Texas Register


Please share the following information with your nurses.


  • There is a new Texas Nurse Portal (Portal), which was launched on June 15, 2020. It is a paperless, confidential, and secure system that allows individuals to apply for nurse licensure by examination and endorsement and renew their licenses. The proposed rules state that:  items submitted through the portal are considered complete and return receipt requested will be provided electronically.
  • CHAPTER 217.LICENSURE, PEER ASSISTANCE AND PRACTICE 22 TAC §217.5relates to out-of-state licensure of military spouse applicants. The proposed amendment eliminates the need for a military spouse applicant to submit proof of residency in Texas in order to obtain single state licensure and practice in Texas.

To review the above proposed amendments, go to:  Proposed Rules Title 22 (state.tx.us)


Centers for Medicare and Medicaid Services (CMS)


Do you participate in the CMS Value Based Insurance Design Model?  Even if you don’t, you may be affected.  Medicare Advantage Value-Based Insurance Design Model

Through the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model, CMS is testing a broad array of complementary MA health plan innovations designed to reduce Medicare program expenditures, improve the quality of care for Medicare beneficiaries, and improve the coordination and efficiency of health care service delivery. The intent is to improve health outcomes.

Healthcare Providers Solutions provided the following information for hospice providers on a national level.  You can listen on the you-tube channel at: https://www.youtube.com/watch?v=Nvowo8X3LLA.

  • VBID began in 2021 and will continue in 2022 with Phase 2.
  • Several MA plans have been added to the model.
  • VBID is in 22 states.
  • You may not be in a state that is currently listed as a state with one of these active MA plans in VBID.
  • If you have a patient that has moved to your state, a non-participating state, from a state participating in VBID and on a MA plan you, the hospice provider, just became a participant in VBID! See the recommendations below regarding Medicare eligibility verification.

The presenter recommended:

  1. In January 2022, you will note that most of your patients have signed for a new plan for the first time or have been using MA for a long time. Verify Medicare eligibility for the patient to ensure you know what program they are enrolled in. Healthcare Solutions recommended it be done every week for ALL Medicare eligible, for the month of January 2022 and into February.
  2. If you have a patient enrolled in one of the MA plans for the VBID model you are required to submit a notice of election to the MA plan and traditional Medicare. In addition, submit monthly claims to MA and Medicare MAC.

For more VBID Information, go to:

VBID Model Hospice Benefit Component Overview | CMS Innovation Center

Medicare Advantage Value-Based Insurance Design Model | CMS Innovation Center

Value-Based Insurance Design Model (VBID) Fact Sheet CY 2020 | CMS



42 CFR Chapter 488 Survey, Certification and Enforcement applies to hospice.    In the November 10th, 2021 Regulatory Update, I told you about some of the CMS changes in Chapter 488, such as:

  •  Establish survey and enforcement requirements for hospice programs as set forth in the CAA 202l.
  • Enhance the hospice program survey process by requiring the use of multidisciplinary survey teams, prohibiting surveyor conflicts of interest, expanding CMS-based surveyor training to accrediting organizations (AO) and requiring AOs with CMS approved hospice programs to begin use of the form CMS 2567.
  • Provisions to establish a hospice program complaint hotline.  In Texas, legacy DADS complaint hotline was determined to meet the needs of a hospice complaint hotline; however, HHSC will continue to review this in light of final HH rules.
  • Provisions to create the authority for imposing enforcement remedies for noncompliant hospice programs including the development and implementation of a range of remedies as well as procedure for appealing determinations regarding these remedies.
  • The new survey requirements will be implemented on or before October 1, 2022.  No further information is available.

Centers for Disease Control (CDC)


Staffing Shortages and Work Restrictions

The CDC has updated information for healthcare providers on guidance for staffing shortages and work restrictions for healthcare workers with infection and exposure to COVID.

CDC Key Points

  • Maintain appropriate staffing is essential to providing a safe work environment; and
  • Maximize interventions to protect healthcare providers, patients, and visitors at all times, including when considering strategies to address staffing shortages.
  • The CDC offers a continuum of options for addressing staffing shortages.

To access the updated information, go to:  Strategies to Mitigate Healthcare Personnel Staffing Shortages | CDC.

Be familiar with your state rules on staffing, emergency preparedness and infection control.





Reminder: Provider Self-Determined Aggregate Cap Limitation Form is Due February 28, 2022

The cap for 2021 only applies to hospices certified on or before October 1, 2020. The first cap period for providers certified after October 1, 2020, is the 2022 cap report and will be due February 28, 2023.  Please remember that:

  • The form is required of hospital-based and freestanding hospices for whom Palmetto GBA processes claims
  • If the form is not received timely, a past due letter will be issued and payments will be suspended

For more information go to:


National News


Hospice Medical Director Certification Board (HMDCB)

The 2022 HMDCB Initial Application is now open! We encourage you to help spread the word about the initial cycle to help enhance the value of your HMDC credential. Earning the HMDC® credential through the Hospice Medical Director Certification Board (HMDCB) shows patients, families, colleagues, and employers your commitment to professional development and excellent clinical care.

There are several ways you can help spread the word and encourage your hospice physicians to become certified:

  1. Forward the below resources to your non-certified colleagues.
  2. Follow us on Twitter @hmdcert and like/repost our tweets. HMDCB (@hmdcert) / Twitter
  3. Share the initial flyer at your organization or email to your colleagues. Initial_Flyer_2022.pdf (hmdcb.org)
  4. Email Gina at [email protected] for additional marketing tools.

As we certify more physicians, we can continue to carry out our mission to help relieve suffering and improve quality of life by promoting the excellence and professional competency of hospice physicians. In addition, the more physicians that become certified, the more valuable the HMDC credential will become as it increases in recognition within the field.

Thank you for your ongoing support! If you have any questions, feel free to contact us at [email protected] or call 847-375-6740.



Texas News and Information


Texas Medicaid Healthcare Partnership (TMHP)


LTC Online Portal Unavailable at 9:00 p.m. on February 9 Through February 15, 2022

The Long-term Care (LTC) Online Portal will be unavailable because of system maintenance beginning Wednesday, February 9, 2022, at 9 p.m. through Tuesday, February 15, 2022, at 11:59 p.m. During the system maintenance outage, all LTC Online Portal functions will be unavailable. Providers should complete form submissions by 12 noon on February 9, 2022, to ensure processing, although the portal will be available until 9:00 p.m. On Thursday, February 10, providers should verify processing using Medicaid Eligibility Service Authorization Verification (MESAV).



Health and Human Services Commission (HHSC)


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:


HHSC Launches Human Trafficking Prevention Training Course; Training Helps Health Care Providers Recognize, Address Trafficking

Many professional licenses require a course in human trafficking.  Please ensure your professional staff see the below article.

The Texas Health and Human Services Commission is encouraging health care practitioners and interested members of the public to take its new online human trafficking awareness and prevention training course.

The free online course, “HEART”—which stands for “Hearing, Evaluating, Activating, Resourcing and Training”—teaches physicians, nurses and other health care providers how to recognize the signs or red flags of trafficking, support the well-being of at-risk individuals, and understand how trauma impacts overall health outcomes.

“We are confident that health care practitioners who complete this new training will be better equipped to identify trafficking, and this will lead to better outcomes for survivors of this devastating crime,” said Michael Roberts, associate commissioner for HHSC Specialty and Family Services.

During National Slavery and Human Trafficking Prevention Month in January, organizations throughout the nation raise awareness of human trafficking, or the exploitation of people for commercial sex or labor against their will. According to a 2016 study by The University of Texas at Austin, at any given time there are an estimated 234,000 victims of labor trafficking and 79,000 youth victims of sex trafficking in Texas.

House Bill 2059, from the 86th Legislature in 2019, requires HHSC to review training courses on human trafficking for health care practitioners and list approved trainings on its website. Certain health care practitioners must complete an approved course to renew their registration or license.

HHSC also recently launched the new Stop Human Trafficking public donation account to raise funds for youth survivors of human trafficking. House Bill 2633 from the 87th Legislature in 2021 authorizes the creation of the account to provide grants to facilities committed to the recovery and protection of vulnerable children and adolescents impacted by human trafficking. To learn more, visit the Stop Human Trafficking donation webpage:  Stop Human Trafficking Donation Service | Texas Health and Human Services Commission (HHSC)

For more information about human trafficking, visit the HHS website:  Texas Human Trafficking Resource Center | Texas Health and Human Services


About the Human Trafficking Resource Center

Texas HHSC’s Human Trafficking Resource Center assists agency staff, external stakeholders and people experiencing trafficking in finding resources. The center also serves as the liaison between stakeholders and agency programs on issues regarding human trafficking. HHSC has approved and listed 70 human trafficking training courses produced by a variety of outside organizations, and HEART is the first course produced by HHSC. HEART is sponsored by Texas WIC:  WIC Texas | Texas WIC





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.