Texas Register March 7, 2025 Volume: 50 Number: 10

Texas Register Table of Contents

1 Texas Department of State Health Services
- - 1.0.1 Proposed Rules Re:
    - 1.0.1.1 Amending 25 TAC §289.230, to update the requirements for mammography reports.
    - 1.0.1.2 Amending 25 TAC §289.234, to delete an invalid rule.
  - 1.0.2 In Addition Re:
2 State Board of Dental Examiners
3 Texas Health and Human Services Commission:
4 Cancer Prevention and Research Institute of Texas
- - 4.0.1 Adopted Rules Re:
    - 4.0.1.1 Adopting 25 TAC §703.13, §703.26, to increase the grant recipient audit threshold, which is consistent with CPRIT’s administrative rules; add certain unallowable expenses for grant recipients; and make other non-substantive, technical amendments.

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §289.230, to update the requirements for mammography reports.

CHAPTER 289. RADIATION CONTROL
SUBCHAPTER E. REGISTRATION REGULATIONS
25 TAC §289.230

OVERALL

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes an amendment to §289.230, concerning Certification of Mammography Systems and Mammography Machines Used for Interventional Breast Radiography, and the repeal of §289.234, concerning Mammography Accreditation.

BACKGROUND AND INFORMATION

The purpose of the proposal is to amend §289.230, relating to requirements for the certification and use of radiation machines in mammography and interventional breast radiography. The amendment is necessary to align with the United States Food and Drug Administration (FDA) Mammography Quality Standards Act (MQSA) under 21 Code of Federal Regulations (CFR) Part 900.

Additionally, the proposal repeals §289.234, relating to mammography accreditation, because DSHS no longer accredits mammography facilities due to an expired contract which ended on August 31, 2024. With the contract’s expiration, this rule is no longer valid.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §289.230 updates the requirements concerning breast tissue density in mammography reports and plain language notification statements to patients. Three new outcome data reporting requirements for the interpreting physician and the facility have been added. The outcome data report must include calculations for positive predictive value, cancer detection rate, and recall rate.

Additional changes to §289.230 include reorganizing the rule to mirror the layout of other sections of this chapter, adding survey report requirements, and adding and clarifying definitions for various terms related to mammography machines. The proposal adopts 21 CFR Part 900 by reference for system design, screen-film, processor performance testing, equipment variances, and investigational device requirements. The proposed changes enhance clarity, safety, and regulatory compliance in the field of mammography. Other edits are made to improve grammar, formatting, and rule clarity.

Amending 25 TAC §289.234, to delete an invalid rule.

CHAPTER 289. RADIATION CONTROL
SUBCHAPTER E. REGISTRATION REGULATIONS
25 TAC §289.234

OVERALL

BACKGROUND AND INFORMATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §289.234 is necessary to delete an invalid rule.

In Addition Re:

Correction of Error

The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposed an amendment to 25 TAC §289.230 as well as the repeal of 25 TAC §289.234 in the February 21, 2025, issue of the Texas Register (50 TexReg 908). Due to an error by the Texas Register, numerous provisions in the amendment were formatted incorrectly or were omitted from the proposed rulemaking notice. The corrected proposal as well as the repeal are republished in the Proposed Rules section of the March 7, 2025, issue of the Texas Register.

Licensing Actions for Radioactive Materials (.pdf)

For more information, please visit this week’s edition of the Texas Register at 50 Tex. Reg. 1851.

Licensing Actions for Radioactive Materials (.pdf)

For more information, please visit this week’s edition of the Texas Register at 50 Tex. Reg. 1857.

State Board of Dental Examiners

Withdrawn Rules Re:

Withdrawing 22 TAC §104.1, to amend continuing education requirements by reducing dentists and dental hygienists 24-hour continuing education requirement by 2 hours if they attest they read all newsletters issued by the Texas State Board of Dental Examiners during their renewal period.

CHAPTER 104. CONTINUING EDUCATION
22 TAC §104.1

OVERVIEW

The State Board of Dental Examiners withdraws proposed amendments to 22 TAC §104.1 which appeared in the December 6, 2024, issue of the Texas Register (49 TexReg 9864).

Adopted Rules Re:

Adopting 22 TAC §102.1, to establish the fees due upon initial licensure or registration, and each renewal.

CHAPTER 102. FEES
22 TAC §102.1

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §102.1, concerning fees without changes to the proposal as published in the December 13, 2024, issue of the Texas Register (49 TexReg 10094) and will not be republished. The adopted amendment includes a $100.00 fee for applicants who apply to become a Board approved continuing education course provider.

Adopting 22 TAC §108.42, to remove the requirement that a mobile dental facility or portable dental unit have a lead apron with thyroid shields when x-rays are made.

CHAPTER 108. PROFESSIONAL CONDUCT
SUBCHAPTER D. MOBILE DENTAL FACILITIES
22 TAC §108.42

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §108.42, concerning obtaining a permit. The amendment is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9866) and will not be republished. The adopted amendment removes the requirement that a mobile dental facility or portable dental unit must have a lead apron with thyroid shield when x-rays are made. The American Academy of Oral and Maxillofacial Radiology (AAOMR) recently issued guidelines titled “Patient shielding during dentomaxillofacial radiography” where the AAOMR recommended discontinuing the use of lead aprons and thyroid shields when making x-rays. The Board held a stakeholder meeting on September 27, 2024, where a majority of stakeholders stated that Board rules should be amended to remove requiring the use of lead aprons and thyroid shields based on the AAOMR guidelines.

The Texas Academy of General Dentistry (TAGD) provided a written comment in support of adoption of the rule as proposed. TAGD states that the amendment aligns with current research and best practices by organizations, including the AAOMR. The Board agrees with the comment, and no changes to the rule were made as a result of the comment.

Adopting 22 TAC §111.1, to remove unnecessary subsections no longer in effect.

CHAPTER 111. STANDARDS FOR PRESCRIBING CONTROLLED SUBSTANCES AND DANGEROUS DRUGS
22 TAC §111.1

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §111.1, concerning additional continuing education requirements. The amendment is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9867) and will not be republished. The adopted amendment removes subsections (a) and (b)(1) because they are no longer in effect. The current continuing education requirement regarding controlled substances is found in paragraph (1) of this amended rule and in 22 TAC §104.1(2)(B). The adopted amendment also updates the name of the title for 22 TAC §104.1.

Adopting 22 TAC §113.2, to remove the requirement that dental patients must be protected by a lead apron with thyroid collar.

CHAPTER 113. REQUIREMENTS FOR DENTAL OFFICES
22 TAC §113.2

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §113.2, concerning x-ray laboratories. The amendment is adopted without changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9868) and will not be republished. The adopted amendment removes the requirement that dental patients must be protected by a lead apron with thyroid collar. The American Academy of Oral and Maxillofacial Radiology (AAOMR) recently issued guidelines titled “Patient shielding during dentomaxillofacial radiography” where the AAOMR recommended discontinuing the use of lead aprons and thyroid shields when making x-rays. The Board held a stakeholder meeting on September 27, 2024, where a majority of stakeholders stated that Board rules should be amended to remove requiring the use of lead aprons and thyroid shields based on the AAOMR guidelines.

The Texas Academy of General Dentistry (TAGD) provided a written comment in support of adoption of the rule as proposed. TAGD states that the amendment aligns with current research and best practices by organizations, including the AAOMR. The Board agrees with this comment, and no changes to the rule were made as a result of the comment.

Adopting 22 TAC §114.12, to require a biennial renewal cycle for dental assistant registrations.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.12

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §114.12, concerning continuing education for registered dental assistants. The amendment is adopted with changes to the proposed text as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9869) and will be republished. The adopted amendment updates the rule to reflect that dental assistant registrations have a biennial renewal cycle.

Adopted Rule Reviews Re:

Adopting Title 22, Part 5, concerning Professional Conduct and Visual Dental Health Inspections.

The Texas State Board of Dental Examiners (Board) adopts the review of the chapters below in Title 22, Part 5, of the Texas Administrative Code (TAC):

Chapter 108, Professional Conduct; and

Chapter 112, Visual Dental Health Inspections.

Texas Health and Human Services Commission:

Adopted Rules Re:

Adopting 1 TAC §§371.1, 371.3, 371.31, to update section references to be consistent with the Texas Government Code.

CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER B. OFFICE OF INSPECTOR GENERAL
1 TAC §§371.1, 371.3, 371.31

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Office of Inspector General (OIG), adopts in the Texas Administrative Code, Title 1, Part 15, Chapter 371 amendments to §371.1, concerning Definitions; §371.3, concerning Purpose and Authority; §371.31, concerning Federal Felony Match; §371.1011, concerning Recommendation Criteria; §371.1305, concerning Preliminary Investigation; §371.1613, concerning Informal Resolution Process; §371.1663, concerning Managed Care; §371.1669, concerning Self-Dealing; and §371.1709, concerning Payment Hold.

The amendments to §§371.1, 371.3, 371.31, 371.1011, 371.1305, 371.1613, 371.1663, 371.1669, and 371.1709 are adopted without changes to the proposed text as published in the November 8, 2024, issue of the Texas Register (49 TexReg 8797). These rules will not be republished.

BACKGROUND AND INFORMATION

House Bill 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. The amendments are necessary to update citations in the rules to reflect changes in the organization of the Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code and revise Texas Administrative Code references.

Adopting 1 TAC §371.1011, to update section references to be consistent with the Texas Government Code.

CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER E. PROVIDER DISCLOSURE AND SCREENING
1 TAC §371.1011

OVERVIEW

BACKGROUND AND INFORMATION

Adopting 1 TAC §371.1305, to update section references to be consistent with the Texas Government Code.

CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER F. INVESTIGATIONS
1 TAC §371.1305

OVERVIEW

BACKGROUND AND INFORMATION

Adopting 1 TAC §371.1613, to update section references to be consistent with the Texas Government Code.

CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER G. ADMINISTRATIVE ACTIONS AND SANCTIONS
DIVISION 1. GENERAL PROVISIONS
1 TAC §371.1613

OVERVIEW

BACKGROUND AND INFORMATION

Adopting 1 TAC §371.1663, §371.1669, to update section references to be consistent with the Texas Government Code.

CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
1 TAC §371.1663, §371.1669

OVERVIEW

BACKGROUND AND INFORMATION

Adopting 1 TAC §371.1709, to update section references to be consistent with the Texas Government Code.

CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
1 TAC §371.1709

OVERVIEW

BACKGROUND AND INFORMATION

Adopting 1 TAC §377.107, §377.113, to clarify the requirements for volunteer advocate goals in the contract and broaden the applicability of the grievance procedure to current and former clients who received services from the volunteer advocate program.

CHAPTER 377. CHILDREN’S ADVOCACY PROGRAMS
SUBCHAPTER B. STANDARDS OF OPERATION FOR LOCAL COURT-APPOINTED VOLUNTEER ADVOCATE PROGRAMS
1 TAC §377.107, §377.113

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §377.107, concerning Contract with Statewide Volunteer Advocate Organization, and §377.113, concerning Local Volunteer Advocate Program Administration.

The amendments are adopted without changes to the proposed text as published in the November 8, 2024, issue of the Texas Register (49 TexReg 8810). The rules will not be republished.

BACKGROUND AND INFORMATION

The amendments are necessary to comply with House Bill (H.B.) 474, 88th Legislature, Regular Session, 2023, which amends Texas Family Code §264.603 and §264.604, which requires HHSC to include in the contract measurable goals and objectives for the number of active and inactive volunteers in the Court Appointed Volunteer Advocate Program, and to ensure the statewide volunteer advocate organization adopts a grievance process for complaints regarding negligence or misconduct by a volunteer advocate.

Adopting 26 TAC §745.117, to update the requirements for an exemption to require a program to be located in a county with a municipality with a population of 500,000 and update language and references in the figure.

CHAPTER 745. LICENSING
SUBCHAPTER C. OPERATIONS THAT ARE EXEMPT FROM REGULATION
DIVISION 2. EXEMPTIONS FROM REGULATION
26 TAC §745.117

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §745.117, concerning Exemptions for Programs of Limited Duration.

The amendment to §745.117 is adopted with changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8542). This rule will be republished.

BACKGROUND AND INFORMATION

The amendment is necessary to implement Section 115 of House Bill (H.B.) 4559, 88th Legislature, Regular Session, 2023. This section of H.B. 4559 amended a requirement in Texas Human Resources Code (HRC) §42.041, which identifies certain programs that meet the definition of “child-care facility” in HRC §42.002(3) that are exempt from requiring a license under HRC Chapter 42. HRC §42.041(b)(3) includes an exemption for a program that provides short-term child care that meets certain requirements in connection with a shopping center, business or other activity. In turn, HRC §42.041(g) limits the number of hours a week that a certain type of program that meets this exemption language may operate. H.B. 4559 amended the requirements in HRC Section 42.041(g). Prior to the effective date of H.B. 4559, HRC Section 42.041(g) limited a program exempt under HRC Section 42.041(b)(3) to providing a maximum of 15 hours per week of childcare to an individual child if the program (1) provides child-care so that a person may attend an educational class provided by a nonprofit entity and (2) is located in a county that has a population of 800,000 and on an international border. H.B. 4559 amended the population requirement so that the limits in subsection (g) apply if the program is located in a county with a municipality with a population of at least 500,000. Accordingly, HHSC Child Care Regulation (CCR) is adopting amended §745.117 to reflect the amended statutory language.

Proposed Rule Reviews Re:

Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal of the chapter concerning Continuity of Services–Transferring Individuals from State Supported Living Centers to State Hospitals.

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 902, Continuity of Services–Transferring Individuals from State Supported Living Centers to State Hospitals

In Addition Re:

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 amendments will be effective April 1, 2025.

Cancer Prevention and Research Institute of Texas

Adopted Rules Re:

Adopting 25 TAC §703.13, §703.26, to increase the grant recipient audit threshold, which is consistent with CPRIT’s administrative rules; add certain unallowable expenses for grant recipients; and make other non-substantive, technical amendments.

CHAPTER 703. GRANTS FOR CANCER PREVENTION AND RESEARCH
25 TAC §703.13, §703.26

OVERVIEW

The Cancer Prevention and Research Institute of Texas (“CPRIT” or “the Institute”) adopts the amendments to 25 Texas Administrative Code §703.13 and §703.26 without changes to the proposed amendments as published in the December 6, 2024, issue of the Texas Register (49 TexReg 9888); therefore, the rules will not be republished.

BACKGROUND AND INFORMATION

The amendment to § 703.13(b) increases the grant recipient audit threshold from $750,000 to $1 million. The amendment harmonizes CPRIT’s administrative rules with recent changes to the Texas Grant Management Standards (TxGMS) published by the Comptroller of Public Accounts.

The amendment to § 703.26(e) adds the following as an unallowable expense for grant recipients, “Reimbursements to employees for their out-of-pocket health insurance premium or other health care expenses which are not made through an employer-sponsored plan established under Section 105 of the Internal Revenue Code.” For these expenses to be considered fringe benefits that are reimbursable from CPRIT grant funds, the employer must have an established health reimbursement arrangement program under Section 105 of the Internal Revenue Code. Thus, this amendment clarifies that CPRIT program standards for reimbursements conform to other relevant laws.

Lastly, the non-substantive, technical amendment to § 703.26(b) replaces an outdated reference to the Uniform Grant Management Standards (UGMS) with a reference to TxGMS.