Proposed Rules Title 26

TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 338. DISASTER RULE FLEXIBILITIES FOR LOCAL INTELLECTUAL AND DEVELOPMENTAL DISABILITY AUTHORITIES (LIDDAs)

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Title 26, Texas Administrative Code (TAC), new Chapter 338, Disaster Rule Flexibilities for Local Intellectual and Developmental Disability Authorities (LIDDAs), comprising of §338.1, concerning Disaster Flexibilities.

BACKGROUND AND PURPOSE

The purpose of the proposal is to add a new chapter and rule to allow LIDDAs to use certain flexibilities to certain rules when providing services during a declared disaster under Texas Government Code §418.014.

LIDDAs provide essential services to individuals with intellectual or developmental disabilities (IDD). This vulnerable population relies on LIDDA staff to assist them in securing the services they need, achieving their desired outcomes and best quality of life. Disaster rule flexibilities for LIDDAs ensure that when a disaster declaration is in effect, HHSC may issue timely guidance and authorize flexibilities for LIDDAs to provide services.

The proposal creates a standing rule allowing HHSC to notify LIDDAs of certain flexibilities immediately upon a disaster declaration. These flexibilities include allowing service coordination to be delivered via audio-only or audio-visual communication to ensure continuity of services, as well as extending some timeframes for LIDDAs. In addition, the proposal requires that LIDDAs follow HHSC guidance related to the rules, comply with all applicable requirements related to security and privacy of information, and notify persons impacted by the flexibilities, if applicable.

SECTION-BY-SECTION SUMMARY

Proposed new §338.1(a) establishes definitions for terminology used in this chapter, including "audio-only," "audio-visual," "face-to-face," and "in-person (or in person)."

Proposed new §338.1(b) establishes that in the event of a declared state of disaster, HHSC may allow flexibilities described in subsection (c). HHSC will notify LIDDAs of the beginning and end dates for rule flexibilities.

Proposed new §338.1(c) identifies the rules for which HHSC will allow flexibilities to the extent authorized under federal and state law, including a flexibility to 26 TAC §331.11(d) that allows LIDDAs to provide service coordination using audio-visual or audio-only communication instead of in person. Additionally, HHSC may allow flexibilities to certain rules that set forth timeframes applicable to the LIDDAs by extending the timeframes.

Proposed new §338.1(d) requires LIDDAs that use the flexibilities to comply with all guidance on the application of the rules identified in subsection (c) published by HHSC, including policy guidance issued by HHSC's Community Services Division and Medicaid and CHIP Services.

Proposed new §338.1(e) requires that LIDDAs ensure audio-only or audio-visual communication complies with all applicable requirements related to security and privacy of information.

Proposed new §338.1(f) requires LIDDAs to notify persons receiving services, or other individuals, as applicable, of the extensions to the timeframes permitted under subsection (c)(2).

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rule will be in effect:

(1) the proposed rule will not create or eliminate a government program;

(2) implementation of the proposed rule will not affect the number of HHSC employee positions;

(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;

(4) the proposed rule will not affect fees paid to HHSC;

(5) the proposed rule will create a new rule;

(6) the proposed rule will not expand, limit, or repeal existing rules;

(7) the proposed rule will not change the number of individuals subject to the rule; and

(8) the proposed rule will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there is no adverse economic effect on small businesses, micro-businesses, or rural communities. The proposed rule provides certain flexibilities for LIDDAs during a declared disaster, but there is no requirement to alter current business practices. No rural communities contract with HHSC in any program or service affected by the proposed rule.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect the local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule is necessary to protect the health, safety, and welfare of the residents of Texas; does not impose a cost on regulated persons; and is proposed to reduce the burden or responsibilities imposed on regulated persons by the rule.

PUBLIC BENEFIT AND COSTS

Haley Turner, Deputy Executive Commissioner for Community Services, has determined that for each year of the first five years the rule is in effect, the public benefit will be the continuity of services to vulnerable Texans during declared disasters.

Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because there is no requirement to alter current business practices. LIDDAs are not required to utilize HHSC-authorized flexibilities during declared disasters.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 701 W. 51st Street, Austin, Texas 78751 or by email to Brandi Lambert at IDDServicesPolicyandRules@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 23R019" in the subject line.

STATUTORY AUTHORITY

The new section is authorized by 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; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program; and Texas Health & Safety Code §533A.0355(a), which provides that the Executive Commissioner of HHSC shall adopt rules establishing the roles and responsibilities of LIDDAs.

The new section affects Texas Government Code §§531.0055 and 531.021, Texas Human Resources Code §32.021, and Texas Health & Safety Code §533A.0355(a).

§338.1.Disaster Flexibilities.

(a) Definitions. The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Audio-only--An interactive, two-way audio communication that uses only sound and that meets the privacy requirements of the Health Insurance Portability and Accountability Act. Audio-only includes the use of telephonic communication. Audio-only does not include face-to-face communication.

(2) Audio-visual--An interactive, two-way audio and video communication that conforms to privacy requirements under the Health Insurance Portability and Accountability Act. Audio-visual does not include audio-only or in-person communication.

(3) Face-to-face--In-person or audio-visual communication that meets the requirements of the Health Insurance Portability and Accountability Act. Face-to-face does not include audio-only communication.

(4) In-person (or in person)--Within the physical presence of another person. In-person or in person does not include audio-visual or audio-only communication.

(b) The Texas Health and Human Services Commission (HHSC) may allow local intellectual and developmental disability authorities (LIDDAs) to use the flexibilities described in subsection (c) of this section while an executive order or proclamation declaring a state of disaster under Texas Government Code §418.014 is in effect. HHSC will notify LIDDAs when a flexibility is permitted and the date the flexibility must no longer be used, which may be before the declaration of a state of disaster expires.

(c) Subject to the notification by HHSC, the following flexibilities may be available to LIDDAs to the extent the flexibility is permitted by and does not conflict with other laws or obligations of the LIDDA and is allowed by federal and state law.

(1) Service coordination required to be provided in person under 26 TAC §331.11(d) of this title (relating to LIDDA's Responsibilities) may be provided using audio-visual or audio-only communication.

(2) HHSC may extend the timeframes for LIDDAs in the following rules:

(A) the timeframe to request an administrative hearing in 40 TAC §4.156 (relating to Request for an Administrative Hearing);

(B) the timeframe for a person and legally authorized representative (LAR) to request a review of a decision to deny or terminate services in 40 TAC §2.46(e)(3) (relating to Notification and Appeals Process);

(C) the timeframe for a person or the person's parent to comply with the applicable accountability requirement in 40 TAC §2.105(f)(1) (relating to Accountability)in order for the LIDDA to retroactively adjust the person's account; and

(D) the timeframe for a person or parent to submit a request to review a LIDDA's appeal decision to HHSC in 40 TAC §2.109(e)(3) (relating to Payments, Collections, and Non-payment).

(d) LIDDAs that use one or more of the flexibilities allowed under subsection (c) of this section must comply with:

(1) all policy guidance applicable to the rules identified in subsection (c) of this section issued by HHSC Community Services Division during the declaration of disaster that is published by HHSC on its LIDDA website or in another communication format HHSC determines appropriate; and

(2) all policy guidance applicable to the rules identified in subsection (c) of this section issued by HHSC Medicaid and CHIP Services.

(e) LIDDAs must ensure audio-only or audio-visual communication complies with all applicable requirements related to security and privacy of information.

(f) LIDDAs must notify the person, the LAR, or the person's parent if the person is younger than 18 years of age, of the extension of timeframes permitted under subsection (c)(2) of this section that apply to the person receiving services.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 20, 2023.

TRD-202304333

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: January 7, 2024

For further information, please call: (512) 438-5609

CHAPTER 745. LICENSING

SUBCHAPTER G. CONTROLLING PERSONS

26 TAC §§745.901, 745.903 - 745.905

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §745.901, concerning Who is a controlling person at a child-care operation, §745.903, concerning When and how must an operation submit controlling-person information to Licensing, and §745.905, concerning When will Licensing designate someone at my child-care operation as a controlling person; and new §745.904, concerning What must I do to verify the accuracy of the list of controlling persons associated with my operation, in Texas Administrative Code, Title 26, Chapter 745, Licensing, Subchapter G, Controlling Persons.

BACKGROUND AND PURPOSE

The purpose of this proposal is to adopt rules in Chapter 745 to implement HHSC Child Care Regulation's (CCR) Performance Management Unit (PMU) recommendations from the Fiscal Year (FY) 2019 and FY 2021 reports: Annual Casereading, Read-Behind, and Field Assessment. In these reports, PMU recommended IT enhancements to support a change in current business practice related to verifying an operation's controlling persons list. The current practice requires CCR inspectors to verify an operation's controlling persons list during all monitoring inspections. PMU recommended CCR change to a new practice that would require an operation to validate the controlling persons list on a scheduled basis using the operation's online Child Care Regulation Account.

The IT enhancements, and consequently the rules, also support implementation of Texas Human Resources Code (HRC) §42.025(b)(4) and (c), which were added by Senate Bill 225, 87th Legislature, Regular Session, 2021. HRC §42.025(b)(4) and (c) require CCR to list certain information for child-care homes and listed family homes on the Search Texas Child Care website regarding involuntary suspensions, revocations, and refusals to renew permits.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §745.901 (1) reorganizes a subdivision of the rule to improve readability; (2) adds language to clarify that a child-care home includes a licensed or registered child-care home; and (3) adds the primary caregiver of a listed family home and the caregiver's spouse to the definition of a controlling person.

The proposed amendment to §745.903 (1) updates language and punctuation to improve readability; (2) updates a reference; and (3) updates language to reflect that a child-care operation may submit controlling person information online through the operation's Child Care Regulation Account, not the DFPS website.

Proposed new §745.904 outlines what a child-care operation must do to verify the accuracy of the operation's controlling persons list by requiring a child-care operation to validate the controlling persons list, including each person's role at the operation, on a scheduled basis and prescribing the way the operation must complete the validation. The rule requires (1) a School-Age and Before or After-School Program, Licensed Child-Care Center, General Residential Operation, and Child-Placing Agency to validate the accuracy of the list quarterly and make necessary corrections via the child-care operation's online Child Care Regulation Account; (2) a Licensed Child-Care Home and Registered Child-Care Home to validate the accuracy of the list annually and make necessary corrections via the child-care home's online Child Care Regulation Account; and (3) a Listed Family Home to validate the accuracy of the list annually and make necessary corrections via the home's online Child Care Regulation Account or by contacting the local Child Care Regulation office.

The proposed amendment to §745.905 (1) updates a reference; (2) updates language to improve readability; (3) corrects an inaccurate pronoun usage; and (4) removes language that implies a Controlling Person Form is the only way an operation may submit controlling person information.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local governments. All costs related to IT enhancements will be absorbed with existing resources.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create a new rule;

(6) the proposed rules will expand an existing rule;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the rules do not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas and do not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rules are in effect, the public will benefit through improved safety of children in out of home care as a result of more timely and accurate accounting of the controlling persons associated with a child-care operation and rules that support a change to business practice.

Trey Wood has also determined that for the first five years the rules are in effect there are no anticipated economic costs to persons who are required to comply with the proposed rules. The controlling persons validation requirements can be implemented by each child-care operation's existing administrative processes and do not require additional staff.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

Questions about the content of this proposal may be directed to Aimee Belden by email at Aimee.Belden@hhs.texas.gov.

Written comments on the proposal may be submitted to Aimee Belden, Rules Writer, Child Care Regulation, Texas Health and Human Services Commission, E-550, P.O. Box 149030, Austin, Texas 78714-9030; or by email to CCRRules@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 23R016" in the subject line.

STATUTORY AUTHORITY

The amendments and new section are authorized by 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 §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.

The amendments and new section affect Texas Government Code §531.0055 and HRC §42.042.

§745.901.Who is a controlling person at a child-care operation?

(a) A controlling person of a child-care operation is any:

(1) Owner of the operation or member of the governing body of the operation, including, as applicable: [,]

(A) An [an] executive, an officer, or a board member; [,]

(B) A [a] partner;[,]

(D) The [~~the~~] primary caregiver at a licensed child-care home, registered child-care home, or listed family home and the primary caregiver's spouse;

(2) Person who manages, administrates, or directs the operation or its governing body, including a day care director or a licensed administrator; or

(3) Person who either alone or in connection with others has the ability to influence or direct the management, expenditures, or policies of the operation. For example, a person may have influence over the operation because of a personal, familial, or other relationship with the governing body, manager, or other controlling person of the operation.

(b) A person does not have to be present at the operation or hold an official title at the operation or governing body in order to be a controlling person.

(c) An employee, lender, secured creditor, or landlord of the operation is not a controlling person unless the person meets a definition in subsection (a) of this section.

§745.903.When and how must I [~~an operation~~] submit controlling person [~~controlling-person~~ ] information to Licensing?

(a) You must provide information about each person that is a controlling person at your operation as defined in §745.901(a) of this subchapter [~~title~~] (relating to Who is a controlling person at a child-care operation?) when you apply for your permit.

(b) After you receive a permit from us, you must provide us information about someone who is a controlling person at your operation within two days after a person becomes a controlling person.

(1) Enter the information online [~~on-line~~] through your Child Care Regulation Account [~~the DFPS website~~]; or

(2) Submit a completed Controlling Person Form to your local Child Care Regulation [~~Licensing~~] office.

§745.904.What must I do to verify the accuracy of the list of controlling persons associated with my operation?

You must validate the accuracy of your controlling persons list, including each person's role at your operation, and make any necessary corrections:

(1) Every three months through your online Child Care Regulation Account for:

(A) School-Age or Before or After-School Programs;

(B) Licensed Child-Care Centers;

(D) Child-Placing Agencies;

(2) Once a year through your online Child Care Regulation Account for:

(A) Licensed Child-Care Homes; and

(B) Registered Child-Care Homes; and

(3) Once a year for Listed Family Homes:

(A) Through your online Child Care Regulation Account; or

(B) By contacting the local Child Care Regulation office.

§745.905.When will Licensing designate someone at my child-care operation as a controlling person?

(a) We will designate each person who meets the definition of a controlling person in §745.901(a) of this subchapter [~~title~~] (relating to Who is a controlling person at a child-care operation?) as a controlling person at your operation when:

(1) We revoke your permit; or

(2) You voluntarily close your operation or relinquish your permit after you receive notice of our intent to revoke your permit or that we are revoking your permit.

(b) We may designate a person at your operation as a controlling person, regardless of whether you submitted the person's [~~their~~] name as a controlling person at your child-care operation [~~on a Controlling Person Form~~].

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 21, 2023.

TRD-202304342

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: January 7, 2024

For further information, please call: (512) 438-3269

CHAPTER 926. TRAINING FOR FACILITY STAFF

26 TAC §§926.1 - 926.6

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §926.1, concerning Application; §926.2, concerning Definitions; concerning §926.3, concerning Training for New Employees; §926.4, concerning Additional Training for Employees who Provide Direct Care to Individuals; §926.5, concerning State Hospital Refresher Training; and §926.6, concerning State Supported Living Center (SSLC) Refresher Training.

BACKGROUND AND PURPOSE

The purpose of the proposed new rules is to reflect the move of the state hospitals from the Department of State Health Services and the state supported living centers from the Department of Aging and Disability Services to HHSC. HHSC is moving several rules from Title 25 of the Texas Administrative Code (TAC), Chapter 417, Subchapter A and 40 TAC Chapter 3, Subchapter D, Training, and consolidating rules under 26 TAC Chapter 926. The proposed rules update agency information, provide uniform training topics and timeframes, and remove text regarding expedited training due to the COVID-19 disaster declaration. The repeal of certain rules from 25 TAC Chapter 417, Subchapter A and 40 TAC Chapter 3, Subchapter D is proposed simultaneously elsewhere in this issue of the Texas Register.

SECTION-BY-SECTION SUMMARY

Proposed new §926.1 establishes that the chapter applies to state hospitals in accordance with Texas Health and Safety Code §552.052 and state supported living centers in accordance with Texas Health and Safety Code §555.024.

Proposed new §926.2 provides the definition of certain terms used within the chapter.

Proposed new §926.3 outlines training provided to all new facility employees.

Proposed new §926.4 outlines additional training provided to facility employees who provide direct care.

Proposed new §926.5 outlines refresher training provided to state hospital employees.

Proposed new §926.6 outlines refresher training provided to SSLC employees.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years the rules will be in effect, enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new rules;

(6) the proposed rules will not expand, limit, or repeal existing rules;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The proposed rules do not apply to small businesses, micro-businesses, or rural communities.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

Scott Schalchlin, Deputy Executive Commissioner of Health and Specialty Care System, has determined that for each year of the first five years the rules are in effect, the public benefit will be consolidation of HHSC rules in 26 TAC, and improved general public access to requirements.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the rules because the rule applies only to HHSC.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

Written comments on the proposal may be submitted to HHSC, Mail Code E619, P.O. Box 13247, Austin, Texas 78711-3247, or by email to HealthandSpecialtyCare@hhsc.state.tx.us.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 23R006" in the subject line.

STATUTORY AUTHORITY

The new rules are authorized by 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, Health and Safety Code §552.052, which requires HHSC to provide certain training to state hospital employees, and for the Executive Commissioner to adopt rules regarding refresher trainings for employees, and Texas Health and Safety Code §555.024, which requires HHSC to provide certain training to SSLC employees, and for the Executive Commissioner to adopt rules regarding refresher trainings for employees.

The new rules affect Texas Government Code §531.0055, and Texas Health and Safety Code §§552.052 and 555.024.

§926.1.Application.

This chapter applies to state hospitals in accordance with Texas Health and Safety Code (HSC) §552.052 and state supported living centers in accordance with Texas HSC §555.024.

§926.2.Definitions.

The following words and terms, when used in this chapter, have the following meaning, unless the context clearly indicates otherwise.

(1) Direct care employee--A facility employee who provides direct delivery of services to an individual.

(2) Facility--A state hospital or state supported living center.

(3) Individual--A person who is receiving services at a facility.

(4) State hospital--A hospital as defined under Texas Health and Safety Code (HSC) §552.0011 operated by the Texas Health and Human Services Commission (HHSC) primarily to provide inpatient care and treatment for individuals with mental illness.

(5) State supported living center (SSLC)--An SSLC as defined by Texas HSC §531.002 and the intermediate care facility for individuals with intellectual disabilities component of the Rio Grande State Center operated by HHSC.

§926.3.Training for New Employees.

Before an employee performs employment duties without direct supervision, the employee must receive competency-based training and instruction on general duties.

(1) The focus of training must be on:

(A) the uniqueness of the individuals with whom the employee works;

(B) techniques for improving quality of life for and promoting the health and safety of individuals; and

(2) The training must include instruction and information on:

(A) the general operation and layout of the facility at which the person is employed;

(B) armed intruder lockdown procedures;

(D) the safe and proper use of restraints;

(E) recognizing and reporting:

(i) abuse, neglect, and exploitation of individuals;

(ii) unusual or reportable incidents;

(iii) reasonable suspicion of illegal drug use in the workplace;

(iv) workplace violence; and

(v) sexual harassment in the workplace;

(F) preventing and treating infection;

(G) responding to emergencies, including information about first aid and cardiopulmonary resuscitation procedures;

(H) the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191);

(I) the rights of employees;

(J) additional topics for state hospital employees, which include:

(i) an introduction to mental illness;

(ii) an introduction to substance use;

(iii) an introduction to dual diagnosis; and

(iv) the rights of individuals with mental illness;

(K) additional topics for state supported living center employees, which include:

(i) an introduction to intellectual disabilities;

(ii) an introduction to autism; and

(iii) an introduction to mental illness and dual diagnosis; and

(L) the rights of individuals with an intellectual or developmental disability, including the right to live in the least restrictive setting appropriate to the individual's needs and abilities.

§926.4.Additional Training for Employees who Provide Direct Care to Individuals.

(a) Before an employee who provides direct delivery of services begins to perform direct care duties without direct supervision, the facility must provide the employee relevant training essential to perform the employee's duties regarding implementation of the interdisciplinary treatment program for each individual for whom the employee will provide direct care, including the following topics:

(1) prevention and management of aggressive or violent behavior;

(2) observing and reporting changes in behavior, appearance, or health of an individual;

(3) positive behavior support;

(4) emergency response;

(5) person-directed plans;

(6) self-determination; and

(7) trauma-informed care.

(b) Facilities must provide training on the following topics relevant to the individuals the direct care employee will serve:

(1) techniques for lifting, positioning, moving and increasing mobility;

(2) specialized needs of geriatric individuals;

(3) assisting individuals with visual, hearing, or communication impairments or who require adaptive devices and specialized equipment;

(4) recognizing appropriate food textures;

(5) using proper feeding techniques to assist individuals with meals;

(6) specific to state supported living center direct care employees:

(A) seizure safety;

(B) working with aging individuals;

(D) physical and nutritional management plans;

(E) home and community-based services, including the principles of community inclusion and participation and the community living options information process; and

(F) procedures for securing evidence following an incident of suspected abuse, neglect, or exploitation; and

(7) specific to state hospital direct care employees:

(A) seizure safety;

(B) assisting patients with personal hygiene; and

§926.5.State Hospital Refresher Training.

State hospitals must provide all employees annual training relevant to their position on the topics outlined in §926.3 of this chapter (relating to Training for New Employees) and §926.4 of this chapter (relating to Additional Training for Employees who Provide Direct Care to Individuals), as the topics pertain to state hospital employees. State hospitals must provide this training throughout an employee's employment or association with the state hospital, unless the agency determines in good faith and with good reason a particular employee's performance will not be adversely affected in the absence of such refresher training.

§926.6.State Supported Living Center (SSLC) Refresher Training.

(a) An SSLC must provide employees annual training on:

(1) abuse, neglect, and exploitation; and

(2) unusual incidents.

(b) An SSLC must provide training to employees who are not direct care employees on the rights of individuals every two years.

(c) An SSLC must provide all direct care employees annual training relevant to their position on the topics outlined in §926.3 of this chapter (relating to Training for New Employees) and §926.4 of this chapter (relating to Additional Training for Employees who Provide Direct Care to Individuals), unless otherwise addressed in this section, as the topics pertain to SSLC employees.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 20, 2023.

TRD-202304328

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: January 7, 2024

For further information, please call: (512) 438-3049