded in the state budget for the 2024-2025 biennium, including a 3% rate increase for certain women’s health surgeries and a more than $72 million all funds increase in rural hospital rates. The hearing will be conducted both in-person and online, and registration is available here. Any written comments must be submitted by 5:00 p.m. CT on July 11. More information can be found on the HHSC event announcement. (Anna Stelter)

Texas Register Highlights

As previously reported in the June 8 edition of the Health Care Advocate, the Health and Human Services Commission (HHSC) finalized rules governing the Medicaid Disproportionate Share Hospital (DSH) program, Hospital Specific Limit (HSL) calculation, and Uncompensated Care (UC) pool payments to hospitals. The final rules adopt HHSC’s proposal on the HSL and UC pools largely as proposed but make substantive modifications to the agency’s original proposal on DSH in response to public comment. The rules were formally published on June 16 and were effective June 20. (June 16) (Steve Wohleb, J.D.)

The Health Care Advocate is a publication of the Texas Hospital Association, 1108 Lavaca, Austin Tx 78701. Telephone 512/465-1570 for information. For additional information regarding specific articles, please contact the THA staff member(s) listed at the bottom of each full article. According to Texas Government Code 305.027, this material may be considered “legislative advertising.” Authorization for its publication is made by Jennifer Banda, J.D., Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas 78701-2180.