Governor
Appointments Re:
Appointed to the Texas Medical Board District One Review Committee for a term to expire January 15, 2032, Adrian Caraves of Galveston, Texas (replacing Kimberly R. Phillips of Houston whose term expired).
Appointed to the Texas Medical Board District One Review Committee for a term to expire January 15, 2032, Elizabeth A. Cloninger, M.D. of League City, Texas (replacing Imran A. Dar, M.D. of Houston whose term expired).
Appointed to the Texas Medical Board District Two Review Committee for a term to expire January 15, 2032, Ivan D. Rovner, M.D. of Plano, Texas (Dr. Rovner is being reappointed).
Appointed to the Texas Medical Board District Two Review Committee for a term to expire January 15, 2032, Steven B. “Steve” Westbrook, Ed.D. of Nacogdoches, Texas (replacing Angela A. Downes of Irving whose term expired).
Appointed to the Texas Medical Board District Four Review Committee for a term to expire January 15, 2032, Ruth Villarreal of Mission, Texas (Ms. Villarreal is being reappointed).
Appointed to the Texas Medical Board District Four Review Committee for a term to expire January 15, 2032, Matthew T. “Matt” Wallace, M.D. of Austin, Texas (replacing Andrew J. “Jimmy” Widmer, M.D. of Celina whose term expired).
Appointed to the Early Childhood Intervention Advisory Committee for a term to expire February 1, 2029, Sheri L. O’Daniel of Amarillo, Texas (replacing Audrey K. Jackson of San Marcos who resigned).
Appointed to the Early Childhood Intervention Advisory Committee for a term to expire February 1, 2031, Dana L. Dodgen of Dallas, Texas (replacing Cynthia D. “Cindy” Lee, Ed.D. of McKinney who resigned).
Appointed to the Early Childhood Intervention Advisory Committee for a term to expire February 1, 2031, Celina C. Perez of San Benito, Texas (replacing Chasey M. Sanchez, Ed.D. of Orange Grove whose term expired).
Executive Order Re:
Executive Order GA-57 relating to coordinated efforts to eliminate unlawful birth tourism schemes in Texas.
WHEREAS, entities doing business in the State of Texas, including hospitals, have sought to profit from the ongoing effects of this disaster by incentivizing “birth tourism” schemes-the practice of non-citizen aliens exploiting our laws by traveling to the United States illegally or under false pretenses solely to give birth and secure citizenship for their child; and
WHEREAS, I, Greg Abbott, Governor of Texas, directed the Texas Health and Human Services Commission (HHSC) on July 7, 2026, to launch an immediate investigation into reports that Texas hospitals were advertising birth tourism packages to individuals in foreign countries and to refer any violations of state law to the Office of the Attorney General for civil enforcement and to the appropriate District or County Attorney for criminal prosecution; and
WHEREAS, HHSC acted swiftly in referring to the Texas Attorney General two Texas hospitals that allegedly placed billboards in a foreign country advertising “birth packages” in South Texas for fixed prices starting as low as $3,950, and directed viewers to a website soliciting patients to engage in medical birthing services; and
WHEREAS, no person may establish or operate a hospital, birthing center, freestanding emergency medical care facility, or any other facility authorized to conduct births in Texas without a license issued by the State of Texas, see TEX. HEALTH & SAFETY CODE §§ 241.021, 244.003, 254.051; and
WHEREAS, HHSC is responsible for promulgating the rules and minimum standards for hospitals and other health care providers and ensuring the efficient use of state and local health-related resources and monitoring Medicaid and other federal funding programs supporting health care services, see TEX. GOV’T CODE §§ 523.0001, 523.0002, 524.0001, 524.0151; TEX. HEALTH & SAFETY CODE §§ 62.051, 241.026; TEX. HUM. RES. CODE § 32.021; and
WHEREAS, the Texas Department of State Health Services (DSHS) administers the registration of vital statistics and licensing and regulates birthing facilities in Texas, see TEX. HEALTH & SAFETY CODE §§ 191.002, 192.002, 244.003, 311.032, 311.033; and
WHEREAS, the Office of Inspector General (OIG) of HHSC is tasked with preventing, detecting, auditing, inspecting, and investigating fraud, waste, and abuse in the provision and delivery of all health and human services in this State, see TEX. GOV’T CODE § 544.0103; and
WHEREAS, the Texas Medical Board (TMB) is tasked with regulating the practice of medicine, issuing, suspending, or revoking medical licenses, and promulgating rules concerning false or misleading advertising or other deceptive practices by a person licensed to practice medicine, see TEX. OCC. CODE §§ 152.001, 153.001, 153.002, 155.002, 155.212; and
WHEREAS, the Texas Board of Nursing (BON) is tasked with regulating the practice of professional nursing and vocational nursing, including by promulgating rules regarding specialized training, prescribing standards of professional conduct, and prohibiting false or misleading advertising or other deceptive practices, see TEX. OCC. CODE §§ 301.151, 301.152, 301.153; and
WHEREAS, the Texas Department of Licensing and Regulation (TDLR) is tasked with regulating the practice of midwifery, including by issuing, suspending, or revoking midwifery licenses, and promulgating rules prescribing the standards for the practice of midwifery, see TEX. OCC. CODE §§ 203.151, 203.251, 203.404;
NOW, THEREFORE, I, GREG ABBOTT, Governor of Texas, by virtue of the power and authority vested in me by the Constitution and Statutes of the State of Texas, do hereby direct the following actions:
(1) DSHS, HHSC, OIG, TMB, BON, and TDLR must investigate claims of birth tourism schemes in Texas’ healthcare industry and take action against licensed or regulated individuals and entities advertising, soliciting, engaging in, assisting with, providing, or otherwise participating in such activities, including by revoking or suspending licensure, prohibiting participation in state contracts, denying state benefits, or taking other enforcement action; and
(2) DSHS, HHSC, OIG, TMB, BON, and TDLR may, subject to approval by the Governor consistent with Article IV, Section 10 of the Texas Constitution, partner with federal prosecutors to identify and combat birth tourism schemes in Texas’ healthcare industry, including by sharing information or resources and referring potential violations of federal law.
This executive order supersedes all previous orders in conflict or inconsistent with its terms and shall remain in effect and in full force until modified, amended, rescinded, or superseded by the Governor.
Given under my hand this the 21st day of July, 2026.
Texas Health and Human Services Commission
Proposed Rules Re:
Adding new 26 TAC §742.402, to require listed family homes to collect and disclose revocations of state-issued occupational licenses and notify parents, implementing Senate Bill 225.
CHAPTER 742. MINIMUM STANDARDS FOR LISTED FAMILY HOMES
SUBCHAPTER D. NOTIFICATIONS AND LIABILITY INSURANCE REQUIREMENTS
26 TAC §742.402
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §742.402, concerning Disclosed Revocations and Parental Notice Requirements.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with Senate Bill (SB) 225, 87th Legislature, Regular Session, 2021.
SB 225 added Texas Human Resources Code §42.0562, which requires the collection of information on any child care home employee who has had a revocation of a state-issued license, registration, certificate, permit, or other occupational authorization by a licensing authority.
HHSC Child Care Regulation (CCR) proposes a new rule to meet the requirements of Texas Human Resources Code §42.0562 and to extend those requirements to listed family home permit holders, controlling persons, employees, and prospective employees. The new rule also requires the listed family home to notify a parent for each enrolled child if a revocation is disclosed.
SECTION-BY-SECTION SUMMARY
Proposed new §742.402 requires (1) each permit holder, controlling person, employee, and prospective employee of a listed family home to complete a form disclosing any revocation of state-issued license, registration, certificate, permit, or other occupational authorization that allowed the practice or engagement in a particular business, occupation, or profession before the revocation; (2) a listed family home to notify, in writing, parents of children enrolled in the home if any person disclosed a revocation and what license, registration, or other occupational authorization was revoked; (3) a listed family home to keep the disclosure form and parental notice on file; and (4) parental notice only if the person who discloses the revocation is hired or continues to be affiliated with the listed family home.
Amending 26 TAC §747.207, to require child care home primary caregivers to comply with Child Care Services subsidy requirements, implementing Senate Bill 225.
CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE HOMES
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION
DIVISION 1. PRIMARY CAREGIVER RESPONSIBILITIES
26 TAC §747.207
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §747.207 concerning What are my responsibilities as the primary caregiver; and new §747.311, concerning Disclosed Revocations and Parental Notice Requirements.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with Senate Bill (SB) 225, 87th Legislature, Regular Session, 2021.
SB 225 added Texas Human Resources Code §42.0562, which requires the collection of information on any child care home employee who has had a revocation of a state-issued license, registration, certificate, permit, or other occupational authorization by a licensing authority.
The proposal also amends a rule to require that a child care home’s primary caregiver comply with Texas Workforce Commission Child Care Services (CCS) requirements when receiving subsidies. The proposed amendment strengthens rules related to a child care home’s compliance with the CCS program requirements if receiving subsidies.
HHSC Child Care Regulation (CCR) proposes a new rule to meet the requirements of Texas Human Resources Code §42.0562 and to extend those requirements to child care home permit holders, controlling persons, employees, and prospective employees. The new rule also requires the child care home to notify a parent for each enrolled child if a revocation is disclosed.
In addition, CCR is making non-substantive changes, including the removal of the hyphen between “child” and “care.”
SECTION-BY-SECTION SUMMARY
The proposed amendment to §747.207 (1) amends the rule title; (2) adds language requiring compliance with CCS program requirements if receiving CCS subsidies; and (3) makes non-substantive changes for better readability and understanding.
Adding new 26 TAC §747.311, to require child care homes to collect and disclose revocations of state-issued occupational licenses and notify parents, implementing Senate Bill 225.
CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE HOMES
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION
DIVISION 2. REQUIRED NOTIFICATIONS
26 TAC §747.311
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §747.207 concerning What are my responsibilities as the primary caregiver; and new §747.311, concerning Disclosed Revocations and Parental Notice Requirements.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with Senate Bill (SB) 225, 87th Legislature, Regular Session, 2021.
SB 225 added Texas Human Resources Code §42.0562, which requires the collection of information on any child care home employee who has had a revocation of a state-issued license, registration, certificate, permit, or other occupational authorization by a licensing authority.
The proposal also amends a rule to require that a child care home’s primary caregiver comply with Texas Workforce Commission Child Care Services (CCS) requirements when receiving subsidies. The proposed amendment strengthens rules related to a child care home’s compliance with the CCS program requirements if receiving subsidies.
HHSC Child Care Regulation (CCR) proposes a new rule to meet the requirements of Texas Human Resources Code §42.0562 and to extend those requirements to child care home permit holders, controlling persons, employees, and prospective employees. The new rule also requires the child care home to notify a parent for each enrolled child if a revocation is disclosed.
In addition, CCR is making non-substantive changes, including the removal of the hyphen between “child” and “care.”
SECTION-BY-SECTION SUMMARY
Proposed new §747.311 requires (1) each permit holder, controlling person, employee, and prospective employee of a child care home to complete a form disclosing any revocation of state-issued license, registration, or other occupational authorization that allowed the practice or engagement in a particular business, occupation, or profession before the revocation; (2) a child care home to notify, in writing, parents of children enrolled in the child care home if any person disclosed a revocation and what license, registration, or other occupational authorization was revoked; (3) a child care home to keep the disclosure form and parental notice on file; and (4) parental notice only if the person who discloses the revocation is hired or continues to be affiliated with the child care home.
In Addition Re:
Correction of Error
The Texas Health and Human Services Commission (HHSC) adopted amendments to several rules in Title 26, Chapter 745 in the July 17, 2026, issue of the Texas Register (51 TexReg 4693). Due to errors by the Texas Register, some of the amendments were published incorrectly.
Text was omitted from the final paragraph preceding the statutory authority section of the preamble. The final paragraph should read as follows:
Additionally, HHSC is not adopting the proposed changes to division numbers for Subchapter F, Division 7, “Immediate Threat or Danger to the Health or Safety of Children” and Division 8, “Administrator’s Licensing.” These divisions will remain as currently numbered.
The correct division name for the amendments to 26 TAC §745.609 and §745.615 was omitted. These amendments should have been published as Division 1 with the division name “Requesting Background Checks”.
The correct division name for the amendments to 26 TAC §745.631 and §745.643 was omitted. These amendments should have been published as Division 2 with the division name “Determinations Regarding Background Checks”.
The amendment to 26 TAC §745.751 was published under the wrong division name and number. The amendment should have been published under Division 7 with the division name “Immediate Threat or Danger to the Health or Safety of Children”.
The amendment to 26 TAC §745.775 was published under the wrong division name and number. The amendment should have been published under Division 8 with the division name “Administrator’s Licensing”.
Notice of Public Hearing on Proposed Rule Amendments for Hospital Augmented Reimbursement Program (HARP)
Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on August 14, 2026, at 1:00 p.m. CDT to receive public comments on proposed rule amendments to Title 1 Texas Administrative Code §355.8070, concerning the Hospital Augmented Reimbursement Program.
This hearing will be conducted online only. There is no physical location for this hearing.
Proposal. The rule amendments to §355.8070 are proposed to be effective October 2026.
Written Comments. Written comments regarding the proposed rule amendments may be submitted instead of, or in addition to, oral testimony until 11:59 p.m. on August 21, 2026.
Texas Department of Insurance, Division of Workers’ Compensation
Proposed Rules Re:
Amending 28 TAC §21.109 and §21.120, to update insurance advertising rules to conform to new terminology for loss-control and value-added products or services and modernize advertising-filing procedures, implementing House Bill 2221.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER B. ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION
DIVISION 1. INSURANCE ADVERTISING
28 TAC §21.109, §21.120
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC §§21.109, 21.120, 21.701, 21.705, 21.3003, 21.4003, 21.4502, 21.4703, 21.5501, and 21.5503 concerning trade practices. The amendments implement House Bills 721, 1620, and 2221, and Senate Bills 1236 and 1332, 89th Legislature, 2025; House Bill 4611, 88th Legislature, 2023; and House Bill 2090, 87th Legislature, 2021.
BACKGROUND AND JUSTIFICATION
Amendments to §§21.109, 21.701, 21.3003, 21.4003, 21.4502, 21.4703, and 21.5501 are necessary to implement the following legislation. From the 89th Legislature:
- HB 721 revises the applicability of Insurance Code Chapter 1662 to remove regional and local health care programs that operate under Health and Safety Code Chapter 75.
- HB 2221 moves requirements concerning unlawful rebates and inducements to new Insurance Code Chapter 1702.
- SB 1236 requires the inclusion of unique group numbers on pharmacy benefit ID cards.
- SB 1332 permits health benefit plans to waive a group policyholder’s liability under the circumstances outlined in the bill.
From the 88th Legislature, HB 4611 reorganized Medicaid managed care provisions in the Government Code by repealing Chapter 533 and adding new Chapter 540.
From the 87th Legislature, HB 2090 created price transparency requirements for certain health benefit plans.
SECTION-BY-SECTION SUMMARY
Section §21.109. To implement HB 2221, the proposed amendments to §§21.109(a)(1) and 21.109(a)(3) replace the term “health related services or health related information” with “loss-control or value-added products or services” to conform with terminology used in new Insurance Code Chapter 1702.
The proposed amendments to §21.109(a)(2) reference the definition for “loss-control or value-added products or services” and add a citation to Insurance Code §1702.002. The amendments also remove subparagraphs (A) and (B) of §21.109(a)(2), which contain definitions for “health-related services” and “health-related information.” Those terms are no longer relevant, since HB 2221 repealed Insurance Code §541.058.
Section §21.120. The proposed amendments to §21.120(a) update and clarify instructions for submission of advertising filings. The requirement to include a transmittal letter addressed to TDI’s mailing address is removed and replaced with instructions to submit an advertisement consistent with filing procedures in 28 TAC Chapter 3, Subchapter A. Those rules were modernized in 2025 and clarify that advertising filings are submitted through the System for Electronic Rates and Forms Filing (SERFF). The amendments to subsection (a) clarify that the contents specified in paragraphs (1) – (6) must be included in the filing, rather than in a transmittal letter. Consistent with 28 TAC §3.11, this eliminates unnecessary duplication because some of the information may be captured in SERFF data fields.
TDI proposes to remove current §21.120(b), since the department no longer requires advertisements to be filed in duplicate. The remaining subsections are redesignated to reflect this removal.
The proposed amendments to current §21.120(d), redesignated as §21.120(c), modify the subsection to align with filing rules in 28 TAC Chapter 3, Subchapter A. The term “the same as” is replaced with “an exact copy,” with reference to the definitions in 28 TAC Chapter 3, Subchapter A. The amendments clarify that the process to submit a substantially similar advertising file is to classify the filing as informational when submitting in SERFF. The requirement to include a signed statement is amended to require a signed certification, with reference to the requirements in 28 TAC Chapter 3, Subchapter A. The term “SERFF filing number” replaces the reference to the department’s filing number.
Amending 28 TAC §21.701 and §21.705, to update prohibited-discrimination cross-references and HIV testing standards for underwriting purposes, implementing House Bill 2221.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER H. UNFAIR DISCRIMINATION
28 TAC §21.701, §21.705
SECTION-BY-SECTION SUMMARY
Section §21.701. The proposed amendments to §21.701 implement HB 2221 by replacing the reference to Insurance Code §541.057 with Insurance Code §1702.103 and §1702.153, since §541.057 was repealed by HB 2221.
Section §21.705. The proposed amendments to §21.705 update the types of HIV tests that may be used for underwriting purposes by replacing references to outdated tests with tests recommended by the Centers for Disease Control and Prevention (CDC).
Amending 28 TAC §21.3003, to require unique pharmacy benefit ID card group numbers by line of business, implementing Senate Bill 1236.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER V. PHARMACY BENEFITS
DIVISION 2. IDENTIFICATION CARDS
28 TAC §21.3003
SECTION-BY-SECTION SUMMARY
Section §21.3003. The proposed amendments to §21.3003 correct a citation in subsection (a)(3) by replacing the reference to Insurance Code Chapter 1251, Subchapter E with Subchapter G, which addresses continuation of coverage for dependents. This change aligns the citation with the original version of the rule, which referenced Article 3.51-6, §3B.
Amendments to §21.3003(b)(3) improve readability by breaking the paragraph into subparagraphs (A) and (B) to separately address group and individual health benefit plans and add a reference to the group number requirements in new subsection (e).
TDI proposes new §21.3003(e) and (f) to implement SB 1236. New subsection (e) requires that a group number on an identification card must distinguish between lines of business, such that a group number provided to an enrollee in a plan subject to Insurance Code Chapter 1369, Subchapter D, cannot be assigned to an enrollee in a plan that is not subject to Subchapter D. Additionally, unique group numbers must be assigned for each line of business specified in Insurance Code §1251.151(b), which addresses employer plans for state employees, teachers, and university employees, as well as Medicaid and CHIP. Since these plans are exempt from many of the requirements in Insurance Code Chapter 1369, using the same group numbers could create confusion.
New §21.3003(f) requires a health benefit plan issuer to provide a method to identify, based on the group number provided on the identification card, whether an enrollee is covered by a plan that is subject to Insurance Code Chapter 1369, Subchapter D. For example, the issuer could include an identifier within the group numbering convention, or the issuer could maintain a list of group numbers that are associated with applicable health benefit plans. New §21.3003(f) requires the issuer to make the identification method publicly available on its website.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER FF. OBLIGATION TO CONTINUE PREMIUM PAYMENT AND COVERAGE AFTER NOTICE OF LOST GROUP ELIGIBILITY
28 TAC §21.4003
SECTION-BY-SECTION SUMMARY
Section §21.4003. The proposed amendment to §21.4003 implements SB 1332 by adding new subsection (c). The new subsection clarifies that if a health carrier chooses to waive an employer’s liability for a terminated employee’s premium as allowed by Insurance Code §843.210(e) and §1301.0061(e), the carrier must do so in a manner that ensures equal treatment of similarly situated employer groups.
Also, an amendment to §21.4003(a)(3)(B) updates examples of what might constitute immediate written notification.
Amending 28 TAC §21.4502, to update a Medicaid managed care statutory cross-reference in health care reimbursement rate reporting rules, implementing House Bill 4611.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER KK. HEALTH CARE REIMBURSEMENT RATE INFORMATION
28 TAC §21.4502
SECTION-BY-SECTION SUMMARY
Section §21.4502. The proposed amendment to §21.4502(c)(4) removes the outdated reference to Government Code 533 and replaces it with Government Code Chapter 540, consistent with HB 4611.
Also, an amendment to §21.4502(f) corrects a citation by adding the words “Insurance Code.”
Amending 28 TAC §21.4703, to update a statutory cross-reference in the wellness programs exception rule, implementing House Bill 2221.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER MM. WELLNESS PROGRAMS
28 TAC §21.4703
SECTION-BY-SECTION SUMMARY
Section §21.4703. The proposed amendments to §21.4703 replace the reference to Insurance Code §541.056(a) with §1702.102, consistent with HB 2221.
Amending 28 TAC §21.5501 and §21.5503, to remove regional and local health care programs from machine-readable file requirements and update price transparency data schemas, implementing House Bill 721 and House Bill 2090.
CHAPTER 21. TRADE PRACTICES
SUBCHAPTER UU. MACHINE-READABLE FILES
28 TAC §21.5501, §21.5503
SECTION-BY-SECTION SUMMARY
Section §21.5501. The proposed amendments to §21.5501 implement HB 721. The proposal deletes paragraph (3) of §21.5501(a) and adds new paragraph (5) to §21.5501(b), to clarify that the rules in Subchapter UU no longer apply to a regional or local health care program. To conform to HB 4611, an amendment is proposed to revise the Government Code reference in §21.5501(b)(4) from Chapter 533 to Chapter 540. Additionally, the proposal removes §21.5501(c) – (e), which address the initial implementation deadlines, because those are no longer relevant.
Section §21.5503. The proposal amends §21.5503(a), (b), and (d), updating data schemas for the “in-network rates,” “allowed-amounts,” and “table-of-contents” files. The version 2.0 schemas replace the version 1.1 schemas and conform to schema updates published October 1, 2025, by the Centers for Medicare and Medicaid Services (CMS). The schema updates focus on improving the organization of machine-readable files and reducing duplication. The schema for the “prescription-drugs” file in subsection (c) is not being updated, because CMS, after initially delaying enforcement, has not finalized a schema for prescription drugs. The proposal deletes subsection (e) because CMS no longer publishes a separate provider reference file schema.