Texas Register Table of Contents
- 1 Governor
- 2 State Office of Administrative Hearings
- 2.0.1 Proposed Rules Re:
- 2.0.1.1 Amending 1 TAC §167.1, §167.3, to repeal the sections concerning the general purpose and scope, and definitions.
- 2.0.1.2 Amending 1 TAC §167.51, to repeal the section concerning the forms related to the initiating appointment of a mediator.
- 2.0.1.3 Amending 1 TAC §§167.101, 167.103, 167.105, 167.107, 167.109, to repeal the sections concerning mediator qualifications, the roster of mediators, mediator roster updates, withdrawals, and fee arrangements, appointments of a mediator, and mediator duties and responsibilities.
- 2.0.1.4 Amending 1 TAC §167.151, to repeal the sections concerning a mediator’s reports following mediation.
- 2.0.1.5 Amending 1 TAC §§167.201, 167.203, 167.205, 167.207, 167.209, to repeal the sections concerning special judge qualifications, the order of referral to a special judge, the roster of special judges, the appointment of a special judge, and the special judge roster update, withdrawal, and fee arrangement.
- 2.0.2 Proposed Rule Review Re:
- 2.0.1 Proposed Rules Re:
- 3 Texas Department of Insurance
- 4 Texas Optometry Board
- 4.0.1 Withdrawn Rules Re:
- 4.0.1.1 Withdrawing 22 TAC §279.1, to require that an optometrist or therapeutic optometrist personally examine the patient for three of the ten findings during an initial visit for contact lenses.
- 4.0.1.2 Withdrawing 22 TAC §279.3, to require that an optometrist or therapeutic optometrist personally examine the patient for three of the ten findings during an initial visit for a spectacle prescription.
- 4.0.1 Withdrawn Rules Re:
- 5 Texas Health and Human Services Commission
- 5.0.1 Adopted Rules Re:
- 5.0.1.1 Adopting 1 TAC §354.1271, to remove the reference to a 60-day timeframe for postpartum services and specify that women are eligible for maternity clinic services in the postpartum period.
- 5.0.1.2 Adopting 1 TAC §366.303, §366.325, to remove the exception of the end of pregnancy to continuous coverage and to add that a Medicaid recipient will receive continuous Medicaid coverage for 12 months after the pregnancy ends.
- 5.0.1.3 Adopting 1 TAC §366.827, to provide that the pregnant woman is continuously eligible through her pregnancy and the end of the month in which the 12-month postpartum period ends once a pregnant woman meets spend down, and is not required to meet spend down again until the end of the 12-month postpartum period.
- 5.0.1.4 Adopting 1 TAC §§366.1011, 366.1025, 366.1031, to explain that a pregnant Former Foster Care Children’s Program recipient remains continuously eligible through the end of the 12-month postpartum period and that a renewal will be conducted at the end of the 12-month postpartum period if the Former Foster Care Children’s Program recipient is pregnant.
- 5.0.1.5 Adopting 1 TAC §370.42, §370.49, to add that a pregnant CHIP member is eligible to receive CHIP for 12 months following the end of the pregnancy even if the CHIP member reaches age nineteen and to explain that if a CHIP member voluntarily elects to end their CHIP enrollment during the postpartum period, the member will no longer be eligible to receive continuous eligibility for the remainder of the member’s postpartum period.
- 5.0.1.6 Adopting 1 TAC §370.60, to explain that a renewal will be conducted at the end of the 12-month postpartum period if the CHIP member is pregnant.
- 5.0.1.7 Adopting 1 TAC §370.307, to state that a pregnant member enrolled in CHIP is eligible to receive coverage until the postpartum period ends even if the member turns nineteen and to modify exception to the continuous enrollment period in CHIP.
- 5.0.1.8 Adopting 26 TAC §§307.301, 307.303, 307.305, 307.307, 307.309, 307.311, 307.313, 307.315, to explain that the conditions of the grant are subject to requirements found in the contract executed by HHSC and other requirements for grant proposals.
- 5.0.1.9 Adopting 26 TAC §§307.351, 307.353, 307.355, 307.357, 307.359, 307.361, 307.363, 307.365, 307.367, to describe the requirements and selection process for grant proposals.
- 5.0.2 Proposed Rule Reviews Re:
- 5.0.3 Adopted Rule Reviews Re:
- 5.0.1 Adopted Rules Re:
- 6 Texas Department of Insurance, Division of Workers’ Compensation
- 7 Texas Department of Licensing and Regulation
- 8 Texas Medical Board
- 9 Texas State Board of Pharmacy
- 10 Texas Department of State Health Services
- 11 Council on Cardiovascular Disease and Stroke
- 12 Executive Council of Physical Therapy and Occupational Therapy Examiners
Governor
Appointments Re:
Appointed to the Texas Diabetes Council for a term to expire February 1, 2025, Michael P. Kelly, Ph.D. of El Paso, Texas.
State Office of Administrative Hearings
Proposed Rules Re:
Amending 1 TAC §167.1, §167.3, to repeal the sections concerning the general purpose and scope, and definitions.
CHAPTER 167. DISPUTE RESOLUTION PROCESSES APPLICABLE TO CERTAIN CONSUMER HEALTH BENEFIT DISPUTES
SUBCHAPTER A. GENERAL
1 TAC §167.1, §167.3
OVERVIEW
The State Office of Administrative Hearings (SOAH) proposes the repeal of Title I, Chapter 167 in its entirety concerning the Dispute Resolution Process Applicable to Certain Consumer Health Benefits Disputes.
BACKGROUND AND JUSTIFICATION
House Bill 2256, 81st R.S. (2009) enacted Chapter 1467 of the Texas Insurance Code relating to Out-Of-Network Claim Dispute Resolution. From September 1, 2009, to August 31, 2019, Insurance Code Chapter 1467 required SOAH to administer a mandatory “balance billing mediation” program for the resolution of certain consumer disputes relating to medical bills for out-of-network health benefit claims. Texas Insurance Code §1467.004 formerly required SOAH to adopt administrative rules relating to SOAH’s implementation of the mediation program, and these rules were adopted as Title I, Chapter 167, Subchapters A, B, C, D, and E (Rules §§167.1 – 167.209). Senate Bill 1264, 86th R.S. (2019) amended chapter 1467 of the Insurance Code to establish a revised out-of-network claim dispute resolution program at the Texas Department of Insurance.
Although Section 3.03 of S.B. 1264 repealed relevant sections of Insurance Code, Chapter 1467 pertaining to SOAH’s balance billing mediation program, Section 5.01 of S.B. 1264 provided that “The changes in law made by this Act apply only to a health care or medical service or supply provided on or after January 1, 2020. A health care or medical service or supply provided before January 1, 2020, is governed by the law in effect immediately before the effective date of this Act [Sept. 1, 2019], and that law is continued in effect for that purpose.” This transition provision required SOAH to continue to administer balance billing mediations for both existing and new out-of-network health benefit claims that were eligible under the repealed Insurance Code provisions and SOAH rules.
On or about December 18, 2023, SOAH referred all of the remaining health benefit dispute cases that could not be successfully resolved by mediation to a special judge for trial in accordance with the requirements of the former Insurance Code §1467.057. Now that SOAH’s administrative duties under the former law have been concluded, the repeal of SOAH’s rules in Title 1, Chapter 167 is necessary to fully-implement S.B. 1264.
CHAPTER 167. DISPUTE RESOLUTION PROCESSES APPLICABLE TO CERTAIN CONSUMER HEALTH BENEFIT DISPUTES
SUBCHAPTER B. INITIATING APPOINTMENT OF A MEDIATOR
1 TAC §167.51
OVERVIEW
The State Office of Administrative Hearings (SOAH) proposes the repeal of Title I, Chapter 167 in its entirety concerning the Dispute Resolution Process Applicable to Certain Consumer Health Benefits Disputes.
BACKGROUND AND JUSTIFICATION
House Bill 2256, 81st R.S. (2009) enacted Chapter 1467 of the Texas Insurance Code relating to Out-Of-Network Claim Dispute Resolution. From September 1, 2009, to August 31, 2019, Insurance Code Chapter 1467 required SOAH to administer a mandatory “balance billing mediation” program for the resolution of certain consumer disputes relating to medical bills for out-of-network health benefit claims. Texas Insurance Code §1467.004 formerly required SOAH to adopt administrative rules relating to SOAH’s implementation of the mediation program, and these rules were adopted as Title I, Chapter 167, Subchapters A, B, C, D, and E (Rules §§167.1 – 167.209). Senate Bill 1264, 86th R.S. (2019) amended chapter 1467 of the Insurance Code to establish a revised out-of-network claim dispute resolution program at the Texas Department of Insurance.
Although Section 3.03 of S.B. 1264 repealed relevant sections of Insurance Code, Chapter 1467 pertaining to SOAH’s balance billing mediation program, Section 5.01 of S.B. 1264 provided that “The changes in law made by this Act apply only to a health care or medical service or supply provided on or after January 1, 2020. A health care or medical service or supply provided before January 1, 2020, is governed by the law in effect immediately before the effective date of this Act [Sept. 1, 2019], and that law is continued in effect for that purpose.” This transition provision required SOAH to continue to administer balance billing mediations for both existing and new out-of-network health benefit claims that were eligible under the repealed Insurance Code provisions and SOAH rules.
On or about December 18, 2023, SOAH referred all of the remaining health benefit dispute cases that could not be successfully resolved by mediation to a special judge for trial in accordance with the requirements of the former Insurance Code §1467.057. Now that SOAH’s administrative duties under the former law have been concluded, the repeal of SOAH’s rules in Title 1, Chapter 167 is necessary to fully-implement S.B. 1264.
Amending 1 TAC §§167.101, 167.103, 167.105, 167.107, 167.109, to repeal the sections concerning mediator qualifications, the roster of mediators, mediator roster updates, withdrawals, and fee arrangements, appointments of a mediator, and mediator duties and responsibilities.
CHAPTER 167. DISPUTE RESOLUTION PROCESSES APPLICABLE TO CERTAIN CONSUMER HEALTH BENEFIT DISPUTES
SUBCHAPTER C. MEDIATOR
1 TAC §§167.101, 167.103, 167.105, 167.107, 167.109
OVERVIEW
The State Office of Administrative Hearings (SOAH) proposes the repeal of Title I, Chapter 167 in its entirety concerning the Dispute Resolution Process Applicable to Certain Consumer Health Benefits Disputes.
BACKGROUND AND JUSTIFICATION
House Bill 2256, 81st R.S. (2009) enacted Chapter 1467 of the Texas Insurance Code relating to Out-Of-Network Claim Dispute Resolution. From September 1, 2009, to August 31, 2019, Insurance Code Chapter 1467 required SOAH to administer a mandatory “balance billing mediation” program for the resolution of certain consumer disputes relating to medical bills for out-of-network health benefit claims. Texas Insurance Code §1467.004 formerly required SOAH to adopt administrative rules relating to SOAH’s implementation of the mediation program, and these rules were adopted as Title I, Chapter 167, Subchapters A, B, C, D, and E (Rules §§167.1 – 167.209). Senate Bill 1264, 86th R.S. (2019) amended chapter 1467 of the Insurance Code to establish a revised out-of-network claim dispute resolution program at the Texas Department of Insurance.
Although Section 3.03 of S.B. 1264 repealed relevant sections of Insurance Code, Chapter 1467 pertaining to SOAH’s balance billing mediation program, Section 5.01 of S.B. 1264 provided that “The changes in law made by this Act apply only to a health care or medical service or supply provided on or after January 1, 2020. A health care or medical service or supply provided before January 1, 2020, is governed by the law in effect immediately before the effective date of this Act [Sept. 1, 2019], and that law is continued in effect for that purpose.” This transition provision required SOAH to continue to administer balance billing mediations for both existing and new out-of-network health benefit claims that were eligible under the repealed Insurance Code provisions and SOAH rules.
On or about December 18, 2023, SOAH referred all of the remaining health benefit dispute cases that could not be successfully resolved by mediation to a special judge for trial in accordance with the requirements of the former Insurance Code §1467.057. Now that SOAH’s administrative duties under the former law have been concluded, the repeal of SOAH’s rules in Title 1, Chapter 167 is necessary to fully-implement S.B. 1264.
Amending 1 TAC §167.151, to repeal the sections concerning a mediator’s reports following mediation.
CHAPTER 167. DISPUTE RESOLUTION PROCESSES APPLICABLE TO CERTAIN CONSUMER HEALTH BENEFIT DISPUTES
SUBCHAPTER D. POST MEDIATION REPORTS
1 TAC §167.151
OVERVIEW
The State Office of Administrative Hearings (SOAH) proposes the repeal of Title I, Chapter 167 in its entirety concerning the Dispute Resolution Process Applicable to Certain Consumer Health Benefits Disputes.
BACKGROUND AND JUSTIFICATION
House Bill 2256, 81st R.S. (2009) enacted Chapter 1467 of the Texas Insurance Code relating to Out-Of-Network Claim Dispute Resolution. From September 1, 2009, to August 31, 2019, Insurance Code Chapter 1467 required SOAH to administer a mandatory “balance billing mediation” program for the resolution of certain consumer disputes relating to medical bills for out-of-network health benefit claims. Texas Insurance Code §1467.004 formerly required SOAH to adopt administrative rules relating to SOAH’s implementation of the mediation program, and these rules were adopted as Title I, Chapter 167, Subchapters A, B, C, D, and E (Rules §§167.1 – 167.209). Senate Bill 1264, 86th R.S. (2019) amended chapter 1467 of the Insurance Code to establish a revised out-of-network claim dispute resolution program at the Texas Department of Insurance.
Although Section 3.03 of S.B. 1264 repealed relevant sections of Insurance Code, Chapter 1467 pertaining to SOAH’s balance billing mediation program, Section 5.01 of S.B. 1264 provided that “The changes in law made by this Act apply only to a health care or medical service or supply provided on or after January 1, 2020. A health care or medical service or supply provided before January 1, 2020, is governed by the law in effect immediately before the effective date of this Act [Sept. 1, 2019], and that law is continued in effect for that purpose.” This transition provision required SOAH to continue to administer balance billing mediations for both existing and new out-of-network health benefit claims that were eligible under the repealed Insurance Code provisions and SOAH rules.
On or about December 18, 2023, SOAH referred all of the remaining health benefit dispute cases that could not be successfully resolved by mediation to a special judge for trial in accordance with the requirements of the former Insurance Code §1467.057. Now that SOAH’s administrative duties under the former law have been concluded, the repeal of SOAH’s rules in Title 1, Chapter 167 is necessary to fully-implement S.B. 1264.
Amending 1 TAC §§167.201, 167.203, 167.205, 167.207, 167.209, to repeal the sections concerning special judge qualifications, the order of referral to a special judge, the roster of special judges, the appointment of a special judge, and the special judge roster update, withdrawal, and fee arrangement.
CHAPTER 167. DISPUTE RESOLUTION PROCESSES APPLICABLE TO CERTAIN CONSUMER HEALTH BENEFIT DISPUTES
SUBCHAPTER E. SPECIAL JUDGES
1 TAC §§167.201, 167.203, 167.205, 167.207, 167.209
OVERVIEW
The State Office of Administrative Hearings (SOAH) proposes the repeal of Title I, Chapter 167 in its entirety concerning the Dispute Resolution Process Applicable to Certain Consumer Health Benefits Disputes.
BACKGROUND AND JUSTIFICATION
House Bill 2256, 81st R.S. (2009) enacted Chapter 1467 of the Texas Insurance Code relating to Out-Of-Network Claim Dispute Resolution. From September 1, 2009, to August 31, 2019, Insurance Code Chapter 1467 required SOAH to administer a mandatory “balance billing mediation” program for the resolution of certain consumer disputes relating to medical bills for out-of-network health benefit claims. Texas Insurance Code §1467.004 formerly required SOAH to adopt administrative rules relating to SOAH’s implementation of the mediation program, and these rules were adopted as Title I, Chapter 167, Subchapters A, B, C, D, and E (Rules §§167.1 – 167.209). Senate Bill 1264, 86th R.S. (2019) amended chapter 1467 of the Insurance Code to establish a revised out-of-network claim dispute resolution program at the Texas Department of Insurance.
Although Section 3.03 of S.B. 1264 repealed relevant sections of Insurance Code, Chapter 1467 pertaining to SOAH’s balance billing mediation program, Section 5.01 of S.B. 1264 provided that “The changes in law made by this Act apply only to a health care or medical service or supply provided on or after January 1, 2020. A health care or medical service or supply provided before January 1, 2020, is governed by the law in effect immediately before the effective date of this Act [Sept. 1, 2019], and that law is continued in effect for that purpose.” This transition provision required SOAH to continue to administer balance billing mediations for both existing and new out-of-network health benefit claims that were eligible under the repealed Insurance Code provisions and SOAH rules.
On or about December 18, 2023, SOAH referred all of the remaining health benefit dispute cases that could not be successfully resolved by mediation to a special judge for trial in accordance with the requirements of the former Insurance Code §1467.057. Now that SOAH’s administrative duties under the former law have been concluded, the repeal of SOAH’s rules in Title 1, Chapter 167 is necessary to fully-implement S.B. 1264.
Proposed Rule Review Re:
Reviewing Title 1, Part 7, to review and consider for readoption, revision, or repeal the chapter concerning the Arbitration Procedures for Certain Enforcement Actions of the Texas Department of Aging and Disability Services Regarding Convalescent and Nursing Homes.
In accordance with Government Code §2001.039, the Texas State Office of Administrative Hearings (SOAH) files this notice of intention to review and consider for re-adoption, re-adoption with amendments, or repeal, the following chapters listed below contained in Title 1, Part 7, of the Texas Administrative Code:
Chapter 156. Arbitration Procedures for Certain Enforcement Actions of the Department of Aging and Disability Services Regarding Assisted Living Facilities
Chapter 163. Arbitration Procedures for Certain Enforcement Actions of the Texas Department of Aging and Disability Services Regarding Convalescent and Nursing Homes
Texas Department of Insurance
Proposed Rules Re:
Amending 28 TAC §21.501, to define the term “termination” to include nonrenewal and discontinuation as terminations for the Insurance Code.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER F. ELECTRONIC TRANSACTIONS
28 TAC §21.501
OVERVIEW
The Texas Department of Insurance (TDI) proposes to add new 28 TAC §21.501, concerning notices of termination of insurance policies. The new section will be in new Subchapter F, Electronic Transactions. Proposed new §21.501 implements House Bill 1040, 88th Legislature, 2023.
BACKGROUND AND JUSTIFICATION
New §21.501 defines “termination” to specify that nonrenewal and discontinuation are terminations for the purposes of Insurance Code §35.004.
In Addition Re:
Company Licensing — Applications to do Business
Application for Highmark Casualty Insurance Company, a foreign fire and/or casualty company, to change its name to Bridge City Insurance Company. The home office is in Pittsburgh, Pennsylvania.
Application for Midwest Builders’ Casualty Mutual Company, a foreign fire and/or casualty company, to change its name to Waypoint Mutual. The home office is in Kansas City, Missouri.
Texas Optometry Board
Withdrawn Rules Re:
Withdrawing 22 TAC §279.1, to require that an optometrist or therapeutic optometrist personally examine the patient for three of the ten findings during an initial visit for contact lenses.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.1
OVERVIEW
The Texas Optometry Board withdraws proposed amendments to §279.1 which appeared in the January 5, 2024, issue of the Texas Register (49 TexReg 7).
Withdrawing 22 TAC §279.3, to require that an optometrist or therapeutic optometrist personally examine the patient for three of the ten findings during an initial visit for a spectacle prescription.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.3
OVERVIEW
The Texas Optometry Board withdraws proposed amendments to §279.3 which appeared in the January 5, 2024, issue of the Texas Register (49 TexReg 7).
Texas Health and Human Services Commission
Adopted Rules Re:
Adopting 1 TAC §354.1271, to remove the reference to a 60-day timeframe for postpartum services and specify that women are eligible for maternity clinic services in the postpartum period.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 18. MATERNITY CLINIC SERVICES
1 TAC §354.1271
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §354.1271, concerning Benefits and Limitations.
The amendment to §354.1271 is adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 611). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment complies with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children’s Health Insurance Program (CHIP).
Adopting 1 TAC §366.303, §366.325, to remove the exception of the end of pregnancy to continuous coverage and to add that a Medicaid recipient will receive continuous Medicaid coverage for 12 months after the pregnancy ends.
CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER C. PREGNANT WOMEN’S MEDICAID
1 TAC §366.303, §366.325
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Dates, §366.827, concerning Medicaid Eligibility Effective Dates, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 613). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children’s Health Insurance Program (CHIP).
Adopting 1 TAC §366.827, to provide that the pregnant woman is continuously eligible through her pregnancy and the end of the month in which the 12-month postpartum period ends once a pregnant woman meets spend down, and is not required to meet spend down again until the end of the 12-month postpartum period.
CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER H. MEDICALLY NEEDY PROGRAM
1 TAC §366.827
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Date, §366.827, concerning Medicaid Eligibility Effective Date, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 613). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).
Adopting 1 TAC §§366.1011, 366.1025, 366.1031, to explain that a pregnant Former Foster Care Children’s Program recipient remains continuously eligible through the end of the 12-month postpartum period and that a renewal will be conducted at the end of the 12-month postpartum period if the Former Foster Care Children’s Program recipient is pregnant.
CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER J. FORMER FOSTER CARE CHILDREN’S PROGRAM
1 TAC §§366.1011, 366.1025, 366.1031
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Date, §366.827, concerning Medicaid Eligibility Effective Date, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 613). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).
Adopting 1 TAC §370.42, §370.49, to add that a pregnant CHIP member is eligible to receive CHIP for 12 months following the end of the pregnancy even if the CHIP member reaches age nineteen and to explain that if a CHIP member voluntarily elects to end their CHIP enrollment during the postpartum period, the member will no longer be eligible to receive continuous eligibility for the remainder of the member’s postpartum period.
CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER B. APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT
DIVISION 4. ELIGIBILITY CRITERIA
1 TAC §370.42, §370.49
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §370.42, concerning Age Limits, §370.49, concerning Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 616). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children’s Health Insurance Program (CHIP).
Adopting 1 TAC §370.60, to explain that a renewal will be conducted at the end of the 12-month postpartum period if the CHIP member is pregnant.
CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER B. APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT
1 TAC §370.60
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §370.42, concerning Age Limits, §370.49, concerning Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 616). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children’s Health Insurance Program (CHIP).
Adopting 1 TAC §370.307, to state that a pregnant member enrolled in CHIP is eligible to receive coverage until the postpartum period ends even if the member turns nineteen and to modify exception to the continuous enrollment period in CHIP.
CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER C. ENROLLMENT, RENEWAL, DISENROLLMENT, AND COST SHARING
DIVISION 1. ENROLLMENT AND DISENROLLMENT
1 TAC §370.307
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §370.42, concerning Age Limits, §370.49, concerning Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 616). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children’s Health Insurance Program (CHIP).
Adopting 26 TAC §§307.301, 307.303, 307.305, 307.307, 307.309, 307.311, 307.313, 307.315, to explain that the conditions of the grant are subject to requirements found in the contract executed by HHSC and other requirements for grant proposals.
CHAPTER 307. BEHAVIORAL HEALTH PROGRAMS
SUBCHAPTER G. BEHAVIORAL HEALTH GRANT AND FUNDING PROGRAMS
26 TAC §§307.301, 307.303, 307.305, 307.307, 307.309, 307.311, 307.313, 307.315
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts §307.301, concerning Purpose, §307.305, concerning General Conditions of a Grant, §307.307, concerning Eligible Applicants, §307.309, concerning Eligible Projects, §307.311, concerning Grant Proposals and Selection Process, §307.313, concerning Contract Execution, and §307.315, concerning Project Review and Evaluation Report, in new Subchapter G, new Division 1, concerning Mental Health Grant Program for Justice-Involved Individuals, and new §307.351, concerning Purpose, §307.353, concerning Definitions, §307.355, concerning General Conditions of a Grant, §307.357, concerning Eligible Applicants, §307.359, concerning Eligible Projects, §307.361, concerning Grant Proposals and Selection Process, 307.363, concerning Selection Criteria, §307.365, concerning Contract Execution, and §307.367, concerning Project Review and Evaluation Report, in new Subchapter G, new Division 2, concerning Rural Initiatives Grant Program.
Sections 307.303, 307.309, 307.311, and 307.359 are adopted with changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 620). These rules will be republished.
Sections 307.301,307.305, 307.307, 307.313, 307.315, 307.351, 307.353, 307.355, 307.357, 307.361, 307.363, 307.365, and 307.367 are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 620). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The purpose of the adopted rules is to comply with Senate Bill (S.B.) 1677, 88th Legislature, Regular Session, 2023, which requires HHSC to adopt rules to implement Texas Government Code §531.0993(d-1), and §531.09936.
The adopted rules in new Subchapter G, outline the general conditions of the grant, eligible applicants, selection process, contract execution, reporting requirements, and HHSC inspections of the operation and provision of mental health services under the Mental Health Grant for Justice-Involved Individuals (MHGJII) and the Rural Initiatives Grant Program.
The adopted rules in Division 1 establish the requirements of the MHGJII to provide grants to county-based community collaboratives for the purpose of reducing: (1) recidivism by, the frequency of arrests of, and incarceration of persons with mental illness; and (2) the total waiting time for forensic commitment of persons with mental illness to a state hospital. The adopted rules outline the assistance offered by HHSC to community collaboratives that include a county with a population of less than 250,000 in submitting a proposal for the MHGJII.
The adopted rules in Division 2 establish the requirements for the Rural Initiatives Grant Program, to provide grants to establish or expand behavioral health centers or jail diversion centers in a local service area of a local mental health authority (LMHA) or local behavioral health authority located primarily in rural areas to provide one or more of the following types of services: (1) additional forensic hospital beds and competency restoration services; (2) inpatient and outpatient mental health services to adults and children; or (3) services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness.
Adopting 26 TAC §§307.351, 307.353, 307.355, 307.357, 307.359, 307.361, 307.363, 307.365, 307.367, to describe the requirements and selection process for grant proposals.
CHAPTER 307. BEHAVIORAL HEALTH PROGRAMS
SUBCHAPTER G. BEHAVIORAL HEALTH GRANT AND FUNDING PROGRAMS
26 TAC §§307.351, 307.353, 307.355, 307.357, 307.359, 307.361, 307.363, 307.365, 307.367
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts §307.301, concerning Purpose, §307.305, concerning General Conditions of a Grant, §307.307, concerning Eligible Applicants, §307.309, concerning Eligible Projects, §307.311, concerning Grant Proposals and Selection Process, §307.313, concerning Contract Execution, and §307.315, concerning Project Review and Evaluation Report, in new Subchapter G, new Division 1, concerning Mental Health Grant Program for Justice-Involved Individuals, and new §307.351, concerning Purpose, §307.353, concerning Definitions, §307.355, concerning General Conditions of a Grant, §307.357, concerning Eligible Applicants, §307.359, concerning Eligible Projects, §307.361, concerning Grant Proposals and Selection Process, 307.363, concerning Selection Criteria, §307.365, concerning Contract Execution, and §307.367, concerning Project Review and Evaluation Report, in new Subchapter G, new Division 2, concerning Rural Initiatives Grant Program.
Sections 307.303, 307.309, 307.311, and 307.359 are adopted with changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 620). These rules will be republished.
Sections 307.301,307.305, 307.307, 307.313, 307.315, 307.351, 307.353, 307.355, 307.357, 307.361, 307.363, 307.365, and 307.367 are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 620). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The purpose of the adopted rules is to comply with Senate Bill (S.B.) 1677, 88th Legislature, Regular Session, 2023, which requires HHSC to adopt rules to implement Texas Government Code §531.0993(d-1), and §531.09936.
The adopted rules in new Subchapter G, outline the general conditions of the grant, eligible applicants, selection process, contract execution, reporting requirements, and HHSC inspections of the operation and provision of mental health services under the Mental Health Grant for Justice-Involved Individuals (MHGJII) and the Rural Initiatives Grant Program.
The adopted rules in Division 1 establish the requirements of the MHGJII to provide grants to county-based community collaboratives for the purpose of reducing: (1) recidivism by, the frequency of arrests of, and incarceration of persons with mental illness; and (2) the total waiting time for forensic commitment of persons with mental illness to a state hospital. The adopted rules outline the assistance offered by HHSC to community collaboratives that include a county with a population of less than 250,000 in submitting a proposal for the MHGJII.
The adopted rules in Division 2 establish the requirements for the Rural Initiatives Grant Program, to provide grants to establish or expand behavioral health centers or jail diversion centers in a local service area of a local mental health authority (LMHA) or local behavioral health authority located primarily in rural areas to provide one or more of the following types of services: (1) additional forensic hospital beds and competency restoration services; (2) inpatient and outpatient mental health services to adults and children; or (3) services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness.
Proposed Rule Reviews Re:
Reviewing Title 26, Part 1, to review and consider for readoption, revision, or repeal the chapter concerning the Community Care for Aged and Disabled.
The Texas Health and Human Services Commission (HHSC) proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 26, Part 1, of the Texas Administrative Code (TAC):
Chapter 271, Community Care for Aged and Disabled
Adopted Rule Reviews Re:
Adopting the review of Title 1, Part 15, concerning the Medicaid Estate Recovery Program.
The Texas Health and Human Services Commission (HHSC), on behalf of the Office of Inspector General (OIG), adopts the review of the chapter below in Title 1, Part 15, of the Texas Administrative Code (TAC):
Chapter 373, Medicaid Estate Recovery Program
Adopting the review of Title 26, Part 1, concerning Nursing Facility Administrators.
The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code (TAC):
Chapter 555, Nursing Facility Administrators
Texas Department of Insurance, Division of Workers’ Compensation
Adopted Rules Re:
Adopting 28 TAC §180.2, to prevent health care providers or their agents from using the DWC’s complaint process to submit complaints for medical billing issues from more than 12 months before the date of the complaint, unless there is an MFDR exception.
CHAPTER 180. MONITORING AND ENFORCEMENT
SUBCHAPTER A. GENERAL RULES FOR ENFORCEMENT
28 TAC §180.2
OVERVIEW
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts amendments to 28 TAC §180.2, concerning filing a complaint. The amendments are adopted without changes to the proposed text published in the March 22, 2024, issue of the Texas Register (49 TexReg 1872). The rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments prevent health care providers or their agents from trying to use DWC’s complaint process to collect fees instead of submitting their medical fee disputes properly through the medical fee dispute resolution (MFDR) process established by Texas Labor Code §413.031. Under the MFDR process, health care providers have one year after the date of service to bring a fee dispute, unless an exception applies. However, some health care providers and their agents have tried to use DWC’s complaint process to collect disputed fees when they fail to file a fee dispute before the MFDR deadline. To address this problem, the amendments clarify that a health care provider cannot submit a complaint about a medical billing issue if the date of service for the medical billing issue was more than 12 months before the date of the complaint, unless an MFDR deadline exception applies. The restriction does not apply to a health care provider submitting a complaint under Insurance Code Chapter 1305.
The amendments also include nonsubstantive editorial and formatting changes that make updates for plain language and agency style to improve the rule’s clarity.
Amending §180.2 is necessary to ensure that no health care provider or agent can use the complaint process to circumvent the MFDR filing deadline in 28 TAC §133.307(c), concerning medical fee dispute resolution. Labor Code §402.023 requires the commissioner to adopt rules about filing complaints, including how to file a complaint and what constitutes a frivolous complaint. Labor Code §413.031 requires the commissioner to adjudicate disputes over the amount of payment due for services determined to be medically necessary and appropriate for treatment of a compensable injury. DWC’s MFDR rules, including §133.307, contain requirements for adjudicating those disputes. Amending §180.2 as proposed will prevent health care providers and their agents from using DWC’s complaint process to avoid the MFDR rules that the commissioner adopted to comply with Labor Code §§402.023 and 413.031.
Texas Department of Licensing and Regulation
Proposed Rule Reviews Re:
Reviewing Title 16, Part 4, to review and consider for readoption, revision, or repeal the chapter concerning Licensed Dyslexia Therapists and Licensed Dyslexia Practitioners.
The Texas Department of Licensing and Regulation (Department) files this Notice of Intent to Review to consider for re-adoption, revision, or repeal the chapters listed below, in their entirety, contained in Title 16, Part 4, of the Texas Administrative Code. This review is being conducted in accordance with Texas Government Code §2001.039.
Chapter 120, Licensed Dyslexia Therapists and Licensed Dyslexia Practitioners
Texas Medical Board
Proposed Rule Reviews Re:
Reviewing Title 22, Part 9, to review and consider for readoption, revision, or repeal the chapters concerning Medical Physicists, General Provisions, Supervision of Medical School Students, Licensure, Physician Advertising, Medical Records, Physician Registration, Reinstatement and Reissuance, Criminal History Evaluation Letters, Authority of Physicians To Supply Drugs, Prescription of Controlled Substances, Postgraduate Training Permits, Temporary and Limited Licenses, Physician Profiles, Telemedicine, Fees and Penalties, Health Care Liability Lawsuits and Settlements, Business Organizations and Agreements, Complaints, Investigations, Texas Physician Health Program, Contact Lens Prescriptions, Use of Experts, Acupuncture, Surgical Assistants, Physician Assistants, Respiratory Care Practitioners, Procedural Rules, Perfusionists, Compliance Program, Disciplinary Guidelines, District Review Committees, Office-Based Anesthesia Services, Standing Delegation Orders, Medical Radiologic Technology, Pain Management Clinics, Voluntary Relinquishment Or Surrender Of A Medical License, Emergency Medical Service, Standards For Use Of Investigational Agents, Public Information, Standards For Physicians Practicing Complementary and Alternative Medicine.
The Texas Medical Board (Board) proposes to review and consider for readoption, revision, or repeal the following chapters listed below, in its entirety, contained in Title 22, Part 9, of the Texas Administrative Code:
Chapter 160, Medical Physicists
Chapter 161, General Provisions
Chapter 162, Supervision of Medical School Students
Chapter 163, Licensure
Chapter 164, Physician Advertising
Chapter 165, Medical Records
Chapter 166, Physician Registration
Chapter 167, Reinstatement and Reissuance
Chapter 168, Criminal History Evaluation Letters
Chapter 169, Authority of Physicians To Supply Drugs
Chapter 170, Prescription of Controlled Substances
Chapter 171, Postgraduate Training Permits
Chapter 172, Temporary and Limited Licenses
Chapter 173, Physician Profiles
Chapter 174, Telemedicine
Chapter 175, Fees and Penalties
Chapter 176, Health Care Liability Lawsuits and Settlements
Chapter 177, Business Organizations and Agreements
Chapter 178, Complaints
Chapter 179, Investigations
Chapter 180, Texas Physician Health Program
Chapter 181, Contact Lens Prescriptions
Chapter 182, Use of Experts
Chapter 183, Acupuncture
Chapter 184, Surgical Assistants
Chapter 185, Physician Assistants
Chapter 186, Respiratory Care Practitioners
Chapter 187, Procedural Rules
Chapter 188, Perfusionists
Chapter 189, Compliance Program
Chapter 190, Disciplinary Guidelines
Chapter 191, District Review Committees
Chapter 192, Office-Based Anesthesia Services
Chapter 193, Standing Delegation Orders
Chapter 194, Medical Radiologic Technology
Chapter 195, Pain Management Clinics
Chapter 196, Voluntary Relinquishment Or Surrender Of A Medical License
Chapter 197, Emergency Medical Service
Chapter 198, Standards For Use Of Investigational Agents
Chapter 199, Public Information
Chapter 200, Standards For Physicians Practicing Complementary and Alternative Medicine
Texas State Board of Pharmacy
Proposed Rule Reviews Re:
Reviewing Title 22, Part 15, to review and consider for readoption, revision, or repeal the chapters concerning Pharmacies.
The Texas State Board of Pharmacy files this notice of intent to review Chapter 291, Subchapter D (§§291.71 – 291.77), concerning Pharmacies (Institutional Pharmacy (Class C)), pursuant to Texas Government Code §2001.039, regarding Agency Review of Existing Rules.
Adopted Rule Reviews Re:
Adopting the review of Title 22, Part 15, concerning Administrative Practices and Procedures.
The Texas State Board of Pharmacy adopts the review of Chapter 281, (§§281.1 – 281.23, 281.30 – 281.35, 281.60 – 281.70), concerning Administrative Practices and Procedures, pursuant to the Texas Government Code §2001.039, regarding Agency Review of Existing Rules.
Texas Department of State Health Services
Proposed Rule Reviews Re:
Reviewing Title 25, Part 1, to review and consider for readoption, revision, or repeal the chapters concerning General Sanitation.
The Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 25, Part 1, of the Texas Administrative Code:
Chapter 265, General Sanitation
Adopted Rule Reviews Re:
Adopting Title 25, Part 1, concerning Nutrition Services.
The Texas Health and Human Services Commission (HHSC), in its own capacity and on behalf of the Texas Department of State Health Services (DSHS), adopts the review of the chapter below in Title 25, Part 1, of the Texas Administrative Code (TAC):
Chapter 31, Nutrition Services
Council on Cardiovascular Disease and Stroke
Proposed Rule Reviews Re:
Reviewing Title 25, Part 15, to review and consider for readoption, revision, or repeal the chapters concerning Rules.
The Council on Cardiovascular Disease and Stroke proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 25, Part 15, of the Texas Administrative Code:
Chapter 1051, Rules
Executive Council of Physical Therapy and Occupational Therapy Examiners
Adopted Rule Reviews Re:
Adopting Title 22, Part 28, concerning Fees.
The Executive Council of Physical Therapy and Occupational Therapy Examiners (Executive Council) readopts the rules in Title 22 Texas Administrative Code Chapter 651, Fees, in accordance with Texas Government Code §2001.039.