Texas Register


TITLE 22. EXAMINING BOARDS PART 9. TEXAS MEDICAL BOARD CHAPTER 174 TELEMEDICINE, SUBCHAPTER A. TELEMEDICINE 22 TAC §174.5–The Texas Medical Board (Board) adopts, on an emergency basis, amendments to 22 TAC §174.5, effective March 3, 2021.  On March 19, 2020, the Texas Governor issued a waiver suspending the strict enforcement of §174.5(e)(2)(A) which generally prohibits the utilization of telemedicine to prescribe scheduled drugs for the treatment of chronic pain. The emergency amendment to §174.5(e) is immediately necessary to help the state’s physicians, physician assistants and other health care professionals continue to mitigate the risk of exposure to COVID-19 and provide necessary medical services to related to issuance of prescriptions including controlled substances for patients. Physicians can continue to provide telephone refills for prescriptions for established patients after having an in-person or two audio and video communications telemedicine medical services within the last 90 days. This waiver and emergency rule includes allowing a physician to issue a prescription for the treatment of chronic pain with scheduled medications.  The emergency amendment would allow physicians to utilize telemedicine to issue refill prescriptions for scheduled medications to established chronic pain patients, if the physician has, within the past 90 days, seen a patient in-person or via a telemedicine visit using two-way audio and video communication.  To review the details in full and the emergency rule, go to:  https://www.sos.state.tx.us/texreg/archive/March122021/Emergency%20Rules/22.EXAMINING%20BOARDS.html#3.


TITLE 26. HEALTH AND HUMAN SERVICES PART 1. HEALTH AND HUMAN SERVICES COMMISSION CHAPTER 556. NURSE AIDES 26 TAC §§556.2, 556.3, 556.6, 556.9–The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §556.2, concerning Definitions; §556.3, concerning Nurse Aide Training and Competency Evaluation Program (NATCEP) Requirements; §556.6, concerning Competency Evaluation Requirements; and §556.9, concerning Nurse Aide Registry and Renewal.  The purpose of the proposal is to allow a NATCEP provider to offer certain components of required training online in a virtual classroom location. A NATCEP is a program approved by HHSC to train and evaluate an individual’s ability to work as a nurse aide in a nursing facility. Currently, all NATCEP training is provided in a classroom and clinical setting.  This program initiative is a response to a critical shortage in trained nurse aides in nursing homes. External stakeholders, such as Texas Health Care Association and Leading Age, have requested that HHSC allow NATCEP providers to offer online training opportunities for portions of the NATCEP classroom curriculum. This option will increase the number of nurse aides qualified for employment in a nursing facility.  Due to the challenges presented by the COVID-19 pandemic and the need for greater awareness and emphasis on infection control, HHSC is also proposing NATCEP providers increase infection control training and continuing education requirements for nurse aides.  To review, go to:  https://www.sos.state.tx.us/texreg/archive/March122021/Proposed%20Rules/26.HEALTH%20AND%20HUMAN%20SERVICES.html#44.


Centers for Medicare & Medicaid Services (CMS)

CMS Updates Nursing Home Guidance with Revised Visitation Recommendations

The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance today for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE).

This latest guidance comes as more than three million doses of vaccines have been administered within nursing homes, thanks in part to the CDC’s Pharmacy Partnership for Long-Term Care Program, following the U.S. Food and Drug Administration’s (FDA) authorization for emergency use of COVID-19 vaccines.


According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation for:

  • Unvaccinated residents, if the COVID-19 county positivity rate is greater than 10 percent andless than 70 percent of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions; or
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.


The updated guidance also emphasizes that “compassionate care” visits should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak. Compassionate care visits include visits for a resident whose health has sharply declined or is experiencing a significant change in circumstances.


CMS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection control, including maintaining physical distancing and conducting visits outdoors whenever possible. This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated.

“CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” said Dr. Lee Fleisher, MD, CMS Chief Medical Officer and Director of CMS’ Center for Clinical Standards and Quality. “That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely. This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19.”

High vaccination rates among nursing home residents, and the diligence of committed nursing home staff to adhere to infection control protocols, which are enforced by CMS, have helped significantly reduce COVID-19 positivity rates and the risk of transmission in nursing homes.

Although outbreaks increase the risk of COVID-19 transmission, as long as there is evidence that the outbreak is contained to a single unit or separate area of the facility, visitation can still occur.

For additional details on the updated nursing home visitation guidance released today, visit here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised.

A Fact Sheet can be found here:  https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised.


Health and Human Services Commission (HHSC)

Reminder: Providers Can Request Free COVID-19 Testing Kits

ALF, HCS, HCSSA, ICF/IID and NF providers in counties where the COVID-19 positivity rate is more than 10 percent can request free COVID-19 testing kits.


The test kits are only to test essential caregivers or HCSSA staff going into an NF or ALF who have direct contact with people receiving hospice services. Providers can request the free BinaxNOW point-of-care antigen COVID-19 test kits by filling out the attestation form. The attestation form includes instructions for requesting the free COVID-19 testing kits for each eligible provider type.  To access, go to:  https://hhs.texas.gov/sites/default/files/documents/services/health/coronavirus-covid-19/attestation-free-covid-19-test-kits.pdf.