Texas Register June 11, 2025 Volume: 50 Number: 28

Texas Register Table of Contents

1 Texas Health and Human Services Commission
- - 1.0.1 Proposed Rules Re:
  - 1.0.2 In Addition Re:
2 Texas State Board of Examiners of Psychologists
- - 2.0.1 Adopted Rules Re:
    - 2.0.1.1 Adopting 22 TAC §463.35, to clarify the required professional development a licensee must receive when providing services to unique populations.
    - 2.0.1.2 Adopting 22 TAC §465.38, to update the description of the scope of practice for Licensed Specialists in School Psychology.
3 Texas State Board of Examiners of Professional Counselors
- - 3.0.1 Adopted Rules Re:
    - 3.0.1.1 Adopting 22 TAC §681.72, to remove the expiration provisions of supervision training courses required for applications for supervisor status.
    - 3.0.1.2 Adopting 22 TAC §681.140, to clarify the required professional development a licensee must receive when providing services to unique populations.
4 Texas State Board of Social Worker Examiners
- - 4.0.1 Adopted Rules Re:
    - 4.0.1.1 Adopting 22 TAC §781.501, to clarify the required professional development a licensee must receive when providing services to unique populations.
5 Texas State Board of Examiners of Marriage and Family Therapists
- - 5.0.1 Adopted Rules Re:
    - 5.0.1.1 Adopting 22 TAC §801.261, to clarify the required professional development a licensee must receive when providing services to unique populations.
6 Texas Behavioral Health Executive Council
- - 6.0.1 Adopted Rules Re:

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §355.102, §355.105, to clarify training requirements for cost report submission and require contracted providers’ cost reporting period to align with the state fiscal year.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER A. COST DETERMINATION PROCESS
1 TAC §355.102, §355.105

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to Texas Administrative Code Title 1, Chapter 355, Subchapter A, §355.102 and §355.105; Subchapter C, §355.318; Subchapter D, §355.456; Subchapter E, §§355.503, 355.505, 355.507, 355.509, and 355.513; Subchapter F, §355.723; Subchapter G, §355.5902 and §355.6907; Subchapter H, §355.7051; Subchapter M, §355.9090; new rules in Subchapter C, §355.305; and Subchapter H, §355.7052; and the repeals in Subchapter A, §355.112; Subchapter C, §§355.304; 355.306 – 355.308; and 355.320; Subchapter D, §355.457; and Subchapter F, §355.722.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement the 2026-27 General Appropriations Act (GAA), Senate Bill (S.B.) 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 23 and Rider 25, respectively) and Senate Bill 457 (S.B. 457), 89th Legislature, Regular Session, 2025. The proposal amends and repeals existing rules and creates new rules that address the following topics.

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The 2026-27 General Appropriations Act (GAA), Senate Bill (S.B.) 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 23) (Rider 23) provides appropriations for HHSC to increase the wage for personal attendants assumed in the adopted rates for attendant and attendant-like services to $13.00 per hour and to increase the associated payroll costs, taxes, and benefits percentage to 14 percent for community services and 15 percent for residential services. Rider 23 also discontinues the Attendant Compensation Rate enhancement program.

The proposal amends §355.105, General Reporting and Documentation Requirements, Methods, and Procedures, to update the language so that cost reports must be completed every state fiscal year and removes the mention of the Internal Revenue Service fiscal year in cost reporting. The proposal specifies how related party attendant staff costs will be limited in the rate methodology for programs with attendant services. The proposal repeals §355.457, Cost Finding Methodology, because the amendment of §355.105 makes this rule obsolete. The proposal repeals §355.722, Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers, because the amendment of §355.105 makes this rule obsolete.

The proposal repeals §355.112, Attendant Compensation Rate Enhancement, to implement a requirement of Rider 23. The proposal creates new rule §355.7052, Reimbursement Methodology for Determining Attendant Cost Component, to establish the rate methodology for the attendant cost rate component, which currently exists in §355.112.

The proposal amends §355.456, Reimbursement Methodology; §355.503, Reimbursement Methodology for Long-Term Services and Supports State Plan and Home and Community-Based Services Waiver Program Services Delivered through the STAR+PLUS Managed Care Program; §355.505, Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program; §355.507, Reimbursement Methodology for Long-Term Services and Supports State Plan and Medically Dependent Children Waiver Program Services Delivered through the STAR Kids and STAR Health Managed Care Programs; §355.509, Reimbursement Methodology for Residential Care; §355.513, Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver Program; §355.723, Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs; §355.5902, Reimbursement Methodology for Primary Home Care; and §355.6907, Reimbursement Methodology for Day Activity and Health Services; to replace references to §355.112, which is being repealed by this proposal, with proposed new rule §355.7052. The proposal amends §355.9090, Reimbursement Methodology for Community First Choice, to add a reference to proposed new §355.7052. The proposal amends §355.7051, concerning Base Wage for Personal Attendant, to update the rule title to reflect that this rule will expire on August 31, 2025.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

General Appropriations Act (GAA), Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 25) (Rider 25) and Senate Bill 457, 89th Legislature, Regular Session, 2025 (S.B. 457) provide additional appropriations to fund dietary and administrative costs for nursing facilities. The proposal modifies reimbursement methodology to support the implementation of Rider 25 and S.B. 457.

The proposal repeals §355.304, Direct Care Staff Spending Requirement on or after September 1, 2023, to implement S.B. 457. The proposal adds new §355.305, Annual Patient Care Expense Ratio for Nursing Facilities, to implement the requirement of S.B. 457. The proposal repeals §355.306, Cost Finding Methodology before September 1, 2025, and §355.307, Reimbursement Setting Methodology before September 1, 2025, because the amendment of §355.318 makes these rules obsolete.

The proposal amends §355.318, Reimbursement Setting Methodology for Nursing Facilities on or after September 1, 2025, to implement S.B. 457. The proposal repeals §355.308, concerning Direct Care Staff Rate Component before September 1, 2025, and §355.320, Nursing Care Staff Rate Enhancement Program for Nursing Facilities on or after September 1, 2025, to implement S.B 457. This bill discontinues the Nursing Care Staff Rate Enhancement Program for Nursing Facilities.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

Editorial revisions are made throughout the rules to update formatting, organization, punctuation, and references.

The proposed amendment to §355.102(d) clarifies training requirements for cost report submission. Cost report preparers must complete a required state-sponsored training for each program in which a cost report is required. The training applies to any required reports for that program during the following cost report collection period. The proposed amendment also enables HHSC to require that a contracted provider’s primary entity or financial contacts complete state-sponsored training to certify and submit a cost report. The training would apply to the submission of any other reports in the following calendar year. The proposed amendment also deletes references to accountability reports.

The proposed amendment to §355.105(b) requires that contracted providers’ cost reporting period aligns with the state fiscal year. The proposed amendment also deletes references to the Attendant Compensation Rate Enhancement program and the Direct Care Staff Enhancement program. The proposed amendment to §355.105(i) limits related party attendant staff costs to calculate the methodological attendant cost rate component for programs with attendant services.

Amending 1 TAC §355.112, to repeal this section because the Attendant Compensation Rate Enhancement Program is being discontinued.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER A. COST DETERMINATION PROCESS
1 TAC §355.112

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposal repeals §355.112 because the Attendant Compensation Rate Enhancement Program is being discontinued effective September 1, 2025. The proposal repeals §355.304, §355.306, §355.307, §355.308, and §355.320 because these requirements no longer apply to reimbursement of nursing facilities effective September 1, 2025.

Amending 1 TAC §§355.304, 355.306 – 355.308, 355.320, to repeal the following sections.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §§355.304, 355.306 – 355.308, 355.320

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

Amending 1 TAC §355.305, §355.318, to introduce the new annual patient expense ratio for nursing facilities and clarify how HHSC defines the various components.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.305, §355.318

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed new §355.305(a) introduces the new annual patient expense ratio for nursing facilities effective September 1, 2025. Subsection (b) defines terms used in the rule. Subsection (c) requires that nursing facilities must submit annual cost reports to HHSC. Subsections (d) and (e) establish how HHSC will calculate the annual expense ratio and determine recoupments for nursing facility providers who fail to meet spending requirements. Subsection (f) establishes criteria to exclude nursing facility providers from recoupment for failing to meet spending requirements under subsection (e). Subsection (g) establishes how HHSC will notify nursing facility providers regarding the annual patient expense ratio. Subsection (h) confirms that this section does not apply to state-owned facilities.

The proposed amendment to §355.318(d) clarifies how HHSC defines the nursing, Brief Interview for Mental Status (BIMS), and non-therapy ancillary rate components. The proposal also replaces the non-case-mix rate component with new rate components for dietary costs, operations costs, administration costs, and fixed capital assets costs. The amendment to subsection (e) establishes how HHSC calculates the new dietary, operations, administration, and fixed capital assets rate components. The amendment to subsection (g) replaces the reference to the non-case-mix component with the administration rate component. A reference to the new §355.321, which is also proposed in this issue, Reimbursement Methodology for Intellectual and Developmental Disabilities Nursing Facilities Special Reimbursement Class, is added to subsection (h). New subsection (k) establishes how the Medicaid Swing Bed Program for Rural Hospitals will be reimbursed under this section.

Amending 1 TAC §355.321, to introduce the new special reimbursement class for nursing facilities serving individuals with intellectual and developmental disabilities.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.321

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §355.321, concerning Reimbursement Methodology for Intellectual and Developmental Disabilities Nursing Facility Special Reimbursement Class.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement the 2026-27 General Appropriations Act (GAA), Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 31) (Rider 31). Rider 31 provides appropriations for HHSC to implement a new payment methodology for a new special reimbursement class to achieve improved care for long-term stay nursing facilities (NF) serving residents with intellectual and developmental disabilities (IDD).

SECTION-BY-SECTION SUMMARY

Proposed new §355.321(a) introduces the new special reimbursement class for nursing facilities serving individuals with intellectual and developmental disabilities. Subsection (b) defines terms used in the rule. Subsection (c) establishes how HHSC will calculate payment rates for facilities under this section. Subsection (d) establishes the criteria under which facilities qualify for membership in the special reimbursement class. Subsection (e) establishes the criteria under which facilities could be disqualified from membership in the special reimbursement class.

Amending 1 TAC §355.456, to replace references to §355.112 with proposed new §355.7052 and deletes references to §355.320 and replaces it with §355.318.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER D. REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID)
1 TAC §355.456

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.456(d) replaces references to §355.112 with proposed new §355.7052 and deletes references to §355.320 and replaces it with §355.318. The proposed amendment deletes current subsection (d)(6) related to the High Medical Needs Add-on reimbursement rate before September 1, 2025.

Amending 1 TAC §355.457, to deletes the rule as it is no longer necessary.

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §355.457 deletes the rule as it is no longer necessary because the rule is superseded by the amendment of §355.105.

Amending 1 TAC §§355.503, 355.505, 355.507, 355.509, 355.513, to replace update references.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER E. COMMUNITY CARE FOR AGED AND DISABLED
1 TAC §§355.503, 355.505, 355.507, 355.509, 355.513

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.503(c) replaces references to §355.112 with proposed new §355.7052 and replaces references to §355.509(c)(2)(E)(iii) with reference to §355.509(c)(2).

The proposed amendment to §355.505(b) replaces references to the “Department of Aging and Disability Services (DADS)” with “the Texas Health and Human Services Commission (HHSC)” and replaces references to §355.112 with proposed new §355.7052 in subsection (c) and deletes information about the attendant compensation rate enhancement in §355.505(b)(2)(A).

The proposed amendment to §355.507(c) replaces references to §355.112 with new §355.7052.

The proposed amendment to §355.509(c) replaces references to §355.112 with proposed new §355.7052. The proposed amendment to subsection (d) replaces a reference to “DADS” with “HHSC.”

The proposed amendment to §355.513(c) replaces references to §355.112 with proposed new §355.7052.

Amending 1 TAC §355.722, to repeal the section because it is no longer necessary.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §355.722

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §355.722 deletes the rule as it is no longer necessary because the rule is superseded by the amendment of §355.105.

Amending 1 TAC §355.723, to update references.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §355.723

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.723(c) replaces references to §355.112 with proposed new §355.7052 and deletes a reference to §355.722 and replaces it with §355.102.

Amending 1 TAC §355.5902, §355.6907, to replace references.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER G. ADVANCED TELECOMMUNICATIONS SERVICES AND OTHER COMMUNITY-BASED SERVICES
1 TAC §355.5902, §355.6907

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.5902(c) replaces references to §355.112 with proposed new §355.7052.

The proposed amendment to §355.6907(a) and subsection (h) replaces a reference to “Department of Aging and Disability Services (DADS)” with “Texas Health and Human Services Commission (HHSC).” The amendment of subsection (f) replaces references to §355.112 with proposed new §355.7052.

Amending 1 TAC §355.7051, §355.7052, to change the title of the rule and introduce the rate methodology for the attendant cost component.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER H. ATTENDANT COST DETERMINATION
1 TAC §355.7051, §355.7052

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.7051 retitles the rule to “Base Wage for a Personal Attendant before September 1, 2025” to establish that the rule applies before September 1, 2025.

Proposed new §355.7052(a) introduces the rate methodology for the attendant cost component. Subsection (b) defines terms used in the rule. Subsection (c) establishes the attendant cost center. Subsection (d) lists the programs and services that apply to this section. Subsection (e) establishes how HHSC will calculate the attendant cost component for the applicable programs and services. Subsection (f) establishes how HHSC will calculate the attendant cost component for services delivered through the Consumer Directed Services (CDS) option. Subsection (g) specifies that the attendant cost component is limited to available appropriations.

Amending 1 TAC §355.9090, to revise how the Community First Choice- State Plan Attendant and Habilitation rate is calculated.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER M. MISCELLANEOUS PROGRAMS
DIVISION 7. COMMUNITY FIRST CHOICE
1 TAC §355.9090

OVERVIEW

BACKGROUND AND PURPOSE

The proposal revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The proposal revises the rate methodology for Nursing facilities (NFs), implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

The proposal amends §355.102, General Principles of Allowable and Unallowable Costs, to update the language for the cost report training requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.9090(b) revises how the Community First Choice- State Plan Attendant and Habilitation rate is calculated by defining an attendant rate component and an administration and operations rate component.

Amending 26 TAC §259.51, to amend the cost for the individual’s IPC CLASS Program services to be 210 percent of the annualized cost of care in an ICF/IID using the unweighted average of the current non-state-operated small facility daily rates for levels of need 1, 5, and 8.

CHAPTER 259. COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW
DIVISION 1. ELIGIBILITY AND MAINTENANCE OF THE CLASS INTEREST LIST
26 TAC §259.51

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §259.51, concerning Eligibility Criteria for CLASS Program Services and CFC Services.

BACKGROUND AND PURPOSE

The 2026-2027 General Appropriations Act, Senate Bill 1, 89th Texas Legislature, Regular Session, 2025 (Article II, HHSC Rider 23) includes appropriations to increase the base wage for personal attendant services. This wage increase will impact Medicaid personal attendant reimbursement rates.

As a result of this direction and prior reimbursement rate increases, HHSC proposes to amend the waiver cost limit, where applicable, for the Community Living Assistance and Support Services (CLASS) waiver program to ensure the cost limits align with the rate increases. The purpose for increasing the waiver cost limit for an individual’s plan of care (IPC) is to off-set the cost of higher personal attendant reimbursement rates while allowing the individual to continue to qualify for services in the CLASS Program by not exceeding the cost limit for the IPC.

HHSC will also propose an amendment in the waiver cost limit for an individual’s IPC in the Deaf Blind with Multiple Disabilities and Texas Home Living Programs, and the waiver cost limits in the Home and Community-based Services Program, in this same issue of the Texas Register .

SECTION-BY-SECTION SUMMARY

The proposed amendment to §259.51(a)(4) amends the cost for the individual’s IPC CLASS Program services to be 210 percent of the annualized cost of care in an ICF/IID using the unweighted average of the current non-state-operated small facility daily rates for levels of need 1, 5, and 8, rounded to the nearest dollar. This change provides more funding to pay for the services an individual needs, including the higher cost for personal attendant-like services, while maintaining eligibility for the program.

Amending 26 TAC §260.51, to amend the cost for the individual’s IPC TxHmL Program services to not exceed 50 percent of the annualized cost of care in an ICF/IID using the current non-state-operated small facility daily rate for level of need 1.

CHAPTER 262. TEXAS HOME LIVING (TxHmL) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW

26 TAC §262.101
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §262.101, concerning Eligibility Criteria for TxHmL Program Services and CFC Services.

BACKGROUND AND PURPOSE

As a result of this direction and prior reimbursement rate increases, HHSC proposes to amend the waiver cost limit, where applicable, for the Texas Home Living (TxHmL) waiver program to ensure the cost align with the rate increases. The purpose for increasing the waiver cost limit for an individual’s plan of care (IPC) is to off-set the cost of higher personal attendant reimbursement rates while allowing the individual to continue to qualify for services in the TxHmL Program by not exceeding the cost limit for the IPC.

HHSC will also propose an amendment in the waiver cost limit for an individual’s IPC in the Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities, and the waiver cost limits in the Home and Community-based Services Programs in this same issue of the Texas Register .

SECTION-BY-SECTION SUMMARY

The proposed amendment to §262.101(a)(4) amends the cost for the individual’s IPC TxHmL Program services to not exceed 50 percent of the annualized cost of care in an ICF/IID using the current non-state-operated small facility daily rate for level of need 1, rounded to the nearest dollar. This change provides more money to pay for the services an individual needs, including the higher cost to pay for personal attendant-like services, while maintaining eligibility for the program.

Amending 26 TAC §263.101, to amend the cost for the individual’s IPC HCS Program services to be 210 percent of the annualized cost of care in an ICF/IID using the current non-state-operated small facility daily rate for level of need (LON) 8.

CHAPTER 263. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER B. ELIGIBILITY, ENROLLMENT, AND REVIEW
26 TAC §263.101

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §263.101, concerning Eligibility Criteria for HCS Program Services and CFC Services.

BACKGROUND AND PURPOSE

As a result of this direction and prior reimbursement rate increases, HHSC proposes to amend the waiver cost limit, where applicable, for the Home and Community-based Services waiver program to ensure the cost limits align with the rate increases. The purpose for increasing the waiver cost limit for an individual’s plan of care (IPC) is to off-set the cost of higher personal attendant reimbursement rates while allowing the individual to continue to qualify for services in the HCS Program by not exceeding the cost limit for the IPC.

HHSC will also propose an amendment in the waiver cost limit for an individual’s IPC in the Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities, and Texas Home Living Programs in this same issue of the Texas Register .

SECTION-BY-SECTION SUMMARY

The proposed amendment to §263.101(a)(3)(A) amends the cost for the individual’s IPC HCS Program services to be 210 percent of the annualized cost of care in an ICF/IID using the current non-state-operated small facility daily rate for level of need (LON) 8, rounded to the nearest dollar for an applicant or individual with an LON 1, LON 5, or LON 8. This change provides more money to pay for the services an individual needs, including the higher cost to pay for personal attendant-like services, while maintaining eligibility for the program.

The proposed amendment to §263.101(a)(3)(B) amends the cost for the individual’s IPC HCS Program services to be 210 percent of the annualized cost of care in an ICF/IID using the current non-state-operated small facility daily rate for LON 6, rounded to the nearest dollar for an applicant or individual with an LON 6. This change provides more money to pay for the services an individual needs, including the higher cost to pay for personal attendant-like services, while maintaining eligibility for the program.

The proposed amendment to §263.101(a)(3)(C) amends the cost for the individual’s IPC HCS Program services to be 210 percent of the annualized cost of care in an ICF/IID using the current non-state-operated small facility daily rate for LON 9, rounded to the nearest dollar for an applicant or individual with an LON 9. This change provides more money to pay for the services an individual needs, including the higher cost to pay for personal attendant-like services, while maintaining eligibility for the program.

Amending 26 TAC §745.8301, to expand the definition of kinship foster home, update language, and rename the section.

CHAPTER 745. LICENSING
SUBCHAPTER J. WAIVERS AND VARIANCES FOR MINIMUM STANDARDS
26 TAC §745.8301

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §745.8301, concerning What words must I know to understand this subchapter, in Title 26, Texas Administrative Code, Chapter 745, Licensing.

BACKGROUND AND PURPOSE

The purpose of this proposal is to implement House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023, which requires Child Care Regulation (CCR) to collaborate with the Department of Family and Protective Services (DFPS) to develop and adopt a set of licensing and approval standards for kinship foster homes pursuant to the adoption of federal rules. The Administration for Children and Families amended 45 Code of Federal Regulations (CFR) Parts 1355 and 1356, with the amendments effective on November 27, 2023. The amendments allow CCR to adopt a set of licensing or approval standards for all kinship foster homes that (1) are different from the standards used for non-kinship foster homes, and (2) will allow a child-placing agency (CPA) to issue a foster home verification to a kinship foster home that meets the new standards.

CCR is proposing an amendment to §745.8301(3) to amend the definition of “kinship foster home” to be consistent with how the term is defined across CCR and DFPS rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §745.8301 (1) expands the definition of kinship foster home to include foster parents who have a longstanding and significant relationship with the foster child’s family; (2) removes language from the rule for consistency with language in DFPS rules and (3) replaces “Licensing” with “Child Care Regulation (CCR)”; and (4) renames the section to “Definitions for Subchapter J.”

Amending 26 TAC §749.2472, to delete the rule as it is no longer necessary.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER M. FOSTER HOMES: SCREENINGS AND VERIFICATIONS
DIVISION 3. VERIFICATION OF FOSTER HOME
26 TAC §749.2472

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §749.2472 and new §§749.4401, 749.4403, 749.4421, 749.4423, 749.4425, 749.4427, 749.4429, 749.4441, 749.4443, 749.4445, 479.4447, 479.4449, 749.4451, 749.4461, 749.4463, 749.4465, 749.4471, 749.4473, 749.4475, 749.4477, 749.4479, 749.4481, 749.4483, 749.4485, 749.4487, 749.4489, 749.4491, 749.4493, 749.4501, 749.4503, 749.4505, 749.4507, 749.4509, 749.4511, 749.4513, 749.4515, 749.4517, 749.4519, 749.4521, 749.4523, 749.4551, 749.4553, 749.4555, 749.4557, 749.4559, 749.4561, 749.4563, 749.4565, 749.4567, 749.4569, 749.4571, 749.4573, 749.4575, 749.4577, 749.4579, and 749.4581 in Texas Administrative Code, Title 26, Chapter 749, Minimum Standards for Child-Placing Agencies.

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §749.2472 deletes the rule as it is no longer necessary because the content of the rule has been modified and moved to new §749.4503(a)(2).

Amending 26 TAC §749.4401, §749.4403, to define terms and establish the requirements for a kinship foster home verification.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 1. DEFINITIONS AND SCOPE
26 TAC §749.4401, §749.4403

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4401, Definitions for Subchapter W, provides terms and definitions that are used throughout the subchapter. The rule (1) includes definitions for the terms “affinity” and “consanguinity,” which are identical to the definitions found in Chapter 745, Licensing, Subchapter A, §745.21; and (2) adds definitions for “kinship caregiver,” “kinship foster child,” “kinship foster home,” “kinship foster home verification,” and “kinship foster parent.”

Proposed new §749.4403, Scope, establishes that a CPA must comply with the rules in new Subchapter W (1) before issuing a kinship foster home verification and (2) while the kinship foster home verification is in effect. It also identifies the other subchapters in Chapter 749 that apply to kinship foster homes. The rule clarifies that if a home is both a foster family home and a kinship foster home, the home may follow the rules in Subchapter W relating to the direct care of a kinship foster child, but the home must: (1) be verified as a kinship foster home; and (2) follow all other applicable rules in Chapter 749 for non-kinship foster children.

Amending 26 TAC §§749.4421, 749.4423, 749.4425, 749.4427, 749.4429, to set out the requirements for documentation of required trainings; pre-verification training; pediatric first aid and pediatric cardiopulmonary resuscitation; and other general as well as additional training.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 2. PRE-VERIFICATION AND ONGOING TRAINING REQUIREMENTS
26 TAC §§749.4421, 749.4423, 749.4425, 749.4427, 749.4429

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4421, Documentation of Required Trainings, establishes documentation requirements for required trainings. The rule requires a CPA to document the completion of all required trainings and signed agreements. It also requires that certificates for pediatric first aid and pediatric cardiopulmonary resuscitation have an expiration date and be renewed prior to the expiration date. The rule clarifies that if a CPA requires a home to complete additional training, the documentation must include (1) the topics covered; (2) the curriculum used; and (3) how the CPA determined which training topics to use.

Proposed new §749.4423, Pre-Verification Training Requirements, establishes pre-verification training requirements. The rule requires each kinship caregiver to have pre-verification training that includes: (1) an overview of the minimum standards in Chapter 749 the kinship caregiver must follow; (2) the CPA’s philosophy, structure, policies, and services; (3) a review of the prudent parent standard; (4) a review of the agreements between the CPA and kinship foster parents; and (5) a review of the CCR Statement of Foster Parents and Child-Placing Agency Rights and Responsibilities.

Proposed new §749.4425, Pediatric Fist Aid and Pediatric Cardiopulmonary Resuscitation (CPR) Requirements, requires one kinship foster parent to be certified in pediatric first aid and pediatric CPR prior to the home’s verification. The rule allows subsequent caregivers to be certified within 90 days after the CPA issues the home’s verification. The rule clarifies that the training must (1) include rescue breathing and choking, and (2) adhere to guidelines for CPR established by the American Heart Association.

Proposed new §749.4427, General Training Requirements, establishes the general training requirements and timeframes for completion for kinship caregivers. The rule requires all kinship caregivers to complete four hours of general training and at least six hours of emergency behavior intervention training within 60 days after the CPA issues the home’s verification. If the home will care for children younger than two years of age, it also requires one kinship foster parent to complete safe sleep training prior to the CPA verifying the home; the rule additionally requires all other caregivers in the home to complete safe sleep training within 90 days after the verification. For all caregivers that administer psychotropic medication, the rule requires them to complete training on administering psychotropic medication prior to administering the medication. The rule specifies that general caregiver training must include specific curriculum requirements; however, for the other trainings, the CPA must determine the appropriate curriculum.

Proposed new §749.4429, Additional Training Requirements, establishes the additional training requirements for kinship caregivers. The rule requires the CPA to annually evaluate the kinship foster home for any areas of non-compliance with minimum standards. If the CPA identifies areas of non-compliance with minimum standards, the rule requires the CPA to provide all kinship caregivers in the home with additional training appropriate to the areas of non-compliance. The rule also requires the CPA to provide at least one hour of annual training to each kinship foster parent that provides care to a kinship foster child receiving treatment services for emotional disorders, intellectual disabilities, or autism spectrum disorder.

Amending 26 TAC §§749.4441, 749.4443, 749.4445, 749.4447, 749.4449, 749.4451, to

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 3. ADMISSION AND PLACEMENT
26 TAC §§749.4441, 749.4443, 749.4445, 749.4447, 749.4449, 749.4451

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4441, Admission Criteria, establishes criteria for admitting a kinship foster child. The rule (1) allows for regular or emergency admissions; (2) requires the CPA to ensure the placement meets the kinship foster child’s needs; and (3) establishes situations when an individual over the age of 18 years old can remain in care or be admitted into the care of a kinship foster home.

Proposed new §749.4443, Documentation of Admission Information, specifies the admission information that a CPA must document into a kinship foster child’s record.

Proposed new §749.4445, Initial Requirements at the Time of Admission or Verification, establishes the initial admission requirements for a kinship foster child. The rule requires the CPA to obtain specific information about the child, including (1) the circumstances that brought the child into care; (2) the child’s current health status and medical conditions; (3) high-risk behaviors, including a suicide risk screening when applicable; (4) known contraindications to the use of restraint; and (5) any safety plans the kinship caregiver will implement related to the behaviors or risk factors.

Proposed new §749.4447, Placement Agreement, describes the general purpose of a placement agreement and specifies what the agreement must include.

Proposed new §749.4449, Admission Assessment, establishes requirements for the admission assessment. The rule describes functions for which the CPA must use information obtained during the assessment; timeframes for when the assessment must be completed; and what the assessment must include. For a child who is over three years of age, the rule also allows the CPA to use a written assessment of the child’s needs provided by DFPS in lieu of the admission assessment; this documentation is presently entitled the Child Assessment of Needs and Strengths (CANS).

Proposed new §749.4451, Post-Placement Contacts, establishes requirements for post-placement contacts with the kinship foster child. The rule requires the CPA to have monthly face-to-face contact with a kinship foster child. The rule establishes requirements for the length and content of the visits.

Amending 26 TAC §§749.4461, 749.4463, 749.4465, to establish documentation requirements related to medical and dental care, general medical, dental, and medication requirements, and requirements for immunizations and tuberculosis testing for kinship foster children.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 4. MEDICAL AND DENTAL REQUIREMENTS
26 TAC §§749.4461, 749.4463, 749.4465

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4461, Documentation Requirements for Medical and Dental Care, establishes documentation requirements related to medical and dental care. The rule specifies information the CPA must verify is documented in the kinship foster child’s health passport or record; information a kinship foster home must maintain in a daily medication log for the child on a form provided by the CPA; and documentation requirements when a kinship caregiver fails to administer any medication to the child according to the medication label or subsequent signed orders.

Proposed new §749.4463 General Medical, Dental, and Medication Requirements, establishes the general medical, dental, and medication requirements. The rule describes requirements for medical and dental care that a kinship foster child must receive and requires (1) a kinship foster child to receive timely routine and emergency medical and dental care; (2) the CPA to verify that a kinship foster child at least three years of age has had (A) a medical examination in the last year and (B) a dental examination in the last year; (3) all medications to be administered according to the label or to a prescriber’s subsequent signed orders; and (4) all medications to be stored securely and in a way that makes them inaccessible to kinship foster children.

Proposed new §749.4465, Immunization and Tuberculosis Testing, establishes requirements for immunizations and tuberculosis testing for kinship foster children.

Amending 26 TAC §§749.4471, 749.4473, 749.4475, 749.4477, 749.4479, 749.4481, 749.4483, 749.4485, 749.4487, 749.4489, 749.4491, 749.4493, to establish kinship foster parent requirements for toddlers and infants.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 5. DAILY CARE, EDUCATION, AND DISCIPLINE
26 TAC §§749.4471, 749.4473, 749.4475, 749.4477, 749.4479, 749.4481, 749.4483, 749.4485, 749.4487, 749.4489, 749.4491, 749.4493

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4471, Normalcy, requires a kinship foster parent to ensure a kinship foster child can participate in childhood activities, including unsupervised activities, that are appropriate in relation to the child’s age and developmental needs.

Proposed new §749.4473, Infants: Basic Care and Supervision, establishes basic care and supervision requirements for infants in a kinship foster home. The rule establishes (1) that infants receive individual and prompt attention; (2) environmental requirements, including (A) keeping the area free of harmful objects, including diaper changing items, and (B) ensuring electrical outlets are inaccessible; and (3) that an infant may never be left unsupervised. The rule defines what is considered supervision for a sleeping infant, an awake infant, and further establishes supervision requirements.

Proposed new §749.4475, Infants: Cribs, establishes crib requirements for infants. The rule (1) requires a kinship foster home to have an individual crib that meets certain requirements for an infant; (2) clarifies when the home may use a full-sized, portable, or mesh-side crib; (3) prohibits (A) using a stackable crib for an infant and (B) leaving an infant in a crib portable crib, or mesh-side crib with a side folded down; (4) clarifies that special items may be used to assist with safe sleep in a crib used by an infant with primary medical needs with the written recommendation from a health care professional; and (5) requires the CPA to notify the parent of each child in care of each foster home verified by the CPA if specific rules in this section are cited as deficient.

Proposed new §749.4477, Infants: Safe Sleep Requirements, establishes safe sleep requirements for infants. The rule requires kinship caregivers to (1) place an infant who is unable to turn over unassisted in a face up sleeping position unless they have signed orders from a health care professional; (2) ensure the infant’s head, face, and crib are not covered by any item; (3) ensure the infant does not (A) co-sleep with an adult or (B) sleep in a restrictive device, such as a car seat, swing, or highchair; and (4) ensure infants who can roll over are not swaddled. The rule requires the CPA to notify the parent of each child in care of each foster home verified by the CPA if specific rules in this section are cited as deficient.

Proposed new §749.4479, Infants: Equipment Safety, establishes equipment safety requirements for infants.

Proposed new §749.4481, Infants: Feeding Requirements, establishes feeding requirements for infants. The rule requires kinship caregivers to (1) feed an infant based on the recommendations of the infant’s health-care professional; (2) hold infants birth through six months old or unable to sit unassisted while feeding; (3) never prop a bottle with anything other than the infant’s or adult’s hands; and (4) sterilize shared bottles and clean highchair trays before each use when caring for more than one infant.

Proposed new §749.4483, Toddlers: Basic Care Requirements, establishes basic care requirements for toddlers. The rule includes (1) environmental requirements, including (A) keeping the area free of harmful objects, and (B) ensuring electrical outlets are inaccessible; and (2) supervision requirements, including (A) never leaving a toddler unsupervised, and (B) ensuring the toddler is within eyesight or hearing range. The rule allows for the use of video camera or audio monitoring if the kinship caregiver is close enough to intervene as needed.

Proposed new §749.4485, Additional Requirements for Pregnant Kinship Foster Children, establishes additional requirements for pregnant kinship foster children. The rule requires the CPA to ensure information, training, and counseling is available to the kinship foster child.

Proposed new §749.4487, Additional Requirements for Kinship Foster Children Receiving Treatment Services for Primary Medical Needs or Intellectual Disabilities, establishes additional requirements for kinship foster children receiving treatment services for primary medical needs or intellectual disabilities. The rule requires kinship caregivers to (1) follow recommendations from the kinship foster child’s medical providers; and (2) ensure that a kinship foster child receiving treatment services for primary medical needs or an intellectual disability has opportunities for sensory stimulation.

Proposed new §749.4489, Educational Services: General, establishes general educational requirements for kinship foster children. The rule requires the CPA to arrange appropriate education that includes an approved or accredited educational facility or program, and to advocate for a kinship foster child to receive educational and related services to which they are entitled under federal and state law. The rule establishes specific requirements for kinship foster children with autism spectrum disorder. The rule also requires the CPA to designate a liaison between the agency and the school for a kinship foster child who receives treatment services.

Proposed new §749.4491, Education Services: Caregiver Responsibilities, establishes kinship caregiver responsibilities related to education. The rule requires kinship caregivers to (1) request educational meetings with the school if concerns are identified; (2) attend scheduled educational meetings and staffings; and (3) know what is in the kinship foster child’s Individual Education Plan.

Proposed new §749.4493, Discipline and Punishment, establishes discipline and punishment requirements in a kinship foster home. The rule requires (1) only a kinship caregiver known to a kinship foster child can discipline the child; and (2) all disciplinary measures be consistent with child’s rights related to discipline and punishment.

Amending 26 TAC §§749.4501, 749.4503, 749.4505, 749.4507, 749.4509, 749.4511, 749.4513, 749.4515, 749.4517, 749.4519, 749.4521, 749.4523, to establish the general requirements for kinship foster home verification and screening.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 6. SCREENINGS AND VERIFICATIONS
26 TAC §§749.4501, 749.4503, 749.4505, 749.4507, 749.4509, 749.4511, 749.4513, 749.4515, 749.4517, 749.4519, 749.4521, 749.4523

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4501, General Requirements, establishes the general requirements for a kinship foster home verification. The rule (1) requires kinship parents to be at least 18 years old; (2) establishes circumstances when a CPA can verify an individual spouse as a kinship foster parent; and (3) prohibits a kinship foster home from being verified by more than one CPA at a time for kinship foster care services.

Proposed new §749.4503, Kinship Foster Home Screenings, establishes the steps that a CPA takes to complete a home screening for a kinship foster home. The rule clarifies that the CPA (1) may (A) complete the home screening as detailed in the rule, or (B) use a completed home assessment obtained from the Department of Family and Protective Services (DFPS) or Single Source Continuum Contractor (SSCC) that meets the requirements of the Subchapter W, Division 5; and (2) must update a kinship foster home screening any time there is a major life change. The rule describes the specific categories of information that the CPA must discuss, document, and assess through interviews with each prospective kinship foster parent and joint interviews. The rule also requires a CPA to report to CCR any information obtained about domestic violence.

Proposed new §749.4505, Verifying a Kinship Foster Home, establishes steps the CPA takes to complete a kinship foster home verification. The rule requires the CPA to (1) complete and document requirements of Subchapter W, Division 5; (2) obtain a sketch or photo of the inside and outside of the home; (3) inspect the home and ensure and document compliance with applicable rules relating to Daily Care, Education, and Discipline, and Health and Safety Requirements, Environment, Space, and Equipment; (4) evaluate and make recommendations about the home’s ability to keep children safe; (5) document (A) any indicators of substantial safety risk to children based on the evaluation of the home and (B) how the CPA addressed them prior to approving and verifying the home; (6) obtain from the child placement management staff (CPMS) (A) review and approval of the home screening and (B) recommendation for verification of the home; and (7) issue a verification certificate that includes (A) the name of the kinship foster family, (B) capacity details, and (C) services the kinship foster home provides.

Proposed new §749.4507, Previously Verified Kinship Foster Homes, establishes requirements for working with kinship foster homes that were previously verified by or transferring from another CPA.

Proposed new §749.4509, Releasing Information About a Previously Verified Kinship Foster Home, establishes requirements for releasing information about a previously verified kinship foster home. The rule requires a CPA to release background information about current and previous kinship foster homes to other CPAs and independent contractors who are hired or required by the court.

Proposed new §749.4511, Changes to the Verification Status of a Kinship Foster Home, establishes requirements for changing the verification status of a kinship foster home. The rule (1) describes changes a CPA must inform CCR about within two business days; (2) requires that child placement management staff ensure that any additional services offered by a kinship foster home do not create a conflict of care with children currently in the home; and (3) includes requirements for when a kinship foster home adds a new, unrelated household member.

Proposed new §749.4513, Transferring or Closing a Kinship Foster Home, establishes the criteria for a transfer or closing summary for a kinship foster home, including what the summary must include and timeframes for their completion.

Proposed new §749.4515, Temporary Kinship Foster Home Verifications, establishes criteria for issuing a temporary kinship foster home verification, including inspection requirements, that the temporary verification can be valid for a maximum of six months, and that the CPA must ensure compliance with requirements in subchapter W before issuing a non-expiring kinship foster home verification to the home at the new location.

Proposed new §749.4517, Capacity and Child/Caregiver Ratio, establishes capacity and child/caregiver ratio for a kinship foster home.

Proposed new §749.4519, Supervision, establishes supervision requirements at a kinship foster home. The rule addresses what the CPA must ensure that the supervision of a kinship foster child accounts for; describes the responsibilities of a kinship caregiver; and information that a kinship caregiver must have when a kinship foster child participates in an unsupervised childhood activity.

Proposed new §749.4521, Kinship Foster Children as Babysitters, establishes requirements for when a kinship foster child may act as a babysitter.

Proposed new §749.4523, Respite Child-Care Services, establishes that a kinship foster home may only provide respite care services for kinship foster children. The rule requires the CPMS to (1) approve of any respite placement to ensure the respite care will not cause a conflict of care; and (2) ensure information is shared about kinship foster children for continuity of care.

Amending 26 TAC §§749.4551, 749.4553, 749.4555, 749.4557, 749.4559, 749.4561, 749.4563, 749.4565, 749.4567, 749.4569, 749.4571, 749.4573, 749.4575, 749.4577, 749.4579, 749.4581, to define health and safety procedures and requirements.

CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
SUBCHAPTER W. KINSHIP FOSTER HOMES
DIVISION 7. HEALTH AND SAFETY REQUIREMENTS, ENVIRONMENT, SPACE, AND EQUIPMENT
26 TAC §§749.4551, 749.4553, 749.4555, 749.4557, 749.4559, 749.4561, 749.4563, 749.4565, 749.4567, 749.4569, 749.4571, 749.4573, 749.4575, 749.4577, 749.4579, 749.4581

OVERVIEW

BACKGROUND AND PURPOSE

CCR is proposing the repeal of §749.2472 and new rules, in new Subchapter W of Chapter 749, to establish a CPA’s ability to issue a non-expiring foster home verification to a kinship foster home.

SECTION-BY-SECTION SUMMARY

Proposed new §749.4551, Documentation of Health and Safety Requirements, establishes what a CPA must document in a kinship foster home’s record related to health and safety requirements.

Proposed new §749.4553, Health and Fire Inspections, establishes requirements for health and fire inspections or evaluations at a kinship foster home. The rule describes who must conduct each type of inspection or evaluation and requires a home to correct deficiencies and comply with any conditions or restrictions.

Proposed new §749.4555, Emergency Plans, establishes requirements for a written plan that a kinship foster home must have for handling potential disasters and emergencies, including fire and severe weather. The rule requires the CPA that verified the home to annually review and evaluate the plan with all kinship caregivers and kinship foster children in the home. The rule allows the CPA to develop the plan or to obtain a copy of the plan the kinship foster family developed with DFPS or the relevant Single Source Continuum Contractor.

Proposed new §749.4557, Fire Safety, establishes fire safety requirements. The rule includes the places in a kinship foster home where there must be a working smoke detector; a requirement for the home to have at least one non-expired and operational fire extinguisher that is accessible in an emergency; and that the home must ensure that exits to the home are not blocked.

Proposed new §749.4559, Animals, requires that any animals in a kinship foster home do not pose a health or safety threat to kinship foster children.

Proposed new §749.4561, Weapons, Firearms, Explosive Materials, and Projectiles at a Kinship Foster Home, establishes requirements related to weapons, firearms, explosive materials, and projectiles at a kinship foster home. The rule requires a CPA to have a policy identifying specific precautions to ensure that a kinship foster child does not have unsupervised access to these items; requires the CPA to determine whether it is appropriate for a specific kinship foster child to use a weapon, firearm, explosive material, or projectile or to use a toy that explodes or shoots; and exempts a firearm that is inoperable and solely ornamental from storage requirements.

Proposed new §749.4563, Storage of Weapons, Firearms, Explosive Materials, or Projectiles in a Kinship Foster Home, establishes what factors the CPA must consider when determining if a weapon, firearm, explosive material, or projectile is stored adequately in a kinship foster home. The rule specifies that a CPA may not require a kinship foster home to disclose the specific types of firearms that are stored or otherwise present in the kinship foster home, nor may a CPA require a kinship foster home to notify the CPA if there is any change in the types of firearms present in the home.

Proposed new §749.4565, Determining Weapons, Firearms, Explosive Materials, or Projectiles are Present in a Kinship Foster Home, establishes how a CPA determines if weapons, firearms, explosive materials, and projectiles are present at a kinship foster home. The rule requires the CPA to assess this information during the home screening and document (1) whether weapons, firearms, explosive materials, or projectiles are present in the home; and (2) specific precautions the kinship caregiver must take to ensure that the kinship foster children do not have unsupervised access. The rule specifies that a CPA may not require a kinship foster home to disclose the specific types of firearms that are present in the kinship foster home or to notify the CPA if there is any change in the types of firearms present in the home. The rule further requires the CPA to discuss these items with the kinship foster home during the two-year evaluation.

Proposed new §749.4567, Transporting a Kinship Foster Child in a Vehicle Where Firearms, Explosive Materials, or Projectiles are Present, establishes requirements for transporting a kinship foster child in a vehicle where firearms, explosive materials, or projectiles are present. Due to the statutory requirements in Texas Human Resources Code §42.042(e-2), the rule addresses requirements related to transporting a child in a vehicle where a handgun is present separately from requirements related to transporting a child in a vehicle where another type of firearm or an explosive material or projectile is present.

Proposed new §749.4569, Physical Environment of a Kinship Foster Home, establishes requirements related to the safety of indoor and outdoor space and equipment. The rule requires the home to ensure that indoor and outdoor space and equipment do not pose a safety risk to kinship foster children. The rule also includes supervision requirements to prevent a kinship foster child from having access to space or equipment, if necessary, based on the child’s age, maturity, and service plan restrictions.

Proposed new §749.4571, Indoor Space: Sleeping Spaces and Sleeping Surfaces, establishes requirements related to sleeping spaces and surfaces used by a kinship foster child, as well as what CPMS must determine and document before approving a kinship foster child to share a sleeping space or surface with another individual.

Proposed new §749.4573, Indoor Space: Bathrooms, describes bathroom requirements for a kinship foster home.

Proposed new §749.4575, Nutrition and Food Safety, establishes requirements for food and food safety at a kinship foster home, including that (1) kinship caregivers provide kinship foster children with drinking water and food that is served in a safe and sanitary manner; and (2) all food items are stored in a manner that protects them from contamination, spoiling, and insects and rodents.

Proposed new §749.4577, Transportation, establishes requirements for transporting a kinship foster child. The rule requires (1) kinship caregivers to secure safe and reliable transportation; (2) special provisions to be made for transporting non-ambulatory and non-mobile children; and (3) each kinship foster child to be secured in a safety seat or safety belt appropriate to their age, height, and weight.

Proposed new §749.4579, Water Safety: Pools, Hot Tubs, and Bodies of Water, establishes general water safety rules. The rule includes requirements related to a door alarm or lock; the bottom of a pool having to be visible; and swimming pool chemicals and machinery being inaccessible to kinship foster children.

Proposed new §749.4581, Swimming Supervision, establishes supervision requirements for swimming activities. The rule requires kinship caregivers to (1) inform each kinship foster child about house rules related to water activities; (2) adequately supervise and monitor kinship foster children while participating in water activities; (3) ensure that a kinship foster child has access to a lifesaving device when participating in water activities; and (4) be able to clearly see all parts of the swimming pool or hot tub while supervising. The rule defines “personal floatation device” (PFD) and requires a kinship foster child who is unable to swim to wear a PFD of the correct size for the child while participating in water activities.

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 to receive public comments on proposed Medicaid payment Rates for the 89th Legislative Session: Rural Hospital Inpatient Rates, Rural Hospital Outpatient Rates, and Rural Hospital Obstetrics-Gynecology (OB-GYN) Standard Dollar Amount (SDA) Add-On. Proposed legislative rate actions are based on direction provided by the 2026-27 General Appropriations Act (GAA), Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 8(h)) and the Rural Health Stabilization and Innovation Act, House Bill 18, 89th Legislature, Regular Session, 2025 (Section 532.0155(g)).

Public Notice: Texas State Plan for Medical Assistance Amendment

The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendment, transmittal number 25-0028, 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 the amendment, transmittal number 25-0024, 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 Examiners of Psychologists

Adopted Rules Re:

Adopting 22 TAC §463.35, to clarify the required professional development a licensee must receive when providing services to unique populations.

CHAPTER 463. APPLICATIONS AND EXAMINATIONS
SUBCHAPTER F. PROFESSIONAL DEVELOPMENT
22 TAC §463.35

OVERVIEW

The Texas Behavioral Health Executive Council on behalf of the Texas State Board of Examiners of Psychologists adopts amendments to §463.35, relating to Professional Development. Section 463.35 is amended without changes as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2044) and will not be republished.

BACKGROUND AND PURPOSE

The amendments will clarify the nature of professional development a licensee must receive related to maintaining competency when providing ser-vices to unique populations.

Adopting 22 TAC §465.38, to update the description of the scope of practice for Licensed Specialists in School Psychology.

CHAPTER 465. RULES OF PRACTICE
22 TAC §465.38

OVERVIEW

The Texas Behavioral Health Executive Council on behalf of the Texas State Board of Examiners of Psychologists adopts amendment to §465.38, relating to Psychological Services for Schools. Section 465.38 is amended without changes as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2046) and will not be republished.

BACKGROUND AND PURPOSE

The amendments will update the description of the scope of practice for Licensed Specialists in School Psychology to better reflect the full scope of practice and align with national standards, without substantively altering the scope of practice.

Texas State Board of Examiners of Professional Counselors

Adopted Rules Re:

Adopting 22 TAC §681.72, to remove the expiration provisions of supervision training courses required for applications for supervisor status.

CHAPTER 681. PROFESSIONAL COUNSELORS
SUBCHAPTER C. APPLICATION AND LICENSING
22 TAC §681.72

OVERVIEW

The Texas Behavioral Health Executive Council on behalf of the Texas State Board of Examiners of Professional Counselors adopts amendments to §681.72, relating to Required Application Materials. Section 681.72 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2048) and will not be republished.

BACKGROUND AND PURPOSE

The amendments would remove the expiration provisions related to supervision training courses required for applications for supervisor status.

Adopting 22 TAC §681.140, to clarify the required professional development a licensee must receive when providing services to unique populations.

CHAPTER 681. PROFESSIONAL COUNSELORS
SUBCHAPTER C. APPLICATION AND LICENSING
22 TAC §681.140

OVERVIEW

The Texas Behavioral Health Executive Council on behalf of the Texas State Board of Examiners of Professional Counselors adopts amendments to §681.140, relating to Requirements for Continuing Education. Section 681.140 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2050) and will not be republished.

BACKGROUND AND PURPOSE

The amendments will clarify the nature of professional development a licensee must receive related to maintaining competency when providing services to unique populations.

Texas State Board of Social Worker Examiners

Adopted Rules Re:

Adopting 22 TAC §781.501, to clarify the required professional development a licensee must receive when providing services to unique populations.

CHAPTER 781. SOCIAL WORKER LICENSURE
SUBCHAPTER C. APPLICATION AND LICENSING
22 TAC §781.501

OVERVIEW

The Texas Behavioral Health Executive Council on behalf of the Texas State Board of Examiners of Social Workers adopts amendments to §781.501, relating to Requirements for Continuing Education. Section 781.501 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2052) and will not be republished.

BACKGROUND AND PURPOSE

The adopted amendments will clarify the nature of professional development a licensee must receive related to maintaining competency when providing services to unique populations.

Texas State Board of Examiners of Marriage and Family Therapists

Adopted Rules Re:

Adopting 22 TAC §801.261, to clarify the required professional development a licensee must receive when providing services to unique populations.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER C. APPLICATIONS AND LICENSING
22 TAC §801.261

OVERVIEW

The Texas Behavioral Health Executive Council on behalf of the Texas State Board of Examiners of Marriage and Family Therapists adopts amendments to §801.261, relating to Continuing Education. Section 801.261 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2054) and will not be republished.

BACKGROUND AND PURPOSE

The adopted amendment will clarify the nature of professional development a licensee must receive related to maintaining competency when providing services to unique populations.

Texas Behavioral Health Executive Council

Adopted Rules Re:

Adopting 22 TAC §882.50, to require license holders to use the online systems adopted by the Council for reporting continuing education hours.

CHAPTER 882. APPLICATIONS AND LICENSING
SUBCHAPTER E. CONTINUING EDUCATION
22 TAC §882.50

OVERVIEW

The Texas Behavioral Health Executive Council adopts amendments to §882.50, relating to Continuing Education and Audits. Section 882.50 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2057) and will not be republished.

BACKGROUND AND PURPOSE

The amendment will require license holders to use any online system adopted by the Council for reporting continuing education hours.

Adopting 22 TAC §884.10, to clarify when a licensee is subject to the jurisdiction of the Council.

CHAPTER 884. COMPLAINTS AND ENFORCEMENT
SUBCHAPTER B. INVESTIGATIONS AND DISPOSITION OF COMPLAINTS
22 TAC §884.10

OVERVIEW

The Texas Behavioral Health Executive Council adopts amendments to §884.10, relating to Investigation of Complaints. Section 884.10 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2058) and will not be republished.

BACKGROUND AND PURPOSE

The proposed amendment will clarify when a licensee is presumed to be engaging in the scope of practice of their license, and therefore subject to the jurisdiction of the Council, versus when conduct or statements by a licensee that are within the scope of practice will, nevertheless, be considered not done under the authority of their license.

Adopting 22 TAC §885.1, to eliminate the fee requirement for verification.

CHAPTER 885. FEES
22 TAC §885.1

OVERVIEW

The Texas Behavioral Health Executive Council adopts amendments to §885.1, relating to Executive Council Fees. Section 885.1 is adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2060) and will not be republished.

BACKGROUND AND PURPOSE

The proposed amendment would eliminate the fee requirement for a verification, which is available on the Council website.