Texas Register Table of Contents
- 1 Texas Health and Human Services Commission
- 1.0.1 Proposed Rules Re:
- 1.0.2 In Addition Re:
- 1.0.2.1 Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates
- 1.0.2.2 Notice of Public Hearing on the Proposed Texas Administrative Code Amendments to Implement the 2026-27 General Appropriations Act, Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Riders 23, 25, and 31), and Senate Bill 457, 89th Legislature, Regular Session, 2025
- 1.0.2.3 Public Notice: Texas State Plan for Medical Assistance Amendment
- 1.0.2.4 Public Notice: Texas State Plan for Medical Assistance Amendment
- 1.0.2.5 Public Notice: Texas State Plan for Medical Assistance Amendment
- 1.0.2.6 Public Notice: Texas State Plan for Medical Assistance Amendment
- 2 Texas State Board of Pharmacy
- 2.0.1 Proposed Rules Re:
- 2.0.1.1 Amending 22 TAC §291.6, to increase pharmacy license fees based on expected expenses following the appropriations made to TSBP.
- 2.0.1.2 Amending 22 TAC §295.5, to increase pharmacy license fees based on expected expenses following the appropriations made to TSBP.
- 2.0.1.3 Amending 22 TAC §297.4, to increase pharmacy license fees based on expected expenses following the appropriations made to TSBP.
- 2.0.2 Withdrawn Rules Re:
- 2.0.1 Proposed Rules Re:
- 3 Texas Department of State Health Services
- 4 Texas Board of Nursing
Texas Health and Human Services Commission
Proposed Rules Re:
Amending 1 TAC §354.1291, to allow a broader range of individuals to prescribe physical therapy services to a Medicaid recipient.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 20. PHYSICAL THERAPY SERVICES
1 TAC §354.1291
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §354.1291, concerning Benefits and Limitations.
BACKGROUND AND PURPOSE
The purpose of the proposal is to expand who can prescribe physical therapy (PT) services to a Medicaid recipient. The rule currently provides that physical therapy services must be prescribed by a physician to be reimbursed by Medicaid. This amendment allows a physician, a physician assistant (PA), an advanced practice registered nurse (APRN), including a certified nurse practitioner (CNP) or a clinical nurse specialist (CNS), to prescribe physical therapy services. This amendment clarifies the type of practitioner allowed to prescribe physical therapy services from physician only to physicians and allowed practitioners to align with the rules governing physical therapy as a home health benefit in §354.1031(b)(1)(B) and §354.1039(a)(5)(C). The proposed amendment also updates references, clarifies language, improves accuracy and uniformity to enhance understanding of services under Texas Medicaid.
SECTION-BY-SECTION SUMMARY
The title of Division 20 is currently, “Physical Therapists’ Services.” It is retitled as “Physical Therapy Services” to specify the name of the service described in the rule.
The proposed amendment to §354.1291, makes the following changes to the rule.
Proposed new subsection (a) adds definitions to provide the meaning of terms used in the rule. Definitions for “allowed practitioner,” “physical therapist,” “physical therapist assistant,” “physical therapy,” “physician,” and “prescribing provider” are added. The new definition of “prescribing provider” when used in the proposed rule means a physician or an allowed practitioner. “Allowed practitioner” means an individual with a valid and registered prescriptive authority agreement in accordance with Texas Occupations Code, Chapter 157, Subchapter B, and is licensed as a PA or an APRN licensed as a certified nurse practitioner or clinical nurse specialist. The new definition of “physician” is also used in the proposed rule as a person who provides physical therapy services.
Proposed new subsection (b), currently subsection (a), removes the reference to “the Texas Department of Health (department) or its designee” and replaces it with “HHSC” to update an agency name. The amendment also replaces “the Texas Medical Assistance Program” with “Texas Medicaid.”
Proposed new subsection (c) sets forth the requirements for physical therapy services to be reimbursable. Proposed new subsection (c)(1) requires physical therapy to be provided by a physician, physical therapist, or a physical therapist assistant under the supervision of the physical therapist. Proposed new subsection (c) uses prescribing provider instead of physician to allow a physician or an allowed practitioner to prescribe physical therapy services.
Current subsection (b) is deleted because its contents have been replaced by proposed new subsection (c).
Proposed new subsection (d), combines current subsections (d) and (e) and sets forth what is not considered reimbursable as physical therapy services under Texas Medicaid. This change is necessary to enhance clarity and group together items that are not reimbursable in a single subsection.
Current subsections (d) and (e) are deleted because their contents have been replaced by proposed new subsection (d).
Proposed new subsection (e), currently subsection (c), sets forth that a provider of physical therapy services must have a treatment plan on file and available for inspection for each Medicaid recipient who is treated. Proposed subsection (e) includes that both a physician and a physical therapist can provide physical therapy services. Proposed subsection (e) allows a treatment plan to be based on a prescribing provider’s prescription instead of being established by the attending physician and/or by the therapist. Proposed subsection (e) removes that a prescription must be “written” to allow for electronic prescriptions. Proposed subsection (e) contains some formatting changes for clarity and readability.
The proposed amendment to subsection (f) removes the term “licensed” with respect to physical therapist and clarifies that the therapist may not bill Texas Medicaid for physical therapy services if it would result in duplicate billing. Additionally, a portion of subsection (f) related to the basis and amount of Medicaid reimbursement actually provided is relocated to new subsection (g). This change is necessary to separate the two different topics. Other non-substantive edits are made for clarity.
Proposed new subsection (h), currently subsection (g), clarifies that “services” is referring to “physical therapy services” and clarifies that physical therapy services provided in long-term care facilities must be billed to the Medicaid recipient’s nursing facility rather than the Nursing Home Program.
In Addition Re:
Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates
Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on July 22, 2025, at 9:00 a.m., to receive public comments on proposed updates to Maternal Fetal Medicine Radiological Services, Applied Behavior Analysis Services, and Dental Reimbursement. The proposed rate actions are based on direction provided by the 2025-2026 General Appropriations Act (GAA), Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Special Provisions Relating to all Health and Human Services).
Notice of Public Hearing on the Proposed Texas Administrative Code Amendments to Implement the 2026-27 General Appropriations Act, Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Riders 23, 25, and 31), and Senate Bill 457, 89th Legislature, Regular Session, 2025
Hearing. The Texas Health and Human Services Commission (HHSC) will hold a public hearing on July 25, 2025, from 9:00 a.m. to 12:00 p.m. CDT to receive public comments on the proposed Title 1 Texas Administrative Code (TAC) amendments to implement the 2026-27 General Appropriations Act (GAA), Senate Bill (S.B.) 1, 89th Legislature, Regular Session, 2025 (Article II, HHSC, Riders 23, 25, and 31), and S.B. 457, 89th Legislature, Regular Session, 2025, for Long-Term Care (LTC) Rate Setting Methodology.
Public Notice: Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The proposed amendment is effective September 1, 2025.
Public Notice: Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The proposed amendment is effective September 1, 2025.
Public Notice: Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The proposed amendment is effective September 1, 2025.
Public Notice: Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The proposed amendment is effective September 1, 2025.
Texas State Board of Pharmacy
Proposed Rules Re:
Amending 22 TAC §291.6, to increase pharmacy license fees based on expected expenses following the appropriations made to TSBP.
CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
22 TAC §291.6
OVERVIEW
The Texas State Board of Pharmacy (TSBP) proposes amendments to §291.6, concerning Pharmacy License Fees. The amendments, if adopted, increase pharmacy license fees based on expected expenses following the appropriations made to TSBP under the General Appropriations Act of the Eighty-Ninth Legislature.
Amending 22 TAC §295.5, to increase pharmacy license fees based on expected expenses following the appropriations made to TSBP.
CHAPTER 295. PHARMACISTS
22 TAC §295.5
OVERVIEW
The Texas State Board of Pharmacy proposes amendments to §295.5, concerning Pharmacist License or Renewal Fees. The amendments, if adopted, increase pharmacist license fees based on expected expenses following the appropriations made to TSBP under the General Appropriations Act of the Eighty-Ninth Legislature.
Amending 22 TAC §297.4, to increase pharmacy license fees based on expected expenses following the appropriations made to TSBP.
CHAPTER 297. PHARMACY TECHNICIANS AND PHARMACY TECHNICIAN TRAINEES
22 TAC §297.4
OVERVIEW
The Texas State Board of Pharmacy proposes amendments to §297.4, concerning Fees. The amendments, if adopted, increase pharmacy technician registration fees based on expected expenses following the appropriations made to TSBP under the General Appropriations Act of the Eighty-Ninth Legislature.
Withdrawn Rules Re:
Withdrawing 22 TAC §291.72, to add definitions.
CHAPTER 291. PHARMACIES
SUBCHAPTER D. INSTITUTIONAL PHARMACY (CLASS C)
22 TAC §291.72
OVERVIEW
The Texas State Board of Pharmacy withdraws proposed amendments to §291.72 which appeared in the March 21, 2025, issue of the Texas Register (50 TexReg 2038).
Withdrawing 22 TAC §291.120, to add new definitions.
CHAPTER 291. PHARMACIES
SUBCHAPTER G. SERVICES PROVIDED BY PHARMACIES
22 TAC §291.120
OVERVIEW
The Texas State Board of Pharmacy withdraws proposed amendments to §291.120 which appeared in the March 21, 2025, issue of the Texas Register (50 TexReg 2042).
Withdrawing 22 TAC §291.133, to update procedures for pharmacies compounding sterile preparations.
CHAPTER 291. PHARMACIES
SUBCHAPTER G. SERVICES PROVIDED BY PHARMACIES
22 TAC §291.133
OVERVIEW
The Texas State Board of Pharmacy withdraws proposed amendments to §291.133 which appeared in the December 27, 2024, issue of the Texas Register (49 TexReg 10463).
Texas Department of State Health Services
Proposed Rules Re:
Amending 25 TAC §97.62, to allow exclusions from compliance on an individual basis for specific reasons including medical contraindications, reasons of conscience, and active duty with the armed forces of the United States.
CHAPTER 97. COMMUNICABLE DISEASES
SUBCHAPTER B. IMMUNIZATION REQUIREMENTS IN TEXAS ELEMENTARY AND SECONDARY SCHOOLS AND INSTITUTIONS OF HIGHER EDUCATION
25 TAC §97.62
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 §97.62 concerning Exclusions from Compliance.
BACKGROUND AND PURPOSE
Section 97.62 provides that exclusions from compliance are allowable on an individual basis for medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States. The rule outlines the steps of how an individual can claim any of these exclusions.
The purpose of the proposal is to comply with Health and Safety Code §161.0041, as amended by House Bill (H.B.) 1586, 89th Legislature, Regular Session, which requires DSHS to develop a blank affidavit form to be used by a person claiming an exemption from a required immunization and make the affidavit form available on the DSHS website. DSHS will post a blank affidavit form on the website for a person to download and submit to their child-care facility, school, or institution of higher education, including medical or veterinary school.
The current process requires individuals to request an affidavit form from DSHS, which DSHS must print on security-sealed paper and mail to the requesting individual.
Individuals will print these documents themselves (or request that DSHS send them a blank affidavit, which does not need to be printed on this special paper), and thus DSHS anticipates the volume of requests to decrease to the point we won’t need contractors. Also anticipate envelopes, postage, and printing costs decrease.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §97.62 allows a person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization to obtain an affidavit form by downloading it from the department’s internet website or submitting the request to the department.
The proposal also removes the requirement for the submitted request to include full name and date of birth of child or student. Submitting a request (via online, fax, mail or hand-delivery) will only require a mailing address and number of affidavit forms requested. Those downloading the affidavit will not need to submit any information.
H.B. 1586’s changes begin with the 2025-2026 school year.
Texas Board of Nursing
Proposed Rule Reviews Re:
In accordance with Government Code §2001.039, the Texas Board of Nursing (Board) files this 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.
Chapter 213. Practice and Procedure, §§213.1 – 213.37
Chapter 214. Vocational Nursing Education, §§214.1 – 214.14
Chapter 215. Professional Nursing Education, §§215.1 – 215.14
Chapter 216. Continuing Competency, §§216.1 – 216.11
Chapter 221. Advanced Practice Nurses, §§221.1 – 221.17
Chapter 222. Advanced Practice Registered Nurses with Prescriptive Authority, §§222.1 – 222.12
Chapter 227. Pilot Programs for Innovative Applications to Vocational and Professional Nursing Education, §§227.1 – 227.6