Texas Register May 16, 2025 Volume: 50 Number: 20

Texas Register Table of Contents

1 Texas Health and Human Services Commission
2 Texas Department of State Health Services
- - 2.0.1 Proposed Rules Re:
3 State Board of Dental Examiners
- - 3.0.1 Adopted Rules Re:
  - 3.0.2 Proposed Rule Reviews Re:
    - 3.0.2.1 Reviewing Title 22, Part 5, to consider for readoption, revision, or repeal of the chapter concerning sedation and anesthesia, and requirements for dental offices.
4 Texas Medical Disclosure Panel
- - 4.0.1 Adopted Rules Re:
    - 4.0.1.1 Adopting 25 TAC §§602.3, 602.5, 602.9, 602.16, to update the list of procedures and risks and hazards with plain language when possible, specifically the Digestive System, Endocrine System, Breast Surgery, and Urinary System Treatments and Procedures.
    - 4.0.1.2 Adopting 25 TAC §603.3, §603.16, to update the list of procedures and risks and hazards with plain language, when possible, specifically the Digestive System and Urinary System Treatments and Procedures.
5 Texas Board of Occupational Therapy Examiners
- - 5.0.1 Adopted Rules Re:
    - 5.0.1.1 Adopting 40 TAC §374.1, §374.2, to update definitions and clarify situations in which disciplinary action is appropriate.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §355.312, to clarify the calculation methodology for liability insurance add-on rates for nursing facility providers.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.312

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §355.312, concerning Reimbursement Setting Methodology–Liability Insurance Costs.

BACKGROUND AND PURPOSE

The purpose of this proposal is to revise the methodology for liability insurance add-on rates for nursing facility providers. The proposed amendment clarifies HHSC will pay the same add-on rate for providers who purchase general liability insurance without professional liability insurance, providers who purchase professional liability insurance without general liability insurance, and providers who purchase both general and professional liability insurance. This change ensures that HHSC is applying the appropriation uniformly across all nursing facility providers that carry liability insurance.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.112(d) clarifies the calculation of the rate add-ons before and after September 1, 2025, due to the anticipated implementation of Patient Driven Payment Model Long-Term Care. The amendment also clarifies the same add-on reimbursement rate will apply for providers who purchase general liability insurance without professional liability insurance, providers who purchase professional liability insurance without general liability insurance, and providers who purchase both general and professional liability insurance. The proposed amendment deletes text that is no longer applicable.

Amending 26 TAC §271.1, to make grammatical changes to improve clarity and update references.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER A. DEFINITIONS
26 TAC §271.1

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §271.1, concerning Definitions of Program Terms; §271.5, concerning Community Care Interest Lists; §271.7, concerning Enrollment; §271.51, concerning Eligibility for Services; §271.53, concerning Income and Income Eligibles; §271.55, Determination of Countable Income; §271.57, concerning Income from Excludable Sources; §271.59, concerning Income from Exempt Sources; §271.61, concerning Age; §271.63, concerning Need; §271.65, concerning Indian-related Exemptions; §271.69, concerning Family Care; §271.71, concerning Home-Delivered Meals; §271.73, concerning Adult Foster Care; §271.75, concerning Special Services to Persons with Disabilities; §271.77, concerning Day Activity and Health Services; §271.79, concerning Case Management Services; §271.81, concerning Primary Home Care or Community Attendant Services; §271.83, concerning Time Allocation for Escort Services; §271.85, concerning Residential Care; §271.87, concerning Emergency Care; §271.89, concerning Resource Limits; §271.91, concerning Countable Resources; §271.93, concerning Resource Exclusions; §271.95, concerning Emergency Response Services; §271.97, concerning Residential Care Services; §271.151, concerning Application for Services; §271.153, concerning Recertification; §271.155, concerning Denial, Reduction, and Termination of Benefits; §271.159, concerning Adult Foster Care Client Rights and Responsibilities, and the repeal of §271.3, concerning Definitions.

BACKGROUND AND PURPOSE

Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015, abolished the Texas Department of Aging and Disability Services (DADS) and transferred its functions to the Texas Health and Human Services Commission (HHSC), including Community Care for Aged and Disabled (CCAD). The program name was subsequently renamed to Community Care Services Eligibility (CCSE) on September 1, 2016. The rules for CCSE were administratively transferred from Title 40 Texas Administrative Code (TAC) to Title 26. The purpose of this proposal is to update references and terms in the rules to reflect the transition of the program from DADS to HHSC.

Currently, references to DADS and CCAD remain where HHSC and CCSE are the appropriate oversight agency and program. Additionally, there are references to outdated terms and program names such as “food stamps” or “aid to families with dependent children.” The proposal updates those references to align 26 TAC, Part 1, Chapter 271, with both the agency’s person-centered language policy and Texas Government Code Chapter 392. Eligibility requirements for the program are not changing.

SECTION-BY-SECTION SUMMARY

The proposal includes renaming the chapter title from Community Care for Aged and Disabled to Community Care Services Eligibility.

The proposed amendment to §271.1 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed. Definitions of abuse, neglect, and exploitation have been updated.

Amending 26 TAC §271.3, to repeal this section.

CHAPTER 271. COMMUNITY CARE FOR AGED AND DISABLED
SUBCHAPTER B. INTEREST LISTS
26 TAC §271.3

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

Section 271.3 is proposed for repeal. All relevant definitions are included in the proposed amendment to §271.1.

Amending 26 TAC §271.5, §271.7, to make grammatical changes and update references.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER B. INTEREST LISTS
26 TAC §271.5, §271.7

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §271.5 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed.

The proposed amendment to §271.7 updates the citations to sections of the subchapter, as it previously used §48.1302(d), when the chapter was in Title 40. The proposed amendment makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

Amending 26 TAC §§271.51, 271.53, 271.55, 271.57, 271.59, 271.61, 271.63, 271.65, 271.69, 271.71, 271.73, 271.75, 271.77, 271.79, 271.81, 271.83, 271.85, 271.87, 271.89, 271.91, 271.93, 271.95, 271.97, to update the text of the section to person-centered plain language.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER C. ELIGIBILITY
26 TAC §§271.51, 271.53, 271.55, 271.57, 271.59, 271.61, 271.63, 271.65, 271.69, 271.71, 271.73, 271.75, 271.77, 271.79, 271.81, 271.83, 271.85, 271.87, 271.89, 271.91, 271.93, 271.95, 271.97

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §271.51 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed.

The proposed amendment to §271.53 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed.

The proposed amendment to §271.55 updates the citations to sections of the subchapter, as the previous citation was §48.2904 and §48.2905 when the chapter was in Title 40. The proposed amendment makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs have been removed.

The proposed amendment to §271.57 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. The proposed amendment also amends a figure and renames it with the correct citation.

The proposed amendment to §271.59 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.61 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language.

The proposed amendment to §271.63 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language.

The proposed amendment to §271.65 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. The proposed amendment also amends a figure and renames it with the correct citation. The proposed amendment adds the previously omitted income and resource exemptions of P.L. 103-444, payments made, or benefits granted by the Crow Boundary Settlement Act of 1994, and P.L. 108-270, per capita distribution judgment funds granted by the Western Shoshone Claims Distribution Act of 2004.

The proposed amendment to §271.69 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs, their citations, and terms have been removed. The proposed amendment also updates the citations to sections of the subchapter, as §§48.2902, 48.2903, 48.2922, and 48.2923 were previously used when the chapter was in Title 40.

The proposed amendment to §271.71 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.73 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.75 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.77 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. The location of the CCSE Handbook has been updated to www.hhs.texas.gov. The proposed amendment also updates the citations to sections of the subchapter, as §§48.2902, 48.2903, 48.2903, 48.2922, and 48.2923 were previously used when the chapter was in Title 40. The proposed amendment replaces references to §98.203 and §98.204 with §211.203 and §211.204.

The proposed amendment to §271.79 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.81 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.83 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.85 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.87 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

The proposed amendment to §271.89 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.91 makes grammatical changes for improved wording. References to CCAD have been replaced with CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.93 makes grammatical changes for improved wording. References to DADS and CCAD have been replaced with HHSC and CCSE. Outdated or missing terms have been corrected and updated. Text has been updated to person-centered and plain language. References to outdated programs and terms have been removed.

The proposed amendment to §271.95 makes grammatical changes for improved wording. References to Department of Human Services (DHS) and CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.97 makes grammatical changes for improved wording. Text has been updated to person-centered and plain language.

Amending 26 TAC §§271.151, 271.153, 271.155, 271.159, to update the text of the section to person-centered plain language, as well as update citations.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER D. CASE MANAGEMENT
26 TAC §§271.151, 271.153, 271.155, 271.159

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §271.151 makes grammatical changes for improved wording. References to Department of Human Services (DHS) and CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.153 makes grammatical changes for improved wording. References to CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language.

The proposed amendment to §271.155 makes grammatical changes for improved wording. References to Department of Human Services (DHS) and CCAD have been replaced with HHSC and CCSE. Text has been updated to person-centered and plain language. The proposed amendment also amends a figure and renames it with the correct citation.

The proposed amendment to §271.159 makes grammatical changes for improved wording. References to Department of Human Services (DHS) has been replaced with HHSC. Text has been updated to person-centered and plain language. Clarifies which investigatory agency should receive complaints about ANE.

Amending 26 TAC §§331.1, 331.3, 331.5, 331.7, 331.9, 331.11, 331.13, 331.15, 331.17, 331.19, 331.21, 331.23, to update references and revise the text of the section to person-centered plain language.

CHAPTER 331. LIDDA SERVICE COORDINATION
26 TAC §§331.1, 331.3, 331.5, 331.7, 331.9, 331.11, 331.13, 331.15, 331.17, 331.19, 331.21, 331.23

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §331.1, concerning Purpose; §331.3, concerning Application; §331.5, concerning Definitions; §331.7, concerning Eligibility; §331.9, concerning Funding Service Coordination; §331.11, concerning LIDDA’s Responsibilities; §331.13, concerning Caseloads; §331.15, concerning Termination of Service Coordination; §331.17, concerning Minimum Qualifications; §331.19, concerning Staff Person Training; §331.21, concerning Documentation of Service Coordination; and §331.23, concerning Review Process.

BACKGROUND AND PURPOSE

The purpose of the proposed amendments is to implement House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021, which requires HHSC to ensure Medicaid recipients, child health care plan program enrollees, and other individuals receiving benefits under a public benefits program administered by HHSC or another health and human services agency have the option to receive services as telemedicine medical services, telehealth services, or other telecommunications or information technology to the extent it is cost effective and clinically effective. The proposed amendments include defining terms pertaining to the implementation of H.B. 4 and updating documentation requirements.

The proposed amendments clarify the minimum qualifications and training requirements for service coordinators and requirements regarding minimum contact. The proposed amendments update agency names and citations.

The proposed amendments also update citations to the Texas Government Code related to H.B. 4611, 88th Legislature, Regular Session, 2023, effective April 1, 2025, which 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.

SECTION-BY-SECTION SUMMARY

The proposed amendments to §331.1, Purpose, and §331.3, Application, update text to person-centered language and makes other non-substantive wording changes.

The proposed amendment to §331.5, Definitions, adds terms related to the implementation of H.B. 4: “audio-only,” “audio-visual,” and “in-person (or in person).” Throughout the rules, HHSC replaced the term “face-to-face” with the term “in person” or “in-person.” The proposed amendment adds definitions for “comprehensive encounter,” “follow-up encounter,” “HHSC,” and “TAC.” The proposed amendment revises the definitions of “actively involved person,” “CFC services,” “Designated LIDDA,” “ICF/IID level-of-care”, “Frequency,” “General revenue,” “HCS Program,” “ICF/IID level-of-care,” “ICF/IID Program,” “Institution,” “Institution for mental diseases,” “Intellectual disability,” “LAR,” “LIDDA,” “LIDDA priority population,” “local service area,” “MCO,” “Plan of services and supports,” “Related condition,” “Service coordination,” “State hospital,” “State supported living center,” “Subaverage general intellectual functioning,” and “TxHmL Program.” The proposed amendment removes the following definitions no longer being used in the rules “CARE,” “DADS,” “Department,” “Designated MRA,” “ICF/MR Program,” “Mental retardation,” “Mental retardation priority population,” “MRA,” “Parent Case Management Program,” and “Partners in Policy Making.” The proposed amendment changes the term “Person-directed planning” to “Person-centered planning.” The proposed amendment renumbers the rule to account for the new definitions, removed definitions, and revisions made to existing definitions.

The proposed amendment to §331.7, Eligibility, clarifies that the HHSC Service Coordination Assessment form is used to document that an individual meets the eligibility criteria for service coordination described in subsection (a)(1)(A). The proposed amendment also adds “a facility with an HHSC-contracted psychiatric bed” to subsection (a)(1)(F) to include service coordination responsibilities set forth in 26 Texas Administrative Code (TAC) §306.201 relating to Discharge Planning. The proposed amendment removes subsection (c) because the rule has been relocated and updated in the proposed amendment in §331.11(e). The proposed amendment uses the updated term “state hospital” to replace “MH facility” and makes other non-substantive wording changes.

The proposed amendment to §331.9, Funding Service Coordination, updates the citations from the previous locations in 40 TAC §2.554. The proposed amendment also makes other non-substantive wording changes.

The proposed amendment to §331.11, LIDDA’s Responsibilities, changes the title to “Designated LIDDA’s Responsibilities.” The proposed amendment removes the subsection titles in current subsections (a) – (f). The proposed amendment to subsection (a) changes the reference to the DADS Person Directed Planning Guidelines to the HHSC Person-Centered Planning Guidelines and updates citations from the previous locations in 40 TAC §9.153 and §9.553. The proposed amendment to subsection (b) renumbers the rules on service coordination in new paragraphs (1) and (2) under subsection (b); renumbers subsection (b)(2) to organize the rule on crisis prevention and management in a new subsection (c); and removes paragraph (3) under subsection (b) to move the content of the rule to proposed new subsection (k). The proposed amendment to subsection (b) also replaces “staff person” with the term “employee.” The proposed amendment to §331.11 adds new subsections, and therefore, renumbers some of the current subsections. New subsection (d) details LIDDA responsibilities related to when the HHSC Service Coordination Assessment form must be completed. New subsection (e) describes who must complete the HHSC Service Coordination Assessment and requires the HHSC Service Coordination Assessment form to identify the frequency of in-person service coordination contacts. Subsection (c), renumbered as subsection (f), is amended to replace “person-directed” with “person-centered,” update agency names, better organize the requirements for a service coordinator to revise an individual’s plan of services and supports, and makes other non-substantive wording changes. New subsection (g) contains the requirement from current subsection (d)(2), and clarifies that one of the four elements of service coordination is required for both comprehensive and follow-up encounters. The proposed amendment to subsection (d), renumbered as subsection (h), revises the minimum contact requirement to add that an in-person meeting may need to occur more frequently than once every 90 days in accordance with the HHSC Service Coordination Assessment form. New subsections (i) and (j) provide requirements for audio-visual or audio-only comprehensive encounters. New subsection (k) contains the requirement that was moved from subsection (b)(3), and clarifies that concerns identified during any service coordination activity, not just during monitoring, should be communicated to the entity providing services and supports. The proposed amendment to subsection (e), renumbered as subsection (l), and to subsection (f), renumbered as subsection (m), updates citations from the previous locations in 40 TAC Chapter 9, Subchapters D and N, and 40 TAC Chapter 41.

The proposed amendment to §331.13, Caseloads, updates text to person-centered language, changes “staff person” to “employee, and updates that the frequency of contacts to consider is the “frequency of in-person contacts.”

The proposed amendment to §331.15, Termination of Service Coordination, updates text to person-centered language and updates a citation from the previous location in 40 TAC Chapter 2, §2.554.

The proposed amendment to §331.17, Minimum Qualifications, revises the grandfathering language in subsection (d), removes subsections (e) and (f) related to minimum qualifications for service coordinators, and updates the reference in subsection (b) to subsection (d) of this section. The proposed amendment also makes other non-substantive wording changes.

The proposed amendment to §331.19, Staff Person Training, retitles the rules as “Employee Training” and updates the term “staff person” to “employee” as needed throughout the rule. The proposed amendment also updates outdated rule language. The proposed amendment in subsection (b)(1) adds “additional trainings designated by HHSC” to allow for any new or temporary training requirements. The proposed amendment in subsection (b)(2) requires completion of person-centered training for service coordinators within the first six months of the hire date unless an extension is granted by HHSC, instead of within 2 years, to align with the training requirement in 26 TAC Chapter 263 for the Home and Community-based Services (HCS) Program. The amendment also clarifies that the person-centered training must be comprehensive and non-introductory.

The proposed amendment to §331.21, Documentation of Service Coordination, adds requirements for a service coordinator’s documentation to include whether the contact with an individual was in person, via audio-visual communication, or via audio-only communication, and the location of the contact. The proposed amendment renumbers paragraphs (1) – (5) as paragraphs (3) – (7) because of adding the new documentation requirements. The proposed amendment in renumbered paragraph (4) references the definition of “service coordination” in proposed §331.5 to clarify that the service coordinator must document which element listed in the definition was provided. The proposed amendment updates text to person-centered language and makes other non-substantive wording changes.

The proposed amendment to §331.23, Review Process, removes the subsection titles in subsection (a) and (b), updates text to person-centered language, and updates a citation from the previous location in 40 TAC Chapter 2, §2.46.

Adopted Rules Re:

Adopting 1 TAC §355.8085, to clarify the current reimbursement methodologies for certain services and programs administered by HHSC.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 5. GENERAL ADMINISTRATION
1 TAC §355.8085

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §355.8085, concerning Reimbursement Methodology for Physicians and Other Practitioners; and §355.8441, concerning Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services.

Sections 355.8085 and 355.8441 are adopted without changes to the proposed text as published in the January 31, 2025, issue of the Texas Register (50 TexReg 595). These rules will not be republished.

BACKGROUND AND PURPOSE

The amendments are necessary to clarify the current structure of reimbursement methodologies for certain services and programs administered by HHSC. The amendments add details to describe the methodology HHSC uses to determine reimbursement amounts to Licensed Behavior Analysts (LBAs) and Licensed Assistant Behavior Analysts (LaBAs) for Applied Behavior Analysis (ABA) professional services. The amendments also add to the types of analyses that can be utilized for reimbursement methodology for Physicians and Other Practitioners.

In addition, following a Centers for Medicare & Medicaid Services (CMS) revision of their reimbursement methodologies, references to the Medicare reimbursement methodology are updated to comply with the CMS changes. The intent is to remove outdated reimbursement percentages and references to the Medicare average sales price and replace them with simpler references to the Medicare fee schedules where applicable. Where §355.8085 currently specifies its applicability to the Texas Medicaid program, the language has been revised to include “and other programs administered by Texas HHSC,” in order to add clarity that the rule can apply to other programs in addition to Medicaid. This update provides clarification regarding the scope of the reimbursement methods.

Adopting 1 TAC §355.8441, to define reimbursement methodologies for LBAs and LaBAs.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 23. EARLY AND PERIODIC SCREENING, DIAGNOSIS,AND TREATMENT (EPSDT)
1 TAC §355.8441

OVERVIEW

Sections 355.8085 and 355.8441 are adopted without changes to the proposed text as published in the January 31, 2025, issue of the Texas Register (50 TexReg 595). These rules will not be republished.

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.1, to set forth new definitions for terms used in the chapter and remove older definitions no longer required or defined in other statutes.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER A. DEFINITIONS
26 TAC §356.1

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §§356.1, 356.101 – 356.104, 356.201 – 356.206, 356.301, 356.302, 356.401 – 356.403, 356.405, 356.501, 356.503 – 356.507, 356.510, 356.601, 356.602, 356.604, 356.606, 356.607, 356.609 – 356.621, 356.623, 356.626, 356.627, 356.629, 356.631, 356.635, 356.701 – 356.704, 356.706 – 356.709, 356.711, 356.713, 356.714, 356.718, 356.803, 356.901, 356.902, 356.1001, 356.1002, 356.1101 – 356.1103, 356.1105, 356.1201, 356.1202, 356.1301, 356.1302, 356.1304, 356.1306, 356.1308 – 356.1313, 356.1315 – 356.1319, 356.1321, 356.1402, 356.1403, 356.1405, 356.1501 – 356.1504, 356.1602, 356.1604, 356.1605, 356.1701, 356.1702, 356.1801 – 356.1803, 356.1805, 356.1901 – 356.1903, 356.2001, 356.2002, 356.2004, 356.2006, 356.2007, 356.2009 – 356.2019, 356.2021, 356.2024, 356.2026, 356.2029, 356.2033, 356.2101 – 356.2103, 356.2105, 356.2106, 356.2108, 356.2110; new §§356.208, 356.303, 356.603, 356.636, 356.637, 356.705, 356.710, 356.716, 356.719, 356.720, 356.1003, 356.1303, 356.1324, 356.1325, 356.1401, 356.1404, 356.1408, 356.1409, 356.1703, 356.2003, 356.2034, 356.2035, 356.2104, 356.2107, 356.2112, 356.2114, 356.2115, 356.2201; and the repeal of §§356.207, 356.406 – 356.408, 356.508, 356.603, 356.622, 356.624, 356.625, 356.630, 356.632, 356.633, 356.705, 356.710, 356.712, 356.716, 356.717, 356.719, 356.1303, 356.1314, 356.1320, 356.1322, 356.1401, 356.1404, 356.1406, 356.1408, 356.1806, 356.1807, 356.2003, 356.2020, 356.2022, 356.2028, 356.2030, 356.2031, 356.2104, 356.2107, 356.2109, 356.2112, 356.2113, and 356.2114, concerning Family Violence Program.

New §356.716 and the amendments to §§356.612, 356.1402, and 356.2105 are adopted with changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10229). These rules will be republished.

The amendments to §§356.1, 356.101 – 356.104, 356.201 – 356.206, 356.301, 356.302, 356.401 – 356.403, 356.405, 356.501, 356.503 – 356.507, 356.510, 356.601, 356.602, 356.604, 356.606, 356.607, 356.609 – 356.621, 356.623, 356.626, 356.627, 356.629, 356.631, 356.635, 356.701 – 356.704, 356.706 – 356.709, 356.711, 356.713, 356.714, 356.718, 356.803, 356.901, 356.902, 356.1001, 356.1002, 356.1101 – 356.1103, 356.1105, 356.1201, 356.1202, 356.1301, 356.1302, 356.1304, 356.1306, 356.1308 – 356.1313, 356.1315 – 356.1319, 356.1321, 356.1402, 356.1403, 356.1405, 356.1501 – 356.1504, 356.1602, 356.1604, 356.1605, 356.1701, 356.1702, 356.1801 – 356.1803, 356.1805, 356.1901 – 356.1903, 356.2001, 356.2002, 356.2004, 356.2006, 356.2007, 356.2009 – 356.2019, 356.2021, 356.2024, 356.2026, 356.2029, 356.2033, 356.2101 – 356.2103, 356.2106, 356.2108, and 356.2110; new §§356.208, 356.303, 356.603, 356.636, 356.637, 356.705, 356.710, 356.719, 356.720, 356.1003, 356.1303, 356.1324, 356.1325, 356.1401, 356.1404, 356.1408, 356.1409, 356.1703, 356.2003, 356.2034, 356.2035, 356.2104, 356.2107, 356.2112, 356.2114, 356.2115, and 356.2201; and the repeal of §§356.207, 356.406 – 356.408, 356.508, 356.603, 356.622, 356.624, 356.625, 356.630, 356.632, 356.633, 356.705, 356.710, 356.712, 356.716, 356.717, 356.719, 356.1303, 356.1314, 356.1320, 356.1322, 356.1401, 356.1404, 356.1406, 356.1408, 356.1806, 356.1807, 356.2003, 356.2020, 356.2022, 356.2028, 356.2030, 356.2031, 356.2104, 356.2107, 356.2109, and 356.2112 – 356.2114 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10229). These rules will not be republished.

BACKGROUND AND PURPOSE

The amendments, new sections, and repeals ensure that the rules in Texas Administrative Code (TAC) Title 26, Chapter 356 comply with changes to state and federal laws and regulations. The adoption clarifies and improves the rules to be more survivor-centered, trauma-informed, and accessible. The adoption will enable Family Violence Program (FVP) providers to better serve survivors of family violence and their children across the state and improve confidential and privileged communications in response to statutory changes.

Specifically, the amendments, new sections, and repeals implement changes made to the Code of Federal Regulations, Title 45 (45 CFR), Part 1370, on November 2, 2016; as well as changes to Texas Human Resources Code Chapter 51, made by Senate Bill 1841, 88th Legislature, Regular Session, 2023; Texas Human Resources Code Chapter 51A, created by Senate Bill 1325, 88th Legislature, Regular Session, 2023; and Texas Family Code Chapter 93, created by House Bill 3649, 85th Legislature, Regular Session, 2017.

45 CFR, Part 1370 ensures that rules pertaining to the administration of the Family Violence Prevention and Services Act (FVPSA) meet statutory requirements and best practices. These rule updates include training provisions, trauma-informed and survivor-centered service regulations, and increase access to services for survivors from underserved populations.

Texas Human Resources Code Chapter 51 promotes development of and access to locally based and supported nonprofit services for victims of family violence throughout the state. These updates add definitions, change the minimum required services for contracting with the FVP, and require FVP centers to demonstrate the use of a voluntary and trauma-informed advocacy service model. These updates also add the new requirement in Texas Human Resources Code Chapter 51A requiring HHSC to adopt a written notice to be provided to victims of family violence, stalking, harassment, or terroristic threat to assist victims in obtaining services.

Texas Family Code Chapter 93 establishes a victim-advocate privilege that victims and certain other parties may invoke to refuse to disclose and to prevent another from disclosing a confidential communication between the victim and family violence center trained advocates.

Additionally, the adoption updates child care rule references as a result of the administrative transfer of chapters from 40 TAC Chapters 743, 745, and 746 to 26 TAC Chapters 743, 745, and 746 in May 2018, July 2019, and March 2018, respectively.

Adopting 26 TAC §§356.101 – 356.104, to revise the title to the rule and clarify the role of the board of directors; revise the requirements of the board handbook; revise the terms of required training for board members; and amend the requirements for board member knowledge of confidentiality policies.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 1. BOARD OF DIRECTORS
26 TAC §§356.101 – 356.104

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.201 – 356.206, 356.208, to revise the title to the rule, replace terms and definitions, and outline requirements for shelters.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 2. CONTRACT STANDARDS
26 TAC §§356.201 – 356.206, 356.208

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.207, to repeal the “More than One Funding Percentage Waiver,” which prohibits a center from receiving more than two funding waivers in consecutive contract terms.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 2. CONTRACT STANDARDS
26 TAC §356.207

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.301 – 356.303, to better align accounting practices with Texas Health and Human Services policy and best practices, and the procedures for reporting suspected or confirmed fraud, waste, or abuse of funds.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 3. FISCAL MANAGEMENT
26 TAC §§356.301 – 356.303

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.401 – 356.403, 356.405, to revise the requirements of the personnel handbook and the amendment process; update certain agreement review requirements; clarify language around the use and possession of drugs and alcohol; and revise the title of the rule.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 4. PERSONNEL
26 TAC §§356.401 – 356.403, 356.405

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.406 – 356.408, to repeal the rules as they are no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 4. PERSONNEL
26 TAC §§356.406 – 356.408

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.501, 356.503 – 356.507, 356.510, to specify requirements for safe indoor and outdoor play areas; require centers to mark safety measures; clarify language concerning the use of security systems in HHSC-funded centers; require HHSC-funded shelter centers to have policies that address threats of violence and public health emergencies; requirements concerning the provision of general hygiene and personal items; and make revisions to the title of the rules.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 5. FACILITY, SAFETY, AND HEALTH REQUIREMENTS
26 TAC §§356.501, 356.503 – 356.507, 356.510

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.508, to remove a rule no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 5. FACILITY, SAFETY, AND HEALTH REQUIREMENTS
26 TAC §356.508

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.601 – 356.604, 356.606, 356.607, 356.609 – 356.621, 356.623, 356.626, 356.627, 356.629, 356.631, 356.635 – 356.637, to add requirements to ensure access to services is aligned with the Family Violence Prevention and Services Act.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §§356.601 – 356.604, 356.606, 356.607, 356.609 – 356.621, 356.623, 356.626, 356.627, 356.629, 356.631, 356.635 – 356.637

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.603, 356.622, 356.624, 356.625, 356.630, 356.632, 356.633, to delete rules that are no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §§356.603, 356.622, 356.624, 356.625, 356.630, 356.632, 356.633

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.701 – 356.711, 356.713, 356.714, 356.716, 356.718 – 356.720, to revise the list of required services to align with legislative updates to the Texas Human Resources Code Chapter 51.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §§356.701 – 356.711, 356.713, 356.714, 356.716, 356.718 – 356.720

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.705, 356.710, 356.712, 356.716, 356.717, 356.719, to repeal chapters no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §§356.705, 356.710, 356.712, 356.716, 356.717, 356.719

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.803, to require board members to have knowledge of confidentiality policies and require board members to provide written assurance that the member will not use their position to obtain access to unauthorized confidential information.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 1. BOARD OF DIRECTORS
26 TAC §356.803

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.901, §356.902, to revise the title of the rule and clarify the procedures to request a waiver.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 2. CONTRACT STANDARDS
26 TAC §356.901, §356.902

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1001 – 356.1003, to better align accounting practices with the Texas Health and Human Services policy and best practices and reporting procedures for any suspected or confirmed fraud, waste, or abuse of funds.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 3. FISCAL MANAGEMENT
26 TAC §§356.1001 – 356.1003

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1101 – 356.1103, 356.1105, to revise the requirements for the personnel handbook and the procedures to amend policies.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 4. PERSONNEL
26 TAC §§356.1101 – 356.1103, 356.1105

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.1201, §356.1202, to add requirements for centers to provide safety measures, plans, and inspections, and secure locations for cleaners and hazardous materials.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 5. FACILITY, SAFETY, AND HEALTH REQUIREMENTS
26 TAC §356.1201, §356.1202

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1301 – 356.1304, 356.1306, 356.1308 – 356.1313, 356.1315 – 356.1319, 356.1321, 356.1324, 356.1325, to reorganize the rule, provide definitions, and define eligibility and other relevant procedures.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §§356.1301 – 356.1304, 356.1306, 356.1308 – 356.1313, 356.1315 – 356.1319, 356.1321, 356.1324, 356.1325

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1303, 356.1314, 356.1320, 356.1322, to repeal rules no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECTS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §§356.1303, 356.1314, 356.1320, 356.1322

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1401, 356.1404, 356.1406, 356.1408, to remove rules no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECTS
DIVISION 7. SERVICE DELIVERY
26 TAC §§356.1401, 356.1404, 356.1406, 356.1408

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1401 – 356.1405, 356.1408, 356.1409, to outline the requirements for centers with a special nonresidential project.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §§356.1401 – 356.1405, 356.1408, 356.1409

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1501 – 356.1504, to revise the title of the rule; require the provision of the board handbook to board members; and amend board member training requirements.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 1. BOARD OF DIRECTORS
26 TAC §§356.1501 – 356.1504

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1602, 356.1604, 356.1605, to revise the procedures to request a waiver.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 2. CONTRACT STANDARDS
26 TAC §§356.1602, 356.1604, 356.1605

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1701 – 356.1703, to align accounting practices with the Texas Health and Human Services policy and best practices and outline the procedures for reporting any suspected or confirmed fraud, waste, or abuse of funds.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 3. FISCAL MANAGEMENT
26 TAC §§356.1701 – 356.1703

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1801 – 356.1803, 356.1805, to revise the requirements for the personnel handbook and the procedures to amend policies.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 4. PERSONNEL
26 TAC §§356.1801 – 356.1803, 356.1805

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.1806, §356.1807, to repeal rules no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 4. PERSONNEL
26 TAC §356.1806, §356.1807

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.1901 – 356.1903, to require centers to mark safety measures, plans, and inspections, and secure cleaning products and other hazardous items.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 5. FACILITY, SAFETY, AND HEALTH REQUIREMENTS
26 TAC §§356.1901 – 356.1903

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.2001 – 356.2004, 356.2006, 356.2007, 356.2009 – 356.2019, 356.2021, 356.2024, 356.2026, 356.2029, 356.2033 – 356.2035, to ensure access to services is aligned with the Family Violence Prevention and Services Act.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §§356.2001 – 356.2004, 356.2006, 356.2007, 356.2009 – 356.2019, 356.2021, 356.2024, 356.2026, 356.2029, 356.2033 – 356.2035

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.2003, 356.2020, 356.2022, 356.2028, 356.2030, 356.2031, to repeal rules no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §§356.2003, 356.2020, 356.2022, 356.2028, 356.2030, 356.2031

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.2101 – 356.2108, 356.2110, 356.2112, 356.2114, 356.2115, to revise the requirements to align with legislative updates to Texas Human Resources Code Chapter 51.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §§356.2101 – 356.2108, 356.2110, 356.2112, 356.2114, 356.2115

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §§356.2104, 356.2107, 356.2109, 356.2112 – 356.2114, to repeal rules no longer necessary.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §§356.2104, 356.2107, 356.2109, 356.2112 – 356.2114

OVERVIEW

BACKGROUND AND PURPOSE

Adopting 26 TAC §356.2201, to require HHSC to create and maintain a written notice to be provided to victims of family violence, stalking, harassment, or terroristic threat to assist those victims in obtaining services.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER E. WRITTEN NOTICE TO VICTIMS
DIVISION 1. NOTICE
26 TAC §356.2201

OVERVIEW

BACKGROUND AND PURPOSE

Adopted Rule Reviews Re:

Adopting Title 26, Part 1, concerning long-term care provider rules during a public health emergency or disaster.

The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code (TAC):

Chapter 570, Long-Term Care Provider Rules During a Public Health Emergency or Disaster

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §217.2, to adopt the revisions of the PMO, Procedures, Methods, and EML as a reference for milk and dairy farm, processor, and laboratory inspections and surveys.

CHAPTER 217. MILK AND DAIRY
SUBCHAPTER A. GRADE SPECIFICATIONS AND REQUIREMENTS FOR MILK
25 TAC §217.2

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 25 Texas Administrative Code (TAC) §217.2, concerning Adopted Regulations and Standards.

BACKGROUND AND PURPOSE

The proposal is necessary to reflect the current revision of the Pasteurized Milk Ordinance (PMO). This proposal is also necessary to adopt the current revision of three additional sets of federal standards and regulations which, like the PMO, are published as a joint effort between the United States Department of Health and Human Services (USDHHS), United States Food and Drug Administration (FDA), United States Public Health Service (USPHS), and National Conference of Interstate Milk Shipments (NCIMS). The additional standards and regulations are entitled:

1) Procedures Governing the Cooperative State-Public Health Service/Food and Drug Administration Program of the National Conference on Interstate Milk Shipments (Procedures);

2) Methods for Making Sanitation Ratings of Milk Shippers and the Certifications/Listings of Single-Service Containers and/or Closures for Milk and/or Milk Product Manufacturers (Methods); and

3) Evaluation of Milk Laboratories (EML).

SECTION-BY-SECTION SUMMARY

Proposed amendment to §217.2, Adopted Regulations and Standards, includes the adoption of the current revisions of the PMO, Procedures, Methods, and EML as a reference for milk and dairy farm, processor, and laboratory inspections and surveys.

Amending 25 TAC §401.464, to delete the rule.

CHAPTER 401. MENTAL HEALTH SYSTEM ADMINISTRATION
SUBCHAPTER G. LOCAL MENTAL HEALTH AUTHORITY NOTIFICATION AND APPEAL
25 TAC §401.464

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 401, consisting of §401.464, concerning Notification and Appeals Process.

BACKGROUND AND PURPOSE

The purpose of the proposal is to repeal an obsolete rule in Title 25, Texas Administrative Code (TAC), Chapter 401, Subchapter G, adopted in 1994. HHSC addresses the topic of this rule in similar rules located in 26 TAC, Chapter 301, Subchapter D.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §401.464 deletes the rule because the content of the rule is in 26 TAC, Chapter 301, Subchapter D.

Amending 25 TAC §404.168, §404.169, to delete the rules.

CHAPTER 404. PROTECTION OF CLIENTS AND STAFF–MENTAL HEALTH SERVICES
SUBCHAPTER E. RIGHTS OF PERSONS RECEIVING MENTAL HEALTH SERVICES
25 TAC §404.168, §404.169

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 404, consisting of §404.168, concerning References; and §404.169, concerning Distribution.

BACKGROUND AND PURPOSE

The purpose of the proposal is to repeal obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 404, Subchapter E, adopted in 1996. The rules are no longer necessary.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §404.168 and §404.169 deletes rules that are no longer necessary.

Amending 25 TAC §405.116, to delete the rule.

CHAPTER 405. PATIENT CARE–MENTAL HEALTH SERVICES
SUBCHAPTER E. ELECTROCONVULSIVE THERAPY (ECT)
25 TAC §405.116

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 405, consisting of §405.116, concerning Distribution.

BACKGROUND AND PURPOSE

The purpose of the proposal is to repeal an obsolete rule in Title 25, Texas Administrative Code (TAC), Chapter 405, Subchapter E, adopted in 1993. Senate Bill 800, 87th Legislature, Regular Session, 2021, repealed the requirement to submit an annual report.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §405.116 deletes a rule that is no longer necessary.

Amending 25 TAC §§411.61, 411.62, 411.64, to delete the rules.

CHAPTER 411. STATE MENTAL HEALTH AUTHORITY RESPONSIBILITIES
SUBCHAPTER B. INTERAGENCY AGREEMENTS
25 TAC §§411.61, 411.62, 411.64

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 411, consisting of §411.61, concerning Memorandum of Understanding Concerning Capacity Assessment for Self Care and Financial Management; §411.62, concerning Memorandum of Understanding concerning Continuity of Care System for Offenders with Mental Impairments; and §411.64, concerning Memorandum of Understanding (MOU) on Relocation Pilot Program.

BACKGROUND AND PURPOSE

The purpose of the proposed repeals is to delete obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 411, Subchapter B, adopted in 1999 and 2003. Texas Health and Safety Code §533.044 and 40 TAC, §71.104, have been repealed. Additionally, Texas Health and Safety Code §614.013 no longer requires an MOU to be formally adopted by rule.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §411.61 and §411.64 deletes the rules because the requirements have been repealed in statute. The proposed repeal of §411.62 deletes the rule because the MOU is not required to be formally adopted by rule.

Amending 25 TAC §412.63, §412.64, to delete the rules.

CHAPTER 412. LOCAL MENTAL HEALTH AUTHORITY RESPONSIBILITIES
SUBCHAPTER B. CONTRACTS MANAGEMENT FOR LOCAL AUTHORITIES
25 TAC §412.63, §412.64

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 412, consisting of §412.63 concerning References; §412.64, concerning Distribution; §412.114, concerning References; and §412.115, concerning Distribution.

BACKGROUND AND PURPOSE

The purpose of the proposed repeal is to delete obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 412, Local Mental Health Authority Responsibilities, Subchapter B and Subchapter C. The rules are outdated and no longer necessary.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§412.63, 412.64, 412.114, and §412.115 deletes the rules because the rules are outdated and no longer necessary.

Amending 25 TAC §412.114, §412.115, to delete the rules.

CHAPTER 412. LOCAL MENTAL HEALTH AUTHORITY RESPONSIBILITIES
SUBCHAPTER C. CHARGES FOR COMMUNITY SERVICES
25 TAC §412.114, §412.115

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§412.63, 412.64, 412.114, and §412.115 deletes the rules because the rules are outdated and no longer necessary.

Amending 25 TAC §414.414, §414.415, to delete the rules.

CHAPTER 414. RIGHTS AND PROTECTIONS OF PERSONS RECEIVING MENTAL HEALTH SERVICES
SUBCHAPTER I. CONSENT TO TREATMENT WITH PSYCHOACTIVE MEDICATION–MENTAL HEALTH SERVICES
25 TAC §414.414, §414.415

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 414, consisting of: §414.414, concerning References; §414.415 concerning Distribution; §414.508, concerning References; §414.509, concerning Distribution; §414.551, concerning Purpose; §414.552, concerning Application; §414.553, concerning Definitions; §414.554, concerning Responsibilities of Local Authorities, Community Centers, and Contractors; §414.555, concerning Information To Be Provided to Victim or Alleged Victim and Others; §414.556, concerning Investigations Conducted by the Texas Department of Protective and Regulatory Services (TDPRS); §414.557, concerning Disciplinary and Other Action; §414.558, concerning Data Reporting Responsibilities; §414.559, concerning Confidentiality of Investigative Process and Report; §414.560, concerning Competency of Employees and Agents; §414.561, concerning TDMHMR Oversight Responsibilities; §414.562, concerning Exhibits; §414.563, concerning References; and §414.564 concerning Distribution.

BACKGROUND AND PURPOSE

The proposal repeals obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 414, Subchapter I and Subchapter K, adopted in 2004. The rules are outdated and no longer necessary.

Additionally, the proposal repeals obsolete rules in 25 TAC Chapter 414, Subchapter L, adopted in 2001. HHSC addresses the topic of these rules in similar rules located in 26 TAC, Chapter 301, Subchapter M.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§414.414, 414.415, 414.508, and 414.509 deletes the rules because the titles and content of the rules are no longer used by the HHSC in rulemaking. The proposed repeal of §§414.551 – 414.564 deletes the rules because the content of the rules exists in 26 TAC, Chapter 301, Subchapter M.

Amending 25 TAC §414.508, §414.509, to delete the rules.

CHAPTER 414. RIGHTS AND PROTECTIONS OF PERSONS RECEIVING MENTAL HEALTH SERVICES
SUBCHAPTER K. CRIMINAL HISTORY AND REGISTRY CLEARANCES
25 TAC §414.508, §414.509

OVERVIEW

BACKGROUND AND PURPOSE

The proposal repeals obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 414, Subchapter I and Subchapter K, adopted in 2004. The rules are outdated and no longer necessary.

SECTION-BY-SECTION SUMMARY

Amending 25 TAC §§414.551 – 414.564, to delete the rules.

CHAPTER 414. RIGHTS AND PROTECTIONS OF PERSONS RECEIVING MENTAL HEALTH SERVICES
SUBCHAPTER L. ABUSE, NEGLECT, AND EXPLOITATION IN LOCAL AUTHORITIES AND COMMUNITY CENTERS
25 TAC §§414.551 – 414.564

OVERVIEW

BACKGROUND AND PURPOSE

The proposal repeals obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 414, Subchapter I and Subchapter K, adopted in 2004. The rules are outdated and no longer necessary.

SECTION-BY-SECTION SUMMARY

Amending 25 TAC §§415.4, 415.9, 415.13, 415.14, to remove the requirements regarding to consent to treatment with psychoactive medications because of they are duplicative.

CHAPTER 415. PROVIDER CLINICAL RESPONSIBILITIES–MENTAL HEALTH SERVICES
SUBCHAPTER A. PRESCRIBING OF PSYCHOACTIVE MEDICATION
25 TAC §§415.4, 415.9, 415.13, 415.14

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §415.4, concerning Philosophy; §415.9, concerning Consent and Patient Education; §415.13, concerning References; and §415.14, concerning Distribution.

BACKGROUND AND PURPOSE

The purpose of the proposal is to repeal obsolete rules in Title 25, Texas Administrative Code (TAC), Chapter 415, Subchapter A, adopted in 2004. The rules are duplicative or are no longer necessary.

SECTION-BY-SECTION SUMMARY

The proposed repeal to §415.9 deletes requirements regarding consent to treatment with psychoactive medications because they are duplicative, and are currently located in 26 TAC, Chapter 320, Subchapter B. The proposed repeal of §§415.4, 415.13, and 415.14 deletes rules that are no longer necessary.

State Board of Dental Examiners

Adopted Rules Re:

Adopting 22 TAC §104.2, to remove Dental Risk Solutions, LLC as a continuing education provider.

CHAPTER 104. CONTINUING EDUCATION
22 TAC §104.2

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §104.2, concerning continuing education providers. The amendment is adopted without changes to the proposed text as published in the March 28, 2025, issue of the Texas Register (50 TexReg 2152) and will not be republished. The Board conducted a review of the continuing education providers in accordance with this rule, and voted to review the provider Dental Risk Solutions, LLC. The Board sent a notice to the mailing address of record for Dental Risk Solutions, LLC, informing it that the Board will consider whether to remove or reclassify it as a provider during its next scheduled meetings on February 20-21, 2025. The notice was returned to the Board as “Unable to Forward.” The Board voted to remove Dental Risk Solutions, LLC as a continuing education provider at the February 2025 meeting.

Adopting 22 TAC §107.400, to set forth a requirement of a yearly report instead of a quarterly report to the Board.

CHAPTER 107. DENTAL BOARD PROCEDURES
SUBCHAPTER E. DATA REPORTING
22 TAC §107.400

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §107.400, concerning collection and reporting of enforcement and licensing data. The amendment is adopted without changes to the proposed text as published in the March 28, 2025, issue of the Texas Register (50 TexReg 2153) and will not be republished. The adopted amendment requires a yearly report to the Board instead of a quarterly report because a yearly report will provide a better snapshot of the data. The adopted amendment updates the rule to reflect that the Board no longer issues administrative citations, but rather administrative penalties. The adopted amendment also corrects a punctuation error.

Adopting 22 TAC §108.8, to require dentists to use radiographs in accordance with the minimum standard of care.

CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.8

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §108.8, concerning the records of a dentist. The amendment is adopted without changes to the proposed text as published in the March 28, 2025, issue of the Texas Register (50 TexReg 2155) and will not be republished. The adopted amendment removes the language that the use of radiographs should be in accordance with ADA guidelines, and instead requires dentists to use radiographs in accordance with the minimum standard of care.

Adopting 22 TAC §108.52, to specify that which dental specialties are approved by the National Commission on Recognition of Dental Specialties and Certifying Boards, and various grammar changes.

CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER E. BUSINESS PROMOTION
22 TAC §108.52

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §108.52, concerning names and responsibilities. The amendment is adopted without changes to the proposed text as published in the March 28, 2025, issue of the Texas Register (50 TexReg 2157) and will not be republished. The adopted amendment specifies that dental specialties are approved by the National Commission on Recognition of Dental Specialties and Certifying Boards. The proposed amendment also includes grammar changes.

Proposed Rule Reviews Re:

Reviewing Title 22, Part 5, to consider for readoption, revision, or repeal of the chapter concerning sedation and anesthesia, and requirements for dental offices.

The Texas State Board of Dental Examiners (Board) files this Notice of Intent to Review to consider for re-adoption, revision, or repeal the chapters listed below, in their entirety, contained in Title 22, Part 5, of the Texas Administrative Code. This review is being conducted in accordance with Texas Government Code §2001.039.

Texas Medical Disclosure Panel

Adopted Rules Re:

Adopting 25 TAC §§602.3, 602.5, 602.9, 602.16, to update the list of procedures and risks and hazards with plain language when possible, specifically the Digestive System, Endocrine System, Breast Surgery, and Urinary System Treatments and Procedures.

CHAPTER 602. PROCEDURE REQUIRING FULL DISCLOSURE OF SPECIFIC RISKS AND HAZARDS–LIST A
25 TAC §§602.3, 602.5, 602.9, 602.16

OVERVIEW

The Texas Medical Disclosure Panel (Panel) adopts amendments to §602.3, concerning Digestive System Treatments and Procedures; §602.5, concerning Endocrine System Treatments and Procedures; §602.9, concerning Breast Surgery (non-cosmetic) Treatments and Procedures; and §602.16, concerning Urinary System Treatments and Procedures.

Sections 602.3, 602.9, and 602.16 are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9880). These rules will not be republished.

Section 602.5 is adopted with changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9880). This rule will be republished.

BACKGROUND AND PURPOSE

These amendments are adopted in accordance with Texas Civil Practice and Remedies Code §74.102, which created the Panel to determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to their patients or persons authorized to consent for their patients and to establish the general form and substance of such disclosure.

The amendments modify the lists of procedures in §§602.3, 602.5, 602.9, and 602.16 requiring full disclosure of risks and hazards and update the rules using plain language when possible.

Adopting 25 TAC §603.3, §603.16, to update the list of procedures and risks and hazards with plain language, when possible, specifically the Digestive System and Urinary System Treatments and Procedures.

CHAPTER 603. PROCEDURES REQUIRING NO DISCLOSURE OF SPECIFIC RISKS AND HAZARDS–LIST B
25 TAC §603.3, §603.16

OVERVIEW

The Texas Medical Disclosure Panel (Panel) adopts amendments to §603.3, concerning Digestive System Treatments and Procedures; and §603.16, concerning Urinary System Treatments and Procedures. Section 603.3 and §603.16 are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9886). These rules will not be republished.

BACKGROUND AND PURPOSE

The amendments modify the lists of procedures in §603.3 and §603.16 requiring no disclosure of specific risks and hazards and update the rules using plain language when possible.

Texas Board of Occupational Therapy Examiners

Adopted Rules Re:

Adopting 40 TAC §374.1, §374.2, to update definitions and clarify situations in which disciplinary action is appropriate.

CHAPTER 374. DISCIPLINARY ACTIONS/DETRIMENTAL PRACTICE/COMPLAINT PROCESS/CODE OF ETHICS/LICENSURE OF PERSONS WITH CRIMINAL CONVICTIONS
40 TAC §374.1, §374.2

OVERVIEW

The Texas Board of Occupational Therapy Examiners adopts amendments to the Schedule of Sanctions figure in 40 Texas Administrative Code §374.1, Disciplinary Actions, and §374.2, Detrimental Practice. The amendments are adopted with changes to the proposed text as published in the March 14, 2025, issue of the Texas Register (50 TexReg 1896). The amendments will be republished. The changes at adoption are to correct a clerical error and replace the word “and” with “or” in §374.2(5) and (6) and in the corresponding items in the Schedule of Sanctions.

The amendments to §374.2 will update the definition of “practiced occupational therapy in a manner detrimental to the public health and welfare” and clarify conduct that constitutes grounds to take disciplinary action against license holders.

Amendments to the Schedule of Sanctions in §374.1 will align the provisions therein with the changes to §374.2; update the minimum, intermediate, and maximum discipline columns to reflect current trends in disciplinary action; and update administrative penalties for each day a violation continues or occurs. The amendments to the Schedule of Sanctions also include the addition of a violation related to failure to inform the Board of information changes pursuant to §369.2, Changes of Name or Contact Information. The amendments include general cleanups, as well, including the removal of the current §374.2(12) and corresponding item in the Schedule of Sanctions, which concerned deceptive and fraudulent advertising, as a related item is already listed under Texas Occupations Code §454.301, Grounds for Denial of License or Discipline of License Holder; in tandem with the change, that related item from §454.301 has been added to the Schedule of Sanctions.

The amendments are adopted to ensure that the rules clearly identify the conduct that may be considered detrimental practice and the corresponding discipline. The changes will also facilitate the ability of individuals and the Board to identify violations and related discipline in order to ensure the health, safety, and welfare of the public.

Public comment from the Texas Occupational Therapy Association (TOTA) was received regarding the proposed amendments to §374.2, Detrimental Practice. The comment noted that TOTA appreciates the Board’s efforts in updating the definition of “practiced occupational therapy in a manner detrimental to the public health and welfare” and clarifying conduct for which the Board may take disciplinary action. The comment also noted that TOTA’s Standards and Practice Committee members have concerns regarding Section 18, “failing to provide sufficient prior written notice of resignation from employment or termination of contract.” TOTA asked if the Board could include that occupational therapy practitioners who are concerned regarding abandonment can contact the Board to prevent possible disciplinary action.

The Board disagrees with the comment. Firstly, the amendments would replace more general extant language with language that is more specific with regard to what abandonment entails, which will better facilitate a licensee’s ability to identify what abandonment is and avoid it. Secondly, while a licensee can contact the Board regarding provisions in the OT Act and Rules, the ultimate responsibility for compliance with such is the licensee’s and it is through the complaint process, addressed in Chapter 374 of the OT Rules, that it is determined if a violation has occurred. In addition, with regard to disciplinary action by the Board, as noted for each item in the Schedule of Sanctions, alternative disciplinary decisions or pursuing other courses of action may depend on the nature of the situation, repeat of violation, or development.

The amendments are adopted under Texas Occupations Code §454.102, which authorizes the Board to adopt rules to carry out its duties under Chapter 454. The amendments are also adopted under §454.3025, which requires the Board by rule to adopt a schedule of administrative penalties and other sanctions that the Board may impose under this chapter, and under §454.3521, which authorizes the Board to impose an administrative penalty, not to exceed $200 for each day a violation continues or occurs, under this chapter for a violation of this chapter or a rule or order adopted under this chapter. The amendments, lastly, are adopted under Texas Occupations Code §454.301, which includes that the Board may deny, suspend, or revoke a license or take other disciplinary action against a license holder if the applicant or license holder has practiced occupational therapy in a manner detrimental to the public health and welfare.