TITLE 1. ADMINISTRATION

PART 2. TEXAS ETHICS COMMISSION

CHAPTER 26. POLITICAL AND LEGISLATIVE ADVERTISING

The Texas Ethics Commission (the TEC) proposes an amendment to Texas Ethics Commission Rules in Chapter 26 (relating to Political and Legislative Advertising). Specifically, the TEC proposes an amendment to §26.1 regarding Disclosure Statement.

State law requires state agencies to "review and consider for readoption each of its rules … not later than the fourth anniversary of the date on which the rule takes effect and every four years after that date." Tex. Gov't Code §2001.039. The law further requires agencies to "readopt, readopt with amendments, or repeal a rule as the result of reviewing the rule under this section." Id.

The TEC is continuing its comprehensive review with a review of the TEC's rules regarding political and legislative advertising, which are codified in Chapter 26.

Amanda Arriaga, General Counsel, has determined that for the first five-year period the proposed amended rule is in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the proposed amended rule.

The General Counsel has also determined that for each year of the first five years the proposed amended rule is in effect, the public benefit will be consistency and clarity in the Commission's rules regarding political and legislative advertising. There will not be an effect on small businesses, microbusinesses or rural communities. There is no anticipated economic cost to persons who are required to comply with the proposed amended rule.

The General Counsel has determined that during the first five years that the proposed amended rule is in effect, it will not: create or eliminate a government program; require the creation of new employee positions or the elimination of existing employee positions; require an increase in future legislative appropriations to the agency; require an increase or decrease in fees paid to the agency; expand, limit, or repeal an existing regulation; create a new regulation; increase or decrease the number of individuals subject to the rules' applicability; or positively or adversely affect this state's economy.

The Commission invites comments on the proposed amended rule from any member of the public. A written statement should be emailed to public_comment@ethics.state.tx.us, or mailed or delivered to James Tinley, Executive Director, Texas Ethics Commission, P.O. Box 12070, Austin, Texas 78711-2070. A person who wants to offer spoken comments to the Commission concerning the proposed amended rule may do so at any Commission meeting during the agenda item relating to the proposed amended rule. Information concerning the date, time, and location of Commission meetings is available by telephoning (512) 463-5800 or on the Commission's website at www.ethics.state.tx.us.

The amended rule is proposed under Texas Government Code §571.062, which authorizes the Commission to adopt rules to administer Title 15 of the Election Code and Chapter 571 of the Government Code.

The proposed amended rule affects Chapter 255 of the Election Code.

§26.1. Disclosure Statement.

(a) A disclosure statement that is required by §255.001, Election Code[, must contain the words "political advertising" or any recognizable abbreviation, and] must:

(1) appear on one line of text or on successive lines of text on the face of the political advertising; or

(2) be clearly spoken in the political advertising if the political advertising does not include written text.

(b) A disclosure statement is not required on political advertising printed on letterhead stationery if the letterhead contains the full name of one of the following:

(1) the person who paid for the political advertising;

(2) the political committee authorizing the political advertising; or

(3) the candidate authorizing the political advertising.

(c) A disclosure statement is not required on:

(1) campaign buttons, pins, or hats, or on objects whose size makes printing the disclosure impractical;

(2) political advertising posted or re-posted on an Internet website, as long as the person posting or re-posting the political advertising:

(A) is not an officeholder, candidate, or political committee;

(B) did not make an expenditure exceeding $100 in a reporting period for political advertising beyond the basic cost of hardware messaging software and bandwidth; and

(C) did not post or re-post the political advertising in return for consideration.

(3) the Internet social media profile webpage of a candidate or officeholder, provided the webpage clearly and conspicuously displays the full name of the candidate or officeholder; or

(4) political advertising posted or re-posted by a person on an Internet website, provided the advertising is posted with a link to a publicly viewable Internet webpage that:

(A) contains the disclosure statement; or

(B) is exempt from containing the disclosure statement under Subsection (c)(3).

(d) For the purposes of Subsection (c), an "Internet social media profile webpage" is an Internet webpage on a website where members of the public may, for no charge, connect electronically with other members of the public and share text, images, videos, and similar forms of communications.

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 March 20, 2026.

TRD-202601334

Amanda Arriaga

General Counsel

Texas Ethics Commission

Earliest possible date of adoption: May 3, 2026

For further information, please call: (512) 463-5800

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 353. MEDICAID MANAGED CARE

SUBCHAPTER J. OUTPATIENT PHARMACY SERVICES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.903, concerning Definitions; and §353.907, concerning Prior Authorization Requirements.

BACKGROUND AND PURPOSE

Previous HHSC rule amendments in the Vendor Drug Program (VDP) implemented portions of House Bill (HB) 3286, 88th Legislature Regular Session, 2023, and became effective in November 2024. These amendments elaborated on existing Preferred Drug List (PDL) exceptions regarding when a non-preferred drug can be used and added new PDL exceptions.

The purpose of this proposal is to implement the portion of HB 3286 that amended Texas Government Code §531.072 by adding subsection (h). However, effective September 1, 2025, Texas Government Code §531.072(h), was transferred to Texas Government Code, Chapter 549, and redesignated as §549.0209, as a result of HB 1620, 89th Legislature Regular Session, 2025.

Therefore, this proposal implements Texas Government Code §549.0209, that requires HHSC to: (1) grant temporary non-preferred (TNP) status to new drugs that are available on the Medicaid formulary but have not been reviewed by the Drug Utilization Review Board (DURB); and (2) establish criteria for authorizing drugs with this status. This change required HHSC to submit a Medicaid State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS), which was approved on August 29, 2024. The proposed amendments in Texas Administrative Code (TAC), Title 1, §353.903 and §353.907 address these requirements for managed care, defines TNP drugs and revises existing term definitions, and provides clarifications on application of PDL prior authorization to TNP drugs.

The amendments establish a new TNP status for drugs that are new to the market added to the VDP formulary that have not yet been reviewed by the DURB. This status will apply to new-to-market drugs upon addition to the Texas Medicaid formulary if they fall into an existing PDL class. These drugs will remain temporary non-preferred until reviewed and recommended by the DURB as preferred or non-preferred and approved by the Executive Commissioner.

TNP status does not apply to existing PDL drugs with new label indications. The proposed amendments will require a health care managed care organization (health care MCO) to have a temporary non-preferred drug list prior authorization for coverage.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §353.903 adds a definition of "temporary non-preferred drug," defined as a covered outpatient drug that the DURB has not yet reviewed and recommended as preferred or non-preferred and not yet approved by the Executive Commissioner. The definition of "Preferred drug list" (PDL) is revised to mean the list of covered outpatient drugs defined in proposed §353.903 as a non-preferred drug, preferred drug, or temporary non-preferred drug. The definition of "Preferred drug list prior authorization" (PDL PA) is revised to mean a review a health care MCO does before a network provider can give a non-preferred drug or a temporary non-preferred drug to a member. This change in the definition of PDL PA adds the new term "temporary non-preferred drug" as a type of drug that requires a PDL PA. The definitions of "non-preferred drug" and "preferred drug" are revised to include clarification on the drug designation process.

The proposed amendment to §353.907 establishes that a health care MCO may require a PDL PA for a temporary non-preferred drug. The amendment prohibits a health care MCO from requiring a PDL PA for a covered outpatient drug that was prescribed for a member before the date HHSC decides the drug is non-preferred or temporary non-preferred. The amendment also makes several editorial changes throughout §353.907 to improve the clarity of the rules.

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 not create new regulations;

(6) the proposed rules will expand 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 because the proposed 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 and are 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 rules are in effect, the rules will benefit people who receive Medicaid by allowing access to additional medications that have not yet been reviewed by the DURB. In addition, potential confusion is eliminated for stakeholders by aligning the rules with the Texas Government Code.

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 TNP status does not impact the amount a provider is reimbursed for the drugs and there are no copays for people on Texas Medicaid.

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, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, 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 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 25R014" 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 Human Resources Code §32.021 which authorize HHSC to administer the federal medical assistance (Medicaid) program; and Texas Government Code §540.0051, which authorizes HHSC to implement the Medicaid managed care program.

The amendments affect Texas Government Code §524.0151 and §549.0202 and Texas Human Resources Code §32.021.

§353.903. Definitions.

The following words and terms, when used in this subchapter, have the following meaning unless the context clearly indicates otherwise.

(1) Clinical prior authorization (clinical PA)--A health care managed care organization (MCO) must review and approve certain drugs before a pharmacy can dispense the drug to a Medicaid member. HHSC decides which drugs need clinical prior authorization, and this information is found on the HHSC Medicaid Vendor Drug Program website. [A review process authorized by HHSC that is conducted by a healthcare managed care organization (health care MCO) prior to dispensing a drug. All clinical PAs must be identified on the Medicaid Vendor Drug Program website at http://www.txvendordrug.com.]

(2) Covered outpatient drug--A drug or biological product included on the formulary that a network provider can provide to a Medicaid member [and provided] in an outpatient setting.

(3) Formulary--The list of covered outpatient drugs for the Texas Medicaid program.

(4) Maximum allowable cost--The highest unit price set by a health care MCO, or its subcontractor, for reimbursement of therapeutically equivalent multi-source drugs.

(5) Network provider--A pharmacy provider who has entered into a contract with the health care MCO to provide outpatient drug benefits to Medicaid enrollees.

(6) Non-preferred drug--A covered outpatient drug on the preferred drug list (PDL) that has been:

(C) designated by HHSC as non-preferred on the preferred drug list.

(7) Pharmacy benefits manager (PBM)--An entity that administers the Medicaid outpatient drug benefit on behalf of a health care MCO.

(8) Preferred drug--A covered outpatient drug on the preferred drug list [PDL] that has been:

(C) designated by HHSC as preferred on the preferred drug list [because it has been evaluated to be safe, clinically effective, and cost-effective compared to other drugs in the same therapeutic drug class on the market].

(9) Preferred drug list (PDL)--The list of covered outpatient drugs defined in this section as a:

(C) temporary non-preferred drug. [reviewed by the Drug Utilization Review Board (DUR Board). Reviewed drugs are recommended by the DUR Board as either preferred or non-preferred and HHSC establishes the final designation.]

(10) Preferred drug list prior authorization (PDL PA)--A review a health care MCO does before a pharmacy can dispense [conducted by a health care MCO prior to dispensing] a non-preferred drug or a temporary non-preferred drug to a Medicaid member in an outpatient setting.

§353.907. Prior Authorization Requirements.

(a) Except for a temporary non-preferred drug, a [A] health care managed care organization (health care MCO) may not require [impose] a preferred drug list prior authorization (PDL PA) for [on] a covered outpatient drug until HHSC designates the drug as non-preferred. [before the drug has been considered at a meeting of the Health and Human Services Commission's (HHSC's) Drug Utilization Review Board.]

(b) A health care MCO may not require [impose] a PDL PA for [on] a covered outpatient drug that was prescribed for a member before HHSC decides the drug is non-preferred or temporary non-preferred, unless the member has used up the whole prescription, [HHSC's designation of the drug as non-preferred, unless the member has exhausted all of the prescription,] including any authorized refills.

(c) A health care MCO must allow a network provider to submit a request for prior authorization for [of] a covered outpatient drug by telephone, fax, or [electronic communications] through the Internet.

(d) A health care MCO must respond to a request for prior authorization by telephone, fax, or [electronic communications] through the Internet no later than 24 hours after the MCO receives [receiving] the request. If the health care MCO cannot respond to the prior authorization request within this time, then the health care MCO must allow a pharmacy to dispense a 72-hour supply of the prescribed drug.

(e) A health care MCO must not [cannot] require a PDL PA for a preferred drug.

(f) A health care MCO must require a PDL PA for a non-preferred drug or a temporary non-preferred drug.

(g) If a member's medical condition does not match the health care MCO's clinical criteria for dispensing a covered outpatient drug, the health care MCO may require a clinical PA for a preferred, [or] non-preferred, or temporary non-preferred drug [drug].

(h) [HHSC will post on its website clinical PAs that are used in HHSC's fee-for-service Vendor Drug Program.] A health care MCO must implement all clinical PAs that HHSC designates [has designated] as "mandatory" for [the] Medicaid managed care programs.

(i) A health care MCO must accept a standard prior authorization form for a covered outpatient drug in accordance with Texas Insurance Code Chapter 1369, Subchapter F.

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 March 20, 2026.

TRD-202601332

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: May 3, 2026

For further information, please call: (512) 289-2482

CHAPTER 354. MEDICAID HEALTH SERVICES

SUBCHAPTER F. PHARMACY SERVICES

SUBCHAPTER O. ELECTRONIC VISIT VERIFICATION

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.4003, concerning Definitions; §354.4005, concerning Personal Care Services that Require the Use of EVV; §354.4006, concerning Home Health Care Services that Require the Use of EVV; and §354.4013, concerning HHSC and MCO Compliance Reviews and Enforcement Actions.

BACKGROUND AND PURPOSE

A Medicare-Medicaid Plan (MMP) is a health plan that provides both Medicare and STAR+PLUS Medicaid services under one contract. The Centers for Medicare & Medicaid Services (CMS) Contract Year 2023 Medicare Advantage and Part D Final Rule (Final Rule) required states to phase-out their MMP Dual Demonstration Program. With input from MMPs and other stakeholders, HHSC is complying with the Final Rule and ending the MMP's contracts effective December 31, 2025.

The proposed amendments reflect that the STAR+PLUS MMP ended December 31, 2025, and that electronic visit verification (EVV) was required for STAR+PLUS MMP services, if delivered before January 1, 2026.

The proposed amendments remove Free Text Reviews from the list of compliance reviews because HHSC and managed care organizations (MCOs) ceased conducting these reviews in 2023.

An alternative device allows a service provider of a program provider or consumer directed services (CDS) employer to clock in and clock out of the electronic visit verification (EVV) system. HHSC is limiting the use of alternative devices as an approved method to clock in and clock out to enhance program integrity. The alternative device limit is being implemented over three fiscal years to allow program providers and CDS employers time to adjust their business and gradually reduce reliance on alternative devices. This also allows program providers and CDS employers time to migrate their service providers and CDS employees to one of the other approved clock in and clock out methods. The alternative device reduction schedule is in the EVV Policy Handbook.

The proposed amendments add an EVV Alternative Device Compliance Review, and the actions HHSC and the MCO may take, if a program provider's or CDS employer's EVV Alternative Device Compliance score exceeds the allowable percentage score described in the EVV Policy Handbook.

The proposed amendments add that a program provider or CDS employer must use EVV if Medicaid pays for any part of the services that require EVV. These changes clarify that EVV must be used if the services that require EVV are paid for by both Medicaid and a third party, such as private insurance.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §354.4003 revises the definition of CDS employer to remove duplicate language regarding CDS employer responsibilities. The proposed amendment revises the definition of CDS option to add a reference to 26 TAC Chapter 264, and to make the CDS employer's responsibilities easier to read and understand. The proposed amendment adds a definition of "dual eligible member" to make sure the public understands the meaning of this term when used in the rules. The proposed amendment revises the definition of EVV proprietary system to update that it is a system a program provider or a financial management services agency (FMSA) uses instead of the EVV state vendor system and is approved by HHSC as described in the EVV Policy Handbook and to remove the reference to §354.4013 of this subchapter. The proposed amendment revises the definition of EVV state vendor system to clarify that a program provider or an FMSA may use the state system for free. The proposed amendment updates the TAC references in the definitions of Community Attendant Services Program, FC Program--Family Care Program, FMSA--Financial management services agency, IMD--Institution for mental diseases, PDN--Private duty nursing, Primary Home Care Program, and SRO--Service responsibility option. The proposed amendment revises the definition of program provider to clarify the meaning by removing incorrect language. The proposed amendment revises the definition of STAR+PLUS MMP to indicate this program ended on December 31, 2025. The proposed amendment, after the new definition of dual-eligible member, renumbers paragraphs (8) - (57) as (9) - (58).

The proposed amendment to §354.4005, in subsections (a) and (b), adds "if HHSC, an HHSC designated contractor, or an MCO pays for any part of a claim for these services." These changes clarify that EVV must be used for personal care services paid for by both Medicaid and a third party, such as private insurance. The proposed amendment in subsections (a)(13) and (b)(12) adds "if delivered before January 1, 2026," to the STAR+PLUS MMP personal care services to indicate that only MMP services delivered before January 1, 2026, require EVV. This clarification is necessary because though the MMP Dual Demonstration Program ended on December 31, 2025, program providers and FMSAs may need to submit claims for MMP services that were delivered before the MMP Dual Demonstration Program end date.

The proposed amendment to §354.4006, in subsections (a) and (b), adds "if HHSC, an HHSC designated contractor, or an MCO pays for any part of a claim for these services." These changes clarify that EVV must be used for home health care services paid for by both Medicaid and a third party, such as private insurance. The proposed amendment in subsections (a)(11) and (b)(7) adds "if delivered before January 1, 2026," to the STAR+PLUS MMP home health services to indicate that only MMP home health services delivered before January 1, 2026, require EVV. This clarification is necessary because though the MMP Dual Demonstration Program ended on December 31, 2025, program providers and FMSAs may need to submit claims for MMP services that were delivered before the MMP Dual Demonstration Program end date.

The proposed amendment to §354.4013, in subsection (a), removes EVV Required Free Text Reviews in the list of compliance reviews. The proposed amendment removes subsection (h) relating to EVV Required Free Text Reviews. These changes are necessary because HHSC and MCOs no longer conduct these reviews. The proposed amendment, in subsection (a), adds an EVV Alternative Device Compliance Review in the list of compliance reviews because HHSC and MCOs have started conducting these reviews. The proposed amendment in subsection (c)(3) replaces "terminate" with "end" to refer to the action HHSC or an MCO may propose the third time a CDS employer does not meet the EVV Usage Score. This change is made to clarify that the proposed action may end the member's participation in the CDS option, not terminate the member from the Medicaid program. The proposed amendment in subsections (d) and (g)(3) adds the language "payment hold" to the actions HHSC or the MCO may take when a program provider or FMSA fails to take the required training or complete the required corrective action plan as described in the rules. This change makes sure the rule includes the terminology used in all programs. The proposed amendment adds new subsections (h) and (i) to describe the actions HHSC or an MCO may take if a program provider's or a CDS employer's use of an alternative device exceeds the allowable percentage described in the EVV Policy Handbook. The proposed amendment adds new subsections (j) - (l) to describe the actions HHSC or the MCO may take if the program provider or CDS employer fails to complete the required actions.

FISCAL NOTE

Trey Wood, 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 new regulations;

(6) the proposed rules will limit 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules because there is no requirement to alter current business practices and there are no new fees or costs imposed on those required to comply.

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 and are necessary to receive a source of federal funds or comply with federal law.

PUBLIC BENEFIT AND COSTS

Emily Zalkovsky, Chief Medicaid and CHIP Services Officer, has determined that for each year of the first five years the rules are in effect, the public benefit is that the rules will specify that MMP ended on December 31, 2025, and the use of EVV is not required for MMP after December 31, 2025. In addition, the public will be able to locate the requirements for alternative device compliance reviews and the actions that HHSC or an MCO may take when a program provider, FMSA, or CDS employer fails to meet the alternative device compliance standards.

Trey Wood has also determined that for the first five years the rules are in effect, the proposed rules are not expected to have any economic costs for persons required to comply because there is no requirement to alter current business practices and there are no new fees or costs imposed on those required to comply.

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, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, 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 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 26R004" 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; Texas Government Code §532.0260, which provides the executive commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021, which provides HHSC with the authority to administer the federal medical assistance program in Texas and to adopt rules and standards for program administration.

The amendments affect Texas Government Code §524.0151, Texas Government Code §532.0260, and Texas Human Resources Code §32.021.

§354.4003. Definitions.

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.[:]

(1) CDS employer--Consumer directed services employer. A member or the member's legally authorized representative who participates in the CDS option and whose financial management services agency (FMSA) uses an electronic visit verification (EVV) vendor system or an EVV proprietary system. [A CDS employer is responsible for hiring and retaining a service provider who delivers a service described in §354.4005 of this subchapter (relating to Personal Care Services that Require the Use of EVV) or §354.4006 of this subchapter (relating to Home Health Care Services that Require the Use of EVV).]

(2) CDS option--Consumer directed services option. A service delivery option described in 26 TAC Chapter 264 (relating to Consumer Directed Services Option). In the CDS option, [in which] a CDS employer: [employs and retains a]

(A) hires the service provider; and

(B) manages how the service provider delivers [directs the delivery of] a service described in §354.4005 of this subchapter (relating to Personal Care Services that Require the Use of EVV) or §354.4006 of this subchapter (relating to Home Health Care Services that Require the Use of EVV).

(3) CFC--Community First Choice. A Medicaid state plan option governed by 42 CFR [42 Code of Federal Regulations, Title 42], Part 441, Subpart K, Home and Community-Based Attendant Services and Supports State Plan Option (Community First Choice). CFC services include the following.

(A) CFC HAB--CFC habilitation. A Medicaid state plan service that provides habilitation through CFC as described in §354.1361 of this chapter (relating to Definitions).

(B) CFC PAS--CFC personal assistance services. A Medicaid state plan service that provides personal assistance services through CFC as described in §354.1361 of this chapter.

(C) CFC PAS/HAB--CFC personal assistance services/habilitation. A Medicaid state plan service provided through CFC that provides both personal assistance services and habilitation.

(4) CLASS Program--Community Living Assistance and Support Services Program. A Medicaid waiver program approved by the Centers for Medicare & Medicaid Services under Title XIX, Section 1915(c) of the Social Security Act, as described in 26 TAC Chapter 259 (relating to Community Living Assistance and Support Services (CLASS) Program and Community First Choice (CFC) Services).

(5) CMS--Centers for Medicare & Medicaid Services. The federal agency within the United States Department of Health and Human Services that administers the Medicare and Medicaid programs.

(6) Community Attendant Services Program--A Medicaid state plan program operating under Title XIX of the Social Security Act, as described in 26 TAC Chapter 277 [40 TAC Chapter 47] (relating to Primary Home Care, Community Attendant Services, and Family Care Programs).

(7) DBMD Program--Deaf Blind with Multiple Disabilities. The Medicaid waiver program approved by CMS under Title XIX, Section 1915(c) of the Social Security Act, as described in 26 TAC Chapter 260 (relating to Deaf Blind with Multiple Disabilities (DBMD) Program and Community First Choice (CFC) Services).

(9) [(8)] EVV--Electronic visit verification. The documentation and verification of service delivery through an EVV system.

(10) [(9)] EVV aggregator--A centralized database that collects, validates, and stores statewide EVV visit data transmitted by an EVV system.

(11) [(10)] EVV claim--A request for payment of a service described in §354.4005 or §354.4006 of this subchapter submitted to HHSC, HHSC's designated contractor, or a managed care organization (MCO) in accordance with the EVV Policy Handbook.

(12) [(11)] EVV Policy Handbook--A handbook promulgated by HHSC that contains policies and requirements related to EVV.

(13) [(12)] EVV portal--An online system established by HHSC that allows users to perform searches, view reports and view EVV claim match results associated with data in the EVV aggregator.

(14) [(13)] EVV portal user--A person who is employed by or contracts with a program provider or FMSA and has access to the EVV portal.

(15) [(14)] EVV proprietary system--An [HHSC] EVV system that:

(A) [purchased or developed by] a program provider or an FMSA [approved by HHSC in accordance with §354.4013 of this subchapter (relating to HHSC and MCO Compliance Reviews and Enforcement Actions) that a program provider or FMSA] uses instead of the [an] EVV state vendor system; and[.]

(16) [(15)] EVV system--An EVV vendor system or an EVV proprietary system used to electronically document and verify the data elements described in §354.4009(a) of this subchapter (relating to EVV Visit Transaction and EVV Claim) for a visit conducted to provide a service described in §354.4005 or §354.4006 of this subchapter.

(17) [(16)] EVV system user--A person who has access to the EVV system, including a person employed by or contracting with a program provider, FMSA, or CDS employer.

(18) [(17)] EVV state vendor system--An EVV system:

(A) created [developed] and operated by a vendor that has a contract [contracts] with HHSC or an HHSC [HHSC's] designated contractor; and

(B) that a program provider or an FMSA may use for free [uses] instead of using an EVV proprietary system.

(19) [(18)] EVV visit transaction--A record generated by an EVV system that contains the data elements described in §354.4009(a) of this subchapter for a visit conducted to provide a service described in §354.4005 or §354.4006 of this subchapter.

(20) [(19) FC Program--Family Care Program. A program funded under Title XX, Subtitle A of the Social Security Act, as described in 26 TAC Chapter 277 [40 TAC Chapter 47].

(21) [(20)] FMSA--Financial management services agency. A program provider that contracts with HHSC or an MCO to provide financial management services to a CDS employer as described in 26 TAC Chapter 264 [40 TAC Chapter 41] (relating to Consumer Directed Services Option).

(22) [(21)] HCBS-AMH Program--Home and Community-Based Services Adult Mental Health Program. A Medicaid state plan option approved by CMS under Title XIX, Section 1915(i) of the Social Security Act, as described in 26 TAC Chapter 307, Subchapter B (relating to Home and Community-Based Services--Adult Mental Health Program).

(23) [(22)] HCS Program--Home and Community-based Services Program. A Medicaid waiver program approved by CMS under Title XIX, Section 1915(c) of the Social Security Act, as described in 26 TAC Chapter 263 (relating to Home and Community-based Services (HCS) Program and Community First Choice (CFC)).

(24) [(23)] HHSC--The Texas Health and Human Services Commission.

(25) [(24)] Home health aide--Has the meaning set forth in 26 TAC §558.2 (relating to Definitions).

(26) [(25)] ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions. An ICF/IID is a facility that is licensed in accordance with THSC Chapter 252 or certified by HHSC.

(27) [(26)] IMD--Institution for mental diseases. Has the meaning set forth in 26 TAC §273.3 [25 TAC §419.373] (relating to Definitions).

(28) [(27)] LVN--Licensed vocational nurse. A person licensed to practice as a vocational nurse as described in Texas Occupations Code Chapter 301.

(29) [(28)] MCO--Managed care organization. Has the meaning set forth in Texas Government Code §543A.0001.

(30) [(29)] MDCP--Medically Dependent Children Program. A Medicaid waiver program approved by CMS under Title XIX, Section 1915(c) of the Social Security Act, as described in Chapter 353, Subchapter M of this title (relating to Home and Community Based Services in Managed Care).

(31) [(30)] MDCP STAR Health covered service--Medically Dependent Children Program STAR Health covered service. A service provided to a member eligible to receive MDCP benefits under the STAR Health Program.

(32) [(31)] MDCP STAR Kids covered service--Medically Dependent Children Program STAR Kids covered service. A service provided to a member eligible to receive MDCP benefits under the STAR Kids Program.

(33) [(32)] Member--A person enrolled in one of the following:

(A) traditional Medicaid service delivery model also referred to as fee-for-service;

(B) the CLASS Program;

(C) the Community Attendant Services Program;

(D) the DBMD Program;

(E) the FC Program;

(F) the HCBS-AMH Program;

(G) the HCS Program;

(H) the Primary Home Care Program;

(I) the STAR Program;

(J) the STAR Health Program;

(K) the STAR Kids Program;

(L) the STAR+PLUS Program;

(M) the STAR+PLUS Home and Community-Based Services Program;

(N) the STAR+PLUS Medicare-Medicaid Program;

(O) the Texas Home Living Program;

(P) Texas Health Steps Comprehensive Care Program (CCP); or

(Q) the Youth Empowerment Services Program.

(34) [(33)] Nursing facility--A facility licensed in accordance with Texas Health and Safety Code Chapter 242.

(35) [(34)] Occupational therapist--A person licensed as an occupational therapist in accordance with Texas Occupations Code Chapter 454.

(36) [(35)] PCS--Personal Care Services. Support services provided to a member enrolled in Texas Health Steps CCP who requires assistance with activities of daily living or instrumental activities of daily living as described in §363.602 of this title (relating to Definitions).

(37) [(36)] PDN--Private duty nursing. Has the same meaning as the term "Private duty nursing (PDN) Services" in [1 TAC Chapter 363, Subchapter C,] §363.303 of this title (relating to Definitions).

(38) [(37)] Primary Home Care Program--A Medicaid state plan program operating under Title XIX of the Social Security Act, as described in 26 TAC Chapter 277 [40 TAC Chapter 47].

(39) [(38)] Physical therapist--A person licensed as a physical therapist in accordance with Texas Occupations Code Chapter 453.

(40) [(39)] Program provider--An entity that contracts with HHSC or an MCO to provide a service listed [described] in §354.4005 or §354.4006 of this subchapter and that uses an EVV state vendor system or an EVV proprietary system. [A service provider described in paragraph (43)(B) of this section is both a program provider and a service provider.]

(41) [(40)] PSO--Proprietary system operator. A program provider or an FMSA that uses an EVV proprietary system.

(42) [(41)] Reason code--A standardized HHSC-approved code entered in an EVV system to explain the reason for completing visit maintenance.

(43) [(42)] RN--Registered nurse. A person licensed to practice as a registered nurse as described in Texas Occupations Code Chapter 301.

(44) [(43)] Service provider--A person who provides a service described in §354.4005 or §354.4006 of this subchapter and who:

(A) is employed by or contracting with:

(i) a program provider; or

(ii) a CDS employer; or

(B) who is contracting with:

(i) an MCO; or

(ii) HHSC.

(45) [(44)] SRO--Service responsibility option. A service delivery option described in 26 TAC Chapter 265 [40 TAC Chapter 43] (relating to Service Responsibility Option) in which a member or legally authorized representative selects, trains, and provides daily management of a service provider, while the fiscal, personnel, and service back-up plan responsibilities remain with the program provider.

(46) [(45)] STAR--State of Texas Access Reform.

(47) [(46)] STAR Health Program--A Medicaid program operating under Title XIX, Section 1915(a) of the Social Security Act and Texas Family Code, Chapter 266. The program provides services through a managed care delivery model to a member enrolled in STAR Health as described in Chapter 353, Subchapter H of this title (relating to STAR Health).

(48) [(47)] STAR Kids Program--A Medicaid program operating under Title XIX, Section 1115 of the Social Security Act and Texas Government Code Chapter 540. The program provides services through a managed care delivery model to a member enrolled in STAR Kids as described in Chapter 353, Subchapter N of this title (relating to STAR Kids).

(49) [(48)] STAR Program--A Medicaid program operating under Title XIX, Section 1115 of the Social Security Act. The program provides services through a managed care delivery model to a member enrolled in STAR as described in Chapter 353, Subchapter I of this title (relating to STAR).

(50) [(49)] STAR+PLUS HCBS Program--STAR+PLUS Home and Community-Based Services Program. A Medicaid program operating through a federal waiver under Title XIX, Section 1115 of the Social Security Act. The program provides services to a member eligible to receive HCBS benefits under the STAR+PLUS Program, as described in Chapter 353, Subchapter M of this title (relating to Home and Community Based Services in Managed Care).

(51) [(50)] STAR+PLUS MMP--STAR+PLUS Medicare-Medicaid Plan. A managed care program operating under Title XIX, Section 1115A of the Social Security Act that provides the authority to test and evaluate a fully integrated care model for [clients who are] dual eligible members. The STAR+PLUS MMPs contract with CMS and HHSC to participate in the Dual Demonstration Program described in Chapter 353, Subchapter L of this title (relating to Texas Dual Eligibles Integrated Care Demonstration Project). The MMP Dual Demonstration Program ended on December 31, 2025.

(52) [(51)] STAR+PLUS Program--A Medicaid program operating under Title XIX, Section 1115 of the Social Security Act, and Texas Government Code Chapter 540. The program provides services through a managed care delivery model to a member enrolled in STAR+PLUS as described in Chapter 353, Subchapter G of this title (relating to STAR+PLUS).

(53) [(52)] TAC--Texas Administrative Code.

(54) [(53)] Texas Health Steps CCP--Texas Health Steps Comprehensive Care Program. A Medicaid comprehensive program approved by CMS under Title XIX, Section 1905 of the Social Security Act, as described in Chapter 363 of this title (relating to Texas Health Steps Comprehensive Care Program).

(55) [(54)] TxHmL--Texas Home Living Program. A Medicaid waiver program approved by CMS under Title XIX, Section 1915(c) of the Social Security Act, as described in 26 TAC Chapter 262 (relating to Texas Home Living (TxHmL) Program and Community First Choice (CFC)).

(56) [(55)] Vendor hold--A temporary suspension of payments for claims that are due to a program provider or FMSA.

(57) [(56)] Visit maintenance--As described in the EVV Policy Handbook, a process to:

(A) manually enter data elements described in §354.4009(a) of this subchapter in an EVV system;

(B) correct the data elements described in §354.4009(a) of this subchapter that are inaccurate in an EVV visit transaction; or

(C) include the data elements described in §354.4009(a) of this subchapter that are missing in an EVV visit transaction.

(58) [(57)] YES Program--Youth Empowerment Services Program. A Medicaid waiver approved by CMS under Title XIX, Section 1915(c) of the Social Security Act as described in 26 TAC Chapter 307, Subchapter A (relating to Youth Empowerment Services (YES)).

§354.4005. Personal Care Services that Require the Use of EVV.

(a) A program provider must use [ensure a service provider uses] EVV to document the delivery [provision] of the following personal care services by the program provider if HHSC, an HHSC designated contractor, or an MCO pays for any part of the claim for these services:

(1) in the traditional Medicaid service model also referred to as fee-for-service, including for members enrolled in STAR who receive PCS through fee-for-service:

(A) CFC PAS;

(B) CFC HAB;

(C) PCS provided under Texas Health Steps CCP, including SRO; and

(D) PCS-Behavioral Health provided under Texas Health Steps CCP, including SRO;

(2) in the CLASS Program:

(A) CFC PAS/HAB; and

(B) in-home respite;

(3) personal attendant services provided through the Community Attendant Services Program, including SRO;

(4) in the DBMD Program:

(A) CFC PAS/HAB; and

(B) in-home respite;

(5) personal attendant services provided through the FC Program, including SRO;

(6) in the HCBS-AMH Program:

(A) supported home living; and

(B) in-home respite;

(7) in the HCS Program:

(A) CFC PAS/HAB;

(B) in-home respite; and

(C) in-home individualized skills and socialization provided to members with the residential type of "own/family home";

(8) personal attendant services provided through the Primary Home Care Program, including SRO;

(9) in the STAR Health Program:

(A) CFC PAS, including SRO;

(B) CFC HAB, including SRO; and

(C) for a member in STAR Health MDCP:

(i) in-home respite, with and without RN delegation, including SRO; and

(ii) flexible family support, with and without RN delegation, including SRO;

(10) in the STAR Kids Program:

(A) CFC PAS, including SRO;

(B) CFC HAB, including SRO; and

(C) for a member in STAR Kids MDCP:

(i) in-home respite, with and without RN delegation, including SRO; and

(ii) flexible family support, with and without RN delegation, including SRO;

(11) in the STAR+PLUS Program:

(A) personal assistance services, including SRO;

(B) CFC PAS, including SRO; and

(C) CFC HAB, including SRO;

(12) in the STAR+PLUS HCBS Program:

(A) in-home respite care, including SRO;

(B) protective supervision, including SRO;

(C) personal assistance services, including SRO;

(D) CFC PAS, including SRO; and

(E) CFC HAB, including SRO;

(13) in the STAR+PLUS MMP, if delivered before January 1, 2026:

(A) in-home respite care, including SRO;

(B) protective supervision, including SRO;

(C) personal assistance services, including SRO;

(D) CFC PAS, including SRO; and

(E) CFC HAB, including SRO;

(14) in the TxHmL Program:

(A) CFC PAS/HAB;

(B) in-home respite; and

(C) in-home individualized skills and socialization;

(15) in-home respite provided in the YES Program; and

(16) any other service required by federal or state mandates.

(b) A CDS employer must ensure a service provider uses EVV to document the delivery [provision] of the following personal care services through the CDS option if HHSC, an HHSC designated contractor, or an MCO pays for any part of the claim for these services:

(1) in the traditional Medicaid service model also referred to as fee-for-service:

(A) CFC PAS;

(B) CFC HAB;

(C) PCS provided under Texas Health Steps CCP; and

(D) PCS-Behavioral Health provided under Texas Health Steps CCP;

(2) in the CLASS Program:

(A) CFC PAS/HAB; and

(B) in-home respite;

(3) personal attendant services provided through the Community Attendant Services Program;

(4) in the DBMD Program:

(A) CFC PAS/HAB; and

(B) in-home respite;

(5) personal attendant services provided through the FC Program;

(6) in the HCS Program:

(A) CFC PAS/HAB; and

(B) in-home respite;

(7) personal attendant services provided through the Primary Home Care Program;

(8) in the STAR Health Program:

(A) CFC PAS;

(B) CFC HAB; and

(C) for a member in STAR Health MDCP:

(i) in-home respite, with and without RN delegation; and

(ii) flexible family support, with and without RN delegation;

(9) in the STAR Kids Program:

(A) CFC PAS;

(B) CFC HAB; and

(C) for a member in STAR Kids MDCP:

(i) in-home respite, with and without RN delegation; and

(ii) flexible family support, with and without RN delegation;

(10) in the STAR+PLUS Program:

(A) personal assistance services;

(B) CFC PAS; and

(C) CFC HAB;

(11) in the STAR+PLUS HCBS Program:

(A) in-home respite care;

(B) protective supervision;

(C) personal assistance services;

(D) CFC PAS; and

(E) CFC HAB;

(12) in the STAR+PLUS MMP, if delivered before January 1, 2026:

(A) in-home respite care;

(B) protective supervision;

(C) personal assistance services;

(D) CFC PAS; and

(E) CFC HAB; and

(13) in the TxHmL Program:

(A) CFC PAS/HAB;

(B) in-home respite; and

(C) in-home individualized skills and socialization.

§354.4006. Home Health Care Services that Require the Use of EVV.

(a) A program provider must use [ensure a service provider uses] EVV to document the delivery [provision] of the following home health care services by the program provider if HHSC, an HHSC designated contractor, or an MCO pays for any part of the claim for these services [on or after January 1, 2024]:

(1) in the traditional Medicaid service model also referred to as fee-for-service, for a member who does not reside in a nursing facility, an ICF/IID, or an IMD, the following services when provided in the residence of the member:

(A) any nursing service, other than PDN;

(B) occupational therapy; and

(C) physical therapy;

(2) in the CLASS Program, for a member who does not receive support family services or continued family services, the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy;

(3) in the DBMD Program, for a member who does not receive licensed assisted living or licensed home health assisted living, the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy;

(4) in the HCS Program, for a member whose residential type is "own/family home," the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy;

(5) in the HCBS-AMH Program, for a member who does not receive host home/companion care, supervised living services, or assisted living services, the following services when provided in the residence of the member:

(A) nursing - RN; and

(B) nursing - LVN;

(6) in the STAR Program, the following services when provided in the residence of the member:

(A) home health nursing;

(B) occupational therapy;

(C) physical therapy; and

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist;

(7) in the STAR Health Program, the following services when provided in the residence of the member:

(A) home health nursing, other than PDN;

(B) occupational therapy;

(C) physical therapy; and

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist;

(E) nursing delegation and supervision of PCS and CFC tasks; and

(F) for a member in STAR Health MDCP, the following services when provided in the residence of the member:

(i) RN delegation and supervision of personal care services and CFC tasks, other than PDN;

(ii) flexible family supports services performed by RN or an LVN; and

(iii) in-home respite performed by RN or an LVN;

(8) in the STAR Kids Program, the following services when provided in the residence of the member:

(A) home health nursing, other than PDN;

(B) occupational therapy;

(C) physical therapy;

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist;

(E) nursing delegation and supervision of PCS and CFC tasks; and

(F) for a member in STAR Kids MDCP, the following services when provided in the residence of the member:

(i) RN delegation and supervision of personal care services and CFC tasks, other than PDN;

(ii) flexible family supports services performed by an RN or LVN; and

(iii) in-home respite performed by an RN or LVN;

(9) in the STAR+PLUS Program, the following services when provided in the residence of the member:

(A) home health nursing;

(B) occupational therapy;

(C) physical therapy; and

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist;

(10) in the STAR+PLUS HCBS Program, for members not receiving adult foster care, assisted living services - single occupancy, assisted living services - double occupancy, or assisted living services - non-apartment, the following services when provided in the residence of the member:

(A) home health nursing, including SRO;

(B) occupational therapy, including SRO;

(C) physical therapy, including SRO; and

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist, including SRO;

(11) in the STAR+PLUS MMP, for members not receiving adult foster care, assisted living services - single occupancy, assisted living services - double occupancy, or assisted living services - non-apartment, the following services when provided in the member's home, if delivered before January 1, 2026 [residence of the member]:

(A) home health nursing, including SRO;

(B) occupational therapy, including SRO;

(C) physical therapy, including SRO; and

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist, including SRO;

(12) in the TxHmL Program, the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy; and

(13) any other service required by federal or state mandates.

(b) A CDS employer must ensure a service provider uses EVV to document the delivery [provision] of the following home health care services using the CDS option, if HHSC, an HHSC designated contractor, or an MCO pays for any part of the claim for these services [on or after January 1, 2024]:

(1) in the CLASS Program, the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy;

(2) in the HCS Program, for a member whose residential type is "own/family home," the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy;

(3) in the STAR Health Program for a member in STAR Health MDCP, the following services when provided in the residence of the member:

(A) flexible family supports services performed by any RN or any LVN; and

(B) in-home respite performed by any RN or any LVN;

(4) in the STAR Kids Program for a member in STAR Kids MDCP, the following services when provided in the residence of the member:

(A) flexible family supports services performed by any RN or any LVN; and

(B) in-home respite performed by any RN or any LVN;

(5) in the STAR+PLUS Program, the following services when provided in the residence of the member:

(A) home health nursing;

(B) occupational therapy;

(C) physical therapy; and

(D) personal care services provided by a home health aide under the supervision of an RN, occupational therapist, or physical therapist;

(6) in the STAR+PLUS HCBS Program, the following services when provided in the residence of the member:

(A) home health nursing;

(B) occupational therapy;

(C) physical therapy; and

(D) home health aide services as an extension of physical therapy, occupational therapy, or nursing services;

(7) in the STAR+PLUS MMP, the following services when provided in the member's home, if delivered before January 1, 2026 [residence of the member]:

(A) home health nursing;

(B) occupational therapy;

(C) physical therapy; and

(D) home health aide services as an extension of physical therapy, occupational therapy, or nursing services; and

(8) in the TxHmL Program, the following services when provided in the residence of the member:

(A) any nursing service;

(B) occupational therapy; and

(C) physical therapy.

§354.4013. HHSC and MCO Compliance Reviews and Enforcement Actions.

(a) HHSC and an MCO conduct the following compliance reviews in accordance with the EVV Policy Handbook:

(1) an EVV Usage Review;

(2) an EVV Landline Phone Verification Review; and

(3) an EVV Alternative Device Compliance [Required Free Text] Review.

(b) If HHSC or an MCO determines from an EVV Usage Review that a program provider's or FMSA's EVV Usage score is less than 80% and such score is:

(1) the first occurrence within a 24-month period, HHSC or an MCO may require the program provider or FMSA to complete EVV policy, system, and portal trainings within a specific time frame;

(2) the second occurrence within a 24-month period, HHSC or an MCO may require the program provider or FMSA to complete a corrective action plan within 10 business days after the date the program provider or FMSA is notified that the EVV Usage score is less than 80%; or

(3) the third occurrence within a 24-month period, HHSC or an MCO may propose to terminate the contract of the program provider or FMSA.

(c) If HHSC or an MCO determines from an EVV Usage Review that a CDS Employer's EVV Usage score is less than 80% and such score is:

(1) the first occurrence within a 24-month period, HHSC or an MCO may require the CDS employer to complete EVV policy and system trainings within a specific time frame;

(2) the second occurrence within a 24-month period, HHSC or an MCO may require the CDS employer to complete a corrective action plan within 10 business days after the date the CDS employer is notified that the EVV Usage score is less than 80%; or

(3) the third occurrence within a 24-month period, HHSC or an MCO may propose to end [terminate] the member's participation in the CDS option.

(d) If a program provider or an FMSA does not complete the required EVV trainings listed in subsection (b)(1) of this section, or does not complete a corrective action plan as required by subsection (b)(1) and (2) of this section, HHSC or the MCO may place [impose] a vendor hold or payment hold on the program provider or FMSA until the EVV trainings or a corrective action plan is completed.

(e) If a CDS employer does not complete EVV trainings required by subsection (c)(1) of this section, HHSC or the MCO may require the CDS employer to complete a corrective action plan within 10 business days after the date the CDS employer is notified that EVV trainings were not completed.

(f) If a CDS employer does not complete a corrective action plan as required by subsections (c)(2) or (e) of this section, HHSC or the MCO may propose to end [terminate] the member's participation in the CDS option.

(g) If HHSC or an MCO determines from an EVV Landline Phone Verification Review that a service provider has used an unallowable phone type as described in the EVV Policy Handbook to clock in and clock out of the EVV system:

(1) HHSC or an MCO provides written notification of such determination to the program provider or FMSA;

(2) within 20 business days after receipt of the written notification, the program provider or FMSA must provide the documentation described in the written notification to HHSC or the MCO; and

(3) if the program provider or FMSA does not send the documentation listed [provide the documentation described] in the written notice [notification] to HHSC or the MCO within the deadline described in paragraph (2) of this subsection, HHSC or the MCO may place [impose] a vendor hold or payment hold on the program provider or FMSA until the date HHSC or the MCO receives the documentation from the program provider or FMSA [provides the documentation].

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 March 20, 2026.

TRD-202601336

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: May 3, 2026

For further information, please call: (512) 438-5241