Health Care Advocate: Nov. 16, 2023


Table of Contents

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

Hospitals Exempt as Immigration Bill Heads to Governor’s Desk

An immigration enforcement measure with a key THA-driven exemption for hospitals passed the Texas House of Representatives on Tuesday, sending Senate Bill 4 to Gov. Greg Abbott’s desk.

The bill by Sen. Charles Perry (R-Lubbock) gives local and state law enforcement the ability to arrest and detain foreign nationals who are in Texas illegally, a function reserved for federal authorities. At THA’s urging, the measure contains health care facilities as one of several types of exempted sites, specifying that a person who is on the facility grounds to receive treatment cannot be arrested or detained under the bill.

SB 4 would also indemnify state and local government officials, employees and contractors against any legal action arising from enforcement of the law. The bill passed the House on third and final reading Tuesday by an 83-61 vote. (Sara González/Heather De La Garza, J.D.)

Medicaid DSH Cuts Again Delayed in Stopgap Funding Bill

The short-term funding bill that will keep the federal government operating into early 2024 is headed to President Joe Biden’s desk, once again including a delay of the Medicaid disproportionate share hospital (DSH) cuts that THA and other have advocated for repealing.

The Senate passed the House’s funding measure on Wednesday, which would delay the DSH cuts through Jan. 19, 2024, the date through which part of the government is funded under the bill. (The rest would be funded through Feb. 2.) President Biden was expected to sign the bill before Friday’s expiration of the in-effect funding measure.

THA has and will continue to advocate for full repeal of the DSH cuts, which would carry an overall hit of $16 million to safety-net hospitals nationwide across fiscal years 2024 and 2025. (Jennifer Banda, J.D.)

Coming Up: HHSC Hearing on Proposals for CHIRP, Other Programs

The Texas Health and Human Services Commission (HHSC) is holding a public hearing on Nov. 28 at 10 a.m. to receive comments on proposed amendments to several directed payment programs for SFY 2025. The hearing will be held via webinar and registration is available here. The rules with proposed amendments for discussion include:

  • Quality Incentive Payment Program (QIPP)
  • Comprehensive Hospital Increase Reimbursement Program (CHIRP); Quality Metrics for CHIRP;
  • Texas Incentives for Physicians and Professional Services (TIPPS);
  • Rural Access to Primary and Preventive Services Program (RAPPS); and

On November 30, HHSC will hold a public hearing on proposed SFY 2025 quality metrics and performance requirements for CHIRP. The hearing will be held via webinar and registration is available here. A briefing package describing the proposed metrics and specifications is available here.

More information about the hearing and the rule updates is available on the HHSC Provider Finance Department website. (Sara González/Anna Stelter)

HHSC Finalizes Contraceptive Supply Policy for New Law

The Texas Health and Human Services Commission’s Vendor Drug Program (VDP) has announced its finalized policy to implement House Bill 916, a mandatory conception coverage measure that will be effective for Medicaid on Jan. 1, 2024.

The Texas Legislature passed HB 916 during this year’s regular session. It requires most health benefit plans, including Medicaid fee-for-service and managed care, to provide coverage for enrollees to obtain a one-time, three-month supply of a covered prescription contraceptive the first time the enrollee fills this prescription and, subsequently, a one-time, 12-month supply of a covered prescription contraceptive for each 12-month period. The new policy will be added to the VDP Pharmacy Provider Procedure Manual. (Erika Ramirez)

Apply Now for Fiscal Year 2024 HARP

The Texas Health and Human Services Commission announced the beginning of the open enrollment period for the Hospital Augmented Reimbursement Program (HARP) for fiscal year (FY) 2024 last Friday. The enrollment period will be active until Dec. 5, and eligible public and private hospitals are encouraged to apply here. Beginning in FY 2024, HARP is among the voluntary supplemental payment programs in which most eligible hospitals are now required to enroll as a condition of participation in the uncompensated care and disproportionate share hospital payment programs. (Anna Stelter/Sara González)

CDC Reports High Blood Lead Levels Tied to Applesauce Packets

Federal health authorities have reported potential cases across the country, including in Texas, of high blood lead levels (BLL) in children consuming recalled cinnamon applesauce packets. The Centers for Disease Control and Prevention (CDC) has issued a health advisory for facilities and clinicians to be on the lookout for illnesses as a result of lead exposure.

As of Nov. 7, CDC reported 22 cases of children ages 1 to 3 years across Texas and several other states who experienced high BLL. Those cases experienced signs and symptoms that included headache, nausea, diarrhea, vomiting, change in activity level and anemia, CDC said. The companies WanaBana, Schnucks and Weis have initiated voluntary recalls of certain lots of specific cinnamon-containing apple purée and applesauce products.

CDC recommends physicians consider diagnoses for lead exposure and be familiar with the CDC testing recommendations or contact the regional Pediatric Environmental Health Specialty Units or health department for more specific guidance. Facilities should be prepared to advise parents about the symptoms of lead exposure. (Carrie Kroll/Erika Ramirez)

Application Deadline Extended for 2024 Leadership Fellows Cohort

The application deadline for the 2024 cohort of THA Leadership Fellows has been extended to Wednesday, Nov. 22. CEOs, c-suite, executive and director-level leaders within THA member hospitals who are interested in learning more about health care policy in Texas are encouraged to apply. The program consists of four modules that take place in-person at THA’s headquarters in Austin over the course of one calendar year. Review the application checklist here and apply here. (Lindsay Thompson)

Complete THA Member Satisfaction Survey by Dec. 1

To gauge members’ feedback on THA’s efforts, priorities and work, THA recently launched its 2023 Member Satisfaction Survey. This brief survey asks members to rate THA’s effectiveness in communications, advocacy and resource development, with an optional extended survey at the end. Members are encouraged to take the quick, three-minute survey by Dec. 1. Members can access the survey here. (Amy Rios)

Nominate a Colleague for THA’s 12 Days of Health Care Heroes

To recognize the health care workers who continue to serve and protect the wellbeing of all Texans, THA is bringing back its annual “12 Days of Health Care Heroes” campaign. From Dec. 13 through Dec. 24, THA will highlight the life-saving work of a health care hero every day across all social media platforms. This year, health care heroes will also be featured on The Scope. Members are encouraged to nominate a deserving health care professional by submitting a photo with a brief three- to four-sentence description to Julia Mann at [email protected] by Thursday, Nov. 30. (Julia Mann)

This Week on The Scope

Focused on THA member hospitals/health systems and the issues they face, The Scope is THA’s No. 1 source for news, information and thought leadership related to Texas hospitals and priority issues impacting health care. Featured this week:

Keeping the Lifeblood Flowing: National Rural Health Day
THA reflects on the integral presence of hospitals in Texas’ most remote areas, and continues advocating for policy improvements to help care for those communities.

Learning to Affect Change for Rural Texas Hospitals
How a THA Leadership Fellows Program capstone project for Titus Regional Medical Center’s Kathy Griffis went from spark of inspiration to statewide policy.

More content is available on The Scope. (Julia Mann/Amy Rios)

Health Care Advocate Resumes Nov. 30

Due to the Thanksgiving holiday, the Health Care Advocate will not publish next week. Look for the next edition of the Advocate in your inbox on the evening of Thursday, Nov. 30. (Joey Berlin)

Texas Register Highlights

The Texas Health and Human Services Commission (HHSC) proposed amendments at Title 25, Texas Administrative Code, Chapter 448 (governing the Standard of Care in chemical dependency treatment facilities) at §448.801 (concerning Screening); §448.803 (concerning Assessment); and §448.911 (concerning Treatment Services Provided by Electronic Means). The proposed amendments are necessary to comply with and implement House Bill 4, 87th Legislature, Regular Session (2021). HB 4 amended Texas Government Code Chapter 531 to require HHSC to determine which services are cost-effective and clinically effective and adopt rules to develop and implement a system to allow providers to provide certain behavioral health services using audio-only means. The proposed amendments allow a chemical dependency treatment facility (CDTF) to deliver certain audio-only substance use disorder treatment services that HHSC determined are clinically effective and safe. The proposal also updates the requirements for providing services through electronic means to increase clarity and readability. Comments on the proposed rules are due Dec. 10. (Nov. 10) (Steve Wohleb J.D.)

Federal Register Highlights

The Centers for Medicare and Medicaid Services published final rules that set forth routine updates to the Medicare home health payment rates for calendar year (CY) 2024 in accordance with existing statutory and regulatory requirements. The rule also:

  • Discusses comments received regarding access to home health aide services;
  • Implements home health payment-related changes;
  • Rebases and revises the home health market basket and revises the labor-related share;
  • Codifies statutory requirements for disposable negative pressure wound therapy;
  • Implements the new items and services payment for the home intravenous immune globulin benefit;
  • Finalizes changes to the Home Health Quality Reporting Program requirements and the expanded Home Health Value-Based Purchasing Model;
  • Implements the new Part B benefit for lymphedema compression treatment items, codifies the Medicare definition of “brace” and makes other codification changes based on recent legislation;
  • Adds an informal dispute resolution and special focus program for hospice programs;
  • Codifies Durable Medical Equipment Prosthetics and Orthotics Supplies refill policy; and
  • Finalizes proposed revisions for Medicare provider and supplier enrollment requirements.

These regulations are effective on Jan. 1, 2024. (Nov. 13) (Steve Wohleb J.D.)

The Centers for Medicare & Medicaid Services’ Office of the National Coordinator for Health Policy published proposed rules to revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan and Programs of All-Inclusive Care for the Elderly regulations to implement changes related to star ratings, marketing and communications, agent/broker compensation, health equity, dual eligible special needs plans (D-SNPs), utilization management, network adequacy and other programmatic areas. The proposed rule also includes language to codify existing sub-regulatory guidance in the Part C and Part D programs. The proposed rule includes a number of new policies that would improve these programs beginning with contract year 2025 and proposes to codify existing Part C and Part D sub-regulatory guidance. The proposed rule also includes revisions to existing regulations in the Risk Adjustment Data Validation audit appeals process and the appeals process for quality bonus payment determination. One important element of the proposed regulatory changes is intended to increase access to behavioral health care by adding certain behavioral health provider specialties to Medicare Advantage network adequacy standards, specifically, adding a new facility-specialty type, “outpatient behavioral health,” to the existing list evaluated as part of network adequacy reviews. Comments must be received no later than 5 p.m. on Jan. 5, 2024. (Nov. 15) (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.