Texas Register

HHSCis promulgating rules which address “religious counselor” visitation in the hospital.  Things to note are:

patients have a right to this visitation during a public health emergency at the request of the patient, family, or legally authorized representative. The hospital could prohibit such visitation based on federal law or state requirements.  The hospital will have policy and procedures in place that address the health and safety requirements for in person visitation with the religious counselors, denials for visits are based on the health of the patient based on what the current PHE situation.  The P&P will address infection control, end of life, screenings, PPE etc.  A provider letter has been issued by HHSC (See below).

Title 25. Health Services Part 1. Department of State Health Services Subchapter C. Operational Requirements 25 TAC §133.51

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §133.51, concerning In-Person Visitation During a Public Health Emergency or Disaster.  The proposal is necessary to comply with Senate Bill (S.B.) 572, 87th Legislature, 2021, Regular Session. S.B. 572 requires HHSC to adopt rules establishing guidelines for certain health care facilities, including hospitals and special care facilities, to use when developing policies and procedures for in-person religious counselor visitation during a public health emergency, as required under Texas Health and Safety Code Chapter 260C.  You can read the rules at:  https://www.sos.state.tx.us/texreg/archive/June242022/Proposed%20Rules/25.HEALTH%20SERVICES.html#56.


Federal News and Information

Updated:  IRS increases mileage rate for remainder of 2022

The Internal Revenue Service today announced an increase in the optional standard mileage rate for the final 6 months of 2022. Taxpayers may use the optional standard mileage rates to calculate the deductible costs of operating an automobile for business and certain other purposes.

For the final 6 months of 2022, the standard mileage rate for business travel will be 62.5 cents per mile, up 4 cents from the rate effective at the start of the year. The new rate for deductible medical or moving expenses (available for active-duty members of the military) will be 22 cents for the remainder of 2022, up 4 cents from the rate effective at the start of 2022. These new rates become effective July 1, 2022. The IRS provided legal guidance on the new rates in Announcement 2022-13, issued at: https://www.irs.gov/pub/irs-drop/a-22-13.pdf.

In recognition of recent gasoline price increases, the IRS made this special adjustment for the final months of 2022. The IRS normally updates the mileage rates once a year in the fall for the next calendar year. For travel from January 1 through June 30, 2022, taxpayers should use the rates set forth in Notice 2022-03:  https://www.irs.gov/pub/irs-drop/n-22-03.pdf.

Medicare Care Choices Model; Annual Report

The Medicare Care Choices Model (MCCM) tested whether offering eligible beneficiaries the option to receive supportive services at the end of life without forgoing payment for treatment of their terminal conditions (which is required to enroll in the Medicare hospice benefit) improved the quality of care, increased beneficiaries’ satisfaction, and reduced Medicare expenditures. In general, the outcomes were what was expected.  You can obtain more detailed information under Resources below.

Participants were:

  • 141 hospices participated nationwide
  • 6,427 Medicare fee-for-service beneficiaries enrolled in MCCM through September 2020

Findings were:

  • Reduced Medicare expenditures
  • Reduced use of resource-intensive services
  • Increased use of the Medicare hospice benefit
  • Improved quality of end-of-life care



CMS Open Door Forum

The CMS Open Door Forum was held on June 29th.   The FY23 Final Hospice Rule will be published in August 2022, reconsideration period notifications will be distributed in mid-July 2022 for FY2023, and a technical report on the hospice quality care index along with a user manual will be published in July 2022.

Hospices, be aware of the following information from CMS!

Important Updates on the Hospice Quality Reporting Program (HQRP)

Swingtech sends informational messages to hospices related to the Quality Reporting Program (QRP) on a quarterly basis. Their latest outreach communication can be found on the HQRP Requirements and Best Practices webpage: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HQRP-Requirements-and-Best-Practices. If you want to receive Swingtech’s quarterly emails, then add or update the email addresses to which these messages are sent by sending an email to [email protected]. Be sure to include your facility name and CMS Certification Number (CCN) along with any requested updates.

Hospice Care Index Technical Report Now Available

The Hospice Care Index (HCI) Technical Report is now available. This report provides descriptive analyses and detailed contextual information about the new HCI quality measure. Please navigate to the Downloads section of the Current Measures webpage to access this report.  Go to:  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Current-Measures.



A friendly reminder to all hospice providers; especially NEW PROVIDERS

Hospice Quality Reporting Program (HQRP) Compliance

Most new hospices are not aware that all Medicare-certified hospice providers must comply with the individual submission requirements of Hospice Quality Reporting Program (HQRP) or be subject to a percentage point reduction in their annual payment update (APU). The payment reduction is currently two percent of the APU for existing hospices but is increasing to four percent of their APU beginning in FY 2024 for all 2022 non-compliance hospices. Payment reductions are based on individual fiscal year reporting. To assist and support new and existing hospices, the CMS Hospice Quality Reporting Program (HQRP) webpage provides detailed information and training a hospice may use to ensure HQRP compliance. Please review this information and share it with appropriate staff.

Gap Billing Between Hospice Transfers

This was effective Date on July 1, 2022.

New system edits are completed to prevent gap billing between hospice transfer!  In addition,

Pub 100-04, Chapter 11, Section 20.1.3 – Change of Provider/Transfer Notice was revised to include additional instructions about hospice transfers to administer existing hospice benefit policy more efficiently.  You can review this at: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2022-02-17-mlnc#:~:text=There%20can%E2%80%99t%20be%20a%20gap%20in%20the%20number,as%20the%20%E2%80%9Cthrough%20date%E2%80%9D%20for%20the%20transferring%20hospice


Texas News and Information

Health and Human Services Commission

Due to COVID cases on the rise, HHSC has updated the NF COVID response plan.  This may be of interest to you.

HHSC Updates the NF COVID-19 Response Plan Document

HHSC Long-term Care Regulation updated the COVID-19 Response Plan document for nursing facilities.

The revisions reflect the following updates:

  • Updates guidance to reflect current Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention guidance.
  • Removes outdated guidance and references.
  • Adds new templates for resident and facility communication plans.
  • Adds new guidance for CDC COVID-19 vaccination recommendations.

Read the updated NF COVID-19 Response Plan at: https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/long-term-care/nf/covid-response-nursing-facilities.pdf.


Please share this with your chaplains!

Religious Counselor Visits in Certain Health Care Facilities

PL 2022-13, Version 2 New Rules Implementing Senate Bill (S.B.) 25 and Senate Bill (S.B.) 572, 87th Legislature, Regular Session, 2021 was issued on July 1, 2022.  New rules were adopted in the Texas Register on June 1, 2022.

  • B. 25, relating to the right of residents in certain long-term care facilities to designate an essential caregiver for in-person visitation, was effective on September 1, 2021.
  • B. 572, relating to in-person visitation of religious counselors with certain health care facility residents during a public health emergency, was effective on September 1, 2021.

The final rules only apply during a declared public health emergency or disaster.  The amendment to the first letter is as follows:  A facility or program provider may petition HHSC to suspend in-person essential caregiver visits for no more than 7 consecutive calendar days if in-person visitation poses a serious community health risk. To petition for a suspension of in-person essential caregiver visits, a facility or program provider must submit a request to their Regional Director (RD) by email. The contact information for each Regional Director is available on the Long-term Care Regulatory Regional Contact Numbers website. A facility or program provider may request an extension from HHSC to suspend in-person essential caregiver visitation beyond the original request, but HHSC may not approve an extension that exceeds 7 days. HHSC may deny a petition to suspend in-person essential caregiver visits if HHSC determines that in-person essential caregiver visits does not pose a serious community health risk.  The letter can be accessed at:  https://www.hhs.texas.gov/sites/default/files/documents/pl2022-13.pdf.


Texas Medicaid Healthcare Partnership (TMHP)

Hospice providers regarding of payor source are required to complete and submit a PL1 on patients who have or are suspected of having a mental Illness or intellectual disability.  As a member, you have access to the FAQs posted at our Members Only Website.  You will find a FAQ on the Preadmission Screening and Resident Review.  I strongly encourage to you read the FAQ and become familiar with its requirements.  Please note the following:

NFs Will Be Able to Admit Individuals on Preadmission PL1 Forms With Negative PE Beginning August 25, 2022

Beginning August 25, 2022, nursing facility (NF) users will be able to admit individuals to the facility by clicking the “Admitted to NF” button. This button is displayed on the Preadmission Screening and Resident Review (PASRR) Level 1 (PL1) form with admission type Preadmission. The “Admitted to NF” button will be present once an associated negative PASRR Evaluation (PE) form is successfully submitted. The NF will no longer be required to certify their ability to serve the individual on the PL1 in this case. With this change, the system will update the status of the Preadmission PL1 to “Individual Placed in NF – PE Confirmed.” Upon confirmation of the status change, the form history notes of the PL1 will be updated to indicate the individual has been admitted to the NF.



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.