TITLE 1. ADMINISTRATION

DIVISION 1. COMMITTEES

1 TAC §§351.805, 351.821, 351.823, 351.825, 351.827

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §351.805, concerning State Medicaid Managed Care Advisory Committee; §351.821, concerning Value-Based Payment and Quality Improvement Advisory Committee; §351.823, concerning e-Health Advisory Committee; §351.825, concerning Texas Brain Injury Advisory Council; and §351.827, concerning Palliative Care Interdisciplinary Advisory Council.

BACKGROUND AND PURPOSE

The proposal is necessary to align the rules with statute and Executive Order No. GA-55 issued January 31, 2025.

The proposal also replaces citations to Texas Government Code §531.012 with §523.0201 and §523.0203 in §§351.805, 351.821, 351.823, and 351.825 to comply with House Bill 4611, 88th Legislature, Regular Session, 2023. House Bill 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature's ongoing statutory revision program. The new Texas Government Code sections became effective April 1, 2025.

Additionally, the proposal amends §351.823 to extend the e-Health Advisory Committee (e-HAC) abolition date from December 31, 2025, to December 31, 2027. HHSC conducted an internal evaluation of e-HAC, including review of implementation of its recommendations to the agency, public and committee member participation at open meetings, and committee input to the agency regarding policy development and legislative implementation. In alignment with HHSC's strategic goals and objectives, HHSC proposes extending the committee for two years.

The proposal also includes edits that align the rules with the current HHSC advisory committee rule template.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §351.805 revises language to align the rule with statute and Executive Order No. GA-55 issued January 31, 2025. The amendment also includes edits to align the rule with the current HHSC advisory committee rule template.

The proposed amendment to §351.821 updates citations to Texas Government Code and revises language to align the rule with statute and Executive Order No. GA-55 issued January 31, 2025. The amendment also includes edits to align the rule with the current HHSC advisory committee rule template.

The proposed amendment to §351.823 updates citations to Texas Government Code and revises language to align the rule with statute and Executive Order No. GA-55 issued January 31, 2025, and extends the abolition date of the e-Health Advisory Committee to December 31, 2027. The amendment also includes edits to align the rule with the current HHSC advisory committee rule template.

The proposed amendment to §351.825 updates citations to Texas Government Code and revises the language to align the rule with statute and Executive Order No. GA-55 issued January 31, 2025. The amendment also includes edits to align the rule with the current HHSC advisory committee rule template.

The proposed amendment to §351.827 updates citations to Texas Government Code and revises the language to align the rule with statute and Executive Order No. GA-55 issued January 31, 2025. The amendment also includes edits to align the rule with the current HHSC advisory committee rule template.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rules will expand and 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 has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rules do not apply to small or micro-businesses, or rural communities.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

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

PUBLIC BENEFIT AND COSTS

Libby Elliott, Deputy Executive Commissioner, Office of Policy and Rules, has determined that for each year of the first five years the rules are in effect, the public benefit will be that the rules align with statute and Executive Order No. GA-55 issued January 31, 2025 and accurately cites the laws governing HHSC, Medicaid, and other social services. Also, the extension of the e-Health Advisory Committee will benefit the public as the committee will continue to advise Health and Human Services.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules apply 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 Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 21 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 faxing or emailing comments, please indicate "Comments on Proposed Rule 25R024" in the subject line.

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §523.0201 and §523.0203, which authorizes the executive commissioner to establish advisory committees by rule.

The amendments affect Texas Government Code §524.0151, §523.0201, and §523.0203.

§ 351.805. State Medicaid Managed Care Advisory Committee.

(a) Statutory authority. The State Medicaid Managed Care Advisory Committee (SMMCAC) is established under Texas Government Code §523.0201 and §523.0203. The SMMCAC is subject to §351.801 of this division (relating to Authority and General Provisions).

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

(1) program design and benefits;

(2) systemic concerns from consumers and providers;

(3) efficiency and quality of services;

(4) contract requirements;

(5) provider network adequacy;

(6) trends in claims processing; and

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

(c) Tasks. The SMMCAC performs the following tasks:

(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. No later than December 31st of each year, the SMMCAC files an annual written report with the [ HHSC ] executive commissioner covering 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 SMMCAC;

(D) a description of how the SMMCAC accomplished its tasks;

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

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

(G) recommended amendments to this section; and

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

(e) Meetings.

(1) Open meetings. The SMMCAC complies with the requirements for open meetings under Texas Government Code Chapter 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. In selecting members to serve on the SMMCAC, HHSC [ : ]

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

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

(2) 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 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) 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) of this subparagraph;

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

(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

(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;

(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) obstetrical care providers;

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

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

(ix) non-physician mental health providers;

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

(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) national plans;

(ii) community-based plans; and

(iii) 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 two consecutive terms as chair or vice chair.

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

(1) this section;

(2) §351.801 of this division;

(3) Texas Government Code Chapter 523, Subchapter E [ §523.0201 ];

(4) Texas Government Code Chapters 551, 552, and 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) Date of abolition. The SMMCAC is abolished, and this section expires, on December 31, 2028.

§ 351.821. Value-Based Payment and Quality Improvement Advisory Committee.

(a) Statutory authority. The Value-Based Payment and Quality Improvement Advisory Committee (VBPQIAC) is established under Texas Government Code §523.0201 and §523.0203. The VBPQIAC [ §531.012 and ] is subject to §351.801 of this division (relating to Authority and General Provisions).

(b) Purpose. The VBPQIAC advises the executive commissioner [ Texas Health and Human Services (HHSC) Executive Commissioner ] and Health and Human Services system agencies (HHS agencies) on quality improvement and value-based payment initiatives for Medicaid, other publicly funded health services, and the wider health care system.

(c) Tasks. The VBPQIAC performs the following tasks:

(1) studies and makes recommendations regarding:

(A) value-based payment and quality improvement initiatives to promote better care, better outcomes, and lower costs for publicly funded health care services;

(B) core metrics and a data analytics framework to support value-based purchasing and quality improvement in Medicaid and CHIP;

(C) HHSC and managed care organization incentive and disincentive programs based on value; and

(D) the strategic direction for Medicaid and CHIP value-based programs; and

(2) adopts bylaws to guide the operation of the committee; and

(3) pursues other deliverables consistent with its purpose to improve quality and efficiency in state health care services as requested by the executive commissioner [ HHSC Executive Commissioner ] or adopted into the work plan or bylaws of the committee.

(d) Reporting Requirements.

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

(A) a list of the meeting dates;

(B) the members' attendance records;

(C) a brief description of the actions taken by the VBPQIAC;

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

(E) a description of the activities the VBPQIAC anticipates undertaking in the next year;

(F) recommended amendments to this section; and

(G) the costs related to the VBPQIAC, including the cost of HHSC staff time spent supporting the VBPQIAC's activities and the source of funds used to support the VBPQIAC's activities.

(2) No later than December 1st of each even-numbered year, the VBPQIAC submits a written report to the executive commissioner [ HHSC Executive Commissioner ] and Texas Legislature that:

(A) describes current trends and identifies best practices in health care for value-based payment and quality improvement; and

(B) provides recommendations consistent with the purposes of the VBPQIAC.

(e) Meetings.

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

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

(3) Quorum. A majority of members constitutes a quorum for the purpose of transacting official business. [ (To calculate a majority for a committee with an even number of members, divide the membership by two and add one; for a committee with an odd number of members, divide the membership by two and round up to the next whole number.) ]

(f) Membership.

(1) The VBPQIAC is composed of 19 voting members and up to four non-voting ex officio members appointed by the executive commissioner [ HHSC Executive Commissioner ]. In selecting members to serve on the VBPQIAC, HHSC considers the applicants' qualifications, background, [ and ] interest in serving , and geographic location .

(A) The 19 voting members represent the following categories:

(i) Medicaid managed care organizations;

(ii) hospitals;

(iii) physicians;

(iv) nurses;

(v) pharmacies;

(vi) providers of long-term services and supports;

(vii) academic systems; and

(viii) other disciplines or organizations with expertise in health care finance, delivery, or quality improvement.

(B) Four non-voting, ex officio members may be appointed to the VBPQIAC as determined by the executive commissioner [ HHSC Executive Commissioner ].

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

(2) [ (3) ] Members are appointed for staggered terms so that the terms of an equal or almost equal number of members 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.

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

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

(C) This subsection does not apply to ex officio members, who serve at the pleasure of the executive commissioner [ HHSC Executive Commissioner ] and do not have the authority to vote on items before the full committee.

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

(1) The chair serves until December 31 of each odd-numbered year. The vice chair serves until December 31 of each even-numbered year.

(2) A member may serve up to two consecutive terms as chair or vice chair.

[(3) A member is not eligible to serve in the role of chair or vice chair once another person has been appointed to fill the member's position on the VBPQIAC.]

(h) Required Training. Each member must complete training on relevant statutes and rules, including this section, §351.801 of this division, Texas Government Code Chapter 523, Subchapter E [ §531.012 ], Texas Government Code Chapters 551, 552, and 2110, the HHS Ethics Policy, the Advisory Committee Member Code of Conduct, and other relevant HHS policies. Training will be provided by HHSC.

(i) Travel Reimbursement. Unless permitted by the current General Appropriations Act, members of the VBPQIAC are not paid to participate in the VBPQIAC nor reimbursed for travel to and from meetings.

(j) Date of abolition. The VBPQIAC is abolished and this section expires on December 31, 2027.

§ 351.823. e-Health Advisory Committee.

(a) Statutory authority. The e-Health Advisory Committee (committee) is established under Texas Government Code §523.0201 and §523.0203. The committee [ §531.012 and ] is subject to §351.801 of this division (relating to Authority and General Provisions).

(b) Purpose. The committee advises the executive commissioner [ Texas Health and Human Services Commission (HHSC) Executive Commissioner ] and Health and Human Services system agencies (HHS agencies) on strategic planning, policy, rules, and services related to the use of health information technology, health information exchange systems, telemedicine, telehealth, and home telemonitoring services.

(c) Tasks. The committee performs the following tasks :

(1) advises HHS agencies on the development, implementation, and long-range plans for health care information technology and health information exchange, including the use of electronic health records, computerized clinical support systems, health information exchange systems for exchanging clinical and other types of health information, and other methods of incorporating health information technology in pursuit of greater cost-effectiveness and better patient outcomes in health care and population health;

(2) advises HHS agencies on incentives for increasing health care provider adoption and usage of an electronic health record and health information exchange systems;

(3) advises HHS agencies on the development, use, and long-range plans for telemedicine, telehealth, and home telemonitoring services, including consultations, reimbursements, and new benefits for inclusion in Medicaid telemedicine, telehealth, and home telemonitoring programs;

(4) makes recommendations to HHS agencies through regularly scheduled meetings and verbal or written recommendations communicated to HHSC staff assigned to the committee;

(5) performs other tasks consistent with its purpose as requested by the executive commissioner [ Executive Commissioner ]; and

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

(d) Reporting Requirements.

(1) By [ No later than ] December 1 of each even-numbered year, the committee files a written report with the executive commissioner [ HHSC Executive Commissioner ] and the Texas Legislature covering the meetings and activities not covered in its most recent report filed with the executive commissioner [ HHSC Executive Commissioner ] and Texas Legislature through September 30 of the even-numbered year the report is due to be filed. The report includes:

(A) a list of the meeting dates;

(B) the members' attendance records;

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

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

(E) a summary of the status of any rules that the committee recommended to HHSC;

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

(G) recommended amendments to this section;

(H) any policy recommendations; and

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

(2) By [ No later than ] December 1 of each odd-numbered year, the committee submits to the executive commissioner [ HHSC Executive Commissioner ] an informational briefing memorandum describing the committee's costs, accomplishments, and areas of focus that covers October 1 of the preceding year through September 30 of the odd- numbered year the informational briefing memorandum is due to be filed.

(e) Meetings.

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

(2) Frequency. The committee will meet at least three times a year at the call of the presiding officer.

(3) Quorum. A majority of members constitutes a quorum.

(f) Membership.

(1) The committee is composed of no more than 24 members appointed by the executive commissioner [ HHSC Executive Commissioner ]. In selecting voting members to serve on the committee, HHSC considers the applicants' qualifications, background, [ and ] interest in serving , and geographic location .

(2) The committee includes representatives of HHS agencies, other state agencies, and other health and human services stakeholders concerned with the use of health information technology, health information exchange systems, telemedicine, telehealth, and home telemonitoring services. The committee comprises the following voting and non-voting ex officio members:

(A) Voting members representing the following categories:

(i) at least one representative from the Texas Medical Board;

(ii) at least one representative from the Texas Board of Nursing;

(iii) at least one representative from the Texas State Board of Pharmacy;

(iv) at least one representative from the Statewide Health Coordinating Council;

(v) at least one representative of a managed care organization;

(vi) at least one representative of the pharmaceutical industry;

(vii) at least one representative of a health science center in Texas;

(viii) at least one expert on telemedicine;

(ix) at least one expert on home telemonitoring services;

(x) at least one representative of consumers of health services provided through telemedicine;

(xi) at least one Medicaid provider or child health plan program provider;

(xii) at least one representative from the Texas Health Services Authority established under Texas Health and Safety Code Chapter 182;

(xiii) at least one representative of a local or regional health information exchange; and

(xiv) at least one representative with expertise related to the implementation of electronic health records, computerized clinical support systems, and health information exchange systems for exchanging clinical and other types of health information.

(B) At least three non-voting [ Non-voting ] ex officio members representing the following categories:

(i) at least two non-voting ex officio representatives from HHSC; and

(ii) at least one non-voting ex officio representative from the Texas Department of State Health Services.

(3) When appointing members, the executive commissioner [ HHSC Executive Commissioner ] considers the [ cultural, ethnic, and ] geographic diversity of Texas, including representation from at least 6 of the 11 Public Health Regions as defined by the Texas Department of State Health Services in accordance with Texas Health and Safety Code §121.007.

(4) Members are appointed for staggered terms so that the terms of half of the members expire on December 31 [ 31st ] of each year. Regardless of the term limit, a member serves until the member's replacement has been appointed. This ensures sufficient, appropriate representation.

(A) If a vacancy occurs, the executive commissioner [ HHSC Executive Commissioner ] appoints 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 two years. A member may apply to serve one additional [ and be appointed for a second ] two-year term [ , which may be served consecutively or nonconsecutively ].

(C) This subsection [ section ] does not apply to non-voting ex officio members, who serve at the pleasure of the executive commissioner and do not have the authority to vote on items before the full committee [ HHSC Executive Commissioner ].

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

(1) The chair [ presiding officer ] serves until July 1st of each even-numbered year. The vice-chair [ assistant presiding officer ] serves until July 1 of each odd-numbered year.

(2) A member may serve up to two consecutive terms as chair [ presiding officer ] or vice-chair [ assistant presiding officer ].

[(3) A member whose term has expired is not eligible to serve in the officer role of chair or vice chair once another person has been appointed to fill the member's position on the committee.]

(h) Required Training. Each member must complete training on relevant statutes and rules, including this section; §351.801 of this subchapter; Texas Government Code Chapter 523, Subchapter E [ §531.012 ]; Texas Government Code Chapters 551, 552, and 2110; the HHS Ethics Policy ; [ , ] the Advisory Committee Member Code of Conduct; and other relevant HHS policies. Training will be provided by HHSC.

(i) Travel Reimbursement. Unless permitted by the current General Appropriations Act, members of the committee are not paid to participate in the committee nor reimbursed for travel to and from meetings.

(j) Date of abolition. The committee is abolished and this section expires on December 31, 2027 [ 2025 ].

§ 351.825. Texas Brain Injury Advisory Council.

(a) Statutory authority. The Texas Brain Injury Advisory Council (TBIAC) is established under Texas Government Code §523.0201 and §523.0203. The TBIAC [ §531.012 and ] is subject to §351.801 of this division (relating to Authority and General Provisions).

(b) Purpose. The TBIAC advises the executive commissioner [ Texas Health and Human Services Commission (HHSC) Executive Commissioner ] and the Health and Human Services system on strategic planning, policy, rules, and services related to the prevention of brain injury; rehabilitation; and the provision of long-term services and supports for persons who have survived brain injuries to improve their quality of life and ability to function independently in the home and community.

(c) Tasks. The TBIAC performs the following tasks:

(1) informs state leadership of the needs of persons who have survived a brain injury and their families regarding rehabilitation and the provision of long-term services and supports to improve health and functioning that leads to achieving maximum independence in home and community living and participation;

(2) encourages research into the causes and effects of brain injuries as well as promising and best practice approaches for prevention, early intervention, treatment and care of brain injuries and the provision of long-term services and supports;

(3) recommends policies that facilitate the implementation of the most current promising and evidence-based practices for the care, rehabilitation, and the provision of long-term services and supports to persons who have survived a brain injury;

(4) promotes brain injury awareness, education, and implementation of health promotion and prevention strategies across Texas;

(5) facilitates the development of partnerships among diverse public and private provider and consumer stakeholder groups to develop and implement sustainable service and support strategies that meet the complex needs of persons who have survived a brain injury and those experiencing co-occurring conditions; and

(6) adopts bylaws to guide the operation of the TBIAC.

(d) Reporting requirements.

(1) Reporting to the executive commissioner [ HHSC Executive Commissioner ]. By November 1 of each year, the TBIAC files an annual written report with the executive commissioner [ HHSC Executive Commissioner ] covering the meetings and activities in the immediately preceding fiscal year and reports any recommendations to the executive commissioner [ HHSC Executive Commissioner ] at a meeting of the Texas Health and Human Services Commission Executive Council. The report includes:

(A) a list of the meeting dates;

(B) the members' attendance records;

(C) a brief description of actions taken by the TBIAC;

(D) a description of how the TBIAC accomplished its tasks;

(E) a description of activities the TBIAC anticipates undertaking in the next fiscal year;

(F) recommendations made by the TBIAC, if any;

(G) recommended amendments to this section; and

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

(2) Reporting to Texas Legislature. The TBIAC shall submit a written report to the Texas Legislature of any policy recommendations made to the executive commissioner [ HHSC Executive Commissioner ] by December 1 of each even-numbered year.

(e) Meetings.

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

(2) Frequency. The TBIAC will meet quarterly.

(3) Quorum. Eight members constitute a quorum.

(f) Membership.

(1) The TBIAC is composed of 15 members appointed by the executive commissioner [ HHSC Executive Commissioner ] representing the categories below. In selecting members to serve on the TBIAC, HHSC considers the applicants' qualifications, background, geographic location, and interest in serving.

(A) One representative from acute hospital trauma units.

(B) One representative from post-acute rehabilitation facilities.

(C) One representative of a long-term care facility that serves persons who have survived a brain injury.

(D) One healthcare practitioner or service provider who has specialized training or interest in the prevention of brain injuries or the care, treatment, and rehabilitation of persons who have survived a brain injury.

(E) One representative of an institution of higher education engaged in research that impacts persons who have survived a brain injury.

(F) Five persons who have survived a brain injury representing [ diverse ethnic or cultural groups and ] geographic regions of Texas, with:

(i) at least one of these being a transition age youth (age 18-26);

(ii) at least one of these being a person who has survived a traumatic brain injury; and

(iii) at least one of these being a person who has survived a non-traumatic brain injury.

(G) Four family members actively involved in the care of loved ones who have sustained a brain injury, with:

(i) at least one of these being a person whose loved one has survived a traumatic brain injury; and

(ii) at least one of these being a person whose loved one has survived a non- traumatic brain injury.

(H) One representative from the stroke committee of the Governor's Emergency Medical Services (EMS) & Trauma Advisory Council or other stakeholder group with a focus on stroke.

(2) Members are appointed for staggered terms so that the terms of five, or almost five, members 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.

(A) If a vacancy occurs, the executive commissioner [ 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 TBIAC selects a chair and vice chair of the TBIAC from among its members. The chair or the vice chair must be a person who has survived a brain injury or a family member actively involved in the care of a loved one who has survived a brain injury.

(1) The chair serves until December 31 of each even-numbered year. The vice chair serves until December 31 of each odd-numbered year.

(2) A member may serve up to two consecutive terms as chair or vice chair.

(h) Required Training. Each member must complete training on relevant statutes and rules, including this section and §351.801 of this division; Texas Government Code Chapter 523, Subchapter E; [ §531.012, ] Chapters 551, 552, and 2110; the HHS Ethics Policy; the Advisory Committee Member Code of Conduct; and other relevant HHS policies. Training will be provided by HHSC.

(i) Travel Reimbursement. To the extent permitted by the current General Appropriations Act, a member of the TBIAC may be reimbursed for their travel to and from meetings if funds are appropriated and available and in accordance with the HHSC Travel Policy.

(j) Date of abolition. The TBIAC is abolished and this section expires on July 1, 2028, in compliance with Texas Government Code §2110.008(b).

§ 351.827. Palliative Care Interdisciplinary Advisory Council.

(a) Statutory authority. The Palliative Care Interdisciplinary Advisory Council (Council) is established in accordance with Texas Health and Safety Code Chapter 118.

(b) Purpose. The Council assesses the availability of patient-centered and family- focused, interdisciplinary team-based palliative care in Texas for patients and families facing serious illness. The Council works to ensure that relevant, comprehensive, and accurate information and education about palliative care is available to the public, health care providers, and health care facilities. This includes information and education about complex symptom management, care planning, and coordination needed to address the physical, emotional, social, and spiritual suffering associated with serious illness.

(c) Tasks. The Council performs the following tasks:

(1) consults with and advises HHSC on matters related to the establishment, maintenance, operation, and outcome evaluation of the palliative care consumer and professional information and education program established under Texas Health and Safety Code §118.011;

(2) studies and makes recommendations to remove barriers to appropriate palliative care services for patients and families facing serious illness in Texas of any age and at any stage of illness; [ and ]

(3) pursues other deliverables consistent with its purpose as requested by the executive commissioner [ Executive Commissioner ] or adopted into the work plan or bylaws of the council ; and [ . ]

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

(d) Reporting requirements.

(1) Reporting to executive commissioner [ Executive Commissioner ]. By December 31 of each year, the Council files a written report with the executive commissioner [ Executive Commissioner ] 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 committee;

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

(E) a summary of the status of any rules that the committee recommended to HHSC;

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

(G) recommended amendments to this section; and

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

(2) Reporting to executive commissioner [ Executive Commissioner ] and Texas Legislature. By October 1 of each even-numbered year, the Council submits a written report to the executive commissioner [ Executive Commissioner ] and the standing committees of the Texas senate and house with primary jurisdiction over health matters. The report:

(A) assesses the availability of palliative care in Texas for patients in the early stages of serious disease;

(B) analyzes barriers to greater access to palliative care;

(C) analyzes policies, practices, and protocols in Texas concerning patients' rights related to palliative care, including:

(i) whether a palliative care team member may introduce palliative care options to a patient without the consent of the patient's attending physician or practitioner;

(ii) the practices and protocols for discussions between a palliative care team member and a patient on life-sustaining treatment or advance directives decisions; and

(iii) the practices and protocols on informed consent and disclosure requirements for palliative care services; and

(D) provides recommendations consistent with the purposes of the Council.

(e) Open meetings. The Council complies with the requirements for open meetings under Texas Government Code Chapter 551 as if it were a governmental body.

(f) Membership.

(1) The Council is composed of at least 15 voting members appointed by the executive commissioner [ Executive Commissioner ] and nonvoting agency, ex officio representatives as determined by the executive commissioner [ Executive Commissioner ]. Total membership on the Council will not exceed 24.

(2) Voting membership.

(A) The Council must include:

(i) at least five physician members, including:

(I) two who are board certified in hospice and palliative care; and

(II) one who is board certified in pain management;

(ii) three palliative care practitioner members, including:

(I) two advanced practice registered nurses who are board-certified in hospice and palliative care; and

(II) one physician assistant who has experience providing palliative care;

(iii) four health care professional members, including:

(I) a nurse;

(II) a social worker;

(III) a pharmacist; and

(IV) a spiritual-care professional; and

(iv) at least three members:

(I) with experience as an advocate for patients and the patients' family caregivers;

(II) who are independent of a hospital or other health care facility; and

(III) at least one of whom represents an established patient advocacy organization.

(B) Health care professional members listed in subparagraph (A)(iii) of this paragraph must meet one or more of the following qualifications:

(i) experience providing palliative care to pediatric, youth, or adult populations;

(ii) expertise in palliative care delivery in an inpatient, outpatient, or community setting; or

(iii) expertise in interdisciplinary palliative care.

(C) In selecting voting members, the executive commissioner [ Executive Commissioner ] considers [ ethnic and minority representation and ] geographic representation.

(D) Members are appointed to staggered terms so that the terms of approximately one-quarter of the members' terms expire on December 31 of each year.

(E) Except as necessary to stagger terms, the term of each voting member is four years.

(g) Officers. The Council selects from its members a presiding officer and an assistant presiding officer.

[(1)] 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.

[(2) The presiding officer and the assistant presiding officer remain in their positions until the Council selects a successor; however, the individual may not remain in office past the individual's membership term.]

(h) Required Training. Each member 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) ; Texas Health and Safety Code Chapter 118; [ 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 may be reimbursed for their travel to and from meetings if funds are appropriated and available and in accordance with the HHSC Travel Policy.

(j) [ (i) ] Date of abolition [ Abolition. ] The Council is required by statute and will continue as long as the state law that requires it remains in effect.

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 May 21, 2025.

TRD-202501742

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: July 6, 2025

For further information, please call: (512) 221-9021

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