Texas Register October 9, 2026 Volume: 51 Number: 41

Governor

Appointments Re:

Appointed to the Texas Medical Board District Three Review Committee for a term to expire January 15, 2030, Ricky A. “Rick” Siewert, D.O. of Amarillo, Texas (replacing Gabrielle H. Rich, D.O. of Big Spring who resigned).

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §§217.61 – 217.65, to update the bulk milk hauler/sampler, holding tank, milk tank truck, and unloading station rules to align with the Grade “A” Pasteurized Milk Ordinance and current program practices.

CHAPTER 217. MILK AND DAIRY
SUBCHAPTER D. BULK MILK REGULATIONS
25 TAC §§217.61 – 217.65

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §217.61, concerning Bulk Milk Hauler/Sampler Qualifications and Requirements; §217.62, concerning Bulk Milk Holding Tanks; §217.63, concerning Milk Tank Trucks; §217.64, concerning Unloading Stations and Milk Tank Truck Cleaning Facilities; and §217.65, concerning Responsibilities of the Bulk Milk Hauler/Sampler.

BACKGROUND AND JUSTIFICATION

The purpose of the proposal is to update and clarify regulations related to bulk milk operations to ensure consistency with current industry practices and federal requirements in the Grade “A” Pasteurized Milk Ordinance (PMO). The proposed amendments to Chapter 217, Subchapter D, are necessary to align rule language with current federal standards governing the production, transportation, and handling of milk and dairy products in interstate commerce and to reflect current program practices.

The proposed amendments remove references to the PMO because it is adopted by reference in §217.2, relating to Adopted Regulations and Standards for milk. The proposal updates terminology, improves clarity, and incorporates plain language revisions to enhance readability and understanding. The proposed amendments also remove duplicative or unnecessary provisions and clarify existing requirements without creating new regulatory obligations.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §217.61 requires bulk milk haulers and samplers to collect a temperature control at the first stop and label it appropriately and updates a reference.

The proposed amendment to §271.62 updates a reference.

The proposed amendment to §217.63 allows DSHS to honor the milk tank truck permits of the regulatory agencies of other states and modifies the requirement that milk tank trucks be inspected every 12 months to every 24 months.

The proposed amendment to §217.64 removes the requirement for unloading stations to provide agitation equipment and a minimum agitation time of milk prior to sampling; uses the department issued certification number instead of the sample collector’s driver’s license number; removes outdated or unnecessary requirements, including limitations on the distance between unloading and wash stations, and duplicative provisions to improve clarity and consistency; revises cleaning requirements to align with manufacturer specifications for cleaning solutions; allows milk tank trucks to deliver to only one facility without a wash tag if the facility can demonstrate that cleaning and sanitizing occurred; and updates a reference.

The proposed amendment to §217.65 requires bulk milk haulers and samplers to request certification renewal before certification expires and updates a reference.

Amending 25 TAC §229.261, to add Texas Health and Safety Code Chapter 436 to the chapters under which DSHS proposes and assesses administrative penalties.

CHAPTER 229. FOOD AND DRUG
SUBCHAPTER P. ASSESSMENT OF ADMINISTRATIVE PENALTIES
25 TAC §229.261

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes an amendment to Subchapter P §229.261, concerning Assessment of Administrative Penalties; and new Subchapter JJ, Shrimp Labeling, consisting of §229.1101, concerning Purpose and Scope; §229.1102, concerning Definitions; §229.1103, concerning Exemptions; §229.1104, concerning Shrimp Labeling; §229.1105, concerning Records; and §229.1106, concerning Enforcement.

BACKGROUND AND JUSTIFICATION

The proposal is necessary to comply with Senate Bill (SB) 823, 89th Legislature, Regular Session, 2025, which amended Texas Health and Safety Code (HSC) Chapter 436, Subchapter F, by adding §436.083. HSC §436.083 requires wholesalers to label shrimp as imported if the shrimp does not satisfy the United States country of origin requirements for wild or farm-raised shellfish established by Title 7 Code of Federal Regulations §60.128, or successor regulations. SB 823 allows DSHS to assess administrative penalties for violators that are required to license with DSHS according to HSC Chapter 431. The proposal amends §229.261 by adding HSC Chapter 436 for penalty assessment and adds new Subchapter JJ to implement labeling requirements.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §229.261 adds a reference to HSC Chapter 436 for the assessment of administrative penalties, updates rule citation for formal hearing rules, and makes plain language revisions to improve clarity, readability, and consistency with current drafting standards.

New 25 TAC §§229.1101 – 229.1106, to require wholesalers to label shrimp sold in Texas as imported or not and to keep records supporting the notice, as required by SB 823.

CHAPTER 229. FOOD AND DRUG
SUBCHAPTER JJ. SHRIMP LABELING
25 TAC §§229.1101 – 229.1106

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Proposed new Subchapter JJ, Shrimp Labeling, adds a new subchapter in Chapter 229 to implement state legislation as listed below.

Proposed new §229.1101 describes the purpose and scope of the rule. Statutory authority and the applicability of the rule to shrimp wholesaled into and within Texas are described in this section.

Proposed new §229.1102 establishes the definitions used throughout the subchapter.

Proposed new §229.1103 establishes exemptions to the rule.

Proposed new §229.1104 establishes the labeling requirements for shrimp.

Proposed new §229.1105 establishes the records wholesalers must retain to substantiate the labeling.

Proposed new §229.1106 establishes DSHS’ authority to assess administrative penalties for rule violations.

Texas Department of Insurance

Adopted Rules Re:

Adopting 28 TAC §11.202, to delete the requirement that each item in an application for a certificate of authority be identified by a unique form number.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER C. APPLICATION FOR CERTIFICATE OF AUTHORITY
28 TAC §11.202

OVERVIEW

The commissioner of insurance adopts amendments to 28 TAC §§11.202, 11.301, 11.302, 11.501 – 11.504, 11.506, 11.701, 11.901, 11.902, 11.1402, 11.1604, and 11.2503 and the repeal of 28 TAC §11.505. These sections concern health maintenance organizations (HMOs). The amendments to §§11.202, 11.302, 11.501, 11.503, 11.506, 11.901, 11.1402, 11.1604, and 11.2503 and the repeal of §11.505 are adopted without changes to the proposed text published in the May 8, 2026 issue of the Texas Register (51 TexReg 3058). These sections will not be republished. The amendments to §§11.301, 11.502, 11.504, and 11.701 are adopted with nonsubstantive changes to the proposed text. Section 11.902 is adopted with changes to the proposed text that include revisions in response to public comment. Sections 11.301, 11.502, 11.504, 11.701, and 11.902 will be republished.

BACKGROUND AND JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

Separate adoption orders amend sections in 28 TAC Chapters 3 and 26 to implement the previously referenced legislation. The adopted amendments are also published in this issue of the Texas Register. In a separate proposal published in the May 29, 2026 issue of the Texas Register (51 TexReg 3679), TDI proposed amendments to 28 TAC §3.3704 to implement SB 926. TDI also adopted by reference LHL 138 (Patient Health Plan Coverage Form) and LHL139 (Enrollee’s Other Health Plan Coverage Form), which contain two versions of a uniform coordination of benefits questionnaire, effective January 1, 2026, in 28 TAC Chapter 3, Subchapter V, to implement HB 388. TDI has proposed amendments to 28 TAC Chapter 21 to implement provisions in HB 2221 and SB 1236, and the proposal was published in the July 31, 2026 issue of the Texas Register (51 TexReg 4991).

The amendments to §§11.202, 11.301, 11.302, 11.501 – 11.504, 11.701, and 11.1604, and the repeal of §11.505 are also necessary to update HMO filing rules to align with filing requirements for life, health, and HMO products in 28 TAC Chapter 3, Subchapter A. Historically, HMO filing requirements were addressed exclusively in Chapter 11. However, in 2025, TDI modernized the rules in Chapter 3, Subchapter A, and expanded the scope to include all HMO filings that are filed with TDI’s Life and Health Division through the NAIC’s System for Electronic Rates and Forms Filing (SERFF) after an HMO receives a certificate of authority. The amendments and repeal remove provisions that duplicate or conflict with the provisions in 28 TAC Chapter 3, Subchapter A. Because of the reorganization of §11.301, cross-references in other sections of Chapter 11 are amended to conform to the reorganized subsections and paragraphs.

These amendments will further the goals of Government Code Chapter 465 to ensure that TDI’s rules are clear, concise, and consistent. The adopted amendments and repeal are described in the following paragraphs.

SECTION-BY-SECTION SUMMARY

Section 11.202. The amendments to §11.202 delete subsection (i), which requires each item in an application for a certificate of authority to be identified by a unique form number. This requirement is no longer necessary. Form numbers are needed only for filings made in SERFF, and applicable requirements are contained in 28 TAC Chapter 3, Subchapter A. The deletion of subsection (i) conforms to the amendments to §11.301.

Adopting 28 TAC §11.301 and §11.302, to reorganize HMO filing requirements after issuance of a certificate of authority and conform them to the filing rules in 28 TAC Chapter 3, Subchapter A.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER D. REGULATORY REQUIREMENTS FOR AN HMO AFTER ISSUANCE OF CERTIFICATE OF AUTHORITY
28 TAC §11.301, §11.302

OVERVIEW

REASONED JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.301. The amendments to §11.301 modify the filing requirements to conform to changes previously adopted in 28 TAC Chapter 3, Subchapter A, which broadly address filing requirements for life, health, and HMO products and remove the need for most HMO-specific filing requirements. As part of these amendments, provisions throughout the section are reorganized into subsections, renumbered paragraphs, and redesignated subparagraphs.

To improve readability, amendments to newly designated subsection (a) add statutory citations that are currently included in paragraph (1) and remove language addressing filings for preapproval or for information only, as those filing types are addressed in subsequent subsections. Cross-references to paragraphs (4) and (5) are revised to instead reference newly designated subsections (c) and (d) to reflect the section’s reorganization. A sentence related to paper and electronic filings is deleted since other references in the section delineating such filing methods are also removed.

Paragraph (1) and subparagraph (A) are redesignated as subsection (b) and the catchline is modified to remove the words “and format,” consistent with other changes to the subsection. To improve readability, the references to statutory citations that require filings for approval are moved to subsection (a). References to statutes and rules specifying the information that must be contained for a filing to be considered complete are reorganized into new paragraphs (1) – (3) in new subsection (b). New paragraph (4) adds a reference to filing rules in 28 TAC Chapter 3, Subchapter A, regarding submission requirements for life, health, and HMO products. Subparagraphs (B) – (E), related to filing format and methods, are deleted. Because almost all filings are made electronically, the provisions for paper filings are not necessary. The references to filing methods are unnecessary because they are addressed in newly designated subsections (c) and (d).

Paragraphs (2) and (3), related to form numbers, certification and transmittal forms, supporting documentation, and filing fees, are deleted because similar provisions are contained in 28 TAC Chapter 3, Subchapter A. Since form numbers are not required for filings outside the scope of 28 TAC Chapter 3, Subchapter A, and as previously discussed, the amendment makes a conforming amendment to §11.202 to remove a reference to paragraph (2).

Paragraph (4) is redesignated as subsection (c). References to submissions through SERFF are replaced with a reference to 28 TAC Chapter 3, Subchapter A, which requires electronic submission through SERFF. A nonsubstantive change is made to the proposed text of redesignated subsection (c)(1)(C) to delete an extraneous “and” at the end of the subparagraph.

Paragraph (5) is redesignated as subsection (d). The catchline and the paragraph are expanded to include filings for review because some filings, such as the schedule of charges, are classified as rate filings subject to review under 28 TAC Chapter 3, Subchapter A. To avoid duplication with filing requirements in 28 TAC Chapter 3, Subchapter A, the requirement for accompanying documents is removed. References to SERFF submissions are replaced with a reference to 28 TAC Chapter 3, Subchapter A, which requires electronic submission through SERFF. Nonsubstantive changes are made to the proposed text of redesignated subsection (d) by deleting the word “and” at the end of subparagraph (1)(B) and adding the word “and” to the end of paragraph (2).

Paragraph (6) is redesignated as subsection (e).

Paragraph (7) is redesignated as subsection (f) and updated to align with 28 TAC Chapter 3, Subchapter A. The catchline is revised to reference “requests for corrections” instead of “pending.” Internal cross-references are updated to conform with organizational changes throughout the section. Subparagraph (C), which addresses holding a filing in a pending status, is deleted, since a corresponding requirement is not found in Insurance Code Chapter 1271 or in the filing rules in 28 TAC Chapter 3, Subchapter A. Redesignated paragraph (3) is revised to add a reference to 28 TAC §3.23 and to indicate that if an HMO has not addressed TDI’s request for corrections or additional information within 10 business days, TDI may consider the filing withdrawn from review. This aligns with 28 TAC §3.23(c)(3) and replaces the current provision, stating that after 15 calendar days, the HMO may withdraw the filing before the end of the review period.

Section 11.302. The amendments to §11.302(b)(4) revise a reference to §11.301 to conform to proposed amendments to that section.

Adopting 28 TAC §§11.501 – 11.504 and §11.506 and the repeal of §11.505, to conform evidence of coverage filing rules to 28 TAC Chapter 3, Subchapter A, and extend required newborn coverage from 31 to 60 days under SB 896.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER F. EVIDENCE OF COVERAGE
28 TAC §§11.501 – 11.504, 11.506
28 TAC §11.505

OVERVIEW

REASONED JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.501. The amendments to §11.501 remove outdated filing fee provisions in subsection (b) and replace them with references to the filing requirements in 28 TAC Chapter 3, Subchapter A. Subsection (c), regarding matrix filing fees, is deleted.

Section 11.502. The amendments to §11.502 modify subsection (a) to revise the reference to §11.301 to conform to the amendments reorganizing that section and add a reference to filing requirements in 28 TAC Chapter 3, Subchapter A. A nonsubstantive change to the proposed text of subsection (a) adds “of this title” in the reference to 28 TAC Chapter 3, Subchapter A.

Section 11.503. The amendments to §11.503 revise subsection (a) to add a reference to filing requirements contained in 28 TAC Chapter 3, Subchapter A. Subsection (c) is amended to remove a reference to §11.505, which is repealed. To avoid duplication with provisions in 28 TAC §3.23 and §11.301, subsections (d) – (f) are deleted.

Section 11.504. The amendments to §11.504 revise subsection (a)(1) to add a reference to filing requirements in 28 TAC Chapter 3, Subchapter A, and revise subsection (a)(3) to implement HB 2221 by adding a reference to new Insurance Code Chapter 1702. Subsection (a)(1) as proposed is changed to correct the heading in the reference to Insurance Code Chapter 1271 by adding the word “Organizations.” Subsection (a)(3) as proposed is changed to correct a reference to Insurance Code Chapter 1702 by removing “Insurance Code Chapter” and changing the word “Of” to lowercase.

Section 11.505. The repeal of §11.505 avoids duplication with filing requirements in 28 TAC Chapter 3, Subchapter A.

Section 11.506. The amendments to §11.506(b)(8)(D)(iii) and (v) implement SB 896 by expanding required coverage for newborn children from 31 days to 60 days following birth and by extending the deadline to notify the HMO.

Adopting 28 TAC §11.701, to require HMO schedule of charges filings to follow 28 TAC Chapter 3, Subchapter A, and the major medical rate filing requirements in Subchapter F.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER H. SCHEDULE OF CHARGES
28 TAC §11.701

OVERVIEW

REASONED JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.701. The amendments to §11.701 add a reference in subsection (a) to the filing requirements in 28 TAC Chapter 3, Subchapter A. New subsection (c) is added to reference requirements for major medical rate filings in 28 TAC Chapter 3, Subchapter F, which implements Insurance Code Chapter 1698. Subsection (a) as proposed is changed to correct a punctuation error in the new reference by adding a comma after “Subchapter A,” and to correct a reference to the heading for 28 TAC Chapter 3, Subchapter A, by adding an “s” to the term “Filing.”

Adopting 28 TAC §11.901 and §11.902, to implement HB 388, HB 3211, SB 493, SB 926, and SB 1236 as to HMO physician, provider, pharmacy, and vision care contracts and prohibited actions.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER J. PHYSICIAN AND PROVIDER CONTRACTS AND ARRANGEMENTS
28 TAC §11.901, §11.902

OVERVIEW

REASONED JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.901. The amendments to §11.901 implement legislation related to health plan contracting. An amendment to subsection (b)(12) implements HB 388 by adding a requirement of consistency with new Insurance Code §1203.153, with regard to the mandate for a contracted physician or provider to retain records on a patient’s other health plan coverage. This change will require the inclusion of the coordination of benefits questionnaire with these records. New subsection (h) is added to implement SB 1236 by requiring that a contract between an HMO and a pharmacy or pharmacist comply with pharmacy benefits contracting standards in Insurance Code Chapter 1369.

Section 11.902. Subsection (a)(7) is redesignated as (a)(8), and new subsection (a)(7) is added to implement HB 3211 by prohibiting HMO conduct that violates Insurance Code §1451.1545 or §1451.157. New subsection (a)(9) is added to implement SB 493 by prohibiting conduct that violates Insurance Code §4151.155.

Subsection (b) is amended to implement SB 926 by adding a reference to Insurance Code §843.322. To avoid duplicating the statute, subparagraphs (A) – (D) of paragraph (3) are deleted.

In response to public comment, subsection (b) as proposed has been changed to align with corresponding rule text in 28 TAC §3.3704(e) in a separate TDI rule proposal published in the May 29, 2026 issue of the Texas Register (51 TexReg 3679). These revisions include:

applying the provisions in subsection (b) to an HMO that encourages an enrollee to obtain care from a particular “physician or provider,” consistent with the terminology in §843.322, rather than “provider, as defined in Insurance Code Chapter 1458”;
replacing “do so in a manner that complies” with “comply”; and
deleting paragraphs (1) – (3).

Nonsubstantive revisions correct minor errors in the proposal. Subsection (a)(6) has been revised to remove the extraneous word “or” at the end of the paragraph and to correct a reference to the heading for Insurance Code §1451.156 to read “Certain Conduct Prohibited.” Subsection (b) as proposed has been changed to correct a reference to Insurance Code §843.322 by replacing the word “and” with “or” in the heading.

Adopting 28 TAC §11.1402, to require vision care plans to comply with Insurance Code §1451.1545 under HB 3211.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER O. ADMINISTRATIVE PROCEDURES
28 TAC §11.1402

OVERVIEW

REASONED JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.1402. An amendment to §11.1402 implements HB 3211 by adding new subsection (e) to require vision care plans specifically to comply with Insurance Code §1451.1545.

Adopting 28 TAC §11.1604, to update a cross-reference to conform to the reorganized §11.301.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER Q. OTHER REQUIREMENTS
28 TAC §11.1604

OVERVIEW

REASONED JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.1604. An amendment to §11.1604 revises a reference in paragraph (2) to §11.301 to conform to amendments to that section.

Adopting 28 TAC §11.2503, to add a citation to new Insurance Code Chapter 1702 under HB 2221.

CHAPTER 11. HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER Z. POINT-OF-SERVICE RIDERS
28 TAC §11.2503

OVERVIEW

BACKGROUND AND JUSTIFICATION

The amendments and repeal are necessary to implement the following legislation:

House Bill 388, 89th Legislature, 2025, requires health plans to use a uniform coordination of benefits questionnaire that is adopted by TDI.
House Bill 2221, 89th Legislature, 2025, repeals certain provisions in Insurance Code Chapter 541, concerning unlawful rebates and inducements, and replaces them with similar provisions in new Chapter 1702.
House Bill 3211, 89th Legislature, 2025, establishes new contracting requirements for vision care plans.
Senate Bill 493, 89th Legislature, 2025, prohibits certain pharmacy benefit manager contract provisions.
Senate Bill 896, 89th Legislature, 2025, extends the period during which a newborn child is automatically covered and the deadline to enroll a newborn child into coverage.
Senate Bill 926, 89th Legislature, 2025, expands provisions related to health plans that use steering or tiering to encourage enrollees to use certain network physicians and providers.
Senate Bill 1236, 89th Legislature, 2025, expands requirements for pharmacy benefit network contracts.

SECTION-BY-SECTION SUMMARY

Section 11.2503. An amendment to §11.2503(d) implements HB 2221 by adding a citation to Insurance Code Chapter 1702.

Adopting 28 TAC §26.9, to extend small employer health plan coverage of newborn children to the 61st day after birth and the notice and premium payment deadline to the 60th day under SB 896.

CHAPTER 26. EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS
SUBCHAPTER A. DEFINITIONS, SEVERABILITY, AND SMALL EMPLOYER HEALTH REGULATIONS
28 TAC §26.9

OVERVIEW

The commissioner of insurance adopts amendments to 28 TAC §26.9 and §26.305, concerning small employer and large employer health benefit plans. The amendments implement Senate Bill 896, 89th Legislature, 2025. The amendments are adopted without changes to the proposed text published in the May 8, 2026 issue of the Texas Register (51 TexReg 3081). The sections will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments to §26.9 and §26.305 are necessary to implement SB 896, which expands the coverage period for newborn children under small and large employer health plans subject to Insurance Code Chapter 1501. SB 896 extends the end date of the mandatory coverage period from the 32nd day to the 61st day after a child’s birth, and extends the deadline for an enrollee to notify the health plan and pay any additional premium from the 31st day to the 60th day after the date of birth.

Separate adoption orders amend or repeal sections in 28 TAC Chapters 3 and 11 to implement multiple bills, including SB 896. The adopted amendments and repeal are also published in this issue of the Texas Register.

SECTION-BY-SECTION SUMMARY

Section 26.9. Amendments to §26.9(a)(4) replace a reference to newborn coverage termination on the 32nd day after birth with the 61st day after birth and replace references to a 31-day premium payment deadline with a 60-day payment deadline.

Adopting 28 TAC §26.305, to extend large employer health plan coverage of newborn children to the 61st day after birth and the notice and premium payment deadline to the 60th day under SB 896.

CHAPTER 26. EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS
SUBCHAPTER C. LARGE EMPLOYER HEALTH INSURANCE REGULATIONS
28 TAC §26.305

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 26.305. An amendment to §26.305 replaces the reference in subsection (f) to newborn coverage termination on the 32nd day after birth with the 61st day after birth. Subsection (f)(2) is amended by replacing the references to a 31-day premium payment deadline with a 60-day payment deadline.

Texas Health and Human Services Commission

Adopted Rules Re:

Adopting 26 TAC §370.1, to add medical assistants, first responders, and tattoo or body piercing studio employees to the professions required to take HHSC-approved human trafficking prevention training.

CHAPTER 370. HUMAN TRAFFICKING RESOURCE CENTER
26 TAC §370.1

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §370.1, concerning Human Trafficking Prevention Training Requirements.

Section 370.1 is adopted without changes to the proposed text as published in the June 26, 2026, issue of the Texas Register (51 TexReg 4104). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment is necessary to comply with House Bill (HB) 742, HB 754, and HB 1778, 89th Legislature, Regular Session, 2025, which requires HHSC to include medical assistants, first responders, and tattoo or body piercing studio employees, to the list of professions required to take HHSC-approved human trafficking prevention training.

HB 742 and HB 754 amended Texas Health and Safety Code (HSC) Chapter 763 to require human trafficking prevention training for first responders and medical assistants, respectively. HB 1778 added HSC §146.0075 to require each employee of a tattoo studio or body piercing studio to complete human trafficking prevention training.

In Addition Re:

Correction of Error

The Texas Health and Human Services Commission (HHSC) proposed amendments and new rules in Title 26, Chapter 558 in the September 18, 2026, issue of the Texas Register (51 TexReg 6429). Due to errors by the Texas Register, the text for several rules was published incorrectly.

Public Hearing Notice – Medically Dependent Children Program Nursing Facility Diversion Slots

October 12, 2026

10:00 a.m.

Public Hearing Site:

Texas Health and Human Services Commission (HHSC)

John H. Winters Building

Public Hearing Room 125, First Floor

701 West 51st Street

Austin, Texas 78751

This public hearing will be webcast. Members of the public may attend the public hearing in person at the address above or access a live stream of the public hearing at https://texashhs.org/HHSWebcast. Select the tab for the Winters Live on the date and time for this public hearing. Please e-mail Webcasting@hhsc.state.tx.us if you have any problems with the webcasting function.

Public Hearing. The Health and Human Services Commission (HHSC) will conduct a hybrid public hearing, at the date, time, and location stated above, to solicit feedback and public comment on the proposed rule amendment to Texas Administrative Code, Title 1, Part 15, Chapter 353, Subchapter M, Section 353.1155. This rule amendment creates diversion slots that will allow certain individuals who are at risk of nursing facility admission to access the Medically Dependent Children Program.

Contact: Questions regarding agenda items, content, or public hearing arrangements should be directed to MDCPPolicy@hhs.texas.gov.

Persons who want to attend the public hearing and require assistive technology or services should contact MDCPPolicy@hhs.texas.gov at least 72 hours before the public hearing so appropriate arrangements can be made.