Texas Register December 23, 2022 Volume: 47 Number: 51

Texas Register Table of Contents

1 State Board of Dental Examiners
- - 1.0.1 Proposed Rules Re:
2 Texas State Board of Pharmacy
- - 2.0.1 Proposed Rules Re:
3 Texas Department of State Health Services
- - 3.0.1 Adopted Rules Re:
    - 3.0.1.1 Repealing 25 TAC §§265.181 – 265.211, removing outdated language regarding public swimming pools and spas.
    - 3.0.1.2 New TAC §§265.181 – 265.198, concerning new specifications and safety requirements for public swimming pools and spas.
4 Texas Health and Human Services Commission
5 Department of Aging and Disability Services
- - 5.0.1 Adopted Rules Re:
    - 5.0.1.1 Repealing 40 TAC §§8.281 – 8.297, regarding HIV prevention and treatment in state sponsored living centers.
    - 5.0.1.2 Repealing 40 TAC §§91.1 – 91.8, to realign and reorganize the rules following the abolition of the Department of Aging and Disability Services (DADS).

State Board of Dental Examiners

Proposed Rules Re:

Amending 22 TAC §104.1, regarding continuing education requirements.

CHAPTER 104. CONTINUING EDUCATION
22 TAC §104.1

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §104.1, concerning continuing education requirements. The proposed amendment updates subsection (6) to reflect the merger of the regional examining board CDCA-WREB-CITA, and includes the regional examining board States Resources for Testing and Assessments (SRTA).

Amending 22 TAC §104.2, regarding continuing education providers.

CHAPTER 104. CONTINUING EDUCATION
22 TAC §104.2

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §104.2, concerning continuing education providers. The proposed amendment reflects the merger of the regional examining board CDCA-WREB-CITA, and includes the States Resources for Testing and Assessments (SRTA) and Central Regional Dental Testing Services Inc. (CRDTS) as board approved continuing education providers.

Amending 22 TAC §114.1, which addresses the permitted duties of a dental assistant.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.1

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §114.1, concerning permitted duties of a dental assistant. The proposed amendment updates the language with the applicable section of the Dental Practice Act. Specifically, Texas Occupations Code §265.005 was repealed and the applicable section is currently Texas Occupations Code §265.001.

Amending 22 TAC §114.6, regarding qualifications for registration or certification of a dental assistant.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.6

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §114.6, concerning general qualifications for registration or certification of a dental assistant. The proposed amendment updates the language with the applicable section of the Dental Practice Act. Specifically, Texas Occupations Code §265.005 was repealed and the applicable section is currently Texas Occupations Code §265.001(d). The amendment also removes certain portions of subsection (g) of this rule because it contains language from 22 Texas Administrative Code §101.8 that is duplicative or no longer in effect.

Amending 22 TAC §114.21, addressing the requirements for dental assistant registration courses and examinations.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.21

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §114.21, concerning requirements for dental assistant registration courses and examinations. The proposed amendment removes language pertaining to the Dental Assistant Advisory Committee because the committee is no longer required by the Dental Practice Act and the Board does not currently have a need for the committee.

Amending 22 TAC §115.2, regarding the permitted duties of dental hygienists.

CHAPTER 115. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL HYGIENE
22 TAC §115.2

OVERVIEW

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §115.2, concerning permitted duties of a dental hygienist. The proposed amendment updates the language to reflect that the Board no longer issues certificates to dental hygienists to apply pit and fissure sealants or to monitor nitrous oxide. Dental hygienists must continue to ensure they meet all qualifications required by the Dental Practice Act and Board rules before performing a service or procedure.

Texas State Board of Pharmacy

Proposed Rules Re:

Amending 22 TAC §291.76, regarding Class C Pharmacies located in a freestanding ambulatory surgical center.

CHAPTER 291. PHARMACIES
SUBCHAPTER D. INSTITUTIONAL PHARMACY (CLASS C)
22 TAC §291.76

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §291.76, concerning Class C Pharmacies Located in a Freestanding Ambulatory Surgical Center. The amendments, if adopted, clarify that a pharmacist must verify the completeness and reconciliation of the perpetual inventory of controlled substances for an ASC pharmacy.

Amending 22 TAC §291.104, which will correct a drafting error in a section regarding operational standards.

CHAPTER 291. PHARMACIES
SUBCHAPTER F. NON-RESIDENT PHARMACY (CLASS E)
22 TAC §291.104

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §291.104, concerning Operational Standards. The amendments, if adopted, correct a drafting error by adding an omitted word.

Amending 22 TAC §303.1, addressing the destruction of dispensed drugs.

CHAPTER 303. DESTRUCTION OF DRUGS
22 TAC §303.1

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §303.1, concerning Destruction of Dispensed Drugs. The amendments, if adopted, remove the inventory requirements for destruction using a waste disposal service of dangerous drugs dispensed in health care facilities or institutions and clarify dangerous drugs may be comingled with controlled substances in a shared container prior to destruction as allowed by federal laws and regulations.

Amending 22 TAC §315.6, regarding pharmacy responsibility and electronic reporting.

CHAPTER 315. CONTROLLED SUBSTANCES
22 TAC §315.6

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §315.6, concerning Pharmacy Responsibility – Electronic Reporting. The amendments, if adopted, specify that a pharmacy must report the data elements indicated as required by the board’s Data Submission Guide for Dispensers.

Texas Department of State Health Services

Adopted Rules Re:

Repealing 25 TAC §§265.181 – 265.211, removing outdated language regarding public swimming pools and spas.

CHAPTER 265. GENERAL SANITATION
SUBCHAPTER L. PUBLIC SWIMMING POOLS AND SPAS
25 TAC §§265.181 – 265.211

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts the repeal of §§265.181 – 265.211 and new §§265.181 – 265.198, concerning Public Swimming Pools and Spas.

New §§265.181 – 265.183, 265.187, 265.189, 265.191 and 265.193 are adopted with changes to the proposed text as published in the July 15, 2022, issue of the Texas Register (47 TexReg 4053). These rules will be republished. The repeal of §§265.181 – 265.211 and new §§265.184 – 265.186, 265.188, 265.190, 265.192, and 265.194 – 265.198 are adopted without changes to the proposed text as published in the July 15, 2022, issue of the Texas Register (47 TexReg 4053). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The repeal of rules and new rules comply with House Bill (H.B.) 2205, 87th Legislature, Regular Session, 2021, which amended Texas Health and Safety Code, Chapter 341, by requiring the adoption, by reference, of a version of the International Swimming Pool and Spa Code (ISPSC), as defined by Texas Local Government Code, §214.103, that is not older than the version in effect on May 1, 2019, regarding all construction, alteration, renovation, enlargement, and repair of commercial swimming pools and spas.

New TAC §§265.181 – 265.198, concerning new specifications and safety requirements for public swimming pools and spas.

CHAPTER 265. GENERAL SANITATION
SUBCHAPTER L. PUBLIC SWIMMING POOLS AND SPAS
25 TAC §§265.181 – 265.198

OVERVIEW

BACKGROUND AND JUSTIFICATION

Texas Health and Human Services Commission

Adopted Rules Re:

New 26 TAC §§110.1, 110.3, 110.5, 110.7, 110.9, 110.11, 110.13, 110.15, moving appeals for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) from the HHSV Appeals Division to the Texas State Office of Administrative Hearings (SOAH).

CHAPTER 110. HEARINGS UNDER THE ADMINSTRATIVE PROCEDURE ACT
26 TAC §§110.1, 110.3, 110.5, 110.7, 110.9, 110.11, 110.13, 110.15

OVERVIEW

As required by Texas Government Code §531.0202(b), the Texas Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts new 26 TAC, Part 1, Chapter 110, concerning Hearings Under the Administrative Procedure Act, comprised of §§110.1, 110.3, 110.5, 110.7, 110.9, 110,11, 110.13, and 110.15.

The new rules in §110.1 and §110.3 are adopted without changes to the proposed text as published in the August 26, 2022, issue of the Texas Register (47 TexReg 5070). These rules will not be republished.

The new rules in §§110.5, 110.7, 110.9, 110.11, 110.13, and 110.15 are adopted with changes to the proposed text as published in the August 26, 2022, issue of the Texas Register (47 TexReg 5070). These rules will be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the new rules is to move appeals for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) administrative penalties, contract terminations, vendor holds, recoupments, and denial of payment appeal cases from the HHSC Appeals Division to the Texas State Office of Administrative Hearings (SOAH).

The rules make HCS and TxHmL consistent with other long-term care regulation programs that are heard by SOAH. The project will also update outdated rule references, change references from DADS to HHSC, improve readability.

New 26 TAC §§260.501, 260.503, 260.505, 260.507, 260.509, 260.511, 260.513, 260.515, 260.517, concerning individualized skills and socializations for Deaf Blind with Multiple Disabilities (DBMD) Program and Community First Choice (CFC).

CHAPTER 260. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER I. INDIVIDUALIZED SKILLS AND SOCIALIZATION
26 TAC §§260.501, 260.503, 260.505, 260.507, 260.509, 260.511, 260.513, 260.515, 260.517

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts new §260.501, concerning Definitions; §260.503, concerning Description of Individualized Skills and Socialization; §260.505, concerning Provision of Individualized Skills and Socialization; §260.507, concerning Staffing Ratios; §260.509, concerning Discontinuation of Day Habilitation; §260.511, concerning Including Individualized Skills and Socialization on an IPC; §260.513, concerning Service Provider Qualifications and Training; §260.515, concerning Contracting to Provide Individualized Skills and Socialization; and §260.517, concerning Program Provider Reimbursement for Individualized Skills and Socialization, in new Chapter 260, Subchapter I, Individualized Skills and Socialization.

Sections 260.501, 260.503, 260.505, 260.513, 260.515, and 260.517 are adopted with changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4803). These rules will be republished.

Sections 260.507, 260.509, and 260.511 are adopted without changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4803). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (42 CFR), §441.301(c)(4)(i) – (v), which require home and community based settings in programs authorized by §1915(c) of the Social Security Act to have certain qualities, including being integrated in and supporting full access of individuals to the greater community. The Centers for Medicare &Medicaid Services (CMS) is requiring that states be in compliance with these regulations by March 17, 2023.

The 2020-21 General Appropriations Act (GAA), House Bill 1, 86th Legislature, Regular Session, 2019 (Article II, Health and Human Services Commission, Rider 21) required HHSC to develop a plan to replace day habilitation in its Medicaid §1915(c) waiver programs for individuals with intellectual and developmental disabilities with more integrated services that maximize participation and integration of the individuals in the community.

In accordance with Rider 21, HHSC developed a plan to replace day habilitation provided in the Home and Community-Based Services (HCS), Texas Home Living (TxHmL), and Deaf Blind with Multiple Disabilities (DBMD) Programs with individualized skills and socialization. The plan included proposed ratios for service providers of individualized skills and socialization to individuals receiving individualized skills and socialization to help ensure that individuals receiving the service have adequate support to achieve their goals.

The 2022-2023 GAA, Senate Bill 1, 87th Legislature, Regular Session, 2021 (Article II, Health and Human Services Commission, Rider 23) authorized funding for the provision of individualized skills and socialization in the HCS, TxHmL, and DBMD Programs.

The adopted rules implement the plan required by Rider 21 to replace day habilitation with individualized skills and socialization in the DBMD Program and ensure that HHSC is in compliance with 42 CFR §441.301(c)(4)(i) – (v) by March 17, 2023.

The adopted rules describe the two types of individualized skills and socialization, on-site individualized skills and socialization and off-site individualized skills and socialization and require that both types be provided by an individualized skills and socialization provider.

The adopted rules include requirements for a program provider to make available both on-site and off-site individualized skills and socialization to individuals. The adopted rules include requirements for an individualized skills and socialization provider to meet staffing ratios.

The adopted rules also discontinue day habilitation effective March 1, 2023.

The rules implementing individualized skills and socialization in the HCS and TxHmL Programs are being adopted in Texas Administrative Code (TAC) Title 26, Chapter 263, Subchapter L and in 26 TAC Chapter 262, Subchapter J, and published elsewhere in this issue of the Texas Register.

The rules requiring a provider of individualized skills and socialization to be licensed in accordance with Texas Human Resources Code Chapter 103 are being adopted in 26 TAC Chapter 559.

New 26 TAC §§262.901, 262.903, 262.905, 262.907, 262.909, 262.911, 262.913, 262.915, 262.917, 262.919, 262.921, 262.923, 262.925, 262.927, concerning individualized skills and socializations for Texas Home Living (TxHmL).

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER J. INDIVIDUALIZED SKILLS AND SOCIALIZATION
26 TAC §§262.901, 262.903, 262.905, 262.907, 262.909, 262.911, 262.913, 262.915, 262.917, 262.919, 262.921, 262.923, 262.925, 262.927

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts new §262.901, concerning Definitions; §262.903, concerning Types of Individualized Skills and Socialization; §262.905, concerning Description of On-Site and Off-Site Individualized Skills and Socialization; §262.907, concerning Description of and Criteria for an Individual to Receive In-Home Individualized Skills and Socialization; §262.909, concerning Exceptions to Certain Requirements During Declaration of Disaster; §262.911, concerning Provision of On-Site and Off-Site Individualized Skills and Socialization; §262.913, concerning Provision of In-Home Individualized Skills and Socialization; §262.915, concerning Service Limit for On-Site, Off-Site, and In-Home Individualized Skills and Socialization; §262.917, concerning Staffing Ratios for Off-Site Individualized Skills and Socialization; §262.919, concerning Discontinuation of Day Habilitation; §262.921, concerning Including On-Site, Off-Site, and In-Home Individualized Skills and Socialization on an IPC; §262.923, concerning Service Provider Qualifications and Training for In-Home Individualized Skills and Socialization; §262.925, concerning Program Provider Reimbursement for On-Site, Off-Site, and In-Home Individualized Skills and Socialization; and §262.927, concerning Enhanced Staffing Rate, in Texas Administrative Code (TAC), new Chapter 262, Subchapter J, Individualized Skills and Socialization.

Sections 262.901, 262.905, 262.911, 262.917, 262.923, 262.925, and 262.927 are adopted with changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4809). These rules will be republished.

Sections 262.903, 262.907, 262.909, 262.913, 262.915, 262.919, and 262.921 are adopted without changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4809). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted rules are necessary to comply with Title 42, Code of Federal Regulations (CFR), §441.301(c)(4)(i) – (v), which require home and community based settings in programs authorized by §1915(c) of the Social Security Act to have certain qualities, including being integrated in and supporting full access of individuals to the greater community. The Centers for Medicare and Medicaid Services (CMS) is requiring that states be in compliance with these regulations by March 17, 2023.

In accordance with Rider 21, HHSC developed a plan to replace day habilitation provided in the Home and Community-Based Services (HCS), Texas Home Living (TxHmL), and Deaf Blind with Multiple Disabilities (DBMD) Programs with individualized skills and socialization. The plan included the use of staffing ratios while providing off-site individualized skills and socialization to individuals to ensure that the individuals receive more personalized attention and more easily meet their personal goals and to ensure the health and safety of the individuals.

The adopted rules implement the plan required by Rider 21 to replace day habilitation with individualized skills and socialization in the TxHmL Program and will ensure HHSC’s compliance with 42 CFR §441.301(c)(4)(i) – (v) by March 17, 2023.

The adopted rules describe the three types of individualized skills and socialization, on-site individualized skills and socialization, off-site individualized skills and socialization, and in-home individualized skills and socialization. The adopted rules require that on-site and off-site individualized skills and socialization be provided by an individualized skills and socialization provider.

The rules requiring a provider of individualized skills and socialization to be licensed in accordance with Texas Human Resources Code Chapter 103 are being adopted in 26 TAC Chapter 559 and published elsewhere in this issue of the Texas Register. The rules will require an individualized skills and socialization provider to be licensed as a day activity and health services facility with a special designation for individualized skills and socialization.

The adopted rules also include requirements for the provision of in-home individualized skills and socialization including criteria that must be met for an individual to receive the service and that the service must be provided in the residence of the individual receiving the service.

To help providers to operate and provide services effectively during a disaster, the adopted rules provide that HHSC may allow program providers to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect.

The adopted rules discontinue day habilitation which includes in-home day habilitation effective March 1, 2023.

The rules implementing individualized skills and socialization in the HCS and DBMD Programs are being adopted in 26 TAC Chapter 263, Subchapter L and in 26 TAC Chapter 260, Subchapter I, and published elsewhere in the same issue of the Texas Register.

New 26 TAC §§263.2001, 263.2003, 263.2005, 263.2007, 263.2009, 263.2011, 263.2013, 263.2015, 263.2017, 263.2019, 263.2021, 263.2023, 263.2025, 263.2027, concerning individualized skills and socializations for Home and Community-Based Services (HCS).

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER L. INDIVIDUALIZED SKILLS AND SOCIALIZATION
26 TAC §§263.2001, 263.2003, 263.2005, 263.2007, 263.2009, 263.2011, 263.2013, 263.2015, 263.2017, 263.2019, 263.2021, 263.2023, 263.2025, 263.2027

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts new §263.2001, concerning Definitions; §263.2003, concerning Types of Individualized Skills and Socialization; §263.2005, concerning Description of On-Site and Off-Site Individualized Skills and Socialization; §263.2007, concerning Description of and Criteria for an Individual to Receive In-Home Individualized Skills and Socialization; §263.2009, concerning Exceptions to Certain Requirements During Declaration of Disaster; §263.2011, concerning Provision of On-Site and Off-Site Individualized Skills and Socialization; §263.2013, concerning Provision of In-Home Individualized Skills and Socialization; §263.2015, concerning Service Limit for On-Site, Off-Site, and In-Home Individualized Skills and Socialization; §263.2017, concerning Staffing Ratios for Off-Site Individualized Skills and Socialization; §263.2019, concerning Discontinuation of Day Habilitation; §263.2021, concerning Including On-Site, Off-Site, and In-Home Individualized Skills and Socialization on an IPC; §263.2023, concerning Service Provider Qualifications and Training for In-Home Individualized Skills and Socialization; §263.2025, concerning Program Provider Reimbursement for On-Site, Off-Site, and In-Home Individualized Skills and Socialization; and §263.2027, concerning Enhanced Staffing Rate, in Texas Administrative Code (TAC), new Chapter 263, Subchapter L, Individualized Skills and Socialization.

Sections 263.2001, 263.2005, 263.2011, 263.2017, 263.2023, 263.2025, and 263.2027 are adopted with changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4818). These rules will be republished.

Sections 263.2003, 263.2007, 263.2009, 263.2013, 263.2015, 263.2019, and 263.2021 are adopted without changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4818). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

In accordance with Rider 21, HHSC developed a plan to replace day habilitation provided in the Home and Community-Based Services (HCS), Texas Home Living (TxHmL), and Deaf Blind with Multiple Disabilities (DBMD) Programs with individualized skills and socialization. The plan included the use of staffing ratios while providing off-site individualized skills and socialization to individuals to ensure that the individuals receive more personalized attention and more easily meet their personal goals and to ensure the health and safety of the individuals.

The adopted rules implement the plan required by Rider 21 to replace day habilitation with individualized skills and socialization in the HCS Program and will ensure HHSC’s compliance with 42 CFR §441.301(c)(4)(i) – (v) by March 17, 2023.

The adopted rules describe the three types of individualized skills and socialization – on-site individualized skills and socialization, off-site individualized skills and socialization, and in-home individualized skills and socialization. The adopted rules require that on-site and off-site individualized skills and socialization be provided by an individualized skills and socialization provider.

The rules requiring a provider of individualized skills and socialization to be licensed in accordance with Texas Human Resources Code Chapter 103, are being adopted in 26 TAC Chapter 559, Subchapter H and published elsewhere in this issue of the Texas Register. The rules in Chapter 559, Subchapter H will require an individualized skills and socialization provider to be licensed as a day activity and health services facility with a special designation for individualized skills and socialization.

The adopted rules discontinue day habilitation which includes in-home day habilitation effective March 1, 2023.

The rules implementing individualized skills and socialization in the TxHmL and DBMD Programs are being adopted in 26 TAC Chapter 262 Subchapter J and in 26 TAC Chapter 260, Subchapter I and published elsewhere in the same issue of the Texas Register.

New 26 TAC §559.201, §559.203, regarding definitions and statutory authority for new individualized skills and socialization program for Deaf Blind with Multiple Disabilities, Home and Community-Based Services, and Texas Home Living.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER H. INDIVIDUALIZED SKILLS AND SOCIALIZATION PROVIDER REQUIREMENTS
26 TAC §559.201, §559.203

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §§559.201, 559.203, 559.205, 559.207, 559.209, 559.211, 559.213, 559.215, 559.217, 559.219, 559.221, 559.223, 559.225, 559.227, 559.229, 559.231, 559.233, 559.235, 559.237, 559.239, 559.241, 559.243, 559.245, 559.247, 559.249, and 559.251.

New §§559.201, 559.207, 559.215, 559.217, 559.221, 559.235, 559.239, 559.247, and 559.249 are adopted without changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4827). These rules will not be republished.

New §§559.203, 559.205, 559.209, 559.211, 559.213, 559.219, 559.223, 559.225, 559.227, 559.229, 559.231, 559.233, 559.237, 559.241, 559.243, 559.245, and 559.251 are adopted with changes to the proposed text as published in the August 12, 2022, issue of the Texas Register (47 TexReg 4827). These rules will be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the new rules is to implement a new subcategory of day activity and health services (DAHS) licensure for individualized skills and socialization providers. This ensures individualized skills and socialization providers’ compliance with appropriate oversight and regulations without the cost and operational complexity involved in creating a new licensure type.

The new rules are necessary to comply with the 2020-2021 General Appropriations Act, 86th Legislature, Regular Session, 2019 (Article II, Health and Human Services Commission, Rider 21), which requires HHSC to establish the individualized skills and socialization provider as a new provider type to replace traditional day habilitation providers. These new rules license these new providers under the current DAHS statute (Chapter 103, Texas Human Resources Code) and establish a new subchapter of rules specific to these providers within existing DAHS rules.

New 26 TAC §§559.205, 559.207, 559.209, 559.211, 559.213, 559.215, 559.217, 559.219, 559.221, 559.223, pertaining to licensing of individualized skills and socialization providers.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER H. INDIVIDUALIZED SKILLS AND SOCIALIZATION PROVIDER REQUIREMENTS
26 TAC §§559.205, 559.207, 559.209, 559.211, 559.213, 559.215, 559.217, 559.219, 559.221, 559.223

OVERVIEW

BACKGROUND AND JUSTIFICATION

New 26 TAC §§559.225, 559.227, 559.229, describing the requirements for an individualized skills and socialization program and an emergency response plan.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER H. INDIVIDUALIZED SKILLS AND SOCIALIZATION PROVIDER REQUIREMENTS
26 TAC §§559.225, 559.227, 559.229

OVERVIEW

BACKGROUND AND JUSTIFICATION

New 26 TAC §§559.231, 559.233, 559.235, 559.237, 559.239, 559.241, 559.243, 559.245, 559.247, 559.249, 559.251, regarding inspections, reporting abuse, and investigations.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER H. INDIVIDUALIZED SKILLS AND SOCIALIZATION PROVIDER REQUIREMENTS
26 TAC §§559.231, 559.233, 559.235, 559.237, 559.239, 559.241, 559.243, 559.245, 559.247, 559.249, 559.251

OVERVIEW

BACKGROUND AND JUSTIFICATION

Amending 26 TAC §§567.2 and 567.6 to clarify existing definitions and existing language in a Certificate of Public Advantage (COPA).

CHAPTER 567. CERTIFICATE OF PUBLIC ADVANTAGE
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §567.2, §567.6

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §567.2, concerning Definitions; §567.6, concerning Scope; §567.21, concerning Changes That Could Affect the Certificate of Public Advantage; §567.22, concerning Application; §567.25, concerning Fees; §567.26, concerning Conditions for Issuing a Certificate of Public Advantage; §567.41, concerning Rate Reviews for Hospitals Operating Under a Certificate of Public Advantage; §567.52, concerning Annual Review; §567.53, concerning Investigation; Consequences; and §567.54, concerning Corrective Action Plan; the repeals of §567.31, concerning Terms; §567.32, concerning Annual Report; and §567.33, concerning Voluntary Termination; and new §567.31, concerning Terms; §567.32, concerning Changes that May Affect the Certificate of Public Advantage; §567.33, concerning Annual Public Hearing; §567.34, concerning Annual Report; §567.35, concerning Voluntary Termination; and §567.36, concerning Supervision Fees.

The repeals of §§567.31 – 567.33; amendments to §§567.21, 567.25, 567.41, 567.52, and 567.54; and new §§567.32, 567.34, and 567.35 are adopted without changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3909). These rules will not be republished.

The amendments to §§567.2, 567.6, 567.22, 567.26, and 567.53 and new §§567.31, 567.33, and 567.36 are adopted with changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3909). These rules will be republished.

BACKGROUND AND JUSTIFICATION

The amendments, repeals, and new sections update the rules regarding a Certificate of Public Advantage (COPA). The rules provide additional clarity to internal and external stakeholders, update supervision fees and reporting requirements, and ensure consistency between these rules and Texas Health and Safety Code (HSC) Chapter 314A, as added by House Bill 3301, 86th Legislature, Regular Session, 2019.

Amending 26 TAC §§567.21, 567.22, 567.25, 567.26 to update words and the list of application items, and to clarify fees for Certificate of Public Advantage (COPA).

CHAPTER 567. CERTIFICATE OF PUBLIC ADVANTAGE
SUBCHAPTER B. APPLICATION AND ISSUANCE
26 TAC §§567.21, 567.22, 567.25, 567.26

OVERVIEW

BACKGROUND AND JUSTIFICATION

Repealing 26 TAC §§567.31 – 567.33, concerning terms, annual report, and voluntary termination of Certificate of Public Advantage (COPA).

CHAPTER 567. CERTIFICATE OF PUBLIC ADVANTAGE
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §§567.31 – 567.33

OVERVIEW

BACKGROUND AND JUSTIFICATION

New 26 TAC §§567.31 – 567.36, concerning terms, changes that may affect Certificate of Public Advantage (COPA), annual public hearing, annual report, voluntary termination, and supervision fees.

CHAPTER 567. CERTIFICATE OF PUBLIC ADVANTAGE
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §§567.31 – 567.36

OVERVIEW

BACKGROUND AND JUSTIFICATION

Amending 26 TAC §567.41 to clarify rate review requirements for hospitals operating under a Certificate of Public Advantage (COPA).

CHAPTER 567. CERTIFICATE OF PUBLIC ADVANTAGE
SUBCHAPTER D. RATE REVIEW
26 TAC §567.41

OVERVIEW

BACKGROUND AND JUSTIFICATION

Amending 26 TAC §§567.52 – 567.54, concerning annual review, investigation, consequences, and corrective action plan.

CHAPTER 567. CERTIFICATE OF PUBLIC ADVANTAGE
SUBCHAPTER E. ENFORCEMENT
26 TAC §§567.52 – 567.54

OVERVIEW

BACKGROUND AND JUSTIFICATION

New 26 TAC §§985.1 – 985.6, outlining the general provisions regarding human immunodeficiency virus prevention and treatment in state supported living centers.

CHAPTER 985. HUMAN IMMUNODEFICIENCY VIRUS PREVENTION AND TREATMENT IN STATE SUPPORTED LIVING CENTERS
26 TAC §§985.1 – 985.6

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC), Title 26, new Chapter 985, Human Immunodeficiency Virus Prevention and Treatment in State Supported Living Centers, comprising §985.1, concerning Purpose; §985.2, concerning Application; §985.3, concerning Definitions; §985.4, concerning Education; §985.5, concerning Counseling; and §985.6, concerning Limitation of an Individual’s Activity.

Sections 985.1 – 985.6 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5745). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

This adoption transfers HHSC rules regarding Human Immunodeficiency Virus (HIV) prevention, testing, and treatment from 40 TAC Chapter 8, Subchapter L to 26 TAC Chapter 985. The new rules simplify and consolidate requirements for the state supported living centers regarding the prevention, testing, and treatment of human immunodeficiency virus for individuals served, and workplace guidelines for contractors providing services to individuals served by the SSLCs. The repeal of 40 TAC Chapter 8, Subchapter L is adopted simultaneously elsewhere in this issue of the Texas Register.

Review of Agency Rules Re:

The review of Title 26, Part 1 has been adopted by the Texas Health and Human Services Commission.

The Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code:

Chapter 550, Licensing Standards for Prescribed Pediatric Extended Care Centers

Subchapter A, Purpose, Scope, Limitations, Compliance, and Definitions

Subchapter B, Licensing Application, Maintenance, and Fees

Subchapter C, General Provisions

Subchapter D, Transportation

Subchapter E, Building Requirements

Subchapter F, Inspections and Visits

Subchapter G, Enforcement

Notice of the review of this chapter was published in the August 19, 2022, issue of the Texas Register (47 TexReg 5006). HHSC received no comments concerning this chapter.

HHSC has reviewed Chapter 550 in accordance with §2001.039 of the Government Code, which requires state agencies to assess, every four years, whether the initial reasons for adopting a rule continue to exist. The agency determined that the original reasons for adopting all rules in the chapter continue to exist and readopts Chapter 550. Any appropriate amendments to Chapter 550 identified by HHSC during the rule review will be proposed in a future issue of the Texas Register.

In Addition Re:

Public Notice: Proposed Revisions to the UC Ambulance Protocol and Tool as Required by CMS

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces that Center for Medicare & Medicaid Services (CMS) requires revisions to the Uncompensated Care (UC) Payment Protocol and cost reporting tool for the Uncompensated Care (UC) Ambulance program.

The Uncompensated Care (UC) Payment Protocol is submitted pursuant to the Special Terms and Conditions (STCs) of the Texas Healthcare Transformation and Quality Improvement Program, Section 1115 Waiver Demonstration No. 11-W-00278/6.

CMS requested that HHSC make modifications to the Ambulance UC protocol to restrict the ability of providers to claim costs in excess of those for direct medical care associated with uninsured charity care. The changes in the protocol and cost report tool will specify that UC Ambulance providers report uninsured charity care costs directly attributed to direct medical services. These changes will be submitted to CMS on January 6, 2023.

Department of Aging and Disability Services

Adopted Rules Re:

Repealing 40 TAC §§8.281 – 8.297, regarding HIV prevention and treatment in state sponsored living centers.

CHAPTER 8. CLIENT CARE–INTELLECTUAL DISABILITY SERVICES
SUBCHAPTER L. HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION, TESTING, AND TREATMENT
40 TAC §§8.281 – 8.297

OVERVIEW

As required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts the repeal of Title 40, Part 1, Chapter 8, Subchapter L, Human Immunodeficiency Virus (HIV) Prevention, Testing, and Treatment, which comprises §8.281, concerning Purpose; §8.282, concerning Application; §8.283, concerning Definitions; §8.284, concerning Policy Overview; §8.285, concerning Education; §8.286, concerning Screening for HIV Antibody; §8.287, concerning Counseling; §8.288, concerning Confidentiality of Test Results; §8.289, concerning Documentation of Test Results; §8.290, concerning Required Reporting of Test Results; §8.291, concerning Management of Exposure to Blood/Body Substances; §8.292, concerning Limitation of Client Activity; §8.293, concerning Personnel Issues; §8.294, concerning Responsibility and Resources; §8.295, concerning Exhibits; §8.296, concerning References; and §8.297, concerning Distribution.

The repeals of §§8.281 – 8.297 are adopted without changes to the proposed text as published in the September 16, 2022, issue of the Texas Register (47 TexReg 5767). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The repeals remove HHSC rules from Texas Administrative Code (TAC) Title 40, Chapter 8, Subchapter L. The repeals delete rules as no longer necessary because content of the rules have been added to new rules in 26 TAC Chapter 985, Human Immunodeficiency Virus Prevention and Treatment in State Supported Living Centers. The new rules are adopted elsewhere in this issue of the TexasRegister.

Repealing 40 TAC §§91.1 – 91.8, to realign and reorganize the rules following the abolition of the Department of Aging and Disability Services (DADS).

CHAPTER 91. HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT
40 TAC §§91.1 – 91.8

As required by Texas Government Code §531.0202(b), the Texas Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts the repeal of 40 TAC, Part 1, Chapter 91, Hearings Under the Administrative Procedure Act, comprised of §§91.1 – 91.8.

The repeal of §§91.1 – 91.8 is adopted without changes to the proposed text as published in the August 26, 2022, issue of the Texas Register (47 TexReg 5080). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The repeal of 40 TAC, Chapter 91 deletes the rules as no longer needed, because the content of the rules has been added to proposed new 26 TAC, Chapter 110.