A Message from Max

2021 was a challenging year for all of us; a continuation of 2020!  Between the ongoing COVID-19 pandemic and the February winter storm everyone should have been worn out; but like troopers you kept on doing what you needed to do to meet your patients and family’s needs.  No sooner would we think we understood the way care should be provided then it changed only adding to the confusion.  I don’t know about you, but there were days when I had to call my colleagues around Texas to ensure I had processes, policy or rules straight!?!?   The Texas and New Mexico Hospice Organization (TNMHO) is grateful to you for all you have done during these challenging times.  No one knows what 2022 will bring, but like always we know you will bear up under the challenges and frustrations that may come.  TNMHO staff is available to you.  Remember the motto “We are all hospice all the time”.

TNMHO thanks the Texas state government staff for continuing the COVID-19 webinars that address Home and Community Support Services Agencies (HCSSA), Assisted Living (AL), Nursing Facility (NF) and ICFIID facilities.  Staff’s openness to questions via calls, emails and webinars helped everyone.  Of course, nothing was perfect.  Hospice staff had a very difficult time providing good quality services to their patients in long term care (LTC) during COVID, even after the state staff advised all providers that essential caregivers and end-of-life visits were allowed when screening protocols were met!  Many of our families depended on the hospice staff to provide information on their loved one in the LTC facility since they were unable visit.  During the 87th Texas Legislative Session several bills were filed addressing essential caregiver visits in hospitals and LTC.  TNMHO reached out to legislative staff expressing our concerns over hospices inability to access their patients in LTC facilities.  Providers, associations and state government staff will continue to work together for the good of our patients and their families.

TNMHO sends a thank you to the staff with New Mexico Department of Health (DoH) who made every effort to assist us with our questions and rule clarification requests.  TNMHO participates on a quarterly association call with the NMDoH.  This has been a great help.  We look forward to future collaborations with New Mexico!



Texas Register



  • CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES SUBCHAPTER K. COVID-19 RESPONSE 26 TAC §553.2004-The emergency rule is for assisted living facilities and addresses COVID-19 vaccination data reporting and the emergency communication system enrollment.
  • CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION SUBCHAPTER CC. COVID-19 EMERGENCY RULE 26 TAC §554.2804-This emergency rule addresses the tracking of vaccinations of staff and residents in long-term care facilities and to facilitate timely emergency communications between HHSC and nursing facilities in Texas.

To review the above emergency rules, go to:  https://www.sos.state.tx.us/texreg/archive/January142022/Emergency%20Rules/26.HEALTH%20AND%20HUMAN%20SERVICES.html#1.


National Hospice and Palliative Care Organization (NHPCO)


ALERT!  Breaking News: CMS Vaccine Policy Now Enforceable in All 50 States

The federal COVID-19 vaccine mandate for health care workers can officially go into effect nationwide after a judge threw out a challenge to the mandate from Texas on Wednesday, January 19, 2022. A judge in the United States District Court for the Northern District of Texas granted a temporary block of the CMS requirement that employees at Medicare and Medicaid-certified facilities be fully vaccinated against COVID-19 in Texas. But Texas moved to dismiss the case on Tuesday following the Supreme Court’s decision to let the CMS enforce the mandate while appeals are considered at lower courts.

It is unknown at this time about the deadlines for the first and second dose and whether they will be changed for Texas providers. Texas Health and Human Services Commission (HHSC) has no information at this time.

As posted in the November 10th Regulatory Update:


DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services

42 CFR Parts 416, 418, 441, 460, 482, 483, 484, 485, 486, 491 and 494 Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination–  The requirements outline what most Medicare- and Medicaid-certified providers and suppliers must meet to participate in the Medicare and Medicaid programs. These changes are necessary to help protect the health and safety of residents, clients, patients, PACE participants, and staff, and reflect lessons learned to date as a result of the COVID-19 public health emergency. The revisions to the requirements establish COVID-19 vaccination requirements for staff at the included Medicare- and Medicaid-certified providers and suppliers.  To review, go to the:  Federal Register, Volume 86 Issue 212 (Friday, November 5, 2021).  Amendments for hospice providers are under 42 CFR 418.60:  https://www.govinfo.gov/app/frtoc/2021-11-05.

For the CMS FAQ, go to: CMS Omnibus Staff Vax Requirements – External FAQ (508 Compliant). https://www.cms.gov/files/document/cms-omnibus-covid-19-health-care-staff-vaccination-requirements-2021.pdf.

CMS held a webinar meeting regarding these new requirements.  To view the video, visit: https://www.youtube.com/watch?v=xHA0zY1aC-Y.



Centers for Medicare and Medicaid Services (CMS)


The following information is intended for nursing facilities; however, they go into detail on the mandated visitation.

COVID-19: Updated Materials for Visiting Nursing Homes During Omicron Surge

CMS updated our Nursing Home Resource Center with 2 new informational products.  As of January 6, we updated the Nursing Home Visitation FAQs (PDF) to give additional guidance about visitation during the Omicron surge. We also created an infographic (PDF) to graphically represent how to safely conduct visits to nursing homes during this time of spiking COVID cases around the country. Nursing home providers, patients, caregivers, and CMS partners can use these 2 new resources to stay informed about CMS’ latest thinking for keeping nursing homes safe in the current COVID climate.






The following is information only~


Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, Value-Based Insurance Design (VBID) Model, Participating Medicare Advantage Organizations (MAOs) Letter and Checklist

Starting in January 2021, some plans offered by certain Medicare Advantage Organizations (MAOs) include the Medicare hospice benefit in their benefits package as part of a CMS Innovation Center Model. Under the Model, the participating MAOs are responsible for coverage and payment of all services covered by Original Medicare, including hospice. In 2022, the Model expanded to additional states and plans.

A letter and check list was recently sent to Hospices to raise general awareness of the hospice benefit component and provide education on participation and billing for Medicare Advantage enrollees that receive services in affected areas.  To access the checklist, go to: https://palmettogba.com/palmetto/providers.nsf/files/CR12524_2022-VBID-Hospice-Provider-Letter-Checklist.pdf/$FILE/CR12524_2022-VBID-Hospice-Provider-Letter-Checklist.pdf.  


Texas News and Information


Texas Healthcare Partnership (TMHP)


Medicaid Hospice Providers please note~

TMHP Experiencing High Call Volumes Information

TMHP is experiencing an unusually high volume of calls from providers with questions about the Provider Enrollment and Management System (PEMS). As a result, there may be delays in receiving a call back from a Provider Relations representative. For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.


Health and Human Services Commission (HHSC)


Medicaid hospice providers, HHSC has published your new rates.

Payment Rates for Medicaid Community Hospice (IL 2022-03)

HSC approved IL 2022-03 Medicaid Community Hospice payment rates, effective retroactively to Oct. 1, 2021.  To access the letter, go to:  https://www.hhs.texas.gov/sites/default/files/documents/IL2022-03.pdf.    For questions call 512-424-6637.


TNMHO shared the following information with you in the last regulatory update.  HHSC continues to review the information on its impact to hospice providers who have agreements with nursing facilities.

HHSC Publishes Guidance Regarding NF Rule Updates (PL 2021-43)

Hospice providers must be aware of the following provider letter issued to nursing facilities (NF).  HHSC nursing facility policy staff are  researching its impact on and expectations of the hospice provider where antipsychotic and neuroleptic medications are concerned. Hospice providers should begin to move forward in getting these forms done and into the NF.  TNMHO will appraise its membership on the HHSC guidance.

HHSC Long-term Care Regulation published Provider Letter 2021-43 Updates to Nursing Facility Rules for nursing facilities on December 21, 2021.

The letter provides guidance related to newly amended rules in 26 Texas Administrative Code (TAC) Chapter 554, which became effective January 1, 2022. The newly amended rules implement House Bill 1848 and House Bill (HB) 2050 passed during the 86th Texas Legislative Session, 2019, Regular Session, and includes additional requirements related to:

The newly amended rules also amend requirements related to annual in- service training for nurse aides include infection prevention and control training (26 TAC §554.1001).

To access the above information, go to:


Disclaimer:  The Texas and New Mexico Hospice Organization publishes the Regulatory Update as an information only item.  TNMHO has no attorneys nor does it represent the state and federal governments.  All legal questions or concerns should be directed to your attorney or the governments involved.