Texas Register Table of Contents
- 1 Texas Education Agency
- 1.0.1 Proposed Rules Re:
- 1.0.2 Proposed Rule Reviews Re:
- 1.0.2.1 Reviewing Title 19, Part 2, to consider for readoption, revision, or repeal the chapters concerning School Districts.
- 1.0.2.2 Reviewing Title 19, Part 2, to consider for readoption, revision, or repeal the chapters concerning School Districts, Commissioner’s Rules on School Finance, Reporting Requirements, School Facilities, Missing Child Prevention and Identification Programs, Veterans and Military Dependents, Classroom Supply Reimbursement Program, Automatic College Admission, and County Boards of Education.
- 2 Texas Medical Board
- 3 Texas Funeral Service Commission
- 3.0.1 Proposed Rules Re:
- 3.0.1.1 New 22 TAC §203.36, to establish procedures for the inspection of a funeral establishment’s solid waste disposal and sanitation facilities when those facilities have not been inspected by the Texas Department of State Health Services.
- 3.0.1.2 New 22 TAC §206.9, to adopt a donor acknowledgement form required for adults donating their bodies by will or other instrument to willed body programs and non-transplant anatomical donation organizations for the advancement of medical or forensic science.
- 3.0.1 Proposed Rules Re:
- 4 Texas Health and Human Services Commission
- 5 Texas Department of Insurance
- 5.0.1 Proposed Rules Re:
- 5.0.1.1 Amending 28 TAC §§3.3309, 3.3312, and 3.3324, to implement House Bill 2516, 89th Legislature, 2025, by requiring insurers to offer Medicare supplement coverage to individuals younger than 65 enrolled in Medicare by reason of end stage renal disease or amyotrophic lateral sclerosis, and clarifying guaranteed issuance and rating protections for disabled enrollees who turn 65.
- 5.0.1.2 Amending 28 TAC §12.601, to implement House Bill 3812, 89th Legislature, 2025, by specifying the independent review organization process for reviewing a health plan’s determination to deny a preauthorization exemption.
- 5.0.1.3 Amending 28 TAC §§19.1006 and 19.1028, to update continuing education and certification course requirements by adding references to Insurance Code Chapter 1702 and correcting statutory citation titles.
- 5.0.1.4 Amending 28 TAC §§19.1702, 19.1705, 19.1706, 19.1709, 19.1710, 19.1730 – 19.1733, and new 28 TAC §19.1734, to update utilization review and preauthorization exemption requirements by revising statutory references and definitions, clarifying screening criteria and adverse determination notice requirements, establishing electronic prior authorization system requirements, modifying evaluation, denial, rescission, and independent review procedures for preauthorization exemptions, and implementing annual reporting requirements for issuers and affiliates.
- 5.0.1.5 Amending 28 TAC §§19.1801 and 19.1803, to update statutory references related to prior authorization request forms by removing outdated references to repealed or redesignated statutes and replacing them with current references to Insurance Code Chapter 1217, Insurance Code Chapter 1369, Subchapter G, and Government Code Chapter 540.
- 5.0.1.6 Amending 28 TAC §§19.2005, 19.2006, 19.2009, and 19.2010, to update utilization review agent certification, utilization review plan, screening criteria disclosure, and peer-to-peer discussion requirements for utilization review agents under workers’ compensation insurance coverage.
- 5.0.1 Proposed Rules Re:
- 6 Texas Board of Occupational Therapy Examiners
- 7 Texas Health and Human Services Commission
Texas Education Agency
Proposed Rules Re:
Amending 19 TAC §§89.1005, 89.1040, 89.1075, 89.1121, and 89.1125 to update provisions governing instructional arrangements and educational environments to align with the revised state special education funding framework enacted by HB 2 and SB 568, 89th Texas Legislature, Regular Session, 2025.
CHAPTER 89. ADAPTATIONS FOR SPECIAL POPULATIONS
SUBCHAPTER AA. COMMISSIONER’S RULES CONCERNING SPECIAL EDUCATION SERVICES
19 TAC §89.1005
OVERVIEW
The Texas Education Agency (TEA) proposes amendments to §§89.1005, 89.1040, 89.1075, 89.1121, and 89.1125; the repeal of §89.1092 and §89.1094; and new §89.1092 and §89.1094, concerning special education services. The proposed revisions would clarify and align requirements related to instructional arrangements, eligibility and placement, general program operations, and the distribution and allowable use of state special education funds and would update approval, oversight, reporting, and funding requirements for residential and day placement programs to align with House Bill (HB) 2 and Senate Bill (SB) 568, 89th Texas Legislature, Regular Session, 2025.
BACKGROUND AND JUSTIFICATION
The proposed amendment to §89.1005 would update provisions governing instructional arrangements and educational environments to align with the revised state special education funding framework enacted by HB 2 and SB 568, 89th Texas Legislature, Regular Session, 2025. The proposed amendment would update terminology, clarify transition-period reporting requirements, and specify how admission, review, and dismissal (ARD) committee placement decisions are reported through the Texas Student Data System Public Education Information Management System (TSDS PEIMS) to support consistent statewide reporting under the revised funding framework.
The proposed amendment to §89.1040 would update eligibility criteria for special education and related services to support consistent statewide implementation. To improve clarity, the proposed amendment would address evaluation procedures and eligibility determinations, including requirements for full individual and initial evaluations and reevaluations. Together, the proposed changes would strengthen consistent and accurate identification of students eligible for special education and related services across the state.
The proposed amendment to §89.1075 would address general program requirements and local district procedures to support consistent statewide implementation. The proposed amendment would update statutory cross references, clarify documentation and contracting requirements, revise the timeline for providing prior written notice to parents, and specify training requirements for district transition and employment designees.
Section 89.1092 would be repealed and proposed as a new rule. The new rule would reorganize and clarify requirements applicable to residential placement programs used to provide free appropriate public education (FAPE) to students with disabilities. The new language would also clarify approval, reapproval, and monitoring requirements for providers; distinguish between ARD committee-placed and non-ARD committee-placed residential placements; and update requirements related to contracts, onsite monitoring, notice to TEA, and funding. Funding and reporting provisions would be aligned with statutory changes enacted by HB 2 and SB 569, 89th Texas Legislature, Regular Session, 2025, while other revisions would clarify existing oversight and procedural expectations specific to residential placements.
Section 89.1094 would be repealed and proposed as a new rule. The new rule would revise the structure and oversight of public and private day placement programs used to provide FAPE. The new language would also clarify distinctions between district-operated, non-district-operated, and private day placement programs; refine approval, reapproval, and monitoring requirements for program administrators and providers; and update contracting, onsite reviews, notice, and funding eligibility provisions. The provisions would align day placement program requirements with HB 2 and SB 569, 89th Texas Legislature, Regular Session, 2025, by reflecting the revised state special education funding framework and eligibility for the day placement allotment, while also organizing and clarifying existing administrative and procedural requirements.
The proposed amendment to §89.1121 would update the distribution of state special education funds to reflect the transition from instructional arrangements to tiers and service groups in accordance with HB 2 and SB 569, 89th Texas Legislature, Regular Session, 2025. The amendment would require state special education funding to be based on assigned tiers and service groups under Texas Education Code (TEC), §48.102 and §48.1021; establish transition-year funding for the 2026-2027 school year under TEC, §48.1022; and clarify reporting through the Student Attendance Accounting Handbook adopted under 19 TAC §129.1025. These changes would support consistent statewide implementation of the tier- and service group-based funding structure.
The proposed amendment to §89.1125 would clarify how state special education funds may be used under the revised funding framework enacted by HB 2 and SB 568, 89th Texas Legislature, Regular Session, 2025. The proposed amendment would specify permissible uses of state special education funds and reinforce that such funds must be used to support special education and related services in accordance with students’ individualized education program and applicable funding requirements. The proposed changes would promote transparency, consistency, and compliance in the use of state special education funds.
Proposed Rule Reviews Re:
Reviewing Title 19, Part 2, to consider for readoption, revision, or repeal the chapters concerning School Districts.
The State Board of Education (SBOE) proposes the review of 19 TAC Chapter 61, School Districts, Subchapter A, Board of Trustees Relationship, and Subchapter B, Special Purpose School Districts, pursuant to Texas Government Code, §2001.039.
As required by Texas Government Code, §2001.039, the SBOE will accept comments as to whether the reasons for adopting Chapter 61, Subchapters A and B, continue to exist.
The public comment period on the review begins May 15, 2026, and ends at 5:00 p.m. on June 15, 2026. A form for submitting public comments on the proposed rule review is available on the TEA website at https://tea.texas.gov/about-tea/laws-and-rules/sboe-rules-tac/state-board-of-education-rule-review. The SBOE will take registered oral and written comments on the review at the appropriate committee meeting in June 2026 in accordance with the SBOE board operating policies and procedures.
Reviewing Title 19, Part 2, to consider for readoption, revision, or repeal the chapters concerning School Districts, Commissioner’s Rules on School Finance, Reporting Requirements, School Facilities, Missing Child Prevention and Identification Programs, Veterans and Military Dependents, Classroom Supply Reimbursement Program, Automatic College Admission, and County Boards of Education.
Texas Education Agency (TEA) proposes the review of 19 TAC Chapter 61, School Districts, Subchapter AA, Commissioner’s Rules on School Finance; Subchapter BB, Commissioner’s Rules on Reporting Requirements; Subchapter CC, Commissioner’s Rules Concerning School Facilities; Subchapter DD, Commissioner’s Rules Concerning Missing Child Prevention and Identification Programs; Subchapter FF, Commissioner’s Rules Concerning Veterans and Military Dependents; Subchapter HH, Commissioner’s Rules Concerning Classroom Supply Reimbursement Program; Subchapter JJ, Commissioner’s Rules Concerning Automatic College Admission; and Subchapter KK, Commissioner’s Rules on County Boards of Education, pursuant to Texas Government Code, §2001.039.
As required by Texas Government Code, §2001.039, TEA will accept comments as to whether the reasons for adopting Chapter 61 continue to exist. The public comment period on the review begins May 15, 2026, and ends June 15, 2026. A form for submitting public comments on the proposed rule review is available on the TEA website at https://tea.texas.gov/about-tea/laws-and-rules/commissioner-rules-tac/commissioner-of-education-rule-review.
Texas Medical Board
Proposed Rules Re:
New 22 TAC §§173.6 – 173.18, to establish minimum standards for the provision of psychotropic ketamine therapy, including registration, operation, physician requirements, monitoring, equipment, and inspection requirements for clinics providing parenteral ketamine for psychiatric indications.
CHAPTER 173. OFFICE-BASED ANESTHESIA SERVICES
SUBCHAPTER B. PARENTERAL KETAMINE THERAPY
22 TAC §§173.6 – 173.18
OVERVIEW
The Texas Medical Board (Board) proposes new rule concerning Chapter 173, Office-Based Anesthesia Services, Subchapter B, concerning Parenteral Ketamine Therapy, §§173.6 – 173.18.
The proposed new sections are as follows:
New §173.6, Definitions, sets forth definitions for ketamine administration and psychotropic ketamine therapy (PKT).
New §173.7, Exception for Licensed Hospice Provider, provides an exception to the application of the rules under the subchapter for patients enrolled in a hospice program licensed by Texas Health and Human Services.
New §173.8, Mandatory Registration, requires registration for practice settings providing psychotropic ketamine therapy and provides exceptions to registration for certain practice settings.
New §173.9, Operation of PKT Clinics, sets forth requirements for operation of clinics providing PKT and limits the administration of psychotropic ketamine therapy to physicians and midlevel providers. The new section further specifies training, certification, patient monitoring, emergency management and consultation and delegation requirements for the provision of psychotropic ketamine therapy. The new section provides that delegating physicians are limited to delegating to no more than six delegates total or delegates at no more than three PKT clinics, whichever is less.
New §173.10, Physician Requirements, sets forth requirements for physicians ordering PKT for psychiatric indications. The requirements include education and training, delegation, Prescription Monitoring Program verifications, maintenance of ASA guidelines for moderate sedation, and pregnancy verification for women of child-bearing age.
New §173.11, Minimum Standards When Administering PKT, sets forth minimum standards related to medical record documentation, patient evaluation, diagnosis, informed consent, time out procedures, continuous monitoring; and equipment standards when providing psychotropic ketamine therapy.
New §173.12, Monitoring Requirements During PKT Administration, sets forth additional requirements for administering or delegating physicians to ensure adequate monitoring during PKT administration, until complete.
New §173.13, Monitoring Requirements After the Completion of PKT Administration, sets forth monitoring requirements for patients upon completion of PKT administration and prior to discharge.
New §173.14, Minimum Equipment Requirements, sets forth on-site equipment requirements for continuous monitoring and in cases of emergency.
New §173.15, Prohibited PKT Administration, provides that the following prohibitions on parenteral PKT apply: the administration of PKT outside of a registered clinic or an exempt setting set forth under Section 173.8 and the prescribing of PKT for home use.
New §173.16, Complaints and Investigations, clarifies that the medical director and physician owner(s) are responsible for the clinic’s operations and regulatory compliance.
New §173.17, Renewal of PKT Clinic Registration, sets forth a registration term of two years and registration renewal requirements.
New §173.18, Audits, Inspections, and Investigations, mandates that psychotropic ketamine therapy clinics be subject to audits, inspections and investigations as outlined in Chapter 172 of the Board rules related to pain management clinics.
BACKGROUND AND JUSTIFICATION
Mr. Scott Freshour, General Counsel for the Texas Medical Board, has determined that, for each year of the first five years the proposed new rules are in effect, the public benefit anticipated as a result of enforcing these proposed new rules will be to enhance the safety of the public health and welfare through the establishment of minimum standards for the provision of psychotropic ketamine therapy.
Mr. Freshour has also determined that for the first five-year period these proposed new rules are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed sections.
Mr. Freshour has also determined that for the first five-year period these proposed new sections are in effect there may be a minimal economic cost to individuals required to comply with these proposed sections. Those economic costs will vary and may include the following: 1) new education and training requirements for ketamine clinic providers and staff; 2) possible increased staffing to meet requirements for the evaluation of patients and administering and monitoring of patients receiving PKT; and 3) costs related to purchasing equipment required for monitoring patients receiving PKT treatment. The expenditures described above will be one-time expenditures and may not apply if an individual subject to these rules already meets the requirements.
Withdrawn Rules Re:
Withdrawing 22 TAC §§173.6 – 173.15, to establish minimum standards for the provision of psychotropic ketamine therapy.
CHAPTER 173. OFFICE-BASED ANESTHESIA SERVICES
SUBCHAPTER B. PARENTERAL KETAMINE THERAPY
22 TAC §§173.6 – 173.15
OVERVIEW
The Texas Medical Board withdraws proposed new §§173.6 – 173.15 which appeared in the January 2, 2026, issue of the Texas Register (51 TexReg 25).
Texas Funeral Service Commission
Proposed Rules Re:
New 22 TAC §203.36, to establish procedures for the inspection of a funeral establishment’s solid waste disposal and sanitation facilities when those facilities have not been inspected by the Texas Department of State Health Services.
CHAPTER 203. LICENSING AND ENFORCEMENT–SPECIFIC SUBSTANTIVE RULES
SUBCHAPTER C. ENFORCEMENT
22 TAC §203.36
OVERVIEW
The Texas Funeral Service Commission (Commission) proposes new §203.36 of Title 22, Part 10, Chapter 203 of the Texas Administrative Code (TAC), to be titled Inspection of Solid Waste Disposal and Sanitation Facilities. The proposed new rule establishes procedures, as required by Texas Occupations Code §651.158(b), for the inspection of a funeral establishment’s solid waste disposal and sanitation facilities when those facilities have not been inspected by the Texas Department of State Health Services (DSHS).
BACKGROUND AND JUSTIFICATION
The proposed rule under 22 TAC, Chapter 203, implements Texas Occupations Code §651.158, Inspection of Certain Facilities.
Section 651.158(a) authorizes the Commission to require a funeral establishment that has solid waste disposal and sanitation facilities that have not been inspected by the Texas Department of Health to be inspected by Commission inspectors. (The Texas Department of Health was abolished and its functions transferred to DSHS under House Bill 2292, 78th Legislature, Regular Session, 2003, effective September 1, 2004; references in §651.158 to the Texas Department of Health should be read as references to DSHS.) Section 651.158(b) requires the Commission, by rule, to establish procedures for any inspection required under that section. This rule satisfies that statutory directive.
Specifically, proposed new §203.36 authorizes a funeral establishment whose solid waste disposal and sanitation facilities have not been inspected by DSHS to be inspected for compliance with the standards specified by DSHS by Commission inspectors.
The proposed rule does not establish new substantive sanitation standards; rather, it creates a procedural pathway for demonstrating compliance with existing DSHS-equivalent standards in circumstances in which DSHS has not itself performed an inspection. The proposed rule preserves the Commission’s authority to require additional or independent inspection under §651.158 or other applicable law.
New 22 TAC §206.9, to adopt a donor acknowledgement form required for adults donating their bodies by will or other instrument to willed body programs and non-transplant anatomical donation organizations for the advancement of medical or forensic science.
CHAPTER 206. ANATOMICAL FACILITIES, NON-TRANSPLANT ANATOMICAL DONATION ORGANIZATIONS, AND WILLED BODY PROGRAMS
22 TAC §206.9
OVERVIEW
The Texas Funeral Service Commission (Commission) proposes a new rule to Texas Administrative Code (TAC), Title 22, Part 10, Chapter 206, Anatomical Facilities, Non-Transplant Anatomical Donation Organizations, and Willed Body Programs, §206.9, regarding the implementation of a donor acknowledgement form to be used by an adult of sound mind in Texas who is donating his or her body by will or other instrument to willed body programs and non-transplant anatomical donation organizations to be used for the advancement of medical or forensic science.
BACKGROUND AND JUSTIFICATION
The proposed rule under 22 TAC, Chapter 210, implements Texas Health and Safety Code Section 691.028, Donation of Body by Written Instrument.
The Texas Legislature amended Texas Health and Safety Code Section 691.028 to include a donor acknowledgment form as part of the informed consent requirements in order to make effective an adult’s donation of his or her whole body to a university willed body program or a non-transplant anatomical donation organization to be used for the advancement of medical or forensic science. Section 691.028(b)(2) sets forth the elements that must be in the donor acknowledgment, and Section 691.028(b-1) requires the Commission, by rule, to design and adopt a form that complies with Section 691.028(b) that willed body programs and non-transplant anatomical donation organizations must use. This rule satisfies this statutory directive.
Specifically, proposed new §206.9 adopts the Commission prescribed Donor Acknowledgement Form that must be used by willed body programs and NADOs in order to use the decedent donor’s body or body parts for the advancement of medical or forensic science if the decedent donated his or her body in a willed or written instrument. The proposed new rule further requires the elements that the donor acknowledgement form must include that are applicable to the particular willed body program and non-transplant anatomical donation organization.
Texas Health and Human Services Commission
Proposed Rules Re:
New 26 TAC §§910.301, 910.303, 910.305, and 910.307, to require Texas state hospitals to employ a superintendent and describe the duties a superintendent must perform, as required by Texas Health and Safety Code §552.154.
CHAPTER 910. STATE FACILITY BUSINESS OPERATIONS
SUBCHAPTER G. STATE HOSPITAL MANAGEMENT
26 TAC §§910.301, 910.303, 910.305, 910.307
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §910.301, concerning Purpose; §910.303, concerning Application; §910.305, concerning Definitions; and §910.307, concerning State Hospital Superintendent, in Texas Administrative Code Title 26, Part 1, Chapter 910, new Subchapter G, concerning State Hospital Management.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with Texas Health and Safety Code (HSC) §552.154 added by House Bill (HB) 913, 89th Legislature, Regular Session, 2025. It provides that the HHSC executive commissioner shall, by rule, require state hospitals to employ a superintendent at a Texas state hospital. A Texas state hospital also includes a facility that HHSC operates as a state hospital. HB 913 amended HSC §532.001(b) and §552.002(a)(2) to separate the North Texas State Hospital into two state hospitals, Vernon and Wichita Falls. HSC §532.001(b) and §552.002(a)(2) were amended to also add the new Panhandle State Hospital and the Lubbock Psychiatric Center to the list of state hospitals.
This proposal also outlines the duties a superintendent must perform in a Texas state hospital, as required by HSC §551.022.
SECTION-BY-SECTION SUMMARY
Proposed new §910.301 describes that the purpose of the subchapter is to require a Texas state hospital to employ a superintendent as stated in HSC §552.154.
Proposed new §910.303 states that the rules apply to a superintendent of a Texas state hospital and to a Texas state hospital listed in HSC §552.002(a)(2). Section 910.303 clarifies that the rule does not apply to state hospital contracted beds.
Proposed new §910.305 defines terms used in this subchapter.
Proposed new §910.307 describes requirements for a Texas state hospital to employ a superintendent as required by HSC §552.154. Section 551.022 describes the duties the superintendent must perform.
Texas Department of Insurance
Proposed Rules Re:
Amending 28 TAC §§3.3309, 3.3312, and 3.3324, to implement House Bill 2516, 89th Legislature, 2025, by requiring insurers to offer Medicare supplement coverage to individuals younger than 65 enrolled in Medicare by reason of end stage renal disease or amyotrophic lateral sclerosis, and clarifying guaranteed issuance and rating protections for disabled enrollees who turn 65.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER T. MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES
28 TAC §§3.3309, 3.3312, 3.3324
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC §§3.3309, 3.3312, and 3.3324, concerning requirements for Medicare supplement coverage. The proposed amendments implement House Bill 2516, 89th Legislature, 2025.
BACKGROUND AND JUSTIFICATION
The amendments to §§3.3309, 3.3312, and 3.3324 are necessary to implement HB 2516, which added Insurance Code §1652.059 and §1652.060, requiring that individuals younger than 65 who become enrolled in Medicare by reason of end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) be given access to the same coverage, and in some cases at the same rates, as those offered to individuals 65 and older. The amendments also clarify the existing language and protections regarding guaranteed issuance and the rating of disabled enrollees when they turn 65, which were discussed in Bulletin #B-0027-21 (available online at www.tdi.texas.gov/bulletins/2021/B-0027-21.html).
SECTION-BY-SECTION SUMMARY
Section 3.3309.
Proposed amendments to subsection (a)(1) remove language from subparagraphs (D) and (E) related to coverage for outpatient prescription drugs. Those provisions were included to implement the Medicare Prescription Drug Improvement and Modernization Act of 2003 but are no longer relevant.
Proposed amendments to subsection (b) require that Medicare supplement applications elicit information as to whether someone younger than 65 qualifies under HB 2516. These changes are necessary to ensure that issuers have the information to comply with the new requirements. The amendments also delete extraneous language from the subsection.
Proposed amendments to Figure: 28 TAC §3.3309(f) remove a reference to enrollment in Part D, which is no longer needed, and remove unnecessary underlines.
A proposed amendment to subsection (g) revises a reference in the rule text that incorrectly refers to parts of Figure: 28 TAC §3.3309(f) as paragraphs of subsection (f).
Proposed amendments also include nonsubstantive rule drafting and formatting changes for plain language and to conform to the agency’s current style and improve clarity. For example, “shall” is changed to “must” throughout the rule text, and “preexisting conditions” is changed to “preexisting condition limitations.”
Section 3.3312.
The title of this section is proposed to be amended to add a reference “Notice Requirements” in light of the notification requirement found in new subsection (f) of this section.
Proposed amendments to subsection (a)(1) reference that individuals will indicate on their application that they meet the section’s eligibility requirements and submit evidence of eligibility as necessary. An extraneous “and” is deleted in subsection (a)(2).
Proposed amendments to subsection (b) delete paragraphs (7) and (9) relating to enrollment in Medicare Part D and the Texas Health Insurance Pool, as the references in these paragraphs are obsolete and unnecessary, and renumber current paragraph (8) as paragraph (7). New subsection (b)(8) identifies for purposes of other amendments individuals meeting the requirements of Insurance Code §1652.059 and enrolled in Medicare before the effective date of the rule amendments.
An amendment in subsection (c)(1) revises a reference to the paragraphs in subsection (b) to reflect the changes to the paragraphs in that subsection. Subparagraphs (A) and (B) in subsection (c)(1) are amended to implement HB 2516 by clarifying that individuals eligible under that bill are entitled to the same plans that anyone turning 65 is eligible for. To conform to the deletion of subsection (b)(7), subsection (c)(2) is amended to remove provisions related to the removal of prescription drug coverage, and subsection (c)(4) is deleted.
Proposed new subsection (c)(4) implements the protections of HB 2516 by providing that individuals eligible under that bill are entitled to the same plans offered to others by the issuer and may not be subject to separate forms or rates.
An amendment is proposed to delete current subsection (d)(5) to conform to the deletion of subsection (b)(7). Subsequent paragraphs are renumbered.
Subsection (d)(6) is amended to delete the reference to the Texas Health Insurance Pool, as it is obsolete. In accordance with Insurance Code §1652.060(d), which authorizes the commissioner to designate enrollment periods by rule, new text is added in subsection (d)(6) to provide a guaranteed issue period for those eligible under HB 2516 from October 15, 2026, through March 31, 2027. This aligns with Medicare open enrollment periods to support individuals who may switch from a Medicare Advantage plan to traditional Medicare and want to purchase Medicare supplement coverage.
Proposed new subsection (f) requires issuers to provide timely notice to those eligible for the enrollment period created by subsection (d)(6). This will ensure that those eligible under HB 2516 receive notice of their opportunity to realize the benefits of that legislation.
In addition, the proposed amendments include nonsubstantive rule drafting and formatting changes for plain language and to conform the section to the agency’s current style and improve clarity. For example, “in accordance with” is changed to “according to,” and edits are made to paragraph organization for clarity.
Section 3.3324.
Proposed amendments to subsection (a) make clarifying changes to implement HB 2516. The changes relate to medical underwriting and exceptions to the required availability of Medicare supplement policies and certificates.
Proposed amendments to subsection (b)(1) are necessary to distinguish between requirements for individuals younger than 65 who are eligible under HB 2516 and those who are not.
Proposed amendments to subsection (b)(2) clarify that an individual turning 65 who previously obtained Medicare supplement coverage due to disability and early enrollment in Medicare has the same rights to obtain Medicare supplement coverage at age 65 as anyone else turning 65. If an individual chooses to remain with their plan, they must be charged the same premium as someone enrolling for the first time at age 65.
Proposed new subsection (b)(3) requires notice (beginning 90 days after the effective date of the section) to those enrollees turning 65 of any premium adjustment and new open enrollment period under subsection (b)(2). These changes are consistent with TDI’s 2021 Bulletin #B-0027-21 (online at www.tdi.texas.gov/bulletins/2021/B-0027-21.html), which cited CMS’ December 2002 guidance, Transmittal No. 02-03 (available online at www.cms.gov/Medicare/Health-Plans/Medigap/Downloads/mdgp0203.pdf), requiring a second open enrollment opportunity at age 65 for Medicare supplement policyholders who obtained coverage before 65 because of disability.
Proposed new subsection (b)(4) implements the requirements of HB 2516 by requiring that qualifying individuals be charged the same rates as others for some plans and no more than 200% of the rates charged others for other plans. It also prohibits application of preexisting condition exclusions or waiting periods to these qualifying individuals.
Proposed new subsection (b)(5) provides that issuers filing for rate increases before January 1, 2028, in which they rely on HB 2516 as justification for the rate increase, must also affirm that the rates for those individuals that do not qualify under HB 2516 will continue to meet the loss ratio standards of 28 TAC §3.3307. This will assist TDI’s review of rate increase requests and ensure compliance with rating requirements. In particular, TDI is concerned about cases in which issuers reexamine their rates and increase them when eligible individuals are moved into the larger risk pool of those who become eligible for Medicare at age 65. In those cases, the rates of those individuals younger than 65 who are not eligible under HB 2516 and who remain in a separate risk pool that now no longer includes individuals with ESRD or ALS should also be reexamined to ensure they are not excessive.
CHAPTER 12. INDEPENDENT REVIEW ORGANIZATIONS
SUBCHAPTER G. INDEPENDENT REVIEW OF PREAUTHORIZATION EXEMPTIONS
28 TAC §12.601
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC §12.601, concerning review of preauthorization exemptions by independent review organizations (IROs). The amended section implements House Bill 3812, 89th Legislature, 2025. In a separate rulemaking published in this issue of the Texas Register, TDI proposes to amend related rules in 28 TAC §§19.1730 – 19.1733 to address other provisions related to preauthorization exemptions that are impacted by HB 3812.
BACKGROUND AND JUSTIFICATION
Amending §12.601 is necessary to implement HB 3812, which amended Insurance Code §4201.656(a) to specify that a physician or provider has a right to an independent review of a health plan’s determination to deny a preauthorization exemption.
SECTION-BY-SECTION SUMMARY
Subsection (e) of §12.601 is amended to clarify that it applies with respect to a review of a rescission, and to update the reference to the title of §19.1733.
New subsection (f) is added to address a review of a preauthorization exemption denial. Section 12.601(f) specifies that if a denial of a preauthorization exemption is based on five or fewer adverse determinations that were not previously upheld by an IRO or external reviewer, the IRO must review all the adverse determinations. If a denial is based on more than five adverse determinations that were not previously upheld by an IRO or external reviewer, the IRO may select a random sample of at least five and no more than 20 adverse determinations to review. If the IRO determines that one or more of the adverse determinations reviewed met the applicable medical necessity criteria and should have been approved, the IRO must recalculate an adjusted approval rate. New Figure: 28 TAC §12.601(f) is included to provide guidance on calculating the adjusted approval rate. Current subsections (f) – (g) are redesignated as appropriate.
New subsection (i) is added to clarify the meaning of the term “external reviewer,” with reference to federal rules under 45 CFR §147.136.
Amending 28 TAC §§19.1006 and 19.1028, to update continuing education and certification course requirements by adding references to Insurance Code Chapter 1702 and correcting statutory citation titles.
CHAPTER 19. LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
SUBCHAPTER K
28 TAC §19.1006, §19.1028
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC: Section 19.1006 and §19.1028, concerning licensee continuing education courses and requirements for adjuster licensing, and annuity certification courses; Sections 19.1702, 19.1705, 19.1706, 19.1709, and 19.1710, concerning utilization review; Sections 19.1730 – 19.1733, concerning preauthorization exemptions; Sections 19.1801 and §19.1803, concerning prior authorization request forms; and Sections 19.2005, 19.2006, 19.2009, and 19.2010, concerning utilization review and utilization review agents under workers’ compensation insurance coverage. TDI also proposes new §19.1734, concerning preauthorization exemptions. The proposed amendments and new section implement House Bills 2221 and 3812, 89th Legislature, 2025, and Senate Bill 815, 89th Legislature, 2025. The proposed amendments also implement House Bill 4611, 88th Legislature, 2023; Senate Bill 1296, 84th Legislature, 2015; and Senate Bill 1216, 83rd Legislature, 2013.
BACKGROUND AND JUSTIFICATION
HB 2221 reorganized Insurance Code provisions related to rebating and unlawful inducements by repealing certain provisions in Insurance Code Chapter 541 and enacting similar provisions in new Insurance Code Chapter 1702. To conform to HB 2221, the proposal amends §19.1006 and §19.1028, which reference Insurance Code Chapter 541. The amendments revise provisions that reference Insurance Code Chapter 541 to also reference Insurance Code Chapter 1702.
SB 815 prohibits a utilization review agent (URA) from using an automated decision system to make an adverse determination. To implement this provision, the proposal amends §19.1705(d) and §19.2005(d) to reference new Insurance Code §4201.156. SB 815 also modifies the required contents of adverse determination notices. To implement these changes, the proposal amends §19.1709(c) and §19.2009(b) to conform to Insurance Code §4201.303.
SB 1216 created Insurance Code §1217.004(b), which requires issuers to exchange prior authorization requests electronically with a physician or provider who initiates a request electronically. Recent federal rules adopted 45 CFR §156.223, which requires qualified health plans to maintain electronic systems for prior authorization that meet federal standards. By establishing national electronic prior authorization standards and requiring commercial health plans to use those standards, the federal rules trigger the implementation of Insurance Code §1217.004(b). The proposal amends §19.1702 to reference Insurance Code Chapter 1217 and amends §19.1705 to add new subsection (g) to implement §1217.004 no later than January 1, 2027.
HB 3812 amended Insurance Code §4201.152 to specify that a physician who directs utilization review may not hold a license to practice administrative medicine. To implement this provision, the proposal amends requirements related to URA personnel in §19.1706 and §19.2006.
HB 3812 also amended provisions in Insurance Code Chapter 4201, Subchapter N, related to preauthorization exemptions. To implement these changes, the proposal amends §§19.1730 – 19.1733 and adds new §19.1734 to specify data submission requirements for issuers to report annual data.
HB 4611 reorganized Medicaid provisions in the Government Code by repealing Chapter 533 and adding new Chapter 540. To conform to these bills, the proposal amends §19.1801 and §19.1803 to remove outdated references to Government Code Chapter 533 and replace them with references to Government Code Chapter 540.
SECTION-BY-SECTION SUMMARY
Section 19.1006. An amendment to §19.1006 adds new subparagraph (D) to subsection (a)(8) referencing Insurance Code Chapter 1702, which was added under HB 2221. Subsequent subparagraphs are redesignated. Subsection (a)(8)(E), as redesignated, is amended to correct the title of a statutory citation.
Section 19.1028. An amendment to §19.1028 adds paragraph (3) to subsection (g) referencing Insurance Code Chapter 1702, which was added by HB 2221. Existing paragraphs within subsection (g) that follow new paragraph (3) are redesignated.
CHAPTER 19. LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
SUBCHAPTER R
28 TAC §1702, §19.1705, §19.1706, §19.1709, §19.1710
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC: Section 19.1006 and §19.1028, concerning licensee continuing education courses and requirements for adjuster licensing, and annuity certification courses; Sections 19.1702, 19.1705, 19.1706, 19.1709, and 19.1710, concerning utilization review; Sections 19.1730 – 19.1733, concerning preauthorization exemptions; Sections 19.1801 and §19.1803, concerning prior authorization request forms; and Sections 19.2005, 19.2006, 19.2009, and 19.2010, concerning utilization review and utilization review agents under workers’ compensation insurance coverage. TDI also proposes new §19.1734, concerning preauthorization exemptions. The proposed amendments and new section implement House Bills 2221 and 3812, 89th Legislature, 2025, and Senate Bill 815, 89th Legislature, 2025. The proposed amendments also implement House Bill 4611, 88th Legislature, 2023; Senate Bill 1296, 84th Legislature, 2015; and Senate Bill 1216, 83rd Legislature, 2013.
SECTION BY SECTION SUMMARY
Section 19.1702. Subsection (b) of §19.1702 is amended to add a reference to Insurance Code Chapter 1217. An amendment adds the title of Insurance Code Chapter 4201 to subsection (a).
Section 19.1705. Amendments to subsections (b) and (c) add titles to the Insurance Code citations and clarify that screening criteria must not be more restrictive than the coverage standards in Title 8, Subtitle E, of the Insurance Code. Subsection (d) is amended to reference new Insurance Code §4201.156. Subsection (g) is added to require an issuer to maintain an electronic prior authorization system that meets the national standards identified in 45 CFR §156.223, no later than January 1, 2027.
Section 19.1706. Subsection (a) is amended to reference Insurance Code Chapter 4201. New subsection (f) is added to require utilization review to be conducted under the direction of a licensed physician consistent with Insurance Code §4201.152, which requires that the physician does not hold a license to practice administrative medicine.
Section 19.1709. Subsection (c)(3) is amended to require both a description of and the source of the screening criteria and review procedures used in the determination. Subsection (c)(4) is amended to require URAs to include either the name or the National Provider Identifier of the physician, doctor, or other health care provider that made the adverse determination.
Section 19.1710. The existing provisions in §19.1710 are designated as subsection (a). The phrase “prior to the issuance of” is replaced with “before issuing.” New subsection (b) is added to clarify that a URA must act in good faith to provide a reasonable opportunity for peer-to-peer discussion before issuing an adverse determination, but if there are fewer than 12 hours available during normal business hours between the time a request is received and the time a determination must be issued, the URA must issue the determination within the required timeframe.
Section 19.1730. The proposed amendments add the defined term “affiliate” to align with Insurance Code §4201.651 and renumber subsequent definitions. The definition of “adverse determination regarding a preauthorization exemption” is amended to broaden the term to include adverse determinations in connection with a denial of a preauthorization exemption. The definition of “eligible preauthorization request” is amended to include preauthorization requests submitted to an issuer or an affiliate of the issuer, regardless of whether the request was made in connection with a policy or plan subject to Insurance Code Chapter 4201, Subchapter N. The definition of “evaluation” is amended to reference the evaluation threshold of five eligible preauthorization requests. The definition of “evaluation period” is amended to permit an issuer to determine the evaluation period for a determination issued on or after September 1, 2025, as long as the end of the evaluation period is not more than 12 months from the last day of the previous evaluation period.
Section 19.1731. Subsection (b) is amended to clarify that the evaluation requirement applies to all eligible preauthorization requests submitted to the issuer or its affiliate. Subsection (c) is amended to clarify the number of claims that must be reviewed to rescind an exemption, depending on whether there are at least five claims available for review.
Section 19.1732. Subsection (a) is amended to remove the requirement for an exemption to be in place at least six months. Subsection (b) is amended to require denial and rescission notices to comply with §19.1732 and specify that sample forms are available on TDI’s website at www.tdi.texas.gov/forms. Subsection (d) is amended to require that a notice of rescission be provided no later than three months following the day after the end of the evaluation period. Current subsection (e) is redesignated as subsection (f), and new subsection (e) is added to specify the requirements for notifying a physician or provider that their request for a preauthorization exemption is denied.
Section 19.1733. The title of §19.1733 is amended to replace “retrospective” with “utilization” and to add a reference to denials of preauthorization exemptions. Subsection (c) is amended to clarify the deadlines for a physician or provider to request an independent review of a denial or a rescission. Subsection (d) is amended to broadly reference “an adverse determination regarding a preauthorization exemption” and to clarify that an adverse determination previously appealed to and upheld by an IRO is not eligible for a subsequent independent review. New subsection (f) is added to explain the scope of the IRO’s review for a denial of a preauthorization exemption. Current subsection (f) and subsequent subsections are redesignated.
Section 19.1734. New §19.1734 is added to specify reporting requirements consistent with Insurance Code §4201.660, as added by HB 3812. Subsection (a) specifies an annual due date of March 1. Subsection (b) specifies the contents of the report, including the issuer’s name, NAIC number, and contact information; name and NAIC number of each affiliate of the issuer; the number of lives covered by the issuer and each affiliate within each line of business; the number of particular health care services requiring preauthorization; the number of in-network physicians and providers; and the number of in-network physicians and providers receiving at least one preauthorization exemption. Subsection (c) states that a report submitted under this section is public information subject to disclosure under Government Code Chapter 552.
CHAPTER 19. LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
SUBCHAPTER S
28 TAC §19.1801, §19.1803
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC: Section 19.1006 and §19.1028, concerning licensee continuing education courses and requirements for adjuster licensing, and annuity certification courses; Sections 19.1702, 19.1705, 19.1706, 19.1709, and 19.1710, concerning utilization review; Sections 19.1730 – 19.1733, concerning preauthorization exemptions; Sections 19.1801 and §19.1803, concerning prior authorization request forms; and Sections 19.2005, 19.2006, 19.2009, and 19.2010, concerning utilization review and utilization review agents under workers’ compensation insurance coverage. TDI also proposes new §19.1734, concerning preauthorization exemptions. The proposed amendments and new section implement House Bills 2221 and 3812, 89th Legislature, 2025, and Senate Bill 815, 89th Legislature, 2025. The proposed amendments also implement House Bill 4611, 88th Legislature, 2023; Senate Bill 1296, 84th Legislature, 2015; and Senate Bill 1216, 83rd Legislature, 2013.
SECTION BY SECTION SUMMARY
Section 19.1801. The section is amended to remove the outdated reference to Government Code Chapter 533 and simply reference Insurance Code Chapter 1217 and Chapter 1369, Subchapter G.
Section 19.1803. Paragraph (6)(B)(iii) of §19.1803 is amended to reference Government Code Chapter 540, instead of Chapter 533, which was repealed and replaced by HB 4611. Paragraph (7) is amended to replace a reference to Insurance Code §1369.252 with a reference to Insurance Code §1369.302 because the section was redesignated in 2015 by SB 1296.
Amending 28 TAC §§19.2005, 19.2006, 19.2009, and 19.2010, to update utilization review agent certification, utilization review plan, screening criteria disclosure, and peer-to-peer discussion requirements for utilization review agents under workers’ compensation insurance coverage.
CHAPTER 19. LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
SUBCHAPTER U.
28 TAC §19.2005, §19.2006, §19.2009, §19.2010
OVERVIEW
The Texas Department of Insurance (TDI) proposes to amend 28 TAC: Section 19.1006 and §19.1028, concerning licensee continuing education courses and requirements for adjuster licensing, and annuity certification courses; Sections 19.1702, 19.1705, 19.1706, 19.1709, and 19.1710, concerning utilization review; Sections 19.1730 – 19.1733, concerning preauthorization exemptions; Sections 19.1801 and §19.1803, concerning prior authorization request forms; and Sections 19.2005, 19.2006, 19.2009, and 19.2010, concerning utilization review and utilization review agents under workers’ compensation insurance coverage. TDI also proposes new §19.1734, concerning preauthorization exemptions. The proposed amendments and new section implement House Bills 2221 and 3812, 89th Legislature, 2025, and Senate Bill 815, 89th Legislature, 2025. The proposed amendments also implement House Bill 4611, 88th Legislature, 2023; Senate Bill 1296, 84th Legislature, 2015; and Senate Bill 1216, 83rd Legislature, 2013.
SECTION BY SECTION SUMMARY
Section 19.2005. Subsection (d) is amended to reference new Insurance Code §4201.156.
Section 19.2006. Subsection (a) is amended to reference Insurance Code Chapter 4201. Subsection (e) is amended to add a reference to Insurance Code §4201.152.
Section 19.2009. Subsection (b)(7) and (8) are amended to require both a description of and the source of the screening criteria and review procedures used in the determination.
Section 19.2010. The existing provisions in §19.2010 are designated as subsection (a). The phrase “prior to the issuance of” is replaced with “before issuing.” New subsection (b) is added to clarify that a URA must act in good faith to provide a reasonable opportunity for peer-to-peer discussion before issuing an adverse determination, but if there are fewer than 12 hours available during normal business hours between the time a request is received and the time a determination must be issued, the URA must issue the determination within the required timeframe.
Texas Board of Occupational Therapy Examiners
Adopted Rules Re:
Amending 40 TAC §374.1, to correct a typographical error replacing “4safety” with “safety” in subsection (d)(1)(B) of the section.
CHAPTER 374. DISCIPLINARY ACTIONS/DETRIMENTAL PRACTICE/COMPLAINT PROCESS/CODE OF ETHICS/LICENSURE OF PERSONS WITH CRIMINAL CONVICTIONS
40 TAC §374.1
OVERVIEW
The Texas Board of Occupational Therapy Examiners adopts an amendment to 40 Texas Administrative Code §374.1, Disciplinary Actions. The amendment is adopted without changes to the proposed text as published in the March 27, 2026, issue of the Texas Register (51 TexReg 2018) and will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment to §374.1 corrects a typographical error to replace “4safety” with “safety” in subsection (d)(1)(B) of the section. The amendment is adopted to correct the typographical error in the provision.
No comments were received regarding adoption of the amendments.
The amendment is adopted under Texas Occupations Code §454.102, which authorizes the Board to adopt rules to carry out its duties under Chapter 454. The amendment is also adopted under §454.3025, which requires the Board by rule to adopt a schedule of administrative penalties and other sanctions that the Board may impose under this chapter, and under §454.3521, which authorizes the Board to impose an administrative penalty, not to exceed $200 for each day a violation continues or occurs, under this chapter for a violation of this chapter or a rule or order adopted under this chapter.
No other statutes, articles, or codes are affected by the amendment.
Texas Health and Human Services Commission
Adopted Rule Reviews Re:
Adopting Title 26, Part 1, concerning IDD-BH Training.
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 302, IDD-BH Training
Notice of the review of this chapter was published in the February 27, 2026, issue of the Texas Register (51 TexReg 1314) for public comment.
The 31-day comment period ended March 30, 2026. During this period, HHSC did not receive any comments regarding the proposed rule review.
HHSC has reviewed Chapter 302 in accordance with Texas Government Code §2001.039, which requires state agencies to assess, every four years, whether the initial reasons for adopting a rule continue to exist.
The agency determined that the original reasons for adopting all rules in the chapter continue to exist and readopts Chapter 302. Any amendments, if applicable, to Chapter 302 identified by HHSC in the rule review will be proposed in a future issue of the Texas Register.
Adopting Title 26, Part 1, concerning Denial or Refusal of License.
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 560, Denial or Refusal of License
Notice of the review of this chapter was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1430) for public comment.
The 31-day comment period ended April 6, 2026. During this period, HHSC did not receive any comments regarding the proposed rule review.
HHSC has reviewed Chapter 560 in accordance with Texas Government Code §2001.039, which requires state agencies to assess, every four years, whether the initial reasons for adopting a rule continue to exist.
The agency determined that the original reasons for adopting all rules in the chapter continue to exist and readopts Chapter 560. Any amendments, if applicable, to Chapter 560 identified by HHSC in the rule review will be proposed in a future issue of the Texas Register.
Adopting Title 26, Part 1, concerning Investigations of Individuals Receiving Services from Certain Providers.
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 711, Investigations of Individuals Receiving Services from Certain Providers
Notice of the review of this chapter was published in the March 13, 2026, issue of the Texas Register (51 TexReg 1720) for public comment.
The 31-day comment period ended April 13, 2026. During this period, HHSC did not receive any comments regarding the proposed rule review.
HHSC has reviewed Chapter 711 in accordance with Texas Government Code §2001.039, which requires state agencies to assess, every four years, whether the initial reasons for adopting a rule continue to exist.
The agency determined that the original reasons for adopting all rules in the chapter continue to exist and readopts Chapter 711. Any amendments, if applicable, to Chapter 711 identified by HHSC in the rule review will be proposed in a future issue of the Texas Register.
In Addition Re:
Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates for the Comprehensive Rehabilitation Services Program, Effective September 1, 2026.
The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on May 26, 2026, at 9:00 a.m., to receive public comments on proposed Special Review updates. This hearing will be conducted as an in-person and online event.
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 June 1, 2026.