Texas Register June 25, 2021 Volume: 46 Number: 25

Office of the Attorney General

June 25, 2021: Re: Authority of the Behavioral Health Executive Council to adopt a rule prohibiting certain discriminatory conduct by licensed social workers (RQ-0391-KP).

SUMMARY

The Legislature authorized the Behavioral Health Executive Council to take disciplinary action against social workers who refuse to perform an act or service within the scope of their licenses solely because of the recipient’s age, sex, race, religion, national origin, color, or political affiliation. The Council adopted a rule changing the word “sex” to “gender” and authorizing disciplinary action for refusal of service based on disability, sexual orientation, and gender identity and expression. In doing so, the Council exceeded the authority granted to it by the Legislature by rewriting the language chosen by the Legislature and imposing additional restrictions in excess of the relevant statutory provisions. A court would likely conclude that the rule is invalid to the extent that it is inconsistent with and exceeds the Council’s statutory authority.

No Texas statute prohibits discrimination based on sexual orientation or gender identity or expression, and the U.S. Supreme Court has emphasized that religious and philosophical objections to categories of sexual orientation are protected views and in some instances protected forms of expression under the First Amendment. If the Legislature intends otherwise, it may expressly amend the statute to so provide. A Council rule prohibiting that expression conflicts with the longstanding constitutional protection for an individual’s free exercise of religion.

While a social worker may not discriminate based on disability in contravention of state and federal law, the Council lacks statutory authority to discipline a licensee for discrimination based on disability.

Texas Department on Aging and Disability Services

June 25, 2021: Emergency Rule Renewing 40 TAC §§3.401 – 3.403 to amend staff training requirements at state-supported living centers in response to COVID-19

CHAPTER 3. RESPONSIBILITIES OF STATE FACILITIES

SUBCHAPTER D. TRAINING

40 TAC §§3.401 – 3.403

OVERVIEW

The Department of Aging and Disability Services is renewing the effectiveness of emergency amended §§3.401 – 3.403 for a 60-day period. The text of the emergency rule was originally published in the February 26, 2021, issue of the Texas Register (46 Tex Reg 1316).

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) renews on an emergency basis in Title 40 Texas Administrative Code, Chapter 3, Responsibilities of State Facilities, amendments to the following rules to ensure necessary state supported living center staffing levels and infection control during the COVID-19 pandemic:

• §3.401 (Training for New Employees)

• §3.402 (Additional Training for Direct Support Professionals)

• §3.403 (Refresher Training)

HHSC previously adopted emergency rules concerning staff training to efficiently and effectively deploy staff to meet basic needs during the COVID-19 pandemic, without posing risk to the individuals served. As the COVID-19 pandemic and the Governor’s proclamation of disaster have continued, so has the need for training requirements that ensure adequate training and staffing levels at state supported living centers. These emergency rules update training requirements to require training of infection control specific to COVID-19, including prevention, screening, isolation, and the use of personal protective equipment.

BACKGROUND AND JUSTIFICATION

As authorized by Texas Government Code §2001.034, the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

The purpose of the emergency rulemaking is to support the Governor’s March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. HHSC accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of these training rules.

Texas Department of State Health Services

June 25, 2021: Adopted Rules Renewing 25 TAC §417.47 to require training of infection-control practices specific to COVID-19

CHAPTER 417. AGENCY AND FACILITY RESPONSIBILITIES

SUBCHAPTER A. STANDARD OPERATING PROCEDURES

25 TAC §417.47

OVERVIEW

The Department of State Health Services is renewing the effectiveness of emergency amended §417.47 for a 60-day period. The text of the emergency rule was originally published in the February 26, 2021, issue of the Texas Register (46 Tex Reg 1311).

HHSC previously adopted emergency rules concerning staff training in order to efficiently and effectively deploy staff to meet basic needs during the COVID-19 pandemic, without posing risk to the individuals served. As the COVID-19 pandemic and the Governor’s proclamation of disaster have continued, so has the need for training requirements that ensure adequate training and staffing levels at state hospitals. This emergency rule updates those training requirements to require training of infection control specific to COVID-19, including prevention, screening, isolation, and the use of personal protective equipment.

BACKGROUND AND JUSTIFICATION

As authorized by Texas Government Code §2001.034, the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

The purpose of the emergency rulemaking is to support the Governor’s March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. HHSC accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this standard operating procedures.

46 TexReg 3781

June 25, 2021: Adopted Rules Repealing 25 TAC, Chapter 295, Subchapter C, and replacing with new Chapter 296 to update and expand on Asbestos health protection requirements

CHAPTER 295. OCCUPATIONAL HEALTH

SUBCHAPTER C. TEXAS ASBESTOS HEALTH PROTECTION

25 TAC §§295.31 – 295.73

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts the repeal of §§295.31 – 295.73, concerning Texas Asbestos Health Protection, and adoption of new Chapter 296, Subchapters A-Q, Texas Asbestos Health Protection.

The repeal of Chapter 295, Subchapter C, and adoption of new Chapter 296, Subchapter A-Q, update training, licensing, and work practice requirements; incorporates guidance from 22 separately-published rule clarifications; and implements amendments to Texas statutes.

BACKGROUND AND JUSTIFICATION

The repeal of the rules located in 25 Texas Administrative Code, Chapter 295, Subchapter C, Texas Asbestos Health Protection, §§295.31 – 295.73 is necessary to replace with new rules in Chapter 296, Subchapters A-Q, Texas Asbestos Health Protection. The new Chapter 296 is adopted elsewhere in this issue of the Texas Register.

46 TexReg 3880

June 25, 2021: In Addition Amendment Placing Five Fentanyl-related Substances into Schedule I; Temporarily Placing Brorphine into Schedule I, and Permanently Placing Lemborexant into Schedule IV

Amendment Placing Five Fentanyl-related Substances into Schedule I; Temporarily Placing Brorphine into Schedule I, and Permanently Placing Lemborexant into Schedule IV

OVERVIEW

The Drug Enforcement Administration issued a final rule placing cyclopentyl fentanyl (N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopentanecarboxamide), isobutyryl fentanyl (N-(1-phenethylpiperidin-4-yl)-N-phenylisobutyramide), p-chloroisobutyryl fentanyl (N-(4-chlorophenyl)-N-(1-phenethylpiperidin-4- yl)isobutyramide), p-methoxybutyryl fentanyl (N-(4-methoxyphenyl)-N-(1- phenethylpiperidin-4-yl)butyramide), and valeryl fentanyl (N-(1- phenethylpiperidin-4-yl)-N-phenylpentanamide), including their isomers, esters, ethers, salts, and salts of isomers, esters, and ethers whenever the existence of such isomers, esters, ethers, and salts is possible, into Schedule I of the Controlled Substances Act. This final rule was published in the November 25, 2020 issue of the Federal Register, Volume 85, Number 228, pages 75231-75235 and was effective November 25, 2020.

For a full pdf of the amendment, visit 46 Tex Reg 3957.

Texas Health and Human Services Commission

June 25, 2021: Emergency Rule New 26 TAC §551.46, describing requirements for containing COVID-19 at intermediate care facilities for individuals with an intellectual disability or related condition

CHAPTER 551. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS

SUBCHAPTER C. STANDARDS FOR LICENSURE

26 TAC §551.46

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26, Part 1, Texas Administrative Code, Chapter 551, Subchapter C, new §551.46, concerning an emergency rule to mitigate and contain COVID-19 in an intermediate care facility for individuals with an intellectual disability (ICF/IID) or related condition.

The purpose of the new rule is to describe requirements for ICF/IID Provider Response to COVID-19.

BACKGROUND AND JUSTIFICATION

As authorized by Texas Government Code §2001.034, the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

The purpose of this emergency rulemaking is to support the Governor’s March 13, 2020 proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. HHSC accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this emergency rule for ICF/IID Provider Response to COVID-19 – Mitigation.

46 TexReg 3781

June 25, 2021: Emergency Rule Renewing 26 TAC §551.48 to outline COVID-19 vaccination reporting requirements for intermediate care facilities for individuals with an intellectual disability or related condition

CHAPTER 551. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS

SUBCHAPTER C. STANDARDS FOR LICENSURE

26 TAC §551.48

OVERVIEW

The Health and Human Services Commission is renewing the effectiveness of emergency new §551.48 for a 60-day period. The text of the emergency rule was originally published in the February 26, 2021, issue of the Texas Register (46 Tex Reg 1315).

HHSC is renewing an emergency rule to require ICF/IIDs to accurately report COVID-19 vaccination data for staff and residents in the format established by HHSC within 24 hours of completing or receiving a round of vaccinations. The emergency rule is necessary to accurately track vaccinations of staff and residents in intermediate care facilities in Texas.

BACKGROUND AND JUSTIFICATION

As authorized by Texas Government Code, §2001.034, HHSC may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code, §2001.034, may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

The purpose of the emergency rulemaking is to support the Governor’s March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. HHSC accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this emergency rule for ICF/IID Provider COVID-19 Vaccination Data Reporting Requirement.

46 TexReg 3783

June 25, 2021: Proposed Rules Amending 1 TAC §355.8052 to provide clarity concerning Medicaid reimbursement for inpatient treatment at certain hospitals

CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER J. PURCHASED HEALTH SERVICES

DIVISION 4. MEDICAID HOSPITAL SERVICES

1 TAC §355.8052

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §355.8052, concerning Inpatient Hospital Reimbursement.

BACKGROUND AND JUSTIFICATION

The purpose of the proposed amendment to §355.8052 is to comply with Senate Bill 170 (S.B. 170), 86th Legislature, Regular Session 2019 and Senate Bill 1621 (S.B. 1621), 86th Legislature, Regular Session, 2019, and to make other amendments to enhance clarity, consistency, and specificity. HHSC is required by S.B. 170, to the extent allowed by law, to calculate Medicaid rural hospital inpatient rates using a cost-based prospective reimbursement methodology. Additionally, HHSC must calculate rates for rural hospitals once every two years, using the most recent cost information available. The current rule does not require a biennial review of the rural hospital rates. Rates have not been realigned or rebased since state fiscal year 2014. Previously, HHSC converted the rural hospital reimbursement from the methodology described in the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) to the prospective payment All Patient Refined Diagnosis Related Group (APR-DRG) methodology.

Pursuant to S.B. 1621 and S.B. 170, HHSC’s managed care contracts require managed care organizations to reimburse rural hospitals using a minimum fee schedule for services delivered through the Medicaid managed care program. The proposed amendment adds subsection (e)(4), requiring a Medicaid minimum fee schedule for all rural hospitals, to conform the rule to the current law as well.

Presently, §355.8052 explains the standard dollar amount (SDA) rate setting process by addressing the multiple hospital types (rural, urban, and children’s), concurrently. The proposed amendment arranges the rule by hospital type to enhance clarity, consistency, and specificity. The amendment adds and modifies definitions, including “rebasing” and “realignment.” The proposed amendment also specifies a policy for updating DRG statistical calculations to align with 3MTM Grouper changes.

SECTION-BY-SECTION SUMMARY

A detailed summary of changes made by the proposed amendments is included in this week’s edition of the Texas Register (46 Tex Reg 3785).

46 TexReg 3785

June 25, 2021: Adopted Rules Amending 1 TAC §355.8065 to update reimbursement methodology for disproportionate share hospitals

CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER J. PURCHASED HEALTH SERVICES

DIVISION 4. MEDICAID HOSPITAL SERVICES

1 TAC §355.8065

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology. Section 355.8065 is adopted with changes to the proposed text as published in the April 16, 2021, issue of the Texas Register (46 Tex Reg 2533). The rule will be republished.

BACKGROUND AND JUSTIFICATION

The Disproportionate Share Hospital (DSH) program payments are made by HHSC to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. Federal law establishes an annual DSH allotment for each state that limits Federal Financial Participation (FFP) for total statewide DSH payments made to hospitals. Federal law also limits FFP for DSH payments through the hospital-specific DSH limit. In Texas, the state has established a State Payment Cap that limits the amount of payments that a provider receives through the interim payment process. This adoption amends the definitions of certain provider classes and makes other clarifying amendments.

Historically, HHSC has allowed state institutions of mental disease (IMDs) to participate in the DSH program. However, the current rule makes no mention of State IMDs nor the fact that IMDs have been recognized as state-owned providers for many years. The adoption amends the definition of state-owned hospitals to be broader and include these hospitals.

The definition of “Urban public hospitals – Class one” is amended to clarify that the providers in this class must be owned-and-operated by the hospital districts included in the provider class.

The DSH rule requires providers to maintain a Trauma system designation or actively pursue one. Yet several providers do not have them because the designation does not fit the hospital’s function. Children’s hospitals, IMDs, and State IMDs generally fall into this misalignment category. However, the rule makes no mention of an exemption for these providers though it has been established practice to exempt them from this requirement. HHSC adopts this amendment to explicitly exempt these providers.

The DSH rule currently has no provision for the DSH advanced payment methodology and leaves it up to HHSC’s discretion. The Provider Finance Department has been using a methodology for several years to accomplish this payment and the rule amendment incorporates the established methodology into the rule.

46 TexReg 3857

June 25, 2021: Adopted Rules New 1 TAC §355.8215, describing requirements for participation in the Public Health Provider – Charity Care Program (PHP-CCP)

CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER J. PURCHASED HEALTH SERVICES

DIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT

1 TAC §355.8215

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts new §355.8215, concerning Public Health Provider – Charity Care Program (PHP-CCP). New §355.8215 is adopted with changes to the proposed text as published in the March 19, 2021, issue of the Texas Register (46 Tex Reg 1715). The text of the rule will be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the new rule is to authorize HHSC to implement the PHP-CCP under the 1115 waiver to reimburse certain costs for qualifying providers associated with providing care, including behavioral health, immunizations, chronic disease prevention, and other preventative services for the uninsured. This program was created as part of the 1115 waiver extension and will provide an opportunity for reimbursement of charity care costs (or Medicaid shortfall in the first year of the program). The new rule describes the requirements for participation in the PHP-CCP.

In accordance with the Special Terms and Conditions of the 1115 waiver, to participate in the program, providers must be funded by a unit of government to be able to certify public expenditures. Publicly-owned and operated Community Mental Health Clinics (CMHCs), community centers, Local Behavioral Health Authorities (LBHAs), and Local Mental Health Authorities (LMHAs) that are established under the Texas Health and Safety Code Chapters 533 or 534 and are primarily providing behavioral health services, and Local Health Departments (LHDs) and Public Health Districts (PHDs) that are established under the Texas Health and Safety Code Chapter 121 are eligible to participate.

46 TexReg 3869

June 25, 2021: In Addition Notice of Post Award Forum for the 1115 Texas Healthcare Transformation Quality Improvement Program Waiver (THTQIP Waiver)

Notice of Post Award Forum for the 1115 Texas Healthcare Transformation Quality Improvement Program Waiver (THTQIP Waiver)

OVERVIEW

The Health and Human Services Commission (HHSC) will conduct a virtual post award forum and public hearing on July 14, 2021, beginning at 9:30 a.m. (CDT) to provide updates and to solicit feedback and receive comment on the progress of the extension of the 1115 Texas Healthcare Transformation Quality Improvement Program (THTQIP) Waiver extension that was approved January 15, 2021.

HEARING DETAILS

The hearing will be conducted virtually using GoToWebinar only. To join the hearing, go to https://attendee.gotowebinar.com/register/5517627940174108940.

The agenda for the hearing is:

1. Welcome and introductions;

2. Post-Award Forum on the THTQIP Waiver extension approved January 15, 2021;

3. Public comment; and

4. Adjournment.

PUBLIC COMMENT

Written comments may be submitted instead of, or in addition to, oral testimony until 5:00 p.m. on Wednesday July 14th, 2021. Written comments may be submitted by U.S. mail to the Texas Health and Human Services Commission, Attention: Basundhara Raychaudhuri, Waiver Coordinator, Policy Development Support, Mail Code H-600, P.O. Box 13247, Austin, Texas 78711-3247; by fax to Basundhara Raychaudhuri at (512) 206-3975; or by e-mail to TX_Medicaid_Waivers@hhsc.state.tx.us.

46 TexReg 3955

June 25, 2021: In Addition Notice of Public Hearing on Proposed Payment Rates for Pediatric Long-term Care Facilities

Notice of Public Hearing on Proposed Payment Rates for Pediatric Long-term Care Facilities

OVERVIEW

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on July 12, 2021, at 9:00 a.m., to receive public comments on the proposed payment rates for Pediatric Long-term Care Facilities.

HEARING DETAILS

The hearing will be conducted online only. Physical entry to the hearing will not be permitted. To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance using the following link:

https://attendee.gotowebinar.com/register/825080537950819086.

After registering, you will receive a confirmation email containing information about joining the hearing. You can also dial in using your phone at (415) 655-0060, access code: 451-524-012.

If you are new to GoToWebinar, please download the GoToMeeting app at https://global.gotomeeting.com/install/626873213 before the hearing starts.

BACKGROUND AND JUSTIFICATION

HHSC proposes to increase the per diem rate for Pediatric Long-term Care Facilities to $383.08, effective September 1, 2021.

The rate increase is proposed in order to comply with the 2022-2023 General Appropriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular Session, 2021, (Article II, HHSC, Rider 40), which requires a rate methodology revision for pediatric long-term care facilities to mirror Medicare rates. HHSC intends to revise the rate methodology published in Title 1 of the Texas Administrative Code, §355.307, relating to Reimbursement Setting Methodology, in accordance with Rider 40 so that the rate for all facilities in this special reimbursement class of nursing facilities will be based upon the unadjusted federal per diem rate for rural Medicare skilled nursing facilities for the most recent federal fiscal year. HHSC also intends to propose a new rule as part of this methodological revision.

PUBLIC COMMENT

Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing. Written comments may be sent by U.S. mail to the Texas Health and Human Services Commission, Attention: Provider Finance, Mail Code H-400, P.O. Box 149030, Austin, Texas 78714-9030; by fax to Provider Finance at (512) 730-7475; or by email to PFD-LTSS@hhs.texas.gov. In addition, written comments may be sent by overnight mail or hand delivered to Texas Health and Human Services Commission, Attention: Provider Finance, Mail Code H-400, North Austin Complex Building, 4601 W. Guadalupe St., Austin, Texas 78751.

46 TexReg 3955

June 25, 2021: In Addition Notice of Public Hearing on Proposed Rate Actions for HCS and TxHmL and the FY 2020-21 Quarter 4 Biennial Fee Review

Notice of Public Hearing on Proposed Rate Actions for HCS and TxHmL and the FY 2020-21 Quarter 4 Biennial Fee Review

OVERVIEW

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on July 14, 2021, at 9:00 a.m., to receive public comments on proposed rate actions for the fiscal year 2020-21 quarter 4 biennial fee review and Home and Community-Based Waiver (HCS) and Texas Home Living Waiver (TxHmL) respite and day habilitation services.

HHSC proposes to include two groups of rate updates during the rate hearing.

As part of the biennial fee review, which includes existing services with rates that are reviewed at least once every two years, HHSC is proposing rates for Emergency Response Services and for Preadmission Screening and Resident Review Intellectual and Developmental Disabilities Habilitative Specialized Services, proposed to be effective September 1, 2021.

HHSC is also proposing rates for in-home and out-of-home day habilitation and in-home and out-of-home respite in HCS and TxHmL to comply with Electronic Visit Verification requirements. The HCS and TxHmL rates are proposed to be effective August 1, 2021.

HEARING DETAILS

The hearing will be conducted online only. Physical entry to the hearing will not be permitted. Join the meeting from your computer, tablet, or smartphone at the following link:

https://attendee.gotowebinar.com/register/1792567207796862733

After registering, you will receive a confirmation email containing information about joining the webinar. You can also dial in using your phone at (562) 247-8422, access code 688-125-053.

If you are new to GoToWebinar, download the GoToMeeting app at https://global.gotomeeting.com/install/626873213 before the hearing starts.

BACKGROUND AND JUSTIFICATION

The proposed payment rates for these topics are guided by the following sections in Title 1 of the Texas Administrative Code: §355.510, related to the Reimbursement Methodology for Emergency Response Services (ERS); §355.315 related to the Reimbursement Methodology for Preadmission Screening and Resident Review (PASRR) Specialized Services; §355.723, related to the Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs; and §355.9090, related to the Reimbursement Methodology for Community First Choice.

The billing codes for day habilitation and respite in HCS and TxHmL are being modified to comply with EVV requirements, and the proposed rates will follow these modified billing codes.

A briefing packet describing the proposed payment rates will be available at https://rad.hhs.texas.gov/proposed-rate-packets on or after June 30, 2021. Interested parties may obtain a copy of the briefing packet before the hearing by contacting the HHSC Provider Finance Department by telephone at (512) 424-6637; by fax at (512) 730-7475; or by e-mail at pfd-ltss@hhs.texas.gov.

PUBLIC COMMENT

Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing. Written comments may be sent by U.S. mail to the Texas Health and Human Services Commission, Attention: Provider Finance, Mail Code H-400, P.O. Box 149030, Austin, Texas 78714-9030; by fax to Provider Finance at (512) 730-7475; or by email to pfd-ltss@hhs.texas.gov. In addition, written comments may be sent by overnight mail or hand-delivered to Texas Health and Human Services Commission, Attention: Provider Finance, Mail Code H-400, North Austin Complex, 4601 W Guadalupe St., Austin, Texas 78751.

46 TexReg 3956

Texas State Board of Pharmacy

June 25, 2021: Proposed Rules Amending 22 TAC §283.4 to update the required number of internship hours

CHAPTER 283. LICENSING REQUIREMENTS FOR PHARMACISTS

22 TAC §283.4

The Texas State Board of Pharmacy proposes amendments to §283.4, concerning Internship Requirements. The amendments, if adopted, update the internship hours requirement to reflect that the board requires the number of intern hours required by the Accreditation Council for Pharmacy Education (ACPE).

46 TexReg 3810

June 25, 2021: Proposed Rules Amending 22 TAC §291.6 to update pharmacy license fees

CHAPTER 291. PHARMACIES

SUBCHAPTER A. ALL CLASSES OF PHARMACIES

22 TAC §291.6

The Texas State Board of Pharmacy proposes amendments to §291.6, concerning Pharmacy License Fees. The amendments, if adopted, will increase pharmacy license fees based on expected expenses.

46 TexReg 3813

June 25, 2021: Proposed Rules Amending 22 TAC §291.76 to update requirements concerning Class C pharmacies located in a freestanding ambulatory surgical center

CHAPTER 291. PHARMACIES

SUBCHAPTER D. INSTITUTIONAL PHARMACY (CLASS C)

22 TAC §291.76

The Texas State Board of Pharmacy proposes amendments to §291.76 concerning Class C Pharmacies Located in a Freestanding Ambulatory Surgical Center. The amendments, if adopted, allow a licensed nurse who is authorized by the pharmacist to perform the loading of an automated medication supply system; update the time interval in which a pharmacist must verify a drug withdrawal; update the requirements for using a floor stock method of drug distribution; update records requirements; and correct grammatical errors.

46 TexReg 3814

June 25, 2021: Proposed Rules Amending 22 TAC §291.121 to authorize certain pharmacies to provide remote pharmacy services using an automated dispensing and delivery system

CHAPTER 291. PHARMACIES

SUBCHAPTER G. SERVICES PROVIDED BY PHARMACIES

22 TAC §291.121

The Texas State Board of Pharmacy proposes amendments to §291.121 concerning Remote Pharmacy Services. The amendments, if adopted, authorize a Class A or Class C pharmacy to provide remote pharmacy services using an automated dispensing and delivery system and correct grammatical errors.

46 TexReg 3823

June 25, 2021: Proposed Rules Amending 22 TAC §291.151 to update requirements concerning pharmacies located in a Freestanding Emergency Medical Care Facility (Class F)

CHAPTER 291. PHARMACIES

SUBCHAPTER H. OTHER CLASSES OF PHARMACY

22 TAC §291.151

The Texas State Board of Pharmacy proposes amendments to §291.151, concerning Pharmacies Located in a Freestanding Emergency Medical Care Facility (Class F). The amendments, if adopted, allow a licensed nurse who is authorized by the pharmacist to perform the loading of an automated medication supply system; update the time interval in which a pharmacist must verify a drug withdrawal; update the requirements for using a floor stock method of drug distribution; update records requirements; update references to DEA 222 form requirements to be consistent with federal regulations; and correct grammatical errors.

46 TexReg 3825

June 25, 2021: Proposed Rules Amending 22 TAC §295.5 to update pharmacist license or renewal fees

CHAPTER 295. PHARMACISTS

22 TAC §295.5

The Texas State Board of Pharmacy proposes amendments to §295.5, concerning Pharmacist License or Renewal Fees. The amendments, if adopted, will increase pharmacist license fees based on expected expenses.

46 TexReg 3844

June 25, 2021: Proposed Rules Amending 22 TAC §297.4 to update pharmacy technician registration fees

CHAPTER 297. PHARMACY TECHNICIANS AND PHARMACY TECHNICIAN TRAINEES

22 TAC §297.4

The Texas State Board of Pharmacy proposes amendments to §297.4, concerning Fees. The amendments, if adopted, will increase pharmacy technician registration fees based on expected expenses.

46 TexReg 3845