TITLE 26. HEALTH AND HUMAN SERVICES
PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM
SUBCHAPTER
C.
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §306.101, concerning Purpose; §306.103, concerning Application; §306.105, concerning Definitions; §306.107, concerning Certification Eligibility; §306.109, concerning Application Process; and §306.111, concerning Certification Standards.
Section 306.105 and §306.107 are adopted with changes to the proposed text as published in the November 28, 2025, issue of the Texas Register (50 TexReg 7691). These rules will be republished.
Sections 306.101, 306.103, 306.109, and 306.111 are adopted without changes to the proposed text as published in the November 28, 2025, issue of the Texas Register (50 TexReg 7691). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to add definitions for terms used in the subchapter and provide further clarification for certification requirements for Texas Certified Community Behavioral Health Clinics (T-CCBHCs).
COMMENTS
The 31-day comment period ended December 29, 2025.
During this period, HHSC received comments regarding the proposed rules from four commenters. HHSC received comments from the Texas Counseling Association, the Texas Association of Community Health Centers, and a joint submission from the Texas Nurse Practitioners and the Texas Academy of Physician Assistants. A summary of comments relating to the rules and HHSC's responses follows.
Comment: Multiple commenters suggested that the terminology used in §306.105(10)(A), "medication management and physician evaluation and treatment services," included in the definition of outpatient mental health services in §306.105, be amended to ensure that nurse practitioners and physician assistants, who are authorized to prescribe medication under their scope of practice, may be included in the definition.
Response: HHSC agrees and revised the rule to use the terminology "pharmacological management" in place of "medication management and physician evaluation and treatment services" so that the service is not limited to a physician but may also be provided by nurse practitioners and physician assistants eligible to prescribe medication under their scope of practice.
Comment: One commenter requested a change in §306.107(4)(A). The commenter recommended aligning T-CCBHC service standards with federal CCBHC standards, which allow all services, including all crisis services, to be contracted as long as 51 percent of the services are delivered directly.
Response: HHSC declines to revise the rule in response to this comment. The rule amendment requires all T-CCBHCs to directly deliver crisis intervention and crisis stabilization services. The rule amendment also requires non-LMHAs/LBHAs to enter into an agreement with their local LMHA/LBHA for provision of MCOT services. All T-CCBHCs should be able to intervene and stabilize a person experiencing a behavioral health crisis. Texas does not participate in the federal CCBHC Medicaid demonstration or state plan option and has the ability to create more stringent standards than are federally required to align with state priorities. The rule does not prohibit T-CCBHCs from supplementing direct service delivery with service delivery through other providers. T-CCBHCs may supplement their direct delivery with an agreement with an LMHA/LBHA or other providers in the community.
Comment: One commenter expressed support for the proposed rules, specifically the requirement for T-CCBHCs to serve people regardless of address or lack thereof.
Response: HHSC acknowledges the comment.
Comment: One commenter requested that HHSC prioritize Federally Qualified Health Centers in the application and review process for new T-CCBHCs.
Response: HHSC declines to revise the rule in response to this comment. HHSC reviews T-CCBHC applicants on the inquiry list in the order in which they request to be added to the list. Applicants on the inquiry list were notified of this approach when they requested to be added.
HHSC revised §306.107(4)(A)(i)(I) because subparagraph (C) is the correct reference to use in the rule, not subparagraph (D).
STATUTORY AUTHORITY
The amendments are adopted under 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 Health and Safety Code §531.001 which provides HHSC with authority to oversee community mental health services.
§306.105.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Applicant--An entity applying or reapplying for certification as a Texas Certified Community Behavioral Health Clinic (T-CCBHC).
(2) Application--A form that an applicant submits to the Texas Health and Human Services Commission to apply for or renew the applicant's certification as a T-CCBHC.
(3) Community needs assessment--A method to identify the needs of the community and to describe how the applicant can meet those needs. This assessment is objective and includes feedback from people receiving services, program staff, and other key community members.
(4) Crisis stabilization--Services to address a mental health or substance use crisis.
(5) Family-centered--A way to plan, deliver, and evaluate services that involves participation between families, caregivers, and professionals.
(6) Governmental entity--A state agency or a political subdivision of Texas, such as a city, county, hospital district, hospital authority, or state entity.
(7) HHSC--The Texas Health and Human Services Commission or its designee.
(8) LBHA--Local behavioral health authority. An entity designated by HHSC under Texas Health and Safety Code §533.0356(a) as the local behavioral health authority.
(9) LMHA--Local mental health authority. An entity designated by HHSC under Texas Health and Safety Code §533.035(a) as the local mental health authority.
(10) Outpatient mental health treatment services--Mental health services a T-CCBHC directly provides to adults and youth consisting of:
(A) pharmacological management;
(B) individual counseling or psychotherapy;
(C) group counseling or psychotherapy; and
(D) family counseling or psychotherapy.
(11) Outpatient substance use treatment services--Substance use treatment services a T-CCBHC directly provides to adults and youth consisting of:
(A) individual substance use counseling;
(B) group substance use counseling; and
(C) substance use education services.
(12) Person--An individual receiving services under this subchapter.
(13) Person-centered--Approaches that focus on a person's strengths and personal goals giving the person the chance to improve their quality of life, make choices, and have control. This method helps a person explore the person's preferences, needs, and wants while addressing medical and non-medical needs to support the person in reaching the person's full potential.
(14) T-CCBHC--Texas Certified Community Behavioral Health Clinic. An entity HHSC certifies under this subchapter.
§306.107.
An applicant must meet the criteria in this section for certification.
(1) Staffing requirements.
(A) Staffing plans must reflect the findings of the applicant's community needs assessment.
(B) The applicant's staff members must have and be current with all necessary licenses and accreditations required by the state to provide the required services.
(C) Staff members must be trained to serve the needs of the clinic's patients as identified through the community needs assessment and in compliance with Section 223(a)(2)(A) of the Protecting Access to Medicare Act of 2014.
(D) Staff must be trained in a person-centered and family-centered approach.
(2) Availability and accessibility of services.
(A) An applicant may not refuse or limit services if a person cannot pay for the services.
(B) An applicant may not refuse or limit services to any person in the local service area based on where the person lives, the person's housing situation, or if the person does not have a permanent address. An applicant may coordinate care and transfer services to an appropriate provider for a person who lives outside the applicant's local service area.
(3) Care coordination.
(A) An applicant must coordinate care across settings and providers to make sure that transitions are seamless for a person receiving health services.
(B) A T-CCBHC must have:
(i) a health information technology system that includes an electronic health record; and
(ii) a plan focusing on ways to improve care coordination using health information technology.
(4) Scope of services.
(A) An applicant must directly provide the following services:
(i) crisis services, including:
(I) 24-hour mobile crisis outreach services, except as required under subparagraph (C) of this paragraph;
(II) crisis intervention services; and
(III) crisis stabilization services;
(ii) mental health and substance use screening, assessment, and diagnosis, including risk assessment for possible harm to self or others;
(iii) person-centered treatment planning, and family-centered treatment planning, when appropriate; and
(iv) outpatient mental health treatment services and outpatient substance use treatment services.
(B) An applicant must provide the following services either directly or by agreement with another entity:
(i) outpatient primary care screening and monitoring of health indicators and health risks;
(ii) mental health targeted case management as defined in 1 TAC §353.1403 (relating to Definitions);
(iii) mental health rehabilitative services as defined in 1 TAC §353.1403;
(iv) peer specialist services, as defined in 1 TAC §354.3013 (relating to Services Provided), and family partner supports; and
(v) community-based mental health and substance use care for members of the armed forces and veterans.
(C) A T-CCBHC that is not an LMHA or LBHA must make an agreement with an LMHA or LBHA in the applicant's local service area to provide mobile crisis outreach services. This agreement must include shared protocols for coordination. HHSC may grant permission for a T-CCBHC to provide mobile crisis outreach services directly if the T-CCBHC has a dedicated, long-term funding source that is not time limited, and a government entity oversees the mobile crisis outreach services.
(5) Quality and other reporting.
(A) A T-CCBHC must report encounter data, clinical outcomes data, quality data, and other data that HHSC may request.
(B) A T-CCBHC must have health information technology systems that allow reporting on data and quality measures.
(6) Organizational authority.
(A) An applicant must be:
(i) a non-profit or governmental entity;
(ii) an entity operated under the authority of the Indian Health Service, an Indian tribe, or tribal organization, pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act and Education Act (25 U.S.C 5301, et seq.); or
(iii) an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (25 U.S.C 1601, et seq.).
(B) An applicant must operate as an entity listed under subparagraph (A) of this paragraph for at least two years in Texas before applying for T-CCBHC certification.
(C) An applicant's T-CCBHC must have a governing board.
(i) The governing board must:
(I) have at least 51 percent of its members be people with lived experience of a mental health or substance use need or family members of people receiving behavioral health services; or
(II) create an advisory committee that meets the requirements of subclause (I) of this clause that gives feedback to the governing board about the T-CCBHC's:
(-a-) community needs;
(-b-) goals and objectives;
(-c-) service development;
(-d-) quality improvement and activities;
(-e-) fiscal and budgetary priorities; and
(-f-) governance.
(ii) The governing board must consider feedback provided by an advisory committee described in clause (i)(II) of this subparagraph in its decision-making processes.
(D) An applicant must:
(i) be enrolled as a Medicaid provider;
(ii) be credentialed and contracted with at least one managed care organization; and
(iii) have a Chemical Dependency Treatment Facility license under Chapter 564 of this title (relating to Chemical Dependency Treatment Facilities) to deliver adult and youth outpatient substance use treatment.
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 March 27, 2026.
TRD-202601388
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: April 16, 2026
Proposal publication date: November 28, 2025
For further information, please call: (512) 458-0775
CHAPTER 321. SUBSTANCE USE SERVICES
SUBCHAPTER
A.
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts the repeal of §321.1, concerning Purpose; §321.3, concerning Application; §321.5, concerning Definitions; and §321.7, concerning Program Description, and new §321.1, concerning Purpose; §321.3, concerning Application; §321.5, concerning Definitions; §321.7, concerning General Program Requirements; §321.9, concerning Program Staffing; and §321.11, concerning Program Service Delivery.
Sections 321.5 and 321.7 are adopted with changes to the proposed text as published in the October 31, 2025, issue of the Texas Register (50 TexReg 7096). These rules will be republished.
Sections 321.1, 321.3, 321.9, and 321.11 are adopted without changes to the proposed text as published in the October 31, 2025, issue of the Texas Register (50 TexReg 7096). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repeal of the rules is necessary to replace the current rules in Title 26, Texas Administrative Code Chapter 321, Subchapter A relating to Substance Use Prevention, with new rules that clarify provider requirements related to training, staffing, written policies and procedures, screening tools, and other requirements that inform substance use prevention service delivery.
COMMENTS
The 31-day comment period ended on December 1, 2025.
During this period, HHSC received comments regarding the proposed rules from one commenter, the Banks Law Firm. A summary of comments relating to the rules and HHSC's responses follows.
Comment: The commenter suggested including "marijuana misuse" and "underage cannabinoid use" in §321.7 to align with the legality and access to consumable hemp products in Texas.
Response: HHSC declines to make this exact change but revised §321.7 for clarity.
A minor editorial change was made to §321.5(16) to remove (A)-(E). Listing the five domains of non-medical drivers of health (NMODH) was not necessary for the definition.
A minor editorial change was made to §321.5(22) to improve clarity and be less prescriptive.
A change was made to §321.7(a) to improve clarity and be less restrictive on the general program requirements for providers.
A minor editorial change was made to §321.7(b)(1)(C) to include "or" to improve clarity.
26 TAC §§321.1, 321.3, 321.5, 321.7STATUTORY AUTHORITY
The repealed sections are adopted under 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; Texas Health and Safety Code §1001.073, which provides HHSC the responsibility for administering, coordinating, and contracting for the delivery of substance use prevention services; §1001.075, which provides that the executive commissioner of HHSC may adopt rules reasonably necessary for the administration of substance use prevention services; §461A.052, which provides that HHSC shall plan, develop, coordinate, evaluate, and implement programs for the prevention of substance use; and §461A.051, which provides that the executive commissioner of HHSC shall adopt rules governing the functions of the agency in relation to substance use services.
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 March 27, 2026.
TRD-202601386
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: April 16, 2026
Proposal publication date: October 31, 2025
For further information, please call: (512) 902-8075
26 TAC §§321.1, 321.3, 321.5, 321.7, 321.9, 321.11
STATUTORY AUTHORITY
The new sections are adopted under 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; Texas Health and Safety Code §1001.073, which provides HHSC the responsibility for administering, coordinating, and contracting for the delivery of substance use prevention services; §1001.075, which provides that the executive commissioner of HHSC may adopt rules reasonably necessary for the administration of substance use prevention services; §461A.052, which provides that HHSC shall plan, develop, coordinate, evaluate, and implement programs for the prevention of substance use; and §461A.051, which provides that the executive commissioner of HHSC shall adopt rules governing the functions of the agency in relation to substance use services.
§321.5.
The words and terms below have the assigned meanings when used in this subchapter, unless the context indicates otherwise.
(1) ACE--Adverse childhood experiences. Childhood events that may be traumatic.
(2) Alternatives--A primary prevention strategy that is defined in 45 CFR §96.125(b)(3).
(3) Behavioral health--Refers to the topics of mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms.
(4) Behavioral health promotion--The advancement of mental health, resilience, and well-being.
(5) CFR--Code of Federal Regulations.
(6) CLAS--Culturally and linguistically appropriate services. National standards for a set of 15 action steps. These standards aim to improve behavioral health quality and outcomes.
(7) Community-based process--A primary prevention strategy that is defined in 45 CFR §96.125(b)(5).
(8) CSAP--Center for Substance Abuse Prevention. A center under the Substance Abuse Mental Health Services Administration (SAMHSA).
(9) CSAP strategies--The evidence-based primary prevention strategies that are used by SAMHSA and defined in 45 CFR §96.125(b).
(10) Education--A primary prevention strategy that is defined in 45 CFR §96.125(b)(2).
(11) Environmental--A primary prevention strategy that is defined in 45 CFR §96.125(b)(6).
(12) Evidence-based--Models, curricula, and other interventions proven to be effective through research.
(13) HHSC--Texas Health and Human Services Commission or its designee.
(14) Individual--A person who receives services under this subchapter.
(15) Information dissemination--A primary prevention strategy that is defined in 45 CFR §96.125(b)(1).
(16) NMDOH--Non-medical drivers of health. The conditions where people live, learn, work, and play that affect a wide range of health outcomes.
(17) Prevention strategies--Proactive approaches that help individuals and communities promote healthy behaviors and lifestyles, including strategies defined in 45 CFR §96.125(b).
(18) Primary prevention--Activities that target individuals who do not need treatment for substance use disorder, which is defined in 45 CFR §96.121. These activities may include education, mentoring, and other activities that reduce the risk of substance use.
(19) Problem identification and referral--A primary prevention strategy that is defined in 45 CFR §96.125(b)(4).
(20) Protective factors--Elements that reduce the impact of risk factors. These elements build resilience and decrease the likelihood of developing behaviors that could lead to substance use and misuse.
(21) Provider--A person or entity that contracts with HHSC to provide substance use prevention services.
(22) Risk factors--Biological, psychological, family, community, or environmental influences that precede and are associated with a higher likelihood of negative outcomes.
(23) SAMHSA--Substance Abuse and Mental Health Services Administration. An agency within the U.S. Department of Health and Human Services.
(24) Socio-ecological model--A framework that explains the different factors that affect health behavior and how to organize health intervention strategies.
(25) Strategic prevention framework--A framework created by SAMHSA used in prevention planning to address substance use and mental health issues.
§321.7.
(a) A provider must:
(1) promote behavioral health;
(2) focus on preventing and delaying first use of substances;
(3) attempt to reduce long-term consequences of substance misuse;
(4) provide services using the socio-ecological model and SAMHSA's Strategic Prevention Framework;
(5) incorporate CSAP strategies that apply to the program, including Alternatives, Community-based Process, Information Dissemination, Education, Environmental, and Problem Identification, and Referral;
(6) follow CLAS; and
(7) offer services that help fill gaps in line with the current Statewide Behavioral Health Coordinating Council's Behavioral Health Strategic Plan required by Texas Government Code §547.0156.
(b) A provider must use prevention strategies that:
(1) focus on risk factors that lead to substance use and misuse, including:
(A) ACEs;
(B) NMDOH;
(C) unequal access to healthcare and behavioral health services; or
(D) other youth, family, and community risk factors; and
(2) promote behavioral health and help build protective factors.
(c) Before providing substance use prevention education services, the provider must complete memorandums of understanding or community agreements with public schools and agencies, businesses, or community partners to ensure programs operate efficiently.
(d) A provider must operate a program according to written policies and procedures to support implementation.
(e) The policies and procedures must:
(1) follow the rules in this subchapter;
(2) meet any of HHSC's contractual and financial requirements; and
(3) follow all relevant state and federal laws or rules.
(f) The provider must:
(1) keep a copy of the policies and procedures;
(2) provide a copy of the policies and procedures to staff; and
(3) provide a copy of the policies and procedures to HHSC, if requested.
(g) A screening tool is not required for referral to services. If a tool is used, it must be HHSC-approved and not be used for purposes of diagnosis or treatment.
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 March 27, 2026.
TRD-202601387
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: April 16, 2026
Proposal publication date: October 31, 2025
For further information, please call: (512) 902-8075