TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 550. LICENSING STANDARDS FOR PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §§550.1, 550.5, 550.101 - 550.106, 550.108 - 550.115, 550.118 - 550.123, 550.202, 550.203, 550.205 - 550.207, 550.210, 550.211, 550.301, 550.303 - 550.306, 550.308 - 550.311, 550.402 - 550.406, 550.409 - 550.411, 550.413, 550.415, 550.417, 550.418, 550.504, 550.506 - 550.508, 550.510, 550.511, 550.601 - 550.608, 550.701, 550.703, 550.705, 550.707, 550.802, 550.803, 550.901 - 550.906, 550.1001 - 550.1003, 550.1101, 550.1102, 550.1202 - 550.1204, 550.1206, 550.1207, 550.1211, 550.1215, 550.1217 - 550.1220, 550.1222, 550.1224, 550.1301 - 550.1305, and 550.1401 - 550.1408.

The amendments to §§550.1, 550.5, 550.101 - 550.106, 550.108 - 550.115, 550.118 - 550.123, 550.202, 550.203, 550.205 - 550.207, 550.210, 550.211, 550.301, 550.303 - 550.306, 550.308 - 550.311, 550.402 - 550.406, 550.409 - 550.411, 550.413, 550.415, 550.417, 550.418, 550.504, 550.506 - 550.508, 550.510, 550.511, 550.601 - 550.608, 550.701, 550.703, 550.705, 550.707, 550.802, 550.803, 550.901 - 550.906, 550.1001 - 550.1003, 550.1101, 550.1102, 550.1202 - 550.1204, 550.1206, 550.1207, 550.1211, 550.1215, 550.1217 - 550.1220, 550.1222, 550.1224, 550.1301 - 550.1305, and 550.1401 - 550.1408 are adopted without changes to the proposed text as published in the June 14, 2024, issue of the Texas Register (49 TexReg 4357). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to comply with House Bill (H.B.) 1009 and H.B. 3550 from the 88th Legislature, Regular Session, 2023, that apply to Prescribed Pediatric Extended Care Centers (PPECC). H.B. 1009 requires a facility to suspend an employee who has been found by HHSC to have engaged in reportable conduct for purposes of inclusion on the Employee Misconduct Registry during any appeals. H.B. 3550 establishes minimum standards for transportation services whereby a center coordinates the schedule of transportation services with a minor's parent, guardian, or other legally authorized representative; determines what type of provider needs to be present during transportation; and permits a minor's parent, guardian, or other legally authorized representative to decline a center's transportation services entirely or only on a specific date. The rules also set forth that a center may not require a plan of care or physician's order to document a minor's need for transportation services to access PPECC services or consider transportation services as nursing services in a minor's plan of care. The amendments also update terminology and references throughout the chapter and reflect current processes.

COMMENTS

The 31-day comment period ended July 15, 2024.

During this period, HHSC received two comments regarding the proposed rules from two commenters, Earth Angels Pediatric Day Center and one individual. A summary of comments relating to the rules and HHSC's responses follows.

Comment: One commenter expressed full agreement with the amended rules.

Response: HHSC appreciates the support of the rules.

Comment: One commenter suggested an amendment to §550.418 to allow providers to place employees in temporary roles rather than suspend them, or to pay employees while they are on suspension during the appeals process when HHSC makes a referral to the Employee Misconduct Registry. The commenter also suggested clearing the suspension from the employee's personnel record if the employee wins on appeal.

Response: HHSC declines to make the suggested change. HHSC Long-term Care regulations do not address employee assignments or pay. Also, the rule reflects the language used in H.B. 1009 from current Texas Health and Safety Code §253.0025. Section 253.0025 requires the PPECC to suspend the employment of the employee HHSC finds engaged in reportable conduct throughout any applicable appeals process.

SUBCHAPTER A. PURPOSE, SCOPE, LIMITATIONS, COMPLIANCE, AND DEFINITIONS

26 TAC §550.1, §550.5

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404336

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


SUBCHAPTER B. LICENSING APPLICATION, MAINTENANCE, AND FEES

26 TAC §§550.101 - 550.106, 550.108 - 550.115, 550.118 - 550.123

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404339

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


SUBCHAPTER C. GENERAL PROVISIONS

DIVISION 1. OPERATIONS AND SAFETY PROVISIONS

26 TAC §§550.202, 550.203, 550.205 - 550.207, 550.210, 550.211

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404345

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 2. ADMINISTRATION AND MANAGEMENT

26 TAC §§550.301, 550.303 - 550.306, 550.308 - 550.311

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404348

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 3. NURSING AND STAFFING REQUIREMENTS

26 TAC §§550.402 - 550.406, 550.409 - 550.411, 550.413, 550.415, 550.417, 550.418

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404350

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 4. GENERAL SERVICES

26 TAC §§550.504, 550.506 - 550.508, 550.510, 550.511

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404353

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 5. ADMISSION CRITERIA, CONFERENCE, ASSESSMENT, INTERDISCIPLINARY PLAN OF CARE, AND DISCHARGE OR TRANSFER

26 TAC §§550.601 - 550.608

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404357

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 6. PHYSICIAN, PHARMACY, MEDICATION, AND LABORATORY SERVICES

26 TAC §§550.701, 550.703, 550.705, 550.707

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404358

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 7. CARE POLICIES, COORDINATION OF SERVICES, AND CENSUS

26 TAC §550.802, §550.803

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404359

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 8. RIGHTS AND RESPONSIBILITIES, ADVANCE DIRECTIVES, ABUSE, NEGLECT, AND EXPLOITATION, INVESTIGATIONS, DEATH REPORTING, AND INSPECTION RESULTS

26 TAC §§550.901 - 550.906

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404360

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


DIVISION 9. MEDICAL RECORDS, QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT, DISSOLUTION AND RETENTION OF RECORDS

26 TAC §§550.1001 - 550.1003

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404361

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


SUBCHAPTER D. TRANSPORTATION

26 TAC §550.1101, §550.1102

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404362

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


SUBCHAPTER E. BUILDING REQUIREMENTS

26 TAC §§550.1202 - 550.1204, 550.1206, 550.1207, 550.1211, 550.1215, 550.1217 - 550.1220, 550.1222, 550.1224

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404363

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


SUBCHAPTER F. INSPECTIONS AND VISITS

26 TAC §§550.1301 - 550.1305

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404366

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161


SUBCHAPTER G. ENFORCEMENT

26 TAC §§550.1401 - 550.1408

STATUTORY AUTHORITY

The amendments 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 Health and Safety Code §248A.101, which provides that the Executive Commissioner of HHSC shall adopt rules necessary to implement Chapter 248A, including for prescribing minimum standards to protect the health and safety of the public and to ensure the health, safety, and comfort of minors being served in PPECCs.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 9, 2024.

TRD-202404364

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 16, 2024

Proposal publication date: June 14, 2024

For further information, please call: (512) 438-3161