Texas Register December 19, 2025 Volume: 50 Number: 51

Texas Register Table of Contents

1 Texas Board of Nursing
- - 1.0.1 Proposed Rules Re:
    - 1.0.1.1 Adopting 22 TAC §213.13, to remove outdated language, incorporate modern complaint submission and investigation practices, and ensure compliance with current statutory requirements governing notification and investigative procedures.
    - 1.0.1.2 Amending 22 TAC §217.24, to define the required informed consent documentation for the provision of telehealth nursing services.
  - 1.0.2 Adopted Rule Reviews Re:
    - 1.0.2.1 Adopting Title 22, Part 11, concerning nursing practice and procedure; vocational nursing education; professional nursing education; continuing competency; advanced practice nurses; advanced practice registered nurses with prescriptive authority, and pilot programs for innovative applications to vocational and professional nursing education.
2 Texas Department of State Health Services
- - 2.0.1 Adopted Rules Re:
3 Texas Health and Human Services Commission

Texas Board of Nursing

Proposed Rules Re:

Adopting 22 TAC §213.13, to remove outdated language, incorporate modern complaint submission and investigation practices, and ensure compliance with current statutory requirements governing notification and investigative procedures.

CHAPTER 213. PRACTICE AND PROCEDURE
22 TAC §213.13

OVERVIEW

The Texas Board of Nursing (Board) proposes amendments to §213.13, relating to Complaint Investigation and Disposition. The amendments are being proposed under the authority of the Occupations Code §301.151.

BACKGROUND AND JUSTIFICATION

The Board’s Enforcement Department underwent an internal audit, with the final report issued on May 21, 2025. The audit found that portions of Board Rule 213.13 are outdated and do not align with current enforcement practices and procedures. The proposed amendments address the complaint submission requirements, as the audit identified that some of the information currently required may not be available to complainants, resulting in procedures that conflict with the rule. The amendments also revise the complaint priority system, as the agency has determined that enforcement personnel will no longer use priority level four when designating complaints, necessitating a rule change. Finally, the amendments clarify the timeline notification requirements to ensure consistency with current standards, as recommended in the audit report.

SECTION-BY-SECTION SUMMARY

Proposed amendments to §213.13 are primarily intended to modernize and clarify existing language to reflect current agency processes for receiving and investigating complaints.

In subsection (a), the Board proposes to amend the rule to specify that complaints may be submitted in writing or by the agency’s online complaint portal, reflecting the current means by which most complaints are received. The subsection also updates language identifying additional data to be collected to initiate or conduct an investigation, including the nurse’s license number, contact information, patient identifiers, witness information, and the date and time of the incident. These additions clarify the type of information necessary for staff to begin investigative work and ensure that the rule reflects current operational practice. Proposed subsection (a) consolidates the requirements of current subsections (a) and (b). The proposed amendments remove language requiring additional information that may be unnecessary to undertake an investigation.

In proposed subsection (b), the language is updated with three defined levels of complaint priority based on the seriousness of the conduct and potential risk to clients or the public. Priority 4 is removed from the language as that priority is not currently being used by the agency.

The Board proposes to divide current subsection (d) into proposed subsections (c), (d), and (e) for clarity and to better reflect the structure of Texas Occupations Code §301.457. The Board proposes to amend subsection (c) to specify that, within 30 days after receipt of a complaint, staff will complete a preliminary investigation to determine the identity of the person named or described in the complaint, if not known, and process the complaint to determine priority scheduling, which establishes a schedule for case completion. This addition incorporates a step already followed in practice and improves clarity regarding early-stage complaint processing.

The Board proposes amendments to subsection (d) to ensure consistency with Texas Occupations Code §301.457. It provides that parties to the complaint will be notified of the expected timeline of the investigation as soon as practicable and that any change to the timeline will be documented in the case file and communicated to all parties. This addition promotes transparency and aligns the rule with statutory notice requirements.

These proposed amendments remove the language of current subsection (e), which requires background checks on the party identified in the complaint. While the background checks are conducted as part of agency procedure, they are not conducted at this stage in the investigatory process.

Proposed subsections (e) and (f) substantively retain their existing structure with only minor revisions to remove obsolete text. These provisions define when an investigation is considered complete and require staff to provide summary data to the executive director for cases extending beyond expected timelines.

Overall, the proposed amendments remove outdated language, incorporate modern complaint submission and investigation practices, and ensure compliance with current statutory requirements governing notification and investigative procedures.

Amending 22 TAC §217.24, to define the required informed consent documentation for the provision of telehealth nursing services.

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

OVERVIEW

The Texas Board of Nursing (Board) proposes amendments to §217.24, relating Telemedicine Medical Service Prescriptions. The amendments are being proposed under the authority of the Occupations Code §301.151.

BACKGROUND AND JUSTIFICATION

The proposed amendments to §217.24 reflect changes required by House Bill 1700, which amended Texas Occupations Code §111.004. Specifically, the bill specifies the informed consent documentation that is required when licensees perform telehealth service or telemedicine medical service. The proposed amendments ensure that a written record is maintained of informed consent when nursing services are provided by video or telephone.

SECTION-BY-SECTION SUMMARY

Proposed amendments to §217.24 are primarily intended to comply with the requirements of new legislation.

In Subsection (a), the Board defines “telehealth service” and “telemedicine medical service” based on the relevant sections of Texas Occupations Code §111.001.

In proposed Subsection (b), the Board specifies that standards of care are the same regardless of the format of telehealth or telemedicine medical service, as required by HB 1700.

Subsection (c) specifies the requirements for documentation of informed consent prior to telehealth or telemedicine medical service. These requirements include signature by the patient, parent, or legal guardian, disclosure of complications, risks, hazards for treatment methods, nursing license numbers, and practice location. A nurse is also required to confirm the identity of the patient taking part in telehealth or telemedicine medical service, verify their health history, and inform the patient regarding risks of electronic and digital communications in the provision of care.

Subsection (d) required telehealth and telemedicine medical service records regarding informed consent must be retained for seven years.

Subsection (e) was not amended except for adding a title to clarify the content relates to issuance of prescriptions. Subsections (f), (g), (h) and (i) substantively retain their existing structure, except for amendments to Texas Medical Board rules citations, which were recently recodified by the agency.

Adopted Rule Reviews Re:

Adopting Title 22, Part 11, concerning nursing practice and procedure; vocational nursing education; professional nursing education; continuing competency; advanced practice nurses; advanced practice registered nurses with prescriptive authority, and pilot programs for innovative applications to vocational and professional nursing education.

In accordance with Government Code §2001.039, the Texas Board of Nursing (Board) filed a notice of intention to review and consider for re-adoption, re-adoption with amendments, or repeal, the following chapters contained in Title 22, Part 11, of the Texas Administrative Code, pursuant to the 2022 rule review plan adopted by the Board at its April 2022 meeting, in the July 4, 2025, issue of the Texas Register (50 TexReg 3921).

Chapter 213. Practice and Procedure, §§213.1 – 213.37

Chapter 214. Vocational Nursing Education, §§214.1 – 214.14

Chapter 215. Professional Nursing Education, §§215.1 – 215.14

Chapter 216. Continuing Competency, §§216.1 – 216.11

Chapter 221. Advanced Practice Nurses, §§221.1 – 221.17

Chapter 222. Advanced Practice Registered Nurses with Prescriptive Authority, §§222.1 – 222.12

Chapter 227. Pilot Programs for Innovative Applications to Vocational and Professional Nursing Education, §§227.1 – 227.6

Texas Department of State Health Services

Adopted Rules Re:

Adopting 25 TAC §117.1, §117.2, to repeal these sections.

CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER A. GENERAL PROVISIONS
25 TAC §117.1, §117.2

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts the repeal of Chapter 117 in Texas Administrative Code (TAC) Title 25, which consists of §§117.1, 117.2, 117.11 – 117.19, 117.31 – 117.33, 117.41 – 117.49, 117.61 – 117.65, and 117.81 – 117.86.

The repeals are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3362) and will not be republished.

BACKGROUND AND JUSTIFICATION

The adoption of these repeals removes them from 25 TAC Chapter 117, End Stage Renal Disease Facilities, Subchapters A – F, to replace them with similar and updated new rules in 26 TAC Chapter 507, Subchapters A – F, End Stage Renal Disease Facilities. The adoption of the new rules is published elsewhere in this issue of the Texas Register. 25 TAC Chapter 117, Subchapters G and H, were administratively transferred to 26 TAC 507, Subchapters Y and Z.

Adopting 25 TAC §§117.11 – 117.19, to repeal these sections

CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER B. APPLICATION AND ISSUANCE OF A LICENSE
25 TAC §§117.11 – 117.19

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3362) and will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 25 TAC §§117.31 – 117.33, to repeal these sections.

CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER C. MINIMUM STANDARDS FOR EQUIPMENT, WATER TREATMENT AND REUSE, AND SANITARY AND HYGIENIC CONDITIONS
25 TAC §§117.31 – 117.33

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3362) and will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 25 TAC §§117.41 – 117.49, to repeal these sections.

CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER D. MINIMUM STANDARDS FOR PATIENT CARE AND TREATMENT
25 TAC §§117.41 – 117.49

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3362) and will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 25 TAC §§117.61 – 117.65, to repeal these sections.

CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER E. DIALYSIS TECHNICIANS
25 TAC §§117.61 – 117.65

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3362) and will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 25 TAC §§117.81 – 117.86, to repeal these sections.

CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER F. CORRECTIVE ACTION PLAN AND ENFORCEMENT
25 TAC §§117.81 – 117.86

OVERVIEW

The repeals are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3362) and will not be republished.

BACKGROUND AND JUSTIFICATION

Texas Health and Human Services Commission

Adopted Rules Re:

Adopting 26 TAC §507.1, §507.2, to add new terminology to reflect current practices and new technology.

CHAPTER 507. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §507.1, §507.2

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §§507.1, 507.2, 507.11 – 507.24, 507.30 – 507.38, 507.41 – 507.49, 507.51 – 507.60, 507.71 – 507.75, and 507.81 – 507.93, concerning End Stage Renal Disease Facilities.

New §§507.2; 507.11 – 507.17; 507.21 and 507.31; 507.33 – 507.36; 507.38, 507.41, 507.42, 507.48, and 507.49; 507.51 – 507.57; 507.59, 507.60, 507.72, 507.73, and 507.75; 507.82; and 507.90 are adopted with changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3367). These rules will be republished.

New §§507.1; 507.18 – 507.20; 507.22 – 507.24; 507.30, 507.32, and 507.37; 507.43 – 507.47; 507.58, 507.71, and 507.74; 507.81, 507.83 – 507.89 and 507.91 – 507.93 are adopted without changes to the proposed text as published in the June 6, 2025, issue of the Texas Register (50 TexReg 3367). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to comprehensively update the end stage renal disease (ESRD) facility rules to align with Texas Health and Safety Code Chapter 251. The new sections ensure patient safety while reducing unnecessary administrative burdens and allowing ESRDs more flexibility in the delivery of care. The new sections ensure alignment with current facility licensing, inspection, and investigation procedures; and reflect current technologies. The new sections also provide updated definitions and improve rule organization and readability.

The new sections require ESRD facilities to comply with the most current applicable guidelines and standards, for example, those from the Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention, U.S. Food and Drug Administration, and Association for the Advancement of Medical Instrumentation, to ensure patient safety.

The new sections improve consistency across HHSC Health Care Regulation (HCR) rulesets and correct outdated language, references, and citations. The new sections reflect the transition of regulatory jurisdiction from the Texas Department of State Health Services (DSHS) to HHSC and replace the ESRD facility rules in Title 25 of the Texas Administrative Code (25 TAC).