PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 506. SPECIAL CARE FACILITIES
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §506.37, concerning Billing Requirements.
The amendment to §506.37 is adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2621). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.
S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.
HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.
The amendment is necessary to add information regarding these itemized-bill requirements.
COMMENTS
The 31-day comment period ended May 28, 2024.
During this period, HHSC did not receive any comments regarding the proposed rule.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and HSC §248.006, which requires HHSC to adopt rules establishing minimum standards for special care facilities.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403481
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 834-4591
SUBCHAPTER D. OPERATIONAL REQUIREMENTS FOR PATIENT CARE AND TREATMENT
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §507.50, concerning Billing Requirements.
The amendment to §507.50 is adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2623). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.
S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.
HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.
The amendment is necessary to add information regarding these itemized-bill requirements.
COMMENTS
The 31-day comment period ended May 28, 2024.
During this period, HHSC received comments regarding the proposed rule from DaVita Inc. A summary of their comments relating to the rule and HHSC's responses follow.
Comment: DaVita Inc. stated listing each individual item and its associated amount to draft an itemized bill would be a significant departure from current billing requirements and processes and noted end stage renal disease (ESRD) facilities bill for services and supplies using bundled codes as required under federal law and the Medicare policy. DaVita Inc. further stated ESRD facilities receive one payment per session or per day, depending on the treatment modality, for all items and services provided when treating ESRD.
DaVita Inc. stated an itemized bill would not be an accurate representation of a dialysis provider's billing computation because the sum of the individual charges would not necessarily equal the total bundled amount charged, given that there are efficiencies built into the dialysis bundled rate. DaVita Inc. stated they are concerned that their patients would not understand the concept of a bundled or composite payment rate and how each individual item does not equate to the full bundled payment amount.
Response: HHSC declines to revise §507.50 because a provider that submits billing codes for bundled services to a third party for reimbursement may meet the itemized billing requirements by including all bundle codes and the amounts billed for each bundle code in the itemized bill instead of listing the name and cost of each item and service provided.
Comment: DaVita Inc. stated that while the proposed rule provides a definition for "healthcare service," there is no definition for "supply," and recommended HHSC add a definition defining the term as "any and all medically necessary items used or furnished related to the provision of renal dialysis services in a sterile environment."
Response: HHSC declines to revise §507.50 because the rule is consistent with HSC Chapter 185, which does not define the term "supply."
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; HSC §251.003, which requires HHSC to adopt rules for the issuance, renewal, denial, suspension, and revocation of a license to operate an ESRD facility; and HSC §251.014, which requires these rules to include minimum standards to protect the health and safety of a patient of an ESRD facility.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403480
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 834-4591
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §509.67, concerning Billing Requirements.
The amendment to §509.67 is adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2624). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.
S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.
HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.
The amendment is necessary to add information regarding these itemized-bill requirements.
COMMENTS
The 31-day comment period ended May 28, 2024.
During this period, HHSC received a comment regarding the proposed rule from Hollowbeck Solutions, LLC. A summary of the comment relating to the rule and HHSC's response follows.
Comment: Hollowbeck Solutions, LLC stated that HHSC seems more concerned about billing than patient care. Hollowbeck Solutions, LLC also stated HHSC does not hold urgent cares or medical spas accountable and stated freestanding emergency medical care facilities should be subject to the same standards as hospitals when regulating similar issues.
Response: HHSC acknowledges this comment and declines to revise §509.67. HHSC notes that while HHSC is committed to ensuring patient safety, HHSC does not have the statutory authority to regulate urgent care centers or medical spas. Furthermore, HHSC notes that the hospital rule at §133.46, which was proposed elsewhere in the April 26, 2024, issue of the Texas Register (49 TexReg 2612), also contains the same language as the Freestanding Emergency Medical Care (FEMC) facility rule requiring compliance with HSC Chapter 185.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and HSC §254.101, which authorizes HHSC to adopt rules regarding FEMC facilities.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403479
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 834-4591
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §510.45, concerning Billing Requirements.
The amendment to §510.45 is adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2626). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.
S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.
HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.
The amendment is necessary to add information regarding these itemized-bill requirements.
COMMENTS
The 31-day comment period ended May 28, 2024.
During this period, HHSC did not receive any comments regarding the proposed rule.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and HSC §577.010, which requires HHSC to adopt rules and standards necessary and appropriate to ensure the proper care and treatment of patients in a private mental hospital or mental health facility.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403478
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 834-4591
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §511.75, concerning Billing Requirements.
The amendment to §511.75 is adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2627). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.
S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.
HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.
The amendment is necessary to add information regarding these itemized-bill requirements.
COMMENTS
The 31-day comment period ended May 28, 2024.
During this period, HHSC did not receive any comments regarding the proposed rule.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and HSC §241.302(b), which provides that the Executive Commissioner of HHSC shall adopt rules to implement that section and establish minimum standards for limited services rural hospitals.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403477
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 834-4591
SUBCHAPTER C. OPERATIONAL REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §564.28, concerning Billing Requirements.
The amendment to §564.28 is adopted without changes to the proposed text as published in the April 26, 2024, issue of the Texas Register (49 TexReg 2629). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement Senate Bill (S.B.) 490, 88th Legislature, Regular Session, 2023.
S.B. 490 added new Texas Health and Safety Code (HSC) Chapter 185, which requires a health care provider to send a written, itemized bill of the alleged cost of each health care service and supply when the provider requests payment from a patient after providing the patient with a health care service or related supply.
HSC §185.003, as added by S.B. 490, requires HHSC to take disciplinary action against a provider that violates HSC Chapter 185 on or after September 1, 2023, as if the provider violated an applicable licensing law.
The amendment is necessary to add information regarding these itemized-bill requirements.
COMMENTS
The 31-day comment period ended May 28, 2024.
During this period, HHSC did not receive any comments regarding the proposed rule.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; and HSC §464.009, which authorizes the Executive Commissioner to adopt rules governing organization and structure, policies and procedures, staffing requirements, services, client rights, records, physical plant requirements, and standards for licensed chemical dependency treatment facilities.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403476
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: April 26, 2024
For further information, please call: (512) 834-4591
The Texas Health and Human Services Commission (HHSC) adopts new Chapter 571, concerning Voluntary Recovery Housing Accreditation. The new chapter consists of §571.1, concerning Purpose; §571.2, concerning Definitions; §571.3, concerning Approved Accrediting Organizations; §571.4, concerning Accreditation Not Required; §571.5, concerning Places Ineligible for Accreditation as a Recovery House; §571.11, concerning Standards for Accreditation; §571.21, concerning Accrediting Organization Requirements; §571.31, concerning Soliciting; §571.32, concerning Advertising Restrictions; and §571.41, concerning Accrediting Organization Enforcement Actions.
New §571.21 and §571.32 are adopted with changes to the proposed text as published in the May 3, 2024, issue of the Texas Register (49 TexReg 2950). These rules will be republished.
New §§571.1-571.5, 571.11, 571.31, and 571.41 are adopted without changes to the proposed text as published in the May 3, 2024, issue of the Texas Register (49 TexReg 2950). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The new rules are necessary to implement House Bill (H.B.) 299, 88th Legislature, Regular Session, 2023.
H.B. 299 added new Texas Health and Safety Code (THSC) Chapter 469 to establish a voluntary accreditation program for recovery housing programs. THSC Chapter 469, in part, requires HHSC to adopt minimum standards for a voluntary recovery housing accreditation process. THSC §469.002(b) requires HHSC to approve only the National Alliance for Recovery Residences (NARR) or the Oxford House Incorporated to serve as an accrediting organization that provides accreditation to qualifying recovery houses.
THSC Chapter 469 also defines several key terms, outlines the responsibilities of the accreditation organizations, clarifies certain places are ineligible for accreditation as a recovery house, requires certain recovery houses to designate a responsible party, requires HHSC to prepare an annual report, prohibits soliciting and certain advertising, outlines enforcement procedures for accreditation organizations, and clarifies effective September 1, 2025, a recovery house must be accredited by an accrediting organization under this chapter to receive state money.
The new rules are necessary to establish and adopt the minimum standards for recovery housing accreditation required by THSC §469.002.
COMMENTS
The 31-day comment period ended June 3, 2024.
During this period, HHSC received comments regarding the proposed rules from seven commenters: the Association of Substance Abuse Programs (ASAP), Clean Cause Foundation (CCF), the Hogg Foundation for Mental Health, La Hacienda Treatment Center, Recovery People, Stages of Recovery, and Texas Coalition for Healthy Minds (TCHM). A summary of the comments and HHSC's responses follow.
Comment: CCF, the Hogg Foundation for Mental Health, La Hacienda Treatment Center, Recovery People, and TCHM commented on paragraph three of the Government Growth Impact statement in the proposed preamble, which states, "implementation of the proposed rules will result in no assumed change in future legislative appropriations" and requested NARR to receive dedicated funding since the Oxford House has received funding for 10 years from the state and only provides Level I care. These commenters stated by contrast, NARR provides Level II and III recovery housing services and will need assistance in dealing with startup costs.
Response: HHSC acknowledges this comment and notes paragraph three of the Government Growth Impact statement reflects the impact of the proposed rules on future legislative appropriations and does not limit the Legislature's ability to appropriate funds. HHSC also notes that funding decisions are determined by the Legislature, and the HHSC does not have authority or influence over these appropriations.
Comment: Stages of Recovery requested HHSC offer additional training and resources, such as workshops, online courses, or training materials for designated responsible parties and staff.
Response: HHSC acknowledges this comment and declines to revise the rules in response because this request is beyond the scope of this rule project.
Comment: Stages of Recovery requested HHSC create a formal method for accredited recovery houses to provide feedback directly to HHSC so HHSC can make necessary adjustments and improvements to the program.
Response: HHSC acknowledges this comment and declines to revise the rules in response because this request is beyond the scope of this rule project.
Comment: Stages of Recovery requested HHSC maintain regular communication with accredited recovery houses regarding any potential updates or changes to standards or procedures to ensure providers are informed and prepared.
Response: HHSC acknowledges this comment and notes that HHSC communicates with providers via various methods, including email and GovDelivery. Additionally, any future proposed rule changes or updates will be posted for public comment in the Texas Register in accordance with the Administrative Procedure Act.
Comment: Stages of Recovery requested HHSC coordinate with existing state and local programs for substance use recovery to streamline support for recovery houses and avoid duplicative efforts.
Response: HHSC acknowledges this comment and declines to revise the rules in response because this request is beyond the scope of this rule project.
Comment: Stages of Recovery requested HHSC add detailed guidelines on the accreditation standards in §571.11 and any additional requirements beyond those of the NARR.
Response: HHSC declines to revise §571.11 as suggested because the language is consistent with THSC §469.002(a).
Comment: ASAP requested HHSC revise §571.11 to remove the specific publication dates for the Oxford House manual and NARR's Recovery Residence Quality Standards and recommended updating the section to adopt by reference the most current version of those standards.
Response: HHSC declines to revise §571.11 as suggested because it has determined the specific versions of the organizations' publications align with HHSC's priorities in implementing S.B. 299. If those organizations amend their standards, HHSC will consider revising this rule accordingly, based on the content of any amendments.
Comment: ASAP requested HHSC revise §571.21(a)(5) to "more clearly state when providing treatment services would make a recovery home ineligible for accreditation."
Response: HHSC declines to revise §571.21(a)(5) as suggested because the language is consistent with THSC Chapter 464, THSC §462.001(10), and THSC §469.003(7).
Comment: CCF, the Hogg Foundation for Mental Health, La Hacienda Treatment Center, Recovery People, and TCHM requested HHSC clarify in §571.21(a)(5) that recovery houses who provide chemical dependency treatment services are not eligible for accreditation under 26 TAC Chapter 571 when they provide those services "at the site of the recovery house."
Response: HHSC revises §571.21(a)(5) by removing the last sentence in the paragraph clarifying a recovery house that offers chemical dependency treatment services is not eligible for accreditation under 26 TAC Chapter 571 to further align §571.21(a)(5) with THSC Chapter 469.
Comment: ASAP requested HHSC revise §571.32 to clarify the rule only applies to accredited recovery houses or consider whether the rule is necessary to enact THSC §469.007.
CCF, the Hogg Foundation for Mental Health, Recovery People, and TCHM requested HHSC either remove §571.32 or clarify the rule only applies to accredited recovery houses.
Response: HHSC revises §571.32 to clarify accreditation organizations are required to ensure a recovery house accredited by that organization complies with §571.32.
HHSC made minor editorial changes to §571.21(a)(5) to ensure consistency with HHSC rulemaking guidelines regarding referencing the titles of statutes and rule chapters and to update references to current rules.
SUBCHAPTER A. GENERAL PROVISIONS
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and THSC §469.002, which requires HHSC establish minimum standards for accreditation as a recovery house.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403470
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and THSC §469.002, which requires HHSC establish minimum standards for accreditation as a recovery house.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403471
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and THSC §469.002, which requires HHSC establish minimum standards for accreditation as a recovery house.
§571.21.Accrediting Organization Requirements.
(a) An accrediting organization shall:
(1) develop procedures to:
(A) provide an easily accessible method for a recovery house seeking accreditation to find, complete, and submit an accreditation application;
(B) before accrediting an applicant or reaccrediting a recovery house, ensure the applicant or accredited recovery house at a minimum meets:
(i) the accrediting organization's standards in §571.11(a) of this chapter (relating to Standards for Accreditation) adopted by HHSC by reference; and
(ii) the additional standards in §571.11(b) of this chapter;
(C) determine the accreditation and reaccreditation period;
(D) require an accredited recovery house to submit all required reaccreditation information before the recovery house's accreditation period expires;
(E) require an applicant or accredited recovery house to adjust its practices to meet the standards for accreditation or reaccreditation;
(F) take an adverse action under §571.41 of this chapter (relating to Accrediting Organization Enforcement Actions) when a recovery house fails to meet the standards described in paragraph (2) of this subsection; and
(G) assess application accreditation and reaccreditation fees;
(2) provide training to recovery house staff concerning the accreditation standards in §571.11 of this chapter;
(3) develop a code of ethics;
(4) annually provide the following information to HHSC:
(A) the total number of accredited recovery houses;
(B) the number of recovery houses accredited during the preceding year;
(C) any issues concerning the accreditation or reaccreditation process;
(D) the number of accredited recovery houses that had an accreditation revoked during the preceding year; and
(E) the reasons for the revocation; and
(5) ensure a recovery house does not offer or claim to offer chemical dependency treatment services as outlined in THSC §464.001(4) and Title 26 Texas Administrative Code (26 TAC) Chapter 564 (relating to Chemical Dependency Treatment Facilities) at the site of the recovery house without a chemical dependency treatment facility license issued under 26 TAC Chapter 564.
(b) In addition to the requirements in subsection (a) of this section, the National Alliance for Recovery Residences shall:
(1) require an applicant or accredited recovery house to designate at least one individual to serve as the recovery house's responsible party, in accordance with THSC §469.004;
(2) require the responsible party to:
(A) satisfactorily complete training the accrediting organization provides concerning the accreditation standards in §571.11 of this chapter and the accrediting organization's accreditation and reaccreditation requirements; and
(B) be responsible for administering the recovery house in accordance with the accreditation standards in this chapter and the accrediting organization's accreditation and reaccreditation requirements; and
(3) require an accredited recovery house to notify the accrediting organization before the 30th business day after the date of any change to the recovery house's designated responsible party.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403472
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and THSC §469.002, which requires HHSC establish minimum standards for accreditation as a recovery house.
§571.32.Advertising Restrictions.
Pursuant to THSC §469.007, an accrediting organization shall ensure a recovery house accredited by that organization:
(1) does not advertise or otherwise communicate that the recovery house is accredited by an accrediting organization unless the recovery house is accredited by an accrediting organization in accordance with THSC Chapter 469 and this chapter; and
(2) does not advertise or cause to be advertised in any manner any false, misleading, or deceptive information about the recovery house.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403473
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and THSC §469.002, which requires HHSC establish minimum standards for accreditation as a recovery house.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 29, 2024.
TRD-202403474
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 18, 2024
Proposal publication date: May 3, 2024
For further information, please call: (512) 834-4591
The Texas Health and Human Services Commission (HHSC) adopts amendments to §744.405, concerning What telephone numbers and other contact information must I post and where must I post this information; §744.501, concerning What written operational policies must I have; and §744.2801, concerning To whom may I release a child; and new §744.521, concerning What rights does a parent of a child in care of my child-care operation have.
New §744.521 and amended §744.501 and §744.2801 are adopted with changes to the proposed text as published in the April 19, 2024, issue of the Texas Register (49 TexReg 2383). These rules will be republished.
Amended §744.405 is adopted without changes to the proposed text as published in the April 19, 2024, issue of the Texas Register (49 TexReg 2383). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and new section are necessary to comply with Senate Bill (S.B.) 1098, 88th Legislature, Regular Session, 2023. S.B. 1098 amended Texas Human Resources Code (HRC), Chapter 42, by adding §42.04271 to establish specific rights of the parent or guardian of a child enrolled in a licensed or registered child day care operation. Accordingly, HHSC Child Care Regulation (CCR) is adopting rules in Chapter 744 that will (1) establish new requirements related to parent rights, and (2) update and clarify current requirements that are related to parent rights.
COMMENTS
The 31-day comment period ended May 20, 2024. During this period, HHSC did not receive any comments regarding the proposed rules.
HHSC did receive comments on parallel rules in Chapter 746, Minimum Standards for Child-Care Centers, published in the April 19, 2024, issue of the Texas Register (49 TexReg 2386) and Chapter 747, Minimum Standards for Child-Care Homes, published in the April 19, 2024, issue of the Texas Register (49 TexReg 2391). HHSC is amending the proposed text related to complying with court orders that prevent a parent from picking up a child from the child-care operation in new §744.521 and amended §744.2801 to ensure the minimum standards remain congruent throughout Chapters 744, 746, and 747. For a more detailed description of comments received for Chapters 746 and 747, and the HHSC response, please see the preambles for Chapters 746 and 747, which are published elsewhere in this issue of the Texas Register.
HHSC is also amending §744.501 to correct punctuation in the rule.
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION
DIVISION 3. REQUIRED POSTINGS
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403510
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§744.501.What written operational policies must I have?
You must develop written operational policies and procedures that at a minimum address each of the following:
(1) Hours, days, and months of operation;
(2) Procedures for the release of children;
(3) Illness and exclusion criteria;
(4) Procedures for dispensing medication or a statement that medication is not dispensed;
(5) Procedures for handling medical emergencies;
(6) Procedures for parental notifications;
(7) Discipline and guidance that is consistent with Subchapter G of this chapter (relating to Discipline and Guidance). A copy of Subchapter G may be used for your discipline and guidance policy, unless you use disciplinary and training measures specific to a skills-based program, as specified in §744.2109 of this chapter (relating to May I use disciplinary measures that are fundamental to teaching a skill, talent, ability, expertise, or proficiency?);
(8) Suspension and expulsion of children;
(9) Meals and food service practices;
(10) Immunization requirements for children, including tuberculosis screening and testing if required by your regional Texas Department of State Health Services or local health authority;
(11) Enrollment procedures, including how and when parents will be notified of policy changes;
(12) Transportation, if applicable;
(13) Water activities, if applicable;
(14) Field trips, if applicable;
(15) Animals, if applicable;
(16) Procedures for providing and applying, as needed, insect repellent and sunscreen, including what types will be used, if applicable;
(17) Parent rights that are consistent with the rules in Division 5 of this subchapter (relating to Parent Rights);
(18) Procedures for parents to review and discuss with the director any questions or concerns about the policies and procedures of the operation;
(19) Procedures for parents to participate in the operation's activities;
(20) Instructions on how a parent may access the:
(A) Minimum standards online;
(B) Texas Abuse and Neglect Hotline; and
(C) HHSC website.
(21) Emergency preparedness plan;
(22) Procedures for conducting health checks, if applicable;
(23) Information on vaccine-preventable diseases for employees, unless your operation is in the home of the permit holder, the director, or a caregiver. The policy must address the requirements outlined in §744.2581 of this chapter (relating to What must a policy for protecting children from vaccine-preventable diseases include?);
(24) If your operation maintains and administers unassigned epinephrine auto-injectors to use when a child in care has an emergency anaphylaxis reaction, policies for maintenance, administration, and disposal of unassigned epinephrine auto-injectors that comply with the unassigned epinephrine auto-injector requirements set by the Texas Department of State Health Services, as specified in Texas Administrative Code, Title 25, Chapter 40, Subchapter C (relating to Epinephrine Auto-Injector Policies in Youth Facilities) and Texas Health and Safety Code §773.0145; and
(25) Procedures for supporting inclusive services to children with special care needs. The policy must address the requirements outlined in §744.2009 of this chapter (relating to What are my responsibilities when planning activities for a child in care with special care needs?).
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403509
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§744.521.What rights does a parent of a child in care of my child-care operation have?
A parent of a child in care has the right to:
(1) Enter and examine your operation during its hours of operation without advance notice;
(2) File a complaint against your operation;
(3) Review your operation's publicly accessible records;
(4) Review your operation's written records concerning the parent's child, as outlined in §744.601 of this chapter (relating to Who has the right to access children's records?);
(5) Receive from your operation:
(A) HHSC's inspection reports for your operation; and
(B) Information regarding how to access your operation's compliance history online;
(6) Have your operation comply with a valid court order signed by a judge that prevents another parent from visiting or removing the parent's child from your operation, as outlined in §744.2801 of this chapter (relating to To whom may I release a child?);
(7) Be provided with contact information for Child Care Regulation, including the department's name, address, and telephone number;
(8) View any video recordings of an alleged incident of abuse or neglect involving the parent's child maintained by your operation as long as:
(A) Video recordings of the alleged incident are available;
(B) The parent is not allowed to retain any portion of the video depicting a child who is not the parent's child; and
(C) Your operation notifies in writing the parent of any other child captured in the video recording, before allowing the parent to inspect the video recording;
(9) Obtain a copy of your operation's policies and procedures, as outlined in §744.503 of this subchapter (relating to Must I provide parents with a copy of my operational policies?);
(10) Review, upon request of the parent, your:
(A) Staff training records; and
(B) In-house training curriculum, if any; and
(11) Be free from any retaliatory action by your operation for exercising any of the parent's rights.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403513
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
DIVISION 5. RELEASE OF CHILDREN
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§744.2801.To whom may I release a child?
(a) You must release a child only to a parent or a person designated by the parent.
(b) Upon receipt of a valid court order signed by a judge that prohibits a parent from removing the named child or children from the child-care operation, the child-care operation must:
(1) Comply with the court order immediately and until:
(A) Receipt of a subsequent court order that revokes the primary order; or
(B) The court order expires as defined in the document; and
(2) Maintain a copy of the court order in the child's file.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403515
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
The Texas Health and Human Services Commission (HHSC) adopts amendments to §746.405, concerning What telephone numbers and other contact information must I post and where must I post this information; §746.501, concerning What written operational policies must I have; §746.1317, concerning Must the training for my caregivers and the director meet certain criteria; and §746.4101, concerning To whom may I release a child; and new §746.521, concerning What rights does a parent of a child in care of my child-care center have.
New §746.521 and amended §746.501 and §746.4101 are adopted with changes to the proposed text as published in the April 19, 2024, issue of the Texas Register (49 TexReg 2386) These rules will be republished.
Amended §746.405 and §746.1317 are adopted without changes to the proposed text as published in the April 19, 2024, issue of the Texas Register (49 TexReg 2386). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and new section are necessary to comply with Senate Bill (S.B.) 1098 and S.B. 1242, 88th Legislature, Regular Session, 2023. S.B. 1098 amended Texas Human Resources Code (HRC), Chapter 42, by adding §42.04271 to establish specific rights of the parent or guardian of a child enrolled in a licensed or registered child day care operation. S.B. 1242 amended HRC §42.0421 by adding Subsection (g-1) to allow a child-care center director to provide training to center staff if the individual was not the director of the child-care center at the time HHSC imposed an administrative penalty on the operation. Accordingly, HHSC Child Care Regulation (CCR) is adopting rules in Chapter 746 that will (1) establish new requirements related to parent rights, (2) update and clarify current requirements that are related to parent rights, and (3) update a requirement related to the criteria a child-care center director must meet to provide training to the director's staff.
COMMENTS
The 31-day comment period ended May 20, 2024. During this period, HHSC received comments regarding the proposed rules from eight commenters representing licensed child-care centers, including Toy Town PreSchool, Immanuel Baptist Church Child Development Center, Giorgi's Child Care, Legacy Kids Academy, Countryside Montessori, Jewel's Learning Center, Barnyard Kids Learning Center, and Wonderland Montessori. A summary of comments relating to the rules and HHSC's responses follows.
Comment: Regarding §746.521, one commenter stated that while parents have rights and transparency in a child-care center is important, offering parents more rights and freedom to inspect a child-care center opens the center to lawsuits and closure. The commenter stated that it is becoming increasingly difficult to be a center director due to current staff issues and shortages, regulation requirements, administrative duties, and the parents with which the centers deal. The commenter added that child-care centers no longer feel protected.
Response: HHSC disagrees with the comment and declines to revise the rule. The Texas legislature already created the parent rights in HRC §42.04271. HHSC must align the rule with the statutory requirements.
Comment: Regarding §746.521(1), one commenter stated that while parents must have some rights when it comes to childcare and the care of their children, they should not be allowed to come to the center without advance notice as they could pose a safety concern. The commenter stated that the policies of the commenter's center require parents to provide advance notice before visiting the center.
Response: HHSC disagrees with the comment and declines to revise the rule. HHSC must align the rule with the statutory requirements related to parent rights in HRC §42.04271. Moreover, prior to the creation of §42.04271, HRC §42.0427 already required that all areas of a licensed facility, which includes a child-care center, must be accessible to a parent of a child in the operation's care if the parent visits the child during the facility's hours of operation. Because of that statute, the requirement to allow a parent to visit the center without securing approval is not new. HHSC has moved the requirement from its current location at §746.501(b)(1) to §746.521(1). §746.501(b)(1) currently requires a child-care center to allow parents to visit the child-care center at any time during the center's hours of operation to observe the parents' child, program activities, building, premises, and equipment without having to secure prior approval.
Comment: Regarding §746.521(4), one commenter stated that parents should not be allowed to review written records about their child unless the parent has provided the record to the center or in circumstances where the parent has signed an injury or incident report. The commenter stated that other records concerning the child may have confidential information that a parent may never need to see.
Response: HHSC disagrees with the comment and declines to revise the rule. The Texas legislature already created the parent rights in HRC §42.04271. HHSC must align the rule with the statutory requirements. Moreover, the requirement to allow parents to review written records about their child is not new. Section 746.521(4) references the current requirement at §746.601(b), which allows parents to access their child's records during a parent conference with the caregiver or child-care center director.
Comment: Regarding §746.521(5)(A), one commenter asked if the rule will include guidance for how child-care centers should provide inspection reports to parents and whether posting the inspection reports per §746.401 was still the expected way for parents to receive inspection reports.
Response: HHSC disagrees that any change is necessary based on this comment. There is no single required method for a child-care center to provide parents with inspection reports. However, HHSC has provided child-care centers with recommended options in the Technical Assistance (TA) box that follows the rule in the minimum standards courtesy publication.
Comment: Regarding §746.521(6), one commenter stated the commenter's child-care center does its best to comply with court orders but will not put themselves in harm's way if a parent does not willingly comply with the order. The commenter stated that the most the center can do is call the police or custodial parent.
Response: HHSC agrees that a child-care center may encounter sensitive situations when complying with a court order but declines to revise the rule in response to the comment. HHSC must align the rule with the statutory requirements related to parent rights in HRC §42.04271. However, to aid child-care providers in managing sensitive custody issues in relation to court orders, HHSC will create a TA document with resources and tips for child-care providers that will be available to all child-care providers via the CCR TA Library.
Comment: Regarding §746.521(6) and §746.4101(b), one commenter asked if HHSC has discussed, outside of trainings, how to handle a parent who becomes upset when not allowed to pick up a child. The commenter also asked whether HHSC has discussed child-care providers who get caught in the middle of a custody situation.
Another commenter stated that the wording of the new rule places liability on child-care centers to enforce court orders relating to custody agreements that most police departments will not enforce, citing it as a civil matter. The commenter stated that the most a center can do in these situations is lock the non-custodial parent out of the center and call the custodial parent and the police, the latter of which will typically allow the non-custodial parent to pick up the child once they obtain identification verifying the individual is the child's parent. The commenter stated this rule places an unfair burden on centers who should not be placed in the middle of custody issues.
Response: HHSC agrees that a child-care center may encounter sensitive situations when complying with a court order. However, HHSC declines to revise the rules in response to the comment. HHSC must align the rule with the statutory requirements related to parent rights in HRC §42.04271. However, to aid child-care providers in managing sensitive custody issues as they related to court orders, HHSC will create a TA document with resources and tips for child-care providers that will be available to all child-care providers via the CCR TA Library.
Comment: Regarding §746.521(8), one commenter stated that she considered removing video cameras from her child-care center in response to this rule. The commenter stated parents can misinterpret information in a video and turn it into something "out of hand" or file a lawsuit against the center. The commenter recommended HHSC remove poor performing child-care providers from the child-care industry rather than imposing this rule that puts undue stress on centers trying to provide the highest quality care to children.
Response: HHSC disagrees with the comment and declines to revise the rule. The Texas legislature already created the parent rights in HRC §42.04271. HHSC must align the rule with the statutory requirements. In addition, the rule limits parental access to video recordings to specific instances only, specifically when a parent's child is involved in an alleged incident of abuse or neglect.
Comment: Regarding §746.521(8), one commenter asked HHSC to re-evaluate the requirements related to video recordings. The commenter stated that many insurance companies stress that a child-care center not let anyone outside of Child Care Regulation (CCR) watch any video without a subpoena. The commenter also stated that insurance is getting harder for child-care centers to obtain due to child care being a "high risk" business, and the rule will not help this area of the center's daily business.
Response: HHSC agrees that a child-care center may have to consider insurance requirements when operating as a business. However, HHSC declines to revise the rule in response to the comment. The Texas legislature already created the parent rights in HRC §42.04271. HHSC must align the rule with the statutory requirements. In addition, the rule limits parental access to video recordings to specific instances only, specifically when a parent's child is involved in an alleged incident of abuse or neglect.
Comment: Regarding §746.521(10), two commenters stated that parents do not need to have access to staff training records or training curriculum. One commenter stated that CCR looks at the records and will hold the center accountable for any discrepancies with state requirements. The commenter also stated that parents do not know what to look for in assessing a training record or curriculum. The other commenter stated that training records are not the parents' business. The commenter stated it is the director's job to ensure staff are well trained.
Response: HHSC disagrees with the comments and declines to revise the rule. The Texas legislature already created the parent rights in HRC §42.04271. HHSC must align the rule with the statutory requirements.
Comment: Regarding §746.521(11), one commenter stated that providers at child-care centers have feelings, and when parents make false allegations, they will likely do so again. The commenter stated that she will not continue to serve a disgruntled family.
Response: HHSC disagrees with the comment and declines to revise the rule. The Texas legislature already created the parent rights in HRC §42.04271. HHSC must align the rule with the statutory requirements. Regarding the commenter's concern about serving a disgruntled family, there is currently TA following §746.501 in the minimum standards courtesy publication and in the CCR TA library that addresses expulsion policies in a child-care center's operational policies.
Comment: Regarding §746.1317(6)(C), one commenter stated that the amount of changes that have been submitted within the past few years are becoming excessive. The commenter also stated that most child-care centers are already providing their staff over 30 hours of training a year, and there are limited resources for these. The commenter recommended that if HHSC is going to continue to make changes to training requirements, HHSC needs to provide more resources to access these at reasonable hours (holidays and weekends), so that staff can continue to attend work and provide care. The commenter added that a lot of the current resources are very mismanaged, and daycare centers feel left behind. The commenter stated that at this rate they are all going to be out of business within the next decade.
Response: HHSC disagrees with the comment and declines to revise the rule. HHSC must align the rule with the statutory requirements in HRC §42.0421(g-1). In addition, the rule amendment does not require additional training, but expands the circumstances under which a director of a child-care center may train the director's own staff. This amendment allows a child-care center more flexibility to provide training.
Comment: Regarding §746.4101(b), one commenter stated that section (b) is peculiarly phrased, suggesting that the parents' desires take precedence over the court order when a court order is a crucial legal document that must be strictly adhered to in childcare operations. The commenter stated that regardless of the parent's request, child-care operations are bound to follow the court order, even if the custodial parent requests the restricted parent be granted authorization for pick up. The court order takes precedence, and the named individual in the document is prohibited from picking up the child. The commenter stated that the act of the parent wielding the court order's presentation automatically supports section (a) as their indication of who is and is not authorized to pick up a child. The commenter recommended HHSC update the rule language and suggested specific language to clarify the intent of the rule.
Response: HHSC agrees with the comment and revised the rule to reflect that a child-care center must follow a valid court order, once received, until a subsequent order revokes the primary order or the court order expires, regardless of parental request
Comment: Regarding §746.4101(b), one commenter asked if the rule will include guidelines for documenting or having court orders. The commenter also asked if court order requirements will be added to §746.603 as a record a child-care center must keep on file.
Response: HHSC agrees with the comment and revised the rule to require a child-care center to maintain a copy of the court order in the child's file. HHSC has not revised §746.603 because the rule was not proposed for amendment in this project.
Comment: Regarding the rules in general, one commenter issued a statement of support for the rule amendments and new rules in the project. The commenter stated that all the changes look to be logical and reasonable, some of which are in place and have been for quite some time. The commenter added that the remaining changes can be easily inserted into existing policies and procedures.
Response: HHSC appreciates support of the rules.
In addition, HHSC received comments on parallel rules in Chapter 747, Minimum Standards for Child-Care Homes, published in the April 19, 2024, issue of the Texas Register (49 TexReg 2391). HHSC is amending the proposed text related to a parent's right for the child-care center to comply with a court order that prevents a parent from picking up a child from the child-care operation in new §746.521 to ensure the minimum standards remain congruent throughout Chapters 746 and 747. For a more detailed description of comments received for Chapter 747, and the HHSC response, please see the preamble for Chapter 747, which is published elsewhere in this issue of the Texas Register.
HHSC is also amending §746.501 to correct punctuation in the rule.
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION
DIVISION 3. REQUIRED POSTINGS
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403517
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§746.501.What written operational policies must I have?
(a) You must develop written operational policies and procedures that at a minimum address each of the following:
(1) Hours, days, and months of operation;
(2) Procedures for the release of children;
(3) Illness and exclusion criteria;
(4) Procedures for dispensing medication or a statement that medication is not dispensed;
(5) Procedures for handling medical emergencies;
(6) Procedures for parental notifications;
(7) Discipline and guidance that is consistent with Subchapter L of this chapter (relating to Discipline and Guidance). A copy of Subchapter L may be used for your discipline and guidance policy;
(8) Suspension and expulsion of children;
(9) Safe sleep policy for infants from birth through 12 months old that is consistent with the rules in Subchapter H of this chapter (relating to Basic Requirements for Infants) that relate to sleep requirements and restrictions, including sleep positioning, and crib requirements and restrictions, including mattresses, bedding, blankets, toys, and restrictive devices;
(10) Meals and food service practices;
(11) Immunization requirements for children, including tuberculosis screening and testing if required by your regional Texas Department of State Health Services or local health authority;
(12) Hearing and vision screening requirements;
(13) Enrollment procedures, including how and when parents will be notified of policy changes;
(14) Transportation, if applicable;
(15) Water activities, if applicable;
(16) Field trips, if applicable;
(17) Animals, if applicable;
(18) Promotion of indoor and outdoor physical activity that is consistent with Subchapter F of this chapter (relating to Developmental Activities and Activity Plan); your policies must include:
(A) The benefits of physical activity and outdoor play;
(B) The duration of physical activity at your operation, both indoor and outdoor;
(C) The type of physical activity (structured and unstructured) that children may engage in at your operation;
(D) Each setting in which your physical activity program will take place;
(E) The recommended clothing and footwear that will allow a child to participate freely and safely in physical activities;
(F) The criteria you will use to determine when extreme weather conditions pose a significant health risk that prohibits or limits outdoor play; and
(G) A plan to ensure physical activity occurs on days when extreme weather conditions prohibit or limit outdoor play.
(19) Procedures for providing and applying, as needed, insect repellent and sunscreen, including what types will be used, if applicable;
(20) Parent rights that are consistent with the rules in Division 5 of this subchapter (relating to Parent Rights);
(21) Procedures for parents to review and discuss with the child-care center director any questions or concerns about the policies and procedures of the child-care center;
(22) Procedures for parents to participate in the child-care center's operation and activities;
(23) Instructions on how a parent may access the:
(A) Minimum standards online;
(B) Texas Abuse and Neglect Hotline; and
(C) HHSC website.
(24) Your emergency preparedness plan;
(25) Your provisions to provide a comfortable place with an adult sized seat in your center or within a classroom that enables a mother to breastfeed her child. In addition, your policies must inform parents that they have the right to breastfeed or provide breast milk for their child while in care;
(26) Preventing and responding to abuse and neglect of children, including:
(A) Required annual training for employees;
(B) Methods for increasing employee and parent awareness of issues regarding child abuse and neglect, including warning signs that a child may be a victim of abuse or neglect and factors indicating a child is at risk for abuse or neglect;
(C) Methods for increasing employee and parent awareness of prevention techniques for child abuse and neglect;
(D) Strategies for coordination between the center and appropriate community organizations; and
(E) Actions that the parent of a child who is a victim of abuse or neglect should take to obtain assistance and intervention, including procedures for reporting child abuse or neglect;
(27) Procedures for conducting health checks, if applicable;
(28) Information on vaccine-preventable diseases for employees, unless your center is in the home of the permit holder. The policy must address the requirements outlined in §746.3611 of this chapter (relating to What must a policy for protecting children from vaccine-preventable diseases include?);
(29) If your operation maintains and administers unassigned epinephrine auto-injectors to use when a child in care has an emergency anaphylaxis reaction, policies for maintenance, administration, and disposal of unassigned epinephrine auto-injectors that comply with the unassigned epinephrine auto-injector requirements set by the Texas Department of State Health Services, as specified in Texas Administrative Code, Title 25, Chapter 40, Subchapter C (relating to Epinephrine Auto-Injector Policies in Youth Facilities) and in Texas Health and Safety Code §773.0145; and
(30) Procedures for supporting inclusive services to children with special care needs. The policy must address the requirements outlined in §746.2202 of this chapter (relating to What are my responsibilities when planning activities for a child in care with special care needs?).
(b) You must also inform the parents that any area within 1,000 feet of a child-care center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to a harsher penalty under the Texas Penal Code. You may inform the parents by:
(1) Providing this information in the operational policies;
(2) Distributing the information in writing to the parents; or
(3) Informing the parents verbally as part of an individual or group parent orientation.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403518
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§746.521.What rights does a parent of a child in care of my child-care center have?
A parent of a child in care has the right to:
(1) Enter and examine your center during its hours of operation without advance notice;
(2) File a complaint against your center;
(3) Review your center's publicly accessible records;
(4) Review your center's written records concerning the parent's child, as outlined in §746.601 of this chapter (relating to Who has the right to access children's records?);
(5) Receive from your center:
(A) HHSC's inspection reports for your center; and
(B) Information regarding how to access your center's compliance history online;
(6) Have your center comply with a valid court order signed by a judge that prevents another parent from visiting or removing the parent's child from your center, as outlined in §746.4101 of this chapter (relating to To whom may I release a child?);
(7) Be provided with contact information for Child Care Regulation, including the department's name, address, and telephone number;
(8) View any video recordings of an alleged incident of abuse or neglect involving the parent's child maintained by your center as long as:
(A) Video recordings of the alleged incident are available;
(B) The parent is not allowed to retain any portion of the video depicting a child who is not the parent's child; and
(C) Your center notifies in writing the parent of any other child captured in the video recording, before allowing the parent to inspect the video recording;
(9) Obtain a copy of your center's policies and procedures, as outlined in §746.503 of this subchapter (relating to Must I provide parents with a copy of my operational policies?);
(10) Review, upon request of the parent, your:
(A) Staff training records; and
(B) In-house training curriculum, if any; and
(11) Be free from any retaliatory action by your center for exercising any of the parent's rights.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403519
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
DIVISION 4. PROFESSIONAL DEVELOPMENT
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403520
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
DIVISION 5. RELEASE OF CHILDREN
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§746.4101.To whom may I release a child?
(a) You must release a child only to a parent or a person designated by the parent.
(b) Upon receipt of a valid court order signed by a judge that prohibits a parent from removing the named child or children from the child-care center, the child-care center must:
(1) Comply with the court order immediately and until:
(A) Receipt of a subsequent court order that revokes the primary order; or
(B) The court order expires as defined in the document; and
(2) Maintain a copy of the court order in the child's file.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403521
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
The Texas Health and Human Services Commission (HHSC) adopts amendments to §747.403, concerning What telephone numbers and other contact information must I post and where must I post this information; §747.501, concerning What written operational policies must I have; and §747.3901, concerning To whom may I release a child; and new §747.521, concerning What rights does a parent of a child in care of my child-care home have.
New §747.521 and amended §747.3901 are adopted with changes to the proposed text as published in the April 19, 2024, issue of the Texas Register (49 TexReg 2391). These rules will be republished.
Amended §747.403 and §747.501 are adopted without changes to the proposed text as published in the April 19, 2024, issue of the Texas Register (49 TexReg 2391). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and new sections are necessary to comply with Senate Bill (S.B.) 1098, 88th Legislature, Regular Session, 2023. S.B. 1098 amended Texas Human Resources Code (HRC), Chapter 42, by adding §42.04271 to establish specific rights of the parent or guardian of a child enrolled in a licensed or registered child day care operation. Accordingly, HHSC Child Care Regulation (CCR) is adopting rules in Chapter 747 that will (1) establish new requirements related to parent rights; and (2) update and clarify current requirements that are related to parent rights.
COMMENTS
The 31-day comment period ended May 20, 2024. During this period, HHSC received a comment regarding the proposed rules from one commenter representing a licensed child-care home. A summary of the comment relating to the rules and HHSC's responses follows.
Comment: Regarding §747.521(6), one commenter requested HHSC change the rule language to clarify that a valid court order must include the signature of a judge.
Response: HHSC agrees with the comment and revised the rule to specify that a valid court order must include the signature of a judge.
In addition, HHSC received comments on parallel rules in Chapter 746, Minimum Standards for Child-Care Centers, published in the April 19, 2024, issue of the Texas Register (49 TexReg 2386). HHSC is amending the proposed text related to complying with court orders that prevent a parent from picking up a child from the child-care operation in amended §747.3901 to ensure the minimum standards remain congruent throughout Chapters 746 and 747. For a more detailed description of comments received for Chapter 746, and the HHSC response, please see the preamble for Chapter 746, which is published elsewhere in this issue of the Texas Register.
SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION
DIVISION 3. REQUIRED POSTINGS
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403522
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403523
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§747.521.What rights does a parent of a child in care of my child-care home have?
A parent of a child in care has the right to:
(1) Enter and examine your child-care home during its hours of operation without advance notice;
(2) File a complaint against your child-care home;
(3) Review your child-care home's publicly accessible records;
(4) Review your child-care home's written records concerning the parent's child, as outlined in §747.601 of this chapter (relating to Who has the right to access children's records?);
(5) Receive from your child-care home:
(A) HHSC's inspection reports for your child-care home; and
(B) Information regarding how to access your child-care home's compliance history online;
(6) Have your child-care home comply with a valid court order signed by a judge that prevents another parent from visiting or removing the parent's child from your child-care home, as outlined in §747.3901 of this chapter (relating to To whom may I release a child?);
(7) Be provided with contact information for Child Care Regulation, including the department's name, address, and telephone number;
(8) View any video recordings of an alleged incident of abuse or neglect involving the parent's child maintained by your child-care home as long as:
(A) Video recordings of the alleged incident are available;
(B) The parent is not allowed to retain any portion of the video depicting a child who is not the parent's child; and
(C) Your child-care home notifies in writing the parent of any other child captured in the video recording, before allowing the parent to inspect the video recording;
(9) Obtain a copy of your child-care home's policies and procedures, as outlined in §747.503 of this subchapter (relating to Must I provide parents with a copy of my operational policies?);
(10) Review, upon request of the parent, your:
(A) Staff training records; and
(B) In-house training curriculum, if any; and
(11) Be free from any retaliatory action by your child-care home for exercising any of the parent's rights.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403525
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269
DIVISION 5. RELEASE OF CHILDREN
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, as well as Texas Government Code §531.033, which requires the Executive Commissioner to adopt rules necessary to carry out the duties of HHSC duties under Chapter 531 of Texas Government Code. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§747.3901.To whom may I release a child?
(a) You may release a child only to a parent or a person designated by the parent.
(b) Upon receipt of a valid court order signed by a judge that prohibits a parent from removing the named child or children from the child-care home, the child-care home must:
(1) Comply with the court order immediately and until:
(A) Receipt of a subsequent court order that revokes the primary order; or
(B) The court order expires as defined in the document; and
(2) Maintain a copy of the court order in the child's file.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on July 30, 2024.
TRD-202403526
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 19, 2024
Proposal publication date: April 19, 2024
For further information, please call: (512) 438-3269