Texas Register October 20, 2023 Volume: 48 Number: 42

Texas Register Table of Contents

1 Governor
- - 1.0.1 Proclamations Re:
    - 1.0.1.1 Proclamation 41-4077, to consider legislation that would prohibit COVID-19 vaccine mandates by private employers.
2 Office of the Attorney General
- - 2.0.1 Request for Opinions Re:
    - 2.0.1.1 Whether the refund of court costs required by Health and Safety Code subsection 571.018(j) is limited to patients who are committed to a mental health facility (RQ-0515-KP)
3 Texas Health and Human Services Commission
4 Texas Department of State Health Services
5 Department of Aging and Disability Services
- - 5.0.1 Proposed Rules Re:

Governor

Proclamations Re:

Proclamation 41-4077, to consider legislation that would prohibit COVID-19 vaccine mandates by private employers.

OVERVIEW

TO ALL TO WHOM THESE PRESENTS SHALL COME:

I, GREG ABBOTT, Governor of the State of Texas, by the authority vested in me by Article III, Sections 5 and 40, and Article IV, Section 8 of the Texas Constitution, do hereby call extraordinary session #3 of the 88th Legislature, to convene in the City of Austin, commencing at 1 p.m. on Monday, October 9, 2023, for the following purposes:

To consider and act upon the following:

Legislation prohibiting COVID-19 vaccine mandates by private employers.

Office of the Attorney General

Request for Opinions Re:

Whether the refund of court costs required by Health and Safety Code subsection 571.018(j) is limited to patients who are committed to a mental health facility (RQ-0515-KP)

Briefs requested by November 6, 2023

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §355.102, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the cost determination process.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER A. COST DETERMINATION PROCESS
1 TAC §355.102

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.306, concerning Cost Finding Methodology; §355.314, concerning Supplemental Payments to Non-State Government-Owned Nursing Facilities; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.743, concerning Reimbursement Methodology for Mental Health Case Management; §355.746, concerning Reimbursement Methodology for Mental Retardation Service Coordination; §355.781, concerning Rehabilitative Services Reimbursement Methodology; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8421, concerning Reimbursement for Case Management Services for Infants and Toddlers with Developmental Disabilities; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.

BACKGROUND AND JUSTIFICATION

In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The purpose of the proposal is to amend several rules within the Texas Administrative Code that contain instances of the previous department name and replace them with the current department name.

SECTION-BY-SECTION

The proposed amendments to §355.102, §355.306, §355.314, §355.458, §355.722, §355.743, §355.746, §355.781, §355.8210, §355.8421, §355.8422, and §355.9040 replace instances of “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively.

Amending 1 TAC §355.306, §355.314, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the reimbursement methodology for nursing facilities.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.306, §355.314

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION

Amending 1 TAC §355.458, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the reimbursement methodology for ICF/IID.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER D. REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID)
1 TAC §355.458

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION

Amending 1 TAC §§355.722, 355.743, 355.746, 355.781, to use the phrases “Provider Finance,” “Provider Finance Department,” and “PFD” as they relate to the reimbursement methodology for programs serving persons with mental illness or intellectual or developmental disability.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH MENTAL ILLNESS OR INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §§355.722, 355.743, 355.746, 355.781

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION

Amending 1 TAC §355.8210, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to purchased health services.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8210

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION

Amending 1 TAC §355.8421, §355.8422, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD” as they relate to the reimbursement methodology for the Early Childhood Intervention Program.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 22. REIMBURSEMENT METHODOLOGY FOR THE EARLY CHILDHOOD INTERVENTION PROGRAM
1 TAC §355.8421, §355.8422

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION

Amending 1 TAC §355.9040, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD” when referring to miscellaneous programs.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER M. MISCELLANEOUS PROGRAMS
1 TAC §355.9040

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION

Amending 26 TAC §303.102, to add new definitions for “audio-only,” “audio-visual,” “extenuating circumstances,” “HHSC instructor-led training,” and “in-person.”

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §303.102

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Part 1, Chapter 303, concerning Preadmission Screening and Resident Review (PASRR), amendments to §§303.102, 303.201, 303.302, 303.303, 303.502, 303.503, 303.601, 303.602, 303.701, 303.703, 303.905, 303.907, 303.909, 303.910, and 303.912. HHSC also proposes new §303.901, §303.914 and new Subchapter J, concerning Disaster Rule Flexibilities, comprised of §303.1000; and the repeal of §303.901.

BACKGROUND AND JUSTIFICATION

House Bill 4, 87th Legislature, Regular Session, 2021 added §531.02161 to the Texas Government Code which requires HHSC to ensure that Medicaid recipients have the option to receive services through telecommunications to the extent it is cost effective and clinically appropriate. A purpose of the proposed rules is to implement Texas Government Code §531.02161 as it applies to the preadmission screening and resident review (PASRR) process. Another purpose of the proposed rules is to define terms used in the revised PASRR rule for clarification. The proposed revisions to the training requirements for the habilitation coordinator, service coordinator, qualified mental health professional-community services (QMHP-CS), and staff involved in the PASRR process ensures training requirements are similar for all staff across all local intellectual and developmental disability authorities (LIDDAs), local mental health authorities (LMHAs), and local behavioral health authorities (LBHAs). The proposed revisions also address documentation requirements related to the PASRR process, including the new requirement to obtain written or oral consent for the use of audio-visual or audio-only communication methods. The proposed rules also require adjustments to the frequency of follow-up visits for residents with mental illness (MI), which mirrors the requirements of the habilitation coordinator related to the PASRR process. The proposed rules also require the MI specialized services team to agree the resident with MI no longer benefits from the MI specialized services when one or more specialized service is terminated.

The proposed rules provide that HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions specified in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. This provision is added to ensure that LIDDAs, LMHAs, LBHAs are able to operate and provide services effectively during a disaster.

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.102, Definitions, adds definitions for the following new terms: “audio-only,” “audio-visual,” “extenuating circumstances,” “HHSC instructor-led training,” and “in-person.” The proposed amendment makes a minor change to the definition of “PCRP–Person-centered recovery plan” for clarity and references §303.302(a)(2) in the definitions of “PE–PASRR level II evaluation” and “Resident review” for clarity. The proposed amendment revises the definition of “SPT–Service planning team” to require that the person who develops a permanency plan using the HHSC Permanency Planning Instrument for Children Under 22 Years of Age form and performs other permanency planning activities for a designated resident under 22 years of age must be included on the SPT if the designated resident is at least 21 years of age but younger than 22 years of age. Further, the definition of “SPT” is amended to clarify that the following persons are required participants of an SPT: (1) a concerned person whose inclusion is requested by the designated resident or the LAR; and (2) at the discretion of the LIDDA, an individual who is directly involved in the delivery of services for people with ID or DD. The proposed amendment renumbers the definitions to account for the new definitions and changes made to existing definitions.

Amending 26 TAC §303.201, to clarify the Preadmission Screening and Resident Review (PASRR) screening and evaluation process.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER B. PASRR SCREENING AND EVALUATION PROCESS
26 TAC §303.201

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.201, Preadmission Process, clarifies that the LIDDA, LMHA, or LBHA, if provided a copy of a PL1 in accordance with subsection (a)(1)(B) of the section, must comply with §303.302(a)(1).

Amending 26 TAC §303.302, §303.303, to outline the responsibilities related to the Preadmission Screening and Resident Review (PASRR) process.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER C. RESPONSIBILITIES
26 TAC §303.302, §303.303

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.302, LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process allows a LIDDA, LMHA, or LBHA to meet with the individual or resident at the referring entity or nursing facility to gather information to complete a PASRR Level II evaluation (PE) resident review by audio-visual communication in extenuating circumstances if the LIDDA, LMHA, or LBHA obtains the written informed consent or oral consent of the individual, designated resident, or LAR and documents in the individual’s or designated resident’s record a description of the extenuating circumstances that prevented meeting in person with the individual or the designated resident. Further, the proposed amendment requires the LIDDA, LMHA, or LBHA to, if written or oral consent is not obtained to conduct this meeting, to instead meet with the LAR and NF staff most familiar with the individual or designated resident to review and gather all necessary information to complete the PE and enter the PE in the LTC online portal. The proposed amendment also allows a LIDDA, LMHA, or LBHA to complete the PE or resident review by meeting with the individual’s LAR or resident’s LAR in-person, via audio-visual communication, or via audio-only communication according to the LAR’s preference. The proposed amendment requires a LIDDA, LMHA, or LBHA to ensure a habilitation coordinator or QMHP-CS or both, as applicable, participates in person, or via audio-visual communication in extenuating circumstances, in the resident’s IDT meeting required by §303.302(c)(1). The proposed amendment replaces the term “face-to-face” with “in person” and makes minor changes for clarity.
The proposed amendment to §303.303, Qualifications and Requirements for Staff Person Conducting a PE or Resident Review, requires an LMHA or LBHA to ensure that before a staff person conducts a PE or resident review, the staff person receives “HHSC instructor-led” training, instead of “HHSC-developed training,” about how to conduct a PE and resident review.

Amending 26 TAC §303.502, §303.503, to update requirements for the habilitation coordinator for the Preadmission Screening and Resident Review (PASRR) process.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER E. HABILITATION COORDINATION
26 TAC §303.502, §303.503

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.502, Required Training for a Habilitation Coordinator, provides that a LIDDA must ensure a habilitation coordinator completes “HHSC approved computer-based person-centered planning and practices training” within the first 60 days of performing habilitation coordination duties; all “HHSC instructor-led,” instead of “HHSC-developed” training, related to PASRR habilitation coordination within the first 60 days of performing habilitation coordination duties; and person-centered thinking training approved by HHSC within the first year of performing habilitation coordination duties. The proposed amendment makes minor changes for clarity.
The proposed amendment to §303.503, Documenting Habilitation Coordination Contacts, substitutes the phrase “in person, via audio-visual communication, or via audio-only communication” for “face-to-face or by telephone.”

Amending 26 TAC §303.601, §303.602, to update habilitation coordinator duties and to outline when quarterly SPT meetings may be conducted via audio-visual communication.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER F. HABILITATIVE SERVICE PLANNING FOR A DESIGNATED RESIDENT
26 TAC §303.601, §303.602

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.601, Habilitation Coordination for a Designated Resident, requires a LIDDA to assign a habilitation coordinator to each designated resident within two days after a PE is completed, if the PE is positive for intellectual disability (ID) or development disability (DD). The proposed amendment clarifies that the habilitation coordinator must meet with the designated resident to provide habilitation coordination at least monthly if the designated resident is receiving a specialized service in addition to habilitation coordination and requires the habilitation coordinator to meet in person at least quarterly or more frequently as determined by the SPT using the findings of the HHSC Habilitative Assessment form and meet via audio-visual communication in a month when a meeting is not conducted in person if the designated resident or LAR consents orally or in writing to meeting via audio-visual communication. The proposed amendment also requires the habilitation coordinator to document the designated resident’s or LAR’s refusal in the designated resident’s record if written or oral consent to meet via audio-visual communication is not obtained. The proposed amendment also makes minor edits and formatting changes for clarity.
The proposed amendment to §303.602, Service Planning Team Responsibilities Related to Specialized Services, substitutes the phrase “via audio-visual communication, or via audio-only communication,” for “by phone.” The proposed amendment also allows a habilitation coordinator to facilitate a quarterly SPT meeting via audio-visual communication in extenuating circumstances if the habilitation coordinator obtains written or oral consent to meet via audio-visual communication from the designated resident, or LAR and documents a description of the extenuating circumstances prior to convening the meeting. The proposed amendment also requires the habilitation coordinator to document the designated resident’s or LAR’s refusal in the designated resident’s record if written or oral consent to meet via audio-visual communication is not obtained. In addition, the proposed amendment requires a SPT member who is a provider of a specialized service to participate, instead of “actively participate,” in an SPT meeting, in person, via audio-visual communication, or via audio-only communication, unless the habilitation coordinator determines “participation,” instead of “active participation” by the provider is not necessary. Further, the proposed amendment requires a habilitation coordinator to take certain action if the habilitation coordinator determines that “participation,” instead of “active participation” by a provider is not necessary.

Amending 26 TAC §303.701, §303.703, to clarify responsibilities of a service coordinator in conducting transition planning under the PASRR process.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER G. TRANSITION PLANNING
26 TAC §303.701, §303.703

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.701, Transition Planning for a Designated Resident, substitutes the phrase “via audio-visual communication, or via audio-only communication,” for “by phone.” The proposed amendment also allows a service coordinator to facilitate an SPT meeting convened by the service coordinator via audio-visual communication in extenuating circumstances if the service coordinator obtains written or oral consent to meet via audio-visual communication from the designated resident or LAR and documents a description of the extenuating circumstances prior to convening the meeting. The proposed amendment also requires the service coordinator to document the designated resident’s or LAR’s refusal in the designated resident’s record if written or oral consent to meet via audio-visual communication is not obtained. In addition, the proposed amendment requires an SPT member who is a provider of a specialized service to participate, instead of “actively participate,” in an SPT meeting, in person, via audio-visual communication, or via audio-only communication, unless the service coordinator determines that the provider’s “participation,” instead of “active participation” is not necessary. Further, the proposed amendment requires a service coordinator to take certain action if the service coordinator determines that the provider’s “participation,” instead of the provider’s “active participation” is not necessary.
The proposed amendment to §303.703, Requirements for Service Coordinators Conducting Transition Planning, requires a service coordinator to complete “HHSC approved computer-based person-centered planning and practices” training instead of “person-center thinking” training. The proposed amendment substitutes the term “HHSC instructor-led” training for “HHSC-developed” training. A proposed amendment to add “person-centered thinking training approved by HHSC to be completed by the habilitation coordinator within the first year of performing habilitation coordination duties. The proposed amendment also corrects a rule reference and makes a minor change for clarity.

New 26 TAC §303.901, to require an LMHA or LBHA to perform a uniform assessment to determine the appropriate level of care and available specialized services for a resident with mental illness.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER I. MI SPECIALIZED SERVICES
26 TAC §303.901

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

Proposed new §303.901, Description of MI Specialized Services, requires an LMHA or LBHA staff to conduct the uniform assessment to determine which level of care the resident with MI will receive and describes the specialized services available for a resident with MI. This new section reorders and reformats the content in repealed §303.901, Description of MI Specialized Services, to be consistent with the Texas Resiliency and Recovery (TRR) offered services, a service delivery system in Texas for community mental health services.

Repealing 26 TAC §303.901, to be replaced with new §303.901 concerning mental illness specialized services.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER I. MI SPECIALIZED SERVICES
26 TAC §303.901

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §303.901, Description of MI Specialized Services deletes the rule as no longer necessary, and replaces it with proposed new §303.901, Description of MI Specialized Services.

Amending 26 TAC §§ 303.905, 303.907, 303.909, 303.910, 303.912 and new 26 TAC § 303.914, to describe requirements for mental illness specialized services.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER I. MI SPECIALIZED SERVICES
26 TAC §§ 303.905, 303.907, 303.909, 303.910, 303.912, 303.914

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

Proposed amendment to §303.905, Process for Service Initiation, requires an LMHA or LBHA to convene the meeting described in subsection (c)(3) in person or in extenuating circumstances via audio-visual communication. To conduct the meeting via audio-visual communication, a LMHA or LBHA must obtain written or oral consent to meet via audio-visual communication from the resident with MI or LAR and document a description of the extenuating circumstances prior to the meeting. The proposed amendment also requires the LMHA or LBHA to document the refusal of the resident with MI or LAR in the resident’s record if written or oral consent to meet via audio-visual communication is not obtained. The proposed amendment also makes minor changes for clarity.
Proposed amendment to §303.907, Renewal and Revision of Person-Centered Recovery Plan, requires the QMHP-CS to convene an MI quarterly meeting in person, or in extenuating circumstances via audio-visual communication. To conduct the meeting via audio-visual communication, a QMHP-CS must obtain written or oral consent to meet via audio-visual communication from the resident with MI or LAR and document a description of the extenuating circumstances prior to the meeting. The proposed amendment also requires the QMHP-CS to document the refusal of the resident with MI or LAR in the resident’s record if written or oral consent to meet via audio-visual communication is not obtained. The proposed amendment also makes minor changes for clarity.
Proposed amendment to §303.909, Refusal of the Uniform Assessment or MI Specialized Services, requires the LMHA or LBHA to inform the resident with MI who refuses to complete the uniform assessment or participate in MI specialized services that a follow-up visit will be conducted at the first MI quarterly meeting and removes the requirement for visits every 30 days for 90 days after the initial IDT meeting. The proposed amendment also requires the LMHA or LBHA to, if the resident with MI or the LAR refuses the uniform assessment or MI specialized services “at the first MI quarterly meeting,” (instead of “after 90 days”) inform the resident and the LAR that an annual IDT meeting is required and will be conducted, at which time the uniform assessment and MI specialized services will be offered again. The proposed amendment also makes minor changes for clarity.
Proposed amendment to §303.910, Suspension and Termination of MI Specialized Services, removes the requirement that an LMHA or LBHA suspend MI specialized services for a resident with MI if the resident or LAR requests that MI specialized services be suspended when transferring from one NF to another NF without an intervening hospital stay. The proposed amendment allows the LMHA or LBHA to terminate one or more MI specialized services if the MI specialized services team agrees that the resident with MI no longer benefits from the services. The proposed amendment also makes minor changes for clarity.
Proposed amendment to §303.912, Documentation, removes the reference to the required 30, 60, and 90 day follow-up meetings held after the initial IDT meeting for a resident with MI who refuses MI specialized services and makes minor changes for clarity.
Proposed new §303.914, Required Training for an LMHA or LBHA Staff Responsible for Coordinating MI Specialized Services, requires the LMHA and LBHA to ensure that an LMHA or LBHA staff responsible for coordinating MI specialized services completes specified training before coordinating MI specialized services and completes HHSC approved computer-based person-centered planning and practices training within the first 60 days of coordinating MI specialized services. The proposed new rule also requires that the LMHA or LBHA ensure that a supervisor, team lead, or quality monitoring staff person who has successfully completed the HHSC approved computer-based person-centered planning and practices training reviews and signs off on work completed by an LMHA or LBHA staff until such staff completes the training. The proposed new rule further requires the LMHA and LBHA to ensure that staff responsible for coordinating MI specialized services completes HHSC approved person-centered thinking training within the first year of coordinating MI specialized services and that staff responsible for coordinating MI specialized services demonstrate competency in the coordination of MI specialized services and maintain documentation of the training received by the staff.

New 26 TAC §303.1000, to provide disaster rule flexibilities under the PASRR process.

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
SUBCHAPTER J. DISASTER RULE FLEXIBILITIES
26 TAC §303.1000

OVERVIEW

BACKGROUND AND JUSTIFICATION

The proposed rules repeal §303.901, Description of MI Specialized Services, and replace it with proposed new §303.901, Description of MI Specialized Services.

SECTION-BY-SECTION SUMMARY

Proposed new §303.1000, Flexibilities to Certain Requirements During Declaration of Disaster, provides that HHSC may allow LIDDAs, LMHAs, and LBHAs to use one or more of the exceptions described in the rule while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. The rule provides that HHSC notifies LIDDAs, LMHAs, and LBHAs if it allows an exception to be used and the date an allowed exception must no longer be used.

Adopted Rules Re:

Amending 1 TAC §351.821, to conform with HHSC standards for the advisory committees specifically adding language regarding required training and travel reimbursements.

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B. ADVISORY COMMITTEES
1 TAC §351.821

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §351.821, concerning the Value-Based Payment and Quality Improvement Advisory Committee. The amendment to §351.821 is adopted without changes to the proposed text as published in the July 14, 2023, issue of the Texas Register (48 TexReg 3787). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

The Value-Based Payment and Quality Improvement Advisory Committee (VBPQIAC) was established in 2016 by the HHSC Executive Commissioner, under the authority of Texas Government Code §531.012. This statute requires the HHSC Executive Commissioner to establish and maintain advisory committees; establish rules for the operation of advisory committees; and for advisory committees to provide recommendations to the HHSC Executive Commissioner and the Texas Legislature.

The VBPQIAC advises the HHSC Executive Commissioner and Texas Health and Human Services agencies (HHS agencies) on quality improvement and value-based payment initiatives for Medicaid, other publicly funded health services, and the wider health care system. The VBPQIAC consolidated the functions of the previous Medicaid and CHIP Quality Based Payment Advisory Committee and the Texas Institute of Health Care Quality and Efficiency. Members meet approximately four times a year in Austin.

In §351.821, the VBPQIAC is set to abolish on December 31, 2023. Abolition of the VBPQIAC would result in the loss of a primary source of public input for key Medicaid value-based and quality improvement programs, such as the state’s Alternative Payment Models initiative. The VBPQIAC maintains strong participation from stakeholders.

The amendment extends the VBPQIAC by four years to December 31, 2027, updates membership categories by removing “Regional Healthcare Partnerships,” and aligns the rule with current HHSC advisory committee rule formatting and standards.

New 26 TAC §§374.1 – 374.4, to implement the Mental Health Early Intervention and Treatment Grant.

CHAPTER 374. MENTAL HEALTH EARLY INTERVENTION AND TREATMENT GRANT
26 TAC §§374.1 – 374.4

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts new §374.1, concerning Purpose and Objectives; §374.2, concerning Definitions; §374.3, concerning Eligibility Criteria for Applicants; and §374.4, concerning Application and Selection Process, in new Chapter 374, Mental Health Early Intervention and Treatment Grant.

New §374.2 is adopted with changes to the proposed text as published in the August 4, 2023, issue of the Texas Register (48 TexReg 4240). This rule will be republished. Sections 374.1, 374.3, and 374.4 are adopted without changes to the proposed text as published in the August 4, 2023, issue of the Texas Register (48 TexReg 4240). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The new sections are necessary to comply with Senate Bill (S.B.) 26, 88th Legislature, Regular Session, 2023, which adds new §531.09915 to the Texas Government Code effective September 1, 2023. Section 531.09915 requires the Health and Human Services Commission (HHSC) to implement a competitive grant program to support community-based initiatives that promote identification of mental health issues and improve access to early intervention and treatment for children and families. The adopted rules establish the application and eligibility requirements for an entity to be awarded a grant.

In Addition Re:

Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates

OVERVIEW

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 14, 2023, at 9:00 a.m., to receive public comments on proposed updates to Medicaid payment rates resulting from Calendar Fee Reviews, Medical Policy Reviews, Healthcare Common Procedure Coding System (HCPCS) Updates, and Special Reviews.

Texas Department of State Health Services

Proposed Rules Re:

New 25 TAC §133.54, to establish the conditions and application process for hospitals to operate a hospital at home program.

CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
25 TAC §133.54

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §133.54, concerning Hospital at Home Program Application and Operational Requirements.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to implement House Bill (H.B.) 1890, 88th Legislature, Regular Session, 2023. H.B. 1890 amended Texas Health and Safety Code (HSC) Chapter 241 by adding new Subchapter M to allow a licensed hospital to operate a hospital at home program with approval from the Centers for Medicare & Medicaid Services (CMS) and HHSC.

HSC §241.403(a), as added by H.B. 1890, requires HHSC to adopt rules establishing minimum standards for the operation of a hospital at home program by a hospital.

In March of 2020, CMS created the Acute Hospital Care at Home program, originally called the Hospitals Without Walls program, to increase hospital capacity during the COVID-19 pandemic.

In response to state and federal state of disaster declarations relating to COVID-19, HHSC adopted an emergency rule in the Texas Administrative Code, Title 26, Chapter 500, §500.4, relating to Participating in the Centers for Medicare and Medicaid Services Acute Hospital Care at Home Program During the COVID-19 Pandemic. This emergency rule expired July 28, 2023.

SECTION-BY-SECTION SUMMARY

Proposed new §133.54 implements the provisions in HSC Chapter 241, Subchapter M.
Proposed new §133.54(a) defines “acute hospital care at home waiver program” and “hospital at home program” to establish their meaning when used in the new rule. These definitions are based on their meaning in HSC §241.401.
Proposed new §133.54(b) establishes conditions for which a hospital may operate a hospital at home program.
Proposed new §133.54(c) establishes the application process for a licensed hospital to seek HHSC approval to operate a hospital at home program and establishes an application fee.
Proposed new §133.54(d) requires hospitals to reapply for approval when applying to renew the hospital’s license.
Proposed new §133.54(e) establishes the renewal application fee.
Proposed new §133.54(f) requires hospitals operating a hospital at home program to comply with CMS requirements and maintain CMS approval to participate in the acute hospital care at home waiver program and adopt policies and procedures to ensure hospital patient and staff safety.
Proposed new §133.54(g) clarifies HHSC may withdraw its approval for a hospital to operate a hospital at home program at any time if HHSC finds a threat to patient health or safety.

Adopted Rules Re:

Repealing 25 TAC §§37.601 – 37.611, to remove obsolete rules concerning stock medication in schools, youth facilities, and other entities.

CHAPTER 37. MATERNAL AND INFANT HEALTH SERVICES
SUBCHAPTER U. EPINEPHRINE AUTO-INJECTOR POLICIES IN SCHOOLS
25 TAC §§37.601 – 37.611

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts the repeal of §§37.601 – 37.611, concerning Epinephrine Auto-Injector Policies in Schools. These rules are adopted without changes to the proposed text as published in the August 4, 2023, issue of the Texas Register (48 TexReg 4233) and the sections will not be republished.

BACKGROUND AND JUSTIFICATION

The repeal of 25 Texas Administrative Code (TAC) Chapter 37, Subchapter U, places all stock medication rules under 25 TAC Chapter 40. The new rules for 25 TAC Chapter 40, Subchapter E, Epinephrine Auto-Injector Policies in Schools, is published in the same issue of the Texas Register.

The repeal of §§37.601 – 37.611 removes rules no longer necessary under 25 TAC Chapter 37. The new rules in 25 TAC §§40.81 – 40.89 aligns the rules with similar TAC rules relating to stock medications in schools, youth facilities, and other entities such as amusement parks, restaurants, and sport venues.

New 25 TAC §§40.61 – 40.71, to outline the requirements for epinephrine auto-injector policies implemented by school districts, open-enrollment charter schools, and private schools.

CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER E. EPINEPHRINE AUTO-INJECTOR 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 Department of State Health Services (DSHS), adopts new Subchapter E, §§40.61 – 40.71, concerning Epinephrine Auto-Injector Policies in Schools; and new Subchapter F, §§40.81 – 40.89, concerning Opioid Antagonist Medication Requirements in Schools.

Sections 40.61, 40.63 – 40.68, 40.70, 40.71, and §§40.81 – 40.89 are adopted with changes to the proposed text as published in the August 4, 2023, issue of the Texas Register (48 TexReg 4234) and these sections will be republished. Some of these changes provide clarity and consistency throughout the subchapters but do not impact the requirements under Subchapter E or Subchapter F. Sections 40.62 and 40.69 are adopted without changes to the proposed text as published in the August 4, 2023, issue of the Texas Register (48 TexReg 4234) and these sections will not be republished.

This adoption renames 25 Texas Administrative Code (TAC) Chapter 40, as “Stock Medication in Schools and Other Entities” to reflect the broader scope of stock medication rules that will be included under this chapter.

BACKGROUND AND JUSTIFICATION

The adoption implements Senate Bill (S.B.) 629, 88th Legislature, Regular Session, 2023, which amends Texas Education Code Chapter 38 by adding Subchapter E-1. As required by S.B. 629, the Texas Education Agency was consulted and provided comments to the proposed rules relating to maintenance, administration, and disposal of opioid antagonists. S.B. 629 also requires the rules to establish a process for checking inventory and the amount of training for school personnel and volunteers. Finally, S.B. 629 requires schools to report information on the administration of opioid antagonists to the Commissioner of DSHS.

To place all stock medication rules under the same chapter in TAC, this rule adoption adds new Subchapter E, Epinephrine Auto-Injector Policies in Schools, to 25 TAC Chapter 40. The repeal of 25 TAC Chapter 37, Subchapter U is published in this same issue of the Texas Register.

This adoption adds new Subchapter F, Opioid Antagonist Medication Requirements in Schools, as required by S.B. 629.

New 25 TAC §§40.81 – 40.89, to establish minimum standards for administering, maintaining, and disposing of opioid antagonist medication in school districts, open-enrollment charter schools, and private schools.

CHAPTER 40. STOCK MEDICATION IN SCHOOLS AND OTHER ENTITIES
SUBCHAPTER F. OPIOID ANTAGONIST MEDICATION REQUIREMENTS IN SCHOOLS
25 TAC §§40.81 – 40.89

OVERVIEW

BACKGROUND AND JUSTIFICATION

This adoption adds new Subchapter F, Opioid Antagonist Medication Requirements in Schools, as required by S.B. 629.

In Addition Re:

Licensing Actions for Radioactive Materials

For more information, please visit this week’s edition of the Texas Register at 48 Tex Reg 6243.

Department of Aging and Disability Services

Proposed Rules Re:

Repealing 40 TAC §94.1, to delete the rule under the DADS which has been replaced with the proposed new rules in Title 26, Part 1, Chapter 556.

CHAPTER 94. NURSE AIDES
40 TAC §94.1

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Title 40, Part 1, Chapter 94, Nurse Aides, consisting of §94.1.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to remove unnecessary rules from the Texas Administrative Code. 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 HHSC in accordance with Texas Government Code §531.0201 and §531.02011. In September 2018, the rules pertaining to Nurse Aides in Chapter 94 were repealed and proposed as new rules in Title 26, Part 1, Chapter 556, and a reference to those rules was adopted in Chapter 94. This reference is no longer needed and not the current practice for repealing and proposing new rules.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §94.1 deletes the rule as it is no longer necessary.

Repealing 40 TAC §95.1, to delete the rule under the DADS which has been replaced with the proposed new rules in Title 26, Part 1, Chapter 557.

CHAPTER 95. MEDICATION AIDES–PROGRAM REQUIREMENTS
40 TAC §95.1

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Title 40, Part 1, Chapter 95, Medication Aides–Program Requirements, consisting of §95.1.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to remove unnecessary rules from the Texas Administrative Code. 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 HHSC in accordance with Texas Government Code §531.0201 and §531.02011. In September 2018, the rules pertaining to Medication Aides–Program Requirements in Chapter 95 were repealed and proposed as new rules in Title 26, Part 1, Chapter 557, and a reference to those rules was adopted in Chapter 95. This reference is no longer needed and not the current practice for repealing and proposing new rules.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §95.1 deletes the rule as it is no longer necessary.

Repealing 40 TAC §99.1, to delete the rule under the DADS which has been replaced with the proposed new rules in Title 26, Part 1, Chapter 560, addressing denial or refusal of license.

CHAPTER 99. DENIAL OR REFUSAL OF LICENSE
40 TAC §99.1

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Title 40, Part 1, Chapter 99, Denial or Refusal of License, consisting of §99.1.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to remove unnecessary rules from the Texas Administrative Code. 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 HHSC in accordance with Texas Government Code §531.0201 and §531.02011. In September 2018, the rules pertaining to Denial or Refusal of License in Chapter 99 were repealed and proposed as new rules in Title 26, Part 1, Chapter 560, and a reference to those rules was adopted in Chapter 99. This reference is no longer needed and not the current practice for repealing and proposing new rules.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §99.1 deletes the rule as it is no longer necessary.