Texas Register Table of Contents
- 1 Texas Health and Human Services Commission
- 1.0.1 Proposed Rules Re:
- 1.0.1.1 Amending 1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751, to update citations to the Texas Government Code.
- 1.0.1.2 Amending 1 TAC §§351.801, 351.807, 351.809, 351.811, 351.821, 351.823, 351.825, 351.827, 351.841, to update citations to the Texas Government Code.
- 1.0.1.3 Amending 1 TAC §352.1, §352.3, to update citations in the rules to the Texas Government Code.
- 1.0.1.4 Amending 1 TAC §353.8, to update citations in the rules to the Texas Government Code.
- 1.0.1.5 Amending 1 TAC §353.101, to update citations in the rules to Texas Government Code.
- 1.0.1.6 Amending 1 TAC §353.201, to update citations in the rules to Texas Government Code.
- 1.0.1.7 Amending 1 TAC §§353.407, 353.425, 353.427, to update citations in the rules to the Texas Government Code.
- 1.0.1.8 Amending 1 TAC §353.501, to update citations in the rules to Texas Government Code.
- 1.0.1.9 Amending 1 TAC §353.901, §353.905, to update citations in the rules to the Texas Government Code.
- 1.0.1.10 Amending 1 TAC §353.1153, §353.1155, to update citations in the rules to the Texas Government Code.
- 1.0.1.11 Amending 1 TAC §353.1451, to update citations in the rules to Texas Government Code.
- 1.0.1.12 Amending 1 TAC §353.1309, to update citations in the rules to Texas Government Code.
- 1.0.1.13 Amending 1 TAC §354.1189, to update citations in the rules to Texas Government Code.
- 1.0.1.14 Amending 1 TAC §354.1435, to update citations in the rules to Texas Government Code.
- 1.0.1.15 Amending 1 TAC §354.1924, to update citations in the rules to Texas Government Code.
- 1.0.1.16 Amending 1 TAC §354.1941, to update citations in the rules to Texas Government Code.
- 1.0.1.17 Amending 1 TAC §354.2501, to update citations in the rules to Texas Government Code.
- 1.0.1.18 Amending 1 TAC §354.2603, to update citations in the rules to Texas Government Code.
- 1.0.1.19 Amending 1 TAC §354.3001, to update citations in the rules to Texas Government Code.
- 1.0.1.20 Amending 1 TAC §354.4001, §354.4003, to update citations in the rules to Texas Government Code.
- 1.0.1.21 Amending 1 TAC §354.5011, to update citations in the rules to Texas Government Code.
- 1.0.1.22 Amending 1 TAC §355.201, to update citations in the rules to Texas Government Code.
- 1.0.1.23 Amending 1 TAC §355.311, to update citations in the rules to Texas Government Code.
- 1.0.1.24 Amending 1 TAC §355.7001, to update citations in the rules to Texas Government Code.
- 1.0.1.25 Amending 1 TAC §355.8200, to update citations in the rules to Texas Government Code.
- 1.0.1.26 Amending 1 TAC §355.8261, to update citations in the rules to Texas Government Code.
- 1.0.1.27 Amending 1 TAC §355.456, to update the reimbursement procedures for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) high medical needs add-on rates based on the Patient-Driven Payment Model Long-Term Care (PDPM LTC) for nursing facilities.
- 1.0.1.28 Amending 1 TAC §357.562, to update citations in the rules to Texas Government Code.
- 1.0.1.29 Amending 1 TAC §360.101, to update citations in the rules to Texas Government Code.
- 1.0.1.30 Amending 1 TAC §361.101, to update citations in the rules to Texas Government Code.
- 1.0.1.31 Amending 1 TAC §370.501, to update citations in the rules to Texas Government Code.
- 1.0.1.32 Amending 1 TAC §380.101, to update citations in the rules to Texas Government Code.
- 1.0.1.33 Amending 1 TAC §391.247, to update citations in the rules to Texas Government Code.
- 1.0.1.34 Amending 1 TAC §395.2, to update citations in the rules to Texas Government Code.
- 1.0.2 Adopted Rules Re:
- 1.0.2.1 Adopting 1 TAC §351.805, to improve the language and structure for better readability; clarify the tasks and requirements for SMMCAC meetings; restructure the membership subcategories for individuals and providers enrollment in Medicaid managed care; add training requirements for SMMCAC members; describe SMMCAC member travel reimbursements; and update the numbering of the subsections and paragraphs.
- 1.0.2.2 Adopting 26 TAC §506.61, §506.62, to repeal Inspection and Investigation Procedures, and Complaint Against a Texas Department of Health Representative, because the rule has been added to proposed new §§506.62 – 506.64 and §506.66.
- 1.0.2.3 Adopting 26 TAC §§506.61 – 506.66, to place limits on a facility’s authority to record HHSC interviews and internal discussions; update special care facility inspection requirements; update special care facility complaint investigation requirements; inform a facility of the required timeframes for responding to a written Statement of Deficiencies; inform providers that HHSC reports conduct issues or complaints to the appropriate licensing authorities; and inform a facility about complaint registration against an HHSC inspector or investigator.
- 1.0.2.4 Adopting 26 TAC §506.71, §506.73, to create consistency between the ruleset for a special care facility and other HHSC facility types, as well as reflecting the transition of responsibility for special care facilities from DSHS to HHSC.
- 1.0.2.5 Adopting 26 TAC §510.1, §510.2, to update the statutory reference for the rules and add definitions to increase consistency across the rule sets for licensed health care facilities.
- 1.0.2.6 Adopting 26 TAC §§510.21 – 510.26, to update rule references to reflect the rule transfer from 25 TAC to 26 TAC, update rule language to ensure consistency with the statute, and make other non-substantive edits to improve clarity.
- 1.0.2.7 Adopting 26 TAC §§510.41 – 510.43, 510.46, to update rule references to reflect the rule chapter transfer from 25 TAC to 26 TAC, update rule language to ensure consistency with the statute, and makes other non-substantive edits to improve clarity.
- 1.0.2.8 Adopting 26 TAC §510.61, §510.62, to update rule references to reflect the rules transfer from 25 TAC to 26 TAC, update rule language to ensure consistency with the statute, make other non-substantive edits to improve clarity, and revise the title of Subchapter F to “Fire Prevention and Protection.”
- 1.0.2.9 Adopting 26 TAC §510.101, to update outdated information, correct typographical errors, and update rule references to reflect the rules transfer from 25 TAC to 26 TAC.
- 1.0.2.10 Adopting 26 TAC §§510.121 – 510.123, 510.125, 510.127 – 510.129, 510.131, to replace terms, update outdated information, update rule references to reflect the rules transfer from 25 TAC to 26 TAC, update figure titles, and make non-substantive edits to improve clarity and ensure consistency with HHSC rulemaking guidelines.
- 1.0.2.11 Adopting 26 TAC §§510.81 – 510.83, to repeal the Survey and Investigation Procedures, Complaint Against a Texas Department of Health Representative, and Enforcement rules because the content of the rules have been added to proposed new §§510.82 – 510.84, §510.86, and §510.87.
- 1.0.2.12 Adopting 26 TAC §§510.81 – 510.87, to place limits on a facility’s authority to record HHSC interviews and internal discussions; update PPHCSU inspection requirements; update PPHCSU complaint investigation requirements; inform a facility of the required timeframes for responding to a written Statement of Deficiencies; inform providers that HHSC reports conduct issues or complaints to the appropriate licensing authorities; inform a facility about complaint registration against an HHSC inspector or investigator; and create consistency between PPHCSU ruleset and other HHSC facility types.
- 1.0.2.13 Adopting 26 TAC §745.9037, to update the rule that individuals who have been rejected by the HHSC are not eligible to apply for an administrator’s license under HRC Chapter 43 for five years.
- 1.0.2.14 Adopting 26 TAC §§746.1053, 746.1065, 746.1067, 746.1069, to improve clarity and reorganize the rule; provide definitions for interim director; outline designation process of interim director of a child-care center; and clarify the circumstances under which someone serving as an interim director may continue to serve as a director after a child-care center receives a full license.
- 1.0.3 Transferred Rules Re:
- 1.0.3.1 Transferring The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 31, Subchapter C, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 366.
- 1.0.3.2 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 415, Subchapter F, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 320, Subchapter C.
- 1.0.4 Adopted Rule Reviews Re:
- 1.0.5 In Addition Re:
- 1.0.1 Proposed Rules Re:
- 2 Texas Board of Veterinary Medical Examiners
- 3 Texas Department of State Health Services
- 3.0.1 Proposed Rules Re:
- 3.0.2 Adopted Rules Re:
- 3.0.2.1 Adopting 25 TAC §§97.3, 97.4, 97.6, to update the public website link to include Cronobacter spp. in infants and melioidosis as notifiable conditions in Texas and update the preferred reporting option as electronic data transmissions.
- 3.0.2.2 Adopting 25 TAC §133.47, to update contact information to submit complaints and reflect the change of statutory authority from the Department of State Health Services to the Texas Health and Human Services Commission (“HHSC”).
- 3.0.2.3 Adopting 25 TAC §133.101, §133.102, to repeal the Inspection and Investigation Procedures and the Complaint Against a Department of State Health Services Surveyor because the content of the rule has been added to proposed new §§133.102 – 133.104.
- 3.0.2.4 Adopting 25 TAC §§133.101 – 133.106, to place limits on a facility’s authority to record HHSC interviews and internal discussions; updates hospital and special hospital inspection requirements; establishes the required timeframes regarding responding to a written Statement of Deficiencies; informs providers that HHSC reports issues or complaints to the appropriate licensing authorities; and notifies a hospital about the complaint registration process against an HHSC inspector or investigator.
- 3.0.2.5 Adopting 25 TAC §133.121, to update the rule’s title for consistency purposes and make necessary corrections and updates to reflect current practices and conform with the statute.
- 3.0.2.6 Adopting 25 TAC §§135.21, 135.24, 135.25, to repeal the Inspections, Enforcement, and Complaints sections because the content of the rule has been added to proposed new §135.62, §135.67, and §135.63.
- 3.0.2.7 Adopting 25 TAC §135.22, to reflect the transition of regulatory authority from DHS to HHSC, as well as specify the time frame for an ASC to return the license to HHSC when the ASC cannot provide sufficient evidence that it submitted a renewal application and fee.
- 3.0.2.8 Adopting 25 TAC §§135.61 – 135.67, to place limits on an ASC’s authority to record HHSC interviews and internal discussions; update ASC inspection requirements; update ASC complaint investigation requirements; inform an ASC of the required timeframes for responding to a written Statement of Deficiencies; inform providers that HHSC reports conduct issues or complaints to the appropriate licensing authorities; inform an ASC about complaint registration against an HHSC inspector or investigator; and creates greater consistency between the ASC ruleset and other HHSC facility types.
- 3.0.2.9 Adopting 25 TAC §140.433, to reorganize the rule language and update each subsection with the new rule.
- 3.0.2.10 Adopting 25 TAC §140.433, to set forth the licensing requirements for military service members, military spouses, and military veterans.
- 3.0.2.11 Adopting 25 TAC §157.2, to integrate terminology for the RACs, emergency medical systems, trauma facilities, stroke facilities, and current national standards into Definitions.
- 3.0.2.12 Amending 25 TAC §§157.123, 157.130, 157.131, to repeal and replace with a new §157.123.
- 3.0.3 Transferred Rules Re:
- 3.0.3.1 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 31, Subchapter C, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 366.
- 3.0.3.2 Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 415, Subchapter F, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 320, Subchapter C.
- 4 Texas Department of Insurance, Division of Workers’ Compensation
- 4.0.1 Adopted Rules Re:
- 4.0.1.1 Adopting 28 TAC §127.1, §127.25, to outline the requirements for denials for DD examinations and issues concerning the suspension, re-initiation, and reinstatement of benefits when an injured employee fails to attend a DD examination.
- 4.0.1.2 Adopting 28 TAC §§131.1, to outline the requirements for the initiation of lifetime income benefits by the insurance carrier or at the request of the injured employee and provides for the approval or denial of those benefits.
- 4.0.1.3 Adopting 28 TAC §§131.10 – 131.14, to add definitions, provide a list of individuals entitled to these benefits, outline first responders’ annual certification to the insurance carrier requirements, list the suspension and reinstatement of lifetime income benefits for first responders, and provide for the dispute of a first responder’s continuing entitlement to lifetime income benefits.
- 4.0.1 Adopted Rules Re:
- 5 Texas Department of Insurance
- 5.0.1 Company Licensing
- 5.0.1.1 Application for incorporation in the state of Texas for Access to Care Health Plan, LLC, a domestic Health Maintenance Organization (HMO). The home office is in Austin, Texas.
- 5.0.1.2 Application to do business in the state of Texas for Immigrant Life Insurance Company of America, a foreign life, accident and/or health company. The home office is in Stamford, Connecticut.
- 5.0.1 Company Licensing
Texas Health and Human Services Commission
Proposed Rules Re:
Amending 1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751, to update citations to the Texas Government Code.
CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §351.4, concerning Health and Human Services Commission Executive Council; §351.11, concerning Reports on Efforts to Streamline and Simplify Delivery of Services; §351.504, concerning Caseload Reduction Plan for Adult Protective Services; §351.507, concerning Adverse Licensing, Listing, or Registration Decisions by Health and Human Services Agencies; §351.701, concerning Unrelated Donor Umbilical Cord Blood Bank Program; §351.751, concerning Integrated eligibility services call centers; §351.801, concerning Authority and General Provisions; §351.807, concerning Behavioral Health Advisory Committee; §351.809, concerning Drug Utilization Review Board; §351.811, concerning Intellectual and Developmental Disability System Redesign Advisory Committee; §351.821, concerning Value-Based Payment and Quality Improvement Advisory Committee; §351.823, concerning e-Health Advisory Committee; §351.825, concerning Texas Brain Injury Advisory Council; §351.827, concerning Palliative Care Interdisciplinary Advisory Council; and §351.841, concerning Joint Committee on Access and Forensic Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §§351.801, 351.807, 351.809, 351.811, 351.821, 351.823, 351.825, 351.827, 351.841, to update citations to the Texas Government Code.
CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
DIVISION 1. COMMITTEES
1 TAC §§351.801, 351.807, 351.809, 351.811, 351.821, 351.823, 351.825, 351.827, 351.841
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §351.4, concerning Health and Human Services Commission Executive Council; §351.11, concerning Reports on Efforts to Streamline and Simplify Delivery of Services; §351.504, concerning Caseload Reduction Plan for Adult Protective Services; §351.507, concerning Adverse Licensing, Listing, or Registration Decisions by Health and Human Services Agencies; §351.701, concerning Unrelated Donor Umbilical Cord Blood Bank Program; §351.751, concerning Integrated eligibility services call centers; §351.801, concerning Authority and General Provisions; §351.807, concerning Behavioral Health Advisory Committee; §351.809, concerning Drug Utilization Review Board; §351.811, concerning Intellectual and Developmental Disability System Redesign Advisory Committee; §351.821, concerning Value-Based Payment and Quality Improvement Advisory Committee; §351.823, concerning e-Health Advisory Committee; §351.825, concerning Texas Brain Injury Advisory Council; §351.827, concerning Palliative Care Interdisciplinary Advisory Council; and §351.841, concerning Joint Committee on Access and Forensic Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §352.1, §352.3, to update citations in the rules to the Texas Government Code.
CHAPTER 352. MEDICAID AND CHILDREN’S HEALTH INSURANCE PROGRAM PROVIDER ENROLLMENT
1 TAC §352.1, §352.3
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §352.1, concerning Purpose; and §352.3, concerning Definitions.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.8, to update citations in the rules to the Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER A. GENERAL PROVISIONS
1 TAC §353.8
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.101, to update citations in the rules to Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER B. PROVIDER AND MEMBER EDUCATION PROGRAMS
1 TAC §353.101
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.201, to update citations in the rules to Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER C. MEMBER BILL OF RIGHTS AND RESPONSIBILITIES
1 TAC §353.201
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §§353.407, 353.425, 353.427, to update citations in the rules to the Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER E. STANDARDS FOR MEDICAID MANAGED CARE
1 TAC §§353.407, 353.425, 353.427
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.501, to update citations in the rules to Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER F. SPECIAL INVESTIGATIVE UNITS
1 TAC §353.501
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.901, §353.905, to update citations in the rules to the Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER J. OUTPATIENT PHARMACY SERVICES
1 TAC §353.901, §353.905
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.1153, §353.1155, to update citations in the rules to the Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER M. HOME AND COMMUNITY BASED SERVICES IN MANAGED CARE
1 TAC §353.1153, §353.1155
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.1451, to update citations in the rules to Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER Q. PROCESS TO RECOUP CERTAIN OVERPAYMENTS
1 TAC §353.1451
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §353.1309, to update citations in the rules to Texas Government Code.
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
1 TAC §353.1309
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.1189, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 11. GENERAL ADMINISTRATION
1 TAC §354.1189
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.1435, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 33. ADVANCED TELECOMMUNICATIONS SERVICES
1 TAC §354.1435
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.1924, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER F. PHARMACY SERVICES
DIVISION 7. TEXAS DRUG CODE INDEX–ADDITIONS, RETENTIONS, AND DELETIONS
1 TAC §354.1924
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.1941, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER F. PHARMACY SERVICES
DIVISION 8. DRUG UTILIZATION REVIEW BOARD
1 TAC §354.1941
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.2501, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER L. QUALITY IMPROVEMENT PROCESS FOR CLINICAL INITIATIVES
1 TAC §354.2501
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.2603, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER M. MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION
DIVISION 1. GENERAL PROVISIONS
1 TAC §354.2603
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.3001, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER N. PEER SPECIALIST SERVICES
DIVISION 1. GENERAL PROVISIONS
1 TAC §354.3001
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.4001, §354.4003, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER O. ELECTRONIC VISIT VERIFICATION
1 TAC §354.4001, §354.4003
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §354.5011, to update citations in the rules to Texas Government Code.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER P. AUTISM SERVICES
DIVISION 2. SERVICE PROVIDERS
1 TAC §354.5011
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §355.201, to update citations in the rules to Texas Government Code.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER B. ESTABLISHMENT AND ADJUSTMENT OF REIMBURSEMENT RATES FOR MEDICAID
1 TAC §355.201
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.201, concerning Establishment and Adjustment of Reimbursement Rates for Medicaid; §355.311, concerning Medicaid Reimbursement Rates for State Veterans Homes; §355.7001, concerning Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services; §355.8200, concerning Retained Funds for the Uncompensated Care Program; and §355.8261, concerning Federally Qualified Health Center Services Reimbursement.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §355.311, to update citations in the rules to Texas Government Code.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.311
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.201, concerning Establishment and Adjustment of Reimbursement Rates for Medicaid; §355.311, concerning Medicaid Reimbursement Rates for State Veterans Homes; §355.7001, concerning Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services; §355.8200, concerning Retained Funds for the Uncompensated Care Program; and §355.8261, concerning Federally Qualified Health Center Services Reimbursement.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §355.7001, to update citations in the rules to Texas Government Code.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER G. ADVANCED TELECOMMUNICATIONS SERVICES AND OTHER COMMUNITY-BASED SERVICES
1 TAC §355.7001
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.201, concerning Establishment and Adjustment of Reimbursement Rates for Medicaid; §355.311, concerning Medicaid Reimbursement Rates for State Veterans Homes; §355.7001, concerning Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services; §355.8200, concerning Retained Funds for the Uncompensated Care Program; and §355.8261, concerning Federally Qualified Health Center Services Reimbursement.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §355.8200, to update citations in the rules to Texas Government Code.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT
1 TAC §355.8200
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.201, concerning Establishment and Adjustment of Reimbursement Rates for Medicaid; §355.311, concerning Medicaid Reimbursement Rates for State Veterans Homes; §355.7001, concerning Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services; §355.8200, concerning Retained Funds for the Uncompensated Care Program; and §355.8261, concerning Federally Qualified Health Center Services Reimbursement.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §355.8261, to update citations in the rules to Texas Government Code.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 14. FEDERALLY QUALIFIED HEALTH CENTER SERVICES
1 TAC §355.8261
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.201, concerning Establishment and Adjustment of Reimbursement Rates for Medicaid; §355.311, concerning Medicaid Reimbursement Rates for State Veterans Homes; §355.7001, concerning Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services; §355.8200, concerning Retained Funds for the Uncompensated Care Program; and §355.8261, concerning Federally Qualified Health Center Services Reimbursement.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendments update the affected citations to the Texas Government Code.
Amending 1 TAC §355.456, to update the reimbursement procedures for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) high medical needs add-on rates based on the Patient-Driven Payment Model Long-Term Care (PDPM LTC) for nursing facilities.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER D. REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID)
1 TAC §355.456
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §355.456, concerning Reimbursement Methodology.
BACKGROUND AND PURPOSE
The purpose of the proposal is to update the reimbursement methodology for the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) high medical needs add-on rates based on the Patient Driven Payment Model Long-Term Care (PDPM LTC) for nursing facilities. The current reimbursement methodology for ICF/IID high medical needs add-on is based on the Resource Utilization Group version 3 (RUG-III) classification system and associated costs. The 88th Legislature, Regular Session, 2023 directed HHSC to “develop and implement a Texas version of the Patient Driven Payment Model methodology for the reimbursement of long-term stay nursing facility services in the Medicaid program” according to the 2024-25 General Appropriations Act, House Bill 1, 88th Legislature, Regular Session, 2023 (Article II, Health and Human Services Commission, Rider 25). The PDPM LTC methodology implements a new nursing facility classification system for Medicaid residents. This amendment uses PDPM LTC classifications to establish the reimbursement methodology for the ICF/IID high medical needs add-ons.
SECTION-BY-SECTION SUMMARY
The amendment to §355.456(d) clarifies that the current high medical needs add-on reimbursement methodology in paragraph (6) applies before September 1, 2025, when the PDPM LTC methodology required under Rider 25 is anticipated to be implemented. New paragraph (7) establishes the revised high medical needs add-on methodology on or after September 1, 2025, using PDPM LTC nursing case-mix classifiers for each high medical needs add-on group. The amendment also removes subsection (j) related to the total Medicaid spending requirement as this provision is no longer applicable.
Amending 1 TAC §357.562, to update citations in the rules to Texas Government Code.
CHAPTER 357. HEARINGS
SUBCHAPTER L. FRAUD INVOLVING RECIPIENTS
1 TAC §357.562
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §357.562, concerning Determination and Disposition of Intentional Program Violations.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citation to the Texas Government Code.
Amending 1 TAC §360.101, to update citations in the rules to Texas Government Code.
CHAPTER 360. MEDICAID BUY-IN PROGRAM
1 TAC §360.101
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §360.101, concerning Overview and Purpose.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citation to the Texas Government Code.
Amending 1 TAC §361.101, to update citations in the rules to Texas Government Code.
CHAPTER 361. MEDICAID BUY-IN FOR CHILDREN PROGRAM
1 TAC §361.101
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §361.101, concerning Overview and Purpose.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citation to the Texas Government Code.
Amending 1 TAC §370.501, to update citations in the rules to Texas Government Code.
CHAPTER 370. STATE CHILDREN’S HEALTH INSURANCE PROGRAM
SUBCHAPTER F. SPECIAL INVESTIGATIVE UNITS
1 TAC §370.501
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §370.501, concerning Purpose.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citation to the Texas Government Code.
Amending 1 TAC §380.101, to update citations in the rules to Texas Government Code.
CHAPTER 380. MEDICAL TRANSPORTATION PROGRAM
SUBCHAPTER A. PROGRAM OVERVIEW
1 TAC §380.101
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §380.101, concerning Definitions.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citation to the Texas Government Code.
Amending 1 TAC §391.247, to update citations in the rules to Texas Government Code.
CHAPTER 391. PURCHASE OF GOODS AND SERVICES BY THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION
SUBCHAPTER B. PROCUREMENT AND SPECIAL CONTRACTING METHODS
DIVISION 2. SPECIAL CONTRACTING METHODS
1 TAC §391.247
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §391.247, concerning Direct Contract Award.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citations to the Texas Government Code.
Amending 1 TAC §395.2, to update citations in the rules to Texas Government Code.
CHAPTER 395. CIVIL RIGHTS
SUBCHAPTER A. GENERAL PROVISIONS
1 TAC §395.2
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §395.2, concerning Definitions.
BACKGROUND AND PURPOSE
House Bill 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. This proposal is necessary to update citations in the rules to Texas Government Code sections that become effective on April 1, 2025. The proposed amendment updates the affected citation to the Texas Government Code.
Adopted Rules Re:
Adopting 1 TAC §351.805, to improve the language and structure for better readability; clarify the tasks and requirements for SMMCAC meetings; restructure the membership subcategories for individuals and providers enrollment in Medicaid managed care; add training requirements for SMMCAC members; describe SMMCAC member travel reimbursements; and update the numbering of the subsections and paragraphs.
CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
DIVISION 1. COMMITTEES
1 TAC §351.805
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §351.805, concerning State Medicaid Managed Care Advisory Committee.
Section 351.805 is adopted with changes to the proposed text as published in the July 19, 2024, issue of the Texas Register (49 TexReg 5215). This rule will be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to extend the State Medicaid Managed Care Advisory Committee (SMMCAC) and align the rule with HHSC advisory committee rule standards. Under the general authority of the Executive Commissioner, the SMMCAC was re-established in 2016 to consider managed care issues and make recommendations to HHSC. The SMMCAC is currently set to abolish on December 31, 2024. The rule amendment changes the SMMCAC abolish date from December 31, 2024, to December 31, 2028, which will allow SMMCAC to continue providing recommendations and ongoing input to HHSC on the statewide operation of Medicaid managed care programs for an additional four years. Additionally, the rule amendment restructures membership subcategories to increase representation for youth and adult populations and adds a new membership subcategory for persons transitioning from children to adult Medicaid managed care programs. The rule amendment will align §351.805 with agency standards for advisory committees by including a subsection on how eligible SMMCAC members may be reimbursed for travel.
Adopting 26 TAC §506.61, §506.62, to repeal Inspection and Investigation Procedures, and Complaint Against a Texas Department of Health Representative, because the rule has been added to proposed new §§506.62 – 506.64 and §506.66.
CHAPTER 506. SPECIAL CARE FACILITIES
SUBCHAPTER E. INSPECTIONS AND INVESTIGATIONS
26 TAC §506.61, §506.62
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §506.61, concerning Inspection and Investigation Procedures, and §506.62, concerning Complaint Against a Texas Department of Health Representative; new §506.61, concerning Integrity of Inspections and Investigations; §506.62, concerning Inspections; §506.63, concerning Complaint Investigations; §506.64, concerning Notice; §506.65, concerning Professional Conduct; and §506.66, concerning Complaint Against an HHSC Representative; and amended §506.71, concerning License Denial, Suspension, Revocation and Probation, and §506.73, concerning Administrative Penalties.
The repeal of §506.61 and §506.62; new §§506.64, 506.65, and 506.66; and amended §506.73 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3122). These rules will not be republished.
New §§506.61, 506.62, and 506.63, and amended §506.71 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3122). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to update the inspection, complaint investigation, and enforcement procedures for special care facilities. These updates are necessary to hold facilities accountable during the inspection and investigation processes and ensure facilities provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for special care facilities from the Department of State Health Services to HHSC.
CHAPTER 506. SPECIAL CARE FACILITIES
SUBCHAPTER E. INSPECTIONS AND INVESTIGATIONS
26 TAC §§506.61 – 506.66
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §506.61, concerning Inspection and Investigation Procedures, and §506.62, concerning Complaint Against a Texas Department of Health Representative; new §506.61, concerning Integrity of Inspections and Investigations; §506.62, concerning Inspections; §506.63, concerning Complaint Investigations; §506.64, concerning Notice; §506.65, concerning Professional Conduct; and §506.66, concerning Complaint Against an HHSC Representative; and amended §506.71, concerning License Denial, Suspension, Revocation and Probation, and §506.73, concerning Administrative Penalties.
The repeal of §506.61 and §506.62; new §§506.64, 506.65, and 506.66; and amended §506.73 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3122). These rules will not be republished.
New §§506.61, 506.62, and 506.63, and amended §506.71 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3122). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to update the inspection, complaint investigation, and enforcement procedures for special care facilities. These updates are necessary to hold facilities accountable during the inspection and investigation processes and ensure facilities provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for special care facilities from the Department of State Health Services to HHSC.
Adopting 26 TAC §506.71, §506.73, to create consistency between the ruleset for a special care facility and other HHSC facility types, as well as reflecting the transition of responsibility for special care facilities from DSHS to HHSC.
CHAPTER 506. SPECIAL CARE FACILITIES
SUBCHAPTER F. ENFORCEMENT
26 TAC §506.71, §506.73
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §506.61, concerning Inspection and Investigation Procedures, and §506.62, concerning Complaint Against a Texas Department of Health Representative; new §506.61, concerning Integrity of Inspections and Investigations; §506.62, concerning Inspections; §506.63, concerning Complaint Investigations; §506.64, concerning Notice; §506.65, concerning Professional Conduct; and §506.66, concerning Complaint Against an HHSC Representative; and amended §506.71, concerning License Denial, Suspension, Revocation and Probation, and §506.73, concerning Administrative Penalties.
The repeal of §506.61 and §506.62; new §§506.64, 506.65, and 506.66; and amended §506.73 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3122). These rules will not be republished.
New §§506.61, 506.62, and 506.63, and amended §506.71 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3122). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to update the inspection, complaint investigation, and enforcement procedures for special care facilities. These updates are necessary to hold facilities accountable during the inspection and investigation processes and ensure facilities provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for special care facilities from the Department of State Health Services to HHSC.
Adopting 26 TAC §510.1, §510.2, to update the statutory reference for the rules and add definitions to increase consistency across the rule sets for licensed health care facilities.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §510.1, §510.2
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §510.1, concerning Purpose; §510.2, concerning Definitions; §510.21, concerning General; §510.22, concerning Application and Issuance of Initial License; §510.23, concerning Application and Issuance of Renewal License; §510.24, concerning Change of Ownership; §510.25, concerning Time Periods for Processing and Issuing Licenses; §510.26, concerning Fees; §510.41, concerning Facility Functions and Services; §510.42, concerning Discrimination or Retaliation Standards; §510.43, concerning Patient Transfer Policy; §510.46, concerning Abuse and Neglect Issues; §510.61, concerning Patient Transfer Agreements; §510.62, concerning Cooperative Agreements; §510.101, concerning Fire Prevention and Protection; §510.121, concerning Requirements for Buildings in which Existing Licensed Facilities are Located; §510.122, concerning New Construction Requirements; §510.123, concerning Spatial Requirements for New Construction; §510.125, concerning Building with Multiple Occupancies; §510.127, concerning Preparation, Submittal, Review and Approval of Plans; §510.128, concerning Construction, Surveys, and Approval of Project; §510.129, concerning Waiver Requests, and §510.131, concerning Tables.
Amended §§510.1, 510.2, 510.21 – 510.26, 510.41 – 510.43, 510.61, 510.62, 510.101, 510.121, 510.125 – 510.129, and 510.131 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will not be republished.
Amended §§510.46, 510.122, and 510.123 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to correct cross-references throughout 26 TAC Chapter 510 after the rules were administratively transferred from 25 TAC Chapter 134 to 26 TAC Chapter 510. These non-substantive amendments will maintain accurate references to 25 TAC and 26 TAC. The amendments also correct outdated citations and references to programs that no longer exist; update language to reflect current HHSC organization; and increase consistency with statute, HHSC rules, and HHSC rulemaking guidelines.
Adopting 26 TAC §§510.21 – 510.26, to update rule references to reflect the rule transfer from 25 TAC to 26 TAC, update rule language to ensure consistency with the statute, and make other non-substantive edits to improve clarity.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER B. APPLICATION AND ISSUANCE OF A LICENSE
26 TAC §§510.21 – 510.26
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §510.1, concerning Purpose; §510.2, concerning Definitions; §510.21, concerning General; §510.22, concerning Application and Issuance of Initial License; §510.23, concerning Application and Issuance of Renewal License; §510.24, concerning Change of Ownership; §510.25, concerning Time Periods for Processing and Issuing Licenses; §510.26, concerning Fees; §510.41, concerning Facility Functions and Services; §510.42, concerning Discrimination or Retaliation Standards; §510.43, concerning Patient Transfer Policy; §510.46, concerning Abuse and Neglect Issues; §510.61, concerning Patient Transfer Agreements; §510.62, concerning Cooperative Agreements; §510.101, concerning Fire Prevention and Protection; §510.121, concerning Requirements for Buildings in which Existing Licensed Facilities are Located; §510.122, concerning New Construction Requirements; §510.123, concerning Spatial Requirements for New Construction; §510.125, concerning Building with Multiple Occupancies; §510.127, concerning Preparation, Submittal, Review and Approval of Plans; §510.128, concerning Construction, Surveys, and Approval of Project; §510.129, concerning Waiver Requests, and §510.131, concerning Tables.
Amended §§510.1, 510.2, 510.21 – 510.26, 510.41 – 510.43, 510.61, 510.62, 510.101, 510.121, 510.125 – 510.129, and 510.131 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will not be republished.
Amended §§510.46, 510.122, and 510.123 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to correct cross-references throughout 26 TAC Chapter 510 after the rules were administratively transferred from 25 TAC Chapter 134 to 26 TAC Chapter 510. These non-substantive amendments will maintain accurate references to 25 TAC and 26 TAC. The amendments also correct outdated citations and references to programs that no longer exist; update language to reflect current HHSC organization; and increase consistency with statute, HHSC rules, and HHSC rulemaking guidelines.
Adopting 26 TAC §§510.41 – 510.43, 510.46, to update rule references to reflect the rule chapter transfer from 25 TAC to 26 TAC, update rule language to ensure consistency with the statute, and makes other non-substantive edits to improve clarity.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
26 TAC §§510.41 – 510.43, 510.46
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §510.1, concerning Purpose; §510.2, concerning Definitions; §510.21, concerning General; §510.22, concerning Application and Issuance of Initial License; §510.23, concerning Application and Issuance of Renewal License; §510.24, concerning Change of Ownership; §510.25, concerning Time Periods for Processing and Issuing Licenses; §510.26, concerning Fees; §510.41, concerning Facility Functions and Services; §510.42, concerning Discrimination or Retaliation Standards; §510.43, concerning Patient Transfer Policy; §510.46, concerning Abuse and Neglect Issues; §510.61, concerning Patient Transfer Agreements; §510.62, concerning Cooperative Agreements; §510.101, concerning Fire Prevention and Protection; §510.121, concerning Requirements for Buildings in which Existing Licensed Facilities are Located; §510.122, concerning New Construction Requirements; §510.123, concerning Spatial Requirements for New Construction; §510.125, concerning Building with Multiple Occupancies; §510.127, concerning Preparation, Submittal, Review and Approval of Plans; §510.128, concerning Construction, Surveys, and Approval of Project; §510.129, concerning Waiver Requests, and §510.131, concerning Tables.
Amended §§510.1, 510.2, 510.21 – 510.26, 510.41 – 510.43, 510.61, 510.62, 510.101, 510.121, 510.125 – 510.129, and 510.131 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will not be republished.
Amended §§510.46, 510.122, and 510.123 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to correct cross-references throughout 26 TAC Chapter 510 after the rules were administratively transferred from 25 TAC Chapter 134 to 26 TAC Chapter 510. These non-substantive amendments will maintain accurate references to 25 TAC and 26 TAC. The amendments also correct outdated citations and references to programs that no longer exist; update language to reflect current HHSC organization; and increase consistency with statute, HHSC rules, and HHSC rulemaking guidelines.
Adopting 26 TAC §510.61, §510.62, to update rule references to reflect the rules transfer from 25 TAC to 26 TAC, update rule language to ensure consistency with the statute, make other non-substantive edits to improve clarity, and revise the title of Subchapter F to “Fire Prevention and Protection.”
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER D. VOLUNTARY AGREEMENTS
26 TAC §510.61, §510.62
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §510.1, concerning Purpose; §510.2, concerning Definitions; §510.21, concerning General; §510.22, concerning Application and Issuance of Initial License; §510.23, concerning Application and Issuance of Renewal License; §510.24, concerning Change of Ownership; §510.25, concerning Time Periods for Processing and Issuing Licenses; §510.26, concerning Fees; §510.41, concerning Facility Functions and Services; §510.42, concerning Discrimination or Retaliation Standards; §510.43, concerning Patient Transfer Policy; §510.46, concerning Abuse and Neglect Issues; §510.61, concerning Patient Transfer Agreements; §510.62, concerning Cooperative Agreements; §510.101, concerning Fire Prevention and Protection; §510.121, concerning Requirements for Buildings in which Existing Licensed Facilities are Located; §510.122, concerning New Construction Requirements; §510.123, concerning Spatial Requirements for New Construction; §510.125, concerning Building with Multiple Occupancies; §510.127, concerning Preparation, Submittal, Review and Approval of Plans; §510.128, concerning Construction, Surveys, and Approval of Project; §510.129, concerning Waiver Requests, and §510.131, concerning Tables.
Amended §§510.1, 510.2, 510.21 – 510.26, 510.41 – 510.43, 510.61, 510.62, 510.101, 510.121, 510.125 – 510.129, and 510.131 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will not be republished.
Amended §§510.46, 510.122, and 510.123 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to correct cross-references throughout 26 TAC Chapter 510 after the rules were administratively transferred from 25 TAC Chapter 134 to 26 TAC Chapter 510. These non-substantive amendments will maintain accurate references to 25 TAC and 26 TAC. The amendments also correct outdated citations and references to programs that no longer exist; update language to reflect current HHSC organization; and increase consistency with statute, HHSC rules, and HHSC rulemaking guidelines.
Adopting 26 TAC §510.101, to update outdated information, correct typographical errors, and update rule references to reflect the rules transfer from 25 TAC to 26 TAC.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER F. FIRE PREVENTION AND SAFETY REQUIREMENTS
26 TAC §510.101
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §510.1, concerning Purpose; §510.2, concerning Definitions; §510.21, concerning General; §510.22, concerning Application and Issuance of Initial License; §510.23, concerning Application and Issuance of Renewal License; §510.24, concerning Change of Ownership; §510.25, concerning Time Periods for Processing and Issuing Licenses; §510.26, concerning Fees; §510.41, concerning Facility Functions and Services; §510.42, concerning Discrimination or Retaliation Standards; §510.43, concerning Patient Transfer Policy; §510.46, concerning Abuse and Neglect Issues; §510.61, concerning Patient Transfer Agreements; §510.62, concerning Cooperative Agreements; §510.101, concerning Fire Prevention and Protection; §510.121, concerning Requirements for Buildings in which Existing Licensed Facilities are Located; §510.122, concerning New Construction Requirements; §510.123, concerning Spatial Requirements for New Construction; §510.125, concerning Building with Multiple Occupancies; §510.127, concerning Preparation, Submittal, Review and Approval of Plans; §510.128, concerning Construction, Surveys, and Approval of Project; §510.129, concerning Waiver Requests, and §510.131, concerning Tables.
Amended §§510.1, 510.2, 510.21 – 510.26, 510.41 – 510.43, 510.61, 510.62, 510.101, 510.121, 510.125 – 510.129, and 510.131 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will not be republished.
Amended §§510.46, 510.122, and 510.123 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to correct cross-references throughout 26 TAC Chapter 510 after the rules were administratively transferred from 25 TAC Chapter 134 to 26 TAC Chapter 510. These non-substantive amendments will maintain accurate references to 25 TAC and 26 TAC. The amendments also correct outdated citations and references to programs that no longer exist; update language to reflect current HHSC organization; and increase consistency with statute, HHSC rules, and HHSC rulemaking guidelines.
Adopting 26 TAC §§510.121 – 510.123, 510.125, 510.127 – 510.129, 510.131, to replace terms, update outdated information, update rule references to reflect the rules transfer from 25 TAC to 26 TAC, update figure titles, and make non-substantive edits to improve clarity and ensure consistency with HHSC rulemaking guidelines.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER G. PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
26 TAC §§510.121 – 510.123, 510.125, 510.127 – 510.129, 510.131
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §510.1, concerning Purpose; §510.2, concerning Definitions; §510.21, concerning General; §510.22, concerning Application and Issuance of Initial License; §510.23, concerning Application and Issuance of Renewal License; §510.24, concerning Change of Ownership; §510.25, concerning Time Periods for Processing and Issuing Licenses; §510.26, concerning Fees; §510.41, concerning Facility Functions and Services; §510.42, concerning Discrimination or Retaliation Standards; §510.43, concerning Patient Transfer Policy; §510.46, concerning Abuse and Neglect Issues; §510.61, concerning Patient Transfer Agreements; §510.62, concerning Cooperative Agreements; §510.101, concerning Fire Prevention and Protection; §510.121, concerning Requirements for Buildings in which Existing Licensed Facilities are Located; §510.122, concerning New Construction Requirements; §510.123, concerning Spatial Requirements for New Construction; §510.125, concerning Building with Multiple Occupancies; §510.127, concerning Preparation, Submittal, Review and Approval of Plans; §510.128, concerning Construction, Surveys, and Approval of Project; §510.129, concerning Waiver Requests, and §510.131, concerning Tables.
Amended §§510.1, 510.2, 510.21 – 510.26, 510.41 – 510.43, 510.61, 510.62, 510.101, 510.121, 510.125 – 510.129, and 510.131 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will not be republished.
Amended §§510.46, 510.122, and 510.123 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3129). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to correct cross-references throughout 26 TAC Chapter 510 after the rules were administratively transferred from 25 TAC Chapter 134 to 26 TAC Chapter 510. These non-substantive amendments will maintain accurate references to 25 TAC and 26 TAC. The amendments also correct outdated citations and references to programs that no longer exist; update language to reflect current HHSC organization; and increase consistency with statute, HHSC rules, and HHSC rulemaking guidelines.
Adopting 26 TAC §§510.81 – 510.83, to repeal the Survey and Investigation Procedures, Complaint Against a Texas Department of Health Representative, and Enforcement rules because the content of the rules have been added to proposed new §§510.82 – 510.84, §510.86, and §510.87.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER E. ENFORCEMENT
26 TAC §§510.81 – 510.83
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §§510.81, concerning Survey and Investigation Procedures; 510.82, concerning Complaint Against a Texas Department of Health Representative; and 510.83, concerning Enforcement; and new §§510.81, concerning Integrity of Inspections and Investigations; 510.82, concerning Inspections; 510.83, concerning Complaint Investigations; 510.84, concerning Notice; 510.85, concerning Professional Conduct; 510.86, concerning Complaint Against an HHSC Representative; and 510.87, concerning Enforcement.
The repeal of §§510.81 – 510.83 and new §§510.84 – 510.86 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3186). These rules will not be republished.
New §§510.81 – 510.83, and 510.87 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3186). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement House Bill (H.B.) 49, 88th Legislature, Regular Session, 2023. H.B. 49 amended Texas Health and Safety Code (HSC) §577.013 to make certain information related to facility investigations subject to disclosure and create a requirement for HHSC to post certain information related to hospital investigations on the HHSC website.
The adoption is also necessary to update the inspection, complaint investigation, and enforcement procedures for private psychiatric hospitals and crisis stabilization units (PPHCSUs). These updates are necessary to hold PPHCSUs accountable during the inspection and investigation processes and ensure PPHCSUs provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for PPHCSUs from the Department of State Health Services to HHSC.
CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS
SUBCHAPTER E. ENFORCEMENT
26 TAC §§510.81 – 510.87
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §§510.81, concerning Survey and Investigation Procedures; 510.82, concerning Complaint Against a Texas Department of Health Representative; and 510.83, concerning Enforcement; and new §§510.81, concerning Integrity of Inspections and Investigations; 510.82, concerning Inspections; 510.83, concerning Complaint Investigations; 510.84, concerning Notice; 510.85, concerning Professional Conduct; 510.86, concerning Complaint Against an HHSC Representative; and 510.87, concerning Enforcement.
The repeal of §§510.81 – 510.83 and new §§510.84 – 510.86 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3186). These rules will not be republished.
New §§510.81 – 510.83, and 510.87 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3186). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement House Bill (H.B.) 49, 88th Legislature, Regular Session, 2023. H.B. 49 amended Texas Health and Safety Code (HSC) §577.013 to make certain information related to facility investigations subject to disclosure and create a requirement for HHSC to post certain information related to hospital investigations on the HHSC website.
The adoption is also necessary to update the inspection, complaint investigation, and enforcement procedures for private psychiatric hospitals and crisis stabilization units (PPHCSUs). These updates are necessary to hold PPHCSUs accountable during the inspection and investigation processes and ensure PPHCSUs provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for PPHCSUs from the Department of State Health Services to HHSC.
Adopting 26 TAC §745.9037, to update the rule that individuals who have been rejected by the HHSC are not eligible to apply for an administrator’s license under HRC Chapter 43 for five years.
CHAPTER 745. LICENSING
SUBCHAPTER N. ADMINISTRATOR’S LICENSING
DIVISION 7. REMEDIAL ACTIONS
26 TAC §745.9037
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §745.9037, concerning Under what circumstances may Licensing take remedial action against my administrator’s license or administrator’s license application.
The amendment to §745.9037 is adopted without changes to the proposed text as published in the July 19, 2024, issue of the Texas Register (49 TexReg 5313). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement House Bill (H.B.) 4170, 88th Legislature, Regular Session, 2023. H.B. 4170 amended Texas Human Resources Code (HRC) §43.010(b), which makes a person ineligible to apply for another administrator’s license for five years after the date HHSC refused to renew the administrator’s license. Prior to this amendment, this subsection only applied the five-year ban to when HHSC revoked an administrator’s license. The amendment to §745.9037 is necessary for this rule to be consistent with HRC §43.010(b).
Adopting 26 TAC §§746.1053, 746.1065, 746.1067, 746.1069, to improve clarity and reorganize the rule; provide definitions for interim director; outline designation process of interim director of a child-care center; and clarify the circumstances under which someone serving as an interim director may continue to serve as a director after a child-care center receives a full license.
CHAPTER 746. MINIMUM STANDARDS FOR CHILD-CARE CENTERS
SUBCHAPTER D. PERSONNEL
DIVISION 1. CHILD-CARE CENTER DIRECTOR
26 TAC §§746.1053, 746.1065, 746.1067, 746.1069
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §746.1053, concerning Will the director’s certificate expire; and new §746.1065, concerning What is an interim director, §746.1067, concerning When may a child-care center designate someone as the interim director of the center, and §746.1069, concerning May someone serving as interim director of a child-care center continue to serve as director after the center receives a full license.
Amended §746.1053; and new §§746.1065, 746.1067, and 746.1069 are adopted with changes to the proposed text as published in the July 19, 2024, issue of the Texas Register (49 TexReg 5315). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The amendment and new sections are necessary to comply with Senate Bill (S.B.) 1327, 88th Legislature, Regular Session, 2023. S.B. 1327 amended Texas Human Resources Code (HRC), Chapter 42, by adding §42.04201 and amending §42.0761(a). HRC §42.04201 allows a child-care center operating under an initial license to designate an individual who meets all the director qualifications, except the education requirement, to serve as an interim director. Since an initial license is valid for six months from the date that HHSC Child Care Regulation (HHSC CCR) issues it and may be renewed for an additional six months, the statute allows a person to serve as an interim director for up to 12 months. Before the prospective 12-month period expires, the interim director may obtain the education requirements and be designated as a qualified director. If the interim director does not meet the education requirements at the end of the 12-month period, the child-care center must obtain an approved waiver for the requirements or employ a new director. HRC §42.0761(a) adds the term “interim director” to the statute that requires a child-care center to designate a qualified director who is routinely present at the operation.
HHSC CCR is adopting new rules in Chapter 746 to provide a definition of “interim director” and describe the requirements related to qualifying for that designation. HHSC CCR is also adopting an amendment to one rule related to expiring director certificates.
Transferred Rules Re:
Transferring The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 31, Subchapter C, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 366.
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 31, Nutrition Services, Subchapter C, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 366, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 415, Subchapter F, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 320, Subchapter C.
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 415, Provider Clinical Responsibilities–Mental Health Services, Subchapter F, Interventions in Mental Health Services, that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 320, Rights of Individuals, Subchapter C, Interventions in Mental Health Services.
Adopted Rule Reviews Re:
Adopting Title 26, Part 1, concerning Day Activity and Health Services (DAHS) Contractual Requirements.
OVERVIEW
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 211, Day Activity and Health Services (DAHS) Contractual Requirements
In Addition Re:
Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates for Medical Policy Reviews, Special Review and HCPCS Quarterly Updates
Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on December 4, 2024, at 9:00 a.m., to receive public comments on proposed updates to Medical Policy Reviews, HCPCS Quarterly Updates and a Special Review.
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 December 1, 2024.
Texas Board of Veterinary Medical Examiners
Proposed Rules Re:
Amending 22 TAC §571.7, to extend the time period in which an applicant who has not yet graduated from veterinary medical school may obtain a document confirming their expected graduation date to apply for the State Board Examination from 60 to 120 days.
CHAPTER 571. LICENSING
SUBCHAPTER A. GENERAL
22 TAC §571.7
OVERVIEW
The Texas Department of Licensing and Regulation (Department), on behalf of the Texas Board of Veterinary Medical Examiners (TBVME), proposes an amendment to the existing rules at 22 Texas Administrative Code (TAC), Chapter 571, Subchapter A, §571.7, regarding the Licensing duties. The proposed change is referred to as the “proposed rule.”
BACKGROUND AND PURPOSE
The rules under 22 TAC, Chapter 571, implement Texas Occupations Code, Chapter 801, Veterinary Licensing Act.
The proposed rule extends the time period in which an applicant for a veterinary license who has not yet graduated from veterinary medical school may obtain a document confirming their expected graduation date in order to apply for the State Board Examination (SBE) from 60 days to 120 days. This proposed rule change was suggested by a major stakeholder, Texas Tech University School of Veterinary Medicine (Texas Tech), to align with their schedule for students in their final year of school. Texas Tech fourth-year students spend most of their year at externships throughout the state but return to the campus in February of the year they graduate. Texas Tech, in an attempt to limit costs to their students, wants to proctor a SBE for their graduating students in February while the students are all on campus. By allowing the students to obtain a document confirming their expected graduation date 120 days prior to graduation, this allows Texas Tech students to take the SBE on campus in February prior to their graduation. This change will also benefit all graduating veterinary students, both in-state and out-of-state, in that it allows them to take the SBE sooner.
Texas Department of State Health Services
Proposed Rules Re:
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER D. MAINTENANCE AND ADMINISTRATION OF [ASTHMA ] MEDICATION FOR RESPIRATORY DISTRESS
25 TAC §§40.41 – 40.49
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendments to 25 Texas Administrative Code (TAC) Chapter 40, Subchapter D, §§40.41 – 40.49, concerning Maintenance and Administration of Asthma Medication.
BACKGROUND AND PURPOSE
The purpose of the proposal is to implement Senate Bill (S.B.) 294, 88th Legislature, Regular Session, 2023, which amends Texas Education Code (TEC) Chapter 38, Subchapter E by replacing references to asthma medication with medication for respiratory distress.
TEC §38.208 requires the Executive Commissioner of the Health and Human Services Commission, in consultation with the commissioner of Texas Education Agency (TEA) and the Stock Epinephrine Advisory Committee (SEAC), to adopt rules regarding the maintenance, administration, and disposal of medication for respiratory distress at a school campus subject to a policy adopted and implemented by each school district, open-enrollment charter school, and private school.
TEC §38.208 also requires the rules to establish the process for checking inventory, the amount of training for school personnel and volunteers, and the types of medication that may be administered.
TEC §38.2091 requires schools to report information on the administration of medication for respiratory distress to the commissioner of DSHS.
SECTION-BY-SECTION SUMMARY
The proposed amendments replace references to “asthma medication” with “medication for respiratory distress” for consistency throughout the subchapter. This proposal renames Subchapter D, as Maintenance and Administration of Medication for Respiratory Distress.
The proposed amendment to §40.41 replaces wording, edits language for clarity, and adds an acronym for Texas Education Code.
The proposed amendment to §40.42 provides revised and new definitions, replaces an acronym with the spelled out reference, and renumbers the subsection.
The proposed amendment to §40.43 replaces wording and edits language for clarity.
The proposed amendment to §40.44 adds policy requirements for school personnel and volunteers authorized and trained to administer medications, the treatment of multiple students, medication inventory, referral process for student to primary healthcare provider, process for providing information to assist in selecting a primary healthcare provider for the student, and renumbers the subsection.
The proposed amendment to §40.45 replaces wording, edits language for clarity, adds an acronym for Texas Education Code, and adds policy requirements for storage of medication.
The proposed amendment to §40.46 replaces policy requirements for training nurses by expanding training to school personnel or school volunteers in the administration of unassigned medication for respiratory distress, replaces wording, edits for language clarity, adds policy requirements for hands-on training, and informing of the purpose and use of asthma action plans.
The proposed amendment to §40.47 replaces wording and edits for language clarity, replaces policy requirements of nurse administering the medication for respiratory distress to school personnel or school volunteer, replaces reporting to a school administrator with reporting to the school district, charter holder or governing body of a private school, replaces a spelled out reference to an acronym, and renumbers the subsection.
The proposed amendment to §40.48 replaces wording and edits for language clarity and replaces a spelled out reference to an acronym.
The proposed amendment to §40.49 replaces a spelled out reference to an acronym.
Adopted Rules Re:
Adopting 25 TAC §§97.3, 97.4, 97.6, to update the public website link to include Cronobacter spp. in infants and melioidosis as notifiable conditions in Texas and update the preferred reporting option as electronic data transmissions.
CHAPTER 97. COMMUNICABLE DISEASES
SUBCHAPTER A. CONTROL OF COMMUNICABLE DISEASES
25 TAC §§97.3, 97.4, 97.6
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §97.3, concerning What Condition to Report and What Isolates to Report or Submit; §97.4, concerning When and How to Report a Condition or Isolate; and §97.6, concerning Reporting and Other Duties of Local Health Authorities and Regional Directors. The amendments to §§97.3, 97.4, and 97.6 are adopted without changes to the proposed text as published in the August 9, 2024, issue of the Texas Register (49 TexReg 5907), and therefore will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to comply with Texas Health and Safety Code Chapter 81, amended by Senate Bill 969, 87th Regular Session, 2021, and update the list of notifiable conditions in Texas.
The amendment to §97.3 adds melioidosis and Cronobacter spp. in infants as notifiable conditions in Texas.
The amendments to §97.4 and to §97.6 implement the revisions to Texas Health and Safety Code Chapter 81 by updating the acceptable methods of reporting notifiable conditions to electronic data transmission, telephone, or fax. Notifiable conditions reported by telephone must be followed-up with an electronic data transmission through an approved electronic means within 24 hours of the original notification. The amendments improve the ability of public health entities to plan and implement response and mitigation measures, enhance public surveillance and timely reporting, and increase the availability of public health data in Texas.
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
25 TAC §133.47
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §133.101, concerning Inspection and Investigation Procedures; and §133.102, concerning Complaint Against Department of State Health Services Surveyor; new §§133.101, concerning Integrity of Inspections and Investigations; 133.102, concerning Inspections; 133.103, concerning Complaint Investigations; 133.104, concerning Notice; 133.105, concerning Professional Conduct; and 133.106, concerning Complaint Against an HHSC Representative; and amendments to §133.47, concerning Abuse and Neglect Issues; and §133.121, concerning Enforcement.
The repeal of §133.101 and §133.102, and new §§133.104, 133.105, and 133.106 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will not be republished.
New §§133.101, 133.102, and 133.103 and amended §133.47 and §133.121 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement House Bill (H.B.) 49, 88th Legislature, Regular Session, 2023. H.B. 49 amended Texas Health and Safety Code (HSC) §241.051 to make certain information related to hospital investigations subject to disclosure and create a requirement for HHSC to post certain information related to hospital investigations on the HHSC website.
The adoption is also necessary to update the inspection, complaint investigation, and enforcement procedures for general and special hospitals. These updates are necessary to hold hospitals accountable during the inspection and investigation processes and ensure hospitals provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for hospitals from the Department of State Health Services (DSHS) to HHSC.
Adopting 25 TAC §133.101, §133.102, to repeal the Inspection and Investigation Procedures and the Complaint Against a Department of State Health Services Surveyor because the content of the rule has been added to proposed new §§133.102 – 133.104.
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER F. INSPECTION AND INVESTIGATION PROCEDURES
25 TAC §133.101, §133.102
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §133.101, concerning Inspection and Investigation Procedures; and §133.102, concerning Complaint Against Department of State Health Services Surveyor; new §§133.101, concerning Integrity of Inspections and Investigations; 133.102, concerning Inspections; 133.103, concerning Complaint Investigations; 133.104, concerning Notice; 133.105, concerning Professional Conduct; and 133.106, concerning Complaint Against an HHSC Representative; and amendments to §133.47, concerning Abuse and Neglect Issues; and §133.121, concerning Enforcement.
The repeal of §133.101 and §133.102, and new §§133.104, 133.105, and 133.106 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will not be republished.
New §§133.101, 133.102, and 133.103 and amended §133.47 and §133.121 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement House Bill (H.B.) 49, 88th Legislature, Regular Session, 2023. H.B. 49 amended Texas Health and Safety Code (HSC) §241.051 to make certain information related to hospital investigations subject to disclosure and create a requirement for HHSC to post certain information related to hospital investigations on the HHSC website.
The adoption is also necessary to update the inspection, complaint investigation, and enforcement procedures for general and special hospitals. These updates are necessary to hold hospitals accountable during the inspection and investigation processes and ensure hospitals provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for hospitals from the Department of State Health Services (DSHS) to HHSC.
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER F. INSPECTION AND INVESTIGATION PROCEDURES
25 TAC §§133.101 – 133.106
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §133.101, concerning Inspection and Investigation Procedures; and §133.102, concerning Complaint Against Department of State Health Services Surveyor; new §§133.101, concerning Integrity of Inspections and Investigations; 133.102, concerning Inspections; 133.103, concerning Complaint Investigations; 133.104, concerning Notice; 133.105, concerning Professional Conduct; and 133.106, concerning Complaint Against an HHSC Representative; and amendments to §133.47, concerning Abuse and Neglect Issues; and §133.121, concerning Enforcement.
The repeal of §133.101 and §133.102, and new §§133.104, 133.105, and 133.106 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will not be republished.
New §§133.101, 133.102, and 133.103 and amended §133.47 and §133.121 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement House Bill (H.B.) 49, 88th Legislature, Regular Session, 2023. H.B. 49 amended Texas Health and Safety Code (HSC) §241.051 to make certain information related to hospital investigations subject to disclosure and create a requirement for HHSC to post certain information related to hospital investigations on the HHSC website.
The adoption is also necessary to update the inspection, complaint investigation, and enforcement procedures for general and special hospitals. These updates are necessary to hold hospitals accountable during the inspection and investigation processes and ensure hospitals provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for hospitals from the Department of State Health Services (DSHS) to HHSC.
Adopting 25 TAC §133.121, to update the rule’s title for consistency purposes and make necessary corrections and updates to reflect current practices and conform with the statute.
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER G. ENFORCEMENT
25 TAC §133.121
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §133.101, concerning Inspection and Investigation Procedures; and §133.102, concerning Complaint Against Department of State Health Services Surveyor; new §§133.101, concerning Integrity of Inspections and Investigations; 133.102, concerning Inspections; 133.103, concerning Complaint Investigations; 133.104, concerning Notice; 133.105, concerning Professional Conduct; and 133.106, concerning Complaint Against an HHSC Representative; and amendments to §133.47, concerning Abuse and Neglect Issues; and §133.121, concerning Enforcement.
The repeal of §133.101 and §133.102, and new §§133.104, 133.105, and 133.106 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will not be republished.
New §§133.101, 133.102, and 133.103 and amended §133.47 and §133.121 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3106). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement House Bill (H.B.) 49, 88th Legislature, Regular Session, 2023. H.B. 49 amended Texas Health and Safety Code (HSC) §241.051 to make certain information related to hospital investigations subject to disclosure and create a requirement for HHSC to post certain information related to hospital investigations on the HHSC website.
The adoption is also necessary to update the inspection, complaint investigation, and enforcement procedures for general and special hospitals. These updates are necessary to hold hospitals accountable during the inspection and investigation processes and ensure hospitals provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for hospitals from the Department of State Health Services (DSHS) to HHSC.
Adopting 25 TAC §§135.21, 135.24, 135.25, to repeal the Inspections, Enforcement, and Complaints sections because the content of the rule has been added to proposed new §135.62, §135.67, and §135.63.
CHAPTER 135. AMBULATORY SURGICAL CENTERS
SUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS
25 TAC §§135.21, 135.24, 135.25
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §135.21, concerning Inspections; §135.24, concerning Enforcement; and §135.25, concerning Complaints; an amendment to §135.22, concerning Renewal of License; and new §135.61, concerning Integrity of Inspections and Investigations; §135.62, concerning Inspections; §135.63, concerning Complaint Investigations; §135.64, concerning Notice; §135.65, concerning Professional Conduct; §135.66, concerning Complaint Against an HHSC Representative; and §135.67, concerning Enforcement.
The repeal of §§135.21, 135.24, and 135.25; new §§135.64, 135.65, 135.66, and 135.67; and amended §135.22 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3115). These rules will not be republished.
New §§135.61, 135.62, and 135.63 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3115). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to update the inspection, complaint investigation, and enforcement procedures for ambulatory surgical centers (ASCs). These updates are necessary to hold ASCs accountable during the inspection and investigation processes and ensure ASCs provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for ASCs from the Department of State Health Services to HHSC.
CHAPTER 135. AMBULATORY SURGICAL CENTERS
SUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS
25 TAC §135.22
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §135.21, concerning Inspections; §135.24, concerning Enforcement; and §135.25, concerning Complaints; an amendment to §135.22, concerning Renewal of License; and new §135.61, concerning Integrity of Inspections and Investigations; §135.62, concerning Inspections; §135.63, concerning Complaint Investigations; §135.64, concerning Notice; §135.65, concerning Professional Conduct; §135.66, concerning Complaint Against an HHSC Representative; and §135.67, concerning Enforcement.
The repeal of §§135.21, 135.24, and 135.25; new §§135.64, 135.65, 135.66, and 135.67; and amended §135.22 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3115). These rules will not be republished.
New §§135.61, 135.62, and 135.63 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3115). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to update the inspection, complaint investigation, and enforcement procedures for ambulatory surgical centers (ASCs). These updates are necessary to hold ASCs accountable during the inspection and investigation processes and ensure ASCs provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for ASCs from the Department of State Health Services to HHSC.
CHAPTER 135. AMBULATORY SURGICAL CENTERS
SUBCHAPTER D. INSPECTION, INVESTIGATION, AND ENFORCEMENT PROCEDURES
25 TAC §§135.61 – 135.67
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §135.21, concerning Inspections; §135.24, concerning Enforcement; and §135.25, concerning Complaints; an amendment to §135.22, concerning Renewal of License; and new §135.61, concerning Integrity of Inspections and Investigations; §135.62, concerning Inspections; §135.63, concerning Complaint Investigations; §135.64, concerning Notice; §135.65, concerning Professional Conduct; §135.66, concerning Complaint Against an HHSC Representative; and §135.67, concerning Enforcement.
The repeal of §§135.21, 135.24, and 135.25; new §§135.64, 135.65, 135.66, and 135.67; and amended §135.22 are adopted without changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3115). These rules will not be republished.
New §§135.61, 135.62, and 135.63 are adopted with changes to the proposed text as published in the May 10, 2024, issue of the Texas Register (49 TexReg 3115). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to update the inspection, complaint investigation, and enforcement procedures for ambulatory surgical centers (ASCs). These updates are necessary to hold ASCs accountable during the inspection and investigation processes and ensure ASCs provide necessary documentation in a timely manner to HHSC representatives. The adopted rules revise enforcement procedures to ensure conformity with current practices and statutes. These updates also ensure consistent practices across HHSC Health Care Regulation, correct outdated language and contact information, and reflect the transition of regulatory authority for ASCs from the Department of State Health Services to HHSC.
Adopting 25 TAC §140.433, to reorganize the rule language and update each subsection with the new rule.
CHAPTER 140. HEALTH PROFESSIONS REGULATION
SUBCHAPTER I. LICENSED CHEMICAL DEPENDENCY COUNSELORS
25 TAC §140.433
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §140.433, concerning Licensing, Certification, or Registration of Military Service Members, Military Veterans, and Military Spouses, and new §140.433, concerning Licensing, Certification, or Registration of Military Service Members, Military Spouses, and Military Veterans.
Repealed §140.433 and new §140.433 are adopted without changes to the proposed text as published in the July 19, 2024, issue of the Texas Register (49 TexReg 5258). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement Senate Bill (S.B.) 422, 88th Legislature, Regular Session, 2023. S.B. 422, in part, amended Texas Occupations Code (TOC) Chapter 55 to update requirements for a state agency’s recognition of a military service member’s and military spouse’s out-of-state professional license, which includes a licensed chemical dependency counselor (LCDC) license.
The adoption increases consistency between the adopted rule, the HHSC rules at 1 Texas Administrative Code (TAC) §351.3 and §351.6, and the statutory requirements regarding the licensing process for military service members, military spouses, and military veterans. The adoption also retains and updates certain language currently found in 25 TAC §140.433.
Adopting 25 TAC §140.433, to set forth the licensing requirements for military service members, military spouses, and military veterans.
CHAPTER 140. HEALTH PROFESSIONS REGULATION
SUBCHAPTER I. LICENSED CHEMICAL DEPENDENCY COUNSELORS
25 TAC §140.433
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts the repeal of §140.433, concerning Licensing, Certification, or Registration of Military Service Members, Military Veterans, and Military Spouses, and new §140.433, concerning Licensing, Certification, or Registration of Military Service Members, Military Spouses, and Military Veterans.
Repealed §140.433 and new §140.433 are adopted without changes to the proposed text as published in the July 19, 2024, issue of the Texas Register (49 TexReg 5258). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The adoption is necessary to implement Senate Bill (S.B.) 422, 88th Legislature, Regular Session, 2023. S.B. 422, in part, amended Texas Occupations Code (TOC) Chapter 55 to update requirements for a state agency’s recognition of a military service member’s and military spouse’s out-of-state professional license, which includes a licensed chemical dependency counselor (LCDC) license.
The adoption increases consistency between the adopted rule, the HHSC rules at 1 Texas Administrative Code (TAC) §351.3 and §351.6, and the statutory requirements regarding the licensing process for military service members, military spouses, and military veterans. The adoption also retains and updates certain language currently found in 25 TAC §140.433.
Adopting 25 TAC §157.2, to integrate terminology for the RACs, emergency medical systems, trauma facilities, stroke facilities, and current national standards into Definitions.
CHAPTER 157. EMERGENCY MEDICAL CARE
SUBCHAPTER A. EMERGENCY MEDICAL SERVICES – PART A
25 TAC §157.2
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §157.2, concerning Definitions; §157.125, concerning Requirements for Trauma Facility Designation Effective Through August 31, 2025; and §157.128, concerning Denial, Suspension, and Revocation of Trauma Facility Designation; the repeal of §157.123, concerning Regional Emergency Medical Services/Trauma Systems; §157.130, concerning Emergency Medical Services and Trauma Care System Account and Emergency Medical Services, Trauma Facilities, and Trauma Care System Fund; and §157.131, concerning Designated Trauma Facility and Emergency Medical Services Account; and new §157.123, concerning Regional Advisory Councils; §157.126, concerning Trauma Facility Designation Requirements Effective on September 1, 2025; and §157.130, concerning Funds for Emergency Medical Services, Trauma Facilities, and Trauma Care Systems, and the Designated Trauma Facility and Emergency Medical Services Account.
Sections 157.2, 157.123, 157.125, 157.126, and 157.130 are adopted with changes to the proposed text as published in the August 2, 2024, issue of the Texas Register (49 TexReg 5648) and these rules will be republished.
The amendment of §157.128 and the repeals of §§157.123, 157.130 and 157.131 are adopted without changes to the proposed text as published in the August 2, 2024, issue of the Texas Register (49 TexReg 5648) and the rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments, repeal, and new sections update the content and processes with the advances, evidence-based practices, and system processes that have developed since these rules were adopted and to align with American College of Surgeons (ACS) standards. The rules also require amendments to implement legislation passed since the rules were last adopted. Senate Bill (S.B.) 330, 79th Legislature, Regular Session, 2005, amends Texas Health and Safety Code §773.203, requiring the development of regional stroke plans. House Bill (H.B.) 15, 83rd Legislature, Regular Session, 2013, and H.B. 3433, 84th Legislature, Regular Session, 2015, amend Texas Health and Safety Code §241.183, requiring the development of perinatal care regions. S.B. 984, 87th Legislature, Regular Session, 2021, amends Texas Health and Safety Code §81.027, directing the Regional Advisory Councils (RACs) to collect specific health care data. S.B. 969, 87th Legislature, Regular Session, 2021, amends Texas Health and Safety Code §81.0445, requiring the RACs to provide public information regarding public health disasters to stakeholders. S.B. 1397, 87th Legislature, Regular Session, 2021, amends Texas Health and Safety Code §773.1141, requiring a RAC with at least one county located on the international border of Texas and at least one county adjacent to the Gulf of Mexico to track all patient transfers and the reasons for the transfers out of its region.
A workgroup was formed to collaborate with DSHS staff to review the public comments received and determine the most appropriate language to ensure the health and safety of trauma patients and prevent any undue burden on the facilities providing trauma care. The workgroup composition included representatives from the Governor’s Emergency Medical Services (EMS) and Trauma Advisory Council (GETAC), GETAC Trauma Systems Committee, Regional Advisory Councils (RACs), Texas Hospital Association (THA), Texas Organization of Rural and Community Hospitals (TORCH), and Texas Medical Association (TMA) with diverse backgrounds and geographic locations.
Amending 25 TAC §§157.123, 157.130, 157.131, to repeal and replace with a new §157.123.
CHAPTER 157. EMERGENCY MEDICAL CARE
SUBCHAPTER G. EMERGENCY MEDICAL SERVICES TRAUMA SYSTEMS
25 TAC §§157.123, 157.130, 157.131
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §157.2, concerning Definitions; §157.125, concerning Requirements for Trauma Facility Designation Effective Through August 31, 2025; and §157.128, concerning Denial, Suspension, and Revocation of Trauma Facility Designation; the repeal of §157.123, concerning Regional Emergency Medical Services/Trauma Systems; §157.130, concerning Emergency Medical Services and Trauma Care System Account and Emergency Medical Services, Trauma Facilities, and Trauma Care System Fund; and §157.131, concerning Designated Trauma Facility and Emergency Medical Services Account; and new §157.123, concerning Regional Advisory Councils; §157.126, concerning Trauma Facility Designation Requirements Effective on September 1, 2025; and §157.130, concerning Funds for Emergency Medical Services, Trauma Facilities, and Trauma Care Systems, and the Designated Trauma Facility and Emergency Medical Services Account.
Sections 157.2, 157.123, 157.125, 157.126, and 157.130 are adopted with changes to the proposed text as published in the August 2, 2024, issue of the Texas Register (49 TexReg 5648) and these rules will be republished.
The amendment of §157.128 and the repeals of §§157.123, 157.130 and 157.131 are adopted without changes to the proposed text as published in the August 2, 2024, issue of the Texas Register (49 TexReg 5648) and the rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments, repeal, and new sections update the content and processes with the advances, evidence-based practices, and system processes that have developed since these rules were adopted and to align with American College of Surgeons (ACS) standards. The rules also require amendments to implement legislation passed since the rules were last adopted. Senate Bill (S.B.) 330, 79th Legislature, Regular Session, 2005, amends Texas Health and Safety Code §773.203, requiring the development of regional stroke plans. House Bill (H.B.) 15, 83rd Legislature, Regular Session, 2013, and H.B. 3433, 84th Legislature, Regular Session, 2015, amend Texas Health and Safety Code §241.183, requiring the development of perinatal care regions. S.B. 984, 87th Legislature, Regular Session, 2021, amends Texas Health and Safety Code §81.027, directing the Regional Advisory Councils (RACs) to collect specific health care data. S.B. 969, 87th Legislature, Regular Session, 2021, amends Texas Health and Safety Code §81.0445, requiring the RACs to provide public information regarding public health disasters to stakeholders. S.B. 1397, 87th Legislature, Regular Session, 2021, amends Texas Health and Safety Code §773.1141, requiring a RAC with at least one county located on the international border of Texas and at least one county adjacent to the Gulf of Mexico to track all patient transfers and the reasons for the transfers out of its region.
A workgroup was formed to collaborate with DSHS staff to review the public comments received and determine the most appropriate language to ensure the health and safety of trauma patients and prevent any undue burden on the facilities providing trauma care. The workgroup composition included representatives from the Governor’s Emergency Medical Services (EMS) and Trauma Advisory Council (GETAC), GETAC Trauma Systems Committee, Regional Advisory Councils (RACs), Texas Hospital Association (THA), Texas Organization of Rural and Community Hospitals (TORCH), and Texas Medical Association (TMA) with diverse backgrounds and geographic locations.
Transferred Rules Re:
Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 31, Subchapter C, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 366.
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 31, Nutrition Services, Subchapter C, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 366, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Transferring the DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 415, Subchapter F, to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 320, Subchapter C.
OVERVIEW
During the 84th Legislative Session, the Texas Legislature passed Senate Bill 200, addressing the reorganization of health and human services delivery in Texas. As a result, certain functions previously performed by the Department of State Health Services (DSHS), including client services, certain regulatory functions, and the operation of state hospitals, transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code, §531.0201 and §531.02011. The DSHS rules in Texas Administrative Code, Title 25, Part 1, Chapter 415, Provider Clinical Responsibilities–Mental Health Services, Subchapter F, Interventions in Mental Health Services, that are related to these transferred functions, are being transferred to HHSC under Texas Administrative Code, Title 26, Part 1, Chapter 320, Rights of Individuals, Subchapter C, Interventions in Mental Health Services.
Texas Department of Insurance, Division of Workers’ Compensation
Adopted Rules Re:
Adopting 28 TAC §127.1, §127.25, to outline the requirements for denials for DD examinations and issues concerning the suspension, re-initiation, and reinstatement of benefits when an injured employee fails to attend a DD examination.
CHAPTER 127. DESIGNATED DOCTOR PROCEDURES AND REQUIREMENTS
SUBCHAPTER A. DESIGNATED DOCTOR SCHEDULING AND EXAMINATIONS
28 TAC §127.1, §127.25
OVERVIEW
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts amended 28 TAC §127.1, concerning designated doctor (DD) examination requests and §127.25, concerning failure to attend a DD examination.
The amendments to §127.1 and §127.25 are adopted without changes to the proposed text published in the May 31, 2024, issue of the Texas Register (49 TexReg 3909). Section 127.1 and §127.25 will not be republished.
BACKGROUND AND PURPOSE
The amendments to 28 TAC §127.1 and §127.25 are necessary to implement House Bill (HB) 2468, 88th Legislature, Regular Session (2023). HB 2468 amended Texas Labor Code §408.0041 to include individuals receiving lifetime income benefits under new Labor Code §408.1615. Section 408.1615 allows insurance carriers to suspend benefits if the first responder does not submit to a DD examination as required by Labor Code §§408.0041(a), 408.0041(f), or 408.1615(h). DWC amends 28 TAC §127.1 and §127.5 to reflect these statutory changes.
Section 127.1 concerns requesting DD examinations. The injured employee or an insurance carrier may ask DWC to order, or DWC on its own motion may order, an examination by a DD to resolve questions about the employee’s injury. Section 127.1(d)(2) states that DWC will deny a request for a DD examination under §127.1 if the request would require a DD examination that violates certain statutes. The amendment to §127.1(d)(2) adds a reference to Labor Code §408.1615 as one of these statutes because HB 2468 amended §408.0041 to include individuals receiving lifetime income benefits under §408.1615.
Section 127.25 concerns the suspension, reinitiation, and reinstatement of benefits when an injured employee fails to attend a DD examination. Amending §127.25 is necessary to implement HB 2468. HB 2468 amended Labor Code §408.0041 to include individuals receiving lifetime income benefits under new Labor Code §408.1615. The adopted amendments to §127.25 allow for the suspension of lifetime benefits received under §408.1615 and for the reinstatement of those benefits after completing a missed DD examination.
Adopting 28 TAC §§131.1, to outline the requirements for the initiation of lifetime income benefits by the insurance carrier or at the request of the injured employee and provides for the approval or denial of those benefits.
CHAPTER 131. BENEFITS–LIFETIME INCOME BENEFITS
SUBCHAPTER A. GENERAL PROVISIONS
28 TAC §§131.1
OVERVIEW
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts amended 28 TAC §131.1, concerning the initiation of and request to receive lifetime income benefits, the restructuring of §§131.1 – 131.4 into new Subchapter A, new §§131.10 – 131.14, concerning lifetime income benefits for first responders under Texas Labor Code §408.1615. The amendments and new sections will restructure Chapter 131 into two subchapters. New Subchapter A will include the existing sections of Chapter 131, which are §§131.1 – 131.4. New Subchapter B will include the new sections of Chapter 131, which are §§131.10 – 131.14.
New §§131.10, 131.12, and 131.14 are adopted with changes to the proposed text published in the May 31, 2024, issue of the Texas Register (49 TexReg 3911) and will be republished. In response to public comment, DWC revised the definition of “first responders” to “first responder” in §131.10 to be consistent with the term used in Labor Code §408.1615, replaced the term “electronically” with “electronic transmission” in §131.12(c)(1) to maintain consistency with terminology in other rules, changed “division” to “commissioner” in proposed §131.14(b) to be consistent with the Labor Code, changed proposed §131.14(b) to state that once DWC “reviews” information from the insurance carrier versus “upon receipt” of the information, and added language to §131.12(d) that requires the insurance carrier to include on a first responder’s annual certification the date by which the certification must be returned to the insurance carrier under §131.12(c).
Sections 131.1 – 131.4, 131.11, and 131.13 are adopted without changes to the proposed text published in the May 31, 2024, issue of the Texas Register (49 TexReg 3911) and will not be republished.
BACKGROUND AND PURPOSE
The amendments to §131.1 and new §§131.10 – 131.14 are necessary to implement House Bill (HB) 2468, 88th Legislature, Regular Session (2023). HB 2468 amended Labor Code §408.0041 and enacted Labor Code §408.1615, which allows certain first responders to receive lifetime income benefits.
The amendments and new sections add definitions and create procedures for a first responder’s annual certification to the insurance carrier, the suspension and reinstatement of lifetime income benefits, and the dispute of a first responder’s continuing entitlement to lifetime income benefits.
The amendments and new sections also include nonsubstantive editorial and formatting changes to conform the sections to the agency’s current style and improve the rule’s clarity.
Section 131.1 concerns the initiation of lifetime income benefits by the insurance carrier or at the request of the injured employee and provides for the approval or denial of those benefits. Amending §131.1 was necessary to implement Labor Code §408.1615. Section 408.1615 makes certain first responders eligible for lifetime income benefits. The amendments add a reference to Labor Code §408.1615 in §131.1 to include individuals who are eligible to receive lifetime income benefits under §408.1615.
Section 131.10 concerns definitions in new Labor Code §408.1615. Definitions were added to improve the rule’s clarity.
Section 131.11 concerns applicability for new Subchapter B. New §131.11 is necessary to implement Labor Code §408.1615, which created lifetime income benefits for certain first responders. Section 131.11 lists who may be entitled to these benefits under §408.1615.
Section 131.12 concerns a first responder’s annual certification to the insurance carrier as required by Labor Code §408.1615. New §131.12 is necessary to implement §408.1615 by listing the content, method, and timing of the certification. To help first responders comply with the certification submission required under §408.1615, new §131.12 requires insurance carriers to provide notice to those receiving benefits under §408.1615 by sending the first responder their certification to complete 30 days before the certification is due. The insurance carrier must include on the certification the anniversary date the first responder’s benefits began to accrue and the date by which the first responder must return the certification to the insurance carrier.
Section 131.13 concerns the suspension and reinstatement of lifetime income benefits for first responders under Labor Code §408.1615. New §131.13 is necessary to implement Labor Code §408.1615, which states when an insurance carrier may suspend a first responder’s lifetime income benefits under that section and when an insurance carrier must reinstate those benefits. Section 408.1615(i) requires the commissioner, by rule, to ensure that an employee receives reasonable notice of the insurance carrier’s basis for the suspension of lifetime income benefits and is provided a reasonable opportunity to complete the annual certification or otherwise respond to the notice. DWC interprets a reasonable opportunity as being 20 days. As a result, new §131.13 requires the insurance carrier to give the first responder a plain-language notice of the basis for the suspension, and requires the first responder to respond to the notice within 20 days of receiving it, before the insurance carrier may suspend the first responder’s benefits. In addition, new §131.13 states that if the suspension is due to a missing annual certification, the insurance carrier must reinstate benefits within seven days of receiving the certification. It also states that if the suspension is due to failure to attend a designated doctor (DD) examination, the insurance carrier must follow §127.25 of this title for suspension and reinstatement of the first responder’s benefits. If the first responder believes that the insurance carrier’s assertion that the first responder was employed is not correct, then the first responder may request dispute resolution under Chapters 140 – 144 and 147 of this title (relating to Dispute Resolution). If the suspension is due to employment in any capacity, new §131.13 requires the first responder to submit a new request for lifetime income benefits under §131.1. Finally, new §131.13 clarifies that if the insurance carrier suspends or reinstates benefits under §131.13, the insurance carrier must comply with the electronic notification requirements to DWC in §124.2 and Chapter 124, Subchapter B (relating to Insurance Carrier Claim Electronic Data Interchange Reporting to the Division).
Section 131.14 provides for the dispute of a first responder’s continuing entitlement to lifetime income benefits. New §131.14 is necessary to implement Labor Code §408.1615, which allows an insurance carrier to review a first responder’s continuing entitlement to lifetime income benefits more than once in a five-year period if the insurance carrier provides evidence to DWC that the first responder’s annual certification is not accurate, and the commissioner finds that the evidence is sufficient. If the evidence is sufficient, the insurance carrier must request a DD exam to determine whether the first responder remains eligible to receive lifetime income benefits under §408.1615. New §131.14 details this process. Once the commissioner receives the evidence from an insurance carrier, the commissioner will issue an order stating whether the insurance carrier is entitled to require the first responder to submit to a DD examination under §408.1615(h). If a DD exam is completed, the parties may dispute the DD’s opinion on the first responder’s continuing entitlement to lifetime income benefits through DWC’s dispute resolution process.
Adopting 28 TAC §§131.10 – 131.14, to add definitions, provide a list of individuals entitled to these benefits, outline first responders’ annual certification to the insurance carrier requirements, list the suspension and reinstatement of lifetime income benefits for first responders, and provide for the dispute of a first responder’s continuing entitlement to lifetime income benefits.
CHAPTER 131. BENEFITS–LIFETIME INCOME BENEFITS
SUBCHAPTER B. LIFETIME INCOME BENEFITS–CERTAIN FIRST RESPONDERS
28 TAC §§131.10 – 131.14
OVERVIEW
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) adopts amended 28 TAC §131.1, concerning the initiation of and request to receive lifetime income benefits, the restructuring of §§131.1 – 131.4 into new Subchapter A, new §§131.10 – 131.14, concerning lifetime income benefits for first responders under Texas Labor Code §408.1615. The amendments and new sections will restructure Chapter 131 into two subchapters. New Subchapter A will include the existing sections of Chapter 131, which are §§131.1 – 131.4. New Subchapter B will include the new sections of Chapter 131, which are §§131.10 – 131.14.
New §§131.10, 131.12, and 131.14 are adopted with changes to the proposed text published in the May 31, 2024, issue of the Texas Register (49 TexReg 3911) and will be republished. In response to public comment, DWC revised the definition of “first responders” to “first responder” in §131.10 to be consistent with the term used in Labor Code §408.1615, replaced the term “electronically” with “electronic transmission” in §131.12(c)(1) to maintain consistency with terminology in other rules, changed “division” to “commissioner” in proposed §131.14(b) to be consistent with the Labor Code, changed proposed §131.14(b) to state that once DWC “reviews” information from the insurance carrier versus “upon receipt” of the information, and added language to §131.12(d) that requires the insurance carrier to include on a first responder’s annual certification the date by which the certification must be returned to the insurance carrier under §131.12(c).
Sections 131.1 – 131.4, 131.11, and 131.13 are adopted without changes to the proposed text published in the May 31, 2024, issue of the Texas Register (49 TexReg 3911) and will not be republished.
BACKGROUND AND PURPOSE
The amendments to §131.1 and new §§131.10 – 131.14 are necessary to implement House Bill (HB) 2468, 88th Legislature, Regular Session (2023). HB 2468 amended Labor Code §408.0041 and enacted Labor Code §408.1615, which allows certain first responders to receive lifetime income benefits.
The amendments and new sections add definitions and create procedures for a first responder’s annual certification to the insurance carrier, the suspension and reinstatement of lifetime income benefits, and the dispute of a first responder’s continuing entitlement to lifetime income benefits.
The amendments and new sections also include nonsubstantive editorial and formatting changes to conform the sections to the agency’s current style and improve the rule’s clarity.
Section 131.1 concerns the initiation of lifetime income benefits by the insurance carrier or at the request of the injured employee and provides for the approval or denial of those benefits. Amending §131.1 was necessary to implement Labor Code §408.1615. Section 408.1615 makes certain first responders eligible for lifetime income benefits. The amendments add a reference to Labor Code §408.1615 in §131.1 to include individuals who are eligible to receive lifetime income benefits under §408.1615.
Section 131.10 concerns definitions in new Labor Code §408.1615. Definitions were added to improve the rule’s clarity.
Section 131.11 concerns applicability for new Subchapter B. New §131.11 is necessary to implement Labor Code §408.1615, which created lifetime income benefits for certain first responders. Section 131.11 lists who may be entitled to these benefits under §408.1615.
Section 131.12 concerns a first responder’s annual certification to the insurance carrier as required by Labor Code §408.1615. New §131.12 is necessary to implement §408.1615 by listing the content, method, and timing of the certification. To help first responders comply with the certification submission required under §408.1615, new §131.12 requires insurance carriers to provide notice to those receiving benefits under §408.1615 by sending the first responder their certification to complete 30 days before the certification is due. The insurance carrier must include on the certification the anniversary date the first responder’s benefits began to accrue and the date by which the first responder must return the certification to the insurance carrier.
Section 131.13 concerns the suspension and reinstatement of lifetime income benefits for first responders under Labor Code §408.1615. New §131.13 is necessary to implement Labor Code §408.1615, which states when an insurance carrier may suspend a first responder’s lifetime income benefits under that section and when an insurance carrier must reinstate those benefits. Section 408.1615(i) requires the commissioner, by rule, to ensure that an employee receives reasonable notice of the insurance carrier’s basis for the suspension of lifetime income benefits and is provided a reasonable opportunity to complete the annual certification or otherwise respond to the notice. DWC interprets a reasonable opportunity as being 20 days. As a result, new §131.13 requires the insurance carrier to give the first responder a plain-language notice of the basis for the suspension, and requires the first responder to respond to the notice within 20 days of receiving it, before the insurance carrier may suspend the first responder’s benefits. In addition, new §131.13 states that if the suspension is due to a missing annual certification, the insurance carrier must reinstate benefits within seven days of receiving the certification. It also states that if the suspension is due to failure to attend a designated doctor (DD) examination, the insurance carrier must follow §127.25 of this title for suspension and reinstatement of the first responder’s benefits. If the first responder believes that the insurance carrier’s assertion that the first responder was employed is not correct, then the first responder may request dispute resolution under Chapters 140 – 144 and 147 of this title (relating to Dispute Resolution). If the suspension is due to employment in any capacity, new §131.13 requires the first responder to submit a new request for lifetime income benefits under §131.1. Finally, new §131.13 clarifies that if the insurance carrier suspends or reinstates benefits under §131.13, the insurance carrier must comply with the electronic notification requirements to DWC in §124.2 and Chapter 124, Subchapter B (relating to Insurance Carrier Claim Electronic Data Interchange Reporting to the Division).
Section 131.14 provides for the dispute of a first responder’s continuing entitlement to lifetime income benefits. New §131.14 is necessary to implement Labor Code §408.1615, which allows an insurance carrier to review a first responder’s continuing entitlement to lifetime income benefits more than once in a five-year period if the insurance carrier provides evidence to DWC that the first responder’s annual certification is not accurate, and the commissioner finds that the evidence is sufficient. If the evidence is sufficient, the insurance carrier must request a DD exam to determine whether the first responder remains eligible to receive lifetime income benefits under §408.1615. New §131.14 details this process. Once the commissioner receives the evidence from an insurance carrier, the commissioner will issue an order stating whether the insurance carrier is entitled to require the first responder to submit to a DD examination under §408.1615(h). If a DD exam is completed, the parties may dispute the DD’s opinion on the first responder’s continuing entitlement to lifetime income benefits through DWC’s dispute resolution process.