PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B. ADVISORY COMMITTEES

DIVISION 1. COMMITTEES

1 TAC §351.805

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §351.805, concerning State Medicaid Managed Care Advisory Committee.

BACKGROUND AND PURPOSE

The purpose of the proposal is to extend the State Medicaid Managed Care Advisory Committee (SMMCAC) and align the rule with HHSC advisory committee rule standards. Under the general authority of the Executive Commissioner, the SMMCAC was re-established in 2016 to consider managed care issues and make recommendations to HHSC. The SMMCAC is currently set to abolish on December 31, 2024. The proposed rule amendment changes the SMMCAC abolish date from December 31, 2024, to December 31, 2028, which will allow SMMCAC to continue providing recommendations and ongoing input to HHSC on the statewide operation of Medicaid managed care programs for an additional four years. Additionally, the rule amendment restructures membership subcategories to increase representation for youth and adult populations and adds a new membership subcategory for persons transitioning from children to adult Medicaid managed care programs. The rule amendment will align §351.805 with agency standards for advisory committees by including a subsection on how eligible SMMCAC members may be reimbursed for travel.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §351.805: (1) updates language and structure for better readability and understanding; (2) clarifies what tasks the SMMCAC performs; (3) clarifies the frequency of SMMCAC meetings; (4) clarifies how many members constitute a quorum; (5) restructures the membership subcategories for persons enrolled in Medicaid managed care and adds a new membership subcategory for youth transitioning from children to adult Medicaid managed care programs; (6) expands the membership subcategory for persons dually eligible for both Medicare and Medicaid to allow persons of any age to be represented; (7) restructures the membership subcategory for providers contracted with a Medicaid managed care organization and clarifies requirements for the membership subcategory of a community-based organization; (8) clarifies the membership subcategory for managed care organizations that are national and community-based; (9) adds requirements that the SMMCAC members complete training on the HHS Ethics Policy, the Advisory Committee Member Code of Conduct; and other relevant HHSC policies; (10) adds a subsection to describe when HHSC may reimburse a SMMCAC member for travel; (11) extends the SMMCAC abolishment date from December 31, 2024, to December 31, 2028; and (12) updates the numbering of the subsections and paragraphs accordingly.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will expand existing regulations;

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

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Emily Zalkovsky, Chief Medicaid and CHIP Services Officer, has determined that for each year of the first five years the rule is in effect, the public benefit will be improved public and stakeholder engagement with the agency as a result of SMMCAC (1) serving as a central source for stakeholder input on Medicaid managed care programs, policies, and concerns; (2) reviewing issues related to the implementation and operation of Medicaid managed care; and (3) making recommendations to HHSC on Medicaid managed care program improvements.

Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the proposed rule amendment relates only to advisory committee expiration and adding language to align the rule with HHSC advisory committee rule standards. There is no cost of compliance as the amendment does not create any substantive changes for the SMMCAC.

TAKINGS IMPACT ASSESSMENT

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

PUBLIC COMMENT

Written comments on the proposal may be submitted to Medicaid and CHIP Services Office of Policy, P.O. Box 13247, Mail Code H600, Austin, Texas 78711, or street address 701 W. 51st Street, Austin, Texas 78751; or by e-mail to OPP_SMMCAC@hhsc.state.tx.us.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R043" in the subject line.

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.012, which authorizes the Executive Commissioner to establish advisory committees by rule.

The amendment affects Texas Government Codes §531.0055 and §531.012.

§351.805.State Medicaid Managed Care Advisory Committee.

(a) Statutory authority. The State Medicaid Managed Care Advisory Committee (SMMCAC) is established under [in accordance with] Texas Government Code §531.012 and is subject to §351.801 of this division (relating to Authority and General Provisions).

(b) Purpose.

[(1)] The SMMCAC advises the Texas Health and Human Services Commission (HHSC) executive commissioner [Executive Commissioner] and the health and human services system (HHS) [the Texas Health and Human Services Commission (HHSC)] on the statewide operation of Medicaid managed care, including:

(1) program design and benefits; [benefits,]

(2) systemic concerns from consumers and providers; [providers,]

(3) efficiency and quality of services; [services,]

(4) contract requirements; [requirements,]

(5) provider network adequacy; [adequacy,]

(6) trends in claims processing; [processing,] and

(7) other issues as requested by the HHSC executive commissioner. [Executive Commissioner.]

[(2) The SMMCAC assists HHSC with Medicaid managed care issues.]

[(3) The SMMCAC disseminates Medicaid managed care best practice information as appropriate.]

(c) Tasks. The SMMCAC performs the following tasks: [The SMMCAC makes recommendations to HHSC and performs other tasks consistent with its purpose.]

(1) makes recommendations to HHSC;

(2) advises HHSC on Medicaid managed care issues;

(3) disseminates Medicaid managed care best practice information as appropriate;

(4) adopts bylaws to guide the operation of the SMMCAC; and

(5) performs other tasks consistent with its purpose.

(d) Reporting requirements.

(1) Report to the HHSC executive commissioner. [Executive Commissioner.] No later than [By] December 31st of each year, the SMMCAC files an annual [a ] written report with the HHSC executive commissioner [Executive Commissioner] covering the meetings and activities in the immediately preceding fiscal year. The report includes: [:]

(A) a list of [lists] the meeting dates;

(B) [provides] the members' attendance records;

(C) a brief description of actions taken by the SMMCAC [briefly describes actions taken by the committee];

(D) a description of how the SMMCAC [describes how the committee has] accomplished its tasks;

(E) a summary of [summarizes] the status of any recommendations that the SMMCAC made to HHSC;

(F) a description of activities the SMMCAC [describes activities the committee] anticipates undertaking in the next fiscal year;

(G) [describes] recommended amendments to this section; and

(H) [describes] the costs related to the SMMCAC, [committee,] including the cost of HHSC staff time spent supporting the SMMCAC's [committee's] activities and the source of funds used to support the SMMCAC's [committee's] activities.

(2) Report to the Texas Legislature. By December 31st of each even-numbered year, the SMMCAC files a written report with the Texas Legislature of any policy recommendations made to the HHSC executive commissioner. [Executive Commissioner.]

(e) Meetings.

(1) Open meetings. The SMMCAC complies with the requirements [requirement] for open meetings under Texas Government Code Chapter 551 [551.] as if it were a governmental body.

(2) Frequency. The SMMCAC will meet quarterly.

(3) Quorum. Thirteen members constitute a quorum.

(f) Membership.

(1) The SMMCAC is composed of no more than 24 members appointed by the HHSC executive commissioner. [Executive Commissioner. Except as may be necessary to stagger terms, the term of office of each member is three years. A member may apply to serve one additional term.] In selecting members to serve on the SMMCAC, HHSC: [committee, HHSC]

(A) considers the [an] applicant's qualifications, background, and interest in serving; and [serving.]

(B) [HHSC] tries to choose committee members who represent the diversity of all Texans, including ethnicity, gender, and geographic location.

[(1) Members are appointed for staggered terms so that terms of an equal or almost equal number of members expire on August 31st of each year. Regardless of the term limit, a member serves until his or her replacement has been appointed. This ensures sufficient, appropriate representation.]

[(2) If a vacancy occurs, a person is appointed to serve the unexpired portion of that term.]

(2) [(3)] The SMMCAC consists of representatives of the following categories:

(A)ten people who are enrolled in Medicaid managed care or represent a person enrolled in Medicaid managed care and who are appointed from one or more of the following subcategories:

(i) a person who has low-income, a family member of the person, or an advocate representing people with low-income;

(ii) a person [age 21 or older] with an intellectual, a developmental, or a physical disability, including a person with autism spectrum disorder, or a family member of the person, or an advocate representing people with an intellectual, a developmental, or a physical disability, including persons with autism spectrum disorder;

(iii) a person using mental health services, a family member of the person, or an advocate representing people who use mental health services;

(iv) a person using non-emergency medical transportation services, a family member of the person, or an advocate representing persons using non-emergency medical transportation;

(v) a person who is dually enrolled in Medicaid and Medicare, a family member of the person, or an advocate representing persons who are dually enrolled in Medicaid and Medicare;

(vi) [(iii)] a family member of a child who is a Medicaid recipient or an advocate representing children who are Medicaid recipients, except for a child with special health care needs listed in clause (vii) [(iv)] of this subparagraph;

(vii) [(iv)] a family member of a child with special health care needs or an advocate representing children with special health care needs;

[(v) a person who is 65 years of age or older, the person's family member, or an advocate representing persons who are 65 years of age or older;]

(viii) a person who is 18 years of age or older who will transition or has transitioned from a child and adolescent managed care program to an adult managed care program, a guardian of the person, or an advocate representing persons transitioning from a child and adolescent managed care program to an adult managed care program; or

[(vi) a person 21 or older who is dually enrolled in Medicaid and Medicare, a family member of the person, or an advocate representing people 21 or older who are dually enrolled in Medicaid and Medicare;]

[(vii) a person using mental health services, a family member of the person, or an advocate representing people who use mental health services; or]

(ix) a person who is 65 years of age or older, the person's family member, or an advocate representing persons who are 65 years of age or older;

[(viii) a person using non-emergency medical transportation services, a family member of the person, or an advocate representing persons using non-emergency medical transportation;]

(B) ten providers contracted with Texas Medicaid managed care organizations, appointed from one or more of the following subcategories:

(i) rural providers;

(ii) hospitals;

(iii) primary care providers;

(iv) pediatric health care providers;

(v) dentists;

[(vi) community-based organizations either:]

[(I) serving children enrolled in Medicaid who are low-income and their families;]

[(II) serving people age 65 or older and people with disabilities; or]

[(III) engaged in perinatal services and outreach;]

(vi) [(vii)] obstetrical care providers;

(vii) [(viii)] providers serving people dually enrolled in Medicaid and Medicare;

(viii) [(ix)] providers serving people who are 21 years of age or older and have a disability;

(ix) [(x)] non-physician mental health providers; [or]

(x) [(xi)] long-term services and supports providers, including nursing facility providers and direct service workers; or [and]

(xi) an organization, association, corporation that is representative of and located in, or in close proximity to, a community where it serves or conducts outreach for:

(I) people enrolled in Medicaid;

(II) children from families that are low-income;

(III) children with special health care needs;

(IV) people with disabilities;

(V) people 65 years of age or older; or

(VI) people needing perinatal care; and

(C) four managed care organizations participating in Texas Medicaid, including:

(i) [both] national plans; [and]

(ii) community-based plans; and

(iii) [(ii)] dental maintenance organizations (for the purpose of this section).

(3) HHSC appoints members for staggered terms so that terms of an equal or almost equal number of members expire on August 31st of each year. Regardless of the term limit, a member serves until his or her replacement has been appointed. This ensures sufficient, appropriate representation.

(A) If a vacancy occurs, the HHSC executive commissioner will appoint a person to serve the unexpired portion of that term.

(B) Except as may be necessary to stagger terms, the term of each member is three years. A member may apply to serve one additional term.

(g) Officers. The SMMCAC selects a chair and vice chair of the committee from among its members.

(1) The chair serves until December 1st of each even-numbered year. The vice chair serves until December 1st of each odd-numbered year.

(2) A member may serve up to [serves no more than] two consecutive terms as chair or vice chair. [A chair or vice chair may not serve beyond their membership term.]

(h) Required Training. Each member must complete training, which will be provided by HHSC, [all training HHSC will provide] on relevant statutes and rules, including:

(1) this section;

(2) §351.801 of this division; [subchapter;]

(3) Texas Government Code §531.012; [and]

(4) Texas Government Code Chapters 551, 552, and 2110; [2110.]

(5) the HHS Ethics Policy;

(6) the Advisory Committee Member Code of Conduct; and

(7) other relevant HHS policies.

(i) Travel Reimbursement. To the extent permitted by the current General Appropriations Act, HHSC may reimburse a SMMCAC member for his or her travel to and from SMMCAC meetings only if:

(1) funds are appropriated and available; and

(2) the member:

(A) receives Medicaid services or is a family member of a client that receives Medicaid services; and

(B) submits the request for travel reimbursement in accordance with the HHSC Travel Policy.

(j) [(i)] Date of abolition. The SMMCAC is abolished, and this section expires, on December 31, 2028 [December 31st, 2024].

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402978

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (512) 438-2910

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §351.815, concerning the Policy Council for Children and Families.

BACKGROUND AND PURPOSE

The Policy Council for Children and Families (PCCF) was established by the HHSC Executive Commissioner under the authority of Texas Government Code §531.012. This statute requires the HHSC Executive Commissioner to establish and maintain advisory committees, establish rules for the operation of advisory committees, and for advisory committees to provide recommendations to the HHSC Executive Commissioner and the Texas Legislature.

The PCCF advises the HHSC Executive Commissioner and Health and Human Services system agencies (HHS agencies) to improve the coordination, quality, efficiency, and outcomes of services provided to children and the families of children with disabilities and special health care needs, including mental health needs, through the state's health, education, and human services systems. Members meet approximately four times a year in Austin.

Section 351.815 is set to expire on December 31, 2024, which will abolish the PCCF. The proposed amendment would extend the committee by four years to December 31, 2028, and update existing membership categories for one voting and one ex-officio members. Other edits align the rule with current HHSC advisory committee rulemaking guidelines.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §351.815 adds "HHSC" in front of "Executive Commissioner" and uses the acronym "PCCF" for the "Policy Council for Children and Families" or "committee." The section is revised to ensure it conforms with HHSC's advisory committee rule template guidelines.

The proposed amendment to subsection (a) adds that the section is subject to §351.801, relating to Authority and General Provisions.

The proposed amendment adds a new paragraph (8) in subsection (c) providing that the PCCF adopts bylaws to guide the operation of the committee.

The proposed amendment updates subsection (d) for clarity.

The proposed amendment adds new paragraphs (2) and (3) in subsection (e), regarding frequency of meetings and quorum, respectively.

The proposed amendment adds language to subsection (f) regarding membership requirements and terms of service, including adding HHSC's Community Services Division as an ex-officio representative and specifying that a previously "at large" voting membership category should be for a person with cross-system experience supporting children and the families of children with a disability.

The proposed amendment adds language to subsection (g) regarding the selection of a chair and vice chair and the terms of the officers.

The proposed amendment edits subsection (h) to update training requirements.

New subsection (i) explains the travel reimbursement policy.

The proposed amendment to subsection (j) extends the date of abolition of the PCCF from December 31, 2024, to December 31, 2028.

FISCAL NOTE

Trey Wood, HHSC Chief Financial Officer, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state government because there is no change to state procedures or additional costs.

The rule does not have any fiscal implications to local governments because the rule does not apply to any local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

(5) the proposed rule will not create a new regulation;

(6) the proposed rule will not expand an existing regulation;

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

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

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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the proposed amendment applies only to HHSC.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect the local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons and the rule is necessary to protect the health, safety, and welfare of the residents of Texas.

PUBLIC BENEFIT AND COSTS

Emily Zalkovsky, State Medicaid Director, has determined that for each year of the first five years the rule is in effect, the public benefit will be that the PCCF will continue to advise HHS agencies on opportunities to improve services for children with disabilities and their families.

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

TAKINGS IMPACT ASSESSMENT

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

PUBLIC COMMENT

Written comments on the proposal may be submitted to Quality and Program Improvement, Medicaid and CHIP Services, P.O. Box 13247, Mail Code H250, Austin, Texas 78711-3247; or street address 701 West 51st Street, Austin, 78751; or by email to mcsrulespubliccomments@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R037" in the subject line.

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.012(c)(1), which requires the Executive Commissioner to adopt rules consistent with Texas Government Code Chapter 2110 to govern an advisory committee's report requirements.

The amendment affects Texas Government Code §531.0055 and Texas Government Code §531.012.

§351.815.Policy Council for Children and Families.

(a) Statutory authority. The Policy Council for Children and Families (PCCF) [(Policy Council)] is established in accordance with Texas Government Code §531.012 and is subject to §351.801 of this division (relating to Authority and General Provisions).

(b) Purpose. The PCCF [Policy Council] works to improve the coordination, quality, efficiency, and outcomes of services provided to children with disabilities and their families through the state's health, education, and human services systems.

(c) Tasks. The PCCF [Policy Council] performs the following tasks:

(1) studies and makes recommendations to improve coordination between the state's health, education, and human services systems to ensure that children with disabilities and their families have access to high quality services;

(2) studies and makes recommendations to improve long-term services and supports, including community-based supports for children with special health and mental health care needs, as well as children with disabilities and their families receiving protective services from the state;

(3) studies and makes recommendations regarding emerging issues affecting the quality and availability of services available to children with disabilities and their families;

(4) studies and makes recommendations to better align resources with the service needs of children with disabilities and their families;

(5) studies and makes recommendations to ensure that the needs of children with autism spectrum disorder and their families are addressed, and that all available resources are coordinated to meet those needs;

(6) makes recommendations regarding the implementation and improvement of the STAR Kids managed care program; [and]

(7) performs other tasks consistent with its purpose as requested by the HHSC Executive Commissioner; and [.]

(8) adopts bylaws to guide the operation of the committee.

(d) Reporting requirements.

(1) Not later than [Reporting to Executive Commissioner. By] December 31 of each year, the PCCF [Policy Council] files a written report with the HHSC Executive Commissioner covering [that covers] the meetings and activities in the immediately preceding fiscal year. The report includes:

(A) a list of the meeting dates;

(B) the members' attendance records;

(C) a brief description of actions taken by the PCCF [committee];

(D) a description of how the PCCF [committee ] accomplished its tasks;

(E) a summary of the status of any PCCF [committee ] recommendations to HHSC;

(F) a description of activities the PCCF [committee] anticipates undertaking in the next fiscal year;

(G) recommended amendments to this section; and

(H) the costs related to the PCCF [committee ], including the cost of HHSC staff time spent supporting the PCCF's [committee's] activities and the source of funds used to support the PCCF's [committee's] activities.

(2) Not later than November 1 of each even-numbered year [Reporting to Executive Commissioner and Texas Legislature. By November 1 of each even-numbered year], the PCCF [Policy Council] submits a written report to the HHSC Executive Commissioner and Texas Legislature that:

(A) describes current gaps and barriers to the provision of services to children with disabilities and their families through the state's health and human services system; and

(B) provides recommendations consistent with the PCCF's [Policy Council's] purposes.

(e) Meetings.

(1) Open Meetings. The PCCF [Policy Council] complies with the requirements for open meetings under Texas Government Code Chapter 551, as if it were a governmental body.

(2) Frequency. The PCCF will meet at least twice each year.

(3) Quorum. Thirteen members constitutes a quorum.

(f) Membership.

(1) The PCCF [Policy Council] is composed of 24 members, with 19 voting members and five ex officio members appointed by the HHSC Executive Commissioner. In selecting the voting members, the HHSC Executive Commissioner considers the applicants' qualifications, background, and interest in serving. The membership comprises:

(A) eleven voting members from families with a child under the age of 26 with a disability, including [five nonvoting, ex officio members, one from each of the following state programs and agencies or their successors, as selected by the represented agency]:

(i) at least one adolescent or young adult under the age of 26 with a disability receiving services from the health and human services system [HHSC Medicaid and CHIP Services];

(ii) at least one member of a family of a child with mental health care needs; and

(iii) at least one member of a family of a child with autism spectrum disorder;

[(ii) HHSC Health, Developmental & Independence Services;]

[(iii) Texas Council on Developmental Disabilities;]

[(iv) Texas Department of Family and Protective Services; and]

[(v) Texas Department of State Health Services;]

[(B) eleven voting members selected by the Executive Commissioner from families with a child under the age of 26 with a disability, including:]

[(i) at least one adolescent or young adult under the age of 26 with a disability receiving services from a health and human services system agency; and]

[(ii) at least one member of a family of a child with mental health care needs; and]

[(iii) at least one member of a family of a child with autism spectrum disorder;]

(B) [(C)] eight professional voting members, [selected by the Executive Commissioner,] one each to represent the following types of organizations or areas of expertise:

(i) a faith-based organization;

(ii) an organization that is an advocate for children with disabilities;

(iii) a physician providing services to children with complex needs;

(iv) an individual with expertise providing mental health services to children with disabilities;

(v) an organization providing services to children with disabilities and their families;

(vi) an organization providing community services;

(vii) an organization or professional that advocates for or provides services or resources to children and the families of children with autism spectrum disorder; and

(viii) one individual with expertise or experience providing cross-system, holistic support for children and the families of children with disabilities; [one at large position for an individual with expertise or experience relevant to the purposes and tasks of the Policy Council.]

(C) five non-voting, ex officio members, one from each of the following state programs and agencies or their successors, as nominated by the represented agency, and appointed by the HHSC Executive Commissioner:

(i) HHSC Medicaid and CHIP Services;

(ii) HHSC Community Services Division;

(iii) Texas Council for Developmental Disabilities;

(iv) Texas Department of Family and Protective Services; and

(v) Texas Department of State Health Services.

[(2) In selecting members, the Executive Commissioner considers ethnic and minority representation and diverse disability representation.]

(2) [(3)] Members appointed under paragraphs (1)(A) and (1)(B) [paragraph (1)(B) and (C)] of this subsection serve staggered terms so that the terms of approximately one-quarter of these members' terms expire on December 31 of each year. Regardless of the term limit, a member serves until his or her replacement has been appointed. This ensures sufficient, appropriate representation.

(3) If a vacancy occurs, the HHSC Executive Commissioner will appoint a person to serve the unexpired portion of that term.

(4) Except as may be necessary to stagger terms, the term of [office of] each [non-agency] member [, described in paragraph (1)(B) and (C) of this subsection,]is four years. A member may apply to serve one additional term. This paragraph does not apply to members serving under paragraph (1)(C).

[(5) A member with an expiring term may apply to serve one additional term.]

[(6) A member with an expiring term may continue to serve on the Policy Council until a new member is appointed.]

(g) Officers. The PCCF [Policy Council] selects a chair and vice chair of the PCCF from among its members [from among its members a presiding officer and an assistant presiding officer].

(1) The chair and vice chair of the PCCF will serve a term of two years, with the chair serving until December 31 of each odd-numbered year and the vice chair serving until December 31 of each even-numbered year [presiding and assistant presiding officers must be appointed family representatives].

(2) A member may serve up to two consecutive terms as chair or vice chair [The presiding officer serves until December 31 of each odd-numbered year. The assistant presiding officer serves until December 31 of each even-numbered year].

[(3) A presiding officer or assistant presiding officer remains in his or her position until the Policy Council selects a successor; however, the individual may not remain in office past the individual's membership term.]

(h) Required Training. Each member must [shall ] complete all training on relevant statutes and rules, including this section and §351.801 of this division [subchapter ] (relating to Authority and General Provisions); [and] Texas Government Code §531.012; [, and] Texas Government Code Chapters 551, 552, and 2110; the HHS Ethics Policy; the Advisory Committee Member Code of Conduct; and other relevant HHS policies. HHSC will provide the training.

(i) Travel Reimbursement. To the extent permitted by the current General Appropriations Act, a member of the committee who receives services from HHSC or is a family member of a client may be reimbursed for their travel to and from meetings if funds are appropriated and available and in accordance with the HHSC Travel Policy. Other committee members are not reimbursed for travel to and from committee meetings.

(j) [(i)] Date of abolition. The PCCF [Policy Council] is abolished, and this section expires [,] on December 31, 2028 [2024].

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402973

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (512) 438-2910

SUBCHAPTER E. STANDARDS FOR MEDICAID MANAGED CARE

1 TAC §353.421

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §353.421, concerning Special Disease Management for Health Care MCOs.

BACKGROUND AND PURPOSE

The purpose of proposal is to implement House Bill (H.B.) 2658, 87th Legislature, Regular Session, 2021. H.B. 2658 amended Texas Government Code §533.009(c), to require a Medicaid health care managed care organization (MCO) with low active participation rates in the MCO's special disease management program to identify the reason for the low rates and develop approaches to increase active participation in the program for high-risk recipients.

The proposed amendment to §353.421 includes a new subsection (a) to organize the definition of "special disease management" with the new definitions "active participation" and "high-risk member" into one rule. The proposed definitions identify what these terms mean when used in the section.

The proposed amendment adds a new paragraph (5) in subsection (b) to require a health care MCO to include mechanisms to identify low active participation rates in the MCO's special disease management program and the reason for the low rates and to increase active participation in the program for high-risk members. This is proposed to implement Texas Government Code Section 533.009(c)(3) added by H.B. 2658.

The proposed amendment, throughout the section and in the rule title, includes editorial changes to use correct formatting, use consistent terminology, and correct the use of acronyms to improve the readability of the section.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

(5) the proposed rule will not create a new regulation;

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

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

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

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

Trey Wood has also determined that the rule does not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rule.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule is necessary to protect the health, safety, and welfare of the residents of Texas; does not impose a cost on regulated persons; and is necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Emily Zalkovsky, State Medicaid Director, has determined that for each year of the first five years the rule is in effect, the public will benefit from this rule project by having access to more effective and accountable special disease management programs which may positively impact health outcomes for Medicaid recipients enrolled in or eligible for special disease management programs.

Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because Medicaid health care MCOs already have mechanisms in place to implement the proposed rule amendment.

TAKINGS IMPACT ASSESSMENT

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

PUBLIC COMMENT

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

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R048" in the subject line.

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §533.009, which requires the Executive Commissioner of HHSC, by rule, to prescribe the minimum standards that a managed care organization must meet in providing special disease management.

The amendment affects Texas Government Code §531.0055, Texas Government Code §533.009, and Texas Human Resources Code, Chapter 32. No other statutes, articles, or codes are affected by this proposal.

§353.421.Special Disease Management for a Health Care Managed Care Organization [MCOs].

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

(1) Active participation--One or more encounters in a calendar year, either face-to-face or by an approved telehealth modality, between the disease management staff of a health care managed care organization (MCO) and a member or the member's representative. In determining active participation, a member who is assessed and provided supports and services that address a chronic disease, but is not participating in the MCO's special disease management program as described in Texas Government Code §533.009 should not be counted as participating in the disease management program.

(2) High-risk member--A member at high-risk for non-adherence to the member's plan of care that addresses the member's disease or other chronic health condition, such as heart disease; chronic kidney disease and its medical complications; respiratory illness, including asthma; diabetes; end-stage renal disease; human immunodeficiency virus infection (HIV), or acquired immunodeficiency syndrome (AIDS). A high risk member has multiple or complex medical or behavioral health conditions, or both, with clinical instability undergoing active treatment and at risk of avoidable emergency room visits or hospitalizations.

(3) Special disease management--Coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.

[(a) For purposes of this rule, "Special Disease Management" means a program of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.]

(b) A [In order for a] health care MCO must [to receive a contract from HHSC to] provide special disease management services. A [, the] health care MCO must:

(1) implement [Implement] policies and procedures to ensure that a member who requires [members requiring] special disease management services are identified and enrolled into the MCO's special [a] disease management program;

(2) develop [Develop] and maintain screening and evaluation procedures for the early detection, prevention, treatment, or referral of a member [participants] at risk for or diagnosed with chronic conditions such as heart disease;[,] chronic kidney disease and its medical complications;[,] respiratory illness, including asthma;[,] diabetes;[, and] HIV infection; or AIDS;

(3) ensure a member who is enrolled in the MCO's [Ensure that all members identified for] special disease management program has [are enrolled in and have] the opportunity to disenroll from the program [opt out of special disease management services] within 30 days while still maintaining access to all other covered services; [and]

(4) show [Show] evidence of the ability to manage complex diseases in the Medicaid population by demonstrating [. Such evidence shall be demonstrated by] the health care MCO's ability to comply [compliance] with this section; and [subchapter.]

(5) include mechanisms to:

(A) identify:

(i) low active participation rates in the MCO's special disease management program; and

(ii) the reason for the low rates; and

(B) increase active participation in the disease management program for high-risk members.

(c) A special [Special] disease management program [programs] must include:

(1) patient [Patient] self-management education;

(2) patient [Patient] education regarding the role of the provider;

(3) evidence-supported [Evidence-supported ] models, standards of care in the medical community, and clinical outcomes;

(4) standardized [Standardized] protocols and participation criteria;

(5) physician-directed [Physician-directed ] or physician-supervised care;

(6) implementation [Implementation] of interventions that address the continuum of care;

(7) mechanisms [Mechanisms] to modify or change interventions that have not been proven effective;

(8) mechanisms [Mechanisms] to monitor the impact of the special disease management program over time, including both the clinical and the financial impact;

(9) a [A] system to track and monitor all members enrolled in a special disease management program [participants] for clinical, utilization, and cost measures;

(10) designated [Designated] staff to implement and maintain the program and assist members in accessing program services;

(11) a [A] system that enables providers to request specific special disease management interventions; and

(12) provider [Provider] information, including:

(A) the differences between recommended prevention and treatment and actual care received by a member enrolled in a special disease management program; [participants,]

(B) information concerning the member's [participant's] adherence to a service plan; and

(C) reports on changes in each member's [participant's] health status.

(d) A health care MCO's special [Special] disease management program [programs] must have performance measures for particular diseases. HHSC reviews [will review] the performance measures submitted by a special disease management program for comparability with the relevant performance measures in Texas Government Code §533.009, relating to contracts for disease management programs.

(e) A health care MCO implementing a special disease management program for chronic kidney disease and its medical complications that includes screening for and diagnosis and treatment of this disease and its medical complications, must, for the screening, diagnosis and treatment, use generally recognized clinical practice guidelines and laboratory assessments that identify chronic kidney disease on the basis of impaired kidney function or the presence of kidney damage.

(f) A health care MCO that develops and implements a special disease management program must coordinate participant care with a provider of a disease management program under Texas Human Resources Code §32.057, [Human Resources Code,] during a transition period for patients that move from one disease management program to another program.

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402977

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (512) 438-2910

1 TAC §353.1311

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §353.1311, concerning Quality Metrics for the Texas Incentives for Physicians and Professional Services Program.

BACKGROUND AND PURPOSE

The purpose of the proposal is to amend §353.1311 to implement the quality reporting necessary for the pay-for-performance component of §353.1309.

Each directed payment program (DPP) has a quality rule and a financial rule. Effective January 28, 2024, HHSC amended the Texas Incentives for Physicians and Professional Services (TIPPS) financial rule to add a pay-for-performance component to TIPPS beginning with state fiscal year 2026. The proposed changes amend the TIPPS quality rule to implement the quality reporting necessary for the pay-for-performance component of the TIPPS financial rule. The amendment will also align the TIPPS quality rule with the quality rules for other DPPs.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §353.1311 implements the quality reporting necessary for the TIPPS pay-for-performance component in §353.1309. The amendment also makes the language in this TIPPS quality rule more consistent with the language in the Comprehensive Hospital Increase Reimbursement Program quality rule in §353.1307, a directed payment program with a pay-for-performance component.

Subsection (a) of the rule makes nonsubstantive changes to the text of the rule to make the rule language mirror the quality rules for other DPPs.

Subsection (b) of the rule makes nonsubstantive changes to the text of the rule to make the rule language mirror the quality rules for other DPPs.

Subsection (c) of the rule makes nonsubstantive changes to the text of the rule to make the rule language mirror the quality rules for other DPPs, provides that metrics may change from one program period to the next, and provides that quality metrics will be presented to the public for comment.

Subsection (d) of the rule provides that HHSC will specify performance requirements for each quality metric, that achievement of performance requirements will trigger payments, and that quality metrics will be presented to the public for comment.

Subsection (e) of the rule specifies that HHSC will use reported performance of quality metrics to evaluate the degree to which the program advances certain goals and objectives. The proposed amendment renumbers the remaining subsections in §353.1311 accordingly, given the addition of subsection (e).

Subsection (f) of the rule consists of language previously contained in former subsection (d) and makes nonsubstantive changes to the text of the rule to make the rule language mirror the quality rules for other DPPs.

Subsection (g) of the rule consists of language previously contained in former subsection (e), changes the dates by which the proposed metrics and performance requirements will be published, and increases the number of days that interested parties may comment on the proposed metrics.

Subsection (h) of the rule consists of language previously contained in former subsection (f) and changes the date by which the final metrics and performance requirements will be published to give participating physician groups more notice of the final measures and requirements.

Subsection (i) of the rule consists of language previously contained in former subsection (f) and adds language to authorize HHSC to substitute measures for those suggested or published by HHSC if CMS requires the substituted measures.

Subsection (j) renumbers former subsection (g).

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

(5) the proposed rule will not create a new regulation;

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

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

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Emily Zalkovsky, State Medicaid Director, has determined that for each year of the first five years the rule is in effect, the public benefit will be the ability of Medicaid managed care clients to have continued access to care and to incentivize providers to improve the quality of services provided.

Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule does not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply.

TAKINGS IMPACT ASSESSMENT

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

PUBLIC COMMENT

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

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R069" in the subject line.

STATUTORY AUTHORITY

The amendment is proposed under Texas Government Code §531.033, which provides the Executive Commissioner with broad rulemaking authority; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §533.002, which authorizes HHSC to implement the Medicaid managed care program.

The amendment affects Texas Government Code, Chapters 531 and 533, and Texas Human Resources Code, Chapter 32.

§353.1311.Quality Metrics for the Texas Incentives for Physicians and Professional Services Program.

(a) Introduction. This section establishes the quality metrics for [that may be used in] the Texas Incentives for Physician and Professional Services (TIPPS) program.

(b) Definitions. Terms that are used in this and other sections of this subchapter [section] may be defined in §353.1301 of this subchapter (relating to General Provisions) or §353.1309 of this subchapter (relating to the Texas Incentives for Physicians and Professional Services).

(c) Quality metrics. For each program period, HHSC will designate one or more quality metrics for each TIPPS capitation rate component as described in §353.1309(g) of this subchapter. Any quality metric included in TIPPS will be evidence-based and

[(1) Each quality metric will be] identified as a structure, process, or outcome measure [, improvement over self (IOS) measure, or benchmark measure]. HHSC may modify quality metrics from one program period to the next. The proposed quality metrics for a program period will be presented to the public for comment in accordance with subsection (g) of this section.

[(2) Any metric developed for inclusion in TIPPS will be evidence-based.]

(d) Performance [Quality metric] requirements. For each program period, HHSC will specify the performance requirements [that will be] associated with [the] designated quality metrics. The proposed performance requirements for a program period will be presented to the public for comment in accordance with subsection (g) of this section. Achievement of performance requirements will trigger payments as described in §353.1309 of this subchapter [metric].

(e) Quality metrics and program evaluation. HHSC will use reported performance of quality metrics to evaluate the degree to which the arrangement advances at least one of the goals and objectives that are incentivized by the payments described under §353.1309(g) of this subchapter.

(1) All [A physician group must report all] quality metrics for [in] any Component in which a physician group [it] is participating must be reported by the participating physician group as a condition of participation.

(2) Participating physician groups must stratify any reported data by payor type and must report data according to requirements published under subsection (f) of this section.

(f) Participating physician group reporting frequency.

(1) [(2)] Participating physician groups will be required to report on quality [Reporting frequency. Quality] metrics [will be reported] semi-annually unless otherwise specified by the [quality] metric.

(2) Participating physician groups will also be required to furnish information and data related to quality metrics [measures] and performance requirements established in accordance with subsection (g) [(e)] of this section within 30 calendar days after a request from HHSC for more information.

(g) [(e)] Notice and hearing.

(1) HHSC will publish notice of the proposed metrics and their associated performance requirements no later than August 10 of the calendar year that precedes [January 31 preceding] the first month of the program period. The notice must be published either by publication on the HHSC [HHSC's ] website or in the Texas Register. The notice required under this section will include [the following]:

(A) instructions for interested parties to submit written comments to HHSC regarding the proposed metrics and performance requirements; and

(B) the date, time, and location of a public hearing.

(2) Written comments will be accepted within 30 calendar [for 15 business] days of [following ] publication. There will also be a public hearing within that 30-day [15-day] period to allow interested persons to present comments on the proposed metrics and performance requirements.

(h) [(f)] Quality metric publication [Publication of Final Metrics and Requirements]. Final quality metrics and performance requirements will be provided through the TIPPS quality webpage on the HHSC [HHSC's] website on or before October 1 [February 28] of the calendar year that precedes [also contains] the first month of the program period.

(i) Alternate measures may be substituted for measures proposed under subsection (g) of this section or published under subsection (h) of this section if required by the Centers for Medicare and Medicaid Services for federal approval of the program. If the Centers for Medicare and Medicaid Services requires changes to quality metrics or performance requirements after October 1 [February 28 of the calendar year], HHSC will provide notice of the changes through the HHSC [HHSC's] website.

(j) [(g)] Evaluation Reports.

(1) HHSC will evaluate the success of the program based on a statewide review of reported metrics. HHSC may publish more detailed information about specific performance of various participating physician groups, classes of physician groups, or service delivery areas.

(2) HHSC will publish interim evaluation findings regarding the degree to which the arrangement advanced the established goal and objectives of each capitation rate component.

(3) HHSC will publish a final evaluation report within 270 days of the conclusion of the program period.

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

Filed with the Office of the Secretary of State on July 3, 2024.

TRD-202402976

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (512) 438-2910

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Subchapter A, concerning Program Purpose and Scope, comprising of §§375.101 - 375.103; Subchapter B, concerning Contractor Requirements for the Refugee Cash Assistance Program (RCA), comprising of §§375.201, 375.203, 375.205, 375.207, 375.209, 375.211, 375.213, 375.215, 375.217, 375.219, 375.221; Subchapter C, concerning Program Administration for the Refugee Cash Assistance Program (RCA), comprising of §§375.301, 375.303, 375.305, 375.307, 375.309, 375.311, 375.313, 375.315, 375.317, 375.319, 375.321, 375.323, 375.325, 375.327, 375.329, 375.331, 375.333, 375.335, 375.337, 375.339, 375.341, 375.343, 375.345, 375.347, 375.349, 375.351, 375.353; Subchapter D, concerning Refugee Cash Assistance Participant Requirements, comprising of §§375.401, 375.403, 375.405, 375.407, 375.409, 375.411, 375.413, 375.415, 375.417, 375.419; Subchapter E, concerning Refugee Medical Assistance, comprising of §§375.501, 375.503, 375.505, 375.507, 375.509, 375.511, 375.513, 375.515, 375.517, 375.519, 375.521, 375.523, 375.525, 375.527, 375.529, 375.531; Subchapter F, concerning Modified Adjusted Gross Income Methodology, comprising of §§375.601, 375.603, 375.605, 375.607, 375.609, 375.611, 375.613, 375.615, and an amendment to §375.701 in Subchapter G, concerning Local Resettlement Agency Requirements, in Title 1, Part 15, Chapter 375, concerning Refugee Cash Assistance and Medical Assistance Programs.

BACKGROUND AND PURPOSE

The purpose of the proposal is to remove rules which are no longer necessary and to update a rule that is required by statute. On September 30, 2016, the State of Texas withdrew from the administration of federally funded refugee services and benefits program effective January 31, 2017, following refusal by the federal Office of Refugee Resettlement to unconditionally approve Texas' amended state refugee plan. Texas Government Code §531.0411 requires rules regarding refugee resettlement program; therefore, §375.701 will be retained and updated.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Subchapter A, Program Purpose and Scope; Subchapter B, Contractor Requirements for The Refugee Cash Assistance Program (RCA); Subchapter C, Program Administration for the Refugee Cash Assistance Program (RCA); Subchapter D, Refugee Cash Assistance Participant Requirements; Subchapter E, Refugee Medical Assistance; and Subchapter F, Modified Adjusted Gross Income Methodology, deletes the rules because they are no longer necessary as HHSC no longer administers the federally funded refugee services and benefits in Texas.

The proposed amendment to §375.701 deletes subsection (i) which no longer applies. The terms "C.F.R." and "refugee" are defined and minor non-substantive edits are made to correct formatting to align with HHSC rulemaking guidelines.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

(5) the proposed rules will not create a new regulation;

(6) the proposed rules will repeal existing regulations;

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

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed amended rule and repeals will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to the amended rule and repeals because the amended rule and repeals do not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Rob Ries, Deputy Executive Commissioner for Family Health Services has determined that for each year of the first five years the amended rule and repeals are in effect, the public benefit will be removal of unnecessary rules from the Texas Administrative Code and updating a rule to improve clarity of rule requirements.

Trey Wood, Chief Financial Officer, has also determined that for the first five years the amended rule and repeals are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed amended rule and repeals because the amendments do not change any current requirements.

TAKINGS IMPACT ASSESSMENT

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

PUBLIC COMMENT

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

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R034" in the subject line.

SUBCHAPTER A. PROGRAM PURPOSE AND SCOPE

1 TAC §§375.101 - 375.103

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§375.101.What is the scope of the chapter?

§375.102.What is the purpose of this chapter?

§375.103.How are the terms in this chapter defined?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402955

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§375.201, 375.203, 375.205, 375.207, 375.209, 375.211, 375.213, 375.215, 375.217, 375.219, 375.221

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§375.201.What is the purpose of this subchapter?

§375.203.Who can apply for a RCA contract?

§375.205.What is the financial responsibility of the contractor's board of directors?

§375.207.Are there accounting requirements the contractor must meet to receive a contract?

§375.209.Does the Texas Department of Human Services (DHS) require contractors to have a fidelity bond?

§375.211.What are the confidentiality requirements of a contract?

§375.213.Are contractors responsible for having a nepotism policy?

§375.215.Are contractors responsible for having a conflict of interest policy?

§375.217.Are contractors required to comply with the Limited English Proficiency (LEP) provisions of Title VI of the Civil Rights Act?

§375.219.What are the record keeping requirements of the contract?

§375.221.How long are contractors required to keep records?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402956

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§375.301, 375.303, 375.305, 375.307, 375.309, 375.311, 375.313, 375.315, 375.317, 375.319, 375.321, 375.323, 375.325, 375.327, 375.329, 375.331, 375.333, 375.335, 375.337, 375.339, 375.341, 375.343, 375.345, 375.347, 375.349, 375.351, 375.353

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§375.301.What is the purpose of this subchapter?

§375.303.Who is eligible for Refugee Cash Assistance (RCA) benefits?

§375.305.What is the income eligibility standard for months one through four of the eight months of eligibility?

§375.307.What is the income eligibility standard for months five through eight of the eight months of eligibility?

§375.309.What income must be disregarded when determining eligibility?

§375.311.Are contractors required to report changes in a participant's income to the Texas Department of Human Services (DHS)?

§375.313.Who determines a refugee's eligibility for Refugee Cash Assistance (RCA) benefits?

§375.315.Are there special provisions when enrolling families with children in Refugee Cash Assistance?

§375.317.How long can a participant receive Refugee Cash Assistance (RCA) benefits?

§375.319.What is the beginning date of the eligibility period for Refugee Cash Assistance (RCA) benefits?

§375.321.How does the contractor determine eligibility for a refugee who has moved from another state to Texas?

§375.323.What happens if a participant has a child after arriving in the U.S.?

§375.325.Can a contractor consider participants as a family unit if they do not live together?

§375.327.If two or more unrelated participants live together, are they considered a family unit?

§375.329.What is the start date for benefits for approved applicants entering the program?

§375.331.What payment levels and types of payments will the contractor use when providing cash assistance?

§375.333.Who is eligible to receive an incentive payment?

§375.335.How is the incentive payment disbursed for a family unit larger than one?

§375.337.What happens if a participant is underpaid?

§375.339.What happens if a participant is overpaid?

§375.341.Are contractors responsible for translating materials for participants?

§375.343.What information and materials must a contractor provide to the participant upon enrollment?

§375.345.What procedures must a contractor follow when authorizing or denying an applicant benefits?

§375.347.When may a contractor reduce, suspend, or terminate benefits?

§375.349.What must a contractor do when reducing, suspending, or terminating benefits?

§375.351.Can a contractor reduce, suspend, or terminate cash assistance if the participant requests a hearing?

§375.353.How must contractors participate in coordination activities with other refugee providers?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402957

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§375.401, 375.403, 375.405, 375.407, 375.409, 375.411, 375.413, 375.415, 375.417, 375.419

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§375.401.What is the purpose of this subchapter?

§375.403.Are there employment requirements for participants in this program?

§375.405.What are the exemptions for employment participation requirements?

§375.407.What are the temporary good cause exemptions from employment participation requirements?

§375.409.What happens if a non-exempt participant fails to meet employment requirements?

§375.411.What happens to a family unit's benefits if one member of a family unit fails to meet employment requirements?

§375.413.What action does a contractor take if an applicant voluntarily quits employment within 30 days of applying for Refugee Cash Assistance (RCA) benefits?

§375.415.What action does a contractor take if a participant voluntarily quits employment after enrolling in Refugee Cash Assistance (RCA) benefits?

§375.417.If a Refugee Cash Assistance (RCA) contractor denies, terminates, or reduces benefits, how may an applicant or participant appeal the decision?

§375.419.If a participant's benefits are denied, terminated, or reduced because the employment provider has reported that the participant is not meeting the employment requirements of the program, how can a participant appeal the decision?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402958

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§375.501, 375.503, 375.505, 375.507, 375.509, 375.511, 375.513, 375.515, 375.517, 375.519, 375.521, 375.523, 375.525, 375.527, 375.529, 375.531

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§375.501.What is the purpose of this subchapter?

§375.503.Who is eligible for Refugee Medical Assistance (RMA) benefits?

§375.505.How does a person apply for Refugee Medical Assistance (RMA)?

§375.507.Are Refugee Medical Assistance (RMA) applicants required to apply for Refugee Cash Assistance (RCA)?

§375.509.Are there special considerations when Refugee Cash Assistance (RCA) participants apply for Refugee Medical Assistance (RMA)?

§375.511.Who determines eligibility for Refugee Medical Assistance (RMA)?

§375.513.How is the beginning date of the eight-month period of eligibility for Refugee Medical Assistance (RMA) benefits determined?

§375.515.What are the income and resource considerations for Refugee Medical Assistance (RMA) eligibility?

§375.517.How does having a child after arrival affect Refugee Medical Assistance (RMA) benefits?

§375.519.If two or more unrelated applicants live together, can they be certified as a family unit?

§375.521.Are benefits continued if a participant's income increases due to employment?

§375.523.Is a refugee who has been terminated from Medicaid because of earnings eligible for Refugee Medical Assistance (RMA)?

§375.525.What changes are Refugee Medical Assistance (RMA) participants required to report?

§375.527.What services are provided under Refugee Medical Assistance (RMA)?

§375.529.What happens if the refugee becomes covered by employer-provided insurance?

§375.531.What notices will HHSC provide to Refugee Medical Assistance (RMA) participants?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402959

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§375.601, 375.603, 375.605, 375.607, 375.609, 375.611, 375.613, 375.615

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§375.601.Purpose and Scope.

§375.603.Definitions.

§375.605.Methodology

§375.607.Determination of Household Composition.

§375.609.Calculation of Individual Income.

§375.611.Determination Regarding Inclusion of Individual Income in the Household Income.

§375.613.Calculation of Household Income.

§375.615.Modification.

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402960

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §375.701

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The amendment implements Texas Government Code §531.0055 and §531.0411.

§375.701.Local Governmental and Community Input.

(a) For purposes of this subchapter, the following definitions apply.[:]

(1) Business day--A day that is not a Saturday, Sunday, or federal legal holiday. In computing a period of business days, the first day is excluded and the last day is included. If the last day of any period is a Saturday, Sunday, or federal legal holiday, the period is extended to include the next day that is not a Saturday, Sunday, or federal legal holiday.

(2) C.F.R.--Code of Federal Regulations.

(3) [(2)] HHSC--Texas Health and Human Services Commission, or its designee.

(4) [(3)] Local resettlement agency--As defined by 45 C.F.R. §400.2, means a local affiliate or subcontractor of a national voluntary agency that has entered into a grant, contract, or cooperative agreement with the United States Department of State or other appropriate federal agency to provide for the reception and initial placement of refugees in the United States.

(5) [(4)] National voluntary agency--As defined by 45 C.F.R. §400.2, means one of the national resettlement agencies or a state or local government that has entered into a grant, contract, or cooperative agreement with the United States Department of State or other appropriate federal agency to provide for the reception and initial placement of refugees in the United States.

(6) Refugee--An individual admitted to the United States under section 207 of the Immigration and Nationality Act.

(b) A local resettlement agency must convene meetings at least quarterly at which representatives of the local resettlement agency have an opportunity to consult with and obtain feedback regarding proposed refugee placement from, at a minimum:

(1) local governmental entities and officials, including:

(A) municipal and county officials;

(B) local school district officials; and

(C) representatives of local law enforcement agencies; and

(2) community stakeholders, including:

(A) major providers under the local health care system; and

(B) major employers of refugees.

(c) In addition to the quarterly meetings held under subsection (b) of this section, local governmental entities and community stakeholders may request to meet with a local resettlement agency regarding refugee placement.

(1) A local resettlement agency must respond within 10 [ten] business days to a request from a local governmental entity or community stakeholder to meet.

(2) If a request for a meeting is denied, the response must be in writing and the reason for denial must be clearly stated.

(3) A copy of the denial must be submitted to HHSC by the local resettlement agency no later than three business days after it is sent to the local governmental entity or community stakeholder.

(d) To facilitate consultation and effective feedback, local governmental entities and community stakeholders may request information from a local resettlement agency related to the resettlement process.

(1) A local resettlement agency must respond within 10 [ten] business days as to whether a request for information from a local governmental entity or community stakeholder will be granted.

(2) If the request is granted, the local resettlement agency must provide the requested information no later than 20 [twenty] business days from the date of the receipt of the request, to the extent not otherwise prohibited by state or federal law.

(3) If a request for information is denied, the response must be in writing and the reason for denial must be clearly stated.

(4) A copy of the denial must be submitted to HHSC by the local resettlement agency no later than three business days after it is sent to the local governmental entity or community stakeholder.

(e) A local resettlement agency must consider all feedback obtained in community consultation meetings under subsections (b) and (c) of this section in reporting annual refugee placement information to the local refugee resettlement agency's national voluntary agency for purposes of 8 United States Code (U.S.C.) §1522(b)(7)(E) [U.S.C. Section 1522(b)(7)(E)].

(f) A local resettlement agency must provide HHSC, local governmental entities and officials, and community stakeholders described under subsection (b) of this section a copy of proposed annual refugee placement data for purposes of 8 U.S.C. §1522(b)(7)(E) [Section 1522(b)(7)(E)].

(g) A local resettlement agency must develop and submit a final annual report to the local refugee resettlement agency's national voluntary agency and for HHSC that includes a summary regarding how community stakeholder input contributed to the development of an annual refugee placement report for purposes of 8 U.S.C. §1522(b)(7)(E) [Section 1522(b)(7)(E)].

(h) A local resettlement agency must provide HHSC with the preliminary number of refugees the local resettlement agencies recommend to the national voluntary agencies for placement throughout the State of Texas.

[(i) In addition to applicable requirements specified in Subchapter B of this chapter (relating to Contractor Requirements for the Refugee Cash Assistance Program), Subchapter C of this chapter (relating to Program Administration for the Refugee Cash Assistance Program), and Subchapter E of this chapter (relating to Refugee Medical Assistance), a contract with a local resettlement agency to provide Refugee Cash Assistance services must comply with the requirements of this subchapter.]

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402961

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Subchapter A, concerning Purpose and Scope, comprised of §§376.101 - 376.104; Subchapter B, concerning Contractor Requirements, comprised of §§376.201, 376.203, 376.205, 376.207, 376.209, 376.211, 376.213, 376.215, 376.217, 376.219, 376.221, 376.223, 376.225, 376.227, 376.229, 376.231, 376.233, 376.235, 376.237; Subchapter C, concerning General Program Administration, comprised of §§376.301, 376.303, 376.305, 376.307, 376.309, 376.311, 376.313, 376.315, 376.317, 376.319, 376.321, 376.323, 376.325, 376.327, 376.329, 376.331, 376.333; Subchapter D, concerning Employment Services: Refugee Social Services (RSS), comprised of §§376.401, 376.403, 376.405, 376.407, 376.409, 376.411, 376.413, 376.415, 376.417, 376.419, 376.421, 376.423, 376.425, 376.427; Subchapter E, concerning Employment Services: Refugee Cash Assistance (RCA), comprised of §§376.501, 376.503, 376.505, 376.507, 376.509, 376.511, 376.513, 376.515, 376.517, 376.519; Subchapter F, concerning English as a Second Language (ESL) Services, comprised of §376.601 and §376.602; Subchapter G, concerning Other Employability Services, comprised of §§376.701, 376.703, 376.705, 376.707, 376.709, 376.711, 376.713, 376.715, 376.717, 376.719, 376.721; Subchapter H, concerning Targeted Assistance Grant (TAG) Services, comprised of §§376.801 - 376.806; Subchapter I, concerning Unaccompanied Refugee Minor (URM) Program, comprised of §§376.901 - 376.907; and an amendment to §376.1001 in Subchapter J, concerning Local Resettlement Agency Requirements, in Title 1, Chapter 376, concerning Refugee Social Services.

BACKGROUND AND PURPOSE

The purpose of the proposal is to remove rules which are no longer necessary and to update a rule that is required by statute. On September 30, 2016, the State of Texas withdrew from the administration of federally funded refugee services and benefits program effective January 31, 2017, following refusal by the federal Office of Refugee Resettlement to unconditionally approve Texas' amended state refugee plan. Texas Government Code §531.0411 requires rules regarding refugee resettlement program; therefore, §376.1001 will be retained and updated.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Subchapter A, Purpose and Scope; Subchapter B, Contractor Requirements; Subchapter C, General Program Administration; Subchapter D, Employment Services: Refugee Social Services (RSS); Subchapter E, Employment Services: Refugee Cash Assistance (RCA); Subchapter F, English As a Second Language (ESL) Services; Subchapter G, Other Employability Services; Subchapter H, Targeted Assistance Grant (TAG) Services; and Subchapter I, Unaccompanied Refugee Minor (URM) Program, deletes the rules because they are no longer necessary as HHSC no longer administers the federally funded refugee services and benefits in Texas.

The proposed amendment to §376.1001 deletes subsection (i) which no longer applies. The terms "C.F.R." and "refugee" are defined and minor non-substantive edits are made to correct formatting to align with HHSC rulemaking guidelines.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

(5) the proposed rules will not create a new regulation;

(6) the proposed rules will repeal existing regulations;

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

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these amended rule and repeals because the amended rule and repeals do not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Rob Ries, Deputy Executive Commissioner for Family Health Services, has determined that for each year of the first five years the amended rule and repeals are in effect, the public benefit will be removal of unnecessary rules from the Texas Administrative Code and updating a rule to improve clarity of rule requirements.

Trey Wood, Chief Financial Officer, has also determined that for the first five years the amended rule and repeals are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the amendments do not change any current requirements.

TAKINGS IMPACT ASSESSMENT

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

PUBLIC COMMENT

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

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 24R034" in the subject line.

SUBCHAPTER A. PURPOSE AND SCOPE

1 TAC §§376.101 - 376.104

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.101.What is the basis of this chapter?

§376.102.What is the purpose of this chapter?

§376.103.How are the terms in this chapter defined?

§376.104.Is the term "refugee" used throughout this chapter to designate all those eligible for refugee social services?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402962

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.201, 376.203, 376.205, 376.207, 376.209, 376.211, 376.213, 376.215, 376.217, 376.219, 376.221, 376.223, 376.225, 376.227, 376.229, 376.231, 376.233, 376.235, 376.237

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.201.What is the purpose of this subchapter?

§376.203.Who can apply for a refugee social services contract?

§376.205.How are refugee social services contracts awarded?

§376.207.What is the financial responsibility of the contractor's board of directors?

§376.209.What accounting requirements must the contractor meet?

§376.211.Does the Texas Department of Human Services (DHS) require contractors to have a fidelity bond?

§376.213.What are the confidentiality requirements of a contractor?

§376.215.Are contractors responsible for having a nepotism policy?

§376.217.Are contractors responsible for having a conflict of interest policy?

§376.219.What issues must the conflict of interest policy address?

§376.221.Are contractors required to comply with the Limited English Proficiency provisions of Title VI of the Civil Rights Act?

§376.223.With what Limited English Proficiency (LEP) provisions is a contractor required to comply?

§376.225.What are the staffing requirements for contractors?

§376.227.Are there requirements for hiring bilingual or bicultural women?

§376.229.What are the record keeping requirements of the contract?

§376.231.How long are contractors required to keep records?

§376.233.What are the reporting requirements for contractors?

§376.235.If a refugee is receiving services under another program funded by the Office of Refugee Resettlement, can similar services be provided under a contract funded by a Refugee Social Services Grant (RSS) or a Targeted Assistance Grant (TAG)?

§376.237.Can a contractor subcontract services?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402963

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.301, 376.303, 376.305, 376.307, 376.309, 376.311, 376.313, 376.315, 376.317, 376.319, 376.321, 376.323, 376.325, 376.327, 376.329, 376.331, 376.333

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.301.What is the purpose of this subchapter?

§376.303.What services may be provided to assist refugees with employability skills?

§376.305.Can additional services be provided?

§376.307.Who is eligible for refugee social services?

§376.309.Are individuals applying for asylum through the Immigration and Naturalization Service eligible for refugee social services assistance?

§376.311.Can refugees younger than 16 years of age receive refugee social services?

§376.313.Who determines a refugee's eligibility for refugee social services benefits?

§376.315.Are there equal opportunity requirements for refugee women?

§376.317.How long can a participant receive refugee social services?

§376.319.Can employability services be provided after a refugee finds a job?

§376.321.How does a contractor determine eligibility for a refugee who has moved to Texas from another state?

§376.323.Is coordination with other refugee providers required?

§376.325.Can participants who do not speak English participate in employment services?

§376.327.Are contractors required to report changes in a participant's income or address to the Texas Department of Human Services (DHS)?

§376.329.What information and materials must a contractor provide to the participant upon or during intake for services?

§376.331.Can an applicant or recipient appeal an adverse determination by a contractor?

§376.333.What should the contractor know about applicant or participant appeals?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402964

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.401, 376.403, 376.405, 376.407, 376.409, 376.411, 376.413, 376.415, 376.417, 376.419, 376.421, 376.423, 376.425, 376.427

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.401.What is the purpose of this subchapter?

§376.403.What criteria should be followed when providing refugee employment services?

§376.405.How are refugees prioritized for employment services under Refugee Social Services (RSS) grants?

§376.407.How must Refugee Social Services (RSS) employment services be designed?

§376.409.What types of services are appropriate employment services?

§376.411.Can a contractor consider participants as a family unit if they do not live together?

§376.413.If two or more unrelated participants live together, are they considered a family unit?

§376.415.Is a Family Self-Sufficiency Plan (FSSP) required for all employable participants?

§376.417.What does an Individual Employability Plan include and how is it developed?

§376.419.Are refugees required to accept job offers?

§376.421.What criteria must employment training services meet?

§376.423.Can employment training be provided beyond one year?

§376.425.Do participants in vocational employment training programs have to work while receiving training?

§376.427.Can a contractor enroll a refugee in a professional recertification program?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402965

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.501, 376.503, 376.505, 376.507, 376.509, 376.511, 376.513, 376.515, 376.517, 376.519

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.501.What is the purpose of this subchapter?

§376.503.What regulations govern the Refugee Cash Assistance (RCA) program?

§376.505.What are the employment requirements for participants in the Refugee Cash Assistance (RCA) program?

§376.507.Can an applicant for refugee cash assistance claim adverse effects of accepting employment?

§376.509.What are the employment requirements for Refugee Cash Assistance participants living outside of refugee resettlement areas?

§376.511.When must Refugee Cash Assistance (RCA) participants register for employment services?

§376.513.Do contractors need to schedule and provide services for Refugee Cash Assistance (RCA) recipients?

§376.515.What are the requirements for Refugee Cash Assistance (RCA) recipients who are employed fewer than 30 hours per week?

§376.517.Are there coordination requirements between employment services and Refugee Cash Assistance (RCA) providers?

§376.519.What procedures must a contractor follow when authorizing or denying an applicant benefits?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402966

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §376.601, §376.602

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.601.What is the purpose of this subchapter?

§376.602.Can English as a Second Language (ESL) be provided as a stand-alone service?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402967

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.701, 376.703, 376.705, 376.707, 376.709, 376.711, 376.713, 376.715, 376.717, 376.719, 376.721

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.701.What is the purpose of this subchapter?

§376.703.What other employability services may be provided under Refugee Social Services and Targeted Assistance grant-funded programs?

§376.705.What are outreach services?

§376.707.What are emergency services?

§376.709.What are health services?

§376.711.What are home management services?

§376.713.When can child day care services be provided?

§376.715.What standards must child day care meet?

§376.717.When can transportation services be provided?

§376.719.What are citizenship and naturalization services?

§376.721.Can immigration fee payments be made under Refugee Social Services (RSS) contracts?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402968

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.801 - 376.806

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.801.What is the purpose of this subchapter?

§376.802.What is a Targeted Assistance Grant (TAG)?

§376.803.Are Targeted Assistance Grant (TAG) programs subject to the same regulations as other Refugee Social Services (RSS) programs?

§376.804.What services are allowable under Targeted Assistance Grant (TAG) programs?

§376.805.Which refugee groups receive priority for services under Targeted Assistance Grant (TAG) programs?

§376.806.Can Targeted Assistance Grant (TAG) and Refugee Social Services (RSS) assistance be provided to a refugee at the same time?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402969

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §§376.901 - 376.907

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The repeals implement Texas Government Code §531.0055 and §531.0411.

§376.901.What is the purpose of this subchapter?

§376.902.Who provides care and services for unaccompanied refugee minors (URM)?

§376.903.What services are available to unaccompanied refugee minors?

§376.904.How long can an unaccompanied refugee minor (URM) receive services?

§376.905.How are services provided to unaccompanied refugee minors (URM) who move to or from another state?

§376.906.Are unaccompanied refugee minors (URM) eligible for adoption?

§376.907.How is adult legal responsibility for an unaccompanied refugee minor established?

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402970

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585

1 TAC §376.1001

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.0411, which requires the Executive Commissioner of HHSC to adopt rules regarding refugee resettlement.

The amendment implements Texas Government Code §531.0055 and §531.0411.

§376.1001.Local Governmental and Community Input.

(a) For purposes of this subchapter, the following definitions apply. [:]

(1) Business day--A day that is not a Saturday, Sunday, or federal legal holiday. In computing a period of business days, the first day is excluded and the last day is included. If the last day of any period is a Saturday, Sunday, or federal legal holiday, the period is extended to include the next day that is not a Saturday, Sunday, or federal legal holiday.

(2) C.F.R.--Code of Federal Regulations.

(3) [(2)] HHSC--Texas Health and Human Services Commission, or its designee.

(4) [(3)] Local resettlement agency--As defined by 45 C.F.R. §400.2, means a local affiliate or subcontractor of a national voluntary agency that has entered into a grant, contract, or cooperative agreement with the United States Department of State or other appropriate federal agency to provide for the reception and initial placement of refugees in the United States.

(5) [(4)] National voluntary agency--As defined by 45 C.F.R. §400.2, means one of the national resettlement agencies or a state or local government that has entered into a grant, contract, or cooperative agreement with the United States Department of State or other appropriate federal agency to provide for the reception and initial placement of refugees in the United States.

(6) Refugee--An individual admitted to the United States under section 207 of the Immigration and Nationality Act.

(b) A local resettlement agency must convene meetings at least quarterly at which representatives of the local resettlement agency have an opportunity to consult with and obtain feedback regarding proposed refugee placement from, at a minimum:

(1) local governmental entities and officials, including:

(A) municipal and county officials;

(B) local school district officials; and

(C) representatives of local law enforcement agencies; and

(2) community stakeholders, including:

(A) major providers under the local health care system; and

(B) major employers of refugees.

(c) In addition to the quarterly meetings held under subsection (b) of this section, local governmental entities and community stakeholders may request to meet with a local resettlement agency regarding refugee placement.

(1) A local resettlement agency must respond within 10 [ten] business days to a request from a local governmental entity or community stakeholder to meet.

(2) If a request for a meeting is denied, the response must be in writing and the reason for denial must be clearly stated.

(3) A copy of the denial must be submitted to HHSC by the local resettlement agency no later than three business days after it is sent to the local governmental entity or community stakeholder.

(d) To facilitate consultation and effective feedback, local governmental entities and community stakeholders may request information from a local resettlement agency related to the resettlement process.

(1) A local resettlement agency must respond within 10 [ten] business days as to whether a request for information from a local governmental entity or community stakeholder will be granted.

(2) If the request is granted, the local resettlement agency must provide the requested information no later than 20 [twenty] business days from the date of the receipt of the request, to the extent not otherwise prohibited by state or federal law.

(3) If a request for information is denied, the response must be in writing and the reason for denial must be clearly stated.

(4) A copy of the denial must be submitted to HHSC by the local resettlement agency no later than three business days after it is sent to the local governmental entity or community stakeholder.

(e) A local resettlement agency must consider all feedback obtained in community consultation meetings under subsections (b) and (c) of this section in reporting annual refugee placement information to the local refugee resettlement agency's national voluntary agency for purposes of 8 United States Code (U.S.C.) §1522(b)(7)(E) [8 U.S.C. Section 1522(b)(7)(E)].

(f) A local resettlement agency must provide HHSC, local governmental entities and officials, and community stakeholders described under subsection (b) of this section a copy of proposed annual refugee placement data for purposes of 8 U.S.C. §1522(b)(7)(E) [8 U.S.C. Section 1522(b)(7)(E)].

(g) A local resettlement agency must develop and submit a final annual report to the local refugee resettlement agency's national voluntary agency and for HHSC that includes a summary regarding how community stakeholder input contributed to the development of an annual refugee placement report for purposes of 8 U.S.C. §1522(b)(7)(E) [8 U.S.C. Section 1522(b)(7)(E)].

(h) A local resettlement agency must provide HHSC with the preliminary number of refugees the local resettlement agencies recommend to the national voluntary agencies for placement throughout the State of Texas.

[(i) In addition to applicable requirements specified in Subchapter B of this chapter (relating to Contractor Requirements), a contract with a local resettlement agency to provide Refugee Social Services must comply with the requirements of this subchapter.]

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

Filed with the Office of the Secretary of State on July 8, 2024.

TRD-202402971

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: August 18, 2024

For further information, please call: (737) 867-7585