17 Jun 2023

Texas Register June 16, 2023 Volume: 48 Number: 24

by | posted in: Department of Aging and Disability Services, Texas Board of Physical Therapy Examiners, Texas Department of State Health Services, Texas Health and Human Services Commission, Texas State Board of Pharmacy |

Texas Register Table of Contents

Texas State Board of Pharmacy

Proposed Rules Re:

Amending 22 TAC § 283.4, which would extend the period that internship hours may be used for licensure to three years from the date the internship is completed.

CHAPTER 283. LICENSING REQUIREMENTS FOR PHARMACISTS
22 TAC §283.4

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §283.4, concerning Internship Requirements. The amendments, if adopted, extend the period that internship hours may be used for licensure from two years to three years from the date the internship is completed.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Ms. Spier has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will be to provide clearer and more efficient requirements for pharmacist licensure. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

Amending 22 TAC § 283.6 removing the condition that a pharmacist preceptor must have six months of residency training if the pharmacist-intern’s residency program is accredited by the American Society of Health System Pharmacists.

CHAPTER 283. LICENSING REQUIREMENTS FOR PHARMACISTS
22 TAC §283.6

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §283.6, concerning Preceptor Requirements and Ratio of Preceptors to Pharmacist-Interns. The amendments, if adopted, remove the condition that a pharmacist preceptor must have six months of residency training if the pharmacist-intern’s residency program is accredited by the American Society of Health System Pharmacists.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Ms. Spier has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will be to remove an unnecessary distinction between residency programs in relation to pharmacist preceptor requirements. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

New 22 TAC § 291.12, specifying requirements for the delivery of prescription drugs to a patient or patient’s agent.

CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
22 TAC §291.12

OVERVIEW

The Texas State Board of Pharmacy proposes a new rule §291.12, concerning Delivery of Prescription Drugs. The new rule, if adopted, specifies requirements for the delivery of prescription drugs to a patient or patient’s agent.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Ms. Spier has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the proposed rule will be to improve the health, safety, and welfare of patients by ensuring the safety and efficacy of prescription drugs that are delivered to a patient or patient’s agent by Class A, Class A-S, Class E, and Class E-S pharmacies. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

Repealing 22 TAC §291.24, which would remove the standards for a statutory program that no longer exists.

CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
22 TAC §291.24

OVERVIEW

The Texas State Board of Pharmacy proposes the repeal of §291.24, concerning Pharmacy Residency Programs. The proposed repeal, if adopted, removes standards for a statutory program that no longer exists.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the repeal is in effect, there will be no fiscal implications for state or local government as a result of repealing the rule. Ms. Spier has determined that, for each year of the first five-year period the repeal will be in effect, the public benefit anticipated as a result of the repeal will be clearer and more concise agency regulations. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

Amending 22 TAC § 291.27, which corrects a misspelled word.

CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
22 TAC §291.27

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §291.27, concerning Confidentiality. The amendments, if adopted, correct a misspelled word.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Ms. Spier has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will be clear and correct regulations. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

Amending 22 TAC § 291.121, allowing remote pharmacy services to be provided using an automated pharmacy system.

CHAPTER 291. PHARMACIES
SUBCHAPTER G. SERVICES PROVIDED BY PHARMACIES
22 TAC §291.121

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §291.121, concerning Remote Pharmacy Services. The amendments, if adopted, allow remote pharmacy services to be provided using an automated pharmacy system to be provided at healthcare facilities regulated under Chapter 534, Health and Safety Code.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Ms. Spier has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will to improve public access to pharmacy services by allowing remote pharmacy services to be provided at more types of healthcare facilities. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

Amending 22 TAC § 291.151, clarifying that a pharmacist must verify the completeness and reconciliation of the perpetual inventory of controlled substances for an FEMCF pharmacy.

CHAPTER 291. PHARMACIES
SUBCHAPTER H. OTHER CLASSES OF PHARMACY
22 TAC §291.151

OVERVIEW

The Texas State Board of Pharmacy proposes amendments to §291.151, concerning Pharmacies Located in a Freestanding Emergency Medical Care Facility (Class F). The amendments, if adopted, clarify that a pharmacist must verify the completeness and reconciliation of the perpetual inventory of controlled substances for an FEMCF pharmacy.

BACKGROUND AND JUSTIFICATION

Julie Spier, R.Ph., President, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Ms. Spier has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will be clear and grammatically correct regulations. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.

Texas Board of Physical Therapy Examiners

Proposed Rules Re:

Amending 22 TAC §§343.5, 343.6, 343.8, 343.9, 343.21, 343.22, 343.36, 343.40, 343.41, concerning grounds for denial of a license or discipline of a licensee.

CHAPTER 343. CONTESTED CASE PROCEDURE
22 TAC §§343.5, 343.6, 343.8, 343.9, 343.21, 343.22, 343.36, 343.40, 343.41

OVERVIEW

The Texas Board of Physical Therapy Examiners (board) proposes amending Chapter 343. Contested Case Procedures, Occupations Code. Specifically, the Board proposes amendments to §343.5. Licensure of Persons with a History of Substance Abuse, §343.6. Other Grounds for Denial of a License or Discipline of a Licensee, §343.8. Licensure of Persons with a History of Voluntary or Involuntary Psychiatric Hospitalization, §343.9. Licensure of Persons with Criminal Convictions, §343.21. Witness Fees and Expenses, §343.22. Service of Notice, §343.36. Filing and Receipt of Complaints, §343.40. Informal Conference, and §343.41. Agreed Orders.

BACKGROUND AND JUSTIFICATION

The amendments are proposed in order to provide clarity to the procedures for contested cases, to correct inaccurate and outdated references, and to conform the rules with the physical therapy provisions in Chapter 453, Occupations Code; with the administrative procedures in Chapter 2001, Government Code; and with the consequences of criminal conviction in Chapter 53, Occupations Code.

Amending 22 TAC § 346.3, which relates to the provision of physical therapy services to infants and toddlers in an early childhood setting.

CHAPTER 346. PRACTICE SETTINGS FOR PHYSICAL THERAPY
22 TAC §346.3

OVERVIEW

The Texas Board of Physical Therapy Examiners proposes amending §346.3. Early Childhood Intervention (ECI) Setting. relating to the provision of physical therapy services to infants and toddlers in an early childhood setting.

BACKGROUND AND JUSTIFICATION

The amendment is proposed in order to update a Code of Federal Regulations reference, to eliminate the requirement for the completion of an evaluation and reevaluation to be done onsite allowing for provision via telehealth if indicated, to align the 60-day review of the plan of care (POC) to the requirement in other settings prior to continuation of treatment by a physical therapist assistant, and to report recommendations following a review of the POC to the ECI Interdisciplinary Team.

Texas Health and Human Services Commission

Proposed Rules Re:

New 26 TAC §§511.1 – 511.3, describing the statutory purpose and including new definitions.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §§511.1 – 511.3

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

  • Proposed new §511.1, Purpose, describes the purpose, statutory authority, and general requirements of Chapter 511.
  • Proposed new §511.2, Definitions, describes the definitions for words and terms that have meanings specific to this chapter.
  • Proposed new §511.3, Waiver Provisions, describes the process an LSRH must use when requesting a waiver of a particular provision of HSC Chapter 241 or this chapter, except for fire safety requirements, and the process HHSC uses to determine whether to grant a waiver request.
New 26 TAC §§511.11 – 511.17, concerning the licensure requirements for Limited Services Rural Hospitals (LSRH).

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER B. LICENSING REQUIREMENTS
26 TAC §§511.11 – 511.17

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

  • Proposed new §511.11, General, describes the general license requirements for an entity to obtain an LSRH license.
  • Proposed new §511.12, Application and Issuance of Initial License, describes the initial application requirements for an applicant seeking a license to operate as an LSRH within the state of Texas.
  • Proposed new §511.13, Application and Issuance of Renewal License, describes the requirements for an applicant to renew their previously issued license to operate an LSRH.
  • Proposed new §511.14, Inactive Status and Closure, describes the requirements and process for placing an LSRH on inactive status and the procedures required if an LSRH closes.
  • Proposed new §511.15, Change of Ownership, describes the license requirements for an LSRH that changes ownership.
  • Proposed new §511.16, Time Periods for Processing and Issuing Limited Services Rural Hospital Licenses, describes the time period for HHSC to process applications, causes for exceeding this time period, and information on reimbursement.
  • Proposed new §511.17, Fees, describes the fees for LSRH initial and renewal application and construction plan reviews.
New 26 TAC §§511.41 – 511.78, describing minimum standards that LSRH must meet.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §§511.41 – 511.78

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

  • Proposed new §511.41, Governing Body Organization, describes the standards the LSRHs must meet and maintain in organizing the governing body.
  • Proposed new §511.42, Governing Body Responsibilities, describes the responsibilities of an LSRH’s governing body.
  • Proposed new §511.43, Administration, describes the administrative standards an LSRH must meet and maintain to ensure the orderly and efficient management of the LSRH.
  • Proposed new §511.44, Emergency Services, describes the standards which an LSRH must meet and maintain to deliver emergency services.
  • Proposed new §511.45, Laboratory Services, describes the standards an LSRH must meet and maintain to deliver laboratory services.
  • Proposed new §511.46, Radiological Services, describes the standards that an LSRH must meet and maintain when conducting radiological services.
  • Proposed new §511.47, Pharmaceutical Services, describes the standards an LSRH must meet and maintain when providing pharmaceutical and related services.
  • Proposed new §511.48, Abuse and Neglect Issues, describes issues relating to abuse and neglect and the process HHSC uses to investigate abuse, neglect, and exploitation allegations.
  • Proposed new §511.49, Medical Director, describes the standards an LSRH must meet and maintain for the medical director position.
  • Proposed new §511.50, Medical Staff, describes the standards an LSRH must meet and maintain for medical staff.
  • Proposed new §511.51, Provision of Services, describes the professional standards an LSRH must meet and maintain when providing services.
  • Proposed new §511.52, Surgical Services within the Scope of the Practice of Emergency Medicine, describes the standards an LSRHs must meet and maintain when performing limited surgical procedures as an emergency procedure.
  • Proposed new §511.53, Dietary Services, describes the standards an LSRH must meet and maintain when providing food to patients, including standards associated with contracted food management services and other related services.
  • Proposed new §511.54, General Outpatient Requirements, describes the general standards an LSRH must meet and maintain when the LSRH offers outpatient services.
  • Proposed new §511.55, Surgical Services, describes the standards an LSRH must meet and maintain when providing surgical services.
  • Proposed new §511.56, Anesthesia Services, describes the standards an LSRH must meet and maintain when providing anesthesia services.
  • Proposed new §511.57, Therapy Services, describes the standards an LSRH must meet and maintain when providing therapeutic services.
  • Proposed new §511.58, Renal Dialysis Services, describes the standards an LSRH must meet and maintain when providing renal dialysis services.
  • Proposed new §511.59, Infection Prevention and Control and Antibiotic Stewardship Programs, describes the standards an LSRH must meet and maintain to prevent and control infection and form an antibiotic stewardship program.
  • Proposed new §511.60, Staffing and Staff Responsibilities, describes the standards and responsibilities an LSRH must meet and maintain to properly staff the facility.
  • Proposed new §511.61, Nursing Services, describes the standards and responsibilities an LSRH must meet and maintain when providing nursing services.
  • Proposed new §511.62, Discharge Planning, describes the standards and responsibilities an LSRH must meet and maintain when discharging patients.
  • Proposed new §511.63, Patient’s Rights, describes standards an LSRH must meet and maintain to protect and promote patient rights.
  • Proposed new §511.64, Quality Assessment and Performance Improvement Program, describes the standards an LSRH must meet and maintain when forming and operating the required quality assessment and performance improvement program.
  • Proposed new §511.65, Patient Transfer Policy, describes the standards an LSRH must meet and maintain when patient transfers occur with hospitals not currently in a patient transfer agreement.
  • Proposed new §511.66, Patient Transfer Agreements, describes the standards an LSRH must meet and maintain when forming and holding patient transfer agreements with qualified general hospitals.
  • Proposed new §511.67, Medical Records, describes the standards an LSRH must meet and maintain regarding documenting, storing, and providing access to patient medical records.
  • Proposed new §511.68, Emergency Preparedness, describes the standards an LSRH must meet and maintain for proper emergency preparedness.
  • Proposed new §511.69, Skilled Nursing Facility as a Distinct Unit, describes the standards an LSRH must meet and maintain when providing a skilled nursing facility, which includes complying with the separate licensing requirements under Texas Health and Safety Code Chapter 242 and federal regulations.
  • Proposed new §511.70, Respiratory Care Services, describes the standards an LSRH must meet and maintain if the LSRH decides to provide respiratory care services.
  • Proposed new §511.71, Waste and Waste Disposal, describes the standards an LSRH must meet and maintain when handling waste and conducting waste disposal services.
  • Proposed new §511.72, Linen and Laundry Services, describes the standards an LSRH must meet and maintain when caring for linens and conducting laundry services.
  • Proposed new §511.73, Sterilization, describes the standards an LSRH must meet and maintain when sterilizing equipment and associated actions.
  • Proposed new §511.74, Sanitary Conditions and Hygienic Practices, describes the standards an LSRH must meet and maintain for sanitary conditions and to prevent disease transmission.
  • Proposed new §511.75, Limited Services Rural Hospital Billing, describes the standards LSRHs must meet and maintain when billing and conducting billing related actions, including complying with state law and Texas Department of Insurance rules regarding balance billing.
  • Proposed new §511.76, Patient Visitation, requires an LSRH to adopt patient visitation policies and procedures, requires an LSRH to inform patients of their visitation rights, and describes the standards an LSRH must meet and maintain to ensure in-person visitation during a public health emergency or disaster.
  • Proposed new §511.77, Hospital Price Transparency Reporting and Enforcement, describes the requirements for price transparency reporting under HSC Chapter 327 and the enforcement procedures and administrative penalties HHSC may assess for violations of HSC Chapter 327.
  • Proposed new §511.78, Restraint and Seclusion, describes restraint and seclusion requirements an LSRH must meet and maintain.
New 26 TAC §§511.111 – 511.116, concerning the expectations and requirements of inspections and investigations.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER D. INSPECTIONS AND INVESTIGATIONS
26 TAC §§511.111 – 511.116

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

  • Proposed new §511.111, Integrity of Inspections and Investigations, places limits on an LSRH’s authority to record HHSC interviews and internal discussions.
  • Proposed new §511.112, Inspections, describes the requirements of the HHSC inspection process for an LSRH.
  • Proposed new §511.113, Complaint Investigations, describes the requirements of the HHSC investigation process after receiving a complaint against and LSRH.
  • Proposed new §511.114, Notice, informs an LSRH of the required timeframes regarding responding to deficiencies, plans of correction, and the provision of additional evidence.
  • Proposed new §511.115, Professional Conduct, notifies an LSRH that HHSC will report enforcement actions to appropriate licensing authorities.
  • Proposed new §511.116, Complaint Against an HHSC Representative, informs an LSRH about registering a complaint against an HHSC representative.
New 26 TAC §511.121, which outlines enforcement procedures that may be taken by HHSC in the event of a violation.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER E. ENFORCEMENT
26 TAC §511.121

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

Proposed new §511.121, Enforcement, describes enforcement procedures HHSC may take when an LSRH commits a violation of statute or rule.

New 26 TAC §§511.141 – 511.143, regarding fire and general safety requirements that LSRHs must meet.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER F. FIRE PREVENTION AND SAFETY
26 TAC §§511.141 – 511.143

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

  • Proposed new §511.141, Fire Prevention and Protection, describes the standards LSRHs must meet and maintain for fire prevention and protection, including requirements for fire inspections, reporting, protection, smoking rules, extinguishing systems, evacuation and protection plans, drills, alarm systems, and fire department protection.
  • Proposed new §511.142, General Safety, describes the standards an LSRH must meet and maintain for general safety, including requirements for a safety committee, safety manual, and emergency communication system.
  • Proposed new §511.143, Handling and Storage of Gases, Anesthetics, and Flammable Liquids, describes the standards an LSRH must meet and maintain when it comes to handling and storing gases, anesthetics, and flammable liquids.
New 26 TAC §§511.161 – 511.169, outlining the requisite construction and building standards for LSRHs.

CHAPTER 511. LIMITED SERVICES RURAL HOSPITALS
SUBCHAPTER G. PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
26 TAC §§511.161 – 511.169

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Chapter 511, concerning Limited Services Rural Hospitals, comprising of §§511.1 – 511.3, 511.11 – 511.17, 511.41 – 511.78, 511.111 – 511.116, 511.121, 511.141 – 511.143, and 511.161 – 511.169 in Texas Administrative Code Title 26.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement Senate Bill (S.B.) 1621, 86th Legislature, Regular Session, 2019, relating to certain rural medical facilities; requiring a license; authorizing fees and taxes, which amends Texas Health and Safety Code (HSC) Chapter 241 by adding Subchapter K, relating to Limited Services Rural Hospital.

HSC §241.302(b), as added by S.B. 1621, requires HHSC to adopt rules to establish the minimum standards for limited services rural hospitals (LSRHs) and to implement licensing standards for LSRHs under HSC §241.302 if the United States Congress enacts a bill creating a payment program for LSRHs or similarly designated hospitals that becomes law.

The federal Consolidated Appropriations Act, 2021, became law on December 27, 2020, and required the Centers for Medicare and Medicaid Services (CMS) to establish a federal rural emergency hospital (REH) designation. CMS adopted federal Conditions of Participation for REHs effective January 1, 2023, and now HHSC must adopt rules as required by HSC Section 241.302(b).

Pursuant to Texas Government Code §2005.003, HHSC proposes a 45-day processing timeline for applications to maintain consistency processing timeframes for other acute health care facilities. HHSC is unable to provide the maximum, minimum, and median time frames required by §2005.003(d)(1) because the LSRH licenses are a new licensure type and HHSC currently lacks the data to estimate these statistics.

SECTION-BY-SECTION SUMMARY

  • Proposed new §511.161, Requirements for Buildings in Which Existing Licensed Hospitals are Located, describes the standards an LSRH must meet and maintain for the building in which existing general or special hospitals licensed by HHSC are located. This includes fire safety, construction, and remodeling requirements.
  • Proposed new §511.162, General Construction Requirements, describes the general construction standards an LSRH must meet and maintain. This includes physical conditions, environmental considerations, and on-site conditions.
  • Proposed new §511.163, Spatial Requirements, describes the spatial standards an LSRH must meet and maintain for different unit and sections of the LSRH.
  • Proposed new §511.164, Elevators, Escalators, and Conveyors, describes the standards an LSRH must meet and maintain for any elevators, escalators, and conveyors used in the building.
  • Proposed new §511.165, Building with Multiple Occupancies, describes the standards an LSRH located in a building with multiple occupancies must meet and maintain.
  • Proposed new §511.166, Mobile, Transportable, and Relocatable Units, describes the standards an LSRH must meet and maintain when the LSRH uses a mobile, transportable, or relocatable unit to provide patient treatment services.
  • Proposed new §511.167, Preparation, Submittal, Review and Approval of Plans, and Retention of Records, describes the standards and processes an LSRH must meet and maintain for construction plans. This applies to new buildings, additions to or renovations or conversions of existing buildings.
  • Proposed new §511.168, Construction, Inspections, and Approval of Project, describes the construction standards and processes to obtain HHSC approval on construction projects.
  • Proposed new §511.169, Tables, describes the standards an LSRH must meet and maintain for flame spread and smoke production, ventilation, and hot water use.
Amending 26 TAC §746.201, concerning the responsibilities of permit holders.

CHAPTER 746. MINIMUM STANDARDS FOR CHILD-CARE CENTERS
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION
26 TAC §746.201

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §746.201, concerning What are my responsibilities as the permit holder.

BACKGROUND AND JUSTIFICATION

The purpose of this project is to update a reference to Texas Family Code to correct a typographical error. While the reference was accurately referenced in the proposed version of the rule as published in the September 23, 2022, issue of the Texas Register (47 TexReg 6102), the reference in the recently adopted rule was incorrect in that it referenced Texas Family Code §261.10. This project will correct the reference to §261.101.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §746.201 corrects the reference to the Texas Family Code from §261.10 to §261.101.

Adopted Rules Re:

Amending 1 TAC §355.8065, §355.8066, to update reimbursement rates and payment methodology for certain health services.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8065, §355.8066

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology, §355.8066, concerning Hospital-Specific Limit Methodology, and §355.8212, concerning Waiver Payments to Hospitals for Uncompensated Charity Care. Sections 355.8065, 355.8066, and 355.8212 are adopted with changes to the proposed text as published in the April 14, 2023, issue of the Texas Register (48 TexReg 1903). These rules will be republished.

BACKGROUND AND JUSTIFICATION

HHSC has operated portions of the Medicaid program under the authority of an 1115 Healthcare Transformation and Quality Improvement Demonstration Waiver (1115 Waiver) since 2011. When the 1115 Waiver began, Texas received authority for Medicaid-managed care for several populations of existing Medicaid beneficiaries as well as expenditure authority for two supplemental funding pools – the Delivery System Reform Incentive Payment (DSRIP) Program and the Uncompensated Care (UC) Program. The non-federal share of the payments was funded using primarily local funds matched with federal Medicaid funds. Payments were valued based on allocations that were made early in the waiver development process and were based upon projects, and then achievement, not the utilization of Medicaid services. When the waiver was renewed in 2017, the Special Terms and Conditions of the 1115 Waiver required Texas to reduce expenditures through DSRIP before ultimately ending the DSRIP program on September 30, 2021.

HHSC planned successor financial programs that were referred to collectively as the “DSRIP Transition.” Through these successor financial programs, HHSC was able to fully replace (and exceed) the total Medicaid expenditures that would have been lost due to the end of DSRIP. This overall maintenance of funding in the health care system is important because the overall economic stability of Texas is not projected to be negatively impacted by the DSRIP Transition. However, complicating the DSRIP Transition, the COVID-19 global pandemic overlapped with the time frame and caused provider market instability and fundamental shifts in historically stable utilization. As a result of various limitations on expenditures and reimbursements contained within various federal statutes and regulations, HHSC was unable to replace expenditures on a per-provider or even a per-class basis, and the regional impact of the transition has resulted in disparate impacts in rural and urban markets.

Amending 1 TAC §355.8212, to modify definitions and remove certain payment requirements for purchased health services.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8212

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology, §355.8066, concerning Hospital-Specific Limit Methodology, and §355.8212, concerning Waiver Payments to Hospitals for Uncompensated Charity Care. Sections 355.8065, 355.8066, and 355.8212 are adopted with changes to the proposed text as published in the April 14, 2023, issue of the Texas Register (48 TexReg 1903). These rules will be republished.

BACKGROUND AND JUSTIFICATION

HHSC has operated portions of the Medicaid program under the authority of an 1115 Healthcare Transformation and Quality Improvement Demonstration Waiver (1115 Waiver) since 2011. When the 1115 Waiver began, Texas received authority for Medicaid-managed care for several populations of existing Medicaid beneficiaries as well as expenditure authority for two supplemental funding pools – the Delivery System Reform Incentive Payment (DSRIP) Program and the Uncompensated Care (UC) Program. The non-federal share of the payments was funded using primarily local funds matched with federal Medicaid funds. Payments were valued based on allocations that were made early in the waiver development process and were based upon projects, and then achievement, not the utilization of Medicaid services. When the waiver was renewed in 2017, the Special Terms and Conditions of the 1115 Waiver required Texas to reduce expenditures through DSRIP before ultimately ending the DSRIP program on September 30, 2021.

HHSC planned successor financial programs that were referred to collectively as the “DSRIP Transition.” Through these successor financial programs, HHSC was able to fully replace (and exceed) the total Medicaid expenditures that would have been lost due to the end of DSRIP. This overall maintenance of funding in the health care system is important because the overall economic stability of Texas is not projected to be negatively impacted by the DSRIP Transition. However, complicating the DSRIP Transition, the COVID-19 global pandemic overlapped with the time frame and caused provider market instability and fundamental shifts in historically stable utilization. As a result of various limitations on expenditures and reimbursements contained within various federal statutes and regulations, HHSC was unable to replace expenditures on a per-provider or even a per-class basis, and the regional impact of the transition has resulted in disparate impacts in rural and urban markets.

New 26 TAC §565.2, §565.3, concerning purpose, scope, and definitions for the Home and Community-based programs.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER B. OVERVIEW
26 TAC §565.2, §565.3

OVERVIEW

The Executive Commissioner of Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 565, Home and Community-based Program (HCS) Certification Standards, new §§565.2, 565.3, 565.5, 565.7, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, 565.41, 565.43, 565.47, and 565.49.

New §§565.3, 565.5, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.31, 565.35, 565.37, and 565.49 are adopted with changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will be republished. These rules contain references to §565.45, Administrative Penalties, which is being administratively transferred from 40 TAC §9.181, effective the same day these rules are adopted.

New §§565.2, 565.7, 565.29, 565.33, 565.39, 565.41, 565.43, and 565.47 are adopted without changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to describe the regulatory certification standards for HCS Medicaid waiver program providers.

The rules describe certification standards regarding service delivery; rights of individuals; requirements related to abuse, neglect, and exploitation; staff member and service provider requirements; and quality assurance. The rules also include requirements from the program’s residential checklist along with new requirements for emergency preparedness, fire drills, and evacuation drills in all residential types in the HCS program. The rules set forth recommendations for increased oversight of HCS host home/companion care homes, clarify restraint and seclusion requirements, and add language for restricting the use of enclosed beds. The rules also modify HHSC surveyor requirements to allow for survey flexibility as the HCS waiver program evolves.

New 26 TAC §565.5, regarding individual’s rights in HCS programs and program providers’ responsibility to ensure those rights are exercised.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER C. CERTIFICATION STANDARDS: INDIVIDUAL’S RIGHTS
26 TAC §565.5

OVERVIEW

The Executive Commissioner of Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 565, Home and Community-based Program (HCS) Certification Standards, new §§565.2, 565.3, 565.5, 565.7, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, 565.41, 565.43, 565.47, and 565.49.

New §§565.3, 565.5, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.31, 565.35, 565.37, and 565.49 are adopted with changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will be republished. These rules contain references to §565.45, Administrative Penalties, which is being administratively transferred from 40 TAC §9.181, effective the same day these rules are adopted.

New §§565.2, 565.7, 565.29, 565.33, 565.39, 565.41, 565.43, and 565.47 are adopted without changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to describe the regulatory certification standards for HCS Medicaid waiver program providers.

The rules describe certification standards regarding service delivery; rights of individuals; requirements related to abuse, neglect, and exploitation; staff member and service provider requirements; and quality assurance. The rules also include requirements from the program’s residential checklist along with new requirements for emergency preparedness, fire drills, and evacuation drills in all residential types in the HCS program. The rules set forth recommendations for increased oversight of HCS host home/companion care homes, clarify restraint and seclusion requirements, and add language for restricting the use of enclosed beds. The rules also modify HHSC surveyor requirements to allow for survey flexibility as the HCS waiver program evolves.

New 26 TAC §565.7, §565.9, describing the hiring requirements and program provider requirements.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER D. CERTIFICATION STANDARDS: STAFF MEMBER AND SERVICE PROVIDER REQUIREMENTS
26 TAC §565.7, §565.9

OVERVIEW

The Executive Commissioner of Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 565, Home and Community-based Program (HCS) Certification Standards, new §§565.2, 565.3, 565.5, 565.7, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, 565.41, 565.43, 565.47, and 565.49.

New §§565.3, 565.5, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.31, 565.35, 565.37, and 565.49 are adopted with changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will be republished. These rules contain references to §565.45, Administrative Penalties, which is being administratively transferred from 40 TAC §9.181, effective the same day these rules are adopted.

New §§565.2, 565.7, 565.29, 565.33, 565.39, 565.41, 565.43, and 565.47 are adopted without changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to describe the regulatory certification standards for HCS Medicaid waiver program providers.

The rules describe certification standards regarding service delivery; rights of individuals; requirements related to abuse, neglect, and exploitation; staff member and service provider requirements; and quality assurance. The rules also include requirements from the program’s residential checklist along with new requirements for emergency preparedness, fire drills, and evacuation drills in all residential types in the HCS program. The rules set forth recommendations for increased oversight of HCS host home/companion care homes, clarify restraint and seclusion requirements, and add language for restricting the use of enclosed beds. The rules also modify HHSC surveyor requirements to allow for survey flexibility as the HCS waiver program evolves.

New 26 TAC §§565.11, 565.13, 565.15, 565.17, 565.19, 565.21, concerning service delivery and pre-enrollment minor modifications.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER E. CERTIFICATION STANDARDS: SERVICE DELIVERY
26 TAC §§565.11, 565.13, 565.15, 565.17, 565.19, 565.21

OVERVIEW

The Executive Commissioner of Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 565, Home and Community-based Program (HCS) Certification Standards, new §§565.2, 565.3, 565.5, 565.7, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, 565.41, 565.43, 565.47, and 565.49.

New §§565.3, 565.5, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.31, 565.35, 565.37, and 565.49 are adopted with changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will be republished. These rules contain references to §565.45, Administrative Penalties, which is being administratively transferred from 40 TAC §9.181, effective the same day these rules are adopted.

New §§565.2, 565.7, 565.29, 565.33, 565.39, 565.41, 565.43, and 565.47 are adopted without changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to describe the regulatory certification standards for HCS Medicaid waiver program providers.

The rules describe certification standards regarding service delivery; rights of individuals; requirements related to abuse, neglect, and exploitation; staff member and service provider requirements; and quality assurance. The rules also include requirements from the program’s residential checklist along with new requirements for emergency preparedness, fire drills, and evacuation drills in all residential types in the HCS program. The rules set forth recommendations for increased oversight of HCS host home/companion care homes, clarify restraint and seclusion requirements, and add language for restricting the use of enclosed beds. The rules also modify HHSC surveyor requirements to allow for survey flexibility as the HCS waiver program evolves.

New 26 TAC §§565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, regarding quality assurance and residential requirements.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER F. CERTIFICATION STANDARDS: QUALITY ASSURANCE
26 TAC §§565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39

OVERVIEW

The Executive Commissioner of Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 565, Home and Community-based Program (HCS) Certification Standards, new §§565.2, 565.3, 565.5, 565.7, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, 565.41, 565.43, 565.47, and 565.49.

New §§565.3, 565.5, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.31, 565.35, 565.37, and 565.49 are adopted with changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will be republished. These rules contain references to §565.45, Administrative Penalties, which is being administratively transferred from 40 TAC §9.181, effective the same day these rules are adopted.

New §§565.2, 565.7, 565.29, 565.33, 565.39, 565.41, 565.43, and 565.47 are adopted without changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to describe the regulatory certification standards for HCS Medicaid waiver program providers.

The rules describe certification standards regarding service delivery; rights of individuals; requirements related to abuse, neglect, and exploitation; staff member and service provider requirements; and quality assurance. The rules also include requirements from the program’s residential checklist along with new requirements for emergency preparedness, fire drills, and evacuation drills in all residential types in the HCS program. The rules set forth recommendations for increased oversight of HCS host home/companion care homes, clarify restraint and seclusion requirements, and add language for restricting the use of enclosed beds. The rules also modify HHSC surveyor requirements to allow for survey flexibility as the HCS waiver program evolves.

New 26 TAC §§565.41, 565.43, 565.47, 565.49, which includes HHSC surveys for service providers, methods for approval of four-person residences, and corrective actions.

CHAPTER 565. HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
SUBCHAPTER G. HHSC ACTIONS
26 TAC §§565.41, 565.43, 565.47, 565.49

OVERVIEW

The Executive Commissioner of Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 565, Home and Community-based Program (HCS) Certification Standards, new §§565.2, 565.3, 565.5, 565.7, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.29, 565.31, 565.33, 565.35, 565.37, 565.39, 565.41, 565.43, 565.47, and 565.49.

New §§565.3, 565.5, 565.9, 565.11, 565.13, 565.15, 565.17, 565.19, 565.21, 565.23, 565.25, 565.27, 565.31, 565.35, 565.37, and 565.49 are adopted with changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will be republished. These rules contain references to §565.45, Administrative Penalties, which is being administratively transferred from 40 TAC §9.181, effective the same day these rules are adopted.

New §§565.2, 565.7, 565.29, 565.33, 565.39, 565.41, 565.43, and 565.47 are adopted without changes to the proposed text as published in the February 17, 2023, issue of the Texas Register (48 TexReg 789). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to describe the regulatory certification standards for HCS Medicaid waiver program providers.

The rules describe certification standards regarding service delivery; rights of individuals; requirements related to abuse, neglect, and exploitation; staff member and service provider requirements; and quality assurance. The rules also include requirements from the program’s residential checklist along with new requirements for emergency preparedness, fire drills, and evacuation drills in all residential types in the HCS program. The rules set forth recommendations for increased oversight of HCS host home/companion care homes, clarify restraint and seclusion requirements, and add language for restricting the use of enclosed beds. The rules also modify HHSC surveyor requirements to allow for survey flexibility as the HCS waiver program evolves.

Amending 26 TAC §748.105, adding screening requirements for applicants for positions at GROs.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER C. ORGANIZATION AND ADMINISTRATION
26 TAC §748.105

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §748.105, concerning What are the requirements for my personnel policies and procedures, §748.363, concerning What information must the personnel record of an employee include, and §748.505, concerning What minimum qualifications must all employees meet; and new §748.751, concerning What are the requirements for obtaining and verifying an applicant’s employment history, and §748.753, concerning What are the requirements for completing an applicant’s reference checks, in Texas Administrative Code, Title 26, Chapter 748, Minimum Standards for General Residential Operations.

New §748.751 and §748.753 are adopted with changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will be republished.

Amended §§748.105, 748.363, and 748.505 are adopted without changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amended and new sections are necessary to support the June 9, 2022, court filing regarding the June 6, 2022, status hearing in the MD v. Abbott litigation. The filing, signed by the court, refers to an agreement by HHSC to initiate rulemaking to require operations to contact all an applicant’s job references prior to commencement of employment. In addition to this court filing, CCR has determined that the rules will improve the safety of children in care in general residential operations by requiring a more thorough vetting of prospective employees.

Accordingly, HHSC Child Care Regulation (CCR) is adopting new and amended rules to establish (1) employment history verification standards that require a General Residential Operation (GRO) to obtain and verify the most recent five years of an applicant’s employment history; and (2) applicant reference check requirements that require a GRO to complete reference checks for each applicant by obtaining at least two references and contacting each of those references as part of an operation’s pre-employment screening process.

Amending 26 TAC §748.363, requiring additional information to be included in an employee’s personnel record.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER D. REPORTS AND RECORD KEEPING
26 TAC §748.363

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §748.105, concerning What are the requirements for my personnel policies and procedures, §748.363, concerning What information must the personnel record of an employee include, and §748.505, concerning What minimum qualifications must all employees meet; and new §748.751, concerning What are the requirements for obtaining and verifying an applicant’s employment history, and §748.753, concerning What are the requirements for completing an applicant’s reference checks, in Texas Administrative Code, Title 26, Chapter 748, Minimum Standards for General Residential Operations.

New §748.751 and §748.753 are adopted with changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will be republished.

Amended §§748.105, 748.363, and 748.505 are adopted without changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amended and new sections are necessary to support the June 9, 2022, court filing regarding the June 6, 2022, status hearing in the MD v. Abbott litigation. The filing, signed by the court, refers to an agreement by HHSC to initiate rulemaking to require operations to contact all an applicant’s job references prior to commencement of employment. In addition to this court filing, CCR has determined that the rules will improve the safety of children in care in general residential operations by requiring a more thorough vetting of prospective employees.

Accordingly, HHSC Child Care Regulation (CCR) is adopting new and amended rules to establish (1) employment history verification standards that require a General Residential Operation (GRO) to obtain and verify the most recent five years of an applicant’s employment history; and (2) applicant reference check requirements that require a GRO to complete reference checks for each applicant by obtaining at least two references and contacting each of those references as part of an operation’s pre-employment screening process.

Amending 26 TAC §748.505, outlining the pre-employment screening requirements for GRO employees.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER E. PERSONNEL
26 TAC §748.505

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §748.105, concerning What are the requirements for my personnel policies and procedures, §748.363, concerning What information must the personnel record of an employee include, and §748.505, concerning What minimum qualifications must all employees meet; and new §748.751, concerning What are the requirements for obtaining and verifying an applicant’s employment history, and §748.753, concerning What are the requirements for completing an applicant’s reference checks, in Texas Administrative Code, Title 26, Chapter 748, Minimum Standards for General Residential Operations.

New §748.751 and §748.753 are adopted with changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will be republished.

Amended §§748.105, 748.363, and 748.505 are adopted without changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amended and new sections are necessary to support the June 9, 2022, court filing regarding the June 6, 2022, status hearing in the MD v. Abbott litigation. The filing, signed by the court, refers to an agreement by HHSC to initiate rulemaking to require operations to contact all an applicant’s job references prior to commencement of employment. In addition to this court filing, CCR has determined that the rules will improve the safety of children in care in general residential operations by requiring a more thorough vetting of prospective employees.

Accordingly, HHSC Child Care Regulation (CCR) is adopting new and amended rules to establish (1) employment history verification standards that require a General Residential Operation (GRO) to obtain and verify the most recent five years of an applicant’s employment history; and (2) applicant reference check requirements that require a GRO to complete reference checks for each applicant by obtaining at least two references and contacting each of those references as part of an operation’s pre-employment screening process.

New 26 TAC §748.751, §748.753, concerning the requirements for applicant’s employment history and background checks.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER E. PERSONNEL
26 TAC §748.751, §748.753

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §748.105, concerning What are the requirements for my personnel policies and procedures, §748.363, concerning What information must the personnel record of an employee include, and §748.505, concerning What minimum qualifications must all employees meet; and new §748.751, concerning What are the requirements for obtaining and verifying an applicant’s employment history, and §748.753, concerning What are the requirements for completing an applicant’s reference checks, in Texas Administrative Code, Title 26, Chapter 748, Minimum Standards for General Residential Operations.

New §748.751 and §748.753 are adopted with changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will be republished.

Amended §§748.105, 748.363, and 748.505 are adopted without changes to the proposed text as published in the March 17, 2023, issue of the Texas Register (48 TexReg 1531). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amended and new sections are necessary to support the June 9, 2022, court filing regarding the June 6, 2022, status hearing in the MD v. Abbott litigation. The filing, signed by the court, refers to an agreement by HHSC to initiate rulemaking to require operations to contact all an applicant’s job references prior to commencement of employment. In addition to this court filing, CCR has determined that the rules will improve the safety of children in care in general residential operations by requiring a more thorough vetting of prospective employees.

Accordingly, HHSC Child Care Regulation (CCR) is adopting new and amended rules to establish (1) employment history verification standards that require a General Residential Operation (GRO) to obtain and verify the most recent five years of an applicant’s employment history; and (2) applicant reference check requirements that require a GRO to complete reference checks for each applicant by obtaining at least two references and contacting each of those references as part of an operation’s pre-employment screening process.

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 11, 2023, at 9:00 a.m. to receive public comments on proposed updates to Medicaid payment rates resulting from Legislative Reviews.

Texas Department of State Health Services

Adopted Rules Re:

Amending 25 TAC §§131.181 – 131.191, to revise definitions and clarify hospital level of care designations for neonatal and maternal care programs.

CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER J. HOSPITAL LEVEL OF CARE DESIGNATIONS FOR NEONATAL CARE
25 TAC §§133.181 – 133.191

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §133.181, concerning Purpose; §133.182, concerning Definitions; §133.183, concerning General Requirements; §133.184, concerning the Designation Process; §133.185, concerning Program Requirements; §133.186, concerning Neonatal Designation Level I; §133.187, concerning Neonatal Designation Level II; §133.188, concerning Neonatal Designation Level III; §133.189, concerning Neonatal Designation Level IV; §133.190, concerning the Survey Team; and new §133.191, concerning the Perinatal Care Regions (PCRs). The amendments to §§133.182 – 133.190 are adopted with changes to the proposed text as published in the January 13, 2023, issue of the Texas Register (48 TexReg 83) and the sections will be republished. The amendment to §133.181 and new §133.191 are adopted without changes and will not be republished.

BACKGROUND AND JUSTIFICATION

The adoption updates the content and processes with the advances and practices since these rules were adopted in 2016. Senate Bill (S.B.) 749, 86th Legislature, Regular Session, 2019, amended the Texas Health and Safety Code, Chapter 241. S.B. 749 requires language specific to waiver agreements, a three-person appeal panel for designation reviews, and language specific to telemedicine and telehealth be integrated into the neonatal rules.

In addition, the Perinatal Advisory Council (PAC) provided DSHS with rule language recommendations designed to clarify specific subsections of the rules. The recommendations include the use of prearranged consultative agreements using telemedicine technology, and consideration of a waiver agreement for facilities that cannot meet a specific designation requirement. The recommendations further define the process for the three-person appeal panel, clarify that pediatric echocardiography with pediatric cardiology interpretation and consultation to be completed in a time period consistent with standards of professional practice, and include national accredited organizations providing resuscitation courses.

In Addition Re:

Licensing Actions for Radioactive Material

For more information, please visit this week’s edition of the Texas Register at 48 TexReg 3343.

Licensing Actions for Radioactive Material

For more information, please visit this week’s edition of the Texas Register at 48 TexReg 3349.

Licensing Actions for Radioactive Material

For more information, please visit this week’s edition of the Texas Register at 48 TexReg 3354.

Department of Aging and Disability Services

Adopted Rules Re:

Repealing 40 TAC §§9.153, 9.171 – 9.175, 9.177 – 9.180, 9.182, 9.183, 9.187, 9.188, concerning home and community-based services programs that have been replaced by proposed new rules.

CHAPTER 9. INTELLECTUAL DISABILITY SERVICES–MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER D. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
40 TAC §§9.153, 9.171 – 9.175, 9.177 – 9.180, 9.182, 9.183, 9.187, 9.188

OVERVIEW

As required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Texas Administrative Code (TAC) Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in 40 TAC Part 1. Therefore, the Executive Commissioner of HHSC repeals in 40 TAC Part 1, Chapter 9, Subchapter D, Home and Community-based Services (HCS) Program and Community First Choice (CFC) §§9.153, 9.171 – 9.175, 9.177 – 9.180, 9.182, 9.183, 9.187, and 9.188.

The repeal of §§9.153, 9.171 – 9.175, 9.177 – 9.180, 9.182, 9.183, 9.187, and 9.188 is adopted without changes as published in the February 17, 2023, issue of the Texas Register (48 TexReg 835). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The repeals are necessary to remove the rules in 40 TAC Part 1, Chapter 9, Subchapter D, and adopt new rules in 26 TAC Part 1, Chapter 565, Home and Community-based Services (HCS) Program Certification Standards.