Health Care Advocate: Nov. 9, 2023


Table of Contents

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

New Immigration Arrest Bill Includes Hospital Exemption

After the third special session of the Texas Legislature adjourned without a deal on an immigration enforcement bill, Gov. Greg Abbott quickly called a fourth special session this week that included a directive to address the same issue.

THA – which fought for hospitals to be exempt from the previous bill giving local and state law enforcement the ability to arrest and detain foreign nationals illegally in Texas – is now monitoring the newest version and the latest round of talks.

Hospitals and other health care facilities are currently exempt from the new House Bill 4 by Rep. David Spiller (R-Jacksboro) and its companion, Senate Bill 4 by Sen. Charles Perry (R-Lubbock), meaning peace officers could not arrest and detain an undocumented person on the premises of a health care facility while the person is seeking medical treatment.

HB 4 was heard today in the House Committee on State Affairs, where lawmakers voted to advance it by an 8-4 vote. Meanwhile, the Senate State Affairs Committee voted to advance SB 4, and Senate rules were then suspended, paving the way for its expected consideration on the Senate floor this evening.

THA is closely monitoring the legislation, which also includes language that would indemnify state and local government officials, employees and contractors against any legal action taken as a result of enforcing the would-be law. (Sara González/Heather De La Garza, J.D.)

Voters Approve Fund to Expand High-Speed Internet

Access to care in Texas earned a much-needed boost on Election Day, with nearly 70% of voters approving a dedicated broadband infrastructure fund for expanded high-speed internet across the state.

Proposition 8 to dedicate $1.5 billion to the new fund passed Tuesday with more than 1.7 million votes. With about 7 million Texans lacking internet access, THA advocated for Prop 8’s passage, noting the impact expanded broadband would have on rural communities. (Jennifer Banda, J.D.)

Abbott to Sign COVID Vaccine Mandate Ban With Hospital Safeguards

Gov. Greg Abbott plans to sign Senate Bill 7 by Sen. Mayes Middleton (R-Galveston) – banning any business from imposing a COVID-19 vaccine mandate on employees – at a signing ceremony Friday.

The final bill, as negotiated by THA during the just-completed third special session of the Texas Legislature, allows hospitals to have policies addressing accommodations for employees who refuse the COVID-19 vaccine. Hospitals are permitted to implement reasonable policies addressing unvaccinated employees with routine and direct exposure to patients, such as the use of personal protective equipment and reassigning those employees to other parts of the facility. If the Texas Workforce Commission receives a complaint over such a policy, it must consult the Texas Department of State Health Services to determine whether the policy was reasonable. THA pursued those considerations after it became clear a full exemption for hospitals wasn’t palatable to lawmakers.

Late amendments to the bill included considering medical and nursing students as contract personnel for whom COVID-19 vaccines can’t be required and setting the penalty for employers at $50,000 per violation. (Carrie Kroll)

Procedural Denials Top 800,000 in Latest Medicaid Unwinding Data

The Texas Health and Human Services Commission (HHSC) continues to process a large number of Medicaid redeterminations related to the unwinding of COVID-19-era continuous Medicaid coverage and has released updated data showing outcomes for renewals initiated between April 1 and Oct. 8.

During that time period, the agency initiated 4.6 million Medicaid renewals. However, HHSC’s latest report only has outcome data finalized for 2,330,312 of those renewals. Here is the outcome breakdown HHSC recently published:

  • 748,866 beneficiaries were successfully renewed and retained Medicaid coverage;
  • 1,250,063 beneficiaries lost Medicaid coverage, of which 817,067 were denied for a procedural reason, such as failure to respond or failure to submit all necessary documents;
  • 331,383 beneficiaries have their renewals pended (meaning they have been initiated but not completed).

Based on stakeholder questions and feedback, HHSC is working on quantifying any backlog of Medicaid applications. If you or your team are experiencing any problems with obtaining information or helping beneficiaries submit renewals or applications, please send an email with the details to [email protected] and CC Erika Ramirez, THA senior director of health policy, at [email protected]. (Sara González/Erika Ramirez)

Texas Hospitals Oppose Minimum Staffing Standards by CMS

THA submitted a comment letter on Monday to address the minimum staffing standards rule proposed by the Centers for Medicare & Medicaid Services (CMS) that would mandate a nationwide patient-to-physician ratio for long-term care facilities. THA, along with the American Hospital Association, urged CMS to consider the complexities of health care staffing, citing the staffing need differences between a specialty facility versus those of a general facility as an example.

“Individual facilities are best positioned to assess their patients’ care needs, and the staffing level and mix necessary to meet these needs,” THA wrote.

Additionally, THA warned in writing that the new rule would make staffing shortages across the country more severe, driving unnecessary competition among facilities. This is especially true where the variation in geography and demographics creates challenges for facilities, THA wrote. The letter cites a recent Kaiser Family Foundation article which predicts “less than 20% of facilities subject to the proposed rule would be able to comply.” THA cautioned that a one-size-fits-all solution would be a setup for certain failure.

“An inflexible requirement … may lead to a reduction of available services, closure of facilities that are unable to meet the requirements (especially in already underserved areas), longer waits for care, and, almost certainly, increased staff shortages amongst all facilities. None of these outcomes will benefit patients,” THA cautioned. (Cesar Lopez, J.D.)

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)

State Posts Draft Modeling Files for OPPS

The Texas Health and Human Services Commission (HHSC) is preparing for its future transition to an outpatient prospective payment system (OPPS) in late 2024 – as required by Texas law – by developing draft OPPS modeling files using 3M Enhanced Ambulatory Patient Groups (EAPGs).

In late September, EAPG posted a new round of files under the Enhanced Ambulatory Patient Groups heading on its Provider Finance Communications page:

  • EAPG Methodology Presentation;
  • Provider Rates, 3M Weights and EAPG Type Analysis File;
  • Provider Impact Analysis with additional breakdown; and
  • 3M’s definition manual URL with registration instructions.

Questions about the draft OPPS modeling files may be directed to HHSC Provider Finance. HHSC is planning to implement OPPS reimbursement on Dec. 1, 2024. (Sara González/Anna Stelter/Matt Turner)

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:

Serving Those Who Served: Dr. Rodney Gonzalez’s Dedication to Veterans’ Health
THA sat down with Amarillo VA Health System Director Dr. Rodney S. Gonzalez to discuss his military service and career in health care leadership ahead of Veteran’s Day.

Money Attracts But Fails to Retain New Physicians
New research from MGMA and Jackson Physician Search explores what residents and fellows want in their first jobs, as well as what could influence them to stay.

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

Federal Register Highlights

The Centers for Medicare & Medicaid Services (CMS) has published notice announcing members of the Performance Review Board. A copy of the notice can be found here. (Nov. 2)

The Centers for Medicare & Medicaid Services (CMS), Employee Benefits Security Administration of the Department of Labor (DOL), and the Internal Revenue Service (IRS) have proposed rules related to the federal independent dispute resolution (IDR) process of the No Surprises Act (NSA). The proposed rules set forth the requirements for the information group health plans and health insurance issuers offering group or individual health insurance coverage have to provide related to the NSA and the IDR process. A copy of the proposed rules can be found here. Comments are due Jan. 2, 2024, and may be submitted to with the file code RIN-0938-AV15. (Nov. 3)

The Centers for Medicare & Medicaid Services (CMS) has published the final rule on the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2024. The final rule also updates the payment rate for renal dialysis services furnished by ESRDs to people with acute kidney injury and final requirements for the ESRD Quality Incentive Program and ESRD Treatment Choices Model. The regulations go into effect Jan. 1, 2024. A copy of the final rule can be found here. (Nov. 6)

The Centers for Medicare & Medicaid Services (CMS) has published notice of the application fee of $709 for calendar year 2024 for institutional providers seeking to (a) initially enroll in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), (b) revalidate their Medicare, Medicaid or CHIP enrollment, or (c) add a new Medicare location. This new fee is effective on Jan. 1, 2024. (Nov. 7)

The Centers for Medicare & Medicaid Services (CMS) has published its final rule adopting a proposed rule on the remedy related to the adjustment of Medicare payment rates for drugs acquired under the 340B Drug Pricing Program from calendar year 2018 through Sept. 27, 2022. This includes the lump-sum repayment proposal and the long-term recoupment. CMS is asking all 340B hospitals to review the proposed lump-sum repayment amounts listed in Addendum AAA for their respective hospital and submit any necessary corrections to CMS by Nov. 30. Hospitals should email CMS at [email protected]. The submission must include (1) a description of the nature of the error, (2) a designated contact person for the purpose of addressing the error; and (3) relevant supporting documentation such as claim numbers, total units, payment amount received and day of payment. A copy of the final rule for the remedy can be found here. (Nov. 8) (Heather De La Garza, 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.