Texas Register Table of Contents
- 1 Texas Medical Board
- 1.0.1 Proposed Rules Re:
- 1.0.2 Adopted Rules Re:
- 1.0.2.1 Adopting 22 TAC §161.48, to establish another pathway for individuals to be issued a limited license to practice medicine under a supervising practice agreement with a sponsoring physician.
- 1.0.2.2 Adopting 22 TAC §161.53, to set forth the requirements for the Board to issue an initial provisional license to practice medicine.
- 2 Texas Optometry Board
- 2.0.1 Proposed Rules Re:
- 2.0.1.1 Amending 22 TAC §271.4, to incorporate definitions from Chapter 55 of the Texas Occupations Code and outline licensing requirements and related procedures.
- 2.0.1.2 Amending 22 TAC §273.14, to repeal the rule.
- 2.0.1.3 Amending 22 TAC §279.16, to add language requiring informed consent for the provision of telehealth and defining the minimum requirements to satisfy informed consent.
- 2.0.1 Proposed Rules Re:
- 3 Texas Health and Human Services Commission
- 4 Texas Department of State Health Services
Texas Medical Board
Proposed Rules Re:
CHAPTER 173. OFFICE-BASED ANESTHESIA SERVICES
SUBCHAPTER B. PARENTERAL KETAMINE THERAPY
22 TAC §§173.6 – 173.15
OVERVIEW
The Texas Medical Board (Board) proposes new rule concerning Chapter 173, Office-Based Anesthesia Services, Subchapter B, concerning Parenteral Ketamine Therapy, §§173.6 – 173.15.
SECTION-BY-SECTION SUMMARY
New §173.6, Definitions, set forth definitions for ketamine administration and psychotropic ketamine therapy.
New §173.7, Exception for Licensed Hospice Provider, provides an exception to the application of the rules under the subchapter for patients enrolled in a hospice program licensed by Texas Health and Human Services.
New §173.8, Mandatory Registration, proposes to require registration for practice settings providing psychotropic ketamine therapy and provides exceptions to registration for certain practice settings.
New §173.9, Operation of PKT Clinics, proposes to limit the provision of psychotropic ketamine therapy to physicians, midlevel providers, or RNs. The new section further specifies training, certification, and delegation requirements for the provision of psychotropic ketamine therapy.
New §173.10, Physician Requirements, sets forth requirements for physicians ordering PKT for psychiatric indications.
New §173.11, Minimum Standards When Administering PKT, proposes to set forth minimum standards related to medical record documentation, patient evaluation, diagnosis, informed consent, and monitoring, and equipment standards when providing psychotropic ketamine therapy.
New §173.12, Prohibited PKT Uses, prohibits any home use, prescribing, or administration of parenteral ketamine.
New §173.13, Complaints and Investigations, proposes to clarify that the medical director and physician owner(s) are responsible for the clinic’s operations and regulatory compliance.
New §173.14, Renewal of PKT Clinic Registration, proposes to set forth a registration term of two years and registration renewal requirements.
New §173.15, Audits, Inspections, and Investigations, proposes that psychotropic ketamine therapy clinics will be subject to audits, inspection and investigations as outlined in Chapter 172 of the Board rules related to pain management clinics.
Adopted Rules Re:
Adopting 22 TAC §161.48, to establish another pathway for individuals to be issued a limited license to practice medicine under a supervising practice agreement with a sponsoring physician.
CHAPTER 161. PHYSICIAN LICENSURE
SUBCHAPTER J. LIMITED LICENSES
22 TAC §161.48
OVERVIEW
The Texas Medical Board (Board) adopts new rule §161.48, concerning Physician Graduates, and new rule §161.53, concerning Provisional License to Foreign Medical License Holders with Offers of Employment. New rule §161.48 is being adopted without changes and new rule §161.53 is being adopted with non-substantive changes to the proposed text as published in the November 7, 2025, issue of the Texas Register (50 TexReg 7219). Rule §161.48 will not be republished. Rule §161.53 will be republished with non-substantive changes.
These rules are mandated by the passage of HB 2038 (89th Regular Legislative Session) which amended the Texas Occupations Code Chapter 155. HB 2038, known as the “DOCTOR Act,” provides new pathways to licensing foreign trained physicians and medical school graduates who do not match into a resident training program.
SECTION-BY-SECTION SUMMARY
New §161.48, Physician Graduates, provides a pathway for certain individuals to be issued a limited license under to practice medicine under a supervising practice agreement with a sponsoring physician. The Bill provides that the Board shall issue a license to an individual who has graduated from a board-recognized accredited medical school in the United States or Canada or a medical school located outside of the United States and Canada that the board recognizes as acceptable; be licensed and in good standing to practice medicine in another country; has passed the first and second components of the USMLE; and is not enrolled in a board-approved postgraduate residency program. The bill requires the Medical Board to adopt rules as necessary to implement the new provisions of the Texas Occupations Code.
Adopting 22 TAC §161.53, to set forth the requirements for the Board to issue an initial provisional license to practice medicine.
CHAPTER 161. PHYSICIAN LICENSURE
SUBCHAPTER K. TEMPORARY LICENSES
22 TAC §161.53
OVERVIEW
The Texas Medical Board (Board) adopts new rule §161.48, concerning Physician Graduates, and new rule §161.53, concerning Provisional License to Foreign Medical License Holders with Offers of Employment. New rule §161.48 is being adopted without changes and new rule §161.53 is being adopted with non-substantive changes to the proposed text as published in the November 7, 2025, issue of the Texas Register (50 TexReg 7219). Rule §161.48 will not be republished. Rule §161.53 will be republished with non-substantive changes.
These rules are mandated by the passage of HB 2038 (89th Regular Legislative Session) which amended the Texas Occupations Code Chapter 155. HB 2038, known as the “DOCTOR Act,” provides new pathways to licensing foreign trained physicians and medical school graduates who do not match into a resident training program.
SECTION-BY-SECTION SUMMARY
New §161.53, Provisional License to Foreign Medical License Holders with Offers of Employment, provides that the Board shall issue an initial provisional license to practice medicine to an applicant who: has been granted a degree of doctor of medicine by a program of medical education that meets eligibility requirements for the applicant to apply for certification by the Educational Commission for Foreign Medial Graduates; has been licensed in good standing to practice medicine in another country and is not the subject of any pending disciplinary action before the licensing body; has completed a residency or a substantially similar postgraduate medical training required by the applicant’s country of licensure; passes the Texas medical jurisprudence examination; has proficiency in the English language; is authorized under federal law to work in the United States; has been offered employment in this state as a physician by a person who provides health care services in the normal course of business in a facility-based or group practice setting, including a health system, hospital, hospital-based facility, freestanding emergency facility, or urgent care clinic; has passed the first and second steps of the USMLE examination.
Texas Optometry Board
Proposed Rules Re:
CHAPTER 271. EXAMINATIONS
22 TAC §271.4
OVERVIEW
The Texas Optometry Board (Board) proposes 22 TAC Title 14 Chapter 271 – Examinations, new §271.4 – Licensing for Military Service Member, Military Veteran, and Military Spouse to incorporate legislation passed by the 89th Texas Legislature. The current rule relating to military licensing (§273.14 – License Applications for Military Service Member, Military Veteran, and Military Spouse) is being repealed in a separate Texas Register submission.
EXPLANATION AND JUSTIFICATION
HB 5629 and SB 1818, adopted by the 89th Legislature, Regular Session, established new criteria for licensing agencies to consider upon receipt of an application by a member of the military, veteran or a military spouse. Both bills took effect on September 1, 2025.
The purpose of this new rule is to incorporate the updated statutory provisions into language of the current rule (found at TAC §273.14). Additionally, the agency is moving the language related to military licensing from Chapter 273 to Chapter 271 to consolidate agency rules related to licensing into the same chapter for ease of use by applicants and interested parties.
HB 5629 changes the threshold of military licensing from those that have licensing requirements that are substantially equivalent to instead require the Board to consider licenses that are similar in scope of practice and that are in good standing. HB 1818 requires the Board to immediately issue a 180-day provisional license to military applicants while an application for full licensure is pending.
SECTION-BY-SECTION SUMMARY
Section (a) incorporates definitions as found in Chapter 55 of the Texas Occupations Code.
Section (b) outlines how the agency will identify states with similar scope.
Section (c) outlines that the Executive Director can waive licensing requirements except for requiring graduation from optometry school and passage of nationally accepted exams.
Section (d) requires applicants to complete a criminal background check.
Section (e) outlines what it means for a person to be in good standing with another state’s licensing board.
Section (f) outlines the procedure the agency will use to license military members, spouses and veterans. It includes language to provide for a 180-day provisional license to be issued while the application is being processed.
Section (g) provides for the recognition of out of state licenses if certain conditions are met. Individuals whose out of state licenses are recognized would not be licensed in Texas and will not be issued an active Texas license number. No verification from Texas will be provided for these recognized licenses.
Section (h) outlines which fees an applicant under this section would be required to pay.
Amending 22 TAC §273.14, to repeal the rule.
CHAPTER 273. GENERAL RULES
22 TAC §273.14
OVERVIEW
The Texas Optometry Board (Board) proposes to repeal to §273.14 — License Applications for Military Service Member, Military Veteran, and Military Spouse. The rule is being re-proposed under Chapter 271-Examinations with changes to incorporate legislation passed by the 89th Texas Legislature in a separate Texas Register submission.
EXPLANATION AND JUSTIFICATION
HB 5629 and SB 1818, adopted by the 89th Legislature, Regular Session, established new criteria for licensing agencies to consider upon receipt of an application by a member of the military, veteran or a military spouse. Both bills take effect on September 1, 2025. In the scope of incorporating the new provisions of the legislation, the Board has determined it makes sense to move the current rule regarding licensing military related optometrist to the Chapter of its rules related to licensing.
The substance of the language will be proposed for amendment to Chapter 271 in a separate rule submission with the Texas Register.
Amending 22 TAC §279.16, to add language requiring informed consent for the provision of telehealth and defining the minimum requirements to satisfy informed consent.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.16
OVERVIEW
The Texas Optometry Board (Board) proposes amendments to 22 TAC Title 14 Chapter 279 – Interpretations §279.16 – Telehealth Services.
EXPLANATION AND JUSTIFICATION
The proposed rule specifies the informed consent documentation that is required when licensees perform telehealth services for optometry. The Board proposes this rule in accordance with House Bill 1700 of the 89th Texas Legislature, Regular Session (2025), and Chapter 111, Texas Occupations Code.
SECTION-BY-SECTION SUMMARY
The amendment adds language that informed consent for the provision of telehealth services shall be in writing and must be maintained in the patient record. However, it does provide that if the informed consent was obtained in an audio-only format, the licensee shall document in the patient record the time and date that the consent was granted.
It goes to list minimum requirements for the written informed consent to include: (1) the patient’s consent to treatment by the optometrist or therapeutic optometrist via telehealth services; (2) the patient’s acknowledgement that patient’s health data is being collected and shared using electronic and digital communication; and (3) the patient’s acknowledgement of a potential for breach of confidentiality, or inadvertent access, of protected health information using electronic and digital communication in the provision of care.
Texas Health and Human Services Commission
Proposed Rules Re:
Amending 26 TAC §507.516, to repeal the rule.
CHAPTER 507. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER Z. PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
26 TAC §507.516
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §507.516, concerning Tables.
BACKGROUND AND JUSTIFICATION
The purpose of this proposal is to repeal the staffing table located in Texas Administrative Code (TAC) Title 26, Chapter 507, End Stage Renal Disease Facilities, Subchapter Z, Physical Plant and Construction Requirements, §507.516, Tables. A new staffing table was adopted in 26 TAC §507.60 and was effective on December 23, 2025.
Adopted Rules Re:
Adopting 1 TAC §351.851, to establish an the Interested Parties Advisory Group to advise and consult with HHSC.
CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
DIVISION 1. COMMITTEES
1 TAC §351.851
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §351.851, concerning the Interested Parties Advisory Group.
Section 351.851 is adopted with changes to the proposed text as published in the October 31, 2025, issue of the Texas Register (50 TexReg 7087). This rule will be republished.
BACKGROUND AND JUSTIFICATION
The new section is necessary to comply with 42 Code of Federal Regulations (42 CFR) §447.203(b)(6), which requires HHSC to “establish an advisory group for interested parties to advise and consult on provider rates with respect to service categories under the Medicaid State Plan, 1915(c) waiver, and demonstration programs, as applicable, where payments are made to direct care workers specified in 42 CFR §441.311(e)(1)(ii) for the self-directed or agency-directed services found at §440.180(b)(2) through (4), and (6).”
New §351.851 establishes the Interested Parties Advisory Group (IPAG) to advise and consult with HHSC on current and proposed payment rates, Home and Community Based Services (HCBS) payment adequacy data as required by 42 CFR §441.311(e), and access to care metrics described in 42 CFR §441.311(d)(2), associated with services found in 42 CFR §440.180(b)(2) through (4) and (6).
The IPAG is intended to advise the executive commissioner and HHSC on certain current and proposed Medicaid provider payment rates to ensure the relevant Medicaid payment rates are sufficient to ensure Medicaid beneficiaries access to personal care, home health aide, homemaker, and habilitation services.
Texas Department of State Health Services
Adopted Rules Re:
Adopting 25 TAC §§229.432 – 229.437, 229.439 – 229.443, to replace language and update wording for improved consistency.
CHAPTER 229. FOOD AND DRUG
SUBCHAPTER X. LICENSING OF DEVICE DISTRIBUTORS AND MANUFACTURERS
25 TAC §§229.432 – 229.437, 229.439 – 229.443
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §§229.432 – 229.437, and 229.439 – 229.443, concerning Licensing of Device Distributors and Manufacturers, and the repeal of §229.444 concerning Device Distributors and Manufacturers Advisory Committee.
Sections 229.433, 229.440, and 229.443 are adopted with changes to the proposed text as published in the October 3, 2025, issue of the Texas Register (50 TexReg 6451). These rules will be republished.
Sections 229.432, 229.434 – 229.439, 229.441, 229.442, and the repeal of 229.444 are adopted without changes to the proposed text as published in the October 3, 2025, issue of the Texas Register (50 TexReg 6451). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to continue adherence with applicable federal laws pertaining to medical devices. The adopted amendments align the minimum standards in the Texas Administrative Code with new device Good Manufacturing Practice requirements under 21 Code of Federal Regulations Part 820, which take effect on February 2, 2026. The adopted amendments update the licensure fees based on a licensee’s gross sales, update definitions to clarify intent, and improve compliance by harmonizing state and federal regulations. The repeal of §229.444 is required because the advisory committee no longer exists. Lastly, the adopted amendments update the rules with plain language requirements to improve readability.
Adopting 25 TAC §229.444, to repeal the section because the advisory committee no longer exists.
CHAPTER 229. FOOD AND DRUG
SUBCHAPTER X. LICENSING OF DEVICE DISTRIBUTORS AND MANUFACTURERS
25 TAC §229.444
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §§229.432 – 229.437, and 229.439 – 229.443, concerning Licensing of Device Distributors and Manufacturers, and the repeal of §229.444 concerning Device Distributors and Manufacturers Advisory Committee.
Sections 229.433, 229.440, and 229.443 are adopted with changes to the proposed text as published in the October 3, 2025, issue of the Texas Register (50 TexReg 6451). These rules will be republished.
Sections 229.432, 229.434 – 229.439, 229.441, 229.442, and the repeal of 229.444 are adopted without changes to the proposed text as published in the October 3, 2025, issue of the Texas Register (50 TexReg 6451). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to continue adherence with applicable federal laws pertaining to medical devices. The adopted amendments align the minimum standards in the Texas Administrative Code with new device Good Manufacturing Practice requirements under 21 Code of Federal Regulations Part 820, which take effect on February 2, 2026. The adopted amendments update the licensure fees based on a licensee’s gross sales, update definitions to clarify intent, and improve compliance by harmonizing state and federal regulations. The repeal of §229.444 is required because the advisory committee no longer exists. Lastly, the adopted amendments update the rules with plain language requirements to improve readability.