Texas Register March 8, 2024 Volume: 49 Number: 10

Texas Register Table of Contents

1 Texas Health and Human Services Commission
2 State Board of Dental Examiners
- - 2.0.1 Adopted Rules Re:
3 Texas State Board of Pharmacy
- - 3.0.1 Adopted Rules Re:
4 Texas Department of State Health Services
- - 4.0.1 Adopted Rule Reviews Re:
    - 4.0.1.1 Adopting the review of Title 25, Part 1, concerning Minimum Guidelines for Human Donor Milk Banks.
    - 4.0.1.2 Adopting the review of Title 25, Part 1, concerning Specific Additional Requirements for Drugs.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §§382.1, 382.5, 382.7, 382.9, 382.15, 382.17, to outline the rules governing the administration of the Healthy Texas Women (HTW) Program.

CHAPTER 382. WOMEN’S HEALTH SERVICES
SUBCHAPTER A. HEALTHY TEXAS WOMEN
1 TAC §§382.1, 382.5, 382.7, 382.9, 382.15, 382.17

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §382.1, concerning Introduction; §382.5, concerning Definitions; §382.7, concerning Client Eligibility; §382.9, concerning Application and Renewal Procedures; §382.15, concerning Covered and Non-covered Services; §382.17, concerning Health-Care Providers; §382.101, concerning Introduction; §382.105, concerning Definitions; §382.107, concerning Client Eligibility; §382.109, concerning Financial Eligibility Requirements; §382.113, concerning Covered and Non-covered Services; §382.115, concerning Family Planning Program Providers; §382.119, concerning Reimbursement; §382.121, concerning Provider’s Request for Review of Claim Denial; §382.123, concerning Record Retention; §382.125, concerning Confidentiality and Consent; and §382.127, concerning FPP Services for Minors; and proposes the repeal of §382.3, concerning Non-entitlement and Availability; and §382.11, concerning Financial Eligibility Requirements.

BACKGROUND AND JUSTIFICATION

The primary purpose of the proposal is to update eligibility and other Medicaid requirements in the Healthy Texas Women (HTW) program to describe the agency’s compliance with the HTW Section 1115 Demonstration that was approved by the Centers for Medicare and Medicaid Services on January 22, 2020, and transitioned the majority of the program into Medicaid. For eligible minors, the HTW program remains fully funded by state general revenue.

Another purpose of the proposal is to comply with Texas Health and Safety Code §32.102, added by Senate Bill (S.B.) 750, 86th Legislature, Regular Session, 2019, which requires HHSC to provide enhanced postpartum care services, called HTW Plus, to eligible clients. HHSC made HTW Plus available to eligible clients enrolled in the HTW program beginning September 1, 2020.

Another purpose of the proposal is to comply with Texas Health and Safety Code §31.018, also added by S.B. 750, to include a requirement for women in HTW to receive referrals to the Primary Health Care Services Program.

Another purpose of the proposal is to make conforming amendments to the Family Planning Program (FPP) rules where necessary and update covered and non-covered services for HTW and FPP.

Other non-substantive clarifying changes were made throughout the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §382.1, Introduction, replaces references to statutes that have expired with a reference to the original bill in §382.1(b) and deletes “non-federally funded services” from §382.1(c)(5) because it no longer applies to the majority of the HTW program under the authority of the HTW Section 1115 Demonstration. The HTW Section 1115 Demonstration is state and federally funded through Medicaid. The proposed amendment also makes clarifications related to the use of state funds and minor changes to use “HTW program” consistently.
The proposed amendment to §382.5, Definitions, deletes the definition for “elective abortion” and adds a definition for “abortion” that aligns with the Texas Health and Safety Code. The proposed amendment adds definitions for “CHIP” and “HTW Plus” because they are new terms used in the proposed rules. The proposed amendment revises the terms “client,” “covered service,” “HTW,” “HTW Provider,” “Medicaid,” “third-party resource,” and “unintended pregnancy.” The proposed amendment to “covered service” clarifies that a service reimbursable under the HTW program includes HTW Plus services to comply with Texas Health and Safety Code §32.102. The proposed amendments to “HTW” and “Medicaid” clarify that the terms refer to programs. The proposed amendment to “HTW Provider” specifies that HTW providers must be enrolled in the Texas Medicaid program and may also have a cost reimbursement contract with HHSC. The proposed amendment to “third-party resource” complies with federal Medicaid third-party resource requirements. The proposed amendment to “unintended pregnancy” makes the term plural to conform with the usage of the term in §382.1. The proposed amendment deletes the terms “child,” “contraceptive method,” “corporate entity,” “health care provider,” and “health clinic” because they are no longer used in Chapter 382, Subchapter A.
The proposed amendment to §382.7, Client Eligibility, updates eligibility requirements in the HTW program to reflect changes made to comply with the HTW Section 1115 Demonstration and federal Medicaid requirements, as well as Texas Health and Safety Code §32.102. The eligibility requirements updated include income, citizenship, HTW Plus eligibility criteria, period of eligibility, automatic eligibility determination, and third-party resources. The proposed amendment updates rule references and reformats the rule to improve readability of the rules.
The proposed amendment to §382.9, Application and Renewal Procedures, revises the title of the section to “Initial Application and Renewal Procedures.” The proposed amendment also updates §382.9(a) to specify that women apply for HTW using the medical assistance application form and can apply for HTW online. The proposed amendment in §382.9(h)(2) adds that HTW clients can renew online. The proposed amendment complies with the HTW Section 1115 Demonstration and federal Medicaid requirements. The proposed amendment updates a rule reference and makes editorial changes to improve readability of the rules.
The proposed amendment to §382.15, Covered and Non-covered Services, adds language on HTW Plus services in §382.15(b) to comply with Texas Health and Safety Code §32.102 and updates language on covered and non-covered services for more specificity as to services available in the HTW program. The proposed amendment clarifies that women receiving HTW Plus services can also receive HTW services listed in §382.15(a).
The proposed amendment to §382.17, Health-Care Providers, revises the title of the section to “HTW Providers.” The proposed amendment also adds language to §382.17(a)(5) on requirements for HTW providers to refer women in HTW to HHSC programs like the Primary Health Care Services Program to comply with Texas Health and Safety Code §31.018. The proposed amendment to §382.17(e) changes the HTW provider requirement to certify compliance with §382.17(b) from annually to periodically using an HHSC -approved form. The proposed amendment deletes §382.17(h) because the initial certification period for the HTW program has passed.

Repealing 1 TAC §382.3, §382.11, to remove the non-entitlement and availability rule and the financial eligibility requirements.

CHAPTER 382. WOMEN’S HEALTH SERVICES
1 TAC §382.3, §382.11

OVERVIEW

BACKGROUND AND JUSTIFICATION

Another purpose of the proposal is to make conforming amendments to the Family Planning Program (FPP) rules where necessary and update covered and non-covered services for HTW and FPP.

Other non-substantive clarifying changes were made throughout the rules.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §382.3, Non-entitlement and Availability, deletes the rule as no longer necessary because it is no longer applicable to the HTW Section 1115 Demonstration. Within Medicaid, HTW is an entitlement program.
The proposed repeal of §382.11, Financial Eligibility Requirements, deletes the rule because updated financial and income eligibility requirements were added to proposed amended §382.7, Client Eligibility.

Amending 1 TAC §§382.101, 382.105, 382.107, 382.109, 382.113, 382.115, 382.119, 382.121, 382.123, 382.125, 382.127, to replace references to expired statutes, improve the clarity of definitions, enhance the readability of the rules, and making conforming changes to the use of specific terms.

CHAPTER 382. WOMEN’S HEALTH SERVICES
SUBCHAPTER B. FAMILY PLANNING PROGRAM
1 TAC §§382.101, 382.105, 382.107, 382.109, 382.113, 382.115, 382.119, 382.121, 382.123, 382.125, 382.127

OVERVIEW

BACKGROUND AND JUSTIFICATION

Another purpose of the proposal is to make conforming amendments to the Family Planning Program (FPP) rules where necessary and update covered and non-covered services for HTW and FPP.

Other non-substantive clarifying changes were made throughout the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §382.101, Introduction, replaces references to statutes that have expired with a reference to the original bill in §382.1(b) and makes clarifications related to the use of state funds and minor changes to use “FPP” consistently.
The proposed amendment to §382.105, Definitions, deletes the definition for “elective abortion” and adds a definition for “abortion” that aligns with the Texas Health and Safety Code. The proposed amendment replaces the definition for “contractor” with a definition for “grantee” to align current terminology. The proposed amendment revises the terms “covered service,” “Family Planning Program provider,” “Medicaid,” “third-party resource,” and “unintended pregnancy.” The proposed amendment to “covered service” clarifies the definition using plain language. The proposed amendment to “Family Planning Program provider” removes the term “health-care” as it is included in the definition. The proposed amendment to “Medicaid” clarifies that the term refers to a program. The proposed amendment to “third-party resource” is consistent with third-party resource requirements used in HTW. The proposed amendment to “unintended pregnancy” makes the term plural to conform with the usage of the term in §382.101. The proposed amendment deletes the terms “corporate entity,” “contraceptive method,” and “health clinic,” because the terms are not used in Chapter 382, Subchapter B.
The proposed amendment to §382.107, Client Eligibility, improves readability of the rules. The proposed amendment removes Medicaid for Pregnant Women from adjunctive eligibility as that program provides full health benefits.
The proposed amendment to §382.109, Financial Eligibility Requirements, improves readability of the rules.
The proposed amendment to §382.113, Covered and Non-covered Services, updates language on covered and non-covered services for more specificity as to services available in FPP and adds language on new services.
The proposed amendment to §382.115, Family Planning Program Health-Care Providers, improves readability; makes conforming changes to use the term, “FPP provider,” instead of, “FPP health-care provider;” and revises the title of the section to, “Family Planning Program Providers.” The proposed amendment to §382.115(e) changes the FPP provider requirement to certify compliance with §382.115(b) from annually to before initially providing covered services using an HHSC-approved form.
The proposed amendment to §382.119, Reimbursement, makes conforming changes to use the term, “FPP provider,” instead of, “FPP health-care provider.”
The proposed amendment to §382.121, Provider’s Request for Review of Claim Denial, makes conforming changes to use the term, “FPP provider,” instead of, “FPP health-care provider.”
The proposed amendment to §382.123, Record Retention, makes conforming changes to use the term, “FPP provider,” instead of, “FPP health-care provider.”
The proposed amendment to §382.125, Confidentiality and Consent, makes conforming changes to use the term, “FPP provider,” instead of, “FPP health-care provider.”
The proposed amendment to §382.127, FPP Services for Minors, makes conforming changes to use the term, “FPP provider,” instead of, “FPP health-care provider.”

Amending 26 TAC §559.1, §559.3, to update requirements for a Day Activity and Health Services (DAHS) facility contracting with DADS to provide DAHS under Title XIX or Title XX of the Social Security Act and replace definitions for specific terms.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER A. INTRODUCTION
26 TAC §559.1, §559.3

OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§559.1, 559.11, 559.81, and 559.91; the repeal of §§559.2, 559.12 – 559.23, 559.61 – 559.64, 559.82 – 559.84, 559.92 – 559.95, and 559.102 – 559.105; and new §§559.3, 559.13, 559.15, 559.17, 559.19, 559.21, 559.23, 559.25, 559.27, 559.29, 559.31, 559.33, 559.35, 559.37, 559.39, 559.50 – 559.53, 559.55, 559.57, 559.59, 559.61, 559.63, 559.65, 559.67, 559.69, 559.71, 559.73, 559.75, 559.77, 559.79, 559.83, 559.85, 559.87, 559.93, 559.95, 559.97, 559.99, 559.101, 559.103, 559.105, and 559.107, in Texas Administrative Code (TAC), Title 26, Part 1, Chapter 559, Day Activity and Health Services Requirements.

BACKGROUND AND JUSTIFICATION

The purpose of this proposal is to comply with House Bill (H.B.) 1009 and H.B. 4696 from the 88th Legislature, Regular Session, 2023. The proposal also reorganizes rule sections so that key topics are easier to find, adds clarity and specificity to rules, and updates references throughout the chapter.

SECTION-BY-SECTION SUMMARY

Proposed amendments throughout the chapter update citations and references and restructure sentences to use active voice. Other proposed amendments throughout the chapter replace “individual” with “client” for consistency.
The proposed amendment to §559.1, Purpose, removes requirements for a Day Activity and Health Services (DAHS) facility contracting with DADS to provide DAHS under Title XIX or Title XX of the Social Security Act. These requirements are in 40 TAC Chapter 98, Day Activity and Health Services Requirements, Subchapter H, Day Activity and Health Services (DAHS) Contractual Requirements.
Proposed new §559.3, Definitions, relocates the rule from proposed repealed §559.2, Definitions. The proposed new rule deletes definitions for the terms “authorization,” “case manager,” “caseworker,” and “Medicaid eligible” as these terms are only used in 40 TAC Chapter 98, Subchapter H, DAHS Contractual Requirements. The proposed new rule adds definitions for the terms “controlling person,” “online portal,” and “willfully interfere.”

Repealing 26 TAC §559.2, to remove an unnecessary rule.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS

BACKGROUND AND PURPOSE

SECTION-BY-SECTION SUMMARY

Proposed amendments throughout the chapter update citations and references and restructure sentences to use active voice. Other proposed amendments throughout the chapter replace “individual” with “client” for consistency.
The proposed repeal of §559.2, Definitions, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.3, Definitions.

Amending 26 TAC §§559.11, 559.13, 559.15, 559.17, 559.19, 559.21, 559.23, 559.25, 559.27, 559.29, 559.31, 559.33, 559.35, 559.37, 559.39, to outline the procedures, qualifications, and other requirements for applying, processing, approving, and maintaining licenses for buildings.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER B. LICENSING
26 TAC §§559.11, 559.13, 559.15, 559.17, 559.19, 559.21, 559.23, 559.25, 559.27, 559.29, 559.31, 559.33, 559.35, 559.37, 559.39

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§559.1, 559.11, 559.81, and 559.91; the repeal of §§559.2, 559.12 – 559.23, 559.61 – 559.64, 559.82 – 559.84, 559.92 – 559.95, and 559.102 – 559.105; and new §§559.3, 559.13, 559.15, 559.17, 559.19, 559.21, 559.23, 559.25, 559.27, 559.29, 559.31, 559.33, 559.35, 559.37, 559.39, 559.50 – 559.53, 559.55, 559.57, 559.59, 559.61, 559.63, 559.65, 559.67, 559.69, 559.71, 559.73, 559.75, 559.77, 559.79, 559.83, 559.85, 559.87, 559.93, 559.95, 559.97, 559.99, 559.101, 559.103, 559.105, and 559.107, in Texas Administrative Code (TAC), Title 26, Part 1, Chapter 559, Day Activity and Health Services Requirements.

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed amendments throughout the chapter update citations and references and restructure sentences to use active voice. Other proposed amendments throughout the chapter replace “individual” with “client” for consistency.
The proposed amendment to §559.11, Criteria for Licensing, requires submission of license applications through the online portal, adds controlling parties to the list of individuals whose background and qualification HHSC considers for licensure, and clarifies that the term of a license is three years.
The proposed repeal of §559.13, Applicant Disclosure Requirements, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.19, Applicant Disclosure Requirements.
Proposed new §559.13, General Application Requirements, creates a new section requiring applicants to use the online portal to submit a license application and fulfill all licensure requirements.
The proposed repeal of §559.15, Renewal Procedures and Qualifications, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.23, Renewal Procedures and Qualifications.
Proposed new §559.15, Time Periods for Processing Licensing Applications, relocates the rule from proposed repealed §559.18, Time Periods for Processing Licensing Applications, and updates citations and references.
The proposed repeal of §559.17, Change of Staff, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.29, Change of Staff.
Proposed new §559.17, Building Approval, relocates the rule from proposed repealed §559.12, Building Approval, and updates citations and references.
The proposed repeal of §559.19, Criteria for Denying a License or Renewal of a License, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.31, Criteria for Denying a License or Renewal of a License.
Proposed new §559.19, Applicant Disclosure Requirements, relocates the rule from proposed repealed §559.13, Applicant Disclosure Requirements, and updates citations and references.
The proposed repeal of §559.21, License Fees, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.37, Fees.
Proposed new §559.21, Initial License Application Procedures and Requirements, creates a new section requiring full payment of fees with the application submission for an initial license. Additionally, the proposed new rule requires an applicant to notify HHSC via the online portal when the facility is ready for a Life Safety Code inspection and when the facility is ready for a health inspection.
The proposed repeal of §559.23, Relocation, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.27, Relocation.
Proposed new §559.23, Renewal Procedures and Qualifications, relocates the rule from proposed repealed §559.15, Renewal Procedures and Qualifications, and updates citations and references. The proposed new rule clarifies that license renewals expire three years after the date of issuance.
Proposed new §559.25, Change of Ownership and Notice of Changes, relocates the rule from proposed repealed §559.16, Change of Ownership and Notice of Changes.
Proposed new §559.27, Relocation, relocates the rule from proposed repealed §559.23, Relocation, and updates citations and references.
Proposed new §559.29, Change of Staff, relocates the rule from proposed repealed §559.17, Change of Staff, and updates citations and references. The proposed new rule requires facilities to submit an application for a change of director through the online portal within 30 days before or after the change.
Proposed new §559.31, Criteria for Denying a License or Renewal of a License, relocates the rule from proposed repealed §559.19, Criteria for Denying a License or Renewal of a License, and updates citations and references.
Proposed new §559.33, Opportunity to Show Compliance, relocates the rule from proposed repealed §559.20, Opportunity to Show Compliance, and updates citations and references.
Proposed new §559.35, Change in Capacity, relocates the rule from proposed repealed §559.14, Increase in Capacity, and updates citations and references. The proposed new rule requires license holders that wish to decrease the licensed capacity of the facility to provide notification via the online portal.
Proposed new §559.37, Fees, relocates the rules from proposed repealed §559.21, License Fees and §559.22, Plan Review Fees, and updates citations and references. The proposed new rule requires payment of fees in accordance with the options available in the online portal and removes the option of payment for a two-year license.
Proposed new §559.39, Voluntary Closure, creates a new section requiring providers to notify HHSC in writing at least five days before permanent closure of the operation.

Repealing 26 TAC §§559.12 – 559.23 and new 26 TAC §§559.12 – 559.23, to outline the procedures, qualifications, and other requirements for applying for licenses for buildings.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER B. APPLICATION PROCEDURES
26 TAC §§559.12 – 559.23

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed amendments throughout the chapter update citations and references and restructure sentences to use active voice. Other proposed amendments throughout the chapter replace “individual” with “client” for consistency.
The proposed repeal of §559.12, Building Approval, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.17, Building Approval.
The proposed repeal of §559.13, Applicant Disclosure Requirements, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.19, Applicant Disclosure Requirements.
Proposed new §559.13, General Application Requirements, creates a new section requiring applicants to use the online portal to submit a license application and fulfill all licensure requirements.
The proposed repeal of §559.14, Increase in Capacity, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.35, Change in Capacity.
The proposed repeal of §559.15, Renewal Procedures and Qualifications, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.23, Renewal Procedures and Qualifications.
Proposed new §559.15, Time Periods for Processing Licensing Applications, relocates the rule from proposed repealed §559.18, Time Periods for Processing Licensing Applications, and updates citations and references.
The proposed repeal of §559.16, Change of Ownership and Notice of Changes, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.25, Change of Ownership and Notice of Changes.
The proposed repeal of §559.17, Change of Staff, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.29, Change of Staff.
Proposed new §559.17, Building Approval, relocates the rule from proposed repealed §559.12, Building Approval, and updates citations and references.
The proposed repeal of §559.18, Time Periods for Processing Licensing Applications, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.15, Time Periods for Processing Licensing Applications.
The proposed repeal of §559.19, Criteria for Denying a License or Renewal of a License, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.31, Criteria for Denying a License or Renewal of a License.
Proposed new §559.19, Applicant Disclosure Requirements, relocates the rule from proposed repealed §559.13, Applicant Disclosure Requirements, and updates citations and references.
The proposed repeal of §559.20, Opportunity to Show Compliance, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.33, Opportunity to Show Compliance.
The proposed repeal of §559.21, License Fees, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.37, Fees.
Proposed new §559.21, Initial License Application Procedures and Requirements, creates a new section requiring full payment of fees with the application submission for an initial license. Additionally, the proposed new rule requires an applicant to notify HHSC via the online portal when the facility is ready for a Life Safety Code inspection and when the facility is ready for a health inspection.
The proposed repeal of §559.22, Plan Review Fees, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.37, Fees

The proposed repeal of §559.23, to delete the rule which is no longer necessary because the content of the rule has been added to proposed new §559.27, Relocation.

New 26 TAC §§559.50 – 559.53, 559.55, 559.57, 559.59, 559.61, 559.63, 559.65, 559.67, 559.69, 559.71, 559.73, 559.75, 559.77, and 559.79, to relocate rules pertaining to abuse and neglect.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER D. STANDARDS FOR LICENSURE [AND PROGRAM REQUIREMENTS]
26 TAC §§559.50 – 559.53, 559.55, 559.57, 559.59, 559.61, 559.63, 559.65, 559.67, 559.69, 559.71, 559.73, 559.75, 559.77, 559.79

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed amendments throughout the chapter update citations and references and restructure sentences to use active voice. Other proposed amendments throughout the chapter replace “individual” with “client” for consistency.
Proposed new §559.50, Purpose, creates a new section defining the term “communicable diseases” used in the subchapter.
Proposed new §559.51, Compliance, relocates the rule from proposed repealed §559.61(b), and updates citations and references. The proposed new rule defines “reportable conduct” used in this section and implements H.B. 1009 requiring a facility to suspend an employee who has been reported to the Employee Misconduct Registry (EMR) during any appeals process.
Proposed new §559.52, Client Rights, creates a new section requiring facilities to extend the enumerated rights to all adult clients, not just those over age 60.
Proposed new §559.53, Maintenance of Policies and Procedures, relocates the rule from proposed repealed §559.61(c) and updates citations and references.
Proposed new §559.55, Reporting Incidents of Abuse or Neglect, relocates the rule from proposed repealed §559.61(d) and updates citations and references. The proposed new rule requires facilities report to HHSC via the online portal or by speaking with an HHSC agent at 1-800-458-9858 upon learning of alleged abuse or neglect of a client.
Proposed new §559.57, Postings, relocates the rule from proposed repealed §559.61(e) and updates citations and references.
Proposed new §559.59, Staff Qualifications, relocates the rule from proposed repealed §559.62(a) and updates citations and references. The proposed new rule adds basic infection prevention and control measures and emergency preparedness and response to the list of options for director annual continuing education. The proposed new rule deletes requirements for a facility that contracts with HHSC.
Proposed new §559.61, Staffing Ratio and Hours, relocates the rule from proposed repealed §559.62(b) and updates citations and references.
Proposed new §559.63, Infection Prevention and Control, relocates the rule from proposed repealed §559.62(c) and updates citations and references. The proposed new rule requires facilities to develop, implement, enforce, and maintain an infection prevention and control program that provides a safe, sanitary, and comfortable environment and helps prevent the development and transmission of disease and infection.
The proposed repeal of §559.64, Emergency Preparedness and Response deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.79, Emergency Preparedness and Response.
Proposed new §559.65, Staff Responsibilities, relocates the rule from proposed repealed §559.62(d) and updates citations and references. The proposed new rule requires facilities ensure clients have a choice in whether to participate in facility activities.
Proposed new §559.67, Training, relocates the rule from proposed repealed §559.62(e) and updates citations and references. The proposed new rule adds a list of possible topics that may be covered in the required quarterly training to direct service staff.
Proposed new §559.69, Medications, relocates the rule from proposed repealed §559.62(f) and updates citations and references. The proposed new rule clarifies that a person who administers medications to clients must hold a current license under applicable state law authorizing the licensee to administer medications. The proposed new rule requires facilities to dispose of medication in accordance with federal and state laws and allows for disposal of medications via local pharmacy on-site medication drop-off boxes or local law enforcement or community drug take-back programs.
Proposed new §559.71, Accident, Injury, or Acute Illness, relocates the rule from proposed repealed §559.62(g) and updates citations and references.
Proposed new §559.73, Menus, relocates the rule from proposed repealed §559.62(h) and updates citations and references.
Proposed new §559.75, Client Records, creates a new section with facility requirements for retention of records, destruction of records, and client access to records.
Proposed new §559.77, Peer Review, relocates the rule from proposed repealed §559.63, Peer Review.
Proposed new §559.79, Emergency Preparedness and Response, relocates the rule from proposed repealed §559.64, Emergency Preparedness and Response. The proposed new rule adds definitions to the terms “designated emergency contact,” “disaster or emergency,” “emergency management coordinator,” “emergency preparedness coordinator,” “plan,” and “risk assessment.” The proposed new rule removes references to “receiving facility” to avoid confusion.

Repealing 26 TAC §559.61 – 559.64, to delete old rules regarding compliance, reporting of abuse and neglect, and program requirements which have been replaced by new rules.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER D. LICENSURE AND PROGRAM REQUIREMENTS
26 TAC §559.61 – 559.64

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §559.61, General Requirements, deletes the rule as no longer necessary because the content of the rule has been added to proposed new rules as follows: §559.61(b) content added to §559.51, Compliance; §559.61(c) content added to §559.53, Maintenance of Policies and Procedures; §559.61(d) content added to §559.55, Reporting Incidents of Abuse or Neglect; and §559.61(e) content added to §559.57, Postings.
The proposed repeal of §559.62, Program Requirements, deletes the rule as no longer necessary because the content of the rule has been added to proposed new rules as follows: §559.62(a) content added to §559.59, Staff Qualifications; §559.62(b) content added to §559.61, Staffing Ratio and Hours; §559.62(c) content added to §559.63, Infection Prevention and Control; §559.62(d) content added to §559.65, Staff Responsibilities; §559.62(e) content added to §559.67, Training; §559.62(f) content added to §559.69, Medications; §559.62(g) content added to §559.71, Accident, Injury, or Acute Illness; and §559.62(h) content added to §559.73, Menus.
The proposed repeal of §559.63, Peer Review, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.77, Peer Review.
The proposed repeal of §559.64, Emergency Preparedness and Response deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.79, Emergency Preparedness and Response.

Amending 26 TAC §559.81, and new 26 TAC §§559.83, 559.85, and 559.87, to outline inspection requirements after a complaint has been received.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER E. INSPECTIONS, SURVEYS, AND VISITS
26 TAC §§559.81, 559.83, 559.85, 559.87

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §559.81, Procedural Requirements, implements H.B. 4696, requiring HHSC to perform an inspection as soon as feasible but not later than the 14th day after the date HHSC receives a complaint alleging abuse, neglect, or exploitation (ANE) rather than not later than the 30th day. H.B. 4696 also provides that if a complaint does not allege ANE, HHSC must investigate the complaint not later than the 45th day after the complaint is received. The amendment requires facilities that maintain electronic records to have a mechanism for printing documentation if a surveyor or investigator requests copies.
Proposed new §559.83, Determinations and Actions Pursuant to Inspections, relocates the rule from proposed repealed §559.82, Determinations and Actions Pursuant to Inspections, and updates citations and references.
Proposed new §559.85, Referrals to the Attorney General, relocates the rule from proposed repealed §559.83, Referrals to the Attorney General, and updates citations and references.
Proposed new §559.87, Procedures for Inspection of Public Records, relocates the rule from proposed repealed §559.84, Procedures for Inspection of Public Records, and updates citations and references.

Repealing 26 TAC §§559.82 – 559.84, to delete replaced rules concerning inspections, referrals to the Attorney General, and inspection procedures of public records.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER E. INSPECTIONS, SURVEYS, AND VISITS
26 TAC §§559.82 – 559.84

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §559.82, Determinations and Actions Pursuant to Inspections, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.83, Determinations and Actions Pursuant to Inspections.
The proposed repeal of §559.83, Referrals to the Attorney General, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.85, Referrals to the Attorney General.
The proposed repeal of §559.84, Procedures for Inspection of Public Records, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.87, Procedures for Inspection of Public Records.

Amending 26 TAC §559.91, and new 26 TAC §559.91, 559.93, 559.95, 559.97, and 559.99, to update a reference and relocate rules pertaining to reportable abuse, neglect, or exploitation, and information about complaint investigation.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER F. ABUSE, NEGLECT, AND EXPLOITATION: COMPLAINT AND INCIDENT REPORTS AND INVESTIGATIONS
26 TAC §§559.91, 559.93, 559.95, 559.97, 559.99

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §559.91, Definitions of Abuse, Neglect, and Exploitation, updates an outdated reference to §98.1.
Proposed new §559.93, Abuse, Neglect, or Exploitation Reportable to HHSC by Facilities, relocates the rule from proposed repealed §559.92, Abuse, Neglect, or Exploitation Reportable to DADS by Facilities, and updates citations and references. The proposed new rule requires facilities to investigate alleged abuse, neglect, or exploitation and submit a written report of the investigation via the online portal.
Proposed new §559.95, Complaint Investigation, relocates the rule from proposed repealed §559.93, Complaint Investigation, and updates citations and references.
Proposed new §559.97, Investigations of Complaints, relocates the rule from proposed repealed §559.94, Investigations of Complaints, and updates citations and references.
Proposed new §559.99, Confidentiality, relocates the rule from proposed repealed §559.95, Confidentiality, and updates citations and references.

Repealing 26 TAC §§559.92 – 559.95, to delete unnecessary rules regarding reportable abuse, neglect, and exploitation and complaint investigation.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER F. ABUSE, NEGLECT, AND EXPLOITATION: COMPLAINT AND INCIDENT REPORTS AND INVESTIGATIONS
26 TAC §§559.92 – 559.95

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §559.92, Abuse, Neglect, or Exploitation Reportable to DADS by Facilities, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.93, Abuse, Neglect, or Exploitation Reportable to HHSC by Facilities.
The proposed repeal of §559.93, Complaint Investigation, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.95, Complaint Investigation.
The proposed repeal of §559.94, Investigations of Complaints, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.97, Investigations of Complaints.
The proposed repeal of §559.95, Confidentiality, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.99, Confidentiality.

New 26 TAC §§559.101, 559.103, 559.105, 559.107, to relocate rules regarding nonemergency suspension, revocation of a license, emergency suspensions and closing orders, and administrative penalties.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER G. ENFORCEMENT
26 TAC §§559.101, 559.103, 559.105, 559.107

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed new §559.101, Nonemergency Suspension, relocates the rule from proposed repealed §559.102, Nonemergency Suspension, and updates citations and references. The proposed new rule requires a facility whose license has been suspended to return the license to HHSC within 72 hours of the passing of the appeal deadline or, if an appeal is filed, the final disposition of the appeal.
Proposed new §559.103, Revocation, relocates the rule from proposed repealed §559.103, Revocation, and updates citations and references. The proposed new rule requires a facility whose license has been revoked to return the license to HHSC within 72 hours of the passing of the appeal deadline or, if an appeal is filed, the final disposition of the appeal.
Proposed new §559.105, Emergency Suspension and Closing Order, relocates the rule from proposed repealed §559.104, Emergency Suspension and Closing Order, and updates citations and references.
Proposed new §559.107, Administrative Penalties, relocates the rule from proposed repealed §559.105, Administrative Penalties, and updates citations and references.

Repealing 26 TAC §§559.102 – 559.105, to delete unnecessary rules concerning nonemergency suspension, revocation of a license, emergency suspensions and closing orders, and administrative penalties.

CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER G. ENFORCEMENT
26 TAC §§559.102 – 559.105

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §559.102, Nonemergency Suspension, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.101, Nonemergency Suspension.
The proposed repeal of §559.103, Revocation, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.103, Revocation.
The proposed repeal of §559.104, Emergency Suspension and Closing Order, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.105, Emergency Suspension and Closing Order.
The proposed repeal of §559.105, Administrative Penalties, deletes the rule as no longer necessary because the content of the rule has been added to proposed new §559.107, Administrative Penalties.

Withdrawn Rules Re:

Withdrawing the proposed amendment to 1 TAC §§382.1, 382.5, 382.7, 382.9, 382.15, 382.17, to provide updates on the eligibility requirements in the HTW program and replace references and language which is outdated.

CHAPTER 382. WOMEN’S HEALTH SERVICES
SUBCHAPTER A. HEALTHY TEXAS WOMEN
1 TAC §§382.1, 382.5, 382.7, 382.9, 382.15, 382.17

OVERVIEW

The Texas Health and Human Services Commission withdraws proposed amendments to 1 TAC §§382.1, 382.5, 382.7, 382.9, 382.15 and 382.17 which appeared in the January 26, 2024, issue of the Texas Register (49 TexReg 308).

Withdrawing the proposed amendment to 1 TAC §382.3, §382.11, to delete a rule pertaining to financial and income eligibility requirements.

CHAPTER 382. WOMEN’S HEALTH SERVICES
SUBCHAPTER A. HEALTHY TEXAS WOMEN
1 TAC §382.3, §382.11

OVERVIEW

The Texas Health and Human Services Commission withdraws the proposed repeal of 1 TAC §382.3 and §382.11 which appeared in the January 26, 2024, issue of the Texas Register (49 TexReg 308).

Withdrawing the proposed amendment to 1 TAC §§382.101, 382.105, 382.107, 382.109, 382.113, 382.115, 382.119, 382.121, 382.123, 382.125, 382.127, to improve readability and update terms.

CHAPTER 382. WOMEN’S HEALTH SERVICES
SUBCHAPTER B. FAMILY PLANNING PROGRAM
1 TAC §§382.101, 382.105, 382.107, 382.109, 382.113, 382.115, 382.119, 382.121, 382.123, 382.125, 382.127

OVERVIEW

The Texas Health and Human Services Commission withdraws proposed amendments to 1 TAC §§382.101, 382.105, 382.107, 382.109, 382.113, 382.115, 382.119, 382.121, 382.123, 382.125 and 382.127 which appeared in the January 26, 2024, issue of the Texas Register (49 TexReg 308).

Adopted Rules Re:

New 26 TAC §338.1, to allow LIDDAs during a declared disaster to use certain flexibilities for some rules when providing services.

CHAPTER 338. DISASTER RULE FLEXIBILITIES FOR LOCAL INTELLECTUAL AND DEVELOPMENTAL DISABILITY AUTHORITIES (LIDDAs)
26 TAC §338.1

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §338.1, concerning Disaster Rule Flexibilities for Local Intellectual and Developmental Disability Authorities (LIDDAs). The new §338.1 is adopted with changes to the proposed text as published in the December 8, 2023, issue of the Texas Register (48 TexReg 7123). This rule will be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the new rule is to allow LIDDAs to use certain flexibilities to rules when providing services during a declared disaster under Texas Government Code §418.014. LIDDAs provide essential services to individuals with intellectual or developmental disabilities (IDD). This vulnerable population relies on LIDDA staff to assist them in securing the services they need, achieving their desired outcomes and best quality of life. Disaster rule flexibilities for LIDDAs ensure that when a disaster declaration is in effect, HHSC may issue timely guidance and authorize flexibilities for LIDDAs to provide services.

The new rule allows HHSC to notify LIDDAs of certain flexibilities immediately upon a disaster declaration to prevent interruption of service delivery. These flexibilities include allowing service coordination to be delivered via audio-only or audio-visual communication to ensure continuity of services, as well as extending some timeframes for LIDDAs. In addition, the rule requires that LIDDAs follow HHSC guidance related to the rules, comply with all applicable requirements related to security and privacy of information, and notify persons impacted by the flexibilities, if applicable.

Amending 26 TAC §§556.2, 556.3, 556.5, 556.8, to update references and definitions and to revise Nurse Aide Competency Evaluation Program (NATCEP) requirements.

CHAPTER 556. NURSE AIDES
26 TAC §§556.2, 556.3, 556.5, 556.8

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments §556.2, concerning Definitions; §556.3, concerning NATCEP Requirements; §556.5, concerning Program Director, Program Instructor, Supplemental Trainers, and Skills Examiner Requirements; and §556.8, concerning Withdrawal of Approval of a NATCEP.

The amendments to §§556.2, 556.3, 556.5, and 556.8 are adopted without changes to the proposed text as published in the October 27, 2023, issue of the Texas Register (48 TexReg 6332). These rules will be not republished.

BACKGROUND AND JUSTIFICATION

The amended rules stipulate that Nurse Aide Competency Evaluation Programs (NATCEPs) must accept 60 hours of classroom training through HHSC’s computer-based training (CBT) for nurse aide candidates seeking to qualify for the Certified Nurse Aide (CNA) exam. The amendments update definitions and references associated with the nurse aide CBT training and clarify related requirements. The amended rules also revise language regarding credentials for NATCEP directors and instructors, making them more consistent with federal requirements. Specifically, the Code of Federal Regulations (CFR) does not differentiate between the credentials required by the NATCEP program director versus the program instructor. It states that the program must train nurse aides under the general supervision of a registered nurse with at least two years of nursing experience, at least one of which must be in providing long term care services. The amended rules remove specific credentialing requirements for NATCEP directors and instructors and replace them with language allowing either or both to meet the federal requirements outlined in the CFR.

Transferred Rules Re:

Rule Transfer, to transfer Title 1, Part 15, Chapter 379, Family Violence Program to the Texas Administrative Code, Title 26, Part 1, Chapter 356, Family Violence Program.

OVERVIEW

During the 84th Legislative Session, the Texas Legislature passed Senate Bill (S.B.) 200, addressing the reorganization of health and human services delivery in Texas. To comply with the requirements of S.B. 200, the Texas Register created new Title 26, Health and Human Services, in the Texas Administrative Code. Rules currently in the Texas Administrative Code that concern health and human services may transition to the new title. This transition may affect all or part of the agency’s rules in Title 1, Part 15, Texas Health and Human Services Commission. The HHSC rules in Texas Administrative Code, Title 1, Part 15, Chapter 379, Family Violence Program are being transferred to Texas Administrative Code, Title 26, Part 1, Chapter 356, Family Violence Program.

Rule Transfer, to transfer Title 1, Part 15, Chapter 379, Family Violence Program to the Texas Administrative Code, Title 26, Part 1, Chapter 356, Family Violence Program.

OVERVIEW

Adopted Rule Review Re:

Adopting the review of Title 26, Part 1, concerning Early Childhood Intervention Services.

The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code (TAC):

Chapter 350, Early Childhood Intervention Services

Notice of the review of this chapter was published in the December 29, 2023, issue of the Texas Register (48 TexReg 8393). HHSC received no comments concerning this chapter.

In Addition Re:

Public Hearing – Revised Date – Texas State Hospital Long-Range Planning Report Meetings

HHSC will conduct two hybrid (in-person and virtual) meetings on March 13th and April 16th, 2024, to receive public comment on the draft long-range planning report for the Texas State Hospitals. A draft report will be available to the public on the HHS website prior to the March 19th meeting. The report will address:

(1) projected future bed requirements for state hospitals;

(2) documenting the methodology used to develop the projection of future bed requirements;

(3) projected maintenance costs for institutional facilities;

(4) recommended strategies to maximize the use of institutional facilities; and

(5) how each state hospital will:

(A) serve and support the communities and consumers in its service area; and

(B) fulfill statewide needs for specialized services.

The initiatives outlined in this report will guide the Texas State Hospitals for the next six years. This report is developed under the authority of Texas Health and Safety Code §533.032.

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, 2024.

The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for Family Planning Services.

The proposed amendment is estimated to result in an annual aggregate expenditure of $3,058 for federal fiscal year (FFY) 2024, consisting of $2,735 in federal funds and $306 in state general revenue. For FFY 2025, the estimated annual aggregate expenditure is $6,050 consisting of $5,445 in federal funds and $605 in state general revenue. For FFY 2026, the estimated annual aggregate expenditure is $5,987 consisting of $5,388 in federal funds and $599 in state general revenue.

State Board of Dental Examiners

Adopted Rules Re:

Amending 22 TAC §111.5, to replace the requirement for a written statement for waivers with a requirement that a dentist attest to the circumstances necessitating a waiver.

CHAPTER 111. STANDARDS FOR PRESCRIBING CONTROLLED SUBSTANCES AND DANGEROUS DRUGS
22 TAC §111.5

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §111.5, concerning electronic prescribing waivers without changes to the proposal as published in the December 15, 2023, issue of the Texas Register (48 TexReg 7280). The rule willl not be republished. The adopted amendment removes the requirement that a dentist must submit a written statement and supporting documentation describing the circumstances necessitating a waiver, and instead requires a dentist to attest to the circumstances necessitating a waiver. This amendment will make it less burdensome on the dentist when submitting a waiver request to the Board, and it will make the Board’s waiver process more efficient.

The Texas Dental Association (TDA) provided a written comment in support of adoption of the rule as proposed. No changes to the proposed rule were made as a result of the comment.

New 22 TAC §114.8, to allow dental assistance to apply to the Board to retire or reinstate their retired registrations.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.8

OVERVIEW

The State Board of Dental Examiners (Board) adopts this new rule 22 TAC §114.8, concerning the retired status of a dental assistant registration, without changes to the proposal as published in the December 15, 2023, issue of the Texas Register (48 TexReg 7281) and will not be republished. This rule will allow registered dental assistants to apply to the Board to retire their registrations and also to reinstate their retired registrations.

The Texas Dental Association (TDA) provided a written comment in support of adoption of the rule as proposed. No changes to the proposed rule were made as a result of the comment.

New 22 TAC §114.13, to allow registered dental assistants to apply to the Board to reinstate a cancelled registration.

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.13

OVERVIEW

The State Board of Dental Examiners (Board) adopts this new rule 22 TAC §114.13, concerning the reinstatement of a cancelled registration, without changes to the proposal as published in the December 15, 2023, issue of the Texas Register (48 TexReg 7283) and will not be republished. This rule will allow registered dental assistants to apply to the Board to reinstate a cancelled registration.

The Texas Dental Association (TDA) provided a written comment in support of adoption of the rule as proposed. No changes to the proposed rule were made as a result of the comment.

Texas State Board of Pharmacy

Adopted Rules Re:

Amending 22 TAC §283.9, to clarify the fees for failure to timely submit the initial renewal application and license fee for a license to practice pharmacy.

CHAPTER 283. LICENSING REQUIREMENTS FOR PHARMACISTS
22 TAC §283.9

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §283.9, concerning Fee Requirements for Licensure by Examination, Score Transfer and Reciprocity. These amendments are adopted without changes to the proposed text as published in the December 15, 2023, issue of the Texas Register (48 TexReg 7288). The rule will not be republished.

The amendments clarify how the board calculates the fee for failing to timely submit the initial renewal application and license fee for a license to practice pharmacy and correct grammatical errors.

Amending 22 TAC §283.12, to specify that the requirements for obtaining an interim license for a military service member or military spouse do not affect rights that may be provided under federal law.

CHAPTER 283. LICENSING REQUIREMENTS FOR PHARMACISTS
22 TAC §283.12

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §283.12, concerning Licenses for Military Service Members, Military Veterans, and Military Spouses. These amendments are adopted without changes to the proposed text as published in the December 22, 2023, issue of the Texas Register (48 TexReg 7745). The rule will not be republished.

Amending 22 TAC §291.74, to specify the labeling requirements for a participating provider to dispense donated prescription drugs.

CHAPTER 291. PHARMACIES
SUBCHAPTER D. INSTITUTIONAL PHARMACY (CLASS C)
22 TAC §291.74

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §291.74, concerning Operational Standards. These amendments are adopted with changes to the proposed text as published in the December 22, 2023, issue of the Texas Register (48 TexReg 7748). The rule will be republished.

Amending 22 TAC §297.10, to specify that he requirements for obtaining an interim registration for a military service member or military spouse do not affect rights that may be provided under federal law.

CHAPTER 297. PHARMACY TECHNICIANS AND PHARMACY TECHNICIAN TRAINEES
22 TAC §297.10

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §297.10, concerning Registration for Military Service Members, Military Veterans, and Military Spouses. These amendments are adopted without changes to the proposed text as published in the December 22, 2023, issue of the Texas Register (48 TexReg 7757). The rule will not be republished.

Amending 22 TAC §315.9, to clarify that the requirement for the dispensing of a Schedule II controlled substance prescription which is issued by a practitioner in another state apply to electronic prescriptions.

CHAPTER 315. CONTROLLED SUBSTANCES
22 TAC §315.9

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §315.9, concerning Pharmacy Responsibility – Out-of-State Practitioner – Effective September 1, 2016. These amendments are adopted without changes to the proposed text as published in the December 15, 2023, issue of the Texas Register (48 TexReg 7289). The rule will not be republished.

Amending 28 TAC §133.10, §133.20, to require an assignment number for certain enumerated services and to clarify that the ninety-five day period for the timely submission of a bill for additional testing begins on the date of service of the additional testing.

CHAPTER 133. GENERAL MEDICAL PROVISIONS
SUBCHAPTER B. HEALTH CARE PROVIDER BILLING PROCEDURES
28 TAC §133.10, §133.20

OVERVIEW

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts amended 28 TAC §§133.10, 133.20, 133.200, and 133.502, concerning billing and reimbursement for certain workers’ compensation-specific services, including designated doctor examinations, required medical examinations, work status reports, and maximum medical improvement (MMI) evaluations and impairment rating (IR) examinations by treating and referred doctors. The amendments implement Texas Labor Code Chapters 408 and 413, which govern workers’ compensation benefits, including medical examinations required to establish benefit entitlements, and medical review to ensure compliance with DWC rules for health care, including medical policies and fee guidelines. The DWC medical advisor recommended the amendments to the commissioner of workers’ compensation under Labor Code §413.0511(b). The amendments to §§133.10, 133.20, and 133.502 are adopted with three changes to the proposed text published in the December 29, 2023, issue of the Texas Register (48 TexReg 8153). The changes clarify the effective dates in §§133.10(l), 133.20(o), and 133.502(g). These rules will be republished. Section 133.200 is adopted without changes and will not be republished.

BACKGROUND AND JUSTIFICATION

Amending §§133.10, 133.20, 133.200, and 133.502 is necessary to attract and retain designated doctors, required medical examination doctors, and doctors that perform MMI evaluations and IR examinations by addressing billing and reimbursement issues, reducing disputes, and decreasing the administrative burden of participating in the program. Labor Code Chapter 408 entitles an employee that sustains a compensable injury to all health care reasonably required by the nature of the injury as and when needed. Specifically, the employee is entitled to health care that cures or relieves the effects naturally resulting from the compensable injury, promotes recovery, or enhances the ability of the employee to return to or retain employment. To help determine the health care that meets those standards, the designated doctor program established under Chapter 408 provides for commissioner-ordered medical examinations to resolve any question about the impairment caused by the compensable injury, the attainment of MMI, the extent of the employee’s compensable injury, whether the injured employee’s disability is a direct result of the work-related injury, the ability of the employee to return to work, or other similar issues. Maintaining a viable program that ensures that injured employees can access examinations in a timely way is essential to meeting the statutory mandate of providing health care for injured employees.

Amending 28 TAC §133.200, to correct a reference in the rules relating to medical bill processing.

CHAPTER 133. GENERAL MEDICAL PROVISIONS
SUBCHAPTER C. MEDICAL BILL PROCESSING/AUDIT BY INSURANCE CARRIER
28 TAC §133.200

OVERVIEW

BACKGROUND AND JUSTIFICATION

Amending 28 TAC §133.502, to require an assignment number in the prior authorization field for professional, institutional or hospital, dental, and pharmacy electronic medical bills.

CHAPTER 133. GENERAL MEDICAL PROVISIONS
SUBCHAPTER G. ELECTRONIC MEDICAL BILLING, REIMBURSEMENT, AND DOCUMENTATION
28 TAC §133.502

OVERVIEW

BACKGROUND AND JUSTIFICATION

Amending 28 TAC §§134.209, 134.210, 134.235, 134.239, 134.240, 134.250, 134.260, to update references and to clarify reimbursements and modifiers for billing.

CHAPTER 134. BENEFITS–GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS
SUBCHAPTER C. MEDICAL FEE GUIDELINES
28 TAC §§134.209, 134.210, 134.235, 134.239, 134.240, 134.250, 134.260

OVERVIEW

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts the repeal of 28 TAC §§134.235, 134.239, and 134.240; and new and amended 28 TAC §§134.209, 134.210, 134.235, 134.239, 134.240, 134.250, and 134.260, concerning medical fee guidelines for certain workers’ compensation-specific services, including designated doctor examinations, required medical examinations, work status reports, and maximum medical improvement (MMI) evaluations and impairment rating (IR) examinations by treating and referred doctors. The sections implement Texas Labor Code Chapters 408 and 413, which govern workers’ compensation benefits, including medical examinations required to establish benefit entitlements, and medical review to ensure compliance with DWC rules for health care, including medical policies and fee guidelines. The DWC medical advisor recommended the changes to the commissioner of workers’ compensation under Labor Code §413.0511(b). The repealed, new and amended sections are adopted without changes to the proposed text published in the December 29, 2023, issue of the Texas Register (48 TexReg 8165). The rules will not be republished.

BACKGROUND AND JUSTIFICATION

The changes in the new and amended sections adjust the billing methodology and reimbursement rates for certain workers’ compensation-specific services, including designated doctor examinations, required medical examinations, work status reports, and MMI evaluations and IR examinations by treating and referred doctors. They adjust the fees once by applying the Medicare Economic Index (MEI) percentage adjustment factor for the period 2009 – 2024, and then after the initial adjustment, adjust the fees annually on January 1 by applying the MEI percentage adjustment factor in §134.203(c)(2), which is how most other professional fees are adjusted annually in the system. They round the fees to whole dollars to simplify calculations and reduce errors. They eliminate unnecessary billing modifiers, eliminate a required sequence for modifiers, and replace the diagnosis-related estimate and range of motion billing methods with a single method of billing. They also create a $100 missed appointment fee and a $300 specialist fee. In addition, they eliminate tiering. For designated doctors and required medical examination doctors, all issues addressed within one examination will be paid at the established fee and not reduced.

Texas Department of State Health Services

Adopted Rule Reviews Re:

Adopting the review of Title 25, Part 1, concerning Minimum Guidelines for Human Donor Milk Banks.

The Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts the review of the chapter below in Title 25, Part 1, of the Texas Administrative Code (TAC):

Chapter 227, Minimum Guidelines for Human Donor Milk Banks

Adopting the review of Title 25, Part 1, concerning Specific Additional Requirements for Drugs.

Chapter 230, Specific Additional Requirements for Drugs