Health Care Advocate: June 29, 2023


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

Submit Comments to CMS to Oppose Harmful Directed Payment Rule

This week, THA is urging members to act, once again, to protect Medicaid payments by telling the Centers for Medicare & Medicaid Services (CMS) to withdraw a harmful proposal that would limit total amounts available under directed payment programs and restrict states’ ability to draw down federal Medicaid dollars. CMS’s proposed rule – called Medicaid and CHIP Managed Care Access, Finance, and Quality – is the agency’s latest attempt to restrict permissible financing in Medicaid programs in a similar fashion as its roundly maligned Medicaid Fiscal Accountability Regulation (MFAR), which was eventually withdrawn.

The July 3 comment deadline is quickly approaching. An Action Alert distributed to THA members yesterday provides a template letter and other resources for hospitals to personalize written comments asking CMS to withdraw the rule’s payment and financing restrictions. These would devastate hospitals’ ability to provide much needed access to care for Medicaid patients and cut directed payment programs in Texas by as much as $5 billion. Hospitals can use the following to assist in drafting comment letters:

Submit a comment at the Federal Register by clicking the green Submit a Formal Comment button. Comments are due by 4 p.m. CT Monday, July 3.

THA’s comment letter will be submitted to CMS Friday, June 30. THA continues to work closely with organizations representing Texas hospitals, other state hospital associations, and state leadership to have the payment and financing proposals in this rule withdrawn. Questions should be directed to Anna Stelter. (Anna Stelter/Jennifer Banda J.D.)

THA Requests Larger Inpatient Reimbursement Increases from CMS

On June 9, THA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on federal fiscal year 2024 Inpatient Prospective Payment System (IPPS) rules. THA, along with the American Hospital Association and other hospital associations, requested that CMS utilize its discretionary authority to reconsider and increase its proposed 2.8% increase in operating payments. THA also requested that CMS consider Medicaid disenrollment in its insurance coverage estimates for the Medicare DSH program and recommended considerable refinement in its approach to supporting safety net hospitals using proxy indices. Additional details and THA’s full comment letter are available here. (Anna Stelter)

CDC Advisory Alerts Health Care Facilities of Locally Acquired Malaria Cases

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network Health Advisory for locally acquired malaria cases in the U.S., one case in Texas and four in Florida. Malaria symptoms present from 10 days to 4 weeks after infection and include fever, chills, headaches, myalgias and fatigue. Clinicians are advised to consider patients with travel history to areas where malaria propagates or areas in the United States where locally acquired malaria cases have occurred. The disease should be treated as a medical emergency and patients should be diagnosed and treated within 24 hours of presentation. Health care professionals are recommended to provide a microscopic examination of thin and thick blood smears and a rapid diagnostic test if available. A step-by-step guide on the process can be found here, including treatment options and diagnostic steps.

Any locally acquired cases of malaria should be reported to any regional or state health department, and the CDC is on call 24/7 to provide advice to health care providers. Hospitals are recommended to stock up on IV artesunate and artemether-lumefantrine or Atovaquone-proguanil in preparation for malaria care. Public health stakeholders are encouraged to contact CDC’s malaria branch and emergency operations center for assistance and to communicate mosquito borne illness reduction strategies to communities at risk. (Carrie Kroll)

THA Takes Stock of the 88th Legislative Session

As Texas hospitals and health care advocates analyze the outcomes of the legislative session, THA has compiled a summary of the most substantial legislative wins and challenges for hospitals. Read the 2023 regular session roundup and watch an end-of-session Q&A with THA’s lobbying team who fought for top-line policies and hospital interests under the dome. For a more in-depth look at the session, THA released its end-of-session report for the 88th legislative session detailing efforts to protect hospitals and launch grassroot opposition against bad bills. (Jennifer Banda, J.D.)

HHSC Opens SFY2023 DPP Corrections Period

The State Fiscal Year 2023 (SFY23) Corrections Period for the state’s directed payment programs (DPPs) is now open. Providers participating in CHIRP, RAPPS or TIPPS can correct SFY23 reporting for Round 1 structure measures and Round 2 process and outcome measures prior to the Health and Human Services Commission submitting data to the Centers for Medicare & Medicaid Services. Participating providers must upload corrections templates to the DPP reporting portal. Providers needing access to the portal must complete a DPP Contact Change form. All corrections must be submitted by July 22. (Anna Stelter/Matt Turner)

Registration Open for TexasAIM Substance Use Disorder Summit

TexasAIM is inviting stakeholders to register for its Opioid and Other Substance Use Disorder Summit set for Aug. 2 from 12:30 to 5 p.m. in Houston. The event is an opportunity for hospitals, state agencies, leaders and other stakeholders to receive updates on maternal and obstetric care for women with substance abuse disorders and network with colleagues. Key speakers include:

  • Dr. Michael Warren, Associate Administrator of the Maternal and Child Health Bureau, part of the U.S. Department of Health and Human Services’ Health Resources and Services Administration; and
  • Dr. Jennifer Shuford, Commissioner of the Texas Department of State Health Services.

Registration is limited so secure your spot today by filling out this registration form. For those unable to attend in person, there is a virtual online option. Any questions should be addressed to [email protected]. (Erika Ramirez)

New Medicaid Rates for Ambulatory Surgical Centers and Hospital Ambulatory Surgical Centers Now Effective

New Medicaid rates for Ambulatory Surgical Centers (ASC)/Hospital Ambulatory Surgical Centers (HASC) recently took effect on June 1. Payments for these services transitioned to a Healthcare Common Procedure Coding System (HCPCS) based fee schedule. Rates for many ASC/HASC services increased, with the exception of non-Medicare codes. Methods the Texas Health and Human Services Commission used to develop the new rates can be found in the applicable rate packet. (Anna Stelter)

Uncompensated Trauma Care Fund Distributions to Hospitals Announced

The Texas Department of State Health Services (DSHS) announced that uncompensated trauma care fund distributions to designated trauma facilities occurred the week of June 19. The disbursement serves two purposes: (1) ensuring that any hospital that received the Medicaid standard dollar amount trauma care add-on payment did not receive less than the amount calculated for the DSHS FY 2021 uncompensated trauma care disbursement, and (2) distributing funds in the state’s dedicated EMS/Trauma funding accounts to all eligible hospitals. A total of $9,995,174 was distributed from three designated trauma funding accounts. Hospitals should review announced disbursements from Account 5111 and Accounts 5007/5108 and ensure funds were received. Contact Jorie Klein with questions. (Anna Stelter)

Time is Running Out to Recommend Leaders for THA

The deadline to nominate individuals for the THA Board or the Council on Policy Development is June 30. There are several critical THA leadership positions available, including nine members of the THA Board of Trustees, the next Board chair-elect, and 24 members of THA’s Council on Policy Development. Nominations can be made by completing the online nomination form. Multiple nominations and self-nominations will be accepted; however, a separate form must be completed for each submission. Learn more about boards, councils and committees involvement here. (Sharon Beasley)

Texas Register Highlights

The Texas Health and Human Services Commission (HHSC) proposes rules concerning reimbursement for outpatient hospital, renal dialysis, and clinical laboratory services.

The proposal implements the outpatient prospective payment system (OPPS) reimbursement as required by Texas Government Code §536.005, (enacted in the 82nd Texas Legislature, 1st Called Session,) which requires that HHSC “convert outpatient hospital reimbursement systems to an appropriate prospective payment system.” In addition, the 2014-15 General Appropriations Act, 83rd Legislature, Regular Session, 2013 (Article II, HHSC, Rider 38) stated that “in order to ensure that access to emergency and outpatient services remain in rural parts of Texas, it is the intent of the Legislature that when HHSC changes its outpatient reimbursement methodology to a 3M Enhanced Ambulatory Patient Groups or similar methodology, HHSC will put into effect a separate or modified payment level for the above-defined providers.” HHSC has been unable to implement EAPGs in the current Medicaid Management Information System (MMIS) without significant technology costs. Now that HHSC is moving to a modernized MMIS, EAPGs are being implemented in the same timeframe. The contracts related to the modernized MMIS anticipated the new system would become operational on Sept. 1. However, the deadline may be moved forward for system readiness.

The OPPS that HHSC is proposing to implement is the EAPG grouper methodology. HHSC is working through the evaluation of the potential impacts in payments to hospitals and other impacted providers and expects to share those impacts in May as the evaluation is completed. The rule amendments update the reimbursement methodology in each of the four rules to clarify the transition to EAPGs. Any comments are due within 31 days of publication. (June 23)

The Texas Department of Insurance (TDI) proposes rules concerning telemedicine and telehealth services and necessary to conform to Texas Occupations Code Chapter 111, which was amended to define “teledentistry dental service” by House Bill 2056, 87th Legislature, Regular Session (2021), and sets billing requirements when a health care provider provides telemedicine and telehealth services.

Currently, the code has definitions for “telemedicine services” and “telehealth services” but does not define “teledentistry dental service,” and requires health care providers to bill for “telemedicine services” and “telehealth services” using the applicable Medicare payment policies and requirements. TDI proposes to add a definition for “teledentistry services” and to add Medicaid payment policies to the list of applicable payment policies that health care providers must use to bill for telemedicine, telehealth, and teledentistry services. Any comments are due by July 24. (June 23) (Cesar Lopez, 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.