PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 352. MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAM PROVIDER ENROLLMENT
The Texas Health and Human Services Commission (HHSC) adopts amendments to §352.1, concerning Purpose; and §352.3, concerning Definitions.
The amendments to §352.1 and §352.3 are adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9100). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 2024. During this period, HHSC did not receive any comments regarding the proposed rules.
STATUTORY AUTHORITY
The amendments 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 Chapters 521 and 532.
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 January 30, 2025.
TRD-202500310
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
The Texas Health and Human Services Commission (HHSC) adopts amendments to §353.8, concerning Certification of Managed Care Organizations Prior to Contract Awards; §353.101, concerning Purpose; §353.201, concerning Purpose; §353.407, concerning Requirements of Managed Care Plans; §353.425, MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation; §353.427, Accessibility of Information Regarding Medicaid Prior Authorization Requirements; §353.501, concerning Purpose; §353.901, concerning Purpose; §353.905, concerning Managed Care Organization Requirements; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; §353.1155, concerning Medically Dependent Children Program; and §353.1451, concerning Purpose and Authority.
The amendments to §§353.8, 353.101, 353.201, 353.407, 353.425, 353.427, 353.501, 353.901, 353.905, 353.1153, 353.1155, and 353.1451 are adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9102). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 2024. During this period, HHSC did not receive any comments regarding the proposed rules.
SUBCHAPTER A. GENERAL PROVISIONS
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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500311
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500312
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500313
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
1 TAC §§353.407, 353.425, 353.427
STATUTORY AUTHORITY
The amendments 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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500314
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500315
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
STATUTORY AUTHORITY
The amendments 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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500316
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
STATUTORY AUTHORITY
The amendments 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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500317
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 523, 526, 540, and 544.
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 January 30, 2025.
TRD-202500318
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
The Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1189, concerning Acute Care Medicaid Billing Coordination System; §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; §354.1924, concerning Preferred Drug List; §354.1941, concerning Drug Utilization Review Board; §354.2501, concerning Definitions; §354.2603, concerning Definitions; §354.3001, concerning Purpose and Applicability; §354.4001, concerning Purpose and Authority; §354.4003, concerning Definitions; and §354.5011, concerning Providers of Applied Behavior Analysis (ABA) Services.
The amendments to §§354.1189, 354.1435, 354.1941, 354.2501, 354.2603, 354.3001, 354.4001, 354.4003, and 354.5011 are adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9115). These rules will not be republished.
The amendment to §354.1924 is adopted with changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9115). The rule will be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 2024. During this period, HHSC did not receive any comments regarding the proposed rules.
HHSC made a minor change to §354.1924(g) to update the statutory reference to include all applicable sections in Texas Government Code Chapter 549, Subchapter C, pertaining to the supplemental rebate agreement.
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 11. GENERAL ADMINISTRATION
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500319
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500320
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
DIVISION 7. TEXAS DRUG CODE INDEX--ADDITIONS, RETENTIONS, AND DELETIONS
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
§354.1924.Preferred Drug List.
(a) Purpose. This section implements the provisions of Texas Government Code §549.0202, which directs the Health and Human Services Commission (HHSC) to develop and implement a preferred drug list (PDL) for the Texas Medical Assistance Program.
(b) Applicability. This section applies to drugs included in the Texas Drug Code Index (TDCI) established under §354.1921 of this title (relating to Addition of Drugs to the Texas Drug Code Index).
(c) Selection of drugs for the PDL. HHSC will include a drug listed on the TDCI in the PDL on the basis of:
(1) The recommendations of the Drug Utilization Review Board (DUR Board) established under §354.1941 of this subchapter (relating to Drug Utilization Review Board);
(2) The clinical efficacy of the drug, consistent with the determination of the Food and Drug Administration and the recommendations of the DUR Board;
(3) Comparison of the price of the drug and the price of competing drugs. For purposes of this section, the price of a drug is determined by reference to the reimbursement for the drug established under §355.8541 of this title (relating to Legend and Nonlegend Medications) and after deducting Texas and federal rebates;
(4) A program benefit offered by the manufacturer or labeler of the drug and accepted by HHSC in accordance with Texas Government Code §549.0106; and
(5) Written evidence offered by a manufacturer or labeler supporting the inclusion of a product on the PDL.
(d) Distribution of PDL. HHSC will publish the PDL on its Internet website (http://www.hhsc.state.tx.us/). A health care provider may also request a copy of the PDL from HHSC by sending a written request to the HHSC or its designee.
(e) Revisions to the PDL. Within 10 days following HHSC's decision on the recommendations of the DUR Board, HHSC will publish the revised PDL.
(f) Exclusion of a drug from the PDL. A drug that is not included in the PDL will be subject to prior authorization by HHSC or its designee in accordance with §354.1832 of this title (relating to Prior Authorization Procedures).
(g) Agreement on supplemental rebate necessary. HHSC will only include on the PDL drugs provided by a manufacturer or labeler that reaches an agreement on a supplemental rebate with HHSC in accordance with Texas Government Code Chapter 549, Subchapter C. Such agreement may provide for a program benefit offered by the manufacturer or labeler of the drug and accepted by HHSC in accordance with Texas Government Code §549.0106.
(h) Notwithstanding subsection (g) of this section, the preferred drug list may contain a drug provided by a manufacturer or labeler that has not reached a supplemental rebate agreement with HHSC if HHSC determines that inclusion of the drug on the preferred drug list will have no negative cost impact to the state, in accordance with Texas Government Code §549.0204.
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 January 30, 2025.
TRD-202500321
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500322
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500323
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
DIVISION 1. GENERAL PROVISIONS
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500324
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
DIVISION 1. GENERAL PROVISIONS
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500325
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
STATUTORY AUTHORITY
The amendments 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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500326
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
DIVISION 2. SERVICE PROVIDERS
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 Chapters 521, 524, 532, 543A, 547, 548, and 549.
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 January 30, 2025.
TRD-202500327
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.201, concerning Establishment and Adjustment of Reimbursement Rates for Medicaid; §355.311, concerning Medicaid Reimbursement Rates for State Veterans Homes; §355.7001, concerning Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services; §355.8200, concerning Retained Funds for the Uncompensated Care Program; and §355.8261, concerning Federally Qualified Health Center Services Reimbursement.
The amendments to §§355.201, 355.311, 355.7001, 355.8200, and 355.8261 are adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9125). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 2024. During this period, HHSC did not receive any comments regarding the proposed rules.
SUBCHAPTER B. ESTABLISHMENT AND ADJUSTMENT OF REIMBURSEMENT RATES FOR MEDICAID
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 Chapters 532, 540, and 548.
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 January 30, 2025.
TRD-202500328
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 532, 540, and 548.
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 January 30, 2025.
TRD-202500329
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 532, 540, and 548.
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 January 30, 2025.
TRD-202500330
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
DIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT
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 Chapters 532, 540, and 548.
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 January 30, 2025.
TRD-202500331
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
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 Chapters 532, 540, and 548.
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 January 30, 2025.
TRD-202500332
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
SUBCHAPTER L. FRAUD INVOLVING RECIPIENTS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §357.562, concerning Determination and Disposition of Intentional Program Violations.
The amendment to §357.562 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9137). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 544.
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 January 30, 2025.
TRD-202500333
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §360.101, concerning Overview and Purpose.
The amendment to §360.101 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9139). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 532.
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 January 30, 2025.
TRD-202500334
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §361.101, concerning Overview and Purpose.
The amendment to §361.101 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9140). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 532.
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 January 30, 2025.
TRD-202500335
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
SUBCHAPTER B. PRESCRIBED PEDIATRIC EXTENDED CARE CENTER SERVICES
1 TAC §§363.203, 363.205, 363.207, 363.209, 363.211 - 363.213, 363.215
The Texas Health and Human Services Commission (HHSC) adopts amendments to §363.203, concerning Definitions; §363.205, concerning Provider Participation Requirements; §363.207, concerning Participant Eligibility Criteria; §363.209, concerning Benefits and Limitations; §363.211, concerning Service Authorization; §363.213, concerning Ordering Physician Responsibilities; and §363.215, concerning Termination, Reduction, or Denial of Authorization for Prescribed Pediatric Extended Care Center Services; and new §363.212, concerning Documentation Requirements for Services Other than Transportation Services.
The amendment to §363.203 is adopted with changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8511). This rule will be republished.
The amendments to §§363.205, 363.207, 363.209, 363.211, 363.213 and 363.215, and new §363.212 are adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8511). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments and new section are necessary to comply with Texas Health and Safety Code, §248A.1015, §248A.158, and §248A.159, and Texas Human Resources Code, §32.0287, added or amended by House Bill (H.B.) 3550, 88th Legislature, Regular Session, 2023. H.B. 3550 requires rules establishing minimum standards for transportation services for individuals served by Prescribed Pediatric Extended Care Centers (PPECCs). H.B. 3550 also requires rules for the reimbursement of services provided by PPECCs, under Medicaid, to clearly identify the documentation that PPECCs must obtain and maintain for reimbursement.
The adopted rules establish minimum standards for transportation services when transporting participants to a PPECC by requiring a center to coordinate the schedule of transportation services with the participant's responsible adult, as defined in the rules; determine what type of provider needs to be present during transportation; and allow the participant's responsible adult to decline a center's transportation services entirely or on a specific date.
The adopted rules remove the requirement that the plan of care and the physician's order document a participant's need for transportation services as nursing services in a participant's plan of care.
The adopted rules update guidelines allowing participants who are eligible to receive authorized continuous skilled nursing service hours for private duty nursing services, PPECC services, or a combination of both services with certain limitations. The adopted rules clarify that PPECC services must be a replacement of other skilled nursing services provided in a setting other than a PPECC unless additional nursing services are medically necessary.
The adopted rules establish and outline documentation requirements for admission to a PPECC and for non-transportation PPECC services for reimbursement eligibility. The adopted rules require a PPECC to include the documentation of PPECC services provided to a participant in the participant's medical record.
COMMENTS
The 31-day comment period ended November 25, 2024.
During this period, HHSC did not receive any comments regarding the proposed rules.
HHSC revised §363.203(6) to make the definition of "HHSC" more consistent with the definition used in other HHSC rules.
STATUTORY AUTHORITY
The amendments and new section 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; Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; Texas Human Resources Code §32.021, which provides HHSC with the authority to administer the federal medical assistance program in Texas and to adopt rules and standards for program administration; and Texas Health & Safety Code §248A.1015, which provides that the Executive Commissioner shall by rule establish minimum standards for transportation services, including reimbursement, by Prescribed Pediatric Extended Care Centers (PPECCs).
§363.203.Definitions.
The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.
(1) Activities of daily living (ADLs)--Activities that include eating, toileting, personal hygiene, dressing, bathing, transferring, positioning, and locomotion or mobility.
(2) Basic services--Basic services include:
(A) the development, implementation, and monitoring of a comprehensive protocol of care that:
(i) is provided to a medically dependent or technologically dependent participant;
(ii) is developed in conjunction with the participant's responsible adult; and
(iii) specifies the medical, nursing, psychosocial, therapeutic, and developmental services required by the participant; and
(B) the caregiver training needs of a medically dependent or technologically dependent participant's parent or responsible adult.
(3) Correct or ameliorate--To improve, maintain, or slow the deterioration of the participant's health status.
(4) Direct care staff--An employee or contractor of a PPECC who:
(A) works under the supervision of a registered nurse;
(B) provides direct care to a participant; and
(C) meets the qualifications described in 26 TAC §550.409(a) (relating to Direct Care Staff Qualifications).
(5) Fair hearing--The process HHSC has adopted and implemented in Chapter 357, Subchapter A, of this title (relating to Uniform Fair Hearing Rules) in compliance with federal and state regulations governing Medicaid Fair Hearings.
(6) HHSC--The Texas Health and Human Services Commission or its designee.
(7) Licensed vocational nurse (LVN)--An employee or contractor of a PPECC who is licensed by the Texas Board of Nursing to practice vocational nursing in accordance with Texas Occupations Code Chapter 301.
(8) Medicaid managed care organization (MCO)--Any entity with which HHSC contracts to provide Medicaid services and that complies with Chapter 353 of this title (relating to Medicaid Managed Care).
(9) Medically or technologically dependent participant--
(A) An individual 20 years of age or younger:
(i) who has an acute or chronic medically complex or fragile condition or disability; and
(ii) whose condition or disability, as stated in clause (i) of this subparagraph, requires:
(I) ongoing skilled nursing care beyond the level of skilled nursing visits normally authorized under Texas Medicaid home health skilled nursing and home health aide services, prescribed by a physician to avert death or further disability; or
(II) the routine use of a medical device to compensate for a deficit in a life-sustaining bodily function.
(B) The term does not include a participant with a controlled or occasional medical condition that does not require ongoing nursing care.
(10) Notice (or notification)--A letter provided by HHSC or an MCO to a participant informing the participant of any reduction, denial, or termination of a requested service, as described in the Code of Federal Regulations, Title 42, §§431.206 and 431.210.
(11) Ordering physician--A doctor of medicine or doctor of osteopathy (M.D. or D.O.), legally authorized to practice medicine or osteopathy who provides ongoing medical care for the participant and continuing medical supervision of the participant's plan of care.
(12) Participant--An individual who is eligible to receive PPECC services under the Texas Health Steps Comprehensive Care Program from a provider enrolled in the Texas Medicaid program.
(13) Plan of care (POC)--A written comprehensive, interdisciplinary protocol of care that includes the physician's order for needed services, nursing care plan, and protocols establishing delegated tasks, plans to address functional developmental needs, plans to address psychosocial needs, personal care services for assistance with activities of daily living, and therapeutic service needs required by a participant and family served.
(14) PPECC--Prescribed Pediatric Extended Care Center. A center operated on a for-profit or nonprofit basis that provides non-residential basic services to four or more medically dependent or technologically dependent participants who require the services of the center and who are not related by blood, marriage, or adoption to the owner or operator of the center.
(15) Private Duty Nursing (PDN)--Nursing, as described by Texas Occupations Code Chapter 301, and its implementing regulations in 22 TAC Part 11 (relating to the Texas Board of Nursing), that provides a participant with more individual and ongoing care than is available from a visiting nurse or than is routinely provided by the nursing staff of a hospital or skilled nursing facility. PDN services include observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings for a participant who has a disability or chronic health condition or who is experiencing a change in normal health processes.
(16) Registered nurse (RN)--An employee or contractor of a PPECC who is licensed by the Texas Board of Nursing to practice professional nursing in accordance with Texas Occupations Code Chapter 301.
(17) Respite--Services provided to relieve a participant's primary care giver.
(18) Responsible adult--An adult, as defined by Texas Family Code §101.003, who has agreed to accept the responsibility for providing food, shelter, clothing, education, nurturing, and supervision for a participant. Responsible adults include biological parents, adoptive parents, foster parents, guardians, court-appointed managing conservators, and other family members by birth or marriage. If the participant is 18 years of age or older, the responsible adult must be the participant's managing conservator or legal guardian.
(19) Skilled nursing--Services provided by a registered nurse or by a licensed vocational nurse, as authorized by Texas Occupations Code Chapter 301 and 22 TAC §217.11 (relating to Standards of Nursing Practice) and §217.12 (relating to Unprofessional Conduct).
(20) Stable--A status determined by a participant's ordering physician that the participant's health condition does not prohibit utilizing transportation to access outpatient medical services and does not present significant risk to other participants or personnel at the center.
(21) Texas Health Steps Comprehensive Care Program (THSteps-CCP)--A federal program, required by Medicaid and known as Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), for children under 21 years of age who meet certain criteria for eligibility. Services are defined in the United States Code, Title 42, §1396d(r), and the Code of Federal Regulations, Title 42, §440.40(b).
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 January 30, 2025.
TRD-202500349
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 19, 2025
Proposal publication date: October 25, 2024
For further information, please call: (512) 438-2910
SUBCHAPTER F. SPECIAL INVESTIGATIVE UNITS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §370.501, concerning Purpose.
The amendment to §370.501 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9141). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 544.
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 January 30, 2025.
TRD-202500336
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
SUBCHAPTER A. PROGRAM OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §380.101, concerning Definitions.
The amendment to §380.101 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9142). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 526.
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 January 30, 2025.
TRD-202500337
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
SUBCHAPTER B. PROCUREMENT AND SPECIAL CONTRACTING METHODS
DIVISION 2. SPECIAL CONTRACTING METHODS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §391.247, concerning Direct Contract Award.
The amendment to §391.247 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9145). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 544.
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 January 30, 2025.
TRD-202500338
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
SUBCHAPTER A. GENERAL PROVISIONS
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §395.2, concerning Definitions.
The §395.2 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9146). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. This adopted amendment updates citations in the rule to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 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 Chapter 521.
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 January 30, 2025.
TRD-202500339
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021