Texas Register November 18, 2022 Volume: 47 Number: 46

Texas Register Table of Contents

1 Texas Board of Chiropractic Examiners
- - 1.0.1 Proposed Rules Re:
  - 1.0.2 Adopted Rules Re:
    - 1.0.2.1 Amending 22 TAC §72.3 and 22 TAC §72.5, to address the change in the organization of the accrediting entities for chiropractic schools.
    - 1.0.2.2 Amending 22 TAC §75.10, to provide telehealth requirements for chiropractors.
2 Texas Optometry Board
- - 2.0.1 Proposed Rules Re:
3 Texas Health and Human Services Commission
4 Department of Aging and Disability Services
- - 4.0.1 Adopted Rules Re:
    - 4.0.1.1 Repealing 40 TAC §§4.751 – 4.765 to reflect the transition of programs from the Department of Aging and Disability Services (DADS) to the Texas Health and Human Services Commission (HHSC).
5 Texas Board of Occupational Therapy Examiners
- - 5.0.1 Adopted Rules Re:
    - 5.0.1.1 Amending 40 TAC §374.3 to remove the certified mail and notarized signatures requirement for agreed orders.
6 State Board of Dental Examiners
- - 6.0.1 Adopted Rules Re:
7 Texas State Board of Examiners of Marriage and Family Therapist
- - 7.0.1 Withdrawn Rules Re:
    - 7.0.1.1 Withdrawing amendment to 22 TAC §801.142 to correct typographical errors.
  - 7.0.2 Adopted Rules Re:
8 Texas Behavioral Health Executive Council
- - 8.0.1 Adopted Rules Re:
    - 8.0.1.1 Amending 22 TAC §885.1 to reduce fees for licensing applications.
9 Texas Department of State Health Services
- - 9.0.1 Adopted Rules Re:

Texas Board of Chiropractic Examiners

Proposed Rules Re:

Repealing 22 TAC §73.3, which pertains to requirements for Sponsors of Continuing Education.

CHAPTER 73. CONTINUING EDUCATION
22 TAC §73.3

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes repealing 22 TAC §73.3 (Requirements for Sponsors of Continuing Education). The Board will propose a new §73.3 in a separate rulemaking. This rulemaking action will update language of what topics a sponsor of continuing education may provide to licensees.

BACKGROUND AND JUSTIFICATION

The repeal is proposed under Texas Occupations Code §201.152 (which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic) and Texas Occupations Code §201.356 (which authorizes the Board to establish continuing education requirements).

New 22 TAC §73.3, updating the requirements for continuing education courses.

CHAPTER 73. CONTINUING EDUCATION
22 TAC §73.3

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes new 22 TAC §73.3 (Requirements for Sponsors of Continuing Education Courses). The current §73.3 is being repealed in a separate rulemaking action.

BACKGROUD AND JUSTIFICATION

Under Texas Occupations Code §201.356, the Board is required to adopt requirements for its licensees for continuing education courses relating to the practice of chiropractic. The Board has done so in the current 22 TAC §73.3; however, the Board has determined that the topics contained in current subsection (j)(4) of needed minor revisions. Those have been updated.

Additionally, the proposed new version of the rule clarifies that topics for instruction must be within or relate to the chiropractic scope of practice. As portal-of-entry healthcare providers in Texas, chiropractors, while performing a differential diagnosis of a patient, must be able to recognize conditions that may not be within their scope of practice in order to properly refer a patient to another healthcare provider. The proposed rule keeps the current requirement that all continuing education courses must be approved by the Board beforehand.

The rule is proposed under Texas Occupations Code §201.152 (which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic), and Texas Occupations Code §201.356 (which requires the Board to establish continuing education relating to chiropractic for its licensees).

Repealing 22 TAC §75.6, concerning mandatory notice to the public.

CHAPTER 75. BUSINESS PRACTICES
22 TAC §75.6

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes repealing 22 TAC §75.6 (Mandatory Notice to the Public). The Board will propose a new §75.6 in a separate rulemaking.

BACKGROUND AND JUSTIFICATION

The repeal is proposed under Texas Occupations Code §201.152, which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic.

New 22 TAC §75.6, updating the Board’s address and contact information for public placards on the graphics that licensees are required to display.

CHAPTER 75. BUSINESS PRACTICES
22 TAC §75.6

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes new 22 TAC §75.6 (Mandatory Notice to Public). The current §75.6 is being repealed in a separate rulemaking action.

BACKGROUND AND JUSTIFICATION

The proposed rule simply updates the Board’s address and contact information on the mandatory notice to the public placard contained in the attached graphic that licensees are required to display.

The rule is proposed under Texas Occupations Code §201.152, which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic.

New 22 TAC §75.11, permitting licensees to charge a no-show fee to patients under certain circumstances.

CHAPTER 75. BUSINESS PRACTICES
22 TAC §75.11

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes new 22 TAC §75.11 (Appointment Cancellation or No-Show Fees). Under the Board’s statutes in Occupations Code Chapter 201, there is currently nothing to prevent a licensee from charging a patient a cancellation or no-show fee for a patient’s failure to attend a scheduled appointment with the licensee. It is a permissible practice. However, the Board nonetheless continually receives questions on this topic from its licensees looking for guidance. Instead of answering licensees’ questions one-by-one, the Board believes a rule containing its guidance on the topic would be beneficial to both licensees and patients.

BACKGROUND AND JUSTIFICATION

The proposed rule states that charging cancellation or no-show fees to patients is a permissible practice, as long as the fee is reasonable and patients are notified of the licensee’s fee policies in advance and in writing. The proposed rule also restates current law that cancellation or no-show fees are an administrative fee and not to be attributed to actual chiropractic services rendered

The rule is proposed under Texas Occupations Code §201.152, which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic.

Repealing 22 TAC §76.3, concerning fees for providing patient records.

CHAPTER 76. PATIENT RECORDS AND DOCUMENTATION
22 TAC §76.3

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes repealing 22 TAC §76.3 (Fees for Providing Patient Records). The Board will propose a new §76.3 in a separate rulemaking. This rulemaking action will clarify language relating to permissible fees.

BACKGROUND AND JUSTIFICATION

The repeal is proposed under Texas Occupations Code §201.152, which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic.

New 22 TAC §76.3, clarifying the language that concerns charging patients additional fees for providing patient records.

CHAPTER 76. PATIENT RECORDS AND DOCUMENTATION
22 TAC §76.3

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) proposes new 22 TAC §76.3 (Fees for Providing Patient Records). The current §76.3 is being repealed in a separate rulemaking action.

BACKGROUND AND JUSTIFICATION

The proposed rule does not substantively change the current one. Licensees informed the Board that they were confused as to the clear meaning of subsections (a) through (d) relating to the minimum fee a licensee could charge (and additional fees for additional pages) for providing patient records. The Board agreed the language could be improved. The Board trusts the new language is more precise as to the amount of permissible administrative fees a licensee can charge a patient for records.

The rule is proposed under Texas Occupations Code §201.152, which authorizes the Board to adopt rules necessary to perform the Board’s duties and to regulate the practice of chiropractic.

Adopted Rules Re:

Amending 22 TAC §72.3 and 22 TAC §72.5, to address the change in the organization of the accrediting entities for chiropractic schools.

CHAPTER 72. BOARD FEES, LICENSE APPLICATIONS, AND RENEWALS
22 TAC §72.3 and 22 TAC §72.5

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) adopts amended 22 TAC §72.3 (Qualifications) without changes as published in the September 9, 2022, issue of the Texas Register (47 TexReg 5391). The organization of the accrediting entities for chiropractic schools recognized by the Board for licensing purposes has changed; the amendment updates that change. The rule will not be republished.

Amending 22 TAC §75.10, to provide telehealth requirements for chiropractors.

CHAPTER 75. BUSINESS PRACTICES
22 TAC §75.10

OVERVIEW

The Texas Board of Chiropractic Examiners (Board) adopts new 22 TAC §75.10 (Chiropractic Health Requirements) with change as published in the September 9, 2022, issue of the Texas Register (47 TexReg 5393). The rule will be republished. This rule reiterates the current statutory requirements for chiropractors providing telehealth services found in Texas Occupations Code Chapter 111 (Telemedicine, Teledentistry, and Telehealth). The new rule also adds a requirement that licensed chiropractors provide their patients with access to copies of their Board-issued license and the Board-required mandatory notice to the public. A chiropractor is already required to provide access to those two documents (found in 22 TAC §75.6 and §75.7) to patients during live face-to-face visits; the proposed rule merely extends that requirement to telehealth visits.

Texas Optometry Board

Proposed Rules Re:

Amending 22 TAC §277.1, to update the complaint and investigation procedures related to the treatment of glaucoma.

CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.1

OVERVIEW

The Texas Optometry Board proposes amendments to 22 TAC Chapter 277.1 – Complaint Procedures.

BACKGROUND AND JUSTIFICATION

The rules in the Chapter 277 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the June 10, 2022, issue of the Texas Register (47 TexReg 3487). No comments were received regarding the Board’s notice of review.

The Board has determined that there continues to be a need for the rules in Chapter 277. The Board has also determined that changes to Rule 277.1 as currently in effect are necessary.

A substantive change to the rule involves the addition of complaints related to the treatment of glaucoma to the high priority classification. Investigation of glaucoma complaints is authorized under SB 993 87R. In May 2022 (47 TexReg 3139), Rules §277.13 and §277.14 were adopted to outline the investigation of glaucoma complaints. This amendment reinforces that process as a high-priority for the Board.

Additionally, the amendment adds that during an investigation the Board shall consider Rules §279.1 – Contact Lens Examination and §279.3 – Spectacle Examination when determining basic competency. It goes on to clarify that if the optometrist or therapeutic optometrist fails to complete all the of required findings in an initial examination at which a prescription for corrective lenses is written, the completed report of investigation shall be classified as a complaint.

Amending 22 TAC §277.2, to specify the notice language required when entering into a default judgement under the rule.

CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.2

OVERVIEW

The Texas Optometry Board proposes amendments to 22 TAC Chapter 277, §277.2 – Disciplinary Proceedings.

BACKGROUND AND JUSTIFICATION

The Board has determined that there continues to be a need for the rules in Chapter 277. The Board has also determined that changes to Rule 277.2 as currently in effect are necessary.

The amendment outlines the specific language that must be included on the notice when entering a default judgment under the rule “FAILURE TO RESPOND TO THE ALLEGATIONS, BY EITHER PERSONAL APPEARANCE AT THE INFORMAL CONFERENCE OR IN WRITING, WILL RESULT IN THE ALLEGATIONS BEING ADMITTED AS TRUE AND THE RECOMMENDED SANCTION MADE AT THE INFORMAL CONFERENCE BEING GRANTED BY DEFAULT.”

The amendment also makes non-substantive capitalization changes to ensure consistency across the Board’s rules.

Amending 22 TAC §§277.3 – 277.6, 277.10 – 277.12, which changes the capitalization in the rule to be consistent with the rest of the chapter.

CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §§277.3 – 277.6, 277.10 – 277.12

OVERVIEW

The Texas Optometry Board proposes amendments to 22 TAC Chapter 277, Practice and Procedure.

BACKGROUND AND JUSTIFICATION

The Board has determined that there continues to be a need for the rules in Chapter 277. The Board has also determined that changes to certain rules as currently in effect are necessary. The specific rules being amended include: 277.3 – Probation, 277.4 – Reinstatement, 277.5 – Convictions, 277.6 – Administrative Fines and Penalties, 277.10 – Remedial Plans, 277.11 – Submission to Mental or Physical Examination, and 277.12 – Denial of License and Disciplinary Action by Board.

The amendments outlined in this proposal are non-substantive in that they primarily change capitalization in order for the language across the entirety of Chapter 277 to be consistent. The amendments include changing all references from “board” to “Board” and from “executive director” to “Executive Director.”

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 26 TAC §745.475, §745.477, to update requirements for license renewals.

CHAPTER 745. LICENSING
SUBCHAPTER D. APPLICATION PROCESS
26 TAC §745.475, §745.477

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §745.475, concerning What does a completed renewal application for a permit include, and §745.477, concerning What happens after Licensing receives my renewal application, in Title 26, Texas Administrative Code, Chapter 745, Licensing, Subchapter D, Application Process.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to implement the portions of Senate Bill (S.B.) 225, 87th Legislature, Regular Session, 2021, that amended Texas Human Resources Code (HRC) §42.050(c) and §42.052(f-2). These amendments change the time period, from two to five years, that HHSC Child Care Regulation (CCR) must review for patterns of violations when evaluating whether to renew a license, certification, or registration. CCR is also proposing a rule amendment to remove requirements that a completed renewal application include verifications from the provider that deficiencies have been corrected and all fees and administrative penalties owed have been paid, because these provider verifications are not part of the current business process and CCR conducts these verifications when processing a renewal application.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §745.475 removes subsection (a)(3) and (4) that require a provider to verify as part of a completed renewal application that (1) the provider has corrected deficiencies; and (2) all fees and administrative penalties owed have been paid. These provider verifications are not part of the renewal application, nor are they necessary, because CCR verifies these requirements when processing the renewal application as required by §745.477(a)(3) and (5).
The proposed amendment to §745.477 changes the time period, from two to five years, CCR will review for patterns of violations when evaluating whether to renew an operation’s license, certification, or registration. This amendment is necessary to comply with changes that S.B. 225 made to HRC §42.050(c) and §42.052(f-2).

Adopted Rules Re:

Amending 1 TAC §354.1341, §354.1342, to clarify reimbursement procedures for audiology services under the School Health and Related Services (SHARS) program.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
1 TAC §354.1341, §354.1342

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1341, concerning Benefits and Limitations; and §354.1342, concerning Conditions for Participation. The amendments to §354.1341 and §354.1342 are adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 Tex Reg 4607). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The School Health and Related Services (SHARS) program is jointly administered by HHSC and the Texas Education Agency (TEA). The SHARS program allows independent school districts and public charter schools to obtain Medicaid reimbursement for the provision of certain direct medical and transportation services to Medicaid enrolled students who receive benefits to meet federal and state laws guaranteeing the students a free and appropriate public education. Currently, SHARS must be prescribed in a student’s individualized education program (IEP) as required by the Texas Education Code, §29.001(7), and implemented through Commissioner of Education rule at Title 19 Texas Administrative Code (TAC) §89.1001.

The adopted amendment to §354.1341 is necessary to comply with implementation of House Bill (H.B.) 706, 86th Legislature, Regular Session, 2019. H.B. 706 amended the Texas Education Code by adding §38.033 to permit SHARS providers to bill and receive reimbursement for allowable audiology services provided to Medicaid-eligible children as prescribed in a plan created under Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794). H.B. 706 requires HHSC to adopt rules necessary to implement Texas Education Code Section 38.033 (redesignated as Section 38.034 by H.B. 3607, 87th Legislature, Regular Session, 2021) in consultation with the Texas Education Agency and as approved by the Centers for Medicare and Medicaid Services (CMS).

The adopted amendment to §354.1342 implements H.B. 2658, 87th Legislature, Regular Session, 2021, effective September 1, 2021. H.B. 2658 added Human Resources Code §32.0317. The adopted amendment restated and clarified the federal requirement to obtain parental consent to access a student’s Medicaid in order to receive Medicaid reimbursement for all SHARS services.

The adopted amendments to §354.1341 and §354.1342 also align these rules with 1 TAC §355.8443, concerning Reimbursement Methodology for School Health and Related Services (SHARS), and include other clarifying language.

Amending 26 TAC §§ 553.3, 553.17, 553.103, 553.257, 553.259 to update requirements concerning construction and licensing of Assisted Living Facilities (ALF).

CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER A. INTRODUCTION
26 TAC §§ 553.3, 553.17, 553.103, 553.257, 553.259

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 553, Licensing Standards for Assisted Living Facilities, amendments to §553.3, relating to Definitions; §553.17, relating to Criteria for Licensing; §553.103, relating to Site and Location for all Assisted Living Facilities; §553.257, relating to Human Resources; and §553.259, relating to Admission Policies and Procedures.

The amendments to §§553.3, 553.17, 553.103, and 553.257 are adopted with changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4633). These rules will be republished.

The amendments to §553.259 are adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4633). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the amendments to §553.17 and §553.103 is to implement House Bill (H.B.) 1681, 87th Legislature, Regular Session, 2021. H.B. 1681 prohibits new construction of assisted living facilities (ALFs) in a 100-year flood plain in counties of more than 3.3 million residents. The amendments also update outdated procedural information related to the licensing process.

The purpose of the amendments to §553.257 is to implement Senate Bill (S.B.) 271, 87th Legislature, Regular Session, 2021. S.B. 271 requires ALFs to obtain a signed disclosure, on an HHSC prescribed form, from applicants for employment regarding out-of-state criminal convictions and to perform a name-based criminal history check in any state the applicant has lived in during the previous five years.

The purpose of the amendments to §553.3 and §553.259 is to implement S.B. 383, 87th Legislature, Regular Session, 2021. S.B. 383 requires an ALF that advertises, markets, or otherwise promotes that it provides memory care services to provide an additional HHSC-prescribed memory care disclosure statement to each resident.

The amendments also update rule references that became outdated as a result of the administrative transfer of rules from 40 TAC Chapter 92 to 26 TAC Chapter 553, reflect the transfer of functions from the Texas Department of Human Services or the Texas Department of Aging and Disability Services to HHSC, update terminology, and remove outdated references and requirements.

Amending 26 TAC §§ 554.101, 554.204, 554.403, 554.1913, 554.1921, 554. 1935, 554.2002, 554.2326 to implement required disclosure statements for nursing facilities that advertise, market, or promote that it provides memory care facilities.

CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER B. DEFINITIONS
26 TAC §§ 554.101, 554.204, 554.403, 554.1913, 554.1921, 554. 1935, 554.2002, 554.2326

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 26, Part 1, Chapter 554, Licensing Standards for Licensure and Medicaid Certification, amendments to §554.101, relating to Definitions; §554.204, relating to Application Requirements; §554.403, relating to Notice of Rights and Services; §554.1921, relating to General Requirements for a Nursing Facility; §554.1935, relating to Automated External Defibrillators; §554.2002, relating to Procedural Requirements–Licensure Inspections and Surveys; §554.2326, relating to Medicaid Swing Bed Program for Rural Hospitals; and the repeal of §554.1913, relating to Clinical Records Service Supervisor.

The amendments to §§554.101, 554.403, 554.1921 and §554.2326 are adopted with changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4645). These rules will be republished.

The amendments to §§554.204, 554.1935, and 554.2002, and the repeal of §554.1913 are adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4645). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the amendments to §§554.101, 554.204, 554.403, and 554.1921 is to implement Senate Bill (S.B.) 383, 87th Legislature, Regular Session, 2021. S.B. 383 requires a nursing facility (NF) that advertises, markets, or otherwise promotes that it provides memory care services to provide an additional HHSC prescribed memory care disclosure statement to each resident or resident representative and to each person applying for services from the facility or that person’s next of kin or guardian.

The purpose of the repeal of §554.1913 and amendments to §554.2326 is to remove the requirement for a NF to employ a clinical records supervisor or other medical records keeper.

The purpose of the amendments to §554.1935 is to implement S.B. 199, 87th Legislature, Regular Session, 2021. S.B. 199 requires a NF to conduct monthly inspections of its automated external defibrillator.

The purpose of the amendment to §554.2002 is to implement House Bill (H.B.) 1423, 87th Legislature, Regular Session, 2021. H.B. 1423 increases the survey frequency of required unannounced NF inspections from two per three-year licensing period to one annually. H.B. 1423 also allows HHSC to conduct a follow-up inspection for evaluation and monitoring purposes to ensure HHSC is citing deficiencies consistently.

The amendments also update rule references that became outdated as a result of the administrative transfer of rules from 40 TAC Chapter 19 to 26 TAC Chapter 554, reflect the transfer of functions from the Texas Department of Human Services or the Texas Department of Aging and Disability Services to HHSC, update terminology, and remove outdated references and requirements.

Amending 26 TAC §§745.273, 745.275, 745.277, concerning license revocation.

CHAPTER 745. LICENSING
26 TAC §§745.273, 745.275, 745.277

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §§745.273, 745.275, 745.277, and 745.435 in Title 26, Texas Administrative Code, Chapter 745, Licensing.

Amendments to §745.435 are adopted with changes to the proposed text as published in the July 22, 2022, issue of the Texas Register (47 TexReg 4254). This rule will be republished.

Amendments to §§745.273, 745.275, and 745.277 are adopted without changes to the proposed text, as published in the July 22, 2022, issue of the Texas Register (47 TexReg 4254). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to implement sections of statute that were amended by Senate Bill (S.B.) 225, 87th Texas Legislature, Regular Session, 2021.

S.B. 225, SECTIONS 5 and 9, amended Texas Human Resources Code (HRC) §42.048(e) and §42.048(e-3) to (1) delete the requirement that a license or certificate is automatically revoked when certain operations change location (although HRC §42.048 only explicitly applies to licensed operations, this provision also applies to certified operations by way of HRC §42.052(b)); (2) require the operation to inform HHSC Child Care Regulation (CCR) of the new location before moving there; and (3) allow the operation to operate at the new location after CCR approves the location as meeting all relevant requirements.

These changes to HRC §42.048 took effect on September 1, 2021, and apply to the following operation types that may now change location without their license or certification being automatically revoked: (1) school-age programs, regardless of when they operate; (2) before or after-school programs; (3) licensed child-care homes; (4) child-care centers; and (5) general residential operations (GROs). Child-placing agencies (CPAs) were already able to change location without these statutory changes. However, the bill repealed the subsection that explicitly addressed CPAs, so CCR is aligning requirements for CPAs with those for other licensed or certified operation types for consistency.

The amendments are also necessary to implement sections of statute added by S.B. 781, 86th Texas Legislature, Regular Session, 2019. This bill added HRC Chapter 42, Subchapter H, which includes requirements for GROs that provide treatment services to children with emotional disorders. CCR is clarifying in rule that if such an operation fails to comply with any applicable public notice and hearing requirements, CCR may deny the operation an amendment to provide treatment services to children with emotional disorders.

CCR conducted two work group meetings: one on November 15, 2021, which included 32 invited participants with day care experience, and one on November 18, 2021, which included 12 invited participants with residential care experience. The workgroups met to discuss rule changes needed to implement the legislation and provided feedback on the drafted rules.

Amending 26 TAC §748.153, to update minimum standards for general residential operations.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER C. ORGANIZATION AND ADMINISTRATION
26 TAC §748.153

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §748.153 and §748.303 in Title 26, Texas Administrative Code, Chapter 748, Minimum Standards for General Residential Operations.

Amendments to §748.153 and §748.303 are adopted without changes to the proposed text, as published in the July 22, 2022, issue of the Texas Register (47 TexReg 4257). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to implement sections of statute that were amended by Senate Bill (S.B.) 225 and S.B. 863, 87th Texas Legislature, Regular Session, 2021.

S.B. 863 took effect on May 15, 2021. This bill amended HRC §42.048 by adding subsection (e-4), which allows CCR to comply with a local or state order during a declared disaster (as described in Texas Government Code Chapter 418) by authorizing a licensed or certified residential child-care facility to temporarily (1) move to a new location not on the facility’s license application; or (2) provide care for one or more children at an additional location that is not stated in the facility’s license application.

Amending 26 TAC §748.303, to address license revocation for certain operations changes.

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER D. REPORTS AND RECORD KEEPING
26 TAC §748.303

OVERVIEW

BACKGROUND AND JUSTIFICATION

The amendments are necessary to implement sections of statute that were amended by Senate Bill (S.B.) 225 and S.B. 863, 87th Texas Legislature, Regular Session, 2021.

New 26 TAC §§925.1 – 925.11 to describe components and use of an institutional review board for the review of certain research requests and activities pertaining to mental health, substance use, and intellectual or developmental disabilities services within HHSC.

CHAPTER 925. RESEARCH INVOLVING HEALTH AND HUMAN SERVICES COMMISSION SERVICES
26 TAC §§925.1 – 925.11

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 1, Part 1, new Chapter 925, concerning Research Involving Health and Human Services Commission Services, consisting of §925.1, concerning Purpose; §925.2, concerning Application; §925.3, concerning Definitions; §925.4, concerning General Principles; §925.5, concerning Designated Institutional Review Board; §925.6, concerning Designated Institutional Review Board Functions and Operations; §925.7, concerning Review and Approval of Proposed Research; §925.8, concerning Informed Consent; §925.9, concerning Using and Disclosing Protected Health Information in Research; §925.10, concerning Investigation of Allegations of Misconduct in Science; and §925.11, concerning Responsibilities of the Institutional Review Board 2.

Sections 925.3, 925.6, 925.7, and 925.8 are adopted with changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3917). These rules will be republished.

Sections 925.1, 925.2, 925.4, 925.5, 925.9, 925.10, and 925.11 are adopted without changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3917). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the new rules is to move HHSC rules in 25 TAC Chapter 414, Subchapter P and 40 TAC Chapter 4, Subchapter P to 26 TAC Chapter 925 as part of consolidating HHSC rules. The adopted rules have up-to-date agency information, research protocols, population language, and includes plain language where possible. The adoption of repealed 25 TAC Chapter 414, Subchapter P, concerning Research in TDMHMR Facilities, and repealed 40 TAC Chapter 4, Subchapter P, concerning Research in State Facilities, are published simultaneously elsewhere in this issue of the Texas Register.

The adopted rules describe the components and use of an institutional review board for the review of research requests and activities pertaining to mental health, substance use, and intellectual or developmental disabilities services within HHSC, involving one or more of the following: HHSC in-patient or community-based mental health services; HHSC community-based substance use services; HHSC intellectual or developmental disabilities services; data owned or created regarding individuals receiving HHSC services; or related HHSC resources (e.g., employees, property, and non-public information).

In Addition Re:

Notice of Public Hearing on Proposed Federal Fiscal Year (FFY) 2023 Payment Rates for Medicaid Community Hospice for Routine Home Care, Continuous Home Care, Inpatient Respite Care, General Inpatient Care Services, and the Service Intensity Add-on Effective Retroactive to October 1, 2022

OVERVIEW

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 29, 2022, at 9:00 a.m. to receive public comments on federal fiscal year 2023 proposed payment rates for the Medicaid Community Hospice Care, effective retroactive to October 1, 2022.

The public hearing will be held in the HHSC North Austin Complex Building, Public Hearing Room 1.401, First Floor, at 4601 W. Guadalupe St., Austin, Texas 78751. Free parking is available in the adjacent parking garage. HHSC will also broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and accessible on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code Section 32.0282, which requires public notice of hearings on proposed Medicaid reimbursements.

Proposal. Federal fiscal year 2023 payment rates for Medicaid Community Hospice for routine home care, continuous home care, inpatient respite care, general inpatient care services, and the service intensity add-on effective retroactive to October 1, 2022.

BACKGROUND AND JUSTIFICATION

Payment rates for hospice care are authorized by Section 1814(i)(1)(C)(ii) of the Social Security Act, which outlines annual increases in payment rates for hospice care services. Rates for hospice physician services are not increased under this provision. Section 1814(i)(5)(A)(i) of the Social Security Act requires that beginning with federal fiscal year 2014 and each subsequent federal fiscal year, the Health and Human Services Secretary shall reduce the market basket update by two percentage points for any hospice provider that does not comply with the quality data submission requirements.

Department of Aging and Disability Services

Adopted Rules Re:

Repealing 40 TAC §§4.751 – 4.765 to reflect the transition of programs from the Department of Aging and Disability Services (DADS) to the Texas Health and Human Services Commission (HHSC).

CHAPTER 4. RIGHTS AND PROTECTION OF INDIVIDUALS RECEIVING INTELLECTUAL DISABILITY SERVICES
SUBCHAPTER P. RESEARCH IN STATE FACILITIES
40 TAC §§4.751 – 4.765

OVERVIEW

As required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system, including rules in Title 40, Part 1.

Therefore, the Executive Commissioner of HHSC adopts the repeal of Title 40, Part 1, Chapter 4, Subchapter P, consisting of §4.751, concerning Purpose; §4.752, concerning Application; §4.753, concerning Definitions; §4.754, concerning General Principles; §4.755, concerning Designated Institutional Review Board (IRB); §4.756, concerning IRB Functions and Operations; §4.757, concerning Review and Approval of Proposed Research; §4.758, concerning Informed Consent; §4.759, concerning Research Involving Offenders as Human Subjects; §4.760, concerning Using and Disclosing Protected Health Information (PHI) in Research; §4.761, concerning Investigation of Allegations of Misconduct in Science; §4.762, concerning Responsibilities of the Office of Research Administration (ORA), §4.763, concerning Exhibits; §4.764, concerning References; and §4.765, concerning Distribution.

Sections 4.751, 4.752, 4.753, 4.754, 4.755, 4.756, 4.757, 4.758, 4.759, 4.760, 4.761, 4.762, 4.763, 4.764, and 4.765 are adopted without changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3956). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the adoption is to reflect the transition of programs from DADS to HHSC. The adoption of new rules addressing research in state hospitals, state supported living centers, and by community service providers is simultaneously published elsewhere in this issue of the Texas Register. The new rules reflect the transition of programs to HHSC and current research protocols which align with applicable federal laws.

Texas Board of Occupational Therapy Examiners

Adopted Rules Re:

Amending 40 TAC §374.3 to remove the certified mail and notarized signatures requirement for agreed orders.

CHAPTER 374. DISCIPLINARY ACTIONS/DETRIMENTAL PRACTICE/COMPLAINT PROCESS/CODE OF ETHICS/LICENSURE OF PERSONS WITH CRIMINAL CONVICTIONS
40 TAC §374.3

OVERVIEW

The Texas Board of Occupational Therapy Examiners adopts amendments to the 40 Texas Administrative Code §374.3, Complaint Process. The amendments are adopted to remove certified mail and notarized signatures requirements with regard to agreed orders. The changes will allow orders and notices to be sent by all the methods listed in Texas Government Code section 2001.054(c), and will not limit delivery to certified mail, return receipt requested. The amendments are adopted without changes to the proposed text as published in the September 9, 2022, issue of the Texas Register (47 TexReg 5452) and will not be republished.

BACKGROUND AND JUSTIFICATION

Changes to the section include the removal of requirements concerning the Board’s use of certified mail when sending agreed orders to the respondent to a complaint. The amendments will also remove the requirement that respondents have their signatures notarized on agreed orders.

These changes will streamline both board processes regarding mailing and requirements for respondents concerning agreed orders. The Board anticipates that these changes will increase the efficiency of investigative mailing processes and reduce the possible complications respondents to a complaint may encounter when responding to agreed orders.

The amendments also include a revision to correct a reference in the section to Texas Government Code section 2001.054(c). The change is adopted to increase the accuracy of the board rules.

State Board of Dental Examiners

Adopted Rules Re:

Amending 22 TAC §101.2, to clarify that clinical examinations must use live patients or hands-on simulations.

CHAPTER 101. DENTAL LICENSURE
22 TAC §101.2

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §101.2, concerning licensure by examination for dentists. The amendment updates the language to clarify that clinical examinations must use live patients or hands-on simulations. The amendment reflects the merger of the regional examining board CDCA-WREB-CITA, and the name change of the regional examining board SRTA. The amendment also changes the time period the Board will accept examination results. This rule is adopted with no changes to the proposed text published in the September 30, 2022 issue of the Texas Register (47 TexReg 6377), and will not be republished.

Amending 22 TAC §101.3, to update and clarify the clinical examination requirements.

CHAPTER 101. DENTAL LICENSURE
22 TAC §101.3

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §101.3, concerning dental licensure by credentials. The amendment updates the language to clarify that clinical examinations must use live patients or hands-on simulations. This rule is adopted with no changes to the proposed text published in the September 30, 2022 issue of the Texas Register (47 TexReg 6379), and will not be republished.

Amending 22 TAC §103.2, to require the use of live patients or hands-on simulations for licensure by examination for dental hygienists.

CHAPTER 103. DENTAL HYGIENE LICENSURE
22 TAC §103.2

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §103.2, concerning licensure by examination for dental hygienists. The amendment updates the language to clarify that clinical examinations must use live patients or hands-on simulations. The amendment reflects the merger of the regional examining board CDCA-WREB-CITA, and the name change of the regional examining board SRTA. The amendment also changes the time period the Board will accept examination results. This rule is adopted with changes to the proposed text published in the September 30, 2022 issue of the Texas Register (47 TexReg 6380), and will be republished. The change to the published text is to update Southern Regional Testing Agency to States Resources for Testing and Assessments due to its name change.

Amending 22 TAC §103.3, to outline the clinical examination requirements for dental hygiene licensure.

CHAPTER 103. DENTAL HYGIENE LICENSURE
22 TAC §103.3

OVERVIEW

The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §103.3, concerning dental hygiene licensure by credentials. The amendment updates the language to clarify that clinical examinations must use live patients or hands-on simulations. This rule is adopted with no changes to the proposed text published in the September 30, 2022 issue of the Texas Register (47 TexReg 6381), and will not be republished.

Texas State Board of Examiners of Marriage and Family Therapist

Withdrawn Rules Re:

Withdrawing amendment to 22 TAC §801.142 to correct typographical errors.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER C. APPLICATIONS AND LICENSING
22 TAC §801.142

The Texas Behavioral Health Executive Council withdraws the proposed amendment to §801.142, Supervised Clinical Experience Requirements and Conditions which appears in the September 30, 2022, issue of the Texas Register (47 TexReg 6398).

Adopted Rules Re:

Amending 26 TAC § 801.2 to add the definition of direct clinical services to couples or families.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER A. GENERAL PROVISIONS
22 TAC §801.2

OVERVIEW

The Texas Behavioral Health Executive Council adopts amended §801.2, relating to Definitions. Section 801.2 is adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4624) and will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendment adds a definition for direct clinical services to couples or family for the purpose of providing greater clarity in the rules.

Amending 22 TAC §801.43 to clarify how supervisees must represent themselves to clients and the public.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER B. RULES OF PRACTICE
22 TAC §801.43

OVERVIEW

The Texas Behavioral Health Executive Council adopts amendments to §801.43, relating to Professional Representation. Section 801.43 is adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4626) and will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted amendment clarifies how supervisees must represent themselves to clients and the public.

Amending 22 TAC §801.302 to outline the schedule of suspensions relating to the licensure and regulation of marriage and family therapists.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER D. SCHEDULE OF SANCTIONS
22 TAC §801.302

The Texas Behavioral Health Executive Council adopts amended §801.302, relating to Severity Level and Sanction Guide. Section 801.302 is adopted with changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4628) and will be republished. These changes further clarify and streamline the rule; references to the maximum penalty amounts have been removed from paragraphs (1) and (2) and have been consolidated under paragraph (5) which specifically covers the assessment of administrative penalties.

BACKGROUND AND JUSTIFICATION

The adopted rule amendments are adopted, with changes, to make the rule clearer and to simplify the guide by combining levels 2 and 3 into a suspension for any amount of time. Additionally, the possible penalty amount for all levels has been clarified, to match Section 507.352 of the Occupations Code.

Repealing 22 TAC §801.305, which concerned the schedule of sanctions for marriage and family therapists.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER D. SCHEDULE OF SANCTIONS
22 TAC §801.305

OVERVIEW

The Texas Behavioral Health Executive Council adopts the repeal of §801.305, relating to Schedule of Sanctions. The repeal of §801.305 is adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4629) and will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted repeal of this rule is necessary because this rule is being replaced with a new schedule of sanctions rule, which is adopted elsewhere in this same issue of the Texas Register.

New 22 TAC §801.305, replacing the schedule of sanctions relating to the licensure and regulation of marriage and family therapists.

CHAPTER 801. LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS
SUBCHAPTER D. SCHEDULE OF SANCTIONS
22 TAC §801.305

OVERVIEW

The Texas Behavioral Health Executive Council adopts new §801.305, relating to Schedule of Sanctions. Section 801.305 is adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4630) and will not be republished.

BACKGROUND AND JUSTIFICATION

This new rule has been adopted to make the format of the schedule of sanctions easier to use and standardized between the other behavioral health boards. There are a few substantive changes being adopted to the schedule currently in effect. Rules that are currently split between an extended and moderate suspension are proposed to be a Level 2 suspension to align with the adopted changes to §801.302, which combines the two suspension levels into one, for example see §§801.44(t) and (v), 801.47, and 801.57(e). Additionally, a few typographical errors are being corrected with this adopted change, the sanction for 801.47 is now split into subsections (a) and (b) which are a suspension and revocation respectively. And §801.44(s) – (v) have been updated to correspond more accurately to the correct rule and sanction. Lastly, in the April 22, 2022, edition of the Texas Register, §801.143(h) – (l) were adopted to be amended so corresponding amendments have been made to match those previously proposed changes.

Texas Behavioral Health Executive Council

Adopted Rules Re:

Amending 22 TAC §885.1 to reduce fees for licensing applications.

CHAPTER 885. FEES
22 TAC §885.1

OVERVIEW

The Texas Behavioral Health Executive Council adopts amendments to §885.1, relating to Executive Council Fees. Section 885.1 is adopted without changes to the proposed text as published in the August 5, 2022, issue of the Texas Register (47 TexReg 4632) and will not be republished.

BACKGROUND AND JUSTIFICATION

On October 8, 2019, Governor Greg Abbott sent a letter to all Texas State agency heads instructing agencies to reform occupational-licensing rules in several areas. One such area the Governor focused on was the reduction of fees, specifically the Governor instructed agencies to develop and implement plans to reduce license applications fees to 75% or less of the national average for equivalent or comparable occupations, whenever possible. This adopted amendment is intended to do just that, all application and renewal licensing fees have either been reduced to 75% of the national average or, if the fee was already below 75% of the national average, then the fee stayed the same. The current fee schedule will remain in effect until September 1, 2023, on this date these new fee changes are scheduled to take effect. Application fees are adopted to be reduced for the following license types: LCSW by $9.00, LPC and LPC-Associate by $56.00, LPA by $189.00, LP by $426.00, and LSSP by $36.00. Renewal fees are adopted to be reduced for the following license types: LBSW and LMSW by $33.00, LCSW and LMSW-AP by $55.00, and LP by $129.00. Additionally, the $4.00 Texas.gov fee is adopted to be removed from the temporary license application for social workers and the application for criminal history evaluation. The implementation of these fee changes is scheduled to take effect on September 1, 2023, to provide all interested parties the opportunity to comment on these changes, and based upon future comments and information gathered these fee changes may be subject to future amendments.

Texas Department of State Health Services

Adopted Rules Re:

Amending 25 TAC §§139.2, 139.4, 139.5 to update requirements related to abortion facility reporting and licensing following the establishment of an online electronic reporting system.

CHAPTER 139. ABORTION FACILITY REPORTING AND LICENSING
SUBCHAPTER A. GENERAL PROVISIONS
25 TAC §§139.2, 139.4, 139.5

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §139.2, concerning Definitions; §139.4, concerning Monthly Reporting Requirements for All Abortions Performed or Induced; §139.5, concerning Additional Reporting Requirements; §139.32, concerning License Denial, Suspension, Probation, or Revocation; §139.50, concerning Disclosure Requirements; §139.52, concerning Patient Education/Information Services; §139.53, concerning Medical and Clinical Services; and §139.55, concerning Clinical Records.

The amendments to §§139.2, 139.4, 139.5, and 139.53 are adopted with changes to the proposed text as published in the May 6, 2022, issue of the Texas Register (47 TexReg 2694). These rules will be republished.

The amendments to §§139.32, 139.50, 139.52, and 139.55 are adopted without changes to the proposed text as published in the May 6, 2022, issue of the Texas Register (47 TexReg 2694). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to comply with Senate Bill (S.B.) 8, 87th Legislature, 2021, Regular Session, and S.B. 4, 87th Legislature, 2021, Second Called Session. S.B. 8 requires physicians who perform an abortion on or after September 1, 2021, to maintain certain documentation regarding the reasons for an abortion and prohibits HHSC from enforcing Texas Health and Safety Code (HSC) Chapter 171, Subchapter H, concerning Detection of Fetal Heartbeat. S.B. 4 amends abortion complication reporting requirements and requirements for providing abortion-inducing drugs for abortions performed on or after December 2, 2021. The amendments are also necessary to remove outdated information and ensure consistency with current HHSC terminology.

Amending 25 TAC §139.32 to increase consistency with other HHS enforcement rules and guidelines.

CHAPTER 139. ABORTION FACILITY REPORTING AND LICENSING
SUBCHAPTER C. ENFORCEMENT
25 TAC §139.32

OVERVIEW

BACKGROUND AND JUSTIFICATION

Amending 25 TAC §§139.50, 139.52, 139.53, 139.55 to update minimum standards for licensed abortion facilities.

CHAPTER 139. ABORTION FACILITY REPORTING AND LICENSING
SUBCHAPTER D. MINIMUM STANDARDS FOR LICENSED ABORTION FACILITIES
25 TAC §§139.50, 139.52, 139.53, 139.55

OVERVIEW

BACKGROUND AND JUSTIFICATION

Repealing 25 TAC §§414.751 – 414.765, concerning a transition of programs to HHSC and updated research protocols in order to align with applicable federal laws.

CHAPTER 414. RIGHTS AND PROTECTIONS OF PERSONS RECEIVING MENTAL HEALTH SERVICES
SUBCHAPTER P. RESEARCH IN TDMHMR FACILITIES
25 TAC §§414.751 – 414.765

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts the repeal of Texas Administrative Code (TAC) Title 25, Part 1, Chapter 414, Subchapter P, consisting of §414.751, concerning Purpose; §414.752, concerning Application; §414.753, concerning Definitions; §414.754, concerning General Principles; §414.755, concerning Designated Institutional Review Board (IRB); §414.756, concerning IRB Functions and Operations; §414.757, concerning Review and Approval of Proposed Research; §414.758, concerning Informed Consent; §414.759, concerning Research Involving Offenders as Human Subjects; §414.760, concerning Using and Disclosing Protected Health Information (PHI) in Research; §414.761, concerning Investigation of Allegations of Misconduct in Science; §414.762, concerning Responsibilities of the Office of Research Administration (ORA); §414.763, concerning Exhibits; §414.764, concerning References; and §414.765, concerning Distribution.

Sections 414.751 – 414.765 are adopted without changes to the proposed text as published in the July 8, 2022, issue of the Texas Register (47 TexReg 3908). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The purpose of the adoption is to reflect the transition of programs from DSHS to HHSC by repealing rules in 25 TAC, Part 1, Chapter 414, Subchapter P and simultaneously adopting new rules in 26 TAC Chapter 925. The adoption of new rules is published elsewhere in this issue of the Texas Register. The new rules reflect the transition of programs to HHSC; and update research protocols to align with applicable federal laws.