Governor
Appointments Re:
Appointed to the Texas State Board of Examiners of Marriage and Family Therapists for a term to expire February 1, 2029, Misti K. Nielsen of Houston, Texas (replacing Lisa V. Merchant, Ph.D. of Clyde who resigned).
Texas Optometry Board
Proposed Rules Re:
Amending 22 TAC §277.7, to clarify what constitutes a patient record, remove language duplicative of §279.1 and §279.3, and allow patient records to be maintained in any format.
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.7
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 277, §277.7 – Patient Records. The amendments clarify the Board’s requirements for what constitutes a patient record; repeal current language that duplicates the requirements found in Rules 279.1 and 279.3 for clarity and ease of use by stakeholders; and allow records to be maintained in any format in response to the comment during the quadrennial review.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 277 were reviewed as a result of the Board’s general rule review under Texas Government Code §2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). One comment was received regarding the Board’s notice of review related to §277.7. The commenter stated the “written” patient record needed to be updated as most records are no longer written.
The Board has determined that there continues to be a need for the rules in Chapter 277. The Board has also determined that changes to §277.7 as currently in effect are necessary.
In conjunction with the quadrennial review, the rule was reviewed by the Texas Regulatory Efficiency Office (TREO). These amendments incorporate recommendations by TREO to reduce regulatory burdens; eliminate waste, fraud, and unnecessary rules; and increase transparency for Texas taxpayers.
CHAPTER 277. PRACTICE AND PROCEDURE
22 TAC §277.10
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 277, §277.10 – Remedial Plans. The rule deletes the authority for the Executive Director to issue remedial plans and instead leaves the authority with the Board.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 277 were reviewed as a result of the Board’s general rule review under Texas Government Code §2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received regarding this rule during the review period.
The Board has determined that there continues to be a need for the rules in Chapter 277. The Board has also determined that changes to §277.10 as currently in effect are necessary.
Amending 22 TAC §279.1, to update contact lens examination requirements regarding photograph use, patient knowledge of lens handling, sanitary office standards, and disciplinary language.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.1
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.1 – Contact Lens Examination. The proposed amendments update the requirements for a contact lens examination to clarify that a photograph can be used for other purposes besides documentation or consultation; confirm that a patient has knowledge regarding the correct handling of contact lenses; update what constitutes a sanitary office; remove the language related to willful or repeated noncompliance for disciplinary reasons; and make style changes for consistency across rules. The rule also deletes specific requirements for dispensers as the Board does not regulate dispensers.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). Comments received during the review were considered by the committee.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.1 as currently in effect are necessary.
In conjunction with the quadrennial review, the rule was reviewed by the Texas Regulatory Efficiency Office (TREO). These amendments incorporate many recommendations by TREO to reduce regulatory burdens; eliminate waste, fraud, and unnecessary rules; and increase transparency for Texas taxpayers.
Amending 22 TAC §279.2, to add electronic signature requirements for contact lens prescriptions and clarify the prescription verification process.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.2
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.2 – Contact Lens Prescriptions. The proposed amendments update requirements for a contact lens prescription to include electronic signature requirements; clarify the prescription verification process; delete language directing dispensers to act as the Board does not regulate dispensers; and make style changes for consistency across rules.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). Comments received during the review were considered by the committee.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.2 as currently in effect are necessary.
In conjunction with the quadrennial review, the rule was reviewed by the Texas Regulatory Efficiency Office (TREO). These amendments incorporate many recommendations by TREO to reduce regulatory burdens; eliminate waste, fraud, and unnecessary rules; and increase transparency for Texas taxpayers.
Amending 22 TAC §279.3, to remove willful or repeated noncompliance language from the spectacle examination rule.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.3
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.3 – Spectacle Examination. The proposed amendments update the requirements for a spectacle lens examination to remove the language related to willful or repeated noncompliance for disciplinary reasons and make style changes for consistency across rules.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this rule during the review.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.3 as currently in effect are necessary.
Amending 22 TAC §279.4, to define a fully written spectacle prescription, update electronic signature requirements, and add a duty to report prescriptions issued without the licensee’s knowledge.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.4
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.4 – Spectacle and Ophthalmic Devices Prescriptions. The proposed amendments define what constitutes a fully written spectacle prescription and update electronic signature requirements; and add a reference to §351.453 of the Optometry Act regarding signing a prescription without personally examining the eyes of the patient. It adds language that a licensee is responsible for prescriptions signed under his/her name and adds a requirement to report to the Board if a prescription was issued without his/her knowledge similar to language found in Board Rule §279.2.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this rule during the review.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.4 as currently in effect are necessary.
Amending 22 TAC §279.5, to remove language directing ophthalmic dispensers, a profession the Board does not regulate.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.5
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.5 – Dispensing Ophthalmic Materials. The rule makes style changes for consistency across rules and removes language directing an ophthalmic dispenser as the Board does not regulate that profession.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this rule during the review.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.5 as currently in effect are necessary.
Amending 22 TAC §279.9, to clarify that the advertising rule applies to both optometrists and therapeutic optometrists.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.9
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.9 – Advertising. The proposed amendment simply clarifies that the rule is applied to both an optometrist and therapeutic optometrist.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the open review.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.9 as currently in effect are necessary.
Amending 22 TAC §279.10, to clarify what a licensee must do to satisfy the Optometry Act’s name-display requirement.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.10
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.10 – Professional Identification. The proposed amendment removes unnecessary language from the rule to state what a licensee must do to satisfy §351.458 of the Optometry Act in regard to display of name at a practice location.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the review period.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.10 as currently in effect are necessary.
Amending 22 TAC §279.11, to delete language duplicative of statute regarding relationships with dispensing opticians.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.11
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.11 – Relationship with Dispensing Optician – Books and Records. The proposed amendment deletes language from the rule that is duplicative of statute.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the review period.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.11 as currently in effect are necessary.
Amending 22 TAC §279.12, to delete statute-duplicative language and affirm the Board’s intent on separation between optometrists and dispensing opticians.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.12
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.12 – Relationship with Dispensing Optician – Separation of Offices. The proposed amendment deletes language from the rule that is duplicative of statute and affirms the Board’s intent regarding separation between a dispensing optician and an optometrist.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the review period.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.12 as currently in effect are necessary.
Amending 22 TAC §279.13, to clarify an optometrist’s responsibility to patients when practicing away from the office.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.13
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.13 – Professional Responsibility for Off-Site Examinations: Improper Solicitation of Patients. The proposed amendment clarifies the responsibility of an optometrist practicing away from his/her office to the patient. The amendments also make style changes for consistency across rules.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the review period.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.13 as currently in effect are necessary.
Amending 22 TAC §279.14, to add a reference to statute in the patient files rule.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.14
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.14 – Patient Files. The amendment adds a reference to statute.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the review period.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.14 as currently in effect are necessary.
Amending 22 TAC §279.15, to remove specific disease examples and clarify the definition of a contagious disease.
CHAPTER 279. INTERPRETATIONS
22 TAC §279.15
OVERVIEW
The Texas Optometry Board proposes amendments to 22 TAC Chapter 279, §279.15 – Practice with Contagious or Infectious Disease. The rule removes specific examples of contagious diseases that could be applicable under the rule and clarifies the definition of a contagious disease under the rule.
BACKGROUND AND JUSTIFICATION
The rules in the Chapter 279 were reviewed as a result of the Board’s general rule review under Texas Government Code Section 2001.039. Notice of the review was published in the March 6, 2026, issue of the Texas Register (51 TexReg 1429). No comments were received on this specific rule during the review period.
The Board determined that there continues to be a need for the rules in Chapter 279. The Board also determined that changes to §279.15 as currently in effect are necessary.
Texas Health and Human Services Commission
Proposed Rules Re:
Amending 26 TAC §§553.3, 553.5, 553.7, and 553.9, to reorganize Subchapter A of the assisted living facility licensing rules, including a minimum resident age of 18 (or emancipated minor) and updated general characteristics of a resident.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER A. INTRODUCTION
26 TAC §§553.3, 553.5, 553.7, 553.9
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.
The proposal includes several important clarifications and enhancements. It clarifies that a resident in an assisted living facility must be at least 18 years old or an emancipated minor, strengthens rules relating to medication administration by requiring the documentation of doses administered instead of doses missed, clarifies that assisted living facilities must offer a planned activity to residents daily instead of at least once per week, adds guidance on the use of bedrails, clarifies that certain assistive devices and postural support devices are not to be construed as restraints, provides more guidance relating to respite admissions, specifies resident records must be retained for five years after services end, and reformats the rules in the enforcement section from question-and-answer format to standard rule format.
The proposal also updates a citation to the Texas Government Code as modified by House Bill (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 citation became effective on April 1, 2025.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §553.3, Definitions, amends the definitions for “abuse,” “exploitation,” and “neglect” to reference the definitions for these terms provided in Texas Health and Safety Code §260A.001. The proposed amendment also adds definitions that are used in the chapter. Definitions related to facility construction are relocated to proposed amended §553.101. The proposed amendment deletes definitions not used in the chapter. The proposed amendment also makes changes to certain definitions to add more clarity or update a reference.
The proposed amendment to §553.5, Types of Assisted Living Facilities, adds additional guidance related to the evacuation capability required of a resident in a Type A facility.
The proposed amendment to §553.7, Assisted Living Facility Services, updates references, adds a defined acronym, and adds clarity to the rule. The amendment also relocates language from §553.259(a)(1).
The proposed amendment to §553.9, General Characteristics of a Resident, adds the statement that a resident must be 18 years of age or older or an emancipated minor and updates guidance related to some general characteristics of a resident. Key updates to the list of general characteristics include statements providing that a resident may be incontinent without pressure sores in the genital or rectal areas or buttocks and use various assistive devices, as well as specifying that a resident may have a permanently placed percutaneous endoscopic gastrostomy tube which requires registered nurse (RN) delegation or RN designation as a health maintenance activity.
Amending 26 TAC §§553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, and 553.47, adding new §553.45, and repealing §553.43, to reorganize Subchapter B licensing procedures, including a new voluntary closure rule and removal of the onsite health inspection requirement for renewal.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER B. LICENSING
26 TAC §§553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.45, 553.47; repeal of 26 TAC §553.43
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.
The proposal includes several important clarifications and enhancements. It clarifies that a resident in an assisted living facility must be at least 18 years old or an emancipated minor, strengthens rules relating to medication administration by requiring the documentation of doses administered instead of doses missed, clarifies that assisted living facilities must offer a planned activity to residents daily instead of at least once per week, adds guidance on the use of bedrails, clarifies that certain assistive devices and postural support devices are not to be construed as restraints, provides more guidance relating to respite admissions, specifies resident records must be retained for five years after services end, and reformats the rules in the enforcement section from question-and-answer format to standard rule format.
The proposal also updates a citation to the Texas Government Code as modified by House Bill (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 citation became effective on April 1, 2025.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §553.17, Criteria for Licensing, adds more specific guidance related to whether an assisted living facility that has multiple buildings requires licensing as a small or large facility or requires multiple licenses. Edits are made to replace “on-site” with “onsite” and improve readability.
The proposed amendment to §553.21, Time Periods for Processing All Types of License Applications, adds clarity related to the payment of fees.
The proposed amendment to §553.23, Initial License Application Procedures and Requirements, adds clarity and standardizes capitalization and hyphenation.
The proposed amendment to §553.25, Initial License for a Type A or Type B Facility for an Applicant in Good Standing, updates references and standardizes capitalization and hyphenation.
The proposed amendment to §553.27, Certification of a Type B Facility or Unit for Persons with Alzheimer’s Disease and Related Disorders, removes the requirement that HHSC cancel an assisted living facility’s Alzheimer’s certification if the facility undergoes a change of ownership; adds a statement that HHSC cancels Alzheimer’s certification if a provider voluntarily surrenders it; and updates citations and references.
The proposed amendment to §553.29, Alzheimer’s Certification of a Type B Facility for an Initial License Applicant in Good Standing, updates references and standardizes capitalization and hyphenation.
The proposed amendment to §553.31, Provisional License, adds clarity, corrects references and citations, deletes redundant language, and standardizes the hyphenation of a word.
The proposed amendment to §553.33, Renewal Procedures and Qualifications, deletes the requirement for an onsite health inspection by HHSC for renewal of a license, clarifies timeframes for presumed receipt when HHSC faxes or emails notices to license holders, adds clarity, and updates references.
The proposed amendment to §553.35, Changes of Ownership and Notice of Changes, updates a reference and standardizes capitalization and hyphenation.
The proposed amendment to §553.37, Relocation, adds clarity, updates capitalization, and standardizes the hyphenation of a word.
The proposed amendment to §553.39, Increase in Capacity, adds clarity and standardizes capitalization and hyphenation.
The proposed repeal of §553.43, Disclosure of Facility Identification Number, deletes the rule as no longer necessary because the information is added to proposed new §553.292.
Proposed new §553.45, Voluntary Closure, clarifies notification requirements for an assisted living facility that chooses to close the facility.
The proposed amendment to §553.47, License Fees, adds clarity, standardizes capitalization and hyphenation, and updates a reference.
Amending 26 TAC §§553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, and 553.245 – 553.249, and adding new §553.250, to reorganize Subchapter D facility construction requirements and consolidate Alzheimer’s assisted living facility construction standards.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER D. FACILITY CONSTRUCTION
26 TAC §§553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, and new §553.250
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.
The proposal includes several important clarifications and enhancements. It clarifies that a resident in an assisted living facility must be at least 18 years old or an emancipated minor, strengthens rules relating to medication administration by requiring the documentation of doses administered instead of doses missed, clarifies that assisted living facilities must offer a planned activity to residents daily instead of at least once per week, adds guidance on the use of bedrails, clarifies that certain assistive devices and postural support devices are not to be construed as restraints, provides more guidance relating to respite admissions, specifies resident records must be retained for five years after services end, and reformats the rules in the enforcement section from question-and-answer format to standard rule format.
The proposal also updates a citation to the Texas Government Code as modified by House Bill (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 citation became effective on April 1, 2025.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §553.100, General Requirements, replaces a reference to NFPA 101, Life Safety Code, published by the National Fire Protection Association with the defined acronym “NFPA 101;” simplifies the statement of requirements based in NFPA 101 by deleting the listed examples of other NFPA 101 chapters that may apply to an assisted living facility without changing the intent of subsection (c); deletes references to the accessibility requirements of the Texas Department of Licensing and Regulation (TDLR) because those requirements are enforced by TDLR, not by HHSC; clarifies that an assisted living facility can only lock doors against egress or escape by means that are not permitted by NFPA 101, or if the facility is a Type B assisted living facility that is a certified Alzheimer’s assisted living facility; and removes a reference to previously repealed §553.51 and adds references to §553.27, §553.29, and proposed new §553.250.
The proposed amendment to §553.101, Definitions, clarifies definitions that relate to certified Alzheimer’s assisted living facilities to align with changes in usage in other sections in the chapter, defines new terms used in the subchapter related to certified Alzheimer’s assisted living facilities, adds definitions specific to facility construction from §553.3, and deletes a defined term that is no longer used in this chapter.
The proposed amendment to §553.103, Site and Location for all Assisted Living Facilities, deletes the minimum number of parking spaces an assisted living facility must provide based on the facility’s licensed capacity; deletes the requirement to provide a guardrail, fence, or handrail where a grade makes an abrupt change in level because the rule is subjective; and clarifies the limitation on licensing a new assisted living facility in a county of more than 3.3 million residents.
The proposed amendment to §553.104, Safety Operations, clarifies that an assisted living facility must maintain onsite documentation or written records for certain inspection, testing, and maintenance activities; reinstates the requirement for an assisted living facility to provide a reduced size floorplan upon request from HHSC, which was inadvertently repealed during a previous rule project; incorporates direct references to applicable requirements for certain assisted living facilities in NFPA 101, Life Safety Code, 2012 edition, as a convenience to assisted living facilities; clarifies references to portable fire extinguishers; clarifies that assisted living facilities must not allow an accumulation of waste in attics; makes changes in grammar that do not substantively change the requirements in the section; removes the requirement that an assisted living facility must have a “contract” with a service company to provide inspection, testing, and maintenance of fire safety systems; and removes the requirement that an assisted living facility must have a “program” to ensure inspection, testing, and maintenance of fire safety systems is performed.
The proposed amendment to §553.107, Building Rehabilitation, removes the requirement for an assisted living facility to notify HHSC before the start of building rehabilitation; incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition; adds lead-in phrases in paragraphs within subsection (c) to enhance readability; corrects references; and corrects the use of terms related to means of egress.
The proposed amendments to §§553.111, 553.121, 553.131, 553.141, 553.211, 553.221, 553.231, and 553.241, Construction Requirements for existing and new small and large Type A and Type B facilities, replace “Texas Health and Human Services Commission” with the defined acronym “HHSC” where applicable and incorporate, as a convenience to assisted living facilities, direct references to applicable requirements in NFPA 101, Life Safety Code, 2012 edition, along with facility-specific clarifications, including high-rise building requirements for existing large Type B facilities, interior finish material application for new large Type A facilities, and occupancy separation requirements for new large Type B facilities.
The proposed amendments to §§553.112, 553.122, 553.132, 553.142, 553.212, 553.222, 553.232, and 553.242, Space Planning and Utilization Requirements, replace the term “social-diversional space” with “common living area” throughout; clarify the requirements for common living areas and dining areas, including how minimum square footage is calculated and how the calculation may be reduced when individual living units include both a bedroom and other living space; clarify requirements related to bedroom windows; and relocate requirements related to food preparation and kitchen operation, which are not facility construction requirements, to §553.275.
The proposed amendments to §§553.113, 553.133, 553.143, 553.213, 553.233, and 553.243, Means of Escape/Egress Requirements, clarify requirements for doors between resident bedrooms or living units and corridors, clarify door-locking prohibitions for large Type B facilities, and clarify inspection and maintenance requirements for doors and other means of egress components.
The proposed amendments to §§553.115, 553.125, 553.135, 553.145, 553.215, 553.225, 553.235, and 553.245, Fire Protection Systems Requirements, clarify fire alarm and fire sprinkler system requirements, extend the deadline for existing facilities with fire sprinkler systems to protect attics to August 31, 2026, and clarify portable fire extinguisher requirements.
The proposed amendments to §§553.118, 553.128, 553.138, 553.148, 553.218, 553.228, 553.238, and 553.248, Electrical Requirements, clarify minimum lighting requirements, update communication system requirements to permit any technology that meets performance requirements, and clarify performance requirements for communication systems.
The proposed amendments to §§553.137 and 553.147, Mechanical Requirements for existing large Type A and Type B facilities, clarify the minimum required number of water closets and lavatories and clarify requirements related to portable space-heating devices.
New Division 12 is added in Subchapter D, titled “Specialized Assisted Living Facilities.” Proposed new §553.250, Construction Requirements for a Certified Alzheimer’s Assisted Living Facility, has construction requirements from repealed §553.311 so that these requirements are located with the other facility construction requirements in Subchapter D and are easier to find. The proposed new rule organizes requirements for Alzheimer’s certification based on whether an assisted living facility is small or large and whether it is fully locked or contains one or more certified Alzheimer’s assisted living units.
Amending 26 TAC §553.253, §553.254, and §553.259, repealing §553.255 and §§553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, and 553.275, and adding new §§553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, and 553.295, to reorganize Subchapter E resident-care standards, including medication administration, restraints, and infection prevention and control.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER E. STANDARDS FOR LICENSURE
26 TAC §§553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295; repeal of 26 TAC §553.255 and §§553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.
The proposal includes several important clarifications and enhancements. It clarifies that a resident in an assisted living facility must be at least 18 years old or an emancipated minor, strengthens rules relating to medication administration by requiring the documentation of doses administered instead of doses missed, clarifies that assisted living facilities must offer a planned activity to residents daily instead of at least once per week, adds guidance on the use of bedrails, clarifies that certain assistive devices and postural support devices are not to be construed as restraints, provides more guidance relating to respite admissions, specifies resident records must be retained for five years after services end, and reformats the rules in the enforcement section from question-and-answer format to standard rule format.
The proposal also updates a citation to the Texas Government Code as modified by House Bill (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 citation became effective on April 1, 2025.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §553.253, Employee Qualifications and Training, reorganizes manager and staff training requirements to add clarity. To be exempt from the 24-hour training course requirement, the amendment increases the time period an assisted living manager can have a break in employment as an assisted living manager from 30 days to 90 days and clarifies that subject matter dealing with internal affairs of an organization does not qualify for credit toward the 24-hour manager training course. The amendment to the section specifies that an attendant can have certification of equivalence of graduation and that a facility must have dedicated staff on duty for each shift and not share on-duty attendants with another facility or provider type. It also adds details to the required posting of the facility’s 24-hour staffing pattern, contains a statement that a facility must not use a companion care provider or solicit or involve family members to provide care to residents to mitigate staffing shortages, adds infection prevention and control principles to the list of required staff training and continued education, and removes the word “certified” from training requirements for medication aides, as medication aides are not certified.
The proposed amendment to §553.254, Training Requirements for Staff Providing Personal Care Services to a Resident With Alzheimer’s Disease or a Related Disorder in a Facility that is Not an Alzheimer’s Certified Facility, incorporates the training policy requirement from repealed §553.255 so all training required for employees providing services to residents with Alzheimer’s and related disorders is grouped into one section and there is no redundant information. The word “With” in the title of this section is changed to “with.”
The proposed repeal of §553.255, All Staff Policy for Residents with Alzheimer’s Disease or a Related Disorder, removes redundant requirements that are located in other sections relating to training policy requirements for employees of facilities with residents who have Alzheimer’s disease and related disorders.
The proposed amendment to §553.259, Admission Policies and Procedures, adds that a facility must not admit a resident under the age of 18 years unless the person is an emancipated minor. The amendment adds the requirement for a facility to share the facility’s disclosure statement and resident service plans with outside resources and obtain resident service (or care) plans from outside resources, adds a requirement that an assisted living facility that allows pets must have a pet policy, and specifies the information the pet policy must include. It also adds a requirement for a facility to address the use of service animals in accordance with the Americans with Disabilities Act, changes the term “resident assessment” to “resident evaluation,” states the resident evaluation must be completed annually and upon a significant change in condition, and updates references.
The proposed repeal of §553.261, Coordination of Care, deletes the rule. New rules are proposed in Subchapter E based on the topic of each subsection of §553.261. These topics include: Medications; Accident, Injury or Acute Illness; Health Care Professional; Activities Program; Dietary Services; Infection Prevention and Control; and Restraints and Seclusion, which includes Wheelchair Self-Release Seat Belts.
The proposed repeal of §553.263, Health maintenance activities; §553.265, Resident Records and Retention; §553.267, Rights; §553.269, Access to Residents and Records by the State Long-Term Care Ombudsman Program; §553.271, Postings; §553.272, Advertisements, Solicitations, and Promotional Material; §553.273, Abuse, Neglect, or Exploitation Reportable to HHSC by Facilities; and §553.275, Emergency Preparedness and Response, deletes the rules. New rules are proposed with the same topics in Subchapter E.
Proposed new §553.261, Inappropriate Placement in a Type A or Type B Facility, relocates content from §553.259 regarding inappropriate placement in Type A or Type B facilities and does not include the requirement for annual completion of HHSC training on aging in place and retaliation, as the requirement was removed from Texas Health and Safety Code §247.066 by House Bill 2358, 89th Legislature, Regular Session, 2025.
Proposed new §553.263, Resident Transfer and Discharge, requires the facility to establish a policy relating to resident transfer and discharge. It outlines residents’ rights pertaining to being transferred or discharged.
Proposed new §553.265, Respite Admissions, provides requirements concerning residents admitted for respite care.
Proposed new §553.267, Medications, has requirements from repealed §553.261. The proposed new rule adds requirements for assisted living facilities to have written medication policies and procedures and maintain a medication profile record and a medication administration record for each resident who receives medication administration or supervision. Staff must record all medication doses administered and missed in the medication administration record. Previously, the rule only required staff to record missed doses.
Proposed new §553.269, Accident, Injury, or Acute Illness, has requirements from repealed §553.261, with updated references. This new rule also provides a requirement for facilities to notify any outside resources that provide care to a resident who has been injured or had an accident or acute illness, within 48 hours.
Proposed new §553.271, Health Care Professional, relocates requirements from repealed §553.261. This section describes that a health care professional may provide services to a resident within the health care professional’s scope of practice.
Proposed new §553.273, Activities Program, has requirements from repealed §553.261. This new rule changes the requirement from offering residents an activity at least once a week to offering residents a daily activity.
Proposed new §553.275, Dietary Services, has requirements from repealed §553.261. This rule contains requirements for food preparation and kitchen area from other amended rules in Subchapter D, as the guidance is relevant in this rule. It also adds a requirement that staff who work with or handle unpackaged food must complete an accredited food handler training course and clarifies that the three daily meals or the equivalent must include all five basic food groups.
Proposed new §553.277, Infection Prevention and Control, has requirements from repealed §553.261. The new rule adds that during a declared public health emergency or disaster, the facility must also follow the requirements in Chapter 570, Subchapter B. The new rule also provides additional guidance for employee tuberculosis (TB) screening and decreases the requirement for employee TB education from annually to at least once every 24 months.
Proposed new §553.279, Restraints and Seclusion, has requirements from repealed §553.261. This section describes the circumstances under which restraints can be used and contains the requirements pertaining to wheelchair self-release seat belts. It also adds specific guidance pertaining to the use of bed rails.
Proposed new §553.281, Health Maintenance Activities, has requirements from repealed §553.263. This section describes the requirements for providing health maintenance activities. It also removes the provisions relating to RN delegation because RN delegation is separate from health maintenance activities and has different requirements.
Proposed new §553.283, RN Delegation of Care Tasks, has requirements from repealed §553.263. The new rule clarifies that RN delegation is distinct from health maintenance activities and that an RN providing RN delegation to staff of the assisted living facility must be an employee or a contractor of the assisted living facility.
Proposed new §553.285, Resident Records and Retention, has requirements from repealed §553.265. The new rule also adds a requirement to retain resident records for at least five years after services end and provides guidance pertaining to electronic records and destruction of records.
Proposed new §553.287, Rights, has requirements from repealed §553.267. The new rule specifies that an assisted living facility must provide a copy of the Residents’ Bill of Rights to each resident or resident’s legally authorized representative in the resident’s primary language and adds specificity and clarity to rules pertaining to residents’ rights to privacy and retaining personal property. The rule also adds a requirement for an assisted living facility to allow residents to form and participate in resident councils.
Proposed new §553.289, Access to Residents and Records by the State Long-Term Care Ombudsman Program, has requirements from repealed §553.269. It adds the requirement that a facility must not require complaints to be made to the assisted living facility before making a complaint to the Ombudsman Program.
Proposed new §553.291, Postings, has requirements from repealed §553.271. It also adds requirements to post the facility’s evacuation floor plan, unless the facility is one-story or is licensed for fewer than 17 residents, the facility’s meal menu for the current week, resident daily activities scheduled for the current month, emergency telephone numbers, and notices about electronic monitoring.
Proposed new §553.292, Advertisements, Solicitations, and Promotional Material, has requirements from repealed §553.272. This section describes the requirement for assisted living facilities to include the state-issued identification number in all advertisements and promotional material and adds forms of advertisement to include social media accounts and websites.
Proposed new §553.293, Abuse, Neglect, or Exploitation and Incidents Reportable to HHSC by Facilities, has requirements from repealed §553.273. This section describes the requirements and procedures for reporting abuse, neglect, and exploitation, and specifies which incidents must be reported to HHSC and law enforcement.
Proposed new §553.295, Emergency Preparedness and Response, has requirements from repealed §553.275. This section describes the requirement for assisted living facilities to have policies and procedures in place, and follow them, in the event of an emergency or disaster. It also adds the clarification that having an evacuation summary is a requirement, and not optional.
Amending 26 TAC §§553.301, 553.303, 553.305, 553.307, and 553.309, and repealing §553.311, to reorganize Subchapter F additional standards for certified Alzheimer’s assisted living facilities.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER F. ADDITIONAL LICENSING STANDARDS FOR CERTIFIED ALZHEIMER’S ASSISTED LIVING FACILITIES
26 TAC §§553.301, 553.303, 553.305, 553.307, 553.309; repeal of 26 TAC §553.311
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §553.301, Manager Qualifications and Training, adds “Alzheimer’s Certified Facility or Unit” and other clarifications to the title. The update aims to clearly differentiate between rules addressing Alzheimer’s certified facilities and those that do not. Edits are made to add references and correct grammar.
The proposed amendment to §553.303, Staff Training, adds “Alzheimer’s Certified Facility or Unit” and other clarifications to the title. The amendments also clarify certain guidance to make information easier to find and understand.
The proposed amendment to §553.305, Staffing, adds “Alzheimer’s Certified Facility or Unit” and other clarifications to the title. The amendments also clarify certain guidance.
The proposed amendment to §553.307, Admission Procedures, Assessment, and Service Plan, adds “Alzheimer’s Certified Facility or Unit” and other clarifications to the title. The amendments also clarify certain guidance.
The proposed amendment to §553.309, Activities Program, adds “Alzheimer’s Certified Facility or Unit” and other clarifications to the title. The amendments also reorganize some rules and clarify certain guidance to make information easier to find and understand.
The proposed repeal of §553.311, Physical Plant Requirements for Alzheimer’s Units, deletes the rule. The information from the rule is relocated to new proposed §553.250.
Amending 26 TAC §553.327, §553.331, and §553.333, and adding new §553.328, to reorganize Subchapter G inspections, investigations, and informal dispute resolution procedures, including a new plan of removal requirement.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER G. INSPECTIONS, INVESTIGATIONS, AND INFORMAL DISPUTE RESOLUTION
26 TAC §553.327, §553.328, §553.331, §553.333
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §553.327, Inspections, Investigations, and Other Visits, adds a requirement that an assisted living facility that maintains electronic records must have a mechanism for printing all documentation if a surveyor or investigator requests a printed copy. The amendment also corrects a grammatical error.
Proposed new §553.328, Plan of Removal, specifies procedures for a facility to submit a plan of removal if HHSC has found a violation that creates an immediate threat to health and safety of a resident.
The proposed amendment to §553.331, Determinations and Actions (Investigation Findings), adds a form name and standardizes hyphenation.
The proposed amendment to §553.333, Informal Dispute Resolution, adds specificity to how HHSC redacts or excludes information on documents related to an informal dispute resolution and updates references.
Amending 26 TAC §553.751, and repealing and replacing the question-and-answer format enforcement rules with standard-format rules, to reorganize Subchapter H enforcement provisions covering license suspension, revocation, injunctions, emergency closure, civil penalties, and trusteeship.
CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER H. ENFORCEMENT
26 TAC §§553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, 553.701, and 553.751; repeal of 26 TAC §§553.351, 553.353, 553.401 – 553.439, 553.451 – 553.483, 553.501, 553.503, 553.551 – 553.597, 553.601, 553.603, 553.651 – 553.661, and 553.701 – 553.711
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 – 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 – 553.133, 553.135, 553.137 – 553.139, 553.141 – 553.143, 553.145, 553.147 – 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 – 553.233, 553.235, 553.237 – 553.239, 553.241 – 553.243, 553.245 – 553.249, 553.253, 553.254, 553.259, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 – 553.273, 553.275, 553.311, 553.351, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 – 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter, and to reformat the rules in the enforcement section from question-and-answer format to standard rule format.
An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.
SECTION-BY-SECTION SUMMARY
The proposed repeal of the question-and-answer format rules in Subchapter H, Divisions 1 through 8, deletes the rules as the provisions from these rules are proposed in new rules, rewritten in standard format rather than the question-and-answer style.
Proposed new §553.351, Enforcement General Information, has requirements from the repealed sections of Subchapter H, Division 1, rewritten in standard format. The rule provides when HHSC may take enforcement actions and the type of enforcement actions that may be taken.
Proposed new §553.401, Suspension Actions Against a License, has requirements from the repealed sections of Subchapter H, Division 2, rewritten in standard format. The rule provides when HHSC may suspend a facility’s license and describes the process for suspension as well as the opportunity to show compliance and the right to appeal.
Proposed new §553.451, Revocation Actions Against a License, has requirements from repealed Subchapter H, Division 3, rewritten in standard format. The rule provides when HHSC may revoke a facility’s license and describes the process for revocation as well as the opportunity to show compliance and the right to appeal.
Proposed new §553.501, Temporary Restraining Order and Injunctions Against a License, has requirements from repealed Subchapter H, Division 4, rewritten in standard format. The rule provides when HHSC will refer a facility to the Office of Attorney General and where HHSC will refer a facility that is operating without a license.
Proposed new §553.551, Emergency License Suspension and Closing Order Actions Against a License, has requirements from repealed Subchapter H, Division 5, rewritten in standard format. The rule provides when HHSC can suspend a license or order an immediate closing of all or part of a facility and the actions the facility must take when a facility is closed partly or fully.
Proposed new §553.601, Civil Penalties, has requirements from repealed Subchapter H, Division 6, rewritten in standard format. The rule provides when HHSC may refer a facility to the Office of the Attorney General and when civil penalties can be assessed.
Proposed new §553.651, Involuntary Appointment of a Trustee, has requirements from repealed Subchapter H, Division 7, rewritten in standard format. The rule provides when HHSC may petition a court for involuntary appointment of a trustee to operate a facility and when HHSC may provide emergency assistance funds.
Proposed new §553.701, Appointment of a Trustee by Agreement, has requirements from repealed Subchapter H, Division 8, rewritten in standard format. The rule provides what happens when a facility requests the appointment of a trustee.
The proposed amendment to §553.751, Administrative Penalties, changes the term “opportunity to correct” to “right to correct,” makes edits for formatting and consistency, and updates references.
Adopted Rules Re:
Amending 26 TAC §748.887, to add crisis response training for emergency behavior intervention with a goal of limiting law enforcement involvement.
CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS
SUBCHAPTER F. TRAINING AND PROFESSIONAL DEVELOPMENT
26 TAC §748.887
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §748.887, concerning Pre-Service Training Curriculum Components for General Residential Operations that Do Not Allow Emergency Behavior Intervention. Section 748.887 is adopted with changes to the proposed text as published in the March 20, 2026, issue of the Texas Register (51 TexReg 1797). This rule will be republished.
BACKGROUND AND JUSTIFICATION
HB 16 amended HRC §42.0426 to require a residential child care facility to include crisis response training for emergency behavior intervention with a goal of limiting law enforcement involvement. A separate rule project will implement the bill for child-placing agencies.
In Addition Re:
Correction of Error
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Office of Inspector General (OIG), adopted amendments to Title 1, Chapter 373 in the August 21, 2026, issue of the Texas Register (51 TexReg 5531). Due to an error by the Texas Register, text was omitted from the first paragraph of the preamble. The first paragraph should read as follows:
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Office of Inspector General (OIG), adopts in the Texas Administrative Code Title 1, Part 15, Chapter 373, Subchapter A, amendments to §§373.101, 373.103, 373.105; Subchapter B, amendments to §§373.201, 373.203, 373.205, 373.207, 373.209, 373.211, 373.213, 373.215, 373.217, and 373.219; and Subchapter C, amendments to §§373.301, 373.303, 373.305, and 373.307.
Correction of Error
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopted a repeal, amendments and new rules in Title 26, Chapter 358, Subchapter C in the August 21, 2026, issue of the Texas Register (51 TexReg 5543). Due to an error by the Texas Register, the new subchapter name for the amendments and new rules was omitted. The subchapter name should read as follows:
SUBCHAPTER C. FOCUSED ABA SERVICES
Texas Department of State Health Services
Adopted Rules Re:
Amending 25 TAC §229.420, to align medical gas standards for wholesale prescription drug distributors with new federal Good Manufacturing Practice requirements.
CHAPTER 229. FOOD AND DRUG
SUBCHAPTER W. LICENSING OF WHOLESALE DISTRIBUTORS OF PRESCRIPTION DRUGS–INCLUDING GOOD MANUFACTURING PRACTICES
25 TAC §229.420
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts an amendment to §229.420, concerning Medical Gases. Section 229.420 is adopted without changes to the proposed text as published in the May 29, 2026, issue of the Texas Register (51 TexReg 3677). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment to Title 25 of the Texas Administrative Code (TAC) Chapter 229, Subchapter W, relating to Licensing of Wholesale Distributors of Prescription Drugs–Including Good Manufacturing Practices (GMP) is necessary to comply with applicable federal laws pertaining to medical gases. Specifically, the amendment aligns the minimum standards in the current rule with new Medical Gases GMP requirements under 21 Code of Federal Regulations (CFR) Part 213 and 21 CFR Part 230, which are already in effect. The amendment will adopt the new 21 CFR Part 213 and 21 CFR Part 230 in 25 TAC §229.420(a).