7 Feb 2020

Texas Register February 7, 2020 Volume: 45 Number: 6

by | posted in: Governor, Texas Board of Physical Therapy Examiners, Texas Department of State Health Services, Texas Department on Aging and Disability Services, Texas Health and Human Services Commission |

Texas Register Table of Contents

Governor

 

Appointments

Governor makes two new appointments and two reappointments to the Council on Cardiovascular Disease and Stroke

Appointments for January 8, 2020Appointed to the Council on Cardiovascular Disease and Stroke, for terms to expire February 1, 2025: Elie R. Balesh, M.D., of Houston, Texas (replacing Michael M Hawkins, M.D., of Temple, whose term expired)Suzanne S. Hildebrand of Live Oak, Texas (Ms. Hildebrand is being reappointed)Samantha Kersey of Dickinson, Texas (replacing Vanessa F. Hicks-Callaway of Victoria, whose term expired)E’Loria Simon-Campbell, Ph.D., of Houston, Texas (Dr. Simon-Campbell is being reappointed)

Governor

Appointments

Governor appoints Suzanne Hildebrand as presiding officer of the Council on Cardiovascular Disease and Stroke

Appointments for January 8, 2020Designated as presiding officer of the Council on Cardiovascular Disease and Stroke, for a term to expire at the pleasure of the Governor, Suzanne S. Hildebrand of Live Oak (Ms. Hildebrand is replacing John N. “Neal” Rutledge, M.D.).

Texas Health and Human Services Commission

Proposed Rules

New §354.1369, increasing base wage requirements for personal attendants in the Medicaid Community First Choice program

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER A. PURCHASED HEALTH SERVICESDIVISION 27. COMMUNITY FIRST CHOICE1 TAC §354.1369The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §354.1369, concerning Attendant Base Wage.BACKGROUND AND PURPOSE:The purpose of the proposed rule is to implement Rider 45 of the 2020-21 General Appropriations Act, Article II, Special Provisions, House Bill 1, 86th Legislature, Regular Session, 2019 (Rider 45). Rider 45 appropriates funds to HHSC to increase the minimum base wage paid to “personal attendants” from $8.00 to $8.11 per hour. Currently, the minimum hourly base wage for a personal attendant is referenced in multiple rules. HHSC is proposing new §355.7051, Base Wage for a Personal Attendant, so that the base wage requirements for all of HHSC’s programs and services will be contained in one section. New §354.1369, Attendant Base Wage, requires that providers of Community First Choice (CFC) personal assistance services and CFC Habilitation pay a personal attendant at least the base wage specified in new §355.7051.SUMMARY OF NEW §354.1369 REQUIREMENTS:Proposed new §354.1369 requires that providers of CFC personal assistance services and CFC Habilitation pay a personal attendant at least the base wage specified in §355.7051 and notify the person employed as an attendant of the base wage requirement.

Texas Health and Human Services Commission

Proposed Rules

New §355.7051, increasing base wage requirements for personal attendants in all HHSC programs and services

CHAPTER 355. REIMBURSEMENT RATESSUBCHAPTER H. BASE WAGE REQUIREMENTS FOR PERSONAL ATTENDANTS1 TAC §355.7051The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §355.7051, concerning Base Wage for a Personal Attendant, in new Subchapter H, Base Wage Requirements for Personal Attendants.BACKGROUND AND PURPOSE:The purpose of the proposed rule is to implement Rider 45 of the 2020-21 General Appropriations Act, Article II, Special Provisions, House Bill 1, 86th Legislature, Regular Session, 2019 (Rider 45). Rider 45 appropriates funds to HHSC to increase the minimum base wage paid to “personal attendants” from $8.00 to $8.11 per hour. Currently, the minimum hourly base wage for a personal attendant is referenced in multiple rules. HHSC is proposing new §355.7051 so that the base wage requirements for all of HHSC’s programs and services will be contained in one section. As a result of this consolidation, the existing sections are being proposed for amendment to remove their specific base wage requirements and instead reference the specific requirements of proposed new §355.7051.SECTION-BY-SECTION SUMMARY: Proposed new §355.7051(a) defines the following terms for use in new subchapter H: “HHSC contractor,” “managed care organization or MCO,” “provider,” and “personal attendant.”Proposed new §355.7051(b) requires that an HHSC contractor, other than an HHSC contractor described in subsection (c) or (d) of the section, pay a base wage of at least $8.11 per hour to a personal attendant.Proposed new §355.7051(c) requires that an HHSC contractor that has a contract for financial management services (FMS) ensure that an employer in the consumer directed services (CDS) option, or their designated representative, pay a personal attendant a base wage of at least $8.11 per hour.Proposed new §355.7051(d) requires an HHSC contractor with a Consumer Managed Personal Attendant Services contract to pay a personal attendant a base wage of at least $8.11 per hour in service delivery options in which a personal attendant is an employee or subcontractor of the HHSC contractor. The proposed new rule also requires an HHSC contractor with a Consumer Managed Personal Attendant Services contract to ensure an individual employer, or the individual’s representative, pay a personal attendant a base wage of at least $8.11 per hour in service delivery options in which a personal attendant is an employee of the individual employer.Proposed new §355.7051(e) requires that a managed care organization (MCO), other than an MCO contractor described in subsection (f) of the section, require an MCO contractor to pay a base wage of at least $8.11 per hour to a personal attendant.Proposed new §355.7051(f) requires an MCO contractor that has a contract for FMS to ensure that an employer in the CDS option or a designated representative pays a personal attendant a base wage of at least $8.11 per hour.

Texas Department on Aging and Disability Services

Proposed Rules

HHSC, acting in place of the former DADS, proposes amendments to 40 TAC §9.177 and §9.579, increasing base wage requirements for personal attendants in Medicaid HCS and TxHmL programs

CHAPTER 9. INTELLECTUAL DISABILITY SERVICES–MEDICAID STATE OPERATING AGENCY RESPONSIBILITIESThe Executive Commissioner of HHSC, operating in place of the former Departments of Aging and Disability Services, proposes amendments to the following sections in Title 40, Part 1, Chapter 9, Intellectual Disability Services–Medicaid State Operating Agency Responsibilities:§9.177, concerning Certification Principles: Staff Member and Service Provider Requirements§9.579, concerning Certification Principles: Staff Member and Service Provider Requirements.HEALTH AND HUMAN SERVICES COMMISSION AUTHORITY: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. BACKGROUND AND PURPOSE OF PROPOSED AMENDMENTS: The purpose of the proposed amendments is to implement Rider 45 of the 2020-21 General Appropriations Act, Article II, Special Provisions, House Bill 1, 86th Legislature, Regular Session, 2019 (Rider 45). Rider 45 appropriates funds to HHSC to increase the minimum base wage paid to “personal attendants” from $8.00 to $8.11 per hour. Currently, the requirements for payment of a base wage to personal attendants in the HCS and TxHmL Programs are addressed in §49.312, Personal Attendants. A new rule, §355.7051, is being proposed  that will address the requirements for payment of a base wage to personal attendants for programs governed by Chapter 49 and for other programs and services administered by HHSC. As a result of the consolidation of base wage requirements, §49.312 is proposed for amendment to delete the base wage requirements in that section and instead reference new §355.7051. Because §49.312 is proposed for amendment, the references to §49.312 in §9.177 (Certification Principles: Staff Member and Service Provider Requirements) and §9.579 (Certification Principles: Staff Member and Service Provider Requirements) need to be amended.

Texas Department on Aging and Disability Services

Proposed Rules

HHSC, acting in place of the former DADS, proposes amendments to 40 TAC §41.505, increasing base wage requirements for personal attendants in the Consumer Directed Services Option

CHAPTER 41. CONSUMER DIRECTED SERVICES OPTIONSUBCHAPTER E. BUDGETS40 TAC §41.505The Executive Commissioner of HHSC, operating in place of the former Departments of Aging and Disability Services, proposes an amendment to §41.505, concerning Payroll Budgeting, in Title 40, Part 1, Chapter 41, Consumer Directed Services Option.HEALTH AND HUMAN SERVICES COMMISSION AUTHORITY: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.BACKGROUND AND PURPOSE OF PROPOSED AMENDMENT: The purpose of the proposed amendment is to implement Rider 45 of the 2020-21 General Appropriations Act, Article II, Special Provisions, House Bill 1, 86th Legislature, Regular Session, 2019 (Rider 45). Rider 45 appropriates funds to HHSC to increase the minimum base wage paid to “personal attendants” from $8.00 to $8.11 per hour. Currently, the requirements for payment of a base wage to personal attendants in the consumer-directed services (CDS) option are addressed in §41.505, Payroll Budgeting. A new rule, §355.7051, is being proposed in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 355, in this issue of the Texas Register, that will address the requirements for payment of a base wage to personal attendants in many of the programs and services administered by HHSC. As a result of the consolidation of base wage requirements, §41.505 is proposed for amendment to delete the base wage requirements in that section and instead reference new §355.7051.

Texas Department on Aging and Disability Services

Proposed Rules

HHSC, acting in place of the former DADS, proposes amendments to 40 TAC §44.302 and §44.422, increasing base wage requirements for personal attendants in the CMPAS program

CHAPTER 44. CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAMThe Executive Commissioner of HHSC, operating in place of the former Departments of Aging and Disability Services, proposes amendments to the following section in Title 40, Part 1, Chapter 44, Consumer Managed Personal Attendant Services (CMPAS) Program:§44.302, concerning Provider Qualifications and Responsibilities in All CMPAS Service Delivery Options§44.422, concerning Individual Responsibilities in the Block Grant OptionHEALTH AND HUMAN SERVICES COMMISSION AUTHORITY: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. BACKGROUND AND PURPOSE FOR PROPOSED AMENDMENTS: The purpose of the proposed amendments is to implement Rider 45 of the 2020-21 General Appropriations Act, Article II, Special Provisions, House Bill 1, 86th Legislature, Regular Session, 2019 (Rider 45). Rider 45 appropriates funds to HHSC to increase the minimum base wage paid to “personal attendants” from $8.00 to $8.11 per hour. Currently, the minimum hourly base wage for a personal attendant is referenced in multiple rules, including §49.312, Personal Attendants, and §41.505, Payroll Budgeting. HHSC is proposing new §355.7051, Base Wage for a Personal Attendant, in Title 1, Part 15, Chapter 355 Texas Administrative Code (TAC), so that the specific base wage requirements for all of HHSC’s programs and services will be contained in one section. Other rules to which the new minimum base wage applies, including in 40 TAC Chapter 44, are being proposed for amendment to cross reference the specific requirements of new §355.7051.

Texas Department on Aging and Disability Services

Proposed Rules

HHSC, acting in place of the former DADS, proposes amendments to 40 TAC §49.102 and §49.312, increasing base wage requirements for personal attendants by community service contractors

CHAPTER 49. CONTRACTING FOR COMMUNITY SERVICESThe Executive Commissioner of HHSC, operating in place of the former Departments of Aging and Disability Services, proposes amendments to the following section in Title 40, Part 1, Chapter 49, Contracting for Community Services:§49.102, concerning Definitions§49.312, concerning Personal AttendantsHEALTH AND HUMAN SERVICES COMMISSION AUTHORITY: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. BACKGROUND AND PURPOSE OF PROPOSED AMENDMENTS: The purpose of the proposed amendments is to implement Rider 45 of the 2020-21 General Appropriations Act, Article II, Special Provisions, House Bill 1, 86th Legislature, Regular Session, 2019 (Rider 45). Rider 45 appropriates funds to HHSC to increase the minimum base wage paid to “personal attendants” from $8.00 to $8.11 per hour. Currently, the requirements for payment of a base wage to personal attendants for contractors subject to Chapter 49 are addressed in §49.312, Personal Attendants. A new rule, §355.7051, is being proposed in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 355, in this issue of the Texas Register, that will address the requirements for payment of a base wage to personal attendants for programs governed by Chapter 49 and for other programs and services administered by HHSC. As a result of the consolidation of base wage requirements, §49.312 is proposed for amendment to delete the base wage requirements in that section and instead reference new §355.7051.

Texas Board of Physical Therapy Examiners

Adopted Rules

Amendment to §322.5, clarifying the role of a physical therapist assistant in in the provision of physical therapy via telehealth

CHAPTER 322. PRACTICE22 TAC §322.5The Texas Board of Physical Therapy Examiners adopts the amendment to §322.5, Telehealth in response to a petition for adoption of rule changes.The amendment is adopted in order to clarify the role of the physical therapist assistant in the provision of physical therapy via telehealth.The amendment is adopted with changes to the proposed text as published in the November 29, 2019, issue of the Texas Register (44 TexReg 7298). The rule will be republished.

Texas Health and Human Services Commission

Adopted Rules

New §553.44, outlining emergency response plan requirements as a condition of licensure for Assisted Living Facilities

CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIESSUBCHAPTER C. STANDARDS FOR LICENSURE26 TAC §553.44The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §553.44, concerning Emergency Preparedness and Response. The new section is adopted with changes to the proposed text as published in the August 16, 2019, issue of the Texas Register (44 TexReg 4291). This rule will be republished.The new rule provides greater detail and specificity to the current requirement in §553.62(d) for assisted living facilities (ALFs) to have a written emergency preparedness and response plan that addresses a minimum of eight specified core functions. New §553.44 describes components of the eight core functions in more detail and provides ALFs with additional direction for developing and implementing a written plan to ensure adequate emergency preparedness and response. The new section includes requirements for ALFs to perform a risk assessment, enhance staff training, plan and map out potential evacuation routes, and develop systems for communication and coordination with state and local resources.

Texas Health and Human Services Commission

In Addition

HHSC invites public comment regarding what types of criminal convictions may affect a person’s ability to be present in child care operations

Criminal History Requirements for Child Care Operations.26 TAC §745.661 (relating to what types of criminal convictions may affect a person’s ability to be present at an operation) states that the three charts listed in subsection (a) of the section will be updated annually and published every January for public comment in the Texas Register. The three charts, which are available in the on-line version of the February 7, 2020, issue of the Texas Register, are entitled: (1) Licensed or Certified Child Care Operations: Criminal History Requirements; (2) Foster or Adoptive Placements: Criminal History Requirements; and (3) Registered Child Care Homes and Listed Family Homes: Criminal History Requirements. Each chart has three parts to it: an introduction that explains the types of operations each chart covers, defines certain terms used in the chart, and clarifies certain assumptions; a Table of Contents; and the actual chart.Questions or comments about the content of the proposed changes may be directed to Child Care Licensing’s Centralized Background Check Unit. Any comments must be received within 30 days of publication in the Texas Register.

Texas Health and Human Services Commission

In Addition

Notice of public hearing on proposed Medicaid payment rates for the Long Acting Reversible Contraceptives (LARCs) Fee Review

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 21, 2020, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Long Acting Reversible Contraceptives (LARCs) Fee Review. Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing.A briefing packet describing the proposed payments rates is available at https://rad.hhs.texas.gov/rate-packets. The payment rates for the LARCs Fee Review are proposed to be effective April 1, 2020. The proposed payment rates were calculated in accordance with the following sections in 1 TAC:§355.8085, regarding reimbursement methodology for physicians and other practitioners§355.8441, regarding reimbursement methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (known in Texas as Texas Health Steps)§355.8581, regarding reimbursement methodology for Family Planning Services§355.8641, regarding reimbursement methodology for the Women’s Health Program

Texas Health and Human Services Commission

In Addition

Notice of public hearing on proposed Medicaid payment rates for the Medical Policy Review of Continuous Glucose Monitoring

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 21, 2020, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medical Policy Review of Continuous Glucose Monitoring. Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing.A briefing packet describing the proposed payment rates is available at https://rad.hhs.texas.gov/rate-packets. The payment rates for the Medical Policy Review of Continuous Glucose Monitoring are proposed to be effective April 1, 2020. The proposed payment rates were calculated in accordance with 1 TAC §355.8023, regarding reimbursement methodology for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

Texas Health and Human Services Commission

Adopted Rules

Notice of public hearing on proposed Medicaid payment rates for the Medical Policy Review of Fetal Magnetic Resonance Imaging (MRI)

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 21, 2020, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medical Policy Review of Fetal Magnetic Resonance Imaging (MRI). Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing.A briefing packet describing the proposed payments rates is available at https://rad.hhs.texas.gov/rate-packets. The payment rates for the Medical Policy Review of Fetal MRI are proposed to be effective April 1, 2020. The proposed payment rates were calculated in accordance with the following sections of 1 TAC:§355.8061, regarding outpatient hospital reimbursement§355.8085, regarding reimbursement methodology for physicians and other practitioners§355.8441, regarding reimbursement methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (known in Texas as Texas Health Steps)

Texas Health and Human Services Commission

In Addition

Notice of public hearing on proposed Medicaid payment rates for the Medical Policy Review of Percutaneous Liver Biopsy

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 21, 2020, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medical Policy Review of Percutaneous Liver Biopsy. Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing.A briefing packet describing the proposed payment rates is available at https://rad.hhs.texas.gov/rate-packets.The payment rates for the Medical Policy Review of Percutaneous Liver Biopsy are proposed to be effective April 1, 2020. The proposed payment rates were calculated in accordance with the following sections of 1 TAC:§355.8085, regarding reimbursement methodology for physicians and other practitioners§355.8441, regarding reimbursement methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (known in Texas as Texas Health Steps)

Texas Health and Human Services Commission

In Addition

Notice of public hearing on proposed Medicaid payment rates for the Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on February 21, 2020, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates. Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5:00 p.m. the day of the hearing.A briefing packet describing the proposed payments rates is available at https://rad.hhs.texas.gov/rate-packets.The payment rates for the Quarterly HCPCS Updates are proposed to be effective April 1, 2020. The proposed payment rates were calculated in accordance with the following sections in 1 TAC:§355.8085, regarding reimbursement methodology for physicians and other practitioners§355.8441, regarding reimbursement methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (known in Texas as Texas Health Steps)

Texas Department of State Health Services

In Addition

Correction of publishing error in 25 TAC §133.41(o), requiring hospitals to provide 24-hour nursing services

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopted amendments to 25 TAC §133.41 in the January 24, 2020, issue of the Texas Register (45 TexReg 556). Due to an error by the Texas Register, the text of subsection (o) was published incorrectly.The corrected text of subsection (o) (Nursing Services), which outlines extensive guidelines informing the requirement that hospitals maintain an organized nursing service providing 24-hour nursing services as needed, is published in the February 7, 2020, issue of the Texas Register, beginning on page 946.

Texas Department of State Health Services

In Addition

Order placing four substances (Cyclopropyl Fentanyl, Methoxyacetyl Fentanyl, ortho-Fluorofentanyl and para-Fluorobutyryl Fentanyl) into Schedule I of the Controlled Substances Act

The Acting Administrator of the Drug Enforcement Administration maintains the placement of the following substances including their isomers, esters, ethers, salts and salts of isomers, esters, and ethers, in schedule I of the Controlled Substances Act (CSA) effective October 25, 2019:cyclopropyl fentanyl (N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopropanecarboxamide)methoxyacetyl fentanyl (2-methoxy-N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide)ortho -fluorofentanyl (N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)propionamide)para-fluorobutyryl fentanyl (N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)butyramide) This final order was published in the Federal Register, Volume 84, Number 207, pages 57323-57326.FEDERAL JUSTIFICATION:1. Cyclopropyl fentanyl, methoxyacetyl fentanyl, ortho-fluorofentanyl and para-fluorobutyryl fentanyl were added to schedule I of the CSA in response to the United States’ obligation to similarly control a substance placed into schedule I of the Single Convention on Narcotic Drugs (1961); and2. Cyclopropyl fentanyl, methoxyacetyl fentanyl, ortho-fluorofentanyl and para-fluorobutyryl fentanyl have no currently accepted medical use in treatment in the United States.TEXAS STATE ACTION:Pursuant to Section 481.034(g), as amended by the 75th legislature, of the Texas Controlled Substances Act, Health and Safety Code, Chapter 481, at least thirty-one days have expired since notice of the above referenced actions were published in the Federal Register. In the capacity as Commissioner of the Texas Department of State Health Services, John Hellerstedt, M.D., does hereby order that the substances cyclopropyl fentanyl, methoxyacetyl fentanyl, ortho-fluorofentanyl and para-fluorobutyryl fentanyl be placed permanently into schedule I. Additionally, schedule I temporarily listed substances are re-numbered to reflect the change.