Texas Register

 

TITLE 22. EXAMINING BOARDS PART 9. TEXAS MEDICAL BOARD CHAPTER 174. TELEMEDICINE SUBCHAPTER A. TELEMEDICINE 22 TAC §174.5The Texas Medical Board (Board) adopts, on an emergency basis, amendments to 22 TAC §174.5, effective September 3, 2020, at 12:01 a.m.  In light of the impending expiration of emergency rule §174.5, the Board adopts, on an emergency basis, amendments to 22 TAC §174.5.

 

Therefore, 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 chronic pain management with controlled substances for patients. Pursuant to the Governor’s declaration of disaster issued on March 13, 2020, related to COVID-19, physicians determining whether to utilize telemedicine medical services for the treatment of chronic pain with scheduled medications, must give due consideration to additional important parameters to ensure the safety of the patient.

 

The emergency amendment would allow physicians to continue to utilize telemedicine to issue refill prescriptions for scheduled medications to established chronic pain patients if the physician determines that such telemedicine treatment is needed due to the COVID-19 pandemic.  To access, go to:  https://www.sos.state.tx.us/texreg/archive/September182020/Emergency%20Rules/22.EXAMINING%20BOARDS.html#4.

 

PART 11. TEXAS BOARD OF NURSING CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE 22 TAC §217.24The Texas Board of Nursing (Board) adopts emergency amendments to §217.24, relating to Telemedicine Medical Service Prescriptions, pursuant to a finding of imminent peril to the public health, safety, and welfare, which requires adoption in fewer than thirty (30) days’ notice, as authorized by Tex. Gov’t. Code §2001.034.  The adoption of emergency amendments to §217.24(e)(1) is immediately necessary to allow APRNs to continue to provide necessary treatment to established patients with chronic pain while mitigating the risk of exposure to COVID-19. Under the emergency amendments, an APRN may treat chronic pain with scheduled drugs through use of telemedicine medical services if a patient is an established chronic pain patient of the APRN, is seeking a telephone refill of an existing prescription, and the APRN determines that the telemedicine treatment is needed due to the COVID-19 pandemic. Further, the medical records must document the exception and the reason that a telemedicine visit was conducted instead of an in-person visit. The APRN must exercise appropriate professional judgment in determining whether to utilize telemedicine medical services for the treatment of chronic pain with controlled substances. The emergency amendments will only apply to those APRNs whose delegating physicians agree to permit them to issue re-fills for these patients, and the services provided are limited to refills of controlled substances in Schedules III through V. Finally, these emergency amendments will only be in effect for a period of 60 days or the duration of the time period that the Governor’s disaster declaration of March 13, 2020, in response to the COVID-19 pandemic is in effect, whichever is shorter.  To review the history and emergency rule, go to:  https://www.sos.state.tx.us/texreg/archive/September182020/Emergency%20Rules/22.EXAMINING%20BOARDS.html#7.

 

Centers for Medicare and Medicaid Services (CMS)

 

QSO-20-39-NH Nursing Home Visitation – COVID-19 was released on September 17, 2020.  Hospice providers please be aware of these guidelines.  Hospice is addressed within the QSO.  CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE. The guidance below provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.  You can access the QSO at:  https://www.cms.gov/files/document/qso-20-39-nh.pdf.

 

National Hospice and Palliative Care Organization (NHPCO)

 

NHPCO shared the following information in italics ~

 

Office for Civil Rights (OCR) Releases Updated Security Risk Assessment Tool

The Office for Civil Rights and the Office of the National Coordinator for Health Information Technology have released version 3.2 of the HHS Security Risk Assessment Tool designed to aid small and medium sized health care organizations in their efforts to assess security risks. This version contains a variety of feature enhancements that provide an improved navigation throughout the assessment sections, export options for reports, and enhanced user interface scaling. To access the tool, go to:  https://www.healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment-tool.

 

Final Rule Revision Eliminates Certain OCR Provisions

As a reminder, the Nondiscrimination in Health and Health Education Programs or Activities Delegation of Authority Final Rule commonly known as the Section 1557 rule, became effective August 18, 2020. The rule can be accessed at:  https://www.hhs.gov/sites/default/files/1557-final-rule.pdf.

HHS revised Section 1557 of the Patient Protection and Affordable Care Act by:

  • Removing health care protections based on gender identity from Section 1557. HHS said that gender identity is not captured within Title IX’s prohibition against discrimination “on the basis of sex.”
  • Eliminating the burdensome requirement for covered entities to send notices and taglines in different languages with all significant communications to ensure compliance with civil rights law. Hospices will no longer be required to include this tagline for the top 15 languages spoken in their service area on the entity’s website, in significant communications and in the physical office. The rule requires covered entities to provide taglines only when “necessary to ensure meaningful access.”

 

 

Counterfeit Respirators / Misrepresentation of NIOSH-Approval

Counterfeit respirators are products that are falsely marketed and sold as being NIOSH-approved and may not be capable of providing appropriate respiratory protection to workers. NIOSH-approved respirators have an approval label on or within the packaging of the respirator (i.e. on the box itself and/or within the users’ instructions). Additionally, an abbreviated approval is on the FFR itself. You can verify the approval number on the NIOSH Certified Equipment List (CEL) or the NIOSH Trusted-Source page to determine if the respirator has been approved by NIOSH. NIOSH-approved FFRs will always have one the following designations: N95, N99, N100, R95, R99, R100, P95, P99, P100. Read updated CDC guidance (09/22/20) at:  https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html.

For trusted sources, go to:

 

 

New Mexico News and Information

 

Office of the Governor

 

New Mexico COVID-19 update

New Mexico state health officials on Thursday announced 159 additional COVID-19 cases. To access the data, go to:

https://www.governor.state.nm.us/2020/09/17/new-mexico-covid-19-update-159-new-cases-totaling-27199-four-additional-deaths/.

 

New Mexico Department of Health

The long term care visitation guidelines and FAQs were updated.  Go to:   

 

 

Texas News and Information

 

Office of the Governor

 

Governor Abbott Expands Capacity For Certain Services In Texas, Announces Guidance For Nursing Home, Long-Term Care Visitations

Governor Greg Abbott held a press conference on September 17th to provide an update on the state’s ongoing efforts to combat COVID-19. During the press conference, the Governor issued Executive Orders expanding occupancy levels for restaurants, retail stores, office buildings, manufacturing facilities, gyms and exercise facilities and classes, museums, and libraries, and re-authorizing elective surgeries for a majority of the state of Texas. The Governor also announced new guidance related to visitations at nursing homes and long-term care facilities across the state.  To review the detailed information, go to:  https://gov.texas.gov/news/post/governor-abbott-expands-capacity-for-certain-services-in-texas-announces-guidance-for-nursing-home-long-term-care-visitations.

 

Health and Human Services

 

Inpatient hospice providers~

GL 20-1011 Emergency Hospital Off-Site Facilities in Response to COVID-19 was released on September 21, 2020.  The Health and Human Services Commission (HHSC) adopted an emergency rule in response to the state of disaster declared in Texas and the United States of America relating to COVID-19. Under the new emergency rule, effective September 21, 2020, currently licensed hospitals are permitted to temporarily operate off-site inpatient facilities without obtaining a new license to more effectively treat and house patients in response to the COVID-19 pandemic. This letter describes the emergency rule and off-site application process.  To review, go to:

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/memos/gl-20-1011.pdf

HHSC Issues COVID-19 Response – Expansion of Reopening Visitation Guidance for Long-term Care Providers

HHSC Long-term Care Regulation issued PL 20-38 COVID-19 Response – Expansion of Reopening Visitation . The letter provides guidance on the adopted expanded visitation emergency rules, which allow for essential caregiver visits, salon services visits, and limited indoor and outdoor visitation. The letter also includes the new Form 2194 as an attachment.  For more information, go to:  https://apps.hhs.texas.gov/providers/communications/2020/letters/PL2020-38.pdf.

HHSC Publishes Expanded Visitation Emergency Rules for Assisted Living (AL) Facilities

HHSC LTCR has published Expansion of Reopening Visitation emergency rules for assisted living facilities. The expanded emergency rules are effective as of 09/24/2020. The rules can be accessed at:  https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/alf/alf-covid-19-expanision-reopening-visitation-emergency-rule.pdf.

 

Here are just some things to know as reviewed by the HHS AL policy staff on September 23, 2020:

  1. Ensure you have signed up for govdocs so you can listen to the ALF webinars and trainings as HHS staff will be going over the Expanded Visitation Emergency Rules applicable to their facility!
  2. If you provide services to a person residing in an AL, please read these rules thoroughly.
  3. The AL rules are effective September 24, 2020!
  4. Visitation is optional for AL.
  5. Hospice is NOT considered an essential caregiver as addressed in these rules! Essential caregivers are family members, friends etc.  Hospice continues to come under “end of life visit”.

 

HHSC Publishes Expanded Visitation Emergency Rules for Nursing Facilities (NF)

HHSC Long-term Care Regulation has published Expansion of Reopening Visitation emergency rules for NFs.  The expanded emergency rules are effective 09/24/2020.  To review the rules, go to:  https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/long-term-care/nf/nf-covid-19-expansion-reopening-visitation-emergency-rule.pdf.

 

Here are just some things to know as reviewed by the HHS NF policy staff on September 23, 2020:

  1. Ensure you have signed up for govdocs so you can listen to the NF webinars and trainings as HHS staff will be going over the Expanded Visitation Emergency Rules applicable to their facility!
  2. If you provide services to a person residing in an NF, please read these rules thoroughly.
  3. The NF rules are effective September 24, 2020!
  4. Visitation is mandatory for NF.
  5. Hospice is NOT considered an essential caregiver as addressed in these rules! Essential caregivers are family members, friends etc.  Hospice continues to come under “end of life visit”.
  6. NF’s must allow the following: closed window visits, end of life visits, and person’s providing critical assistance.
  7. QSO 20-29 NH Nursing Home Visitation can be accessed at: https://www.cms.gov/files/document/qso-20-39-nh.pdf.   The term “compassionate care” within this memo does include “end of life”

HHSC Publishes Hospice Inpatient Unit COVID-19 Emergency Rules

HHSC LTCR has published Hospice Inpatient Units COVID-19 Reopening Visitation emergency rules. The rules are effective 09/24/2020.  To access the rules, go to:

https://hhs.texas.gov/sites/default/files/documents/services/health/coronavirus-covid-19/inpatient-hospice-reopening-visitation-emergency-rules.pdf

Here are just some things to know as reviewed by the HHS NF policy staff on September 23, 2020:

  1. Ensure you have signed up for govdocs so you can listen to the HCSSA webinars and trainings as HHS staff will be going over the Expanded Visitation Emergency Rules applicable to their facility!
  2. Please read these rules thoroughly.
  3. The inpatient hospice rules are effective September 24, 2020!
  4. Approved visitation is not required for a closed window visit, end of life visit or visits by persons providing critical assistance.
  5. Hospice is NOT considered an essential caregiver as addressed in these rules! Essential caregivers are family members.  Hospice continues to come under “end of life visit”.

 

HHSC Publishes Expanded Visitation Emergency Rules for ICF/IIDs

HHSC Long-term Care Regulation has published Expansion of Reopening Visitation emergency rules for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions. The expanded emergency rules are effective 09/24/2020.  To access the rules, go to:  https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/icf/icf-expansion-reopening-visitation-emergency-rule.pdf.