Texas Register February 21, 2025 Volume: 50 Number: 8

Texas Register Table of Contents

1 Office of the Attorney General
- - 1.0.1 Requests for Opinions Re:
    - 1.0.1.1 Whether House Bill 1763 and House Bill 1919, enacted by the 87th Legislature and codified in chapter 1369 of the Insurance Code, are enforceable against a health benefit plan issuer and a pharmacy benefit manager administering the pharmacy benefits of the health benefit plan in certain circumstances (RQ-0539-KP).
2 Texas Department of State Health Services
3 Texas Health and Human Services Commission
4 Texas Department of Insurance, Division of Workers’ Compensation
- - 4.0.1 Adopted Rule Re:
    - 4.0.1.1 Adopting 28 TAC §133.30, to allow a treating doctor to use telemedicine or telehealth for injured employees that meet certain conditions, such as undergoing an examination by the treating doctor for the condition in question at least once before the examination to certify MMI; provide consent; and the injury must qualify as a minor injury.
5 Texas Department of Assistive and Rehabilitative Services
- - 5.0.1 Adopted Rules Re:
6 Texas Medical Liability Insurance Underwriting Association
- - 6.0.1 In Addition Re:
    - 6.0.1.1 Agenda Texas Medical Liability Insurance Underwriting Association (JUA) Board of Directors Meeting – February 28, 2025.

Office of the Attorney General

Requests for Opinions Re:

Whether House Bill 1763 and House Bill 1919, enacted by the 87th Legislature and codified in chapter 1369 of the Insurance Code, are enforceable against a health benefit plan issuer and a pharmacy benefit manager administering the pharmacy benefits of the health benefit plan in certain circumstances (RQ-0539-KP).

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §27.1, §27.3, to remove rules that are to be replaced by new rules in Title 26.

CHAPTER 27. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER A. GENERAL PROVISIONS
25 TAC §27.1, §27.3

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §27.1, Purpose and Application; §27.3, Definitions; §27.5, Client Eligibility; §27.7, Client Rights; §27.9, Client Confidentiality; §27.11, Components of Case Management for Children and Pregnant Women Services; §27.13, Prior Authorization; §27.15, Provider Qualifications; §27.17, Provider Approval Process; §27.19, Provider Responsibilities; §27.21, Case Manager Qualifications; §27.23, Case Manager Responsibilities; §27.25, Utilization and Quality Assurance Reviews and Compliance; and §27.27, Termination, Suspension, Probation, and Reprimand of Providers.

BACKGROUND AND JUSTIFICATION

Case Management for Children and Pregnant Women (CPW) services assist eligible Medicaid clients in gaining access to necessary medical, social, educational, and other services related to the client’s health conditions and health risks. To be eligible for services, a client must be either a child with a health condition or health risk or a pregnant woman with a high-risk condition. The client must also be Medicaid-eligible in Texas, need case management for CPW services, and choose such services.

HHSC proposes to repeal Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and proposes a new Chapter 257, Case Management for Children and Pregnant Women, in Title 26, Part 1, TAC. The purpose for moving the CPW chapter from Title 25 to Title 26 is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services (DSHS) to HHSC.

The new CPW rules in 26 TAC Chapter 257 are proposed elsewhere in this issue of Texas Register.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§27.1, 27.3, 27.5, 27.7, 27.9, 27.11, 27.13, 27.15, 27.17; 27.19, 27.21, 27.23, 27.25, and 27.27 in 25 TAC Chapter 27 removes rules that need to be replaced by new rules in Title 26 under HHSC.

Amending 25 TAC §§27.5, 27.7, 27.9, 27.11, 27.13, to remove rules that are to be replaced by new rules in Title 26.

CHAPTER 27. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER B. CLIENT SERVICES
25 TAC §§27.5, 27.7, 27.9, 27.11, 27.13

OVERVIEW

BACKGROUND AND JUSTIFICATION

The new CPW rules in 26 TAC Chapter 257 are proposed elsewhere in this issue of Texas Register.

SECTION-BY-SECTION SUMMARY

Amending 25 TAC §§27.15, 27.17, 27.19, 27.21, 27.23, 27.25, 27.27, to remove rules that are to be replaced by new rules in Title 26.

CHAPTER 27. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER C. PROVIDER QUALIFICATIONS AND RESPONSIBILITIES
25 TAC §§27.15, 27.17, 27.19, 27.21, 27.23, 27.25, 27.27

OVERVIEW

BACKGROUND AND JUSTIFICATION

The new CPW rules in 26 TAC Chapter 257 are proposed elsewhere in this issue of Texas Register.

SECTION-BY-SECTION SUMMARY

Amending 25 TAC §289.230, to update the requirements for mammography reports.

CHAPTER 289. RADIATION CONTROL
SUBCHAPTER E. REGISTRATION REGULATIONS
25 TAC §289.230

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes an amendment to §289.230, concerning Certification of Mammography Systems and Mammography Machines Used for Interventional Breast Radiography, and the repeal of §289.234, concerning Mammography Accreditation.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to amend §289.230, relating to requirements for the certification and use of radiation machines in mammography and interventional breast radiography. The amendment is necessary to align with the United States Food and Drug Administration (FDA) Mammography Quality Standards Act (MQSA) under 21 Code of Federal Regulations (CFR) Part 900.

Additionally, the proposal repeals §289.234, relating to mammography accreditation, because DSHS no longer accredits mammography facilities due to an expired contract which ended on August 31, 2024. With the contract’s expiration, this rule is no longer valid.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §289.230 updates the requirements concerning breast tissue density in mammography reports and plain language notification statements to patients. Three new outcome data reporting requirements for the interpreting physician and the facility have been added. The outcome data report must include calculations for positive predictive value, cancer detection rate, and recall rate.

Additional changes to §289.230 include reorganizing the rule to mirror the layout of other sections of this chapter, adding survey report requirements, and adding and clarifying definitions for various terms related to mammography machines. The proposal adopts 21 CFR Part 900 by reference for system design, screen-film, processor performance testing, equipment variances, and investigational device requirements. The proposed changes enhance clarity, safety, and regulatory compliance in the field of mammography. Other edits are made to improve grammar, formatting, and rule clarity.

Amending 25 TAC §289.234, to delete an invalid rule.

CHAPTER 289. RADIATION CONTROL
SUBCHAPTER E. REGISTRATION REGULATIONS
25 TAC §289.234

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §289.234 is necessary to delete an invalid rule.

Adopted Rules Re:

Adopting 25 TAC §33.70, to set forth guidelines for teledentistry dental services, establish reimbursement requirements, and add teledentistry dental services as a service provided under Medicaid in the Texas Health Steps Program.

CHAPTER 33. EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT
SUBCHAPTER F. DENTAL SERVICES
25 TAC §33.70

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §33.70, concerning Dental Preventive and Treatment Services.

The amendment to §33.70 is adopted with changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8523). This rule will be republished.

BACKGROUND AND JUSTIFICATION

The amendment to §33.70 is necessary to comply with House Bill (H.B.) 2056, 87th Legislature, Regular Session, 2021.

H.B. 2056 added a requirement for providers to be reimbursed for teledentistry dental services by amending Texas Government Code §531.0216 and §531.02162(b) and (c) and adding Texas Government Code §531.02172. The amendment to §33.70 implements teledentistry dental services under Medicaid in the Texas Health Steps Program.

The Texas State Board of Dental Examiners adopted rules in 2022 to regulate the practice of teledentistry. HHSC waited until the Texas State Board of Dental Examiners rules were adopted to propose the amendment to §33.70. While the Texas State Board of Dental Examiners rules were being adopted, HHSC analyzed which dental services and treatments, available through the Texas Health Steps Program, could safely and effectively be provided as a teledentistry dental service to clients enrolled in the program.

The amendment to §33.70 requires dental providers to perform dental services as described in the Texas Medicaid Provider Procedures Manual. The amendment allows dental providers to conduct an oral evaluation as a teledentistry dental service, as defined in Texas Occupations Code §111.001, for established clients, using synchronous audiovisual technologies.

The amendment allows flexibility for an established client and the dentist to use synchronous audiovisual technologies to conduct an oral evaluation, and thereby, makes oral evaluations more easily available to and prevents unnecessary travel for clients in the Texas Health Steps Program.

Adopting 25 TAC §37.301, to make non-substantive revisions to update citations to the rule in the Texas Government Code.

CHAPTER 37. MATERNAL AND INFANT HEALTH SERVICES
SUBCHAPTER P. SURVEILLANCE AND CONTROL OF BIRTH DEFECTS
25 TAC §37.301

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §37.301, concerning Purpose.

Section 37.301 is adopted without changes to the proposed text as published in the November 8, 2024, issue of the Texas Register (49 TexReg 8828). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.

Adopting 25 TAC §103.1, to update citations to the Texas Government Code.

CHAPTER 103. INJURY PREVENTION AND CONTROL
25 TAC §103.1

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §103.1, concerning Purpose and Purview.

Section 103.1 is adopted without changes to the proposed text as published in the November 8, 2024, issue of the Texas Register (49 TexReg 8829). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 25 TAC §§221.11 – 221.16, to revise the exemption for 9 Code of Federal Regulations (CFR) §303; add definitions; provide additional examples of violations for severity levels I-V; reorganize and consolidate rules; and remove various subsections.

CHAPTER 221. MEAT SAFETY ASSURANCE
SUBCHAPTER B. MEAT AND POULTRY INSPECTION
25 TAC §§221.11 – 221.16

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §221.11, concerning Federal Regulations on Meat and Poultry Inspection; §221.12, concerning Meat and Poultry Inspection; §221.13, concerning Enforcement and Penalties; §221.14, concerning Custom Exempt Slaughter and Processing; Animal Share and Low-Volume Poultry or Rabbit Slaughter Operations; §221.15, concerning Inspection of Alternate Source Food Animals; and §221.16, concerning Fees. The amendments to §§221.11 – 221.16, are adopted without changes to the proposed text as published in the November 22, 2024, issue of the Texas Register (49 TexReg 9472) and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the adopted amendments is to implement Senate Bill (S.B.) 691, 88th Legislature, Regular Session, 2023, that amended Texas Health and Safety Code Chapter 433, Subchapter A, by adding §433.0065, relating to an animal share exemption for certain meat and meat food products and providing for a civil penalty. The amendments also provide guidance regarding how producers may engage in the slaughtering, processing, labeling, and distribution of meat and meat food products produced for members of an animal share while remaining in compliance with state and federal laws and the regulatory requirements of 25 Texas Administrative Code (TAC) §221.14.

Additionally, the adoption implements S.B. 664, 88th Legislature, Regular Session, 2023, that amended Texas Health and Safety Code Chapter 431, Subchapter D, by adding §431.0805, that defines analogue and cell-cultured food products as distinguished from the definitions of “meat,” “poultry,” “meat food products,” and “poultry food products.” The amendments update, correct, improve, and clarify the rule language and incorporate plain language where appropriate.

In Addition Re:

Limited Liability Report for Nonprofit Hospitals and Hospital Systems

OVERVIEW

The Hospital Survey Program in the Center for Health Statistics, Texas Department of State Health Services, has completed its analysis of hospital data for the purpose of certifying nonprofit hospitals or hospital systems for limited liability under Texas Health and Safety Code, §311.0456. Twenty-eight hospitals requested certification. Each of the requesting hospitals will be notified, by mail, on the determination of whether the statutory certification requirements were met. The certification issued under Texas Health and Safety Code §311.0456 to a nonprofit hospital or hospital system takes effect on December 31, 2024, and expires on the anniversary of that date.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 26 TAC §257.1, §257.3, to replace the repealed chapters, summarize the purpose of CPW services, and define terms used in the rules.

CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §257.1, §257.3

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §257.1, concerning Purpose and Application; §257.3, concerning Definitions; §257.5, concerning Client Eligibility; §257.7, concerning Client Rights; §257.9, concerning Client Confidentiality; §257.11, concerning Components of Case Management for Children and Pregnant Women Services; §257.15, concerning Provider Qualifications and Approval Process; §257.17, concerning Provider Responsibilities; §257.19, concerning Case Manager Qualifications; §257.21, concerning Case Manager Responsibilities; and §257.23, concerning Compliance with Utilization Reviews and Quality Assurance Reviews and Overpayments.

BACKGROUND AND JUSTIFICATION

HHSC proposes to repeal Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and proposes a new Chapter 257, Case Management for Children and Pregnant Women, in Title 26, Part 1, TAC. The purpose for moving the CPW rules from Title 25 to Title 26 is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services (DSHS) to HHSC. The repeal of the CPW rules in 25 TAC Chapter 27 is proposed elsewhere in this issue of the Texas Register.

In addition to relocating the CPW rules from DSHS to HHSC, the proposal makes amendments to the CPW rules in accordance with House Bill (H.B.) 133, 87th Legislature, Regular Session, 2021, that directs HHSC to deliver CPW services through managed care organizations (MCOs). The proposal also makes amendments to the CPW rules to implement certain requirements of House Bill (H.B.) 1575, 88th Legislature, Regular Session, 2023. H.B. 1575 authorizes case management services to pregnant women with a high-risk condition to address nonmedical needs; adds two new provider types, doula and community health worker, as eligible to provide CPW services; and establishes CPW provider qualifications for doulas and community health workers. The proposal also updates the CPW rules with appropriate references and terminology and includes organizational and minor editing changes for clarity.

SECTION-BY-SECTION SUMMARY

New Subchapter A, General Provisions

Proposed new §257.1, Purpose and Application, replaces repealed §27.1 and summarizes the purpose of CPW services. The proposed rule differs from the repealed rule by removing references to the Department State Health Services and clarifying that the rules apply to fee-for-service and managed care clients.

Proposed new §257.3, Definitions, replaces repealed §27.3 and explains the meaning of terms used in the rules. The proposed rule differs from the repealed rule by adding new definitions for face-to-face, HHSC, nonmedical need, and provider. The proposed rule amends the definition for access by adding a reference to nonmedical needs. The proposed rule also removes definitions for active providers, application process, prior authorization, and state because the terms are no longer used in the proposed new Chapter 257.

Amending 26 TAC §§257.5, 257.7, 257.9, 257.11, to replace the repealed chapter and define eligible service users and the terms of the use of those services.

CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER B. CLIENT SERVICES
26 TAC §§257.5, 257.7, 257.9, 257.11

OVERVIEW

BACKGROUND AND JUSTIFICATION

HHSC proposes to repeal Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and proposes a new Chapter 257, Case Management for Children and Pregnant Women, in Title 26, Part 1, TAC. The purpose for moving the CPW rules from Title 25 to Title 26 is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services (DSHS) to HHSC. The repeal of the CPW rules in 25 TAC Chapter 27 is proposed elsewhere in this issue of the Texas Register.

SECTION-BY-SECTION SUMMARY

New Subchapter B, Client Services

Proposed new §257.5, Client Eligibility, replaces repealed §27.5 and defines who qualifies to receive the services. The proposed rule differs from the repealed rule by clarifying that a client chooses, rather than desires, to receive CPW services.

Proposed new §257.7, Client Rights, replaces repealed §27.7 and establishes that a client’s use of case management services in CPW is voluntary. The proposed rule provides a client the right to actively participate in case management decisions, receive services free from abuse or harm, have the freedom to choose a provider, and request a fair hearing. The proposed rule differs from the repealed rule by clarifying that a client who receives CPW services through an MCO must exhaust internal MCO appeals before requesting a fair hearing.

Proposed new §257.9, Client Confidentiality, replaces repealed §27.9 and defines the circumstances in which client information can and cannot be shared.

Proposed new §257.11, Components of Case Management for Children and Pregnant Women Services and Reimbursement, replaces repealed §27.11 and outlines the services that are provided and the components that are billable. The proposed rule differs from the repealed rule by adding that a service plan must be signed by the Medicaid provider. The proposal also adds nonmedical needs as a component of CPW and updates requirements for follow-up visits by a case manager. The proposal also removes references to prior authorization and adds that services are not reimbursable when a client is an inpatient at a hospital or other treatment facility.

Amending 26 TAC §§257.15, 257.17, 257.19, 257.21, 257.23, to replace the repealed section to set forth the steps to become a provider of services.

CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER C. PROVIDER QUALIFICATIONS AND RESPONSIBILITIES
26 TAC §§257.15, 257.17, 257.19, 257.21, 257.23

OVERVIEW

BACKGROUND AND JUSTIFICATION

HHSC proposes to repeal Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and proposes a new Chapter 257, Case Management for Children and Pregnant Women, in Title 26, Part 1, TAC. The purpose for moving the CPW rules from Title 25 to Title 26 is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services (DSHS) to HHSC. The repeal of the CPW rules in 25 TAC Chapter 27 is proposed elsewhere in this issue of the Texas Register.

SECTION-BY-SECTION SUMMARY

New Subchapter C, Provider Qualifications and Responsibilities

Proposed new §257.15, Provider Qualifications and Approval Process, replaces repealed §§27.15 and 27.17 and indicates the steps necessary to become a provider of services. The proposed rule differs from the repealed rule by updating a reference to the U.S. HHS Office of Inspector General List of Excluded Individuals/Entities (LEIE); clarifying that interested providers must complete a pre-planning process with HHSC; adding a requirement that providers must complete the HHSC standardized case management training provided by HHSC; and generally condensing the approval process. The proposed rule also differs from the repealed rule by removing references to response times and Medicaid claims administrator and the requirement for a new application if twelve months have lapsed since initial approval was received.

Proposed new §257.17, Provider Responsibilities, replaces repealed §27.19 and specifies what providers must do to maintain the duties of providing services through CPW, including outreach activities.

Proposed new §257.19, Case Manager Qualifications, replaces repealed §27.21 and specifies qualifications to be a case manager in CPW. The proposed rule differs from the repealed rule by adding references to the Texas Occupations Code for advanced practice registered nurse, registered nurse, and social worker and adding community health worker and doula to the list of provider qualifications as required by H.B. 1575.

Proposed new §257.21, Case Manager Responsibilities, replaces repealed §27.23 and describes the requirement to have appropriate and current licensure or certification, provide services convenient to a client, and coordinate services.

Proposed new §257.23, Compliance with Utilization Reviews and Quality Assurance Reviews and Overpayments, replaces repealed §27.25 and explains that the purpose of a utilization review is to ensure fiscal integrity and describes the providers’ responsibility in participating in quality and utilization reviews. The proposed rule differs from the repealed rule by requiring providers to ensure services to a client are within the scope of the client’s service plan; referencing quality assurance and utilization reviews without specifying frequency or timeline for the reviews as compared to reviews being conducted each fiscal year; and removing reference to reviews of inactive providers. The proposed rule also replaces references to “the department” with references to HHSC.

Withdrawn Rules Re:

Withdrawing 1 TAC §§351.821, 351.823, 351.825, 351.827, to update citations to the Texas Government Code.

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
DIVISION 1. COMMITTEES
1 TAC §§351.821, 351.823, 351.825, 351.827

OVERVIEW

The Texas Health and Human Services Commission withdraws proposed amendments to §§351.821, 351.823, 351.825, and 351.827 which appeared in the November 15, 2024, issue of the Texas Register (49 TexReg 9087).

Adopted Rules Re:

Adopting 1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751, to update citations to the Texas Government Code.

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §351.4, concerning Health and Human Services Commission Executive Council; §351.11, concerning Reports on Efforts to Streamline and Simplify Delivery of Services; §351.504, concerning Caseload Reduction Plan for Adult Protective Services; §351.507, concerning Adverse Licensing, Listing, or Registration Decisions by Health and Human Services Agencies; §351.701, concerning Unrelated Donor Umbilical Cord Blood Bank Program; §351.751, concerning Integrated eligibility services call centers; §351.801, concerning Authority and General Provisions; §351.807, concerning Behavioral Health Advisory Committee; §351.809, concerning Drug Utilization Review Board; §351.811, concerning Intellectual and Developmental Disability System Redesign Advisory Committee; and §351.841, concerning Joint Committee on Access and Forensic Services.

The amendments to §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751, 351.801, 351.807, 351.809, 351.811, and 351.841 are adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9087). These rules will not be republished.

HHSC withdraws the proposed amendments to §351.821, concerning Value-Based Payment and Quality Improvement Advisory Committee; §351.823, concerning e-Health Advisory Committee; §351.825, concerning Texas Brain Injury Advisory Council; and §351.827, concerning Palliative Care Interdisciplinary Advisory Council.

BACKGROUND AND JUSTIFICATION

House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.

Adopting 1 TAC §§351.801, 351.807, 351.809, 351.811, 351.841, to update citations to the Texas Government Code.

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
DIVISION 1. COMMITTEES
1 TAC §§351.801, 351.807, 351.809, 351.811, 351.841

OVERVIEW

BACKGROUND AND JUSTIFICATION

House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.

Adopting 1 TAC §353.1309, to update citations in the rules to Texas Government Code.

CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
1 TAC §353.1309

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §353.1309, concerning Texas Incentives for Physicians and Professional Services.

The amendment to §353.1309 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9110). The rule will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment makes modifications to the Texas Incentives for Physicians and Professional Services (TIPPS) program to provide additional details concerning the pay-for-performance model established for Component Two of the program, beginning in State Fiscal Year (SFY) 2026. The rule amendment changes how certain TIPPS funds will be redistributed to certain physician groups participating in TIPPS if a physician group fails to earn those funds due to a failure to achieve performance requirements for Component Two of TIPPS.

HHSC sought and received authorization from the Centers for Medicare and Medicaid Services (CMS) to create TIPPS as part of the financial and quality transition from the Delivery System Reform Incentive Payment (DSRIP) program. Directed payment programs authorized under 42 Code of Federal Regulations (C.F.R.) §438.6(c), including TIPPS, are expected to continue to evolve over time to advance quality goals or objectives the program is intended to impact. HHSC previously amended the TIPPS rule to shift the program structure in SFY 2026 to provide that Component Two will be paid to physician groups based on a pay-for-performance model using achievement of quality measures and paid through a scorecard. Health Related Institution (HRI) and Indirect Medical Education (IME) physician groups are eligible for Component Two payments.

HHSC amends the program rule to allow for the redistribution of Component Two funds if a physician group does not meet the performance requirements. Under this rule amendment, if a physician group does not meet the performance requirements for Component Two, the funds that are not earned by that physician group will be redistributed among other physician groups in the same Service Delivery Area (SDA) and class (HRI or IME), based on how much those physician groups have already earned for Component Two. If no physician group in the same SDA and class earned funds under Component 2, the funds will be distributed across all physician groups in that SDA, based on how much those physician groups have already earned for Component Two. If there are no physician groups in that SDA that earned Component Two funds, the unearned funds will be distributed across all HRI and IME physician groups participating in TIPPS, based on how much those physician groups have already earned for Component Two.

Multiple providers requested that HHSC amend the rule to allow the redistribution of unearned funds in the manner set forth in the amendment.

Adopting 1 TAC §354.1430, §354.1434, to add federally qualified health centers (FQHCs) and rural health clinics (RHCs) as Medicaid providers of home telemonitoring services, require the establishment of a plan of care and define terms used in the newly-added paragraphs.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 33. ADVANCED TELECOMMUNICATIONS SERVICES
1 TAC §354.1430, §354.1434

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1430, concerning Definitions, and §354.1434, concerning Home Telemonitoring Benefits and Limitations.

The amendment to §354.1430 is adopted with changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8509). This rule will be republished.

The amendment to §354.1434 is adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8509) and will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments implement Texas Government Code §531.001(4-a) and §531.02164, amended by House Bill 2727, 88th Legislature, Regular Session, 2023.

To implement Texas Government Code §531.02164, the amendments add federally qualified health centers and rural health clinics as Medicaid providers of home telemonitoring services. To implement Texas Government Code §531.001(4-a), the amendment to §354.1430 clarifies the term “home telemonitoring services” is synonymous with “remote patient monitoring.” Texas Government Code §531.02164(c)(5) requires home telemonitoring providers to establish a plan of care with outcome measures for each recipient, and to share the plan and outcome measures with the recipient’s physician. Texas Government Code §531.02164(2)(B) also reduces the eligibility criteria for the service from two or more risk factors to at least one risk factor.

Adopting 26 TAC §260.61, to remove references to the DFPS and update them with references to HHSC and set forth the requirements for service settings under the Deaf and Blind with Multiple Disabilities Program.

CHAPTER 260. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW
DIVISION 2. ENROLLMENT PROCESS, PERSON-CENTERED PLANNING, AND REQUIREMENTS FOR SERVICE SETTINGS
26 TAC §260.61

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §260.61, concerning Process for Enrollment of an Individual; and §260.219, concerning Reporting Allegations of Abuse, Neglect, or Exploitation of an Individual.

The amendments to §260.61 and §260.219 are adopted without changes to the proposed text as published in the November 1, 2024, issue of the Texas Register (49 TexReg 8689). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to comply with Texas Human Resources Code §48.051(b-1), added by House Bill (H.B.) 4696, 88th Legislature, Regular Session, 2023. Section 48.051 requires a person, including an officer, employee, agent, contractor, or subcontractor of a home and community support services agency (HCSSA) licensed under Texas Health and Safety Code Chapter 142, who has cause to believe that an individual receiving services from the HCSSA, is being or has been subjected to abuse, neglect, or exploitation (ANE), to immediately report it to HHSC.

A program provider in the Deaf Blind Multiple Disabilities (DBMD) Program must be licensed as a HCSSA. To comply with Section 48.051, the amendments change the current DBMD Program ANE reporting requirement from the Texas Department of Family and Protective Services (DFPS) to HHSC. Transferring the function relating to the intake of reports of ANE from DFPS to HHSC creates a more streamlined process because HHSC is currently responsible for investigating these reports in the DBMD Program.

Therefore, the amendments remove all references to DFPS, the DFPS Abuse Hotline toll-free telephone number, and the DFPS Abuse Hotline website and replace them with references to HHSC, the HHSC toll-free telephone number, and the HHSC online Texas Unified Licensure Information Portal. The amendment to §260.61 replaces a reference to Texas Administrative Code (TAC) Title 40, §49.309 that was administratively transferred to TAC Title 26, §52.117, relating to Complaint Process.

Adopting 26 TAC §260.219, to set forth program provider reporting requirements for knowledge or suspicion of abuse, neglect, or exploitation.

CHAPTER 260. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER D. ADDITIONAL PROGRAM PROVIDER PROVISIONS
26 TAC §260.219

OVERVIEW

BACKGROUND AND JUSTIFICATION

Adopting 26 TAC §§306.151 – 306.155, to update the description and formatting of the purpose of the subchapter; clarify the applicability of the rules to different hospitals; defines new terms as used specifically in Subchapter D; revises the definitions of certain terms to be consistent with other rules; deletes obsolete terms; clarifies which individuals are entitled to a hearing after the termination, suspension, or reduction of their services by HHSC; and establishes LMHA, LBHA, and CoC liaison responsibilities.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER D. MENTAL HEALTH SERVICES–ADMISSION, DISCHARGE, AND CONTINUITY OF CARE
DIVISION 1. GENERAL PROVISIONS
26 TAC §§306.151 – 306.155

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §306.151, relating to Purpose; §306.152, relating to Application and Responsibility for Compliance; §306.153, relating to Definitions; §306.154, relating to Notification and Appeals Process for Local Mental Health Authority or Local Behavioral Health Authority Services; §306.161, relating to Screening and Assessment; §306.162, relating to Determining County of Residence; §306.163, relating to Most Appropriate and Available Treatment Options; §306.171, relating to General Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed; §306.172, relating to Admission Criteria for Maximum-Security Units; §306.173, relating to Admission Criteria for an Adolescent Forensic Unit; §306.174, relating to Admission Criteria for Waco Center for Youth; §306.175, relating to Voluntary Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed; §306.176, relating to Admission Criteria for a State Hospital or a Facility with a Contracted Psychiatric Bed for Emergency Detention; §306.177, relating to Admission Criteria Under Order of Protective Custody or Court-ordered Inpatient Mental Health Services; §306.178, relating to Voluntary Treatment Following Involuntary Admission; §306.191, relating to Transfers Between State Hospitals; §306.192, relating to Transfers Between a State Hospital and a State Supported Living Center; §306.193, relating to Transfers Between a State Hospital and an Out-of-State Facility; §306.194, relating to Transfers Between a State Hospital and Another Facility in Texas; §306.195, relating to Changing Local Mental Health Authorities or Local Behavioral Health Authorities; §306.201, relating to Discharge Planning; §306.202, relating to Special Considerations for Discharge Planning; §306.203, relating to Discharge of an Individual Voluntarily Receiving Inpatient Treatment; §306.204, relating to Discharge of an Individual Involuntarily Receiving Treatment; §306.205, relating to Pass or Furlough from a State Hospital or a Facility with a Contracted Psychiatric Bed; §306.207, relating to Post Discharge or Furlough: Contact and Implementation of the Recovery or Treatment Plan; and §306.221, relating to Screening and Intake Assessment Training Requirements at a State Hospital and a Facility with a Contracted Psychiatric Bed.

HHSC adopts new §306.155, relating to Local Mental Health Authority, Local Behavioral Health Authority, and Continuity of Care Liaison Responsibilities; §306.361, relating to Purpose; §306.363, relating to Application; §306.365, relating to Definitions; §306.367, relating to General Provisions; and §306.369, relating to Documentation Requirements.

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

Sections 306.151, 306.153 – 306.155, 306.162, 306.163, 306.171, 306.175 – 306.177, 306.191, 306.194, 306.195, 306.201 – 306.205, 306.207, 306.221, 306.361, 306.363, 306.365, 306.367, and 306.369 are adopted with changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7192). These rules will be republished.

Sections 306.152, 306.161, 306.172 – 306.174, 306.178, 306.192, 306.193 and 306.206 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7192). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The Texas Health and Human Services Commission (HHSC) adopts amendments and the repeal of a rule in the Texas Administrative Code (TAC), Title 26 Chapter 306, Subchapter D relating to Mental Health Services–Admission, Continuity, and Discharge, and adopts new rules in 26 TAC Chapter 306, Subchapter H relating to Behavioral Health Services–Telecommunications. The adopted rules are necessary to implement Senate Bill (S.B.) 26, 88th Legislature, Regular Session, 2023 and House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021.

S.B. 26 requires HHSC to adopt or amend existing rules to address a local mental health authority’s (LMHA’s) responsibility for ensuring the successful transition of patients determined ready for discharge from an HHSC mental health facility. This adoption also includes application to a local behavioral health authority (LBHA). To implement S.B. 26, the adopted rules:

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Require each state hospital to concentrate transition support services on patients admitted and discharged multiple times within 30 days, or patients who had a long-term stay (more than 365 consecutive days); and

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

To implement H.B. 4, the adopted rules ensure that individuals receiving HHSC-funded behavioral health services have the option to receive services as telemedicine or telehealth services, including using an audio-only platform, to the extent it is clinically effective and cost-effective.

Additionally, the adopted rules clarify statutory requirements; add, remove, and update definitions; delete references to managed care organizations (MCOs); update Medicaid-related information; update and add cross-references; and make grammatical and editorial changes for understanding, accuracy, and uniformity.

Adopting 26 TAC §§306.161 – 306.163, to clarify an LMHA or LBHA’s required provision of community services, removes repetitive language, and adds SUD services to LMHA or LBHA services.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
DIVISION 2. SCREENING AND ASSESSMENT FOR CRISIS SERVICES AND ADMISSION INTO LOCAL MENTAL HEALTH AUTHORITY OR LOCAL BEHAVIORAL HEALTH AUTHORITY SERVICES
26 TAC §§306.161 – 306.163

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §§306.171 – 306.178, to rename the section titles, update new terminology and remove overly-restrictive or repetitive terminology, clarify changes in various sections, and outlines admittance process in different circumstances.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
DIVISION 3. ADMISSION TO A STATE HOSPITAL OR A FACILITY WITH A CONTRACTED PSYCHIATRIC BED–PROVIDER RESPONSIBILITIES
26 TAC §§306.171 – 306.178

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §§306.191 – 306.195, to retitle various rules, update rule reference and other minor editing changes, and includes a new paragraph providing that CoC liaisons must initiate transition planning with the receiving LMHA or LBHA.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
DIVISION 4. TRANSFERS AND CHANGING LOCAL MENTAL HEALTH AUTHORITIES OR LOCAL BEHAVIORAL HEALTH AUTHORITIES
26 TAC §§306.191 – 306.195

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §§306.201 – 306.205, 306.207, to impose new discharge planning and implementation obligations on state hospitals or CPBs, clarify the scope and powers of a mental health peer specialist or recovery support peer specialist, retitle rules, correct phrases under the new amendment, and remove obsolete language.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
DIVISION 5. DISCHARGE AND ABSENCES FROM A STATE HOSPITAL OR A FACILITY WITH A CONTRACTED PSYCHIATRIC BED
26 TAC §§306.201 – 306.205, 306.207

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §306.206, to remove unnecessary terminology.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
26 TAC §306.206

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §306.221, to retitle the rule and propose a new subchapter H, Behavioral Health Services–Telecommunications.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
DIVISION 6. TRAINING
26 TAC §306.221

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §§306.361, 306.363, 306.365, 306.367, 306.369, to establish the methods and parameters of service delivery for individuals receiving general-revenue funded behavioral health services; the scope of the rules to apply to LMHAs, LBHAs, substance use intervention providers, substance use treatment providers, and their subcontracted providers; and documentation requirements when rendering services.

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER H. BEHAVIORAL HEALTH SERVICES–TELECOMMUNICATIONS
26 TAC §§306.361, 306.363, 306.365, 306.367, 306.369

OVERVIEW

HHSC adopts the repeal of §306.206, relating to Absence for Trial Placement.

BACKGROUND AND JUSTIFICATION

Require state hospitals to participate in joint discharge planning with an LMHA or LBHA;

Require coordination between the LMHAs or LBHAs and the state hospital to determine appropriate community services for a patient;

Require an LMHA or LBHA to arrange for the provision of services upon discharge;

Require the LMHA’s or LBHA’s transition support services to complement joint discharge planning efforts;

Require each state hospital to designate at least one employee to provide transition support services for patients determined medically appropriate for discharge;

Allow voluntary admission to an inpatient mental health facility, including a state hospital, only if space is available.

Adopting 26 TAC §§307.101, 307.103, 307.105, 307.107, 307.109, 307.111, 307.113, 307.115, 307.117, 307.119, 307.121, 307.123, 307.125, 307.127, 307.129, 307.131, to remove obsolete terms, phrases, and references; add new or amend existing definitions; revise titles and updates cross-references; and reorganize the section.

CHAPTER 307. BEHAVIORAL HEALTH PROGRAM
SUBCHAPTER C. JAIL-BASED COMPETENCY RESTORATION PROGRAM
26 TAC §§307.101, 307.103, 307.105, 307.107, 307.109, 307.111, 307.113, 307.115, 307.117, 307.119, 307.121, 307.123, 307.125, 307.127, 307.129, 307.131

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §307.101, concerning Purpose; §307.103, concerning Application; §307.105, concerning Definitions; §307.107, concerning JBCR Program Eligibility Requirements; §307.109, concerning Service Standards; §307.111, concerning JBCR Provider Staff Member Training; §307.113, concerning Policies and Procedures; §307.115, concerning Individual Eligibility; §307.117, concerning Admission; §307.119, concerning Rights of Individuals Receiving JBCR; §307.121, concerning Treatment Planning; §307.123, concerning Competency Restoration Education; §307.125, concerning Procedures for Determining Competency Status in a JBCR Program; §307.127, concerning Preparation for Discharge from a JBCR Program; §307.129, concerning Outcome Measures; and §307.131, concerning Compliance with Statutes, Rules, and Other Documents.

The amendments to §§307.101, 307.103, 307.105, 307.107, 307.111, 307.113, 307.117, 307.119, 307.121, 307.123, 307.125, 307.127, 307.129, and 307.131 are adopted with changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7227) and will be republished.

The amendments to §307.109 and §307.115 are adopted without changes to the proposed text and will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to comply with Senate Bill 49, 87th Legislature, Regular Session, 2021, which amended Texas Code of Criminal Procedure (CCP) Chapter 46B concerning procedures regarding defendants who are or may be individuals with a mental illness or intellectual disability. The amended rules align the existing rules with CCP Chapter 46B by removing references to the pilot program, defining when the initial competency restoration period and an extension begin, updating requirements for a psychiatrist or psychologist in §307.125, and allowing jail-based competency restoration (JBCR) programs to continue competency restoration services after 60 days if the individual is not restored to competency unless notified that space at a facility or an Outpatient Competency Restoration program appropriate for the individual is available and if the required number of days are remaining in the restoration period. The amended rules expand upon JBCR policies and procedures for consistency in staff training and program operations. The amended rules also update cross-references and terminology for clarity and make minor grammatical and editorial changes for accuracy, understanding, and uniformity.

In Addition Re:

Public Notice – State Plan on Aging for Federal Fiscal Years 2026 – 2028

The Texas Health and Human Services Commission announces a 30-day public comment period effective from February 22, 2025, to March 24, 2025, for the draft State Plan on Aging for Federal Fiscal Years 2026-2028.

Public Notice – Texas State Plan for Medical Assistance Amendment

The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments will be effective March 1, 2025.

Revised Public Notice: Texas State Plan for Medical Assistance

Revised Public Notice: Texas State Plan for Medical Assistance – Home and Community-Based Services Adult Mental Health (HCBS-AMH) §1915(i) State Plan Benefit Renewal

Texas Department of Insurance, Division of Workers’ Compensation

Adopted Rule Re:

Adopting 28 TAC §133.30, to allow a treating doctor to use telemedicine or telehealth for injured employees that meet certain conditions, such as undergoing an examination by the treating doctor for the condition in question at least once before the examination to certify MMI; provide consent; and the injury must qualify as a minor injury.

CHAPTER 133. GENERAL MEDICAL PROVISIONS
SUBCHAPTER B. HEALTH CARE PROVIDER BILLING PROCEDURES
28 TAC §133.30

INTRODUCTION

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts amendments to 28 TAC §133.30, concerning telemedicine, telehealth, and teledentistry services. Section 133.30 implements Texas Labor Code §413.011. The DWC medical advisor recommended the amendments to the commissioner of workers’ compensation under Labor Code §413.0511(b).

The amendments to §133.30 are adopted with two changes to the proposed text published in the December 6, 2024, issue of the Texas Register (49 TexReg 9942). DWC updated the effective dates to June 1, 2025. Section 133.30 will be republished.

BACKGROUND AND JUSTIFICATION

The amendments to §133.30 allow a treating doctor to use telemedicine or telehealth to certify maximum medical improvement (MMI) under §§130.1 and 130.2 of this title, concerning certification of MMI and evaluation of permanent impairment, under the following conditions. The injured employee must have been examined by the treating doctor for the condition in question at least once before the examination to certify MMI. The injured employee must consent to the examination to certify MMI by telemedicine or telehealth. The condition in question must qualify as a minor injury, such as §130.2(a)(2) of this title contemplates, that requires no additional treatment, and has resulted in no impairment. A minor injury does not require application of the American Medical Association (AMA) Guides, so under §130.1 of this title, the treating doctor is allowed to certify MMI with no impairment.

The amendments specify that such an evaluation must be billed in compliance with the MMI billing requirements in §134.250 of this title, concerning MMI evaluations and impairment rating examinations by treating doctors. The treating doctor’s billing and reimbursement are the same for an in-person MMI evaluation and a telemedicine MMI evaluation. They do not expand the scope of practice or authorize new treatments. Health care providers should refer to their licensing boards’ rules for practicing telemedicine and telehealth. The amendments do not allow a doctor to assign an impairment rating by a telemedicine or telehealth examination. The amendments are effective for examinations conducted by treating doctors to certify MMI by telemedicine or telehealth conducted on or after June 1, 2025.

Amending §133.30 is necessary to ensure better and more convenient access to evaluations necessary to certify MMI, to ensure that more required MMI evaluations are conducted on time, and to clarify how doctors must bill and be reimbursed for MMI evaluations conducted by telemedicine or telehealth. For example, when a treating doctor treats and releases an injured employee for a minor injury, such as a scrape or a bruise, and does not anticipate that the injured employee will need additional treatment, the amendments allow the treating doctor to use telemedicine or telehealth to determine that the injured employee has reached MMI but has no permanent impairment. Treating doctors can certify MMI under current rules, and the amendments just allow them to do so by telemedicine or telehealth under specific conditions. In addition, the number of disputes from treating doctor certifications of MMI under current rules is very low. Based on medical billing data reported to DWC, treating doctors submitted over 36,000 bills in calendar year 2023 for these MMI examinations. Over 34,000 claims were associated with those bills containing CPT code 99455 (work-related or medical disability evaluation services), and of those claims, only 259 were associated with an MMI or impairment rating dispute.

Labor Code §413.011 requires the commissioner to adopt health care reimbursement policies and guidelines that reflect the standardized reimbursement structures found in other health care delivery systems with minimal modifications to those reimbursement methodologies as necessary to meet occupational injury requirements. It also requires that the commissioner’s adopted medical policies or guidelines be designed to ensure the quality of medical care and achieve medical cost control, and to enhance a timely and appropriate return to work. Amending §133.30 to allow a treating doctor to use telemedicine or telehealth to certify MMI and to ensure that billing and reimbursement for that evaluation are consistent with the billing requirements in §134.250 meets the requirements in Labor Code §413.011.

DWC invited public comments on an informal draft posted on DWC’s website in July 2024 and revised the text to be more specific about the conditions under which a treating doctor may perform a telemedicine or telehealth examination to certify MMI. In addition, DWC held a hearing on the proposed amendments on January 8, 2025.

Texas Department of Assistive and Rehabilitative Services

Adopted Rules Re:

Adopting 40 TAC §§106.201, 106.203, 106.205, to repeal the chapters concerning the Purpose, Legal Authority, and Definitions under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
DIVISION 1. PROGRAM AND SUBCHAPTER PURPOSE
40 TAC §§106.201, 106.203, 106.205

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts the repeal of Chapter 106 in Texas Administrative Code Title 40, Part 2, concerning Division for Blind Services. The chapter consists of §§106.201, concerning, Purpose; 106.203, concerning Legal Authority; 106.205, concerning Definitions; 106.307, concerning Application; 106.309, concerning Eligibility; 106.311, concerning Prohibited Factors; 106.313, concerning Eligibility Determination Time Frame; 106.315, concerning Determination of Ineligibility; 106.317, concerning Case Closure; 106.407, concerning Provision of Services; 106.409, concerning Assessment for Determining Eligibility, Vocational Rehabilitation Needs, and Rehabilitation Technology Needs; 106.411, concerning Physical and Mental Restoration Services; 106.413, concerning Vocational and Other Training Services; 106.415, concerning Maintenance; 106.417, concerning Transportation; 106.419, concerning Services to Family Members; 106.421, concerning Interpreter Services and Note-Taking Services for Consumers Who Are Deaf and Tactile Interpreting for Consumers Who Are Deafblind; 106.423, concerning Reader Services and Rehabilitation Teaching Services; 106.425, concerning Employment Assistance; 106.427, concerning Post-Employment Services; 106.429, concerning Occupational Licenses, Tools, Equipment, and Initial Stocks and Supplies; 106.431, concerning Assistive Technology Devices; 106.433, concerning Individualized Plan for Employment (IPE); §106.501, concerning Purpose of Consumer Participation; 106.507, concerning Scope of Consumer Participation; 106.509, concerning Refusal to Disclose Economic Resources; 106.607, concerning Comparable Services and Benefits; 106.707, concerning Application of an Order of Selection; 106.801, concerning Purpose; 106.803, concerning Legal Authority; 106.805, concerning Definitions; 106.807, concerning Eligibility; and 106.809, concerning Certificate of Blindness for Tuition Waiver.

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Senate Bill (S.B.) 200, 84th Regular Session, 2015, transferred the functions of the Department of Assistive and Rehabilitative Services (DARS) to HHSC and S.B. 208, 84th Regular Session, 2015, transferred the Vocational Rehabilitation (VR) Program from DARS to the Texas Workforce Commission (TWC). HHSC has identified VR Program rules in 40 TAC Chapter 106, Division for Blind Services, for repeal because HHSC no longer oversees that program. TWC has adopted rules for the VR Program in Title 40, Part 20, Chapter 856, so there will be no disruption to the VR Program or to Texans receiving services.

Adopting 40 TAC §§106.307, 106.309, 106.311, 106.313, 106.315, 106.317, to repeal the chapters concerning Application, Eligibility, Prohibited Factors, Eligibility Determination Time Frame, Determination of Ineligibility, and Case Closure under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
DIVISION 2.ELIGIBILITY
40 TAC §§106.307, 106.309, 106.311, 106.313, 106.315, 106.317

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 40 TAC §§106.407, 106.409, 106.411, 106.413, 106.415, 106.417, 106.419, 106.421, 106.423, 106.425, 106.427, 106.429, 106.431, 106.433, to repeal the chapters concerning the Provision of Services; Assessment for Determining Eligibility, Vocational Rehabilitation Needs, and Rehabilitation Technology Needs; Physical and Mental Restoration Services; Vocational and Other Training Services; Maintenance; Transportation; Services to family Members; Interpreter Services and Note-Taking Services for Consumers Who are Deaf and Tactile Interpreting for Consumers Who Are Deafblind; Reader Services and Rehabilitation Teaching Services; Employment Assistance; Post-Employment Services; Occupational Licenses, Tools, Equipment, and Initial Stocks and supplies; Assistive Technology Devices; and Individualized Plan for Employment (TPF) under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
DIVISION 3. PROVISION OF VOCATIONAL REHABILITATION SERVICES
40 TAC §§106.407, 106.409, 106.411, 106.413, 106.415, 106.417, 106.419, 106.421, 106.423, 106.425, 106.427, 106.429, 106.431, 106.433

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 40 TAC §§106.501, 106.507, 106.509, to repeal the chapters concerning the Purpose of Consumer Participation; the Scope of Consumer Participation, and the Refusal to Disclose Economic Resources under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
DIVISION 4. CONSUMER PARTICIPATION
40 TAC §§106.501, 106.507, 106.509

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 40 TAC §106.607, to repeal the chapter concerning the Application of AN Order of Selection under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
DIVISION 5. COMPARABLE BENEFITS
40 TAC §106.607

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 40 TAC §106.707, to repeal the chapter concerning the Application of an Order of Selection under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
DIVISION 6. METHODS OF ADMINISTRATION OF VOCATIONAL REHABILITATION
40 TAC §106.707

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 40 TAC §§106.801, 106.803, 106.805, 106.807, 106.809, to repeal the chapters concerning Purpose, Legal Authority, Definitions, Eligibility, and the Certificate of Blindness for Tuition Waiver under the Division for Blind Services.

SUBCHAPTER B. VOCATIONAL REHABILITATION PROGRAM
40 TAC §§106.801, 106.803, 106.805, 106.807, 106.809

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8566). The repeals will not be republished.

BACKGROUND AND JUSTIFICATION

Office of the Attorney General

Requests for Opinions Re:

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §27.1, §27.3, to remove rules that are to be replaced by new rules in Title 26.

Amending 25 TAC §§27.5, 27.7, 27.9, 27.11, 27.13, to remove rules that are to be replaced by new rules in Title 26.

Amending 25 TAC §§27.15, 27.17, 27.19, 27.21, 27.23, 27.25, 27.27, to remove rules that are to be replaced by new rules in Title 26.

Amending 25 TAC §289.230, to update the requirements for mammography reports.

Amending 25 TAC §289.234, to delete an invalid rule.

Adopted Rules Re:

Adopting 25 TAC §33.70, to set forth guidelines for teledentistry dental services, establish reimbursement requirements, and add teledentistry dental services as a service provided under Medicaid in the Texas Health Steps Program.

Adopting 25 TAC §37.301, to make non-substantive revisions to update citations to the rule in the Texas Government Code.

Adopting 25 TAC §103.1, to update citations to the Texas Government Code.

Adopting 25 TAC §§221.11 – 221.16, to revise the exemption for 9 Code of Federal Regulations (CFR) §303; add definitions; provide additional examples of violations for severity levels I-V; reorganize and consolidate rules; and remove various subsections.

In Addition Re:

Limited Liability Report for Nonprofit Hospitals and Hospital Systems

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 26 TAC §257.1, §257.3, to replace the repealed chapters, summarize the purpose of CPW services, and define terms used in the rules.

Amending 26 TAC §§257.5, 257.7, 257.9, 257.11, to replace the repealed chapter and define eligible service users and the terms of the use of those services.

Amending 26 TAC §§257.15, 257.17, 257.19, 257.21, 257.23, to replace the repealed section to set forth the steps to become a provider of services.

Withdrawn Rules Re:

Withdrawing 1 TAC §§351.821, 351.823, 351.825, 351.827, to update citations to the Texas Government Code.

Adopted Rules Re:

Adopting 1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751, to update citations to the Texas Government Code.

Adopting 1 TAC §§351.801, 351.807, 351.809, 351.811, 351.841, to update citations to the Texas Government Code.

Adopting 1 TAC §353.1309, to update citations in the rules to Texas Government Code.

Adopting 1 TAC §354.1430, §354.1434, to add federally qualified health centers (FQHCs) and rural health clinics (RHCs) as Medicaid providers of home telemonitoring services, require the establishment of a plan of care and define terms used in the newly-added paragraphs.

Adopting 26 TAC §260.61, to remove references to the DFPS and update them with references to HHSC and set forth the requirements for service settings under the Deaf and Blind with Multiple Disabilities Program.

Adopting 26 TAC §260.219, to set forth program provider reporting requirements for knowledge or suspicion of abuse, neglect, or exploitation.

Adopting 26 TAC §§306.161 – 306.163, to clarify an LMHA or LBHA’s required provision of community services, removes repetitive language, and adds SUD services to LMHA or LBHA services.

Adopting 26 TAC §§306.171 – 306.178, to rename the section titles, update new terminology and remove overly-restrictive or repetitive terminology, clarify changes in various sections, and outlines admittance process in different circumstances.

Adopting 26 TAC §§306.191 – 306.195, to retitle various rules, update rule reference and other minor editing changes, and includes a new paragraph providing that CoC liaisons must initiate transition planning with the receiving LMHA or LBHA.

Adopting 26 TAC §306.206, to remove unnecessary terminology.

Adopting 26 TAC §306.221, to retitle the rule and propose a new subchapter H, Behavioral Health Services–Telecommunications.

In Addition Re:

Public Notice – State Plan on Aging for Federal Fiscal Years 2026 – 2028

Public Notice – Texas State Plan for Medical Assistance Amendment

Revised Public Notice: Texas State Plan for Medical Assistance

Texas Department of Insurance, Division of Workers’ Compensation

Adopted Rule Re:

Texas Department of Assistive and Rehabilitative Services

Adopted Rules Re:

Adopting 40 TAC §§106.201, 106.203, 106.205, to repeal the chapters concerning the Purpose, Legal Authority, and Definitions under the Division for Blind Services.

Adopting 40 TAC §§106.307, 106.309, 106.311, 106.313, 106.315, 106.317, to repeal the chapters concerning Application, Eligibility, Prohibited Factors, Eligibility Determination Time Frame, Determination of Ineligibility, and Case Closure under the Division for Blind Services.

Adopting 40 TAC §§106.501, 106.507, 106.509, to repeal the chapters concerning the Purpose of Consumer Participation; the Scope of Consumer Participation, and the Refusal to Disclose Economic Resources under the Division for Blind Services.

Adopting 40 TAC §106.607, to repeal the chapter concerning the Application of AN Order of Selection under the Division for Blind Services.

Adopting 40 TAC §106.707, to repeal the chapter concerning the Application of an Order of Selection under the Division for Blind Services.

Adopting 40 TAC §§106.801, 106.803, 106.805, 106.807, 106.809, to repeal the chapters concerning Purpose, Legal Authority, Definitions, Eligibility, and the Certificate of Blindness for Tuition Waiver under the Division for Blind Services.

Texas Medical Liability Insurance Underwriting Association

In Addition Re:

Agenda Texas Medical Liability Insurance Underwriting Association (JUA) Board of Directors Meeting – February 28, 2025.