Texas Department of Licensing and Regulation
Proposed Rules Re:
Adding new 16 TAC §116.10 and repealing 16 TAC §§116.10 – 116.14, to consolidate all Dietitians Advisory Board rules under one new section implementing SB 2075.
CHAPTER 116. DIETITIANS
SUBCHAPTER B. DIETITIANS ADVISORY BOARD
16 TAC §116.10; repeal of 16 TAC §§116.10 – 116.14
OVERVIEW
The Texas Department of Licensing and Regulation (Department) proposes a new rule at 16 Texas Administrative Code (TAC), Chapter 116, Subchapter B, §116.10; amendments to existing rules at Subchapter I, §§116.80 – 116.82; and the repeal of existing rules at Subchapter B, §§116.10 – 116.14; and Subchapter I, §116.83, regarding the Dietitians program. These proposed changes are referred to as the “proposed rules.”
BACKGROUND AND JUSTIFICATION
The rules under 16 TAC, Chapter 116, implement Texas Occupations Code, Chapter 701, Dietitians; Chapter 51, the enabling statute of the Texas Commission of Licensing and Regulation (Commission) and the Texas Department of Licensing and Regulation (Department); and other laws applicable to the Commission and the Department.
The proposed rules update Subchapter B, Dietitians Advisory Board, and Subchapter I, Continuing Education, under 16 TAC, Chapter 116. The proposed rules make substantive and clean-up changes to the Dietitians program rules and include changes resulting from legislation, the Department’s regulatory efficiency review, and Department staff and workgroup recommendations.
Changes Resulting from Legislation
The proposed rules incorporate and reflect the changes required by SB 2075, Sections 22 and 23, 89th Legislature, Regular Session (2025), which concerns the Dietitians Advisory Board, and SB 25, 89th Legislature, Regular Session (2025), which concerns licensed dietitians’ continuing education hours and subject matter requirements.
SB 2075, Sections 22 and 23, made changes to Texas Occupations Code, §701.054(a) and §701.057, by removing the specific start dates of the advisory board members’ terms and increasing the presiding officer’s term from one year to two years. SB 25 made changes to §§701.302 – 701.304, by requiring certain continuing education subjects and hourly completion for licensed dietitians.
The proposed rules are necessary to update the advisory board rules as required by SB 2075 and to implement the new SB 25 continuing education requirements for licensed dietitians.
Changes Resulting from Regulatory Efficiency Review
The proposed rules make changes resulting from the regulatory efficiency review conducted by the Department and the Texas Regulatory Efficiency Office (TREO) under Texas Government Code, Chapter 465. The proposed rules are necessary to consolidate and streamline the advisory board rules and to meet efficiency goals of the Department and TREO.
Staff and Workgroup Changes
The proposed rules include continuing education rule changes suggested by Department staff and recommended by the Dietitians Advisory Board Education and Examination Workgroup. The proposed rules are necessary to: make human trafficking prevention training eligible for continuing education credit; and update continuing education hours for book and journal article authorship.
Clean-up Changes
The proposed rules include reorganization and clean-up changes. The proposed rules are necessary to: ensure the Dietitians rules are consistent with other Department continuing education and audit rules; conform with current drafting conventions; and increase readability and organization of the rules.
Advisory Board Recommendations
The proposed rules were presented to and discussed by the Dietitians Advisory Board at its meeting on August 18, 2026. The Advisory Board did not make any changes to the proposed rules. The Advisory Board voted and recommended that the proposed rules be published in the Texas Register for public comment.
SECTION-BY-SECTION SUMMARY
The proposed rules create a new rule §116.10, Dietitians Advisory Board. This new rule consolidates all advisory board rules under this section and reflects efficiency goals of the Department and the Texas Regulatory Efficiency Office (TREO) under Texas Government Code, Chapter 465. The new rule also replaces repeated statutory language with cross references to the applicable advisory board provisions under Texas Occupations Code, Chapters 701 and 51. These statutory references also include changes made by SB 2075, Sections 22 and 23, which removed the specific start date of the advisory board members’ terms and changed the presiding officer’s term from one year to two years.
The proposed rules repeal §116.10, Membership. All advisory board rules are consolidated under new rule §116.10.
The proposed rules repeal §116.11, Duties. All advisory board rules are consolidated under new rule §116.10.
The proposed rules repeal §116.12, Terms; Vacancies. All advisory board rules are consolidated under new rule §116.10.
The proposed rules repeal §116.13, Officers. All advisory board rules are consolidated under new rule §116.10.
The proposed rules repeal §116.14, Meetings. All advisory board rules are consolidated under new rule §116.10.
Amending 16 TAC §§116.80 – 116.82 and repealing 16 TAC §116.83, to implement SB 25’s continuing education requirements for licensed dietitians, including a new metabolic-health/ultra-processed-food CE topic.
CHAPTER 116. DIETITIANS
SUBCHAPTER I. CONTINUING EDUCATION
16 TAC §§116.80 – 116.82; repeal of 16 TAC §116.83
OVERVIEW
The Texas Department of Licensing and Regulation (Department) proposes a new rule at 16 Texas Administrative Code (TAC), Chapter 116, Subchapter B, §116.10; amendments to existing rules at Subchapter I, §§116.80 – 116.82; and the repeal of existing rules at Subchapter B, §§116.10 – 116.14; and Subchapter I, §116.83, regarding the Dietitians program. These proposed changes are referred to as the “proposed rules.”
BACKGROUND AND JUSTIFICATION
The rules under 16 TAC, Chapter 116, implement Texas Occupations Code, Chapter 701, Dietitians; Chapter 51, the enabling statute of the Texas Commission of Licensing and Regulation (Commission) and the Texas Department of Licensing and Regulation (Department); and other laws applicable to the Commission and the Department.
The proposed rules update Subchapter B, Dietitians Advisory Board, and Subchapter I, Continuing Education, under 16 TAC, Chapter 116. The proposed rules make substantive and clean-up changes to the Dietitians program rules and include changes resulting from legislation, the Department’s regulatory efficiency review, and Department staff and workgroup recommendations.
Changes Resulting from Legislation
The proposed rules incorporate and reflect the changes required by SB 2075, Sections 22 and 23, 89th Legislature, Regular Session (2025), which concerns the Dietitians Advisory Board, and SB 25, 89th Legislature, Regular Session (2025), which concerns licensed dietitians’ continuing education hours and subject matter requirements.
SB 25 made changes to §§701.302 – 701.304, by requiring certain continuing education subjects and hourly completion for licensed dietitians. The proposed rules are necessary to implement the new SB 25 continuing education requirements for licensed dietitians.
The proposed rules also include continuing education rule changes suggested by Department staff and recommended by the Dietitians Advisory Board Education and Examination Workgroup, making human trafficking prevention training eligible for continuing education credit and updating continuing education hours for book and journal article authorship, along with clean-up and reorganization changes to conform with current drafting conventions and increase readability.
SECTION-BY-SECTION SUMMARY
The proposed rules amend §116.80, Continuing Education–General Requirements and Hours. The proposed rules provide that a licensed dietitian “must complete 12 hours,” rather than “a minimum of 12 hours,” of continuing education for each license term. This change aligns with the maximum of 12 hours of continuing education allowed by SB 25.
The proposed rules change the title of §116.81 from “Continuing Education–Approved Courses and Credits” to “Continuing Education–Courses, Activities, and Credits.” This title change better reflects the scope and substance of the rule, which addresses courses and activities that are acceptable and unacceptable for continuing education (CE) credit and addresses the amount of credit available for acceptable courses and activities. New subsection (c) implements SB 25 by requiring that on or after January 1, 2027, licensed dietitians seeking license renewal must complete three CE hours in the subjects of metabolic health and the nutritional components and health effects of ultra-processed foods, or topics recommended by the new, Governor-appointed Texas Nutrition Advisory Committee. New subsection (d) provides that acceptable CE activities or courses include the Texas Jurisprudence Examination (1 hour) and the human trafficking prevention training (1 hour) that is required for license renewal.
The proposed rules amend §116.82, Continuing Education–Records and Audits. The proposed rules amend this section by removing obsolete continuing education audit language and replacing this language with a cross reference to Department rule §60.701, Continuing Education Audits for License Renewal. Section 60.701 is located under 16 TAC Chapter 60, Subchapter M, and it applies to continuing education audits of specific Department programs, including the Dietitians program. The continuing education audit rules under §60.701 now apply to licensed dietitians’ continuing education audits.
The proposed rules repeal §116.83, Continuing Education–Failure to Complete. The rules in this section are now outdated or duplicative with other rules that serve the same purpose.
Texas State Board of Pharmacy
Proposed Rules Re:
Amending 22 TAC §291.9, to clarify that a dangerous drug may be delivered to a prescriber’s office for pickup by or administration to the patient there.
CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
22 TAC §291.9
OVERVIEW
The Texas State Board of Pharmacy proposes amendments to §291.9, concerning Prescription Pick Up Locations. The amendments, if adopted, clarify that a dangerous drug may be delivered to the office of a prescriber if the drug is picked up by or administered to the patient in the prescriber’s office.
BACKGROUND AND JUSTIFICATION
Daniel Carroll, Pharm.D., Executive Director/Secretary, has determined that, for the first five-year period the rules are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the rule. Dr. Carroll has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will be clearer regulatory language that more accurately reflects the Board’s requirements for delivery of dangerous drugs to a prescriber’s office. There is no anticipated adverse economic impact on large, small or micro-businesses (pharmacies), rural communities, or local or state employment. Therefore, an economic impact statement and regulatory flexibility analysis are not required.
Texas Department of State Health Services
Proposed Rules Re:
Repealing 25 TAC §§96.302 – 96.304, to remove obsolete needleless-device registration rules no longer required following the repeal of Texas Health and Safety Code §81.307.
CHAPTER 96. BLOODBORNE PATHOGEN CONTROL
25 TAC §§96.302 – 96.304
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 the repeal of §96.302, concerning Device Registration, §96.303, concerning Registration Procedures, and §96.304, concerning Registration Fees.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to repeal rules related to needleless device registration that are no longer required by statute.
The proposal is necessary to comply with Senate Bill 970, 87th Legislature, Regular Session, 2021, which repealed Texas Health and Safety Code §81.307 and removed the requirement for DSHS to register needleless systems and sharps devices with engineered sharps injury protection. As a result, §§96.302 – 96.304 are no longer necessary and are proposed for repeal to align agency rules with current statute.
SECTION-BY-SECTION SUMMARY
The proposed repeal of §§96.302 – 96.304 deletes the rules as no longer necessary because the statutory authority requiring device registration has been removed.
Amending 25 TAC §289.229, to add a definition of “remote operation” clarifying the prohibition on remotely exposing a patient to ionizing radiation, and to remove an obsolete cross-reference to a repealed Texas Medical Board rule.
CHAPTER 289. RADIATION CONTROL
SUBCHAPTER E. REGISTRATION REGULATIONS
25 TAC §289.229
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 Title 25, Texas Administrative Code (TAC) §289.229, concerning Radiation Safety Requirements for Accelerators, Therapeutic Radiation Machines, Radiation Therapy Simulation Systems, and Electronic Brachytherapy Devices.
BACKGROUND AND JUSTIFICATION
DSHS proposes to amend 25 TAC §289.229 to clarify existing requirements and update outdated references to ensure consistency with current law and practice.
In 2024, DSHS amended 25 TAC §289.229 which included a prohibition on the remote operation of radiation machines. Following implementation, DSHS determined that the term “remote operation” may be interpreted inconsistently by stakeholders and could be understood to include activities that were not intended to be prohibited, such as a physician’s interpretation of images.
The proposed amendment adds a definition of “remote operation” to clarify that the prohibition applies specifically to exposing a patient to ionizing radiation by an operator from a remote location rather than at the healthcare facility where the radiation-producing machine is located.
Additionally, the proposed amendment corrects rule references and removes an obsolete reference, 22 TAC §160.17, which was repealed by the Texas Medical Board in January 2025. The proposed amendment revises language related to licensed medical physicists to align with Texas Occupations Code Chapter 602, to ensure the rule reflects current statutory authority.
The proposed amendment improves clarity, accuracy, and stakeholder understanding of the rule while protecting public health and safety.
SECTION-BY-SECTION SUMMARY
Edits are made throughout the section to delete or update references and non-substantive edits are made to improve readability and formatting.
The proposed amendment to §289.229(b) corrects references.
The proposed amendment to §289.229(c) corrects references.
The proposed amendment to §289.229(e) adds a definition for “remote operation”; adds clarifying language to the definitions of “barrier,” “beam-flattening filter,” “kilovolt peak (kVp),” “radiation field,” and “supervision”; and updates formatting.
The proposed amendment to §289.229(f) corrects references and clarifies existing language.
The proposed amendment to §289.229(h) corrects and updates references and formatting, and amends Figure: §289.229(h)(5)(F)(viii).
The proposed amendment to §289.229(j) updates formatting and clarifies existing language.
The proposed amendment to §289.229(l) amends a figure.
In Addition Re:
Licensing Actions for Radioactive Materials
For more information, please visit this week’s edition of the Texas Register at 51 TexReg 6595-6600.
Texas Medical Disclosure Panel
Proposed Rules Re:
Amending 25 TAC §§602.6, 602.8, 602.14, 602.19, and 602.21, to revise List A procedures requiring full risk disclosure and use plain language where possible.
CHAPTER 602. PROCEDURE REQUIRING FULL DISCLOSURE OF SPECIFIC RISKS AND HAZARDS–LIST A
25 TAC §§602.6, 602.8, 602.14, 602.19, 602.21
OVERVIEW
The Texas Medical Disclosure Panel (Panel) proposes amendments to §602.6, concerning Eye Treatments and Procedures; §602.8, concerning Hematic and Lymphatic System Treatments and Procedures; §602.14, concerning Radiology Treatments and Procedures; §602.19, concerning Laparoscopic, Thoracoscopic and Robotic Surgery Treatments and Procedures; and §602.21, concerning Dental Surgery Treatments and Procedures.
BACKGROUND AND JUSTIFICATION
The purpose of this proposal is to revise the lists of procedures and risks and hazards and use plain language when possible.
These proposed amendments are in accordance with Texas Civil Practice and Remedies Code §74.102, which created the Panel to determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to patients or persons authorized to consent for patients and to establish the general form and substance of such disclosure.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §602.6 revises the types of eye system treatments and procedures that the Panel has determined require full disclosure of the risks and hazards associated with the eye system treatments and procedures, and include plain language explanations, where necessary.
The proposed amendment to §602.8 revises the types of hematic and lymphatic system treatments and procedures that the Panel has determined require full disclosure of the risks and hazards associated with the hematic and lymphatic system treatments and procedures, and include plain language explanations, where necessary.
The proposed amendment to §602.14 revises the types of radiology treatments and procedures that the Panel has determined require full disclosure of the risks and hazards associated with the radiology treatments and procedures, and include plain language explanations, where necessary.
The proposed amendment to §602.19 revises the types of laparoscopic, thoracoscopic and robotic surgery treatments and procedures that the Panel has determined require full disclosure of the risks and hazards associated with the laparoscopic, thoracoscopic and robotic surgery treatments and procedures, and include plain language explanations, where necessary.
The proposed amendment to §602.21 revises the types of dental treatments and procedures that the Panel has determined require full disclosure of the risks and hazards associated with the dental treatments and procedures, and include plain language explanations, where necessary.
Amending 25 TAC §603.6 and §603.14, to revise List B procedures requiring no risk disclosure and use plain language where possible.
CHAPTER 603. PROCEDURES REQUIRING NO DISCLOSURE OF SPECIFIC RISKS AND HAZARDS–LIST B
25 TAC §603.6, §603.14
OVERVIEW
The Texas Medical Disclosure Panel (Panel) proposes amendments to §603.6, concerning Eye Treatments and Procedures, and §603.14, concerning Radiology Treatments and Procedures.
BACKGROUND AND JUSTIFICATION
The purpose of this proposal is to revise the list of procedures that do not require disclosure of specific risks and hazards, and to use plain language when possible.
The proposed amendments are in accordance with Texas Civil Practice and Remedies Code §74.102, which created the Panel to determine which risks and hazards related to medical care and surgical procedures must be disclosed by health care providers or physicians to patients or persons authorized to consent for patients and to establish the general form and substance of such disclosure.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §603.6 revises the types of eye treatments and procedures that the Panel has determined require no disclosure of the risks and hazards associated with the eye treatments and procedures, and includes plain language explanations, where necessary.
The proposed amendment to §603.14 revises the types of radiology treatments and procedures that the Panel has determined require no disclosure of the risks and hazards associated with the radiology treatments and procedures and corrects the spelling of “laryngography.”
Texas Health and Human Services Commission
Proposed Rules Re:
Amending 26 TAC §§558.1 – 558.3, to reorganize Subchapter A general provisions, including updated definitions and a three-year renewal license fee structure.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §§558.1 – 558.3
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter A, General Provisions
The proposed amendment to §558.1, Purpose and Scope, adds Texas Human Resources Code Chapter 48, Subchapter F, and Texas Family Code §261.404, as additional statutes that will be implemented by the rules.
The proposed amendment to §558.2, Definitions, adds definitions for terms and amends current definitions to clarify and define terms to reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposed amendment removes outdated or obsolete citations and references.
The proposed amendment to §558.3, License Fees, removes all the renewal license fees for a two-year license because now all renewal license fees are for a three-year license. The amendment updates the fee for an initial alternate delivery site license that includes a change of ownership from $1,000 to $1,500 to be consistent with the statutory three-year license term instead of the former two-year license term. The amendment also maintains consistency throughout the rules and promotes modernization by requiring applicants to submit applications and payment for licensure via the online portal.
Amending 26 TAC §§558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, and 558.30, to update Subchapter B licensing and change-of-ownership procedures, including new grounds for denial and Life Safety Code compliance requirements for hospice inpatient units.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER B. CRITERIA AND ELIGIBILITY, APPLICATION PROCEDURES, AND ISSUANCE OF A LICENSE
26 TAC §§558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter B, Criteria and Eligibility, Application Procedures, and Issuance of a License
The proposed amendment to §558.11, Criteria and Eligibility for Licensing, adds language to reflect changes in §558.604, related to licensure surrender, and allows HHSC to deny an application for an initial license or for renewal of a license if a person described in the rule, in the 12 months preceding the date of the application, has a history in any state or other jurisdiction of willfully operating an agency without a valid and active license.
The proposed amendment to §558.13, Obtaining an Initial License, adds language stating that an applicant may request to be licensed in any combination of the listed categories of services to ensure that the applicant is aware that it is not limited on which combination of services it may provide.
The proposed amendment to §558.15, Issuance of an Initial License, corrects references.
The proposed amendment to §558.17, Application Procedures for a Renewal License, updates references.
The proposed amendment to §558.19, Issuance of a Renewal License, removes extraneous language from subsections (b) and (c). The amendment removes existing subsections (e) and (f) that reference licensure expiration dates between December 31, 2020, and January 1, 2023, as these dates have passed. Removing existing subsections (e) and (f) also removes references to two-year license terms because now all license terms are three years. The amendment to subsection (a) removes references to subsections (e) and (f) that are proposed for removal.
The proposed amendment to §558.21, Denial of an Application or a License, adds that HHSC may deny a licensure application for a hospice inpatient unit that fails to meet the licensure requirements of a Life Safety Code inspection. Continued failure to meet the licensure requirements within 120 days after the initial Life Safety Code inspection will result in a proposed denial of the license and a referral of the application to HHSC Regulatory Enforcement.
The proposed amendment to §558.23, Change of Ownership, clarifies that the current license holder maintains responsibility under its license between the effective date of the change of ownership and the issuance of an initial license to the change of ownership applicant, who may operate the agency on behalf of the current license holder during such time period.
The proposed amendment to §558.25, Requirements for Change of Ownership, replaces a reference to “an initial license application” with a reference to “a change of ownership license application” to clarify the type of application that must be submitted. The amendment specifies what a complete change of ownership application includes. The amendment clarifies that a change of ownership license application is submitted through the online portal to be consistent with this same requirement in other rules for submitting a license application. The amendment also makes non-substantive changes to improve readability and clarity.
The proposed amendment to §558.27, Application and Issuance of an Initial Branch Office License, clarifies who is responsible for denying applications for licensure. The amendment also deletes extraneous language and corrects a grammatical error.
The proposed amendment to §558.29, Application and Issuance of an Alternate Delivery Site License, provides additional guidance regarding notification of readiness for a Life Safety Code survey and specifies that an agency must not admit Medicare beneficiaries before receiving Centers for Medicare & Medicaid Services (CMS) approval, and outlines exemptions and guidance related to the accreditation process. The amendment also updates a reference.
The proposed amendment to §558.30, Operation of an Inpatient Unit at a Parent Agency, updates the section title to “Operation of a Hospice Unit at a Parent Agency.” The amendment adds that an applicant for an initial license to provide hospice services must not have an enforcement action pending against the license. The amendment adds that before HHSC considers whether the application is complete, HHSC determines if the agency is in compliance with the Life Safety Code Requirements in proposed new Division 9 under Subchapter H. The amendment requires the agency, after HHSC issues a license authorizing the hospice inpatient unit, to admit and provide services to a client, and unless exempt as described in the rule, to submit a request for an initial health survey. The proposed amendment also requires an agency to submit the Notification of Readiness for a Health Survey (HHSC Form 2020), in place of Notification of Readiness for a Health Survey (HHSC Form 2020-A).
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER C. MINIMUM STANDARDS FOR ALL HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
26 TAC §§558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.330, 558.332, 558.334, 558.336, 558.338; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338; repeal of 26 TAC §558.251
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter C, Minimum Standards for All Home and Community Support Services Agencies
Division 2, Conditions of a License
The proposed amendment to §558.208, Reporting Changes in Application Information and Fees, updates language to reflect that applications may be submitted online and requires an agency to report a change in accreditation status after HHSC issues a license. The amendment updates the rule by adding that the application required to report a change must be submitted through the online portal. The amendment clarifies a reference and makes non-substantive edits for clarity.
The proposed amendment to §558.210, Agency Operating Hours, updates the section title to “Agency Place of Business and Operating Hours.” The amendment specifies parameters and limitations for an agency’s place of business and describes the requirements that must be met if the place of business is in a co-working workspace. Additionally, the proposed language outlines the requirements for what must be displayed on an agency’s notice or sign.
The proposed amendment to §558.211, Display of License, clarifies that the most current license must be displayed in each place of business. If the information on the license is officially amended, the agency will receive a new license to reflect the changes, which must be posted to provide public notice of the change.
The proposed amendment to §558.213, Agency Relocation, clarifies the procedure for reporting a change in physical location to now specify that a relocation application must be submitted through the online portal. The amendment describes the requirements for an agency with a hospice inpatient unit to relocate the unit. The amendment makes non-substantive changes to improve readability.
The proposed amendment to §558.214, Notification Procedures for a Change in Agency Contact Information and Operating Hours, adds the requirement to submit applications through the online portal to maintain consistency throughout the rules and promote modernization.
The proposed amendment to §558.215, Notification Procedures for an Agency Name Change, adds the requirement to submit applications through the online portal to maintain consistency throughout the rules and promote modernization. The amendment also makes non-substantive changes to improve readability.
The proposed amendment to §558.216, Change in Agency Certification Status, adds a provision regarding the procedures when an agency voluntarily withdraws from the Medicare program but continues to provide services under a licensed-only category, such as licensed home health, hospice, or personal assistance services. The amendment also clarifies that a written notice of voluntary closure must be included if an agency voluntarily withdraws from the Medicare program based on permanent closure.
The proposed amendment to §558.217, Agency Closure Procedures and Voluntary Suspension of Operations, adds guidance about how an agency must notify HHSC of closure or voluntary suspension, instructions regarding how to preserve client records in the event of a closure or voluntary suspension, the consequences an agency will face should it fail to comply with the section, and how an agency may resume operations following a voluntary suspension of operations. The amendment also updates references.
The proposed amendment to §558.218, Agency Organizational Changes, updates language to reflect application submission options via online methods. The amendment updates a reference.
The proposed amendment to §558.219, Procedures for Adding or Deleting a Category to the License, clarifies which HHSC unit is responsible for approving and denying applications that request to add or delete categories of service to a license. The amendment specifies that an agency must not provide services before receiving an updated license with the new category of service listed.
The proposed amendment to §558.220, Service Areas, updates language to reflect application submission options via online methods, provides clarification to providing services to clients who reside outside of a licensed service area, incorporates language regarding compliance when providing teleservices and specifies the location requirements for branch offices or alternate delivery sites.
Division 3, Agency Administration
The proposed amendment to §558.242, Organizational Structure and Lines of Authority, clarifies which positions may be considered a controlling person in the agency’s organizational structure.
The proposed amendment to §558.243, Administrative and Supervisory Responsibilities, updates language to reflect application submission options via online methods, updates language to include when a license holder with multiple categories of services may share a single administrator and alternate administrator and explains date of designation. The amendment updates language to include that it is the administrator’s responsibility to develop and implement an acceptable plan of correction in response to cited deficiencies and violations. The amendment incorporates telecommunications as a method through which the supervising or alternate supervising nurse may be available to agency personnel. The amendment further updates language to ensure compliance with Texas Health and Safety Code Chapter 331 regarding a written workplace violence prevention policy and plan and the establishment of a workplace violence prevention committee and updates references. The amendment also implements language from SB 240 stating that agencies providing licensed home health services that employ two or more nurses must adopt, implement, and enforce a written workplace violence prevention policy and plan and a committee to oversee it.
The proposed amendment to §558.244, Administrator Qualifications and Conditions and Supervising Nurse Qualifications, adds presurvey training completion deadlines before the date of designation for an administrator and alternate administrator and details who is required to complete the presurvey training. The amendment prohibits the employability of an administrator or alternate administrator who has been involved in a final enforcement action by HHSC. The amendment defines the terms “period of time” and “enforcement action” for the purposes of the section. The amendment details when enforcement action is to take effect should an agency appeal enforcement action.
The proposed amendment to §558.245, Staffing Policies, updates language to require that an agency’s written staffing procedures include a process for searches of the medication aide registry (MAR), if applicable, and the SEMARC, in addition to the nurse aide registry (NAR). The amendment also clarifies that evaluation of competencies may be performed via telecommunications for purposes of compliance. The amendment also states that agency training may be conducted virtually with competencies demonstrated and evaluated in person.
The proposed amendment to §558.246, Personnel Records, updates language to clarify that personnel records are required for all employees and volunteers regardless of position and details what documentation personnel records must contain. The amendment also updates language to state that personnel records for an unlicensed employee or unlicensed volunteer whose duties would or do include contact with a client must include a printed or electronic copy of the results of the initial and annual searches of the MAR, if applicable, and the SEMARC established under Texas Health and Safety Code Chapter 810, in addition to the NAR. Updated language specifies that the rule is in accordance with §558.305, Standards for Electronic Record Maintenance and Storage; §558.259, Initial Educational Training in Administration of Agencies; and §558.260, Continuing Education in Administration of Agencies.
The proposed amendment to §558.247, Verification of Employability and Use of Unlicensed Persons, updates the section title to “Verification of Employability and Use of Persons as Employees, Volunteers, and Contractors.” The amendment clarifies how an agency must conduct initial and annual verifications of employability for a person, including a check of the SEMARC, MAR, if applicable, and NAR and specifies the requirements of an initial criminal history check. The amendment implements Texas Health and Safety Code Chapter 810, which requires a HCSSA, as a designated user under §810.004(b)(1)(A), to conduct a search of SEMARC to determine whether an individual who may have access to a client has engaged in reportable conduct and, if the individual has engaged in reportable conduct, whether the individual is ineligible for employment, a volunteer position, or a contract with the agency. The amendment implements Texas Health and Safety Code §253.0025 in §558.247(h)(7) by adding the requirement for an agency to suspend the employment or contract of a person whom has engaged in reportable conduct while the person exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review conducted in accordance with Texas Health and Safety Code §253.004 or §253.005, pending a final decision by an administrative law judge. The updated language also provides guidelines for hiring on a temporary or interim basis in an emergency when background checks are pending and provides the criteria for the immediate hire as permitted by Texas Health and Safety Code Chapter 250. The amendment deletes language that is outdated.
The proposed amendment to §558.248, Volunteers, provides guidance on which roles agencies can place volunteers in.
The proposed amendment to §558.249, Self-Reported Incidents of Abuse, Neglect, and Exploitation, updates the section title to “Incidents of Abuse, Neglect, and Exploitation.” The amendment deletes the requirement for an agency to report abuse, neglect, and exploitation to DFPS and instead requires reporting to HHSC. Additionally, the definitions for “abuse,” “neglect,” and “exploitation” have been included in the definitions section §558.2; therefore, the amendment deletes the references to 26 TAC Chapter 711 and 40 TAC Chapter 705 that initially assigned meanings to those definitions. The proposed amendment also clarifies that to report abuse “immediately” means to report it no later than one hour after suspecting or learning of the incident.
The proposed amendment to §558.250, Agency Investigations, clarifies what information must be included in the HHSC Provider Investigation Report and includes two examples of retaliatory actions.
Proposed new §558.251, Reporting Abuse, Neglect, and Exploitation, requires each employee, contractor, volunteer, client, and legally authorized representative be trained and are knowledgeable on how to protect from and report abuse, neglect, and exploitation (ANE). The rule further states that each employee, contractor, and volunteer sign an acknowledgement that clients are to be free from ANE and that each employee, contractor, and volunteer understand that they may be criminally liable under Texas Human Resources Code Chapter 48 for failure to report suspected ANE.
The proposed repeal of §558.251 deletes the rule as no longer necessary because the content of the rule has been added to proposed new §558.261 and will allow for proposed new §558.251, Reporting Abuse, Neglect, and Exploitation.
The proposed amendment to §558.252, Financial Solvency and Business Records, clarifies that an agency must have sufficient funds to cover all planned services for clients receiving care. The amendment specifies that an agency must maintain business records either in hardcopy or electric form.
The proposed amendment to §558.256, Emergency Preparedness Planning and Implementation, clarifies the requirement that if a client, whom the agency identifies may need evacuation assistance, wants to register with the State of Texas Emergency Assistance Registry (STEAR), the agency must provide the client with the amount of assistance the client requests to complete the registration process for evacuation assistance if STEAR is available in the service area. The amendment removes the option to fax information and updates a reference.
The proposed amendment to §558.257, Medicare Certification Optional, clarifies the requirement that HHSC must receive written approval from CMS via the Medicare Administrative Contractor before amending the licensing status of an agency to include certified home health services to its category of service and before HHSC entering the hospice provider number into the online portal.
The proposed amendment to §558.259, Initial Educational Training in Administration of Agencies, clarifies that the section applies to all newly designated administrators and alternate administrators. The proposed amendment specifies who is considered a newly designated administrator or alternate administrator, outlines the timeframe to complete the 24 hours of educational training, and clarifies the agency’s requirement for documentation of administrator and alternate administrator training. The amendment removes language stating the initial educational training must be approved by HHSC or recognized by a state or national organization or association.
The proposed amendment to §558.260, Continuing Education in Administration of Agencies, clarifies that the section applies to all administrators and alternate administrators in the second through subsequent years of designation to the position. The proposed amendment specifies that an administrator or alternate administrator with a break in designation longer than 12 months from the date of the administrator or alternate administrator’s last designation to the position is considered a newly designated administrator and clarifies the requirements for what topics the 12 hours of continuing education must include. The amendment also deletes language that is outdated.
Proposed new §558.261, Peer Review, moves the repealed peer review language from §558.251 into this section. This was done to allow the new §558.251, Reporting Abuse, Neglect and Exploitation to follow §558.249, Incidents of Abuse, Neglect and Exploitation and §558.250, Agency Investigations.
Division 4, Provision and Coordination of Treatment Services
The proposed amendment to §558.281, Client Care Policies, provides clarity to the elements that must be included in the agency’s written policy that specifies client care practices.
The proposed amendment to §558.282, Client Conduct and Responsibility and Client Rights, adds a provision that at the time of admission, an agency must provide the client a handout regarding the client’s rights. The amendment also adds clarity to some of the provisions outlined for client rights.
The proposed amendment to §558.283, Advance Directives, adds clarity to provisions that outline what must be included in a written policy regarding implementation of advance directives. The amendment also removes the provision that assesses a $500 administrative penalty for a violation of this section without an opportunity to correct.
The proposed amendment to §558.285, Infection Control, adds a provision that an agency’s written infection control policy must address measures the agency will take to prevent the spread of communicable and infectious diseases, including the usage of personal protective equipment. The proposed amendment also states that an agency must designate an infection control officer and outlines what is required of the job position.
The proposed amendment to §558.287, Quality Assessment and Performance Improvement, adds clarity to provisions that outline what must be included in the quality assessment and performance improvement (QAPI) program and the frequency of the QAPI Committee meeting.
The proposed amendment to §558.288, Coordination of Services, states that coordination of services among an agency and all providers of teleservices must be included in an agency’s adopted and enforced written policy. The proposed amendment also provides that if the agency will provide temporary services for a client who is traveling, it must adopt and enforce a written policy regarding the coordination of service delivery on a temporary basis.
The proposed amendment to §558.289, Independent Contractors and Arranged Services, adds a requirement to ensure that the agency or the contracting agency or organization conduct MAR, NAR, and SEMARC checks of unlicensed persons. The amendment also updates a reference.
The proposed amendment to §558.290, Backup Services and After-Hours Care, clarifies that for the purposes of this section, a client’s designee is the individual that the client or client’s legally authorized representative determines can provide services when the agency is unable to provide an employee, volunteer, or contractor. The proposed language clarifies the requirements for an agency’s written policy to ensure that backup services are available when an agency employee or contractor is not available to deliver the services. The amendment also adds provisions related to when an agency must offer backup services.
The proposed amendment to §558.291, Agency Dissolution, updates a reference.
The proposed amendment to §558.292, Agency and Client Agreement and Disclosure, requires that a client’s legally authorized representative also be provided a written agreement of services. The amendment also updates a reference.
The proposed amendment to §558.295, Client Transfer or Discharge Notification Requirements, updates language to specify that in the event of a discharge the agency must notify the client’s primary care physician and includes that written notification may be provided via electronic correspondence that complies with the Health Insurance Portability and Accountability Act.
The proposed amendment to §558.297, Receipt of Physician Orders, updates the section title to “Receipt of Practitioner Orders.” The amendment updates language to include practitioner. The amendment incorporates secure electronic transmission as a means to accept physician or practitioner orders.
Proposed new §558.304, Standards for Electronic Record Maintenance and Storage, adds language to ensure agencies maintain accuracy and confidentiality of electronic records and establish a system or arrangement for preservation of inactive electronic records.
Division 5, Branch Offices and Alternate Delivery Sites
The proposed amendment to §558.321, Standards for Branch Offices, updates language to incorporate online submission methods and states that all electronic records must be maintained in accordance with §558.305. The amendment also states that supervisory visits may be completed virtually with at least one on-site visit conducted quarterly and that all agency policy and procedures be readily accessible to both the parent agency and branch office.
The proposed amendment to §558.322, Standards for Alternate Delivery Sites, provides that all electronic records must be maintained in accordance with §558.305 and corrects a grammatical error.
Proposed new §558.323, Standards for Administrative Support Sites, states that a parent agency is responsible for ensuring that its administrative support site complies with licensing standards. The language outlines the reasons an administrative support site does not require a license or fee and specifies that should it deliver any home health, hospice, or personal assistance services from the location, it will be considered an operating a branch or alternate delivery site. The rule outlines which administrative office and support functions may be and must not be conducted from the administrative support site.
Division 6, Telehealth, Telemedicine, Telemonitoring, and Telecommunication
Proposed new Division 6 under Subchapter C, Telehealth, Telemedicine, Telemonitoring, and Telecommunication, outlines the applicability and general standards for an agency providing services via telehealth, telemedicine, telemonitoring, and telecommunications, also referred to throughout Subchapter C as teleservices.
Proposed new §558.330, Applicability, states that for an agency to provide teleservices, it must be licensed as a home health, licensed, and certified home health, or hospice category of service. The proposed rule also states that an agency cannot provide teleservices and be licensed with a category of personal assistance services only. The proposed rule also states that agencies that provide teleservices must identify the extent to which the services will be utilized in the admission agreement.
Proposed new §558.332, General Standards for Teleservices, states that an agency must evaluate the client, family supports, and environment to determine if teleservices are appropriate for and in line with the client’s needs and goals of care and provides what that evaluation must include. The rule specifies that an agency conducting a client’s initial assessment, comprehensive assessment, or reassessment must ensure all aspects of the assessment can be accurately evaluated via teleservices and that if risk is identified to the client’s health or safety during an assessment via teleservices, then an in-home visit must be completed. The rule states that employees and contractors who provide teleservices must meet all conditions for employment or contracting in accordance with §558.245. The rule specifies that teleservices must be conducted in a language and manner the client can understand, which may require the agency locate and coordinate with an interpreter or translator. The rule outlines how an agency must initially evaluate if teleservices are appropriate for a client and includes what an agency must assess in its annual evaluations of the teleservices program. The rule details that the agency must not require that the client accept teleservices if the client’s preferred service delivery method is in-person and in-person services are available. The rule specifies that if the client’s needs and goals are not being met using teleservices, then the agency must reevaluate the service delivery method for that client. The rule details that if an agency is unable to meet a client’s needs, it must document its concerns and follow transfer and discharge requirements as applicable. The rule states that an agency must adopt and enforce policies and procedures related to the use of teleservices and identify who must be trained on the policies and procedures and how often they must complete the training.
Proposed new §558.334, Standards for Telehealth and Telemedicine, states that agency staff or contractors providing telemedicine and telehealth services must follow any state and federal requirements regarding the use of these services as dictated by the agency staff or contractors’ applicable licensing boards, Texas Occupations Code, or TAC. The rule also states that agency staff or contractors providing telemedicine or telehealth services must maintain confidentiality of protected health information per federal and state law.
Proposed new §558.336, Standards for Telemonitoring, states that telemonitoring must be ordered by the primary care physician and must include the condition to be monitored, how often it must be monitored, any applicable parameters, and any additional instructions required as part of the telemonitoring. The rule states that the agency must adopt and enforce a policy for the delivery, installation, maintenance, and monitoring of the telemonitoring equipment. The rule requires the agency to comply with §558.247 and §558.289 if the agency uses contractor services to provide equipment delivery, installation, maintenance, or monitoring. The proposed rule outlines who the agency must provide education to on the use of home telemonitoring equipment. The rule states that a registered nurse must review any transmitted clinical data at intervals consistent with the client’s needs and goals set by his or her physician, but provides that the agency may use a licensed vocational nurse to assist the registered nurse in providing nursing telemonitoring services. The rule requires the agency to maintain documentation of telemonitoring visits and data and establishes the need for further evaluation of goals and outcomes in the client’s record, in addition to the requirements in §558.301.
Proposed new §558.338, Standards for Telecommunications, states that agency policies, procedures, contracting agreements, medical records, practitioner’s orders, and arranged services agreements may be sent and received electronically. The rule states if an agency provides client admission, discharge, or required notifications via telecommunication or electronic correspondence, it must confirm receipt of the information with the client or the client’s legally authorized representative. The language outlines which documents and notifications can be provided via telecommunications or electronic correspondence and the requirements that must be met should the agency choose to communicate this way.
Amending 26 TAC §558.401, §558.404, and §558.405, to update Subchapter D standards specific to licensed home health, personal assistance, and home dialysis services.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER D. ADDITIONAL STANDARDS SPECIFIC TO LICENSE CATEGORY AND SPECIFIC TO SPECIAL SERVICES
26 TAC §558.401, §558.404, §558.405
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter D, Additional Standards Specific to License Category and Specific to Special Services
The proposed amendment to §558.401, Standards Specific to Licensed Home Health Services, updates the rule to specify what the admission of a client must be based on and provides that it is the responsibility of the agency to communicate with the client’s primary care physician or practitioner regarding any needs the agency will be unable to meet. The amendment specifies that the initial health assessment may be performed either in-person or via teleservices. The amendment specifies that services must be based on the orders of the primary care physician or practitioner and details who must prepare a care plan when a practitioner has not ordered skilled care for a client. The amendment specifies who must be consulted in the development of the care plan.
The proposed amendment to §558.404, Standards Specific to Agencies Licensed to Provide Personal Assistance Services, updates the rule to include that a personal assistance services agency must not provide nursing or skilled services to its clients and that a registered nurse must not perform nursing tasks identified by the Nurse Practice Act §301.002 as part of personal assistance services. The amendment outlines the limitation of nursing services that are to be performed by a registered nurse employed by a personal assistance services agency and states that a registered nurse must ensure that skills performed by unlicensed personnel as part of tube feedings and medication administration through a permanently placed gastrostomy tube are completed as outlined by Texas Board of Nursing rules and the memorandum of understanding between HHSC and the Texas Board of Nursing. The amendment also states that a registered nurse may determine through an in-person assessment which health-related tasks do not require delegation and details the steps to be taken should the task require delegation.
The proposed amendment to §558.405, Standards Specific to Agencies Licensed to Provide Home Dialysis Services, adds language to include “practitioner” as well as primary care physician to maintain consistency within the rules. The amendment also updates a reference, corrects date errors, and deletes old language.
Amending, adding, and repealing sections in 26 TAC Chapter 558, Subchapter E, to update licensure survey procedures, including a new abuse/neglect/exploitation investigation prioritization rule and a new plan-of-removal requirement.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER E. LICENSURE SURVEYS AND INVESTIGATIONS OF ABUSE, NEGLECT, AND EXPLOITATION
26 TAC §§558.501, 558.503, 558.507, 558.521, 558.523, 558.525; new §§558.510, 558.527, 558.529; repeal of 26 TAC §558.527
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter E, Licensure Surveys
Division 1, General
The proposed amendment to §558.501, Survey and Investigation Frequency, provides that HHSC conducts a Life Safety Code survey before issuing a license for an initial parent agency or alternate delivery site with a category of hospice services with an inpatient unit and otherwise clarifies HHSC authority.
The proposed amendment to §558.503, Exemption From a Survey, updates the section title to “Accreditation Process and Exemption from a Survey.” The amendment states that all accreditation organizations with current HHSC approval will be listed on the HCSSA website. The amendment outlines the requirements that an agency must meet if it seeks exemption from a licensing survey via accreditation and provides that the agency must maintain documentation of accreditation organization surveys and outcomes available to be reviewed by HHSC as necessary.
The proposed amendment to §558.507, Agency Cooperation with a Survey, updates references and makes minor editing changes.
Proposed new §558.510, Prioritization of Abuse, Neglect, and Exploitation Investigations, provides an explanation of prioritization timeframes for investigations of abuse, neglect, and exploitation. The new rule also provides an overview of the investigation process.
Division 2, The Survey Process
The proposed amendment updates the title of the subchapter to “Licensure Surveys and Investigations of Abuse, Neglect, and Exploitation”
The proposed amendment to §558.521, Requirements for an Initial Survey, states an agency’s inability to receive payer source authorization or contract for services does not alleviate the agency’s responsibility to submit the letter of readiness within the required six months. The amendment also clarifies when the agency must admit and provide hospice services, per category of service or designation, after the effective date of an agency’s initial license. The proposed amendment also clarifies that HHSC may take enforcement action if an agency fails to admit and provide services to at least one client within six months of the issuance of an agency’s initial license. The amendment removes subsection (g) because the information has been relocated in §558.503.
The proposed amendment to §558.523, Personnel Requirements for a Survey, clarifies existing language to update references and adds additional forms of communication that may be used to contact the administrator, alternate administrator, supervising nurse, or alternate supervising nurse.
The proposed amendment to §558.525, Survey Procedures, clarifies that during a survey, an HHSC representative conducts at least three visits to a hospice inpatient unit to determine compliance with licensing requirements and conducts interviews with clients, staff, contractors, volunteers, and others, as applicable.
Proposed new §558.527, Plan of Removal, states that during an on-site inspection, if HHSC finds that a violation has created an immediate threat to the health and safety of a client, the agency must submit a plan of removal. The amendment also outlines what the plan of removal must include.
The proposed repeal of §558.527, Post-Survey Procedures, deletes the rule as no longer necessary, because the content of the rule has been added to proposed new §558.529 and will allow for the proposed new §558.527, Plan of Removal.
Proposed new §558.529, Post-Survey Procedures, relocates the rule from proposed repealed subsection of §558.527 with non-substantive editorial changes. The rule informs agencies on the post-survey procedures including protocols for the exit conference, identification of violations following the exit conference, plan of correction by the agency and requesting an informal dispute resolution.
Amending 26 TAC §558.601, §558.602, and §558.604, to update Subchapter F enforcement actions, administrative penalty tables, and license surrender/expiration procedures.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER F. ENFORCEMENT
26 TAC §558.601, §558.602, §558.604
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter F, Enforcement
The proposed amendment to §558.601, Enforcement Actions, adds requirements an agency must follow upon dissolution. The amendment updates references and makes non-substantive editorial changes.
The proposed amendment to §558.602, Administrative Penalties, updates the Severity Level A and B Violations chart figures by revising the rule citations and subject matter based on the amendments, repeals, and new rules in this proposal. The amendment also updates references.
The proposed amendment to §558.604, Surrender or Expiration of a License, adds provisions clarifying the actions HHSC will take if the agency either surrenders its license or allows its license to expire in lieu of paying the administrative penalty.
Amending 26 TAC §558.701, to allow virtual home health aide training so long as competencies are demonstrated and evaluated in person.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER G. HOME HEALTH AIDES
26 TAC §558.701
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter G, Home Health Aides
The proposed amendment to §558.701, Home Health Aides, updates language to include a pseudo-person for use during an aide’s performance evaluation and adds that agency training may be conducted virtually so long as the registered nurse or licensed vocational nurse ensures competencies are demonstrated and evaluated in person.
Amending, adding, and repealing sections in 26 TAC Chapter 558, Subchapter H, to update hospice-specific standards and restructure the hospice inpatient unit physical-environment requirements of repealed §558.871 into individual sections.
CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
SUBCHAPTER H. STANDARDS SPECIFIC TO AGENCIES LICENSED TO PROVIDE HOSPICE SERVICES
26 TAC §§558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, 558.880; new §§558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 558.944, 558.946, 558.948, 558.950; repeal of 26 TAC §558.871
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Chapter 558, concerning Licensing Standards for Home and Community Support Services Agencies, amendments to §§558.1 – 558.3, 558.11, 558.13, 558.15, 558.17, 558.19, 558.21, 558.23, 558.25, 558.27, 558.29, 558.30, 558.208, 558.210, 558.211, 558.213 – 558.220, 558.242 – 558.250, 558.252, 558.256, 558.257, 558.259, 558.260, 558.281 – 558.283, 558.285, 558.287 – 558.292, 558.295, 558.297, 558.321, 558.322, 558.401, 558.404, 558.405, 558.501, 558.503, 558.507, 558.521, 558.523, 558.525, 558.601, 558.602, 558.604, 558.701, 558.801, 558.812, 558.823, 558.834, 558.843, 558.857, 558.859, 558.861 – 558.863, 558.870, and 558.880; new §§558.251, 558.261, 558.304, 558.323, 558.330, 558.332, 558.334, 558.336, 558.338, 558.510, 558.527, 558.529, 558.914, 558.916, 558.918, 558.928, 558.930, 558.932, 558.936, 558.940, 558.942, 559.944, 558.946, 558.948, and 558.950; and the repeal of §§558.251, 558.527, and 558.871.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement House Bill (HB) 1009, HB 4696, Senate Bill (SB) 240, and SB 1849 enacted during the 88th Legislature, Regular Session, 2023, and SB 463 enacted during the 89th Legislature, Regular Session, 2025, to prescribe and streamline HHSC’s process for investigating allegations of abuse, neglect, and exploitation of clients, and to ensure the rules reflect current industry practices and changes in service delivery models, licensure requirements, and enforcement procedures. The proposal also updates citations to the Texas Government Code as modified by HB 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature’s ongoing statutory revision program. The updated citations became effective on April 1, 2025.
HB 1009 created Texas Health and Safety Code §253.0025 to require a home and community support services agency (HCSSA or agency) to suspend the employment of an unlicensed employee whom HHSC finds has engaged in reportable conduct while the employee exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review.
HB 4696 amended Texas Human Resources Code §48.252 to require allegations of abuse, neglect, and exploitation to be reported to HHSC rather than the Texas Department of Family and Protective Services (DFPS). HB 4696 also amended Texas Health and Safety Code §142.009(j) to state that a survey may (rather than must) be conducted within 18 months after a survey for an initial license and deleted the requirement that this visit must be made on-site.
SB 240 created Texas Health and Safety Code Chapter 331, to require a HCSSA providing licensed home health services to have a policy and prevention plan related to workplace violence if the HCSSA employs more than two registered nurses.
SB 463 amended Texas Health and Safety Code Chapter 331 to state that all HCSSAs must have a policy and prevention plan related to workplace violence if they employ two or more registered nurses.
SB 1849 created Texas Health and Safety Code Chapter 810, and with it the Interagency Reportable Conduct Search Engine, which is being implemented under the name Search Engine for Multiple Agency Reportable Conduct (SEMARC).
The proposal also deletes or updates obsolete references and contains non-substantive changes to improve readability and formatting.
SECTION-BY-SECTION SUMMARY
Subchapter H, Standards Specific to Agencies Licensed to Provide Hospice Services
Division 1, Hospice General Provisions
The proposed amendment to §558.801, Subchapter H Applicability, requires a statement be in the client’s record to specify that the start of hospice care begins on the effective date.
Division 2, Initial and Comprehensive Assessment of a Hospice
The proposed amendment to §558.812, Update of the Hospice Comprehensive Assessment, provides that the hospice interdisciplinary team may meet in-person or virtually if virtual meetings are effective for the purpose of the discussion.
Division 3, Hospice Interdisciplinary Team, Care Planning, and Coordination of Services
The proposed amendment to §558.823, Coordination of Services by the Hospice, updates the rule to incorporate communication and integration via teleservices, which supports modernization.
Division 4, Hospice Core Services
The proposed amendment to §558.834, Hospice Counseling Services, makes a non-substantive edit.
Division 5, Hospice Non-Core Services
The proposed amendment to §558.843, Hospice Aide Qualifications, adds the option for a hospice aide to be evaluated by a registered nurse using a pseudo-person or person in addition to a client to maintain consistency with the rules.
Division 6, Hospice Organization and Administration of Services
The proposed amendment to §558.857, Hospice Staff Training, adds provisions clarifying what a hospice must include in its staff orientation training.
The proposed amendment to §558.859, Hospice Discharge or Transfer of Care, adds language to include “practitioner” to maintain consistency within the rules.
The proposed amendment to §558.861, Management of Drugs and Biologicals and Disposal of Controlled Substance Prescription Drugs in a Client’s Home or Community Setting, adds language to include “practitioner” instead of physician to maintain consistency within the rules. “Physician assistant” and “prescribing practitioner” were also added to expand authority.
The proposed amendment to §558.862, Management of Drugs and Biologicals and Disposal of Controlled Substance Prescription Drugs in an Inpatient Hospice Unit, adds language to include “practitioner” instead of physician to maintain consistency within the rules and makes minor editing changes.
The proposed amendment to §558.863, Hospice Short-term Inpatient Care, updates references.
Division 7, Hospice Inpatient Units
The title of Division 7 is updated to “Inpatient Units.”
The proposed amendment to §558.870, Staffing in a Hospice Inpatient Unit, includes non-substantive edits.
The proposed repeal of §558.871, Physical Environment in a Hospice Inpatient Unit, deletes the rule as no longer necessary because the content of the rule has been added to proposed new Division 9 under subchapter H.
Division 8, Hospices that Provide Hospice Care to Residents of a Skilled Nursing Facility, Nursing Facility, or Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
The proposed amendment to §558.880, Providing Hospice Care to a Resident of a Skilled Nursing Facility, Nursing Facility, or Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions, includes non-substantive editorial changes.
Division 9, Physical Environment in a Hospice Inpatient Unit
Proposed new §558.914, Safety Management, moves the repealed safety management language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section outlines the responsibility of the inpatient unit to identify possible dangers to the health and safety of clients, and to ensure the creation of a written disaster preparedness plan that includes procedures for designating the staff responsible for carrying out evacuation or sheltering in place protocols that are outlined in the section.
Proposed new §558.916, Physical Plant and Equipment, moves the repealed safety management language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section provides regulations regarding the disposal of trash and medical waste, light, temperature, ventilation, gas and water supply and scheduled and emergency maintenance for equipment.
Proposed new §558.918, Fire Protection, moves the repealed fire protection language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must meet the applicable requirements of the health care occupancy chapters in National Fire Protection Association, 101 and reflects updated National Fire Protection Association, Life Safety Code, 2012 edition (NFPA 101).
Proposed new §558.928, Client Areas, moves the repealed client areas language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must provide a home-like atmosphere and what that entails.
Proposed new §558.930, Client Rooms, moves the repealed client rooms language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must ensure that each client room is designed and equipped to support nursing care and to maintain the dignity, comfort, and privacy of each client when possible and what that entails.
Proposed new §558.932, Plumbing Facilities, moves the repealed plumbing facilities language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs inpatient unit that the inpatient unit must maintain a continuous supply of hot water and install plumbing fixtures equipped with control valves designed to automatically regulate hot water temperatures for client use.
Proposed new §558.936, Infection Control, moves the repealed infection control language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs inpatient unit that the inpatient unit must have an infection control program designed to prevent and control infections and communicable diseases.
Proposed new §558.940, Sanitary Environment, moves the repealed sanitary environment language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must maintain a sanitary environment by following accepted standards of practice and prevent sources and transmission of infections and communicable diseases.
Proposed new §558.942, Linen, moves the repealed linen language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must maintain a sufficient supply of clean linen for client use at all times and that they must handle, transport, and store linens in a way that prevents the spread of contaminants.
Proposed new §558.944, Meal Service and Menu Planning, moves the repealed meal service and menu planning language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must provide meals for clients and outlines requirements for those meals.
Proposed new §558.946, Use of Restraint or Seclusion, moves the repealed use of restraint or seclusion language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that clients have the right to be free from restraint or seclusion and provides requirements for when and how restraint and seclusion may be used.
Proposed new §558.948, Restraint or Seclusion Staff Training Requirements, moves the repealed restraint or seclusion staff training requirements language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead of listing all the requirements in one section as they were previously. This section informs the inpatient unit that the inpatient unit must ensure that client care staff are trained and able to demonstrate competency in the application of restraints and implementation of seclusions and what competencies they must demonstrate.
Proposed new §558.950, Death Reporting Requirements Associated with the Seclusion or Restraint in a Hospice Inpatient, moves the repealed death reporting requirements associated with the seclusion or restraint in a hospice inpatient language from §558.871 into this section. This is based on an HHSC initiative to structure the physical environment requirements for hospice inpatient by section for easy reference instead
Adding new 26 TAC §§926.201, 926.203, 926.205, 926.207, 926.209, and 926.211, to implement Senate Bill 528’s requirements for inpatient competency restoration facilities, including memoranda of understanding and data reporting.
CHAPTER 926. STATE FACILITY REQUIREMENTS TO ENHANCE THE SAFETY OF INDIVIDUALS RECEIVING SERVICES
SUBCHAPTER E. INPATIENT COMPETENCY RESTORATION
26 TAC §§926.201, 926.203, 926.205, 926.207, 926.209, 926.211
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §926.201, concerning Purpose; §926.203, concerning Application; §926.205, concerning Definitions; §926.207, concerning Standardized Competency Restoration Curriculum, §926.209, concerning Memorandum of Understanding, and §926.211, concerning Report to the Texas Health and Human Services Commission.
BACKGROUND AND JUSTIFICATION
The proposal implements Senate Bill 528, 89th Legislature, Regular Session, 2025, which added Texas Health and Safety Code (HSC) Chapter 580, Inpatient Competency Restoration Services.
HSC Chapter 580 requires HHSC to establish rules requiring each facility that contracts with HHSC to provide inpatient competency restoration services to enter into a memorandum of understanding (MOU) to outline the powers and duties of competency restoration services. The MOU is between the facility, the county and municipality where the facility is located, and each local mental health authority or local behavioral health authority that operate in the county or municipality.
The proposal implements HSC §580.004 which requires each facility to report data to HHSC regarding individuals receiving inpatient competency restoration services.
In addition to the changes that implement HSC Chapter 580, the proposal also requires an HHSC contractor to use the Texas State Hospitals standardized competency restoration curriculum. Additionally, the contractor must require the subcontractor to use the Texas State Hospitals standardized competency restoration curriculum in providing inpatient competency restoration services.
SECTION-BY-SECTION SUMMARY
Proposed new §926.201 describes that the purpose of the subchapter is to set standards for inpatient competency restoration services.
Proposed new §926.203 states that the rules apply to a contractor with HHSC to provide inpatient competency restoration services to an individual.
Proposed new §926.205 defines terms used in the subchapter.
Proposed new §926.207 requires a contractor and their subcontractors to use the Texas State Hospitals standardized competency restoration curriculum. It also informs a contractor and a subcontractor how to access the curriculum.
Proposed new §926.209 identifies with whom a facility must enter into an MOU about inpatient competency restoration services. It also identifies the topics the MOU must include.
Proposed new §926.211 requires each facility to collect and submit specific data in the format and timeframe set by HHSC regarding individuals who received inpatient competency restoration services at the facility. It also requires that the facility report data separately for individuals charged with a misdemeanor offense and for individuals charged with a felony offense.
Cancer Prevention and Research Institute of Texas
Adopted Rules Re:
Amending 25 TAC §703.23, to apply the ten percent Grant Award holdback consistently regardless of whether a Product Development Research grant recipient receives funds in advance or by reimbursement, and to allow recipients to request a reduced holdback.
CHAPTER 703. GRANTS FOR CANCER PREVENTION AND RESEARCH
25 TAC §703.23
OVERVIEW
The Cancer Prevention and Research Institute of Texas (“CPRIT” or “the Institute”) adopts amendments to 25 Texas Administrative Code §703.23 without changes to the proposed amendments as published in the June 5, 2026, issue of the Texas Register (51 TexReg 3775); therefore, the rule will not be republished.
BACKGROUND AND JUSTIFICATION
CPRIT may withhold the last ten percent (10%) of the total Grant Award funds from a Grant Recipient that receives Grant Award funds via advance payment. Pursuant to §703.23(a), the Grant Recipient must successfully complete all close out reports required by the Institute to receive the withheld funds. This functions to ensure the Grant Recipient’s required compliance with all Grant Award close out documents.
Grant Recipients under the Product Development Research Program have sought and received advance Grant Award funds. As a result, CPRIT does not disburse the last ten percent (10%) of Grant Award funds for most Product Development Research Grant Recipients until the Grant Recipients have submitted close out documents.
Some Product Development Research Grant Recipients that initially received Grant Award funds paid in advance voluntarily elected to receive Grant Award funds via reimbursement-based disbursement during their Grant Contract term. Section 703.23 does not provide clear guidance regarding the Institute’s ability to withhold the final ten percent (10%) of Grant Award funds when the Grant Recipient has received advanced payment of Grant Award funds in the past but has later shifted to receiving payment of Grant Award funds on a reimbursement basis. The proposed rule change to §703.23 clarifies that all Product Development Research Grant Recipients are subject to the ten percent (10%) holdback regardless of whether they receive Grant Award funds in advance or on a reimbursement basis. All other Grant Recipients may be subject to the ten percent (10%) holdback if the Institute determines it is necessary and provides notice no later than the first day of the final Financial Status Report period for the Grant Award.
The proposed rule change permits the Grant Recipient subject to the ten percent (10%) holdback to submit a written request to CPRIT’s Chief Executive Officer to reduce or eliminate the amount of Grant Award funds otherwise withheld by the Institute. A Grant Recipient’s request must include a reasonable justification of the circumstances supporting a reduced holdback. Because this rule revision codifies the most common practice and applies it to all circumstances easily, it will avoid ambiguity and complexity in the application of the rule with little to no change to current practices.