Texas Register October 10, 2025 Volume: 50 Number: 41

Texas Register Table of Contents

1 Governor
- - 1.0.1 Appointments Re:
2 Texas Department of State Health Services
- - 2.0.1 Proposed Rules Re:
    - 2.0.1.1 Amending 25 TAC §§37.21 – 37.28, to edit and update the language for improved clarity, as well as add electronic eye charts to recordkeeping and reporting requirements.
3 Texas Health and Human Services Commission
4 Department of Aging and Disability Services
- - 4.0.1 Adopted Rules Re:

Governor

Appointments Re:

Appointed to the Real Estate Research Advisory Committee for a term to expire January 31, 2029, Jessica L. “Jessie” Ramirez (replacing Kristi L. Davis of Carrollton who resigned).

Appointed pursuant to HB 4638, 89th Legislature, Regular Session, to the Texas Pharmaceutical Initiative Governing Board for a term to expire February 1, 2027, William A. “Tony” Schell.

Appointed pursuant to HB 4638, 89th Legislature, Regular Session, to the Texas Pharmaceutical Initiative Governing Board for a term to expire February 1, 2029, Michael D. “Mike” McKinney, M.D.

Appointed pursuant to HB 4638, 89th Legislature, Regular Session, to the Texas Pharmaceutical Initiative Governing Board for a term to expire February 1, 2029, Randall P. “Randy” Wright.

Appointed pursuant to HB 4638, 89th Legislature, Regular Session, to the Texas Pharmaceutical Initiative Governing Board for a term to expire February 1, 2031, Golinda Erowele, Pharm.D.

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §§37.21 – 37.28, to edit and update the language for improved clarity, as well as add electronic eye charts to recordkeeping and reporting requirements.

CHAPTER 37. MATERNAL AND INFANT HEALTH SERVICES
SUBCHAPTER C. VISION AND HEARING SCREENING
25 TAC §§37.21 – 37.28

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 §37.21, concerning Purpose; §37.22, concerning Definitions; §37.23, concerning Vision Screening; §37.24, concerning Hearing Screening; §37.25, concerning Facility Requirements; Department Activities; §37.26, concerning Recordkeeping and Reporting; §37.27, concerning Standards and Requirements for Screening Certification and Instructor Training; and §37.28, concerning Hearing Screening Equipment Standards and Requirements.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with House Bill (HB) 1297, 88th Legislature, Regular Session, 2023, which allows electronic eye charts for childhood vision screenings in public and private schools, licensed childcare centers, and licensed childcare homes. The proposed amendments define electronic eye charts and permit their use for visual acuity screenings. The proposal also includes edits to improve clarity and readability, defines terms, adds referral requirements from training materials, removes unnecessary procedural steps and details, removes a photoscreener training requirement, ends audiometer registration, requires facilities and certificate holders to comply with the program’s policy and procedures manuals, adds an optional hearing screen for children with disabilities or for those who do not pass their initial hearing screening, and clarifies who may become a certified screener or external instructor.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §37.21 edits language for clarity and readability.

The proposed amendment to §37.22 adds definitions for: electronic eye chart to comply with HB 1297; instrument-based vision screeners, which is a general term for certain vision screening equipment; optotypes, which are the standardized figures or letters used for visual acuity screening; otoacoustic emissions (OAE) testing, which is a hearing screen that tests vibrations of the inner ear in response to sounds emitted by a probe; screener, which refers to a person who conducts screenings; and vision disorder, which is a broad term for many eye problems. The proposal updates the definitions of “biological calibration checks,” “calibration,” “exhaustive calibration,” “licensed professional,” and “visual acuity,” and replaces the definitions of “certification” with “certificate” and “photoscreening” with “photoscreener.” The proposal edits definitions for clarity and readability. The proposal also updates a reference to the Texas Health and Safety Code.

The proposed amendment to §37.23 adds electronic eye charts for visual acuity screenings to comply with HB 1297. The proposal adds the requirement for children aged four years and younger to be referred for a professional eye examination if either eye cannot identify the majority of optotypes on the 20/40 visual acuity line. The proposal adds an example of a two-line difference on a visual acuity chart. The proposal specifies that screener training and certification is required only for screeners who screen children in facilities and not in other locations. The proposal adds a referral form to the vision screening referral process that is in the training manual.

The proposed amendment to §37.24 edits language for clarity and readability. The proposal removes step-by-step instructions for conducting an extended recheck and makes the extended recheck optional, allowing screeners greater discretion when referring a child for further evaluation. The proposal specifies screener training and certification is required only for screeners who screen children in facilities and not in other locations. The proposal adds a referral form to the hearing screening referral process. The proposal allows screeners to determine when a follow-up screen should be conducted. The proposal adds otoacoustic emissions (OAE) testing as an optional screen for children with disabilities.

The proposed amendment to §37.25 replaces wording and updates the rule title to include of State Health Services (DSHS) , “Facility Requirements; Department of State Health Services (DSHS) Activities.” The proposal changes the screening timeline from any time in the school year to within 120 calendar days of enrollment to allow for early intervention. The proposal adds that an affidavit for screening exemption must be submitted on or before the day the screening is scheduled. The proposal adds that facilities must verify a screener has a valid DSHS screening certificate prior to screening. The proposal adds that DSHS will notify facilities and school districts when external instructors do not comply with the rules and the external instructor manual. The proposal also explains consequences for repeated non-compliance, which may include cancellation of the instructor’s certificate.

The proposed amendment to §37.26 adds electronic eye charts to recordkeeping and reporting requirements to comply with HB 1297 and updates the website address for the DSHS Vision and Hearing Screening Program. The proposal specifies screeners for facilities must comply with recordkeeping and reporting requirements. The proposal removes the specific mention of telebinocular screening. The proposal removes the requirement for screeners to submit documentation of certifications and refresher courses for specific vision screening equipment. The proposal updates the program mail code. The proposal changes the deadline by which screeners must submit screening results to a facility from “same day” to “no later than three business days after the day of screening.” The proposal adds OAE testing to the reporting and recordkeeping requirements.

The proposed amendment to §37.27 replaces the term “instructor” with “external instructor,” replaces additional wording, and edits language for clarity and readability. The proposal specifies screeners in facilities who are not licensed professionals must be certified by DSHS. Further, the definition of licensed professional in §37.22(17) does not include nurses, and therefore nurses must be certified by DSHS. The proposal adds that screeners must follow manufacturer instructions for all instrument-based screening devices. The proposal adds an example of the certificate deadline. The proposal clarifies that screener certification is not intended for medical office staff, nursing students, and individuals who are not screening children in facilities. The proposal adds that DSHS may train a limited number of certified vision or hearing screeners, or both, to become DSHS-certified external instructors who may train and certify screeners, but not other instructors. The proposal adds that DSHS accepts applications to become an external instructor on a limited basis and describes how instructor applications are prioritized. The proposal states external instructors must follow the rules and the external instructors’ manual. The proposal changes the external instructor certificate period from five years to two years and makes external instructors subject to audits and observations. The proposal adds that instructors must maintain a copy of all training records for five years. External instructors must conduct each type of screener training at least once a year to maintain their certificate. This includes basic training and recertification training for vision or hearing, or both. External instructors who do not train screeners for over 18 months must reapply for certification.

The proposed amendment to §37.28 removes the requirement for registration of all pure-tone audiometers and the requirement for DSHS to approve all audiometer technicians. The proposal adds American National Standards Institute as the organization to follow for hearing equipment standards. The proposal clarifies all audiometer standards and requirements apply to audiometers used for hearing screening in facilities. The proposal requires screeners or facilities to store proof of calibration with the audiometer. The proposal requires audiometer biological calibrations both monthly and on each screening day, and the calibration records must be kept for three years.

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 26 TAC §356.603, to replace the use of “and” with “or” throughout subsection (a) to clarify eligibility under the program.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER B. SHELTER CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §356.603

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§356.603, 356.1303, 356.1316, 356.1403, 356.2003, 356.2016, and 356.2103, and the repeal of §356.1323 and §356.2023.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to repeal 26 Texas Administrative Code §356.1323 in Subchapter C and §356.2023 in Subchapter D, concerning Policies and Procedures for the Retention and Destruction of Documentation. HHSC intended to repeal these rules in a previous rule project (24R057) when it adopted the repeal of §356.625, an identical rule in Subchapter B. The repeals of §356.1323 and §356.2023 were inadvertently removed from the final rule document and did not become effective with the rest of the previous project. The proposed repeals of §356.1323 and §356.2023 ensure that retention and destruction of documentation procedures are removed from the entire chapter and do not conflict with the requirements of the HHSC contract related to family violence service delivery. The proposal also amends §§356.1316, 356.1403, 356.2016, and 356.2103 to remove references to the proposed repeals.

Further, HHSC is amending §§356.603, 356.1303, and 356.2003, to clarify there are four types of victims who may be eligible for services in the Family Violence Program. To make this clear, the proposed amendments replace “and” with “or” between the list of victims. This clarifies existing eligibility criteria and does not impact eligibility for services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §356.603, concerning Eligibility, replaces the use of “and” with “or” throughout subsection (a) to clarify that all types of victims listed are eligible for services under this program.

Amending 26 TAC §356.1303, §356.1316, to replace the use of “and” with “or” throughout subsection (a) to clarify eligibility under the program, as well as remove references to repealed sections and make edits to language and formatting to improve readability.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §356.1303, §356.1316

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §356.1303, concerning Eligibility, replaces the use of “and” with “or” throughout subsection (a) to clarify that all types of victims listed are eligible for services under this program.

The proposed amendment to §356.1316, concerning Policies and Procedures Regarding Entries in a Program Participant’s File, in subsection (d)(2) removes the reference to §356.1323, concerning Policies and Procedures for the Retention and Destruction of Documentation, which is proposed for repeal; makes edits to use plain language; and reformats the rule to improve readability and understanding.

Amending 26 TAC §356.1323, to repeal the section.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §356.1323

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §356.1323, concerning Policies and Procedures for the Retention and Destruction of Documentation, ensures that retention and destruction of documentation procedures do not conflict with the requirements of the HHSC contract related to family violence service delivery.

Amending 26 TAC §356.1403, to remove references to repealed sections.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER C. SPECIAL NONRESIDENTIAL PROJECT CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §356.1403

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §356.1403, concerning Crisis Call Hotline, in paragraph (11)(B) removes the reference to §356.1323, concerning Policies and Procedures for the Retention and Destruction of Documentation, proposed for repeal, and instead, requires the center to follow the confidentiality requirements stated in the contract for family violence services with HHSC; it also makes edits to use plain language to improve readability and understanding.

Amending 26 TAC §356.2003, §356.2016, to update the language and structure to improve readability as well as remove references to repealed sections.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §356.2003, §356.2016

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §356.2003, concerning Eligibility, replaces the use of “and” with “or” throughout subsection (a) to clarify that all types of victims listed are eligible for services under this program.

The proposed amendment to §356.2016, concerning Policies and Procedures Regarding Entries in Program Participant’s Files, in subsection (d)(2) removes the reference to §356.2023, concerning Policies and Procedures for the Retention and Destruction of Documentation, proposed for repeal; makes edits to use plain language; and reformats the rule to improve readability and understanding.

Amending 26 TAC §356.2023, to repeal the section.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 6. PROGRAM ADMINISTRATION
26 TAC §356.2023

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed repeal of §356.2023, concerning Policies and Procedures for the Retention and Destruction of Documentation, ensures that retention and destruction of documentation procedures do not conflict with the requirements of the HHSC contract related to family violence service delivery.

Amending 26 TAC §356.2103, to remove references to repealed sections.

CHAPTER 356. FAMILY VIOLENCE PROGRAM
SUBCHAPTER D. NONRESIDENTIAL CENTERS
DIVISION 7. SERVICE DELIVERY
26 TAC §356.2103

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §356.2103, concerning Crisis Call Hotline, in subsection (b)(11)(B) removes the reference to §356.2023, concerning Policies and Procedures for the Retention and Destruction of Documentation, proposed for repeal, and instead, requires the center to follow the confidentiality requirements stated in the contract for family violence services with HHSC; it also makes edits to use plain language to improve readability and understanding.

Adopted Rules Re:

Adopting 26 TAC §§331.1, 331.3, 331.5, 331.7, 331.9, 331.11, 331.13, 331.15, 331.17, 331.19, 331.21, 331.23, to update references and revise the text of the section to person-centered plain language.

CHAPTER 331. LIDDA SERVICE COORDINATION
26 TAC §§331.1, 331.3, 331.5, 331.7, 331.9, 331.11, 331.13, 331.15, 331.17, 331.19, 331.21, 331.23

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §331.1, concerning Purpose; §331.3, concerning Application; §331.5, concerning Definitions; §331.7, concerning Eligibility; §331.9, concerning Funding Service Coordination; §331.11, concerning Designated LIDDA’s Responsibilities; §331.13, concerning Caseloads; §331.15, concerning Termination of Service Coordination; §331.17, concerning Minimum Qualifications; §331.19, concerning Employee Training; §331.21, concerning Documentation of Service Coordination; and §331.23, concerning Review Process.

Sections 331.5, 331.11, and 331.19 are adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2917). These rules will be republished.

Sections 331.1, 331.3, 331.7, 331.9, 331.13, 331.15, 331.17, 331.21, and 331.23 are adopted without changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2917). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted rules implement House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021, to ensure Medicaid recipients, child health care plan program enrollees, and other individuals receiving benefits under a public benefits program administered by HHSC or another health and human services agency have the option to receive services as telemedicine medical services, telehealth services, or other telecommunications or information technology to the extent it is cost effective and clinically effective. The adopted rules define terms pertaining to the implementation of H.B. 4, such as audio-only, audio-visual, and in person to make the meaning of these terms clear. The adopted rules update the documentation requirements for service coordination to identify if a contact with an individual is in person, by audio-visual communication, or by audio-only communication and the location of the contact.

The adopted rules update the minimum qualifications and training requirements for service coordinators, including training on person-centered service planning. These rules ensure that a service coordinator is qualified to provide service coordination. The adopted rules require the HHSC Service Coordination Assessment form to identify the frequency of in-person service coordination contacts an individual needs. This ensures that an individual receives more in-person contacts, if needed based on the Service Coordination Assessment. The adopted rules implement updated agency names and citations.

The adopted rules also update a citation to the Texas Government Code in the definition of “MCO–Managed care organization.” The update is related to H.B. 4611, 88th Legislature, Regular Session, 2023, effective April 1, 2025, which made certain non-substantive revisions to Subtitle I of Title 4 of the Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program.

In Addition Re:

Notice of Public Hearing on Proposed Updates to Non-Medicaid & Medicaid Payment Rates

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 10, 2025, at 9:00 a.m., to receive public comments on proposed payment rates for the Medicaid Family Planning Program, the Title V program, Medicaid Calendar Fee Reviews, Medical Policy Reviews, and Healthcare Common Procedure Code System (HCPCS) Updates.

Notice of Public Hearing on the Rural Health Transformation Program

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing to receive comments on the Rural Health Transformation Program. The hearing will take place on October 13, 2025, at 9:00 a.m. CDT.

Department of Aging and Disability Services

Adopted Rules Re:

Adopting 40 TAC §§1.301 – 1.303, 1.305, 1.307 – 1.312, to repeal the rules.

CHAPTER 1. STATE AUTHORITY RESPONSIBILITIES
SUBCHAPTER G. COMMUNITY CENTERS
40 TAC §§1.301 – 1.303, 1.305, 1.307 – 1.312

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts the repeal of §1.301, concerning Purpose; §1.302, concerning Application; §1.303, concerning Definitions; §1.305, concerning Process to Establish a New Community Center; §1.307, concerning Modifying a Community Center’s Current Plan; §1.308, concerning Dissolution and Merger of Community Centers; §1.309, concerning Appointment of Manager or Management Team; §1.310, concerning Standards of Administration for Boards of Trustees; §1.311, concerning Civil Rights; and §1.312, concerning Fiscal Controls.

The repeal of §§1.301 – 1.303, 1.305, and 1.307 – 1.312 are adopted without changes as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2959). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The repeal of the rules in 40 TAC Chapter 1, State Authority Responsibilities, Subchapter G, is necessary because the rules are duplicative of rules in 26 TAC Chapter 300, Subchapter A.

Adopting 40 TAC §§2.51 – 2.64, to repeal the rules.

CHAPTER 2. LOCAL AUTHORITY RESPONSIBILITIES
SUBCHAPTER B. CONTRACTS MANAGEMENT FOR LOCAL AUTHORITIES
40 TAC §§2.51 – 2.64

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts the repeal of Chapter 2 in Texas Administrative Code Title 40, Part 1, concerning Local Authority Responsibilities, consisting of §2.51, concerning Purpose; §2.52, concerning Application; §2.53, concerning Definitions; §2.54, concerning Accountability; §2.55, concerning Procurement; §2.56, concerning Community Services Contracting Requirements; §2.57, concerning Provisions for Community Services Contracts; §2.58, concerning Competitive Procurement Methods for Community Services; §2.59, concerning Non-competitive Procurement of Community Services; §2.60, concerning Open Enrollment; §2.61, concerning Consumer Access to Participating Community Services Contracts in Provider Network; §2.62, concerning Monitoring and Enforcing Community Services Contracts; §2.63, concerning References; §2.64, concerning Distribution; §2.151, concerning Most Appropriate and Available Treatment Alternative; and §2.152, concerning Special Considerations.

The repeal of §§2.51 – 2.64, 2.151, and 2.152 are adopted without changes as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2960). These rules will not be republished.

Adopting 40 TAC §2.151, §2.152, to repeal the rules.

CHAPTER 2. LOCAL AUTHORITY RESPONSIBILITIES
SUBCHAPTER D. MENTAL HEALTH SERVICES–ADMISSION, CONTINUITY, AND DISCHARGE
40 TAC §2.151, §2.152

OVERVIEW

The repeal of §§2.51 – 2.64, 2.151, and 2.152 are adopted without changes as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2960). These rules will not be republished.