PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 350. EARLY CHILDHOOD INTERVENTION SERVICES
The Texas Health and Human Services Commission (HHSC) adopts amendments to the Texas Administrative Code (TAC), Title 26, Chapter 350, Subchapter A, concerning General Rules, §350.103 and §350.107; Subchapter B, concerning Procedural Safeguards and Due Process Procedures, §350.209 and §350.225; Subchapter C, concerning Staff Qualifications, §§350.303, 350.309, 350.312, 350.313, and 350.315; Subchapter D, concerning Case Management for Infants and Toddlers with Developmental Disabilities, §§350.403, 350.404, 350.405, 350.406, 350.407, 350.411, and 350.415; Subchapter E, concerning Specialized Rehabilitative Services, §350.501 and §350.507; Subchapter F, concerning Public Outreach, §§350.605, 350.607, 350.609, 350.611, 350.613, 350.615, and 350.617; Subchapter G, concerning Referral, Pre-Enrollment, and Developmental Screening, §§350.704, 350.706, 350.707, 350.708, and 350.709; Subchapter H, concerning Eligibility, Evaluation, and Assessment, §§350.805, 350.807, 350.809, 350.811, 350.813, 350.815, 350.817, 350.821, 350.823, 350.825, 350.829, 350.833, 350.835, and 350.837; Subchapter J, concerning Individualized Family Service Plan, §§350.1003, 350.1004, 350.1007, 350.1009, 350.1015, 350.1017, and 350.1019; Subchapter K, concerning Service Delivery, §§350.1104, 350.1108, and 350.1111; Subchapter L, concerning Transition, §§350.1203, 350.1207, 350.1209, 350.1211, 350.1213, 350.1215, 350.1217, 350.1219, and 350.1221; Subchapter M, concerning Child and Family Outcomes, §350.1307 and §350.1309; and Subchapter N, concerning Family Cost Share System, §§350.1405, 350.1411, 350.1413, 350.1431, and 350.1433.
HHSC also adopts the repeal of 26 TAC Subchapter A, concerning General Rules, §350.101; Subchapter B, concerning Procedural Safeguards and Due Process Procedures; §350.201; Subchapter C, concerning Staff Qualifications; §350.301; Subchapter F, concerning Public Outreach, §350.601; Subchapter G, concerning Referral, Pre-Enrollment, and Developmental Screening, §350.701; Subchapter H, concerning Eligibility, Evaluation, and Assessment, §350.801; Subchapter J, concerning Individualized Family Service Plan; §350.1001, Subchapter K, concerning Service Delivery, §350.1101; Subchapter L, concerning Transition, §350.1201, Subchapter M, concerning Child and Family Outcomes, §350.1301; and Subchapter N, concerning Family Cost Share System, §350.1401.
The amendments to Subchapter A, concerning General Rules, §350.103; Subchapter H, concerning Eligibility, Evaluation, and Assessment, §350.813, §350.815 and §350.833; Subchapter J, concerning Individualized Family Service Plan, §350.1009; and Subchapter N, concerning Family Cost Share, §350.1413, are adopted with changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7237). These rules will be republished.
The amendments to Subchapter A, concerning General Rules, §350.107; Subchapter B, concerning Procedural Safeguards and Due Process Procedures, §350.209 and §350.225; Subchapter C, concerning Staff Qualifications, §§350.303, 350.309, 350.312, 350.313, and 350.315; Subchapter D, concerning Case Management for Infants and Toddlers with Developmental Disabilities, §§350.403, 350.404, 350.405, 350.406, 350.407, 350.411, §350.415; Subchapter E, concerning Specialized Rehabilitative Services, §350.501, and 350.507; Subchapter F, concerning Public Outreach, §§350.605, 350.607, 350.609, 350.611, 350.613, 350.615, and 350.617; Subchapter G, concerning Referral, Pre-Enrollment, and Developmental Screening, §§350.704, 350.706, 350.707, 350.708, and 350.709; Subchapter H, concerning Eligibility, Evaluation, and Assessment, §§350.805, 350.807, 350.809, 350.811, 350.817, 350.821, 350.823, 350.825, 350.829, 350.835, and 350.837; Subchapter J, concerning Individualized Family Service Plan, §§350.1003, 350.1004, 350.1007, 350.1015, 350.1017, and 350.1019; Subchapter K, concerning Service Delivery, §§350.1104, 350.1108, and 350.1111; Subchapter L, concerning Transition, §§350.1203, 350.1207, 350.1209, 350.1211, 350.1213, 350.1215, 350.1217, 350.1219, and 350.1221; Subchapter M, concerning Child and Family Outcomes, §350.1307 and §350.1309; and Subchapter N, concerning Family Cost Share System, §§350.1405, 350.1411, 350.1431, and 350.1433; and the repeal of 26 TAC Subchapter A, concerning General Rules, §350.101; Subchapter B, concerning Procedural Safeguards and Due Process Procedures; §350.201; Subchapter C, concerning Staff Qualifications; §350.301; Subchapter F, concerning Public Outreach, §350.601; Subchapter G, concerning Referral, Pre-Enrollment, and Developmental Screening, §350.701; Subchapter H, concerning Eligibility, Evaluation, and Assessment, §350.801; Subchapter J, concerning Individualized Family Service Plan; §350.1001, Subchapter K, concerning Service Delivery, §350.1101; Subchapter L, concerning Transition, §350.1201, Subchapter M, concerning Child and Family Outcomes, §350.1301; and Subchapter N, concerning Family Cost Share System, §350.1401 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7237). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The adoption amends rules as they relate to Early Childhood Intervention (ECI) to align policy with legislation, increase administrative efficiencies, and improve processes for ECI subrecipients. The amendments also include non-substantive changes to improve readability, consistency, and understanding, and to align language with HHSC rulemaking standards.
As required by Texas Government Code Section 2001.039, ECI completed a four-year rule review to determine whether the rule was necessary or if the purpose of creating the rule no longer applied. All repealed rules are the result of the four-year review. The amendment to §350.107 aligns ECI policy with legislation enacted by House Bill 44, 88th Texas Legislature, Regular Session, 2023.
In July 2024, the Texas Education Agency (TEA) amended rules in 19 TAC §89.1040 related to eligibility for children who are deaf, hard of hearing, or have a visual impairment. Because HHSC ECI had already opened rules in 26 TAC Chapter 350, before the TEA rules were enacted, these amendments were not reflected in the proposal rule packet. Due to references in ECI rule to the TEA eligibility requirements, it is necessary to make these amendments now to remove language from the ECI rules that contradicts the amended TEA rules. To align ECI and TEA eligibility requirements, necessary amendments have been made to §350.813 and §350.815 that were not directly in response to formal public comments. The necessary amendments were made through ongoing collaboration with ECI subrecipients, stakeholders, and representatives of TEA.
Remaining amendments are to address input from ECI subrecipients, stakeholders, and HHSC ECI staff to improve clarity, reduce barriers, and make necessary corrections. The amended and repealed rules address several areas including minimum staff qualifications, programmatic requirements, and additional needs identified through ongoing collaboration with ECI subrecipients and stakeholders.
There is no fiscal impact to state government from implementation of the proposed rules. All changes are to provide clarity and align rules with contract and federal requirements, or to allow administrative efficiencies for ECI subrecipients.
COMMENTS
The 31-day comment period ended October 14, 2024.
During this period, HHSC received comments regarding the proposed rules from 10 commenters comprising of two individuals and eight organizations. The organizations are: TexProtects, the Immunization Partnership, the Texas Public Health Coalition, Texas Parent to Parent, the Texas Medical Association, the Department of State Health Services (DSHS) Newborn Screening Unit, Paso Del Norte ECI, and Region 19 Education Service Center ECI. A summary of comments relating to the rules and HHSC's responses follow.
Comment: One commenter requested that proposed rules be amended to include "telemedicine" in addition to telehealth. The commenter asks that telemedicine be defined and used throughout chapter 350, with specific references in §§350.103, 350.403, 350.405, and 350.1104.
Response: HHSC disagrees and declines to revise the rule in response to this comment. "Telemedicine" refers specifically to remote physician services, which are not provided by ECI professionals.
Comment: One commenter requested amendments to the definition of "days" in §350.103 to remove a reference to "school days."
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested amendments to the definition of "interdisciplinary team" in §350.103 to further define the Local Education Agency (LEA) representatives that may be on an interdisciplinary team.
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested the definition of licensed practitioner of the healing arts (LPHA) be amended to remove "licensed audiologist" from the list of professionals who can serve as an LPHA to reduce confusion for audiologists employed by the LEA.
Response: HHSC disagrees and declines to revise the rule in response to this comment. While licensed audiologists who work for the LEA are unable to fill the role of LPHAs on ECI interdisciplinary teams, licensed audiologists who are not employed by the LEA can serve as an LPHA.
Comment: Four commenters stated the opinion that the proposed amendments to §350.107(c) go beyond the scope of the intent of House Bill 44, 88th Texas Legislature, Regular Session, 2023, which specifically applies to Medicaid and CHIP providers who provide services to Medicaid and Children's Health Insurance Program (CHIP) enrolled families. Commenters stated that proposed amendments should not apply to families with private insurance or other third-party payments that are not Medicaid or CHIP.
Response: HHSC disagrees and declines to revise the rule in response to this comment. As required by the Code of Federal Regulations, Title 34, Subtitle B, Chapter III, Part 303, §303.212(a), which requires applications to participate in IDEA Part C must include steps the State is taking to ensure equitable access to, and equitable participation in, the part C statewide system, HHSC ECI cannot implement policies that apply to only certain children based on their insurance type or status.
Comment: Four commenters requested that HHSC reinstate the requirement for ECI subrecipients to inform families of the importance of immunizations in §350.103(c). These comments request that ECI subrecipients continue to help families obtain immunizations if necessary.
Response: HHSC disagrees and declines to revise the rule in response to this comment. There is nothing in ECI rule that prevents ECI subrecipients from informing families about the importance of immunizations or assisting them in accessing vaccinations.
Comment: Three commenters requested HHSC revise §350.107(a)(2)(C) to reinstate immunization requirements as specified by the Department of State Health Services (DSHS).
Response: HHSC disagrees and declines to revise the rule in response to this comment. House Bill 44, 88th Texas Legislature, Regular Session, 2023, stipulates that Medicaid and CHIP providers may not deny services based on immunization status. ECI providers must be able to bill Medicaid and CHIP for their services.
Comment: Three commenters raised concerns about subrecipient policies allowing families to request an exemption for immunizations orally in §350.107(d) and requests the requirement to accept oral requests apply only to Medicaid or CHIP enrolled families. One of these commenters requests HHSC ECI require a documented request and a standardized form to request exemptions, and a robust policy for reviewing and documenting requests.
Response: HHSC disagrees and declines to revise the rule in response to these comments. ECI subrecipients will be responsible for implementing policies and procedures related to requests for exemptions. As required by the Code of Federal Regulations, Title 34, Subtitle B, Chapter III, Part 303, §303.212(a), HHSC cannot implement policies that apply to only certain children based on their insurance type or status.
Comment: One commenter requested a permissive rule to allow ECI subrecipients to post a notice in their offices stating compliance with state law created by House Bill 44, 88th Texas Legislature, Regular Session, 2023. This commenter also requested strengthening the complaint process to provide protections for ECI subrecipients.
Response: HHSC disagrees and declines to revise the rule in response to this comment. There are no rules preventing ECI subrecipients from posting a notice in their main offices. Most ECI services are provided in home or community settings, and clients and their families rarely go to ECI offices. Additionally, 34 Code of Federal Regulations (CFR) §§ 303.432-434 and 26 TAC §350.215 establish requirements for all Part C complaint procedures.
Comment: One commenter requested HHSC clarify and define "timely manner" in §350.704(a)(3), related to contacting families after receiving a referral.
Response: HHSC disagrees and declines to revise the rule in response to this comment. To ensure flexibility, ECI subrecipients define "timely manner" for their agency, within parameters set by HHSC ECI.
Comment: One commenter requested that HHSC add language in §350.813 that would allow subrecipients to engage parents of children with suspected hearing loss and the LEA to ensure the child is seen by a licensed audiologist and receives a formal diagnosis. The comment further recommends including language that alerts the Child Find system to connect the child with an audiologist if they have not had a hearing test by three months of age.
Response: HHSC disagrees and declines to revise the rule in response to this comment. Section 350.813 already requires ECI subrecipients to identify children who need additional hearing assessments and work with parents to get an audiological test for those children.
Comment: One commenter requested clarification for the intent of proposed amendments to §350.813(a).
Response: HHSC amended §350.813(a) to clarify the requirement for ECI subrecipients to ensure children who do not meet eligibility criteria through a medical diagnosis, visual impairment, or developmental delay, but are suspected to be deaf or hard of hearing, receive the necessary evaluations and assessments before they are determined to be ineligible.
Commenter: One commenter requested HHSC revise §350.813(a) to remove "or confirmed to be deaf or hard of hearing" for requirements to refer children with suspected or confirmed hearing loss.
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested revisions to §350.813(a) to remove the reference to "examinations."
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested revisions to §350.813(a) to define the appropriate LEA staff who participate in the interdisciplinary team that determines eligibility.
Response: HHSC disagrees and did not revise the rule in response to this comment. HHSC revises §350.813(a) to remove the reference to the appropriate LEA staff to align with 19 TAC §89.1040. Because the LEA is no longer involved in eligibility determination for ECI services, the reference has been removed.
Comment: Two commenters requested amendments to proposed §350.813(b) and (c) to provide clarification regarding the evaluation results subrecipients must review during eligibility determination to determine a need for further hearing tests.
Response: HHSC agrees and revises the rule to clarify and define evaluation results.
Comment: Two commenters expressed concern that proposed §350.813(b) and (c) allow ECI subrecipients to use screening tools outside of audiological exams for eligibility determination for children who are deaf or hard of hearing.
Response: HHSC agrees proposed amendments to §350.813(b) and (c) create confusion about the intent of these subsections and would like to provide clarification. Subsections (b) and (c) refer to determining the need for further hearing assessment during evaluations of all children, not just those referred due to concerns about hearing. The purpose of this rule is to ensure children who meet eligibility criteria of qualifying diagnosis, determination of developmental delay, or visual impairment, whose evaluations show a need for further hearing assessment, are referred to an audiologist. HHSC has amended §350.813(b) and (c) to clarify this intent.
Comment: Two commenters requested amendments to the requirement for subrecipients to refer a child to an audiologist if a need for further hearing testing is identified, and the child has not had a hearing test within the last six months. The commenter requested the six-month timeframe be reduced to three months.
Response: HHSC disagrees and declines to make the requested change. Section 350.813(d) relates to additional testing after a child has already passed one hearing test. Reducing the time frame would create undue burden on ECI subrecipients and enrolled families.
Comment: One commenter requested an amendment to proposed §350.813(d) to change hearing "assessment" to "evaluation" for consistency.
Response: HHSC agrees with a portion of this comment and has made amendments throughout §350.813 in response to the request. Rather than using the term "evaluation," HHSC has amended the language to indicate hearing "test" to clarify the difference between hearing tests and evaluations. For ECI, tests conducted by a doctor are referred to as "hearing tests," whereas evaluations performed by teachers of the deaf and hard of hearing are referred to as "evaluations."
Comment: One commenter requested the removal of §350.813(e)(1)(A) and (B), because these exams are no longer required per 19 TAC §89.1040.
Response: HHSC agrees and amends the rule as suggested.
Comment: One commenter requested revisions to §350.813(e) to change the requirement from "participate in eligibility determination" to "establish eligibility" for children who have been identified as being deaf or hard of hearing.
Response: HHSC disagrees and declines to amend the rule as requested. The LEA is not involved in establishing eligibility for ECI services. However, amendments have been made to this subsection. HHSC is amending proposed §350.813(e) to align ECI rules with recent amendments to TEA eligibility requirements in 19 TAC §89.1040, which is referenced in ECI eligibility requirements in 26 TAC §350.809(2). Proposed amendments to 26 TAC §350.813 were posted for public comment before amendments to 19 TAC §89.1040 were adopted, and therefore the rules were not aligned. The amendment to 26 TAC §350.813(e) brings this subsection into alignment with current 19 TAC §89.1040.
Comment: One commenter requests a revision to §350.813(e)(2) to require a copy of the audiological evaluation report with the referral to the LEA.
Response: HHSC agrees with a portion of this comment and revises the rule to require a copy of a hearing test with the referral to the LEA if the subrecipient receives hearing test results. Results of a hearing test are not required for the referral of children who are eligible for ECI services with documentation indicating the child has a medical condition that has a high probability of resulting in a developmental delay and sensory impairment.
Comment: One commenter requested a revision to a citation to the United States Code (USC) in §350.813 and §350.815, which currently cite 20 USC §1232g(b).
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested the title of §350.815 be changed to "Visual Impairment."
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested revised language to proposed new §350.815(a) to define the LEA staff referenced.
Response: HHSC disagrees and did not revise the rule in response to this comment. HHSC revises §350.815(a) to remove the reference to the appropriate LEA staff to align with 19 TAC §89.1040. Because the LEA is no longer involved in eligibility determination for ECI services, this reference has been removed.
Comment: Two commenters requested amendments to proposed §350.815(b) and (c) to provide clarification regarding the evaluation results subrecipients must review during eligibility determination to determine a need for further vision tests.
Response: HHSC agrees and revises the rule to clarify and define evaluation results.
Comment: Two commenters expressed concern that §350.815(b) and (c) allow ECI subrecipients to use screening tools outside of vision tests for eligibility determination for children who are visually impaired.
Response: HHSC agrees proposed amendments to §350.815(b) and (c) create confusion about the intent of these subsections and would like to provide clarification. Subsections (b) and (c) refer to determining the need for further vision assessment during all evaluations, not specifically for children who are referred due to vision concerns. The purpose of this rule is to ensure children who meet eligibility criteria of qualifying diagnosis, developmental delay, or being deaf or hard of hearing, and whose evaluations show a need for further vision assessment, are referred for vision testing. HHSC has amended §350.815(b) and (c) to clarify this intent.
Comment: One commenter requested an amendment to §350.815 to adjust the requirement for subrecipients to refer a child to an ophthalmologist or optometrist if a need for further vision testing is identified, and the child has not had a vision test within the last nine months. The commenter requested the nine-month timeframe be shortened to three months.
Response: HHSC disagrees and declines to make the requested change. Section 350.815(d) relates to additional testing after a child has already passed one vision test. Reducing the time frame would create undue burden on ECI subrecipients and enrolled families. To align §350.815 with §350.813, HHSC has made an amendment to reduce the nine-month timeframe to six months.
Comment: One commenter requested amendments to §350.815 to change terminology related to vision "assessment" to vision "evaluation" to enhance consistency.
Response: HHSC agrees with a portion of this comment and has made amendments throughout §350.815 in response to the request. Rather than using the term "evaluation," HHSC has amended the language to indicate vision "test" to clarify the difference between vision tests and evaluations. Tests conducted by a doctor are referred to as "vision tests," whereas evaluations performed by teachers of students with visual impairments are referred to as "evaluations."
Comment: Two commenters request a revision to §350.815 to require a copy of the vision test with the referral to the LEA.
Response: HHSC agrees with a portion of this comment and revises the rule to require a copy of a vision test with the referral to the LEA if the subrecipient receives vision test results. Results of a vision test are not required for the referral of children who are eligible for ECI services with documentation indicating the child has a medical condition that has a high probability of resulting in a developmental delay and sensory impairment.
Comment: One commenter requested adding a new subsection to §350.815 to implement a requirement for subrecipients to refer any child who wears glasses to the LEA.
Response: HHSC disagrees and declines to revise the rule. If the interdisciplinary team does not determine a need for referring a child to the LEA, requiring a referral for all children with glasses, regardless of the interdisciplinary team's opinion, would create undue burden for ECI subrecipients.
Comment: One commenter requested adding a new subsection to §350.815 to define the LEA professionals participating in part of the eligibility determination, and identifying the evaluations and assessments required under 19 TAC §89.1040.
Response: HHSC disagrees and declines to revise the rule with the requested amendment. Per 19 TAC §89.1040, the LEA is not involved in eligibility determination for ECI services. While the LEA is involved in service planning, ECI should not be involved in determining which evaluations LEA staff use to determine service needs.
Comment: One commenter expressed concerns that proposed amendments to §350.821 and §350.823 were identified as non-substantive by HHSC. The commenter believes these amendments are substantive due to the addition of new §350.821(a) and subsequent amendments to §350.821 and §350.823. The amendments to these rules do not allow ECI subrecipients to use qualitative determination of delay (QDD) during determinations of continuing eligibility. The commenter requests amendments to align with the flexibility to use informed clinical opinion for continuing eligibility determinations, per 34 CFR §303.321(a)(3)(iii).
Response: HHSC declines to revise the proposed rule. HHSC recognizes there is confusion by the addition of new §350.821(1), and the subsequent proposed amendments related to this addition. While the amendments referenced do not change existing practice or procedure, they provide clarification of current practices. The purpose of new §350.821(1) is to clarify existing requirements in current §350.823(b)(2)(A), which states that eligibility must be redetermined through an evaluation using the standardized tool designated by HHSC. While QDD cannot be used for continuing eligibility, ECI evaluators may still use informed clinical opinion in determining eligibility.
Comment: Two commenters requested the addition of the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) as an allowable autism spectrum disorders screening in §350.833.
Response: HHSC disagrees with adding a new screening tool to this rule but HHSC agrees to amend the proposed rule to remove specific references to the Modified Checklist for Autism in Toddlers Revised in §350.833(d) through (f). This reference has been changed to indicate a requirement to complete an autism screener as designated by HHSC ECI. This will allow HHSC administrative efficiencies to allow the use of the RITA-T or other autism screeners after HHSC has the opportunity to review and research them.
Comment: One commenter requested the addition of "language skills" in §350.833(c)(2).
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested a revision to §350.1009(c)(2) to replace "teacher of the visually impaired" to "teacher of students with visual impairments and a certified orientation and mobility specialist" as required members of the initial and annual Individualized Family Service Plan (IFSP) meetings for children who are visually impaired.
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested a revision to §350.1009(d)(1) to clarify the requirement for certified teachers to attend meetings for periodic reviews of IFSPs if discussions or changes may affect or be affected by the child being deaf or hard of hearing or having a visual impairment.
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested the removal of §350.1009(f), which states that a certified teacher is not required to attend an IFSP review when changes do not affect the child's deaf and hard of hearing or vision services.
Response: HHSC disagrees with the removal of this subsection but agrees there is a need for clarification. HHSC revises this rule to provide clarification on when a certified teacher is not required to attend a IFSP review.
Comment: One commenter requested revisions to §350.1009(g) to add a requirement for the IFSP team to immediately route the IFSP to the certified teacher and clarify the requirement for the certified teacher to be present if changes affect or are affected by the child's hearing or vision status.
Response: HHSC agrees that the IFSP should be routed quickly and revises the rule to state the IFSP should be routed within two business days.
Comment: One commenter requested a revision to §350.1009(h) to replace "certified teacher of the visually impaired" with "certified teacher of students with visual impairments."
Response: HHSC agrees and revises the rule as suggested.
Comment: One commenter requested amendments to §350.1205, which is not among the open rules, to add references to specific referral networks.
Response: HHSC declines to make the suggested change at this time. HHSC will address the requested change in a future rule project to ensure HHSC has time to review and research all the recommended additions and that the public has the opportunity to comment on the proposed amendment.
Comment: One commenter requested revisions to §350.1413(a)(15) to replace a reference to a child's individualized education program with a reference to a free appropriate public education.
Response: HHSC agrees and revises the rule as suggested.
HHSC made a formatting edit to correct the numbering of §350.815 by adding a paragraph (2) following paragraph (1) in new subsection (c). Also, an edit was made to correct the numbering for §350.103(30)(D).
SUBCHAPTER A. GENERAL RULES
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500224
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
§350.103.Definitions.
The following words and terms, when used in this chapter, will have the following meanings, unless the context clearly indicates otherwise.
(1) Assessment--As defined in 34 CFR §303.321(a)(2)(ii), the ongoing procedures used by appropriate qualified personnel to assess the child's individual strengths and needs and determine the appropriate services to meet those needs throughout the period of a child's eligibility for ECI services.
(2) Child--An infant or toddler under the age of three.
(3) Child find--As described in 34 CFR §§303.115, 303.302, and 303.303, activities and strategies designed to locate and identify, as early as possible, infants and toddlers with developmental delay.
(4) CFR--Code of Federal Regulations. The codification of the general and permanent rules published in the Federal Register by the departments and agencies of the Federal Government.
(5) Complaint--A formal written allegation submitted to HHSC stating that a requirement of IDEA Part C or an applicable federal or state regulation has been violated.
(6) Comprehensive needs assessment--The process for identifying a child's unique strengths and needs, and the family's resources, concerns, and priorities in order to develop an IFSP. The comprehensive needs assessment:
(A) is conducted by an interdisciplinary team as defined in paragraph (29) of this section; and
(B) gathers information across developmental domains regarding the child's abilities to participate in the everyday routines and activities of the family.
(7) Consent--As defined in 34 CFR §303.7 and meeting all requirements in 34 CFR §303.420.
(8) Co-visits--When two or more ECI professionals deliver different services to the child during the same period of time. Co-visits are provided when a child will receive greater benefit from services being provided at the same time, rather than individually.
(9) Days--Calendar days.
(10) Developmental delay--As defined in Texas Human Resources Code §73.001(3) and determined to be significant in compliance with the criteria and procedures in Subchapter H of this chapter (relating to Eligibility, Evaluation, and Assessment).
(11) Developmental screenings--General screenings provided by the ECI program to assess the child's need for further evaluation.
(12) DFPS--Department of Family and Protective Services. The state agency that provides family reunification services for families. These services are provided to families and children to protect the children from abuse and neglect and help the family reduce the risk of abuse and neglect.
(13) ECI--Early Childhood Intervention.
(14) ECI professional--An individual employed by or under the direction of an ECI program who meets the requirements of qualified personnel as defined in 34 CFR §303.13(c) and §303.31, and who is knowledgeable in child development and developmentally appropriate behavior, possesses the requisite education and experience, and demonstrates competence to provide ECI services.
(15) ECI program--In addition to the definition of early intervention service program as defined in 34 CFR §303.11, a program operated by a subrecipient of HHSC ECI with the express purpose of implementing a system to provide ECI services to children with developmental delays and their families.
(16) ECI services--Individualized IDEA Part C services determined by the IFSP team to be necessary to support the family's ability to enhance their child's development. ECI services are further defined in 34 CFR §303.13 and §303.16 and §350.1105 of this chapter (relating to Capacity to Provide Early Childhood Intervention Services).
(17) ECSE--Early Childhood Special Education. The state and federally mandated program for young children with disabilities ages three to five under IDEA Part B, Section 619.
(18) EIS--Early intervention specialist. A credentialed professional who meets specific educational requirements established by HHSC ECI in §350.313(a) of this chapter (relating to Early Intervention Specialist) and has specialized knowledge in early childhood cognitive, physical, communication, social-emotional, and adaptive development.
(19) Evaluation--The procedures used by qualified personnel to determine a child's initial and continuing eligibility for ECI services that comply with the requirements described in 34 CFR §303.21 and §303.321.
(20) Face-to-face--The delivery of ECI services in-person or via telehealth.
(21) FERPA--Family Educational Rights and Privacy Act of 1974, 20 USC §1232g, as amended, and implementing regulations at 34 CFR Part 99. Federal law that outlines privacy protection for parents and children enrolled in the ECI program. FERPA includes rights to confidentiality and restrictions on disclosure of personally identifiable information, and the right to inspect records.
(22) Group services--ECI services provided at the same time to no more than four children and their parent or parents or routine caregivers per ECI professional to meet the developmental needs of the individual infant or toddler.
(23) HHSC--Texas Health and Human Services Commission.
(A) HHSC has the final authority and responsibility for the administration, supervision, and monitoring of programs and activities under this system.
(B) HHSC has the final authority for the obligation and expenditure of funds and compliance with all applicable laws and rules.
(24) HHSC ECI--Texas Health and Human Services Commission Early Childhood Intervention. The entity designated as the lead agency, as defined by 34 CFR §303.22. HHSC ECI is responsible for maintaining and implementing the statewide IDEA Part C system.
(25) IDEA Part C--The Individuals with Disabilities Education Act, Part C, as amended in 2004.
(26) IFSP--Individualized Family Service Plan as defined in 34 CFR §303.20. A written plan of care for providing ECI services and other medical, health, and social services to an eligible child and the child's family when necessary to enhance the child's development. The IFSP is considered complete when the parent has signed the IFSP and received a copy.
(27) IFSP services--The individualized ECI services listed in the IFSP that have been determined by the IFSP team to be necessary to enhance an eligible child's development.
(28) IFSP services pages--The standardized form designated by HHSC ECI that constitutes the required final pages of the IFSP used to record ECI services planned for the child.
(29) IFSP team--An interdisciplinary team that meets the requirements in 34 CFR §303.24(b) and works collaboratively to develop, review, modify, and approve the IFSP. The IFSP team includes, at a minimum, the child's parent and at least two ECI professionals from different disciplines or professions.
(A) At least one of the ECI professionals must be the family's assigned service coordinator.
(B) At least one of the ECI professionals must be an LPHA.
(C) At least one ECI professional must have been involved in conducting the evaluation. This may be the LPHA or another professional.
(D) If the LPHA attending the IFSP meeting did not conduct the evaluation, the subrecipient must ensure that the most recent observations and conclusions of the LPHA who conducted the evaluation were communicated to the LPHA attending the initial IFSP meeting and incorporated into the IFSP.
(E) Other team members may participate by other means acceptable to the team.
(30) Interdisciplinary team--In addition to the definition of multidisciplinary team as defined in 34 CFR §303.24, a team that consists of at least two ECI professionals from different disciplines and the child's parent.
(A) One of the ECI professionals must be an LPHA.
(B) The team may include a teacher for the deaf and hard of hearing, a teacher for students with visual impairments, and a certified orientation and mobility specialist from the child's LEA, as appropriate.
(C) Professionals on the team shall share a common perspective regarding infant and toddler development and developmental delay.
(D) Professionals on the team must work collaboratively to:
(i) conduct the evaluation and assessment;
(ii) develop the IFSP; and
(iii) provide ECI services.
(31) LEA--Local educational agency as defined in 34 CFR §303.23.
(32) LPHA--Licensed practitioner of the healing arts. A licensed physician, registered nurse, licensed physical therapist, licensed occupational therapist, licensed speech language pathologist, licensed professional counselor, licensed clinical social worker, licensed psychologist, licensed dietitian, licensed audiologist, licensed physician assistant, licensed marriage and family therapist, licensed intern in speech language pathology, licensed behavior analyst, or advanced practice registered nurse who is an employee or a subcontractor of an ECI subrecipient. LPHA responsibilities are further described in §350.312 of this chapter (relating to Licensed Practitioner of the Healing Arts).
(33) Medicaid--The medical assistance entitlement program administered by HHSC.
(34) MOU--Memorandum of understanding. A written document evidencing the understanding or agreement of two or more parties regarding the subject matter of the agreement.
(35) Native language--As defined in 34 CFR §303.25.
(A) When used with respect to an individual who is limited English proficient (as that term is defined in IDEA Part B, Section 602(18)), native language means:
(i) the language normally used by that individual, or, in the case of a child, the language normally used by the parents of the child; and
(ii) for evaluations and assessments conducted pursuant to 34 CFR §303.321(a)(5) and (a)(6), the language normally used by the child, if determined developmentally appropriate for the child by qualified personnel conducting the evaluation or assessment.
(B) When used with respect to an individual who is deaf or hard of hearing, blind or visually impaired, or for an individual with no written language, "native language" means the mode of communication that is normally used by the individual (such as sign language, braille, or oral communication).
(36) Natural environments--As defined in 34 CFR §303.26, settings that are natural or typical for a same-aged infant or toddler without a disability. A natural environment may include the home or community settings, include the daily activities of the child and family or caregiver, and must be consistent with the provisions of 34 CFR §303.126.
(37) Parent--As defined in 20 USC §1401(23) and 34 CFR §303.27.
(38) Personally identifiable information--As defined in 34 CFR §99.3 and 34 CFR §303.29.
(39) Pre-enrollment--All family-related activities from the time the referral is received up until the time the parent signs the initial IFSP.
(40) Primary referral sources--As defined in 34 CFR §303.303(c).
(41) Public agency--HHSC and any other state agency or political subdivision of the state that is responsible for providing ECI services to eligible children under IDEA Part C.
(42) Qualifying medical diagnosis--A diagnosed medical condition that has a high probability of developmental delay as determined by HHSC, as described in §350.811 of this chapter (relating to Qualifying Medical Diagnosis).
(43)Referral date--The date the child's name and sufficient information to contact the family was obtained by the subrecipient.
(44) Routine caregiver--An adult who:
(A) has written authorization from the parent to participate in ECI services with the child, even in the absence of the parent;
(B) participates in the child's daily routines;
(C) knows the child's likes, dislikes, strengths, and needs; and
(D) may be the child's relative, childcare provider, or other person who regularly cares for the child.
(45) SEA--State educational agency as defined by 34 CFR §303.3(b).
(46) Service coordinator--An employee or subcontractor of an ECI subrecipient who:
(A) meets all applicable requirements in Subchapter C of this chapter (relating to Staff Qualifications);
(B) is assigned to be the single contact point for the family;
(C) is responsible for providing case management services as described in §350.405 of this chapter (relating to Case Management Services); and
(D) is from the profession most relevant to the child's or family's needs or is otherwise qualified to carry out all applicable responsibilities.
(47) SRS--Specialized rehabilitative services. Rehabilitative services outlined in §350.501 of this chapter (relating to Specialized Rehabilitative Services) that promote age-appropriate development by correcting deficits and teaching compensatory skills for deficits that directly result from medical, developmental, or other health-related conditions.
(48) SST--Specialized skills training. As defined by 34 CFR 303.13(b)(14). SST seeks to reduce the child's functional limitations across developmental domains, including strengthening the child's cognitive skills, positive behaviors, and social interactions.
(49) Subrecipient--A local private or public agency with proper legal status and governed by a board of directors or governing authority that accepts funds from HHSC to administer an ECI program.
(50) Surrogate parent--A person assigned to act as a surrogate for the parent in compliance with IDEA Part C and this chapter.
(51) TAC--Texas Administrative Code. A compilation of all state agency rules in Texas.
(52) TCM--Targeted case management. Case management activities that meet criteria in §350.405(c) of this subchapter and are reimbursable by Medicaid when provided to Medicaid-enrolled children who are eligible for ECI.
(53) TEA--Texas Education Agency. The state agency that oversees primary and secondary public education. It is headed by the commissioner of education.
(54) Telehealth services--Health care services, other than telemedicine medical services, delivered by a health professional licensed, certified, or otherwise entitled to practice in Texas and acting within the scope of the health professional's license, certification, or entitlement to a patient who is located at a different physical location than the health professional using synchronous audio-visual telecommunications or information technology.
(55) USC--United States Code. The official codification of the general and permanent federal statutes of the United States.
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 24, 2025.
TRD-202500225
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500226
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500227
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500228
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500229
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
26 TAC §§350.403 - 350.407, 350.411, 350.415
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500230
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500232
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500233
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500234
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500235
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500236
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500237
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
§350.813.Deaf or Hard of Hearing.
(a) The interdisciplinary team may not determine a child ineligible if the child is suspected to be deaf or hard of hearing until all evaluations and assessments required in this section have been completed and reviewed by the interdisciplinary team.
(b) The interdisciplinary team must determine any need for further hearing testing by analyzing risk factors and evaluation results during every evaluation to determine eligibility.
(1) Evaluation results must include the items listed in §350.809 (relating to Initial Eligibility Criteria).
(2) A hearing screening tool may be used when an evaluation tool is not administered for a child who is eligible based on a medical diagnosis or a child who meets the criteria of having a visual impairment as defined by 19 TAC §89.1040 (relating to Eligibility Criteria).
(c) The subrecipient must refer the child to a licensed audiologist if the child has been identified as having a need for further hearing testing and the child has not had a hearing test within the six months prior to identifying the need.
(1) If necessary to access a licensed audiologist, the subrecipient may refer the child to the child's primary health care provider.
(2) The referral must be made:
(A) within five working days; and
(B) with parental consent.
(d) If the subrecipient receives a hearing test that indicates the child is deaf or hard of hearing or receives documentation that the child has a medical condition that has a high probability of resulting in a developmental delay and sensory impairment, the subrecipient mustenroll the child and make a referral to the LEA.
(1) The referral must be made within five business days after the subrecipient receives:
(A) the hearing test, in which case the referral must include results of the hearing test; or
(B) documentation indicating the child has a medical condition that has a high probability of resulting in a developmental delay and sensory impairment.
(2) Per 20 USC §1232g(b)(1)(A), parental consent is not required for this referral, but the parent must be notified that the referral is being made.
(3) If the child has not been tested by an audiologist, the subrecipient must assist the family in obtaining a hearing test and send the test results to the LEA within five business days of receiving the hearing test.
(e) The subrecipient must refer any child who uses amplification to the LEA.
(f) The Certified Teacher of the Deaf and Hard of Hearing from the LEA participates in the service planning process as part of the interdisciplinary team and, with written parental consent, completes any necessary evaluations.
§350.815.Visual Impairment.
(a) The interdisciplinary team may not determine a child ineligible if the child is suspected to be blind or visually impaired until all evaluations and assessments required in this section have been completed and reviewed by the interdisciplinary team.
(b) The interdisciplinary team must determine any need for further vision testing by analyzing risk factors and evaluation results during every evaluation to determine eligibility.
(1) Evaluation results must include the items listed in §350.809 (relating to Initial Eligibility Criteria).
(2) A vision screening tool may be used when an evaluation tool is not administered for a child who is eligible based on a qualifying medical diagnosis or because the child meets the definition of deaf or hard of hearing in 19 TAC §89.1040 (relating to Eligibility Criteria).
(c) The subrecipient must refer the child to an ophthalmologist or optometrist if the child has been identified as having a need for further vision testing and the child has not had a vision test within the six months prior to identifying the need.
(1) If necessary to access an ophthalmologist or optometrist, the subrecipient may refer the child to the child's primary health care provider.
(2) The referral must be made:
(A) within five working days; and
(B) with parental consent.
(d) If the subrecipient receives a vision test that indicates the child is blind or visually impaired or receives documentation that the child has a physical or mental condition that has a high probability of resulting in a developmental delay and a sensory impairment, the subrecipient must enroll the child and make a referral to the LEA. With written parental consent consistent with §350.207 of this chapter (relating to Parental Consent), the subrecipient must also refer the child to the local office of the Health and Human Services Blind Children's Vocational Discovery and Development Program.
(1) The referral must be made within five business days after the subrecipient receives:
(A) a vision test that indicates the child is blind or visually impaired, in which case the referral must include results of the vision test; or
(B) documentation indicating the child has a medical condition that has a high probability of resulting in a developmental delay and sensory impairment.
(2) Per 20 USC §1232g(b)(1)(A), parental consent is not required for the referral to the LEA, but the parent must be notified that the referral is being made.
(3) If the child has not been tested by an ophthalmologist, an optometrist, or a medical physician, the subrecipient must assist the family in obtaining a vision test and send the test results to the LEA within five business days of receiving the vision test.
(e) The certified teacher of students with visual impairments and the certified orientation and mobility specialist from the LEA participate in the service planning process as part of the interdisciplinary team and, with written parental consent, complete any necessary evaluations.
§350.833.Autism Screening.
(a) Autism screening is not required if the child has been screened for autism spectrum disorder by another entity or has been identified as having autism spectrum disorder.
(b) The subrecipient does not diagnose autism spectrum disorder.
(c) If an enrolled child is 18 months or older, the interdisciplinary team must determine if the child:
(1) has a family history of autism spectrum disorder;
(2) has lost previously acquired language or other communication skills or social skills; or
(3) exhibits a language or cognitive delay or unusual communication patterns combined with a social, emotional, or behavioral concern, including repetitive or stereotypical behaviors.
(d) If the interdisciplinary team identifies any of the issues in subsection (c) of this section, a member of the team must explain to the family the importance of early screening for autism spectrum disorder.
(e) The subrecipient must obtain written parental consent to refer the child to their licensed health care provider to complete an autism screening tool designated by HHSC ECI.
(f) If the child is not screened by the child's licensed health care provider or the subrecipient is unable to receive the screening from the child's licensed health care provider in a timely manner, the subrecipient must obtain written parental consent to:
(1) complete a screening for autism spectrum disorder using a tool designated as appropriate by HHSC ECI; and
(2) if appropriate, complete any additional follow-up activities for a child who does not pass the screening.
(g) The subrecipient must make appropriate referrals if needs are identified. Appropriate referrals may include:
(1) a referral to appropriate clinicians for a child who does not pass the designated screening; and
(2) the provision of case management to assist the parent with having an autism spectrum disorder screening done by the child's licensed health care provider if they do not consent to a screening by the subrecipient.
(h) Screening for autism spectrum disorder using a tool designated as appropriate by HHSC ECI does not take the place of the appropriate evaluation of the child required under this subchapter.
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 24, 2025.
TRD-202500238
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500239
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
§350.1009.Participants in Initial and Annual Individualized Family Service Plan Meetings.
(a) The initial IFSP meeting and each annual meeting to evaluate the IFSP must be conducted by the IFSP team as defined in §350.103 of this chapter (relating to Definitions) and 34 CFR §303.343(a).
(b) With parental consent, the subrecipient must also invite to the initial IFSP meeting and annual meetings to evaluate the IFSP:
(1) Early Head Start or Migrant Head Start staff members, if the family is jointly served by either of these programs; and
(2) representatives from other agencies serving or providing case management to the child or family, including Medicaid managed care programs.
(c) If a child:
(1) is documented to be deaf or hard of hearing as described in §350.809(2) of this chapter (relating to Initial Eligibility Criteria), the IFSP team for an initial IFSP meeting and annual IFSP evaluation meetings must include a certified teacher of the deaf and hard of hearing; or
(2) has a documented visual impairment as described in §350.809(2) of this chapter (relating to Initial Eligibility Criteria), the IFSP team for an initial IFSP meeting and annual IFSP evaluation meetings must include a teacher of students with visual impairments and a certified orientation and mobility specialist.
(d) Unless there is documentation that the LEA has waived notice, the subrecipient must:
(1) provide the certified teacher required in subsection (c) of this section at least a 10-day written notice before the initial IFSP meeting, any annual meetings to evaluate the IFSP, or any review and evaluation when issues will be addressed that are related to or affected by the child being deaf, hard of hearing, or visually impaired; and
(2) keep documentation of the notice in the child's record.
(e) The IFSP team cannot plan deaf and hard of hearing or vision services or make any changes that affect those services if the certified teacher required in subsection (c) of this section is not in attendance.
(f) The certified teacher required in subsection (c) of this section is not required to attend an IFSP review when the following criteria are met, but the subrecipient must obtain the teacher's input.
(1) The IFSP review does not affect the child's vision or hearing services.
(2) Changes made during the IFSP review are not affected by the child's hearing or visual status.
(g) The IFSP team must route the IFSP within two business days to the certified teacher required in subsection (c) of this section for review and signature when changes to the IFSP do not affect the child's deaf and hard of hearing or vision services.
(h) The certified teacher of the deaf and hard of hearing and the certified teacher of the students with visual impairments required in subsection (c) of this section may submit a request within five days of the IFSP meeting to have another IFSP meeting if the teacher disagrees with any portion of the IFSP.
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 24, 2025.
TRD-202500240
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500241
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500242
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500243
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500244
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500245
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500246
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The repeal is adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
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 24, 2025.
TRD-202500248
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580
STATUTORY AUTHORITY
The amendments are adopted under Texas Government Code Section 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 §2001.039, which requires a state agency to review and consider for readoption each of its rules every 4 years, and Texas Government Code §531.02119, which provides that the Executive Commissioner of HHSC shall adopt rules prohibiting discrimination based on immunization status.
§350.1413.Individualized Family Service Plan Services Subject to Out-of-Pocket Payment.
(a) IFSP services subject to out-of-pocket payment are:
(1) assistive technology;
(2) behavioral intervention;
(3) occupational therapy services;
(4) physical therapy services;
(5) speech-language pathology services;
(6) nutrition services;
(7) counseling services;
(8) nursing services;
(9) psychological services;
(10) health services;
(11) social work services;
(12) transportation;
(13) SST;
(14) family education and training; and
(15) any IFSP services to children with visual impairments or who are deaf or hard of hearing that are not part of a free appropriate public education provided by the LEA pursuant to Texas Education Code §29.003(b)(1) and Texas Administrative Code §89.1050(b).
(b) The family pays out-of-pocket up to their maximum charge. The family's maximum charge is determined based on their placement on the HHSC ECI sliding fee scale, as described in §350.1431 of this subchapter (relating to Texas Health and Human Services Commission Early Childhood Intervention Sliding Fee Scale).
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 24, 2025.
TRD-202500249
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: February 13, 2025
Proposal publication date: September 13, 2024
For further information, please call: (512) 424-6580