CNAP staff reviews the Texas Register each week, and reports items of direct interest to APRNs. Check this page regularly to identify new rules from the Board of Nursing and other state agencies that affect your practice. Also check important notices about the Texas Medicaid & CHIP Programs, or state agency meetings you might want to attend.
CNAP Members may access a comprehensive list of CNAP’s Texas Register Reports. Each has its contents summarized, and reports of interest may be downloaded. Members must log-in to access this members-only page.
UPCOMING MEETINGS & RESOURCES
Access the newest Texas Board of Nursing (BON) updates from the BON’s home page. BON board and committee meetings may be accessed from the News tab.
Check HHSC’s Meetings and Events Webpage for future meetings you may be interested in attending or monitoring. While most meetings are held in Austin, some may be held in your area.
Check the bottom of the page for a list of HHSC committees to help readers explore committees or topics of interest. Webcasts of previous meetings may be available.
NOTICES & UPDATES
Below are some important rules and notices listed by date & topic.
August 10, 2018
DSHS adopted amendments to its rules on Designating a Practice as Serving a Medically Underserved Population (MUP). From this point forward, DSHS will verify continued eligibility for this designation every 2 years. APRNs in practices designated before March 1, 2013, would not be affected by a change in site designation as long as §157.051 (11)(G) remains in the Medical Practice Act. Physicians delegating prescriptive authority to APRNs and PAs in MUP Practices designated after that date would not be able to delegate to an unlimited numbers of APRNs and PAs if the practice loses the MUP designation.
July 20, 2018
DSHS adopted rules regarding Epinephrine Auto-Injector Policies in Schools. APRNs with prescriptive authority will be able to prescribe unassigned epinephrine auto-injectors for schools. APRNs prescribing the auto-injectors should be familiar with the rules in 25 TAC Chapter 37, Subchapter U.
June 22, 2018
DSHS adopted rules allowing Texas Health Steps providers to be reimbursed for two types of mental health screenings.
1) Annually between the ages of 12 – 18 years; and
2) Maternal Depression screening for mothers of patients under 1 year.
February 9, 2018
TMB proposed new rules related to Utilization of Opioid Antagonists. While the TMB does not regulate APRNs, the proposed rules will be guidelines for all prescribers when they are adopted. To review the proposed rules, Click Here.
TMB adopted Pain Management Clinic amendments. APRNs should be advised that TMB inspections may increase if APRNs are prescribing opioids, benzodiazepines, barbiturates, or carisoprodol, (not including suboxone) to a significant number of patients. All APRNs prescribing controlled substances must check the PMP before prescribing these drugs for their patients.
February 2, 2018
Rules were adopted that directly affect CNMs, especially those operating a Birth Center. New rules on Disposition of Embryonic & Fetal Tissue remains were adopted on January 29th. On February 2nd, DSHS adopted rule amendments on Food Safety referencing requirements in 25 TAC Chapter 228, Retail Food, if birth centers serve any food that is not prepackage for single servings.
January 1, 2018
HHSC is encouraging use of Electronic Prescribing of Controlled Substances (EPCS) because of its increased security. About 85% of pharmacies in Texas can accept EPCS. More information on getting started with EPCS is available at http://getepcs.com/.
December 29, 2017
HHSC adopted a pharmacy outpatient rule requiring that all providers ordering drugs, medical supplies, or durable medical equipment for Medicaid clients must be enrolled as a Medicaid provider. If a physician must sign any type of prescription for an APRN’s patients, the physician must be an enrolled Medicaid provider. The physician, however, is not required to be in the managed care network.
Important Notice from BON Recommending PMP Registration
If you have prescriptive authority in Texas and also have a US DEA registration number to prescribe controlled substances, the Board of Nursing encourages you to register to use the prescription monitoring program (PMP) through the Texas State Board of Pharmacy (TSBP). The AWARxE program is a PMP that will allow you to query patient reports of controlled substance prescriptions in an effort to help you safely prescribe controlled substances. You can also query the PMP regarding your own prescribing practice to confirm that you issued all prescriptions linked to your prescriber identification in order to protect your prescriptive authority. To register, visit the TSBP’s website at www.pharmacy.texas.gov/PMP.
December 22, 2016
Important Notice from BON Concerning DEA Registration
Starting January 1, 2017, DEA will only send one renewal notification in accordance with Title 21, Code of Federal Regulations, Section 1301.13(e)(3). The renewal notification will be sent to the “mail to” address for each DEA registrant approximately 65 days prior to the expiration date. No other reminders to renew the DEA registration will be mailed, but DEA will send one electronic notification to the email address listed on the registration.
At the present time, DEA is retaining its current policy of renewing registration via the appropriate renewal form for one month after the expiration date. However, be advised that practitioners may not handle or prescribe any controlled substances between midnight of the expiration date and the date of renewal. For practitioners, including APRNs, the renewal form is DEA Form 224a – Retail Pharmacy, Hospital/Clinic, Practitioner, Teaching Institution, or Mid-Level Practitioner.
After one month, online renewal is no longer be available. You will have to complete an application for a new DEA registration if you do not renew by midnight Eastern Time within one month of the expiration date. The original DEA registration will not be reinstated. APRNs would complete DEA Form 224 – Retail Pharmacy, Hospital/Clinic, Practitioner, Teaching Institution, or Mid-Level Practitioner.
Paper renewal applications will not be accepted if not received within one month of the expiration date. If DEA has not received the paper renewal application by that date, mailed renewal applications will be returned and the registrant will have to apply for a new DEA registration using the proper form.
The BON announcement includes this vital warning: Remember, if the DEA registration expires, an APRN cannot prescribe controlled substances until DEA renews the expired registration or issues a new number. As noted by the italicized print in paragraph 2, that prohibition includes practitioners whose renewals are being processed within one month of expiration.
The following is a link to the DEA’s website announcement.
Reporting Requirements (November 18, 2016)
DSHS proposed amendments to rules on reporting communicable diseases and the Texas Immunization Registry (ImmTrac). Both serve as reminders that APRNs must meet certain reporting requirements. Select the links for a list of infectious disease notifiable conditions, or the read more about ImmTrac.
HHSC Prescriber & MCO Documents
- Effective 11/01/2016 Texas Vendor Drug Program (VDP) Service Delivery Area Assistance Chart
- Effective 11/01/2016 VDP Prescriber Assistance Chart
- National Drug Code (NDC)-to-HCPCS Crosswalk for clinician-administered drugs
BON Sunset Review
BON Sunset Bills – HB 2950 / SB 305
Reminder from HHSC – Texas Medicaid mosquito repellent benefit ends on October 30, 2016
Although mosquito season is past its peak in Texas, Zika is not going away. The Medicaid will continue to monitor the circumstances and will provide up to date information as it is available.
For addition information, see the following:
- Texas Department of State Health Services website includes excellent, up-to-date resources for health care professionals and consumers. Informational materials may be ordered at no cost to providers.
- For information about testing for Zika, please Click Here.
- The U.S. Centers for Disease Control & Prevention website
- Texas Vendor Drug Program site provides additional information about prescribing and dispensing mosquito repellent.
September 30, 2016
Topic: Disposing of Special Waste in Birth Centers & other facilities
The Texas Department of State Health Services (DSHS) withdrew rules originally proposed on July 1st related to disposal of special waste in certain health facilities. Among the facilities affected are birth centers. CNMs who own birth centers need to review proposed rules 25 TAC §§1.131 – 1.137.
September 27, 2016 (Copy of HHSC notice)
Topic: Medicaid Re-enrollment Closed: What Happens Now?
The Patient Protection and Affordable Care Act (ACA) requires providers to revalidate their enrollment in state Medicaid programs by Sept. 24, 2016. In accordance with ACA and based on direction from the Texas Health & Human Services Commission (HHSC), the Texas Medicaid & Healthcare Partnership TMHP) accepted and is processing completed re-validation application received by Sept. 24, 2016. There will be no dis-enrollment action taken on providers who met this submission date and continue to respond to application deficiencies by specified deadlines.
TMHP began dis-enrollment actions on providers failing to submit a completed revalidation application by Sept. 24, 2016. Disenrollment actions will be completed with final dis-enrollement effective Jan. 31, 2017. View the original article on the TMHP website.
June 3, 2016 (Adopted as proposed on September 9th)
Topic: Fees for Newborn Screening & other tests performed by State Lab
DSHS proposed increasing the fees for Newborn Screening from $33.60 to $55.24. Some tests performed by the Laboratory Section are slated for the chopping block because they are requested less than 100 times and year. To see fee adjustments for other laboratory tests, see the notice of the proposed DSHS rule, or newly adopted rule 25 TAC 73.54.
CNAP did not comment on this rule because Texas law requires the Laboratory to cover its costs and the fee increase is necessary in order to fulfill that requirement.
COMMITTEES OF INTEREST TO APRNs
HHSC Advisory Committees (Edited from HHS.texas.gov and includes some of the 70 HHSC advisory committees)
- Aging and Disability Resource Center Advisory Committee assists in developing and implementing an ADRC program in Texas to include program and policy development, designing and operating ADRCs, and obtaining stakeholder input.
- Aging Texas Well Advisory Committee advises the department and makes recommendations to state leadership on implementation of the Aging Texas Well Initiative.
- Behavioral Health Advisory Committee provides customer/consumer and stakeholder input by making recommendations regarding the allocation and adequacy of behavioral health services and programs within the state of Texas.
- Behavioral Health Integration Advisory Committee is charged with addressing planning and development needs to integrate Medicaid behavioral health services, including targeted case management, mental health rehabilitative services and physical health services
- Drug Utilization Review Board develops and submits recommendations for the preferred drug list, suggests clinical prior authorizations on outpatient prescription drugs, recommends education interventions for Medicaid providers, and reviews drug usage across Medicaid programs.
- The e-Health Advisory Committee (eHAC) advises the HHS executive commissioner and HHS agencies on strategic planning, policy, rules and services related to the use of health information technology, health information exchange systems, telemedicine, telehealth and home telemonitoring services.
- Early Childhood Intervention Advisory Committee advises the HHSC Division for Early Childhood Intervention Services on development and implementation of policies that constitute the statewide ECI system.
- Governor ’s Emergency Medical Services (EMS) and Trauma Advisory Council promotes, develops and maintains a comprehensive EMS/Trauma System that will meet the needs of all patients and that will raise the standards for community health care by implementing innovative techniques and systems for the delivery of emergency care for the entire population.
- Intellectual and Developmental Disability System Redesign Advisory Committee advises on the implementation of the acute care services and long-term services and supports system redesign for individuals with intellectual and developmental disabilities.
- Interagency Obesity Council monitors and evaluates obesity prevention efforts in the state of Texas for children and adults.
- Maternal Mortality and Morbidity Task Force studies maternal mortality and morbidity by studying and reviewing cases of pregnancy-related deaths and trends in severe maternal morbidity, determining the feasibility of the task force studying cases of severe maternal morbidity, and recommending ways to help reduce the incidence of pregnancy-related deaths and severe maternal morbidity in Texas.
- Medicaid and CHIP Regional Advisory Committees accept public input on Medicaid and Children’s Health Insurance Program (CHIP) and provide program recommendations. Regional advisory committees meet locally within the 13 Medicaid/CHIP Service Delivery Areas on a quarterly basis.
- Medical Care Advisory Committee is a federally mandated committee that reviews and makes recommendations to the state Medicaid director on proposed rules that involve Medicaid policy or affect Medicaid-funded programs.
- Newborn Screening Advisory Committee advises on strategic planning, policy, rules and services related to newborn screening and additional newborn screening tests.
- Palliative Care Interdisciplinary Advisory Council consults with and advises on matters related to the establishment, maintenance, operation and outcome evaluation of the statewide palliative care consumer and professional information and education program.
- Perinatal Advisory Council
- Physician Payment Advisory Committee
- Policy Council for Children and Families works to improve the coordination, quality, efficiency, and outcomes of services provided to children with disabilities and their families through the state’s health, education, and human services systems.
- Preparedness Coordinating Council advises on activities regarding preparedness, training, planning, communications, and emergency response to public health and medical emergencies.
- Promotor(a) or Community Health Worker Training and Certification Advisory Committee advises on rules concerning training and regulation of promotores/community health workers.
- Promoting Independence Advisory Committee supports allowing an individual with a disability to live in the most appropriate care setting available.
- Public Health Funding and Policy Committee defines core public health services a local health entity should provide in a county or municipality; evaluates public health in the state and identifies initiatives for areas that need improvement; identifies funding sources available to local health entities; and establishes public health policy priorities.
- S.B. 1220 Medicaid and CHIP Border Rates and Expenditures Advisory Committee advises HHSC regarding eliminating disparities between the Texas-Mexico border region and other areas of the state in capitation rates fee-for-service per capita expenditures and total professional services expenditures for people under age 19.
- The Sickle Cell Advisory Committee raises public awareness of sickle cell disease and sickle cell trait.
- STAR Kids Managed Care Advisory Committee advises on the establishment and implementation of the STAR Kids Medicaid managed care program which provide services for children with disabilities who have Medicaid coverage to improve coordination and customization of care, access to care, health outcomes, cost containment and quality of care.
- State Child Fatality Review Committee looks to reduce preventable child deaths by understanding the causes and incidences of child deaths, identifing procedures to reduce the number of preventable deaths, and promoting public awareness.
- State Independent Living Council leads, promotes, and advances the independent living philosophy and advocates for the rights of people with disabilities.
- State Medicaid Managed Care Advisory Committee provides recommendations and ongoing input on the statewide implementation and operation of Medicaid managed care.
- State Preventive Health Advisory Committee works with HHS to develop and implement the state plan for the Preventive Health and Health Services Block Grant.
- Statewide Advisory Coalition for Addressing Disproportionality and Disparities address disproportionality and disparities in Texas by addressing racial disproportionality and disparities.
- Statewide Health Coordinating Council ensures health care services and facilities are available to all Texans through health planning activities.
- Stroke Committee (Subcommittee of the Governor’s EMS and Trauma Advisory Council) assists Governor’s EMS & Trauma Advisory Council in the development of a statewide stroke emergency transport plan and stroke facility criteria.
- Task Force on Domestic Violence examines the effect of domestic violence on the health of mothers and children and ways to improve health services for domestic violence victims.
- Texas Brain Injury Advisory Council address strategic planning, policy, rules, and services related to the prevention of brain injury, rehabilitation and the provision of long term services and supports for persons who have survived brain injuries to improve their quality of life and ability to function independently in the home and community.
- Texas Center for Nursing Workforce Studies Advisory Committee serves as a resource for data and research on the nursing workforce in Texas.
- Texas Council on Alzheimer’s Disease and Related Disorders
- Texas Autism Council advises and makes recommendations to state agencies and the state Legislature to ensure that the needs of persons of all ages with autism and other pervasive developmental disorders and their families are addressed and that all available resources are coordinated to meet those needs.
- Texas Council on Cardiovascular Disease and Stroke conducts health education, public awareness and community outreach; improves access to treatment; coordinates activities among state agencies; develops a database of recommendations for treatment and care.
- Texas Council on Consumer Direction advises on the development, implementation, expansion, and delivery of services through consumer direction, in all programs offering long-term services and supports that enhance a consumer’s ability to have freedom and exercise control and authority over the consumer’s choices, regardless of age or disability.
- Texas Diabetes Council addresses issues affecting people with diabetes in Texas and advises the Texas Legislature on legislation that is needed to develop and maintain a statewide system of quality education services for all people with diabetes and health care professionals who offer diabetes treatment and education.
- Texas HIV Medication Advisory Council
- Texas System of Care Consortium helps Texas achieve well-being for children and youth.
- Value-Based Payment and Quality Improvement Advisory Committee provides a forum to promote public-private, multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid, other publicly funded health services and the wider health care system.
- Women’s Health Advisory Committee advises on women’s health programs.
- Youth Camp Advisory Committee(link is external) provides advice on the development of standards, procedures, and rules to implement the Youth Camp Act.
If you have any questions about the notices published here, or any Texas rules & regulations, contact email@example.com.