Texas Register April 26, 2024 Volume: 49 Number: 17

Texas Register Table of Contents

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §133.46, to require hospitals to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
25 TAC §133.46

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §133.46, concerning Hospital Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §133.46 adds paragraph (2) in subsection (a), which requires a hospital to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is revised to “Billing Requirements.” Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as removing short titles to statutes, formatting punctuation and capitalization, and spelling out “HHSC.”


Amending 25 TAC §135.4, to require Ambulatory Surgical Centers to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 135. AMBULATORY SURGICAL CENTERS
SUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS
25 TAC §135.4

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §135.4, concerning Ambulatory Surgical Center (ASC) Operation.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §135.4 adds subsection (n), which requires an ASC to comply with the itemized billing requirements in HSC Chapter 185. Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as deleting superfluous phrases, reorganizing paragraph (11)(B), adding “Texas” before a reference to a Texas statute, and deleting a lead-in phrase for consistency.


Amending 25 TAC §137.39, to require birthing centers to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 137. BIRTHING CENTERS
SUBCHAPTER D. OPERATIONAL AND CLINICAL STANDARDS FOR THE PROVISION AND COORDINATION OF TREATMENT AND SERVICES
25 TAC §137.39

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §137.39, concerning General Requirements for the Provision and Coordination of Treatment and Services.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §137.39 adds subsection (j), which requires a birthing center to comply with the itemized billing requirements in HSC Chapter 185. Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as deleting the lead-in phrase in subsection (i) for consistency.


Amending 25 TAC §139.60, to require abortion facilities to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 139. ABORTION FACILITY REPORTING AND LICENSING
SUBCHAPTER D. MINIMUM STANDARDS FOR LICENSED ABORTION FACILITIES
25 TAC §139.60

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §139.60, concerning Other State and Federal Compliance Requirements.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §139.60 adds subsection (o), which requires an abortion facility to comply with the itemized billing requirements in HSC Chapter 185. Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as formatting punctuation, removing short titles to statutes, adding “Texas” before a reference to a Texas statute, removing a lead-in phrase in subsection (n) for consistency, and abbreviating “Code of Federal Regulations.” The subsections are renumbered to account for the addition of a subsection.


Amending 25 TAC §229.144, to require narcotic treatment programs to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 229. FOOD AND DRUG
SUBCHAPTER J. MINIMUM STANDARDS FOR NARCOTIC TREATMENT PROGRAMS
25 TAC §229.144

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §229.144, concerning State and Federal Statutes and Regulations.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §229.144 adds new subsection (d), which requires a narcotic treatment program (NTP) to comply with the itemized billing requirements in HSC Chapter 185. Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as removing superfluous phrases, adding “Texas” before references to Texas statutes, removing short titles to statutes, formatting punctuation and removing a lead-in phrase for consistency. Subsections are renumbered to account for the addition of a subsection.


Adopted Rules Re:

Amending 25 TAC §265.190, to add the key phrase “where no lifeguard is required or provided” to certain signage and specify lighting requirements for pools and spas which operate at night.

CHAPTER 265. GENERAL SANITATION
SUBCHAPTER L. PUBLIC SWIMMING POOLS AND SPAS
25 TAC §265.190

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts an amendment to §265.190, concerning Safety Features for Pools and Spas.

Section 265.190 is adopted without changes to the proposed text as published in the January 19, 2024, issue of the Texas Register (49 TexReg 236). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment is necessary to comply with Texas Health and Safety Code §341.0645, which requires DSHS adopt pool safety standards necessary to prevent drowning. The amendment revises the requirement for pool and spa signs to clarify that prohibiting persons under the age of 14 years from being in a pool or spa without adult supervision applies only to pools and spas where a lifeguard is not required or provided.

This long-standing provision was inadvertently removed during amendments to Texas Administrative Code (TAC), Title 25, Chapter 265, Subchapter L in 2021. The amendment restores the language that had been in place since at least 1999. The amendment also clarifies lighting requirements and makes editorial changes for clearer language.


Adopted Rule Reviews Re:

Adopting the review of Title 25, Part 1, concerning Case Management for Children and Pregnant Women.

The Texas Health and Human Services Commission (HHSC), in its own capacity and on behalf of the Texas Department of State Health Services, adopts the review of the chapter below in Title 25, Part 1, of the Texas Administrative Code:

Chapter 27, Case Management for Children and Pregnant Women


Texas Health and Human Services Commission

Proposed Rules Re:

Amending 26 TAC §506.37, to require special care facilities to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 506. SPECIAL CARE FACILITIES
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §506.37

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §506.37, concerning Balance Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §506.37 adds new subsection (b), which requires a special care facility (SCF) to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is updated to “Billing Requirements” and the section is reorganized for clarity.


Amending 26 TAC §507.50, to require end stage renal disease facilities to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 507. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER D. OPERATIONAL REQUIREMENTS FOR PATIENT CARE AND TREATMENT
26 TAC §507.50

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §507.50, concerning Balance Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §507.50 adds new subsection (b), which requires an end stage renal disease (ESRD) facility to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is updated to “Billing Requirements” and the section is reorganized for clarity.


Amending 26 TAC §509.67, to require freestanding emergency medical care facilities to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §509.67

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §509.67, concerning Balance Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §509.67 adds new subsection (b), which requires a freestanding emergency medical care (FEMC) facility to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is updated to “Billing Requirements” and the section is reorganized for clarity.


Amending 26 TAC §510.45, to require private psychiatric hospital or crisis stabilization units to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §510.45

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §510.45, concerning Facility Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §510.45 adds new paragraph (2) under subsection (a), which requires a private psychiatric hospital or crisis stabilization unit (CSU) to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is revised to “Billing Requirements.” Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as removing short titles to statutes, formatting punctuation and capitalization, and spelling out “HHSC.”


Amending 26 TAC §511.75, to require limited service rural hospitals to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §511.75

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §511.75, concerning Limited Services Rural Hospital Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §511.75 adds subsection (c), which requires a limited services rural hospital (LSRH) to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is revised to “Billing Requirements.” Other minor stylistic edits are made to comply with current HHSC rulemaking guidelines, such as removing short titles to statutes, spelling out “HHSC,” and the section is renumbered for clarity.


Amending 26 TAC §564.28, to require licensed chemical dependency treatment facilities to comply with HSC Chapter 185 itemized billing requirements.

CHAPTER 564. TREATMENT FACILITIES FOR INDIVIDUALS WITH SUBSTANCE-RELATED DISORDERS
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §564.28

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §564.28, concerning Balance Billing.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.

S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.

HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.

The proposed amendment is necessary to add information regarding these itemized-bill requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §564.28 adds new subsection (b), which requires a licensed chemical dependency treatment facility (CDTF) to comply with the itemized billing requirements in HSC Chapter 185. The title of the section is updated to “Billing Requirements” and the section is reorganized for clarity.


Proposed Rule Reviews Re:

Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal the chapter concerning Minimum Standards for Child-Placing Agencies.

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 749, Minimum Standards for Child-Placing Agencies


Adopted Rule Reviews Re:

Adopting the review of Title 1, Part 15, concerning Texas Health Steps Comprehensive Care Program.

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 (TAC):

Chapter 363, Texas Health Steps Comprehensive Care Program


Adopting the review of Title 26, Part 1, regarding Minimum Standards for General Residential Operations.

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 748, Minimum Standards for General Residential Operations


Adopting the review of Title 26, Part 1, concerning the Health and Specialty Care System.

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 900, Health and Specialty Care System


In Addition Re:

Correction of Error

The Texas Health and Human Services Commission (HHSC) published notice of an administrative rule transfer in the April 12, 2024, issue of the Texas Register (49 TexReg 2321). Due to an error by HHSC, the notice included an incorrect chapter name. The correct chapter name for Title 26, Chapter 300 should be State Authority Responsibilities.


Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on May 21, 2024, at 9:00 a.m., to receive public comments on proposed updates to Medicaid payment rates resulting from Calendar Fee Reviews, Medical Policy Reviews, Legislative Reviews, and Healthcare Common Procedure Coding System (HCPCS) Reviews.


Updated – Texas State Hospital Long-Range Planning Report Meetings

HHSC will conduct the next hybrid (in-person and virtual) meeting on May 13th, 2024, to receive public comment on the draft long-range planning report for the Texas State Hospitals. A draft report will be available to the public on the HHS website on May 6th. The report will address:

(1) projected future bed requirements for state hospitals;

(2) documenting the methodology used to develop the projection of future bed requirements;

(3) projected maintenance costs for institutional facilities;

(4) recommended strategies to maximize the use of institutional facilities; and

(5) how each state hospital will:

(A) serve and support the communities and consumers in its service area; and

(B) fulfill statewide needs for specialized services.

The initiatives outlined in this report will guide the Texas State Hospitals for the next six years. This report is developed under the authority of Texas Health and Safety Code §533.032.


Department of Aging and Disability Services

Adopted Rule Reviews Re:

Adopting the review of Title 40, Part 1, concerning Responsibilities of State Facilities.

The Texas Health and Human Services Commission (HHSC), as the successor agency 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 (TAC):

Chapter 3, Responsibilities of State Facilities


Adopting the review of Title 40, Part 1, regarding Provider Clinical Responsibilities–Intellectual Disability Services.

The Texas Health and Human Services Commission (HHSC), as the successor agency 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 (TAC):

Chapter 5, Provider Clinical Responsibilities–Intellectual Disability Services


Adopting the review of Title 40, Part 1, concerning Contracting to Provide Home-Delivered Meals.

The Texas Health and Human Services Commission (HHSC), as the successor agency to 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 55, Contracting to Provide Home-Delivered Meals


Adopting the review of Title 40, Part 1, regarding Contracting to Provide Programs of All-Inclusive Care for the Elderly (PACE).

The Texas Health and Human Services Commission (HHSC), as the successor agency to Texas Department of Aging and Disability Services, adopts the review of the chapter below in Title 40, Part 1, of the Texas Administrative Code:

Chapter 60, Contracting to Provide Programs of All-Inclusive Care for the Elderly (PACE)