Texas Register

Title 22. Examining Boards Part 11. Texas Board Of Nursing Chapter 221. Advanced Practice Nurses 22 Tac §221.12:

The Board adopts amendments to §221.12, relating to Scope of Practice, with changes to the proposed text published in the August 19, 2022. The amendments are necessary to clarify the professional and individual scope of practice for APRNs. Adopted §221.12(a) provides that an APRN may, within his/her authorized role and population focus area, provide a broad range of health care services to patients in a variety of practice settings.  Adopted amendments are in the following areas:

  • 221.12(b) establishes the foundational premise that APRNs may only perform those functions that are within their Board authorized professional and individual scopes of practice for their role and population focus area
  • 221.12(c) lists the factors the Board will consider when determining whether a particular action falls within an APRN’s authorized professional and individual scope of practice.
  • 221.12(c)(1) requires an analysis of whether the APRN received training regarding the performance of the particular action in his/her advanced educational program.
  • 221.12(c)(4), the Board will also consider whether an APRN has been credentialed by a health care facility’s credentialing body and/or holds a privilege to perform the action at a health care facility.
  • 221.12(c)(5) specifies additional factors the Board will consider when reviewing any additional training obtained by an APRN.
  • 221.12(d) makes it clear that it is the responsibility of the APRN to maintain records of all completed training and competencies.
  • 221.12(e) and (f) are necessary to ensure that the intent of the entire section is not misconstrued. In order to be licensed as an APRN in Texas, an individual must first hold licensure as a registered nurse. Therefore, because an APRN is also a registered nurse, an APRN may continue to practice in the role of a registered nurse.
  • 221.12(g) reminds licensees of the importance of ensuring that all patient care activities are performed in conformity with their respective scopes of practice.
  • For very detailed explanations on the adopted rules


Federal News and Information

Public Health Emergency Resource Update

  • On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. The Centers for Medicare & Medicaid Services has resources available to help you prepare for the end of the PHE, some of which have been updated based on recent action by Congress.
  • On December 29, 2022, H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023 was signed into law. This legislation included an extension of the major telehealth waivers and the Acute Hospital Care at Home (AHCaH) individual waiver that were initiated during the PHE.
  • We will continue to execute the process of a smooth operational wind down of the flexibilities enabled by the COVID-19 emergency declarations. PHE information can be located at the CMS Emergencies PageHospice specific is here.
  • Access the policy to end PHE

Two areas to note: 

  • Hospice telehealth for routine home care (RHC) was included in the list of Hospice 1135 waivers for the COVID PHE. This expires in May 2023.
  • Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can be conducted via telehealth. The hospice face-to-face telehealth flexibility was extended through December 31, 2024, regardless of the status of the PHE.


CMS Revises Hospice Appendix M and Hospice Basic Surveyor Training

TNMHO Note: Please review the information that is in red.  This is new and updated information.  You will get an excellent overview of what the surveyor will ask for, what they would review, etc.  This could assist your quality assurance staff when making sure all is in order.   It is up to the hospice provider to be prepared for a survey at any type at any time.

Texas Providers:  Texas Health and Human Services staff will be drafting a provider letter detailing the changes.

The Centers for Medicare and Medicaid Services (CMS) has issued QSO-23-08-HOSPICE.

QSO-23-08-HOSPICE informs Hospice providers of revisions to the State Operations Manual, Hospice Appendix M, that include:

  • An enhanced approach to investigating quality of care for hospice patients was added that prioritizes the Phase 1 CoPs at §418.52 Patient Rights, §418.54 Initial and comprehensive assessment of the patient, and §418.56 Interdisciplinary Group, care planning, and coordination of services to increase attention to achieving desired outcomes for patients;
  • An additional section of the survey protocol that increases the number of records reviewed from all locations where the hospice operates, and the variety of home settings where patients live; and,
  • An enhanced Pre-Survey task that directs surveyors to review public media for concerns about a hospice, the hospice’s website, CMS Care Compare-Hospice and prior survey reports.

Surveyors use the information contained in the investigational guidelines to help to make a determination about compliance with the requirements, the guidelines are not binding and do not replace or supersede the law or regulations. They contain authoritative interpretations and clarification of statutory and regulatory requirements and are used to assist surveyors in making determinations about a hospice’s compliance, however, may not be used alone as the sole basis for a citation.


CMS Model Examples of the Hospice Election Statement and Election Statement Addendum

TNMHO Election Statement Reminders:  The hospice provider is responsible for ensuring they use current election forms which reflect the hospice requirements.  Providers can utilize the CMS Model.

The Centers for Medicare & Medicaid Services (CMS) has published model examples of the Hospice Election Statement and Election Statement Addendum in the download section of the Hospice spotlight web page. The model examples are not mandatory to use, as each hospice may design and print their own forms, but are suggested to ensure compliance of the information required on each form.

The model example of the Hospice Election Statement includes all the required information outlined in section of the Medicare Benefit Policy Manual Chapter 9 – Coverage of Hospice Services Under Hospital Insurance (PDF). Section of Chapter 9 includes the addendum requirements, put in place for hospice elections beginning on or after October 1, 2020.

The CMS and HHH Medicare Administrative Contractors (MACs) highly recommend hospice agencies compare or model their forms to the examples CMS has provided. Non-compliant hospice election statements continue to be identified as a top denial reason by review contractors, including the MAC’s Targeted Probe and Educate process.


NOW AVAILABLE IN QIES – Hospice Preview Reports for the May 2023 Refresh

Providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. Once released in CASPER, providers will have 30 days during which to review their quality measure results.  Although the actual “preview period” is 30 days, the reports will continue to be available for another 30 days, or a total of 60 days. The preview period for the latest Provider Preview Report lasts from February 15, 2023 to March 17, 2023. CMS encourages providers to download and save their Hospice Provider Preview Reports for future reference, as they will no longer be available in CASPER after this 60-day period.

Learn more about the Provider Preview Report (HIS and Claims-based measures)  here and about the CAHPS Preview Report here. Hospice QRP Key Dates for Providers can be found here. The 3rd Edition HQRP Public Reporting Tip Sheet is available here.


Care Compare Quarterly Refresh – February 2023

The February 2023 quarterly refresh for the Hospice Quality Reporting Program is now available on Care Compare.

For additional information, please see the FY2023 Hospice Wage Index Final Rule. Please visit the Hospice Background and Announcements webpage to review the Claims-Based Measures Questions and Answers downloadable (PDF) for more information on the HCI and HVLDL.



Texas News and Information

Health and Human Services Commission (HHSC)

HHSC Retires NF COVID-19 Response Plan and COVID-19 FAQs

HHSC Long-term Care Regulation has retired the COVID-19 Response Plan for Nursing Facilities (NFs) and the NF Frequently Asked Questions document, effective Feb. 6, 2023.  Facilities can obtain guidance along with resources for infection prevention, control measures and Personal Protective Equipment through the Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF) and Infection Control Basics & Personal Protective Equipment for Essential Caregivers (PDF) documents published by HHSC. These resources can be found on the NF Provider Portal page.

Certified NF providers should review the following CMS QSO memos for information on testing and visitation requirements:


HHSC Publishes Frequently Asked Questions for HCSSA Providers – Feb. 15

HHSC Long-term Care Regulation has published Frequently Asked Questions for HCSSA Providers (PDF).


Texas Medicaid Healthcare Partnership

Medicaid Hospice Election and Certification Form Training

Please be aware that Medicaid hospice policy has updated the election and certification forms and training on the forms to reflect amended rules under Chapter 266.  Forms will identify January 2023 in the upper right hand corner and on the instructions.  You can access the training at the TMHP portal:  https://www.tmhp.com/.




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.