TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 504. ABORTION FACILITY REPORTING AND LICENSING

SUBCHAPTER A. GENERAL PROVISIONS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amended §504.2, concerning Definitions.

BACKGROUND AND PURPOSE

The proposal is necessary to comply with Senate Bill (SB) 31, 89th Legislature, Regular Session, 2025. SB 31 amended Texas Health and Safety Code (THSC) Chapter 245 by expanding the definition of ectopic pregnancy to also mean the implantation of a fertilized egg or embryo in an abnormal location in the uterus, or in a scarred portion of the uterus, causing the pregnancy to be non-viable.

The proposal is necessary to ensure consistency with amended THSC §245.002.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §504.2 updates the definition of ectopic pregnancy to read as the implantation of a fertilized egg or embryo occurring outside of the uterus, or in an abnormal location in the uterus, or in a scarred portion of the uterus, causing the pregnancy to be non-viable.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will not expand, limit, or repeal an existing regulation;

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

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

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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rule does not impose a cost or require small businesses, micro-businesses, or rural communities to alter their current business practices and the rule is codifying current practices as required by statute.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

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

PUBLIC BENEFIT AND COSTS

David Kostroun, Deputy Executive Commissioner, Regulatory Services Division, has determined that for each year of the first five years the rule is in effect, the public benefit will be consistency between rule and statute.

Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule is making the definition of ectopic pregnancy in rule consistent with the definition in statute.

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 26R025" in the subject line.

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §524.0151, which authorizes the executive commissioner of HHSC to adopt rules for the health and human services system; THSC §245.011, which requires physicians to report to HHSC information about each abortion performed; and THSC §171.006, which requires physicians and certain health care facilities to report to HHSC information about each abortion complication diagnosed or treated.

The amendment implements Texas Government Code §524.0151, THSC §245.011, and THSC §171.006.

§504.2. Definitions.

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) - (19) (No change.)

(20) Ectopic pregnancy--The implantation of a fertilized egg or embryo:

(A) outside of the uterus; or [.]

(B) in an abnormal location in the uterus, or in a scarred portion of the uterus, causing the pregnancy to be non-viable.

(21) - (60) (No change.)

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 June 29, 2026.

TRD-202602660

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 834-4591

CHAPTER 505. HOSPITAL LICENSING

SUBCHAPTER C. OPERATIONAL REQUIREMENTS

26 TAC §505.47

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §505.47, concerning Abuse and Neglect Issues.

BACKGROUND AND PURPOSE

The proposal is necessary to comply with Senate Bill (SB) 437, 89th Legislature, Regular Session, 2025. In part, SB 437 amended Texas Health and Safety Code (HSC) §161.133 to allow in-service training on abuse, neglect, exploitation (ANE) and illegal, unprofessional, and unethical conduct in certain health care facilities to be provided either in person or through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee.

The amendment to §505.47 will allow general and special hospitals to provide in-service training either in person or through a live, interactive, instructor-led and electronic method. Additionally, edits are made to update cross references and correct punctuation.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §505.47 allows general and special hospitals to conduct ANE training through in person or a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee. The amendment also updates cross references to other Texas Administrative Code rules and corrects punctuation.

FISCAL NOTE

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

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will not expand, limit, or repeal existing regulations;

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

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

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

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rule does not impose a cost or require small business, micro-businesses, or rural communities to alter current business practices and the rule is codifying current practices as required by statute.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons, is amended to reduce the burden or responsibilities imposed on regulated persons by the rule, and is necessary to implement legislation that does not specifically state that §2001.0045 applies to the rule.

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rule is in effect, facility staff will have easier access to ANE training, and facilities will have greater flexibility in how such training is provided. As a result, the public will benefit from staff trained more easily and quickly which will enhance public safety.

Victoria Grady 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 rule is codifying current practices as required by statute.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

STATUTORY AUTHORITY

The amendment is 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 Health and Safety Code §161.133, which requires the executive commissioner to require certain facilities to annually provide eight hours of ANE training.

The amendment implements Texas Government Code §524.0151 and HSC §161.133.

§505.47. Abuse and Neglect Issues.

(a) Reporting. Incidents of abuse, neglect, exploitation, or illegal, unethical or unprofessional conduct as those terms are defined in subsections (b) and (c) of this section shall be reported to the Texas Health and Human Services Commission (HHSC) as provided in subsections (b) and (c)(3) of this section.

(b) Abuse or neglect of a child, and abuse, neglect, or exploitation of an elderly or disabled person. The following terms in this section have the following meanings unless the context clearly indicates otherwise [~~definitions apply only to this subsection~~].

(1) Abuse or neglect of a child, as defined in 25 TAC §1.204(a) and (b) [~~of this title~~] (relating to Abuse, Neglect, and [or] Exploitation Defined).

(2) Abuse, neglect, or exploitation of an elderly or disabled person, as defined in 25 TAC §1.204 [~~§1.204(a) - (c) of this title~~].

(c) Abuse and neglect of individuals with mental illness, and illegal, unethical, and unprofessional conduct. [~~The requirements of this subsection are in addition to the requirements of subsection (b) of this section.~~]

(1) Definitions. The following terms in this section have the following meanings unless the context clearly indicates otherwise. The terms [~~definitions~~] are in accordance with Texas Health and Safety Code (HSC) §161.131 and apply only to this section [~~subsection~~].

(A) Abuse--

(i) Abuse (as the term is defined in United States Code Title 42 (42 USC) Chapter 114 (relating to Protection and Advocacy for Individuals with Mental Illness) is any act or failure to act by an employee of a facility rendering care or treatment which was performed, or which was failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with mental illness, and includes acts such as:

(I) the rape or sexual assault of an individual with mental illness;

(II) the striking of an individual with mental illness;

(III) the use of excessive force when placing an individual with mental illness in bodily restraints; and

(IV) the use of bodily or chemical restraints on an individual with mental illness which is not in compliance with federal and state laws and regulations.

(ii) In accordance with HSC §161.132(j), abuse also includes coercive or restrictive actions that are illegal or not justified by the patient's condition and that are in response to the patient's request for discharge or refusal of medication, therapy, or treatment.

(B) Illegal conduct--Illegal conduct (as the term is defined in HSC §161.131(4)) is conduct prohibited by law.

(C) Neglect--Neglect (as the term is defined in 42 USC §10801 et seq.) is a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to an individual with mental illness or which placed an individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for an individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to an individual with mental illness, or the failure to provide a safe environment for an individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.

(D) Unethical conduct--Unethical conduct (as the term is defined in HSC §161.131(11)) is conduct prohibited by the ethical standards adopted by state or national professional organizations for their respective professions or by rules established by the state licensing agency for the respective profession.

(E) Unprofessional conduct--Unprofessional conduct (as the term is defined in HSC §161.131(12)) is conduct prohibited under rules adopted by the state licensing agency for the respective profession.

(2) Posting requirements. A hospital shall prominently and conspicuously post for display in a public area that is readily visible to patients, residents, volunteers, employees, and visitors a statement of the duty to report abuse and neglect, or illegal, unethical, or unprofessional conduct in accordance with HSC §161.132(e). The statement shall be in English and in a second language appropriate to the demographic makeup of the community served and contain the current toll-free telephone number for submitting a complaint to HHSC as specified on the HHSC website.

(3) Reporting responsibility.

(A) Reporting abuse and neglect. A person, including an employee, volunteer, or other person associated with the hospital who reasonably believes or who knows of information that would reasonably cause a person to believe that the physical or mental health or welfare of a patient of the hospital who is receiving mental health or chemical dependency services has been, is, or will be adversely affected by abuse or neglect (as those terms are defined in this section [~~subsection~~]) by any person shall as soon as possible report the information supporting the belief to HHSC or to the appropriate state health care regulatory agency in accordance with HSC §161.132(a).

(B) Reporting illegal, unprofessional, or unethical conduct. An employee of or other person associated with a hospital, including a health care professional, who reasonably believes or who knows of information that would reasonably cause a person to believe that the hospital or an employee or health care professional associated with the hospital, has, is, or will be engaged in conduct that is or might be illegal, unprofessional, or unethical and that relates to the operation of the hospital or mental health or chemical dependency services provided in the hospital shall as soon as possible report the information supporting the belief to HHSC or to the appropriate state health care regulatory agency in accordance with HSC §161.132(b).

(4) Training requirements. As a condition of continued licensure, a [A] hospital that provides comprehensive medical rehabilitation, inpatient mental health, or substance use disorder services shall [~~annually~~] provide [~~as a condition of continued licensure~~] a minimum of eight hours of [~~in-service~~] training annually. Training shall be designed to help [~~assist~~] employees and health care professionals associated with the hospital in identifying patient abuse or neglect and illegal, unprofessional, or unethical conduct. A hospital shall [~~by or in the hospital and~~] establish a means for monitoring compliance with the training requirement. This training must be provided either:

(A) in person; or

(B) through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee.

(d) Investigations. A complaint under this section [~~subsection~~] will be investigated or referred by HHSC as follows.

(1) Allegations under subsection (b) of this section will be investigated in accordance with 25 TAC §1.205 [~~of this title~~] (relating to Reports and Investigations) and 25 TAC §1.206 [~~of this title~~] (relating to Completion of Investigation).

(2) Allegations under subsection (c) of this section will be investigated in accordance with §505.103 [~~§133.103~~] of this chapter (relating to Complaint Investigations). Allegations concerning a health care professional's failure to report abuse and neglect or illegal, unprofessional, or unethical conduct will not be investigated by HHSC but will be referred to the individual's licensing board for appropriate disciplinary action.

(3) Allegations under both subsections (b) and (c) will be investigated in accordance with 25 TAC §1.205 and 25 TAC §1.206 [~~of this title~~] except as noted in paragraph (2) of this subsection concerning a health care professional's failure to report.

(e) Submission of complaints. A complaint made under this section may be submitted in writing or verbally to HHSC.

(f) Notification.

(1) For complaints under subsection (b) of this section, HHSC shall provide notification according to the following.

(A) HHSC shall notify the reporter, if known, in writing of the outcome of the completed investigation.

(B) HHSC shall notify the alleged victim, and the alleged victim's parent or guardian if a minor, in writing of the outcome of the completed investigation.

(2) For complaints under subsection (c) of this section, HHSC informs, in writing, the complainant who identifies themselves by name and address of the following:

(A) the receipt of the complaint;

(B) if the complainant's allegations are potential violations of this chapter warranting an investigation;

(D) whether and to whom the complaint will be referred; and

(E) the findings of the complaint investigation.

(g) HHSC reporting and referral.

(1) Reporting health care professional to licensing board.

(A) In cases of abuse, neglect, or exploitation[~~, as those terms are defined in subsection (b) of this section,~~] by a licensed, certified, or registered health care professional, HHSC may forward a copy of the completed investigative report to the state agency that licenses, certifies, or registers the [~~health care~~] professional. Any information in the report which might reveal the identity of the reporter or any other patients of the hospital must be blacked out or de-identified [~~deidentified~~].

(B) A health care professional who fails to report abuse and neglect or illegal, unprofessional, or unethical conduct as required by subsection (c)(3) of this section may be referred by HHSC to the individual's licensing board for appropriate disciplinary action.

(2) Sexual exploitation reporting requirements. In addition to the reporting requirements described in subsection (c)(3) of this section, a mental health services provider must report suspected sexual exploitation in accordance with Texas Civil Practice and Remedies Code §81.006.

(3) Referral follow-up. HHSC shall request a report from each referral agency of the action taken by the agency six months after the referral.

(4) Referral of complaints. A complaint containing allegations which are not a violation of HSC Chapter 241 or this chapter will not be investigated by HHSC but shall be referred to law enforcement agencies or other agencies, as appropriate.

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 June 29, 2026.

TRD-202602661

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 834-4591

CHAPTER 564. CHEMICAL DEPENDENCY TREATMENT FACILITIES

SUBCHAPTER F. PERSONNEL PRACTICES AND DEVELOPMENT

26 TAC §564.603

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §564.603, concerning Training.

BACKGROUND AND PURPOSE

The proposed amendment is necessary for HHSC to update rules for chemical dependency treatment facilities (CDTFs) as current rules prohibit facilities from conducting ANE training virtually.

Additionally, edits are made to remove outdated language and references and to correct grammar. The rule is also reorganized for clarity and to improve readability.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §564.603 removes outdated language and references and corrects grammar. The rule is also reorganized for clarity and to improve readability. The amendment also adds relevant information for the training program to allow CDTFs to conduct ANE training through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employees.

FISCAL NOTE

Victoria Grady, Deputy Chief of Finance, 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 rule will be in effect:

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

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

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

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

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

(6) the proposed rule will not expand, limit, or repeal existing regulations;

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

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

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

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rule does not impose a cost or require small businesses, micro-businesses, or rural communities to alter current business practices and the rule is codifying current practices as required by statute.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rule are in effect, facility staff will have easier access to ANE training, and facilities will have greater flexibility in how such training is provided. As a result, the public will benefit from staff trained more easily and quickly which will enhance public safety.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule is codifying current practices as required by statute.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

STATUTORY AUTHORITY

The amendment is 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; HSC §464.009, which authorizes the executive commissioner of HHSC to adopt rules governing organization and structure, policies and procedures, staffing requirements, services, client rights, records, physical plant requirements, and standards for licensed chemical dependency treatment facilities; and HSC §161.133 which requires the executive commissioner to require certain facilities to annually provide eight hours of ANE training.

The amendment implements Texas Government Code §524.0151, and HSC §464.009 and §161.133.

§564.603. Training.

(a) Virtual Training. Unless otherwise specified, video, manual, or computer-based training is acceptable if the supervisor discusses and documents the material with the staff person in a face-to-face session to highlight key issues and answer questions.

(b) Records. The facility shall maintain documentation of all required training.

(1) Documentation of external training shall include:

(A) date;

(B) number of hours;

(D) instructor's name; and

(E) signature of the instructor (or equivalent verification).

(2) The facility shall maintain documentation of all internal training. For each topic, the file shall include:

(A) an outline of the contents;

(B) the name, credentials, relevant qualifications of the person providing the training, and

(3) For each group training session, the facility shall maintain on file a dated attendee sign-in sheet for the in-person training and a dated attendee list for the virtual training.

(c) Orientation. Prior to performing their duties and responsibilities, the facility shall provide orientation to staff, volunteers, and students. This orientation shall include information addressing:

(1) Texas Health and Human Services (HHSC) [~~TCADA~~] rules;

(2) facility policies and procedures;

(3) client rights;

(4) client grievance procedures;

(5) confidentiality of client-identifying information provided in 42 CFR Part 2 [~~(42 C.F.R. pt. 2; HIPAA)~~];

(6) standards of conduct; and

(7) emergency and evacuation procedures.

(d) Initial training. A facility employee must complete the [~~The~~] following initial training [~~training(s) must be received~~] within the first 90 days of employment [~~and must be completed~~] before the employee can perform a function to which the specific training is applicable. The employee must complete subsequent [~~Subsequent~~] training [~~must be completed~~] as specified.

(e) [~~(1)~~] Abuse, neglect, and exploitation training [~~Neglect, and Exploitation~~]. [All residential program personnel with any direct client contact shall receive eight hours of face-to-face training as described in Figure: 40 TAC §148.603(d)(1) which is attached hereto and incorporated herein as if set forth at length. All outpatient program personnel with any direct client contact shall received two hours of abuse, neglect and exploitation training.]

(1) All direct care staff shall receive abuse, neglect, and exploitation training.

(A) All outpatient program personnel with any direct client contact shall receive at least two hours of abuse, neglect, and exploitation training annually.

(B) All residential program personnel with any direct client contact shall receive at least eight hours of abuse, neglect, and exploitation training annually.

[~~Figure: 40 TAC §148.603(d)(l)~~]

(2) A facility shall provide abuse, neglect, and exploitation training:

(A) in person; or

(B) through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee.

(3) The training shall include at least:

(A) applicable requirements under:

(i) §564.502 of this chapter (relating to Operational Plan, Policies and Procedures); and

(ii) Subchapter G of this chapter (relating to Client Rights);

(B) the facility's policies and procedures relating to client rights, client abuse, neglect, exploitation, and illegal, unprofessional, and unethical conduct, adopted by the facility's governing body as required under §564.502 of this chapter;

(C) procedures and legal requirements, including requirements under §564.509 of this chapter (relating to Incident Reporting) and Texas Health and Safety Code §161.132, for reporting incidents, suspicions, and allegations of client abuse, neglect, exploitation, and illegal, unprofessional, and unethical conduct;

(D) the legal protection afforded to staff, personnel, associated practitioner and any other individual who report client abuse, neglect, exploitation, or illegal, unprofessional, or unethical conduct; and

(E) training to assist the staff and any professional associated with the facility in identifying, minimizing the risk to clients of, and responding to client abuse, neglect, exploitation, and illegal, unprofessional, or unethical conduct by, in, or in connection or association with, the facility.

(f) [~~(2)~~] HIV, Hepatitis B and C, Tuberculosis and Sexually Transmitted Diseases. All personnel with any direct client contact shall receive this training. [~~The training shall be based on the Texas Commission on Alcohol and Drug Abuse Workplace and Education Guidelines for HIV and Other Communicable Diseases.~~]

(1) [~~(A)~~] The initial training shall be three hours in length.

(2) [~~(B)~~] Staff shall receive annual updated information about these diseases.

(g) [~~(3)~~] Cardio Pulmonary Resuscitation (CPR).

(1) [~~(A)~~] All direct care staff in a residential program shall maintain current CPR and First Aid certification.

(2) [~~(B)~~] Licensed health professionals and personnel in licensed medical facilities are exempt if emergency resuscitation equipment and trained response teams are available 24 hours a day.

(h) [~~(4)~~] Nonviolent Crisis Intervention. All direct care staff in residential programs and outpatient programs shall receive this training. The face-to-face training shall teach staff how to use verbal and other non-physical methods for prevention, early intervention, and crisis management. The instructor shall have documented successful completion of a course for crisis intervention instructors or have equivalent documented training and experience.

(1) [~~(A)~~] The initial training shall be four hours in length.

(2) [~~(B)~~] Staff shall complete two hours of annual training thereafter.

(i) [~~(5)~~] Restraint and/or Seclusion. All direct care staff in residential programs and programs accepting court commitments that use or authorize the use of restraint or seclusion shall have face-to-face training and demonstrate competency in the safe methods of the specific procedures before assuming job duties involving direct care responsibilities. This includes programs that accept adolescent residential and emergency detentions.

(1) [~~(A)~~] The initial training must be four hours in length.

(2) [~~(B)~~] Staff shall complete four hours of annual training thereafter.

(3) [~~(C)~~] The training shall include hands-on practice under the supervision of a qualified instructor.

(4) [~~(D)~~] The training program shall include:

(A) [~~(i)~~] identifying the underlying causes of threatening behaviors exhibited by the clients receiving services;

(B) [~~(ii)~~] identifying aggressive or threatening behavior;

(D) [~~(iv)~~] using de-escalation, mediation, self-protection, and other techniques;

(E) [~~(v)~~] recognizing and responding to signs of physical distress in clients who are being restrained, if the facility uses or authorizes the use of restraint;

(F) [~~(vi)~~] identifying the risks associated with positional, compression, or restraint asphyxiation and with prone and supine holds, if the facility uses or authorizes the use of restraint;

(G) [~~(vii)~~] the initiation of seclusion, if the facility uses or authorizes the use of seclusion;

(H) [~~(viii)~~] the application of personal restraint, if the facility uses or authorizes the use of personal restraint;

(I) [~~(ix)~~] the application of approved restraint devices, if the facility has on premises, authorizes the use of, or uses any mechanical restraint devices;

(J) [~~(x)~~] monitoring cardiac and respiratory status and interpreting their relevance to the physical safety of the client in restraint, if the facility uses or authorizes the use of restraint, or seclusion, if the facility uses or authorizes the use of seclusion;

(K) [~~(xi)~~] addressing physical and psychological status and comfort, including signs of distress;

(L) [~~(xii)~~] assisting clients in meeting behavioral criteria for the discontinuation of restraint, if the facility uses or authorizes the use of restraint, or seclusion, if the facility uses or authorizes the use of seclusion;

(M) [~~(xiii)~~] recognizing readiness for the discontinuation of restraint, if the facility uses or authorizes the use of restraint, or seclusion, if the facility uses or authorizes the use of seclusion; and

(N) [~~(xiv)~~] recognizing when to contact emergency medical services to evaluate and [~~and/or~~] treat a client for an emergency medical condition.

(j) [~~(6)~~] Intake, Screening and Admission Authorization. All staff who conduct intake, screening and authorize admission for applicants to receive program services shall complete training in the program's screening and admission procedures. The training shall include two hours of the Diagnostic and Statistical Manual of Mental Disorders [~~DSM~~] diagnostic criteria for substance-related disorders, and other mental health diagnoses.

(1) [~~(A)~~] The initial training shall be eight hours in length.

(2) [~~(B)~~] Staff shall complete eight hours of annual training thereafter.

(3) [~~(C)~~] The training shall be completed before staff screen or authorize applicants for admission.

(k) [~~(7)~~] Self-administration of Medication. All personnel responsible for supervising clients in self-administration of medication, who are not credentialed to administer medication, shall complete this training before performing this task.

(1) [~~(A)~~] Staff shall complete two hours initial one time training.

(2) [~~(B)~~] The training shall be provided by a physician, pharmacist, physician assistant, or registered nurse before administering medication and shall include:

(A) [~~(i)~~] prescription labels;

(B) [~~(ii)~~] medical abbreviations;

(D) [~~(iv)~~] use of drug reference materials;

(E) [~~(v)~~] storage, maintenance, handling, and destruction of medication;

(F) [~~(vi)~~] documentation requirements; and

(G) [~~(vii)~~] procedures for medication errors, adverse reactions, and side effects.

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 June 29, 2026.

TRD-202602662

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 834-4591

CHAPTER 568. STANDARDS OF CARE AND TREATMENT IN PSYCHIATRIC HOSPITALS

SUBCHAPTER G. STAFF DEVELOPMENT

26 TAC §568.121

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §568.121, concerning Staff Member Training.

BACKGROUND AND PURPOSE

The proposed amendment to §568.121 allows private psychiatric hospitals (PPHs) to conduct ANE training through in person or a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §568.121 allows PPHs to conduct ANE training through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee. The amendment also updates cross references to Texas Administrative Code rules.

FISCAL NOTE

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will not expand, limit, or repeal existing regulations;

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

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

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

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rule does not impose a cost or require small businesses, micro-businesses, or rural communities to alter current business practices and the rule is codifying current practices as required by statute.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

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 26R014" in the subject line.

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HSC §161.133.

§568.121. Staff Member Training.

(a) Training. Staff member training shall be in accordance with §301.331 of this title (relating to Competency and Credentialing).

(1) A hospital administrator, or administrator's designee, shall:

(A) ensure that services are provided by staff members who are operating within their scope of their license, credentialing, job description, or contract specification, and in accordance with applicable state law and rule, including Chapter 320, Subchapter C of this title (relating to Interventions in Mental Health Services) [~~25 TAC Chapter 415, Subchapter F (relating to Interventions in Mental Health Services)~~];

(B) define competency-based expectations for each hospital staff position and ensure each staff member receives initial training before the staff member assumes responsibilities required by the hospital and annually throughout the staff member's employment with the hospital;

(C) provide hospital staff with live, interactive, instructor-led electronic or face-to-face training competency-based training; and

(D) require all staff members to demonstrate required competencies delineated in §301.331(a)(3)(A) of this title, including:

(i) identifying, preventing, and reporting abuse and neglect of patients and unprofessional or unethical conduct in the hospital, as defined by Texas Health and Safety Code §161.131 [~~(relating to Definitions)~~];

(ii) identifying, preventing, and reporting abuse, neglect, and exploitation as follows, in accordance with Texas Health and Safety Code §161.133 [~~(relating to In-service Training)~~]:

(I) residential staff must receive eight hours of training;

(II) training must be conducted either in person, or [~~and not~~] through a live, interactive, instructor-led, and electronic method that uses synchronous audiovisual interaction between the instructor and employee [~~teleconferencing, web-based video conferencing, or other technology~~];

(III) a hospital must ensure all new employees receive training on abuse, neglect, and exploitation; and

(IV) a hospital may provide abuse, neglect, and exploitation training to staff or may choose to contract with an outside entity to provide the training;

(iii) preserving and protecting dignity and rights of a patient in accordance with Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services) [~~25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services)~~]; and

(iv) preserving and protecting confidentiality of a patient's information in accordance with Texas Health and Safety Code Chapter 611 or Chapter 241, Subchapter G, as applicable, 42 CFR Part 2, and 45 CFR Parts 160 and 164.

(2) All registered nurses (RNs), licensed vocational nurses (LVNs), and unlicensed assistive personnel (UAP) shall receive training in:

(A) monitoring for patient safety in accordance with §568.67 of this chapter (relating to Protection of a Patient);

(B) infection control in accordance with §510.41(d) of this title (relating to Facility Functions and Services); and

(3) An RN and LVN shall receive training in the process for reporting concerns regarding the adequacy of the staffing plan, as described in §568.63(h) of this chapter.

(4) A staff member routinely providing treatment to, working with, or providing consultation about a patient who is younger than 18 years of age shall receive training in the aspects of growth and development (including physical, emotional, cognitive, educational and social) and the treatment needs of patients in the following age groups:

(A) early childhood (1-5 years of age);

(B) late childhood (6-13 years of age); and

(5) A staff member routinely providing treatment to, working with, or providing consultation about a patient diagnosed with co-occurring psychiatric and substance-related disorders (COPSD) shall receive training in substance-related and addictive disorders.

(6) A staff member routinely providing treatment to, working with, or providing consultation about a geriatric patient shall receive training in the social, psychological, and physiological changes associated with aging.

(7) In accordance with Texas Health and Safety Code §572.0025(e), a pre-admission screening professional (PASP) shall receive at least eight hours of pre-admission screening and intake training, as described in subsection (c) of this section.

(8) In accordance with Texas Health and Safety Code §572.0025(e), a staff member whose responsibilities include conducting the hospital's intake process for a patient shall receive at least eight hours of pre-admission screening and intake training, as described in subsection (c) of this section.

(9) A staff member who may initiate an involuntary intervention shall receive training in and demonstrate competency in performing such interventions in accordance with Chapter 320, Subchapter C of this title before [~~25 TAC Chapter 415, Subchapter F (relating to Interventions in Mental Health Services) prior to~~] performing such interventions.

(b) Breathing and cardiac emergency training. A staff member providing direct patient care shall maintain certification in a course developed by the American Heart Association, the American Red Cross, or the Health and Safety Institute in recognizing and caring for breathing and cardiac emergencies. The course shall teach the following skills appropriate to the age of the hospital's patients:

(1) rescue breathing, with and without devices;

(2) airway obstruction;

(3) cardiopulmonary resuscitation; and

(4) use of an automated external defibrillator.

(c) Pre-admission screening and intake training. The pre-admission screening and intake training required by subsections (a)(7) and (8) of this section shall provide instruction to staff members regarding:

(1) assessing, interviewing, and diagnosing an individual with a mental illness and an individual diagnosed with COPSD;

(2) obtaining relevant information about the patient, including information about finances, insurance benefits and advance directives;

(3) explaining, orally and in writing, the patient's rights described in Chapter 320, Subchapter A of this title [~~25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services)~~];

(4) explaining, orally and in writing, the hospital's services and treatment as they relate to the patient;

(5) informing the patient in writing of the existence, telephone number, and address of the protection and advocacy system of the state of Texas; and

(6) determining whether the patient comprehends the information provided in accordance with paragraphs (3) - (5) of this subsection.

(d) Frequency of training. A hospital shall provide the training described in subsection (a) of this section, periodically, as follows.

(1) A staff member shall receive the patient rights training required by subsection (a)(1)(D)(iii) of this section:

(A) before assuming responsibilities at the hospital; and

(B) annually throughout the staff member's employment or association with the hospital.

(2) A staff member shall receive the training in identifying, preventing, and reporting abuse and neglect of patients and unprofessional or unethical conduct required by subsection (a)(1)(D)(i) of this section annually throughout the staff member's employment or association with the hospital, as set forth in Texas Health and Safety Code §161.133.

(3) A staff member shall receive the training required by subsections (a)(1)(D) and (a)(2) - (5) of this section:

(A) before assuming responsibilities at the hospital; and

(B) annually throughout the staff member's employment or association with the hospital.

(4) A staff member shall have the certification required by subsection (b) of this section:

(A) before assuming responsibilities at the hospital; or

(B) not later than 30 days after the staff member is hired by the hospital if another staff member who has such certification is physically present and on-duty on the same unit on which the uncertified staff member is on-duty.

(5) A pre-admission screening professional (PASP) shall receive the training required by subsection (a)(7) of this section:

(A) before the PASP conducting a pre-admission screening; and

(B) annually throughout the PASP's employment or association with the hospital.

(6) A staff member shall receive the training required by subsection (a)(8) of this section:

(A) before conducting the intake process; and

(B) annually throughout the staff member's employment or association with the hospital.

(7) A staff member shall receive the training required by subsection (a)(9) of this section at the intervals described in Chapter 320, Subchapter C of this title [~~25 TAC Chapter 415, Subchapter F~~].

(e) Documentation of training.

(1) A hospital shall document that a staff member has successfully completed the training described in subsection (a) of this section including:

(A) the date of the training;

(B) the length of the training session; and

(2) A hospital shall maintain certification or other evidence issued by the American Heart Association, the American Red Cross or the Health and Safety Institute that a staff member has successfully completed the training described in subsection (b) of this section.

(f) Performance in accordance with training. A staff member shall perform the staff member's responsibilities in accordance with the training and certification required by this section.

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 June 29, 2026.

TRD-202602663

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 834-4591

CHAPTER 742. MINIMUM STANDARDS FOR LISTED FAMILY HOMES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §742.401, concerning What are the notification requirements; and the repeal of §742.806, concerning What are the requirements if my home chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill (HB) 163, 89th Legislature, Regular Session, 2025. HB 163 repealed statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

The proposed amendment and repeal in Chapter 742 removes the parental notification and policy requirements related to unassigned epinephrine auto-injectors for children in listed family homes.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §742.401, What are the notification requirements, changes the rule title to "Notification Requirements," because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles. The proposed amendment adds statutory and rule references in subsections (a)(1), (b), and (e) because similar rules for other child care operations provide these references. The proposed amendment replaces first-person pronouns with nouns for clarity. The proposed amendment in subsection (c)(3) replaces the requirement for a listed family home caregiver to notify a child's parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement for a listed family home to notify a child's parent immediately if the child requires administration of a medication in a medical emergency as described in Chapter 742. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §742.803(e). The proposed amendment uses plain language to improve understanding and effectiveness of the rule.

The proposed repeal of §742.806 removes the requirement for a home to have and implement a policy if the home maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child care facilities from the list of entities required to adopt such a policy.

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 a new regulation;

(6) the proposed rules will expand and repeal existing regulations;

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

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these 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

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules do not require a listed family home to purchase equipment, supplies, or hire additional personnel to comply with the rules.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rules, 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.

SUBCHAPTER D. NOTIFICATIONS AND LIABILITY INSURANCE REQUIREMENTS

26 TAC §742.401

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and §524.0005, and HRC §42.042(a).

§742.401. Notification Requirements. [~~What are the notification requirements?~~]

(a) A caregiver must notify the Department of Family and Protective Services immediately at 1-800-252-5400 if:

(1) the caregiver suspects a child has been abused, neglected, or exploited, as defined in Texas Family Code §261.001; [~~There is any suspected abuse, neglect, or exploitation;~~]

(2) a [A] child dies while in the caregiver's [~~your~~] care; [or]

(3) a [A] child was left unattended [~~forgotten~~] in the caregiver's [a] vehicle; or

(4) a child wandered away from the caregiver's [~~your~~] home or care unsupervised.

(b) If it is alleged or suspected that a child has been abused, neglected, or exploited as defined in Texas Family Code §261.001, while in the care of the caregiver, the caregiver must notify the parent of the child immediately.

(c) [~~(b)~~] A caregiver [~~You~~] must notify Child Care Regulation (CCR) [~~Licensing~~] immediately if the caregiver becomes [~~you become~~] aware that a household member, caregiver, or child in care contracts an illness deemed notifiable by the Texas Department of State Health Services as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases).

(d) [~~(c)~~] After a caregiver ensures [~~you ensure~~] the safety of a [~~the~~] child, the caregiver [~~you~~] must notify the parent of the child immediately if the child:

(1) is [Is] injured and [~~the injury~~] requires medical treatment by a health-care professional or hospitalization;

(2) shows [~~Shows~~] signs or symptoms of an illness that requires hospitalization;

(3) requires administration of a medication in a medical emergency as described in this chapter [~~Has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector~~]; or

(4) has been involved in any:

(A) non-routine situation that placed, or may have placed, the child at risk for injury or harm; or

(B) situation that renders the listed family home unsafe, such as a fire, flood, or damage to the home as a result of severe weather.

~~[(4) Was forgotten in a vehicle or wandered away from your home or care unsupervised.]~~

(e) [~~(d)~~] A caregiver [~~You~~] must provide written notification to [~~notify~~] the parent of a child in care of any minor [~~less serious~~] injuries when the parent arrives to pick up [~~picks~~] the child [up] from the home. Minor [~~Less serious~~] injuries are those which require a caregiver to provide only basic first-aid such as small [~~include, minor~~] cuts, scratches, bruises, or [~~and~~] bites from other children [~~requiring first aid treatment by caregivers~~].

(f) [~~(e)~~] A caregiver [~~You~~] must provide written notification to [~~notify~~] the parent of each child in care [~~attending the home in writing~~] within 48 hours after the date the caregiver becomes [~~you become~~] aware that a child in care, caregiver, or household member has contracted a communicable disease[~~, caregiver, or child in care contracts an illness~~] deemed notifiable by the Texas Department of State Health Services as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases). [~~; or~~]

(g) [~~(f)~~] A caregiver [~~You~~] must notify CCR [~~Licensing~~] in writing within 15 days after the date the caregiver [of]:

(1) relocates the caregiver's [~~Relocating your~~] listed family home; or

(2) closes [~~Closing~~] the home.

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 June 22, 2026.

TRD-202602556

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

SUBCHAPTER H. HEALTH AND SAFETY PRACTICES

26 TAC §742.806

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of HRC Chapter 42.

The repeal implements Texas Government Code §524.0151 and §524.0005, and HRC §42.042(a).

§742.806. What are the requirements if my home chooses to maintain and administer unassigned epinephrine auto-injectors?.

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 June 22, 2026.

TRD-202602557

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

CHAPTER 743. MINIMUM STANDARDS FOR SHELTER CARE

SUBCHAPTER D. SAFETY PRACTICES

26 TAC §743.301

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §743.301, concerning What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill (HB) 163, 89th Legislature, Regular Session, 2025. HB 163 repealed the statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

The proposed repeal in Chapter 743 removes a policy requirement related to unassigned epinephrine auto-injectors for children in temporary shelter care operations.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §743.301 removes the requirement for a temporary shelter care operation to have and implement a policy if the operation maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child care facilities from the list of entities required to adopt such a policy.

FISCAL NOTE

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will repeal existing regulations;

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

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

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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the rule will be removed.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons and is necessary to implement legislation that does not specifically state that §2001.0045 applies to the rule.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public will benefit from rules that comply with state law.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

STATUTORY AUTHORITY

The repeal implements Texas Government Code §524.0151 and HRC §42.042.

§743.301. What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors?

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 June 22, 2026.

TRD-202602558

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

CHAPTER 744. MINIMUM STANDARDS FOR SCHOOL-AGE AND BEFORE OR AFTER-SCHOOL PROGRAMS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §744.307, concerning What emergency or medical situations must I notify parents about, and §744.701, concerning What written records must I keep of accidents and injuries that occur at my operation.

BACKGROUND AND PURPOSE

The purpose of the proposal is to amend two sections of Chapter 744 to align the rule language with similarly-amended rules for other operation types.

The proposed amendments in Chapter 744 remove parental notification and incident record requirements related to unassigned epinephrine auto-injectors for children in school-age and before or after-school programs.

The proposed amendments replace first-person pronouns with nouns for clarity and change the titles of the rules because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §744.307, What emergency or medical situations must I notify parents about, changes the rule title to "Emergency and Medical Parental Notifications."

The proposed amendment in subsection (b)(3) replaces the requirement for a child care operation to notify a child's parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement for a child care operation to notify a child's parent immediately if the child requires administration of a medication in a medical emergency as described in Chapter 744. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §744.2653(d). The proposed amendment in subsection (b)(4)(A) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk. The proposed amendment in subsection (e) clarifies that an operation must notify parents in writing within 48 hours of learning a child or employee has contracted lice or another communicable parasite and how to provide the written notice.

The proposed amendment to §744.701, What written records must I keep of accidents and incidents that occur at my operation, changes the rule title to "Accident and Incident Records." The proposed amendment, in paragraph (3), replaces the requirement for a child care operation to keep a written record of an incident where a child in care had an emergency anaphylaxis reaction that required use of an unassigned epinephrine auto-injector with a requirement for a child care operation to keep a written record of an incident that required administration of a medication to a child in a medical emergency as described in Chapter 744 for consistency with the proposed amendment to §744.307(b)(3). The proposed amendment in §744.307(b)(4)(A) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

FISCAL NOTE

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 a new regulation;

(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

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules do not require a child care operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION

DIVISION 2. REQUIRED NOTIFICATIONS

26 TAC §744.307

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§744.307. Emergency and Medical Parental Notifications. [~~What emergency or medical situations must I notify parents about?~~]

(a) If it is alleged or suspected [~~You must notify the parent of a child immediately if there is an allegation~~] that a [~~the~~] child has been abused, neglected, or exploited, as defined in Texas Family Code §261.001, while in the [~~your~~] care of an operation, the operation must notify the parent of the child immediately.

(b) After an operation ensures [~~you ensure~~] the safety of a [~~the~~] child, the operation [~~you~~] must notify the parent of the child immediately if [~~after~~] the child:

(1) is [Is] injured and [~~the injury~~] requires medical treatment by a health-care professional or hospitalization;

(2) shows [~~Shows~~] signs or symptoms of an illness that requires hospitalization;

(4) has [~~Has~~] been involved in any:

(A) non-routine situation that placed, or may have placed, the child at risk for injury or harm[~~. For example, a caregiver forgetting the child in an operation vehicle or on the playground or failing to prevent the child from wandering away from the operation unsupervised~~]; or

(B) [~~(5) Has been involved in any~~] situation that renders the operation unsafe, such as a fire, flood, or damage to the operation as a result of severe weather.

(c) An operation [~~You~~] must provide written notification to [~~notify~~] the parent of a child in care of any minor [~~less serious~~] injuries when the parent arrives to pick up [~~picks~~] the child [up] from the operation. Minor [~~Less serious~~] injuries are those that require a caregiver to provide only basic first-aid care such as small [~~include minor~~] cuts, scratches, bruises, or bites from other children [~~and contusions requiring first-aid treatment by employees~~].

(d) An operation [~~You~~] must provide written notification [~~notice~~] to the parent of each child in care [~~attending the operation~~] within 48 hours after the date the operation becomes [~~of becoming~~] aware that a child in [~~your~~] care or an employee has contracted a communicable disease deemed notifiable by the Texas Department of State Health Services, as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases).

(e) An operation [~~You~~] must provide written notification [~~notice~~] to the parent of each child in a group within 48 hours after the date the operation becomes aware that a child in the group has contracted [~~when there is an outbreak of~~] lice, scabies, ringworm, or another communicable parasite [~~or other infestation in the group~~]. An operation [~~You~~] must [~~either~~] post this notice in the operation where it is easy for the parents to see it [~~in a prominent and publicly accessible place where parents can easily view it~~] or send a [~~an individual~~] note to each parent individually.

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 June 22, 2026.

TRD-202602559

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

SUBCHAPTER C. RECORD KEEPING

DIVISION 2. RECORDS OF ACCIDENTS AND INCIDENTS

26 TAC §744.701

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§744.701. Accident and Incident Records. [~~What written records must I keep of accidents and incidents that occur at my operation?~~]

An operation [~~You~~] must keep written records of accidents and incidents that happen while a child is in care. An operation must use [~~record~~] the Child Care Regulation Incident or Illness Report form, [~~following information on the Licensing Incident/Illness Report Form 7239~~] or another form with [~~that contains at least~~] the same information, to record:

(1) an [An] injury to a child in care that required medical treatment by a health-care professional or hospitalization;

(2) an [An] illness that required the hospitalization of a child in care;

(3) an incident that required administration of a medication to the child in a medical emergency as described in this chapter [~~An incident where a child in care had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector~~];

(4) an [An] incident of a child in care or an employee contracting a communicable disease deemed notifiable by the Texas Department of State Health Services as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases); and

(5) any [~~Any other~~] non-routine situation that placed, or may have placed, a child at risk for injury or harm[~~, such as forgetting a child in an operation's vehicle or not preventing a child from wandering away from the operation unsupervised~~].

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 June 22, 2026.

TRD-202602560

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

CHAPTER 745. LICENSING

SUBCHAPTER D. APPLICATION PROCESS

DIVISION 11. EMPLOYER-BASED CHILD CARE

26 TAC §745.469

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §745.469, concerning What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND PURPOSE

The proposed repeal in Chapter 745 removes a policy requirement related to unassigned epinephrine auto-injectors for children in employer-based child care operations.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §745.469 removes the requirement for employer-based child care operations to have and implement a policy if the operation maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child-care facilities from the list of entities required to adopt such a policy.

FISCAL NOTE

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will repeal existing regulations;

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

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

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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the rule will be removed.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule: does not impose a cost on regulated persons and is necessary to implement legislation that does not specifically state that §2001.0045 applies to the rule.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public benefit will be a rule that complies with state law.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code (HRC) §42.042(a) requires HHSC to adopt rules to carry out the requirements of HRC Chapter 42.

The repeal implements Texas Government Code §524.0151 and HRC §42.042.

§745.469. What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors?

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 June 22, 2026.

TRD-202602561

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

CHAPTER 746. MINIMUM STANDARDS FOR CHILD CARE [CHILD-CARE] CENTERS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §746.307, concerning What emergency or medical situations must I notify parents about; §746.701, concerning What written records must I keep of accidents and injuries that occur at my child-care center; and §746.801, concerning What records must I keep at my child-care center.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill (SB) 1619, Section 27, and House Bill (HB) 163, from the 89th Legislature, Regular Session, 2025.

SB 1619, Section 27, amended Texas Human Resources Code (HRC) §42.067(a) by adding the term "epinephrine delivery system" to expand the allowable unassigned epinephrine devices to include epinephrine nasal spray in addition to an epinephrine auto-injector.

HB 163 repealed the statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

The proposed amendments to §746.307 and §746.701 remove parental notification and incident report requirements related to unassigned epinephrine auto-injectors for children in child care centers.

The proposed amendment to §746.801 updates epinephrine terminology in a reporting requirement for a child care center that has an epinephrine policy.

The proposed amendments also change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles. The proposed amendments remove references to other rules to avoid the need for HHSC to amend rules when referenced rules change. The proposal changes the spelling of "child-care" to "child care" in the title of Chapter 746, the title of Division 3 in Subchapter C, and in the rule text.

The proposed amendments replace first-person pronouns nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §746.307, What emergency or medical situations must I notify parents about, changes the rule title to "Emergency and Medical Parental Notifications;" The proposed amendment in subsection (b)(3) replaces the requirement for a child care center to notify a child's parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement to notify a child's parent immediately if the child required emergency administration of a medication. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §746.3803(d). The proposed amendment in subsection (b)(4) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

The proposed amendment to §746.701, What written records must I keep of accidents and incidents that occur at my child-care center, changes the rule title to "Accident and Incident Records." The proposed amendment in paragraph (3) replaces the requirement for a child care operation to keep a written record of an incident where a child in care had an emergency anaphylaxis reaction that required use of an unassigned epinephrine auto-injector with a requirement for a child care center to keep a written record of an incident when a child in care required administration of an emergency medication for consistency with the proposed amendment to §746.307(b)(3). The proposed amendment in paragraph (5) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

The proposed amendment to §746.801, What records must I keep at my child-care center, changes the rule title to "Operation Records Maintained at the Child Care Center." The proposed amendment in paragraph (4) changes the term "licensing" to "Child Care Regulation" or "CCR." The proposed amendment in paragraph (23) for a child care center that maintains and administers an unassigned epinephrine delivery system, updates the name of a Texas Department of State Health Services reporting form and explains that the form is used to report the administration of an unassigned epinephrine delivery system.

FISCAL NOTE

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 a new regulation;

(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

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rules are in effect, the public will benefit from rules that (1) expand the types of unassigned epinephrine delivery devices in child care centers to include epinephrine nasal spray; and (2) comply with state law.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules do not require a child care operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION

DIVISION 2. REQUIRED NOTIFICATION

26 TAC §746.307

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§746.307. Emergency and Medical Parental Notifications. [~~What emergency or medical situations must I notify parents about?~~]

(a) If it is alleged or suspected [~~You must notify the parent of a child immediately if there is an allegation~~] that a [~~the~~] child has been abused, neglected, or exploited, as defined in Texas Family Code §261.001, while in the [~~your~~] care of a child care center, the center must notify the parent of the child immediately.

(b) After a child care center ensures [~~you ensure~~] the safety of a [~~the~~] child, the center [~~you~~] must notify the parent of the child immediately if [~~after~~] the child:

(1) is [Is] injured and [~~the injury~~] requires medical treatment by a health-care professional or hospitalization;

(2) shows [~~Shows~~] signs or symptoms of an illness that requires hospitalization;

(4) has [~~Has~~] been involved in any:

(A) non-routine situation that placed, or may have placed, the child at risk for injury or harm[~~. For example, a caregiver forgetting the child in a center vehicle or failing to prevent the child from wandering away from the child-care center unsupervised~~]; or

(B) [~~(5) Has been involved in any~~] situation that renders the child care [~~child-care~~] center unsafe, such as a fire, flood, or damage to the child care [~~child-care~~] center as a result of severe weather.

(c) A child care center [~~You~~] must provide written notification to [~~notify~~] the parent of a child in care of any minor [~~less serious~~] injuries when the parent arrives to pick up [~~picks~~] the child [up] from the child care [~~child-care~~] center. Minor [~~Less serious~~] injuries are those that require an employee to provide only basic first-aid care such as small [~~include minor~~] cuts, scratches, bruises, or [~~and~~] bites from other children [~~requiring first-aid treatment by employees~~].

(d) A child care center [~~You~~] must provide written notification [~~notice~~] to the parent of each child in care [~~attending the child-care center~~] within 48 hours after the date the child care center becomes [~~of becoming~~] aware that a child in [~~your~~] care or an employee has contracted a communicable disease deemed notifiable by the Texas Department of State Health Services, as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases).

(e) A child care center [~~You~~] must provide written notification [~~notice~~] to the parent of each child in a group within 48 hours after the date the child care center becomes aware that a child in the group has contracted [~~when there is an outbreak of~~] lice, scabies, ringworm, or another communicable parasite [~~or other infestation in the group~~]. A child care center [~~You~~] must [~~either~~] post this notice in the child care center where it is easy for the parents to see it [~~in a prominent and publicly accessible place where parents can easily view it~~] or send a [~~an individual~~] note to each parent individually.

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 June 22, 2026.

TRD-202602563

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

SUBCHAPTER C. RECORD KEEPING

DIVISION 2. RECORDS OF ACCIDENTS AND INCIDENTS

26 TAC §746.701

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§746.701. Accident and Incident Records. [~~What written records must I keep of accidents and incidents that occur at my child-care center?~~]

A child care center [~~You~~] must keep written records of accidents and incidents that happen while a child is in care. A child care center must use [~~record~~] the Child Care Regulation Incident or Illness Report form, [~~following information on the Licensing Incident/Illness Form 7239~~] or another form with [~~that contains at least~~] the same information, to record:

(1) an [An] injury to a child in care that required medical treatment by a health-care professional or hospitalization;

(2) an [An] illness that required the hospitalization of a child in care;

(4) an [An] incident of a child in care or an employee contracting a communicable disease deemed notifiable by the Texas Department of State Health Services, as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases); and

(5) any [~~Any other~~] non-routine situation that placed, or may have placed, a child at risk for injury or harm[~~, such as forgetting a child in a center vehicle or not preventing a child from wandering away from the child-care center unsupervised~~].

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 June 22, 2026.

TRD-202602564

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

DIVISION 3. RECORDS THAT MUST BE KEPT ON FILE AT THE CHILD CARE CENTER

26 TAC §746.801

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§746.801. Operation Records Maintained at the Child Care Center. [~~What records must I keep at my child-care center?~~]

(a) A child care center [~~You~~] must keep [~~maintain and make~~] the following records available for [~~our~~] review by Child Care Regulation (CCR) [~~upon request,~~] during hours of operation : [. Paragraphs (14), (15), and (16) of this section are optional, but if provided will allow Licensing to avoid duplicating the evaluation of standards that have been evaluated by another state agency within the past year:]

(1) children's [~~Children's~~] records, as specified in [~~Division 1 of~~] this subchapter [~~(relating to Records of Children)~~

(2) infant [~~Infant~~] feeding instructions, as required in [~~§746.2421 of~~] this chapter [~~(relating to What written feeding instructions must I obtain for an infant not ready for table food?)~~], if applicable;

(3) personnel [~~Personnel~~] and training records as required in [~~according to Division 4 of~~] this subchapter [~~(relating to Personnel Records)~~];

(4) Child Care [~~Licensing Child-Care~~] Center Director's Certificate issued by CCR;

(5) attendance [~~Attendance~~] records or time sheets that show [~~listing~~] all days and hours worked for each employee;

(6) proof [~~Proof~~] of current liability insurance coverage or[~~, if applicable, that you have provided~~] written notice to [~~the parent of~~] each child's parent if the child care center does [~~child that you do~~] not carry liability [~~the~~] insurance;

(7) medication [~~Medication~~] records, if applicable;

(8) playground [~~Playground~~] maintenance checklists;

(9) pet [~~Pet~~] vaccination records, if applicable;

(10) safety [~~Safety~~] documentation for emergency drills, fire extinguishers, and smoke detectors;

(11) most [~~Most~~] recent fire inspection report, including [~~any~~] written approval from the fire marshal, if care is provided [~~to provide care~~] above or below ground level[~~, if applicable~~];

(12) most [~~Most~~] recent sanitation inspection report;

(13) most [~~Most~~] recent gas inspection report, if applicable;

~~[(14) Most recent Texas Department of State Health Services immunization compliance review form, if applicable;]~~

~~[(15) Most recent Texas Department of Agriculture Child and Adult Care Food Program report, if applicable;]~~

~~[(16) Most recent local workforce board Child-Care Services Contractor inspection report, if applicable;]~~

(14) [~~(17)~~] record [~~Record~~] of pest extermination, if applicable;

(15) [~~(18)~~] most [~~Most~~] recent HHSC Children's Products Certification [~~Licensing~~] form certifying that the child care center has [~~you have~~] reviewed each of the bulletins and notices issued by the United States Consumer Product Safety Commission regarding unsafe children's products and that there are no unsafe children's products in use or accessible to children in the child care [~~child-care~~] center;

(16) [~~(19)~~] a [A] daily tracking system for when a child's care begins and ends, as specified in [~~§746.631 of~~] this subchapter [~~(relating to Must I have a system for signing children in and out of my care?)~~];

(17) [~~(20)~~] documentation [~~Documentation~~] for all full-size and non-full-size cribs, as specified in [~~§746.2409(a)(9) of~~] this chapter [~~(relating to What specific safety requirements must my cribs meet?)~~];

(18) [~~(21)~~] documentation [~~Documentation~~] for vehicles used to transport children, as specified in [~~§746.5627 of~~] this chapter [~~(relating to What documentation must I keep at the child-care center for each vehicle used to transport children in care?)~~], if applicable;

(19) [~~(22)~~] proof [~~Proof~~] that the child care center has [~~you have~~] notified parents in writing of deficiencies related to [in] safe sleeping or [~~and~~] abuse, neglect, or exploitation, as specified in [~~§746.309 of~~] this chapter [(relating to What are the notification requirements when Licensing finds my center deficient in a standard related to safe sleeping or the abuse, neglect, or exploitation of a child?) and §746.311 of this chapter (relating to How must I notify parents of a safe sleeping deficiency or an abuse, neglect, or exploitation deficiency?)]; and

(20) [~~(23)~~] if the child care center maintains and administers an unassigned epinephrine delivery system, a [A] copy of each completed Texas Department of State Health Services (DSHS) Certain Entity- Required Reporting of Unassigned Administered Epinephrine to DSHS form [~~Epinephrine Auto-Injectors Reporting Form~~] used to document [~~report~~] the administration of an unassigned epinephrine delivery system to a child in care [~~auto-injector, if your operation administers and maintains unassigned epinephrine auto-injectors.~~]

(b) A child care center may keep the following records available for review by CCR during hours of operation to avoid repeating the evaluation of standards already reviewed by another state agency within the past year:

(1) most recent Texas Department of State Health Services immunization compliance review form, if applicable;

(2) most recent Texas Department of Agriculture Child and Adult Care Food Program report, if applicable; and

(3) most recent local workforce board Child Care Services Contractor inspection report, if applicable.

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 June 22, 2026.

TRD-202602565

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE [CHILD-CARE] HOMES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §747.305, concerning What emergency and medical situations must I notify parents about, §747.501, concerning What written operational policies must I have, and §747.701, concerning What written records must I keep of accidents and injuries that occur at my child-care home.

BACKGROUND AND PURPOSE

The proposed amendments in Chapter 747 remove parental notification and incident reporting requirements related to unassigned epinephrine auto-injectors for children in licensed and registered child care homes.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using questions for rule titles. The proposed amendments remove references to other rules to avoid the need for HHSC to amend rules when referenced rules change. The proposal changes the spelling of "child-care" to "child care" in the title of Chapter 747 and makes the same changes where needed in the rule text.

The proposed amendments replace first-person pronouns with nouns for clarity. The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §747.305, What emergency and medical situations must I notify parents about, changes the rule title to "Emergency and Medical Parental Notifications." The proposed amendment in subsection (b)(3) replaces the requirement for a child care home to notify a child's parent immediately if the child has had an emergency anaphylaxis reaction that required administration of an unassigned epinephrine auto-injector with a requirement for a child care home to notify a child's parent immediately if the child required emergency administration of a medication. This change is needed to ensure parental notification of any medication administered to a child in a medical emergency to prevent the death or serious bodily injury of the child, as allowed by §747.3603(d). The proposed amendment in paragraph (4) removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk. The proposed amendment in subsection (e) clarifies that a child care home must notify parents in writing within 48 hours of learning a child or employee has contracted lice or another communicable parasite and how to provide the written notice.

The proposed amendment to §747.501, What written operational policies must I have, changes the rule title to "Operational Policies and Procedures Requirements." The proposed amendment removes the requirement in paragraph (14) for a child care home to have and implement a policy if the home maintains, administers, and disposes of unassigned epinephrine auto-injectors because the statutory changes enacted by HB 163 removed child care facilities from the list of entities required to adopt such a policy. The proposed amendment revises the list of policies and procedures a child care home must have for better organization and readability.

The proposed amendment to §747.701, What written records must I keep of accidents and injuries that occur at my child-care home, changes the rule title to "Accident and Incident Records." The proposed amendment replaces the requirement for a child care home to keep a written record of an incident where a child in care had an emergency anaphylaxis reaction that required use of an unassigned epinephrine auto-injector with a requirement for a child care home to keep a written record of an incident where a child in care required administration of an emergency medication for consistency with the proposed amendment to §747.305(b)(3). The proposed amendment in paragraph (5) removes examples removes examples of non-routine situations that place or may place children at risk to help lessen the concern that only the example situations place children at risk.

FISCAL NOTE

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 a new regulation;

(6) the proposed rules will expand and repeal existing regulations;

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules do not require a licensed and registered child care home to purchase equipment, supplies, or hire additional personnel to comply with the rule.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION

DIVISION 2. REQUIRED NOTIFICATIONS

26 TAC §747.305

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§747.305. Emergency and Medical Parental Notifications. [~~What emergency and medical situations must I notify parents about?~~]

(a) If it is alleged or suspected [~~You must notify the parent of a child immediately if there is an allegation~~] that a [~~the~~] child has been abused, neglected, or exploited, as defined in Texas Family Code §261.001, while in the [~~your~~] care of a child care home, the home must notify the parent of the child immediately.

(b) After a child care home ensures [~~you ensure~~] the safety of a [~~the~~] child, the child care home [~~you~~] must notify the parent of the child immediately if [~~after~~] the child:

(1) is [Is] injured and [~~the injury~~] requires medical treatment by a health-care professional or hospitalization;

(2) shows [~~Shows~~] signs or symptoms of an illness that requires hospitalization;

(4) has [~~Has~~] been involved in any:

(A) non-routine situation that placed, or may have placed, the child at risk for injury or harm[~~. For example, forgetting the child in a vehicle or failing to prevent the child from wandering away from your child-care home unsupervised~~]; or

(B) [~~(5) Has been involved in any~~] situation that renders the child care [~~child-care~~] home unsafe, such as a fire, flood, or damage to the child care [~~child-care~~] home as a result of severe weather.

(c) A child care home [~~You~~] must provide written notification to [~~notify~~] the parent of a child in care of any minor [~~less serious~~] injuries when the parent arrives to pick up [~~picks~~] the child [up] from the child care [~~your child-care~~] home. Minor [~~Less serious~~] injuries are those which require an employee to provide only basic first-aid care such as small [~~include minor~~] cuts, scratches, bruises, or [~~and~~] bites from other children [~~requiring first-aid treatment by caregivers~~].

(d) A child care home [~~You~~] must provide written notification [~~notice~~] to the parent of each child in care [~~attending the child-care home~~] within 48 hours after the date the child care home becomes aware that a [~~when any~~] child in [~~your~~] care, a caregiver, or a household member has contracted a communicable disease deemed notifiable by the Texas Department of State Health Services as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Disease).

(e) A child care home [~~You~~ ] must provide written notification [~~notice~~] to the parent of each child in care [~~attending the child-care home~~] within 48 hours after the date the child care home becomes aware that a child in care has contracted [~~when there is an outbreak of~~] lice, scabies, ringworm, or another communicable parasite [~~or other infestation in the child-care home~~]. A child care home must post this notice in the child care home where it is easy for the parents to see it or send a note to each parent individually.

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 June 22, 2026.

TRD-202602566

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

DIVISION 4. OPERATIONAL POLICIES

26 TAC §747.501

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§747.501. Operational Policies and Procedures Requirements. [~~What written operational policies must I have?~~]

You must develop written operational policies and procedures that at a minimum address each of the following:

(1) [~~Procedure for~~] the release of children;

(2) conducting health checks, if applicable [~~Illness and exclusion criteria~~];

(3) [~~Procedures for~~] dispensing medication, or a statement that medication is not dispensed;

(4) [~~Procedures for~~] handling medical emergencies;

(5) discipline [~~Discipline~~] and guidance consistent with the requirements in this chapter [~~policy that is consistent with Subchapter L of this title (relating to Discipline and Guidance). A copy of Subchapter L may be used for your discipline and guidance policy~~];

(6) safe [~~Safe~~] sleep [~~policy~~] for infants from birth through 12 months old that is consistent with the rules in [~~Subchapter H of~~] this chapter about sleep requirements and restrictions [(relating to Basic Requirements for Infants) that relate to sleep requirements and restrictions, including sleep positioning, and crib requirements and restrictions, including mattresses, bedding, blankets, toys, and restrictive devices];

(7) animals [~~Animals~~], if applicable;

(8) promotion [~~Promotion~~] of indoor and outdoor physical activity that is consistent with the rules in [~~Subchapter F of~~] this chapter and includes [~~(relating to Developmental Activities and Activity Plan). Your policies must include~~]:

(A) the [~~The~~] duration of physical activity at the [~~your~~] home, both indoor and outdoor;

(B) the [~~The~~] recommended clothing and footwear that will allow a child to participate freely and safely in physical activities; and

(C) a [A] plan to ensure physical activity occurs on days when extreme weather conditions prohibit or limit outdoor time; [.]

(9) parent [~~Parent~~] rights that are consistent with the rules in [~~Division 5 of~~] this subchapter [~~(relating to Parent Rights)~~];

(10) instructions [~~Instructions~~] on how a parent may access the:

(A) minimum [~~Minimum~~] standards in this chapter online;

(B) Texas Abuse, [~~and~~] Neglect, and Exploitation Hotline; and

(11) [~~Your~~] emergency preparedness plan; and

~~[(12) Procedures for conducting health checks, if applicable;]~~

(12) [~~(13)~~] information [~~Information~~] on vaccine-preventable diseases for employees that addresses the reuirements in this chapter, if the [~~your~~] licensed child care [~~child-care~~] home is not located in the primary caregiver's [~~your own~~] residence. [~~The policy must address the requirements outlined in §747.3411 of this chapter (relating to What must a policy for protecting children from vaccine-preventable diseases include?); and~~]

[(14) If your home maintains and administers unassigned epinephrine auto-injectors to use when a child in care has an emergency anaphylaxis reaction, policies for maintenance, administration, and disposal of unassigned epinephrine auto-injectors that comply with the unassigned epinephrine auto-injector requirements set by the Texas Department of State Health Services, as specified in Texas Administrative Code, Title 25, Chapter 40, Subchapter C (relating to Epinephrine Auto-Injector Policies in Youth Facilities) and in Texas Health and Safety Code §773.0145.]

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 June 22, 2026.

TRD-202602567

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

SUBCHAPTER C. RECORD KEEPING

DIVISION 2. RECORDS OF ACCIDENTS AND INCIDENTS

26 TAC §747.701

STATUTORY AUTHORITY

The amendment implements Texas Government Code §524.0151 and HRC §42.042.

§747.701. Accident and Incident Records. [~~What written records must I keep of accidents and injuries that occur at my child-care home?~~]

You must record the following information on the Licensing Incident/Illness Report Form 7239 or another form that contains at least the same information:

(1) an [An] injury to a child in care that required medical treatment by a health-care professional or hospitalization;

(2) an [An] illness that required the hospitalization of a child in care;

(4) an [An] incident of a child in care, [or] caregiver, or household member contracting a communicable disease deemed notifiable by the Texas Department of State Health Services as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases); and

(5) any [~~Any other~~] non-routine situation that placed, or may have placed, a child at risk for injury or harm[~~, such as forgetting a child in a vehicle or not preventing a child from wandering away from the child-care home~~].

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 June 22, 2026.

TRD-202602568

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS

SUBCHAPTER L. MEDICATION

DIVISION 8. UNASSIGNED EPINEPHRINE AUTO-INJECTORS

26 TAC §748.2271

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §748.2271, concerning What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors.

BACKGROUND AND PURPOSE

The proposed repeal in Chapter 748 removes a policy requirement related to unassigned epinephrine auto-injectors for children in general residential operations (GROs).

SECTION-BY-SECTION SUMMARY

The proposed repeal of §748.2271 removes the requirement for a GRO to have and implement a policy if the GRO maintains and administers unassigned epinephrine auto-injectors because HB 163 removed child-care facilities from the list of entities required to adopt such a policy.

The proposed repeal of Division 8, Unassigned Epinephrine Auto-Injectors, in Subchapter L, is necessary because §748.2271 is the only rule in the division.

FISCAL NOTE

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

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

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

(6) the proposed rule will repeal existing regulations;

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

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

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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the rule will be removed.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

PUBLIC BENEFIT AND COSTS

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

STATUTORY AUTHORITY

The repeal implements Texas Government Code §524.0151 and HRC §42.042.

§748.2271. What are the requirements if my operation chooses to maintain and administer unassigned epinephrine auto-injectors?

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 June 22, 2026.

TRD-202602569

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 9, 2026

For further information, please call: (512) 438-3269