4 Aug 2023

Texas Register August 4, 2023 Volume: 48 Number: 31

by | posted in: Texas Board of Physical Therapy Examiners, Texas Department of State Health Services, Texas Health and Human Services Commission, Uncategorized |

Texas Department of State Health Services

Proposed Rules Re:

Repealing 25 TAC §§37.601 – 37.611, to remove obsolete rules concerning stock medication in schools, youth facilities, and other entities.

CHAPTER 37. MATERNAL AND INFANT HEALTH SERVICES
SUBCHAPTER U. EPINEPHRINE AUTO-INJECTOR POLICIES IN SCHOOLS
25 TAC §§37.601 – 37.611

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes the repeal of §§37.601 – 37.611, concerning Epinephrine Auto-Injector Policies in Schools.

BACKGROUND AND JUSTIFICATION

The purpose of the proposed repeal of 25 Texas Administrative Code (TAC) Chapter 37, Subchapter U, is to place all stock medication rules under 25 TAC Chapter 40. This rule proposal repeals 25 TAC, Chapter 37, Subchapter U. The new rules for 25 TAC Chapter 40, Subchapter E, Epinephrine Auto-Injector Policies in Schools, is published in this same issue of the Texas Register.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§37.601 – 37.611 removes the rules as no longer necessary under 25 TAC Chapter 37. The new rules in 25 TAC, Chapter 40, Subchapter F, §§40.81 – 40.89 aligns the rules with similar TAC rules relating to stock medications in schools, youth facilities, and other entities such as amusement parks, restaurants, and sport venues.

New 25 TAC §§40.61 – 40.71, outlining the requirements for epinephrine auto-injector policies implemented by school districts, open-enrollment charter schools, and private schools.

CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES [EPINEPHRINE AUTO-INJECTOR AND ANAPHYLAXIS POLICIES]
SUBCHAPTER E. EPINEPHRINE AUTO-INJECTOR POLICIES IN SCHOOLS
25 TAC §§40.61 – 40.71

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes new Subchapter E, §§40.61 – 40.71, concerning Epinephrine Auto-Injector Policies in Schools; and new Subchapter F, §§40.81 – 40.89, concerning Opioid Antagonist Medication Requirements in Schools. This proposal renames 25 Texas Administrative Code (TAC) Chapter 40, as “Stock Medication in Schools and Other Entities” to reflect the broader scope of stock medication rules that will be included under this chapter.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement Senate Bill (S.B.) 629, 88th Legislature, Regular Session, 2023, which amends Texas Education Code Chapter 38 by adding Subchapter E-1. S.B. 629 requires the Executive Commissioner of HHSC consult with the commissioner of the Texas Education Agency to adopt rules regarding maintenance, administration, and disposal of opioid antagonists. S.B. 629 also requires the rules to establish a process for checking inventory and the amount of training for school personnel and volunteers. Finally, S.B. 629 requires schools to report information on the administration of opioid antagonists to the commissioner of DSHS.

To place all stock medication rules under the same chapter in TAC, this rule proposal adds new Subchapter E, Epinephrine Auto-Injector Policies in Schools, to 25 TAC Chapter 40. The repeal of 25 TAC Chapter 37, Subchapter U is published in this same issue of the Texas Register.

This proposal adds new Subchapter F, Opioid Antagonist Medication Requirements in Schools, as required by S.B. 629.

SECTION-BY-SECTION SUMMARY

  • Subchapter E, Epinephrine Auto-Injector Policies In Schools
  • Proposed new §40.61 states the purpose of the subchapter, which is to establish minimum standards for administering, maintaining, and disposing of epinephrine auto-injectors in school districts, open-enrollment charter schools, and private schools who adopt unassigned epinephrine auto-injector policies. These standards are implemented under Texas Education Code Chapter 38, Subchapter E.
  • Proposed new §40.62 states that school districts, open-enrollment charter schools, and private schools may adopt and implement a written policy regarding the maintenance, administration, and disposal of unassigned epinephrine auto-injectors at each school campus. Policies adopted must comply with Texas Education Code §38.208.
  • Proposed new §40.63 defines terms used in Subchapter E.
  • Proposed new §40.64 states that the rules apply to any school district, open-enrollment charter school, or private school who voluntarily chooses to adopt and implement a written policy regarding the maintenance, administration, and disposal of unassigned epinephrine auto-injectors on each school campus.
  • Proposed new §40.65 outlines the standards for maintenance, administration, and disposal of unassigned epinephrine auto-injectors for school districts, open-enrollment charter schools, or private schools. The standards address unassigned epinephrine auto-injector prescriptions; policy implementation; training for school personnel or school volunteers to administer an unassigned epinephrine auto-injector; notification for emergency medical services and parents; records retention; and epinephrine auto-injector storage, replacement, and disposal.
  • Proposed new §40.66 addresses the assignment and recruitment of school personnel and school volunteers to be trained to administer epinephrine auto-injectors.
  • Proposed new §40.67 addresses training requirements for school personnel and volunteers in the recognizing of anaphylaxis signs and symptoms and administration of an unassigned epinephrine auto-injector.
  • Proposed new §40.68 requires schools to report on administering epinephrine auto-injectors per Texas Education Code §38.209.
  • Proposed new §40.69 addresses the notification to parents or guardians regarding unassigned epinephrine auto-injector policies in schools.
  • Proposed new §40.70 addresses gifts, grants, and donations that a school district, open-enrollment charter school, or private school may accept to implement the unassigned epinephrine auto-injector policy.
  • Proposed new §40.71 addresses the immunity from liability per Texas Education Code §38.215.
New 25 TAC §§40.81 – 40.89, establishing minimum standards for administering, maintaining, and disposing of opioid antagonist medication in school districts, open-enrollment charter schools, and private schools.

CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES [EPINEPHRINE AUTO-INJECTOR AND ANAPHYLAXIS POLICIES]
SUBCHAPTER F. OPIOID ANTAGONIST MEDICATION REQUIREMENTS IN SCHOOLS
25 TAC §§40.81 – 40.89

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes new Subchapter E, §§40.61 – 40.71, concerning Epinephrine Auto-Injector Policies in Schools; and new Subchapter F, §§40.81 – 40.89, concerning Opioid Antagonist Medication Requirements in Schools. This proposal renames 25 Texas Administrative Code (TAC) Chapter 40, as “Stock Medication in Schools and Other Entities” to reflect the broader scope of stock medication rules that will be included under this chapter.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement Senate Bill (S.B.) 629, 88th Legislature, Regular Session, 2023, which amends Texas Education Code Chapter 38 by adding Subchapter E-1. S.B. 629 requires the Executive Commissioner of HHSC consult with the commissioner of the Texas Education Agency to adopt rules regarding maintenance, administration, and disposal of opioid antagonists. S.B. 629 also requires the rules to establish a process for checking inventory and the amount of training for school personnel and volunteers. Finally, S.B. 629 requires schools to report information on the administration of opioid antagonists to the commissioner of DSHS.

To place all stock medication rules under the same chapter in TAC, this rule proposal adds new Subchapter E, Epinephrine Auto-Injector Policies in Schools, to 25 TAC Chapter 40. The repeal of 25 TAC Chapter 37, Subchapter U is published in this same issue of the Texas Register.

This proposal adds new Subchapter F, Opioid Antagonist Medication Requirements in Schools, as required by S.B. 629.

SECTION-BY-SECTION SUMMARY

Subchapter F, Opioid Antagonist Medication Requirements In Schools

  • Proposed new §40.81 describes the purpose of the subchapter, which is to establish minimum standards for administering, maintaining, and disposing of opioid antagonist medication in school districts, open-enrollment charter schools, and private schools that adopt opioid antagonist medicine policies. These standards are implemented under Texas Education Code Chapter 38, Subchapter E-1.
  • Proposed new §40.82 defines terms used in Subchapter F relating to the maintenance, administration, and disposal of opioid antagonist medication.
  • Proposed new §40.83 states that the rules apply to school districts, open-enrollment charter schools, and private schools that may adopt and implement a written policy regarding the maintenance, administration, and disposal of opioid antagonist medication.
  • Proposed new §40.84 addresses unassigned opioid antagonist medication policy requirements in school districts, open-enrollment charter schools, or private schools.
  • Proposed new §40.85 states that once a policy is implemented, the school district, open-enrollment charter school, or private school must stock opioid antagonist medication. The new rule addresses the authorized healthcare provider prescription, administration to a person who is reasonably believed to be experiencing an opioid-related drug overdose, and the storage and disposal of opioid antagonist medication.
  • Proposed new §40.86 addresses training requirements for school personnel and school volunteers in the administration of opioid antagonist medication, recognition of opioid-related drug overdose, disposal of used or expired opioid antagonists, and use of an opioid antagonist trainer device.
  • Proposed new §40.87 addresses the required reporting of administering opioid antagonist medications and retention of records.
  • Proposed new §40.88 addresses gifts, grants, donations, and federal and local funds that a school district, open-enrollment charter school, or private school may accept to implement the unassigned opioid antagonist policy.
  • Proposed new §40.89 addresses the immunity from liability as outlined in this subchapter or Texas Education Code §38.227.

Texas Health and Human Services Commission

Proposed Rules Re:

New 26 TAC §§374.1 – 374.4, implementing the Mental Health Early Intervention and Treatment Grant.

CHAPTER 374. MENTAL HEALTH EARLY INTERVENTION AND TREATMENT GRANT
26 TAC §§374.1 – 374.4

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §374.1, concerning Purpose and Objectives; §374.2, concerning Definitions; §374.3, concerning Eligibility Criteria for Applicants; and §374.4, concerning Application and Selection Process, in new Chapter 374 Mental Health Early Intervention and Treatment Grant.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with Senate Bill (S.B.) 26, 88th Legislature, Regular Session, 2023, which adds new §531.09915 to the Texas Government Code effective September 1, 2023. Section 531.09915 requires the Health and Human Services Commission (HHSC) to implement a competitive grant program to support community-based initiatives that promote identification of mental health issues and improve access to early intervention and treatment for children and families and to establish by rule the application and eligibility requirements for an entity to be awarded a grant.

SECTION-BY-SECTION SUMMARY

  • Proposed new §374.1 describes the purpose and objective of the Mental Health Early Intervention and Treatment Grant, so that applicants understand the intent and general objectives of establishing community-based initiatives.
  • Proposed new §374.2 describes the definitions for terms used throughout the chapter.
  • Proposed new §374.3 lists the entities eligible for a grant awarded under the grant program in accordance with Texas Government Code §531.09915(e). The new rule is necessary to establish in rule eligibility requirements for entities applying for the grant.
  • Proposed new §374.4 describes the application and selection process leading to final award for potential applicants. The proposed new rule is necessary to establish in rule the application process for entities applying for the grant.

Proposed Rule Reviews Re:

Proposing to review Title 26, Part 1, which covers Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions.

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 551, Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions

Subchapter A Introduction

Subchapter B Application Procedures

Subchapter C Standards for Licensure

Subchapter D General Requirements for Facility Construction

Subchapter F Inspections, Surveys, and Visits

Subchapter G Abuse, Neglect, and Exploitation; Complaint and Incident Reports and Investigations

Subchapter H Enforcement

Subchapter J Respite Care

Subchapter L Provisions Applicable to Facilities Generally

This review is conducted in accordance with the requirements of Texas Government Code §2001.039, which requires state agencies, every four years, to assess whether the initial reasons for adopting a rule continue to exist. After reviewing its rules, the agency will readopt, readopt with amendments, or repeal its rules.

Public Notice – Texas State Plan for Medical Assistance Amendment

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments will be effective September 1, 2023.

The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for the following services:

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEOPOS);

Early and Periodic Screening, Diagnostic and Treatment Services;

Home Health Services; and

Physicians and Other Practitioners

Texas State Board of Physical Therapy Examiners

Adopted Rules Re:

Amending 22 TAC §§343.5, 343.6, 343.8, 343.9, 343.21, 343.22, 343.36, 343.40, 343.41, to outline grounds for denial of a license or discipline of a licensee.

CHAPTER 343. CONTESTED CASE PROCEDURE
22 TAC §§343.5, 343.6, 343.8, 343.9, 343.21, 343.22, 343.36, 343.40, 343.41

OVERVIEW

The Texas Board of Physical Therapy Examiners adopts amendments to 22 Texas Administrative Code (TAC) Chapter 343. Contested Case Procedures, Occupations Code. Specifically, the Board adopts amendments to §343.5. Licensure of Persons with a History of Substance Abuse, §343.6. Other Grounds for Denial of a License or Discipline of a Licensee, §343.8. Licensure of Persons with a History of Voluntary or Involuntary Psychiatric Hospitalization, §343.9. Licensure of Persons with Criminal Convictions, §343.21. Witness Fees and Expenses, §343.22. Service of Notice, §343.36. Filing and Receipt of Complaints, §343.40. Informal Conference, and §343.41. Agreed Orders.

The amendments are adopted without changes to the proposed text as published in the June 16, 2023 issue of the Texas Register (48 TexReg 3060). The rules will not be republished.

The amendments are adopted in order to provide clarity to the procedures for contested cases; to correct inaccurate and outdated references; and to conform the rules with the physical therapy provisions in Chapter 453, Occupations Code, with the administrative procedures in Chapter 2001, Government Code, and with the consequences of criminal conviction in Chapter 53, Occupations Code.

Amending 22 TAC § 346.3, to describe the provision of physical therapy services to infants and toddlers in an early childhood setting.

CHAPTER 346. PRACTICE SETTINGS FOR PHYSICAL THERAPY
22 TAC §346.3

OVERVIEW

The Texas Board of Physical Therapy Examiners adopts amendments to 22 Texas Administrative Code (TAC) §346.3. Early Childhood Intervention (ECI) Setting, relating to the provision of physical therapy services to infants and toddlers in an early childhood setting.

The amendments are adopted in order to update a Code of Federal Regulations reference, to eliminate the requirement for the completion of an evaluation and reevaluation to be done onsite allowing for provision via telehealth if indicated, to align the 60-day review of the plan of care (POC) to the requirement in other settings prior to continuation of treatment by a physical therapist assistant, and to report recommendations following a review of the POC to the ECI Interdisciplinary Team.