Texas Register January 19, 2024 Volume: 49 Number: 3

Texas Register Table of Contents

1 Governor
- - 1.0.1 Appointments Re:
    - 1.0.1.1 Appointed to the Texas State Board of Examiners of Psychologists for a term to expire October 31, 2029:
    - 1.0.1.2 Appointed to the Texas State Board of Pharmacy for a term to expire August 31, 2029:
2 Texas Department of State Health Services
- - 2.0.1 Proposed Rules Re:
  - 2.0.2 Adopted Rules Re:
    - 2.0.2.1 New 25 TAC §133.54, to establish the conditions and application process for hospitals to operate a hospital at home program.
3 Texas State Board of Pharmacy
- - 3.0.1 Withdrawn Rules Re:
    - 3.0.1.1 Withdrawing proposed new 22 TAC §291.12, to specify requirements for the delivery of prescription drugs to a patient or patient’s agent.
4 Texas Health and Human Services Commission
- - 4.0.1 Adopted Rules Re:
    - 4.0.1.1 Amending 1 TAC §353.1315, to add clarity and detail to the Rural Access to Primary and Preventive Services (RAPPS) program regarding the enrollment and timelines to provider information.
    - 4.0.1.2 Amending 1 TAC §353.1320, to add requirements for providers in the Directed Payment Program for the Behavioral Health Services (DPP BHS) program.
  - 4.0.2 Adopted Rule Reviews Re:
    - 4.0.2.1 Adopting the review of Title 26, Part 1, concerning Breast and Cervical Cancer Services.
5 Texas Board of Nursing
- - 5.0.1 Adopted Rule Reviews Re:
    - 5.0.1.1 Adopting the review of Title 22, Part 11, concerning General Provisions, Licensure, Peer Assistance, and Practice, and Advanced Practice Registered Nurse Education.

Governor

Appointments Re:

Appointed to the Texas State Board of Examiners of Psychologists for a term to expire October 31, 2029:

Herman B. Adler of Houston, Texas;
Ryan T. Bridges of Houston, Texas; and
Andoni Zagouris of McAllen, Texas.

Appointed to the Texas State Board of Pharmacy for a term to expire August 31, 2029:

Ricardo “Rick” Fernandez of Argyle, Texas;
Garrett C. Marquis of Dallas, Texas;
Randall D. “Randy” Martin, Pharm.D. of Fort Worth, Texas; and
Juliann R. “Julie” Spier of Katy, Texas.

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §157.2, to incorporate terminology and definitions for RACs, emergency medical systems, trauma facilities, and stroke facilities.

CHAPTER 157. EMERGENCY MEDICAL CARE
SUBCHAPTER A. EMERGENCY MEDICAL SERVICES – PART A
25 TAC §157.2

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendments to §157.2, concerning Definitions, and §157.128, concerning Denial, Suspension, and Revocation of Trauma Facility Designation; the repeal of §157.123, concerning Regional Emergency Medical Services/Trauma Systems; §157.125, concerning Requirements for Trauma Facility Designation; §157.130, concerning Emergency Medical Services and Trauma Care System Account and Emergency Medical Services, Trauma Facilities, and Trauma Care System Fund; and §157.131, concerning Designated Trauma Facility and Emergency Medical Services Account; and new §157.123, concerning Regional Advisory Councils; §157.125, concerning Requirements for Trauma Facility Designation; and §157.130, concerning Funds for Emergency Medical Services, Trauma Facilities, and Trauma Care Systems, and the Designated Trauma Facility and Emergency Services Account.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to update the content and processes with the advances, evidence-based practices, and system processes that have developed since these rules were adopted. The rules also require updates since legislation has been passed since the rules were adopted. Senate Bill (S.B.) 330, 79th Legislature, Regular Session, 2005, requires the development of regional stroke plans. House Bill (H.B.) 15, 83rd Legislature, Regular Session, 2013, and H.B. 3433, 84th Legislature, Regular Session, 2015, require the development of perinatal care regions. S.B. 984, 87th Legislature, Regular Session, 2021, directs the Regional Advisory Councils (RACs) to collect specific health care data. S.B. 969, 87th Legislature, Regular Session, 2021, directs the RACs to provide public information regarding public health disasters to stakeholders. S.B. 1397, 87th Legislature, Regular Session, 2021, directs a RAC to track all transfers and the reason for the transfer out of its region.

SECTION-BY-SECTION SUMMARY

The amendment to §157.2, concerning Definitions, integrates terminology for the RACs, emergency medical systems, trauma facilities, and stroke facilities. The definitions include stroke designation terminology and current national standards. The definitions reflect terms for the trauma and emergency health care system, emergency medical services (EMS), trauma center management, and stroke center management.

Repealing 25 TAC §§157.123, 157.125, 157.130, 157.131, to allow for new rules which integrate legislative requirements and the use of telemedicine for facilities that are in a county of less than 30,000 people.

CHAPTER 157. EMERGENCY MEDICAL CARE
SUBCHAPTER G. EMERGENCY MEDICAL SERVICES TRAUMA SYSTEMS
25 TAC §§157.123, 157.125, 157.130, 157.131

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The repeal of §157.123, concerning Regional Emergency Medical Services/Trauma Systems is replaced with new §157.123, concerning Regional Advisory Councils (RACs), which defines the requirements and functions of the RACs. S.B. 330 amended Texas Health and Safety Code Chapter 773, directing the development of systems of stroke survival, creating a process for stroke designation and regional stroke system plans. H.B. 15 and H.B. 3433 require the development of rules for maternal and neonatal facility designation and the development of perinatal care regions to develop perinatal systems of care. S.B. 1397 adds Texas Health and Safety Code §773.1141, requiring the tracking of all patients transfers out of the identified RAC and the reasons for the transfers. S.B. 984 directs the RACs to collect specific health care data to facilitate emergency response planning and preparedness. S.B. 969 directs the RACs to provide public information regarding public health disasters to stakeholders. The proposed new language of §157.123 integrates these legislative requirements into the rule.
The repeal of §157.125, concerning Requirements for Trauma Facility Designation, is replaced with new §157.125, concerning Requirements for Trauma Facility Designation. The new section replaces the rule adopted in December 2006, with specific changes from 2019 to integrate the use of telemedicine for facilities that are in a county of less than 30,000 people.
The repeal of §157.130, concerning Emergency Medical Services and Trauma Care System Account and Emergency Medical Services, and the repeal of §157.131, concerning Designated Trauma Facility and Emergency Medical Services Account, are necessary to integrate the rule text in new §157.130, concerning Funds for Emergency Medical Services, Trauma Facilities, and Trauma Care Systems, and the Designated Trauma Facility and Emergency Medical Services Account.

New 25 TAC §§157.123, 157.125, 157.128, 157.130, to describe and RAC and to define the requirements a hospital must meet to achieve trauma facility designation.

CHAPTER 157. EMERGENCY MEDICAL CARE
SUBCHAPTER G. EMERGENCY MEDICAL SERVICES TRAUMA SYSTEMS
25 TAC §§157.123, 157.125, 157.128, 157.130

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

New §157.123 uses the term “department” instead of the legacy name “bureau of emergency management (bureau).” Subsection (a) describes a RAC. Subsection (b)(2)(A) requires the RAC to submit a summary of activities validating that all performance criteria are met. Subsection (b)(2)(C) requires the RAC to complete a regional self-assessment, revise the system plan the following year, and have documented evidence that all RAC performance criteria are met. Subsection (c) defines the elements of a regional trauma and emergency health care system plan. Subsection (d) integrates language from S.B. 969 and S.B. 984 into the RAC requirements. Subsection (e) integrates S.B. 1397 requirements for the identified RAC to establish an advisory committee that will develop regional protocols for managing dispatch, triage, transport, and transfer of patients. EMS providers and hospitals are required to collect and report to the RAC data on patients transferred outside of the RAC following established regional protocols. Subsection (f) states the RAC must meet performance criteria to ensure the mission of the regional system is maintained. Subsection (g) defines the relinquishment procedures for a RAC. Subsection (h) describes the procedures to validate RAC documents for compliance.
New §157.125 defines the requirements hospitals must meet to achieve trauma facility designation. The new rule reflects the national standards for trauma centers as outlined by the American College of Surgeons (ACS). New §157.125 uses the word “department” instead of the legacy name “Office of Emergency Medical Services (EMS)/Trauma Systems Coordination (office).” Subsection (a) defines that the department designates hospital applicants as trauma facilities. Subsection (b) describes the documents required for a designation application. Section (c) outlines the steps for approval of a designation application. Subsection (d) defines the eligibility requirements for trauma facility designation. Subsection (e) clarifies that each facility location where inpatients receive hospital services and care may choose to seek separate designation. Subsection (f) describes facilities seeking trauma designation to be validated by a survey organization. Subsection (g) defines the four levels of trauma facility designation. Subsection (g)(1)(A), (2)(A), (3)(A), and (4)(A) integrate the ACS standards into the rule requirements for designation for all levels of trauma centers. Subsection (h) states that Level IV facilities that admit trauma patients to their intensive care unit (ICU) or perform operative interventions on injured patients meeting their trauma activation guidelines or National Trauma Data Bank (NTDB) inclusion criteria or have a projected injury severity score of 11 or greater must meet the Level III ACS verification standards for the laboratory, blood bank, operating suite, ICU, and rehabilitation. Subsection (i) states that Level IV facilities will utilize the most current ACS criteria in addition to the state trauma facility requirements to achieve designation.
Subsection (j) defines the requirements for trauma designation. Subsections (j)(1) and (2) define that facilities seeking trauma designation must meet RAC participation requirements. Subsection (j)(2) states facilities must have evidence of quarterly submission to the State Trauma Registry. Subsection (j)(4) states the facility must maintain a written trauma operational plan for the program. Subsection (j)(10) requires the Chief Executive Officer, Chief Nursing Officer (CNO), Chief Operating Officer, and trauma administrator, in conjunction with the Trauma Medical Director (TMD) and Trauma Program Manager (TPM), to have processes to monitor and track trauma fees and trauma patient uncompensated care; the operational cost of the trauma program; data to assist with completing the uncompensated care grant application; and provide evidence of how these funds are used to demonstrate improvements in the facility’s trauma program. Subsection (j)(11) requires the facility to have written trauma management guidelines for the hospital. Subsection (j)(13) states the facilities must complete an annual online Pediatric Readiness Survey. Subsection (j)(15) states rural Level IV trauma facilities in a county with a population of less than 30,000 may utilize telemedicine resources with an Advanced Practice Provider (APP). Subsections (j)(20) state that the facility must maintain medical records that facilitate documentation and integrate the EMS wristband number and substance misuse screening and interventions. Subsection (j)(21) states the facility must have an organized, effective trauma service that is recognized in the medical staff bylaws. Subsection (j)(22) defines that a trauma facility must have a TMD responsible for the provision of trauma care and defines the requirements. Subsection (j)(22)(B) states rural Level IV facilities that do not routinely admit patients meeting trauma activation guidelines and meeting NTDB inclusion criteria may choose to have a board-certified surgeon, emergency medicine physician, or family practice physician serve as their TMD. Subsection (j)(23) states each designated trauma facility must have an identified TPM. Subsection (j)(24) allows rural Level IV or critical access hospital facilities that have 75 or fewer patients annually meeting trauma activation guidelines or NTDB inclusion criteria and do not admit these patients to their facility for injury management, operative intervention, or intensive care, may choose to utilize a part-time registered nurse in the TPM role, or to integrate the TPM job functions into the CNO’s position, as long as the performance improvement process and trauma registry processes are concurrent. Subsection (j)(25) states the TMD, in conjunction with the trauma liaison, defines the criteria and credentialing guidelines for the trauma service surgeons and specialty surgeons covering trauma calls. Subsection (j)(27) states a trauma facility must have a continuous trauma Performance Improvement Patient Safety (PIPS) plan. Subsection (j)(30) states the trauma PIPS plan must outline the roles and responsibilities of the trauma operations committee and its membership. Subsection (j)(31) requires the trauma facility to define who will attend the trauma multidisciplinary peer review committee and have documentation that reflects a minimum of 50 percent attendance. Subsection (j)(34) requires the facility to submit required trauma data every 90 days or quarterly to the State Trauma Registry and have documented evidence of data validation and correction of identified errors or blank fields. Subsection (j)(37)(A) requires the Level I trauma facilities to provide outreach education to the rural facilities in their region. Subsection (j)(38) defines that the trauma facility must have an individual responsible for injury prevention and public education. Subsection (j)(40) states the trauma facility must have a process in place to provide trauma patient outcomes and feedback to EMS providers.
Subsection (k) outlines the process for facilities seeking trauma designation or renewal of designation to submit the application packet. Subsection (l) defines the process for initial trauma facility designation. Subsection (m) states that facilities seeking designation renewal must submit the required documents to the department no later than 90 days before the facility’s current trauma designation expiration date. Subsection (n) clarifies the application will not be processed if a facility fails to submit the required application documents and designation fee. Subsection (o) clarifies requirements if a facility requests a different level of care or change in ownership or physical address. Subsection (p) outlines the facility’s requirements for scheduling a designation survey through a department-approved survey organization. Subsection (q) defines the requirements for the survey team composition. Subsection (r) requires the survey organizations to follow the department survey guidelines and outlines the conflict of interest for site survey team members. Subsection (s) clarifies that Level I, II, and III facilities using the ACS verification program who do not receive a letter of verification and facilities surveyed by the department-approved survey organization with four or more requirements not met must schedule a conference call with the department. Subsection (t) defines that if a facility’s trauma designation expires, the facility must wait six months and begin the process again if they choose to continue as a designated trauma facility. Subsection (u) defines the appeal process for trauma facilities. Subsection (v) outlines the processes for facilities to notify their RAC when the facility’s capabilities or capacity to manage trauma patients change and outlines the process to request a waiver or exception for a specific designation requirement. Subsection (w) clarifies that facilities seeking a higher level of designation cannot claim or advertise the higher level of designation until the facility has been awarded the designation level. Subsection (x) states that a hospital providing trauma service must not use or authorize any public communication or advertising containing false, misleading, or deceptive claims regarding their designation level. Subsection (y) states that during a survey, the department or surveyor has the right to review and evaluate trauma patient records, trauma multidisciplinary performance improvement plan and process documents, and appropriate committee minutes. Subsection (z) states that the department and department-approved survey organizations comply with all relevant laws related to confidentiality.
Section 157.128, concerning Denial, Suspension, and Revocation of Trauma Facility Designation was adopted in September 2000. The amendment changes the legacy name “Office of EMS/Trauma Systems Coordination (office)” to “department” throughout the rule. Subsection (a) updates the reasons why a facility designation may be denied, suspended, or revoked. Subsection (c) describes the appeal process. Subsection (d) clarifies that six months after a facility is denied designation, the facility may reapply for designation. Subsection (e) clarifies that one year after a facility’s designation is revoked, the facility may reapply for designation. Subsection (f) adds that the department will inform the facility of the potential funding implications related to the designation denial, suspension, or revocation.
New §157.130(a)(1) integrates the subdivision of a fund under Texas Health and Safety Code Chapter 780. Subsection (a)(4) reorganizes all funding requirements specific to the EMS allocation. Subsection (a)(4)(B) describes how EMS providers may contribute funds for a specified purpose within a trauma service area (TSA). Subsection (a)(5) reorganizes all requirements for the TSA allocation into one section. Subsection (a)(6) reorganizes all requirements for hospital allocation into one section. Subsection (b) outlines the formula calculation allocations for EMS, RACs, and hospitals. Subsection (c) states that if the department finds that an EMS, RAC, or hospital has violated Texas Health and Safety Code Chapter 773 or fails to comply with this chapter, the department may withhold account monies for a period of three years, depending on the seriousness of the infraction.

Amending 25 TAC §§229.370 – 229.374, to improve clarity by making non-substantive editorial changes and revisions.

CHAPTER 229. FOOD AND DRUG
SUBCHAPTER U. PERMITTING RETAIL FOOD ESTABLISHMENTS
25 TAC §§229.370 – 229.374

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendments to Subchapter U, §§229.370 – 229.374, relating to Permitting Retail Food Establishments; and amendments to Subchapter Z, §§229.470 – 229.474, relating to Inspection Fees for Retail Food Establishments.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to update definitions, citations, and other language in 25 TAC Chapter 229, Subchapters U and Z due to the 2021 adoption-by-reference of the 2017 U.S. Food and Drug Administration Food Code in 25 TAC Chapter 228, Retail Food Establishments.

The proposal also removes references to “child care center” in §§229.371, 229.372, and 229.471 since permitting and inspections of food service operations of child care centers transferred to HHSC Regulatory Services Division. Those rules are in 26 TAC Chapter 746 and minimum standards for food preparation and food service are in §746.3317.

SECTION-BY-SECTION SUMMARY

The proposed amendments include non-substantive editorial changes and revisions to improve clarity that are not specifically enumerated here.
The proposed amendments replace “these sections” and “these rules” for “this subchapter” throughout the subchapters.

Amending 25 TAC §§229.470 – 229.474, to make non-substantive changes which will improve clarity.

CHAPTER 229. FOOD AND DRUG
SUBCHAPTER Z. INSPECTION FEES FOR RETAIL FOOD ESTABLISHMENTS
25 TAC §§229.470 – 229.474

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendments include non-substantive editorial changes and revisions to improve clarity that are not specifically enumerated here.
The proposed amendments replace “these sections” and “these rules” for “this subchapter” throughout the subchapters.

Amending 25 TAC §265.190, to add the key phrase “where no lifeguard is required or provided” to certain signage and specify lighting requirements for pools and spas which operate at night.

CHAPTER 265. GENERAL SANITATION
SUBCHAPTER L. PUBLIC SWIMMING POOLS AND SPAS
25 TAC §265.190

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes an amendment to §265.190, concerning Safety Features for Pools and Spas.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to revise the requirement for pool and spa signs. The changes to the rule clarify that prohibiting persons under the age of 14 years from being in a pool or spa without adult supervision applies only to pools and spas where a lifeguard is not required or provided.

The changes are needed because previous amendments to Chapter 265, Subchapter L, effective January 2021, inadvertently left out the key phrase, “where no lifeguard is required or provided” from signage requirements on signs stating that persons under the age of 14 may not be in a pool or spa without adult supervision. Recent repeal and adoption of new Chapter 265, Subchapter L, effective January 2023, to comply with House Bill (H.B.) 2205, 87th Legislature, Regular Session, 2021, also failed to include the key phrase. DSHS has received legislative inquiries and public comments regarding the applicability of this signage requirement to public pools and spas with lifeguards present, and the unintended consequences of omitting this key phrase from the signage requirements.

The proposed amendment also clarifies lighting requirements and makes editorial changes for clearer language throughout the rule.

SECTION-BY-SECTION SUMMARY

The amendment adds the key phrase, “where no lifeguard is required or provided” to the figures for required signs reading: “Persons under the age of 14 must not be in the pool without adult supervision” and “Persons under the age of 14 must not be in the spa without adult supervision.” The figure at §265.190(h)(4) is removed. The signage requirement is found in figures §265.190(e)(5) and new §265.190(g)(1). Edits to the rule text in §265.190(e)(5) and §265.190(g)(4) delete the term “subchapter” and replace it with “section” to specify the date for compliance with the signage requirements is the effective date of the section and not the subchapter.
The amendment revises §265.190(i) to clarify lighting requirements for a pool or spa operating at night.
The amendment includes editorial changes for clearer language throughout the rule.

Adopted Rules Re:

New 25 TAC §133.54, to establish the conditions and application process for hospitals to operate a hospital at home program.

CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
25 TAC §133.54

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts new §133.54, concerning Hospital at Home Program Application and Operational Requirements.

New §133.54 is adopted with changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6171). This rule will be republished.

BACKGROUND AND JUSTIFICATION

The new section is necessary to implement House Bill (H.B.) 1890, 88th Legislature, Regular Session, 2023. H.B. 1890 amended Texas Health and Safety Code (HSC) Chapter 241 by adding new Subchapter M to allow a licensed hospital to operate a hospital at home program with approval from the Centers for Medicare and Medicaid Services (CMS) and HHSC.

HSC §241.403(a), as added by H.B. 1890, requires HHSC to adopt rules establishing minimum standards for operation of a hospital at home program by a hospital.

In March 2020, CMS created the Acute Hospital Care at Home program, originally called the Hospitals Without Walls program, to increase hospital capacity during the COVID-19 pandemic.

In response to state and federal state of disaster declarations relating to COVID-19, HHSC adopted an emergency rule in Texas Administrative Code, Title 26, Chapter 500 §500.4, relating to Participating in the Centers for Medicare and Medicaid Services Acute Hospital Care at Home Program During the COVID-19 Pandemic. This emergency rule expired July 28, 2023.

Texas State Board of Pharmacy

Withdrawn Rules Re:

Withdrawing proposed new 22 TAC §291.12, to specify requirements for the delivery of prescription drugs to a patient or patient’s agent.

CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
22 TAC §291.12

OVERVIEW

Proposed new §291.12, published in the June 16, 2023, issue of the Texas Register (48 TexReg 3037), is withdrawn. The agency failed to adopt the proposal within six months of publication. (See Government Code, §2001.027, and 1 TAC §91.38(d).)

Texas Health and Human Services Commission

Adopted Rules Re:

Amending 1 TAC §353.1315, to add clarity and detail to the Rural Access to Primary and Preventive Services (RAPPS) program regarding the enrollment and timelines to provider information.

CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
1 TAC §353.1315

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), adopts an amendment to §353.1315, concerning the Rural Access to Primary and Preventive Services Program.

Section 353.1315 is adopted without change to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6688), and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the adoption is to pursue modifications to the Rural Access to Primary and Preventive Services (RAPPS) to simplify the program structure, provide additional details concerning certain enrollment-related processes and procedures, and reduce the administrative burden of operating the program for HHSC and participating providers.

HHSC sought and received authorization from the Centers for Medicare & Medicaid Services to create RAPPS for state fiscal year (SFY) 2022 as part of the financial and quality transition from the Delivery System Reform Incentive Payment program (DSRIP). HHSC has not made significant modifications to RAPPS since its inception in SFY 2022. Directed payment programs authorized under 42 C.F.R. §438.6(c), including RAPPS, are expected to continue to evolve over time so that the program can continue to advance the quality goal or objective the program is intended to impact.

HHSC has determined that RAPPS contains certain provisions that pose administrative complexity that may impede HHSC’s and the participating providers’ ability to use the program to advance a quality goal or strategy. HHSC, therefore, adopts certain clarifying amendments and other modifications with the intention of reducing administrative complexity and burden for participants. The adopted amendment also consolidates RAPPS into a single component paid via Component 1 only for SFY 2025 and after. All payments will be directed to be paid by the managed care organization (MCO) as a lump sum payment based on a scorecard issued by HHSC. This adopted rule amendment reduces the administrative burden on providers and MCOs, as the payments will no longer be made via the claim adjudication process and will be exclusively made via the monthly scorecard outside of the claims process.

The adopted amendment determines the network status of an enrolling provider for an entire program period based on the submission of supporting documentation at the time of enrollment.

HHSC adopts several other minor clarifying or grammatical amendments to improve the readability of the rule text.

Amending 1 TAC §353.1320, to add requirements for providers in the Directed Payment Program for the Behavioral Health Services (DPP BHS) program.

CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
1 TAC §353.1320

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §353.1320, concerning the Directed Payment Program for Behavioral Health Services.

The amendment to §353.1320 is adopted with changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6691). This rule will be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the amendment is to pursue modifications to the Directed Payment Program for Behavioral Health Services (DPP BHS) to simplify the program structure, provide additional details concerning certain enrollment-related processes and procedures, and reduce the administrative burden of operating the program for HHSC and participating providers.

HHSC sought and received authorization from the Centers for Medicare and Medicaid Services to create DPP BHS for state fiscal year 2022 as part of the financial and quality transition from the Delivery System Reform Incentive Payment program. HHSC has not made significant modifications to DPP BHS since its inception in state fiscal year 2022.

Directed payment programs authorized under 42 C.F.R. §438.6(c), including DPP BHS, are expected to continue to evolve over time so that the program can continue to advance the quality goal or objective the program is intended to impact.

HHSC has determined that DPP BHS contains certain provisions that pose administrative complexity that may impede HHSC’s and the participating providers’ ability to use the program to advance a quality goal or strategy. HHSC, therefore, amends and modifies the program rule to reduce administrative complexity and burden for participants.

The rule amendment also consolidates DPP BHS into a single component to be paid via a scorecard, Component One only, for state fiscal year 2025 and after, so all payments will be paid by managed care organizations (MCOs) as a lump sum payment based on a scorecard issued by HHSC. This rule amendment reduces the administrative burden on providers and MCOs, as the payments will no longer be made via the claim adjudication process and will be exclusively made via the monthly scorecard outside of the claims process.

HHSC is changing the eligible provider classes to only have one eligible provider class now that all participating providers have achieved a Certified Community Behavioral Health Clinic (CCBHC) certification.

HHSC will determine the network status of an enrolling provider for an entire program period based on the submission of supporting documentation through the enrollment process.

HHSC included other minor clarifying or grammatical revisions to improve the readability of the rule text.

Adopted Rule Reviews Re:

Adopting the review of Title 26, Part 1, concerning Breast and Cervical Cancer Services.

The Texas 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 371, Breast and Cervical Cancer Services

Notice of the review of this chapter was published in the November 17, 2023, issue of the Texas Register (48 TexReg 6752). HHSC received one comment concerning this chapter. A summary of the comment and HHSC’s response follows.

Comment: One commenter with the American Cancer Society Cancer Action Network (ACS CAN) offered steadfast support of the Breast and Cervical Cancer Services (BCCS) program and stated that it is available to provide resources and support for the continuation of the vital services that BCCS provides.

Texas Board of Nursing

Adopted Rule Reviews Re:

Adopting the review of Title 22, Part 11, concerning General Provisions, Licensure, Peer Assistance, and Practice, and Advanced Practice Registered Nurse Education.

In accordance with Government Code §2001.039, the Texas Board of Nursing (Board) filed a notice of intention to review and consider for re-adoption, re-adoption with amendments, or repeal, the following chapters contained in Title 22, Part 11, of the Texas Administrative Code, pursuant to the 2022 rule review plan adopted by the Board at its April 2022 meeting, in the November 24, 2023, issue of the Texas Register (48 TexReg 6921).

Chapter 211. General Provisions, §§211.1 – 211.11

Chapter 217. Licensure, Peer Assistance, and Practice §§217.1 – 217.24

Chapter 219. Advanced Practice Registered Nurse Education §§219.1 – 219.13

The Board did not receive comment on the above rules. The Board has completed its review and has determined that the reasons for originally adopting the above rules continue to exist. The rules were also reviewed to determine whether they were obsolete, whether they reflected current legal and policy considerations and current procedures and practices of the Board, and whether they were in compliance with Texas Government Code Chapter 2001 (Texas Administrative Procedure Act). The Board finds that the rules are not obsolete, reflect current legal and policy considerations, current procedures and practices of the Board, and that the rules are in compliance with the Texas Administrative Procedure Act.