Texas Register July 10, 2026 Volume: 51 Number: 28

Texas Medical Board

Proposed Rules Re:

Adding new 22 TAC §160.8, to authorize reimbursement of employee training and education expenses consistent with Texas Government Code Chapter 656.

CHAPTER 160. GENERAL PROVISIONS
SUBCHAPTER A. GENERAL
22 TAC §160.8

OVERVIEW

The Texas Medical Board (Board) proposes new §160.8, concerning Employee Training and Education.

BACKGROUND AND JUSTIFICATION

The proposed new §160.8, relating to Employee Training and Education, authorizes reimbursement of training and education expenses consistent with Subchapters C and D, Chapter 656, Texas Government Code.

Amending 22 TAC §161.35, to require physicians to complete continuing medical education in forensic evidence collection and nutrition/metabolic health, per HB 47 and SB 25.

CHAPTER 161. PHYSICIAN LICENSURE
SUBCHAPTER H. CONTINUING MEDICAL EDUCATION REQUIREMENTS FOR LICENSE RENEWAL
22 TAC §161.35

OVERVIEW

The Texas Medical Board (Board) proposes amendments to Chapter 161, §161.35, concerning Continuing Medical Education (CME) Requirements for License Renewal.

BACKGROUND AND JUSTIFICATION

These rules are mandated by the passage of HB47 and SB25 (89th Regular Legislative Session) which amended the Texas Occupations Code, Sections 156.057 and 156.061. The proposed amendments require licensed physicians to complete specified continuing medical education on forensic evidence collection as well as nutrition and metabolic health.

SECTION-BY-SECTION SUMMARY

The proposed amendments to §161.35 are as follows:

Amendment to §161.35(a) adds paragraph (3)(A), requiring licensed physicians to complete two credit hours of CME in accordance with §156.057 of the Act and provides that the Board will recognize any course found acceptable to the Governor’s Sexual Assault Survivors’ Task Force to meet the requirement for continuing education in forensic evidence collection. The bill requires the Medical Board to adopt rules as necessary to implement the new provisions of the Texas Occupations Code.

Amendment to §161.35(a) adds paragraph (3)(B), requiring licensed physicians to complete one credit hour of CME, in accordance with §156.061 of the Act, in the topic of nutrition and metabolic health focused on the nutritional guidelines recommended by the Texas Nutrition Advisory Committee. The bill requires the Medical Board to adopt rules as necessary to implement the new provisions of the Texas Occupations Code.

Adding new 22 TAC Chapter 173, Subchapter B, §§173.6 – 173.17, to establish registration, medical director, operational, and reporting requirements for Parenteral Ketamine Therapy (PKT) practices.

CHAPTER 173. OFFICE-BASED ANESTHESIA SERVICES
SUBCHAPTER B. PARENTERAL KETAMINE THERAPY
22 TAC §§173.6 – 173.17

OVERVIEW

The Texas Medical Board (Board) proposes Chapter 173, Office-Based Anesthesia Services, new Subchapter B, titled Parenteral Ketamine Therapy, §§173.6 – 173.17.

SECTION-BY-SECTION SUMMARY

The proposed new sections are as follows:

New §173.6, Definitions, sets forth definitions for “administration of ketamine”, “adverse event”, “initial dose”, “medical director”, “PKT practice”, “psychotropic ketamine therapy (PKT)” and “practitioner.”

New §173.7, Mandatory Registration, mandates registration for PKT Practices and sets forth an application procedure. The section further proposes a 180-day grace period for implementation of the requirements set forth under Chapter 173, Subchapter B, except for adverse reporting requirements under New §173.14, which must be met upon the effective date of the rule’s adoption.

New §173.8, Exemptions from Registration, sets forth practice settings exempt from required registration and the rules promulgated under new Subchapter B.

New §173.9, Renewal of PKT Practice Registration, proposes a two-year registration term and sets forth registration renewal requirements.

New §173.10, Medical Director Requirements, sets forth medical director eligibility requirements, duties, and restrictions.

New §173.11, Operation of PKT Clinics, sets forth requirements for operation of PKT Practices. The rule includes limitations on the administration of psychotropic ketamine therapy to practitioners and RNs and outlines requirements that must be met before and during administration of PKT, including informed consent, pregnancy status verification for women of child-bearing age, and continuous monitoring. The new section sets forth practitioner-patient ratios that apply depending on the presence of a physician on-site.

New §173.12, Monitoring Requirements After the Completion of PKT Administration, sets forth monitoring requirements upon the completion of PKT administration and prior to discharge of the patient. The rule further sets forth a maximum practitioner-patient ratio of one monitoring delegate to every four patients.

New §173.13, Minimum Equipment and Medication Requirements, outlines the minimum equipment and medications that must be on-site at all times and readily available to manage adverse events.

New §173.14, Emergency Response Requirements and Adverse Event Reporting, sets forth requirements for medical directors or delegating physicians to respond to non-emergency consultations or emergency situations. The rule further requires that a PKT Practice maintain an adverse event reporting log and outlines minimum requirements for maintaining the log. The section further requires that the Medical Director must ensure the PKT Practice completes and submits to the Board, on a Board approved form, a written report within 24 hours of the following adverse events: (1) emergency transportation; or (2) death.

New §173.15, Prohibited PKT Administration, provides that PKT may not be administered outside of a registered clinic or an exempt setting set forth under §173.8 or prescribed for home use.

New §173.16, Complaints, provides that the Medical Director is responsible for the clinic’s operations and patient care. The new rule further provides that the Medical Director must ensure compliance with all applicable statutes and regulations including 22 Texas Administrative Code §177.2 regarding posting instructions on how to file complaints with the Board.

New §173.17, Audits, Inspections, and Investigations, mandates that PKT practices be subject to audits, inspections and investigations as outlined in Chapter 172 of the Medical Board rules related to pain management clinics.

Amending 22 TAC §183.16, to require physician assistants to complete continuing medical education in forensic evidence collection and nutrition/metabolic health, per HB 47 and SB 25.

CHAPTER 183. PHYSICIAN ASSISTANTS
SUBCHAPTER B. LICENSING AND REGISTRATION
22 TAC §183.16

OVERVIEW

The Texas Medical Board (Board) proposes amendments to Chapter 183, §183.16, concerning Biennial Continuing Medical Education (CME) Requirements concerning Physician Assistants.

BACKGROUND AND JUSTIFICATION

These rules are mandated by the passage of HB47 and SB25 (89th Regular Legislative Session) which amended the Texas Occupations Code, Sections 204.1563. The proposed amendments require licensed physician assistants to complete specified continuing medical education on forensic evidence collection as well as nutrition and metabolic health.

SECTION-BY-SECTION SUMMARY

The proposed amendments to §183.16 are as follows:

Amendment to §183.16(a) adds paragraph (2)(A) requiring physician assistants to complete two credit hours of continuing medical education (CME) in accordance with § 204.1563 of the Act and provides that the Board will recognize any course found acceptable to the Governor’s Sexual Assault Survivors’ Task Force to meet the requirement for continuing education in forensic evidence collection. The bill requires the Medical Board, on recommendations of the Physician Assistant Board, to adopt rules as necessary to implement the new provisions of the Texas Occupations Code.

Amendment to §183.16(a) adds paragraph (2)(B) requiring physician assistants to complete one credit hour of continuing medical education (CME), in accordance with § 204.1563 of the Act, in the topic of nutrition and metabolic health focused on the nutritional guidelines recommended by the Texas Nutrition Advisory Committee. The bill requires the Medical Board on recommendations of the Physician Assistant Board to adopt rules as necessary to implement the new provisions of the Texas Occupations Code.

Withdrawn Rules Re:

The Texas Medical Board withdraws proposed new §§173.6 – 173.18, Office-Based Anesthesia Services, Subchapter B, Parenteral Ketamine Therapy, which appeared in the May 15, 2026, issue of the Texas Register (51 TexReg 3297).

CHAPTER 173. OFFICE-BASED ANESTHESIA SERVICES
SUBCHAPTER B. PARENTERAL KETAMINE THERAPY
22 TAC §§173.6 – 173.18

OVERVIEW

The Texas Medical Board withdraws proposed new §§173.6 – 173.18 which appeared in the May 15, 2026, issue of the Texas Register (51 TexReg 3297).

Texas Funeral Service Commission

Proposed Rules Re:

Repealing 22 TAC §206.1, concerning Jurisdiction of the Board, to be replaced simultaneously with a new, more germane rule.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.1

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes the repeal to §206.1, Jurisdiction of Board, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. The purpose of the proposed repeal is to eliminate the outdated rule and replace it simultaneously with a new more germane rule.

Adding new 22 TAC §206.1, to establish the scope of regulated material and consolidate definitions used throughout Chapter 206, implementing Senate Bill 2040.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.1

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes new §206.1, Scope and Definitions, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. This proposed change is referred to as the “proposed rule.”

BACKGROUND AND JUSTIFICATION

The rules under 22 TAC Chapter 206 implement Texas Health and Safety Code, Chapter 691, Donation of Bodies and Anatomical Specimens, and related provisions of Chapter 692A, Health and Safety Code, and Chapter 651, Occupations Code.

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule rewrites the section to state the purpose and scope of the chapter and to consolidate the definitions used throughout the Commission’s rules implementing Texas Health and Safety Code, Chapters 691 and 692A. The proposed rule identifies the material and persons regulated under the chapter, clarifies that microscopic and laboratory material governed by other law is not regulated as a body or gross anatomical specimen, and defines the terms used throughout the chapter, aligning them with Health and Safety Code §691.001. The proposed rule is necessary to implement Senate Bill 2040, provide a clear and current statement of the chapter’s scope, and give the regulated community and the public consistent, plain-language definitions.

SECTION-BY-SECTION SUMMARY

The proposed rule replaces the prior §206.1, which is repealed in a simultaneous rulemaking.

The new rule identifies the regulated material and the application of the chapter, including its application to a body whose recorded method of final disposition is “Donation” and to anatomical specimens used for purposes other than transplantation; clarifies that microscopic and laboratory material governed by other law is not regulated as a body or gross anatomical specimen; and defines the terms used throughout the chapter, consistent with Health and Safety Code §691.001.

Repealing 22 TAC §206.2, concerning Institutional Requirements, to be replaced simultaneously with a new, more germane rule.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.2

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes repeal of §206.2, Institutional Requirements, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. The purpose of the proposed repeal is to eliminate the outdated rule and replace it simultaneously with a new more germane rule.

Adding new 22 TAC §206.2, to state the activities authorized in relation to the use or dissection of a body or anatomical specimen, consistent with Texas Penal Code §42.08.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.2

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes new §206.2, Authorized Activities, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. This proposed change is referred to as the “proposed rule.”

BACKGROUND AND JUSTIFICATION

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule satisfies the Commission’s mandatory duty under §691.033(d), Health and Safety Code, to clearly state the activities authorized in relation to the use or dissection of a body or anatomical specimen, to aid prosecutions under §42.08, Penal Code. The proposed rule is necessary to satisfy the Commission’s mandatory duty under §691.033(d), Health and Safety Code; provide predictable protection for legitimate professional, educational, research, and forensic practice; and give prosecutors and the public clear notice of the activities authorized and performed with legal authority under Chapter 691.

SECTION-BY-SECTION SUMMARY

The proposed rule replaces the prior §206.2, which is repealed in a simultaneous rulemaking.

The proposed rule states the authority and purpose of the section; identifies the persons who may be designated as authorized persons under §691.033(a) and establishes a process for the Commission, with review by the State Anatomical Advisory Committee, to designate additional authorized persons; lists, by category, the activities authorized when performed by an authorized person within the scope of donor consent documented under §691.028; provides a procedure for activities outside the listed scope; states a safe-harbor provision describing conduct performed with legal authority for purposes of §42.08, Penal Code, consistent with §691.033(c); identifies activities that are not authorized; addresses the section’s relationship to §42.08, Penal Code; and requires periodic review of the section at least once every three years.

Repealing 22 TAC §206.3, concerning Distribution Priorities, to be replaced simultaneously with a new, more germane rule.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.3

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes a repeal of §206.3, Distribution Priorities, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. The purpose of the proposed repeal is to eliminate the outdated rule and replace it simultaneously with a new more germane rule.

Adding new 22 TAC §206.3, to establish chain-of-custody requirements, including a prescribed form, for bodies and anatomical specimens.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.3

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes a new rule §206.3, Chain of Custody, at Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. This proposed change is referred to as the “proposed rule.”

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed rule amends §206.3, Chain of Custody.

The proposed rule amends the section heading and rewrites the section to establish chain-of-custody requirements under §691.031, Health and Safety Code. The proposed amendment states the authority for and application of the section; prescribes the chain-of-custody form (TFSC Form A-1) by reference and authorizes future revision and an electronic conveyance and receipt system; specifies how the form is initiated and completed at each transfer of custody; addresses transport providers, disarticulation and derived specimens, transfer of the form with custody, a seven-year retention period, and acceptable paper and electronic formats; provides for inspection and production to the Commission or a district or county attorney within two business days of a written request, consistent with §691.031(f); and states the consequences of failure to comply.

Amending 22 TAC §206.4, to update transport, importation, and exportation requirements for bodies and anatomical specimens and conform terminology to Senate Bill 2040.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.4

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes amendments to §206.4, Transport, Importation and Exportation of Bodies, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs.

BACKGROUND AND JUSTIFICATION

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule amends the section to conform it to Senate Bill 2040 and current statutory structure, including replacing references to the former “board” and “secretary-treasurer” with the Commission and its Executive Director and updating provisions governing transport, importation, and exportation of bodies and anatomical specimens. It removes a redundant provision regarding violations of rules and also moves and revises a requirement for a yearly procurement and use report for anatomical entities to assist the commission in evaluating compliance with statutory requirements for export. The proposed rule is necessary to conform the rule to Chapter 691 as amended by Senate Bill 2040, ensure the secured and dignified transport of bodies and anatomical specimens, and provide clear conditions for importation into and exportation out of this state.

SECTION-BY-SECTION SUMMARY

The proposed rule amends §206.4, Transport, Importation and Exportation of Bodies.

The proposed rule amends the section to conform it to Senate Bill 2040 and current statutory structure. The proposed amendment replaces references to the “board” and “secretary-treasurer” with the Commission and its Executive Director; updates labeling and secured-transport requirements; provides for transfer to search organizations and forensic science programs consistent with donor authorization under §§691.028 and 692A.009; addresses notification of intent to import and the Commission’s jurisdiction over imported material; revises the conditions for written approval of exportation, including the requirement that an out-of-state recipient be an authorized recipient of the same type listed in §206.2 and the conditions concerning supply, donor authorization, and any site visit; and updates the provisions governing removal from authorized premises and handling of suspected violations. The proposed rule also moves and revises a prior State Anatomical Board rule requiring reporting for anatomical entities to assist the Commission in meeting statutory requirements prior to authorizing export of anatomical specimens.

Amending 22 TAC §206.5, to update the transfer-application and approval process for bodies and anatomical specimens.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.5

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes amendments to §206.5, Transfer of Bodies or Anatomical Specimens, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs.

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed rule amends the section to update the transfer-application and approval process. The proposed amendment provides that an Authorized Person, as defined in §206.1, may request a transfer on the form prescribed by the Commission; designates the Executive Director or the Executive Director’s designee as authorized to approve transfers; requires that recipients of transfers be an approved willed body program, non-transplant anatomical donation organization, or approved anatomical facility; and addresses availability of bodies, allocation of costs, the deadline for return of transferred bodies for final disposition, and extensions. It removes redundant language from the former State Anatomical Board rule.

Repealing 22 TAC §206.7, concerning Board Forms, to be replaced simultaneously with a new, more germane rule.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.7

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes repeal of §206.7, Board Forms, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. The purpose of the proposed repeal is to eliminate the outdated rule and replace it simultaneously with a new more germane rule.

Adding new 22 TAC §206.7, to permit educational use of anatomical material under four conditions and prohibit public display of human remains as spectacle.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.7

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes new §206.7, Educational Use of Anatomical Material; Prohibition of Public Display, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. This proposed change is referred to as the “proposed rule.”

BACKGROUND AND JUSTIFICATION

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule governs the educational use of human anatomical material and to prohibit the public display of a body or gross anatomical specimen as spectacle or entertainment. The proposed rule permits educational observation and participation when four conditions are met – donor consent, an approved setting inspected by the Commission, qualified supervision, and a bona fide educational purpose – and prohibits selling admission to the general public to observe the display, dissection, or examination of human anatomical material. The proposed rule is necessary to ensure that human anatomical material used for educational observation is handled with respect and dignity consistent with the treatment-with-respect standard the Commission is required to adopt under §691.022(b), Health and Safety Code; preserve broad and legitimate access to anatomical education for the scientific and professional community; and prohibit the display of human anatomical material as public spectacle or entertainment.

SECTION-BY-SECTION SUMMARY

The proposed rule replaces the prior §206.7, which is repealed in a simultaneous rulemaking.

The proposed rule addresses the educational use of anatomical material and to prohibit public display. The proposed amendment states the authority for and purpose of the section; establishes the four conditions under which a person may observe or participate in the educational use, dissection, or examination of a body or gross anatomical specimen – donor consent under §§691.028 and 692A.009, an approved setting inspected by the Commission, qualified supervision by a Qualified Instructor or Bioskills Trainer, and a bona fide educational purpose; addresses observation or participation by minors enrolled in an accredited or recognized educational program; prohibits the public display of a body or gross anatomical specimen and the sale of admission to the general public to observe human anatomical material, while preserving legitimate educational programs, reverent consent-based memorials, and accredited museum or scientific exhibitions conducted with documented consent and dignity protections; restricts media and recording consistent with donor consent and dignity protections; applies the treatment-with-respect standard adopted under §691.022(b); and states the enforcement consequences of a violation.

Amending 22 TAC §206.8, to update complaint-notice requirements directing donor and family complaints to the Commission.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.8

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes amendments to §206.8, Forms for Recording of Willed and Donated Bodies, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs.

BACKGROUND AND JUSTIFICATION

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule amends the section governing the forms used to record willed and donated bodies and the complaint-notice information that must be included in a written contract relating to a willed or donated body. The proposed rule replaces the former Anatomical Board references and updates the required complaint-notice language to direct complaints and inquiries to the Commission, and allows the notice to be provided on the contract form itself or on a separate signed acknowledgement kept with the contract and subject to inspection. The proposed rule is necessary to conform the section to Chapter 691 as amended by Senate Bill 2040 and to implement §691.010, Health and Safety Code, which requires the Commission by rule to establish methods by which service recipients are notified of the Commission’s name, mailing address, and telephone number for the purpose of directing complaints.

SECTION-BY-SECTION SUMMARY

The proposed rule amends the section to update the forms and notice requirements for willed and donated bodies. The proposed amendment continues to require entities operating a willed body program and entities or individuals receiving donated bodies, including those authorized under Chapter 692A, to prepare separate forms for pre-death wills under Chapter 691 and post-death donations under Chapter 692A and to deposit a sample with the Commission; replaces the former complaint-notice language directed to the Anatomical Board with language directing complaints and inquiries to the Commission and requiring the name, mailing address, and telephone number of the Commission; and provides that an entity may comply by including the notice on the contract form itself or on a separate notice acknowledgement signed by the donor at execution and kept with the written contract, subject to inspection by the Commission.

Repealing 22 TAC §206.11, concerning Institutions Authorized to Receive and Hold Bodies, as obsolete and duplicative of the current statutory registration-and-distribution framework.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.11

OVERVIEW

The Texas Funeral Service Commission (Commission) proposes the repeal of §206.11, concerning Institutions Authorized to Receive and Hold Bodies.

BACKGROUND AND JUSTIFICATION

Section 206.11 establishes static lists of “approved” and “disapproved” categories of institutions, organizations, and individuals authorized to receive and hold bodies.

Senate Bill 2040, 88th Legislature, Regular Session (2023) (Act of May 28, 2023, 88th Leg., R.S., ch. 961), effective September 1, 2023, revised the statutory framework governing willed body programs, non-transplant anatomical donation organizations, and anatomical facilities, and transferred regulation to the Commission. Under Texas Health and Safety Code §691.034, a willed body program or non-transplant anatomical donation organization may not operate in this state unless it registers with the Commission in the form and manner the Commission prescribes, and the Commission inspects and may approve willed body programs and anatomical facilities for the receipt and use of bodies and anatomical specimens. Texas Health and Safety Code §691.030 governs the distribution and redistribution of bodies and anatomical specimens to the categories of recipients specified by statute.

The categorical approval and disapproval provisions of §206.11 are duplicative of, and in certain respects inconsistent with, the current statutory registration-and-distribution framework. The Commission therefore proposes to repeal §206.11 as obsolete and duplicative.

Repealing 22 TAC §206.12, concerning Application and Inspection of Facilities, to be replaced simultaneously with a new, more germane rule.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.12

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes a repeal of §206.12, Application and Inspection of Facilities, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. The purpose of the proposed repeal is to eliminate the outdated rule and replace it simultaneously with a new more germane rule.

Adding new 22 TAC §206.12, to establish registration, application, inspection, renewal, ownership-change, relocation, and renovation requirements for entities receiving, using, or transferring donor bodies and anatomical specimens.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.12

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes new §206.12, Registration Application and Inspection of Facilities Required, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. This proposed change is referred to as the “proposed rule.”

BACKGROUND AND JUSTIFICATION

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule establishes the application, registration, inspection, renewal, ownership-change, relocation, and renovation requirements for individuals and entities that receive, use, or transfer donor whole bodies or anatomical specimens under Chapter 691, implementing the Commission’s registration and inspection authority under §691.034. The proposed rule is necessary to implement the Commission’s mandatory duties under §691.034, Health and Safety Code, which requires willed body programs and non-transplant anatomical donation organizations to register with the Commission, requires the Commission to inspect and may approve willed body programs and anatomical facilities, and requires the Commission to adopt rules and procedures necessary to administer registration and inspection, and the Commission’s authority under §691.022(c) to establish registration and inspection requirements and procedures.

SECTION-BY-SECTION SUMMARY

The proposed rule replaces the prior §206.12, which is repealed in a simultaneous rulemaking.

The proposed rule establishes registration, application, and inspection requirements. The proposed rule requires any individual or entity wishing to receive, use, or transfer non-transplant donor whole bodies or anatomical specimens for purposes under Chapter 691 to hold an active and valid registration or authorization before operating in Texas, while exempting an individual who merely attends an event as a student or trainee; specifies the contents of an initial application, including ownership and contact information, a notarized non-ownership statement, facility information, and required documentation of regulatory compliance, consent forms, and internal policies for decedent identification, chain of custody, treatment with dignity and respect, video and photography, and security; requires applicants to pass an on-site inspection unless exempt by statute; provides for issuance, display, and a 12-month term of the authorization or registration certificate; establishes renewal requirements, a late-renewal fee, investigation and non-renewal authority, and cancellation if a renewal application is not received within 60 days of expiration; and establishes requirements for change of ownership, relocation, and renovation, each requiring a new application, the nonrefundable fee, and an on-site inspection.

Repealing 22 TAC §206.14, concerning Final Disposition of the Body and Disposition of Remains, to be replaced simultaneously with a new, more germane rule.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.14

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes a repeal of §206.14, Final Disposition of the Body and Disposition of Remains, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. The purpose of the proposed repeal is to eliminate the outdated rule and replace it simultaneously with a new more germane rule.

BACKGROUND AND JUSTIFICATION

The proposed repeal is proposed under Texas Health and Safety Code, Chapter 691, including §691.001, which defines the terms used in the chapter, and §691.022(c), which requires the Commission to adopt rules, establish procedures, and prescribe forms necessary to administer and enforce the chapter. The proposed repeal is also proposed under Chapter 692A, Health and Safety Code, and under Chapter 651, Occupations Code, including §651.005, which directs the Commission to regulate willed body programs, non-transplant anatomical donation organizations, and anatomical facilities as provided by Chapter 691.

The statutory provisions affected by the proposed repeal are those set forth in Texas Health and Safety Code, Chapter 691, and Chapter 692A; and Texas Occupations Code, Chapter 651.

The legislation that enacted the statutory authority under which the proposed repeal is proposed to be adopted is Senate Bill 2040, 88th Legislature, Regular Session (2023).

Adding new 22 TAC §206.14, to govern final disposition of donor whole bodies and anatomical specimens, including compliance with donor disposition instructions.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.14

OVERVIEW

The Texas Funeral Service Commission (Commission or TFSC) proposes new §206.14, Disposition of the Body and Disposition of Remains, Title 22, Texas Administrative Code (TAC), Chapter 206, regarding Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs. This proposed change is referred to as the “proposed rule.”

BACKGROUND AND JUSTIFICATION

The proposed rule updates Chapter 206 to conform the Commission’s anatomical-donation rules to the statutory framework enacted by Senate Bill 2040, 88th Legislature, Regular Session (2023), which transferred regulation of willed body programs, non-transplant anatomical donation organizations, and anatomical facilities to the Commission and redesignated and amended Chapter 691, Health and Safety Code. The proposed rule amends the section heading and rewrites the section governing the final disposition of a donor whole body or anatomical specimen and the disposition of remains after an authorized entity’s use is complete, including return to the providing entity, burial or cremation in compliance with applicable law, and compliance with donor disposition instructions. The proposed rule is necessary to conform the section to Chapter 691 as amended by Senate Bill 2040; implement the Commission’s general duties under §691.022, including the treatment-with-respect standard under §691.022(b); and ensure that final disposition occurs in compliance with Occupations Code, Chapter 651, and Health and Safety Code, Chapter 716, and with documented donor instructions.

SECTION-BY-SECTION SUMMARY

The proposed rule replaces the prior §206.14, which is repealed in a simultaneous rulemaking.

The proposed rule governs final disposition of donor whole bodies and anatomical specimens. The proposed rule provides that, once a donor whole body or anatomical specimen will no longer be used, an authorized entity prohibited by statute from receiving donations directly should return the donor to the providing entity or, in accordance with the instructions from the donor deliver the same to a licensed crematory and if permitted by the donor, inter or scatter the ashes, and an authorized entity permitted to receive donations directly is to bury or cremate the body in compliance with Occupations Code, Chapter 651, Health and Safety Code, Chapter 716, and the Commission’s rules; requires the authorized entity to comply with the donor’s or donor agent’s instructions regarding final disposition to the extent consistent with applicable law, including the return of cremated remains to the designated individual. If remains are to be returned, the cremation chamber must be cleaned between each use and remains cannot be commingled. The proposed rule does not require the cremation or return of residual soft tissue consumed in the process or research or education, provided the requirements of state law for disposal of this tissue are followed.

Repealing 22 TAC §206.21, concerning Statement of the Willed Body Program, as obsolete since it references offices eliminated by Senate Bill 2040.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.21

OVERVIEW

The Texas Funeral Service Commission (Commission) proposes the repeal of §206.21, concerning Statement of the Willed Body Program.

BACKGROUND AND JUSTIFICATION

Section 206.21 provides that each authorized institution or organization that avails itself of the option of conducting a willed body program should provide the secretary-treasurer of the board with a statement of its program, and that an applicant seeking authorization for the first time should include a statement of the provisional willed body program in its application.

The section refers to the “board” and its “secretary-treasurer” – the Anatomical Board of the State of Texas and an office of that board – which no longer perform regulatory functions following Senate Bill 2040, 88th Legislature, Regular Session (2023) (Act of May 28, 2023, 88th Leg., R.S., ch. 961), effective September 1, 2023, which transferred regulation of willed body programs to the Commission. Under Texas Health and Safety Code §691.034, a willed body program now registers with the Commission in the form and manner the Commission prescribes.

Because §206.21 references offices that no longer exist and is duplicative of the statutory registration requirement, the Commission proposes to repeal it as obsolete.

Repealing 22 TAC §206.22, concerning Requirement for Self-Sufficiency, as an aspirational, non-binding provision that does not correspond to the current statutory distribution framework.

CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.22

OVERVIEW

The Texas Funeral Service Commission (Commission) proposes the repeal of §206.22, concerning Requirement for Self-Sufficiency.

BACKGROUND AND JUSTIFICATION

Section 206.22 provides that schools and other major users of cadavers should establish a willed body program with the goal of becoming self-sufficient in obtaining cadavers for their own use within four years of instituting the program.

The provision is aspirational and non-binding, and it does not correspond to the current statutory framework. Following Senate Bill 2040, 88th Legislature, Regular Session (2023) (Act of May 28, 2023, 88th Leg., R.S., ch. 961), effective September 1, 2023, the Commission distributes and redistributes bodies and anatomical specimens under Texas Health and Safety Code §691.030, giving priority to the schools and colleges that need bodies for lectures and demonstrations and otherwise distributing proportionately and equitably according to student enrollment.

Because §206.22 is aspirational, non-binding, and does not correspond to the current statutory distribution framework, the Commission proposes to repeal it as obsolete.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 26 TAC §504.2, to expand the definition of ectopic pregnancy consistent with Senate Bill 31.

CHAPTER 504. ABORTION FACILITY REPORTING AND LICENSING
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §504.2

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amended §504.2, concerning Definitions.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with Senate Bill (SB) 31, 89th Legislature, Regular Session, 2025. SB 31 amended Texas Health and Safety Code (THSC) Chapter 245 by expanding the definition of ectopic pregnancy to also mean the implantation of a fertilized egg or embryo in an abnormal location in the uterus, or in a scarred portion of the uterus, causing the pregnancy to be non-viable.

The proposal is necessary to ensure consistency with amended THSC §245.002.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §504.2 updates the definition of ectopic pregnancy to read as the implantation of a fertilized egg or embryo occurring outside of the uterus, or in an abnormal location in the uterus, or in a scarred portion of the uterus, causing the pregnancy to be non-viable.

Amending 26 TAC §505.47, to allow general and special hospitals to provide abuse/neglect/exploitation training in person or via live, interactive electronic method, per Senate Bill 437.

CHAPTER 505. HOSPITAL LICENSING
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §505.47

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §505.47, concerning Abuse and Neglect Issues.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with Senate Bill (SB) 437, 89th Legislature, Regular Session, 2025. In part, SB 437 amended Texas Health and Safety Code (HSC) §161.133 to allow in-service training on abuse, neglect, exploitation (ANE) and illegal, unprofessional, and unethical conduct in certain health care facilities to be provided either in person or through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee.

The amendment to §505.47 will allow general and special hospitals to provide in-service training either in person or through a live, interactive, instructor-led and electronic method. Additionally, edits are made to update cross references and correct punctuation.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §505.47 allows general and special hospitals to conduct ANE training through in person or a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee. The amendment also updates cross references to other Texas Administrative Code rules and corrects punctuation.

Amending 26 TAC §564.603, to allow chemical dependency treatment facilities to conduct abuse/neglect/exploitation training virtually, per Senate Bill 437, and reorganize the rule for clarity.

CHAPTER 564. CHEMICAL DEPENDENCY TREATMENT FACILITIES
SUBCHAPTER F. PERSONNEL PRACTICES AND DEVELOPMENT
26 TAC §564.603

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §564.603, concerning Training.

BACKGROUND AND JUSTIFICATION

The proposed amendment is necessary for HHSC to update rules for chemical dependency treatment facilities (CDTFs) as current rules prohibit facilities from conducting ANE training virtually.

Additionally, edits are made to remove outdated language and references and to correct grammar. The rule is also reorganized for clarity and to improve readability.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §564.603 removes outdated language and references and corrects grammar. The rule is also reorganized for clarity and to improve readability. The amendment also adds relevant information for the training program to allow CDTFs to conduct ANE training through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employees.

Amending 26 TAC §568.121, to allow private psychiatric hospitals to conduct abuse/neglect/exploitation training via live, interactive electronic method, per Senate Bill 437.

CHAPTER 568. STANDARDS OF CARE AND TREATMENT IN PSYCHIATRIC HOSPITALS
SUBCHAPTER G. STAFF DEVELOPMENT
26 TAC §568.121

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §568.121, concerning Staff Member Training.

BACKGROUND AND JUSTIFICATION

The proposed amendment to §568.121 allows private psychiatric hospitals (PPHs) to conduct ANE training through in person or a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §568.121 allows PPHs to conduct ANE training through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee. The amendment also updates cross references to Texas Administrative Code rules.

Amending 26 TAC §742.401, to update notification requirements for listed family homes and remove epinephrine auto-injector-specific parental notification language, per House Bill 163.

CHAPTER 742. MINIMUM STANDARDS FOR LISTED FAMILY HOMES
SUBCHAPTER D. NOTIFICATIONS AND LIABILITY INSURANCE REQUIREMENTS
26 TAC §742.401

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §742.401, concerning What are the notification requirements; and the repeal of §742.806, concerning What are the requirements if my home chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement House Bill (HB) 163, 89th Legislature, Regular Session, 2025. HB 163 repealed statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

The proposed amendment and repeal in Chapter 742 removes the parental notification and policy requirements related to unassigned epinephrine auto-injectors for children in listed family homes.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §742.401, What are the notification requirements, changes the rule title to “Notification Requirements,” because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles. The proposed amendment adds statutory and rule references in subsections (a)(1), (b), and (e) because similar rules for other child care operations provide these references. The proposed amendment replaces first-person pronouns with nouns for clarity. The proposed amendment in subsection (c)(3) replaces the requirement for a listed family home caregiver to notify a child’s parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement for a listed family home to notify a child’s parent immediately if the child requires administration of a medication in a medical emergency as described in Chapter 742. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §742.803(e). The proposed amendment uses plain language to improve understanding and effectiveness of the rule.

Repealing 26 TAC §742.806, removing the policy requirement for listed family homes that maintain and administer unassigned epinephrine auto-injectors, per House Bill 163.

CHAPTER 742. MINIMUM STANDARDS FOR LISTED FAMILY HOMES
SUBCHAPTER H. HEALTH AND SAFETY PRACTICES
26 TAC §742.806

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed amendment and repeal in Chapter 742 removes the parental notification and policy requirements related to unassigned epinephrine auto-injectors for children in listed family homes.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §742.806 removes the requirement for a home to have and implement a policy if the home maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child care facilities from the list of entities required to adopt such a policy.

Repealing 26 TAC §743.301, removing the policy requirement for temporary shelter care operations that maintain and administer unassigned epinephrine auto-injectors, per House Bill 163.

CHAPTER 743. MINIMUM STANDARDS FOR SHELTER CARE
SUBCHAPTER D. SAFETY PRACTICES
26 TAC §743.301

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §743.301, concerning What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement House Bill (HB) 163, 89th Legislature, Regular Session, 2025. HB 163 repealed the statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

The proposed repeal in Chapter 743 removes a policy requirement related to unassigned epinephrine auto-injectors for children in temporary shelter care operations.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §743.301 removes the requirement for a temporary shelter care operation to have and implement a policy if the operation maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child care facilities from the list of entities required to adopt such a policy.

Amending 26 TAC §744.307, to update parental notification requirements for school-age and before/after-school programs and align with epinephrine terminology changes.

CHAPTER 744. MINIMUM STANDARDS FOR SCHOOL-AGE AND BEFORE OR AFTER-SCHOOL PROGRAMS
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION, DIVISION 2. REQUIRED NOTIFICATIONS
26 TAC §744.307

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §744.307, concerning What emergency or medical situations must I notify parents about, and §744.701, concerning What written records must I keep of accidents and injuries that occur at my operation.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to amend two sections of Chapter 744 to align the rule language with similarly-amended rules for other operation types.

The proposed amendments in Chapter 744 remove parental notification and incident record requirements related to unassigned epinephrine auto-injectors for children in school-age and before or after-school programs.

The proposed amendments replace first-person pronouns with nouns for clarity and change the titles of the rules because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §744.307, What emergency or medical situations must I notify parents about, changes the rule title to “Emergency and Medical Parental Notifications.” The proposed amendment in subsection (b)(3) replaces the requirement for a child care operation to notify a child’s parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement for a child care operation to notify a child’s parent immediately if the child requires administration of a medication in a medical emergency as described in Chapter 744. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §744.2653(d). The proposed amendment in subsection (b)(4)(A) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk. The proposed amendment in subsection (e) clarifies that an operation must notify parents in writing within 48 hours of learning a child or employee has contracted lice or another communicable parasite and how to provide the written notice.

Amending 26 TAC §744.701, to update accident and incident recordkeeping requirements for school-age and before/after-school programs.

CHAPTER 744. MINIMUM STANDARDS FOR SCHOOL-AGE AND BEFORE OR AFTER-SCHOOL PROGRAMS
SUBCHAPTER C. RECORD KEEPING, DIVISION 2. RECORDS OF ACCIDENTS AND INCIDENTS
26 TAC §744.701

OVERVIEW

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to amend two sections of Chapter 744 to align the rule language with similarly-amended rules for other operation types.

The proposed amendments replace first-person pronouns with nouns for clarity and change the titles of the rules because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §744.701, What written records must I keep of accidents and incidents that occur at my operation, changes the rule title to “Accident and Incident Records.” The proposed amendment, in paragraph (3), replaces the requirement for a child care operation to keep a written record of an incident where a child in care had an emergency anaphylaxis reaction that required use of an unassigned epinephrine auto-injector with a requirement for a child care operation to keep a written record of an incident that required administration of a medication to a child in a medical emergency as described in Chapter 744 for consistency with the proposed amendment to §744.307(b)(3). The proposed amendment in §744.307(b)(4)(A) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

Repealing 26 TAC §745.469, removing the policy requirement for employer-based child care operations that maintain and administer unassigned epinephrine auto-injectors, per House Bill 163.

CHAPTER 745. LICENSING
SUBCHAPTER D. APPLICATION PROCESS, DIVISION 11. EMPLOYER-BASED CHILD CARE
26 TAC §745.469

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §745.469, concerning What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND JUSTIFICATION

The proposed repeal in Chapter 745 removes a policy requirement related to unassigned epinephrine auto-injectors for children in employer-based child care operations.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §745.469 removes the requirement for employer-based child care operations to have and implement a policy if the operation maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child-care facilities from the list of entities required to adopt such a policy.

Amending 26 TAC §746.307, to update parental notification requirements for child care centers and expand allowable epinephrine delivery devices, per Senate Bill 1619 and House Bill 163.

CHAPTER 746. MINIMUM STANDARDS FOR CHILD CARE CENTERS
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION, DIVISION 2. REQUIRED NOTIFICATION
26 TAC §746.307

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §746.307, concerning What emergency or medical situations must I notify parents about; §746.701, concerning What written records must I keep of accidents and injuries that occur at my child-care center; and §746.801, concerning What records must I keep at my child-care center.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement Senate Bill (SB) 1619, Section 27, and House Bill (HB) 163, from the 89th Legislature, Regular Session, 2025.

SB 1619, Section 27, amended Texas Human Resources Code (HRC) §42.067(a) by adding the term “epinephrine delivery system” to expand the allowable unassigned epinephrine devices to include epinephrine nasal spray in addition to an epinephrine auto-injector.

HB 163 repealed the statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

The proposed amendments to §746.307 and §746.701 remove parental notification and incident report requirements related to unassigned epinephrine auto-injectors for children in child care centers.

The proposed amendment to §746.801 updates epinephrine terminology in a reporting requirement for a child care center that has an epinephrine policy.

The proposed amendments also change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles. The proposed amendments remove references to other rules to avoid the need for HHSC to amend rules when referenced rules change. The proposal changes the spelling of “child-care” to “child care” in the title of Chapter 746, the title of Division 3 in Subchapter C, and in the rule text.

The proposed amendments replace first-person pronouns nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §746.307, What emergency or medical situations must I notify parents about, changes the rule title to “Emergency and Medical Parental Notifications;” The proposed amendment in subsection (b)(3) replaces the requirement for a child care center to notify a child’s parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement to notify a child’s parent immediately if the child required emergency administration of a medication. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §746.3803(d). The proposed amendment in subsection (b)(4) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

Amending 26 TAC §746.701, to update accident and incident recordkeeping requirements for child care centers.

CHAPTER 746. MINIMUM STANDARDS FOR CHILD CARE CENTERS
SUBCHAPTER C. RECORD KEEPING, DIVISION 2. RECORDS OF ACCIDENTS AND INCIDENTS
26 TAC §746.701

OVERVIEW

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement Senate Bill (SB) 1619, Section 27, and House Bill (HB) 163, from the 89th Legislature, Regular Session, 2025.

The proposed amendments to §746.307 and §746.701 remove parental notification and incident report requirements related to unassigned epinephrine auto-injectors for children in child care centers.

The proposed amendment to §746.801 updates epinephrine terminology in a reporting requirement for a child care center that has an epinephrine policy.

The proposed amendments replace first-person pronouns nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §746.701, What written records must I keep of accidents and incidents that occur at my child-care center, changes the rule title to “Accident and Incident Records.” The proposed amendment in paragraph (3) replaces the requirement for a child care operation to keep a written record of an incident where a child in care had an emergency anaphylaxis reaction that required use of an unassigned epinephrine auto-injector with a requirement for a child care center to keep a written record of an incident when a child in care required administration of an emergency medication for consistency with the proposed amendment to §746.307(b)(3). The proposed amendment in paragraph (5) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

Amending 26 TAC §746.801, to update epinephrine terminology in child care center recordkeeping requirements.

CHAPTER 746. MINIMUM STANDARDS FOR CHILD CARE CENTERS
SUBCHAPTER C. RECORD KEEPING, DIVISION 3. RECORDS THAT MUST BE KEPT ON FILE AT THE CHILD CARE CENTER
26 TAC §746.801

OVERVIEW

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement Senate Bill (SB) 1619, Section 27, and House Bill (HB) 163, from the 89th Legislature, Regular Session, 2025.

The proposed amendments to §746.307 and §746.701 remove parental notification and incident report requirements related to unassigned epinephrine auto-injectors for children in child care centers.

The proposed amendment to §746.801 updates epinephrine terminology in a reporting requirement for a child care center that has an epinephrine policy.

The proposed amendments replace first-person pronouns nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §746.801, What records must I keep at my child-care center, changes the rule title to “Operation Records Maintained at the Child Care Center.” The proposed amendment in paragraph (4) changes the term “licensing” to “Child Care Regulation” or “CCR.” The proposed amendment in paragraph (23) for a child care center that maintains and administers an unassigned epinephrine delivery system, updates the name of a Texas Department of State Health Services reporting form and explains that the form is used to report the administration of an unassigned epinephrine delivery system.

Amending 26 TAC §747.305, to update parental notification requirements for licensed and registered child care homes, per House Bill 163.

CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE HOMES
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION, DIVISION 2. REQUIRED NOTIFICATIONS
26 TAC §747.305

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §747.305, concerning What emergency and medical situations must I notify parents about, §747.501, concerning What written operational policies must I have, and §747.701, concerning What written records must I keep of accidents and injuries that occur at my child-care home.

BACKGROUND AND JUSTIFICATION

The proposed amendments in Chapter 747 remove parental notification and incident reporting requirements related to unassigned epinephrine auto-injectors for children in licensed and registered child care homes.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles. The proposed amendments remove references to other rules to avoid the need for HHSC to amend rules when referenced rules change. The proposal changes the spelling of “child-care” to “child care” in the title of Chapter 747 and makes the same changes where needed in the rule text.

The proposed amendments replace first-person pronouns with nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §747.305, What emergency and medical situations must I notify parents about, changes the rule title to “Emergency and Medical Parental Notifications.” The proposed amendment in subsection (b)(3) replaces the requirement for a child care home to notify a child’s parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement for a child care home to notify a child’s parent immediately if the child required emergency administration of a medication. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §747.3603(d). The proposed amendment in paragraph (4) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk. The proposed amendment in subsection (e) clarifies that a child care home must notify parents in writing within 48 hours of learning a child or employee has contracted lice or another communicable parasite and how to provide the written notice.

Amending 26 TAC §747.501, to remove the requirement for child care homes to have an unassigned epinephrine auto-injector policy, per House Bill 163.

CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE HOMES
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION, DIVISION 4. OPERATIONAL POLICIES
26 TAC §747.501

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed amendments replace first-person pronouns with nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §747.501, What written operational policies must I have, changes the rule title to “Operational Policies and Procedures Requirements.” The proposed amendment removes the requirement in paragraph (14) for a child care home to have and implement a policy if the home maintains, administers, and disposes of unassigned epinephrine auto-injectors because the statutory changes enacted by HB 163 removed child care facilities from the list of entities required to adopt such a policy. The proposed amendment revises the list of policies and procedures a child care home must have for better organization and readability.

Amending 26 TAC §747.701, to update accident and incident recordkeeping requirements for child care homes.

CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE HOMES
SUBCHAPTER C. RECORD KEEPING, DIVISION 2. RECORDS OF ACCIDENTS AND INCIDENTS
26 TAC §747.701

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed amendments replace first-person pronouns with nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §747.701, What written records must I keep of accidents and injuries that occur at my child-care home, changes the rule title to “Accident and Incident Records.” The proposed amendment replaces the requirement for a child care home to keep a written record of an incident where a child in care had an emergency anaphylaxis reaction that required use of an unassigned epinephrine auto-injector with a requirement for a child care home to keep a written record of an incident where a child in care required administration of an emergency medication for consistency with the proposed amendment to §747.305(b)(3). The proposed amendment in paragraph (5) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

Repealing 26 TAC §748.2271 and Division 8, removing the unassigned epinephrine auto-injector policy requirement for general residential operations, per House Bill 163.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER L. MEDICATION, DIVISION 8. UNASSIGNED EPINEPHRINE AUTO-INJECTORS
26 TAC §748.2271

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §748.2271, concerning What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND JUSTIFICATION

The proposed repeal in Chapter 748 removes a policy requirement related to unassigned epinephrine auto-injectors for children in general residential operations (GROs).

SECTION-BY-SECTION SUMMARY

The proposed repeal of §748.2271 removes the requirement for a GRO to have and implement a policy if the GRO maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child-care facilities from the list of entities required to adopt such a policy.

The proposed repeal of Division 8, Unassigned Epinephrine Auto-Injectors, in Subchapter L, is necessary because §748.2271 is the only rule in the division.

Adopted Rules Re:

Adopting new 26 TAC §§307.401, 307.403, 307.405, 307.407, 307.409, 307.411, 307.413, 307.415, 307.417, and 307.419, to establish requirements for providers delivering Coordinated Specialty Care for First Episode Psychosis (CSC-FEP) program services.

CHAPTER 307. BEHAVIORAL HEALTH PROGRAM
SUBCHAPTER H. COORDINATED SPECIALTY CARE FOR FIRST EPISODE PSYCHOSIS PROGRAM
26 TAC §§307.401, 307.403, 307.405, 307.407, 307.409, 307.411, 307.413, 307.415, 307.417, 307.419

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC), in Texas Administrative Code Title 26, Part 1, Chapter 307 adopts new Subchapter H consisting of new §307.401, concerning Purpose; §307.403, concerning Application; §307.405, concerning Definitions; §307.407, concerning Eligibility Requirements; §307.409, concerning Program Requirements; §307.411, concerning Staffing Requirements; §307.413, concerning Training Requirements; §307.415, concerning Outreach Plan; §307.417, concerning Service Provision; and §307.419, concerning Waiver Request.

Section 307.409 is adopted with changes to the proposed text as published in the March 20, 2026, issue of the Texas Register (51 TexReg 1794). This rule will be republished.

Sections 307.401, 307.403, 307.405, 307.407, 307.411, 307.413, 307.415, 307.417, and 307.419 are adopted without changes to the proposed text as published in the March 20, 2026, issue of the Texas Register (51 TexReg 1794). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to establish requirements for providers delivering Coordinated Specialty Care for First Episode Psychosis (CSC-FEP) program services. These new rules outline provider qualifications, staffing requirements, training requirements, program structure, and service delivery expectations to ensure individuals experiencing a first episode of psychosis receive comprehensive, evidence-based treatment and support.

The new rules define key terms, establish eligibility criteria, and describe required services, including psychotherapy, family education and support, peer support, medication management, and support for employment and education. The new rules also set requirements for treatment team composition, service planning, documentation, safety planning, and coordination of care.

The new rules further establish expectations for provider oversight, including training requirements, outreach planning, and processes for waiver requests. These provisions promote consistency, accountability, and quality in the delivery of CSC-FEP services across contracted providers.

Amending 26 TAC §§561.1 – 561.9, to implement Senate Bill 1849 and House Bill 3560 and consolidate Employee Misconduct Registry rules into one chapter.

CHAPTER 561. EMPLOYEE MISCONDUCT REGISTRY
26 TAC §§561.1 – 561.9

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §561.1, concerning Purpose; §561.2, concerning Definitions; §561.3, concerning Employment and Registry Information; §561.4, concerning Investigations; §561.5, concerning Results of Investigation and Notice to Employee; §561.6, concerning Informal Review; §561.7, concerning Reportable Conduct Finding and Notice and Opportunity for Administrative Hearing; §561.8, concerning Entering Information in the EMR; and §561.9, concerning Removal from Employee Misconduct Registry.

Sections 561.1 and 561.3 – 561.9 are adopted without changes to the proposed text as published in the March 27, 2026, issue of the Texas Register (51 TexReg 1998). These rules will not be republished.

Section 561.2 is adopted with changes to the proposed text as published in the March 27, 2026, issue of the Texas Register (51 TexReg 1998). This rule will be republished.

BACKGROUND AND JUSTIFICATION

The adoption is necessary to implement Senate Bill (SB) 1849, 88th Legislature, Regular Session, 2023 and House Bill (HB) 3560, 89th Legislature, Regular Session, 2025.

SB 1849 amended Texas Health and Safety Code §253.010, which allows HHSC to amend rules related to the Employee Misconduct Registry (EMR) to establish criteria for a person to submit a request to be removed from the EMR and establish a process to determine whether a person meets the requirements for inclusion in the EMR.

SB 1849 also created new Texas Health and Safety Code (HSC) Chapter 810, Interagency Reportable Conduct Search Engine, known as Search Engine for Multi-Agency Reportable Conduct (SEMARC), which requires HHSC to amend rules to incorporate information and requirements established by new Chapter 810 relating to:

(1) definitions;

(2) designation of employees and contractors who are eligible to access the search engine;

(3) designation of additional users who are eligible to access the search engine, which may include controlling persons, hiring managers, or administrators;

(4) clarifying that an individual in the search engine is not entitled to notice or a hearing before the information is shared with another state agency or a designated user;

(5) conducting initial and periodic searches to determine whether an individual who may have access to a client has engaged in reportable conduct, and, if so, whether the individual is ineligible for employment, a volunteer position, a contract, or a license;

(6) providing notice and a due process hearing to an individual if HHSC denies, revokes, or suspends a contract or license based on that individual’s reportable conduct under agency rules according to §810.006; and

(7) requiring that information contained in the search engine results and information shared with other agencies is confidential.

HB 3560 amended the definition of “facility” regarding the Employee Misconduct Registry in HSC §253.001(4) to include facilities licensed under HSC Chapter 577, Private Mental Hospitals and Other Mental Health Facilities. This adoption updates the definition of “facility” in the rules.

The adoption improves access to the rules related to the Employment Misconduct Registry by consolidating them into one chapter in the Texas Administrative Code.

The adoption is also necessary to update rules and to improve the readability and understanding of the rules.

Repealing 26 TAC §§711.1401 – 711.1404, 711.1406 – 711.1408, 711.1413 – 711.1415, 711.1417, 711.1419, 711.1421, 711.1423, 711.1425 – 711.1427, 711.1429, 711.1431, 711.1432, and 711.1434, to remove duplicate Employee Misconduct Registry rules consolidated into Chapter 561.

CHAPTER 711. INVESTIGATIONS OF INDIVIDUALS RECEIVING SERVICES FROM CERTAIN PROVIDERS
SUBCHAPTER L. EMPLOYEE MISCONDUCT REGISTRY
26 TAC §§711.1401 – 711.1404, 711.1406 – 711.1408, 711.1413 – 711.1415, 711.1417, 711.1419, 711.1421, 711.1423, 711.1425 – 711.1427, 711.1429, 711.1431, 711.1432, 711.1434

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts the repeal of §§711.1401 – 711.1404, 711.1406 – 711.1408, 711.1413 – 711.1415, 711.1417, 711.1419, 711.1421, 711.1423, 711.1425 – 711.1427, 711.1429, 711.1431, 711.1432, and 711.1434, concerning Employee Misconduct Registry.

Sections 711.1401 – 711.1404, 711.1406 – 711.1408, 711.1413 – 711.1415, 711.1417, 711.1419, 711.1421, 711.1423, 711.1425 – 711.1427, 711.1429, 711.1431, 711.1432, and 711.1434 are adopted without changes to the proposed text as published in the March 27, 2026, issue of the Texas Register (51 TexReg 2005). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the adoption is to remove duplicate rules from the Texas Administrative Code and consolidate the rules into one chapter relating to the Employee Misconduct Registry in 26 TAC Chapter 561. The relevant information in these rules is incorporated into the rules in Chapter 561 with updates for clarification and to align the rules with statute.

In Addition Re:

Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on July 24, 2026, at 9:00 a.m. to receive public comments on proposed Medicaid payment rates for the Rural Hospital Obstetrics and Gynecology (OB-GYN) Standard Dollar Amount (SDA) add-on. Proposed legislative rate actions are based on Texas Government Code 526.0301 (b) and (c).

This hearing will be conducted both in person and online. The hearing will be held in compliance with Texas Human Resources Code Section 32.0282, which requires public notice of and hearings on proposed Medicaid reimbursement rates.

Proposal: The rate actions for the following services are proposed to be effective Sept. 1, 2026:

(A) Legislative Rate Updates

A (1) Rural Hospital OB-GYN SDA add-on

Methodology and Justification: The proposed payment rates were calculated in accordance with the Texas State Plan Amendment pages 4.19-A 8h and 8h.1.

Written comments regarding the proposed payment rates may be submitted instead of, or in addition to, oral testimony until 5:00 p.m. on the day of the hearing.

Texas Department of State Health Services

In Addition Re:

Notice Reinstating Clarifications to the Definitions of Tetrahydrocannabinols and Marihuana Extract to the 2021 Schedule of Controlled Substances, Pursuant to the Opinion Delivered by the Supreme Court of Texas on May 1, 2026.

Texas Board of Nursing

In Addition Re:

Correction of Error

The Texas Board of Nursing proposed amendments to 22 TAC §216.9 in the March 20, 2026, issue of the Texas Register (51 TexReg 1789). Due to an error by the Texas Register, the introductory text preceding the paragraphs in this section was published incorrectly. The correct text should read as follows:

The Board may audit any licensee’s continuing competency to monitor the continuing education tracking system vendor’s performance and to verify licensee compliance. Notification shall be sent to selected licensees. Licensees will have 90 days to show compliance with the Board’s audit. [The Board shall select a random sample of licensees 90 days prior to each renewal month. Notification shall be sent to selected licensees to substantiate compliance with the continuing competency requirements.]