Health Care Advocate: Oct. 28, 2021 


Table of Contents

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

Congressional Outreach Needed to Urge CMS to Honor Medicaid Offer Made to Texas

THA encourages hospital leaders to contact their member of Congress to ask that they urge the Centers for Medicare & Medicaid Services to honor the offer it made to Texas and grant swift approval to key Medicaid payment programs that will help keep Texas’ health care safety net funded for FY 2022.

In August, CMS offered a one-year continuation of Texas’ DSRIP, UHRIP and QIPP programs, but has taken no action to approve the programs since Texas accepted the offer. Hospitals need Texas’ congressional delegation to push CMS to honor the offer it made to Texas and restore potential lapsed funding to the state’s health care safety net. Without swift approval, the state remains unable to make billions of dollars in payments to hospitals that serve low-income Texans. If CMS does not follow through on its agreement by Nov. 1, Texas may not be able to implement the programs this year.

In a letter this week, Texas associations reminded CMS of the urgent need for approval and requested a meeting with CMS leadership. THA also is working closely with the Texas Health and Human Services Commission, the Office of the Governor and the Texas congressional delegation to educate leaders on the negative fiscal consequences to hospitals if approvals remain delayed. More information on the directed payment programs and THA’s advocacy in support is available at (Jennifer Banda, J.D./John Hawkins/Richard Schirmer/Anna Stelter)

HHSC Publishes New Medical Record Copy Fees

The Texas Health and Human Services Commission published its annual notice of new copy fees for medical records in the Oct. 22 issue of the Texas Register. The new fees, which were effective Sept. 1, can be viewed here.

As a reminder, the Health Insurance Portability and Accountability Act privacy regulations specify what hospitals may charge for making copies of medical records. HIPAA regulations allow a hospital to impose a reasonable cost-based fee for providing a copy of protected health information, including the cost of:

  • Labor for copying the information requested by the individual;
  • Supplies for creating the paper copy or electronic record;
  • Postage for mailing; and
  • Preparing an explanation or summary of the requested information.

A guidance document published by the Office of Civil Rights, U.S. Department of Health and Human Services, states that this fee “may not include costs associated with searching for and retrieving the requested information.”

Based on HIPAA regulations and federal guidance, hospitals should consider removing search/retrieval fees allowed under Texas law from their medical record copy charges. Instead, hospitals should focus on imposing reasonable, cost-based fees for labor and supplies for copying the information, postage and preparing an explanation or summary of the requested information. (Sharon J. Beasley/Steve Wohleb, J.D.)

ASPR Hosts Regional Health Care Emergency Preparedness and Response Webinar

The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, is hosting a virtual meeting Nov. 10 from 1 to 2 p.m. CT among the following cooperative agreement recipients:

  • Hospital Association recipients;
  • Hospital Preparedness Program recipients;
  • Health Care Coalition subrecipients;
  • Public Health Emergency Preparedness Program recipients;
  • Regional Disaster Health Response System sites;
  • National Emerging Special Pathogens Training and Education institutions;
  • Regional Ebola and Other Special Pathogen Treatment Center activities; and
  • Pediatric Disaster Centers of Excellence.

Registration is required. The purpose of the discussion is to engage leaders in emergency preparedness and response on the development of regional response systems. The guidelines include current practices and protocols to treat patients and increase medical surge capacity in advance of, during and immediately following a public health emergency. The guidelines can be used by regional systems of hospitals, health care entities and other public and private sector entities. (Sharon J. Beasley/Cameron Duncan, III, J.D./Carrie Kroll)

Register for the 2022 THA Annual Conference & Expo by Oct. 29 for Early Bird Pricing

Oct. 29 is the last day to take advantage of early bird pricing for the 2022 THA Annual Conference & Expo, which will take place Feb. 8-9. This conference will be a hybrid event with the option to attend in person at the Houston Marriott Marquis or virtually from anywhere. The THA Annual Conference & Expo brings together health care leaders from across Texas to discuss the most pressing challenges facing hospitals today. This meeting is a unique opportunity for executives, clinicians, advocates, public health professionals and other health care experts to convene in person and virtually. (Lindsay Thompson)

DSHS Announces Texas Project Firstline

Every health care worker on the frontline, regardless of their educational background and previous training, is critical to stopping the spread of infectious diseases. Texas Department of State Health Services has partnered with Centers for Disease Control and Prevention to present Project Firstline, an interactive series of free online tools that are short and easily understood, designed to give health care providers the foundational knowledge to confidently apply infection control principles and protocols in everyday actions.

Help DSHS reach their goal of 5,000 health care workers to complete a CDC Firstline Training by emailing [email protected]upon completion of the first CDC Project Firstline Training module.

Follow Project Firstline on Facebook and Twitter, and sign up for email updates to know when new trainings and tools are released. (Carrie Kroll)

Texas Register Highlights

The Texas Department of Licensing and Regulation proposes rules regarding the podiatry program. The rules implement new statutory provisions by:

  • Establishing a limited faculty license type;
  • Harmonizing the waiver provisions for licensure between the full and provisional license rules; and
  • Establishing the fee and license term for a limited faculty license.

The rules are necessary to implement the limited faculty license for the opening of Texas’ first podiatry school, the University of Texas Rio Grande Valley School of Podiatry. Additionally, the rules are necessary to harmonize the provisions allowing the Department’s executive director to waive the requirements for the Graduate Podiatric Medical Education and National Board Part III (formerly known as PM Lexis). (Oct. 22)

The Texas Department of State Health Services proposes rules concerning prescription drug price disclosure. The rules implement new statutory provisions that require prescription drug manufacturers to report certain cost data and price increases for prescription drugs. The promulgation of rules allows DSHS to administer fines for failure to disclose price increases. The rules also specify the fee of $250 that is required when drug manufacturers submit each report. (Oct. 22)

The Texas Department of Insurance proposes rules concerning disclosures by out-of-network providers and out-of-network claim dispute resolution. The rules are necessary to implement statutory provisions that allow a nonprofit agricultural organization to offer a health benefit plan. These health benefit plans are subject to certain requirements in the Insurance Code, which create similar requirements for out-of-network billing that already exist for health maintenance organizations and preferred provider benefit plans, as well as for health benefit plans administered by Employees Retirement System of Texas and Teacher Retirement System of Texas plans. (Oct. 22)

The Texas Health and Human Services Commission adopts a rule, effective Oct. 24, concerning outpatient hospital reimbursement. The rule implements state budget provisions that require HHSC to allocate certain funds appropriated to provide an increase to outpatient reimbursement rates for rural hospitals. HHSC will implement an increase to outpatient services reimbursement by removing the cap that was established Sept. 1, 2013 and applying a percentage increase to the cost to charge ratios for rural hospitals. The rule also will eliminate the cost settlement of payments to maintain the level of payment directed by the rider.  Rider 8 states that reimbursement for outpatient emergency department services which do not qualify as emergency visits may not exceed 65 percent of the cost. Therefore, HHSC will decrease the allowable percentage to 55 percent for these services to accommodate the increase in cost to charge ratios and retain the payments below 65 percent of the cost. Pursuant to other statutory provisions, HHSC’s managed care contracts require managed care organizations to reimburse rural hospitals using a minimum fee schedule for services delivered through the Medicaid managed care program. The proposed rule adds language, requiring a Medicaid minimum fee schedule for all rural hospitals, to conform the rule to the current law as well. In addition, the rule explains the cost to charge ratio rate-setting process by including a section specific to rural hospitals. (Oct. 22)

The Texas Board of Physical Therapy Examiners adopts a rule, effective Nov. 1, concerning initiation of physical therapy services. The rule is adopted to include physical therapists who have a doctoral degree in physical therapy and are certified by an entity approved by the PT Board in the group that can treat patients for 15 consecutive business days before requiring a referral from a qualified healthcare practitioner. (Oct. 22)

The Texas Board of Physical Therapy Examiners adopts a rule, effective Nov. 1, concerning recognition of out-of-state license of military spouse. The rule is adopted to include providing a copy of the permanent change of station order for the military service member to whom the spouse is married to the proof of residence requirement. (Oct. 22) (Sharon J. Beasley)

Federal Register Highlights

The Centers for Medicare & Medicaid Services issues an extension of timeline for the publication of the “Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-inclusive Care for the Elderly, Medicaid fee-for-service, and Medicaid managed care programs for years 2020 and 2021” final rule under exceptional circumstances. The timeline for publication of a rule to finalize the Nov. 1, 2018 proposed rule is extended until Nov. 1, 2022. (Oct. 21)

The Department of Veterans Affairs proposes to revise its medical regulations to add chiropractic services to the definitions of medical services and preventive care. VA further revises the definition of medical services to include rehabilitative services consistent with its statutory definition and to reflect changes made in other VA medical regulations and in prior legislation not previously codified. The proposed rules would make VA medical regulations consistent with current practices, prior changes in law and VA’s medical regulations, and changes in law made by the Consolidated Appropriations Act of 2018. These amendments would not substantively change the current administration of medical benefits to veterans. Comments are due by Dec. 20. (Oct. 21) (Sharon J. Beasley)