Upcoming Public Meetings and Events. From HHSC: While every effort has been made to offer an accurate and current listing of meeting agendas and events on this calendar, the information has been compiled from a variety of sources and is subject to change without notice to the user.
Please Note: This is a comprehensive list of upcoming meetings provided by HHSC. Not every meeting fits the parameters for coverage by Texas Insight. If there is a specific meeting you would like us to cover on your behalf, please contact katy@txinsight.com
For details on the postings follow this link Communications & Events | Texas Health and Human Services
*** Designates meetings to be covered by Texas Insight.
April 6, 2022
10:00 am Advisory Committee
April 8, 2022
1:30 pm Advisory Committee
April 11, 2022
9:00 am Public Hearing
April 14, 2022
9:00 am Advisory Committee
1:00 pm Advisory Committee
1:00 pm Advisory Committee
April 20, 2022
10:00 am Advisory Committee
April 22, 2022
9:00 am Advisory Committee
April 28, 2022
9:30 am Advisory Committee
HHSC has the Following Rules Available for Comment. The Administrative Procedure Act (Texas Government Code, Chapter 2001(link is external)) requires the notice published in the Texas Register to include a brief explanation of the proposed rule and a request for comments from any interested person. The notice also includes instructions for submitting comments regarding the rule to the agency, including the date by which comments must be submitted. Agencies must give interested persons “a reasonable opportunity” to submit comments. The public comment period begins on the day after the notice of a proposed rule is published in the Texas Register and lasts for a minimum of 30 calendar days.
The Administrative Procedure Act (Texas Government Code, Chapter 2001(link is external)) requires the notice published in the Texas Register to include a brief explanation of the proposed rule and a request for comments from any interested person. The notice also includes instructions for submitting comments regarding the rule to the agency, including the date by which comments must be submitted. Agencies must give interested persons “a reasonable opportunity” to submit comments. The public comment period begins on the day after the notice of a proposed rule is published in the Texas Register and lasts for a minimum of 30 calendar days. For draft rules detail please see Comment on Proposed & Draft Rules | Texas Health and Human Services or follow the links to each individual rule.
| Title | Project No. / Description | Comment End Date |
| Title 26, Chapter 742, Section 742.508, and Chapter 747, Section 747.2318, conc…
|
#21R160: Tummy Time Supervision in Child-Care Homes | 4/18/22 |
| Title 40, Chapter 30, Medicaid Hospice Program repeal
|
#20R126: Medicaid Hospice Program | 4/18/22 |
| Title 26, Chapter 266, Medicaid Hospice Program
|
#20R126: Medicaid Hospice Program | 4/18/22 |
| Title 25, Chapter 157, Subchapter C, Section 157.41, Automated External Defibri…
|
#21R142: Automated External Defibrillators for Public Access Defibrillation | 4/11/22 |
| Title 1, Chapter 353, Subchapter O, Delivery System and Provider Payment Initia…
|
#22R009: Directed Payment Programs | 4/8/22 |
Informal Comments
Informal opportunities to comment occur before a rule is published in the Texas Register. HHS staff may solicit informal public and stakeholder input by:
- inviting stakeholders to submit comments on potential rule changes during rule development.
- sharing a draft rule with stakeholders for review.
- using existing HHS advisory committees to comment on rules.
The following are draft rules on which HHS is accepting informal public or stakeholder input. All rules are posted in MS Word format unless otherwise noted.
For detail on the rate proposals and older rate proposals please follow the link: Rate Packets | Provider Finance Department (texas.gov) or follow the live link by each proposal.
| Title | Proposed Effective Date | Documents |
| Notice of Proposed Adjustments to Fees, Rates or Charges for Medical Policy Review of Physician Administered Drugs: Vaccines & Toxoids | September 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates or Charges for Mobility Aids | June 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates or Charges for Collaborative Care Management Services | June 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates, or Charges for Medicaid Biennial Calendar Fee Review of the following: Long Acting Reversible Contraceptives (LARCs) | April 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates, or Charges for Policy Fee Review of the following: Prosigna | April 01, 2022 |
|
| Notice of Proposed Temporary Rate Actions for American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments | March 01, 2022 | · Notice of Proposed Temporary Rate Actions for American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments |
| Biennial Calendar Fee Review: Vaccines and Toxoids Q Codes NDCX | March 01, 2022 |
03-01-2022-biennialcalendarfeereview-vaccine-toxoids-qcodes-ndcx.pdf |
| Notice of Proposed Medicaid Payment Rates for the Medical Policy Review of End Stage Renal Dialysis Revenue Codes | March 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates or Charges for IV Therapy Equipment and Supplies | March 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates or Charges for Nutritional (Enteral) Products, Supplies, and Equipment – Home Health & CCP: Immobilized Lipase Cartridge | March 01, 2022 |
|
| Proposed Rate Actions for Fiscal Year 2022-23 Quarter 1 Biennial Fee Review | March 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates or Charges Healthcare Common Procedure Coding System (HCPCS) | March 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates or Charges for Cardiac Magnetic Resonance Imaging | March 01, 2022 |
|
| Biennial Calendar Fee Review | March 01, 2022 |
03-01-2022-biennialcalendarfeereview.pdf
|
| Notice of Proposed Adjustments to Fees, Rates or Charges for Q Codes | March 01, 2022 |
|
| Notice of Proposed Adjustments to Fees, Rates, or Charges for Medicaid Policy Review of Autism Services | February 01, 2022 |
|
Attorney General
No Report This week
Office of the Governor
Governor Abbott, HHSC Announce Extension Of Emergency SNAP Benefits For April 2022
Governor Greg Abbott today announced that the Texas Health and Human Services Commission (HHSC) is providing more than $318 million in emergency Supplemental Nutrition Assistance Program (SNAP) food benefits for the month of April 2022. The allotments are expected to help more than 1.5 million Texas households.
HHSC received federal approval from the U.S. Department of Agriculture (USDA) to extend the maximum, allowable amount of SNAP benefits to recipients based on family size, and all SNAP households will receive a minimum of $95 in emergency allotments. This additional emergency allotment should appear in recipients’ accounts by April 30.
“Emergency SNAP benefits have played an important role in our efforts over the past two years to ensure that every Texan has access to nutritious food,” said Governor Abbott. “We are grateful to HHSC and USDA for helping families across Texas remain safe and healthy.”
“We continue to do our best to support Texans who need a helping hand,” said Texas HHS Access and Eligibility Services Deputy Executive Commissioner Wayne Salter. “These benefits assist families throughout the state to provide nutritious meals to their loved ones.”
The emergency April allotments are in addition to the more than $6.4 billion in benefits previously provided to Texans since April 2020.
Administered by HHSC, SNAP is a federal program that provides food assistance to eligible low-income families and individuals in Texas. Texans in need can apply for benefits, including SNAP and Medicaid, at YourTexasBenefits.com or use the Your Texas Benefits mobile app to manage their benefits.
Governor Abbott Appoints Coorsh To Texas Council for Developmental Disabilities The Governor has appointed William “Bill” Coorsh to the Texas Council for Developmental Disabilities for a term set to expire on February 1, 2027.
William “Bill” Coorsh of Houston is the Director of Investor Relations for Logista Advisors LLC. He is a former senior executive for various energy trading and marketing companies. Additionally, he is an active supporter for the Center for Pursuit, having previously served as the board president. Coorsh received a Bachelor of Science in Industrial Management from Purdue University and a Master of Business Administration from the University of Chicago
Department of Family and Protective Services
No Report This week
Department of State Health Services
DSHS Coronavirus Disease 2019 (COVID-19) Update
Updated Information for COVID-19 Vaccination Providers:
- COVID-19 Vaccine Provider Webinars (last updated 3/29/22)
Main COVID-19 Site Updates:
- Information for COVID-19 Therapeutics Providers (last updated 3/31/22)
- News & Updates
- Provider Resources & Training
- Job Aids & FAQs
- UPDATED: Therapeutics Product Guide – Job Aid (PDF, released 3/30/2022)
- Job Aids & FAQs
- Texas COVID-19 Product Availability
If you have any questions or would like more information about the content on this website, please contact coronavirus@dshs.texas.gov.
DSHS Flu Surveillance Activity Report Update. This information has recently been updated and is now available. Compared to the previous week, the percentage of specimens testing positive for influenza reported by hospital laboratories has decreased. The percentage of patient visits due to influenza-like illness (ILI) has decreased. No influenza-associated pediatric deaths were reported. One influenza-associated institutional outbreak was reported but no school closures were reported.
DSHS RSV Data Update. This information has recently been updated and is now available RSV surveillance in Texas is based on data collected through the National Respiratory and Enteric Virus Surveillance System ( NREVSS) sponsored by the Centers for Disease Control and Prevention (CDC). This is a laboratory-based sentinel surveillance system and participation is voluntary. Sentinel providers report both the number of RSV tests performed and the number of positive tests detected on a weekly basis. Testing is typically by antigen detection; however, viral isolation (i.e., culture) and polymerase chain reaction (PCR) testing are also performed. For the 2016-2017 season, hospital and public health laboratories submitting RSV data are located throughout the state.
DSHS South Texas Laboratory – Correspondence & Bulletins Update
In order to better serve our submitters, we will be conducting renovations of the South Texas Laboratory (STL). In preparation for these renovations, we are asking submitters that submit specimens for tuberculosis testing perform a few tasks so that they can receive TB testing at the Austin laboratory. STL will no longer be able to accept your specimen for TB testing as of April 15, 2022. We do not know when the renovations will be finished but they are scheduled to be completed by the beginning of 2023.
During this time, we are asking our submitters to send TB samples for AFB and culture to Austin laboratory directly. In order to submit specimens to the Austin laboratory for TB testing you will need to request to become a submitter to the Austin laboratory (if you do not already have an Austin submitter number), request shipping containers from the Austin laboratory with the proper label and obtain the Austin laboratory submission form (will be provided once you sign up to become an Austin laboratory submitter).
STL will not be able to forward your specimens to the Austin laboratory during this period and so you will need to request to become an Austin laboratory submitter.
This only applies to TB Samples submitted for AFB smear and culture.
NOTE: DSHS Austin Lab will not accept urine specimens for TB testing.
Contact Person to become a submitter and obtain TB submission form
| Contact information to request TB mailing containers | |
| John Holcomb
Lab Supply Team Lead 1100 W. 49th St. Austin, TX 78756 |
Phone# 512-776-2475
Fax# 512-776-7480 |
| Contact information for shipping and logistical questions | |
| Walter Douglass
Specimen Acquisition |
Phone# 512-776-7569 |
New AHERA Outreach Materials The AHERA program has developed new outreach materials to help with AHERA compliance. You can find these documents under ‘Additional Resources’ on the AHERA Compliance webpage.
Oral Health Updates: Register now for Oral Cancer Webinar and National Oral Health Conference
Upcoming Webinar: Let’s Prevent Oropharyngeal Cancer
Friday, April 8th, the Texas Oral Health Coalition (TxOHC) is hosting “Let’s Prevent Oropharyngeal Cancer (and Avoid Awkward Conversations While Doing It!)” with guest speaker Dr. Rhonda Stokley, DDS. This free webinar will be from 12:00 PM – 1:00 PM CDT. One hour of continuing education will be available for dental professionals.
Vaccination is important to the dental community because most oropharyngeal cancer (OPC) is HPV-associated. OPC affects both men and women. The HPV vaccine also prevents five other types of cancer. Our patients need a strong recommendation from us to vaccinate. This presentation provides information about HPV, OPC and the HPV vaccine. We will also explain what a strong recommendation is and how to integrate HPV vaccine conversations into your practice without having awkward talks about sexual activity.
Register to receive your webinar link and passcode. Click here to learn more about Dr. Stokley, course description, and learning objectives.
National Oral Health Conference (NOHC) is Coming to Texas
Registration is now open for the 23rd annual National Oral Health Conference (NOHC) hosted by the Association of State and Territorial Dental Directors (ASTDD) and the American Association of Public Health Dentistry (AAPHD).
NOHC is “the premier meeting” for those interested in continuing education and networking opportunities within the discipline of Dental Public Health. This conference is designed for dentists, dental hygienists, health researchers, dental/health educators, legislators, public health officials, Medicaid/CHIP dental program staff or consultants, state/territorial dental directors, county/city/local dental directors, community health center personnel, students, school-based and school-linked health center personnel, federally-employed dental personnel, as well as dental manufacturers/distributors and dental insurance companies – in short, anyone interested in engaging in collaboration to improve the oral health of the public.
The conference will be at the Omni Fort Worth Hotel in Ft. Worth, Texas. There will be weekend workshops April 9th and 10th. The main conference will run from April 11-13, 2022. The full schedule is available on their website. Register now to receive discounted rates.
Copy and paste conference link: https://www.eventscribe.net/2022/2022NOHC/
Health and Human Services Commission
Critical Incident Management System Contact Information for CLASS and DBMD Providers
HHSC is installing a new a statewide CIMS. It is for reporting critical incidents in certain Medicaid waiver programs, including the CLASS and Deaf Blind with Multiple Disabilities programs. HHSC is preparing waiver providers’ organization and contract information for affected programs. FEI Systems will upload these into the CIMS system before go-live. HHSC will give the owner or staff identified in the contract administrative rights in the CIMS to update, change, and give more staff access to their waiver providers’ information.
The CLASS-DSA and DBMD waiver program providers and CLASS CMAs send an email to LTSS_Policy if they want a different CIMS administrator than their organizations current point of contact for the Medicaid provider contract.
If a provider does not know the point of contact for the Medicaid provider contract, they should send an email to LTSS Policy. They must include the Tax ID number and program contract number. HHSC will return the point of contact for the organization with the matching TIN and contract ID number.
If the CLASS or DBMD waiver program provider wants to choose a different contact person for CIMS, they must provide the person’s name, phone and email to HHSC using the LTSS Policy mailbox.
CLASS and DBMD waiver services providers and CLASS CMAs must send any needed corrections about the contact people HHSC identified above by April 8.
REMINDER: Medicaid Electronic Health Record Incentive Promoting Interoperability Program Audit Ad Hoc Review Panel Applications Due May 9
If you’re familiar with health information technology initiatives, specifically electronic health record systems and the Medicaid Electronic Health Record Incentive Promoting Interoperability Program, you may want to apply to be a member of the Medicaid EHR Incentive PI Program Audit Ad Hoc Review Panel.
But act quickly as applications are due May 9.
Deadline for Informal Comments on HHS Draft Rules April 14
Texas Health and Human Services Commission (HHSC) is accepting comments from stakeholders on the following draft rules. The comment period has been extended to April 14, 2022.
- Texas Administrative Code,
- Title 40, Part 19, Chapter 745, Subchapter M, Administrative Reviews and Due Process Hearings repeal, and
- Title 26, Part 1, Chapter 745, new Subchapter M, Administrative Reviews and Due Process Hearings. Comments can be emailed to HHS Child Care Regulation.
Questions can be emailed to HHS Rules Coordination Office.
Critical Incident Management System Contact Information for HCS Program Providers, TxHmL Program Providers and LIDDAs
HHSC will install a new a statewide CIMS for reporting critical incidents in certain Medicaid waiver programs. This includes the Home and Community-based Services and Texas Home Living programs. There is short timeline for implementation of the CIMS system. So, HHSC is preparing waiver providers’ organization and contract information for affected programs. FEI Systems will upload these into the CIMS before go-live. HHSC gives the owner or staff identified in the contract administrative rights in the CIMS to update, change, and give staff access to their waiver providers’ information.
HHSC wants Local Intellectual and Developmental Disability Authorities, HCS, and TxHmL providers to review their contract information in the Client Assignment and Registration system. They need to determine if the point of contact listed in CARE is the person each waiver program provider or LIDDA wants designated as the initial CIMS user for their organization. FEI Systems need the name, email address and phone number of each point of contact to create the user account. The user’s email is used for log-in purposes.
LIDDAs, HCS, and TxHmL program providers must verify information in CARE and email any corrections to LTSS_Policy by April 8.
COVID-19 Update to Temporary Change to HCS, TxHmL Policy for Respite, CFC PAS/HAB Service Providers
HHSC has lifted the ban on service providers of respite and Community First Choice PAS/HAB. They can now live in the same home as the person receiving Home and Community-based Services and Texas Home Living program services.
This gives access to needed services for people living in their own or family’s home. A person’s spouse, child or teenager’s parent still cannot be a paid service provider of these services due to guidelines in HCS, TxHmL and CFC handbooks located under Long-term Care Waiver Programs.
This is a temporary policy change. It is effective March 27, 2020 through April 30, 2022, unless the COVID public health emergency ends sooner. HHSC will provide guidance if anything changes.
Program providers must complete the required background checks for all service providers. They must follow:
- The Texas Administrative Code, Title 40, Part 1, Subchapter D and N
- HCS and TxHmL Rules, Section 9.177 (n) and (o), and Section 9.579 (r) and (s)
- HCS and TxHmL Billing Guidelines Section 3400 for service provider qualifications
REMINDER: Medicaid Electronic Health Record Incentive Promoting Interoperability Program Audit Ad Hoc Review Panel Applications Due May 9
If you’re familiar with health information technology initiatives, specifically electronic health record systems and the Medicaid Electronic Health Record Incentive Promoting Interoperability Program, you may want to apply to be a member of the Medicaid EHR Incentive PI Program Audit Ad Hoc Review Panel. But act quickly as applications are due May 9.
HCSSA COVID-19 Response Emergency Rule Revised Effective March 24
HHSC Long-term Care Regulation has published a revised HCSSA COVID-19 Response Emergency Rule (PDF). It became effective March 24, 2022.
The revised rule:
- Points to guidance from HHSC rather than the CDC.
- Removes the requirement for staff and visitor screenings to be documented
April 2022 LTCR Provider Training Opportunities
March 30, 2022
Long-Term Care Regulatory providers are invited to attend the following trainings hosted in April. Visit the Joint Training Opportunities page to register and learn more about each of these events.
Infection Control in Long-Term Care
Monday, April 4
10 a.m. – noon
Register Here
Six Keys to Self-Reporting ANE and Other Incidents – NF (2 hrs.)
Monday, April 4, 2022
1 – 3 p.m.
Register Here
Inappropriate Placements in Assisted Living Facilities – ALFs (1 hr.)
Tuesday, April 5
10 – 11 a.m.
Register Here
Nursing in HCS and TxHmL Settings
Tuesday, April 5
11 a.m. – 2 p.m.
Register Here
CNA Series: The Role of the CNA – Part 2
Thursday, April 7
9 – 10 a.m.
Register Here
CNA Series: Regulatory Requirement Overview – Part 1 (1 hr.)
Thursday, April 7
11 a.m. – noon
Register Here
CNA Series: Regulatory Requirement Overview – Part 2 (1 hr.)
Thursday, April 7
1:30 – 2:30 p.m.
Register Here
CNA Series: Caring for Residents Through the Aging Process – Part 1 (1 hr.)
Thursday, April 7
3:30 – 4:30 p.m.
Register Here
Nursing Scope of Practice in Long-Term Communities (1.5 hrs.)
Monday, April 11
1:30 – 3 p.m.
Register Here
Transition to Practice Series: Providing Individualized Care in the Nursing Home
Tuesday, April 12
9 a.m. – noon
Register Here
Culture Change: Improving Quality of Life in Long-Term Care
Thursday, April 14
10 a.m. – noon
Register Here
Scope and Severity for ALF’s, DAHS, ICF/IID, and PPECC – Providers (1 hr.)
Monday, April 18
11 a.m. – noon
Register Here
OASIS for Clinicians: Patient Tracking and Clinical Record Domains
Tuesday, April 19
11 a.m. – noon
Register Here
LNFA Series: Regulations and Resident Rights
Wednesday, April 20
10 – 11 a.m.
Register Here
Writing Acceptable Plans of Correction for HCS and TxHmL
Wednesday, April 20
1 – 4 p.m.
Register Here
LNFA Series: Complaints, ANE, QAPI
Wednesday, April 20
1 – 2 p.m.
Register Here
LNFA Series: Dementia and Person-Centered Care
Wednesday, April 20
3 – 4 p.m.
Register Here
Workshop for Nursing Facility DONs: A Snapshot
Tuesday, April 26
1 – 4 p.m.
Register Here
Understanding the Survey Process – NF (1.5 hrs.)
Thursday, April 28
10 – 11:30 a.m.
Register Here
Please email Joint Training with any questions
Deadline for Informal Comments on HHS Draft Rules April 5 and 12
Texas Health and Human Services Commission (HHSC) is accepting comments from stakeholders on the following draft rules. The comment period ends April 5, 2022.
- Texas Administrative Code, Title 25, Part 1, Chapter 117, Subchapter D, Section 17.45, and Subchapter G, Section 117.91, concerning Emergency Planning for ESRD Facility Patients. Comments can be emailed to HHS Health Care Regulation Policies and Rules.
HHSC is accepting comments from stakeholders on the following draft rules. The comment period ends April 12, 2022.
- Texas Administrative Code,
- Title 40, Part 19, Chapter 745, Subchapter M, Administrative Reviews and Due Process Hearings repeal, and
- Title 26, Part 1, Chapter 745, new Subchapter M, Administrative Reviews and Due Process Hearings. Comments can be emailed to HHS Child Care Regulation.
Questions can be emailed to HHS Rules Coordination Office.
CHIRP Application Fee Deadline: April 15
HHSC will be collecting an application fee of $8,500 for SFY2023 for the Comprehensive Hospital Increase Reimbursement Program (CHIRP) to defray the cost of administering the program. This application fee will apply to all non-public hospitals who choose to participate in the program. As outlined in Title 1 of the Texas Administrative Code, §353.1301(l), “To the extent authorized under state and federal law, HHSC will collect the state’s cost of administering a program authorized under this subchapter from participants in the program generating the costs.”
- As CHIRP was just approved Friday, March 25, the deadline to submit the application fee will be Friday, April 15, 2022. If no payment is received by the deadline for submission of the application fee, your hospital will be removed from CHIRP and will be ineligible for payment for SFY2023.
- Payment instructions are posted on the Texas Health and Human Services (HHSC) Provider Finance Department (PFD) website.
For more information, please visit the CHIRP webpage on the PFD Website.
HHSC has Published Guidance for FMSAs on CDS Employer Orientations IL 2022-21 IL 2022-21 is posted to the HHS site CDS. It provides updated guidance for Financial Management Services Agencies regarding Consumer Directed Services Employer Orientations, either in person or virtually, under the Consumer Directed Services option. FMSAs, CDS employers and designated representatives must comply with state and federal laws, rules, regulations, and letters about their Medicaid services.
Submit questions to CDS@hhsc.state.tx.us
End Stage Renal Disease Emergency Planning for Facility Patients Draft Rules Posted for Informal Comment – Comments Due April 5, 2022 HHSC posted the emergency planning for end stage renal disease (ESRD) facility patients draft rules for informal comment on March 29, 2022.
In this rule project (Project Number 22R070), HHSC proposes amending §117.45(b), Provision and Coordination of Treatment and Services, and §117.91(h), Fire Prevention, Protection, and Emergency Contingency Plan, to implement Senate Bill 1876.
The proposed amendments to §117.91 also update instructions for reporting incidents of fire in an ESRD facility to HHSC and make other non-substantive edits in the section.
Please review the rules at the link below and send your comments and questions to HCR_PRU@hhs.texas.gov by April 5, 2022.
Enrollment Deadline for Directed Payment Programs – CHIRP, TIPPS, RAPPS, and DPP BHS – Extended to Tuesday, March 29 (Closes Today) HHSC received approval March 25, 2022 from the Centers for Medicare and Medicaid Services to move forward with the state’s directed payment programs: Comprehensive Hospital Increase Reimbursement Program (CHIRP); Texas Incentives for Physicians and Professional Services (TIPPS); and Rural Access to Primary and Preventive Services Program (RAPPS). Read the CMS letters here.
State Fiscal Year 2023 enrollment for participation in the following directed payment programs (DPPs), opened on March 2, 2022 and originally scheduled to close March 22, 2022, closes today, Tuesday, March 29, 2022 at 11:59 PM.
- Comprehensive Hospital Increase Reimbursement Program (CHIRP)
- Texas Incentives for Physicians and Professional Services (TIPPS)
- Rural Access to Primary and Preventive Services Program (RAPPS)
- Directed Payment Program for Behavioral Health Services (DPP BHS)
No Intergovernmental Transfers (IGT) are requested at this time.
Links for each DPP application are below:
- Comprehensive Hospital Increase Reimbursement Program (CHIRP) Application
- Texas Administrative Code (TAC) 353.1306
- CHIRP Application Fee: HHSC will be collecting an application fee of $8,500 for FY2023 for CHIRP to defray the cost of administering the program. This application fee will apply to all non-public hospitals who choose to participate in the program. As outlined in Title 1 of the Texas Administrative Code, §353.1301(l), “To the extent authorized under state and federal law, HHSC will collect the state’s cost of administering a program authorized under this subchapter from participants in the program generating the costs.”
- As CHIRP was just approved Friday March 25, , HHSC will notify providers of the deadline to submit the application fee. If no payment is received by the deadline for submission of the application fee, your hospital will be removed from CHIRP and will be ineligible for payment.
- Payment must be made in the manner determined by HHSC and in compliance with payment instructions that will be posted on the HHSC Provider Finance Department website.
- Texas Incentives for Physicians and Professional Services (TIPPS) Application
- Rural Access to Primary and Preventive Services Program (RAPPS) Application
- Directed Payment Program for Behavioral Health Services (DPP BHS) Application
For SFY2023, two changes are being made to the Texas Incentives for Physicians and Professional Services (TIPPS) and the Directed Payment Program for Behavioral Health Services (DPP BHS) programs. Proposed rule amendments including the changes below were published for public comment in the Texas Register on Friday, March 18, 2022.
- TIPPS – Taxonomy codes related to participation in component 3 are being updated for SFY2023 to include Obstetrics and Gynecology (OB-GYN). Full lists of eligible taxonomy codes are posted under “Enrollment” for SFY2022 and SFY2023 here.
- DPP BHS – Local Behavioral Health Authorities (LBHAs) are being added as a class eligible to participate in the program. More information on DPP BHS is available here.
Enrollment will be open for 21 calendar days and applications will be accepted during this time. For more information on these programs, please contact us at the appropriate email address provided below:
- CHIRP: PFD_hospitals@hhsc.state.tx.us
- TIPPS: PFD_TIPPS@hhs.texas.gov
- RAPPS: PFD_hospitals@hhsc.state.tx.us
- DPP BHS: PFD_DPPBHS@hhs.texas.gov
Extended Outage Scheduled for TMHP LTC Online Portal and HHS SAS There will be a TMHP LTC Online Portal and HHS SAS extended outage to prepare for release of new functionality for the migration of 1915c Waiver Home and Community-based Services and Texas Home Living to these systems.
Both systems will be down Wednesday, April 6 at 9 p.m. CDT. They will be restored by Tuesday, April 12, 2022 at 11:59 p.m.
All web-based functions of the TMHP LTC Online Portal will be unavailable. Users will not be able to access the TMHP LTC Online Portal for form submission or workflow actions.
All front-end and processing functions of HHS SAS will be unavailable. Users will not be able to access HHS SAS for data entry or research purposes. No processing of LTC data will occur.
There will be a notification posted if systems are restored before the date and time listed above.
Contact HHSC at HCS_TxHmL Form Migration with questions.
NF COVID-19 Mitigation, Response Rule Revised Effective March 28
HHSC Long-term Care Regulation has published a revised nursing facility COVID-19 Mitigation and Response Emergency Rule (PDF). It became effective March 28, 2022.
The revised rule:
- Points to guidance from the Texas Department of State Health Services and HHSC rather than the CDC.
- Removes the requirements to have plans for obtaining and maintaining a two-week supply of full PPE.
- Removes the requirement for staff and visitor screenings to be documented.
Read the revised emergency rule.
Texas Department of Insurance
No Report This week
State Auditor’s Office
No Report this week
Health Resources and Services Administration
HRSA Recognizes Key Anniversaries and Works to Increase Health Care Access
In March, HRSA announced the winners of the Promoting Pediatric Primary Prevention Challenge, $66.5 million to support community-based vaccine outreach efforts, more than $560 million in pandemic relief payments to health care providers, funding to increase virtual care quality and access, and new funding to support primary care residency programs.
In March, the Health Resources and Services Administration, the division of the U.S. Department of Health and Human Services devoted to improving health outcomes in underserved communities, promoting health equity, and supporting the health workforce, took the following actions:
Statement of HRSA Administrator Carole Johnson on President Biden’s National Mental Health Strategy
HRSA is working to implement President Biden’s national mental health strategy by taking action to dramatically expand the supply, diversity, and cultural competence of the mental health and substance use disorder workforce. As part of this strategy, HRSA Administrator Carole Johnson visited Nationwide Children’s Hospital in Columbus, Ohio to discuss the importance of mental health services, alongside Second Gentleman Doug Emhoff and HHS Assistant Secretary for Health Admiral Rachel Levine.
New HHS Study in JAMA Pediatrics Shows Significant Increases in Children Diagnosed with Mental Health Conditions from 2016 to 2020
A new HHS study, conducted by HRSA, finds significant increases in the number of children diagnosed with mental health conditions. The findings highlight the critical importance of HRSA’s work to support children’s mental health and well-being through expanding access to mental health services and growing the mental health workforce.
Fact Sheet: American Rescue Plan One Year Anniversary
HRSA marked the first anniversary of the American Rescue Plan by highlighting American Rescue Plan-funded efforts to support COVID-19 vaccination, testing, treatment, and masks for underserved populations and rural communities across the country; keep the doors of health centers open as they led the fight against the pandemic; provide direct resources to rural clinics and hospitals to help rural communities respond to COVID; make record numbers of scholarships and loan repayment awards to clinicians; and expand support for families and children’s essential needs.
HRSA recognized the one-year anniversary of the Health Center COVID-19 Vaccine Program. To date, health centers have administered more than 20 million vaccines in underserved communities across the country through the HRSA program and partnerships with states.
HRSA made more than $413 million in Provider Relief Fund (PRF) payments to more than 3,600 providers across the country. These funds help health care providers prevent, prepare for, and respond to the coronavirus.
Statement of HRSA Administrator Carole Johnson on the Affordable Care Act Anniversary
HRSA Administrator Carole Johnson recognized the anniversary of the Affordable Care Act and highlighted the sea change the law represented for HRSA’s ability to provide equitable access to high-quality health care. In honor of the anniversary, Deputy Administrator Diana Espinosa participated in a celebration hosted by the Centers for Medicare & Medicaid Services.
ICYMI: HRSA Promotes Access to Gender Affirming Care and Treatment in the Ryan White HIV/AIDS Program
HRSA released a letter encouraging Ryan White HIV/AIDS Program service providers to leverage their existing infrastructure to provide access to gender affirming care and treatment services to transgender and gender diverse individuals with HIV.
A Conversation with HHS Women Leaders to Celebrate Women’s History Month
To honor Women’s History Month, HRSA Administrator Carole Johnson joined women leaders across the Department of Health and Human Services (HHS) for a conversation that highlighted HHS’ commitment to advancing the health and well-being of all women.
See News & Announcements on HRSA.gov.
Centers for Medicare and Medicaid Services
Register for the CMS Web Interface and the CAHPS for MIPS Survey Quality Reporting for the 2022 Performance Period by June 30, 2022
Registration is now open for the CMS Web Interface and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the Merit-based Incentive Payment System (MIPS) Survey for the 2022 performance period.
- Groups, virtual groups, and Alternative Payment Model (APM) Entities with 25 or more clinicians (including at least one MIPS eligible clinician) can register through June 30, 2022, to use the CMS Web Interface for reporting quality measures under traditional MIPS.
- Groups, virtual groups, and APM Entities with 2 or more clinicians (including at least one MIPS eligible clinician) can register through 2022 to administer the CAHPS for MIPS Survey under traditional MIPS or the Alternative Payment Model (APM) Performance Pathway (APP).
- Groups, virtual groups and APM Entities only need to register if they intend to report through the CMS Web Interface and/or administer the CAHPS for MIPS Survey for the 2022 performance period.
NOTE: Medicare Shared Savings Program Accountable Care Organizations (Shared Savings Program ACOs) don’t need to register. Shared Savings Program ACOs are automatically registered for the CMS Web Interface and CAHPS for MIPS Survey, as they’re required to meet reporting requirements for the quality performance category under the APM Performance Pathway (APP).
- While Shared Savings Program ACOs are automatically registered for the CMS Web Interface, they aren’t required to report their quality data via the CMS Web Interface. Alternatively, they can choose to meet the APP quality requirements by reporting the 3 required electronic clinical quality measures (eCQMs) or MIPS clinical quality measures (MIPS CQMs).
- The CAHPS for MIPS Survey is required under the APP. Though automatically registered, Shared Savings Program ACOs will still need to hire a CMS-approved vendor to administer the CAHPS for MIPS Survey.
How to Register
If your group, virtual group, or APM Entity (other than a Shared Savings Program ACO) would like to submit quality measures for traditional MIPS using the CMS Web Interface and/or administer the CAHPS for MIPS Survey (for traditional MIPS or the APP) for the 2022 performance period, you must register by 8 p.m. ET on June 30, 2022. You may edit or cancel your registration at any time during the registration period.
To register, please log in to the Quality Payment Program (QPP) website. You’ll need to have the Security Official role in order to register your organization. Please refer to the QPP Access User Guide (ZIP) for information about obtaining a Security Official role for your organization. You can register by:
- Signing in to QPP.
- Going to the Manage Access page.
- Clicking “Edit Registration” by 8 p.m. ET on June 30, 2022.
Please note the following:
- Groups, virtual groups, and APM Entities that submitted data for the quality performance category via the CMS Web Interface for the 2021 performance period will be automatically registered for the CMS Web Interface for the 2022 performance period, unless you cancel your registration.
- However, if your group, virtual group, or APM Entity registered to administer the CAHPS for MIPS Survey for the 2021 performance period, you’ll need to register to administer the CAHPS for MIPS Survey for the 2022 performance period.
- Registered groups, virtual groups, and APM Entities (including Shared Savings Program ACOs) that elect to administer the CAHPS for MIPS Survey will need to hire a CMS-approved vendor to administer the survey. If you don’t plan to administer the CAHPS for MIPS Survey for the 2022 performance period, we encourage you to cancel your registration by 8 p.m. ET on June 30, 2022.
Due to scheduled system maintenance, the CMS Web Interface and the CAHPS for MIPS Survey registration for the 2022 performance period will likely be unavailable on Saturday, April 2, 2022.
Additional Resources
- How to Register for the CMS Web Interface and the CAHPS for MIPS Survey (webpage)
- 2022 CAHPS for MIPS Overview Fact Sheet (PDF)
Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
3/8 – 3/9 ICD-10 Coordination and Maintenance Committee Meeting Update.
Meeting Materials
An updated Agenda packet and an updated post-meeting Q&As document from the procedure code portion of the March 8, 2022 ICD-10 Coordination and Maintenance Committee Meeting are now available at https://www.cms.gov/Medicare/Coding/ICD10/C-and-M-Meeting-Materials.html.
Please visit CDC’s webpage for all diagnosis code related topic information at https://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm.
Deadlines Reminder:
- April 8, 2022 is the deadline for receipt of public comments on proposed new procedure codes and revisions being considered for implementation on October 1, 2022.
- May 9, 2022 is the deadline for receipt of public comments on proposed new diagnosis codes and revisions being considered for implementation on October 1, 2023.
Comments on procedure code topics should be directed to CMS at ICDProcedureCodeRequest@cms.hhs.gov.
Comments on diagnosis code topics should be directed to NCHS at nchsicd10cm@cdc.gov.
Open Payments Pre-Publication Review and Dispute Now Available
Pre-publication review and dispute for the Program Year 2021 Open Payments data is available beginning today, April 1, 2022 through May 15, 2022.
The Centers for Medicare & Medicaid Services (CMS) will publish the Open Payments Program Year 2021 data and updates to the previous program years’ data in June 2022.
Physician and teaching hospital review of the data is voluntary, but strongly encouraged. Please keep in mind the following reminders:
- Disputes must be initiated by May 15, 2022 in order to be reflected in the June 2022 data publication. For more information on review and dispute timing and publication, refer to the Review and Dispute Timing and Data Publication Quick Reference Guide.
- CMS does not meditate or facilitate disputes. Physicians and teaching hospitals should work directly with reporting entities to resolve disputes.
- Registration in the Open Payments system is required in order to participate in review and dispute activities
If you have never registered with Open Payments before:
Make sure you have your National Provider Identifier (NPI) number and State License Number (SLN). Initial registration is a two-step process:
- Register in the CMS Identity Management System (IDM);
- Register in the Open Payments system
For users who have previously registered: Users that have registered during previous program years do not need to re-register.
Please note: If the account has not been accessed within the last 60 days the account will have been locked due to inactivity. To unlock an account, go to the CMS Enterprise Portal, enter your user ID and correctly answer all challenge questions to gain access to your account. You will be prompted to create a new password.
If the account has not been accessed for 180 days or more, the account will be deactivated. To reinstate the account, call the Open Payments Help Desk at 1-855-326-8366; (TTY Line:1-844-649-2766)
For more information about the registration process, visit the covered recipient registration page on the Open Payments website.
Available Resources
We are pleased to share two feature videos about the program. There is an Open Payments Overview Video which provides details about what the program is, who is involved, and how the program operates. There is also a Natures of Payment video that highlights what the Open Payments Natures of Payments are and how they are reflected in the data.
In addition to the videos, there are a variety of resources available on the Resources for Covered Recipients page. These include Quick Reference Guides and tutorials on the registration process as well as review and dispute activities.
Questions – Contact Live Help Desk
Need help or have questions? Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or call 1-855-326-8366 (TTY Line: 1-844-649-2766). The Help Desk is available Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET), excluding Federal holidays.
The Help Desk refers media inquiries to CMS’ Press Office for response.
National Minority Health Month During April, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Minority Health Month. Officially established by Congress in 2002, this health observance offers an opportunity to build awareness about the health inequities that have historically affected underserved and marginalized communities.
In keeping with Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, our office is working to develop a comprehensive approach to advance equity for all including people of color and those adversely affected by persistent poverty and inequity to ensure those served by CMS can achieve their highest level of health and well-being. This is an effort that has involved furthering and embedding equity work across all CMS programs and continuing to provide resources to encourage advancing health equity for all the populations we serve. From the CMS Innovation Center, to the Medicare program, Medicaid and CHIP programs across the country, the Marketplace team, and more, CMS is committed to advancing health equity across Medicare, the Marketplaces, and Medicaid and CHIP.
This observance exemplifies our goal to help eliminate health disparities while improving the health of all minority populations. Below is a list of the resources offered by CMS OMH in order to help achieve this goal.
Resources
- Review the Health Equity Challenges and CMS Resources to Help Address Them infographic, which outlines various barriers to health equity and related challenges that populations often face and shares CMS resources that can help close the health equity gap.
- Review the Health Equity Technical Assistance Program which offers resources aimed at helping health care organizations take action against health disparities.
- Use the Mapping Medicare Disparities Tool to identify areas of disparity between subgroups of people with Medicare (e.g., racial and ethnic groups) in health outcomes, utilization, and spending.
- Download Improving Health in Rural Communities: 2021 Year in Review to learn about the activities and accomplishments that CMS has made in improving the health and wellbeing of individuals living and working in rural, frontier, and tribal communities in fiscal year 2021.
- Download Paving the Way to Equity: A Progress Report to learn more about the progress CMS has made in advancing health equity between 2015 and 2021.
- View our Coverage to Care initiative, which was developed to help people understand their health coverage and connect to the primary care and preventive services that are best for them
Inpatient Psychiatric Facilities: Fiscal Year 2023 Proposed Rule — Submit Comments by May 31
On March 31, CMS issued the fiscal year 2023 inpatient psychiatric facility (IPF) prospective payment system proposed rule to update IPF payments, wage index, and policies. See a summary of key provisions.
Proposals include:
- Updating payment rates by 2.7% with estimated payments to increase by 1.5% after productivity adjustment
- Requesting comments on the IPF prospective payment system refinement analysis
- Applying a permanent 5% cap on wage index decreases
We encourage you to review the rule, and submit formal comments by May 31, 2022.
Inpatient Rehabilitation Facilities: Fiscal Year 2023 Proposed Rule — Submit Comments by May 31 On March 31, CMS issued the fiscal year 2023 inpatient rehabilitation facility (IRF) prospective payment system proposed rule to update Medicare payment policies and rates. See a summary of key provisions.
Proposals include:
- Updating payment rates by 2.8%, with estimated overall payments to increase by 2.0% after productivity and outlier adjustments
- Applying a permanent 5% cap on annual wage index decreases
- Expanding quality data reporting on all IRF patients, regardless of payer
We encourage you to review the rule, and submit formal comments by May 31, 2022
Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program (CMS-1767-P)
On March 31, 2022 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1767-P) that provides updates to and proposals for the fiscal year (FY) 2023 Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP). This rule includes one new proposal: Quality Data Reporting on Patients for the IRF QRP Regardless of Payer. In addition, this proposed rule includes three Requests for Information (RFI) which include: future measure concepts for the IRF QRP; inclusion of a new National Healthcare Safety Network (NHSN) Healthcare-associated Clostridioides difficile Infection Outcome Measure in the IRF QRP; and Overarching Principles for Measuring Equity and Healthcare Quality Disparities across CMS Quality Programs. The proposed rule went on display at the Federal Register and will be available at: https://www.federalregister.gov/public-inspection
Join the CMS Office of Minority Health for the 2022 Virtual CMS Quality Conference The virtual CMS Quality Conference will take place April 12-13, 2022. The theme for the 2022 conference is New Hope, New Health: Charting a Path Forward. Join the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) to discuss health equity! Please find registration information at www.cmsqualityconference.com in order to attend the event.
Mini Plenary Session
Dr. LaShawn McIver, CMS OMH Director, will address “Leading the Way Toward Our Healthiest Nation: Advancing Health Equity Across CMS Programs and Policies” on Tuesday, April 12th from 11:00 – 12:30 pm ET. She will speak to the charge at CMS, to advance health equity by addressing the health disparities that underlie our health system and assessing the equity implications of our policy choices and investments.
Health Equity Sessions
CMS OMH will also lead three additional sessions focused on health equity, covering the following topics:
Data and Social Determinants of Health
Session #24: Z Codes for Social Determinants of Health (SDOH): The Important Role of Standardized SDOH Data Collection for Maximizing the Health of People with Medicare
- Tuesday, April 12 12:45 – 1:45 pm ET
- Standardized tracking of social determinants of health is critical to ensuring optimal health and wellbeing of all people on Medicare and thus key in working toward health equity. Z codes for capturing social determinants of health information remain. As a result, CMS OMH has published a Z codes journey map that provides guidance to health care administrators, clinicians and other members of health care teams and coding professionals on best practices for screening for social determinants of health and coding Z codes for social determinants of health. Join us to learn more about social determinants of health and Z Codes.
Rural Health
Listening Session #32: CMS Rural Health Strategy Listening Session
- Tuesday, April 12th, 2:45 – 3:45 pm ET
- Join a listening session to help guide the next steps for rural health in CMS programs. CMS seeks to validate and update the strategy objectives in the current CMS Rural Health Strategy (from 2018) to ensure the content continues to reflect rural stakeholder needs. This session will be a live moderated conversation where you can provide feedback about how to update the current strategy and discuss what CMS can do to advance health equity in rural and frontier communities, Tribal Nations, and U.S. territories.
Stakeholder Engagement and Individuals with Disabilities
Session #25: The Importance of Stakeholder Engagement when Designing, Policies, Programs, and Resources for Individuals with Disabilities: One Size Does Not Fit All
- Tuesday, April 12th, 4:00 – 5:00 pm ET
- This session will focus on approaches and examples of stakeholder engagement, with a focus on individuals with disabilities. The session will highlight the need to use a variety of lenses to engage people with disabilities. Panelists will also provide insight into tactics and approaches that can be used to actively partner with, and learn from members of our communities who have disabilities.
Posters
CMS OMH work will also be presented in these posters:
- Coverage to Care (C2C): C2C is an initiative to help you understand your health coverage and how to connect to primary and preventative care services. The poster will showcase the updated documents, design, content, and new materials of the C2C Relaunch.
- Mapping Medicare Disparities Tool (MMD): The poster will take an in depth look at the MMD tool.
Health Equity Technical Assistance
Stop by our virtual booth to learn more about our offerings of Health Equity Technical Assistance program. This is a great opportunity to spread the word and hear how to reduce disparities among those you serve. We will explore how your program can identify, track, and act on disparities. We’ll be on hand to:
- Answer questions
- Share our interactive data and web-based tools
- Talk about community outreach
- Learn how to make a Disparities Impact Statement
- Continue health equity work after the conference.
Join the conversation
Follow CMS OMH with our #CMSHealthEquity posts and see live tweets with the conference hashtag, #CMSQualCon22 and follow @CMSGov!
Technical Support
If you have technology questions about how to attend the virtual conference please find information at the following link: https://www.cmsqcvirtual.com/page/2035205/technical-support.
Program Year 2021 Data Submission & Attestation Reminder
This is a reminder that today March 31, 2022 is the final day for applicable manufacturers and group purchasing organizations (GPOs) to submit and attest to data for the June 2022 publication of Program Year 2021 data.
You must complete the attestation for your submitted data by 11:59 p.m. (ET) on March 31, 2022, in order for your data submission to be considered timely and be included in the data publication.
Reporting entities are encouraged to perform final submission and attestation of all entered records as soon as possible to avoid potential processing delays nearing the reporting deadline.
Data submission and attestation activities are completed by logging into the Open Payments system through the IDM Portal.
If you have reported data during previous program years, but have not started reporting for Program Year 2021, you need to recertify in the Open Payments system before you can begin any submission activities.
For more information about the recertification process as well as new registrations, refer to the Applicable Manufacturer and GPO Registration and Re-Certification – Quick Reference Guide to help you complete this necessary step.
For all other resources including the Open Payments User Guide for Reporting Entities, go to the Resources page on our website.
Questions—Contact Live Help Desk
Need help or have more questions? Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or call 1-855-326-8366 (TTY Line: 1-844-649-2766). The Help Desk is available Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET), excluding Federal holidays. The Help Desk refers media inquiries to CMS’ Press Office for response.
Fiscal Year 2023 Hospice Payment Rate Update Proposed Rule — Comment by May 31 On March 30, CMS issued a proposed rule (CMS-1773-P) that would provide routine updates to hospice-based payments and the aggregate cap amount for fiscal year (FY) 2023 in accordance with existing statutory and regulatory requirements. This rule proposes to establish a permanent mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index.
CMS is committed to addressing consistent and persistent inequities in health outcomes by improving data collection to measure and analyze disparities across programs and policies that apply to the Hospice Quality Reporting Program (HQRP). This rule discusses the HQRP including the Hospice Outcomes and Patient Evaluation (HOPE) tool; provides an update on quality measures (QMs) that will be in effect in FY 2023 as well as future QMs; and also provides updates on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey Mode Experiment. This rule also contains a request for information (RFI) on health equity and proposes updates to advancing a health information exchange.
Proposed Medicare Hospice Payment Policies:
This proposed rule proposes a permanent, budget neutral approach to smooth year-to-year changes in the hospice wage index. Specifically, we are proposing a permanent cap on negative wage index changes greater than a 5% decrease from the prior year (regardless of the underlying reason for the decrease) for hospices in the FY 2023 proposed rule.
Routine Annual Rate Setting Changes:
As proposed, hospices would see a 2.7% ($580 million) increase in their payments for FY 2023. The proposed 2.7% hospice payment update for FY 2023 is based on the estimated 3.1% inpatient hospital market basket update reduced by the productivity adjustment (0.4 percentage point). Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual market basket update for FY 2023.
The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed cap amount for FY 2023 is $32,142.65 (FY 2022 cap amount of $31,297.61 increased by 2.7%.
Hospice Quality Reporting Program:
This rule provides an update on the development of a patient assessment instrument, titled HOPE, which would contribute to a patient’s plan of care when adopted. This includes an update on the BETA testing and derivatives that will be achieved during this phase of testing, such as burden estimates and timepoints for collection, as well as additional outreach efforts that will be conducted during and after BETA testing and during our future plans for adoption. CMS also discusses potential future quality measures within the HQRP based on HOPE and administrative data, including HOPE-based process measures and hybrid quality measures, which could be based upon multiple sources that include HOPE, claims, and other data sources.
This rule announces a potential future update to the CAHPS Hospice Survey, which is used to collect data on experiences of hospice care from primary caregivers of hospice patients. In particular, CMS is providing an update on a mode experiment whose goal was to test the effect of adding a web-based mode to the CAHPS Hospice Survey.
In this proposed rule, we are seeking information on our Health Equity Initiative within the HQRP by describing our current assessment of health equity within hospice. We are also seeking input on a potential future structural measure as well as responses to specific questions that would further inform future efforts.
More Information:
- Proposed rule: We’ll accept public comments until May 31, 2022
- Hospice Center webpage
Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model Overview for Safety-Net Providers
The Center for Medicare and Medicaid Innovation (Innovation Center) recently released a Request for Applications (RFA) to solicit a cohort of participants for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.
CMS is hosting three (3) webinars intended for Safety-Net Providers interested in learning more about the ACO REACH model and how to participate in Performance Year (PY) 2023. This target audience includes, but is not limited to, Rural Health Centers, Community Health Centers (CHCs) also known as Federally Qualified Health Centers (FQHCs), Critical Access Hospitals (CAH) Method II, and Sole Community Hospitals (SCH). These webinars will be presented via Zoom and will occur on the following the dates/times:
- Wednesday, April 6th at 10:30 -11:30 am EST (9:30 CST; 8:30 MST, 7:30 PST)
- Thursday, April 7th at 10:00 – 11:00 am EST (9:00 CST; 8:00 MST, 7:00 PST)
- Thursday, April 7th at 4:30 – 5:30 pm EST (3:30 CST; 2:30 MST, 1:30 PST)
Please register in advance to attend the webinar at https://cms.zoomgov.com/webinar/register/WN_y8fynDtKTSWmqcnQ7FHgTg
ACO REACH is a redesign of the Global and Professional Direct Contracting (GPDC) Model in response to stakeholder feedback, participant experience, including a commitment to advancing health equity. Its new name better reflects the purpose of the model: to improve the quality of care for people with Medicare through better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved.
Details on the ACO REACH model, as well as eligibility requirements can be found in the Request for Applications (RFA). Interested stakeholders should submit their application via web portal by April 22, 2022 at 11:59 PM EDT.
Also, please monitor the ACO REACH website for future announcements and contact the model’s helpdesk at ACOREACH@cms.hhs.gov with any questions.
Fiscal Year 2023 Hospice Payment Rate Update Proposed Rule Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1754-P) that would provide routine updates on the development of a patient assessment instrument Hospice Outcomes and Patient Evaluation (HOPE) assessment tool, which would contribute to the patients plan of care when adopted within the Hospice Quality Reporting Program (HQRP). CMS also proposes an update on potential future quality measures within the HQRP based on HOPE and administrative data including HOPE-based process measures as well as hybrid quality measures which could be based upon multiple sources including HOPE, claims and other data sources. This rule also proposes an update on the CAHPS Hospice Survey and seeks information on our Health Equity Initiative within the HQRP.
The proposed rule went on display on March 30, 2022 at the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at https://www.federalregister.gov/public-inspection.
For further information, visit the Hospice Center | CMS webpage.
LTCH CARE Data Submission Specifications The complete set of LTCH CARE Data Submission Specifications have been updated and posted on the LTCH Quality Reporting Technical webpage https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Technical-Information. The new version is V4.00.1 and the documents containing the specifications are dated 02/14/2022. These FINAL specifications go into effect on October 1, 2022.
Attention LTCH Providers: LTCH Provider Preview Reports Related to the March 2022 Care Compare Refresh Have Been Reissued and are Now Available
The Centers for Medicare and Medicaid Services (CMS) discovered an error in measure calculations for the Ventilator Liberation Rate measure in the provider preview reports previously issued on January 26, 2022, related to the March 2022 refresh of Care Compare, for the reporting period July 01, 2020 through June 30, 2021. The update corrected the patient counts included in the Ventilator Liberation Rate measure.
Additionally, an error was discovered in the National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure (NQF #1717) for the reporting period April 01, 2019 through September 30, 2020. This error stemmed from the change to allow four non-contiguous quarters of data due to the reporting exceptions implemented during the COVID-19 public health emergency.
These provider preview reports will be re-released on March 07, 2022, and the new preview period will begin on March 07, 2022 and continue through April 06, 2022. For any questions, please reach out to LTCHPRquestions@cms.hhs.gov.
LTCHs can access their preview report by logging in to iQIES at https://iqies.cms.gov/. At the main screen, select Reports; then ‘My Reports’.
For more information, please visit the CMS LTCH QRP Public Reporting website.
Attention IRF Providers: IRF Provider Preview Reports Related to the March 2022 Care Compare Refresh Have Been Reissued and are Now Available
The Centers for Medicare and Medicaid Services (CMS) discovered an error in measure calculations for the IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634) and IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636) measures in the IRF provider preview reports previously issued on January 26, 2022, related to the March 2022 refresh of Care Compare, for the reporting period July 01, 2020 through June 30, 2021. The update addressed the usage of the wheelchair items in Section GG, as directed in the measure specifications, if the patient was unable to walk as indicated by one of the “activity not attempted” codes.
Additionally, an error was discovered in the National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure (NQF #1717) for the reporting period April 01, 2019 through September 30, 2020. This error stemmed from the change to allow four non-contiguous quarters of data due to the reporting exceptions implemented during the COVID-19 public health emergency.
These provider preview reports will be re-released on March 07, 2022, and the new preview period will begin on March 07, 2021, and continue through April 06, 2022. For any questions, please reach out to IRFPRQuestions@cms.hhs.gov.
IRFs can access their preview report by logging in to iQIES at https://iqies.cms.gov/. At the main screen, select Reports; then ‘My Reports’.
For more information, please visit the CMS IRF QRP Public Reporting website.
Important Updates on the Hospice Quality Reporting Program (HQRP)
Swingtech sends informational messages to hospices related to the Quality Reporting Program (QRP) on a quarterly basis. Their latest outreach communication can be found on the HQRP Requirements and Best Practices webpage. If you want to receive Swingtech’s quarterly emails, then add or update the email addresses to which these messages are sent by sending an email to QRPHelp@swingtech.com. Be sure to include your facility name and CMS Certification Number (CCN) along with any requested updates.
Reminder: 2022 Call for MIPS Promoting Interoperability Measures and Improvement Activities is Open The Centers for Medicare & Medicaid Services (CMS) reminds you to submit Promoting Interoperability measures and improvement activities for consideration for future years of the Merit-based Incentive Payment System (MIPS). The MIPS Annual Call for Measures and Activities process allows clinicians, professional associations and medical societies that represent clinicians, researchers, consumer groups, and others to identify and submit measures and activities. Currently, we are accepting submissions for:
- Measures for the Promoting Interoperability performance category
- Activities for the improvement activities performance category
What We’re Looking For
For Promoting Interoperability: CMS is looking for specific measures that build on the advanced use of certified EHR technology (CEHRT) using 2015 Edition Certification Standards and Criteria; promote interoperability and health information exchange; improve program efficiency, effectiveness, and flexibility; provide patients access to their health information; reduce clinician burden; and align with MIPS improvement activities and quality performance categories.
For Improvement Activities: CMS is looking for activities that can be considered higher than the standard of care. This means that the sets of practices or activities being proposed for consideration exceed defined, commonly accepted guidelines for level of quality or attainment in clinical care or quality improvement guidelines. CMS will not accept duplicative concepts to existing or retired activities.
How to Submit Measures and Activities
If you’re interested in proposing new measures and activities for MIPS, review the 2022 Call for Measures and Activities Overview Fact Sheet in this toolkit (zip) and fill out and submit the forms from the toolkit for the following performance categories during the specified submission periods:
- Promoting Interoperability Performance Category (Submission Period: February 1 – July 1, 2022 for 2024 measures)
- Improvement Activities Performance Category (Submission Period: February 1 – July 1, 2022 for 2024 activities)
For More Information
- Download the 2022 MIPS Call for Measures and Activities (zip) in the Quality Payment Program (QPP) Resource Library.
- Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 AM and after 2 PM ET. We also encourage you to contact us earlier in the year, as response times often increase with heavier demand as the March 31 data submission deadline approaches.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
MS Office of the Actuary Releases 2021-2030 Projections of National Health Expenditures Report shows slower projected national health spending growth after the rapid 2020 growth associated with the COVID-19 pandemic
Today, the Centers for Medicare & Medicaid Services (CMS) released the 2021-2030 National Health Expenditure (NHE) report, prepared by the CMS Office of the Actuary, that presents health spending and enrollment projections for the coming decade. The report notably shows that despite the increased demand for patient care in 2021, the growth in national health spending is estimated to have slowed to 4.2%, from 9.7% in 2020, as supplemental funding for public health activity and other federal programs, specifically those associated with the COVID-19 pandemic, declined significantly.
The NHE has been published annually since 1960, and is often referred to as the “official” estimates of U.S. health spending. The historical and projected estimates of NHE measure total annual U.S. spending for the delivery of health care goods and services by type of good or service (hospital, physician, prescription drugs, etc.), type of payer (private health insurance, Medicare, Medicaid, etc.), and type of sponsor (businesses, households and federal/state governments). The NHE report also includes spending on government public health, investment in structures and equipment, and noncommercial research, as well as information on insurance enrollment and uninsured estimates.
The report finds that annual growth in national health spending is expected to average 5.1% over 2021-2030, and to reach nearly $6.8 trillion by 2030. Growth in the nation’s Gross Domestic Product (GDP) is also projected to be 5.1% annually over the same period. As a result of the comparable projected rates of growth, the health share of GDP is expected to be 19.6% in 2030, nearly the same as the 2020 share of 19.7%.
Near-term expected trends in health spending and insurance enrollments are significantly influenced by the COVID-19 public health emergency (PHE). In 2021, spending for other federal programs and public health activity (the NHE Accounts categories that include the federal COVID-19 supplemental funding) is expected to have declined from $417.6 billion in 2020 to $286.8 billion. Additionally, following the declines observed in 2020, health care utilization is expected to rebound starting in 2021 and then normalize through 2024. As COVID-19 federal supplemental funding is expected to wane between 2021 and 2024, the government’s share of national health spending is expected to fall to 46% by 2024, down from an all-time high of 51% in 2020.
The average annual growth in national health spending over the latter half of the next decade (2025-2030) is projected to be 5.3% and is expected to be driven primarily by more traditional elements, including economic, demographic, and health-specific factors. During this time, upward pressure on spending growth for Medicaid is expected, in part due to the expiration of Disproportionate Share Hospital payment cap reductions statutorily scheduled to end in 2027. Conversely, downward pressure on spending growth is expected for Medicare (related to the end of the Baby Boomers’ enrollments), as well as for private health insurance and out-of-pocket spending in lagged response to slowing income growth earlier in the period.
The percentage of the population with health insurance is expected to be 91.1% in 2021 and 2022 (mainly due to gains in Medicaid enrollment that are, in large part, due to special rules in effect only during the COVID-19 PHE). After the end of the COVID-19 PHE, enrollments are projected to begin returning to pre-pandemic distributions. The 2030 insured rate is projected to be 89.8%.
Selected highlights in national health expenditures by major payer include:
Medicare: Medicare spending growth is projected to average 7.2% over 2021-2030, the fastest rate among the major payers. Projected spending growth of 11.3% in 2021 is expected to be mainly influenced by an assumed acceleration in utilization growth, while growth in 2022 of 7.5% is expected to reflect more moderate growth in use, as well as lower fee-for-service payment rate updates and the phasing in of sequestration cuts. Spending is projected to exceed $1 trillion for the first time in 2023. By 2030, Medicare spending growth is expected to slow to 4.3% as the Baby Boomers are no longer enrolling and as further increases in sequestration cuts occur.
Medicaid: Average annual growth of 5.6% is projected for Medicaid spending for 2021-2030. Medicaid spending growth is expected to have accelerated to 10.4% in 2021, associated with rapid gains in enrollment. Over 2022 and 2023, Medicaid spending growth is expected to slow to 5.7% and 2.7%, respectively, as a result of projected enrollment declines, after the end of the COVID-19 PHE, when the continuous enrollment condition under the Families First Coronavirus Response Act expires and states begin to disenroll beneficiaries no longer eligible for Medicaid. Over 2025-2030, spending growth is projected to increase an average 5.6%, in part due to the expiration of Disproportionate Share Hospital payment cap reductions set for late-2027. Spending is projected to exceed $1 trillion for the first time in 2028.
Private Health Insurance and Out-of-Pocket: For 2021-2030, private health insurance spending growth is projected to average 5.7%. A rebound in utilization is expected to primarily influence private health insurance spending growth over 2021 (6.3%) and 2022 (8.3%), and then normalize through 2024. Over 2025-2030, as health spending trends by private payers tend to be influenced on a lagged basis by changes in income growth, average growth for private health insurance spending is then expected to slow to 4.8% by 2030 in response to slowing income growth earlier in the projection period. Out-of-pocket expenditures are projected to grow at an average rate of 4.6% over 2021-2030 and to represent 9% of total spending by 2030 (ultimately falling from its current historic low of 9.4% in 2020).
Selected highlights in projected health expenditures for the three largest goods and services categories are as follows:
Hospital: Hospital spending growth is projected to average 5.7% for 2021-2030. In 2021, hospital spending growth is expected to be 5.7%, a deceleration from 6.4% in 2020, largely due to declining federal supplemental payments. However, growth in hospital spending for Medicare, Medicaid, and private health insurance are expected to have grown faster compared to 2020 due to a partial rebound in utilization. Demand for care is expected to remain elevated in 2022, along with a projected acceleration in price growth; as a result, hospital spending growth is likewise expected to accelerate to 6.9% in 2022. Over 2023 and 2024, growth is expected to normalize (5.6% per year) and transition away from pandemic-related impacts on utilization, federal program funding, and changes in insurance enrollment, and remain similar on average through 2030 (5.5% per year). Key factors influencing hospital spending growth over 2025-30 is faster projected growth in Medicaid spending due to the scheduled expiration of Disproportionate Share Hospital payment cap reductions, as well as slower expected growth in Medicare spending (slower enrollment growth and larger sequestration-based cuts) and private health insurance spending (in lagged response to slowing income growth).
Physician and Clinical Services: Physician and clinical services spending is projected to grow an average of 5.6% per year over 2021-2030. In 2021, growth in physician and clinical services spending is expected be 5.1%, which is slower than growth of 5.4% in 2020, mainly due to declines in supplemental funding more than offsetting expected utilization increases among Medicare and private health insurance enrollees. Consumers are expected to return to more typical use patterns in 2022 resulting in 6.2% growth. Pandemic-related effects are expected to diminish through 2024. Through 2030, average total physician and clinical services spending growth of 5.5% is expected to primarily reflect decelerating spending growth for private health insurance enrollees in lagged response to projected slower growth in incomes earlier in the period.
Retail Prescription Drugs: Spending growth for retail prescription drugs is projected to increase over 2021-2030 at an average rate of 5%. In 2021, growth is expected to accelerate (4.7%) compared to 2020 (3%) due to faster growth in utilization by Medicaid beneficiaries and those enrolled in private health insurance. In 2022, however, overall retail prescription drug spending growth is projected to slow to 4.3%, as declines in Medicaid enrollment are expected to lead to slower drug spending for that program and more than offset faster Medicare spending for drugs in that year. New drugs expected to be approved from 2021-2026 are expected to influence retail prescription drug spending utilization and prices over the remainder of the projection period; over 2025-2030, retail prescription drug spending growth is anticipated to average 5.2%.
The Office of the Actuary’s report will appear at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
An article about the study is also being published by Health Affairs and is available here:
https://www.healthaffairs.org/
CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.
Medicare
As of December 2021, 64.2M people are enrolled in Medicare. This is an increase of over 87K since the last report.
36.2M are enrolled in Original Medicare.
28.0M are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
49.1M are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.
Over 11.8 million individuals are dually eligible for Medicare and Medicaid, and are counted in the enrollment figures for both programs.
Detailed enrollment data can be viewed here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment
Medicaid and Children’s Health Insurance Program (CHIP)
As of November, 2021, 85,809,179 of people are enrolled in Medicaid and CHIP. This is an INCREASE of 980,636 since the last report.
78,910,300 are enrolled in Medicaid
6,898,879 are enrolled in CHIP
For more information on Medicaid/CHIP enrollment, including enrollment trends, visit https://www.medicaid.gov/medicaid/program-information/medicaid-chip-enrollment-data/medicaid-and-chip-enrollment-trend-snapshot/index.html
Every day, CMS ensures that people across the U.S. have coverage that works. See the latest coverage totals across all CMS programs at https://www.cms.gov/pillar/expand-access. This information is updated on a monthly basis. Enrollment data for CMS programs are compiled on different timelines owing to the unique nature of each program.
Congressional Budget Office
Estimated Budgetary Effects of H.R. 6833, the Affordable Insulin Now Act H.R. 6833 (cbo.gov) H.R. 6833 would impose limits on private health insurance plans and plans offering coverage under Medicare Part D with respect to insulin products. Under the bill, Medicare beneficiaries would pay no more than $35 for each 30-day insulin prescription. Cost sharing for beneficiaries in private plans would be limited to the lesser of $35 or 25 percent of the plan’s negotiated price for a 30-day prescription. In addition, plans would be required to offer first-dollar coverage of insulin, without any deductible. H.R. 6833 also would delay for one year the implementation of a rule affecting the treatment of pharmaceutical manufacturers’ rebates in Medicare Part D and increase funding for the Medicare Improvement Fund.
H.R. 6833 would impose a private-sector mandate as defined in the Unfunded Mandates Reform Act (UMRA) by capping the amount that certain group and individual health insurance plans may require enrollees to pay out of pocket for insulin products. CBO estimates that the average annual cost to comply with the mandate would be $2 billion and would exceed the private-sector threshold established in UMRA ($170 million in 2021, adjusted annually for inflation).
Components may not sum to totals because of rounding.
US Food and Drug Administration
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National Institutes of Health
Treating chronic hypertension in early pregnancy benefits parents, babies
Study shows pregnant adults less likely to experience preterm births or other serious problems with treatment .
Adults treated with medication for high blood pressure present before or during the first 20 weeks of pregnancy, defined as chronic hypertension in pregnancy, had fewer adverse pregnancy outcomes compared to adults who did not receive antihypertensive treatment, according to a study supported by the National Institutes of Health.
The study, which involved more than 2,400 pregnant adults, found that those who received medication to lower their blood pressure below 140/90 mm Hg were less likely to have a preterm birth or experience one of several severe pregnancy complications, such as preeclampsia, a condition marked by sudden high blood pressure and early signs of organ dysfunction. The hypertension treatment did not impair fetal growth.
“The impact of treating chronic hypertension during pregnancy represents a major step forward for supporting people at high risk for adverse pregnancy outcomes,” said Alan T. N. Tita, M.D., Ph.D., a principal investigator of the study and the John C. Hauth Endowed Professor of Obstetrics and Gynecology at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine.
The findings from the Chronic Hypertension and Pregnancy(link is external) (CHAP) trial (NCT 02299414), currently the largest trial to study chronic hypertension in pregnancy, published simultaneously in the New England Journal of Medicine(link is external) and were presented on April 2 at the American College of Cardiology’s 71st Annual Scientific Session and Expo. The study is funded by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.
Diane Reid, M.D., a program officer in the Division of Cardiovascular Sciences at NHLBI, said early antihypertensive treatment could be significant for the thousands of U.S. adults who are at risk for preeclampsia or preterm births. Chronic hypertension in pregnancy occurs in more than 2% of people and can more than triple the risk for severe complications.
The CHAP trial enrolled pregnant people with hypertension at 61 U.S. medical centers from 2015-2021. At the start of the trial, hypertension was defined in this study as having systolic blood pressure (top number) above 140 mm Hg and diastolic blood pressure (bottom number) above 90 mm Hg. (Current guidelines define normal blood pressure for non-pregnant adults as less than 120/80 mm Hg.) Participants enrolled in the trial before 23 weeks of pregnancy. As part of the study, they were followed through delivery and for six weeks after giving birth.
Participants were randomized into one of two groups. Those in the intervention arm, 1,208 participants, received antihypertensive medication to keep their blood pressure below 140/90 mm Hg. Those in the control arm, 1,200 participants, did not receive medication to lower their blood pressure unless it rose above 160/105 mm Hg, a threshold for severe hypertension.
Researchers found that of the participants who received antihypertensive treatment, 70% experienced no major negative pregnancy outcome, while 30% experienced one of the following outcomes: preeclampsia with severe features, which usually presents after 20 weeks of pregnancy; placental abruption; preterm birth at less than 35 weeks; or fetal or neonatal death. In comparison, 37% of participants in the control arm experienced a similar negative event. In other words, the researchers said, for every 14-15 people treated for hypertension early in pregnancy, one was spared from experiencing a severe complication measured in the study.
Additionally, the birth weight of the infants did not appear to be affected by antihypertensive treatments. The birth weights of infants remained similar between groups – most had normal weights. Approximately 11.2% of babies born to participants who received medication and 10.4% of babies born to those in the control group had impaired fetal growth, which was defined as birth weight being below the 10th percentile for babies of the same gestational age.
“The study helps reassure that treating hypertension in pregnancy is safe and effective,” said Reid.
She explains the research will also help inform treatment decisions that have varied because of a shortage of evidence about the benefits of these antihypertensive medications, as well as their effects on fetal growth and development. Some medical organizations recommend the treatments; others discourage them, except in cases of severe hypertension. The authors note that this study should inform clinical practice guidelines.
The researchers also note the importance of future studies, such as those looking at long-term health outcomes of participants and their children, to further clarify the use of hypertension treatments during pregnancy.
To learn more about hypertension in pregnancy, visit https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth/listen-to-your-heart/heart-health-and-pregnancy.
To learn more about ways to support cardiovascular health at every age, visit https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth.
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Drug use severity in adolescence affects substance use disorder risk in adulthood NIH-funded study shows screening for substance use disorder in teens may help predict adult prescription drug use and misuse and prevent overdose.
People who reported multiple symptoms consistent with severe substance use disorder at age 18 exhibited two or more of these symptoms in adulthood, according to a new analysis of a nationwide survey in the United States. These individuals were also more likely, as adults, to use and misuse prescription medications, as well as self-treat with opioids, sedatives, or tranquillizers. Published today in JAMA Network Open, the study is funded by the
National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.
While use of alcohol, cannabis, or other drugs is common among adolescents, previous studies have suggested that most teens reduce or cease drug use as they enter adulthood. However, this study indicates that adolescents with multiple symptoms of substance use disorder – indicating higher severity – do not transition out of symptomatic substance use.
“Screening adolescents for drug use is extremely important for early intervention and prevention of the development of substance use disorder,” said Nora Volkow, M.D., director of NIDA. “This is critical especially as the transition from adolescence to adulthood, when brain development is still in progress, appears to be a period of high risk for drug use initiation.” Dr. Volkow further discusses the findings and implications of this study in a related commentary(link is external).
Researchers in this study argue that key knowledge gaps currently hinder the initiation of screening, diagnosis, prevention, and treatment efforts for teens with substance use disorders. For example, previous methods evaluating persistence of substance use disorder tended to treat substance use disorder as one broad category, without looking at severity. They also failed to account for the possibility of polysubstance use, whereby individuals may use multiple drugs or switch the types of drugs they use as they grow older.
The NIDA-funded Monitoring the Future Panel study at the University of Michigan-Ann Arbor helped close this research gap by examining substance use behaviors and related attitudes among 12th graders through their adulthood in the United States. Since 1976, the study has surveyed panels of students for their drug use behaviors across three time periods: lifetime, past year, and past month. In this study, researchers looked primarily at a subgroup of 5,317 12th graders first evaluated between 1976 and 1986, who were followed with additional surveys at two-year, then five-year intervals for up to 32 years, until they reached age 50. Among the respondents, 51% were female and 78% were white.
The research team examined the relationship between substance use disorder symptom severity at age 18 and prescription drug use, prescription drug misuse, and substance use disorder symptoms up to age 50 in these individuals.
To measure severity of substance use disorder symptoms in adolescence, researchers recorded the number of substance use disorder symptoms that participants reported in response to initial survey questions. These questions were based on criteria for alcohol, cannabis, and “other drug” use disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The researchers categorized substance use disorder symptoms into five levels of severity: exhibiting no symptoms, one symptom, two to three symptoms, four to five symptoms, and six or more symptoms. Symptoms included, but were not limited to, substance use resulting in a failure to fulfill major role obligations and repeating substance use even when dangerous to health.
Approximately 12% of surveyed teens indicated “severe” substance use disorder, defined by this study as reporting six or more symptoms. Among this group, more than 60% exhibited at least two symptoms of substance use disorder in adulthood – an association found across alcohol, cannabis, and other drug use disorders. By comparison, roughly 54% of teens reporting two to three symptoms – indicative of “mild” substance use disorder – had two or more substance use disorder symptoms in adulthood. Higher severity of substance use disorder symptoms at age 18 also predicted higher rates of prescription drug misuse in adulthood.
Overall, more than 40% of surveyed 18-year-old individuals reported at least two substance use disorder symptoms (across all substances). More than half of the individuals who were prescribed and used opioids, sedatives, or tranquilizers as adults also reported two or more symptoms at age 18. This finding underlines the importance of strategies to increase safety and properly assess a potential history of substance use disorder symptoms when prescribing controlled medications to adults.
“Teens with substance use disorder will not necessarily mature out of their disorders, and it may be harmful to tell those with severe symptoms that they will,” said Dr. Sean Esteban McCabe, senior author of this study and director of the Center for the Study of Drugs, Alcohol, Smoking and Health at University of Michigan. “Our study shows us that severity matters when it comes to predicting risk decades later, and it’s crucial to educate and ensure that our messaging to teens with the most severe forms of substance use disorder is one that’s realistic. We want to minimize shame and sense of failure for these individuals.”
The authors note that more research is needed to uncover potential neurological mechanisms and other factors behind why adolescents with severe substance use disorder symptoms are at increased risk of drug addiction and misuse in adulthood. Characterizing possible causes of more severe substance use disorder could help improve understanding of vulnerability to chronic substance use and help make prevention and treatment strategies more effective.
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Law enforcement seizures of pills containing fentanyl increased dramatically between 2018-2021 NIH-supported research highlights growing, dangerous trend, particularly for people new to drug use.
NIH-supported research highlights fentanyl-containing pills as a growing, dangerous trend, particularly for people new to drug use.NIDA
Law enforcement seizures of pills containing illicit fentanyl increased dramatically between January 2018 and December 2021, according to a new study. The number of individual pills seized by law enforcement increased nearly 50-fold from the first quarter of 2018 to the last quarter of 2021 and the proportion of pills to total seizures more than doubled, with pills representing over a quarter of illicit fentanyl seizures by the end of 2021. The study also found an increase in the number of fentanyl-containing powder seizures during this time.
This study was published today in Drug and Alcohol Dependence and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. According to the most recent Centers for Disease Control and Prevention data, the United States hit a record high in the number of overdose deaths ever recorded, estimating that nearly 106,000 people died from drug overdoses in the 12-month period ending in October 2021. This rise is largely driven by illicit fentanyl and other synthetic opioids.
Illicit fentanyl is highly potent, cheaply made and easily transported, making it a profitable narcotic. While people may seek out illicit fentanyl intentionally, many people are not aware that the drug they are using – including heroin, cocaine, methamphetamine, or benzodiazepines – may actually be fentanyl, or has been adulterated or contaminated with fentanyl. Because fentanyl is about 50 times more potent than heroin and a lethal dose may be as small as two milligrams, using a drug that has been laced with fentanyl can greatly increase overdose risk.
“An increase in illicit pills containing fentanyl points to a new and increasingly dangerous period in the United States,” said NIDA Director Nora D. Volkow, M.D. “Pills are often taken or snorted by people who are more naïve to drug use, and who have lower tolerances. When a pill is contaminated with fentanyl, as is now often the case, poisoning can easily occur.”
Illicitly manufactured powder fentanyl has been a known adulterant in drugs since 2013(link is external), but the extent that fentanyl is found in counterfeit pills has been largely unknown. To address this question, a team led by Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine and co-investigator on the NIDA-funded National Drug Early Warning System(link is external) (NDEWS), analyzed data on drug seizures by law enforcement. The data were collected between January of 2018 and December of 2021 from the High Intensity Drug Trafficking Areas(link is external) (HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy(link is external) in which the Drug Enforcement Administration(link is external) and the CDC(link is external) play an active role.
Comparing data from the first quarter of 2018 with the last quarter of 2021, the team found that the number of seizures of pills containing fentanyl increased from 68 to 635, and the total number of individual pills seized by law enforcement increased from 42,202 to 2,089,186. Seizures of powder containing fentanyl also increased from 424 to 1,539, and the total weight of powder seized increased from 298.2 kg to 2,416.0 kg.
Unlike most survey data and surveillance systems which can be lagged for a year or more, HIDTA data are made available quarterly, allowing evaluation in almost real time. HIDTA also distinguish between the presence of fentanyl in pill or powder form. Analyzing these data can therefore help identify trends in availability of illicit substances and act as a type of early warning system to shift public health education or interventional resources more quickly.
HIDTA data does not differentiate between fentanyl and its analogs, nor estimate the amount of fentanyl present in seized substances; however, given the small amount necessary for an overdose, the authors note that the presence of any fentanyl is an important indicator of overdose risk. People who purchase counterfeit drugs, such as illicit oxycodone, hydrocodone, or benzodiazepines may be at risk for unintentional exposure to fentanyl, which is associated with increased risk of overdose death. Further, people who use these types of pills are less likely to have a tolerance built to opioids, and when coupled with the sedative effects of non-fentanyl opioids or benzodiazepines, may further increase risk of overdose and death.
“For the first time we can see this rapid rise in pills adulterated with fentanyl, which raises red flags for increasing risk of harm in a population that is possibly less experienced with opioids,” said Dr. Palamar. “We absolutely need more harm reduction strategies, such as naloxone distribution and fentanyl test strips, as well as widespread education about the risk of pills that are not coming from a pharmacy. The immediate message here is that pills illegally obtained can contain fentanyl.”
The researchers emphasize that drug seizure rates are not direct measures of actual drug availability. However, the increase in fentanyl-related drug seizures coincides with increasing synthetic opioid-related overdose death rates. These data also corroborate data from the DEA National Forensic Laboratory Information System(link is external) showing a steady increase in fentanyl seizures in recent years, even across the earlier parts of the COVID-19 pandemic. For additional NDEWS research and reports, visit https://ndews.org(link is external).
“To address the overdose crisis, you need real-time, high-quality drug surveillance data to inform the public health response,” said Linda B. Cottler, Ph.D., M.P.H, principal investigator of NDEWS, and last author on the paper.
“Through collecting and sharing data on drug use trends as we do through our NIDA-funded NDEWS, we aim to guide strategies to curb the overdose crisis of today, while also keeping our eye on the horizon to prepare for the problems of tomorrow.”
Scientists find racial and ethnic disparities in use of pediatric acute asthma care
Large NIH-funded study suggests factors beyond affordability influence disparities in health care utilization.
Black children with asthma accessed community health centers (CHCs) less than white children, while Latino children (who prefer to speak either English or Spanish) were more likely to visit CHCs for acute, chronic, and preventive care overall, according to a new, large study. The pattern of low clinic utilization by Black children was accompanied by more frequent emergency department visits compared to the other groups. The difference in utilization at the CHC level suggests there are other factors beyond affordability influencing disparities in health care utilization. The study, published in Annals of Family Medicine, was largely supported by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health.
The seven-year observational study conducted across 18 states using electronic health record data of 41,276 children with asthma found 54% of black children had fewer than two visits annually, while for white and Spanish-preferring Latino children, it was 49.2% and 30.1%, respectively. The minimum standard of care for children with asthma is two visits annually. The researchers compared acute asthma care visits within CHCs, and the equivalent use within hospital emergency departments by race, ethnicity, and language.
Led by researchers at the Oregon Health & Science University, Portland, the study is the first to demonstrate that patterns of clinic and emergency department acute-care utilization differ for Black and Spanish-preferring Latino children when compared to white children. Previous studies have documented disparities in asthma-related emergency department use. However, none have demonstrated different long-term patterns by race, ethnicity, and language across various acute care settings (clinic, emergency department, inpatient) accounting for health status, social determinants of health and routine primary care.
Additionally, the researchers endeavored to understand how acute care use may reflect social factors across various domains and levels of influence, including aspects of poverty, the experience of cultural affinity in CHCs, and differing effects of segregation and social deprivation. Those and other factors are outlined in NIMHD’s research framework.
Researchers found that most children in the study experienced a wealth gap, but Black children did so more often than others. Seven in 10 (73%) lived in households that were below 138% of the federal poverty level, compared to 54% to 58% in white and Latino children. These children may have been affected by greater financial instability, the inability of guardians to take work leave or fill prescriptions leading to lower primary care usage, and increased exacerbations that could require emergency care. Eliminating the wealth gap experienced by many Black Americans may improve asthma outcomes for this population.
CHCs in this study may be more tailored to care for Latino populations by having providers/staff that may be of Latino origin as well as language services that provide some cultural affinity not experienced by the Black community utilizing these same clinics.
While other research has shown that in equally segregated and socially deprived neighborhoods, immigrants have better health outcomes (including higher primary care utilization) than non-immigrant Black people do. This contrast suggests that the effects of long-term structural racism may have influenced the findings in this study.
“The findings from this research underscore the multi-faceted nature of minority health and health disparities. There are multiple social factors and levels of influence that can impact health behavior within a population with the same diagnosis, and these must be explored to better understand and address health disparities,” said NIMHD Director Eliseo J. Pérez-Stable, M.D.
“Our discovery suggests that the CHC delivery model may be more effective at mitigating disparities in some situations and groups than others. Future research can investigate which features of the CHC delivery approach can be improved or expanded to reach all populations in need of care,” said Jorge Kaufmann, ND, M.S, of the Department of Family Medicine, Oregon Health & Science University, lead author on the study.
The study was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). The ADVANCE network is led by OCHIN in partnership with Health Choice Network, Fenway Health, Oregon Health & Science University, and the Robert Graham Center.
Good hydration may reduce long-term risks for heart failure
Serum sodium levels may help identify adults with a greater chance of experiencing heart disease.
Staying well-hydrated may be associated with a reduced risk for developing heart failure, according to researchers at the National Institutes of Health. Their findings, which appear in the European Heart Journal(link is external), suggest that consuming sufficient amounts of fluids throughout life not only supports essential body functioning, but may also reduce the risk of severe heart problems in the future.
Heart failure, a chronic condition that develops when the heart does not pump enough blood for the body’s needs, affects more than 6.2 million Americans, a little more than 2% of the population. It is also more common among adults ages 65 and older.
“Similar to reducing salt intake, drinking enough water and staying hydrated are ways to support our hearts and may help reduce long-term risks for heart disease,” said Natalia Dmitrieva, Ph.D., the lead study author and a researcher in the Laboratory of Cardiovascular Regenerative Medicine at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.
After conducting preclinical research that suggested connections between dehydration and cardiac fibrosis, a hardening of the heart muscles, Dmitrieva and researchers looked for similar associations in large-scale population studies. To start, they analyzed data from more than 15,000 adults, ages 45-66, who enrolled in the Atherosclerosis Risk in Communities (ARIC) study between 1987-89 and shared information from medical visits over a 25-year period.
In selecting participants for their retrospective review, the scientists focused on those whose hydration levels were within a normal range and who did not have diabetes, obesity, or heart failure at the start of the study. Approximately 11,814 adults were included in the final analysis, and of those, the researchers found, 1,366 (11.56%) later developed heart failure.
To assess potential links with hydration, the team assessed the hydration status of the participants using several clinical measures. Looking at levels of serum sodium, which increases as the body’s fluid levels decrease, was especially useful in helping to identify participants with an increased risk for developing heart failure. It also helped identify older adults with an increased risk for developing both heart failure and left ventricular hypertrophy, an enlargement and thickening of the heart.
For example, adults with serum sodium levels starting at 143 milliequivalents per liter (mEq/L) – a normal range is 135-146 mEq/L – in midlife had a 39% associated increased risk for developing heart failure compared to adults with lower levels. And for every 1 mEq/L increase in serum sodium within the normal range of 135-146 mEq/L, the likelihood of a participant developing heart failure increased by 5%.
In a cohort of about 5,000 adults ages 70-90, those with serum sodium levels of 142.5-143 mEq/L at middle age were 62% more likely to develop left ventricular hypertrophy. Serum sodium levels starting at 143 mEq/L correlated with a 102% increased risk for left ventricular hypertrophy and a 54% increased risk for heart failure.
Based on these data, the authors conclude serum sodium levels above 142 mEq/L in middle age are associated with increased risks for developing left ventricular hypertrophy and heart failure later in life.
A randomized, controlled trial will be necessary to confirm these preliminary findings, the researchers said. However, these early associations suggest good hydration may help prevent or slow the progression of changes within the heart that can lead to heart failure.
“Serum sodium and fluid intake can easily be assessed in clinical exams and help doctors identify patients who may benefit from learning about ways to stay hydrated,” said Manfred Boehm, M.D., who leads the Laboratory of Cardiovascular Regenerative Medicine.
Fluids(link is external) are essential for a range of bodily functions, including helping the heart pump blood efficiently, supporting blood vessel function, and in orchestrating circulation. Yet many people take in far less than they need, the researchers said. While fluid guidelines vary based on the body’s needs, the researchers recommended a daily fluid intake of 6-8 cups (1.5-2.1 liters) for women and 8-12 cups (2-3 liters) for men. The Centers for Disease Control and Prevention also provides tips to support healthy hydration(link is external).
This research was supported by the Division of Intramural Research at NHLBI. Other coauthors include Delong Liu, Ph.D., from the Laboratory of Vascular and Matrix Genetics and Colin O. Wu, Ph.D., from the Office of Biostatistics Research. The ARIC study has been supported by research contracts from NHLBI, NIH, and the Department of Health and Human Services.
All of Us: Release of Nearly 100,000 Whole Genome Sequences Sets Stage for New Discoveries Nearly four years ago, NIH opened national enrollment for the All of Us Research Program. This historic program is building a vital research community within the United States of at least 1 million participant partners from all backgrounds. Its unifying goal is to advance precision medicine, an emerging form of health care tailored specifically to the individual, not the average patient as is now often the case. As part of this historic effort, many participants have offered DNA samples for whole genome sequencing, which provides information about almost all of an individual’s genetic makeup.
Earlier this month, the All of Us Research Program hit an important milestone. We released the first set of nearly 100,000 whole genome sequences from our participant partners. The sequences are stored in the All of Us Researcher Workbench , a powerful, cloud-based analytics platform that makes these data broadly accessible to registered researchers.
The All of Us Research Program and its many participant partners are leading the way toward more equitable representation in medical research. About half of this new genomic information comes from people who self-identify with a racial or ethnic minority group. That’s extremely important because, until now, over 90 percent of participants in large genomic studies were of European descent. This lack of diversity has had huge impacts—deepening health disparities and hindering scientific discovery from fully benefiting everyone.
The Researcher Workbench also contains information from many of the participants’ electronic health records, Fitbit devices, and survey responses. Another neat feature is that the platform links to data from the U.S. Census Bureau’s American Community Survey to provide more details about the communities where participants live.
This unique and comprehensive combination of data will be key in transforming our understanding of health and disease. For example, given the vast amount of data and diversity in the Researcher Workbench, new diseases are undoubtedly waiting to be uncovered and defined. Many new genetic variants are also waiting to be identified that may better predict disease risk and response to treatment.
To speed up the discovery process, these data are being made available, both widely and wisely. To protect participants’ privacy, the program has removed all direct identifiers from the data and upholds strict requirements for researchers seeking access. Already, more than 1,500 scientists across the United States have gained access to the Researcher Workbench through their institutions after completing training and agreeing to the program’s strict rules for responsible use. Some of these researchers are already making discoveries that promote precision medicine, such as finding ways to predict how to best to prevent vision loss in patients with glaucoma.
Beyond making genomic data available for research, All of Us participants have the opportunity to receive their personal DNA results, at no cost to them. So far, the program has offered genetic ancestry and trait results to more than 100,000 participants. Plans are underway to begin sharing health-related DNA results on hereditary disease risk and medication-gene interactions later this year.
This first release of genomic data is a huge milestone for the program and for health research more broadly, but it’s also just the start. The program’s genome centers continue to generate the genomic data and process about 5,000 additional participant DNA samples every week.
The ultimate goal is to gather health data from at least 1 million or more people living in the United States, and there’s plenty of time to join the effort. Whether you would like to contribute your own DNA and health information, engage in research, or support the All of Us Research Program as a partner, it’s easy to get involved. By taking part in this historic program, you can help to build a better and more equitable future for health research and precision medicine.