Texas Health and Human Services Commission
Proposed Rules Re:
Amending 1 TAC §353.2, to update definitions and citations in Medicaid Managed Care rules to align with the Patient Driven Payment Model for Long-Term Care (PDPM LTC) methodology, implement HB 4611 and SB 457, and remove references to the discontinued nursing facility enhancement rate program.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER A. GENERAL PROVISIONS
1 TAC §353.2
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.2, concerning Definitions; §353.1502 concerning Definitions; and §353.1503 concerning Use of Telecommunications in Assessments; and the repeal of §353.608, concerning Minimum Payment Amounts to Qualified Nursing Facilities.
BACKGROUND AND JUSTIFICATION
This proposal is necessary to align Medicaid program rules with the fiscal rules that implemented House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission (HHSC), Rider 25), which require HHSC to implement a Texas version of the Patient Driven Payment Model for Long-Term Care (PDPM LTC) methodology for the reimbursement of long-term stay nursing facility (NF) services in the Medicaid program.
Due to federal requirements in Title 42 Code of Federal Regulations §441.302(e) and (f), changing the NF reimbursement methodology from the Resource Utilization Group (RUG) to the PDPM LTC requires HHSC to incorporate the PDPM LTC methodology into the individual cost limit methodologies and related cost limit methodology. This proposal updates references to the former RUG reimbursement methodology with the term “reimbursement rate” in the Texas Administrative Code (TAC) for the state’s two NF waiver programs, the STAR+PLUS Home and Community-Based Services Program and the Medically Dependent Children Program.
This proposal implements H.B. 4611, 88th Legislature, Regular Session, 2023, which made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The proposed amendment to §353.2 updates Texas Government Code citations for this purpose.
This proposal also implements Senate Bill (S.B.) 457, 89th Legislature, Regular Session, 2025, which eliminated the NF enhancement rate program. The proposed amendment updates definitions to remove references to the NF enhancement rate program.
The proposed repeal of §353.608 removes outdated rules for the Minimum Payment Amount Program (MPAP) for Qualified Nursing Facilities. The MPAP was replaced by the Quality Incentive Payment Program for NFs, which is covered in 1 TAC, §353.1301 and §353.1303.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §353.2 updates citations to reflect the current statute and TAC references; corrects outdated agency acronyms; moves the definition of HHSC so the section is correctly alphabetized and then renumbers the section accordingly; updates the definition of “Nursing facility unit rate” to remove a citation to the former NF rate enhancement program that no longer exists; and makes other minimal changes to grammar and rule structure for clarity.
Repealing 1 TAC §353.608, concerning Minimum Payment Amounts to Qualified Nursing Facilities, as the program it implements has been replaced by the Quality Incentive Payment Program for Nursing Facilities.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER G. STAR+PLUS
1 TAC §353.608
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.2, concerning Definitions; §353.1502 concerning Definitions; and §353.1503 concerning Use of Telecommunications in Assessments; and the repeal of §353.608, concerning Minimum Payment Amounts to Qualified Nursing Facilities.
BACKGROUND AND JUSTIFICATION
This proposal is necessary to align Medicaid program rules with the fiscal rules that implemented House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission (HHSC), Rider 25), which require HHSC to implement a Texas version of the Patient Driven Payment Model for Long-Term Care (PDPM LTC) methodology for the reimbursement of long-term stay nursing facility (NF) services in the Medicaid program.
Due to federal requirements in Title 42 Code of Federal Regulations §441.302(e) and (f), changing the NF reimbursement methodology from the Resource Utilization Group (RUG) to the PDPM LTC requires HHSC to incorporate the PDPM LTC methodology into the individual cost limit methodologies and related cost limit methodology. This proposal updates references to the former RUG reimbursement methodology with the term “reimbursement rate” in the Texas Administrative Code (TAC) for the state’s two NF waiver programs, the STAR+PLUS Home and Community-Based Services Program and the Medically Dependent Children Program.
This proposal implements H.B. 4611, 88th Legislature, Regular Session, 2023, which made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The proposed amendment to §353.2 updates Texas Government Code citations for this purpose.
This proposal also implements Senate Bill (S.B.) 457, 89th Legislature, Regular Session, 2025, which eliminated the NF enhancement rate program. The proposed amendment updates definitions to remove references to the NF enhancement rate program.
The proposed repeal of §353.608 removes outdated rules for the Minimum Payment Amount Program (MPAP) for Qualified Nursing Facilities. The MPAP was replaced by the Quality Incentive Payment Program for NFs, which is covered in 1 TAC, §353.1301 and §353.1303.
SECTION-BY-SECTION SUMMARY
The proposed repeal of §353.608 deleted the rule as no longer necessary, because it refers to use of the MPAP for Qualified Nursing Facilities, which no longer exists.
Amending 1 TAC §353.1502 and §353.1503, to add a definition for the Patient Driven Payment Model for Long-Term Care (PDPM LTC) and replace references to the former Resource Utilization Group (RUG) methodology with PDPM LTC terminology in telecommunications-assessment rules.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER R. TELECOMMUNICATIONS IN MANAGED CARE SERVICE COORDINATION AND ASSESSMENTS
1 TAC §353.1502, §353.1503
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.2, concerning Definitions; §353.1502 concerning Definitions; and §353.1503 concerning Use of Telecommunications in Assessments; and the repeal of §353.608, concerning Minimum Payment Amounts to Qualified Nursing Facilities.
BACKGROUND AND JUSTIFICATION
This proposal is necessary to align Medicaid program rules with the fiscal rules that implemented House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission (HHSC), Rider 25), which require HHSC to implement a Texas version of the Patient Driven Payment Model for Long-Term Care (PDPM LTC) methodology for the reimbursement of long-term stay nursing facility (NF) services in the Medicaid program.
Due to federal requirements in Title 42 Code of Federal Regulations §441.302(e) and (f), changing the NF reimbursement methodology from the Resource Utilization Group (RUG) to the PDPM LTC requires HHSC to incorporate the PDPM LTC methodology into the individual cost limit methodologies and related cost limit methodology. This proposal updates references to the former RUG reimbursement methodology with the term “reimbursement rate” in the Texas Administrative Code (TAC) for the state’s two NF waiver programs, the STAR+PLUS Home and Community-Based Services Program and the Medically Dependent Children Program.
This proposal implements H.B. 4611, 88th Legislature, Regular Session, 2023, which made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The proposed amendment to §353.2 updates Texas Government Code citations for this purpose.
This proposal also implements Senate Bill (S.B.) 457, 89th Legislature, Regular Session, 2025, which eliminated the NF enhancement rate program. The proposed amendment updates definitions to remove references to the NF enhancement rate program.
The proposed repeal of §353.608 removes outdated rules for the Minimum Payment Amount Program (MPAP) for Qualified Nursing Facilities. The MPAP was replaced by the Quality Incentive Payment Program for NFs, which is covered in 1 TAC, §353.1301 and §353.1303.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §353.1502 updates citations to reflect the current TAC references, corrects outdated agency acronyms, updates the HHSC definition, adds a definition for PDPM LTC, removes the RUG definition, renumbers the subsections, and makes other minimal changes to grammar and rule structure for clarity.
The proposed amendment to §353.1503 replaces RUG language with PDPM LTC language.
Repealing 26 TAC §3.251, concerning Interagency Coordination of Special Education Services to Students with Disabilities in Residential Facilities, because the underlying memorandum of understanding is no longer required to be codified in rule.
CHAPTER 3. MEMORANDUM OF UNDERSTANDING WITH OTHER STATE AGENCIES
SUBCHAPTER E. MOU–COORDINATION OF SPECIAL EDUCATION SERVICES TO STUDENTS WITH DISABILITIES IN RESIDENTIAL FACILITIES
26 TAC §3.251
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Texas Administrative Code (TAC), Title 26, Chapter 3, Subchapter E, which consists of §3.251, concerning Interagency Coordination of Special Education Services to Students with Disabilities in Residential Facilities.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to remove an unnecessary rule from the TAC. Texas Education Code §29.012(d) requires the Texas Education Agency (TEA), HHSC, the Department of Family and Protective Services, and the Texas Juvenile Justice Department to have a memorandum of understanding (MOU) for the provision of public education in residential facilities as required by the Individuals with Disabilities Education Act. House Bill 2 and Senate Bill 568, 89th Legislature, Regular Session, 2025, amended Texas Education Code §29.012(d) by removing the requirement to have the MOU in rule. Section 3.251 adopts by reference a TEA rule, 19 TAC §89.1115, that provides the terms of the MOU in rule. While the MOU is still required by statute and is in place, since the MOU is no longer required to be in rule, HHSC is repealing §3.251.
The proposal also supports regulatory reform by removing unnecessary rules in the TAC making the TAC easier to use and understand.
Repealing 26 TAC §300.101, concerning Interagency Coordination of Special Education Services to Students with Disabilities in Residential Facilities, because the underlying memorandum of understanding is no longer required to be codified in rule.
CHAPTER 300. STATE AUTHORITY RESPONSIBILITIES
SUBCHAPTER B. INTERAGENCY AGREEMENTS
26 TAC §300.101
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Texas Administrative Code (TAC), Title 26, Chapter 300, Subchapter B, which consists of §300.101, concerning Interagency Coordination of Special Education Services to Students with Disabilities in Residential Facilities.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to remove an unnecessary rule from the TAC. Texas Education Code §29.012(d) requires the Texas Education Agency (TEA), HHSC, the Department of Family and Protective Services, and the Texas Juvenile Justice Department to have a memorandum of understanding (MOU) for the provision of public education in residential facilities as required by the Individuals with Disabilities Education Act. House Bill 2 and Senate Bill 568, 89th Legislature, Regular Session, 2025, amended Texas Education Code §29.012(d) by removing the requirement to have the MOU in rule. Section 300.101 adopts by reference a TEA rule, 19 TAC §89.1115, that provides the terms of the MOU in rule. While the MOU is still required by statute and is in place, since the MOU is no longer required to be in rule, HHSC is repealing §300.101.
The proposal also supports regulatory reform by removing unnecessary rules in the TAC making the TAC easier to use and understand.
Amending 26 TAC §554.2403, §554.2407, and §554.2413, to replace references to the Resource Utilization Group (RUG) reimbursement methodology with the Patient Driven Payment Model for Long-Term Care (PDPM LTC) reimbursement rate terminology for nursing facility medical necessity determinations.
CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER Y. MEDICAL NECESSITY DETERMINATIONS
26 TAC §§554.2403, 554.2407, 554.2413
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §554.2403, concerning Medical Necessity Determination; §554.2407, concerning Denied Medical Necessity; §554.2413, concerning Determination of Payment Rate Based on the MDS Assessment Submission; §554.2601, concerning Vendor Payment (Items and Services Included); and §554.2611, concerning Retroactive Vendor Payment.
BACKGROUND AND JUSTIFICATION
This proposal is necessary to align Medicaid program rules with the fiscal rules that implement House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission (HHSC), Rider 25), which require HHSC to implement a Texas version of the Patient Driven Payment Model for Long-Term Care (PDPM LTC) methodology for the reimbursement of long-term stay nursing facility (NF) services in the Medicaid program.
Under Title 42 Code of Federal Regulations §441.302(e) and (f), changing the NF reimbursement methodology from the Resource Utilization Group (RUG) to the PDPM LTC requires HHSC to incorporate the PDPM LTC methodology into the individual cost limit methodologies and related cost limit methodology. This proposal updates references to the former RUG reimbursement methodology with the term “reimbursement rate” in the Texas Administrative Code (TAC) for the state’s two NF waiver programs, the STAR+PLUS Home and Community-Based Services Program and the Medically Dependent Children Program.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §554.2403 replaces a reference to the former RUG reimbursement methodology with the term “reimbursement rate” and specifies this term has the meaning defined in §554.2413, updates citations to reflect the current statute and TAC references, corrects outdated agency acronyms, and makes other minimal changes to grammar and rule structure for clarity.
The proposed amendment to §554.2407 replaces a reference to the former RUG reimbursement methodology with the term “reimbursement rate” and specifies this term has the meaning defined in §554.2413, clarifies language, updates citations to reflect the current TAC references, and corrects outdated agency acronyms.
The proposed amendment to §554.2413 updates citations to reflect the current TAC references, corrects outdated agency acronyms, adds a definition of “Reimbursement Rate” that provides a reference to the HHSC reimbursement rules in 1 TAC §355.318, replaces references to the former RUG reimbursement methodology with the term “reimbursement rate” and makes other minimal changes to grammar and rule structure for clarity.
Amending 26 TAC §554.2601 and §554.2611, to align nursing facility vendor payment rules with the Patient Driven Payment Model for Long-Term Care (PDPM LTC) reimbursement methodology.
CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER AA. VENDOR PAYMENT
26 TAC §554.2601, §554.2611
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §554.2403, concerning Medical Necessity Determination; §554.2407, concerning Denied Medical Necessity; §554.2413, concerning Determination of Payment Rate Based on the MDS Assessment Submission; §554.2601, concerning Vendor Payment (Items and Services Included); and §554.2611, concerning Retroactive Vendor Payment.
BACKGROUND AND JUSTIFICATION
This proposal is necessary to align Medicaid program rules with the fiscal rules that implement House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission (HHSC), Rider 25), which require HHSC to implement a Texas version of the Patient Driven Payment Model for Long-Term Care (PDPM LTC) methodology for the reimbursement of long-term stay nursing facility (NF) services in the Medicaid program.
Under Title 42 Code of Federal Regulations §441.302(e) and (f), changing the NF reimbursement methodology from the Resource Utilization Group (RUG) to the PDPM LTC requires HHSC to incorporate the PDPM LTC methodology into the individual cost limit methodologies and related cost limit methodology. This proposal updates references to the former RUG reimbursement methodology with the term “reimbursement rate” in the Texas Administrative Code (TAC) for the state’s two NF waiver programs, the STAR+PLUS Home and Community-Based Services Program and the Medically Dependent Children Program.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §554.2601 clarifies language, updates citations to reflect the current TAC references; corrects outdated agency acronyms; clarifies the requirements for items included in the NF daily vendor rate; and makes other minimal changes to grammar and rule structure for clarity.
The proposed amendment to §554.2611 updates citations to reflect the current TAC references; corrects outdated agency acronyms; replaces a reference to the former RUG reimbursement methodology with the term “reimbursement rate” and specifies this term has the meaning defined in §554.2413; and makes other minimal changes to grammar and rule structure for clarity.
Repealing 26 TAC §562.19 and amending §562.21, to eliminate the inactive license status option for licensed chemical dependency counselors and simplify counselor intern supervision standards by removing references to the CTI and CCS Assessment Form.
CHAPTER 562. LICENSED CHEMICAL DEPENDENCY COUNSELORS
26 TAC §562.19, §562.21
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §562.19, concerning Inactive Status, and an amendment to §562.21, concerning Standards for the Training and Supervision of Counselor Interns.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to reduce potential costs and confusion regarding the license status for licensed chemical dependency counselors (LCDCs) by repealing §562.19 and to improve clarity and remove outdated information in the rule for LCDC counselor interns at §562.21.
The proposed repeal of §562.19 eliminates potential costs to LCDCs by removing the rule that allows an LCDC to apply for inactive status. An LCDC with an inactive license must pay an inactive status fee and maintain continuing education requirements while the license is inactive. An LCDC with a license on inactive status may miss the license renewal deadline and become ineligible for license renewal. The former LCDC would then need to reapply to be licensed as an LCDC again. Repealing §562.19 will reduce the frequency of late fees and new license fees for individuals who would have been able to renew their license if it hadn’t expired while on inactive status.
The proposed amendment of §562.21 simplifies the standards for supervising counselor interns (CIs) by removing references to the CTI and CCS Assessment Form, which HHSC no longer requires. CIs who want to file a complaint about their supervisor will now file a complaint through the HHSC complaint process and not through the CTI and CCS Assessment Form. Requiring CIs to file a complaint through the HHSC complaint process ensures consistency in complaint processes across Health Care Regulation rulesets.
This proposal supports regulatory reform by reducing unnecessary regulatory burden, lowering potential compliance costs, and improving the clarity and accuracy of the rules.
SECTION-BY-SECTION SUMMARY
The proposed repeal of §562.19 removes the rule section.
The proposed amendment to §562.21 simplifies the CI supervisor assessment process by removing references to the CTI and CCS Assessment Form.
The proposed amendment requires the Clinical Training Institution or Certified Clinical Supervisor to instead give the CI information about how to file a complaint with HHSC during the orientation process.
The proposed amendment corrects the spelling of several defined terms, consistently uses “CI” instead of sometimes using “counselor intern,” updates a reference to “HHSC”, and updates rule references.
Repealing 26 TAC §746.3605 and §746.3607, and adopting new §746.3605, to consolidate and update illness and injury response requirements for children in child care centers.
CHAPTER 746. MINIMUM STANDARDS FOR CHILD-CARE CENTERS
SUBCHAPTER R. HEALTH PRACTICES
26 TAC §746.3605, §746.3607
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§746.1107, 746.1317, and 746.4301; the repeal of §§746.201, 746.301, 746.303, 746.607, 746.609, 746.611, 746.625, 746.705, 746.709, 746.805, 746.1021, 746.1045, 746.1057, 746.1309, 746.1311, 746.1313, 746.1329, 746.3605, 746.3607, 746.4201, 746.4203, 746.4205, 746.4207, 746.4401, 746.4403, 746.4405, and 746.4407; and new §§746.201, 746.301, 746.303, 746.609, 746.705, 746.1021, 746.1045, 746.1309, 746.1313, 746.1329, 746.3605, 746.4201, 746.4401, and 746.4407, in Texas Administrative Code, Chapter 746, concerning Minimum Standards for Child-Care Centers.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement changes due to an accelerated review of Chapter 746, Minimum Standards for Licensed Child-Care Centers, conducted by Child Care Regulation (CCR). The project involved reviewing low-weighted minimum standards to identify rules that could be amended, simplified, or removed to streamline requirements necessary to protect the health, safety, and well-being of children in the care of licensed child care centers.
HHSC conducted a review of existing child care rules related to record keeping and reporting to determine if any rules needed to be revised to ensure accountability of child care providers receiving Texas Workforce Commission Child Care Services (CCS) subsidies or improve the accuracy of the information reported. The proposal includes a provision requiring compliance with CCS program rules and requirements and amends rules to make non-substantive changes which remove the hyphen between “child” and “care.”
SECTION-BY-SECTION SUMMARY
Proposed new §746.3605 uses the standard format for the title rather than the question-and-answer format. The rule outlines how operations should respond to illnesses and injuries to children in care.
The proposed repeal of §746.3605 deletes the rule. The content of the rule is added to proposed new §746.3605 with substantive changes.
The proposed repeal of §746.3607 deletes the rule. The content of the rule is added to proposed new §746.3605.
Amending 26 TAC §746.4301; repealing §§746.4201, 746.4203, 746.4205, 746.4207, 746.4401, 746.4403, 746.4405, and 746.4407; and adopting new §746.4201, §746.4401, and §746.4407, to update indoor and outdoor activity space requirements and hand-washing sink and toilet requirements for child care centers.
CHAPTER 746. MINIMUM STANDARDS FOR CHILD-CARE CENTERS
SUBCHAPTER T. PHYSICAL FACILITIES
26 TAC §§746.4201, 746.4203, 746.4205, 746.4207, 746.4301, 746.4401, 746.4403, 746.4405, 746.4407
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§746.1107, 746.1317, and 746.4301; the repeal of §§746.201, 746.301, 746.303, 746.607, 746.609, 746.611, 746.625, 746.705, 746.709, 746.805, 746.1021, 746.1045, 746.1057, 746.1309, 746.1311, 746.1313, 746.1329, 746.3605, 746.3607, 746.4201, 746.4203, 746.4205, 746.4207, 746.4401, 746.4403, 746.4405, and 746.4407; and new §§746.201, 746.301, 746.303, 746.609, 746.705, 746.1021, 746.1045, 746.1309, 746.1313, 746.1329, 746.3605, 746.4201, 746.4401, and 746.4407, in Texas Administrative Code, Chapter 746, concerning Minimum Standards for Child-Care Centers.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement changes due to an accelerated review of Chapter 746, Minimum Standards for Licensed Child-Care Centers, conducted by Child Care Regulation (CCR). The project involved reviewing low-weighted minimum standards to identify rules that could be amended, simplified, or removed to streamline requirements necessary to protect the health, safety, and well-being of children in the care of licensed child care centers.
HHSC conducted a review of existing child care rules related to record keeping and reporting to determine if any rules needed to be revised to ensure accountability of child care providers receiving Texas Workforce Commission Child Care Services (CCS) subsidies or improve the accuracy of the information reported. The proposal includes a provision requiring compliance with CCS program rules and requirements and amends rules to make non-substantive changes which remove the hyphen between “child” and “care.”
SECTION-BY-SECTION SUMMARY
Proposed new §746.4201 uses the standard format for the title rather than the question-and-answer format. The rule outlines the indoor activity space requirements and restrictions.
The proposed repeal of §746.4201 deletes the rule. The content of the rule is added to proposed new §746.4201 with substantive changes.
The proposed repeal of §746.4203 deletes the rule. The content of the rule is added to proposed new §746.4201 with substantive changes.
The proposed repeal of §746.4205 deletes the rule. The content of the rule is added to proposed new §746.4201 with substantive changes.
The proposed repeal of §746.4207 deletes the rule. The content of the rule is added to proposed new §746.4201.
The proposed amendment of §746.4301 uses the standard format for the title rather than the question-and-answer format. The amendment reduces the outdoor square footage requirement per child and updates language to improve readability and understanding.
Proposed new §746.4401 uses the standard format for the title rather than the question-and-answer format. The new rule outlines hand-washing sink requirements for child care centers.
Proposed new §746.4407 uses the standard format for the title rather than the question-and-answer format. The rule outlines toilet requirements for child care centers.
The proposed repeal of §746.4401 deletes the rule. The content of the rule is added to proposed new §746.4401 with substantive changes.
The proposed repeal of §746.4403 deletes the rule. The content of the rule is added to proposed new §746.4401 with substantive changes.
The proposed repeal of §746.4405 deletes the rule. The content of the rule is added to proposed new §746.4401.
The proposed repeal of §746.4407 deletes the rule. The content of the rule is added to proposed new §746.4407 with substantive changes.
Adopted Rules Re:
Adopting new 26 TAC §§910.301, 910.303, 910.305, and 910.307, to require Texas state hospitals to employ a superintendent and outline the superintendent’s duties, implementing House Bill 913.
CHAPTER 910. STATE FACILITY BUSINESS OPERATIONS
SUBCHAPTER G. STATE HOSPITAL MANAGEMENT
26 TAC §§910.301, 910.303, 910.305, 910.307
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §910.301, concerning Purpose; §910.303, concerning Application; §910.305, concerning Definitions; and §910.307, concerning State Hospital Superintendent.
Sections 910.301, 910.303, 910.305, and 910.307 are adopted without changes to the proposed text as published in the May 15, 2026, issue of the Texas Register (51 TexReg 3304). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The new sections are necessary to comply with Texas Health and Safety Code (HSC) §552.154 added by House Bill (HB) 913, 89th Legislature, Regular Session, 2025. Section 552.154 provides that the HHSC executive commissioner shall, by rule, require state hospitals to employ a superintendent at a Texas state hospital. A Texas state hospital also includes a facility that HHSC operates as a state hospital.
HB 913 amended HSC §532.001(b) and §552.002(a)(2) to separate the North Texas State Hospital into two state hospitals, Vernon and Wichita Falls. HSC §532.001(b) and §552.002(a)(2) were amended to also add the new Panhandle State Hospital and the Lubbock Psychiatric Center to the list of state hospitals.
The adopted rules also outline the duties a superintendent must perform in a Texas state hospital, as required by HSC §551.022.
In Addition Re:
Texas Home Living (TxHml) Program Waiver Renewal Application
Public Notice
The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to renew the Texas Home Living (TxHmL) waiver program authorized under §1915(c) of the Social Security Act. CMS has approved the TxHmL waiver application through February 28, 2027. The proposed effective date for the renewal is March 1, 2027.
This renewal request proposes to make the following changes:
Main Appendix
HHSC revised the waiver description and HHSC’s role as a single state Medicaid agency to align with existing policies.
Appendix B: Participant Access and Eligibility
HHSC updated the hyperlink to the Diagnostic Codes for Persons with Related Conditions.
HHSC removed the cost ceiling amount in section B-2-b as the methodology for the cost limit is listed in B-2-a.
HHSC updated the total number of unduplicated participants served, the total number of participants served at any given point-in-time and the reserved capacity projections for waiver years one through five in section B-3-a.
Appendix C: Participant Services
HHSC removed the day habilitation service as well as references to day habilitation from the waiver application since it is no longer a service in the waiver since March 1, 2023.
HHSC updated the hyperlink to the Billing Requirements and handbooks.
HHSC updated, as applicable, the service provider cannot be the individual or the individual’s spouse, the individual’s legally authorized representative (LAR) or the spouse of the LAR.
HHSC updated the respite service definition to clarify that individualized skills and socialization is a setting where Respite can be provided.
HHSC updated service limitations for the Supported Employment and Employment Assistance services to clarify that the service cannot be provided at the same time as Individualized Skills and Socialization, Employment Readiness, Employment Assistance (when Supported Employment is provided), Employment Assistance (when Supported Employment is provided) or Respite to align with existing policy.
HHSC clarified in the Prescription Medication service definition that the service is available for “Adults (21 years and older)” who are dually eligible and excluded from enrollment into managed care.
HHSC clarified in the service definition for Financial Management Services Agency (FMSA) the role the FMSA has with timesheets, processing payroll and ensuring filing and payment of applicable withholdings and updated the term “provider” to “financial services management” under verification of provider qualifications.
HHSC added a link to the billing requirements for Adaptive Aids and Minor Home Modifications.
HHSC updated the Community Support definition to clarify that the service cannot be delivered at the same time as Individualized Skills and Socialization to align with existing policy.
HHSC added clarification that the Dental Treatment limit is one thousand dollars, and the provider can bill for requisition fees which do not count toward the Dental limit to align with existing policy.
HHSC revised section C-5-2, person-centered planning process for Home and Community-Based Settings.
HHSC revised the corrective action plan process for FMSAs during the review period to align with existing practice. HHSC revised the elements in the corrective action plans and clarified the FMSA and the HHSC contract manager’s responsibilities.
Appendix D: Service Delivery
HHSC updated terms, as applicable, from “principles” to “standards” and “option” to “employer, ” throughout the appendix.
HHSC removed outdated language about the COVID-19 Public Health Emergency from section D-1-g, as it no longer applies.
HHSC updated interview modes, in-person or face-to-face, as applicable.
HHSC clarified the Enforcement process in section D-2-b under monitoring safeguards to address noncompliance identified through inspections and surveys.
Appendix E: Participant Direction of Services
HHSC revised the type of traditional agency option individuals can choose.
HHSC updated the Consumer Directed Services (CDS) participant projections for waiver years one through five.
HHSC removed the individual cost limit amount since the methodology is in appendix B-2.
Appendix F: Participant Rights
HHSC revised section F-3 to describe the process the provider must follow to inform the individual or LAR of how to file a complaint to HHSC or the Local Intellectual and Developmental Disability Authority (LIDDA) when the providers resolution is unsatisfactory to the individual or LAR.
Appendix G: Health and Welfare
HHSC clarified in section G-2-c that seclusion is physical abuse and clarified the critical incident reporting requirement and requirements to report to the Department of Family and Protective Services Statewide Intake.
HHSC revised updated abuse, neglect, and exploitation reporting processes to DFPS Statewide Intake and the LIDDA and provider agency complaint process.
Appendix H: Quality Improvement Strategy
HHSC revised section H-1, System Improvements and updated H-1-bi, System design changes and section H-1-b-ii Quality Improvement Strategy sections.
HHSC updated the type of survey tool to NCI-IID IPS Survey.
Appendix I: Financial Accountability
HHSC clarified that the LIDDA may contract as TxHmL provider agencies and must provide all TxHmL services and receive payment for services provided.
Performance Measures
HHSC added a new performance measure, A.a.2, that reads “Number and percent of individuals with records reflecting settings are selected by the individual based on their needs, preferences, and HCBS settings requirements. N: Number of individuals with records reflecting settings are selected by the individual based on their needs, preferences, and HCBS settings requirements. D: Number of individuals with reviewed records requirements.”
HHSC revised the Data Sources for performance measures C.a.2, C.a.3, C.c.1, D.a.1, D.c.1, D.c.2, D.c.3, D.d.1, G.a.1, G.a.2, G.a.3, G.a.4, G.a.5, G.a.6, G.a.7, G.a.8, G.b.1, G.b.2, G.c.1, G.c.2, G.c.2, and G.d.1.
HHSC revised the Sampling Approach for performance measures C.a.2, C.a.3, C.b.2, C.c.1, D.a.1, D.c.2, D.c.3, D.d.1, D.e.1, D.e.2, G.a.4, G.a.6, G.b.1, G.b.3, G.c.1, G.c.2, G.c.3, and G.d.1.
HHSC removed performance measures C.a.4 and G.b.3. Due to the removal of performance measure G.b.3, G.b.4 was renumbered as G.b.3.
HHSC revised performance measures D.a.1, D.c.2, D.c.3, D.d.1, G.a.4, G.a.6, G.d.1 to include the term surveyed contracts instead of reviewed contracts.
Miscellaneous
HHSC updated Texas Administrative Code references throughout the waiver and references of “The State” to “HHSC” throughout the waiver.
HHSC updated the projections in appendix J for the waiver costs (Factor D) and other Medicaid costs for waiver recipients (Factor D’) and the annual average per capita Medicaid costs for all non-waiver institutional services (Factor G) and other Medicaid costs for the institutional population (Factor G’) for all five waiver years.
TxHmL Program Overview
The TxHmL waiver provides essential community-based services and supports to individuals with intellectual disabilities who live in their own homes or in the home of another person, such as a family member. Services and supports are intended to enhance quality of life, functional independence, and health and well-being in continued community-based living and to supplement, rather than replace, existing informal or formal supports and resources.
Current services in the TxHmL waiver are adaptive aids, audiology, behavioral support, community support, dental treatment, dietary services, employment assistance, employment readiness, individualized skills and socialization, minor home modifications, nursing, occupational therapy, physical therapy, respite, speech and language pathology, support consultation, and supported employment.