Texas Health and Human Services Commission
Proposed Rules Re:
New 26 TAC §§306.501, 306.503, 306.505, 306.507, 306.509, 306.511, 306.513, 306.515, 306.517, to designate the Terrell Center for Youth as a state hospital residential treatment facility for adolescents in DFPS conservatorship and set its eligibility, admission, treatment, recovery planning, and discharge requirements.
CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER J. STATE HOSPITAL RESIDENTIAL TREATMENT FACILITIES FOR ADOLESCENTS IN TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES CONSERVATORSHIP
26 TAC §§306.501, 306.503, 306.505, 306.507, 306.509, 306.511, 306.513, 306.515, 306.517
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §306.501, concerning Purpose; §306.503, concerning Application; §306.505, concerning Definitions; §306.507, concerning Memorandum of Understanding; §306.509, concerning Eligibility and Admission Criteria; §306.511, concerning Texas Department of Family and Protective Services Responsibilities; §306.513, concerning Terrell Center for Youth Responsibilities; §306.515, concerning Recovery Planning; and §306.517, concerning Transition Services and Discharge.
BACKGROUND AND JUSTIFICATION
The purpose of this proposal is to designate the Terrell Center for Youth (TCY) as a residential treatment facility, in accordance with House Bill (HB) 109, 89th Legislature, Regular Session, 2025. HB 109 amended Texas Health and Safety Code §554.001 and §554.002, which provides that (1) HHSC designates state facilities for use as residential treatment facilities for adolescents with significant behavioral or mental health needs; and (2) HHSC provides without charge, from funds appropriated for that purpose, appropriate education services for all adolescents residing at the designated state facilities.
Additionally, HB 109 amended Texas Health and Safety Code §551.007 which provides that HHSC may award money appropriated by the legislature for the purpose of the construction, expansion, or operation of certain inpatient mental health facilities as a one-time grant directly to an entity for that purpose. Senate Bill (SB) 1, 89th Legislature, Regular Session, 2025, (Article II, Special Provisions, Section 28) appropriated funds to support HB 109 for construction and staffing of TCY and sets capacity and admissions criteria.
SECTION-BY-SECTION SUMMARY
Proposed new §306.501 describes that the purpose of the subchapter is to establish rules to ensure proper care and treatment of an adolescent receiving services in TCY.
Proposed new §306.503 states that the subchapter governs the admission, treatment, and discharge or transition of an adolescent served by TCY.
Proposed new §306.505 defines terms used in this subchapter.
Proposed new §306.507 describes a memorandum of understanding (MOU) specifying the roles and responsibilities of TCY and DFPS to implement the rules in this subchapter. The MOU will be posted on the TCY website.
Proposed new §306.509 establishes the eligibility and admission criteria for referral and admission to TCY; requires a determination that TCY is the least restrictive appropriate setting; and specifies the HHSC deputy executive commissioner for the Health and Specialty Care System may approve an adolescent for admission to TCY on a case-by-case basis.
Proposed new §306.511 describes DFPS responsibilities, including submitting a referral application to TCY for an adolescent; submitting all available information relevant to the adolescent; assigning a DFPS case manager to TCY. Proposed new §306.511 also establishes the DFPS case manager’s responsibilities.
Proposed new §306.513 describes TCY responsibilities, including admission processes and ensuring the adolescent receives educational and treatment services.
Proposed new §306.515 establishes the required members of the recovery team and the adolescent’s right to have TCY invite any other person authorized by the adolescent to routine recovery plan meetings and any meetings about the adolescent’s discharge plan. Proposed new §306.515 also allows TCY to transfer an adolescent to a higher level of care if clinically indicated and with the consent of the conservatorship case worker.
Proposed new §306.517 describes conditions for transition services and discharge. TCY, DFPS or the SSCC, and the adolescent’s local authority collaborate to identify, recommend, and help arrange the adolescent’s access to needed services and resources after discharge. Proposed new §306.517 also establishes that TCY discharges an adolescent no later than the day before the adolescent’s 18th birthday.
Adopted Rules Re:
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER J. OUTPATIENT PHARMACY SERVICES
1 TAC §353.903, §353.907
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §353.903, concerning Definitions; and §353.907, concerning Prior Authorization Requirements.
Sections 353.903 and 353.907 are adopted with changes to the proposed text as published in the April 3, 2026, issue of the Texas Register (51 TexReg 2162). These rules will be republished.
BACKGROUND AND JUSTIFICATION
Previous HHSC rule amendments in the Vendor Drug Program (VDP) implemented portions of House Bill (HB) 3286, 88th Legislature Regular Session, 2023, and became effective in November 2024. These amendments elaborated on existing Preferred Drug List (PDL) exceptions regarding when a non-preferred drug can be used and added new PDL exceptions.
The adopted amendments implement the portion of HB 3286 that amended Texas Government Code §531.072 by adding subsection (h). However, effective September 1, 2025, Texas Government Code §531.072(h), was transferred to Texas Government Code, Chapter 549, and redesignated as §549.0209, as a result of HB 1620, 89th Legislature Regular Session, 2025.
Therefore, the adopted amendments implement Texas Government Code §549.0209, which requires HHSC to: (1) grant temporary non-preferred (TNP) status to new drugs that are available on the Medicaid formulary but have not been reviewed by the Drug Utilization Review (DUR) Board; and (2) establish criteria for authorizing drugs with this status. This change required HHSC to submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS), which was approved on August 29, 2024. The adopted amendments in §353.903 and §353.907 address these requirements for managed care, define TNP drugs and revise existing term definitions, and provide clarifications on application of PDL prior authorization to TNP drugs.
The adopted amendments establish a new TNP status for new drugs added to the VDP formulary that have not yet been reviewed by the DUR Board. This status will apply to new drugs upon addition to the Texas Medicaid formulary if the drugs fall into an existing PDL class. These drugs will remain TNP until reviewed at a DUR Board meeting and approved by HHSC.
TNP status does not apply to existing PDL drugs with new label indications. The adopted amendments require a health care managed care organization (health care MCO) to have a TNP drug list prior authorization for coverage.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER F. PHARMACY SERVICES
1 TAC §354.1924
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §354.1924, concerning Preferred Drug List.
Section 354.1924 is adopted with changes to the proposed text as published in the April 3, 2026, issue of the Texas Register (51 TexReg 2164). This rule will be republished.
BACKGROUND AND JUSTIFICATION
Previous HHSC rule amendments in the Vendor Drug Program (VDP) implemented portions of House Bill (HB) 3286, 88th Legislature Regular Session, 2023, and became effective in November 2024. These amendments elaborated on existing Preferred Drug List (PDL) exceptions regarding when a non-preferred drug can be used and added new PDL exceptions.
The adopted amendment implements the portion of HB 3286 that amended Texas Government Code §531.072 by adding subsection (h). However, effective September 1, 2025, Texas Government Code §531.072(h), was transferred to Texas Government Code, Chapter 549, and redesignated as §549.0209, as a result of HB 1620, 89th Legislature Regular Session, 2025.
Therefore, the adopted amendment implements Texas Government Code §549.0209, which requires HHSC to: (1) grant temporary non-preferred (TNP) status to new drugs that are available on the Medicaid formulary but have not been reviewed by the Drug Utilization Review (DUR) Board; and (2) establish criteria for authorizing drugs with this status. This change required HHSC to submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS), which was approved on August 29, 2024.
The adopted amendment to §354.1924 clarifies criteria HHSC uses to include a drug on the Texas Drug Code Index (TDCI) in the PDL. The rule amendment defines the term “temporary non-preferred” and adds this term to any lists of preferred drug list statuses.
The adopted amendment adds new subsection (d) to §354.1924 for HHSC to give TNP status to a new drug HHSC adds to the Vendor Drug Program formulary before the drug is reviewed by the Drug Utilization Review (DUR) Board. The adopted amendment also sets the criteria HHSC uses to add a new drug to the formulary with TNP status because the drug falls into an existing PDL class and will remain TNP until reviewed at a DUR Board meeting.
TNP status does not apply to existing PDL drugs with new label indications. Drugs on the Texas Medicaid formulary with a TNP status will require a TNP prior authorization for coverage.
In Addition Re:
Public Notice: Texas Medicaid State Plan Amendment to make Changes to the Peer Specialist Services Medicaid Benefit
The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number 26-0012 to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act.
The purpose of this amendment is to secure the review and approval of an amendment, Transmittal Number (TN) 26-0012, to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act.
The proposed amendment to extend the age of eligibility for the Peer Specialist Services Medicaid benefit to individuals 14 through 20 years of age who meet the clinical criteria is effective December 1, 2026. Currently, the Peer Specialist Services Medicaid benefit is available to individuals 21 years of age and older who have a mental health or substance use condition and who have peer specialist services included as a component of their plan of care. Other non-substantive updates have been made to formatting and language.
The proposed amendment is estimated to result in an annual aggregate cost-savings of ($68,830) for federal fiscal year 2027, consisting of ($40,369) in federal funds and ($28,461) in state general revenue. For federal fiscal year 2028, the estimated annual aggregate cost-savings is ($96,401), consisting of ($56,838) in federal funds and ($39,563) in state general revenue. For federal fiscal year 2029, the estimated annual aggregate cost-savings is ($100,996), consisting of ($59,587) in federal funds and ($41,408) in state general revenue.
To obtain copies of the proposed amendment, interested parties may contact Jayasree Sankaran, State Plan Coordinator, by mail at the Health and Human Services Commission, P.O. Box 13247, Mail Code H-600, Austin, Texas 78711; by telephone at (512) 438-4331; or by email at Medicaid_Chip_SPA_Inquiries@hhsc.state.tx.us. The Access and Eligibility Services for local benefit offices will post this notice for 30 days and will have copies of the amendment available for review.
Texas Department of State Health Services
Adopted Rules Re:
Adopting 25 TAC §§40.1 – 40.8, to implement HB 163 and SB 1619 by updating epinephrine delivery system terminology for institutions of higher education, aligning definitions across Chapter 40, and applying plain-language standards.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER A. EPINEPHRINE DELIVERY SYSTEM POLICIES IN INSTITUTIONS OF HIGHER EDUCATION
25 TAC §§40.1 – 40.8
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28, concerning Stock Medication in Schools and Other Entities.
Sections 40.1 – 40.8, 40.11 – 40.18, 40.21 – 40.28, 40.61 – 40.71, and 40.81 – 40.89 are adopted without changes to the proposed text as published in the July 3, 2026, issue of the Texas Register (51 TexReg 4339). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025. HB 163 amended Texas Health and Safety Code (HSC) §773.0145 by removing the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizing any entity in Texas to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 by replacing the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery system policy and to update the medication and terminology allowed in the unassigned epinephrine delivery system policy. The amendments to 25 TAC Chapter 40, Subchapters A, B, E, and F also align definitions across Chapter 40 and comply with DSHS rule standards for plain language. The repeal of Subchapter C removes duplicative rules because the content in those rules has been incorporated into the amendments in Subchapter B.
Adopting 25 TAC §§40.11 – 40.18, to implement HB 163 by expanding the entities that may adopt an unassigned epinephrine delivery system policy and incorporating the youth-facility rules formerly in Subchapter C.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER B. EPINEPHRINE DELIVERY SYSTEM POLICIES IN CERTAIN ENTITIES
25 TAC §§40.11 – 40.18
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28, concerning Stock Medication in Schools and Other Entities.
Sections 40.1 – 40.8, 40.11 – 40.18, 40.21 – 40.28, 40.61 – 40.71, and 40.81 – 40.89 are adopted without changes to the proposed text as published in the July 3, 2026, issue of the Texas Register (51 TexReg 4339). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025. HB 163 amended Texas Health and Safety Code (HSC) §773.0145 by removing the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizing any entity in Texas to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 by replacing the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery system policy and to update the medication and terminology allowed in the unassigned epinephrine delivery system policy. The amendments to 25 TAC Chapter 40, Subchapters A, B, E, and F also align definitions across Chapter 40 and comply with DSHS rule standards for plain language. The repeal of Subchapter C removes duplicative rules because the content in those rules has been incorporated into the amendments in Subchapter B.
Adopting 25 TAC §§40.21 – 40.28, to repeal the youth-facility epinephrine auto-injector rules as duplicative because their content has been incorporated into Subchapter B.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER C. EPINEPHRINE AUTO-INJECTOR POLICIES IN YOUTH FACILITIES
25 TAC §§40.21 – 40.28
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28, concerning Stock Medication in Schools and Other Entities.
Sections 40.1 – 40.8, 40.11 – 40.18, 40.21 – 40.28, 40.61 – 40.71, and 40.81 – 40.89 are adopted without changes to the proposed text as published in the July 3, 2026, issue of the Texas Register (51 TexReg 4339). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025. HB 163 amended Texas Health and Safety Code (HSC) §773.0145 by removing the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizing any entity in Texas to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 by replacing the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery system policy and to update the medication and terminology allowed in the unassigned epinephrine delivery system policy. The amendments to 25 TAC Chapter 40, Subchapters A, B, E, and F also align definitions across Chapter 40 and comply with DSHS rule standards for plain language. The repeal of Subchapter C removes duplicative rules because the content in those rules has been incorporated into the amendments in Subchapter B.
Adopting 25 TAC §§40.61 – 40.71, to implement SB 1619 by replacing “epinephrine auto-injector” with “epinephrine delivery system” in the school rules, aligning definitions across Chapter 40, and applying plain-language standards.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER E. EPINEPHRINE DELIVERY SYSTEM POLICIES IN SCHOOLS
25 TAC §§40.61 – 40.71
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28, concerning Stock Medication in Schools and Other Entities.
Sections 40.1 – 40.8, 40.11 – 40.18, 40.21 – 40.28, 40.61 – 40.71, and 40.81 – 40.89 are adopted without changes to the proposed text as published in the July 3, 2026, issue of the Texas Register (51 TexReg 4339). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025. HB 163 amended Texas Health and Safety Code (HSC) §773.0145 by removing the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizing any entity in Texas to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 by replacing the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery system policy and to update the medication and terminology allowed in the unassigned epinephrine delivery system policy. The amendments to 25 TAC Chapter 40, Subchapters A, B, E, and F also align definitions across Chapter 40 and comply with DSHS rule standards for plain language. The repeal of Subchapter C removes duplicative rules because the content in those rules has been incorporated into the amendments in Subchapter B.
Adopting 25 TAC §§40.81 – 40.89, to align the opioid antagonist medication rules for schools with definitions across Chapter 40 and DSHS plain-language standards.
CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER F. OPIOID ANTAGONIST MEDICATION REQUIREMENTS IN SCHOOLS
25 TAC §§40.81 – 40.89
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts amendments to §§40.1 – 40.8, 40.11 – 40.18, 40.61 – 40.71, and 40.81 – 40.89; and the repeal of §§40.21 – 40.28, concerning Stock Medication in Schools and Other Entities.
Sections 40.1 – 40.8, 40.11 – 40.18, 40.21 – 40.28, 40.61 – 40.71, and 40.81 – 40.89 are adopted without changes to the proposed text as published in the July 3, 2026, issue of the Texas Register (51 TexReg 4339). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and repeal are necessary to implement House Bill (HB) 163 and Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025. HB 163 amended Texas Health and Safety Code (HSC) §773.0145 by removing the statutory list of specific entities authorized to adopt a policy regarding the maintenance, administration, and disposal of epinephrine delivery systems and instead authorizing any entity in Texas to adopt such a policy. SB 1619 amended Texas Education Code Chapter 38 by replacing the term “epinephrine auto-injector” with “epinephrine delivery system” throughout relevant statutes.
The statutory changes require DSHS to update the rules to expand the entities allowed to implement an unassigned epinephrine delivery system policy and to update the medication and terminology allowed in the unassigned epinephrine delivery system policy. The amendments to 25 TAC Chapter 40, Subchapters A, B, E, and F also align definitions across Chapter 40 and comply with DSHS rule standards for plain language. The repeal of Subchapter C removes duplicative rules because the content in those rules has been incorporated into the amendments in Subchapter B.
Texas Department of Insurance
Adopted Rules Re:
Adopting 28 TAC §3.205, to replace the reference to Insurance Code §541.056(c), repealed by HB 2221, with new Insurance Code §1702.102(c).
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER C. APPROVAL, DISAPPROVAL, AND WITHDRAWAL OF APPROVAL OF CERTAIN PARTICIPATING POLICY FORMS
28 TAC §3.205
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210, concerning certain participating policy forms, health coverage of newborn children, and preferred and exclusive provider benefit plans. The amendments to §§3.205, 3.3403, 3.9208, and 3.9210 are adopted without changes to the proposed text published in the May 8, 2026 issue of the Texas Register (51 TexReg 3043). These sections will not be republished. The amendments to §3.3703 are adopted with a nonsubstantive change to the proposed text to correct a reference to a section heading. This section will be republished.
BACKGROUND AND JUSTIFICATION
The amendments to §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210 are necessary to implement the following legislation.
- House Bill 388, 89th Legislature, 2025, requires health benefit plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
- House Bill 1620, 89th Legislature, 2025, revises Government Code references throughout the Insurance Code to reflect statutory amendments relating to Medicaid enacted in HB 4611, 88th Legislature, 2023, which made nonsubstantive revisions to various health and human services laws.
- House Bill 2221, 89th Legislature, 2025, moves requirements concerning unlawful rebates and inducements to new Insurance Code Chapter 1702.
- Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
- Senate Bill 896, 89th Legislature, 2025, extends the enrollment period for newborn children from 31 days to 60 days.
- Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.
SECTION-BY-SECTION SUMMARY
The adopted amendments are described in the following paragraphs.
Section 3.205. An amendment to §3.205 replaces the reference to Insurance Code §541.056(c), which was repealed by HB 2221, with new Insurance Code §1702.102(c), which was added by HB 2221.
Adopting 28 TAC §3.3403, to implement SB 896 by extending the initial coverage and enrollment period for newborn children from 31 days to 60 days and deleting outdated implementation provisions.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER U. NEWBORN CHILDREN COVERAGE
28 TAC §3.3403
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210, concerning certain participating policy forms, health coverage of newborn children, and preferred and exclusive provider benefit plans. The amendments to §§3.205, 3.3403, 3.9208, and 3.9210 are adopted without changes to the proposed text published in the May 8, 2026 issue of the Texas Register (51 TexReg 3043). These sections will not be republished. The amendments to §3.3703 are adopted with a nonsubstantive change to the proposed text to correct a reference to a section heading. This section will be republished.
BACKGROUND AND JUSTIFICATION
The amendments to §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210 are necessary to implement the following legislation.
- House Bill 388, 89th Legislature, 2025, requires health benefit plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
- House Bill 1620, 89th Legislature, 2025, revises Government Code references throughout the Insurance Code to reflect statutory amendments relating to Medicaid enacted in HB 4611, 88th Legislature, 2023, which made nonsubstantive revisions to various health and human services laws.
- House Bill 2221, 89th Legislature, 2025, moves requirements concerning unlawful rebates and inducements to new Insurance Code Chapter 1702.
- Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
- Senate Bill 896, 89th Legislature, 2025, extends the enrollment period for newborn children from 31 days to 60 days.
- Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.
SECTION-BY-SECTION SUMMARY
The adopted amendments are described in the following paragraphs.
Section 3.3403. The amendments to §3.3403 implement SB 896. Subsections (a), (b), and (d) are amended by striking general references to “for a period of time” for newborn coverage and replacing them with the concrete time period of “before the 61st day after the child’s birth.” Subsection (e) is amended by replacing references to a 31-day initial coverage period with a 60-day initial coverage period.
Subsections (f) – (h), addressing the original implementation period of Insurance Code §1367.003, are deleted because they are no longer relevant. Subsection (i) is redesignated as subsection (f), and a title is added to the statutory reference in the subsection to conform to agency style.
Adopting 28 TAC §3.3703, to add preferred provider plan contracting requirements for pharmacy and pharmacist contracts and third-party administrator contracts and to reference the uniform coordination of benefits questionnaire, implementing HB 388, SB 493, and SB 1236.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER X. PREFERRED AND EXCLUSIVE PROVIDER PLANS
28 TAC §3.3703
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210, concerning certain participating policy forms, health coverage of newborn children, and preferred and exclusive provider benefit plans. The amendments to §§3.205, 3.3403, 3.9208, and 3.9210 are adopted without changes to the proposed text published in the May 8, 2026 issue of the Texas Register (51 TexReg 3043). These sections will not be republished. The amendments to §3.3703 are adopted with a nonsubstantive change to the proposed text to correct a reference to a section heading. This section will be republished.
BACKGROUND AND JUSTIFICATION
The amendments to §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210 are necessary to implement the following legislation.
- House Bill 388, 89th Legislature, 2025, requires health benefit plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
- House Bill 1620, 89th Legislature, 2025, revises Government Code references throughout the Insurance Code to reflect statutory amendments relating to Medicaid enacted in HB 4611, 88th Legislature, 2023, which made nonsubstantive revisions to various health and human services laws.
- House Bill 2221, 89th Legislature, 2025, moves requirements concerning unlawful rebates and inducements to new Insurance Code Chapter 1702.
- Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
- Senate Bill 896, 89th Legislature, 2025, extends the enrollment period for newborn children from 31 days to 60 days.
- Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.
SECTION-BY-SECTION SUMMARY
The adopted amendments are described in the following paragraphs.
Section 3.3703. The amendments to §3.3703 implement HB 388, HB 493, and SB 1236. Subsection (a)(21) is amended by adding a reference to Insurance Code §1203.153. Consistent with SB 1236, new subsection (a)(31) requires a contract between an insurer and a pharmacy or pharmacist to comply with Insurance Code Chapter 1369. New subsection (a)(32) prohibits certain contract provisions in a contract between an insurer and a pharmacy or pharmacist, consistent with Insurance Code §4151.155 as added by SB 493. Although §4151.155 affects contracts involving a pharmacy benefit manager, subsection (a)(32) applies to contracts involving an insurer to ensure requirements for insurers and their pharmacy benefit managers are consistent. New subsection (a)(33) is added to cross-reference 28 TAC §7.1613, which addresses requirements for a contract between an issuer and a third-party administrator (TPA), including a requirement for a TPA to be contractually obligated to comply with all statutory and regulatory requirements related to a function carried out by the TPA. This makes clear that the requirements of §3.3703 apply to health plan contracts with physicians or providers, whether the plan contracts directly or relies on a TPA such as a pharmacy benefit manager to contract.
Subsection (a)(32) as proposed has been changed to correct the reference to Insurance Code §4151.155 by replacing the word “of” with “or” in the statute’s heading.
Adopting 28 TAC §3.9208 and §3.9210, to update exclusive provider benefit plan references from Government Code Chapter 533 to Government Code Chapter 540, consistent with HB 1620.
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER KK. EXCLUSIVE PROVIDER BENEFIT PLAN
28 TAC §3.9208, §3.9210
OVERVIEW
The commissioner of insurance adopts amendments to 28 TAC §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210, concerning certain participating policy forms, health coverage of newborn children, and preferred and exclusive provider benefit plans. The amendments to §§3.205, 3.3403, 3.9208, and 3.9210 are adopted without changes to the proposed text published in the May 8, 2026 issue of the Texas Register (51 TexReg 3043). These sections will not be republished. The amendments to §3.3703 are adopted with a nonsubstantive change to the proposed text to correct a reference to a section heading. This section will be republished.
BACKGROUND AND JUSTIFICATION
The amendments to §§3.205, 3.3403, 3.3703, 3.9208, and 3.9210 are necessary to implement the following legislation.
- House Bill 388, 89th Legislature, 2025, requires health benefit plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
- House Bill 1620, 89th Legislature, 2025, revises Government Code references throughout the Insurance Code to reflect statutory amendments relating to Medicaid enacted in HB 4611, 88th Legislature, 2023, which made nonsubstantive revisions to various health and human services laws.
- House Bill 2221, 89th Legislature, 2025, moves requirements concerning unlawful rebates and inducements to new Insurance Code Chapter 1702.
- Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
- Senate Bill 896, 89th Legislature, 2025, extends the enrollment period for newborn children from 31 days to 60 days.
- Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.
SECTION-BY-SECTION SUMMARY
The adopted amendments are described in the following paragraphs.
Section 3.9208. The amendment to §3.9208 replaces the reference to Government Code Chapter 533 with Government Code Chapter 540, as repealed and replaced by HB 4611, and consistent with HB 1620.
Section 3.9210. An amendment to §3.9210(a) replaces the reference to Government Code Chapter 533 with Government Code Chapter 540, as repealed and replaced by HB 4611 and consistent with HB 1620.