9 Feb 2024

Texas Register February 9, 2024 Volume: 49 Number: 6

by | posted in: Department of Aging and Disability Services, Texas Department of Insurance, Texas Department of State Health Services, Texas Health and Human Services Commission, Texas Higher Education Coordinating Board |

Texas Register Table of Contents

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §354.1271, to remove the reference to a 60-day timeframe for postpartum services and specify that women are eligible for maternity clinic services in the postpartum period.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
1 TAC §354.1271

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §354.1271, concerning Benefits and Limitations.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

The proposed amendment to §354.1271 removes the reference to a 60-day timeframe for postpartum services. This change removes the 60-day clinical postpartum timeframe and specifies that women are eligible for maternity clinic services in the postpartum period. The proposed amendment also changes the term “department” to “HHSC.”

Amending 1 TAC §366.303, §366.325, to remove the exception of the end of pregnancy to continuous coverage and to add that a Medicaid recipent will receive continuous Medicaid coverage for 12-months after the pregnancy ends.

CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER C. PREGNANT WOMEN’S MEDICAID
1 TAC §366.303, §366.325

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Date, §366.827, concerning Medicaid Eligibility Effective Date, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

  • The proposed amendment to §366.303 aligns HHSC rule and policy with H.B. 12 by adding a new term, “change in circumstance,” to the definitions and amending the definition of “continuous coverage.” As amended, the end of a recipient’s pregnancy no longer qualifies as an exception to continuous coverage and is removed from the definition. The “Texas Works Handbook” term is also amended to update the website address. Additionally, the “Medicaid” term is amended to capitalize the word “Chapter.” The subparagraphs are renumbered to account for the addition of a term.
  • The proposed amendment to §366.325 aligns HHSC rule and policy with H.B. 12 by modifying §366.325(3). As amended, a Medicaid recipient will receive continuous Medicaid coverage for 12-months after the pregnancy ends. Additionally, “date” is pluralized in the rule and the title.
Amending 1 TAC §366.827, to provide that the pregnant woman is continuously eligible through her pregnancy and the end of the month in which the 12-month postpartum period ends once a pregnant woman meets spend down, and is not required to meet spend down again until the end of the 12-month postpartum period.

CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER H. MEDICALLY NEEDY PROGRAM
1 TAC §366.827

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Date, §366.827, concerning Medicaid Eligibility Effective Date, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

The proposed amendment to §366.827 pluralizes “date” in the rule title, adds “effective” in the first sentence of the rule, and adds paragraph (4) which provides that once a pregnant woman meets spend down, the pregnant woman is continuously eligible through her pregnancy and the end of the month in which the 12-month postpartum period ends and is not required to meet spend down again until the end of the 12-month postpartum period. This amendment aligns HHSC rule and policy with H.B. 12 requirements to provide continuous postpartum Medicaid coverage 12-months following the end of the woman’s pregnancy. Additionally, this amendment aligns with federal requirements that an individual who attained Medicaid eligibility through a spenddown while pregnant is eligible for the extended postpartum coverage even if the individual does not have sufficient incurred medical or remedial care expenses to meet their spenddown in any subsequent budget period during the pregnancy or extended postpartum period.

Amending 1 TAC §§366.1011, 366.1025, 366.1031, to explain that a pregnant Former Foster Care Children’s Program recipient remains continuously eligible through the end of the 12-month postpartum period and that a renewal will be conducted at the end of the 12-month postpartum period if the Former Foster Care Children’s Program recipient is pregnant.

CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER J. FORMER FOSTER CARE CHILDREN’S PROGRAM
1 TAC §§366.1011, 366.1025, 366.1031

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Date, §366.827, concerning Medicaid Eligibility Effective Date, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

  • The proposed amendment to §366.1011 modifies the eligibility requirement that a Former Foster Care Children’s Program recipient must have been under the conservatorship of “this State” to “a State” to comply with Section 1002 of Public Law 115-271.
  • The proposed amendment to §366.1025 adds subsection (c) providing that a pregnant Former Foster Care Children’s Program recipient remains continuously eligible through the end of the 12-month postpartum period. This amendment aligns this section with H.B. 12.
  • The proposed amendment to §366.1031 adds that a renewal will be conducted at the end of the 12-month postpartum period if the Former Foster Care Children’s Program recipient is pregnant. This amendment aligns HHSC rule and policy with H.B. 12. Additionally, the organization of the rule is amended to include subsections.
Amending 1 TAC §370.42, §370.49, to add that a pregnant CHIP member is eligible to receive CHIP for 12-months following the end of the pregnancy even if the CHIP member reaches age nineteen and to explain that if a CHIP member voluntarily elects to end their CHIP enrollment during the postpartum period, the member will no longer be eligible to receive continuous eligibility for the remainder of the member’s postpartum period.

CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER B. APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT
1 TAC §370.42, §370.49

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §370.42, concerning Age Limits, §370.49, concerning Medicaid Referrals for Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

  • The proposed amendment to §370.42 adds subsection (b) to state that a pregnant CHIP member is eligible to receive CHIP for 12-months following the end of the pregnancy even if the CHIP member reaches age nineteen.
  • The proposed amendment to §370.49 retitles the name of the rule to “Pregnant CHIP Members,” removes information about Medicaid referrals for pregnant CHIP members and modifies CHIP member’s eligibility from two-months to the 12th month following the end of the member’s pregnancy to align this section with H.B. 12. Additionally, new paragraph (2) is added to provide that if a CHIP member voluntarily elects to end their CHIP enrollment during the postpartum period, the member will no longer be eligible to receive continuous eligibility for the remainder of the member’s postpartum period. The rule text is also amended to the singular.
Amending 1 TAC §370.60, to explain that a renewal will be conducted at the end of the 12-month postpartum period if the CHIP member is pregnant.

CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER B. APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT
1 TAC §370.60

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §370.42, concerning Age Limits, §370.49, concerning Medicaid Referrals for Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

The proposed amendment to §370.60 adds subsection (b) that a renewal will be conducted at the end of the 12-month postpartum period if the CHIP member is pregnant. Additionally, subsection (a) is amended to replace the term “recipient” with “member.”

Amending 1 TAC §370.307, to state that a pregnant member enrolled in CHIP is eligible to receive coverage until the postpartum period ends even if the member turns nineteen and to modify exception to the continuous enrollment period in CHIP.

CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER C. ENROLLMENT, RENEWAL, DISENROLLMENT, AND COST SHARING
1 TAC §370.307

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §370.42, concerning Age Limits, §370.49, concerning Medicaid Referrals for Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant children in the Children’s Health Insurance Program (CHIP).

SECTION-BY-SECTION SUMMARY

The proposed amendment to §370.307 adds subsection (b) stating that a pregnant member enrolled in CHIP is eligible to receive coverage until the end of the postpartum period even if they turn age nineteen and modifies the exceptions to the continuous enrollment period in CHIP by removing current (b)(3), (b)(7), and (b)(10), and adding (b)(8). The subparagraphs are renumbered to account for the removal.

New 26 TAC §§307.301, 307.303, 307.305, 307.307, 307.309, 307.311, 307.313, 307.315, to explain that the conditions of the grant are subject to requirements found in the contract executed by HHSC and other requirements for grant proposals.

CHAPTER 307. BEHAVIORAL HEALTH PROGRAMS
SUBCHAPTER G. BEHAVIORAL HEALTH GRANT AND FUNDING PROGRAMS
26 TAC §§307.301, 307.303, 307.305, 307.307, 307.309, 307.311, 307.313, 307.315

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §307.301, concerning Purpose; §307.303, concerning Definitions; §307.305, concerning General Conditions of a Grant; §307.307, concerning Eligible Applicants; §307.309, concerning Eligible Projects; §307.311, concerning Grant Proposals and Selection Process; §307.313, concerning Contract Execution; §307.315, concerning Project Review and Evaluation Report; §307.351, concerning Purpose; §307.353, concerning Definitions; §307.355, concerning General Conditions of a Grant; §307.357, concerning Eligible Applicants; §307.359, concerning Eligible Projects; §307.361, concerning Grant Proposals and Selection Process; §307.363, concerning Selection Criteria; §307.365, concerning Contract Execution; and §307.367, concerning Project Review and Evaluation Report.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to comply with Senate Bill (S.B.) 1677, 88th Legislature, Regular Session, 2023, which requires HHSC to adopt rules to implement Texas Government Code §531.0993(d-1), requiring HHSC to establish procedures to assist community collaboratives that include a county with a population of less than 250,000 and §531.09936, requiring HHSC, to the extent money is appropriated, to contract with nonprofit organizations or governmental entities to establish or expand behavioral health centers or jail diversion centers. The proposed rules in new Subchapter G, new Division 1, establish requirements for the HHSC Mental Health Grant Program for Justice-Involved Individuals (MHGPJII) authorized under Texas Government Code §531.0993, and the proposed rules in new Division 2, establish the Rural Initiatives Grant Program to implement Texas Government Code §531.09936.

The proposed rules in new Division 1 establish the requirements of the MHGPJII to provide grants to county-based community collaboratives for the purpose of reducing: (1) recidivism by, the frequency of arrents of, and incarceration of persons with mental illness; and (2) the total waiting time for forensic commitment of persons with mental illness to a state hospital. The proposed rules outline the assistance offered by HHSC to community collaboratives that include a county with a population of less than 250,000 in submitting a proposal for the MHGPJII.

The proposed rules in Division 2 establish the requirements for the Rural Initiatives Grant Program to provide grants to establish or expand behavioral health centers or jail diversion centers in the local service area of a local mental health authority or local behavioral health authority located primarily in rural areas to provide: (1) additional forensic hospital beds and competency restoration services; (2) inpatient and outpatient mental health services to adults and children; and (3) services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness.

SECTION-BY-SECTION SUMMARY

  • Proposed new §307.301, Purpose, provides that the purpose of the division is to implement Texas Government Code §531.0993 by establishing a grant program.
  • Proposed new §307.303, Definitions, defines terms used in Division 1 of the rules.
  • Proposed new §307.305, General Conditions of a Grant, outlines that grants are subject to the requirements of the contract executed by HHSC. Proposed new subsection (b) outlines that HHSC provides training opportunities annually and technical assistance or data upon request up to six months before the release of a funding opportunity to assist community collaboratives that include counties with a population of less than 250,000. Proposed new subsections (c) and (d) address cancellation of a grant award and HHSC’s authority to accept proposals from community collaboratives if there are appropriated but unawarded funds from the prior state fiscal year pursuant to Texas Government Code §531.0993(d-2).
  • Proposed new §307.307, Eligible Applicants, requires a community collaborative to provide matching funds.
  • Proposed new §307.309, Eligible Projects, sets forth that grant proposals must meet the requirements and specifications set forth by HHSC and lists the types of projects eligible for funding.
  • Proposed new §307.311, Grant Proposals and Selection Process, describes that grant funds are made available to a local mental health authority or local behavioral health authority representing a community collaborative through a competitive request for proposal process. The proposed rule establishes what the collaborative must submit in the proposal and that a proposal received after the deadline will not be considered. The proposed rule sets forth that the amount of grant money reserved for community collaboratives that include a county with a population of less than 250,000, and allows those community collaborative to request technical assistance or data from HHSC. The proposed rule addresses the process if HHSC has additional funds available after selecting grant recipients.
  • Proposed new §307.313, Contract Execution, sets forth contractual requirements for the award of the grant.
  • Proposed new §307.315, Project Review and Evaluation Report, requires grantees to submit performance data for each grant-funded project on a schedule specified by HHSC in the contract and a report. The proposed rule sets forth that HHSC may make inspections of the operation and provision of mental health services provided by a community collaborative to ensure state money appropriated for the grant program is used effectively.
New 26 TAC §§307.351, 307.353, 307.355, 307.357, 307.359, 307.361, 307.363, 307.365, 307.367, to describe the requirements and selection process for grant proposals.

CHAPTER 307. BEHAVIORAL HEALTH PROGRAMS
SUBCHAPTER G. BEHAVIORAL HEALTH GRANT AND FUNDING PROGRAMS
26 TAC §§307.351, 307.353, 307.355, 307.357, 307.359, 307.361, 307.363, 307.365, 307.367

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §307.301, concerning Purpose; §307.303, concerning Definitions; §307.305, concerning General Conditions of a Grant; §307.307, concerning Eligible Applicants; §307.309, concerning Eligible Projects; §307.311, concerning Grant Proposals and Selection Process; §307.313, concerning Contract Execution; §307.315, concerning Project Review and Evaluation Report; §307.351, concerning Purpose; §307.353, concerning Definitions; §307.355, concerning General Conditions of a Grant; §307.357, concerning Eligible Applicants; §307.359, concerning Eligible Projects; §307.361, concerning Grant Proposals and Selection Process; §307.363, concerning Selection Criteria; §307.365, concerning Contract Execution; and §307.367, concerning Project Review and Evaluation Report.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to comply with Senate Bill (S.B.) 1677, 88th Legislature, Regular Session, 2023, which requires HHSC to adopt rules to implement Texas Government Code §531.0993(d-1), requiring HHSC to establish procedures to assist community collaboratives that include a county with a population of less than 250,000 and §531.09936, requiring HHSC, to the extent money is appropriated, to contract with nonprofit organizations or governmental entities to establish or expand behavioral health centers or jail diversion centers. The proposed rules in new Subchapter G, new Division 1, establish requirements for the HHSC Mental Health Grant Program for Justice-Involved Individuals (MHGPJII) authorized under Texas Government Code §531.0993, and the proposed rules in new Division 2, establish the Rural Initiatives Grant Program to implement Texas Government Code §531.09936.

The proposed rules in new Division 1 establish the requirements of the MHGPJII to provide grants to county-based community collaboratives for the purpose of reducing: (1) recidivism by, the frequency of arrents of, and incarceration of persons with mental illness; and (2) the total waiting time for forensic commitment of persons with mental illness to a state hospital. The proposed rules outline the assistance offered by HHSC to community collaboratives that include a county with a population of less than 250,000 in submitting a proposal for the MHGPJII.

The proposed rules in Division 2 establish the requirements for the Rural Initiatives Grant Program to provide grants to establish or expand behavioral health centers or jail diversion centers in the local service area of a local mental health authority or local behavioral health authority located primarily in rural areas to provide: (1) additional forensic hospital beds and competency restoration services; (2) inpatient and outpatient mental health services to adults and children; and (3) services to reduce recidivism and the frequency of arrest, incarceration, and emergency detentions among persons with mental illness.

SECTION-BY-SECTION SUMMARY

  • Proposed new §307.351, Purpose, provides that the purpose of this division is to implement Texas Government Code §531.09936 by establishing a Grant Program.
  • Proposed new §307.353, Definitions, defines terms used in Division 2 of the rules.
  • Proposed new §307.355, General Conditions of a Grant, outlines that grants are subject to the availability of appropriated funding, a competitive award process established by HHSC, and the requirements of the contract executed by HHSC. Proposed new subsection (b) outlines that HHSC provides training opportunities annually and technical assistance or data upon request up to six months before the release of a funding opportunity to governmental entities or nonprofit organizations.
  • Proposed new §307.357, Eligible Applicants, provides that governmental entities and nonprofit organizations are eligible for grants and requires governmental entities and nonprofit organizations to provide matching funds.
  • Proposed new §307.359, Eligible Projects, sets forth that grant proposals must meet the requirements and specifications described in requests for proposals issued by HHSC for eligible funding and describes the type of services that must be part of a proposal to expand or establish a behavioral health center or jail diversion center.
  • Proposed new §307.361, Grant Proposals and Selection Process, requires a governmental entity or nonprofit organization to submit a proposal directly to HHSC in the time and manner specified by HHSC and any proposal received after the deadline will not be considered. The proposed rule sets forth that HHSC reviews and evaluates proposals in accordance with the evaluation methodology published in the request for proposal or other notice of potential award issued by HHSC.
  • Proposed new §307.363, Selection Criteria, outlines HHSC’s criteria for selecting grant recipients.
  • Proposed new §307.365, Contract Execution, sets forth contractual requirements for the award of the grant.
  • Proposed new §307.367, Project Review and Evaluation Report, requires grantees to submit performance data for each grant-funded project on a schedule determined by HHSC and a report. The proposed rule sets forth that HHSC may make inspections of the operation and provision of mental health services provided by a grantee to ensure state money is used effectively.

Proposed Rule Reviews Re:

Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal the chapter concerning Minimum Standards for General Residential Operations.

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 748, Minimum Standards for General Residential Operations

Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal the chapter regarding Health and Specialty Care System.

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 900, Health and Specialty Care System

Adopted Rule Reviews Re:

Adopting the review of Title 26, Part 1, concerning Volunteer and Community Engagement.

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

Chapter 901, Volunteer and Community Engagement

In Addition Re:

Public Notice – CLASS Waiver Renewal

OVERVIEW

The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to renew the Community Living Assistance and Support Services (CLASS) waiver program. HHSC administers the CLASS Program under the authority of §1915(c) of the Social Security Act. CMS has approved the CLASS waiver application through August 31, 2024. The proposed effective date for the renewal is September 1, 2024.

BACKGROUND AND JUSTIFICATION

The CLASS Program provides community-based services and supports to individuals with a related condition who live in their own homes or in the home of another person, such as a family member. Services and supports are intended to enhance quality of life, functional independence, health and welfare, and to supplement, rather than replace, existing informal or formal supports and resources. Services in the CLASS Program are case management, prevocational services, residential habilitation, respite (in-home and out of home), supported employment, prescribed drugs, financial management services, support consultation, adaptive aids, auditory integration training/auditory enhancement training, behavioral support, cognitive rehabilitation therapy, continued family services, dental treatment, dietary, employment assistance, minor home modifications, nursing, occupational therapy services, physical therapy services, specialized therapies, speech and language pathology, support family services and transition assistance services.

Public Notice – Extension of the Healthy Texas Women (HTW) Section 1115 Medicaid Demonstration

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit to the Centers for Medicare & Medicaid Services (CMS) a request to extend the Healthy Texas Women (HTW) demonstration under section 1115 of the Social Security Act.

The current demonstration is approved through December 31, 2024. The proposed effective date for the extension is January 1, 2025. The extension request is for five years, which will allow the demonstration to operate through December 31, 2029. There is a fiscal impact to the extension of the HTW demonstration.

Public Notice – Home and Community-Based Services Adult Mental Health (HCBS-AMH) §1915(i) State Plan Benefit

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number (TN) 24-0008 to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act.

The Centers for Medicare and Medicaid Services approved the Home and Community-Based Services Adult Mental Health (HCBS-AMH) §1915(i) State Plan benefit through August 31, 2025. The requested effective date for this proposed amendment is January 1, 2024.

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 March 1, 2024.

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:

Physicians and Other Practitioners;

Clinical Diagnostic Labs;

Outpatient Hospital Services;

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

Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT).

Texas Department of Insurance

Proposed Rules Re:

Amending 28 TAC §§3.3502, 3.3503, 3.3510, to update the definition of “plan” to include vision coverage and expand applicability to include individual and group health benefit plans or vision benefit plans.

CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER V. COORDINATION OF BENEFITS
28 TAC §§3.3502, 3.3503, 3.3510

OVERVIEW

The Texas Department of Insurance (TDI) proposes to amend 28 TAC §§3.3502, 3.3503, and 3.3510, concerning the applicability of coordination of benefits (COB) to vision and eye care plans. The proposed amendments implement Senate Bill 861, 88th Legislature, 2023, and Senate Bill 1367, 83rd Legislature, 2013. TDI also proposes nonsubstantive amendments to §3.3502 and §3.3503.

BACKGROUND AND JUSTIFICATION

The proposed amendments enact changes in accordance with SB 1367, which abolished the Texas Health Insurance Pool, and SB 861, which specifies COB requirements for vision benefit plans under Insurance Code Chapter 1203, Subchapter C. SB 861 sets out provisions for the coordination of vision and eye care benefits. It also specifies the responsibilities of the primary and secondary issuers of an applicable health or vision benefit plan for an enrollee who is covered by at least two different health or vision benefit plans that provide the enrollee coverage for the same vision or medical eye care services, procedures, or products.

SECTION-BY-SECTION SUMMARY

  • Section 3.3502. To implement SB 861, an amendment to §3.3502 expands the applicability of the subchapter to include individual and group health benefit plans or vision benefit plans, as described by Insurance Code Chapter 1203, Subchapter C, by adding new subsection (a)(6) listing such plans.
  • A nonsubstantive amendment relocates an exclusion addressing disability income protection coverage exclusion, removing it from subsection (a)(1) and addressing it with new text in (b)(1). Another amendment to subsection (a)(1) adds the title of Chapter 1251. And the acronym “(HMO)” is added to subsection (a)(2).
  • An amendment also removes a reference in subsection (b)(1) to the Texas Health Insurance Pool. The Texas Health Insurance Pool was dissolved by SB 1367, effective September 1, 2015.
  • Finally, the proposed amendments to §3.3502 eliminate subsections (c) – (f). The dates specified in these subsections have passed, and the transition period they establish is no longer needed. Consistent with the removal of these subsections, existing subsection (g) is redesignated as new subsection (c).
  • Section 3.3503. To implement SB 861, the definition of “plan” under §3.3503(15) is expanded to include vision plans. An amendment to paragraph (15)(A)(iii) adds the terms “self-funded” and “self-insured” in parentheses to clarify the types of arrangements that are included in the definition. A nonsubstantive amendment to paragraph (15)(B) conforms to the changes made in §3.3502 by replacing the reference to the Texas Health Insurance Pool with a clarification of the exclusion of disability income protection coverage. A missing Insurance Code reference is also added to paragraph (15)(B)(v).
  • Section 3.3510. Amendments to Figure: 28 TAC §3.3510(d) update the definition of “plan” to add a reference to vision coverage and remove a reference to the Texas Health Insurance Pool, consistent with changes made in §3.3502 and §3.3503. These changes ensure the model COB contract provisions are consistent with the rules. Use of the model COB contract provisions contained in Figure: 28 TAC §3.3510(d) is optional. Issuers may use the model COB provisions or make nonsubstantive changes to the provisions, as long as the contract provisions accurately reflect the COB rules. TDI also makes nonsubstantive amendments to Figure: 28 TAC §3.3510(e) to update the model COB notice to use more plain language and make the information easier for consumers to understand. The model COB notice is a resource for health benefit plan issuers. The notice provides a summary of the most common COB circumstances and does not replace or change the contract provisions.

Texas Department of State Health Services

Proposed Rules Re:

Reviewing Title 25, Part 1, to consider for readoption, revision, or repeal the chapter concerning Ambulatory Surgical Centers.

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 25, Part 1, of the Texas Administrative Code:

Chapter 135, Ambulatory Surgical Centers

In Addition Re:

Licensing Actions for Radioactive Materials

For more information, please visit this week’s edition of the Texas Register at 49 Tex Reg 758.

Licensing Actions for Radioactive Materials

For more information, please visit this week’s edition of the Texas Register at 49 Tex Reg 765.

Order Temporarily Placing Etizolam, Flualprazolam, Clonazolam, Flubromazolam, and Diclazepam into Schedule I, Implementing the Designer Steroid control Act of 2014 (Schedule III), and Placing Metonitazene into Schedule I.

For more information, please visit this week’s edition of the Texas Register at 49 Tex Reg 770.

Department of Aging and Disability Services

Proposed Rule Reviews Re:

Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter regarding DADS Administrative Responsibilities.

The Texas Health and Human Services Commission (HHSC), on behalf of the Department of Aging and Disability Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 40, Part 1, of the Texas Administrative Code:

Chapter 7, DADS Administrative Responsibilities

Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter concerning Certification of Long-Term Care Facilities.

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 40, Part 1, of the Texas Administrative Code:

Chapter 96, Certification of Long-Term Care Facilities

Texas Higher Education Coordinating Board

In Addition Re:

Meeting of Negotiated Rulemaking Committee on Nursing Scholarship Program

Date of Meeting: February 26, 2024

Start Time of Meeting: 9:30 a.m.

Additional Information Obtained From: Laurie Frederick, Convener, Laurie.Frederick@highered.texas.gov

Meeting of Negotiated Rulemaking Committee on Professional Nursing Shortage Reduction Program
Date of Meeting: February 20, 2024

Start Time of Meeting: 9:30 a.m.

Additional Information Obtained From: Laurie Frederick, Convener, Laurie.Frederick@highered.texas.gov