Texas Register May 23, 2025 Volume: 50 Number: 21

Texas Register Table of Contents

1 Texas Health and Human Services Commission
2 Texas Board of Physical Therapy Examiners
- - 2.0.1 Proposed Rules Re:
    - 2.0.1.1 Amending 22 TAC §341.2, to clarify that failure to submit documentation of the required number of approved CCUs taken within the audited renewal period may result in disciplinary action.
3 Texas Department of State Health Services
- - 3.0.1 Proposed Rules Re:
    - 3.0.1.1 Amending 25 TAC §448.101, to repeal Chapter 448 because it is obsolete.
  - 3.0.2 Adopted Rules Re:
4 Department of Aging and Disability Services
- - 4.0.1 Proposed Rules Re:
5 Texas Animal Health Commission
- - 5.0.1 Adopted Rules Re:
    - 5.0.1.1 Adopting 4 TAC §51.1, §51.4, to replace definitions and set forth the requirements for entry to shows, fairs, and exhibitions.
6 Texas State Board of Pharmacy
- - 6.0.1 Adopted Rules Re:

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §§394.1 – 394.7, to repeal outdates rules concerning alternative dispute resolution and negotiated rulemaking because they do not reflect current policy.

CHAPTER 394. MEDIATION AND NEGOTIATED RULEMAKING
1 TAC §§394.1 – 394.7

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 394 consisting of §394.1, concerning Definitions; §394.2, concerning Policy; §394.3, concerning Circumstances in Which Mediation is Offered; §394.4, concerning Dispute Resolution Administrator; §394.5, concerning Dispute Resolution Coordinators; §394.6, concerning Mediation Process; and §394.7, concerning Negotiated Rulemaking.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to repeal outdated rules concerning alternative dispute resolution and negotiated rulemaking. The rules were last modified in 2006. Following repeal, HHSC will maintain policies for negotiated rulemaking and alternative dispute resolution as required by Texas Government Code §531.0161.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§394.1 – 394.7 removes rules that are outdated and do not reflect current policy.

Adopted Rules Re:

Adopting 26 TAC §257.1, §257.3, to replace the repealed chapters, summarize the purpose of CPW services, and define terms used in the rules.

CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §257.1, §257.3

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §257.1, concerning Purpose and Application; §257.3, concerning Definitions; §257.5, concerning Client Eligibility; §257.7, concerning Client Rights; §257.9, concerning Client Confidentiality; §257.11, concerning Components of Case Management for Children and Pregnant Women Services; §257.15, concerning Provider Qualifications and Approval Process; §257.17, concerning Provider Responsibilities; §257.19, concerning Case Manager Qualifications; §257.21, concerning Case Manager Responsibilities; and §257.23, concerning Compliance with Utilization Reviews and Quality Assurance Reviews and Overpayments.

Sections 257.1, 257.3, 257.5, 257.7, 257.9, 257.11, 257.15, 257.17, 257.19, 257.21, and 257.23 are adopted without changes to the proposed text as published in the February 21, 2025, issue of the Texas Register (50 TexReg 939). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

Case Management for Children and Pregnant Women (CPW) services, administered by HHSC, provides Medicaid case management to assist eligible Medicaid clients in accessing necessary medical, social, educational, and other services related to health conditions and health risks. To be eligible for services, a client must be either a child with a health condition or health risk or a pregnant woman with a high-risk condition. The client must also be Medicaid-eligible in Texas, need case management for CPW services, and choose such services.

HHSC is repealing Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and adopting new Chapter 257, Case Management for Children and Pregnant Women, in 26 TAC, Part 1. The purpose for moving the CPW chapter from Title 25 to Title 26 is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, including CPW, from the Department of State Health Services (DSHS) to HHSC. The repeal of the CPW rules in 25 TAC Chapter 27 is adopted elsewhere in this issue of the Texas Register .

In addition to relocating the CPW rules from DSHS to HHSC, the new sections are necessary to comply with amendments to the CPW rules in accordance with House Bill (H.B.) 133, 87th Legislature, Regular Session, 2021, that directs HHSC to deliver CPW services through managed care organizations. The adoption also makes amendments to the CPW rules to implement certain requirements of House Bill 1575, 88th Legislature, Regular Session, 2023. H.B. 1575 authorizes case management services to pregnant women with a high-risk condition to address nonmedical needs; adds two new provider types, doula and community health worker, as eligible to provide case management services; and establishes CPW provider qualifications for doulas and community health workers. The adoption also updates the CPW rules with appropriate references and terminology and includes organizational and minor editing changes for clarity.

Adopting 26 TAC §§257.5, 257.7, 257.9, 257.11, to replace the repealed chapter and define eligible service users and the terms of the use of those services.

CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER B. CLIENT SERVICES
26 TAC §§257.5, 257.7, 257.9, 257.11

OVERVIEW

BACKGROUND AND JUSTIFICATION

Adopting 26 TAC §§257.15, 257.17, 257.19, 257.21, 257.23, to replace the repealed section to set forth the steps to become a provider of services.

CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER C. PROVIDER QUALIFICATIONS AND RESPONSIBILITIES
26 TAC §§257.15, 257.17, 257.19, 257.21, 257.23

OVERVIEW

BACKGROUND AND JUSTIFICATION

In Addition Re:

Public Notice – Texas State Plan for Medical Assistance Amendment Effective June 1, 2025

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, 2025.

Texas Board of Physical Therapy Examiners

Proposed Rules Re:

Amending 22 TAC §341.2, to clarify that failure to submit documentation of the required number of approved CCUs taken within the audited renewal period may result in disciplinary action.

CHAPTER 341. LICENSE RENEWAL
22 TAC §341.2

OVERVIEW

The Texas Board of Physical Therapy Examiners (board) proposes amending 22 TAC §341.2(g) relating to Continuing Competence Audits.

The amendment is proposed to clarify that failure to submit documentation of the required number of approved CCUs taken within the audited renewal period may result in disciplinary action. Additionally, the amendment includes licensees who are more than 90 days up to one year late renewing in the Continuing Competence Audit instead of requiring submission of CCU documentation upon renewal.

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §448.101, to repeal Chapter 448 because it is obsolete.

CHAPTER 448. STANDARD OF CARE
SUBCHAPTER A. DEFINITIONS
25 TAC §448.101

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 448 consisting of §448.101, concerning Definitions.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to remove an obsolete rule. Section 448.101 was adopted in 2004 to adopt by reference definitions originally located in Title 40, Chapter 141 that have since been repealed.

Adopted Rules Re:

Adopting 25 TAC §27.1, §27.3, to remove rules that are to be replaced by new rules in Title 26.

CHAPTER 27. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER A. GENERAL PROVISIONS
25 TAC §27.1, §27.3

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts the repeal of §27.1, concerning Purpose and Application, §27.3, concerning Definitions, §27.5, concerning Client Eligibility, §27.7, concerning Client Rights, §27.9, concerning Client Confidentiality, §27.11, concerning Components of Case Management for Children and Pregnant Women Services, §27.13, concerning Prior Authorization, §27.15, concerning Provider Qualifications, §27.17, concerning Provider Approval Process, §27.19, concerning Provider Responsibilities, §27.21, concerning Case Manager Qualifications, §27.23, concerning Case Manager Responsibilities, §27.25, concerning Utilization and Quality Assurance Reviews and Compliance, and §27.27, concerning Termination, Suspension, Probation, and Reprimand of Providers.

The repeal of §§27.1, 27.3, 27.5, 27.7, 27.9, 27.11, 27.13, 27.15, 27.17, 27.19, 27.21, 27.23, 27.25, and 27.27 are adopted without changes to the proposed text as published in the February 21, 2025, issue of the Texas Register (50 TexReg 906). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

HHSC is repealing Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and adopting new Chapter 257, Case Management for Children and Pregnant Women, in 26 TAC, Part 1. The purpose for moving the CPW chapter from Title 25 to Title 26, is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services to HHSC.

Adopting 25 TAC §§27.5, 27.7, 27.9, 27.11, 27.13, to remove rules that are to be replaced by new rules in Title 26.

CHAPTER 27. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER B. CLIENT SERVICES
25 TAC §§27.5, 27.7, 27.9, 27.11, 27.13

OVERVIEW

BACKGROUND AND JUSTIFICATION

HHSC is repealing Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and adopting new Chapter 257, Case Management for Children and Pregnant Women, in 26 TAC, Part 1. The purpose for moving the CPW chapter from Title 25 to Title 26, is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services to HHSC.

Adopting 25 TAC §§27.15, 27.17, 27.19, 27.21, 27.23, 27.25, 27.27, to remove rules that are to be replaced by new rules in Title 26.

CHAPTER 27. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
SUBCHAPTER C. PROVIDER QUALIFICATIONS AND RESPONSIBILITIES
25 TAC §§27.15, 27.17, 27.19, 27.21, 27.23, 27.25, 27.27

OVERVIEW

BACKGROUND AND JUSTIFICATION

HHSC is repealing Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and adopting new Chapter 257, Case Management for Children and Pregnant Women, in 26 TAC, Part 1. The purpose for moving the CPW chapter from Title 25 to Title 26, is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, to include CPW, from the Department of State Health Services to HHSC.

Department of Aging and Disability Services

Proposed Rules Re:

Amending 40 TAC §§71.101 – 71.103, to repeal these rules because they are no longer necessary.

CHAPTER 71. INFORMATION PRACTICES
SUBCHAPTER A. DISCLOSURE OF INFORMATION
40 TAC §§71.101 – 71.103

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Chapter 71 consisting of §71.101, concerning Definitions; §71.102, concerning Requests for Information; §71.103, concerning Schedule of Fees; §71.201, concerning Definitions; §71.202, concerning Confidential Nature of Client Information; §71.203, concerning Client Access to Own Information; §71.204, concerning Release for Death Notification; §71.205, concerning Release for Eligibility Verification, Billing, and Service Delivery; §71.206, concerning Release under Client Authorization; §71.301, concerning Definitions; §71.302, concerning Right of Access to Your Individually Identifiable Health Information; §71.303, concerning Designated Record Sets; §71.304, concerning Right to Report of Disclosures; §71.305, concerning Fees for Copies of Information; §71.306, concerning Requests for Further Limits on Uses and Disclosures of Individually Identifiable Health Information; §71.307, concerning Requests for Communication by Different Means or at Different Locations; §71.308, concerning Verification of Identity and Authority; §71.309, concerning Disclosure of Health Information; §71.310, concerning Complaints; §71.401, concerning Right to Correct Incorrect Information; §71.402, concerning Requesting a Correction; §71.403, concerning Where to Send a Request for Correction; §71.404, concerning The Correction Review; and §71.405, concerning Correction of Individually Identifiable Health Information in a Designated Record Set.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to remove obsolete rules adopted in 2003 by the Texas Department of Human Services concerning information practices. These rules are outdated, duplicative of current rules and contain incorrect agency information.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§71.101 – 71.103, 71.201 – 71.206, 71.301 – 71.310 and 71.401 – 71.405 removes rules no longer necessary.

Amending 40 TAC §§71.201 – 71.206, to repeal these rules because they are no longer necessary.

CHAPTER 71. INFORMATION PRACTICES
SUBCHAPTER B. CLIENT INFORMATION
40 TAC §§71.201 – 71.206

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§71.101 – 71.103, 71.201 – 71.206, 71.301 – 71.310 and 71.401 – 71.405 removes rules no longer necessary.

Amending 40 TAC §§71.301 – 71.310, to repeal these rules because they are no longer necessary.

CHAPTER 71. INFORMATION PRACTICES
SUBCHAPTER C. PRIVACY OF HEALTH INFORMATION
40 TAC §§71.301 – 71.310

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§71.101 – 71.103, 71.201 – 71.206, 71.301 – 71.310 and 71.401 – 71.405 removes rules no longer necessary.

Amending 40 TAC §§71.401 – 71.405, to repeal these rules because they are no longer necessary.

CHAPTER 71. INFORMATION PRACTICES
SUBCHAPTER D. CORRECTING INFORMATION
40 TAC §§71.401 – 71.405

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §§71.101 – 71.103, 71.201 – 71.206, 71.301 – 71.310 and 71.401 – 71.405 removes rules no longer necessary.

Texas Animal Health Commission

Adopted Rules Re:

Adopting 4 TAC §51.1, §51.4, to replace definitions and set forth the requirements for entry to shows, fairs, and exhibitions.

CHAPTER 51. ENTRY REQUIREMENTS
4 TAC §51.1, §51.4

OVERVIEW

The Texas Animal Health Commission (Commission) in a duly noticed meeting on May 6, 2025, adopted amendments to Title 4, Texas Administrative Code, Chapter 51 titled “Entry Requirements.” Specifically, the Commission adopted amendments to §51.1 regarding Definitions and §51.4 regarding Shows, Fairs, and Exhibitions. The amendments to §51.4 are adopted with nonsubstantive changes to the proposed text published in the March 14, 2025 issue of the Texas Register (50 TexReg 1885) to correct a typographical error. The rule will be republished. The amendments to §51.1 are adopted without changes to the proposed text and will not be republished.

BACKGROUND AND JUSTIFICATION

A member of the public petitioned the Commission for a rule change to modify the requirements for Texas origin animals entering Texas exhibition events. The petitioner explained that the current regulations made it expensive for youth competitors to participate in small family-run or 4H/FFA volunteer shows because of the cost of obtaining a certificate of veterinary inspection (CVI) for each show when out-of-state animals are present.

The petitioner requested that the Commission consider removing the requirement that Texas origin animals obtain a CVI for each exhibition.

According to the petitioner, many exhibitors are unable to obtain CVIs for multiple shows due to the cost, only allowing wealthy exhibitors to attend multiple shows, causing a disadvantage to some youth exhibitors. Elimination of the requirement would help level the playing field for all youth competitors.

The petitioner also pointed out that the current rule requires show sponsors to bar out-of-state participants for Texas only shows if they want to eliminate the requirement for Texas participants to have CVIs, resulting in loss revenue from out-of-state participants. The petitioner noted that out-of-state participants provide additional income to local businesses, particularly restaurants, hotels, gas stations, and feed/tack supply stores.

Currently, Commission rules distinguish between interstate shows and intrastate shows and have different entry requirements for each. The Commission considers shows, fairs, and exhibitions to be interstate if they permit livestock and poultry from other states to enter for show or exhibition and be held or exhibited in common facilities with Texas origin livestock and poultry of the same species. For interstate shows all animals must meet the out-of-state entry requirements which includes obtaining a CVI. The Commission considers shows, fairs, or exhibitions to be intrastate if they only allow Texas animals to enter or if they require Texas livestock and poultry of the same species to be housed and exhibited separately from livestock and poultry from out of state. For intrastate exhibitions, CVIs are not generally required.

Any time animals congregate from multiple premises there is an increased risk of disease transmission. The purpose of the entry requirements for shows, fairs, and exhibitions is to reduce the risk of disease transmission and ensure the Commission can perform a disease investigation if needed.

In reviewing the petition, staff at the Commission looked at the overall risk of disease transmission from Texas origin animals and at alternative ways a disease investigation could be conducted. Staff concluded that disease risk was not appreciably higher for interstate shows as long as out-of-state origin animals meet the Texas entry requirements. Staff also concluded that a disease investigation could be accomplished by obtaining information about participants from the show sponsor. Because sponsors typically gather information regarding the animals during the registration process, such as owner information, species, breed, sex, and age, it should not cause unreasonable burden on show sponsors. Commission staff found this recordkeeping would eliminate the need for CVIs for Texas origin animals.

After consideration of the petition, the Commission proposed amendments to the rules that will add a recordkeeping requirement for sponsors of shows, eliminate the distinction between interstate and intrastate shows, maintain entry requirements for out-of-state participants, and eliminate the need for Texas participants to meet the same standards of out-of-state participation. These changes will reduce the barriers for entry to shows, fairs, and exhibitions for Texas participants. Entry requirements for out-of-state participants cannot be reduced further without conflicting with existing federal requirements.

Texas State Board of Pharmacy

Adopted Rules Re:

Adopting 22 TAC §281.2, to correct the chapter range in the definition of the Act.

CHAPTER 281. ADMINISTRATIVE PRACTICE AND PROCEDURES
SUBCHAPTER A. GENERAL PROVISIONS
22 TAC §281.2

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §281.2, concerning Definitions. These amendments are adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2027). The rule will not be republished.

Adopting 22 TAC §291.32, to exclude central fill pharmacies from the required ratio of pharmacists to pharmacy technicians and pharmacy technician trainees.

CHAPTER 291. PHARMACIES
SUBCHAPTER B. COMMUNITY PHARMACY (CLASS A)
22 TAC §291.32

OVERIVEW

The Texas State Board of Pharmacy adopts amendments to §291.32, concerning Personnel. These amendments are adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2031). The rule will not be republished.

The amendments exclude central fill pharmacies that have no patient-facing contact from the required minimum ratio of pharmacists to pharmacy technicians and pharmacy technician trainees.

Adopting 22 TAC §291.55, to update a citation concerning a repealed statutory provision.

CHAPTER 291. PHARMACIES
SUBCHAPTER C. NUCLEAR PHARMACY (CLASS B)
22 TAC §291.55

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §291.55, concerning Records. These amendments are adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2034). The rule will not be republished.

Adopting 22 TAC §291.102, to correct the chapter range in the definition of the Act.

CHAPTER 291. PHARMACIES
SUBCHAPTER F. NON-RESIDENT PHARMACY (CLASS E)
22 TAC §291.102

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §291.102, concerning Definitions. These amendments are adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2041). The rule will not be republished.

Adopting 22 TAC §315.13, to remove a recordkeeping requirement.

CHAPTER 315. CONTROLLED SUBSTANCES
22 TAC §315.13

OVERVIEW

The Texas State Board of Pharmacy adopts amendments to §315.13, concerning Official Prescription Form – Effective September 1, 2016. These amendments are adopted without changes to the proposed text as published in the March 21, 2025, issue of the Texas Register (50 TexReg 2043). The rule will not be republished.