Texas Register September 5, 2025 Volume: 50 Number: 36

Texas Register Table of Contents

1 Texas Department of State Health Services
- - 1.0.1 Proposed Rules Re:
    - 1.0.1.1 Amending 25 TAC §1.61, §1.63, to change the title and prescribe the way a physician may request additional medical conditions be added to the list of qualifying conditions for which low-THC cannabis may be prescribed, as well as define a pulmonary inhalation medical device that may be prescribed to a qualified patient.
  - 1.0.2 Adopted Rules Re:
    - 1.0.2.1 Adopting 25 TAC §289.253, to update references to ensure compatibility with equivalent NRC regulation and improve the rule language for clarity.
2 Texas Health and Human Services Commission
- - 2.0.1 Adopted Rules Re:
  - 2.0.2 In Addition Re:
    - 2.0.2.1 Revised Public Notice: Drug Shortages
3 Texas Optometry Board
- - 3.0.1 Adopted Rules Re:
    - 3.0.1.1 Adopting 22 TAC §275.2, to proposes new changes to replace the expired statute requiring a prescriber of opioids to take an annual hour of continuing education relating to opioid prescribing best practices.

Texas Department of State Health Services

Proposed Rules Re:

Amending 25 TAC §1.61, §1.63, to change the title and prescribe the way a physician may request additional medical conditions be added to the list of qualifying conditions for which low-THC cannabis may be prescribed, as well as define a pulmonary inhalation medical device that may be prescribed to a qualified patient.

CHAPTER 1. MISCELLANEOUS PROVISIONS
SUBCHAPTER D. LOW-THC CANNABIS FOR COMPASSIONATE USE
25 TAC §1.61, §1.63

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 §1.61, concerning Incurable Neurodegenerative Diseases, and new §1.63, concerning Pulmonary Inhalation Devices for Low-THC Cannabis.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill (H.B.) 46, by King et al, 89th Legislature, Regular Session, 2025, which amends Texas Occupations Code §169.003 to allow DSHS to receive physician requests to add medical conditions to the list of qualifying conditions for which physicians may prescribe low-THC cannabis under the Texas Compassionate Use Program at the Texas Department of Public Safety. H.B. 46 also amends Texas Occupations Code Chapter 169 to add §169.006 to allow physicians to prescribe medical devices for the pulmonary inhalation of an aerosol or vapor to administer low-THC cannabis and establish a timeline for reviewing and approving such devices. In accordance with H.B. 46, the rule must be effective not later than October 1, 2025.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §1.61, Incurable Neurodegenerative Diseases, changes the rule title to “Medical Conditions for which a Physician May Prescribe Low-THC Cannabis.” The proposed amendment also prescribes the way a physician may request additional medical conditions be added to the list of qualifying conditions.

Proposed new §1.63, Pulmonary Inhalation Devices for Low-THC Cannabis, defines a pulmonary inhalation medical device of an aerosol or vapor a physician may prescribe to a qualified patient and establishes a timeline for reviewing and approving such devices.

Adopted Rules Re:

Adopting 25 TAC §289.253, to update references to ensure compatibility with equivalent NRC regulation and improve the rule language for clarity.

CHAPTER 289. RADIATION CONTROL
SUBCHAPTER F. LICENSE REGULATIONS
25 TAC §289.253

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts an amendment to §289.253, concerning Radiation Safety Requirements for Well Logging Services Operations and Tracer Studies.

Section 289.253 is adopted without changes to the proposed text as published in the June 13, 2025, issue of the Texas Register (50 TexReg 3554). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

The amendment is necessary for Texas (an Agreement State) to comply with United States Nuclear Regulatory Commission (NRC) procedures, which require Agreement State rules to be compatible with NRC regulations. The amendment corrects the record retention requirements for well logging field stations and temporary job sites as defined in §289.253(cc).

Specifically, the amendment updates §289.253(cc)(2), Records/documents for inspection by the department, to reference only those records listed in the equivalent NRC regulation, 10 CFR §39.73 (Documents and records required at field stations). Additionally, §289.253(cc)(4), Records/documents for inspection by the department, is updated to reference only those records listed in the equivalent NRC regulation, 10 CFR §39.75 (Documents and records required at temporary job sites). The items which must be retained for inspection by the department are listed in Figure: 25 TAC §289.253(ee)(5).

Texas Health and Human Services Commission

Adopted Rules Re:

Adopting 1 TAC §355.102, §355.105, to clarify training requirements for cost report submission and require contracted providers’ cost reporting period to align with the state fiscal year.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER A. COST DETERMINATION PROCESS
1 TAC §355.102, §355.105

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to Texas Administrative Code Title 1, Chapter 355, Subchapter A, concerning Cost Determination Process, §355.102 and §355.105; Subchapter C, concerning Reimbursement Methodology for Nursing Facilities, §355.318; Subchapter D, concerning Reimbursement Methodology for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID), §355.456; Subchapter E, concerning Community Care for Aged and Disabled, §§355.503, 355.505, 355.507, 355.509, and 355.513; Subchapter F, concerning Reimbursement Methodology for Programs Serving Persons with an Intellectual or Developmental Disability, §355.723; Subchapter G, concerning Advanced Telecommunications Services and Other Community-Based Services, §355.5902 and §355.6907; Subchapter H, concerning Attendant Cost Determination, §355.7051; Subchapter M, concerning Miscellaneous Programs, §355.9090; new rules in Subchapter C, concerning Reimbursement Methodology for Nursing Facilities, §355.305; and Subchapter H, concerning Attendant Cost Determination, §355.7052; and the repeals in Subchapter A, concerning Cost Determination Process, §355.112; Subchapter C, concerning Reimbursement Methodology for Nursing Facilities, §§355.304; 355.306; 355.307; 355.308; and 355.320; Subchapter D, concerning Reimbursement Methodology for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID), §355.457; and Subchapter F, concerning Reimbursement Methodology for Programs Serving Persons with an Intellectual or Developmental Disability, §355.722.

Sections 355.102, 355.305, 355.318, 355.456, 355.503, 355.505, 355.513, 355.723, 355.5902, and 355.7052 are adopted with changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3953). These rules will be republished.

Sections 355.105, 355.507, 355.509, 355.6907, 355.7051, and 355.9090 and the repeal of §§355.112, 355.304, 355.306, 355.307, 355.308, 355.320, 355.457, and 355.722 are adopted without changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3953). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments, repeals, and new rules are necessary to implement the 2026-27 General Appropriations Act, Senate Bill (S.B.) 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Riders 23 and 25, respectively) and Senate Bill 457 (S.B. 457), 89th Legislature, Regular Session, 2025. The adoption amends and repeals existing rules, and creates new rules that address the following.

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The 2026-27 General Appropriations Act, S.B. 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 23) (Rider 23) provides appropriations for HHSC to increase the wage for personal attendants assumed in the adopted rates for attendant and attendant-like services to $13.00 per hour and to increase the associated payroll costs, taxes, and benefits percentage to 14 percent for community services and 15 percent for residential services. Rider 23 also discontinues the Attendant Compensation Rate Enhancement program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The 2026-27 General Appropriations Act, S.B. 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 25) (Rider 25) and S.B. 457 provide additional appropriations to fund dietary and administrative costs for nursing facilities. The amendment modifies reimbursement methodology to support the implementation of Rider 25 and S.B. 457.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.112, to repeal this section because the Attendant Compensation Rate Enhancement Program is being discontinued.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER A. COST DETERMINATION PROCESS
1 TAC §355.112

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §§355.304, 355.306 – 355.308, 355.320, to repeal the following sections.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §§355.304, 355.306 – 355.308, 355.320

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.305, §355.318, to introduce the new annual patient expense ratio for nursing facilities and clarify how HHSC defines the various components.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.305, §355.318

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.456, to replace references to §355.112 with proposed new §355.7052 and deletes references to §355.320 and replaces it with §355.318.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER D. REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID)
1 TAC §355.456

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.457, to deletes the rule as it is no longer necessary.

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §§355.503, 355.505, 355.507, 355.509, 355.513, to replace updated references.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER E. COMMUNITY CARE FOR AGED AND DISABLED
1 TAC §§355.503, 355.505, 355.507, 355.509, 355.513

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.722, to repeal the section because it is no longer necessary.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §355.722

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.723, to update references.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §355.723

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.5902, §355.6907, to replace references.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER G. ADVANCED TELECOMMUNICATIONS SERVICES AND OTHER COMMUNITY-BASED SERVICES
1 TAC §355.5902, §355.6907

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.7051, §355.7052, to change the title of the rule and introduce the rate methodology for the attendant cost component.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER H. ATTENDANT COST DETERMINATION
1 TAC §355.7051, §355.7052

OVERVIEW

BACKGROUND AND JUSTIFICATION

The adoption revises the personal attendant wage, creates a new rate methodology for the attendant cost component, and repeals the Attendant Compensation Rate Enhancement Program.

The adoption revises the rate methodology for nursing facilities, implements a new annual patient expense ratio, repeals the Direct Care Staff Enhancement program and direct care spending requirements.

The proposal revises cost report training requirements.

Adopting 1 TAC §355.9090, to revise how the Community First Choice- State Plan Attendant and Habilitation rate is calculated.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER M. MISCELLANEOUS PROGRAMS
DIVISION 7. COMMUNITY FIRST CHOICE
1 TAC §355.9090

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §355.321, concerning Reimbursement Methodology for Intellectual and Developmental Disabilities Nursing Facility Special Reimbursement Class.

Section 355.321 is adopted without changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3966). The rule will not be republished.

BACKGROUND AND JUSTIFICATION

The new rule is necessary to comply with the 2026-27 General Appropriations Act, Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 31) (Rider 31). Rider 31 provides appropriations for HHSC to implement a new payment methodology for a new special reimbursement class to achieve improved care for long-term stay nursing facilities serving residents with intellectual and developmental disabilities.

Adopting 1 TAC §355.321, to introduce the new special reimbursement class for nursing facilities serving individuals with intellectual and developmental disabilities.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.321

OVERVIEW

Section 355.321 is adopted without changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3966). The rule will not be republished.

BACKGROUND AND JUSTIFICATION

Adopting 26 TAC §271.1, to make grammatical changes to improve clarity and update references.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER A. DEFINITIONS
26 TAC §271.1

OVERVIEW

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §271.1, concerning Definitions of Program Terms; §271.5, concerning Community Services Interest Lists; §271.7, concerning Enrollment; §271.51, concerning Eligibility for Services; §271.53, concerning Income and Income Eligibles; §271.55, Determination of Countable Income; §271.57, concerning Income from Excludable Sources; §271.59, concerning Income from Exempt Sources; §271.61, concerning Age; §271.63, concerning Need; §271.65, concerning Indian-related Exemptions; §271.69, concerning Family Care; §271.71, concerning Home Delivered Meals; §271.73, concerning Adult Foster Care; §271.75, concerning Special Services to Persons with Disabilities; §271.77, concerning Day Activity and Health Services; §271.79, concerning Case Management Services; §271.81, concerning Primary Home Care or Community Attendant Services; §271.83, concerning Time Allocation for Escort Services; §271.85, concerning Residential Care; §271.87, concerning Emergency Care; §271.89, concerning Resource Limits; §271.91, concerning Countable Resources; §271.93, concerning Resource Exclusions; §271.95, concerning Emergency Response Services; §271.97, concerning Residential Care Services; §271.151, concerning Application for Services; §271.153, concerning Recertification; §271.155, concerning Denial, Reduction, and Termination of Benefits; §271.159, concerning Adult Foster Care Client Rights and Responsibilities, and the repeal of §271.3, concerning Definitions.

Section 271.5 is adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2898). This rule will be republished.

Sections 271.1, 271.7, 271.51, 271.53, 271.55, 271.57, 271.59, 271.61, 271.63, 271.65, 271.69, 271.71, 271.73, 271.75, 271.77, 271.79, 271.81, 271.83, 271.85, 271.87, 271.89, 271.91, 271.93, 271.95, 271.97, 271.151, 271.153, 271.155, 271.159, and the repeal of §271.3 are adopted without changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2898). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015, abolished the Texas Department of Aging and Disability Services (DADS) and transferred its functions to the Texas Health and Human Services Commission (HHSC), including Community Care for Aged and Disabled (CCAD). The program name was subsequently renamed to Community Care Services Eligibility (CCSE) on September 1, 2016. The rules for CCSE were administratively transferred from Title 40 Texas Administrative Code (TAC) to Title 26. The purpose of this adoption is to update references and terms in the rules to reflect the transition of the program from DADS to HHSC.

The amendments replace outdated references to “DADS” and “CCAD” with “HHSC” and “CCSE,” which are the appropriate oversight agency and program. Additionally, there are references to outdated terms and program names such as “food stamps” or “aid to families with dependent children.” The adoption updates those references to align 26 TAC, Part 1, Chapter 271, with both the agency’s person-centered language policy and Texas Government Code Chapter 392. Eligibility requirements for the program are not changing.

Adopting 26 TAC §271.3, to repeal this section.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER B. INTEREST LISTS
26 TAC §271.3

OVERVIEW

Section 271.5 is adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2898). This rule will be republished.

BACKGROUND AND JUSTIFICATION

Adopting 26 TAC §271.5, §271.7, to make grammatical changes and update references.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER B. INTEREST LISTS
26 TAC §271.5, §271.7

OVERVIEW

Section 271.5 is adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2898). This rule will be republished.

BACKGROUND AND JUSTIFICATION

Adopting 26 TAC §§271.51, 271.53, 271.55, 271.57, 271.59, 271.61, 271.63, 271.65, 271.69, 271.71, 271.73, 271.75, 271.77, 271.79, 271.81, 271.83, 271.85, 271.87, 271.89, 271.91, 271.93, 271.95, 271.97, to update the text of the section to person-centered plain language.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER C. ELIGIBILITY
26 TAC §§271.51, 271.53, 271.55, 271.57, 271.59, 271.61, 271.63, 271.65, 271.69, 271.71, 271.73, 271.75, 271.77, 271.79, 271.81, 271.83, 271.85, 271.87, 271.89, 271.91, 271.93, 271.95, 271.97

OVERVIEW

Section 271.5 is adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2898). This rule will be republished.

BACKGROUND AND JUSTIFICATION

Adopting 26 TAC §§271.151, 271.153, 271.155, 271.159, to update the text of the section to person-centered plain language, as well as update citations.

CHAPTER 271. COMMUNITY CARE SERVICES ELIGIBILITY
SUBCHAPTER D. CASE MANAGEMENT
26 TAC §§271.151, 271.153, 271.155, 271.159

OVERVIEW

Section 271.5 is adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2898). This rule will be republished.

BACKGROUND AND JUSTIFICATION

In Addition Re:

Revised Public Notice: Drug Shortages

The original notice was posted in the Texas Register on July 25, 2025. This revised notice reflects a correction to the proposed amendment language regarding alternative prescribed drugs.

Texas Optometry Board

Adopted Rules Re:

Adopting 22 TAC §275.2, to proposes new changes to replace the expired statute requiring a prescriber of opioids to take an annual hour of continuing education relating to opioid prescribing best practices.

CHAPTER 275. CONTINUING EDUCATION
22 TAC §275.2

OVERVIEW

The Texas Optometry Board (Board) adopts amendments to 22 TAC Title 14 Chapter 275, Continuing Education §275.2 – Required Education. The Board adopts this rule with no changes to the proposed text as published in the April 11, 2025, issue of the Texas Register (50 TexReg 2372). The adopted rule will not be republished.

BACKGROUND AND JUSTIFICATION

Section 481.0764(f), Texas Health and Safety Code, expired on August 31, 2023. This statute required a prescriber of opioids to take an annual hour of continuing education relating to opioid prescribing best practices. As the section requiring continuing education related to opioid prescribing best practices has expired, the Board is repealing the requirement from its rules.