Texas Register July 14, 2023 Volume: 48 Number: 28

Texas Register Table of Contents

1 Texas Health and Human Services Commission
- - 1.0.1 Proposed Rules Re:
2 Texas Behavioral Health Executive Council
- - 2.0.1 Proposed Rules Re:
    - 2.0.1.1 Amending 22 TAC §882.61, to align state and federal law pertaining to licensing exemptions for service members and military spouses.
3 Department of State Health Services
4 Texas Department of Insurance
- - 4.0.1 Proposed Rules Re:
    - 4.0.1.1 Repealing 28 TAC §§3.8001 – 3.8030, to change the chemical dependency treatment standards for group health benefit plans.
    - 4.0.1.2 New 28 TAC §3.8001, to provide new standards for chemical dependency treatment standards for use by group health benefit plans.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §351.821, to conform with HHSC standards for the advisory committees specifically adding language regarding required training and travel reimbursements.

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
1 TAC §351.821

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §351.821, concerning the Value-Based Payment and Quality Improvement Advisory Committee.

BACKGROUND AND JUSTIFICATION

The Value-Based Payment and Quality Improvement Advisory Committee (VBPQIAC) was established in 2016 by the HHSC Executive Commissioner, under the authority of Texas Government Code §531.012. This statute requires the HHSC Executive Commissioner to establish and maintain advisory committees; establish rules for the operation of advisory committees; and for advisory committees to provide recommendations to the HHSC Executive Commissioner and the Texas Legislature.

The VBPQIAC advises the HHSC Executive Commissioner and Texas Health and Human Services agencies (HHS agencies) on quality improvement and value-based payment initiatives for Medicaid, other publicly funded health services, and the wider health care system. The VBPQIAC consolidated the functions of the previous Medicaid and CHIP Quality Based Payment Advisory Committee and the Texas Institute of Health Care Quality and Efficiency. Members meet approximately four times a year in Austin.

In §351.821, the VBPQIAC is set to abolish on December 31, 2023. Abolition of the VBPQIAC would result in the loss of a primary source of public input for key Medicaid value-based and quality improvement programs, such as the state’s Alternative Payment Models initiative. The VBPQIAC maintains strong participation from stakeholders.

The proposed amendment would extend the VBPQIAC by four years to December 31, 2027, update membership categories by removing “Regional Healthcare Partnerships” and align the rule with current HHSC advisory committee rule formatting and standards.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §351.821 adds “HHSC” in front of “Executive Commissioner” and uses the acronym “VBPQIAC” for the Value-Based Payment and Quality Improvement Advisory Committee.
The proposed amendment to §351.821 is revised in several places to ensure the rule conforms with HHSC’s standards for its advisory committee rules. The proposed amendment adds new subsection (e), relating to Meetings, new subsection (h), relating to Required Training, and new subsection (i), relating to Travel Reimbursement. The language relating to abolition is moved to subsection (j) and the date of abolition is updated from December 31, 2023, to December 31, 2027.
The proposed amendment to subsection (a), relating to Statutory authority, adds a reference to §351.801. Language is added to subsection (b) to reference HHSC and the Executive Commissioner. A new paragraph (2) is added to subsection (c), relating to bylaws. Subsection (d), relating to Reporting Requirements, is updated to comply with HHSC’s standards for its advisory committee rules. Subsection (f), relating to Membership, is updated to clarify terms relating to members and language related to “Regional Healthcare Partnerships” in (f)(1)(A)(ii) is deleted and the clauses are renumbered. Regional Healthcare Partnerships are now obsolete due to the end of the Delivery System Reform Incentive Payment program, commonly known as DSRI. Subsection (g), relating to Officers, is updated to clarify terms related to officers.

Amending 1 TAC §351.823, to add new paragraphs related to bylaws, membership, and officers.

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
1 TAC §351.823

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §351.823, concerning the e-Health Advisory Committee.

BACKGROUND AND JUSTIFICATION

The e-Health Advisory Committee (eHAC) was established in 2016 by the HHSC Executive Commissioner, under the authority of Texas Government Code §531.012. This statute requires the HHSC Executive Commissioner to establish and maintain advisory committees; establish rules for the operation of advisory committees; and for advisory committees to provide recommendations to the executive commissioner and the Texas Legislature.

The eHAC advises the HHSC Executive Commissioner and Health and Human Services (HHS) agencies on strategic planning, policy, rules, and services related to the use of health information technology, health information exchange systems, telemedicine, telehealth, and home telemonitoring services. Members meet approximately four times per year in Austin, at the discretion of the eHAC Chair.

In §351.823(i), the eHAC is set for abolition on December 31, 2023. In an eHAC meeting held June 6, 2022, committee members voted to recommend amending the committee rule to extend the eHAC so the committee can continue to advise on issues related to health information technology and exchange systems, as well as teleservices. In response, HHSC proposes to amend §351.823 to extend this committee for two years , from December 31, 2023, to December 31, 2025.

The proposed amendment to §351.823 includes several revisions to ensure the rule meets the HHSC standards for its advisory committee rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §351.823 is revised in several places to add “HHSC” in front of “Executive Commissioner” for clarity.
The proposed amendment to §351.823 makes the following changes to ensure the rule conforms with HHSC’s standards for its advisory committee rules. The proposed amendment adds a new paragraph (6) in subsection (c), relating to bylaws; amends subsection (f), relating to Membership, subsection (g), relating to Officers, and subsection (h), relating to Required Training; and adds a new subsection (i), relating to travel reimbursement.
The proposed amendment to §351.823(e) adds “as if it were a governmental body” to align the rule with §351.801(c) (relating to Authority and General Provisions) and to ensure the rule conforms with HHSC’s standards for advisory committee rules. Additional language is added regarding frequency of meetings and quorum.
The proposed amendment to §351.823(f)(2) replaces “Texas Health Service Regions” with “Public Health Regions” because Texas Health and Safety Code §121.007 authorizes the Department of State Health Services (DSHS) to establish “Public Health Regions.” The proposed amendment also removes the website in the rule in the event it might change in the future.
The proposed amendment to §351.823 renumbers subsection (i) as subsection (j) and extends the date of abolition of the eHAC from December 31, 2023, to December 31, 2025.
The proposed amendment to §351.823 includes minor edits to correct a reference in subsection (a) and renumber the rules in subsections (f) and (g).

New 26 TAC §509.1, §509.2, to describe the purpose of the chapter and definitions in the chapter.

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §509.1, §509.2

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new rules in Texas Administrative Code Title 26, Part 1, Chapter 509, concerning Freestanding Emergency Medical Care Facilities. The new chapter consists of §§509.1, 509.2, 509.21 – 509.30, 509.41 – 509.66, 509.81 – 509.86, and 509.101 – 509.108.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 2041 and H.B. 1112, 86th Legislature, Regular Session, 2019, which amended Texas Health and Safety Code (HSC) Chapter 254, relating to the regulation of Freestanding Emergency Medical Care Facilities. H.B. 2041 requires freestanding emergency medical care (FEMC) facilities to comply with updated advertising requirements, which includes disclosure of facility fees and clarification of health benefit plans that are accepted by the facility, and it requires FEMC facilities to provide a disclosure statement to patients. H.B. 2041 requires an FEMC facility that closes or whose license is expired, suspended, or revoked to remove their signs from the facility. H.B. 1112 similarly requires a closed FEMC facility or an FEMC facility whose license is expired, suspended, or revoked to remove their signage. This proposal also complies with Senate Bill (S.B.) 425, 84th Legislature, Regular Session, 2015, which amended HSC Chapter 254 to require an FEMC facility to post a notice regarding facility fees and provide other consumer information to patients.

A previous version of these rules was proposed in the January 22, 2021, issue of the Texas Register (46 TexReg 520) and expired without being adopted. This new version takes into account comments HHSC received during the previous public comment period, and the public will have another 31-day period to comment on this new version of these proposed rules.

The proposal will also revise sections in the subchapters on Inspection and Investigation Procedures and Enforcement to outline facility documentation expectations to increase consistency across facility rule sets, update language to reflect the transition to HHSC and the relocation of rules from Title 25 to Title 26, and correct outdated references and citations.

To implement this change, rules in Title 25 Chapter 131, Freestanding Emergency Medical Care Facilities, are being repealed and new rules proposed in Title 26 Chapter 509, Freestanding Emergency Medical Care Facilities. The repeal of Title 25 Chapter 131 is proposed elsewhere in this issue of the Texas Register.

SECTION-BY-SECTION SUMMARY

Proposed new Subchapter A, General Provisions, composed of §509.1 and §509.2, provides the purpose of the chapter and definitions used in the chapter. This new subchapter is consistent with the previous Title 25 Chapter 131, Subchapter A, but with edits to correct outdated titles, remove a term not used in the chapter, and update contact information.

New 26 TAC §§509.21 – 509.30, to give guidelines for licensing renewal, changes of ownership, facility closures, and fees.

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER B. LICENSING REQUIREMENTS
26 TAC §§509.21 – 509.30

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed new Subchapter B, Licensing Requirements, composed of §§509.21 – 509.30, provides guidelines on application for initial and renewal licensure, facility closures, facility types, changes of ownership, and fees. Section 509.26, Inactive Status and Closure, updates the previous language in repealed Title 25 §131.27 to clarify the inactive status and closure guidelines for a facility that does not provide services under its license for more than five calendar days. This section also implements H.B. 1112 and H.B. 2041 to require a facility remove signs indicating that the facility is in operation from within view of the general public when it closes or its license is expired, suspended, or revoked. Section 509.30, Fees, increases the term for initial and renewal licenses from one year to two years and accordingly doubles the corresponding license fees because that amount is reasonable and necessary to defray the cost of administering Texas Health and Safety Code Chapter 254 over that timeframe. This new subchapter is consistent with the previous Title 25 Chapter 131, Subchapter B, but with edits to correct citations and remove outdated information.

New 26 TAC §§509.41 – 509.66, to describe the required facility operations standards.

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §§509.41 – 509.66

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed new §§509.41 – 509.66, in Subchapter C, Operational Requirements, detail requirements for proper facility operational standards, including administration, staffing, training, services provided, medical records, infection control, patient rights, and quality assurance. These new sections are consistent with the rules in previous Title 25, Chapter 131, Subchapter C, but with edits to remove outdated information on programs and requirements that no longer exist. Proposed new §509.41, Operational Standards, implements H.B. 1112 and H.B. 2041 to outline advertising and marketing requirements relating to insurers and health benefit plans. These changes also clarify the regulatory consequences of violating these requirements by making false, misleading, or deceptive claims. Proposed new §509.60, Patient Rights, further clarifies and simplifies marketing and advertising guidelines and implements H.B. 2041 by requiring facilities to post a notice of fees and provide a written disclosure statement that details the facility’s fees and accepted health benefit plans to a patient or their legally authorized representative. Section 509.60 also implements S.B. 425 by requiring facilities to comply with HSC Chapter 324, Subchapter C.

New 26 TAC §§509.81 – 509.86, to update and clarify the investigation and inspection procedures for FEMC facilities.

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER D. INSPECTION AND INVESTIGATION PROCEDURES
26 TAC §§509.81 – 509.86

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed new Subchapter D, Inspection and Investigation Procedures, composed of §§509.81 – 509.86, makes comprehensive updates to HHSC’s inspection and investigation procedures for FEMC facilities to clarify provider expectations and provide greater consistency between this chapter and rules for other facility types.

New 26 TAC §§509.101 – 509.108, to outline the procedure for enforcement actions, which include denial of licensure, suspension, revocation, probation, and administrative penalties.

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER E. ENFORCEMENT
26 TAC §§509.101 – 509.108

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed new Subchapter E, Enforcement, composed of §§509.101 – 509.108, provides criteria for enforcement actions, including denial of licensure, suspension, revocation, probation, and administrative penalties. This new subchapter is consistent with the previous Title 25, Chapter 131, Subchapter B, but with edits to correct outdated titles, citations, and contact information, and increase consistency with Texas Health and Safety Code Chapter 254 and rules for other facility types.

Texas Behavioral Health Executive Council

Proposed Rules Re:

Amending 22 TAC §882.61, to align state and federal law pertaining to licensing exemptions for service members and military spouses.

CHAPTER 882. APPLICATIONS AND LICENSING
SUBCHAPTER F. LICENSING PROVISIONS RELATED TO MILITARY SERVICE MEMBERS, VETERANS, AND MILITARY SPOUSES
22 TAC §882.61

OVERVIEW

The Texas Behavioral Health Executive Council proposes amendments to §882.61, relating to Special Licensing Provisions for Service Members and Military Spouses.

Overview and Explanation of the Proposed Rule. The proposed amendments are intended to better align this rule with both state and federal law regarding licensing exemptions for service members and military spouses.

Department of State Health Services

Proposed Rules Re:

Repealing 25 TAC §131.1, §131.2, to allow for similar rules to be proposed in Title 26, Chapter 509 concerning the general provisions surrounding Freestanding Emergency Medical Care Facilities.

CHAPTER 131. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER A. GENERAL PROVISIONS
25 TAC §131.1, §131.2

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Title 25, Part 1, Chapter 131, concerning Freestanding Emergency Medical Care Facilities, the repeal of Subchapter A, concerning General Provisions, Subchapter B, concerning Licensing Requirements, Subchapter C, concerning Operational Requirements, Subchapter D, concerning Inspection and Investigation Procedures, and Subchapter E, concerning Enforcement. The repealed subchapters consist of §§131.1, 131.2, 131.21 – 131.31, 131.41 – 131.68, 131.81, 131.82, and 131.101 – 131.109.

BACKGROUND AND JUSTIFICATION

The purpose of this proposal is to repeal the rules in Chapter 131, Freestanding Emergency Medical Care Facilities, Subchapters A – E, and propose new rules in Title 26, Part 1, Chapter 509, Freestanding Emergency Medical Care Facilities. A previous version of this repeal was proposed in the January 22, 2021, issue of the Texas Register (46 TexReg 517) and expired without being adopted. This version of the proposed repeal takes into account comments HHSC received during the previous public comment period, and the public will have another 31-day period to comment on this version of the proposed repeal.

The new rules for Title 26, Chapter 509 are proposed elsewhere in this issue of the Texas Register and are substantially the same with the rules proposed for repeal.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Title 25, Chapter 131, Subchapters A – E, allows similar rules to be proposed as new rules in Title 26, Chapter 509.

Repealing 25 TAC §§131.21 – 131.31, to allow for similar rules to be proposed in Title 26, Chapter 509 concerning the licensing requirements for Freestanding Emergency Medical Care Facilities.

CHAPTER 131. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER B. LICENSING REQUIREMENTS
25 TAC §§131.21 – 131.31

OVERVIEW

BACKGROUND AND JUSTIFICATION

The new rules for Title 26, Chapter 509 are proposed elsewhere in this issue of the Texas Register and are substantially the same with the rules proposed for repeal.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Title 25, Chapter 131, Subchapters A – E, allows similar rules to be proposed as new rules in Title 26, Chapter 509.

Repealing 25 TAC §§131.41 – 131.68, to allow for similar rules to be proposed in Title 26, Chapter 509 concerning the operational requirements for Freestanding Emergency Medical Care Facilities.

CHAPTER 131. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
25 TAC §§131.41 – 131.68

OVERVIEW

BACKGROUND AND JUSTIFICATION

The new rules for Title 26, Chapter 509 are proposed elsewhere in this issue of the Texas Register and are substantially the same with the rules proposed for repeal.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Title 25, Chapter 131, Subchapters A – E, allows similar rules to be proposed as new rules in Title 26, Chapter 509.

Repealing 25 TAC §§131.41 – 131.68, to allow for similar rules to be proposed in Title 26, Chapter 509 concerning the inspection and investigation procedures for Freestanding Emergency Medical Care Facilities.

CHAPTER 131. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER D. INSPECTION AND INVESTIGATION PROCEDURES
25 TAC §131.81, §131.82

OVERVIEW

BACKGROUND AND JUSTIFICATION

The new rules for Title 26, Chapter 509 are proposed elsewhere in this issue of the Texas Register and are substantially the same with the rules proposed for repeal.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Title 25, Chapter 131, Subchapters A – E, allows similar rules to be proposed as new rules in Title 26, Chapter 509.

Repealing 25 TAC §§131.101 – 131.109, to allow for similar rules to be proposed in Title 26, Chapter 509 concerning the enforcement procedures for Freestanding Emergency Medical Care Facilities.

CHAPTER 131. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER E. ENFORCEMENT
25 TAC §§131.101 – 131.109

OVERVIEW

BACKGROUND AND JUSTIFICATION

The new rules for Title 26, Chapter 509 are proposed elsewhere in this issue of the Texas Register and are substantially the same with the rules proposed for repeal.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Title 25, Chapter 131, Subchapters A – E, allows similar rules to be proposed as new rules in Title 26, Chapter 509.

Adopted Rules Re:

Amending 25 TAC § 181.62, to clarify the documentation requirements for a person’s name and place of birth.

CHAPTER 181. VITAL STATISTICS
SUBCHAPTER E. DELAYED REGISTRATION
25 TAC §181.62

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts an amendment to §181.62, concerning Documentary Evidence; Requirements and Acceptability.

The amendment to §181.62 is adopted without changes to the proposed text as published in the May 26, 2023, issue of the Texas Register (48 TexReg 2657). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment assists people seeking a delayed registration of birth, despite having contradictory documents regarding parentage. Under the previous rule, people were unable to obtain a delayed registration of birth if documents presented to the State Registrar contained contradictory information. An inability to obtain a birth certificate may impact a person’s ability to obtain state-issued identification documents, passports, or other governmental benefits. This rule change assists persons unable to have their birth recorded by requiring that documents not be contradictory on name, date and place of birth, and the identity of one parent. If there are contradictory documents regarding the second parent, the amendment requires that the second parent not be recorded and the field for that parent remain blank on any birth certificate issued.

The amendment also clarifies the number and types of acceptable documents to submit with a request to record a delayed registration of birth.

In Addition Re:

Licensing Actions for Radioactive Materials

For more information, please visit this week’s edition of the Texas Register at 48 Tex Reg 3938.

Texas Department of Insurance

Proposed Rules Re:

Repealing 28 TAC §§3.8001 – 3.8030, to change the chemical dependency treatment standards for group health benefit plans.

CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER HH. STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS
28 TAC §§3.8001 – 3.8030

OVERVIEW

The Texas Department of Insurance (TDI) proposes to repeal 28 TAC §§3.8001 – 3.8030, which established chemical dependency treatment standards, including cost control and utilization review standards, and adopt new 28 TAC §3.8001, regulating chemical dependency treatment standards.

BACKGROUND AND JUSTIFICATION

EXPLANATION. The proposed repeal of §§3.8001 – 3.8030 and proposed adoption of new §3.8001 implement Insurance Code §1368.007. Section 1368.007 requires that TDI adopt by rule chemical dependency treatment standards for use by group health benefit plans, other third-party reimbursement sources, and chemical dependency treatment centers. These standards must provide for (1) reasonable control of costs necessary for inpatient and outpatient treatment of chemical dependency, including guidelines for treatment periods; and (2) appropriate utilization review of treatment, as well as necessary extensions of treatment. When providing coverage for chemical dependency treatment, health benefit plan issuers are also governed by other laws, including utilization review standards in Insurance Code Chapter 4201 and parity requirements for mental health conditions and substance use disorders in Insurance Code Chapter 1355, Subchapter F. Coordination of statutory language is addressed in rules implementing parity requirements at 28 TAC §21.2403. TDI encourages issuers to consider all applicable laws when designing policies and procedures related to coverage for chemical dependency treatment.

New 28 TAC §3.8001, to provide new standards for chemical dependency treatment standards for use by group health benefit plans.

CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER HH. STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS
28 TAC §3.8001

OVERVIEW

BACKGROUND AND JUSTIFICATION