The State Health Services Council met for a work session and council meeting to receive updates from DSHS staff and to approve rule actions for public comment.
Commissioner’s Report
Kirk Cole, Interim Commissioner, DSHS
- Sunset has removed regulations on many licensed services such as contact lens dispensers and tanning beds
- Over the next two biennia, even more license programs will be transferred to the purview of Texas Department of Licensing & Regulation
- Women’s Health Services have been combined into a single program
- HHSC has a new enterprise-wide behavioral health advisory council which will oversee substance abuse programs as well as mental and behavioral health programs
- HHSC is accepting applications for the committee and the first meeting is expected to take place prior to the start of the new year
- DSHS is working with Collin County and the North Texas Behavioral Health Authority concerning the discontinuation of the NorthSTAR program
Report on the Office of Border Health
Dr. R. J. Dutton, Office of Behavioral Health
- Dutton presented general statistics regarding the differences between the demographics of border and non-border populations and health issues that are more prevalent in border populations
- Focusing efforts on border obesity and promoting healthy activities
- Working to expand the J-1 visa program which allows physicians from Mexico to come to Texas and serve in underserved areas
- Border workforce issues will continue to be a focus moving forward
Update on ImmTrac
- Repository of immunization histories for all Texans, consolidates immunization records, confidential and secure, only authorized entities are allowed access
- Est. 1995 and is opt-in
- 135 million immunizations recorded, 7 million children in the registry
- 400k adults in the registry
- 11k active users
- Healthcare provider, any physician, healthcare professional, or facility personnel duly licensed or authorized to administer vaccines-Free, user-friendly application
- Fast and easy access to records
- Consolidates records from multiple providers, health plans, Medicaid and vital statistics
- Interprets schedules and recommends vaccines due
- Helps ensure age-appropriate and timely vaccination
- Prevents over-immunizations and missed opportunities
- Produces reminder and recall reports, letters, and labels
- ImmTrac offers school nurses and child care facilities a source for records and histories
- Electronic Vaccine Inventory Overview
- Allows providers to record inventory and place orders
- DSHS transmits EVI orders to CDC
- Doses administered are recorded in aggregate
- ImmTrac2 combines ImmTrac and EVI
- Web-based and free
- Based on Wisconsin Immunization Registry
- Largely federally funded combined with some state GR $7.3 million
- Registry functional in 2016, inventory functions in 2017
- Will provide more detailed history and forecasting
- Allows providers to reset their own password
- Simplifies report generation and allows ad-hoc report capability
- System costs and maintenance savings
- Single registration process will simplify records and inventory
- Comprehensive preventative healthcare system
- Reliable data during crisis
- Dose-level accountability, enhanced reminder/recall functionality
- Compliance with Immunization Information Functional Standards of the American Immunization Registry Association and CDC
- Working on data gathering, system design, data migration, contract, and budget amendments
- Rolling out beginning in 2016, moving forward to user training and inventory rollout
- Question after children "coming across the border"
- Some vaccines have been provided through Texas Vaccines for Children
- Will doctors be mandated to participate
- Yes, law was made in 1995 requiring participation in ImmTrac, but currently not all do
- Question for description of security procedures
- Firewall is in place, state law provides for exact protocol for registration and access, will need to check with program manager
- Specific demographic data on immunizations is available through other state services which can pull from ImmTrac, system is expected to be more robust in ImmTrac2
Rule Actions
A. Amendments to rules, repeal of a rule, and a new rule concerning the Kidney Health Care Program
- Program provides Medicare part D, premiums, deductibles, etc.
- Chosen from allowable dialysis access services and benefits
- Reviewed based on quadrennial rule review requirement in statute
- Received one comment, has been incorporated and rules drafted
- Not expected to be controversial
- Rules redrafted largely for clarity
- 61.1 General – "authorized entity" language added, replaced KHC with "program"
- 61.2 Definitions – deleted unused definitions, "authorized entity" is an individual who is approved to submit claims on behalf of client
- 61.3 Requirements – removed specific income allowed for financial requirement in program to allow for flexibility, aligned with social security applications rules
- 61.4 Application – "authorized entity" added, removed requirement that notary document application
- 61.5 Benefits – “Drug products” changed to “supplies”
- 61.6 – Removed entirely to comply with HHSC contracting rules, moved from DSHS to HHSC
- 61.7 Claims and payment rates – removed references to old software system, added language to say program will not pay without fully executed provider agreement
- 61.8 Deadlines – clarified claims that do not meet deadlines will be denied
- 61.9 Rights and Responsibilities – minor language changes
- 61.10 Modifications, Suspensions, and Terminations – clarifies clients must reapply if terminated
- 61.11 Rights of Appeal – repealed fully, instead describes appeal process
- No program operations are changed, not expected to significantly impact statistics
- Council asks after removal of specific income, is this established by statute?
- No, statute allows income to be set by board, wanted flexibility to change if necessary, but don't anticipate a need
Staff found the need to change language based on the question regarding specific income; moving financial criteria out of the rule by removing Sec. 61.3(c) from the draft.
Council approved publication.
B. New rules concerning the neonatal level of care designation for hospitals
- EMS Trauma coordination unit is managing the program
- Designation program, rules relate to neonatal designation only
- Implements HB 15 from 82nd
- L1 – self-survey and generally well infants
- L2 – includes some rural facilities more than 75 miles from a designated L3 facility
- L3 – Requires on site survey by external org
- HB 3433 commanded drafting of designation rules, must be in effect by March of 2018
- Dr. Eugene Toy, chairman of the Perinatal Advisory Council discussed the need for and importance of these rules
Council approved publication.
C. Amendments to rules concerning radioactive materials and general requirements and license regulations for radiation control
- Program promotes physical and environmental health of citizens via compliance with rules
- NRC issued security orders in Nov. 2005 to implement increased controls over radioactive materials
- 289.252 ii is being replaced with NRC's new language referring to category 1 and category 2 radioactive material and fingerprinting requirements
- Most of this has been in effect since 2005
- Held three separate comment periods
- Question after "incidents" of radioactive material control problems
- All of these incidents are in the top three levels of incidents, some of them caused concern over operators handling materials, includes accidents and over-exposure incidents
- Licensees encompass Industrial, Medical, Research, and Academic facilities
Council approved publication.