Texas Health and Human Services Commission
Proposed Rules Re:
Amending 1 TAC §358.540, to provide 12 months of continuous Medicaid eligibility for newborns and recipients under 19 years of age, regardless of changes in family income or circumstances, to comply with federal requirements.
CHAPTER 358. MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES
SUBCHAPTER D. APPLICATION AND ELIGIBILITY DETERMINATION
1 TAC §358.540
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §358.540, concerning Medical Effective Date.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with federal requirements. Federal regulations at 42 CFR §435.926 require HHSC to provide 12 months of continuous Medicaid coverage for all children under 19 years of age, regardless of most changes in family income or circumstance.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §358.540 adds new subsection (c) to align HHSC policy with 42 CFR §435.926 requirements. Proposed subsection (c) provides newborns and all recipients under 19 years of age receiving Medicaid, continuous eligibility for 12 months, regardless of changes in family income or circumstances. Proposed subsection (c) establishes when the 12 months of continuous eligibility begins and ends for a newborn and recipients under 19 years of age.
Amending 1 TAC §366.527, to align Medicaid eligibility effective date rules with federal 12-month continuous eligibility requirements for children under 19 years of age.
CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER E. CHILDREN’S MEDICAID
1 TAC §366.527
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §366.527, concerning Medicaid Eligibility Effective Date; and §366.711, concerning Application Processing.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with federal requirements. Federal regulations at 42 CFR §435.926 require HHSC to provide 12 months of continuous Medicaid coverage for all children under 19 years of age, regardless of most changes in family income or circumstance.
Additionally, 42 CFR §435.907(e)(1) only permits states to request information from an applicant that is necessary to make an eligibility determination. HHSC current policy requires an interview with an initial applicant for the Medicaid for Parents and Caretaker Relatives Program. The proposed amendment to §366.711 removes this requirement.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §366.527 aligns HHSC policy with 42 CFR §435.926 requirements by reformatting the rule to add new subsection (b). Proposed new subsection (b) provides newborns and all recipients under 19 years of age receiving Medicaid, continuous eligibility for 12 months. Proposed new subsection (b) establishes when the 12 months of continuous eligibility begins and ends for a newborn and recipients under 19 years of age.
Amending 1 TAC §366.711, to remove the interview requirement for initial applicants of the Medicaid for Parents and Caretaker Relatives Program.
CHAPTER 366. MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
SUBCHAPTER G. MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM
1 TAC §366.711
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §366.527, concerning Medicaid Eligibility Effective Date; and §366.711, concerning Application Processing.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with federal requirements. Federal regulations at 42 CFR §435.926 require HHSC to provide 12 months of continuous Medicaid coverage for all children under 19 years of age, regardless of most changes in family income or circumstance.
Additionally, 42 CFR §435.907(e)(1) only permits states to request information from an applicant that is necessary to make an eligibility determination. HHSC current policy requires an interview with an initial applicant for the Medicaid for Parents and Caretaker Relatives Program. The proposed amendment to §366.711 removes this requirement.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §366.711 removes subsection (d) to align HHSC policy with 42 CFR §435.907(e)(1). As amended, HHSC will no longer require an interview with an initial or renewal application for Medicaid for Parents and Caretaker Relatives benefits. The proposed amendment renumbers the remaining subsections in the rule.
CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER I. MODIFIED ADJUSTED GROSS INCOME METHODOLOGY
1 TAC §370.807
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §370.807, concerning Determination of Household Composition.
BACKGROUND AND JUSTIFICATION
The purpose of the proposed amendment to §370.807(h) is to accurately describe the population of persons referred to in the rule by replacing “pregnant individual” with “pregnant woman.”
The proposed amendment is also necessary to use the same terminology, “pregnant woman,” used in 1 TAC §366.1107, Determination of Household Composition, related to Pregnant Women’s Medicaid, and in 42 CFR §435.603(b) in the definition of “family size” related to determining the family size of a pregnant woman.
In Addition Re:
Amendment to Waiver Application for the Medically Dependent Children Program (MDCP)
The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the waiver application for the Medically Dependent Children Program (MDCP). HHSC administers the MDCP waiver under the authority of Section 1915(c) of the Social Security Act. The proposed effective date for this amendment is December 1, 2026, during waiver year 5 (9/1/2026 through 8/31/2027).
The amendment proposes changes to:
Appendix B
HHSC is proposing to add diversion slots to avoid nursing facility stay, as a reserved waiver capacity group for waiver year 5 (9/1/2026 through 8/31/2027) as this is the waiver year impacted by this amendment. Waiver years 1 through 4 are prior to the effective date of this amendment and were not updated.
This reserved waiver capacity group is for eligible medically fragile individuals up to 20 years old who will be able to enroll in the waiver before reaching the top of the interest list and without requiring admission to a nursing facility. These diversion slots are an estimated number based on currently allocated funding and prior utilization.
Appendix I
HHSC is proposing to update existing language regarding Electronic Visit Verification (EVV) policies. HHSC is proposing adding language that clarifies the EVV policies regarding approved clock in and clock out methods and what in home EVV services are in MDCP.
MDCP Program Overview
The MDCP waiver provides home and community-based services to medically fragile individuals from birth through age 20 who, without the waiver program, would require institutionalization in a nursing facility. Services in the MDCP waiver include adaptive aids, employment assistance, financial management services, flexible family support services, minor home modifications, respite, supported employment, and transition assistance services. Texas uses the MDCP waiver to provide services to Texans in the least restrictive environment possible. These environments include the individual’s or a family member’s home, or a Child Protective Services foster care home which can meet the individual’s complex medical needs.
Comments about the proposed waiver amendment must be submitted to HHSC by August 3, 2026.
Amendment to Waiver Application for the Medically Dependent Children Program (MDCP)
The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the waiver application for the Medically Dependent Children Program (MDCP). HHSC administers the MDCP waiver under the authority of Section 1915(c) of the Social Security Act. The proposed effective date for this amendment is August 31, 2026.
This amendment proposes to make the following changes:
Appendix B
HHSC updated waiver years (WY) 4 and 5 to reflect an increase in the Point-in-Time (PIT) and unduplicated participants (Factor C).
Appendix J
HHSC revised the Average Length of Stay (ALOS), Factor C, and PIT calculations for the overall projected cost of waiver services (Factor D) and the overall projected cost of other Medicaid services furnished to waiver participants (D Prime (D’)) for WYs 4 and 5.
MDCP Program Overview
The MDCP waiver provides home and community-based services to medically fragile individuals from birth through age 20 who, without the waiver program, would require institutionalization in a nursing facility. Services in the MDCP waiver include adaptive aids, employment assistance, financial management services, flexible family support services, minor home modifications, respite, supported employment, and transition assistance services. Texas uses the MDCP waiver to provide services to Texans in the least restrictive environment possible. These environments include the individual’s or a family member’s home, or a Child Protective Services foster care home which can meet the individual’s complex medical needs.
Per CMS guidance, a public notice of intent is not required for non-substantive waiver amendments such as the one described herein.
Home and Community-Based Services (HCS) Waiver Program Amendment
The Texas Health and Human Services Commission (HHSC) submitted a request to the Centers for Medicare & Medicaid Services (CMS) to amend the Home and Community-based Services (HCS) waiver program authorized under §1915(c) of the Social Security Act. CMS has approved the HCS waiver application through August 31, 2028. The proposed effective date for the amendment is August 31, 2026.
This amendment proposes to make the following changes:
Appendix B
HHSC updated waiver years (WY) 3 through 5 to reflect an increase in the Point-in-Time (PIT) and unduplicated participants (Factor C).
Appendix J
HHSC revised Average Length of Stay (ALOS), Factor C, and PIT calculations for the overall projected cost of waiver services (Factor D) and the overall projected cost of other Medicaid services furnished to waiver participants (D Prime (D’)) for WYs 3 through 5.
HCS Program Overview
The HCS waiver provides services and supports to individuals with intellectual disabilities who live in their own homes, in the home of a family member, or another community setting such as a three-person or four-person residence operated by an HCS program provider. Services and supports are intended to enhance quality of life, functional independence, and health and well-being in continued community-based living and to supplement, rather than replace, existing informal or formal supports and resources.
Current services in the HCS waiver include adaptive aids, audiology, behavioral support, cognitive rehabilitation therapy, dental treatment, dietary services, employment assistance, employment readiness, financial management services, individualized skills and socialization, minor home modifications, nursing, occupational therapy, physical therapy, prescribed drugs, residential assistance, respite, social work, speech and language pathology, support consultation, supported employment, supported home living, and transition assistance services.
Per CMS guidance, a public notice of intent is not required for non-substantive waiver amendments such as the one described herein.
The proposed amendment to §40.70 replaces wording for clarity.
The proposed amendment to §40.71 adds an acronym and replaces wording for clarity.
State Board of Dental Examiners
Proposed Rules Re:
Amending 22 TAC §101.8, to update disciplinary guidelines concerning imprisonment of a licensee following a felony conviction or deferred adjudication, in accordance with Senate Bill 1080.
CHAPTER 101. DENTAL LICENSURE
22 TAC §101.8
OVERVIEW
The State Board of Dental Examiners (Board) proposes amendments to 22 TAC §101.8, pertaining to persons with criminal backgrounds. The amendments, if adopted, update the Board’s disciplinary guidelines concerning the imprisonment of a licensee following a felony conviction or deferred adjudication, in accordance with Senate Bill 1080.
Amending 22 TAC §116.3, to update registration and renewal requirements for dental laboratories and remove repetitive language.
CHAPTER 116. DENTAL LABORATORIES
22 TAC §116.3
OVERVIEW
The State Board of Dental Examiners (Board) proposes amendments to 22 TAC §116.3, pertaining to the registration and renewal of a dental laboratory. The amendments: remove repetitive statutory language, remove repetitive language found in the Board’s dental laboratory application, update the rule to reflect the Board’s current licensing process, and include grammatical changes.
Amending 22 TAC §117.2, to remove repetitive statutory language governing dental faculty licensure.
CHAPTER 117. FACULTY AND STUDENTS IN ACCREDITED DENTAL SCHOOLS
22 TAC §117.2
OVERVIEW
The State Board of Dental Examiners (Board) proposes amendments to 22 TAC §117.2, pertaining to dental faculty licensure. The amendments remove repetitive language that is currently found in Chapter 267, Texas Occupations Code, and make grammatical changes.
Amending 22 TAC §117.3, to remove repetitive statutory language governing dental hygiene faculty licensure.
CHAPTER 117. FACULTY AND STUDENTS IN ACCREDITED DENTAL SCHOOLS
22 TAC §117.3
OVERVIEW
The State Board of Dental Examiners (Board) proposes amendments to 22 TAC §117.3, pertaining to dental hygiene faculty licensure. The amendments remove repetitive language that is currently found in Chapter 267, Texas Occupations Code, and make grammatical changes.
Texas Department of State Health Services
Proposed Rules Re:
Amending 25 TAC §§40.1 – 40.8, to update epinephrine delivery system policies for institutions of higher education and align terminology with House Bill 163 and Senate Bill 1619.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER A. EPINEPHRINE DELIVERY SYSTEM POLICIES IN INSTITUTIONS OF HIGHER EDUCATION
25 TAC §§40.1 – 40.8
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to amend 25 Texas Administrative Code (TAC) Chapter 40, Subchapters A, B, E, and F, and repeal Subchapter C, to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025.
HB 163 amended Texas Health and Safety Code §773.0145 and removed the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizes any entity in Texas such as schools, youth facilities and certain entities like an amusement park, restaurant, sports venues, and institutions of higher education to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 and replaced the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery systems policy and to update the medication and terminology allowed in the unassigned epinephrine delivery systems policy. In addition to the changes resulting from the legislature, 25 TAC Chapter 40, Subchapters A, B, E, and F amendments align definitions across 25 TAC Chapter 40 and comply with DSHS rule standards for plain language. The proposed repeal of Subchapter C removes duplicative rules because the content in those rules have been incorporated into the proposed amendments in Subchapter B.
SECTION-BY-SECTION SUMMARY
The proposed amendments to Chapter 40 replace “epinephrine auto-injector” with “epinephrine delivery system,” align terminology across subchapters, and improve overall readability. The proposed amendments include non-substantive editorial and plain-language changes and revisions to improve clarity that are not specifically listed here.
The proposal updates the title of Subchapter A, consisting of §§40.1 – 40.8, to Epinephrine Delivery System Policies in Institutions of Higher Education.
The proposed amendment to §40.1 replaces wording.
The proposed amendment to §40.2 replaces wording and updates the rule title to Voluntary Unassigned Epinephrine Delivery System Policies for an Institution of Higher Education.
The proposed amendment to §40.3 adds the acronym, TEC; reorganizes and renumbers the definitions to alphabetize the terms; replaces wording for clarity; refines the definitions for “campus,” “institution of higher education,” “unassigned epinephrine auto-injector,” and “volunteer”; and adds a new definition for “standard operating hours” and “epinephrine delivery system.”
The proposed amendment to §40.4 replaces wording for clarity.
The proposed amendment to §40.5 changes the number of doses of unassigned adult epinephrine for use in an epinephrine delivery system from one to two on each institution of higher education’s campus; clarifies annual prescription and standing order requirements; adds that an institution may conduct an assessment to determine if additional unassigned epinephrine delivery systems are needed and requirements surrounding the assessment; clarifies statutes for the prescription and standing order; clarifies the designation of a coordinating campus department; and adds requirements for monthly inventory checks. The proposed amendment adds who may administer the institution’s unassigned epinephrine delivery system; clarifies EMS notification; requires replacement planning; and requires trained individual presence during standard operating hours. The proposed amendment clarifies storage requirements and requires policy publication and submission to DSHS. The proposed amendment adds how unassigned epinephrine delivery systems must be stored and clarifies the record retention schedule for the unassigned epinephrine delivery system policy under 13 TAC §6.10. The proposal also updates the rule title to Maintenance, Administration, and Disposal of Unassigned Epinephrine Delivery Systems.
The proposed amendment to §40.6 clarifies the frequency of training; requires hands-on training with a trainer device; replaces wording; and adds the statutory requirements for training.
The proposed amendment to §40.7 removes subsection (a) and renumbers the remaining subsections; adds the acronym, TEC; clarifies that reports to institutions must be sent to the institution’s leadership; updates the DSHS website address; and updates the rule title to Report on Administering Unassigned Epinephrine Delivery Systems.
The proposed amendment to §40.8 adds acronyms, TEC and HSC.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER B. EPINEPHRINE DELIVERY SYSTEM POLICIES IN CERTAIN ENTITIES
25 TAC §§40.11 – 40.18
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to amend 25 Texas Administrative Code (TAC) Chapter 40, Subchapters A, B, E, and F, and repeal Subchapter C, to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025.
HB 163 amended Texas Health and Safety Code §773.0145 and removed the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizes any entity in Texas such as schools, youth facilities and certain entities like an amusement park, restaurant, sports venues, and institutions of higher education to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 and replaced the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery systems policy and to update the medication and terminology allowed in the unassigned epinephrine delivery systems policy. In addition to the changes resulting from the legislature, 25 TAC Chapter 40, Subchapters A, B, E, and F amendments align definitions across 25 TAC Chapter 40 and comply with DSHS rule standards for plain language. The proposed repeal of Subchapter C removes duplicative rules because the content in those rules have been incorporated into the proposed amendments in Subchapter B.
SECTION-BY-SECTION SUMMARY
The proposal updates the title of Subchapter B, consisting of §§40.11 – 40.18, to Epinephrine Delivery System Policies in Certain Entities.
The proposed amendment to §40.11 replaces wording for clarity.
The proposed amendment to §40.12 replaces wording for clarity and updates the rule title to Voluntary Unassigned Epinephrine Delivery System Policies for Certain Entities.
The proposed amendment to §40.13 adds the acronym, TEC; refines the definitions for “authorized healthcare provider,” “unassigned epinephrine delivery system,” and “volunteer”; replaces the term “personnel” with “entity personnel” and clarifies the definition; renumbers the definitions to alphabetize the terms; adds new term “entity” and updates statutory cross-references; and removes “venue.”
The proposed amendment to §40.14 replaces wording to provide clarity for entities adopting voluntarily.
The proposed amendment to §40.15 organizes a plan for ensuring proper maintenance, administration, and disposal of unassigned epinephrine delivery systems in certain entities; changes the number of doses of unassigned adult epinephrine for use in an epinephrine delivery system from one to two at each entity’s property and added that the entity may choose to stock unassigned pediatric epinephrine delivery system packs based on the population served; clarifies annual prescription and standing order requirements; clarifies factors that an entity may consider when conducting an assessment to determine if additional unassigned epinephrine delivery systems are needed; adds “administrator” as an entity coordinator and clarifies coordination and management requirements of the unassigned epinephrine delivery system. The proposed amendment adds who may administer the entity’s unassigned epinephrine delivery system; clarifies EMS notification; requires replacement planning; and requires trained individual presence during all hours the entity is open to the public or to the population the entity serves. The proposed amendment clarifies infectious waste disposal; requires secure and accessible storage; and requires parent notification when serving children under 18 years of age. The proposal updates the rule title to Maintenance, Administration, and Disposal of Unassigned Epinephrine Delivery Systems.
The proposed amendment to §40.16 clarifies the frequency of training; replaces wording; and adds statutory requirements for training.
The proposed amendment to §40.17 adds new subsection (b) to clarify reporting requirements; clarifies that reports must be sent to the entity’s leadership; updates the DSHS website address; and updates the rule title to Report on Administering Unassigned Epinephrine Delivery Systems.
The proposed amendment to §40.18 adds an acronym and replaces wording for clarity.
Repealing 25 TAC §§40.21 – 40.28, to remove duplicative Epinephrine Auto-Injector Policies in Youth Facilities rules, as this content has been incorporated into Subchapter B.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER C. EPINEPHRINE AUTO-INJECTOR POLICIES IN YOUTH FACILITIES
25 TAC §§40.21 – 40.28
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to amend 25 Texas Administrative Code (TAC) Chapter 40, Subchapters A, B, E, and F, and repeal Subchapter C, to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025.
HB 163 amended Texas Health and Safety Code §773.0145 and removed the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizes any entity in Texas such as schools, youth facilities and certain entities like an amusement park, restaurant, sports venues, and institutions of higher education to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 and replaced the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery systems policy and to update the medication and terminology allowed in the unassigned epinephrine delivery systems policy. In addition to the changes resulting from the legislature, 25 TAC Chapter 40, Subchapters A, B, E, and F amendments align definitions across 25 TAC Chapter 40 and comply with DSHS rule standards for plain language. The proposed repeal of Subchapter C removes duplicative rules because the content in those rules have been incorporated into the proposed amendments in Subchapter B.
SECTION-BY-SECTION SUMMARY
The proposed repeal of Subchapter C, Epinephrine Auto-Injector Policies in Youth Facilities, consisting of §§40.21- 40.28, deletes the rules as no longer necessary because the content of these rules has been incorporated into the proposed amendments in Subchapter B to reflect statutory expansion without removing substantive requirements.
Amending 25 TAC §§40.61 – 40.71, to update epinephrine delivery system policies for schools and align terminology with House Bill 163 and Senate Bill 1619.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER E. EPINEPHRINE DELIVERY SYSTEM POLICIES IN SCHOOLS
25 TAC §§40.61 – 40.71
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to amend 25 Texas Administrative Code (TAC) Chapter 40, Subchapters A, B, E, and F, and repeal Subchapter C, to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025.
HB 163 amended Texas Health and Safety Code §773.0145 and removed the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizes any entity in Texas such as schools, youth facilities and certain entities like an amusement park, restaurant, sports venues, and institutions of higher education to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 and replaced the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery systems policy and to update the medication and terminology allowed in the unassigned epinephrine delivery systems policy. In addition to the changes resulting from the legislature, 25 TAC Chapter 40, Subchapters A, B, E, and F amendments align definitions across 25 TAC Chapter 40 and comply with DSHS rule standards for plain language. The proposed repeal of Subchapter C removes duplicative rules because the content in those rules have been incorporated into the proposed amendments in Subchapter B.
SECTION-BY-SECTION SUMMARY
The proposal updates the title of Subchapter E, consisting of §§40.61 – 40.71, to Epinephrine Delivery System Policies in Schools.
The proposed amendment to §40.61 replaces wording for clarity.
The proposed amendment to §40.62 replaces wording for clarity; adds the acronym, TEC; and updates the rule title to Voluntary Unassigned Epinephrine Delivery System Policies for School Districts, Open-enrollment Charter Schools, and Private Schools.
The proposed amendment to §40.63 adds the acronym, TEC; reorganizes and renumbers the definitions to alphabetize the terms; refines the definitions for “campus,” “open-enrollment chart school,” “school personnel,” “school volunteer,” and “unassigned epinephrine delivery system”; and adds new definitions for “epinephrine delivery system” and “school hours.”
The proposed amendment to §40.64 replaces wording for clarity.
The proposed amendment to §40.65 organizes a plan for ensuring proper maintenance, administration, and disposal of unassigned epinephrine delivery systems in schools. The proposed amendment changes the number of doses of unassigned adult epinephrine for use in an epinephrine delivery system from one to two on each school campus and clarifies that schools must equally distribute epinephrine delivery systems across a campus. The proposed amendment clarifies designated school personnel coordinating requirements, including training, inventory checks, and factors to consider when assessing to determine the number of additional unassigned epinephrine delivery systems needed. The proposal changes trained individual presence from “all hours the campus is open for school-sponsored events” to “school hours” and adds “off-campus school event.” The proposed amendment adds that schools may train all personnel and volunteers on food allergies and how to respond to an emergency. The proposal clarifies EMS and parent notification, record retention under 13 TAC §7.125, and storage and disposal requirements; and updates the rule title to Maintenance, Administration, and Disposal of Unassigned Epinephrine Delivery Systems.
The proposed amendment to §40.66 clarifies voluntary participation of personnel; provides protection to untrained personnel from penalty; and updates the rule title to Assignment and Recruitment of School Personnel and School Volunteers Trained to Administer Epinephrine Delivery Systems.
The proposed amendment to §40.67 clarifies annual training requirements; replaces wording for clarity; and adds that the school district, open-enrollment charter school, or private school may contract with a vendor to provide training to school personnel and school volunteers.
The proposed amendment to §40.68 replaces wording to clarify reporting requirements; updates the DSHS website; and updates the rule title to Report on Administering Epinephrine Delivery Systems.
The proposed amendment to §40.69 clarifies parent notice requirements for students enrolled in the district or school, and updates the rule title to Notice to Parents Regarding Unassigned Epinephrine Delivery System Policies in Schools.
Amending 25 TAC §§40.81 – 40.89, to update opioid antagonist medication requirements in schools and align terminology with House Bill 163 and Senate Bill 1619.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER F. OPIOID ANTAGONIST MEDICATION REQUIREMENTS IN SCHOOLS
25 TAC §§40.81 – 40.89
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to amend 25 Texas Administrative Code (TAC) Chapter 40, Subchapters A, B, E, and F, and repeal Subchapter C, to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025.
HB 163 amended Texas Health and Safety Code §773.0145 and removed the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizes any entity in Texas such as schools, youth facilities and certain entities like an amusement park, restaurant, sports venues, and institutions of higher education to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 and replaced the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery systems policy and to update the medication and terminology allowed in the unassigned epinephrine delivery systems policy. In addition to the changes resulting from the legislature, 25 TAC Chapter 40, Subchapters A, B, E, and F amendments align definitions across 25 TAC Chapter 40 and comply with DSHS rule standards for plain language. The proposed repeal of Subchapter C removes duplicative rules because the content in those rules have been incorporated into the proposed amendments in Subchapter B.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §40.81 replaces wording for clarity.
The proposed amendment to §40.82 adds the acronym, TEC; reorganizes and renumbers the definitions to alphabetize the terms; refines the definitions for “campus,” “open-enrollment chart school,” “school personnel,” and “school volunteer”; and adds new definitions for “opioid antagonist medication policy” and “school hours.”
The proposed amendment to §40.83 adds wording for clarity.
The proposed amendment to §40.84 clarifies required and voluntary opioid antagonist policies; removes subsection (c); and renumbers the remaining rule text.
The proposed amendment to §40.85 clarifies the maintenance, administration, and disposal of opioid antagonist medication. The proposed amendment replaces the term “campus” with “school district, open-enrollment charter school, or private school” and changes the established number of doses of opioid antagonist medications determined by a school district, on each campus, to at least two doses of opioid antagonist medication on each school campus. The proposed amendment adds trained individual presence during school hours; who may administer an opioid antagonist medication; and designated school personnel coordination and management requirements, including training and inventory checks. The proposed amendment adds EMS notification, medication replacement planning, and record retention requirements; and clarifies antagonist medication storage and disposal.
The proposed amendment to §40.86 adds the acronym, TEC; adds notification to emergency medical services; and replaces wording to clarify annual training requirements.
The proposed amendment to §40.87 removes subsection (a) and renumbers the remaining subsections; adds the reporting requirement to the DSHS commissioner; and updates the DSHS website.
The proposed amendment to §40.88 replaces wording for clarity.
The proposed amendment to §40.89 adds an acronym and replaces wording for clarity.
Texas Funeral Service Commission
Adopted Rules Re:
Adopting 22 TAC §203.36, to establish procedures for inspecting a funeral establishment’s solid waste disposal and sanitation facilities when those facilities have not been inspected by DSHS.
CHAPTER 203. LICENSING AND ENFORCEMENT–SPECIFIC SUBSTANTIVE RULES
SUBCHAPTER C. ENFORCEMENT
22 TAC §203.36
OVERVIEW
The Texas Funeral Service Commission (Commission) adopts new §203.36 of Title 22, Part 10, Chapter 203 of the Texas Administrative Code (TAC), titled Inspection of Solid Waste Disposal and Sanitation Facilities. The adopted rule establishes procedures, as required by Texas Occupations Code §651.158(b), for the inspection of a funeral establishment’s solid waste disposal and sanitation facilities when those facilities have not been inspected by the Texas Department of State Health Services (DSHS). The new section is adopted as published in the May 15, 2026, issue of the Texas Register (51 TexReg 3301) without changes to the proposed text and will not be republished.
BACKGROUND AND JUSTIFICATION
The adopted rule under 22 TAC, Chapter 203, implements Texas Occupations Code §651.158, Inspection of Certain Facilities.
Section 651.158(a) authorizes the Commission to require a funeral establishment that has solid waste disposal and sanitation facilities that have not been inspected by the Texas Department of Health to be inspected by Commission inspectors. (The Texas Department of Health was abolished and its functions transferred to DSHS under House Bill 2292, 78th Legislature, Regular Session, 2003, effective September 1, 2004; references in §651.158 to the Texas Department of Health should be read as references to DSHS.) Section 651.158(b) requires the Commission, by rule, to establish procedures for any inspection required under that section. This rule satisfies that statutory directive.
Specifically, §203.36 authorizes a funeral establishment whose solid waste disposal and sanitation facilities have not been inspected by DSHS to be inspected for compliance with the standards specified by DSHS by Commission inspectors.
The adopted rule does not establish new substantive sanitation standards; rather, it creates a procedural pathway for demonstrating compliance with existing DSHS-equivalent standards in circumstances in which DSHS has not itself performed an inspection. The adopted rule preserves the Commission’s authority to require additional or independent inspection under §651.158 or other applicable law.
Adopting 22 TAC §206.9, to implement a donor acknowledgement form for individuals donating their bodies to willed body programs and non-transplant anatomical donation organizations.
CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.9
OVERVIEW
The Texas Funeral Service Commission (Commission) adopts a new rule in Texas Administrative Code (TAC), Title 22, Part 10, Chapter 206, Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs, §206.9, regarding the implementation of a donor acknowledgement form to be used by an adult of sound mind in Texas who is donating his or her body by will or other instrument to willed body programs and non-transplant anatomical donation organizations to be used for the advancement of medical or forensic science. The new section is adopted as published in the May 15, 2026, issue of the Texas Register (51 TexReg 3302) without changes to the proposed text and will not be republished.
BACKGROUND AND JUSTIFICATION
The adopted rule under 22 TAC, Chapter 206, implements Texas Health and Safety Code Section 691.028, Donation of Body by Written Instrument.
The Texas Legislature amended Texas Health and Safety Code Section 691.028 to include a donor acknowledgment form as part of the informed consent requirements in order to make effective an adult’s donation of his or her whole body to a university willed body program or a non-transplant anatomical donation organization to be used for the advancement of medical or forensic science. Section 691.028(b)(2) sets forth the elements that must be in the donor acknowledgment, and Section 691.028(b-1) requires the Commission, by rule, to design and adopt a form that complies with Section 691.028(b) that willed body programs and non-transplant anatomical donation organizations must use. This rule satisfies this statutory directive.
Specifically, the new §206.9 adopts the Commission prescribed Donor Acknowledgement Form that must be used by willed body programs and NADOs in order to use the decedent donor’s body or body parts for the advancement of medical or forensic science if the decedent donated his or her body in a willed or written instrument. The adopted rule further requires the elements that the donor acknowledgement form must include that are applicable to the particular willed body program and non-transplant anatomical donation organization.
CHAPTER 206. NON-TRANSPLANT ANATOMICAL DONATIONS: INSPECTIONS
22 TAC §206.31, §206.33
OVERVIEW
The Texas Funeral Service Commission (Commission) adopts new rules in Texas Administrative Code (TAC), Title 22, Part 10, in new Chapter 206, Non-Transplant Anatomical Donations: Inspections, §206.31 and §206.33, regarding the inspection procedures for individuals and entities applying for authorization or registration or currently authorized or registered to receive, use, distribute or transport non-transplant whole body donations for the advancement of medical and forensic science. The new sections are adopted as published in the April 24, 2026, issue of the Texas Register (51 TexReg 2582) without changes to the proposed text and will not be republished.
These sections establish the regulatory framework governing inspections conducted by the Commission for entities involved with non-transplant anatomical specimens. They outline when inspections are required, including initial authorization, renewals, ownership changes, and routine compliance reviews, as well as the Commission’s authority to perform unannounced inspections. The rules further define the responsibilities of inspected entities, including cooperation, access to records and personnel, and participation in entrance and exit conferences. They also detail the process for addressing deficiencies through formal notification and submission of a Plan of Correction, ensuring ongoing compliance with applicable statutes and regulations.
BACKGROUND AND JUSTIFICATION
The adopted rules under 22 TAC, Chapter 206, implement Texas Health and Safety Code §§ 691.012(a)(2)-(3), 691.022(b)-(c), and 691.034 which authorizes the Commission by rule to administer its duties to regulate the receipt, use, transport, and distribution of decedent non-transplant whole human body or body part donations for medical or forensic science.
Each adopted rule described below is in regard to the receipt, use, transport and distribution of non-transplant donations of whole human bodies or body parts for advancing medical or forensic science for purposes allowed under Texas Health and Safety Code chapter 691, unless stated otherwise.
SECTION-BY-SECTION SUMMARY
New 22 TAC §206.31 requires the Commission to conduct an inspection of an individual or entity applying for initial authorization or registration to operate in Texas, undergoing an ownership change, relocating to a new facility or undergoing major renovations to pass the onsite inspection prior to receiving approval from the Commission. The Commission will conduct onsite inspections, which may be unannounced, of authorized entities once every three years, unless the entity is expressly exempted by statute. The inspections may be conducted at reasonable times, including when a lab or event using human bodies or body parts is occurring. Unannounced inspections may also occur to inspect, investigate or evaluate an entity’s compliance with or to prevent a violation of the law; a Plan of Correction; order by the Commissioners, executive director or executive director’s designee; court order for injunctive relief; or other regulatory purpose. The adopted rule establishes the scenarios in which the commission’s inspections are for evaluating the individual’s or entity’s compliance.
The adopted rule further requires the individual or entity being inspected to cooperate with the Commission, including allowing entry to grounds and records, opportunity to interview and request a written statement from certain individuals, make copies of requested records, and if necessary, opportunity to remove records. The Commission must make reasonable effort to return any removed records in a timely manner. If the inspection purpose is to ensure compliance, the Commission must give the individual or entity opportunity to submit relevant information. Any records considered confidential or proprietary subject to the inspection will be maintained as consistent with applicable law, and released in accordance with statute.
The Commission will hold an entrance and exit conference to discuss the inspection nature, scope, time frame, findings, and possible deficiencies or violations. If deficiencies or violations are found, the individual or entity will be given an opportunity to provide information to show compliance. A report will be sent to the individual or entity seven days after the exit conference ended.
New 22 TAC §206.33 establishes procedures for a Plan of Correction should the Commission find deficiencies when inspecting an individual or entity. The plan must be sent to the individual/entity within 15 business days after the exit conference by physical or electronic mail. The recipient has 15 calendar days to respond to each cited deficiencies, propose timeframes for compliance and provide evidence of compliance. The Commission may or may not accept the recipient’s Plan of Correction. If it does not accept, the recipient is given an additional 15 business days to submit a modified Plan of Correction. Even with a Plan of Correction, at any time, the Commission may take enforcement action against the individual or entity.