Texas Register April 3, 2026 Volume 51 Number 14

Texas Register Table of Contents

1 Governor
- - 1.0.1 Appointments Re:
2 Texas Health and Human Services Commission
- - 2.0.1 Proposed Rules Re:
  - 2.0.2 In Addition Re:
3 State Board of Dental Examiners
- - 3.0.1 Proposed Rules Re:
4 Texas Board of Nursing
- - 4.0.1 Adopted Rules Re:
    - 4.0.1.1 Adopting 22 TAC §217.24, to implement House Bill 1700 (89th Legislature) by standardizing informed consent documentation and retention requirements for telehealth and telemedicine medical services provided by nurses, allowing consent to be obtained in written or verbal form including audio-only formats.

Governor

Appointments Re:

Appointed to the Texas Animal Health Commission for a term to expire September 6, 2031, Jimmie Ruth Evans.

Appointed to the Texas Animal Health Commission for a term to expire September 6, 2031, Barret J. Klein.

Appointed to the Texas Animal Health Commission for a term to expire September 6, 2031, Joe L. Leathers.

Appointed to the Texas Animal Health Commission for a term to expire September 6, 2031, Thomas E. “Tommy” Oates.

Appointed to the Texas Animal Health Commission for a term to expire September 6, 2031, Benedict L. “Ben” Scholz.

Appointed to the Texas Council for Developmental Disabilities for a term to expire February 1, 2031, Dakota M. Marks of Huntington.

Appointed to the State Independent Living Council for a term to expire October 24, 2028, Dana L. McGrath.

Appointed to the State Independent Living Council for a term to expire October 24, 2028, Patrick D. Sturdivant.

Appointed to the State Independent Living Council for a term to expire October 24, 2028, Tiffany Walker.

Appointed to the Rehabilitation Council of Texas for a term to expire October 29, 2028, Jean M. “Jeanie” Hanzal Beaman.

Appointed to the Rehabilitation Council of Texas for a term to expire October 29, 2028, Leslie S. Cantu.

Appointed to the Rehabilitation Council of Texas for a term to expire October 29, 2028, Elizabeth G. “Elle” Holtzman.

Appointed to the Rehabilitation Council of Texas for a term to expire October 29, 2028, Peggy Schmidt.

Appointed to the Rehabilitation Council of Texas for a term to expire October 29, 2028, Marla J. Williams.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §353.903 and §353.907, to implement Texas Government Code §549.0209 by establishing a temporary non-preferred (TNP) drug status for new Medicaid formulary drugs not yet reviewed by the Drug Utilization Review Board, updating related definitions, and requiring managed care organizations to obtain prior authorization for TNP drugs.

CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER J. OUTPATIENT PHARMACY SERVICES
1 TAC §353.903, §353.907

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.903, concerning Definitions; and §353.907, concerning Prior Authorization Requirements.

BACKGROUND AND PURPOSE

Previous HHSC rule amendments in the Vendor Drug Program (VDP) implemented portions of House Bill (HB) 3286, 88th Legislature Regular Session, 2023, and became effective in November 2024. These amendments elaborated on existing Preferred Drug List (PDL) exceptions regarding when a non-preferred drug can be used and added new PDL exceptions.

The purpose of this proposal is to implement the portion of HB 3286 that amended Texas Government Code §531.072 by adding subsection (h). However, effective September 1, 2025, Texas Government Code §531.072(h), was transferred to Texas Government Code, Chapter 549, and redesignated as §549.0209, as a result of HB 1620, 89th Legislature Regular Session, 2025.

Therefore, this proposal implements Texas Government Code §549.0209, that requires HHSC to: (1) grant temporary non-preferred (TNP) status to new drugs that are available on the Medicaid formulary but have not been reviewed by the Drug Utilization Review Board (DURB); and (2) establish criteria for authorizing drugs with this status. This change required HHSC to submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS), which was approved on August 29, 2024. The proposed amendments in Texas Administrative Code (TAC), Title 1, §353.903 and §353.907 address these requirements for managed care, defines TNP drugs and revises existing term definitions, and provides clarifications on application of PDL prior authorization to TNP drugs.

The amendments establish a new TNP status for drugs that are new to the market added to the VDP formulary that have not yet been reviewed by the DURB. This status will apply to new-to-market drugs upon addition to the Texas Medicaid formulary if they fall into an existing PDL class. These drugs will remain temporary non-preferred until reviewed and recommended by the DURB as preferred or non-preferred and approved by the Executive Commissioner.

TNP status does not apply to existing PDL drugs with new label indications. The proposed amendments will require a health care managed care organization (health care MCO) to have a temporary non-preferred drug list prior authorization for coverage.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §353.903 adds a definition of “temporary non-preferred drug,” defined as a covered outpatient drug that the DURB has not yet reviewed and recommended as preferred or non-preferred and not yet approved by the Executive Commissioner. The definition of “Preferred drug list” (PDL) is revised to mean the list of covered outpatient drugs defined in proposed §353.903 as a non-preferred drug, preferred drug, or temporary non-preferred drug. The definition of “Preferred drug list prior authorization” (PDL PA) is revised to mean a review a health care MCO does before a network provider can give a non-preferred drug or a temporary non-preferred drug to a member. This change in the definition of PDL PA adds the new term “temporary non-preferred drug” as a type of drug that requires a PDL PA. The definitions of “non-preferred drug” and “preferred drug” are revised to include clarification on the drug designation process.

The proposed amendment to §353.907 establishes that a health care MCO may require a PDL PA for a temporary non-preferred drug. The amendment prohibits a health care MCO from requiring a PDL PA for a covered outpatient drug that was prescribed for a member before the date HHSC decides the drug is non-preferred or temporary non-preferred. The amendment also makes several editorial changes throughout §353.907 to improve the clarity of the rules.

Amending 1 TAC §354.1924, to implement Texas Government Code §549.0209 by adding a TNP drug status for new formulary drugs not yet reviewed by the Drug Utilization Review Board, updating preferred drug list selection criteria, and requiring prior authorization for TNP drugs under the fee-for-service Medicaid program.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER F. PHARMACY SERVICES
DIVISION 7. TEXAS DRUG CODE INDEX–ADDITIONS, RETENTIONS, AND DELETIONS
1 TAC §354.1924

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §354.1924, concerning Preferred Drug List.

BACKGROUND AND PURPOSE

The proposed amendment to 1 Texas Administrative Code §354.1924 clarifies criteria HHSC uses to include a drug on the Texas Drug Code Index (TDCI) in the PDL. The rule amendment defines the term “temporary non-preferred” and adds this term to any lists of preferred drug list (PDL) statuses.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §354.1924 clarifies in subsection (c)(1)-(5) the criteria HHSC uses to include a drug on the TDCI in the PDL. The proposed amendment defines temporary non-preferred drugs as covered outpatient drugs that the DURB has not yet reviewed and recommended as preferred or non-preferred and approved by the Executive Commissioner. The proposed amendment renumbers current subsection (d) as subsection (e) and retitles it from “Distribution of PDL” to “Obtaining a copy of the PDL,” providing the HHSC Vendor Drug Program website as the source for the PDL. The proposed amendment removes current subsection (e) because HHSC no longer publishes the revised PDL within 10 days of the DUR Board’s decision. The proposed amendment requires prior authorization for a drug with temporary non-preferred status.

Amending 1 TAC §§354.4003, 354.4005, 354.4006, and 354.4013, to update Electronic Visit Verification rules to reflect the end of the STAR+PLUS Medicare-Medicaid Plan on December 31, 2025, remove Free Text Reviews from compliance reviews, add an EVV Alternative Device Compliance Review, and clarify that EVV is required when Medicaid pays any part of a claim for covered services.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER O. ELECTRONIC VISIT VERIFICATION
1 TAC §§354.4003, 354.4005, 354.4006, 354.4013

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.4003, concerning Definitions; §354.4005, concerning Personal Care Services that Require the Use of EVV; §354.4006, concerning Home Health Care Services that Require the Use of EVV; and §354.4013, concerning HHSC and MCO Compliance Reviews and Enforcement Actions.

BACKGROUND AND PURPOSE

A Medicare-Medicaid Plan (MMP) is a health plan that provides both Medicare and STAR+PLUS Medicaid services under one contract. The Centers for Medicare & Medicaid Services (CMS) Contract Year 2023 Medicare Advantage and Part D Final Rule required states to phase-out their MMP Dual Demonstration Program. With input from MMPs and other stakeholders, HHSC is complying with the Final Rule and ending the MMP’s contracts effective December 31, 2025.

The proposed amendments reflect that the STAR+PLUS MMP ended December 31, 2025, and that electronic visit verification (EVV) was required for STAR+PLUS MMP services, if delivered before January 1, 2026.

The proposed amendments remove Free Text Reviews from the list of compliance reviews because HHSC and managed care organizations (MCOs) ceased conducting these reviews in 2023.

An alternative device allows a service provider of a program provider or consumer directed services (CDS) employer to clock in and clock out of the EVV system. HHSC is limiting the use of alternative devices as an approved method to clock in and clock out to enhance program integrity. The alternative device limit is being implemented over three fiscal years to allow program providers and CDS employers time to adjust their business and gradually reduce reliance on alternative devices. The alternative device reduction schedule is in the EVV Policy Handbook.

The proposed amendments add an EVV Alternative Device Compliance Review, and the actions HHSC and the MCO may take, if a program provider’s or CDS employer’s EVV Alternative Device Compliance score exceeds the allowable percentage score described in the EVV Policy Handbook.

The proposed amendments add that a program provider or CDS employer must use EVV if Medicaid pays for any part of the services that require EVV. These changes clarify that EVV must be used if the services that require EVV are paid for by both Medicaid and a third party, such as private insurance.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §354.4003 revises several definitions, adds a definition of “dual eligible member,” updates TAC references throughout, revises the definition of STAR+PLUS MMP to indicate the program ended December 31, 2025, and renumbers paragraphs (8)-(57) as (9)-(58) to accommodate the new definition.

The proposed amendments to §354.4005 and §354.4006 add clarifying language that EVV must be used if HHSC, an HHSC designated contractor, or an MCO pays for any part of a claim for covered services, and add “if delivered before January 1, 2026” to STAR+PLUS MMP services in both personal care and home health care service lists.

The proposed amendment to §354.4013 removes EVV Required Free Text Reviews from the list of compliance reviews and from the rule body, adds an EVV Alternative Device Compliance Review, replaces “terminate” with “end” regarding CDS employer actions, adds “payment hold” as an available enforcement action, and adds new subsections (h)-(l) establishing procedures for alternative device compliance reviews for both program providers and CDS employers.

Amending 26 TAC §550.5, to implement SB 1849 (88th Legislature) by updating the definition of “Administrator” and replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in definitions for Prescribed Pediatric Extended Care Centers.

CHAPTER 550. LICENSING STANDARDS FOR PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS
SUBCHAPTER A. PURPOSE, SCOPE, LIMITATIONS, COMPLIANCE, AND DEFINITIONS
26 TAC §550.5

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §550.5, concerning Definitions; §550.304, concerning Administrator Responsibilities; §550.406, concerning Student Nurses; §550.413, concerning Contractors; §550.415, concerning Staffing Policies for Staff Orientation, Development, and Training; §550.417, concerning Personnel Records; and §550.418, concerning Criminal History Checks, Nurse Aide Registry, Medication Aide Registry, and Employee Misconduct Registry Requirements.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill (SB) 1849, 88th Legislature, Regular Session, 2023, which created Texas Health and Safety Code Chapter 810, Interagency Reportable Conduct Search Engine. While the Texas Department of Information Resources (DIR) is responsible for creating the search engine, the chapter also requires HHSC to amend rules relating to the Employee Misconduct Registry search engine and required background check searches providers regulated by HHSC Long-Term Care Regulation (LTCR) must conduct before employing individuals.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §550.5 updates the definition for “Administrator” to clarify that services are being provided to the minor’s parents and includes revisions to grammar and punctuation in the section.

Amending 26 TAC §550.304, to implement SB 1849 (88th Legislature) by updating administrator responsibilities for Prescribed Pediatric Extended Care Centers to require use of the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in pre-employment registry checks.

CHAPTER 550. LICENSING STANDARDS FOR PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS
SUBCHAPTER C. GENERAL PROVISIONS
DIVISION 2. ADMINISTRATION AND MANAGEMENT
26 TAC §550.304

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §550.304 updates subsection (b)(5) to require that an applicant’s criminal history and the nurse aide registry, medication aide registry, and SEMARC established under THSC Chapter 810 are checked before employment, replacing the prior reference to the Employee Misconduct Registry.

Amending 26 TAC §§550.406, 550.413, 550.415, 550.417, and 550.418, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in nursing, contractor, staffing, personnel record, and criminal history check requirements for Prescribed Pediatric Extended Care Centers.

CHAPTER 550. LICENSING STANDARDS FOR PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS
SUBCHAPTER C. GENERAL PROVISIONS
DIVISION 3. NURSING AND STAFFING REQUIREMENTS
26 TAC §§550.406, 550.413, 550.415, 550.417, 550.418

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendments to §§550.406, 550.413, 550.415, 550.417, and 550.418 implement SB 1849 by updating all references from the Employee Misconduct Registry to the SEMARC. Section 550.406 updates the cross-reference in the student nurse criminal history check requirement. Section 550.413 updates the contractor compliance cross-reference. Section 550.415 updates the staffing policy requirement to reference the SEMARC in registry check procedures. Section 550.417 requires that personnel records include printed SEMARC search results and documentation that employees received written information about the SEMARC. Section 550.418 renames the section to include SEMARC, requires centers to search the NAR, MAR, and SEMARC before hiring, requires written SEMARC information to be provided to new employees within five business days, and requires annual NAR and SEMARC searches.

Amending 26 TAC §553.257, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in employment verification requirements for assisted living facilities, and renaming the section from “Human Resources” to “Personnel.”

CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER E. STANDARDS FOR LICENSURE
26 TAC §553.257

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §553.257, concerning Human Resources.

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §553.257 implements SB 1849 relating to an interagency reportable conduct search engine, known as Search Engine for Multi-Agency Reportable Conduct (SEMARC), and updates the requirements for providers to use the SEMARC when verifying employability of a new employee or current employee. The proposed amendment also changes the name of the section from “Human Resources” to “Personnel” and updates references.

Amending 26 TAC §554.101, to implement SB 1849 (88th Legislature) by updating definitions in the Nursing Facility Requirements for Licensure and Medicaid Certification chapter, and clarifying that the definition of “Drug” does not include devices or components.

CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER B. DEFINITIONS
26 TAC §554.101

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §554.101, concerning Definitions; and §554.1921, concerning General Requirements for a Nursing Facility.

BACKGROUND AND PURPOSE

The proposal is also necessary to update rules and to improve the readability and understanding of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §554.101 revises the definition for “Drug” to clarify that the term does not include devices, components, parts, or accessories. The amendment also includes minor editorial revisions for formatting, punctuation, and to update a rule reference.

Amending 26 TAC §554.1921, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in general nursing facility requirements for pre-employment and annual employability verification.

CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER T. ADMINISTRATION
26 TAC §554.1921

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §554.1921 requires nursing facilities to search the NAR and SEMARC before hiring an unlicensed employee to determine if the person is listed as unemployable, prohibits employment of persons listed as unemployable on the NAR or SEMARC, requires facilities to provide notice about the SEMARC to employees, and requires annual searches of both registries with results kept in personnel files.

Amending 26 TAC §555.42, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in alternate licensing requirements for military service personnel seeking nursing facility administrator licenses.

CHAPTER 555. NURSING FACILITY ADMINISTRATORS
SUBCHAPTER C. LICENSES
26 TAC §555.42

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §555.42, concerning Alternate Licensing Requirements for Military Service Personnel.

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §555.42 implements SB 1849 relating to an interagency reportable conduct search engine, known as the Search Engine for Multi-Agency Reportable Conduct (SEMARC), and updates the requirements for confirming if a nursing facility administrator is listed as unemployable. The amendment also includes updates to references.

Amending 26 TAC §§556.3, 556.12, 556.13, and 556.14, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in nurse aide training, waiver, reciprocity, findings, and alternate military licensing requirements.

CHAPTER 556. NURSE AIDES
26 TAC §§556.3, 556.12 – 556.14

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §556.3, concerning NATCEP Requirements; §556.12, concerning Waiver, Reciprocity, and Exemption Requirements; §556.13, concerning Findings and Inquiries; and §556.14, concerning Alternate Licensing Requirements for Military Service Personnel.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill (SB) 1849, 88th Legislature, Regular Session, 2023, which created Texas Health and Safety Code, Chapter 810, Interagency Reportable Conduct Search Engine. While the Texas Department of Information Resources (DIR) is responsible for creating the search engine, the chapter also requires HHSC to amend rules relating to the Employee Misconduct Registry search engine and required background check searches providers regulated by HHSC Long-Term Care Regulation (LTCR) or HHSC must conduct before employing individuals.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §556.3 adds a requirement for a Nurse Aide Training and Competency Evaluation Program to verify a person is not listed as unemployable on the SEMARC before beginning the training program, replacing the prior EMR reference.

The proposed amendment to §556.12 revises the rule to state that HHSC uses the SEMARC to verify a nurse aide is not listed as unemployable before issuing a certificate of registration.

The proposed amendment to §556.13 revises the rule to state that HHSC revokes or suspends the certificate of registration for a nurse aide that works in a different capacity at a nursing facility that is listed as unemployable on the SEMARC. The due process available to a nurse aide before placement on the SEMARC satisfies the due process required before revocation or suspension.

The proposed amendment to §556.14 revises the rule to state that HHSC uses the SEMARC to verify a former nurse aide is not listed as unemployable before approving a request for active status on the nurse aide registry.

Amending 26 TAC §§557.107, 557.113, 557.115, 557.119, and 557.129, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in medication aide training, application, permit renewal, training program, and alternate military licensing requirements.

CHAPTER 557. MEDICATION AIDES–PROGRAM REQUIREMENTS
26 TAC §§557.107, 557.113, 557.115, 557.119, 557.129

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §557.107, concerning Training Requirements; Nursing Graduates; Reciprocity; §557.113, concerning Determination of Eligibility; §557.115, concerning Permit Renewal; §557.119, concerning Training Program Requirements; and §557.129, concerning Alternate Licensing Requirements for Military Service.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill (SB) 1849, 88th Legislature, Regular Session, 2023, which created Texas Health and Safety Code Chapter 810, Interagency Reportable Conduct Search Engine. While the Texas Department of Information Resources (DIR) is responsible for creating the search engine, the chapter also requires HHSC to amend rules relating to the Employee Misconduct Registry search engine and required background check searches providers regulated by HHSC Long Term Care Regulatory (LTCR) or HHSC must conduct before employing individuals.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §557.107 revises the rule to state that an applicant must not be listed as unemployable on the SEMARC.

The proposed amendment to §557.113 revises the rule to state that HHSC denies an application for a medication aide permit if the applicant is listed as unemployable on the SEMARC.

The proposed amendment to §557.115 revises the rule to state that HHSC denies a permit renewal if the medication aide is listed as unemployable on the SEMARC.

The proposed amendment to §557.119 revises the rule to state that training programs accredited by the Texas Workforce Commission or Texas Higher Education Coordinating Board must check the SEMARC to verify a student is not listed as unemployable before beginning the training program. The amendment also revises grammar and punctuation.

The proposed amendment to §557.129 revises the rule to state that HHSC uses the SEMARC to verify a former medication aide is not listed as unemployable before approving a request for renewal of an expired permit. The amendment also updates references in the rule.

Amending 26 TAC §559.3, to update the definition of “NFPA 72” to clarify that it includes fire alarm system components, and to update formatting and punctuation in the section.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER A. INTRODUCTION
26 TAC §559.3

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §559.3, concerning Definitions; §559.51, concerning Compliance; and §559.225, concerning General Requirements.

BACKGROUND AND PURPOSE

The proposal is also necessary to update rules and to improve the readability and understanding of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §559.3 revises the definition for “NFPA 72” to clarify that the definition includes fire alarm system components and updates formatting and punctuation in the section.

Amending 26 TAC §559.51, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in compliance requirements for day activity and health services facilities.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER D. STANDARDS FOR LICENSURE
26 TAC §559.51

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §559.51 requires facilities to search the NAR and SEMARC before hiring an individual to determine if the person is listed as unemployable, replacing the prior reference to the Employee Misconduct Registry. Facilities must provide information about the SEMARC to employees, conduct annual NAR and SEMARC searches, maintain copies of search results in personnel files, and suspend employees found to have engaged in reportable conduct during any applicable appeals process.

Amending 26 TAC §559.225, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in general requirements for individualized skills and socialization providers.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER H. INDIVIDUALIZED SKILLS AND SOCIALIZATION PROVIDER REQUIREMENTS
DIVISION 3. PROVIDER REQUIREMENTS
26 TAC §559.225

OVERVIEW

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §559.225 replaces the Employee Misconduct Registry with the SEMARC as the registry that individualized skills and socialization providers must search before offering employment. Providers must not employ persons listed on the SEMARC as unemployable, must provide information about the SEMARC to employees in accordance with §561.3, and must conduct annual searches of the NAR, MAR, and SEMARC with copies of results maintained in employee personnel files.

Amending 26 TAC §560.4, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) as a basis for HHSC to deny or refuse to renew a facility license.

CHAPTER 560. DENIAL OR REFUSAL OF LICENSE
26 TAC §560.4

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §560.4, concerning Registry Listings Barring Licensure.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill (SB) 1849, 88th Legislature, Regular Session, 2023, which created Texas Health and Safety Code Chapter 810, Interagency Reportable Conduct Search Engine. While the Texas Department of Information Resources (DIR) is responsible for creating the search engine, the chapter also requires HHSC to amend rules relating to the Employee Misconduct Registry search engine and required background check searches for providers regulated by HHSC Long-Term Care Regulation (LTCR).

SECTION-BY-SECTION SUMMARY

The proposed amendment to §560.4 updates language to allow HHSC to deny an application for an initial facility license, or refuse to renew a facility license, if the applicant for the facility license, the facility license holder, or a controlling person of the applicant or facility license holder is listed as unemployable on the SEMARC established under Texas Health and Safety Code Chapter 810, replacing the prior reference to the Employee Misconduct Registry.

Amending 26 TAC §565.9, to implement SB 1849 (88th Legislature) by replacing references to the Employee Misconduct Registry with the Search Engine for Multi-Agency Reportable Conduct (SEMARC) in employment verification requirements for Home and Community-based Services Program providers, and updating outdated rule references.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER D. CERTIFICATION STANDARDS: STAFF MEMBER AND SERVICE PROVIDER REQUIREMENTS
26 TAC §565.9

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §565.9, concerning Program Provider Requirements.

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §565.9 replaces the Employee Misconduct Registry with the SEMARC in the annual registry search requirements for staff members and service providers. Program providers must not hire or continue employment for persons listed on the SEMARC as unemployable, and must search the SEMARC before hire and at least annually thereafter. The amendment also updates outdated references throughout the rule.

Amending 26 TAC §566.9, to implement SB 1849 (88th Legislature) by adding requirements for Texas Home Living Program providers to search the Search Engine for Multi-Agency Reportable Conduct (SEMARC) when verifying employability of new and current employees and contractors, and updating references, punctuation, and formatting throughout the rule.

CHAPTER 566. TEXAS HOME LIVING (TXHML) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
26 TAC §566.9

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §566.9, concerning Certification Principles: Staff Member and Service Provider Requirements.

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

The proposed amendment to §566.9 adds requirements for TxHmL program providers to search the SEMARC and the nurse aide registry before hire and annually thereafter to determine if a staff member or service provider is eligible for employment. Program providers must not hire or continue employment for persons listed on the SEMARC as unemployable or listed on the nurse aide registry as revoked or suspended. The amendment also adds language expanding on existing background check requirements, updates outdated references throughout the rule, and includes punctuation and formatting corrections.

In Addition Re:

Correction of Error

The Texas Health and Human Services Commission proposed amendments to 1 TAC §373.303 and §373.305 in the March 20, 2026, issue of the Texas Register (51 TexReg 1783). Due to an error by the Texas Register, parts of the text in §373.303 and §373.305 were omitted. The correct text of the rules has been republished.

Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on April 24, 2026, at 9:00 a.m., to receive public comments on proposed updates to a Medical Policy Review. The hearing will be conducted as an online event. The hearing concerns proposed payment rates for Radiation Oncology, effective January 1, 2026, calculated in accordance with 1 TAC §355.8085, Reimbursement Methodology for Physicians and Other Practitioners. A briefing packet will be available at https://pfd.hhs.texas.gov/rate-packets on or before April 14, 2026. Written comments may be submitted until 5:00 p.m. on the day of the hearing to PFDAcuteCare@hhs.texas.gov or by mail to Provider Finance, Mail Code H-400, P.O. Box 149030, Austin, Texas 78714-9030.

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, effective May 1, 2026. The amendments update fee schedules for Clinical Diagnostic Labs and are estimated to result in an increase to annual aggregate expenditure of $265,763 for federal fiscal year 2026. Further detail will be available at https://pfd.hhs.texas.gov/rate-packets before the proposed effective date.

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, effective April 4, 2026. The amendments update fee schedules for Physician Services. The proposed amendments are estimated to result in no change to annual aggregate expenditure for federal fiscal years 2026 through 2028. Further detail will be available at https://pfd.hhs.texas.gov/rate-packets before the proposed effective date.

State Board of Dental Examiners

Proposed Rules Re:

Amending 22 TAC §108.2, to implement House Bill 4070 (89th Legislature) by prohibiting dentists from requiring patients to agree to a particular type of orthodontic device as a condition of performing an examination or review, and correcting grammatical errors.

CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.2

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §108.2, pertaining to fair dealing. The amendment pertains to the sale, design, and manufacture of orthodontic devices as set out in House Bill 4070 of the 89th Texas Legislature, Regular Session (2025), and codified at Section 431.024 of the Health and Safety Code. The bill seeks to protect patients from unsafe practices by establishing requirements for a person selling an orthodontic device or providing a service related to the design or manufacture of such a device to patients in Texas. The amendment also includes grammatical changes.

SECTION-BY-SECTION SUMMARY

The proposed amendment adds new subsection (f), stating that in accordance with Health and Safety Code §431.024(f), a dentist may not require a patient to agree to use a particular type of orthodontic device as a condition of performing an examination or review. The amendment also corrects gendered pronouns throughout the section.

Amending 22 TAC §108.7, to implement House Bill 4070 (89th Legislature) by adding a requirement that dentists comply with Health and Safety Code §431.024 before selling an orthodontic device or providing design or manufacture services, including performing an in-person intraoral examination and head and neck examination.

CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.7

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §108.7, pertaining to the minimum standard of care. The amendment pertains to the sale, design, and manufacture of orthodontic devices as set out in House Bill 4070 of the 89th Texas Legislature, Regular Session (2025), and codified at Section 431.024 of the Health and Safety Code.

SECTION-BY-SECTION SUMMARY

The proposed amendment adds new paragraph (17) requiring each dentist to abide by Health and Safety Code §431.024 prior to selling an orthodontic device to a patient or providing a service related to the design or manufacture of an orthodontic device. This includes performing an in-person intraoral examination and an examination of the patient’s head and neck.

Amending 22 TAC §108.8, to implement House Bill 4070 (89th Legislature) by adding documentation requirements for orthodontic device sales, including maintaining a written acknowledgment of treatment options and risks signed by the patient and retaining records for at least seven years, and correcting a grammatical error.

CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.8

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §108.8, pertaining to the records of the dentist. The amendment pertains to the sale, design, and manufacture of orthodontic devices as set out in House Bill 4070 of the 89th Texas Legislature, Regular Session (2025), and codified at Section 431.024 of the Health and Safety Code. The amendment also corrects a grammatical error.

SECTION-BY-SECTION SUMMARY

The proposed amendment adds new subsection (d) requiring dentists to follow the documentation requirements in Health and Safety Code §431.024 prior to selling an orthodontic device or providing orthodontic design or manufacture services. Dentists must maintain a written acknowledgment of counsel signed by the patient regarding available orthodontic treatment options and associated risks, and must maintain those records for not less than seven years. If a patient was younger than 18 years of age when last treated, records must be maintained until the patient reaches age 21 or for seven years from the date of last treatment, whichever is longer.

Amending 22 TAC §114.12, to allow registered dental assistants to complete required continuing education clinical hours through board-approved self-study, interactive computer courses, or lecture courses, removing the prior requirement that clinical hours be completed only through a live course.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.12

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §114.12, pertaining to continuing education for registered dental assistant (RDA) certificate holders. The proposed amendment will allow RDAs to complete their continuing education hours, including clinical hours, through Board-approved self-study, interactive computer courses, or lecture courses. The Board has required clinical hours to be completed through a live course; however, allowing clinical hours to be completed through self-paced or online formats will improve accessibility, efficiency, and affordability while maintaining educational quality.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §114.12 revises subsection (b) to state that a dental assistant may fulfill the continuing education requirement, including clinical hours, through board-approved self-study, interactive computer courses, or lecture courses, removing the prior requirement that clinical hours be completed only through a live course.

Repealing 22 TAC §115.20, to remove the dental hygiene advisory committee rule, which is no longer consistent with state law following the repeal of its statutory basis by Senate Bill 313 (85th Legislature, 2017).

CHAPTER 115. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL HYGIENE
22 TAC §115.20

OVERVIEW

The State Board of Dental Examiners (Board) proposes this repeal of 22 TAC §115.20, concerning the dental hygiene advisory committee. The proposed repeal implements Senate Bill 313 of the 85th Texas Legislature, Regular Session (2017). The bill repealed Subchapter B, Chapter 262 of the Texas Occupations Code, which pertained to the dental hygiene advisory committee. The Board no longer uses the committee.

Texas Board of Nursing

Adopted Rules Re:

Adopting 22 TAC §217.24, to implement House Bill 1700 (89th Legislature) by standardizing informed consent documentation and retention requirements for telehealth and telemedicine medical services provided by nurses, allowing consent to be obtained in written or verbal form including audio-only formats.

CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE
22 TAC §217.24

OVERVIEW

The Texas Board of Nursing (Board) adopts amendments to 22 Texas Administrative Code §217.24, relating to Telehealth Services and Telemedicine Medical Services in Nursing, formerly Telemedicine Medical Service Prescriptions, with changes to the proposed text published in the December 19, 2025 issue of the Texas Register (50 TexReg 8155). The rule will be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendments to Board Rule 217.24 reflect changes required by House Bill 1700 (89th Legislature), which amended Texas Occupations Code §111.004. Specifically, the bill specifies the informed consent documentation that is required when licensees perform telehealth services or telemedicine medical services. The adopted amendments ensure that a written record of informed consent is maintained when nursing services are provided via telehealth. The Board carefully considered public comments regarding the proposed amendments, including concerns about potential administrative burdens and impacts on patient access to care. In response, the Board made revisions to clarify the rule language and ensure that the requirements are consistent with legislative intent and existing standards of care. The rule, as adopted, maintains standardized documentation and retention requirements for informed consent while avoiding unnecessary or duplicative provisions.

SECTION-BY-SECTION SUMMARY

The adopted amendments to §217.24 implement recent statutory changes requiring agencies regulating health professionals who provide telemedicine medical services and telehealth services to adopt rules standardizing the format and retention of patient consent records. These amendments implement Texas Occupations Code §111.004, as amended effective September 1, 2025.

Subsection (a) incorporates the statutory definitions of “telehealth service” and “telemedicine medical service” from Texas Occupations Code §111.001 to ensure consistency with governing law.

Subsection (b) clarifies that the rule’s standards apply equally to video and audio-only encounters, implementing the statutory requirement that consent documentation provisions address audio-only formats based on the appropriate standard of care.

Subsection (c) standardizes informed consent documentation for telehealth and telemedicine services, allowing written or verbal consent and requiring documentation of verbal consent, including the date given and identification of any responsible party providing consent.

Subsection (d) provides uniform record retention requirements for consent documentation, consistent with existing Texas law, including specific provisions for minors, thereby implementing the statutory mandate to standardize retention of consent records.

Subsections (e) through (i) update existing prescription-related provisions, including updated cross-references.