State Board of Dental Examiners
Proposed Rules Re:
Amending 22 TAC §101.1, to allow dental licensure applicants to submit their National Practitioner Data Bank self-query reports electronically by removing the requirement that report results remain in the original sealed envelope.
CHAPTER 101. DENTAL LICENSURE
22 TAC §101.1
OVERVIEW
The State Board of Dental Examiners (Board) propose an amendment to rule 22 TAC §101.1, pertaining to general qualifications for dental licensure. The proposed amendment allows applicants to submit their National Practitioner Data Bank reports electronically.
BACKGROUND AND JUSTIFICATION
This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.
CHAPTER 101. DENTAL LICENSURE
22 TAC §101.8
OVERVIEW
The State Board of Dental Examiners (Board) proposes amendments to rule 22 TAC §101.8, pertaining to persons with criminal backgrounds. The amendments, if adopted, update the Board’s disciplinary guidelines concerning the imprisonment of a licensee following a felony conviction or deferred adjudication, in accordance with Senate Bill 1080.
BACKGROUND AND JUSTIFICATION
This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.
Amending 22 TAC §103.1, to allow dental hygiene licensure applicants to submit their National Practitioner Data Bank self-query reports electronically by removing the requirement that report results remain in the original sealed envelope.
CHAPTER 103. DENTAL HYGIENE LICENSURE
22 TAC §103.1
OVERVIEW
The State Board of Dental Examiners (Board) propose an amendment to rule 22 TAC §103.1, pertaining to general qualifications for hygiene licensure. The proposed amendment allows applicants to submit their National Practitioner Data Bank reports electronically.
BACKGROUND AND JUSTIFICATION
This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.
Amending 22 TAC §104.1, to allow dentists and dental hygienists to complete all 24 hours of required continuing education, including clinical hours, through self-study rather than requiring clinical hours to be completed through a live course.
CHAPTER 104. CONTINUING EDUCATION
22 TAC §104.1
OVERVIEW
The State Board of Dental Examiners (Board) proposes an amendment to rule 22 TAC §104.1, pertaining to continuing education requirements. The proposed amendment will allow dentists and dental hygienists to complete their continuing education hours, including clinical hours, through self-study. The Board has required clinical hours to be completed through a live course. However, allowing clinical hours to be completed through self-paced or online formats will improve accessibility, efficiency, and affordability while maintaining educational quality.
BACKGROUND AND JUSTIFICATION
This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.
Amending 22 TAC §114.6, to allow dental assistant registration and certification applicants to submit their National Practitioner Data Bank self-query reports electronically by removing the requirement that report results remain in the original sealed envelope.
CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS
22 TAC §114.6
OVERVIEW
The State Board of Dental Examiners (Board) propose an amendment to rule 22 TAC §114.6, pertaining to general qualifications for registration or certification. The proposed amendment allows applicants to submit their National Practitioner Data Bank reports electronically.
BACKGROUND AND JUSTIFICATION
This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.
Amending 22 TAC §116.3, to remove repetitive statutory and application language from dental laboratory registration and renewal requirements and update the rule to reflect the Board’s current licensing process.
CHAPTER 116. DENTAL LABORATORIES
22 TAC §116.3
OVERVIEW
The State Board of Dental Examiners (Board) proposes amendments to rule 22 TAC §116.3, pertaining to the registration and renewal of a dental laboratory. The amendments: remove repetitive statutory language, remove repetitive language found in the Board’s dental laboratory application, update the rule to reflect the Board’s current licensing process, and include grammatical changes.
BACKGROUND AND JUSTIFICATION
This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.
Texas Department of State Health Services
Proposed Rules Re:
CHAPTER 146. TRAINING AND CERTIFICATION OF PROMOTORES OR COMMUNITY HEALTH WORKERS
25 TAC §146.1, §146.2, §146.3 (Repeal), §146.4, §146.5, §146.6, §146.7, §146.8
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), proposes amendments to §146.1, concerning Definitions; §146.2, concerning Applicability and Exemption; §146.4, concerning Certification of Training Programs; §146.5, concerning Eligibility Requirements and Application Procedures for Community Health Worker Instructors; §146.6, concerning Eligibility Requirements and Application Procedures for Promotores or Community Health Workers; §146.7, concerning Professional and Ethical Standards; and §146.8, concerning Enforcement; and the repeal of §146.3, concerning Promotor(a) or Community Health Worker Training and Certification Advisory Committee.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to update Texas Administrative Code (TAC) Chapter 146 to improve clarity and consistency in rule language, codify requirements and standards of Texas Department of State Health Services (DSHS) for certification of CHW training centers, instructors, and promotores, and add references to 25 TAC §1.81, concerning Recognition of Out-of-State License of a Military Service Member or Military Spouse, and §1.91, concerning Alternative Licensing for Military Service Members, Military Spouses, and Military Veterans, to allow military service members, military spouses, and veterans to apply for alternative certification or certification exemptions to act as a Community Health Worker (CHW) in Texas. In addition, this proposal repeals 25 TAC §146.3, concerning the Promotor(a) or Community Health Worker Training and Certification Advisory Committee, as this committee was discontinued effective November 4, 2025.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §146.1 updates and clarifies definitions used in Chapter 146. The amendment revises terminology to refer to DSHS, updates several definitions for plain language and clarity, updates the description of core competencies, and removes definitions that are no longer needed, including definitions related to the commission, commissioner, committee, executive commissioner, and program.
The proposed amendment to §146.2 updates applicability and exemption provisions. The amendment clarifies who is subject to the chapter, adds references allowing military service members, military spouses, and military veterans to apply for alternative certification or certification exemptions to act as a CHW in Texas. The amendment references the DSHS website for application forms, instructions, and certification information, and removes a provision related to specialty certification that is no longer included in rule text.
The proposed repeal of §146.3 removes the Promotor(a) or CHW Training and Certification Advisory Committee provisions from Chapter 146 because those provisions are no longer necessary in this chapter. The advisory committee was discontinued effective November 4, 2025.
The proposed amendment to §146.4 updates certification requirements for training programs using plain language. The amendment codifies the standards that DSHS evaluates a training program’s curricula and adds where applicants can find application information for certificates.
The proposed amendment to §146.5 updates eligibility requirements and application procedures for CHW instructors using plain language. The amendment also adds standards for certification for persons with disabilities.
The proposed amendment to §146.6 updates eligibility requirements and application procedures for promotores or CHWs for clarity and plain language. The amendment also replaces older department references with DSHS and standards for certification for persons with disabilities.
The proposed amendment to §146.7 updates professional and ethical standards for clarity and plain language. The amendment revises nondiscrimination language and updates continuing education requirements.
The proposed amendment to §146.8 updates enforcement provisions for clarity and plain language. The amendment removes a separate notice provision from rule text, and clarifies the effect of denial, suspension, or revocation on future eligibility for certification.
Adopted Rules Re:
Adopting 25 TAC §31.1, to update the Texas Mother-Friendly Worksite Program’s name, contact information, and application processes, introduce a redesignation process, and add voluntary Silver and Gold standard designation criteria aligned with worksite lactation best practices.
CHAPTER 31. NUTRITION SERVICES
SUBCHAPTER A. REGISTER OF TEXAS MOTHER-FRIENDLY WORKSITES
25 TAC §31.1
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 §31.1, concerning Register of Texas Mother-Friendly Worksites. Section 31.1 is adopted without changes to the proposed text as published in the June 26, 2026, issue of the Texas Register (51 TexReg 4100). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to support updates to the Texas Department of State Health Services “Mother-Friendly” business designation as directed by the Texas Health and Safety Code Chapter 165, Breast-feeding. The Texas Mother-Friendly Worksite program provides minimum criteria for the designation in Title 25 Texas Administrative Code §31.1 and maintains a listing of designated worksites.
The updates to the rule reflect the program name, Texas Mother-Friendly Worksite Program; updates program contact information and application processes; introduces a redesignation process to ensure program integrity; and introduces additional options for voluntary Silver and Gold standard level designation criteria to align with worksite lactation best practices that reflect changes in business practice and technology.
Texas Health and Human Services Commission
Proposed Rules Re:
Repealing 26 TAC §361.1, proposing new 26 TAC §361.1, and amending 26 TAC §361.3, to consolidate the Guardianship Services Program’s purpose into a new rule and update chapter definitions by removing outdated DADS terminology and adding terms defined in the Texas Estates Code.
CHAPTER 361. GUARDIANSHIP SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
26 TAC §361.1 (Repeal), §361.1 (New), §361.3
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§361.3, 361.25, 361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, 361.83, 361.151, 361.153, 361.155, 361.201, 361.203, 361.205, 361.207, and 361.209; new §§361.1, 361.21, and 361.23; and the repeal of §§361.1, 361.21, 361.23, and 361.81.
BACKGROUND AND JUSTIFICATION
Effective March 15, 2022, the HHSC rules for guardianship services were administratively transferred from Texas Administrative Code (TAC), Title 40 Chapter 10, to TAC Title 26 Chapter 361. The rules were transferred from Title 40 to Title 26 due to the transfer of functions from the former Department of Aging and Disability Services to HHSC.
The purpose of this proposal is to update the guardianship requirements, practices, and procedures. The proposed amendments update the definitions used in the chapter and remove outdated terminology.
The proposal also updates agency names by replacing “DADS” with “HHSC.”
SECTION-BY-SECTION SUMMARY
The proposed repeal of §361.1, Introduction, is needed because the content of the rule contains information covered in proposed new §361.1, Purpose, §361.21, Eligibility for Services, and §361.23, Assessment.
Proposed new §361.1, Purpose, incorporates the content of §361.1, Introduction, which is proposed for repeal, to provide an overview of the HHSC Guardianship Services Program’s purpose.
The proposed amendment to §361.3, Definitions, removes the definition of “Agency” that is currently used in the rules and replaces it with the definition of “Guardianship program.” This change is made to use the term guardianship program in the rules to refer to other guardianship programs. The proposed amendment removes terms that contain “DADS” and the term “Diminished capacity” because they are not used in the chapter. The proposed amendment makes changes to add the acronym for a term at the beginning of the definition. This allows the acronyms to be used in the rules without first spelling them out. The proposed amendment adds definitions of “Alternatives to guardianship,” “Guardian,” “Incapacitated person,” and “Supports and services,” which are defined in the Texas Estates Code and used in the chapter. The term “Guardianship Services Program” is added to define the HHSC program referenced in this chapter. “HHSC” is added to define the agency in these rules. The term “Individual” is added to describe the people who receive services from the HHSC Guardianship Services Program (GSP) and from contractors. The proposed amendment revises the definitions of “Assessment,” “CME–Certificate of Medical Examination,” “Contractor,” “DID– Determination of intellectual disability,” “Judicial Branch Certification Commission,” “Person-directed planning,” “Quality assurance plan,” and “Service plan” to update terminology and make them easier to read and understand.
Repealing 26 TAC §361.21 and §361.23, proposing new 26 TAC §361.21 and §361.23, and amending 26 TAC §361.25, to align Guardianship Services Program eligibility with current statutes and DFPS memorandums of understanding, describe the assessment process for DFPS referrals and court requests, and update annual status reviews to address modification, restoration of capacity, and ineffective guardianships.
CHAPTER 361. GUARDIANSHIP SERVICES
SUBCHAPTER B. ELIGIBILITY AND ASSESSMENT OF INDIVIDUALS FOR GUARDIANSHIP SERVICES
26 TAC §361.21 (Repeal), §361.21 (New), §361.23 (Repeal), §361.23 (New), §361.25
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§361.3, 361.25, 361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, 361.83, 361.151, 361.153, 361.155, 361.201, 361.203, 361.205, 361.207, and 361.209; new §§361.1, 361.21, and 361.23; and the repeal of §§361.1, 361.21, 361.23, and 361.81.
BACKGROUND AND JUSTIFICATION
Effective March 15, 2022, the HHSC rules for guardianship services were administratively transferred from Texas Administrative Code (TAC), Title 40 Chapter 10, to TAC Title 26 Chapter 361. The rules were transferred from Title 40 to Title 26 due to the transfer of functions from the former Department of Aging and Disability Services to HHSC.
The purpose of this proposal is to update the guardianship requirements, practices, and procedures. The proposed amendments update the definitions used in the chapter and remove outdated terminology.
The proposal also updates agency names by replacing “DADS” with “HHSC.”
SECTION-BY-SECTION SUMMARY
The proposed repeal of §361.21, Eligibility for Services, is needed because the content of the rule contains information covered in proposed new §361.21, Eligibility for Services.
Proposed new §361.21, Eligibility for Services, provides clear information about the eligibility requirements for the GSP to match current statutes and memorandums of understanding with the Department of Family and Protective Services (DFPS). To match the Child Protective Services (CPS) Memorandum of Understanding the proposed new rule includes that an individual must be referred by a CPS employee; a person with an intellectual disability or alleged to be a person with an intellectual disability, must be a person with a Determination of Intellectual Disability as defined in 26 TAC §304.102, and a person who meets the requirements of Texas Estates Code §1101.104. The proposed new rule includes details about referrals when a person is at least 17 years of age or 18 years of age. The proposed new rule describes the requirement in Texas Estates Code §1103.003 that the guardianship of an individual meeting the criteria in proposed new subsection (a) may not take effect before the date of the individual’s 18th birthday. This allows the HHSC GSP to file an application no earlier than 180 days before the individual’s 18th birthday in accordance with Texas Estates Code 1103.001, Application for Appointment. Receiving referrals at 17 years or older allows for adequate time to process the referral, conduct the assessment, and file an application for guardianship. The proposed new rule identifies the eligibility criteria for an individual referred to the GSP by the Adult Protective Services Division (APS) of DFPS. The proposed new rule indicates the person must be aged 65 years or older or 18 years of age or older and is a person with a disability; APS has reason to believe the individual is an incapacitated person; and APS has validated that the individual is in a state of abuse, neglect, or exploitation; and the GSP determines guardianship is appropriate. The proposed new rule includes requirements related to citizenship or legal residency in the United States to match program eligibility requirements. The proposed new rule lists additional factors considered by HHSC to decide whether to serve as permanent guardian. The proposed new rule updates language from the proposed repeal of §361.21, Eligibility for Services, to make the rule easier to read and understand.
The proposed repeal of §361.23, Assessment, is needed because the content of the rule is covered in proposed new §361.23, Assessment.
Proposed new §361.23, Assessment, describes the assessment process when the GSP receives a referral from DFPS under §361.21 or a court request under Texas Estates Code §1203.108 or Human Resources Code §161.101(d). The proposed new rule describes how the GSP processes a referral for guardianship including reviewing documentation; conducting an in-person assessment to evaluate an individual’s alleged incapacity; considering alternatives to guardianship; evaluating the availability of alternate guardians; and determining whether to accept or deny a referral.
The proposed amendment to §361.25, Annual Review of a Ward’s Status, changes the title of the rule to “Annual Status Review of an Individual.” The proposed amendment changes all references to a “ward” to references to an “individual.” The proposed amendment simplifies and condenses the language that describes what actions the GSP takes when an individual’s status changes. The proposed amendment combines subsections related to alternative guardians; changes language related to modifying a guardianship to match the Texas Estates Code; adds new language to address restoring an individual’s capacity; and updates language to address when a guardianship does not effectively remedy the issues or meet the needs of the individual.
Amending 26 TAC §§361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, and 361.83, and repealing 26 TAC §361.81, to align guardianship contractor eligibility, employee certification, caseload, training, background check, and service plan requirements with Judicial Branch Certification Commission standards, clarify contractor roles and reporting duties, and remove the outdated guardian of the estate rule.
CHAPTER 361. GUARDIANSHIP SERVICES
SUBCHAPTER C. CONTRACTOR REQUIREMENTS
26 TAC §361.51, §361.53, §361.55, §361.57, §361.59, §361.61, §361.67, §361.69, §361.71, §361.73, §361.75, §361.79, §361.81 (Repeal), §361.83
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§361.3, 361.25, 361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, 361.83, 361.151, 361.153, 361.155, 361.201, 361.203, 361.205, 361.207, and 361.209; new §§361.1, 361.21, and 361.23; and the repeal of §§361.1, 361.21, 361.23, and 361.81.
BACKGROUND AND JUSTIFICATION
Effective March 15, 2022, the HHSC rules for guardianship services were administratively transferred from Texas Administrative Code (TAC), Title 40 Chapter 10, to TAC Title 26 Chapter 361. The rules were transferred from Title 40 to Title 26 due to the transfer of functions from the former Department of Aging and Disability Services to HHSC.
The purpose of this proposal is to update the guardianship requirements, practices, and procedures. The proposed amendments update the definitions used in the chapter and remove outdated terminology.
The proposal also updates agency names by replacing “DADS” with “HHSC.”
SECTION-BY-SECTION SUMMARY
The proposed amendment to §361.51, Guardianship Contracts, removes mentions of DADS and makes changes to use plain language.
The proposed amendment to §361.53, Eligibility To Be a Contractor, changes the requirements for a contractor to be eligible to apply for a guardianship contractor to match statutory requirements for guardianship programs, including requirements from the Judicial Branch Certification Commission for guardianship programs and the certification of guardians. The proposed amendment then removes the requirements in subsections (b) and (c) because they are included with the changes in subsection (a). The proposed amendment adds the requirement for a contractor’s application with HHSC to identify the geographical areas served and the population groups for whom the contractor provides services. The proposed amendment reformats and clarifies the requirement describing when a contractor must terminate an employee and the description of the actions of a contractor that the GSP may use to decide current or future eligibility to contract with HHSC.
The proposed amendment to §361.55, Acceptance of Referrals from DADS, changes the title to “Acceptance of Referrals from HHSC” and removes references to DADS. The proposed amendment removes a contractor application requirement because this requirement is being added in the proposed amendment to §361.53. The proposed amendment renumbers the remaining subsections and edits the remaining rules to improve clarity and readability.
The proposed amendment to §361.57, Policies and Procedures Required of Contractors, adds details about what circumstances lead to a contractor no longer serving as guardian and require notice to the HHSC GSP. The proposed amendment makes changes to use plain language.
The proposed amendment to §361.59, Qualifications and Training Requirements for Contractor Employees, removes the current requirement to provide an adequate number of qualified employees, and the list of qualifications for contractor employees, and replaces them with the requirement for the contractor to follow the Judicial Branch Certification Commission standards regarding maximum caseloads and the requirement to employ case managers certified as guardians by the Judicial Branch Certification Commission. These changes are made because the Judicial Branch Certification Commission is the entity responsible for standards regarding maximum caseloads and guardian certification requirements. The proposed amendment updates and clarifies the employee training requirements for contactors, including removing certain trainings and replacing them with training that explains an overview of the Judicial Branch Certification Commission Code of Ethics and Minimum Standards for Guardianship. This change is made because the Judicial Branch Certification Commission provides standards to make decisions and requirements for certified guardians. The proposed amendment requires a contractor to maintain a personnel record on every employee.
The proposed amendment to §361.61, Qualifications and Training Requirements for Volunteers of Contractors, removes references to DADS and reorganizes rule language to make the rules easier to read and understand. The proposed amendment requires a contractor to maintain a personnel record on every volunteer.
The proposed amendment to §361.67, Criminal Background Checks, changes the title of the rule to “Background Checks” to match the language required by the Department of Public Safety when conducting a background check. The amendment also updates statute references to match current statute titles.
The proposed amendment to §361.69, Quality Assurance Plan, removes the word “ward” and reorganizes rule language to make the rules easier to read and understand.
The proposed amendment to §361.71, Fiscal Management, removes references to DADS, updates to use person-first language, and makes minor wording changes to improve clarity and readability.
The proposed amendment to §361.73, Roles and Responsibilities of Case Managers, changes the title to “Roles and Responsibilities of a Contractor Providing Guardianship Services.” The proposed amendment removes requirements that are required for all guardianship programs or all guardians. The proposed amendment also expands language to be specific in the rule about the roles and responsibilities of a contractor. For example, the proposed amendment lists reasons for case closure and removes requirements related to guardian of the estate.
The proposed amendment to §361.75, Reporting of Abuse, Neglect, or Exploitation, indicates abuse, neglect, or exploitation of an individual is reported to the appropriate investigating authority. The proposed amendment, because reporting is not limited to DFPS, removes subsection (b) and the rest of the rule is reformatted. The proposed amendment reorganizes rule language to make the rules easier to read and understand.
The proposed amendment to §361.79, Responsibilities of the Guardian of the Person, requires a contractor, when appointed guardian of the person, to manage the individual’s case according to the court order appointing the contractor as guardian and the requirements in the Texas Estates Code for Guardian of the Person. The proposed amendment adds a contractor’s responsibility to manage the individual’s finances to clearly explain what is expected of the contractor. The proposed amendment uses person-first language and makes changes for clarity and readability.
The proposed repeal of §361.81, Responsibilities of Guardian of the Estate, removes an outdated rule because the GSP does not refer an individual to a contractor for appointment as the guardian of the individual’s estate.
The proposed amendment to §361.83, Service Plans for Wards, changes the rule title to “Service Plan for Individuals.” The proposed amendment removes some specific services plan requirements and replaces them with references to the Judicial Branch Certification Commission Minimum Standards for Guardianship.
CHAPTER 361. GUARDIANSHIP SERVICES
SUBCHAPTER D. CASE RECORDS MANAGEMENT
26 TAC §§361.151, 361.153, 361.155
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§361.3, 361.25, 361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, 361.83, 361.151, 361.153, 361.155, 361.201, 361.203, 361.205, 361.207, and 361.209; new §§361.1, 361.21, and 361.23; and the repeal of §§361.1, 361.21, 361.23, and 361.81.
BACKGROUND AND JUSTIFICATION
Effective March 15, 2022, the HHSC rules for guardianship services were administratively transferred from Texas Administrative Code (TAC), Title 40 Chapter 10, to TAC Title 26 Chapter 361. The rules were transferred from Title 40 to Title 26 due to the transfer of functions from the former Department of Aging and Disability Services to HHSC.
The purpose of this proposal is to update the guardianship requirements, practices, and procedures. The proposed amendments update the definitions used in the chapter and remove outdated terminology.
The proposal also updates agency names by replacing “DADS” with “HHSC.”
SECTION-BY-SECTION SUMMARY
The proposed amendment to §361.151, Confidentiality of Records, makes minor rule edits for clarity and use of person-first language. The proposed amendment removes confidentiality standards for DADS employees because this rule is for contractors. The proposed amendment removes references to releasing records to an attorney ad litem because an attorney ad litem is not involved when a contractor becomes the successor guardian to HHSC. The proposed amendment removes language about a contractor releasing information to a social services or medical agency without permission from the current guardian. This change is made because a contractor does not manage cases unless the contractor is appointed as guardian.
The proposed amendment to §361.153, Documentation Requirements, changes the title of the rule to “Case Records of an Individual.” The proposed amendment removes the rules for a contractor to maintain financial and contractor-related records because these rules have been moved to proposed §361.155. The proposed amendment adds requirements for searching and documenting the results from the National Sex Offenders Registry website for unsupervised visits because these rules have been removed from proposed §361.67. The proposed amendment removes the requirement for a contractor to maintain personnel records for employees and volunteers because these rules have been moved to §361.59 for employees and §361.61 for volunteers. These changes are being made to improve the organization of these rules within the chapter. The proposed amendment includes the requirements for a contractor to make case records available to the GSP during monitoring visits, for the contents of a case record, and for documenting contacts with an individual.
The proposed amendment to §361.155, Maintenance of Records, adds the requirements removed from §361.153 about maintaining financial and contract-related records and then reformats the rest of the rule. The proposed amendment removes references to DADS and updates and clarifies the requirement if there is a change in the location of the records or the contact to access the records.
Amending 26 TAC §§361.201, 361.203, 361.205, 361.207, and 361.209, to replace DADS references in guardianship contractor monitoring, complaint investigation, fiscal monitoring, sanction, and administrative review rules, update the appeal reference, and set a 10-day deadline for administrative review requests.
CHAPTER 361. GUARDIANSHIP SERVICES
SUBCHAPTER E. CONTRACT MONITORING AND COMPLIANCE
26 TAC §§361.201, 361.203, 361.205, 361.207, 361.209
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§361.3, 361.25, 361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, 361.83, 361.151, 361.153, 361.155, 361.201, 361.203, 361.205, 361.207, and 361.209; new §§361.1, 361.21, and 361.23; and the repeal of §§361.1, 361.21, 361.23, and 361.81.
BACKGROUND AND JUSTIFICATION
Effective March 15, 2022, the HHSC rules for guardianship services were administratively transferred from Texas Administrative Code (TAC), Title 40 Chapter 10, to TAC Title 26 Chapter 361. The rules were transferred from Title 40 to Title 26 due to the transfer of functions from the former Department of Aging and Disability Services to HHSC.
The purpose of this proposal is to update the guardianship requirements, practices, and procedures. The proposed amendments update the definitions used in the chapter and remove outdated terminology.
The proposal also updates agency names by replacing “DADS” with “HHSC.”
SECTION-BY-SECTION SUMMARY
The proposed amendment to §361.201, Monitoring Reviews, removes references to DADS and “ward” and makes minor edits to improve clarity.
The proposed amendment to §361.203, Complaint Investigations, removes references to DADS and “ward” and makes minor edits to improve clarity.
The proposed amendment to §361.205, Fiscal Monitoring, removes references to DADS and “ward” and makes minor edits to improve clarity.
The proposed amendment to §361.207, Sanctions, removes references to DADS and “ward” and makes minor edits to improve clarity. The proposed amendment updates the TAC reference for a contractor’s right to appeal.
The proposed amendment to §361.209, Administrative Review, removes references to DADS and “ward” and makes minor edits to improve clarity. The proposed amendment clarifies that a contractor’s request for an administrative review must be received by the GSP within 10 calendar days after the date the contractor receives the written review findings.
CHAPTER 551. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS
SUBCHAPTER C. STANDARDS FOR LICENSURE
26 TAC §551.51
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §551.51, concerning Workplace Violence Prevention.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement Senate Bill 463, 89th Legislature, Regular Session, 2025, which amended Texas Health and Safety Code §331.001 to include intermediate care facilities for individuals with an intellectual disability (ICFs/IID) and state supported living centers to the definition of “facility” for purposes of establishing workplace violence prevention requirements. The proposed rule establishes standards to protect health care professionals and facility employees from violent behavior and threats of violent behavior within ICF/IID settings.
The proposal is necessary to ensure that facilities adopt, implement, and enforce workplace violence prevention policies and plans, including committee structures, annual reviews, reporting processes, and training obligations. These requirements strengthen safety for facility employees and health care professionals by increasing preparedness, response procedures, and protections against retaliation associated with reporting workplace violence.
SECTION-BY-SECTION SUMMARY
Proposed new §551.51(a) requires each facility to create or designate a workplace violence prevention committee responsible for developing a workplace violence prevention plan; outlines the requirements for committee membership; and allows multi-facility organizations to have a single committee to serve all facilities, if facility-specific plans are maintained.
Proposed new §551.51(b) requires each facility to adopt, implement, and enforce a written workplace violence prevention policy. The policy must require the facility to consider committee recommendations, encourage reporting, protect staff from retaliation, and ensure compliance with HHSC rule requirements.
Proposed new §551.51(c) requires each facility to adopt, implement, and enforce a written workplace violence prevention plan. The plan must be specific to the facility setting, define workplace violence, and address training, security measures, incident reporting, investigation processes, and employee input. The plan must be reviewed annually by the committee, and facilities must provide access to the plan while ensuring sensitive security information is redacted.
Proposed new §551.51(d) requires facilities to provide immediate services to health care professionals and facility employees after an incident of workplace violence, permit staff to contact law enforcement, and prohibit discrimination or retaliation against persons reporting workplace violence or advising others of their right to report.
Amending 26 TAC §562.24, to implement House Bill 1700 (89th Legislature) by establishing requirements for licensed chemical dependency counselors in private practice who provide counseling through synchronous audiovisual or audio-only technology, including verbal consent documentation before each session, security and encryption measures, identity verification, and safeguards for adolescent clients.
CHAPTER 562. LICENSED CHEMICAL DEPENDENCY COUNSELORS
26 TAC §562.24
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §562.24, concerning Standards for Private Practice.
BACKGROUND AND JUSTIFICATION
The proposal is necessary to comply with Texas Occupations Code (TOC) §111.004(c) and (d). House Bill (HB) 1700, 89th Legislature, Regular Session, 2025, amended TOC §111.004 by adding subsection (c) and (d).
TOC §111.004(c) requires HHSC to adopt rules necessary to provide clear and concise standards for patient records and the retention of those records related to a patient’s consent to treatment, data collection, and data sharing.
TOC §111.004(d) requires that any rules adopted under TOC §111.004(c) must address the specific consent documentation required for telehealth services and include provisions, based on the standard of care, for consent documentation in an audio-only format.
To implement TOC §111.004(c) and (d), the proposed amendment to §562.24 adds definitions and requirements for a Licensed Chemical Dependency Counselor (counselor) in private practice to provide counseling services as a telehealth service using electronic means.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §562.24(a) updates language to improve clarity and readability.
The proposed amendment to §562.24(b) adds new definitions to provide clarity for terms used in the subsection. The proposed amendment allows a counselor to provide counseling services using electronic means and outlines the requirements the counselor must follow, including providing in-person, face-to-face counseling services when requested.
The proposed amendment also requires the counselor to have access and security measures in place when communicating with the client electronically and outlines the criteria that must be met to use synchronous audiovisual technology and audio-only technology to provide outpatient counseling services. The proposed amendment outlines the counselor’s responsibilities when technical problems occur and requires adequate security and encryption measures to protect client communications, recordings, and records that adhere to federal and state privacy laws.
The proposed amendment also requires the counselor to create safeguards to ensure adolescent clients receive counseling services separate from adult clients and to verify the identity of the client and any authorized representative.
The proposed amendment requires the counselor to provide appropriate referrals for clients that do not meet the criteria for services. The proposed amendment requires the counselor to provide the criteria for assessing appropriateness of providing services using electronic means and to document the client’s verbal consent for participating in counseling services through electronic means. The proposed amendment outlines the counselor’s responsibilities for obtaining verbal consent to provide counseling services using electronic means and if verbal consent is not obtained, requires in-person and face-to-face counseling services to be provided instead.
The proposed amendment requires the counselor to inform the client who consents to participating in counseling services using electronic means that the counselor will monitor services for evidence of fraud, waste, and abuse; determine if the client needs additional social services or supports; document the client’s verbal consent to participate in the services using electronic means and adhere to federal privacy laws for providing services through electronic means.
The proposed amendment also requires the counselor to provide the client with emergency contact information; to maintain information for client continuity of counseling services based on the client’s physical location; and provide accommodations for the client on request to support the client’s effective participation in counseling services including through electronic means.
The proposed amendment also updates language to improve clarity and readability and updates outdated references.
Adopted Rules Re:
Adopting 1 TAC §355.8070, to establish a calculation allowing unused Hospital Augmented Reimbursement Program (HARP) payment room to be redistributed to other eligible hospitals within the same class in proportion to their remaining Medicaid charges in excess of Medicaid payments.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 4. MEDICAID HOSPITAL SERVICES
1 TAC §355.8070
OVERVIEW
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.8070, concerning Hospital Augmented Reimbursement Program (HARP).
Section 355.8070 is adopted without changes to the proposed text as published in the August 7, 2026, issue of the Texas Register (51 TexReg 5040). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment to §355.8070 establishes a calculation that allows any unused HARP payment room to be distributed to other eligible hospitals within the same class based on an allocation proportionate to the remaining Medicaid charges that exceed all Medicaid payments, including supplemental payments and the portion of HARP payments attributable to the inpatient fee-for-service (FFS) Medicare payment gap.
A previous amendment to §355.8070, related to the HARP program, was adopted and effective on April 2, 2025. That amendment added the Centers for Medicare & Medicaid Services (CMS) definition of a nominal charge provider and clarified that the payment methodology for HARP payments will limit inpatient Medicaid payments, so they do not exceed inpatient Medicaid charges for all providers, except those that meet the Medicare definition of a nominal charge provider.
This amendment establishes a mechanism to distribute any unused payment room after the limitation is applied to other eligible hospitals within the same class. This amendment also includes edits to correct grammar and punctuation, spell out acronyms for clarity, and reorganize parts where necessary.
In Addition Re:
Public Notice – Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments will be effective October 1, 2026.
The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for Physicians and Other Practitioners.
The proposed amendments are estimated to result in a change to annual aggregate expenditure of ($428) for federal fiscal year (FFY) 2027, consisting of ($251) in federal funds and ($177) in state general revenue. For FFY 2028, the estimated result is a change to annual aggregate expenditure of ($474) consisting of ($280) in federal funds and ($194) in state general revenue. For FFY 2029, the estimated result is a change to annual aggregate expenditure of ($480) consisting of ($283) in federal funds and ($197) in state general revenue.
Further detail on specific reimbursement rates and percentage changes will be made available on the HHSC Provider Finance website before the proposed effective date at: https://pfd.hhs.texas.gov/rate-packets.
A Rate Hearing will be conducted online to propose specific rate changes and accept public testimony. Information about the proposed rate changes and hearings will be published in a subsequent issue of the Texas Register. Additional information and the notice of hearings can be found at https://www.sos.state.tx.us/texreg/index.shtml.
Public Notice – Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments will be effective October 1, 2026.
The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for Non-Emergency Medical Transportation (NEMT) Services.
The proposed amendments are estimated to result in a change to annual aggregate expenditure of $500,000 for federal fiscal year (FFY) 2027, consisting of $292,700 in federal funds and $207,300 in state general revenue. For FFY 2028, the estimated result is a change to annual aggregate expenditure of $506,694 consisting of $298,949 in federal funds and $207,745 in state general revenue. For FFY 2029, the estimated result is a change to annual aggregate expenditure of $513,477 consisting of $302,951 in federal funds and $210,526 in state general revenue.
Further detail on specific reimbursement rates and percentage changes will be made available on the HHSC Provider Finance website before the proposed effective date at: https://pfd.hhs.texas.gov/rate-packets.
A Rate Hearing will be conducted online to propose specific rate changes and accept public testimony. Information about the proposed rate changes and hearings will be published in a subsequent issue of the Texas Register . Additional information and the notice of hearings can be found at https://www.sos.state.tx.us/texreg/index.shtml.
Public Notice: Texas State Plan for Medical Assistance Amendment
The Texas Health and Human Services Commission (HHSC) announces its intent to submit two amendments to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act.
The purpose of the amendments is to establish a calculation to allow for any unused HARP payment room to be distributed to other eligible hospitals within the same class based on an allocation proportionate to the remaining Medicaid charges in excess of all Medicaid payments including supplemental payments and the portion of HARP payments for the inpatient FFS Medicare payment gap for non-state government-owned and operated hospitals and private hospitals. The proposed amendment is effective October 1, 2026.
The proposed amendment for non-state government-owned hospitals is estimated to result in an annual expenditure increase of $442,068,263 for Federal Fiscal Year (FFY) 2027, consisting of $258,786,761 in federal funds and $183,281,502 in state funds. For FFY 2028, the estimated annual expenditure increase is $456,656,516, consisting of $269,427,344 in federal funds and $187,229,171in state funds. For FFY 2029, the estimated annual expenditure increase is $471,726,181, consisting of $278,318,447 in federal funds and $193,407,734 in state funds.
The proposed amendment for private hospitals is estimated to have no fiscal impact.
Public Hearing. A public hearing was held on August 14, 2026, at 1:00 p.m. online. Information about the proposed rate change(s) and the hearing can be found in the August 7, 2026, issue of the Texas Register page 5040 at http://www.sos.state.tx.us/texreg/index.shtml.