Texas Register Table of Contents
- 1 Texas Department of State Health Services
- 2 Texas Health and Human Services Commission
- 2.0.1 Proposed Rule Reviews Re:
- 2.0.1.1 Reviewing Title 1, Part 15, to review and consider for readoption, revision, or repeal the chapter concerning the Purchase of Goods and Services for Specific Health and Human Services Commission Programs.
- 2.0.1.2 Reviewing Title 26, Part 1, to review and consider for readoption, revision, or repeal the chapter concerning the Epilepsy Program.
- 2.0.2 Adopted Rule Reviews Re:
- 2.0.3 In Addition Re:
- 2.0.1 Proposed Rule Reviews Re:
- 3 Texas Department of Insurance
- 3.0.1 Withdrawn Rules Re:
- 3.0.2 Adopted Rules Re:
- 3.0.3 Adopted Rules Re:
- 3.0.3.1 Adopting 28 TAC §§3.3702 – 3.3705, 3.3707 – 3.3711, and new §3.3712, to include prohibitions on contractual anti-steering, anti-tiering, most favored nation, and gag clauses and update disclosures requirements.
- 3.0.3.2 Adopting 28 TAC §§3.3720, 3.3722, 3.3723, to update network configuration filing requirements and change some of the rule’s language.
- 3.0.3.3 Adopting 28 TAC §3.3725, to remove sections invalidated by the TAHP Order.
- 3.0.4 In Addition Re:
- 4 Department of Aging and Disability Services
Texas Department of State Health Services
Proposed Rules Re:
Amending 25 TAC §296.131, to repeal a rule no longer required due to the implementation of Senate Bill (S.B.) 422, 88th Legislature, Regular Session, 2023, which extends occupational reciprocity to military services members.
CHAPTER 296. TEXAS ASBESTOS HEALTH PROTECTION
SUBCHAPTER H. LICENSE AND REGISTRATION PROVISIONS RELATED TO MILITARY SERVICE MEMBERS, MILITARY VETERANS, AND MILITARY SPOUSES
25 TAC §296.131
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes the repeal of Texas Administrative Code (TAC), Title 25, Subchapter H, concerning License and Registration Provisions Related to Military Service Members, Military Veterans, and Military Spouses, and §296.131, concerning Military Service Members, Military Veterans, and Military Spouses.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to repeal a rule no longer required due to implementation of Senate Bill (S.B.) 422, 88th Legislature, Regular Session, 2023, extending occupational reciprocity to military service members. DSHS implemented S.B. 422 by adopting amended 25 TAC §1.81, concerning Recognition of Out-of-State License of a Military Service Member and Military Spouse, and new §1.91, concerning Alternative Licensing for Military Service Members, Military Spouses, and Military Veterans.
SECTION-BY-SECTION SUMMARY
- The proposed repeal removes Subchapter H because the only rule it contains is being repealed.
- The proposed repeal of §296.131 removes the rule as no longer necessary. This will avoid repetitive or inconsistent rule language with adopted rules in 25 TAC Chapter 1.
Adopted Rules Review Re:
Adopting the review of Title 25, Part 1, concerning Health Planning and Resource Development.
The Texas Health and Human Services Commission (HHSC), 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 13, Health Planning and Resource Development
Texas Health and Human Services Commission
Proposed Rule Reviews Re:
Reviewing Title 1, Part 15, to review and consider for readoption, revision, or repeal the chapter concerning the Purchase of Goods and Services for Specific Health and Human Services Commission Programs.
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 1, Part 15, of the Texas Administrative Code:
Chapter 392, Purchase of Goods and Services for Specific Health and Human Services Commission Programs
Reviewing Title 26, Part 1, to review and consider for readoption, revision, or repeal the chapter concerning the Epilepsy Program.
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:
Chapter 355, Epilepsy Program
Adopted Rule Reviews Re:
Adopting the review of Title 1, Part 15, concerning Medicaid and CHIP Electronic Health Information.
The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 1, Part 15, of the Texas Administrative Code:
Chapter 356, Medicaid and CHIP Electronic Health Information
Adopting the review of Title 26, Part 1, concerning the Minimum Standards for Child-Care Centers.
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:
Chapter 746, Minimum Standards for Child-Care Centers
In Addition Re:
Notice of Stakeholder Engagement Meetings for Medicaid and Non-Medicaid Payment Rates
OVERVIEW
The Texas Health and Human Services Commission (HHSC) will conduct stakeholder engagement meetings on April 25, 2024, to receive comments on Medicaid and non-Medicaid payment rate topics that may potentially be addressed at the upcoming May 2024 rate hearings. Commentary will be collected solely on the topics listed in this notice. Proposed rates will not be published at this time. These meetings will be conducted online only.
Public Notice – Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments will be effective May 1, 2024.
The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for Physicians and Other Practitioners.
The proposed amendment is estimated to result in an annual aggregate expenditure of $5,480 for federal fiscal year (FFY) 2024, consisting of $3,296 in federal funds and $2,184 in state general revenue. For FFY 2025, the estimated annual aggregate expenditure is $13,004 consisting of $7,802 in federal funds and $5,202 in state general revenue. For FFY 2026, the estimated annual aggregate expenditure is $12,857 consisting of $7,714 in federal funds and $5,143 in state general revenue.
Texas Department of Insurance
Withdrawn Rules Re:
Withdrawing 28 TAC §3.3713, to specify that counties are classified based on determinations made by the federal Centers for Medicare and Medicaid Services as of March 1, 2023.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER X. PREFERRED AND EXCLUSIVE PROVIDER PLANS
DIVISION 1. GENERAL REQUIREMENTS
28 TAC §3.3713
OVERVIEW
The Texas Department of Insurance withdraws proposed new §3.3713, which appeared in the December 8, 2023, issue of the Texas Register (48 TexReg 7129).
Adopted Rules Re:
Adopting 28 TAC §3.3038, to to expand the exceptions for guaranteed renewability to permit coverage under a preferred or exclusive provider benefit plan to be discontinued or nonrenewed if the insured no longer resides, lives, or works in the service area of the issuer.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER S. MINIMUM STANDARDS AND BENEFITS AND READABILITY FOR INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES
28 TAC §3.3038
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.3038, 3.3702 – 3.3705, 3.3707 – 3.3711, 3.3720, 3,3722, and 3.3723; new §3.3712; and the repeal of §3.3725. Proposed §3.3713 is not adopted. The commissioner also adopts amendments to the title of Division 2 of 28 TAC Chapter 3, Subchapter X. These sections concern preferred and exclusive provider benefit plans. The amendments and new section are adopted with changes to the proposed text published in the December 8, 2023, issue of the Texas Register (48 TexReg 7129). These sections, specified subsequently, will be republished. The commissioner adopts §§3.3038, 3.3710, and 3.3720 and the repeal of §3.3725 without changes to the proposed text. These sections will not be republished. The commissioner adopts §§3.3702 – 3.3705, 3.3707 – 3.3709, 3.3711, 3.3712, 3.3722, and 3.3723 with nonsubstantive changes to the proposed text. Sections 3.3703 – 3.3705, 3.3707 – 3709, 3.3712, 3.3722, and 3.3723 were revised in response to public comments. Section 3.3702 and §3.3711 are adopted with nonsubstantive changes to update punctuation and grammar and to reflect current agency drafting style and plain language references.
BACKGROUND AND JUSTIFICATION
The repeal, amendments, and new sections are necessary to implement House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions; House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs; House Bill 1696, 88th Legislature, 2023, which expands protections for optometrists and therapeutic optometrists in contracts with managed care plans; House Bill 2002, 88th Legislature, 2023, which requires insurers to credit certain out-of-network payments to the enrollee’s deductible and maximum out-of-pocket amounts; House Bill 3359, 88th Legislature, 2023, which provides network adequacy standards and requirements; Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories; and Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
Adopted Rules Re:
Adopting 28 TAC §§3.3702 – 3.3705, 3.3707 – 3.3711, and new §3.3712, to include prohibitions on contractual anti-steering, anti-tiering, most favored nation, and gag clauses and update disclosures requirements.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER X. PREFERRED AND EXCLUSIVE PROVIDER PLANS
DIVISION 1. GENERAL REQUIREMENTS
28 TAC §§3.3702 – 3.3705, 3.3707 – 3.3712
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.3038, 3.3702 – 3.3705, 3.3707 – 3.3711, 3.3720, 3,3722, and 3.3723; new §3.3712; and the repeal of §3.3725. Proposed §3.3713 is not adopted. The commissioner also adopts amendments to the title of Division 2 of 28 TAC Chapter 3, Subchapter X. These sections concern preferred and exclusive provider benefit plans. The amendments and new section are adopted with changes to the proposed text published in the December 8, 2023, issue of the Texas Register (48 TexReg 7129). These sections, specified subsequently, will be republished. The commissioner adopts §§3.3038, 3.3710, and 3.3720 and the repeal of §3.3725 without changes to the proposed text. These sections will not be republished. The commissioner adopts §§3.3702 – 3.3705, 3.3707 – 3.3709, 3.3711, 3.3712, 3.3722, and 3.3723 with nonsubstantive changes to the proposed text. Sections 3.3703 – 3.3705, 3.3707 – 3709, 3.3712, 3.3722, and 3.3723 were revised in response to public comments. Section 3.3702 and §3.3711 are adopted with nonsubstantive changes to update punctuation and grammar and to reflect current agency drafting style and plain language references.
BACKGROUND AND JUSTIFICATION
The repeal, amendments, and new sections are necessary to implement House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions; House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs; House Bill 1696, 88th Legislature, 2023, which expands protections for optometrists and therapeutic optometrists in contracts with managed care plans; House Bill 2002, 88th Legislature, 2023, which requires insurers to credit certain out-of-network payments to the enrollee’s deductible and maximum out-of-pocket amounts; House Bill 3359, 88th Legislature, 2023, which provides network adequacy standards and requirements; Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories; and Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
Adopting 28 TAC §§3.3720, 3.3722, 3.3723, to update network configuration filing requirements and change some of the rule’s language.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
DIVISION 2. APPLICATION, EXAMINATION, AND PLAN REQUIREMENTS
28 TAC §§3.3720, 3.3722, 3.3723
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.3038, 3.3702 – 3.3705, 3.3707 – 3.3711, 3.3720, 3,3722, and 3.3723; new §3.3712; and the repeal of §3.3725. Proposed §3.3713 is not adopted. The commissioner also adopts amendments to the title of Division 2 of 28 TAC Chapter 3, Subchapter X. These sections concern preferred and exclusive provider benefit plans. The amendments and new section are adopted with changes to the proposed text published in the December 8, 2023, issue of the Texas Register (48 TexReg 7129). These sections, specified subsequently, will be republished. The commissioner adopts §§3.3038, 3.3710, and 3.3720 and the repeal of §3.3725 without changes to the proposed text. These sections will not be republished. The commissioner adopts §§3.3702 – 3.3705, 3.3707 – 3.3709, 3.3711, 3.3712, 3.3722, and 3.3723 with nonsubstantive changes to the proposed text. Sections 3.3703 – 3.3705, 3.3707 – 3709, 3.3712, 3.3722, and 3.3723 were revised in response to public comments. Section 3.3702 and §3.3711 are adopted with nonsubstantive changes to update punctuation and grammar and to reflect current agency drafting style and plain language references.
BACKGROUND AND JUSTIFICATION
The repeal, amendments, and new sections are necessary to implement House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions; House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs; House Bill 1696, 88th Legislature, 2023, which expands protections for optometrists and therapeutic optometrists in contracts with managed care plans; House Bill 2002, 88th Legislature, 2023, which requires insurers to credit certain out-of-network payments to the enrollee’s deductible and maximum out-of-pocket amounts; House Bill 3359, 88th Legislature, 2023, which provides network adequacy standards and requirements; Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories; and Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
The adopted text also makes additional amendments in Subchapter S and throughout Subchapter X. The amendments remove payment rules that were invalidated by court order in Texas Ass’n of Health Plans v. Texas Dept. of Insurance, Travis County District Court No. D-1-GN-18-003846 (October 15, 2020) (TAHP Order); provide new payment requirements and protections for preferred and exclusive provider plans consistent with Senate Bill 1264, 86th Legislature, 2019; expand exceptions to guaranteed renewability requirements; affirm the Texas Department of Insurance’s (TDI’s) prohibition on referral requirements; prohibit penalties on insureds for failure to obtain a preauthorization; restrict misrepresentation of cost-sharing incentives in advertisements; streamline disclosure requirements for policy terms; require that certain filings be submitted to TDI via the National Association of Insurance Commissioners (NAIC) System for Electronic Rates & Forms Filing (SERFF) instead of email; remove references to a repealed section; and revise sections as necessary to conform to changes in other sections. In addition, an amendment revises the title of Subchapter X, Division 2, to reflect that the division addresses application, examination, and plan requirements and applies to both preferred and exclusive provider benefit plans.
Adopting 28 TAC §3.3725, to remove sections invalidated by the TAHP Order.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER X. PREFERRED AND EXCLUSIVE PROVIDER PLANS
28 TAC §3.3725
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.3038, 3.3702 – 3.3705, 3.3707 – 3.3711, 3.3720, 3,3722, and 3.3723; new §3.3712; and the repeal of §3.3725. Proposed §3.3713 is not adopted. The commissioner also adopts amendments to the title of Division 2 of 28 TAC Chapter 3, Subchapter X. These sections concern preferred and exclusive provider benefit plans. The amendments and new section are adopted with changes to the proposed text published in the December 8, 2023, issue of the Texas Register (48 TexReg 7129). These sections, specified subsequently, will be republished. The commissioner adopts §§3.3038, 3.3710, and 3.3720 and the repeal of §3.3725 without changes to the proposed text. These sections will not be republished. The commissioner adopts §§3.3702 – 3.3705, 3.3707 – 3.3709, 3.3711, 3.3712, 3.3722, and 3.3723 with nonsubstantive changes to the proposed text. Sections 3.3703 – 3.3705, 3.3707 – 3709, 3.3712, 3.3722, and 3.3723 were revised in response to public comments. Section 3.3702 and §3.3711 are adopted with nonsubstantive changes to update punctuation and grammar and to reflect current agency drafting style and plain language references.
BACKGROUND AND JUSTIFICATION
The repeal, amendments, and new sections are necessary to implement House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions; House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs; House Bill 1696, 88th Legislature, 2023, which expands protections for optometrists and therapeutic optometrists in contracts with managed care plans; House Bill 2002, 88th Legislature, 2023, which requires insurers to credit certain out-of-network payments to the enrollee’s deductible and maximum out-of-pocket amounts; House Bill 3359, 88th Legislature, 2023, which provides network adequacy standards and requirements; Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories; and Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
The adopted text also makes additional amendments in Subchapter S and throughout Subchapter X. The amendments remove payment rules that were invalidated by court order in Texas Ass’n of Health Plans v. Texas Dept. of Insurance, Travis County District Court No. D-1-GN-18-003846 (October 15, 2020) (TAHP Order); provide new payment requirements and protections for preferred and exclusive provider plans consistent with Senate Bill 1264, 86th Legislature, 2019; expand exceptions to guaranteed renewability requirements; affirm the Texas Department of Insurance’s (TDI’s) prohibition on referral requirements; prohibit penalties on insureds for failure to obtain a preauthorization; restrict misrepresentation of cost-sharing incentives in advertisements; streamline disclosure requirements for policy terms; require that certain filings be submitted to TDI via the National Association of Insurance Commissioners (NAIC) System for Electronic Rates & Forms Filing (SERFF) instead of email; remove references to a repealed section; and revise sections as necessary to conform to changes in other sections. In addition, an amendment revises the title of Subchapter X, Division 2, to reflect that the division addresses application, examination, and plan requirements and applies to both preferred and exclusive provider benefit plans.
In Addition Re:
Company Licensing — Applications for Incorporations and Name Changes
Application for incorporation in the state of Texas for Tower Hill E&S Insurance Exchange, a domestic reciprocal. The home office is in Dallas, Texas.
Application for Columbian Mutual Life Insurance Company, a foreign life, accident, and/or health company, to change its name to Columbian Life Insurance Company of New York, Inc. The home office is in East Binghamton, New York.
Application for American National Lloyds Insurance Company, a domestic fire and/or casualty company, to change its name to American National Specialty Insurance Company. The home office is in League City, Texas.
Department of Aging and Disability Services
Proposed Rules Review:
Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter concerning Intellectual Disability Services–Medicaid State Operating Agency Responsibilities.
The Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of Aging and Disability Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 40, Part 1, of the Texas Administrative Code:
Chapter 9, Intellectual Disability Services–Medicaid State Operating Agency Responsibilities
Adopted Rules Review:
Adopting Title 40, Part 1, to consider for readoption, revision, or repeal the chapter concerning the Use of General Revenue for Services Exceeding the Individual Cost Limit of a Waiver Program.
The Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of Aging and Disability Services (DADS), adopts the review of the chapter below in Title 40, Part 1, of the Texas Administrative Code:
Chapter 40, Use of General Revenue for Services Exceeding the Individual Cost Limit of a Waiver Program