February 8th, 2021

Draft ICF/IID Rule Changes

Attached please find the following:
Proposed changes of significant importance to ICF/IID providers are those under section 551.42 related to Infection Prevention and Control and section 551.236 related to Administrative Penalties.  See below for details.
Section 551.42:  According to HHSC this section incorporates provisions in  HB 1848  (86th – Klick) as well as clarifies the intent of 42 CFR §483.470 (l) which contains requirements to which ICF/IID providers must already adhere.  Please review the provisions under this section (starts at bottom of page 34) carefully.  Note:  As shared via a previous notice about House bills filed between January 5, 2021 thru January 31, 2021, Representative Campos has filed HB 1221 relating to communicable disease and infection prevention and control measures for certain long-term care facilities; authorizing an administrative penalty. The bill applies to ICFs/IID, NHs and ALFs.
Section 551.236:  The changes are the result of HB 3803 (86th – Guillen & Klick) which were intended to reinstate administrative penalty caps in the ICF/IID program that existed prior to Sunset for the legacy Department of Aging and Disability Services (DADS) in 2015.  As proposed in the attached rule, however, the rule allows the total penalty amounts allowed by law to be levied on a per day basis which conflicts with the intent of HB 3803.  In other words, and as recognized by HHSC during the 86th legislative process, the administrative penalty cap would be a total cap on penalties, not penalties accrued per day (though penalties prior to the cap are accrued on a daily basis).   See page 99 of the attached draft rule
In a conversation the three IDD associations had with HHSC regarding this matter, HHSC acknowledged that the rule was not consistent with the intent of HB 3803.
HHSC agreed to discuss the matter internally and report back to the three provider associations.  Concerned that HHSC will not implement the rule as intended, the three IDD associations will either pursue an amendment to the current statute to ensure intent clarity of Chapter 252, Health and Safety Code, Section  252.065 or request a letter of intent from the authors of HB 3803, or both.

February 7th, 2021

Feb. 8- ICF/IID Provider Bed Hold Payments Webinar &

Reminder to Provide Letter to Families

IL 2020-43ICF/IID Services During COVID-19 directed program providers to give a copy of the letter attached to that IL to each resident who was:

  • Absent from an ICF/IID
  • Not on leave
  • Was not discharged from the ICF/IID

If you have not provided the letter to residents who meet that criteria, do so immediately. It was to be complete by Oct. 5, 2020.  You must assist residents in deciding to do only one of the following:

  • Return to the facility.
  • Continue to be absent from the facility, be discharged, but enter into an agreement with the ICF/IID to hold your place at the facility.
  • Continue to be absent from the facility and be discharged.

HHSC Medicaid and CHIP Services will issue instructions to providers about entering COVID-19 therapeutic leave for days a resident was away from an ICF/IID to reduce the risk of COVID-19 transmission. Register for the following webinar to review the emergency rules authorizing this leave and the instructions for entering it.

ICF/IID Provider Bed Hold Payments Webinar
Friday, Feb. 5
9:30-11 a.m.
Register for the Bed Hold Payment Webinar.

The emergency rule authorizing payment for COVID-19 therapeutic leave (PDF) is effective Jan. 29, 2021.

January 19th, 2021

HHSC Updates the ICF COVID-19 Response Plan and FAQ Document

Please be sure to update your infection control and other related policies based on the updated Response Plan!!! 

Let us know if we can help.  We will be working on some of these addendums in the next few weeks. 

HHSC Long-term Care Regulation updated the ICF COVID-19 Response Plan and FAQ document on Jan. 12, 2021.

Read the updated ICF COVID-19 Response Plan (PDF).

Read the updated ICF FAQs (PDF).

Jan. 25 ICF Provider COVID-19 Webinar with HHSC LTC Regulation

Long-term Care Regulation and the Department of State Health Services provide the latest information on the COVID-19 pandemic and take live questions from participants in this ICF provider webinar. Provider attendance is critical to staying current with COVID-19 requirements and guidance.

ICF/IID providers are strongly encouraged to attend this and all biweekly COVID-19 webinars with LTCR and DSHS.

Those using Internet Explorer may have difficulties registering for the webinar. Please try another browser such as Google Chrome or Microsoft Edge.

ICF Provider Webinar
Jan. 25, 2021
11 a.m. – 12:30 p.m.
Register for the COVID-19 Webinar.

Recording of ICF COVID-19 Jan. 11 Provider Webinar Available

A recording of the January 11, 2021 ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.

Listen to the COVID-19 Q&A recording.

Read the COVID-19 Q&A (PDF).

January 10th, 2021

Informal Comments on Draft Rules for ICF/IID or Related Conditions

HHSC is accepting informal comments from stakeholders on the following draft rules, which are now posted on the HHS Rulemaking page. The comment period ends Jan. 19, 2021.

This project implements two bills from the 86th Legislature, Regular Session, 2019. House Bill (H.B.) 1848 contains required elements for infection prevention and control. H.B. 3803 limits the daily amount of an administrative penalty assessed against an ICF/IID. The project will also update rule references and agency names, amend rules to align with Centers for Medicare & Medicaid Services conditions of participation in the ICF/IID program, and edit the rules for clarity and consistency.

HHSC Publishes Revised Reporting Guidance for Long-Term Care Providers

(PL 20-37)

HHSC has published a revised version of Provider Letter 20-37, Reporting Guidance for Long-Term Care Providers (PDF). The revision includes information for ALF and ICF providers offering point-of-care testing for COVID-19 and clarifies reporting requirements for NF providers.

November 22nd, 2020

November 30 ICF Provider COVID-19 Webinar with HHSC LTC Regulation

LTCR and DSHS provide the latest information on the COVID-19 pandemic and take live questions from participants in this ICF provider webinar. Provider attendance is critical to staying current with COVID-19 requirements and guidance.

ICF/IID providers are strongly encouraged to attend this and all biweekly COVID-19 webinars with HHSC Long-term Care Regulation and the Department of State Health Services.

Those using Internet Explorer may have difficulties registering for the webinar. Please try another browser such as Google Chrome or Microsoft Edge.

ICF Provider Webinar

November 30, 2020

11 a.m. – 12:30 p.m.

Register for the COVID-19 webinar.

Recording of November 16 ICF COVID-19 Q&A Provider Webinar Available

A recording of the November 16, 2020 ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.

View the COVID-19 Q&A recording.

View the COVID-19 Q&A (PDF).


Important Information!

LTCR FORM 2195: Expansion of Reopening Visitation Status Attestation and Letter PL 20-43 (for ICF Only)

Note: to receive an approved general visitation designation, a small ICF/IID that cannot provide separate areas, units, wings, halls, or buildings for individuals who are COVID-19 positive, COVID-19 negative or unknown COVID-19 status, based on the status of the entire facility, must:

  • have no facility-acquired COVID-19 cases in individuals for at least 14 consecutive days; and
  • have no COVID-19 cases in staff.

An ICF/IID must provide instructional signage throughout the facility and proper visitor education regarding

  • signs and symptoms of COVID-19;
  • infection control precautions; and
  • other applicable facility practices (e.g., the use of facemasks or other appropriate PPE, specified entries and exits, routes to designated visitation areas, and hand hygiene).

An ICF/IID that does not meet the criteria for a visitation designation must permit closed window visits and end-of-life visits for individuals regardless of their COVID-19 status, as well as essential caregiver visits for individuals with COVID-19 negative or unknown COVID-19 status.

Such an ICF/IID must also develop and implement a plan to meet the visitation criteria and submit the plan to the regional director in the Long-term Care Regulation (LTCR) region where the ICF/IID is located within five days of submitting the new 2195 Expansion of Reopening Visitation Status Attestation Form,


within five days of receiving notification from HHSC that the ICF/IID was not approved for general visitation designation. 

LTCR Form 2195

Each ICF/IID must submit LTCR Form 2195 to the Regional Director in the LTCR region where the facility is located and must provide information about whether the ICF/IID meets or does not meet the criteria for expanded general visitation.

Each ICF/IID must submit a completed form 2195 to the Regional Director no later than October 31, 2020.

An ICF/IID that does not meet the visitation designation criteria must attest that it:

  • is permitting closed window visits, end of life visits, and essential caregiver visits;
  • will develop and implement a plan to meet the visitation designation criteria as defined in 26 TAC §551.47; and
  • has included the plan with the form or will submit the plan within five business days of submitting the form.

To seek a designation for general visitation, an ICF/IID must complete LTCR Form 2195, Expansion of Reopening Visitation Status Attestation, to notify LTCR that the ICF/IID seeks a designation as a visitation facility.

The form must be emailed to the LTCR regional director in the LTCR region where the facility is located. Any applicable pictures and facility maps must also be included with LTCR Form 2195.

The LTCR regional director or designee will review the form within three working days of submission and notify the ICF/IID whether it has received been approved for a visitation designation.

An ICF/IID with previous approval for visitation does not have to submit LTCR Form 2195 or other documentation unless the previous visitation approval has been withdrawn, rescinded, or canceled, or was for only indoor or outdoor visitation instead of both indoor and outdoor visitation.

If approved, the ICF/IID must allow outdoor visits, indoor plexiglass visits, open window visits, and vehicle parades in accordance with the applicable emergency rule. HHSC LTCR can conduct an on-site visit to confirm an ICF/IID’s compliance with the requirements. If HHSC determines that the ICF/IID does not meet the requirements for the designation as a visitation facility, the ICF/IID must immediately stop all visitation except a closed window visit, end-of-life visit, and visits by persons providing critical assistance, including designated essential caregivers.

If, at any time after a visitation designation is approved by HHSC, the ICF/IID experiences an outbreak of COVID-19, the ICF/IID must notify the Regional Director in the LTCR Region where it is located that the ICF/IID no longer meets visitation criteria, and the ICF/IID must immediately stop all visitation, except a closed window visit, end-of-life visit, or visits by persons providing critical assistance, including essential caregivers.

The ICF/IID can submit a new request for designation when it meets all visitation criteria.

Under Section 37.10 of the Texas Penal Code, a person commits a criminal offense if he or she makes a false entry in a governmental record; makes, presents, or uses any record or document with knowledge of its falsity and intent that it be taken as a genuine governmental record; or makes, presents, or uses a governmental record with knowledge of its falsity. In addition, making a false statement on the attestation form can result in the imposition of an administrative penalty as described in Texas Health and Safety Code, Chapter 252, section 252.065(a)

Contact Information for Submitting LTCR Form 2195 to the LTCR Regional Director: https://hhs.texas.gov/about-hhs/find-us/long-term-care-regulatory-regional-contact-numbers

If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at PolicyRulesTraining@hhsc.state.tx.us or call (512) 438-3161.


Deadline for Decision To Return to Facility/Payment to Hold Bed/Discharge Option  

HHSC Email  Update
“These information letters listed below, provide confirmation of the agency’s intent to seek CMS approval for a retainer or bed hold payment, discusses the emergency rule, and directs providers to share prepared information with clients who are affected by these changes. We understand that the turnaround time to inform clients and their families is minimal; however, we wanted to give families time to decide next steps and providers time to adjust to the families’ decision.”  (November  1st, 2020 is the deadline).  Basically if the individual has been away from the facility during COVID-19, they will need to make a decision of whether they are coming back to occupy a “bed”, pay themselves to keep the “bed” or if they will discontinue services (discharge) without receiving any ICF services at this time.  There is a sample letter to send to the individual and their families to get them ready to make this decision.

Information Letter No. 20-43 ICF/IID Services During COVID-19


Quick TIPS on New Changes for Expansion of Facility Visitation Rules & Other Policies Concerning COVID-19

Essential Caregiver Visits and Salon Services Visitor   (Visitor types above and beyond normal designated visiting facility type)

Essential Caregivers are allowed even if the facility does not have designated visitation.  They must be at least 18 years of age.  Can be family, friend, guardian.

  • 1.They must wear a facemask. 2. They must have evidence of negative COVID-19 test in the past 14 days and must be screened by facility staff prior to the visit.  (Pay attention to the new additional symptoms and discontinuation of asking about international travel). 3. There is a 2- hr limit unless the facility allows a longer period of time. 4.They can have physical contact with their individual (and only their individual)  5.They must be limited to access to their person.  6.An assigned person must escort them to and from the location they are going to meet with the individual- room, outside…  7. The facility must approve the face mask they are going to wear or provide an appropriate mask.  8.If they do not have an appropriate face mask or the facility can’t provide one, they will need to reschedule the visit. 9. The facility must create an identifying badge for the essential caregiver or any salon service visitors. 10. The facility must have attestation stating the essential caregiver has visited and when they left (include time arrived, when they left, who they visited).  11. Essential caregivers must be trained on PPE and how to wear PPE, handwashing, and other infection control practices and there must be proof of this training that the facility maintains.   12..The individual must be COVID-19 negative to have an Essential caregiver visit or Salon Service Visitor.
  • ***(If client status is unknown, the essential visitor would have to wear a face mask (not N-95, save that for your staff who need to work with COVID-19 + individuals), gown, gloves, goggles or face shield, so the facility might need to provide these other items)

Phase I Visitation Rules, no longer in effect!

Expanded Visitation Rules now in effect:  The facility must apply with form 2194  for the Designated Visitation Facility, do not require all these same requirements an essential visitor (or Salon Service Visitors)- Designated visits include: open window visits, closed window visits, parade visits (open window or closed) outside visits, (and in plexiglass separate areas).   Must use physical distance, visitor screening, individual will wear face mask or face covering if tolerated and the same for the visitor -they must wear a face mask or face covering.  Provider Letter 20-38 has the link with form 2194 at the end of it.  We encourage you to email the form.  Most staff at HHSC are not in the office  Visitation Designation department has 3 days to approve or deny the 2194 form request.  Only the administrator or director can fill out form 2194!!

Previous Level 1 Attestation Approval: If you previously submitted the 2192 and received approval, you do not need to request a new one with form 2194, if your status is the same.  If you want to change the visitation type, then you will need a new form. ( i.e. you did not want plexiglass partition previously and now you do.)

Small facilities must request visitation designation for the whole facility (unless you have a way to separate all cohort areas completely.) Do not fill out section #3.  That is only for NF’s. 

The provider must develop and must enforce policies and procedures including testing strategies for Essential Visitors, in addition to the testing that must occur at least 14 days prior to 1st visit and all other polices related, such as essential visitor requirements discussed above.  Remember your testing strategies  are required  to provide expectations for the essential visitor for how often they will be required to test and when, for any visits they are making, after the initial “essential caregiver visit”.

For vehicle parades, the individual needs to remain 10 ft or more from the vehicle for safety.

Plexiglass booths on the inside must be approved by a life safety person for your region Send in pictures.  Does have to be a plexiglass barrier, does not have to be 2 and 3 sided.

**Closed window and End of Life visits are the only visits an individual may have if they are COVID-19 + (positive)

Remember staff should be assigned to an appropriate cohort (COVID-19 +, COVID-19 Negative or Unknown) then they should stay with that Cohort.  In addition, there should be a policy at the facility for limiting the sharing of staff.  If you need help with your policy concerning “COHORTS” and ” Mitigation of COVID-19 by Limiting Sharing of Staff”, please contact us.  I do have some policies you can purchase if needed.  Please contact me at:  info@twogetherconsulting.com


FAQ’s (June 2020)

(Section) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)
How should an ICF handle the discharge summary when a client is admitted on a temporary emergency basis from the community or another ICF?

Answer: Regulations regarding ICF/IID discharge have not been waived. A discharge, even on a temporary emergency basis, requires that key developmental, behavioral, social, health and nutritional information be shared with the accepting facility in the community or non-facility provider. CMS is aware that staffing shortages and/or client surges due to the PHE create a high demand on available staff time that makes it difficult to complete a full discharge summary for each client. Each ICF will need to evaluate what amount and detail of documentation is necessary to ensure that critical health information is shared with the accepting facility or other provider. When available and if appropriate, the Interdisciplinary Team (IDT) should maximize the use of telehealth for the completion of a client’s discharge plan during the PHE.

How should an ICF handle the development of a Comprehensive Functional Assessment (CFA) and an Individual Program Plan (IPP) when a client is admitted on a temporary emergency basis from the community or another ICF?
Answer: Clients who are admitted on a temporary emergency basis to an ICF during the PHE will nonetheless continue to need to have a Comprehensive Functional Assessment (CFA) and an Individual Program Plan (IPP) in accordance with 42 CFR 483.440(c). Completion of these documents will provide an opportunity for the IDT and staff to meet the basic and critical care needs of the client. CMS is aware that staffing shortages and/or client surges due to the PHEmay create a high demand on available staff time that makes it difficult to complete a full CFA and IPP. Each ICF will need to evaluate what amount and detail of documentation is necessary to ensure that critical health and treatment information is identified to allow active treatment during the PHE. This health and treatment information will support successful adjustment for the client to the new temporary living environment. When available and if appropriate, the IDT should maximize the use of telehealth for the development of a client’s IPP for temporary emergency admissions during the PHE.
During the PHE are ICFs still required to have and use a specially constituted committee or committees?
Answer: Yes. CMS believes that the use of this committee may be of value during the time of the COVID-19 PHE. The committee can provide an opportunity to support and make suggestions to facilities as they may need to adapt policies and procedures as well as why and how services are being provided to clients, which clients may find difficult to understand and potentially lead to inappropriate adaptive behavior. When available and if appropriate, the specially constituted committee should maximize the use of telecommunications to convene this committee as a resource to support the challenges faced by staff and clients during the PHE.
When a client has tested positive for COVID-19 and the ICF/IID implements quarantine procedures, client rights are immediately abridged and severe behaviors are likely to occur. What is the guidance from CMS on balancing the CDC expectations with the rights of the individual?
Answer: The health and safety of the clients, visitors, and staff at an ICF/IID are of the utmost importance for CMS. Based on the ICF Emergency Preparedness plan, and in accordance with the requirement at 42 CFR 483.440(c)(3)(v) that the IPP assess the client’s health status in the context of a COVID-19 diagnosis, the ICF/IID must revise the client’s IPP to reflect specific procedures and steps that will be taken to quarantine the client while also taking every step reasonable to protect the rights, safety, and health of the infected client, as well as those of the staff and other clients. ICF/IIDs are encouraged to use telehealth and assistive technology to minimize social isolation to the extent possible.
Are intermediate Care Facilities required to participate in the COVID-19 CDC National Healthcare Safety Network (NHSN) reporting requirements?
Answer: ICF/IIDs do not have a regulatory requirement for the reporting of communicable diseases, healthcare-associated infections, and potential outbreaks to Federal (such as the CDC), State and/or local health departments. ICF/IIDs do have a requirement under 42 CFR 483.420(c)(6), which addresses communication to family and/or guardian when a client’s condition changes, including the onset of serious illness (such as COVID-19). Although reporting to CDC is not required, ICF/IIDs may voluntarily report COVID-19 cases to the CDC, and CMS encourages them to do so to facilitate public health tracking of the pandemic. You may find the following CDC resource links helpful:
Rural Health Clinics (RHC)/Federally Qualified Health Centers (FQHCs)
Has CMS implemented any flexibilities to help RHCs and FQHCs respond to the PHE posed by COVID-19?

Answer: Yes. CMS has temporarily waived certain regulatory requirements providing flexibilities to assist RHCs and FQHCs in furnishing services during the COVID-19 PHE. This includes temporarily modifying the following:(a)50% mid-level staffing requirement for RHCs;(b)Physician supervision requirement for nurse practitioners (NPs), to the extent permitted by State law; and(c)Location requirements for existing RHCs and FQHC to allow additions of temporary service locations.Please see https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf for additional waiver information. Additional flexibilities, including guidance for RHCs and FQHCs furnishing telehealth services during the PHE, are also described in this CMS MLN Article: https://www.cms.gov/files/document/se20016.pdf

When do these flexibilities go into effect?
Answer: The flexibilities for staffing requirements, physician supervision of nurse practitioners, and temporary expansion sites are retroactively effective beginning March 1, 2020, through the end of the emergency declaration and CMS issues an end of outbreak notification.
Do these flexibilities apply to all RHCs and FQHCs?
Answer: The flexibilities for physician supervision of NPs apply to all RHCs and FQHCs, to the extent permitted by state law. Flexibilities to the 50% mid-level staffing requirement apply to RHCs only as the mid-level requirement is RHC specific. Lastly, flexibilities to the location requirement apply to existing RHCs and FQHCs.
How does the mid-level practitioner 50% flexibility benefit an RHC? Are RHCs required to submit any documentation to CMS for this waiver?
Answer: This waiver provides RHCs with flexibilities with regards to the percentage of operating hours the facility has a mid-level practitioner available to furnish patient care services. While the waiver offers flexibilities with staffing mixes, a physician, NP, physician assistant, certified nurse midwife, clinical social worker, or clinical psychologist must be available on site to furnish patient care services whenever the RHC is open and operating. CMS does not require any submission of documentation for this waiver.
How does the waiver affect the physician supervision of NPs?
Answer: During the PHE, NPs may function to the fullest extent possible without physician supervision, and to the extent of applicable state law. However, the physician continues to be responsible for providing the overall medical direction for the RHC/FQHC’s health care activities, consultation for, and medical supervision of all other health care staff, either in person or through telehealth and other remote communications.
41.Question: Can an RHC/FQHC provide patient care services at temporary locations?

Answer: Yes. During the COVID-19 PHE, CMS is allowing currently approved RHCs/FQHCs to provide patient care services in temporary expansion sites to help address the urgent need for supplementary care. These temporary sites are not restricted to the rural/shortage area location requirements. Each location is obligated to follow RHC/FQHC regulations to the extent not waived. Therefore, the RHC/FQHC may provide services provided at a temporary location under the CMS Certification Number (CCN) for the permanent location. The RHC/FQHC is expected to be operating in a manner not inconsistent with its state’s emergency preparedness plan. Note: FQHCs must also have an updated Health Resource and Service Administration (HRSA) Notice of Award, expanding the scope of service to include the temporary location(s) to support response to the COVID-19 PHE.

Do these flexibilities apply to temporary locations established in a parking lot?
Answer: Yes. During the COVID-19 PHE, CMS is allowing RHC/FQHCs to establish temporary expansion sites in a parking lot; either on or off its premises. As with other temporary expansion locations, the parking lot site must meet the same RHC/FQHC regulations as the main site, unless otherwise waived. Therefore, the RHC/FQHC may provide for those services via the existing CCN of its approved permanent location. RHC/FQHC is expected to be operating in a manner not inconsistent with its state’s emergency preparedness plan.
Can an RHC/FQHC provide patient care services to a patient in the patient’s vehicle?
Response:During the COVID-19 PHE, to help minimize transmission, an RHC/FQHC visit can take place if the patient is in a vehicle on the premises of the RHC/FQHC and all requirements for a billable visit are met (e.g. medically-necessary, face-to-face visits with an RHC/FQHC practitioner). The RHC/FQHC would provide the services using its existing CCN. All services provided are held to all RHC/FQHC regulations, unless otherwise waived. This includes, but is not limited to, the provisions of services as per 42 CFR 491.9(c). RHCs/FQHCs must consider the clinical appropriateness of services before conducting a visit and/or treating a patient in their vehicle.
Will a RHC or FQHC seeking approval of its temporary location as being consistent with the emergency response and pandemic plan be provided with evidence of approval or denial from the state?
Answer: State emergency plans and processes will vary. RHCs/FQHCs should retain any communications with the State emergency preparedness representatives to demonstrate that its temporary location(s) are not inconsistent with the state emergency preparedness and pandemic plan for the COVID-19 PHE. Once the state has approved the addition of temporary location(s), there are no additional CMS enrollment or reporting requirements. The RHC/FQHC may begin utilizing the temporary expansion location throughout the duration of the COVID-19 PHE.
May an RHC or FQHC continue providing RHC/FQHC services at the temporary location once the COVID-19 PHE ends?
Answer: No. All waived CoPs, CfCs, requirements, and most temporarily revised regulations will terminate at the end of the PHE. If the RHC/FQHC wishes to continue services at the temporary expansion location after the PHE has ended, the facility must submit form 855A to begin the process of enrollment and initial certification as a RHC or FQHC under the regular process and meet all applicable requirements, including 42 CFR 491.5.

My RHC participates in Medicare through one of the two CMS-approved RHC Accreditation Organizations (AOs). Do waivers of CMS regulations apply to CMS-approved accrediting programs? Do I need to notify the AO of my desire to temporarily add a service location during the COVID-19 PHE?

Answer: The flexibilities apply to both accredited and non-accredited RHCs. Notifying your AO of the temporary location is recommended.
Where can I find answers to COVID-19 flexibilities regarding Medicare Fee-for-Service (FFS) billing for RHCs and FQHCs?

Answer: To assist RHCs and FQHCs in furnishing service during the COVID-19 PHE, CMS has provided additional flexibilities related to billing for services. These temporary flexibilities currently include Expansion of Virtual Communication Services for RHCs and FQHCs to include online digital evaluation and management services using patient portals, and Revision of Home Health Agency Shortage Area Requirement for Visiting Nursing Services Furnished by RHCs and FQHCs. Please see the Medicare FFS Billing FAQ document available at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. Please see Section II.L of the Interim Final Rule with Comment Period, “Medicare and Expanded Flexibilities for Rural Health Clinics (RHCs) Medicaid Programs; Policy and Federally Qualified Health Centers (FQHCs) During Regulatory Revisions in Response to the COVID-–19 Public Health Emergency (PHE)”(85 FR 19230, 19253), available at https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public, for more information on regulatory changes for RHCs and FQHCs.

Webinar info:  How to prevent infectious diseases and the spread of infectious diseases in ICF-Specifically COVID-19 (May 27th, 2020)

See the following pdf link from HHSC


March 13th ICF FAQ’s  See link below:

Survey Operations Resume as of June 15th, 2020

As of June 15, 2020, Survey Operations has begun to resume some normal survey activity, and Enforcement is also resuming enforcement processes and activities. This means we will be issuing various due process notice letters to individuals, agencies, and facilities that have been on hold due to COVID.
Please contact Enforcement Director Derek Jakovich by email at derek.jakovich@hhsc.state.tx.us if you have questions.
In response to questions regarding what normal survey and enforcement activities are resuming as of June 15 and what programs are affected, HHSC replied as follows:
As of June 15, 2020 Survey Operations is resuming some survey activity such as complaints with lower priorities, and possibly some licensure and certification surveys. For Enforcement, due process notice letters such as denials, revocations, and imposition of administrative penalties will be issued and the opportunity to appeal will be provided. Of course, the COVID circumstances may affect these activities.
The notice applies to NF, ALF, DAHS, PPECC, HCSSA, and ICF/IID.

Providers Must Log Residents’ Leave

All community-based ICF/IID program providers must submit an absence request in the TMHP ICF/IID Online Portal for a resident away from the facility for one or more full days. See the TMHP ICF/IID Online Portal User Guide (PDF) starting on page 52 for more information. The program provider must submit a return request within three days after a resident returns to the facility. See page 58 of the Online Portal User Guide for an explanation.

Please ensure that information entered in the portal for absences is current. HHSC uses the information to determine how many residents are absent from their facilities and the length of those absences.


Contact Information
If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at

PolicyRulesTraining@hhsc.state.tx.us or call (512) 438-3161.

Provider Joint Training Opportunities

Check out Joint Provider Trainings link from HHSC, for more info:


Survey Process for ICF Has Changed: Please Be Aware

You may check your SOMA (Surveyor’s Operational Manual for ICF in Appendix J) for these changes.



Appendix Q of SOMA (Immediate Jeopardy) Changes


CMS clarifications letter


Online basic training for Core Appendix Q is available on the Integrated Surveyor Training
Website at the following link:https://surveyortraining.cms.hhs.gov/
This basic training is intended to provide Regional Office and State Survey Agency surveyors, management staff, and
training coordinators, as well as providers, suppliers, and laboratories, and other stakeholders with
the ability to identify immediate jeopardy
NOTE: This is a required training for RO and SA staff involved in immediate jeopardy
determinations. All RO and SA surveyors, members of management, and training coordinators
are expected to take this training as soon as practicable, but not later than March 22, 2019.
Point of Contact:
For questions related to this information, please add in subject line
“Immediate Jeopardy Inquiry” and send your email to:
Effective Date:
Immediately-This policy should be communicated to all survey and certification staff, their managers and the State
and Regional Office training coordinators within 30 days of this memorandum.


SOMA appendix Q Section  Immediate Jeopardy 


II.  Proposed ICF/IID Rates: Below please find the link to information about the August 2, 2019 HHSC public hearing on the proposed ICF/IID rates.  The hearing will be at 3:00 p.m. and held in the HHSC public hearing room (first floor of HHSC).  Additional information about the hearing (specifically, needed member action) will be forthcoming.
Though the above link provides the proposed rates, below is a chart which reflects both the current and proposed ICF/IID rates.  Note that with the exception of LON 9, all LON categories and facility settings/sizes are proposed to receive an increase.  Also, at this time, the specifics regarding the impact of the increases on the rate categories (residential direct and indirect  & day habilitation direct and indirect) are not yet available.  According to HHSC the ‘specifics’ should be available on or after this Friday (July 19, 2019).

LON & Facility Size

Current Rates

Proposed Rates