Texas Register Table of Contents
- 1 Texas Medical Board
- 2 Texas Department of State Health Services
- 3 Texas Department of State Health Services
- 4 Texas Department of State Health Services
- 5 Texas Department of State Health Services
- 6 Texas Department of State Health Services
- 7 Texas Department of State Health Services
- 8 Texas Department on Aging and Disability Services
- 9 Texas Department on Aging and Disability Services
- 10 Texas Department on Aging and Disability Services
- 11 Texas Department on Aging and Disability Services
- 12 Texas Department on Aging and Disability Services
- 13 Texas Department on Aging and Disability Services
- 14 Texas Department on Aging and Disability Services
- 15 Texas Department on Aging and Disability Services
- 16 Texas Board of Nursing
- 17 Texas Health and Human Services Commission
- 18 Texas Health and Human Services Commission
- 19 Texas Health and Human Services Commission
- 20 Texas Health and Human Services Commission
- 21 Texas Department of State Health Services
- 22 Texas Department of State Health Services
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
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- 34
Texas Medical Board
Proposed Rules
Proposes amendments to §§161.1 – 161.6. The Board proposes repeal of §§161.8, 161.9, 161.11 – 161.13.
CHAPTER 161. GENERAL PROVISIONSThe Texas Medical Board (Board) proposes amendments to §§161.1 – 161.6. The Board proposes repeal of §§161.8, 161.9, 161.11 – 161.13.The Board conducted a rule review and determined the rule is still necessary. The Board further determined that the amendments and deletions were necessary to accurately reflect the operations of the board and eliminate obsolete committees and their related functions.The amendment to §161.1, relating to Introduction, adds language to recognize and include all advisory board and committees under TMB authority. The proposed amendment also deletes unnecessary repetitive statutory language.The amendment to §161.2, relating to Purpose and Functions, adds language to recognize and include all advisory board and committees under TMB authority, and the role of the board in determining qualifications and eligibility criteria for certain licenses and permits.The amendment to §161.3, relating to Organization and Structure, deletes unnecessary repetitive statutory language. The proposed amendment simplifies rules relating to standards of eligibility, conduct, and potential grounds for removal of board members.The amendment to §161.4, relating to Officers of the Board, removes an incorrect word.The amendment to §161.5, relating to Meetings, deletes reference to certain committees that are disbanded, obsolete or unnecessary.The amendment to §161.6, relating to Committees of the Board, deletes unnecessary repetitive statutory language.The repeal of §161.8, relating to Chief of Staff, deletes unnecessary repetitive statutory language.The repeal of §161.9, relating to Medical Director, deletes unnecessary repetitive statutory language.The repeal of §161.11, relating to Rule Changes, deletes unnecessary repetitive statutory language.The repeal of §161.12, relating to Compliance with Non-Discrimination Laws, deletes unnecessary repetitive statutory language.The repeal of §161.13, relating to General Considerations, deletes unnecessary repetitive statutory language.
Texas Department of State Health Services
Proposed Rules
Proposes amendments to §131.2, concerning Definitions; and §131.46, concerning Emergency Services (Freestanding Emergency Medical Care Facilities)
CHAPTER 131. FREESTANDING EMERGENCY MEDICAL CARE FACILITIESThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §131.2, concerning Definitions; and §131.46, concerning Emergency Services.BACKGROUND AND PURPOSEThe proposal is necessary to comply with House Bill (H.B.) 3152, 85th Legislature, Regular Session, 2017, which amends the Texas Health and Safety Code, Chapter 323. H.B. 3152 requires HHSC to define facilities as sexual assault forensic exam (SAFE)-ready facilities and requires certain health-care facilities to provide sexual assault survivors the option to transfer to a facility that is SAFE-ready. The proposed amendment to §131.46 will also implement H.B. 4531, 86th Legislature, Regular Session, 2019, concerning the rights and treatment of and services provided to certain adult sexual assault survivors.SECTION-BY-SECTION SUMMARYThe proposed amendment to §131.2 adds definitions of the terms SAFE-ready facility, sexual assault forensic examiner, and sexual assault survivor, and re-numbers the definitions accordingly. This amendment is necessary to comply with H.B. 3152.The proposed amendment to §131.46(h) updates language for emergency services available to sexual assault survivors and adds a reference to Texas Health and Safety Code, Chapter 323, which outlines the care facilities must provide to sexual assault survivors. This amendment is necessary to comply with H.B. 3152 and H.B. 4531.
Texas Department of State Health Services
Proposed Rules
Proposes an amendment to §131.45, concerning Facility Staffing and Training
25 TAC §131.45The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §131.45, concerning Facility Staffing and Training.BACKGROUND AND PURPOSEThe purpose of the proposal is to update the requirements for establishing a nursing peer review committee. The proposal is necessary to comply with House Bill (H.B.) 3296, 85th Legislature, Regular Session, 2017, which amended the Texas Occupations Code, Chapter 303, related to nursing peer review committees.SECTION-BY-SECTION SUMMARYThe proposed amendment to §131.45 adds new subsection (d) to require the establishment of a nursing peer review committee to conduct nursing peer review, as required by Texas Occupations Code, Chapter 303. This amendment is necessary to comply with H.B. 3296.
Texas Department of State Health Services
Proposed Rules
Proposes an amendment to §131.44, concerning emergency services for sexual assault survivors
SUBCHAPTER C. OPERATIONAL REQUIREMENTS25 TAC §131.46STATUTORY AUTHORITYThe amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and the Texas Health and Safety Code, Chapter 323.CROSS REFERENCE TO STATUTEThe rule amendments implement Texas Health and Safety Code, Chapters 254 and 323, and Texas Government Code, Chapter 531.
Texas Department of State Health Services
Proposed Rules
Proposes amendments to Texas Hospital Licensing Law, Health and Safety Code (HSC), Chapters 241 & 323
SUBCHAPTER A. GENERAL PROVISIONS25 TAC §133.2STATUTORY AUTHORITYThe amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and the Texas Health and Safety Code, Chapter 323.The rule amendments implement Texas Health and Safety Code, Chapters 241 and 323, and Texas Government Code, Chapter 531.
Texas Department of State Health Services
Proposed Rules
Proposal to update the requirements for establishing a nursing peer review committee
CHAPTER 135. AMBULATORY SURGICAL CENTERSSUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS25 TAC §135.15The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §135.15, concerning Facility Staffing and Training.BACKGROUND AND PURPOSEThe purpose of the proposal is to update the requirements for establishing a nursing peer review committee. The proposal is necessary to comply with House Bill (H.B.) 3296, 85th Legislature, Regular Session, 2017, which amended the Texas Occupations Code, Chapter 303, related to nursing peer review committees.SECTION-BY-SECTION SUMMARYThe proposed amendment to §135.15 adds new subsection (c) to require the establishment of a nursing peer review committee to conduct nursing peer review, as required by Texas Occupations Code, Chapter 303. This amendment is necessary to comply with H.B. 3296.
Texas Department of State Health Services
Proposed Rules
Proposal to amend Chapter 200 (Reporting of health care-associated infections and preventable adverse events)
CHAPTER 200. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND PREVENTABLE ADVERSE EVENTSSUBCHAPTER A. CONTROL OF COMMUNICABLE DISEASES25 TAC §§200.1 – 200.6The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendments to §200.1, concerning Definitions; §200.2, concerning General Reporting Guidelines for Health Care-Associated Infection and Preventable Adverse Event Data; §200.3, concerning How to Report; §200.4, concerning Which Events to Report; §200.5, concerning Data to Report; and §200.6, concerning When to Initiate Reporting.BACKGROUND AND PURPOSEThe proposal is necessary to comply with Senate Bill (S.B.) 384, 86th Legislature, Regular Session, 2019, which amended Texas Health and Safety Code, Chapter 98, Reporting of Health Care-Associated Infections and Preventable Adverse Events. The new law alters the list of health care-associated infections (HAIs) that health care facilities must report to DSHS by removing the language outlining the specific medical procedures required for HAI reporting by facility type, and replacing it with a requirement for all health care facilities to report the list of HAIs that the Centers for Medicare and Medicaid Services (CMS) require facilities participating in the Medicare program to report. These changes have the effect of aligning state reporting requirements with federal CMS reporting requirements. Health care facilities will now have one set of HAI data elements to report, instead of having to report one set of data elements mandated by Texas and another mandated by CMS. This alignment will significantly ease reporting requirements.SECTION-BY-SECTION SUMMARYSection 200.1 deletes the definitions of “APGAR Score,” “central line,” “medical gas,” “perinatal,” “pediatric and adolescent hospital,” “special care setting,” “unsafe condition,” “urinary catheter,” and “urinary tract infection (UTI).” The amendment revises the name of the definition of “inpatient treatment” to “inpatient,” and deletes the reference “of greater than 24 hours.” The amendment adds a statement “as defined by the NHSN,” an acronym for the Centers for Disease Control and Prevention’s National Healthcare Safety Network or its successor. The amendment uses the acronym HAI for health care-associated infection and uses “HAI data” for health-care associated infection data.The amendment to §200.2 deletes the preventable adverse event (PAE) data information since the PAE data are not reported to NHSN and adds the titles of the referenced sections.The amendment to §200.3(b) adds the titles of the referenced sections. The amendment to §200.3(c) corrects a rule reference for §200.1 that is renumbered due to the deletion of certain definitions. The reference to a hospital and ambulatory surgical center was removed in subsection (c)(2) as those references are listed in subsection (c). The amendment to §200.3(e) deletes the specific reporting requirement for patients identified with a surgical site infection associated with a procedure, since it was removed in §200.4.The amendment to §200.4 removes specific procedures required for HAI reporting by facility type and replaces it with the requirements for all health care facilities to report the list of HAIs that CMS requires facilities participating in the Medicare program to report. The amendment adds a website for a current list of reportable HAIs and PAEs.The amendment to §200.5 includes a DSHS website for HAITexas.org and PAETexas.org for facilities to utilize for data reporting requirements.The amendment to §200.6 removes specific procedures required for HAI reporting by facility type and replaces it with the requirements for all health care facilities to report the list of HAIs that CMS requires facilities participating in the Medicare program to report.
Texas Department on Aging and Disability Services
Adopted Rules
INTELLECTUAL DISABILITY SERVICES–MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
CHAPTER 9. INTELLECTUAL DISABILITY SERVICES–MEDICAID STATE OPERATING AGENCY RESPONSIBILITIESAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts amendments to §§9.153, 9.177, 9.178, and 9.190; and new §9.175; in Subchapter D, Home and Community-based Services (HCS) Program and Community First Choice (CFC); and amendments to §§9.553, 9.555, 9.579, 9.580, and 9.583; and new §9.585; in Subchapter N, Texas Home Living (TxHmL) Program and Community First Choice (CFC); in Title 40, Part 1, Chapter 9, Intellectual Disability Services–Medicaid State Operating Agency Responsibilities.The amendments to §9.178 and §9.580, and new §9.175 and §9.585, are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 942). The amendments to §§9.153, 9.177, 9.190, 9.553, 9.555, 9.579, and 9.583 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 942), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONThe HCS Program and the TxHmL Program are Medicaid waiver programs approved by the Centers for Medicare & Medicaid Services under §1915(c) of the Social Security Act. These programs provide community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting.One of the purposes of the adopted rules is to include in Chapter 9, Subchapters D and N, all of the requirements related to abuse, neglect, and exploitation of an individual in the HCS or TxHmL Program. Currently, Texas Administrative Code, Title 40, (40 TAC) §49.310, Abuse, Neglect, and Exploitation Allegations, applies to the HCS and TxHmL Programs and requires a program provider to take certain actions related to abuse, neglect, and exploitation. Rules in 40 TAC Chapter 49, Contracting for Community Services, are being adopted in this issue of the Texas Register, to include the HCS and TxHmL Programs from §49.310. Those rules are adopted in Chapter 9, Subchapters D and N, to use terminology specific to the HCS and TxHmL Programs, add specificity to the current requirements of §49.310, and add new requirements. For example, the adopted rules require a program provider to (1) conduct training related to abuse, neglect, and exploitation of staff members, service providers, and volunteers before assuming job duties and at least annually thereafter; (2) ensure that the persons who are trained are knowledgeable about signs and symptoms of abuse, neglect, and exploitation; and (3) educate an individual and legally authorized representative (LAR) about protecting the individual from abuse, neglect, and exploitation.Another purpose of the adopted rules is to change current references to “Department of Family and Protective Services (DFPS) investigations” to “HHSC investigations.” This change is necessary because effective September 1, 2017, in accordance with Texas Government Code, §531.02011 and §531.02013, the functions performed by the DFPS Adult Protective Services (APS) Provider Investigations (PI) Program were transferred to HHSC. The adopted rules also clarify that HHSC investigates allegations of abuse, neglect, or exploitation of an individual when the alleged perpetrator is a volunteer or controlling person, in addition to if the alleged perpetrator is a service provider or staff member.Another purpose of the adopted rules is to include current requirements for Local Intellectual and Developmental Disability Authorities (LIDDAs) that address changes to the investigatory process for abuse, neglect, and exploitation as a result of amendments to Texas Human Resources Code, Chapter 48, effective September 1, 2015. The amendments gave the DFPS APS PI Program the authority to investigate an allegation of abuse, neglect, or exploitation of an individual receiving services through the consumer directed services (CDS) option. The adopted rules require a LIDDA to ensure its rights protection officer who receives a copy of an HHSC initial intake report or a final investigative report for individuals receiving services through the CDS option, gives a copy of each report to the individual’s service coordinator so that the service coordinator can perform functions related to those reports. The requirements for service coordinators related to abuse, neglect, and exploitation in the CDS option are being adopted in 40 TAC Chapter 41, Consumer Directed Services Option, in this same issue of the Texas Register.The adopted rules require a service provider of behavioral support who is a behavior analyst to be licensed in accordance with Texas Occupations Code, Chapter 506. This change is based on Senate Bill 589 (85th Legislature, Regular Session, 2017) which added Chapter 506 to the Texas Occupations Code to require a behavior analyst to be licensed by the Texas Department of Licensing and Regulation by September 1, 2018.The adopted rules related to the TxHmL Program delete rules regarding social work services because social work is not a TxHmL Program service.The adopted rules also update agency names and replace specific website addresses.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 41. CONSUMER DIRECTED SERVICES OPTION
CHAPTER 41. CONSUMER DIRECTED SERVICES OPTIONAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1.Therefore, the Executive Commissioner of HHSC adopts amendments to §§41.103, 41.108, 41.238, 41.301, 41.307, 41.309, 41.313, and 41.339 in Title 40, Part 1, Chapter 41, Consumer Directed Services Option. The executive commissioner of HHSC also adopts new §§41.233, 41.701, 41.702, and 41.703 in Title 40, Part 1, Chapter 41. Finally, the executive commissioner of HHSC adopts the repeal of §41.233 and §41.701 in Title 40, Part 1, Chapter 41.The amendments to §§41.238, 41.307, and 41.309, and new §§41.701, 41.702, and 41.703 are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 982). These sections will be republished. The amendments to §§41.103, 41.108, 41.301, 41.313, and 41.339, new §41.233, and the repeal of §41.233 and §41.701 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 982). These sections will not be republished.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 42. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
CHAPTER 42. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICESAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts amendments to §42.103, §42.201, §42.211, §42.212, §42.216, §42.221, §42.223, §42.301, §42.401, §42.405, §42.406, §42.613, §42.614, §42.617, §42.623, §42.632, and §42.641; new §42.220, §42.403, §42.410, and §42.411; and the repeal of §42.222 and §42.403, in Chapter 42, Deaf Blind with Multiple Disabilities (DBMD) Program and Community First Choice (CFC) Services.The amendments to §42.103, §42.201, §42.212, §42.223, §42.301, §42.401, and §42.405, and new §42.403, §42.410, and §42.411 are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 997). The amendments to §42.211, §42.216, §42.221, §42.406, §42.613, §42.614, §42.617, §42.623, §42.632, and §42.641; new §42.220; and the repeal of §42.222 and §42.403 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 997), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONChapter 42, Deaf Blind with Multiple Disabilities and Community First Choice (CFC) Services, governs the Deaf Blind with Multiple Disabilities (DBMD) Program. The DBMD Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. It provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting through the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Program. An individual in the DBMD Program receives DBMD program services, including case management, and CFC services from a single DBMD program provider.One of the purposes of the adopted rules is to address adjustments to the investigatory process for abuse, neglect, and exploitation as a result of amendments to Texas Human Resources Code, Chapter 48, and Texas Family Code, Chapter 261, effective September 1, 2015. The amendments gave the Department of Family and Protective Services (DFPS) Adult Protective Services (APS) Provider Investigation (PI) Program the authority to investigate an allegation of abuse, neglect or exploitation of an individual in the DBMD Program when the alleged perpetrator is a service provider, staff person, volunteer, or controlling person of a DBMD program provider. Effective September 1, 2017, in accordance with Texas Government Code, §§531.02011 and 531.02013, the functions performed by the DFPS APS PI Program were transferred to HHSC. The adopted rules address investigations of allegations of abuse, neglect, and exploitation conducted by HHSC for an individual in the DBMD Program and describe requirements for the DBMD program provider to protect an individual from abuse, neglect, and exploitation and help ensure the health, safety, and welfare of an individual who is abused, neglected, or exploited.The adopted rules also include the current requirements in 40 TAC §49.310, Abuse, Neglect, and Exploitation Allegations, that apply to a DBMD program provider. Rules in 40 TAC Chapter 49, Contracting for Community Services, are being adopted in this issue of the Texas Register, to exclude the DBMD program provider from §49.310. These rules are adopted in Chapter 42 to use terminology specific to the DBMD Program, add specificity to the current requirements of §49.310, and add new requirements for a DBMD program provider. For example, the adopted rules require a DBMD program provider to (1) conduct training of program directors, service providers, staff persons, and volunteers related to abuse, neglect, and exploitation according to specified time frames; (2) ensure that the persons who are trained are knowledgeable about signs and symptoms of abuse, neglect, and exploitation; and (3) educate an individual and legally authorized representative (LAR) or person actively involved with the individual about protecting the individual from abuse, neglect, and exploitation.The adopted rules require a DBMD program provider to report critical incidents to HHSC to address the CMS requirement that HHSC have an incident management system in place to help ensure an individual’s health and welfare.In response to direction from CMS to help meet the requirement in the Code of Federal Regulations, Title 42 (42 CFR), §441.302(b) regarding financial accountability, the adopted rules require a program provider to ensure that, after a DBMD case manager or other program service provider completes an HHSC Documentation of Services Delivered form, a staff person other than the case manager or service provider who completed the form signs and dates the form as a timekeeper as verification of the accuracy of the information on the form.In response to direction from CMS to meet the requirement in 42 CFR §441.302(c)(2), regarding reevaluations of an individual’s level of care (LOC), and §441.301(c)(3) regarding reviews of an individual’s service plan, the adopted rules require a DBMD program provider to have and implement written policies and procedures to ensure the case manager complies with the requirement to submit to HHSC, at least 30 calendar days before the expiration of an individual’s individual plan of care (IPC) period, the documentation HHSC needs to determine whether an individual continues to meet the required LOC and whether the individual’s IPC will be authorized. The adopted rules require a program provider’s written policies and procedures to include using a written or electronic tracking system that alerts the provider to activities that must occur for the provider to timely submit the documentation to HHSC. The adopted rules also replace “diagnostic eligibility” with “LOC VIII” throughout the chapter to conform with the terms used in the eligibility criteria for the DMBD Program described in 40 TAC §9.239.The adopted rules address a CMS requirement that, if an individual’s LOC VIII expires before HHSC determines whether the individual meets the LOC VIII criteria or an individual’s IPC period expires before HHSC authorizes a proposed renewal IPC, the DBMD program provider must continue to provide services to the individual until HHSC authorizes the proposed renewal IPC to ensure continuity of care and prevent the individual’s health and welfare from being jeopardized.In response to direction from CMS to meet the requirement in 42 CFR §441.302(d), the adopted rules require a DBMD program provider to, at least annually after enrollment, obtain the signature of the individual or LAR on a Waiver Program Verification of Freedom of Choice form documenting the individual’s or LAR’s choice of the DBMD Program over the ICF/IID Program.The adopted rules require a service provider of CFC personal assistance services/habilitation (PAS/HAB) to have certification in cardiopulmonary resuscitation (CPR), first aid, and choking prevention so that the service provider is prepared and qualified to assist an individual who needs CPR.The adopted rules require a DBMD program provider to electronically access the Medicaid Eligibility Service Authorization Verification (MESAV) system to determine if the information on an individual’s enrollment IPC, revision IPC, or renewal IPC authorized by HHSC is consistent with the information in MESAV and, if inconsistent, to notify HHSC of the inconsistency. The purpose of this requirement is to help prevent billing discrepancies and payment adjustments that result from inaccurate information being entered into MESAV.The adopted rules also update agency names and replace specific website addresses.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 44. CONSUMER MANAGED PERSONAL ATTENDANT SERVICES
CHAPTER 44. CONSUMER MANAGED PERSONAL ATTENDANT SERVICESAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1, govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts amendments to §§44.102, 44.202, 44.302, 44.306 – 44.308, 44.402, 44.421, 44.422, 44.441, 44.442, 44.502, 44.504, and 44.505; and new §§44.310, 44.311, 44.443, and 44.444 in Title 40, Part 1, Chapter 44, Consumer Managed Personal Attendant Services.The amendments to §§44.102, 44.302, 44.306, 44.402, 44.421, 44.422, 44.441, 44.442, 44.502, and 44.504; and new §§44.311, 44.443, and 44.444 are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1031). The amendments to §§44.202, 44.307, 44.308, and 44.505, and new §44.310 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1031), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONThe adopted rules include requirements in Chapter 44 related to abuse, neglect, and exploitation of an individual in the Consumer Managed Personal Attendant Services (CMPAS) Program. The CMPAS Program is a non-Medicaid Program in which an individual may receive services in one of three service delivery options: the traditional service option; the block grant option; or the consumer directed services (CDS) option. In the CDS option, an individual is the employer of the attendants who provide CMPAS services, while a provider provides financial management services to the individual and completes HHSC training to function as a financial management services agency. In the traditional services option, a provider is the employer of the attendants who provide personal attendant services to an individual. In the block grant option, an individual is the employer of the attendant and a provider is the employer of the substitute attendant. In all three options, a provider is required to provide case management to an individual.The purpose of the adopted rules is to address changes in the investigatory process for abuse, neglect, and exploitation resulting from amendments to Texas Human Resources Code, Chapter 48. The statutory amendments gave the Department of Family and Protective Services (DFPS) Adult Protective Services (APS) Provider Investigation (PI) Program the authority to investigate an allegation of abuse, neglect or exploitation of an individual receiving CMPAS Program services through the CDS option when the alleged perpetrator is a “provider,” as defined for the CDS option under Texas Human Resources Code, Chapter 48. As further specified in the adopted rules, this includes when the alleged perpetrator is an employee of the individual or a staff person or controlling person of the provider.Effective September 1, 2017, in accordance with Texas Government Code, §531.02011 and §531.02013, the functions performed by the DFPS APS PI Program were transferred to HHSC. Therefore, the adopted rules address investigations of allegations of abuse, neglect, and exploitation conducted by HHSC for an individual receiving CMPAS Program services through the CDS option, and describe requirements for the individual and provider to protect an individual from abuse, neglect, and exploitation and secure the safety of an individual who may have been abused, neglected, or exploited.The adopted rules also include the current requirements in Texas Administrative Code, Title 40, (40 TAC) §49.310, Abuse, Neglect, and Exploitation Allegations, that apply to a CMPAS provider. Those rules, as adopted in Chapter 44, use terminology specific to the CMPAS Program, add specificity to the current requirements of §49.310, and add new requirements. For example, the adopted rules require a provider to: (1) conduct training of staff persons on abuse, neglect, and exploitation before the staff persons assume job duties and annually thereafter; (2) ensure such persons are trained about signs and symptoms of abuse, neglect, or exploitation; (3) educate an individual and representative about protecting the individual from abuse, neglect, and exploitation; and (4) give written information to staff on how to report abuse, neglect, or exploitation. Rules adopted in 40 TAC Chapter 49, Contracting for Community Services, to exclude a CMPAS provider from the requirement to comply with §49.310, are also being published in this issue of the Texas Register.The adopted rules define “abuse,” “exploitation,” “neglect,” and other terms related to abuse, neglect, and exploitation to clarify the terms when used in 40 TAC Chapter 44. In addition, the adopted rules define the terms “chemical restraint,” “mechanical restraint,” “physical restraint,” “restraint,” and “seclusion.” They also define “physical abuse” to include the use of restraint or seclusion because restraint and seclusion are prohibited by the adopted CMPAS rules. This is consistent with DFPS rules, which provide that the use of restraint or seclusion that is not in compliance with rules constitutes physical abuse.The adopted rules also make changes to clarify and update provider requirements for interdisciplinary team meetings; development and maintenance of records; attendant time sheets; and billing. The adopted rules also clarify terminology and rules that apply to an individual’s legally authorized representative.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 45. COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICES
CHAPTER 45. COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICESAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts amendments to §45.103, §45.201, §§45.212-§45.214, §45.216, §45.221, §45.223, §45.225, §45.403, §45.405, §45.406, §45.702, §45.704, §45.707, §45.802, §45.804, and §45.807; new §45.226, §45.227, §45.706, §45.708, §45.709, §45.810, and §45.811; and the repeal of §45.706, in Title 40, Part 1, Chapter 45, Community Living Assistance and Support Services and Community First Choice (CFC) Services.The amendments to §45.103, §45.212, §45.405, §45.704, §45.804, and §45.807, and new §45.709 and §45.811, are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1048). The amendments to §45.201, §45.213, §45.214, §45.216, §45.221, §45.223, §45.225, §45.403, §45.406, §45.702, §45.707, and §45.802, new §45.226, §45.227, §45.706, §45.708, and §45.810, and the repeal of §45.706, are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1048), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONChapter 45, Community Living Assistance and Support Services and Community First Choice (CFC) Services, governs the Community Living Assistance and Support Services (CLASS) Program. The CLASS Program is a Medicaid waiver program approved by the Centers for Medicare & Medicaid Services (CMS) under §1915(c) of the Social Security Act. It provides community-based services and supports to an eligible individual as an alternative to services provided in an institutional setting through the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Program. “Direct services,” as defined in Chapter 45, are provided by a CLASS direct services agency (DSA) that contracts with HHSC and holds a home and community support services agency (HCSSA) license. Case management services are provided by a CLASS case management agency (CMA) that contracts with HHSC.One of the purposes of the adopted rules is to address adjustments to the investigatory process for abuse, neglect, and exploitation as a result of amendments to Texas Human Resources Code, Chapter 48, and Texas Family Code, Chapter 261, effective September 1, 2015. The amendments gave the Department of Family and Protective Services (DFPS) Adult Protective Services (APS) Provider Investigation (PI) Program the authority to investigate an allegation of abuse, neglect or exploitation of an individual in the CLASS Program when the alleged perpetrator is a staff person, service provider, volunteer, or controlling person of a CMA or DSA. Effective September 1, 2017, in accordance with Texas Government Code, §§531.02011 and 531.02013, the functions performed by the DFPS APS PI Program were transferred to HHSC. The adopted rules address investigations of allegations of abuse, neglect, and exploitation conducted by HHSC for an individual in the CLASS Program and describe requirements for the CMA and DSA to protect an individual from abuse, neglect, and exploitation and help ensure the health, safety, and welfare of an individual who is abused, neglected, or exploited.The adopted rules also include the current requirements in Texas Administrative Code, Title 40, (40 TAC) §49.310, Abuse, Neglect, and Exploitation Allegations, that apply to a CMA and DSA. Rules in 40 TAC Chapter 49, Contracting for Community Services, are adopted for amendment in this issue of the Texas Register, to exclude the CLASS Program from §49.310. Those rules are adopted in Chapter 45 to use terminology specific to the CLASS Program, add specificity to the current requirements of §49.310, and add new requirements for a CMA and DSA. For example, the adopted rules require a CMA and DSA to (1) conduct training of staff persons, service providers, and volunteers related to abuse, neglect, and exploitation according to specified time frames; (2) ensure that the persons who are trained are knowledgeable about signs and symptoms of abuse, neglect, and exploitation; and (3) educate an individual and legally authorized representative (LAR) or person actively involved with the individual about protecting the individual from abuse, neglect, and exploitation.The adopted rules require a CMA and DSA to report critical incidents to HHSC to address the CMS requirement that HHSC have an incident management system in place to help ensure an individual’s health and welfare.In response to direction from CMS to help meet the requirement in the Code of Federal Regulations, Title 42 (42 CFR), §441.302(b) regarding financial accountability, the adopted rules require a CMA and DSA to ensure that, after a CMA case manager or a DSA service provider completes an HHSC Documentation of Services Delivered form, that a staff person other than the case manager or service provider who completed the form signs and dates the form as a timekeeper as verification of the accuracy of the information on the form.In response to direction from CMS to meet the requirement in 42 CFR §441.302(c)(2), regarding reevaluations of an individual’s level of care (LOC), the adopted rules require a DSA to have and implement written policies and procedures to ensure the DSA complies with the requirement to submit to HHSC, at least 60 calendar days before the expiration of an individual’s individual plan of care (IPC) period, the documentation HHSC needs to determine whether an individual continues to meet the required LOC. The adopted rules require a DSA’s written policies and procedures to include using a written or electronic tracking system that alerts the DSA to activities that must occur for the DSA to timely submit the documentation to HHSC. The adopted rules also replace “diagnostic eligibility” with “LOC VIII” throughout the chapter to conform with the terms used in the eligibility criteria for the CLASS Program described in 40 TAC §9.239.In response to direction from CMS to meet the requirement in 42 CFR §441.301(c)(3), regarding reviews of an individual’s service plan, the adopted rules require a CMA to have and implement written policies and procedures to ensure the CMA complies with the requirement to submit to HHSC, at least 30 calendar days before the end of the individual’s IPC period, the documentation HHSC needs to determine whether the individual’s IPC will be authorized. The adopted rules also require a CMA’s written policies and procedures to include using a written or electronic tracking system that alerts the CMA to activities that must occur for the CMA to timely submit the documentation to HHSC.The adopted rules address a CMS requirement that, if an individual’s LOC VIII expires before HHSC determines whether the individual meets the LOC VIII criteria, or an individual’s IPC period expires before HHSC authorizes a proposed renewal IPC, the CMA and the DSA must continue to provide services to the individual until HHSC authorizes the proposed renewal IPC to ensure continuity of care and prevent the individual’s health and welfare from being jeopardized.In response to direction from CMS to meet the requirement in 42 CFR, §441.302(d), the adopted rules require a CMA to at least annually after enrollment, obtain the signature of the individual or LAR on a Waiver Program Verification of Freedom of Choice form documenting the individual’s or LAR’s choice of the CLASS Program over the ICF/IID Program.The adopted rules require a service provider of CFC personal assistance services/habilitation (PAS/HAB) to have training in cardiopulmonary resuscitation (CPR) and choking prevention so that the service provider is prepared and qualified to assist an individual who needs CPR.The adopted rules require a CMA and DSA to electronically access the Medicaid Eligibility Service Authorization Verification (MESAV) system to determine if the information on an individual’s enrollment IPC, revision IPC, or renewal IPC authorized by HHSC is consistent with the information in MESAV and, if inconsistent, to notify HHSC of the inconsistency. The purpose of this requirement is to help prevent billing discrepancies and payment adjustments that result from inaccurate information being entered into MESAV.The adopted rules also update agency names and replace specific website addresses.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 47. PRIMARY HOME CARE, COMMUNITY ATTENDANT SERVICES, AND FAMILY CARE PROGRAMS
CHAPTER 47. PRIMARY HOME CARE, COMMUNITY ATTENDANT SERVICES, AND FAMILY CARE PROGRAMSAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1, govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055 requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1.Therefore, the Executive Commissioner of HHSC adopts amendments to §47.1, §47.3, §47.21, §47.23, §47.25, §47.41, §47.45, §47.47, §47.49, §47.57, §47.61, §47.63, §47.67, §47.69, §47.71, §47.73, §47.81, §47.83, §47.85, §47.89, and §47.91, new §47.43, §47.74, §47.101, and §47.103, and the repeal of §47.43, §47.59, and §47.72 in Title 40, Part 1, Chapter 47, Contracting to Provide Primary Home Care.The amendments to §47.3, §47.21, §47.23, §47.25, §47.41, and §47.57, and new §47.101 and §47.103 are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1080). The amendments to §47.1, §47.45, §47.47, §47.49, §47.61, §47.63, §47.67, §47.69, §47.71, §47.73, §47.81, §47.83, §47.85, §47.89, and §47.91, new §47.43 and §47.74, and the repeal of §47.43, §47.59, and §47.72 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1080), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONThe adopted rules add requirements in Texas Administrative Code, Title 40 (40 TAC), Chapter 47 related to abuse, neglect, and exploitation of an individual receiving personal attendant services in the Primary Home Care (PHC) Program, Community Attendant Services (CAS) Program, or Family Care (FC) Program from a provider that is required to be licensed in accordance with 26 TAC Chapter 558, Licensing Standards for Home and Community Support Services Agencies. In the PHC, CAS, and FC Programs an individual may receive services through the provider option as described in 40 TAC Chapter 47; the service responsibility option (SRO) as described in 40 TAC Chapter 43, Service Responsibility Option; or the consumer directed services (CDS) option, as described in 40 TAC Chapter 41, Consumer Directed Services Option. Rules in Chapter 41 related to abuse, neglect, and exploitation of an individual receiving services through the CDS option are adopted elsewhere in this issue of the Texas Register.The primary purpose of the adopted rules is to address changes in the investigatory process for abuse, neglect, and exploitation as a result of amendments to Texas Human Resources Code, Chapter 48, and Texas Family Code, Chapter 261, effective September 1, 2015. The amendments gave the Department of Family and Protective Services (DFPS) Adult Protective Services (APS) Provider Investigation (PI) Program the authority to investigate an allegation of abuse, neglect, or exploitation of an individual receiving Medicaid state plan services in the PHC and CAS Programs when the alleged perpetrator is a staff person or controlling person of a provider. Because the FC Program is not a Medicaid program, the amendments to state law did not change the investigatory process for abuse, neglect, and exploitation in the FC Program. Investigations in the FC Program remain under the authority of the DFPS APS In-Home Program when the alleged perpetrator is a staff person or controlling person of a provider.Effective September 1, 2017, in accordance with Texas Government Code, §531.02011 and §531.02013, the functions performed by the DFPS APS PI Program were transferred to HHSC. Therefore, the adopted rules address investigations of allegations of abuse, neglect, and exploitation conducted by HHSC for an individual receiving services in the PHC and CAS Programs through the provider option and the SRO. The adopted rules also describe requirements for the provider to protect an individual from abuse, neglect, and exploitation and help ensure the health, safety, and welfare of an individual who is abused, neglected, or exploited.The adopted rules also include the current requirements in 40 TAC §49.310, Abuse, Neglect, and Exploitation Allegations, that apply to a provider that contracts with HHSC to provide services in the PHC, CAS, and FC Programs. Rules in 40 TAC Chapter 49, Contracting for Community Services, are adopted in this issue of the Texas Register to exclude a provider providing services governed by Chapter 47 from complying with §49.310. These rules are adopted in Chapter 47 to use terminology specific to these programs; add specificity to the current requirements of §49.310; add new requirements; provide protections from abuse, neglect, and exploitation; and help ensure the health, safety, and welfare of an individual who is receiving services in each of these programs and who is abused, neglected, or exploited. The adopted rules require a provider to: (1) train staff persons on abuse, neglect, and exploitation before they assume job duties and at least annually; (2) ensure staff persons are trained and knowledgeable about signs and symptoms of abuse, neglect, and exploitation; (3) educate an individual and his or her representative about protecting the individual from abuse, neglect, and exploitation; and (4) give written information to each staff person on how to report abuse, neglect, and exploitation.The adopted rules also define “abuse,” “exploitation,” “neglect,” and other terms related to abuse, neglect, and exploitation to clarify the terms when used in this chapter. In addition, the adopted rules define the terms “chemical restraint,” “mechanical restraint,” “physical restraint,” “restraint,” and “seclusion.” They also define “physical abuse” to include the use of a restraint or seclusion because the adopted rules prohibit the use of restraint or seclusion on an individual. This is consistent with DFPS rules, which provide that the use of restraint or seclusion not in compliance with rules constitutes physical abuse.The adopted rules also make changes in the title and throughout Chapter 47 to clarify that Chapter 47 governs personal attendant services provided to an individual receiving services in the PHC Program, CAS Program, and FC Program. The adopted rules replace references to the PHC Program as consisting of PHC services, CAS, and FC services. The adopted rules also clarify the requirements that apply to each program or programs. The adopted rules change “DHS” and “DADS” to “HHSC” throughout Chapter 47 to reflect that DHS and DADS have both been abolished and functions have transferred to HHSC. The adopted rules also change “case manager” to “case worker” throughout Chapter 47. The term “case worker” more accurately reflects the duties of this type of HHSC employee.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 47. PRIMARY HOME CARE, COMMUNITY ATTENDANT SERVICES, AND FAMILY CARE PROGRAMS
CHAPTER 47. PRIMARY HOME CARE, COMMUNITY ATTENDANT SERVICES, AND FAMILY CARE PROGRAMSAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1, govern functions previously performed by DADS that have transferred to HHSC. Texas Government Code §531.0055 requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1.Therefore, the Executive Commissioner of HHSC adopts amendments to §47.1, §47.3, §47.21, §47.23, §47.25, §47.41, §47.45, §47.47, §47.49, §47.57, §47.61, §47.63, §47.67, §47.69, §47.71, §47.73, §47.81, §47.83, §47.85, §47.89, and §47.91, new §47.43, §47.74, §47.101, and §47.103, and the repeal of §47.43, §47.59, and §47.72 in Title 40, Part 1, Chapter 47, Contracting to Provide Primary Home Care.The amendments to §47.3, §47.21, §47.23, §47.25, §47.41, and §47.57, and new §47.101 and §47.103 are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1080). The amendments to §47.1, §47.45, §47.47, §47.49, §47.61, §47.63, §47.67, §47.69, §47.71, §47.73, §47.81, §47.83, §47.85, §47.89, and §47.91, new §47.43 and §47.74, and the repeal of §47.43, §47.59, and §47.72 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1080), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONThe adopted rules add requirements in Texas Administrative Code, Title 40 (40 TAC), Chapter 47 related to abuse, neglect, and exploitation of an individual receiving personal attendant services in the Primary Home Care (PHC) Program, Community Attendant Services (CAS) Program, or Family Care (FC) Program from a provider that is required to be licensed in accordance with 26 TAC Chapter 558, Licensing Standards for Home and Community Support Services Agencies. In the PHC, CAS, and FC Programs an individual may receive services through the provider option as described in 40 TAC Chapter 47; the service responsibility option (SRO) as described in 40 TAC Chapter 43, Service Responsibility Option; or the consumer directed services (CDS) option, as described in 40 TAC Chapter 41, Consumer Directed Services Option. Rules in Chapter 41 related to abuse, neglect, and exploitation of an individual receiving services through the CDS option are adopted elsewhere in this issue of the Texas Register.The primary purpose of the adopted rules is to address changes in the investigatory process for abuse, neglect, and exploitation as a result of amendments to Texas Human Resources Code, Chapter 48, and Texas Family Code, Chapter 261, effective September 1, 2015. The amendments gave the Department of Family and Protective Services (DFPS) Adult Protective Services (APS) Provider Investigation (PI) Program the authority to investigate an allegation of abuse, neglect, or exploitation of an individual receiving Medicaid state plan services in the PHC and CAS Programs when the alleged perpetrator is a staff person or controlling person of a provider. Because the FC Program is not a Medicaid program, the amendments to state law did not change the investigatory process for abuse, neglect, and exploitation in the FC Program. Investigations in the FC Program remain under the authority of the DFPS APS In-Home Program when the alleged perpetrator is a staff person or controlling person of a provider.Effective September 1, 2017, in accordance with Texas Government Code, §531.02011 and §531.02013, the functions performed by the DFPS APS PI Program were transferred to HHSC. Therefore, the adopted rules address investigations of allegations of abuse, neglect, and exploitation conducted by HHSC for an individual receiving services in the PHC and CAS Programs through the provider option and the SRO. The adopted rules also describe requirements for the provider to protect an individual from abuse, neglect, and exploitation and help ensure the health, safety, and welfare of an individual who is abused, neglected, or exploited.The adopted rules also include the current requirements in 40 TAC §49.310, Abuse, Neglect, and Exploitation Allegations, that apply to a provider that contracts with HHSC to provide services in the PHC, CAS, and FC Programs. Rules in 40 TAC Chapter 49, Contracting for Community Services, are adopted in this issue of the Texas Register to exclude a provider providing services governed by Chapter 47 from complying with §49.310. These rules are adopted in Chapter 47 to use terminology specific to these programs; add specificity to the current requirements of §49.310; add new requirements; provide protections from abuse, neglect, and exploitation; and help ensure the health, safety, and welfare of an individual who is receiving services in each of these programs and who is abused, neglected, or exploited. The adopted rules require a provider to: (1) train staff persons on abuse, neglect, and exploitation before they assume job duties and at least annually; (2) ensure staff persons are trained and knowledgeable about signs and symptoms of abuse, neglect, and exploitation; (3) educate an individual and his or her representative about protecting the individual from abuse, neglect, and exploitation; and (4) give written information to each staff person on how to report abuse, neglect, and exploitation.The adopted rules also define “abuse,” “exploitation,” “neglect,” and other terms related to abuse, neglect, and exploitation to clarify the terms when used in this chapter. In addition, the adopted rules define the terms “chemical restraint,” “mechanical restraint,” “physical restraint,” “restraint,” and “seclusion.” They also define “physical abuse” to include the use of a restraint or seclusion because the adopted rules prohibit the use of restraint or seclusion on an individual. This is consistent with DFPS rules, which provide that the use of restraint or seclusion not in compliance with rules constitutes physical abuse.The adopted rules also make changes in the title and throughout Chapter 47 to clarify that Chapter 47 governs personal attendant services provided to an individual receiving services in the PHC Program, CAS Program, and FC Program. The adopted rules replace references to the PHC Program as consisting of PHC services, CAS, and FC services. The adopted rules also clarify the requirements that apply to each program or programs. The adopted rules change “DHS” and “DADS” to “HHSC” throughout Chapter 47 to reflect that DHS and DADS have both been abolished and functions have transferred to HHSC. The adopted rules also change “case manager” to “case worker” throughout Chapter 47. The term “case worker” more accurately reflects the duties of this type of HHSC employee.
Texas Department on Aging and Disability Services
Adopted Rules
CHAPTER 49. CONTRACTING FOR COMMUNITY SERVICES
CHAPTER 49. CONTRACTING FOR COMMUNITY SERVICESAs required by Texas Government Code §531.0202(b), the Department of Aging and Disability Services (DADS) was abolished effective September 1, 2017, after all of its functions were transferred to the Texas Health and Human Services Commission (HHSC) in accordance with Texas Government Code §531.0201 and §531.02011. Rules of the former DADS are codified in Title 40, Part 1, and will be repealed or administratively transferred to Title 26, Health and Human Services, as appropriate. Until such action is taken, the rules in Title 40, Part 1 govern functions previously performed by DADS that have transferred to HHSC.Texas Government Code §531.0055, requires the Executive Commissioner of HHSC to adopt rules for the operation of and provision of services by the health and human services system, including rules in Title 40, Part 1. Therefore, the Executive Commissioner of HHSC adopts amendments to §49.101, §49.102, §49.201, §49.205, §49.309, and §49.701; new §49.301; and the repeal of §49.301; in Title 40, Part 1, Chapter 49, Contracting for Community Services.The amendments to §49.205 and §49.309 are adopted with changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1102). These rules will be republished. The amendments to §49.101, §49.102, §49.201, and §49.701; new §49.301; and the repeal of §49.301 are adopted without changes to the proposed text as published in the March 1, 2019, issue of the Texas Register (44 TexReg 1102), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONChapter 49, Contracting for Community Services, governs contracting with HHSC to provide community-based services. The adopted rules provide that §49.310, which relates to abuse, neglect, and exploitation allegations, does not apply to a contractor for any of the following services or programs: a direct services agency in the Community Living Assistance and Support Services (CLASS) Program; a case management agency in the CLASS Program; the Deaf-Blind with Multiple Disabilities (DBMD) Program; the Home and Community-based Services (HCS) Program; the Texas Home Living (TxHmL) Program; the Primary Home Care (PHC) Program; the Community Attendant Services (CAS) Program; the Family Care (FC) Program; the Consumer Managed Personal Attendant Services (CMPAS) Program; a financial management services agency (FMSA) for CLASS, DBMD, HCS, or TxHmL; or an FMSA for PHC, CAS, and FC.HHSC is adopting rules in Title 40, Chapters 9, 41, 42, 44, 45, and 47, in this issue of the Texas Register to add the requirements in §49.310 related to abuse, neglect, and exploitation to the specific rules that govern those programs and services. Those adopted rules will make the application of §49.310 unnecessary for those programs and services.
Texas Board of Nursing
Notices
Rule Review: Chapter 211. General Provisions, §§211.1 – 211.10; Chapter 217. Licensure, Peer Assistance, and Practice, §§217.1 – 217.24; Chapter 219. Advanced Practice Nurse Education, §§219.1 – 219.13
Title 22, Part 11In accordance with Government Code §2001.039, the Texas Board of Nursing (Board) files this notice of intention to review and consider for re-adoption, re-adoption with amendments, or repeal, the following chapters contained in Title 22, Part 11, of the Texas Administrative Code, pursuant to the 2019 rule review plan adopted by the Board at its July 2018 meeting.Chapter 211. General Provisions, §§211.1 – 211.10Chapter 217. Licensure, Peer Assistance, and Practice, §§217.1 – 217.24Chapter 219. Advanced Practice Nurse Education, §§219.1 – 219.13In conducting its review, the Board will assess whether the reasons for originally adopting these chapters continue to exist. Each section of these chapters will be reviewed to determine whether it is obsolete, whether it reflects current legal and policy considerations and current procedures and practices of the Board, and whether it is in compliance with Chapter 2001 of the Government Code (Administrative Procedure Act).The public has thirty (30) days from the publication of this rule review in the Texas Register to comment and submit any response or suggestions. Written comments may be submitted to Dusty Johnston, General Counsel, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, by email to dusty.johnston@bon.texas.gov, or by fax to Dusty Johnston at (512) 305-8101. Any proposed changes to these chapters as a result of this review will be published separately in the Proposed Rules section of the Texas Register and will be open for an additional comment period prior to the final adoption or repeal by the Board.
Texas Health and Human Services Commission
In Addition
Notice of Public Hearing on Payment Rates for Deaf-Blind Multiple Disabilities Waiver Consumer Directed Services Residential Habilitation
Notice of Public Hearing on Payment Rates for Deaf-Blind Multiple Disabilities Waiver Consumer Directed Services Residential HabilitationHearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on September 23, 2019, at 9:00 a.m., to receive comment on proposed payment rate increases for Deaf-Blind Multiple Disabilities Waiver (DBMD) Consumer Directed Services (CDS) Residential Habilitation.
Texas Health and Human Services Commission
In Addition
Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medicaid Calendar Fee Review of Physician-Administered Drugs and Vaccines
Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medicaid Calendar Fee Review of Physician-Administered Drugs and VaccinesHearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on September 20, 2019, at 9:00 a.m., to receive comment on proposed Medicaid payment rates for the Medicaid Calendar Fee Review of Physician-Administered Drugs and Vaccines.The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for the Medicaid Calendar Fee Review of Physician-Administered Drugs and Vaccines are proposed to be effective November 1, 2019.
Texas Health and Human Services Commission
In Addition
Notice of Public Hearing on Proposed Medicaid Payment Rates for the Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates
Notice of Public Hearing on Proposed Medicaid Payment Rates for the Quarterly Healthcare Common Procedure Coding System (HCPCS) UpdatesHearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on September 20, 2019, at 9:00 a.m., to receive comment on proposed Medicaid payment rates for the Quarterly HCPCS Updates.The public hearing will be held in the HHSC Public Hearing Room, Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for Quarterly HCPCS Updates of Physician- Administered Drugs, Outpatient Imaging (Acute Care Services), Outpatient Imaging (Hospital Services), and Clinical Laboratory Services are proposed to be effective November 1, 2019.
Texas Health and Human Services Commission
In Addition
Notice of Public Hearing: Substance Use Disorder Services – Update to Billing Procedure Code for Buprenorphine
Substance Use Disorder Services – Update to Billing Procedure Code for BuprenorphineHearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on September 20, 2019, at 9:00 a.m., to receive to receive public comment on the proposed update to the billing procedure code for buprenorphine.The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The update to the billing procedure code for buprenorphine is proposed to be effective November 1, 2019.
Texas Department of State Health Services
In Addition
Correction of error
Correction of ErrorThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), published a proposal for new §1.81, concerning Recognition of Out-of-State License of Military Spouse in the August 30, 2019, issue of the Texas Register (44 TexReg 4657).The email address for receiving public comments was incorrectly published. The correct email address for receiving public comments is CPDRuleComments@dshs.texas.gov.
Texas Department of State Health Services
In Addition
Order Temporarily Placing N-Ethylhexedrone, alpha-PHP, 4-MEAP, MPHP, PV8, and 4-Chloro-alpha-PVP into Schedule I
Order Temporarily Placing N-Ethylhexedrone, alpha-PHP, 4-MEAP, MPHP, PV8, and 4-Chloro-alpha-PVP into Schedule IThe Acting Administrator of the Drug Enforcement Administration issued a temporary scheduling order placing the synthetic cathinones N-ethylhexedrone (Other name: 2-(ethylamino)-1-phenylhexan-1-one); alpha-pyrrolidinohexanophenone (Other names: alpha-PHP, alpha-pyrrolidinohexiophenone, 1-phenyl-2-(pyrrolidin-1-yl)hexan-1-one); 4-Methyl-alpha-ethylaminopentiophenone (Other names: 4-MEAP, 2-(ethylamino)-1-(4-methylphenyl)pentan-1-one); 4′-Methyl-alpha-pyrrolidinohexiophenone (Other names: MPHP; 4′-methyl-alpha-pyrrolidinohexanophenone, 1-(4-methylphenyl)-2-(pyrrolidin-1-yl)hexan-1-one); alpha-Pyrrolidinoheptaphenone, its optical, positional, and geometric isomers, salts and salts of isomers (Other names: PV8, 1-phenyl-2-(pyrrolidin-1-yl)heptan-1-one); and, 4′-Chloro-alpha-pyrrolidinovalerophenone, its optical, positional, and geometric isomers, salts and salts of isomers (Other names: 4-chloro-alpha-PVP; 4′-chloro-alpha-pyrrolidinopentiophenone; 1-(4-chlorophenyl)-2-(pyrrolidin-1-yl)pentan-1-one) and their optical, positional, and geometric isomers, salts, and salts of isomers into schedule I of the Controlled Substances Act, effective July 18, 2019. This temporary amendment was published in the Federal Register, Volume 84, Number 138, pages 34291-34297.