Texas Register Table of Contents
- 1 State Board of Dental Examiners
- 1.0.1 Proposed Rules Re:
- 1.0.1.1 Amending 22 TAC §104.2, to remove Dental Risk Solutions, LLC as a continuing education provider.
- 1.0.1.2 Amending 22 TAC §107.400, to set forth a requirement of a yearly report instead of a quarterly report to the Board.
- 1.0.1.3 Amending 22 TAC §108.8, to require dentists to use radiographs in accordance with the minimum standard of care.
- 1.0.1.4 Amending 22 TAC §108.52, to specify that which dental specialties are approved by the National Commission on Recognition of Dental Specialties and Certifying Boards, and various grammar changes.
- 1.0.1 Proposed Rules Re:
- 2 Texas Health and Human Services Commission
- 2.0.1 Withdrawn Rules Re:
- 2.0.1.1 Withdrawing 1 TAC §355.8058, to require HHSC to use the most recent final audited cost report to calculate the base year average per resident amount for state-owned or state-operated teaching hospitals.
- 2.0.1.2 Withdrawing 26 TAC §§280.1, 280.3, 280.5, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2 Adopted Rules Re:
- 2.0.2.1 Adopting 1 TAC §353.1306, to increase the maximum ACR UPL percentage.
- 2.0.2.2 Adopting 1 TAC §355.8065, §355.8070, to standardize and clarify current calculation methodologies, allow some rural hospitals to receive advance FFY 2025 Disproportionate Share Hospital payments (DSH); and include Medicare definitions used by CMS, and update existing practices to increase transparency.
- 2.0.2.3 Adopting 1 TAC §355.8212, to add clauses that clarify the occurrence, amount, and allocation of HICH pool payments.
- 2.0.2.4 Adopting 26 TAC §52.1, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.5 Adopting 26 TAC §§87.1, 87.3, 87.5, 87.7, to clarify the rule’s purpose, define terms, and set forth the specifications for an ombudsman program.
- 2.0.2.6 Adopting 26 TAC §§87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, to set out the Office of the Ombudsman Program (OO) responsibilities, reporting requirements, and general operating procedures.
- 2.0.2.7 Adopting 26 TAC §87.41, §87.43, to outline the procedures to access information in the investigation of a complaint and prohibit retaliation for complaints made in good faith.
- 2.0.2.8 Adopting 26 TAC §87.51, to define the scope of the program to include individuals facing barriers in the Medicaid application and enrollment process.
- 2.0.2.9 Adopting 26 TAC §87.61, to define the scope of this program to include children and youth in the conservatorship of DFPS.
- 2.0.2.10 Adopting 26 TAC §87.71, §87.73, to specify that this program is responsible for assisting consumers and behavioral health care providers to resolve issues related to access to care.
- 2.0.2.11 Adopting 26 TAC §87.81, to specify that this program serves as an impartial party to assist individuals with IDD.
- 2.0.2.12 Adopting 26 TAC §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
- 2.0.2.13 Adopting 26 TAC §§87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
- 2.0.2.14 Adopting 26 TAC §§87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
- 2.0.2.15 Adopting 26 TAC §§87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
- 2.0.2.16 Adopting 26 TAC §§87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, 87.519, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
- 2.0.2.17 Adopting 26 TAC §259.5, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.18 Adopting 26 TAC §275.29, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.19 Adopting 26 TAC §306.45, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.20 Adopting 26 TAC §306.273, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.21 Adopting 26 TAC §330.17, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.22 Adopting 26 TAC §351.2, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.23 Adopting 26 TAC §358.103, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.24 Adopting 26 TAC §554.2302, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.25 Adopting 26 TAC §560.3, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.26 Adopting 26 TAC §566.3, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.27 Adopting 26 TAC §711.1, §711.3, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.28 Adopting 26 TAC §711.1402, §711.1406, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.29 Adopting 26 TAC §745.907, §745.911, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.30 Adopting 26 TAC §745.8605, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.31 Adopting 26 TAC §926.51, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.2.32 Adopting 26 TAC §967.1, to update citations in the rule to the Texas Government Code Chapter 546.
- 2.0.3 Transferred Rules Re:
- 2.0.3.1 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 1, Subchapter E that are related to these transferred functions to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 373.
- 2.0.3.2 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 33 that are related to these transferred functions to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 256.
- 2.0.4 Proposed Rule Reviews Re:
- 2.0.5 In Addition Re:
- 2.0.5.1 Notice of Public Hearing on Proposed Medicaid Payment Rate for Truman W. Smith Children’s Care Center, Effective April 1, 2025.
- 2.0.5.2 Public Notice: Mandatory Coverage for Eligible Juveniles who are Inmates of a Public Institution and Post Adjudication of Charges
- 2.0.5.3 Public Notice – Medically Dependent Children Program (MDCP) Amendment
- 2.0.5.4 Public Notice: Texas Medicaid State Plan Amendment to Make Changes to Requirements for Physical Therapy
- 2.0.5.5 Public Notice: Texas State Plan for Medical Assistance Amendment
- 2.0.1 Withdrawn Rules Re:
- 3 Texas Department of State Health Services
- 3.0.1 Adopted Rules Re:
- 3.0.2 Transferred Rules Re:
- 3.0.2.1 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 1, Subchapter E hat are related to these transferred functions to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 373.
- 3.0.2.2 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 33 that are related to these transferred functions to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 256, Early and Periodic Screening, Diagnosis, And Treatment.
- 4 Texas Department of Insurance
- 4.0.1 Adopted Rules Re:
- 4.0.1.1 Adopting 28 TAC §11.506, to clarify that network facilities cannot balance bill enrollees unless they affirmatively choose the provider and receive a cost estimate; update contract requirements related to out-of-network services; expand and update prescription drug coverage requirements; and make grammatical changes to ensure consistency across different codes.
- 4.0.1.2 Adopting 28 TAC §11.901, §11.902, to remove duplicative and outdated sections.
- 4.0.1.3 Adopting 28 TAC §11.1611, §11.1612, to update requirements for out-of-network claims, remove duplicative or unnecessary requirements, and make nonsubstantive formatting and grammatical changes.
- 4.0.1 Adopted Rules Re:
State Board of Dental Examiners
Proposed Rules Re:
Amending 22 TAC §104.2, to remove Dental Risk Solutions, LLC as a continuing education provider.
CHAPTER 104. CONTINUING EDUCATION
22 TAC §104.2
OVERVIEW
The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §104.2, concerning continuing education providers. The Board conducted a review of the continuing education providers in accordance with this rule, and voted to review the provider Dental Risk Solutions, LLC. The Board sent a notice to the mailing address of record for Dental Risk Solutions, LLC, informing it that the Board will consider whether to remove or reclassify it as a provider during its next scheduled meetings on February 20-21, 2025. The notice was returned to the Board as “Unable to Forward.” The Board voted to remove Dental Risk Solutions, LLC as a continuing education provider at the February 2025 meeting.
Amending 22 TAC §107.400, to set forth a requirement of a yearly report instead of a quarterly report to the Board.
CHAPTER 107. DENTAL BOARD PROCEDURES
SUBCHAPTER E. DATA REPORTING
22 TAC §107.400
OVERVIEW
The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §107.400, concerning collection and reporting of enforcement and licensing data. The proposed amendment requires a yearly report to the Board instead of a quarterly report because a yearly report will provide a better snapshot of the data. The proposed amendment updates the rule to reflect that the Board no longer issues administrative citations, but rather administrative penalties. The proposed amendment also corrects a punctuation error.
Amending 22 TAC §108.8, to require dentists to use radiographs in accordance with the minimum standard of care.
CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER A. PROFESSIONAL RESPONSIBILITY
22 TAC §108.8
OVERIVEW
The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §108.8, concerning the records of a dentist. The proposed amendment removes the language that the use of radiographs should be in accordance with ADA guidelines, and instead requires dentists to use radiographs in accordance with the minimum standard of care.
Amending 22 TAC §108.52, to specify that which dental specialties are approved by the National Commission on Recognition of Dental Specialties and Certifying Boards, and various grammar changes.
CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER E. BUSINESS PROMOTION
22 TAC §108.52
OVERVIEW
The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §108.52, concerning names and responsibilities. The proposed amendment specifies that dental specialties are approved by the National Commission on Recognition of Dental Specialties and Certifying Boards. The proposed amendment also includes grammar changes.
Texas Health and Human Services Commission
Withdrawn Rules Re:
Withdrawing 1 TAC §355.8058, to require HHSC to use the most recent final audited cost report to calculate the base year average per resident amount for state-owned or state-operated teaching hospitals.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 4. MEDICAID HOSPITAL SERVICES
1 TAC §355.8058
OVERVIEW
Proposed amended §355.8058, published in the August 16, 2024, issue of the Texas Register (49 TexReg 6103), is withdrawn. The agency failed to adopt the proposal within six months of publication. (See Government Code, §2001.027, and 1 TAC §91.38(d).)
Withdrawing 26 TAC §§280.1, 280.3, 280.5, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 280. PEDIATRIC TELECONNECTIVITY RESOURCE PROGRAM FOR RURAL TEXAS
26 TAC §§280.1, 280.3, 280.5
OVERVIEW
The Health and Human Services Commission withdraws proposed amendments to 26 TAC §§280.1, 280.3, and 280.5 which appeared in the December 6, 2024, issue of the Texas Register (49 TexReg 9904).
Adopted Rules Re:
Adopting 1 TAC §353.1306, to increase the maximum ACR UPL percentage.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
1 TAC §353.1306
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §353.1306, concerning Comprehensive Hospital Increase Reimbursement Program for Program Periods on or after September 1, 2021.
Section 353.1306 is adopted with changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7143). This rule will be republished.
BACKGROUND AND JUSTIFICATION
HHSC has been working since September 2022 to evaluate the future of the Medicaid hospital financing system in a post-public health emergency environment. With the combination of new Medicaid fee-for-service and managed care rules at the federal level, the unwinding of the Medicaid caseload coverage from the public health emergency, and the interplay between directed payment programs and new supplemental payment programs (e.g., the private graduate medical education (GME) and Hospital Augmented Reimbursement program (HARP)), hospital financing in Medicaid and for the uninsured has been challenging to forecast. With the support of hospitals and their representatives, Medicaid managed care organizations and their representatives, and industry subject matter experts, HHSC made final decisions regarding the program design for CHIRP that will be implemented, beginning in state fiscal year (SFY) 2026.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 4. MEDICAID HOSPITAL SERVICES
1 TAC §355.8065, §355.8070
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology; §355.8070, concerning Hospital Augmented Reimbursement Program; and §355.8212, concerning Waiver Payments to Hospitals for Uncompensated Charity Care.
Sections 355.8065, 355.8070, and 355.8212 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7150). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
HHSC has been working since September 2022 to evaluate the future of the Medicaid hospital financing system in a post-public health emergency environment. With the combination of new Medicaid fee-for-service and managed care rules at the federal level, the unwinding of the Medicaid caseload coverage from the public health emergency, and the interplay of new supplemental payment programs (e.g., the private graduate medical education (GME) and Hospital Augmented Reimbursement Program (HARP)), hospital financing in Medicaid and for the uninsured has been challenging to forecast. With the support of hospitals and their representatives, Medicaid managed care organizations and their representatives, industry subject matter experts, and the staff at the Centers for Medicare & Medicaid Services (CMS), HHSC made final decisions about strategies to ensure stability if the Uncompensated Care (UC) pool is reduced in the future.
Adopting 1 TAC §355.8212, to add clauses that clarify the occurrence, amount, and allocation of HICH pool payments.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT
1 TAC §355.8212
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology; §355.8070, concerning Hospital Augmented Reimbursement Program; and §355.8212, concerning Waiver Payments to Hospitals for Uncompensated Charity Care.
Sections 355.8065, 355.8070, and 355.8212 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7150). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
HHSC has been working since September 2022 to evaluate the future of the Medicaid hospital financing system in a post-public health emergency environment. With the combination of new Medicaid fee-for-service and managed care rules at the federal level, the unwinding of the Medicaid caseload coverage from the public health emergency, and the interplay of new supplemental payment programs (e.g., the private graduate medical education (GME) and Hospital Augmented Reimbursement Program (HARP)), hospital financing in Medicaid and for the uninsured has been challenging to forecast. With the support of hospitals and their representatives, Medicaid managed care organizations and their representatives, industry subject matter experts, and the staff at the Centers for Medicare & Medicaid Services (CMS), HHSC made final decisions about strategies to ensure stability if the Uncompensated Care (UC) pool is reduced in the future.
Adopting 26 TAC §52.1, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 52. CONTRACTING FOR COMMUNITY SERVICES
SUBCHAPTER A. APPLICATION AND DEFINITIONS
26 TAC §52.1
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §52.1, concerning Application.
The amendment to §52.1 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9891). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §§87.1, 87.3, 87.5, 87.7, to clarify the rule’s purpose, define terms, and set forth the specifications for an ombudsman program.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER A. PURPOSE, DEFINITIONS, AND ESTABLISHMENT OF OMBUDSMAN PROGRAMS
26 TAC §§87.1, 87.3, 87.5, 87.7
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §§87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, to set out the Office of the Ombudsman Program (OO) responsibilities, reporting requirements, and general operating procedures.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER B. PROVISIONS COMMON TO ALL OMBUDSMAN PROGRAMS
26 TAC §§87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §87.41, §87.43, to outline the procedures to access information in the investigation of a complaint and prohibit retaliation for complaints made in good faith.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER C. PROVISIONS DIRECTING HHS AND DFPS
26 TAC §87.41, §87.43
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §87.51, to define the scope of the program to include individuals facing barriers in the Medicaid application and enrollment process.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER D. OMBUDSMAN FOR MANAGED CARE ASSISTANCE
26 TAC §87.51
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §87.61, to define the scope of this program to include children and youth in the conservatorship of DFPS.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER E. OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE
26 TAC §87.61
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER F. OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO CARE
26 TAC §87.71, §87.73
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §87.81, to specify that this program serves as an impartial party to assist individuals with IDD.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER G. OMBUDSMAN FOR INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY
26 TAC §87.81
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER A. OFFICE OF THE OMBUDSMAN
26 TAC §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §§87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER B. OMBUDSMAN MANAGED CARE ASSISTANCE
26 TAC §§87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §§87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER C. OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE
26 TAC §§87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §§87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER D. OMBUDSMAN FOR BEHAVIORAL HEALTH
26 TAC §§87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §§87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, 87.519, to repeal the following chapters to update and restructure the rules in accordance with legislative changes.
CHAPTER 87. OMBUDSMAN SERVICES
SUBCHAPTER E. INTELLECTUAL OR DEVELOPMENTAL DISABILITY OMBUDSMAN
26 TAC §§87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, 87.519
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new rules in Texas Administrative Code, Title 26 (26 TAC), Part 1, Chapter 87, consisting of §§87.1, 87.3, 87.5, 87.7, 87.15, 87.17, 87.19, 87.21, 87.23, 87.25, 87.27, 87.29, 87.31, 87.33, 87.35, 87.41, 87.43, 87.51, 87.61, 87.71, 87.73, and 87.81, and the repeal of 26 TAC, Part 1, Chapter 87, consisting of §§87.101, 87.103, 87.105, 87.107, 87.109, 87.111, 87.113, 87.115, 87.117, 87.119, 87.201, 87.203, 87.205, 87.207, 87.209, 87.211, 87.213, 87.215, 87.217, 87.219, 87.301, 87.303, 87.305, 87.307, 87.309, 87.311, 87.313, 87.315, 87.317, 87.319, 87.321, 87.401, 87.403, 87.405, 87.407, 87.409, 87.411, 87.413, 87.415, 87.417, 87.419, 87.501, 87.503, 87.505, 87.507, 87.509, 87.511, 87.513, 87.515, 87.517, and 87.519.
The repeal of 26 TAC, Part 1, Chapter 87, and new 26 TAC, Part 1, Chapter 87 are adopted without changes to the proposed text as published in the December 20, 2024, issue of the Texas Register (49 TexReg 10218). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repealed and new rules implement changes made to Texas Government Code, Chapter 531, Subchapter Y, by House Bill (H.B.) 3462, 88th Legislature, Regular Session, 2023. H.B. 3462 consolidated ombudsman statutes by moving the laws requiring different ombudsman programs into the same subchapter of Texas Government Code, Chapter 531. The repealed and new rules clarify the duties and procedures for the Texas Health and Human Services Office of the Ombudsman (OO), including ombudsman programs for children and youth in foster care, managed care assistance, behavioral health access to care, and individuals with an intellectual or developmental disability.
The new rules ensure consistency with legislative changes, group together related subjects to facilitate navigation within the rules and remove duplicative language.
Adopting 26 TAC §259.5, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 259. COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER A. DEFINITIONS, DESCRIPTION OF SERVICES, AND EXCLUDED SERVICES
26 TAC §259.5
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §259.5, concerning Definitions.
The amendment to §259.5 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9893). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §275.29, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 275. CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM
SUBCHAPTER B. ELIGIBILITY AND SERVICE PLANS
26 TAC §275.29
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §275.29, concerning Assessment and Eligibility Determination.
The amendment to §275.29 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9903). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §306.45, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER B. STANDARDS OF CARE IN CRISIS STABILIZATION UNITS
DIVISION 1. GENERAL REQUIREMENTS
26 TAC §306.45
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §306.45, concerning Definitions; and §306.273, concerning MH Case Management Employee Competencies.
The amendments to §306.45 and §306.273 are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9906). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §306.273, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER E. MENTAL HEALTH CASE MANAGEMENT
26 TAC §306.273
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §306.45, concerning Definitions; and §306.273, concerning MH Case Management Employee Competencies.
The amendments to §306.45 and §306.273 are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9906). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §330.17, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 330. LIDDA ROLE AND RESPONSIBILITIES
26 TAC §330.17
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §330.17, concerning LIDDA Administrative Functions.
The amendment to §330.17 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9912). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §351.2, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 351. CHILDREN WITH SPECIAL HEALTH CARE NEEDS SERVICES PROGRAM
26 TAC §351.2
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §351.2, concerning Definitions.
The amendment to §351.2 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9914). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §358.103, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 358. CHILDREN’S AUTISM PROGRAM
SUBCHAPTER A. GENERAL RULES
26 TAC §358.103
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §358.103, concerning Legal Authority.
The amendment to §358.103 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9918). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §554.2302, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER X. REQUIREMENTS FOR MEDICAID-CERTIFIED FACILITIES
26 TAC §554.2302
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §554.2302, concerning Requirements for a Contracted Medicaid Facility.
The amendment to §554.2302 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9919). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §560.3, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 560. DENIAL OR REFUSAL OF LICENSE
26 TAC §560.3
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §560.3, concerning Adverse Licensing Record.
The amendment to §560.3 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9922). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §566.3, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 566. TEXAS HOME LIVING (TXHML) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS
26 TAC §566.3
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §566.3, concerning Definitions.
The amendment to §566.3 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9923). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §711.1, §711.3, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 711. INVESTIGATIONS OF INDIVIDUALS RECEIVING SERVICES FROM CERTAIN PROVIDERS
SUBCHAPTER A. INTRODUCTION
26 TAC §711.1, §711.3
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §711.1, concerning What is the purpose of this chapter; §711.3, concerning How are the terms in this chapter defined; §711.1402, concerning How are the terms in this subchapter defined; and §711.1406, concerning How is the term agency defined for the purpose of this subchapter.
The amendments to §§711.1, 711.3, 711.1402, and 711.1406 are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9929). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §711.1402, §711.1406, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 711. INVESTIGATIONS OF INDIVIDUALS RECEIVING SERVICES FROM CERTAIN PROVIDERS
SUBCHAPTER L. EMPLOYEE MISCONDUCT REGISTRY
26 TAC §711.1402, §711.1406
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §711.1, concerning What is the purpose of this chapter; §711.3, concerning How are the terms in this chapter defined; §711.1402, concerning How are the terms in this subchapter defined; and §711.1406, concerning How is the term agency defined for the purpose of this subchapter.
The amendments to §§711.1, 711.3, 711.1402, and 711.1406 are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9929). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §745.907, §745.911, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 745. LICENSING
SUBCHAPTER G. CONTROLLING PERSONS
26 TAC §745.907, §745.911
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §745.907, concerning What are the consequences of Licensing designating me as a controlling person; §745.911, concerning In what other circumstances may a person not serve as a controlling person at my operation; and §745.8605, concerning When can Licensing recommend or impose an enforcement action against my operation.
The amendments to §§745.907, 745.911, and 745.8605, are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9934). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §745.8605, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 745. LICENSING
SUBCHAPTER L. ENFORCEMENT ACTIONS
DIVISION 1. OVERVIEW OF ENFORCEMENT ACTIONS
26 TAC §745.8605
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §745.907, concerning What are the consequences of Licensing designating me as a controlling person; §745.911, concerning In what other circumstances may a person not serve as a controlling person at my operation; and §745.8605, concerning When can Licensing recommend or impose an enforcement action against my operation.
The amendments to §§745.907, 745.911, and 745.8605, are adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9934). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §926.51, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 926. STATE FACILITY REQUIREMENTS TO ENHANCE THE SAFETY OF INDIVIDUALS RECEIVING SERVICES
SUBCHAPTER B. CRIMINAL HISTORY CHECKS AND REGISTRY CLEARANCES AT STATE FACILITIES
26 TAC §926.51
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §926.51, concerning Definitions.
The amendment to §926.51 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9936). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Adopting 26 TAC §967.1, to update citations in the rule to the Texas Government Code Chapter 546.
CHAPTER 967. CLIENT CARE OF INDIVIDUALS RECEIVING SERVICES AT STATE SUPPORTED LIVING CENTERS
SUBCHAPTER A. STATE SUPPORTED LIVING CENTER INDEPENDENT MORTALITY REVIEW
26 TAC §967.1
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §967.1, concerning Independent Mortality Review.
The amendment to §967.1 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9941). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Transferred Rules Re:
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 1, Miscellaneous Provisions, Subchapter E, A Woman’s Right to Know, that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 373, A Woman’s Right to Know.
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 33, Early and Periodic Screening, Diagnosis, And Treatment, that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 256, Early and Periodic Screening, Diagnosis, And Treatment.
Proposed Rule Reviews Re:
Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal of the chapter concerning Long-Term Care Provider Rules During a Public Health Emergency or Disaster.
OVERVIEW
The Texas Health and Human Services Commission (HHSC) proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 26, Part 1, of the Texas Administrative Code (TAC):
Chapter 570, Long-Term Care Provider Rules During a Public Health Emergency or Disaster
In Addition Re:
Notice of Public Hearing on Proposed Medicaid Payment Rate for Truman W. Smith Children’s Care Center, Effective April 1, 2025.
OVERVIEW
Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on April 1, 2025, at 9:00 a.m. CDT to receive public comments on the proposed Medicaid payment rate for Truman W. Smith Children’s Care Center, a nursing facility in the pediatric care facility special reimbursement class of the Nursing Facility Program.
Public Notice: Mandatory Coverage for Eligible Juveniles who are Inmates of a Public Institution and Post Adjudication of Charges
OVERVIEW
The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number 25-0012 to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act.
Public Notice – Medically Dependent Children Program (MDCP) Amendment
OVERVIEW
The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the waiver application for the Medically Dependent Children Program (MDCP). HHSC administers the MDCP waiver under the authority of Section 1915(c) of the Social Security Act. The proposed effective date for this amendment is September 1, 2025.
Public Notice: Texas Medicaid State Plan Amendment to Make Changes to Requirements for Physical Therapy
OVERVIEW
The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number 25-0009 to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act.
Public Notice: Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The proposed amendment is effective April 1, 2025.
Texas Department of State Health Services
Adopted Rules Re:
CHAPTER 1. MISCELLANEOUS PROVISIONS
SUBCHAPTER Y. ADVERSE LICENSING, LISTING, OR REGISTRATION DECISIONS
25 TAC §1.601
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §1.601, concerning Decisions Based on Interagency Records.
The amendment to §1.601 is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9878). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
Transferred Rules Re:
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 1, Miscellaneous Provisions, Subchapter E, A Woman’s Right to Know, that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 373, A Woman’s Right to Know.
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 33, Early and Periodic Screening, Diagnosis, And Treatment, that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 256, Early and Periodic Screening, Diagnosis, And Treatment.
Texas Department of Insurance
Adopted Rules Re:
CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER F. EVIDENCE OF COVERAGE
28 TAC §11.506
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§11.506, 11.901, 11.902, 11.1611, and 11.1612, concerning health maintenance organizations. The commissioner adopts §11.901 without changes to the proposed text published in the September 20, 2024, issue of the Texas Register (49 TexReg 7616). The section will not be republished. Sections 11.506, 11.902, 11.1611, and 11.1612 are adopted with changes to the proposed text to correct errors and in response to public comments. These sections will be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to implement the following legislation:
- House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions;
- House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs;
- House Bill 3078, 85th Legislature, 2017, which transfers regulation of podiatrists to the Texas Department of Licensing and Regulation;
- Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories;
- Senate Bill 1264, 86th Legislature, 2019, which creates new payment standards and balance billing protections for care provided by non-network facility-based providers in a network facility, diagnostic imaging and laboratory services in connection with care from a network provider, and emergency care; and
- Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
The amendments remove payment rules that were invalidated by court order in Texas Ass’n of Health Plans v. Texas Dept. of Insurance , Travis County District Court No. D-1-GN-18-003846 (October 15, 2020), and update provisions for out-of-network care consistent with SB 1264 and SB 2476.
The amendments also make nonsubstantive changes to (1) add or amend Insurance Code citations for accessibility and consistency with agency rule drafting style preferences; and (2) correct and revise punctuation, capitalization, and grammar to reflect current agency drafting style and plain language preferences.
Adopting 28 TAC §11.901, §11.902, to remove duplicative and outdated sections.
CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER J. PHYSICIAN AND PROVIDER CONTRACTS AND ARRANGEMENTS
28 TAC §11.901, §11.902
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§11.506, 11.901, 11.902, 11.1611, and 11.1612, concerning health maintenance organizations. The commissioner adopts §11.901 without changes to the proposed text published in the September 20, 2024, issue of the Texas Register (49 TexReg 7616). The section will not be republished. Sections 11.506, 11.902, 11.1611, and 11.1612 are adopted with changes to the proposed text to correct errors and in response to public comments. These sections will be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to implement the following legislation:
- House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions;
- House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs;
- House Bill 3078, 85th Legislature, 2017, which transfers regulation of podiatrists to the Texas Department of Licensing and Regulation;
- Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories;
- Senate Bill 1264, 86th Legislature, 2019, which creates new payment standards and balance billing protections for care provided by non-network facility-based providers in a network facility, diagnostic imaging and laboratory services in connection with care from a network provider, and emergency care; and
- Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
The amendments remove payment rules that were invalidated by court order in Texas Ass’n of Health Plans v. Texas Dept. of Insurance , Travis County District Court No. D-1-GN-18-003846 (October 15, 2020), and update provisions for out-of-network care consistent with SB 1264 and SB 2476.
The amendments also make nonsubstantive changes to (1) add or amend Insurance Code citations for accessibility and consistency with agency rule drafting style preferences; and (2) correct and revise punctuation, capitalization, and grammar to reflect current agency drafting style and plain language preferences.
Adopting 28 TAC §11.1611, §11.1612, to update requirements for out-of-network claims, remove duplicative or unnecessary requirements, and make nonsubstantive formatting and grammatical changes.
CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER Q. OTHER REQUIREMENTS
28 TAC §11.1611, §11.1612
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§11.506, 11.901, 11.902, 11.1611, and 11.1612, concerning health maintenance organizations. The commissioner adopts §11.901 without changes to the proposed text published in the September 20, 2024, issue of the Texas Register (49 TexReg 7616). The section will not be republished. Sections 11.506, 11.902, 11.1611, and 11.1612 are adopted with changes to the proposed text to correct errors and in response to public comments. These sections will be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to implement the following legislation:
- House Bill 711, 88th Legislature, 2023, which prohibits anticompetitive contract provisions;
- House Bill 1647, 88th Legislature, 2023, which provides protections for certain clinician-administered drugs;
- House Bill 3078, 85th Legislature, 2017, which transfers regulation of podiatrists to the Texas Department of Licensing and Regulation;
- Senate Bill 1003, 88th Legislature, 2023, which expands facility-based provider types that must be listed in provider directories;
- Senate Bill 1264, 86th Legislature, 2019, which creates new payment standards and balance billing protections for care provided by non-network facility-based providers in a network facility, diagnostic imaging and laboratory services in connection with care from a network provider, and emergency care; and
- Senate Bill 2476, 88th Legislature, 2023, which creates new payment standards and balance billing protections for emergency medical services.
The amendments remove payment rules that were invalidated by court order in Texas Ass’n of Health Plans v. Texas Dept. of Insurance , Travis County District Court No. D-1-GN-18-003846 (October 15, 2020), and update provisions for out-of-network care consistent with SB 1264 and SB 2476.
The amendments also make nonsubstantive changes to (1) add or amend Insurance Code citations for accessibility and consistency with agency rule drafting style preferences; and (2) correct and revise punctuation, capitalization, and grammar to reflect current agency drafting style and plain language preferences.