TITLE 26. HEALTH AND HUMAN SERVICES
PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 301. LOCAL AUTHORITY RESPONSIBILITIES
The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §301.301, concerning Purpose and Application; §301.303, concerning Definitions; §301.321, concerning Leadership; §301.323, concerning Environment of Care and Safety; §301.327, concerning Access to Mental Health Community Services; §301.329, concerning Medical Records System; §301.331, concerning Competency and Credentialing; §301.333, concerning Quality Management; §301.335, concerning Utilization Management; §301.351, concerning Crisis Services; §301.353, concerning Provider Responsibilities for Treatment Planning and Service Authorization; §301.355, concerning Medication Services; §301.357, concerning Additional Standards of Care Specific to Mental Health Community Services for Children and Adolescents; §301.359, concerning Telemedicine Services; §301.361, concerning Documentation of Service Provision; and §301.363, concerning Supervision; and the repeal of §301.305, concerning Responsibility for Compliance, and §301.325, concerning Rights and Protection.
BACKGROUND AND PURPOSE
HHSC proposes to amend rules in the Texas Administrative Code (TAC) Title 26, Chapter 301, Subchapter G relating to Mental Health Community Services Standards. The main purpose of this proposal is to expand the allowable educational and experiential requirements for a Qualified Mental Health Professional-Community Services (QMHP-CS) credential.
The amendments will expand the QMHP-CS criteria to include non-human services degree programs if the applicant or employee has at least one year of experience as an intern or employee in a mental health or substance use program. The proposed changes intend to increase access to behavioral health services by expanding the mental health workforce.
The proposed rules update the list of persons and entities the rules apply to by adding local behavioral health authorities (LBHAs) and removing managed care organizations to align with current practice. These changes are reflected throughout Subchapter G.
Additionally, HHSC proposes amendments to clarify statutory requirements; add, remove, and update definitions; update Medicaid-related information; update and add cross-references; and make grammatical and editorial changes for understanding, accuracy, and uniformity to make the rules easier to read and understand.
SECTION-BY-SECTION SUMMARY
Division 1, General Provisions
The proposed amendment to §301.301 updates terminology to "community mental health services." The proposed amendment also updates the list of persons and entities the chapter applies to. The proposed amendment also updates the TAC cross-references for accuracy.
The proposed amendment to §301.303 adds new definitions; revises definitions for clarification, consistency, and current terminology; aligns definitions with other rules; and removes definitions no longer needed or no longer used in Subchapter G. The definitions are renumbered as a result of these changes.
The proposed repeal of §301.305 deletes the rule as no longer necessary because it contains inaccurate requirements and repetitive information found elsewhere in this subchapter.
Division 2, Organizational Standards
The proposed amendment to §301.321 clarifies that the requirements of this section apply to LBHAs and updates terminology.
The proposed amendment to §301.323 clarifies that the local mental health authority (LMHA), LBHA, and provider must implement an infection control plan and procedures in accordance with applicable state and federal laws. The proposed amendment also reorders the subsections, removes unnecessary rule language, updates terminology, corrects for grammar, and updates TAC cross-references for accuracy.
The proposed repeal of §301.325 deletes the rule as no longer necessary because it contains redundant requirements found in applicable state and federal laws; 26 TAC Chapter 301, Subchapter C, concerning Charges for Community Services; 26 TAC Chapter 301, Subchapter M, concerning Abuse, Neglect, and Exploitation in Local Authorities and Community Centers; and 26 TAC Chapter 320, Subchapter A, concerning Rights of Individuals Receiving Mental Health Services.
The proposed amendment to §301.327 changes the title of this section from "Access to Mental Health Community Services" to "Access to Community Mental Health Services" to update for current terminology. The proposed amendment also updates terminology, corrects for grammar, and updates TAC cross-references for accuracy.
The proposed amendment to §301.329 clarifies that the maintenance of a written disaster recovery plan for information resources will ensure service continuity as required by applicable state and federal laws. The proposed amendment also removes unnecessary language and an outdated TAC cross-reference.
The proposed amendment to §301.331 clarifies in subsection (a) that this requirement applies to the competency of staff members and volunteers. The proposed amendment also revises subsection (d) to be consistent with the new QMHP-CS definition. The proposed amendment in new subsection (i) requires the LMHA, LBHA, and provider to comply with any applicable Medicaid requirements.
The proposed amendment to §301.333 updates terminology throughout the section.
The proposed amendment to §301.335 updates terminology, removes unnecessary language, and updates TAC cross-references for accuracy throughout the section.
Division 3, Standards of Care
The proposed amendment to §301.351 clarifies that the provider of crisis services must maintain documentation of the individual's name and any other identifiable health information in accordance with the Health Insurance Portability and Accountability Act. The proposed amendment also updates terminology, updates TAC cross-references for accuracy, and removes unnecessary language throughout the section.
The proposed amendment to §301.353 removes an outdated requirement in subsection (d)(1)(A) and reorders the subsequent subparagraphs. The proposed amendment also updates terminology, updates TAC cross-references for accuracy, and removes unnecessary language throughout the section.
The proposed amendment to §301.355 updates terminology, removes unnecessary language, and updates a TAC cross-reference for accuracy throughout this section.
The proposed amendment to §301.357 clarifies that the uniform assessment must be administered in accordance with HHSC's utilization management guidelines. The proposed amendment also updates terminology throughout the section.
The proposed amendment to §301.359 makes editorial changes to clarify providers must provide care within the scope of the provider's credential or license.
The proposed amendment to §301.361 updates terminology, corrects for grammar, and updates TAC cross-references for accuracy throughout the section.
The proposed amendment to §301.363 clarifies and removes redundant TAC language by requiring the LMHA, LBHA, and provider to follow the rules listed in 1 TAC §353.1419 (relating to Supervision Requirements).
FISCAL NOTE
Trey Wood, HHSC's 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 increase 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 there is no requirement to alter current business practices.
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 these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas; do not impose a cost on regulated persons; and are amended to reduce the burden or responsibilities imposed on regulated persons by the rules.
PUBLIC BENEFIT AND COSTS
Trina Ita, Deputy Executive Commissioner of Behavioral Health Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be the increase in access to behavioral health services by expanding the mental health workforce to address an increased demand for behavioral health services.
Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because providers will have more flexibility in hiring for the QMHP-CS position and will not incur any additional costs.
TAKINGS IMPACT ASSESSMENT
HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov .
To be considered, comments must be submitted no later than 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 25R004" in the subject line.
SUBCHAPTER G.COMMUNITY ] SERVICES STANDARDS
DIVISION 1. GENERAL PROVISIONS
26 TAC §301.301, §301.303STATUTORY AUTHORITY
The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, Texas Health and Safety Code §533.0345(a), which requires the executive commissioner of HHSC to by rule develop model program standards for mental health services for use by each state agency that provides or pays for mental health services; Texas Health and Safety Code §533.0356(i), which allows the executive commissioner of HHSC to adopt rules to govern the operations of local behavioral health authorities; and Texas Health and Safety Code §534.052(a), which requires the executive commissioner of HHSC to adopt rules, including standards, the executive commissioner considers necessary and appropriate to ensure the adequate provision of community-based mental health services through an LMHA under Texas Health and Safety Code Chapter 534.
The amendments affect Texas Government Code §524.0151 and Texas Health and Safety Code §533.0345(a), §533.0356(i), and §534.052(a).
§301.301.
(a) The purpose of this subchapter is to establish performance requirements and standards for the provision of community mental health [community] services, as authorized by [the] Texas Health and Safety Code[,] §534.052.
(b) This subchapter applies to persons and entities with which the Texas Health and Human Services Commission (HHSC) [ department] contracts, including local mental health authorities (LMHAs)[(LMHA)], local behavioral health authorities (LBHAs)[managed care organizations (MCO)], providers of mental health rehabilitative services, as defined in §306.305 [§419.453] of this title (relating to Definitions), and providers of mental health case management services, as defined in §306.255 [§412.403] of this title (relating to Definitions), and requires that they ensure the performance requirements and standards in this subchapter are met in the provision of community mental health [community] services.
§301.303.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.[:]
(1) Access--The ability to obtain community mental health [community] services based upon components such as availability and acceptability of services to the individual[,] or the individual's LAR [Legally Authorized Representative (LAR) on the individual's behalf, transportation, distance, hours of operation, language, and the cultural competency of staff members. Barriers to access may be structural, financial, or specific to the individual].
(2) Adolescent--An individual who is at least 13 years of age, but younger than 18 years of age.
(3) Adult--An individual who is 18 years of age or older.
[(4) Advanced practice nurse--A staff member who is a registered nurse approved by the Texas Board of Nursing as a clinical nurse specialist in psychiatric/mental health or nurse practitioner in psychiatric/mental health, in accordance with Texas Occupations Code, Chapter 301.]
(4) [(5)] Advocacy--Support for an individual or family member in expressing and resolving issues or concerns regarding access to or quality and appropriateness of services.
(5) [(6)] Appeal--A mechanism for an independent review of an adverse determination.
(6) APRN--Advanced practice registered nurse. A registered nurse licensed by the Texas Board of Nursing as provided in Texas Occupations Code Chapter 301.152.
(7) Assessment--A systematic process for measuring an individual's service needs.
(8) Child--An individual who is at least three years of age, but younger than 13 years of age.
(9) CFP--Certified family partner. A person who meets the credentialing requirements in 1 TAC §353.1415(d) (relating to Staff Member Credentialing).
(10) CFR--Code of Federal Regulations.
(11) Community mental health services--Services medically necessary to treat, care for, supervise, and rehabilitate individuals who have a mental illness or emotional disorder or a COPSD. These services include services for the prevention of and recovery from such disorders, but do not include inpatient services provided in a state facility.
(12) [(9)] Competency--Demonstrated knowledge and skilled performance of a particular activity.
(13) [(10)] Continuity of care [ services]--Activities designed to [Services that] ensure an individual is provided uninterrupted services [are provided to an individual] during a transition between inpatient and outpatient services that assist the individual and LAR, if applicable, in identifying, accessing, and coordinating LMHA or LBHA services and other appropriate services and supports in the community needed by the individual, including [service types (e.g., inpatient services, outpatient services) or providers, in accordance with applicable rules (e.g., Chapter 412, Subchapter D of this title (relating to Mental Health Services - Admission, Continuity, and Discharge)). These activities include]:
(A) assisting with admissions and discharges;
(B) facilitating access to appropriate services and supports in the community, including identifying and connecting the individual with community resources, and coordinating the provision of services;
(C) participating in developing and reviewing the individual's recovery or treatment plan [development and reviews];
(D) promoting implementation of the individual's recovery or treatment plan [or continuing care plan]; and
(E) coordinating notification of continuity of care services between the individual and the individual's family and any other person providing support as authorized by the individual and LAR, if applicable [facilitating coordination and follow-up between the individual and the individual's family, as well as with available community resources].
(14) [(11)] COPSD--Co-occurring [or co-occurring] psychiatric and substance use disorders.[--] The co-occurring diagnoses of psychiatric disorders and substance use disorders.
(15) [(12)] Credentialing--A process to review and approve a staff member's educational status, experience, and licensure status, as applicable, [(as applicable)] to ensure that the staff member meets HHSC's [the departmental] requirements for service provision. [The process includes primary source verification of credentials, establishing and applying specific criteria and prerequisites to determine the staff member's initial and ongoing competency and assessing and validating the staff member's qualification to deliver care. Re-credentialing is the periodic process of reevaluating the staff's competency and qualifications.]
(16) [(13)] Crisis--A situation in which:
(A) an [the] individual presents an immediate danger to self or others; [ or]
(B) an [the] individual's mental or physical health is at risk of serious deterioration; or
(C) an individual believes the individual [ that he or she] presents an immediate danger to self or others , or the individual's [that his or her] mental or physical health is at risk of serious deterioration.
(17) [(14)] Crisis services--Interventions [Mental health community services or other necessary interventions ] provided to an individual in crisis.
(18) [(15)] CSSP--Community [ or community] services specialist.[--] A person [staff member] who, as of August 31, 2004:
(A) received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in accordance with the law of the issuing state;
(B) had three continuous years of documented full-time experience in the provision of mental health rehabilitative services or case management services; and
(C) demonstrated competency in the provision and documentation of mental health rehabilitative or case management services in accordance with Chapter 306 [419], Subchapter F [ L] of this title (relating to Mental Health Rehabilitative Services) and Chapter 306 [412], Subchapter E [ I] of this title (relating to Mental Health Case Management [Services]).
[(16) Cultural competency--Demonstrated knowledge and skill by a staff member to effectively respond to an individual's needs through knowledge of communication, actions, customs, beliefs, and values, within the individual's racial, ethnic, religious beliefs, disability, and social groups.]
[(17) Department--Department of State Health Services (DSHS).]
[(18) Department-approved algorithm--An evidence-based process for providing psychiatric care to adults with severe and persistent mental illnesses and children and adolescents with serious emotional disturbance, consisting of consensus-derived guidelines for medication treatment, training and support for physicians, standardized documentation, and patient and family education.]
(19) DSM--[The current edition of the] Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(20) Emergency care services--Community mental [ Mental] health [community] services or other necessary interventions directed to address the immediate needs of an individual in crisis in order to ensure [assure] the safety of the individual and others who may be placed at risk by the individual's behaviors, including[, but not limited to,] psychiatric evaluations, administration of medications, hospitalization, stabilization or resolution of the crisis.
(21) Face-to-face--A contact with an individual that occurs in person. Face-to-face does not include contacts made through the use of video conferencing or telecommunication technologies, including telemedicine.
(22) Family member--A [Any] person identified by [who] an individual [identifies] as being a member of the individual's [their] family.
[(23) Family partner--An experienced, trained primary caregiver (i.e., parent of an individual with a mental illness or serious emotional disturbance) who provides peer mentoring, education, and support to the caregivers of a child who is receiving mental health community services.]
(23) [(24)] HIPAA--The Health Insurance Portability and Accountability Act, 42 U.S.C. §1320d et seq.
(24) HHSC--The Texas Health and Human Services Commission or its designee.
[(25) Identifying information--The name, address, date of birth, social security number, or any information by which the identity of an individual can be determined either directly or by reference to other publicly available information. The term includes medical records, graphs, and charts that contain an individual's information; statements made by the individual either orally or in writing while receiving mental health community services; videotapes, audiotapes, photographs, and other recorded media; and any acknowledgment that an individual is receiving or has received services from a state facility, LMHA, MCO, or provider.]
(25) [(26)] Indicator--A defined, measurable variable used to monitor the quality or appropriateness of an important aspect of an individual's care or service or an organization's performance of related functions, processes, or outcomes. Indicators can measure activities, events, occurrences, or outcomes for which data can be collected to allow comparison with a threshold, a benchmark, or prior performance.
(26) [(27)] Individual--A person who is seeking or receiving community mental health [community ] services from or through a provider.
(27) [(28)] LAR--Legally [ or legally] authorized representative. [--] A person authorized by state law to act on behalf of an individual with regard to a matter described in this subchapter[, including, but not limited to, a parent, guardian, or managing conservator ].
(28) LBHA--Local behavioral health authority. An entity designated as an LBHA by HHSC in accordance with Texas Health and Safety Code §533.0356(a).
[(29) LCDC or licensed chemical dependency counselor--A counselor licensed by the department pursuant to the Texas Occupations Code, Chapter 504.]
(29) [(30)] LCSW--Licensed [ or licensed] clinical social worker. [--] A person [staff member] who is licensed as a clinical social worker by the Texas State Board of Social Worker Examiners in accordance with the Texas Occupations Code[,] Chapter 505.
(30) [(31)] LMFT--Licensed [ or licensed] marriage and family therapist. [--] A person [staff member] who is licensed as a licensed marriage and family therapist by the Texas State Board of Examiners of Marriage and Family Therapists in accordance with Texas Occupations Code[,] Chapter 502.
(31) [(32)] LMHA--Local [ or local] mental health authority. [--] An entity designated as the LMHA [the local mental authority] by HHSC [the department] in accordance with [the] Texas Health and Safety Code[,] §533.035(a).
(32) [(33)] LOC--Level [ or level] of care. [--] A designation given to services delivered under HHSC's model of community [ the department's standardized packages of] mental health [community] services[, based on the uniform assessment and the utilization management guidelines, which recommend the type, amount, and duration of mental health community services to be provided to an individual].
(33) [(34)] LPC--Licensed [ or licensed] professional counselor. [--] A person [staff member] who is licensed as a licensed professional counselor by the Texas State Board of Examiners of Professional Counselors in accordance with Texas Occupations Code[ ,] Chapter 503.
(34) [(35)] LPHA--Licensed [ or licensed] practitioner of the healing arts. [--] A person [staff member] who is:
(A) a physician;
(B) an LPC [a licensed professional counselor (LPC)];
(C) an LCSW [a licensed clinical social worker (LCSW)];
(D) a psychologist;
(E) an APRN [advanced practice registered nurse (APRN)];
(F) a PA [physician assistant (PA)]; or
(G) an LMFT [a licensed marriage and family therapist (LMFT)].
(35) [(36)] LVN--Licensed [ or licensed] vocational nurse. [--] A person [staff member] who is licensed as a licensed vocational nurse by the Texas Board of Nursing in accordance with Texas Occupations Code[,] Chapter 301.
(36) [(37)] Management information system--An information system designed to supply [an LMHA or MCO with] information needed to plan, organize, staff, direct, and control [their] operations and clinical decision-making.
[(38) MCO or managed care organization--An entity that has a current Texas Department of Insurance certificate of authority to operate as a Health Maintenance Organization (HMO) in the Texas Insurance Code, Chapter 843, or as an approved nonprofit health corporation in the Texas Insurance Code, Chapter 844, and that provides mental health community services pursuant to a contract with the department.]
(37) [(39)] Medical necessity--The need for a service that:
(A) is reasonable and necessary for the diagnosis or treatment of a mental illness [health disorder] or a COPSD [co-occurring psychiatric and substance use disorder (COPSD)] in order to improve or maintain an individual's level of functioning;
(B) is provided in accordance with professionally accepted clinical guidelines and standards of practice in behavioral health care;
(C) is furnished in the most clinically appropriate, available setting in which the service can be safely provided;
(D) is provided at a level that is safe and appropriate for the individual's needs and facilitates the individual's recovery; and
(E) could not be omitted without adversely affecting the individual's mental or physical health or the quality of care rendered.
(38) [(40)] Medical record--An [ The systematic,] organized account[, compiled by health care providers,] of information relevant to the medical services provided to an individual, including[. This includes] an individual's history, present illness, findings on examination, treatment and discharge plans, details of direct and indirect care and services, and notes on progress.
[(41) Mental health community services--All services medically necessary to treat, care for, supervise, and rehabilitate individuals who have a mental illness or emotional disorder or a COPSD. These services include services for the prevention of and recovery from such disorders, but do not include inpatient services provided in a state facility.]
(39) [(42)] Mental illness--This term has the meaning as assigned by Texas Health and Safety Code §571.003. [An illness, disease, or condition (other than a sole diagnosis of epilepsy, dementia, substance use disorder, mental retardation, or pervasive developmental disorder) that:]
[(A) substantially impairs an individual's thought, perception of reality, emotional process, development, or judgment; or]
[(B) grossly impairs an individual's behavior as demonstrated by recent disturbed behavior.]
(40) PA--Physician assistant. A person licensed as a physician assistant by the Texas State Board of Physician Assistant Examiners in accordance with Texas Occupations Code Chapter 204.
(41) [(43)] Peer specialist [ provider]--A person [staff member] who uses lived experience, in addition to skills learned in formal training, to deliver strengths-based, person-centered services to promote an individual's recovery and resiliency in accordance with 1 TAC Chapter 354, Subchapter N (relating to Peer Specialist Services).[ :]
[(A) has received:]
[(i) a high school diploma; or]
[(ii) a high school equivalency certificate issued in accordance with the law of the issuing state;]
[(B) has at least one cumulative year of receiving mental health community services; and]
[(C) is under the direct clinical supervision of an LPHA.]
(42) [(44)] Physician--A person [staff member] who is:
(A) licensed as a physician by the Texas Medical Board in accordance with Texas Occupations Code [,] Chapter 155; or
(B) authorized to perform medical acts under an institutional permit at a Texas postgraduate training program approved by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the Texas Medical Board.
[(45) Physician assistant--A staff member who has specialized psychiatric/mental health training and who is licensed as a physician assistant by the Texas State Board of Physician Assistant Examiners in accordance with Texas Occupations Code, Chapter 204.]
(43) [(46)] Provider--A [ Any] person or [legal] entity that contracts with HHSC [the department, an LMHA, or an MCO] to provide [mental health community] services under this subchapter [to individuals, including that part of an LMHA or MCO directly providing mental health community services to individuals. The term includes providers of mental health case management services and providers of mental health rehabilitative services].
(44) [(47)] Psychologist--A person [staff member] who is licensed as a psychologist by the Texas State Board of Examiners of Psychologists in accordance with Texas Occupations Code[,] Chapter 501.
(45) [(48)] QMHP-CS--Qualified mental health professional-community services. [or qualified mental health professional-community services--] A person [ staff member] who is credentialed as a QMHP-CS in accordance with §301.331 of this subchapter (relating to Competency and Credentialing)[who has demonstrated and documented competency in the work to be performed] and:
(A) has completed a standardized training curriculum;
(B) has demonstrated competency in the work to be performed; and
(C) [(A)] has obtained one of the following:
(i) a bachelor's degree in one of the following disciplines from an accredited college or university : [with a minimum number of hours that is equivalent to a major (as determined by the LMHA or MCO in accordance with §412.316(d) of this title (relating to Competency and Credentialing)) in]
(I) psychology; [,]
(II) social work; [,]
(III) medicine; [,]
(IV) nursing; [,]
(V) rehabilitation; [,]
(VI) counseling; [,]
(VII) sociology; [,]
(VIII) human growth and development; [ ,]
(IX) physician assistant; [,]
(X) gerontology; [,]
(XI) special education; [,]
(XII) educational psychology; [ ,]
(XIII) early childhood education; [ , or]
(XIV) early childhood intervention;
(XV) human development and family sciences;
(XVI) public health; or
(XVII) child and family welfare;
(ii) a bachelor's degree in a discipline other than those listed under clause (i) of this subparagraph from an accredited college or university with at least one year of documented experience as an intern or employee in a program that provides mental health or substance use services;
(iii) [(B)] a license as an RN [is a registered nurse (RN)]; or
(iv) a license as an LPHA.
[(C) completes an alternative credentialing process as determined by the LMHA or MCO in accordance with §412.316(c) and (d) of this title relating to (Competency and Credentialing).]
(46) [(49)] Recovery--The process of change through which an individual improves the individual's health and wellness, lives a self-directed life, and strives to reach the individual's full potential [by which a person becomes able or regains the ability to live, work, learn, and participate fully in his or her community].
(47) Re-credentialing--The periodic process of re-evaluating a staff member's competency and qualifications.
(48) [(50)] Referral--The process of identifying appropriate services and providing the information and assistance needed to access them.
[(51) RN or registered nurse--A staff member who is licensed as a registered nurse by the Texas Board of Nursing in accordance with Texas Occupations Code, Chapter 301.]
(49) [(52)] Restraint--This term has the [The] same meaning as defined in Chapter 320 [415], Subchapter C [F] of this title (relating to Interventions in Mental Health Services [ Programs]).
(50) RN--Registered nurse. A person who is licensed as a registered nurse by the Texas Board of Nursing in accordance with Texas Occupations Code Chapter 301.
(51) [(53)] Routine care services-- Community mental [Mental] health [community] services provided to an individual who is not in crisis.
(52) Screening--Activities to:
(A) collect triage information through interviews with an individual or collateral contact;
(B) determine if the individual's need is emergent, urgent, or routine; and
(C) determine the need for an assessment.
[(54) Safety monitoring--Ongoing observation of an individual to ensure the individual's safety. An appropriate staff person must be continuously present in the individual's immediate vicinity, provide ongoing monitoring of the individual's mental and physical status, and ensure rapid response to indications of a need for assistance or intervention. Safety monitoring includes maintaining continuous visual contact with frequent face-to-face contacts as needed.]
[(55) Screening Activities performed by a Qualified Mental Health Professional--Community Services (QMHP-CS) to gather triage information to determine the need for in-depth assessment. The QMHP-CS collects this information through face-to-face or telephone interviews with the individual or collateral. This service includes screenings to determine if the individual's need is emergent, urgent, or routine (which is conducted prior to the face-to-face assessment to determine the need for emergency services).]
(53) [(56)] Seclusion--This term has the [The] same meaning as defined in Chapter 320 [415], Subchapter C [F] of this title (relating to Interventions in Mental Health Services).
(54) SED--Serious emotional disturbance. A disorder that meets the criteria described in Texas Government Code §547.0051.
(55) [(57)] Staff member--Provider personnel, including a full-time and part-time employee, contractor, or intern, but excluding a volunteer [Anyone who works or provides services for an LMHA, MCO, or provider as an employee, contractor, intern, or volunteer].
(56) [(58)] Support services--Services [Mental health community services] delivered to an individual, the individual's LAR, or family member, as applicable, [member(s)] to assist the individual in functioning in the individual's chosen living, learning, working, and socializing environments.
(57) TAC--Texas Administrative Code.
(58) [(59)] Telemedicine--The use of health care information exchanged from one site to another via electronic communications for the health and education of the individual or provider, and for the purpose of improving patient care, treatment, and services. This definition applies only for purposes of this subchapter and does not affect, modify, or relate in any way to other rules defining the term or regulating the service, or to any statutory definitions or requirements.
(59) [(60)] Uniform assessment--An assessment tool adopted [developed] by HHSC under §301.353 of this subchapter (relating to Provider Responsibilities for Treatment Planning and Service Authorization) used for recommending an individual's LOC [the department that includes, but is not limited to, the Adult Texas Recommended Assessment Guidelines (TRAG), the Children and Adolescent Texas Recommended Assessment Guidelines, and the department-approved algorithms].
(60) [(61)] Urgent care services-- Services [Mental health community services] or other necessary interventions provided to persons in crisis who do not need emergency care services, but who are potentially at risk of serious deterioration.
(61) [(62)] Utilization management exception--The authorization of additional amounts of services based on medical necessity when an [the] individual has reached the maximum service units of the individual's [ their] currently authorized LOC [level of care (LOC)].
(62) [(63)] Utilization management guidelines--HHSC-developed guidelines [Guidelines developed by the department] that establish the type, amount, and duration of community mental health [community] services for each LOC.
(63) [(64)] Volunteer--A person who receives no remuneration for the provision of time, individual attention, or assistance to individuals receiving community mental health [community] services from entities or providers governed by this subchapter. [Volunteers may include:]
[(A) community members;]
[(B) family members of individuals served when not acting in their capacity as a family member;]
[(C) employees when not acting in their capacity as employees; and]
[(D) individuals served when acting on behalf of another individual.]
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 July 14, 2025.
TRD-202502493
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (737) 704-9063
SUBCHAPTER G.
DIVISION 1. GENERAL PROVISIONS
26 TAC §301.305STATUTORY 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, Texas Health and Safety Code §533.0345(a), which requires the executive commissioner of HHSC to by rule develop model program standards for mental health services for use by each state agency that provides or pays for mental health services; Texas Health and Safety Code §533.0356(i), which allows the executive commissioner of HHSC to adopt rules to govern the operations of local behavioral health authorities; and Texas Health and Safety Code §534.052(a), which requires the executive commissioner of HHSC to adopt rules, including standards, the executive commissioner considers necessary and appropriate to ensure the adequate provision of community-based mental health services through an LMHA under Texas Health and Safety Code Chapter 534.
The repeal affects Texas Government Code §524.0151 and Texas Health and Safety Code §533.0345(a), §533.0356(i), and §534.052(a).
§301.305.
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 July 14, 2025.
TRD-202502492
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (737) 704-9063
SUBCHAPTER G.COMMUNITY ] SERVICES STANDARDS
DIVISION 2. ORGANIZATIONAL STANDARDS
26 TAC §§301.321, 301.323, 301.327, 301.329, 301.331, 301.333, 301.335STATUTORY AUTHORITY
The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, Texas Health and Safety Code §533.0345(a), which requires the executive commissioner of HHSC to by rule develop model program standards for mental health services for use by each state agency that provides or pays for mental health services; Texas Health and Safety Code §533.0356(i), which allows the executive commissioner of HHSC to adopt rules to govern the operations of local behavioral health authorities; and Texas Health and Safety Code §534.052(a), which requires the executive commissioner of HHSC to adopt rules, including standards, the executive commissioner considers necessary and appropriate to ensure the adequate provision of community-based mental health services through an LMHA under Texas Health and Safety Code Chapter 534.
The amendments affect Texas Government Code §524.0151 and Texas Health and Safety Code §533.0345(a), §533.0356(i), and §534.052(a).
§301.321.
(a) Organizational planning and communication. The LMHA and LBHA [MCO] must define and implement organizational plans and systems as described in this subchapter, such as a quality management plan or utilization management plan, [ (e.g., quality management plan, utilization management plan)] and ensure that there are mechanisms in place that facilitate effective communication throughout the organization to promote the provision of quality community mental health [community] services.
(b) Management of key processes and functions. The LMHA and LBHA [MCO] must define organizational and clinical processes and functions, including performance activities, as well as:
(1) allocate adequate, appropriate resources; and
(2) provide oversight for such processes and functions.
(c) Management information system. The LMHA, LBHA [ MCO], and provider must ensure their management information systems provide timely, accurate, and accessible information that supports clinical, administrative, and fiscal decision-making.
(d) Consumer advocacy. The LMHA and LBHA [ MCO] must encourage and support advocacy for individuals accessing community mental health [community] services.
(e) Conflict of interest and dual relationships. The LMHA and LBHA [MCO] must develop and implement policies and procedures to ensure that all staff members refrain from activities and relationships whereby personal, financial, professional, or other relationships could compromise or interfere with independent judgment creating a conflict of interest or otherwise having the potential to harm or exploit individuals and families.
(f) Collaboration with other health care agencies and community resources. The LMHA and LBHA [MCO] must demonstrate efforts to collaborate with other health care agencies and community resources to address the physical and behavioral health care needs of individuals, as well as to ensure that these needs are met.
§301.323.
(a) Safe environment. The LMHA, LBHA [MCO], and provider must:
(1) ensure service delivery sites, including facilities and vehicles, [(including, but not limited to, facilities and vehicles)] are safe, sanitary, and free from hazards, including [but not limited to]:
(A) hand washing facilities and supplies in restrooms and in areas where staff have routine physical contact with individuals , such as an exam room, medication area, or laboratory [(e.g., exam rooms, medication areas, laboratories)];
(B) a utility area with necessary equipment for the safe and required cleaning or disposal of instruments, equipment, and sharps;
(C) locked areas for storing drugs, needles, syringes, hazardous materials, other potentially dangerous equipment, and toxic chemical products; and
(D) adequate prevention of exposure to tobacco smoke and other environmental pollutants; [.]
(2) ensure delivery sites are prepared to manage onsite life-threatening [life threatening] emergencies, and that each site will have:
(A) a written plan for the management of onsite medical emergencies requiring ambulance services, hospitalization, or hospital treatment;
(B) emergency resuscitative drugs, supplies, and equipment appropriate to the needs of individuals and staff qualifications;
(C) written protocols and instructions for disasters and other emergencies; and
(D) documented disaster drills appropriate for local conditions; [.]
(3) comply with the most current edition of the National Fire Protection Association's Life Safety Code, and related codes, standards, and other applicable requirements;
(4) implement an infection control plan and procedures for group residential services, clinics, and other areas where a high volume of people congregate, that address the prevention, education, management, and monitoring of significant infections in accordance with applicable state and federal laws. [Components addressed in the plan must include:]
[(A) prevention and management of infection in the service delivery site(s);]
[(B) reporting of reportable diseases as required by Chapter 97, Subchapter A of this title (relating to Control of Communicable Diseases);]
[(C) compliance with the Human Immunodeficiency Virus Services Act (Texas Health and Safety Code, §85.001 et seq.), the Communicable Disease Prevention and Control Act (Texas Health and Safety Code, §81.001 et seq.), and other applicable laws (e.g., the Americans with Disabilities Act of 1990, 42 U.S.C. §12101 et seq.; and the Rehabilitation Act of 1973, 29 U.S.C. §701 et seq.);]
[(D) identification of illnesses and conditions for which an individual's participation in mental health community services is safely allowed;]
[(E) identification of illnesses and conditions for which an individual's participation in mental health community services is restricted and the procedures for minimizing exposure and facilitating an individual's transfer to a more appropriate setting;]
[(5) implement safeguards regarding hazardous equipment and weather; and]
[(6) implement procedures for the disposal of biohazardous wastes that minimize the risks of contamination, injury, and disease transmission.]
(b) Sufficient staff. The provider must have sufficient [number of] qualified and competent staff members on duty to ensure the safety of individuals and adequacy of community mental health [community] services, including responding to crises during the provision of community mental health [community ] services.
[(c) Compliance with state and federal law. The provider must comply with all applicable state and federal law and regulations, including those relating to:]
[(1) blood borne pathogens;]
[(2) food borne pathogen exposure controls; and]
[(3) tuberculosis exposure controls.]
(c) [(d)] Use [Limited use] of restraint or seclusion.
[(1)] [Restraint.] In outpatient settings, a provider may only use restraint or seclusion as described in Chapter 320, Subchapter C of this title (relating to Interventions in Mental Health Services). [if the intervention is:]
[(A) necessary to address a behavioral health emergency, as defined in Chapter 415, Subchapter F of this title (relating to Interventions in Mental Health Programs); and]
[(B) performed according to the department's rules described in Chapter 415, Subchapter F of this title.]
[(2) Seclusion. Seclusion is prohibited in outpatient settings with the exception of partial hospitalization programs for children or adolescents. A provider may only use seclusion in those programs if the conditions in paragraph (1)(A) - (B) of this subsection are met.]
§301.327.Community] Services.
(a) Adequate provider network. The LMHA and LBHA [ MCO] must maintain a provider network that is adequate and qualified to provide all community mental health [community] services that the LMHA and LBHA [MCO] are required to provide under a contract with HHSC [the department].
(b) Crisis screening and response system. The LMHA and LBHA [MCO] must have a crisis screening and response system in operation 24 hours a day, every day of the year, that is available to individuals throughout its contracted service delivery area. The telephone system to access the crisis screening and response system must include a toll-free crisis hotline number and be easily accessible and well publicized. Calls to the crisis hotline must be answered by a hotline staff member who is trained in compliance with this subchapter. The hotline must have teletypewriter (TTY) capabilities or other assistive technology that is available and effective.
(c) Telephone access. In addition to the crisis screening and response system described in subsection (b) of this section, the LMHA and LBHA [MCO] must ensure the availability of a telephone system and call center that allows individuals to contact the LMHA or LBHA [MCO] through a toll-free number that must:
(1) operate without using telephone answering equipment at least on business days during normal business hours, except on national holidays, due to uncontrollable interruption of service, or with prior approval of HHSC [the department];
(2) have sufficient staff to operate efficiently;
(3) collect, document, and store detailed information, including special needs information, on all telephone inquiries and calls;
(4) during times other than those described in paragraph (1) of this subsection provide electronic call answering methods that include an outgoing message providing the crisis hotline telephone number, in languages relevant to the service area, for callers to leave a message; and
(5) return routine calls before the end of the next business day for all messages left after hours.
(d) Timely services based on need. The LMHA or LBHA [ local behavioral health authority (LBHA), as defined at Texas Health and Safety Code §533.0356] must arrange mental health services for an individual within the following time frames.
(1) Crisis services.
(A) Hotline calls. For all calls to the toll-free crisis hotline:
(i) a staff member must answer each call within 30 seconds, on average, at least 95 percent of the time;
(ii) the LMHA, LBHA, or their subcontractors must train a staff member in crisis screening to conduct a crisis hotline screening as provided in the LMHA's [LMHAs'] and LBHA's [LBHAs'] contract with HHSC [the Texas Health and Human Services Commission]; and
(iii) if the staff member determines the call is a potential crisis, a staff member trained in crisis screening, in accordance with clause (ii) of this subparagraph, must begin a telephone screening no later than one minute after the determination is made.
(B) Emergency care services. If a staff member determines during a screening that an individual is experiencing a crisis that may require emergency care services, the staff member trained in crisis screening, in accordance with subparagraph (A)(ii) of this paragraph, must:
(i) take immediate action to address the emergency situation to ensure the safety of all parties involved;
(ii) activate the immediate screening and assessment processes as described in §301.351 of this subchapter (relating to Crisis Services); and
(iii) provide or obtain community mental health [community] services or other necessary interventions to stabilize the crisis.
(C) Urgent care services. If the screening indicates that an individual needs urgent care services, a QMHP-CS must within eight hours of the initial incoming hotline call or notification of a potential crisis situation:
(i) perform a face-to-face assessment; and
(ii) provide or obtain community mental health [community] services or other necessary interventions to stabilize the crisis.
(2) Routine care services. If the screening indicates that an individual needs routine care services, a QMHP-CS must perform a uniform assessment within 14 days after the screening. If the assessment indicates an LOC for routine care services, the individual must begin receiving services immediately. When the provision of the service package is not possible because services are at capacity, the individual must be referred to an available practitioner appropriate to meet the individual's needs or be placed on a waiting list for services, subject to the following exceptions:
(A) individuals eligible for Medicaid who are determined to be in need of mental health case management services [ Mental Health Case Management], under Chapter 306, Subchapter E of this title (relating to Mental Health Case Management), or mental health rehabilitative services [Mental Health Rehabilitative Services], under Chapter 306, Subchapter F of this title (relating to Mental Health Rehabilitative Services), cannot be placed on a waiting list and must be served; and [ .]
(B) individuals eligible for Medicaid who are determined to need services other than mental health case management services [ Mental Health Case Management], under Chapter 306, Subchapter E of this title, and mental health rehabilitative services [ Mental Health Rehabilitative Services], under Chapter 306, Subchapter F of this title, must be referred to appropriate, available practitioners of that service. Only if an appropriate Medicaid practitioner is not available may the individual be placed on a waiting list. All efforts undertaken to refer Medicaid individuals must be documented.
(e) Communication with individuals. The LMHA, LBHA [ MCO], and provider must ensure effective communication with the individual and LAR, if applicable, [(if applicable)] in an understandable format as appropriate to meet the needs of individuals, which may require using:
(1) interpretative services;
(2) translated materials; or
(3) a staff member who can communicate effectively with [respond to the cultural (e.g., customs, beliefs, actions, and values) and language needs of] the individual and LAR, if applicable [(if applicable)].
(f) Service information. The LMHA and LBHA [ MCO] must proactively disseminate to an individual and LAR, if applicable, [individuals and their LAR (if applicable) ] information about mental illness and the LMHA's or LBHA's community [MCO's] mental health [community] services in a format and language that is easily understood and based on the demographics for any group comprising more than 10 percent of the population in the local service area. Information about mental illness and the LMHA's or LBHA's [MCO's] community services must be in a format and language that is accessible [easily understood] by individuals with a disability , such as deafness, hard of hearing, and blindness[(e.g., deafness, hard of hearing, and blindness)].
(g) Access to emergency medical and crisis services. The LMHA and LBHA [MCO] must develop procedures providers can [for its providers'] use to access [in accessing] emergency medical and crisis services for individuals.
(h) Continuity of care [services]. The LMHA and LBHA [MCO] must ensure that individuals:
(1) are provided continuity of care [services ] as defined by this chapter [the department]; and
(2) are informed of whom to contact regarding continuity of care and the coordination of services for the individual [their services], in accordance with Chapter 306[412], Subchapter D of this title (relating to Mental Health Services--Admission, Discharge, [ Continuity,] and Continuity of Care [Discharge]).
(i) Referral for physical health services. If a uniform [nursing or medical] assessment indicates physical health needs outside the scope of the provider's competency, credentialing, or capacity to treat, the LMHA and LBHA [MCO ] must make and document appropriate referrals to other healthcare providers and provide adequate follow up at subsequent visits to confirm access to the referrals.
§301.329.
(a) Maintenance of medical records. The LMHA, LBHA [ MCO], and [the] provider must ensure:
(1) protection against unauthorized access, disclosure, modification or destruction of medical records, whether accidental or deliberate;
(2) the availability, integrity, utility, authenticity, and confidentiality of information within the medical record;
(3) a current, organized, legible, and comprehensive records system that:
(A) conforms to good professional practice;
(B) permits effective clinical review and audit; and
(C) facilitates prompt and systematic retrieval of information;
(4) a medical records system [with sufficient redundancy] to ensure access to individual records; and
(5) compliance with applicable federal and state laws, rules, and regulations, including HIPAA and[,] 42 CFR Part 2[, and the requirements described in Chapter 414, Subchapter A of this title (relating to Protected Health Information)].
(b) Disaster recovery plan. The LMHA, LBHA [ MCO], and [the] provider must maintain a written disaster recovery plan for information resources that will ensure service continuity as required by applicable state and federal laws.
§301.331.
(a) Competency of staff members and[, including] volunteers. The LMHA, LBHA [MCO], and provider must implement a process to ensure the competency of staff members prior to providing services that, at a minimum:
(1) ensures services are provided by staff members who are operating within the scope of their license, job description, or contract specification;
(2) ensures that the community mental health [community] services provided by peer specialists [ providers] are limited to mental health rehabilitative, supported employment, supported housing, parent support group, and CFP [ family partner] services; [and]
(3) defines competency-based expectations for each position as follows:
(A) required competencies must be included for all staff members, including adequate, accurate knowledge of:
(i) the nature of serious [severe and persistent] mental illness, as defined in §306.305 of this title (relating to Definitions), and SEDs [ serious emotional disturbances];
(ii) HHSC's utilization management guidelines [ the recovery and resiliency model of mental illness and serious emotional disturbance];
(iii) the dignity and rights of an individual, as described in Chapter 320 [404], Subchapter A [ E] of this title (relating to Rights of Individuals [ Persons] Receiving Mental Health Services);
(iv) identifying, preventing, and reporting abuse, neglect, and exploitation, in accordance with [Chapter 414,] Subchapter M [L] of this chapter [title ] (relating to Abuse, Neglect, and Exploitation in Local Authorities and Community Centers);
(v) individual client privacy and confidentiality, as described in HIPAA [Chapter 414, Subchapter A of this title (relating to Protected Health Information)] and other relevant state and federal laws affecting confidentiality of medical records, including [Title] 42 CFR Part 2 and Texas Health and Safety Code Chapter 611;
(vi) interacting with an individual who has a physical disability such as a hearing or visual impairment;
(vii) responding to an individual's language and cultural needs [through knowledge of customs, beliefs, and values of various, racial, ethnic, religious, and social groups];
(viii) exposure control of bloodborne [blood borne] pathogens;
(ix) identification of an individual as being in a crisis and accessing emergency or urgent care services;
(x) proper documentation of services provided; and
(xi) planning and training for responding to severe weather, disasters, and bioterrorism;
(B) critical competencies must be included for positions in which a staff member's primary job duties are related to individual service contacts and interactions, including [and include, but are not limited to,] adequate and accurate knowledge of:
(i) cardiopulmonary [cardio pulmonary] resuscitation (CPR);
(ii) first aid;
(iii) safe management of verbally and physically aggressive behavior;
(iv) utilization of assistive technology such as communication devices with individuals who are deaf or hard of hearing; and
(v) seizure response and assessment;
(C) specialty competencies must be included for positions in which a staff member performs specialized services and tasks and include adequate and accurate knowledge of specialized services and tasks, such as:
(i) the requirements of this subchapter;
(ii) age appropriate clinical assessment including the uniform assessment;
(iii) age appropriate engagement techniques, such as motivational interviewing[(e.g., motivational interviewing) ];
(iv) use of telemedicine equipment;
(v) HHSC's [the] utilization management guidelines;
(vi) developing and implementing an individualized treatment plan;
(vii) appropriate actions to take in a crisis, such as screening, intervention, management, and, if applicable, suicide or homicide precautions [(e.g., screening, intervention, management and if applicable, suicide/homicide precautions)];
(viii) services for co-occurring psychiatric and substance use disorders described in Chapter 306 [411], Subchapter A [N] of this title (relating to Standards for Services to Individuals with Co-Occurring Psychiatric and Substance Use Disorders (COPSD));
(ix) accessing resources within the local community;
(x) strategies for effective advocacy and referral for an individual;
(xi) infection control;
(xii) recognition, reporting, and recording of side effects, contraindications, and drug interactions of psychoactive medication;
(xiii) age appropriate rehabilitative approaches;
(xiv) proficiency in specimen collection;
(xv) the peer-provider or consumer-operated service model;
(xvi) assessment and intervention with children, adolescents, and families; and
(xvii) clinical specialties directly related to the services to be performed; [.]
(D) crisis hotline competencies must be included for positions in which a staff member routinely answers the crisis hotline and include adequate and accurate knowledge of:
(i) the nature of serious [severe and persistent] mental illness, as defined in §306.305 of this title (relating to Definitions), SEDs, [and serious emotional disturbances] and COPSD;
(ii) behavioral health crisis situations;
(iii) operating a telephone system to access behavioral health crisis screening and response;
(iv) age appropriate crisis intervention and response;
(v) utilization of assistive technology such as communication devices with individuals who are deaf or hard of hearing;
(vi) advocacy for treatment in the most clinically appropriate, available environment; and
(vii) applicable privacy laws, rules, and regulations including those described in HIPAA, [Chapter 414, Subchapter A of this title (relating to Protected Health Information) and in Title] 42 CFR Part 2, and Texas Health and Safety Code Chapter 611; and [.]
(E) telemedicine competencies must be included for positions in which a staff member's job duties are related to assisting with telemedicine services and include adequate and accurate knowledge of:
(i) operation of the telemedicine equipment; and
(ii) how to use the equipment to adequately present the individual; and [.]
(4) requires staff members to demonstrate competencies in the following manner:
(A) all staff members must demonstrate required competencies before contact with individuals, confidential information, or protected health information and periodically throughout the staff member's tenure of employment or association with the LMHA, LBHA [ MCO], or provider;
(B) all staff members in positions that require critical competencies must demonstrate the critical competencies before contact with individuals and periodically throughout the staff member's or volunteer's tenure of employment or association with the LMHA, LBHA [MCO], or provider;
(C) all staff members in positions that require specialty competencies must demonstrate the specialty competencies before providing the specialized services [service(s)] or performing the specialized tasks [task(s)] and periodically throughout the staff member's or volunteer's tenure of employment or association with the LMHA, LBHA [MCO], or provider; and
(D) all staff members in positions that require crisis hotline competencies must demonstrate those competencies before providing crisis hotline services and at least annually throughout the staff member's or volunteer's tenure of employment or association with the LMHA, LBHA [MCO], or provider.
(b) Competency of crisis services providers. The LMHA and LBHA [MCO] must develop and implement policies and procedures governing the provision of crisis services to ensure that providers with which they contract or employ for the provision of crisis services are trained in:
(1) crisis access and age appropriate assessment and intervention services;
(2) advocacy for the most clinically appropriate, available environment; and
(3) community referral resources.
(c) Credentialing and appeals. Before providing services, the LMHA and LBHA [MCO] must:
(1) implement a timely credentialing and re-credentialing process for all its licensed staff members, peer specialists [ providers], CFPs [family partners], and every QMHP-CS and CSSP;
(2) ensure that documentation verifying a staff member's credentialing and re-credentialing is maintained in the staff member's personnel records;
(3) have a process for staff members to appeal credentialing and re-credentialing decisions; and
(4) require providers to:
(A) use the LMHA's or LBHA's [MCO's ] credentialing and re-credentialing and appeals processes for all of the provider's licensed staff, QMHP-CSs, CSSPs, peer specialists [providers], CFPs [family partners], and utilization management job functions; or
(B) implement a credentialing and re-credentialing process for all of the provider's licensed staff members [ staff], QMHP-CSs, CSSPs, peer specialists [providers ], CFPs [family partners], and utilization management job functions that meets the LMHA's or LBHA's [ MCO's] credentialing and re-credentialing criteria and have a process for those staff members to appeal credentialing and re-credentialing decisions.
(d) Requirements [Additional requirements] for credentialing as a QMHP-CS. For credentialing as a QMHP-CS who is not an RN or an LPHA [a registered nurse], the credentialing and re-credentialing process described in subsection (c) of this section must include:
(1) verifying the requirements listed in §301.303(45)(A) - (C)(i) and (ii) of this subchapter (relating to Definitions) [ determining the minimum number of coursework hours that is equivalent to a major and whether a combination of coursework hours in the specified areas is acceptable];
[(2) reviewing the individual's coursework;] and
(2) [(3)] justifying and documenting the credentialing decisions. [; or]
[(4) completing an alternative credentialing process identified by the department.]
(e) Requirements [Additional requirements] for credentialing as a CSSP. For credentialing as a CSSP, the credentialing and re-credentialing process described in subsection (c) of this section must include:
(1) verifying a high school diploma or high school equivalent certificate issued in accordance with the law of the issuing state;
(2) verifying three continuous years of documented full-time experience in the provision of mental health case management or rehabilitative services before [prior to] August 31, 2004;
(3) reviewing the staff member's provision and documentation of mental health case management or rehabilitative services; and
(4) certifying, justifying, and documenting the credentialing decisions.
(f) Requirements [Additional requirements] for credentialing as a peer specialist [provider]. For credentialing as a peer specialist [provider], the credentialing and re-credentialing process described in subsection (c) of this section must include the peer specialist qualifications described in 1 TAC Chapter 354, Subchapter N (relating to Peer Specialist Services). [or the alternative credentialing by an organization recognized by the department must, at minimum, include:]
[(1) verifying a high school diploma or high school equivalent certificate issued in accordance with the law of the issuing state;]
[(2) verifying at least one cumulative year of receiving mental health community services for a disorder that is treated in the target population for Texas;]
[(3) demonstration of competency in the provision and documentation of mental health rehabilitative services, supported employment, or supported housing; and]
[(4) justifying and documenting the credentialing decisions.]
(g) Requirements [Additional requirements] for utilization management job functions. For credentialing as a staff member who performs utilization management job functions, the credentialing and re-credentialing process described in subsection (c) of this section must include:
(1) the staff member's job description indicating the performance of utilization management functions;
(2) if the staff member is not the utilization management physician, the staff member's job description indicating the staff member does not [they neither] provide services or [nor] supervise service providers;
(3) documenting licenses;
(4) documenting training and supervision received; and
(5) justifying and documenting credentialing decisions.
(h) Maintaining documented personnel information. The LMHA, LBHA [MCO], and provider must maintain personnel files for each staff member that include:
(1) a current, signed job description for each staff member;
(2) documented, periodic performance reviews;
(3) copies of current credentials and training; and
(4) criminal background checks.
(i) The LMHA, LBHA, and provider must also comply with any applicable Medicaid requirements.
§301.333.
(a) Quality management plan. The LMHA and LBHA [ MCO] must develop a written quality management plan that includes:
(1) the quality management program description and work plan;
(2) measurable objective indicators to detect the need for improvement;
(3) procedures and timelines for taking appropriate action when problems are identified; and
(4) approval by the LMHA or LBHA [MCO] governing body.
(b) Quality management program. The LMHA and LBHA [ MCO] must implement a quality management program that includes:
(1) a structure that ensures the program is implemented system-wide;
(2) allocation of adequate resources for implementation;
(3) oversight by professionals with adequate and appropriate experience in quality management;
(4) activities and processes that address identified clinical and organizational problems including fidelity and data integrity;
(5) periodic reporting of quality management program activities to its governing body, providers and other appropriate staff members and community stakeholders such as peer and family organizations;
(6) processes to systematically monitor, analyze, and improve performance of provider services and outcomes for individuals;
(7) review of the provider's treatment to determine:
(A) whether the provider has a plan for compliance with [it is consistent with the department's approved] evidenced-based practices [and the fidelity manual]; and
(B) the accuracy of assessments and treatment planning;
(8) ongoing monitoring of the quality of crisis services, access to services, service delivery, and continuity of care [ services];
(9) provision of technical assistance to providers related to quality oversight necessary to improve the quality and accountability of provider services;
(10) use of reports and data from HHSC [the department] to inform performance improvement activities and assessment of unmet needs of individuals, service delivery problems, and effectiveness of authority functions for the local service area;
(11) mechanisms to measure, assess, and reduce incidents of abuse, neglect, and exploitation and to improve individuals' rights protection processes;
[(12) mechanisms to improve individuals' rights protection processes;]
(12) [(13)] risk management processes such as competency determinations, and the management and reporting of incidents and deaths; and
(13) [(14)] coordination of activities and information management with the utilization management [(UM)] program, including participation in utilization management [ UM] oversight activities.
(c) The LMHA and LBHA [MCO] must establish an integrated system to sufficiently monitor the quality management program for effectiveness on a regular basis and update the quality management plan as needed.
§301.335.
(a) Utilization management plan. The LMHA and LBHA [ MCO] must develop a written utilization management plan that includes:
(1) the utilization management program plan description and work plan;
(2) requirements relating to the utilization management committee credentials, job functions, meetings, and training;
(3) how the utilization management program's effectiveness in meeting goals will be evaluated;
(4) how improvements will be made on a regular basis;
(5) the oversight and control mechanisms to ensure that utilization management [UM] activities meet required standards when the LMHA and LBHA delegate utilization management activities to a subcontractor [they are delegated to an administrative services organization or a DSHS-approved entity]; and
(6) approval by the LMHA or LBHA [MCO] governing body.
(b) Utilization management program. The LMHA and LBHA [MCO] must implement a utilization management program under the direction of a psychiatrist licensed in Texas as required by its contract with HHSC [the department], and in accordance with HHSC's [the] utilization management guidelines, as updated and amended.
(c) Authorization of services. The LMHA and LBHA [ MCO] must ensure that it has an [a timely] authorization system in place to ensure medically necessary services are delivered without delay and with prior authorization, except that the delivery of crisis services does not require prior authorization but rather must be authorized after service [subsequent to] delivery. The LMHA and LBHA [MCO] will review requests for authorization of services, determine if services should be authorized and if so which services to authorize. Services must be authorized using HHSC's [the department's ] utilization management guidelines and based on the uniform assessment, diagnosis, additional clinical information submitted by the requestor, and clinical judgment. The determination and documentation of services to be authorized will occur according to the following timeframes:
(1) crisis intervention services--within two business days of the date of service;
(2) inpatient services--immediately [within sufficient time] to ensure medically necessary services are delivered without delay;
(3) all other community mental health [community ] services, including outpatient and add-on services upon receipt but no later than three business days and prior to service delivery; and
(4) reauthorization for continuing services according to established timeframes in the utilization management guidelines, as updated and amended.
(d) Appeal and Medicaid fair hearing procedures. The LMHA and LBHA [MCO] must implement procedures to give notice of the right to a timely and objective appeal process for all individuals receiving community mental health services, in accordance with §301.155 [§401.464] of this chapter [title] (relating to Notification and Appeals Process). For individuals eligible for Medicaid, the LMHA and LBHA [MCO] must implement procedures that provide notice of the right to request a fair hearing, as described in 1 TAC [Title 1,] Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules [for the Medicaid, TANF, and Food Stamp Programs]), to an individual whose service or benefits are denied, reduced, suspended, or terminated. [The procedures regarding notice of the right to a Medicaid fair hearing must comply with department policy, which may be included in contract provisions.]
(e) Waiting list maintenance requirements. The LMHA and LBHA must comply with [the department's policy on] waiting list maintenance requirements as described[, which may be included in contract provisions and is subject to the requirements set forth] in §301.327(d)(2) [§412.314(d)(2) ] of this subchapter [title] (relating to Access to Community Mental Health [Community] Services).
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 July 14, 2025.
TRD-202502495
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (737) 704-9063
SUBCHAPTER G.
DIVISION 2. ORGANIZATIONAL STANDARDS
26 TAC §301.325STATUTORY 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, Texas Health and Safety Code §533.0345(a), which requires the executive commissioner of HHSC to by rule develop model program standards for mental health services for use by each state agency that provides or pays for mental health services; Texas Health and Safety Code §533.0356(i), which allows the executive commissioner of HHSC to adopt rules to govern the operations of local behavioral health authorities; and Texas Health and Safety Code §534.052(a), which requires the executive commissioner of HHSC to adopt rules, including standards, the executive commissioner considers necessary and appropriate to ensure the adequate provision of community-based mental health services through an LMHA under Texas Health and Safety Code Chapter 534.
The repeal affects Texas Government Code §524.0151 and Texas Health and Safety Code §533.0345(a), §533.0356(i), and §534.052(a).
§301.325.
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 July 14, 2025.
TRD-202502494
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (737) 704-9063
SUBCHAPTER G.COMMUNITY ] SERVICES STANDARDS
DIVISION 3. STANDARDS OF CARE
26 TAC §§301.351, 301.353, 301.355, 301.357, 301.359, 301.361, 301.363STATUTORY AUTHORITY
The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, Texas Health and Safety Code §533.0345(a), which requires the executive commissioner of HHSC to by rule develop model program standards for mental health services for use by each state agency that provides or pays for mental health services; Texas Health and Safety Code §533.0356(i), which allows the executive commissioner of HHSC to adopt rules to govern the operations of local behavioral health authorities; and Texas Health and Safety Code §534.052(a), which requires the executive commissioner of HHSC to adopt rules, including standards, the executive commissioner considers necessary and appropriate to ensure the adequate provision of community-based mental health services through an LMHA under Texas Health and Safety Code Chapter 534.
The amendments affect Texas Government Code §524.0151 and Texas Health and Safety Code §533.0345(a), §533.0356(i), and §534.052(a).
§301.351.
(a) Coordinating provision of crisis services. The LMHA and LBHA [MCO] must develop and implement policies and procedures governing the provision of crisis services that:
(1) identify providers' roles and responsibilities in responding to a crisis;
(2) describe the coordination of crisis services to be required among providers of crisis services, law enforcement, the judicial system, and other community entities; and
(3) comply with Chapter 306 [419], Subchapter F [L] of this title (relating to Mental Health Rehabilitative Services).
(b) Immediate screening and assessment.
(1) Screening and assessment. All providers of crisis services must be available 24 hours a day, every day of the year, to perform immediate screenings and assessments of individuals in crisis, including assessments to determine risk of deterioration and immediate danger to self or others. Crisis assessments cannot be delegated to law enforcement officials.
(2) QMHP-CS assessment. Individuals experiencing a crisis, as determined by a QMHP-CS screening, must be assessed face-to-face or via telemedicine by someone who is at least credentialed as a QMHP-CS within one hour after the individual presents to the provider in a crisis, either via the crisis hotline or a face-to-face encounter [(e.g., walk-in)]. The QMHP-CS must provide ongoing crisis services until the crisis is resolved or the individual is placed in a clinically appropriate environment.
(c) LPHA consultation. An LPHA must always be available for consultation with the QMHP-CS.
(d) Physician assessment. If the individual requires emergency care services, as determined by the QMHP-CS's assessment of risk of deterioration and danger as described in subsection (b) of this section, then the provider of crisis services must have a physician, preferably a psychiatrist, perform a face-to-face or telemedicine assessment of the individual as soon as possible, but not later than 12 hours after the QMHP-CS's assessment to determine the need for emergency services.
(e) Documenting crisis services. The provider of crisis services must maintain documentation of the crisis services, including:
(1) the date the service was provided;
(2) the beginning and end time of the crisis contact;
(3) the individual's name and any other identifiable health [identifying] information, as defined by HIPAA [of the individual to whom the service was provided (if given)];
(4) the location where the service was provided;
(5) the behavioral description of the presenting problem , including: [;]
(A) [(6)] lethality, such as suicide or violence[(e.g., suicide, violence)];
(B) [(7)] substance use [or abuse]; and
(C) [(8)] trauma, abuse, or neglect;
(6) [(9)] the outcome of the crisis [(e.g., individual in hospital, individual with friend and scheduled to see doctor at 9:00 a.m. the following day)];
(7) [(10)] the names and titles of staff members involved;
(8) [(11)] all actions, including rehabilitative interventions and referrals to other agencies, [ (including rehabilitative interventions and referrals to other agencies)] used by the provider to address the problems presented;
(9) [(12)] the response of the individual, and if appropriate, the response of the LAR and family members;
(10) [(13)] the signature of the staff member providing the service and a notation as to whether the staff member is an LPHA or a QMHP-CS;
(11) [(14)] any pertinent event or behavior relating to the individual's treatment which occurs during the provision of the service; and
(12) [(15)] follow up activities, which may include referral to another provider.
(f) Communication of crisis contacts. If an individual who is currently receiving mental health services has experienced a crisis and has been assessed in accordance with subsection (b) of this section, the provider of crisis services must communicate in writing [(e.g., e-mail or fax)] the details of the crisis contact to the provider of ongoing mental health services to ensure that the individual receives continuity of care and treatment and include such communication in the medical record. This crisis contact communication:
(1) may not disclose any substance use-related [ abuse-related] information unless disclosed in compliance with federal law as described in 42 CFR Part 2;
(2) must take place no later than the next business day after conclusion of the crisis contact; and
(3) may disclose mental health information for the purpose of continuity of care and treatment without the individual's consent if disclosure is made in accordance with:
(A) Texas Health and Safety Code[,] §533.009 (relating to Exchange of Patient and Client Records), when the provider of ongoing services is part of HHSC's [the department's ] service delivery system; or
(B) in accordance with Texas Health and Safety Code[, ] §611.004(a)(7) [(relating to the Authorized Disclosure of Confidential Information other than in Judicial or Administrative Proceeding)], when the provider of ongoing services is not part of HHSC's [the department's] service delivery system.
§301.353.
(a) Assessment and documentation. At the first routine face-to-face or telemedicine contact with an individual seeking routine care services, as described in §301.327(d)(2) [§412.314(d)(2) ] of this subchapter [title] (relating to Access to Community Mental Health [Community] Services[,]) a QMHP-CS with appropriate supervision and training must perform an assessment of the individual. The assessment must be documented and must include:
(1) the individual's identifiable health [ identifying] information, as defined by HIPAA;
(2) completion of the appropriate uniform assessment [ assessment(s)] and assessment guideline calculations;
(3) present status and relevant history, including education, employment, housing, legal, military, developmental, and current available social and support systems;
(4) co-occurring mental illness, emotional disturbance, substance use [abuse], chemical dependency, or developmental disorder;
(5) relevant past and current medical and psychiatric information, which may include trauma history;
(6) information from the individual and LAR, if applicable, [(if applicable)] regarding the individual's strengths, needs, natural supports, description of [describe ] community participation, responsiveness to previous treatment, as well as preferences for and objections to specific treatments;
(7) if the individual is an adult without an LAR, the needs and desire of the individual for family member involvement in treatment and community mental health [community] services;
(8) the identification of the LAR's or family members' need for education and support services related to the individual's mental illness or emotional disturbance and the plan to facilitate the LAR's or family members' receipt of the needed education and support services;
(9) recommendations and conclusions regarding treatment needs; and
(10) date, signature, and credentials of staff member completing the assessment.
(b) Diagnostics. The diagnosis of a mental illness must be:
(1) rendered by an LPHA, acting within the scope of his/her license, who has interviewed the individual, either face-to-face or via telemedicine;
(2) based on the DSM;
(3) documented in writing, including the date, signature, and credentials of the person making the diagnosis; and
(4) supported by and included in the assessment.
(c) Provision of services. The LMHA, LBHA [ MCO], and provider must require each provider to implement procedures to ensure that individuals are provided community mental health [community] services based on:
(1) HHSC's [the department's] uniform assessment and utilization management guidelines;
(2) medical necessity as determined by an LPHA; and
(3) health management needs as determined by a physician, PA [physician assistant], or RN [registered nurse].
(d) Prerequisites to provision of services.
(1) Routine care services. For routine care services, before providing community mental health [community] services to an individual, the provider must:
[(A) obtain authorization from the department or its designee for the type(s), amount, and duration of mental health community services to be provided to the individual in accordance with the appropriate uniform assessment and utilization management guidelines;]
(A) [(B)] obtain a determination of medical necessity from an LPHA; and
(B) [(C)] in collaboration with the individual and [their] LAR, if applicable[ (if applicable)], develop a treatment plan for the individual that includes a list of the types [type(s)] of community mental health [community] services [authorized in accordance with subparagraph (A) of this paragraph].
(2) Crisis services. For crisis services, as described in §301.351 [§412.321] of this subchapter [title] (relating to Crisis Services), a provider must deliver services in accordance with the utilization management guidelines and authorization of services and timeframes described in §301.335(c) [§412.318(c)] of this subchapter [title] (relating to Utilization Management). A diagnosis is not required when services are delivered in crisis situations.
(e) Treatment [Content and timeframe of treatment] plan. The [Each] provider must develop a written treatment plan, in consultation with the individual and their LAR, if applicable[(if applicable)], within 10 business days after the date of receipt of notification from HHSC [the department] or its designee that the individual is eligible and has been authorized for routine care services.
(1) A [At minimum, a] staff member with minimum credentialing [credentialed] as a QMHP-CS is responsible for completing and signing the treatment plan. The treatment plan must reflect input from each of the disciplines of treatment to be provided to the individual based upon the assessment. The treatment plan must include:
(A) a description of the presenting problem;
(B) a description of the individual's strengths;
(C) a description of the individual's needs arising from the mental illness or SED[serious emotional disturbance ];
(D) a description of the individual's co-occurring substance use or physical health disorder, if any;
(E) a description of the recovery goals and objectives based upon the assessment, and expected outcomes of the treatment in accordance with paragraph (2) of this subsection;
(F) the expected date by which the recovery goals will be achieved;
(G) a list of resources for recovery supports, such as community volunteer opportunities, family or peer organizations, 12-step programs, churches, colleges, or community education[(e.g., community volunteer opportunities, family or peer organizations, 12-step programs, churches, colleges, or community education)]; and
(H) a list of the types [type(s)] of services within each discipline of treatment that will be provided to the individual, such as psychosocial rehabilitation, medication services, substance use treatment, or supported employment [(e.g., psychosocial rehabilitation, medication services, substance abuse treatment, supported employment)], and for each type of service listed, provide:
(i) a description of the strategies to be implemented by staff members in providing the service and achieving goals;
(ii) the frequency, such as weekly, twice a month, or monthly [(e.g., weekly, twice a month, monthly)], number of units, such as 10 counseling sessions or two skills training sessions [(e.g., 10 counseling sessions, two skills training sessions)], and duration of each service to be provided , such as .5 hour or 1.5 hours [(e.g., .5 hour, 1.5 hours)]; and
(iii) the credentials of the staff member responsible for providing the service.
(2) The goals and objectives with expected outcomes required by paragraph (1)(E) of this subsection must:
(A) specifically address the individual's unique needs, preferences, experiences, and cultural background;
(B) specifically address the individual's co-occurring substance use or physical health disorder, if any;
(C) be expressed in terms of overt, observable actions of the individual;
(D) be objective and measurable using quantifiable criteria; and
(E) reflect the individual's self-direction, autonomy, and desired outcomes.
(3) The individual and LAR, if applicable, [ (if applicable)] must be provided a copy of the treatment plan and each subsequent treatment plan reviewed and revised.
(f) Review of treatment plan.
(1) Each provider must:
(A) review the individual's treatment plan prior to requesting an authorization for the continuation of services;
(B) review the treatment plan in its entirety, as permitted under confidentiality laws by considering input from the individual, the individual's LAR, if applicable[(if applicable)], and each of the disciplines of treatment;
(C) determine if the plan is adequately addressing the needs of the individual; and
(D) document progress on all goals and objectives and any recommendation for continuing services, any change from current services, and any discharge from services.
(2) In addition to the required review under paragraph (1) of this subsection, a provider may review the treatment plan in the following instances:
(A) if clinically indicated; and
(B) at the request of the individual or the LAR, if applicable [(if applicable)], or the primary caregiver of a child or adolescent.
(3) Any time the treatment plan is reviewed, the provider must:
(A) meet with the individual either face to face or via telemedicine to solicit and consider input from the individual regarding a self-assessment of progress toward the recovery goals, as described in subsection (e)(1)(E) of this section;
(B) solicit and consider the input from each of the disciplines of treatment in assessing the individual's progress toward the recovery goals and objectives with expected outcomes, described in subsection (e)(1)(E) of this section;
(C) solicit and consider input from the LAR, if applicable, [(if applicable)] or primary caregiver, if the individual is a child or adolescent regarding the level of satisfaction with the services provided; and
(D) document all the input described in subparagraphs (A) - (C) of this paragraph.
(g) Revisions to the treatment plan. If, after any review of the treatment plan, the provider determines it does not adequately address the needs of the individual, the provider must appropriately revise the content of the plan.
(h) Discharge Summary. Not later than 21 calendar days after an individual's discharge, whether planned or unplanned, the provider must document in the individual's medical record:
(1) a summary, based upon input from all the disciplines of treatment involved in the individual's treatment plan, of all the services provided, the individual's response to treatment, and any other relevant information;
(2) recommendations made to the individual or their LAR, if applicable, [(if applicable)] for follow up services, if any; and
(3) the individual's last diagnosis, based on the DSM.
§301.355.
(a) Prescribing of psychoactive medication. The LMHA and LBHA [MCO] must ensure that psychoactive medication is prescribed in accordance with Chapter 320 [ 415], Subchapter D [A] of this title (relating to Prescribing of Psychoactive Medication).
(b) Medication service delivery. The LMHA, LBHA [ MCO], and provider must implement written procedures to ensure safe medication-related service delivery that include[, but are not limited to,] the following.
(1) A procedure for physician delegation of medical acts to non-physicians. The procedure must address delegation protocols to APRNs or PAs [advanced practice nurses and/or physician assistants], delegation of medical acts to nursing or [ and/or] unlicensed staff members, and the frequency of physician supervision over the staff member to whom a delegation is made. The procedure must provide a method to ensure the staff members are acting within the scope of their license and are [is] qualified and trained to perform the medical act.
(2) A procedure for RNs to make assignments to LVNs or delegate to unlicensed staff members nursing acts for the care of stable individuals with common, well-defined health problems with predictable outcomes. The procedure must address the types of nursing acts that may be delegated, the method to ensure the staff member is trained and qualified to perform a delegated nursing act, and the frequency of nursing supervision of the unlicensed staff member in accordance with Texas Occupations Code[,] Chapter 301[(relating to the Nursing Practice Act)].
(3) A procedure for medication administration by licensed medical or nursing staff that addresses who may access and administer medications, timely administration, documentation of administration, and monitoring of administration, and that complies with applicable professional licensing standards and rules.
(4) A procedure for medication handling that addresses:
(A) dispensing;
(B) labeling and record keeping of sample medications;
(C) limiting access to physician stock medications;
(D) patient assistance or indigent [assistance/indigent ] medication program;
(E) mechanisms to ensure safe temperature-controlled storage and transport of medication;
(F) controlled substances [drugs];
(G) disposal or destruction [disposal/destruction ] of medication; and
(H) locked areas and maintaining security.
(5) A procedure by which a physician, a PA [ physician's assistant], or an RN assesses and determines whether an individual can self-administer medication and whether it can be done without supervision.
(6) A procedure for training and assessing the competency of staff members to perform supervision of self-administration of medication, including:
(A) medication actions;
(B) target symptoms;
(C) understanding prescription labels;
(D) potential toxicity;
(E) side effects;
(F) adverse reactions;
(G) proper storage of medications; and
(H) reporting and documentation requirements.
(7) A procedure for providing appropriate supervision of staff members who are supervising self-administration of medication.
(8) A procedure for medication errors that defines the most common types of medication errors and provides for:
(A) the accurate documentation of medication errors;
(B) the reporting of medication errors to the physician within one hour of their occurrence;
(C) a mechanism for determining medication error trends;
(D) a mechanism for analyzing both individual medication errors and trends for quality improvement; and
(E) the reporting of medication errors, as appropriate.
§301.357.Community] Services for Children and Adolescents.
(a) Administration of the uniform assessment. In accordance with HHSC's utilization management guidelines, the [ The] uniform assessment must be administered face-to-face or via telemedicine with the individual and the LAR, if applicable, [ (if applicable)] or primary caregiver as clinically appropriate according to the child's or adolescent's age, functioning, and current living situation.
(b) Age and developmentally appropriate community mental health [community] services. All community mental health [community] services delivered to children and adolescents by a provider must be, for each child and adolescent, age-appropriate, developmentally appropriate, and consistent with academic development.
(c) Separation of individuals by age. A provider that delivers community mental health [community] services to children and adolescents in group settings [(e.g., residential, day programs, group therapy, partial hospitalization, and inpatient)] must separate children and adolescents from adults. The provider must further separate children from adolescents according to age and developmental needs, unless there is a clinical or developmental justification in the medical record.
(d) Transition to community mental health [community] services for adults. The provider must develop a transition plan for each adolescent who will need community mental health [community] services as [for] adults. The transition plan must be developed in consultation with the adolescent and the LAR, if applicable, [(and LAR if applicable)] and future providers with adequate time to allow both current and future providers to transition the adolescent into adult services without a disruption in services. [The transition plan must include:]
[(1) a summary of the mental health community services and treatment the adolescent received as a child and adolescent;]
[(2) the adolescent's current status (e.g., diagnosis, medications, uniform assessment guideline calculation, and unmet needs);]
[(3) information from the adolescent and the LAR regarding the adolescent's strengths, preferences for mental health community services, and responsiveness to past interventions;]
[(4) a description of the mental health community services the adolescent will receive as an adult;]
[(5) a list of resources for other recovery supports such as volunteer opportunities, family or peer organizations, 12-step programs, churches, colleges, or community education;]
[(6) documentation that the adolescent's services continued throughout the transition without disruptions; and]
[(7) documentation of the follow up to ensure successful transition to adult services.]
§301.359.
The LMHA, LBHA [MCO], and provider must ensure that if a provider uses telemedicine, it is implemented in accordance with written procedures and using a protocol approved by the LMHA's or LBHA's [MCO's] medical director. Procedures regarding the provision of telemedicine service must include the following requirements:
(1) clinical oversight by the LMHA's or LBHA's [MCO's] medical director or designated physician responsible for medical leadership;
(2) contraindications for telemedicine use;
(3) qualified people at the remote site to ensure the safety of the individual being served by telemedicine [at the remote site]; and
(4) use by credentialed or licensed providers who provide clinical care within the scope of the provider's [their ] credential or license.
§301.361.
(a) Progress note content. Except for crisis services as described in §301.351 [§412.321] of this subchapter [title] (relating to Crisis Services) and day programs for acute needs as described in Chapter 306 [419], Subchapter F [L] of this title (relating to Mental Health Rehabilitative Services), and case management services as described in Chapter 306 [412 ], Subchapter E [I] of this title (relating to Mental Health Case Management Services), a provider must document the provision of all other community mental health [community ] services, each service encounter and include at least the following:
(1) the name of the individual to whom the service was provided, including the LAR or primary caregiver, if applicable;
(2) the type of service provided;
(3) the date the service was provided;
(4) the begin and end time of the service;
(5) the location where the service was provided;
(6) a summary of the activities that occurred;
(7) the modality of the service provision, such as individual or group [(e.g., individual, group)];
(8) the method of service provision, such as face-to-face, phone, or telemedicine [(e.g., face-to-face, phone, telemedicine) ];
(9) the training methods used, if applicable, such as instructions, modeling, role play, feedback, or repetition [ (e.g., instructions, modeling, role play, feedback, repetition)];
(10) the title of the curriculum being used, if applicable;
(11) the treatment plan objectives [objective(s) ] that were [was] the focus of the service;
(12) the progress or lack of progress in achieving treatment plan goals;
(13) the signature of the staff member providing the service and a notation as to whether the staff member is an LPHA, a QMHP-CS, a pharmacist, a CSSP, an LVN, a peer specialist [ provider] or otherwise credentialed, as required for that service; and
(14) any pertinent event or behavior relating to the individual's treatment which occurs during the provision of the service.
(b) Frequency of documentation. The documentation required in subsection (a) of this section must be made within two business days after each contact that occurs to provide community mental health [community] services.
(c) Retention. Documentation must be retained in compliance with applicable federal and state laws, rules, and regulations.
§301.363.
The LMHA, LBHA, and provider must follow the supervision requirements in 1 TAC §353.1419 (relating to Supervision Requirements).
[(a) Clinical supervision. Clinical supervision must be accomplished by an LPHA or a QMHP-CS as follows:]
[(1) by conducting a documented meeting with the staff member being supervised at least monthly; and]
[(2) for peer providers, by conducting an additional monthly documented observation of the peer provider providing mental health community services.]
[(b) Policies and procedures. The LMHA or MCO will develop and implement written policies and procedures for supervision of all applicable levels of staff members providing services to individuals.]
[(c) Licensed staff member supervision. All licensed staff members must be supervised in accordance with their practice act and applicable rules.]
[(d) QMHP-CS supervision. A QMHP-CS's designated clinical duties must be clinically supervised by:]
[(1) a QMHP-CS; or]
[(2) an LPHA if the QMHP-CS is clinically supervising the provision of mental health community services.]
[(e) CSSP supervision. A CSSP's designated clinical duties must be clinically supervised by a QMHP-CS. The CSSP must have access to clinical consultation with an LPHA when necessary.]
[(f) Family partner supervision. A family partner is supervised by the mental health children's director, clinic director, case management supervisor, or wraparound supervisor.]
[(g) Peer provider supervision. A peer provider's designated clinical duties must be clinically supervised by an LPHA.]
[(h) Peer review. The LMHA, MCO, and provider must implement a peer review process for licensed staff members that:]
[(1) promotes sound clinical practice;]
[(2) promotes professional growth; and]
[(3) complies with applicable state laws (e.g., Medical Practice Act, Nursing Practice Act, Vocational Nurse Act) and rules.]
[(i) Documentation. All clinical supervision must be documented.]
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 July 14, 2025.
TRD-202502496
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (737) 704-9063
CHAPTER 559. DAY ACTIVITY AND HEALTH SERVICES REQUIREMENTS
SUBCHAPTER H.
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§559.201, 559.203, 559.205, 559.215, 559.225, 559.227, 559.241, and 559.243; new §§559.226, 559.228, 559.253, 559.255, and 559.257; and the repeal of §559.239.
BACKGROUND AND PURPOSE
The purpose of the proposal is to integrate heightened health and safety standards--specifically addressing environmental safety concerns--bolster the rights of individuals receiving individualized skills and socialization services and implement Texas Health and Safety Code §253.0025 (established by House Bill 1009, 88th Legislature, Regular Session, 2023) regarding suspension of employees during due process for reportable conduct. The proposal also establishes alternative pathways to address infractions through administrative penalties, thereby offering providers remedial options beyond license revocation.
The proposal further seeks to clarify existing requirements governing the prevention and investigation of abuse, neglect, or exploitation and to delineate provider requirements and criteria for license issuance or renewal. Additionally, non-substantive grammatical revisions are intended to enhance clarity and coherence within the regulatory framework.
The proposal ensures the efficacy and integrity of environmental safety and the rights of individuals receiving services, establishes administrative penalties services provided under Texas Administrative Code, Title 26, Chapter 559, Subchapter H, and upholds the importance of individual welfare and regulatory compliance.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §559.201, Purpose, incorporates information regarding additional health and safety requirements.
The proposed amendment to §559.203, Definitions, adds definitions for "abuse," "actual harm," "applicant," "cause to believe," "Centers for Medicare and Medicaid Services (CMS)," "exploitation," "immediate threat," "incident," "isolated," "neglect," "pattern," "substantial violation," "widespread," and edits existing definitions for clarity and understanding. It also relocates and revises the definition of "complaint" from §559.243.
The proposed amendment to §559.205, Criteria for Licensing, updates a reference and reflects changes specific to licensing processes regarding HHSC reviewing background and qualifications and issuing temporary licenses for Day Activity and Health Services Individualized Skills and Socialization Only licensure applications.
The proposed amendment to §559.215, Criteria for Denying a License or Renewal of a License, corrects references and revises language to provide clarity and ensure providers are aware of the requirement to disclose all actions to HHSC, whether pending or final.
The proposed amendment to §559.225, General Requirements, makes non-substantive grammatical changes, relocates rule language pertaining to individual rights under proposed new §559.228, adds language necessary to satisfy Texas Health and Safety Code §253.0025 requirements regarding reportable conduct, and outlines individual information documentation requirements.
Proposed new §559.226, Environmental Safety Requirements, describes standards for the physical condition of the location where on-site individualized skills and socialization services are provided, including cleanliness, safety, accessibility, utilities, and maintenance of both interior and exterior areas to ensure the well-being of individuals receiving services.
The proposed amendment to §559.227, Program Requirements, clarifies which requirements providers must follow when providing transportation and determining appropriate settings for service delivery. It also requires an individualized skills and socialization provider to provide services that meet an individual's needs and person-centered objectives, including by following steps for when a modification or restriction of services is needed. It further provides ongoing training parameters to address timeframes and frequency of trainings. Additionally, the amendment clarifies medication record requirements.
Proposed new §559.228, Rights of Individuals, describes the rights of individuals receiving services from individualized skills and socialization providers. It sets forth individualized skills and socialization provider requirements concerning the protection of individuals' rights, including those related to informed decision-making and the filing of grievances. It further requires the development and implementation of policies and procedures to address individuals' service plans; right to live free from abuse, neglect, and exploitation; receive services in a safe and clean environment; enjoy privacy during treatment and care for personal needs; and participate in activities.
The proposed repeal of §559.239, Definitions of Abuse, Neglect, and Exploitation, removes a rule section that is no longer needed, as these definitions have been added to §559.203.
The proposed amendment to §559.241, Reporting Abuse, Neglect, Exploitation, or Incidents to HHSC, revises the title to Reporting Abuse, Neglect, or Exploitation to HHSC. The amendment clarifies reporting requirements for abuse, neglect, or exploitation to HHSC and the requirement to report the death of an individual when the death occurs while the individual is receiving services from an individualized skills and socialization provider. It further establishes language prohibiting retaliation against an individual, legally authorized representative, or service provider for filing a complaint or presenting a grievance or for providing, in good faith, information to HHSC relating to abuse, neglect, or exploitation.
The proposed amendment to §559.243, HHSC Complaint Investigation, removes language regarding reporting Abuse, Neglect, Exploitations, or Incidents to HHSC Complaint and Incident Intake, as this language is included in revised §559.241, as well as language regarding certain internal practices of HHSC. It also deletes the definition of "complaint," as it is now located in §559.203, Definitions, and renumbers the subsections accordingly.
Proposed new §559.253, Administrative Penalties, describes the circumstances in which HHSC may impose administrative penalties on an individualized skills and socialization provider and the HHSC procedure for administrative penalties. It also describes how penalties may be applied for various violations, with factors such as severity and corrective efforts considered, and provides that administrative penalties do not preclude other disciplinary actions for the same violation.
Proposed new §559.255, Individualized Skills and Socialization Provider Compliance and Corrective Action, describes procedures an individualized skills and socialization provider must adhere to in order to maintain compliance with regulations and address corrective measures under the oversight of HHSC. It describes the processes involving follow-up surveys, notices of non-compliance, corrective plans, monitoring, and potential penalties or license actions imposed by HHSC for violations.
Proposed new §559.257, Administrative Hearings, describes the process for administrative hearings regarding administrative penalties imposed on individualized skills and socialization providers. It describes hearing procedures, findings by administrative law judges, penalty assessments or dismissals by the executive commissioner, payment requirements, and interest accrual on unpaid penalties.
FISCAL NOTE
Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, there may be an increase in revenue to state government as a result of enforcing and administering the rules as proposed.
HHSC is unable to determine the increase in state revenue because any assessed administrative penalties collected are dependent on each individualized skills and socialization provider's compliance with regulatory requirements.
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 require an increase in fees paid to the agency;
(5) the proposed rules will create new regulations;
(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) HHS system has insufficient information to determine the effect of the proposed rules on the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Trey Wood has also determined there could be an adverse economic effect on small businesses or micro-businesses, or rural communities.
HHSC estimates that the number of small businesses, micro-businesses, and rural communities subject to the proposed rules is over 900. This is the number of providers licensed to provide individualized skills and socialization services. While an individualized skills and socialization provider's noncompliance with the proposed regulations may result in administrative penalties, HHSC does not have sufficient data to estimate the cost to those businesses. The penalties range from $0 to $500 for initial or repeat non-substantial violations, and $250 to $800 for initial or repeat substantial violations. It is also unknown how many administrative penalties will be collected by HHSC.
HHSC determined that alternative methods to achieve the purpose of the proposed rules for small businesses, micro-businesses, or rural communities would not be consistent with ensuring the health and safety of individuals receiving individualized skills and socialization services.
LOCAL EMPLOYMENT IMPACT
The proposed rules will not affect the local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.
PUBLIC BENEFIT AND COSTS
Stephen Pahl, Deputy Executive Commissioner for Regulatory Services, has determined that for each year of the first five years the rules are in effect implementation of these amendments, new sections, and repeal the public benefits will be enhanced oversight of day activity and community integration services for individuals with intellectual disabilities. The rules are anticipated to foster greater foresight and precautionary measures, thereby bolstering the protection of individual health, safety, and welfare. The public will benefit from the introduction of clearly defined terms and the inclusion of provisions pertaining to administrative penalties, which may serve as an incentive for providers to adhere to the regulations outlined in this chapter.
Trey Wood has also determined that for the first five years the rules are in effect, licensed individualized skills and socialization providers may incur costs related to compliance, should they be assessed administrative penalties.
TAKINGS IMPACT ASSESSMENT
HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751, or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.
To be considered, comments must be submitted no later than 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 24R021" in the subject line.
DIVISION 1. INTRODUCTION
26 TAC §559.201, §559.203STATUTORY AUTHORITY
The amendments are authorized by Texas Government Code §531.0055, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and §531.033, which provides the executive commissioner of HHSC with broad rule-making authority; and Texas Human Resources Code §32.021, which provides that HHSC adopt rules necessary for the proper and efficient operation of the Medicaid program; and §103.004, which requires the executive commissioner of HHSC to adopt rules and set standards implementing Chapter 103.
The amendments implement Texas Government Code §§531.0055, 531.021, and 531.033, and Texas Human Resources Code §§32.021, 103.004, and 103.005.
§559.201.
(a) The purpose of this subchapter is to:
(1) establish licensing procedures, standards, and requirements for an individualized skills and socialization provider licensed as a Day Activity and Health Services (DAHS) facility in accordance with Texas Human Resources Code Chapter 103; and
(2) establish health and safety requirements for a provider licensed by the Texas Health and Human Services Commission to deliver individualized skills and socialization services, including:
(A) environmental safety;
(B) prevention and investigation of abuse, neglect, or exploitation; and
(C) general and program provider requirements.
(b) This subchapter applies to an individualized skills and socialization provider and the provision of on-site and off-site individualized skills and socialization services.
(c) This subchapter does not apply to:
(1) a DAHS facility providing services in the DAHS program; or
(2) the provision of in-home individualized skills and socialization in the Home and Community-based Services and Texas Home Living waiver programs.
§559.203.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Abuse--Intentional or negligent act that results in physical or emotional harm or pain to an individual by an individualized skills and socialization provider or an employee, a contractor, or a volunteer of an individualized skills and socialization provider, including;
(A) injury;
(B) confinement;
(C) intimidation;
(D) cruel punishment; or
(E) sexual abuse, including:
(i) any sexual conduct conducted by a direct provider of individualized skills and socialization services that would constitute an offense under Penal Code §21.08 (relating to Indecent Exposure); or
(ii) any sexual conduct conducted by a direct provider of individualized skills and socialization services that would constitute an offense under Penal Code, Chapter 22 (relating to Assaultive Offenses), committed by a direct provider of individualized skills and socialization services.
(2) Actual harm--A negative outcome that compromises the physical, emotional, or mental well-being of any individual receiving services from the individualized skills and socialization provider.
(3) Applicant--A person or entity seeking licensing through the Texas Health and Human Services Commission (HHSC) to provide individualized skills and socialization services.
(4) Cause to believe--An individualized skills and socialization provider knows, suspects, or receives an allegation regarding abuse, neglect, or exploitation.
(5) Centers for Medicare and Medicaid Services (CMS)--The federal agency within the United States Department of Health and Human Services (HHS) that administers Medicare and Medicaid programs.
(6) [(1)] Change of ownership--An event that results in a change to the federal taxpayer identification number of the license holder [of a facility]. The substitution of a personal representative for a deceased license holder is not a change of ownership.
(7) [(2)] Community setting--A setting accessible to the general public within an individual's community.
(8) Complaint--Any allegation received by HHSC regarding abuse, neglect, or exploitation of an individual or a violation of Texas Human Resources Code Chapter 103 or a rule, standard, or order adopted under Texas Human Resources Code Chapter 103.
(9) [(3)] Day Activity and Health Services (DAHS) directory--A public list generated and maintained by [the] HHSC, listing all DAHS providers, including individualized skills and socialization providers.
(10) [(4)] Deaf Blind with Multiple Disabilities (DBMD) program--A waiver program operated by HHSC, as authorized by CMS [the Centers for Medicare & Medicaid Services (CMS)] in accordance with §1915(c) of the Social Security Act.
(11) Exploitation--An illegal or improper act or process of using resources belonging to an individual receiving services by an individualized skills and socialization provider or an employee, a contractor, or a volunteer of an individualized skills and socialization provider without informed consent from the individual or the individual's legally authorized representative (LAR) for personal or monetary benefit.
(12) [(5)] Home and Community-based Services (HCS) program--A waiver program operated by HHSC as authorized by CMS in accordance with §1915(c) of the Social Security Act.
(13) Immediate threat--A situation that causes, or is likely to cause, injury, harm, impairment, or death of an individual.
(14) [(6)] Implementation plan--In the HCS and TxHmL programs, a written document developed by a program provider outlining the outcomes, [and] objectives, frequency, and duration for each program service on the individual's IPC to be provided by the program provider.
(15) Incident--Any non-routine occurrence that has an impact on the care, supervision, or treatment of an individual receiving services, as described in accordance with HHSC guidance.
(16) [(7)] Individual--A person who applies for or is receiving services from an individualized skills and socialization provider.
(17) [(8)] Individual plan of care (IPC)--A written plan authorized by HHSC that states the type and amount of each DBMD, TxHmL, or HCS program service to be provided to the individual during an IPC year.
(18) [(9)] Individual program plan (IPP)--In the DBMD program, a written plan documented on an HHSC form and completed by an individual's case manager that describes the goals and outcomes for each DBMD program service and Community First Choice (CFC) service, other than CFC support management, included on the individual's IPC.
(19) [(10)] Individualized skills and socialization--A DBMD, TxHmL, or HCS program service described in §260.503 of this title (relating to Description of Individualized Skills and Socialization), §262.905 of this title (relating to Description of On-Site and Off-Site Individualized Skills and Socialization), or §263.2005 of this title (relating to Description of On-Site and Off-Site Individualized Skills and Socialization). The two types of individualized skills and socialization are on-site individualized skills and socialization and off-site individualized skills and socialization.
(20) [(11)] Individualized skills and socialization provider--A provider licensed as a DAHS provider by HHSC to provide individualized skills and socialization services. A provider of individualized skills and socialization services is considered an individualized skills and socialization provider once licensed.
(21) [(12)] In person or in-person--Within the physical presence of another person who is awake. In person or in-person does not include using videoconferencing or a telephone.
(22) Isolated--Describing a violation of Texas Human Resources Code Chapter 103 or a rule, standard, or order adopted under Texas Human Resources Code Chapter 103 by an individualized skills and socialization provider that affects a very limited number of individuals receiving services and that:
(A) involves a very limited number of service providers; or
(B) has only occurred occasionally.
(23) [(13)] Legally authorized representative (LAR)--A person authorized by law to act on behalf of another person regarding [with regard to] a matter described in this subchapter, including a parent, guardian, or managing conservator of a minor; a guardian of an adult; an agent appointed under a power of attorney; or a representative payee appointed by the Social Security Administration. An LAR, such as an agent appointed under a power of attorney or representative payee appointed by the Social Security Administration, may have limited authority to act on behalf of a person.
(24) [(14)] License holder--A person who holds a license as an individualized skills and socialization provider.
(25) Neglect--Failure to provide an individual receiving services with identified health and safety services necessary to avoid infliction of injury, physical or emotional harm, or pain to an individual receiving services by an individualized skills and socialization provider or an employee, contractor, or volunteer of an individualized skills and socialization provider. This includes failure to:
(A) provide services in accordance with an individual's IPC, IPP, PDP, and implementation plan, resulting in infliction of injury, physical or emotional harm, or pain; and
(B) establish effective health and safety precautions to ensure an individual is protected from infliction of injury, physical or emotional harm, or pain.
(26) [(15)] Off-site individualized skills and socialization only--An individualized skills and socialization service provider who only delivers off-site individualized skills and socialization services and does not deliver on-site individualized skills and socialization services.
(27) [(16)] On-site individualized skills and socialization location--The building or a portion of a building that is owned or leased by an individualized skills and socialization provider where on-site individualized skills and socialization service is provided.
(28) [(17)] Online licensure portal--The Texas Unified Licensure Information Portal (TULIP) system. TULIP is the online system for submitting long-term care licensure applications.
(29) Pattern--Describing repeated, but not widespread in scope, violations of Texas Human Resources Code Chapter 103 or a rule, standard, or order adopted under Texas Human Resources Code Chapter 103 by an individualized skills and socialization provider that:
(A) is found throughout the services provided by the individualized skills and socialization provider; or
(B) affects or involves one or more of the same individuals receiving services, or one or more of the same service providers.
(30) [(18)] Person-directed plan (PDP)--In the HCS and the TxHmL programs, a written plan, based on person-directed planning and developed with an applicant or individual using the HHSC person-directed plan form and discovery tool found on the HHSC website, that:
(A) describes the supports and services necessary to achieve the desired outcomes identified by the applicant, individual, or LAR and ensures the applicant's or individual's health and safety; and
(B) includes the setting for each service, which is selected by the individual or LAR from setting options.
(31) [(19)] Program provider--A person, as defined in §52.3 of this title [Texas Administrative Code Title 40, §49.102] (relating to Definitions), who has a contract with HHSC to provide DBMD, TxHmL, or HCS program services, excluding a financial management services agency.
(32) [(20)] Service provider--A person, who may be an employee, contractor, or volunteer of an individualized skills and socialization provider, who directly provides individualized skills and socialization services to an individual.
(33) Substantial violation--A violation for which HHSC may assess an administrative penalty before giving an individualized skills and socialization provider an opportunity to correct the violation. A substantial violation is a violation that HHSC determines:
(A) represents a pattern of violation that results in actual harm;
(B) is widespread in scope and results in actual harm;
(C) is widespread in scope, constitutes a potential for actual harm, and relates to:
(i) staffing, including staff training, ratio, and health under §559.227 of this subchapter (relating to Program Requirements);
(ii) administration of medication under §559.227(m) of this subchapter; or
(iii) emergency preparedness and response under §559.229 of this subchapter (relating to Environment and Emergency Response Plan);
(D) constitutes an immediate threat to the health or safety of an individual receiving services;
(E) substantially limits the providers ability to meet identified health and safety needs of an individual;
(F) a violation described by §559.253(a)(2) - (7) of this subchapter (relating to Administrative Penalties);
(G) a violation of Texas Human Resources Code §103.011; or
(H) a second or subsequent violation of Texas Health and Safety Code §326.002, that occurs before the second anniversary of the date of the first violation.
(34) [(21)] Texas Home Living (TxHmL) program--A waiver program operated by HHSC and approved by CMS in accordance with §1915(c) of the Social Security Act.
(35) Widespread--Describing a violation of Texas Human Resources Code Chapter 103 or a rule, standard, or order adopted under Texas Human Resources Code Chapter 103 by an individualized skills and socialization provider that:
(A) is pervasive throughout the services delivered by the individualized skills and socialization provider; or
(B) represents a systematic failure by the individualized skills and socialization provider that affects or has the potential to affect a large portion of or all individuals receiving services from the individualized skills and socialization provider.
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 July 3, 2025.
TRD-202502246
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (512) 438-3161
DIVISION 2. LICENSING
26 TAC §559.205, §559.215STATUTORY AUTHORITY
The amendments are authorized by Texas Government Code §531.0055, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and §531.033, which provides the executive commissioner of HHSC with broad rule-making authority; and Texas Human Resources Code §32.021, which provides that HHSC adopt rules necessary for the proper and efficient operation of the Medicaid program; and §103.004, which requires the executive commissioner of HHSC to adopt rules and set standards implementing Chapter 103.
The amendments implement Texas Government Code §§531.0055, 531.021, and 531.033, and Texas Human Resources Code §§32.021, 103.004, and 103.005.
§559.205.
(a) An entity may not establish or provide individualized skills and socialization services in Texas without a license issued by the Texas Health and Human Services Commission (HHSC) in accordance with Texas Human Resources Code, Chapter 103, and this subchapter.
(b) An individualized skills and socialization provider must be listed on the HHSC [HHSC's] Day Activity and Health Services (DAHS) directory as an individualized skills and socialization provider [in order] to provide individualized skills and socialization services.
(c) An applicant for a license must follow the application instructions and submit a completed application form, required documentation, and [submit a complete application form, follow the application instructions, electronically upload required documentation, and submit the] required license fee to HHSC through the online licensure portal.
(d) An applicant for a license must complete [the] HHSC required training to become an individualized skills and socialization provider and provide documentation that required training is complete through the application in the online licensure portal.
(e) An applicant for a license must submit to HHSC as part of the application the:
(1) name of the business entity to be licensed;
(2) tax identification number;
(3) name of the chief executive officer (CEO) or equivalent person;
(4) ownership information;
(5) address of the on-site individualized skills and socialization location or, for providers of off-site individualized skills and socialization services only, the designated place of business where records are kept;
(6) name of program providers using this entity for individualized skills and socialization services, if any;
(7) maximum number of individuals who can receive services [individualized skills and socialization] at or from this location, which will become the licensed capacity when approved;
(8) effective date the entity will be available to provide individualized skills and socialization services;
(9) attestation that the applicant has created and implemented a community engagement plan, including:
(A) a description of how the organization will meet the requirement to make off-site individualized skills and socialization available to individuals;
(B) a description of how the organization will work with contracted program providers to obtain information from the individuals' person-directed plans (PDP) and implementation plan, and use that information to inform on-site and off-site activities that are aligned with an individual's PDP; and
(C) a description of how staff will respond to an emergency or other unexpected circumstance that may occur during the provision of on-site and off-site individualized skills and socialization services to ensure the health and safety of all individuals; and
(10) any other information required by the online application instructions.
(f) HHSC may deny an application that remains incomplete after 120 days.
(g) Before issuing a license, HHSC considers the background and qualifications of:
(1) the applicant or license holder;
(2) a person with a disclosable interest;
(3) an affiliate of the applicant or license holder;
(4) an administrator;
(5) a manager; and
(6) any other person disclosed on the submitted application as defined by the application instructions.
(h) If the location where an applicant intends to provide on-site or off-site individualized skills and socialization services [applicant] is located within, on the grounds of, or physically adjacent to a prohibited setting as set forth in the rules governing the Home and Community-based Services (HCBS) waiver programs, as described in §263.2005(d) of this title (relating to Description of On-Site and Off-Site Individualized Skills and Socialization), [HCS Program] and the applicant has not been approved through heightened scrutiny process as described in §263.2005(e) of this title, HHSC will refer the application for enforcement.
(i) HHSC issues a license if it finds that the applicant or license holder, and all persons described in subsection (g) of this section, affirmatively demonstrate compliance with all applicable requirements of this subchapter, based on an on-site survey. [ An applicant for a license must affirmatively demonstrate that the applicant meets the requirements for operation based on an on-site survey. However, through the end of HHSC fiscal year 2023, at its sole discretion, HHSC may issue a temporary initial license effective for 180 days which may be extended until such time as an applicant demonstrates that it meets the requirements for operation based on this on-site survey.]
(j) For DAHS Individualized Skills and Socialization Only licensure applications, HHSC may:
(1) at its sole discretion, issue a temporary initial license effective for 180 days, which may be extended until such time as an applicant demonstrates that it meets the requirements for operation based on an on-site survey; and
(2) issue a three-year license to applicants described under this subsection.
[(j) [HHSC issues a license if it finds that the applicant or license holder, all persons described in subsection (h) of this section, and the provider meet all applicable requirements of this subchapter, and the on-site individualized skills and socialization location, if applicable, meets all requirements of this subchapter.]
(k) For DAHS with Individualized Skills and Socialization licensure applications, HHSC will follow the criteria for licensure as described in §559.11 of this chapter (related to Criteria for Licensing).
[(k) HHSC will implement a system under which licenses issued under this subchapter expire on staggered dates. Through the end of HHSC fiscal year 2023, applicants may receive:]
[(1) a one-year license;]
[(2) a two-year license;]
[(3) a three-year license.]
(l) An individualized skills and socialization provider must not provide services to more individuals than the number of individuals specified on its license.
(m) An individualized skills and socialization provider must prominently and conspicuously post its license for display in a public area of the on-site individualized skills and socialization location that is readily accessible to individuals, employees, and visitors. For an off-site only individualized skills and socialization provider, the license must be displayed in a conspicuous place in the designated place of business.
(n) If any information submitted through the application process changes following licensure, the license holder must submit an application through the online licensure portal to make the changes.
§559.215.
(a) The Texas Health and Human Services Commission (HHSC) may deny an initial license or renewal of a license if any person described in §559.205(g) of this division [§559.205(h) of this subchapter] (relating to Criteria for Licensing):
(1) is subject to denial or refusal as described in Chapter 560 of this title (relating to Denial or Refusal of License) during the time frames described in that chapter;
(2) substantially fails to comply with the requirements described in §559.225 of this subchapter (relating to General Requirements) and §559.227 of this subchapter (relating to Program Requirements), including:
(A) noncompliance that poses a serious threat to health and safety; or
(B) a failure to maintain compliance on a continuous basis;
(3) aids, abets, or permits a substantial violation described in paragraph (2) of this subsection about which the person had or should have had knowledge;
(4) fails to provide the required information, facts, or references;
(5) knowingly provides the following false or fraudulent information:
(A) submits false or intentionally misleading statements to HHSC;
(B) uses subterfuge or other evasive means of filing;
(C) engages in subterfuge or other evasive means of filing on behalf of another who is unqualified for licensure;
(D) knowingly conceals a material fact; or
(E) is responsible for fraud;
(6) fails to pay the following fees, taxes, and assessments when due:
(A) licensing fees as described in §559.219 of this division [subchapter] (relating to License Fees); and
(B) franchise taxes, if applicable; or
(7) has a history of any of the following actions during the five-year period preceding the date of the application:
(A) operation of a facility that has been decertified or had its contract canceled under the Medicare or Medicaid program in any state;
(B) federal or state Medicare or Medicaid sanctions or penalties;
(C) unsatisfied final judgments;
(D) eviction involving any property or space used as a facility in any state; or
(E) suspension of a license to operate a health facility, long-term care facility, or a similar facility in any state.
(b) Concerning subsection (a)(7) of this section, HHSC may consider exculpatory information provided by any person described in §559.205(g) of this division [§559.205(h) of this subchapter] and grant a license if HHSC finds that person able to comply with the rules in this chapter.
(c) HHSC does not issue a license to an applicant if the applicant has a history of any of the following actions during the five-year period preceding the date of the application:
(1) revocation of a license to operate a health care facility, long-term care facility, or similar facility in any state;
(2) debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state; or
(3) a court order [injunction] prohibiting any person described in §559.205(g) of this division [§559.205(h) of this subchapter] from operating a facility.
(d) HHSC considers only [Only] final actions are considered for purposes of subsections (a)(7) and (c) of this section. An action is final when routine administrative and judicial remedies are exhausted. However, a provider must disclose all [All] actions to HHSC, whether pending or final[, must be disclosed].
(e) If an applicant owns multiple facilities, HHSC examines the overall record of compliance for [in] all facilities [will be examined]. An overall record poor enough to deny issuance of a new license will not preclude the renewal of licenses of individual facilities with satisfactory records.
(f) If HHSC denies a license or refuses to issue a renewal of a license, the applicant or license holder may request a hearing by following HHSC [HHSC's] rules in Texas Administrative Code (TAC), Title 1, [TAC] Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act). An administrative hearing is conducted in accordance with Texas Government Code, Chapter 2001, and 1 TAC Chapter 357, Subchapter I.
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 July 3, 2025.
TRD-202502247
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (512) 438-3161
DIVISION 3. PROVIDER REQUIREMENTS
26 TAC §§559.225 - 559.228STATUTORY AUTHORITY
The amendments and new sections are authorized by Texas Government Code §531.0055, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and §531.033, which provides the executive commissioner of HHSC with broad rule-making authority; and Texas Human Resources Code §32.021, which provides that HHSC adopt rules necessary for the proper and efficient operation of the Medicaid program; and §103.004, which requires the executive commissioner of HHSC to adopt rules and set standards implementing Chapter 103.
The amendments and new sections implement Texas Government Code §§531.0055, 531.021, and 531.033, and Texas Human Resources Code §§32.021, 103.004, and 103.005.
§559.225.
(a) An individualized skills and socialization provider must:
(1) comply with the provisions of Texas Health and Safety Code (HSC), Chapter 250 (relating to Nurse Aide Registry and Criminal History Checks of Employees and Applicants for Employment in Certain Facilities Serving the Elderly, Persons with Disabilities, or Persons with Terminal Illnesses);
(2) before offering employment to any person, search the following registries to determine if the person is eligible for employment:
(A) the employee misconduct registry (EMR) established under HSC §253.007;
(B) the Texas Health and Human Services Commission (HHSC) nurse aide registry (NAR) and medication aide registry (MAR);
(C) the List of Excluded Individuals and Entities (USLEIE) maintained by the United States Department of Health and Human Services; and
(D) the List of Excluded Individuals and Entities (LEIE) maintained by HHSC Office of Inspector General;
(3) not employ a person who is listed on the:
(A) HHSC employee misconduct registry as unemployable; or
(B) HHSC nurse or medication aide registries as revoked or suspended; and
(4) provide information about the EMR to an employee in accordance with [26 TAC] §561.3 of this title (relating to Employment and Registry Information).
(b) In addition to the initial search of the EMR, LEIE, NAR, MAR, and USLEIE, an individualized skills and socialization provider must:
(1) conduct a search of the NAR, MAR, and EMR to determine if the employee is designated in those registries as unemployable at least every 12 months; [and]
(2) keep a copy of the results of the initial and annual searches of the NAR, MAR, and EMR in the employee's personnel file and make it available to HHSC upon request; and
(3) comply with all relevant federal and state standards . [; and]
[(4) comply with all applicable provisions of the Texas Human Resource Code (HRC), Chapter 102 (relating to Rights of the Elderly).]
[(c) An individualized skills and socialization provider must:]
[(1) provide an individual who is 55 years of age or older with a written list of the individual's rights, as outlined under HRC §102.004; and]
[(2) create policies and procedures that protect and promote the rights of the individual, including the individual's right to:]
[(A) control his or her schedule and activities related to on-site individualized skills and socialization;]
[(B) access his or her food at any time;]
[(C) receive visitors without prior notice to the individualized skills and socialization provider unless such rights are contraindicated by the individual's rights or the rights of other individuals; and]
[(D) physically access the building.]
(c) [(d)] An individualized skills and socialization provider must:
(1) report abuse, neglect, and exploitation [, and critical incidents] in accordance with §559.241 of this subchapter (relating to Reporting Abuse, Neglect, or Exploitation to HHSC [, or Critical Incidents]);
(2) suspend a service provider who HHSC finds has engaged in reportable conduct while the service provider exhausts any applicable appeals process, including informal and formal appeals and any hearing or judicial review, pending a final decision by an administrative law judge, and may not reinstate the service provider during any applicable appeals process;
(3) [(2)] develop and enforce [ create] policies and procedures for creating and maintaining incident reports; and
(4) [(3)] ensure the confidentiality of individual records and other information related to individuals.[ ; and]
[(4) inform the individual orally and in writing of the individual's rights, responsibilities, and grievance procedures in a language the individual understands.]
(d) [(e)] An individualized skills and socialization provider must prominently and conspicuously post for display in a public area of the on-site individualized skills and socialization location, or designated place of business for off-site only individualized skills and socialization, that is readily available to individuals, employees, and visitors:
(1) the license issued under this chapter;
(2) a sign prescribed by HHSC that describes complaint procedures and specifies how complaints may be filed with HHSC;
(3) a notice in the form prescribed by HHSC stating that survey and related reports are available at the on-site individualized skills and socialization location for public survey and providing the HHSC [HHSC's] toll-free telephone number that may be used to obtain information concerning the individualized skills and socialization provider;
(4) a copy of the most recent survey report relating to the individualized skills and socialization provider;
(5) a brochure, letter, or website that outlines the individualized skills and socialization provider's hours of operation, holidays, and a description of activities offered; and
(6) emergency telephone numbers, including the abuse hotline telephone number.
(e) In addition to the list of individuals served as described in §559.231(f)(3) of this subchapter (relating to Surveys and Visits), an individualized skills and socialization provider must also maintain an individual information document that includes:
(1) which individualized skills and socialization services are being delivered by the individualized skills and socialization provider;
(2) the individual's name, identification, or clinical record number; and
(3) the date the individual began receiving individualized skills and socialization services.
§559.226.
(a) An individualized skills and socialization provider must ensure the facility interior of the on-site location:
(1) has furnishings that are appropriately maintained and safe for use;
(2) is clean, sanitary, and free of odors that are considered disruptive, unpleasant, or potentially offensive;
(3) is free of infestation by bugs, rodents, and other pests;
(4) has walls, ceilings, floors, and windows that are structurally sound;
(5) is free of environmental contaminants, physical hazards, and accumulated waste or trash;
(6) has bathrooms that are accessible, functional, and safe for use;
(7) has hot water available for use by individuals receiving services that:
(A) is located at sinks in the facility that may be used by individuals receiving services; and
(B) does not exceed 120 degrees Fahrenheit;
(8) includes any major appliances necessary for maintaining the health and safety of individuals that are appropriately maintained and in working order;
(9) has a secure storage area for cleaning chemicals and supplies that is located separately from any storage area for food items;
(10) has cleaning chemicals:
(A) stored in their original containers; and
(B) used in accordance with directions and warnings on the product label;
(11) has a location where perishable food is either refrigerated or otherwise stored safely; and
(12) has working smoke alarms in all main areas that:
(A) are maintained in accordance with the manufacturer's instructions;
(B) emit a distinguishable audible response that can be heard throughout the facility including classrooms, common areas, and hallways; and
(C) are used solely for the purpose of alerting individuals and service providers of a fire.
(b) An individualized skills and socialization provider must ensure the facility interior of the on-site location is serviced by a functioning heating and cooling system. The provider must:
(1) ensure the availability of an alternate method of supplying heat and cooling that meets state, local, and federal guidelines in the event the system does not work or is in repair;
(2) ensure that heating and cooling temperature settings are appropriate for maintaining a safe environment for individuals; and
(3) consider the specific health and safety needs of individuals when determining the appropriate heating and cooling temperature settings.
(c) An individualized skills and socialization provider must ensure the facility exterior of the on-site location:
(1) is free of hazards and the accumulation of waste and trash;
(2) is accessible to individuals receiving services;
(3) does not compromise the health or safety of individuals; and
(4) if applicable, has exterior furnishings that are maintained appropriately and safe for use.
§559.227.
(a) Staff qualifications.
(1) An individualized skills and socialization provider must:
(A) employ an administrator;
(B) ensure the administrator meets the requirements outlined in paragraph (2) of this subsection; and
(C) have a policy regarding the delegation of responsibility in the administrator's absence.
(2) A service provider of individualized skills and socialization must be at least 18 years of age and:
(A) have a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma; or
(B) have documentation of a proficiency evaluation of experience and competence to perform the job tasks that includes:
(i) a written competency-based assessment of the ability to document service delivery and observations of the individuals receiving services; and
(ii) at least three written personal references from persons not related by blood that indicate the ability to provide a safe, healthy environment for the individuals receiving services.
(3) A service provider of individualized skills and socialization who provides transportation must:
(A) have a valid driver's license; and
(B) transport individuals in a vehicle that:
(i) is insured in accordance with state law; and
(ii) meets all state registration and safety requirements.
(b) Staffing. An individualized skills and socialization provider must ensure that:
(1) an individual whose needs cannot be met by the individualized skills and socialization provider is not admitted or retained;
(2) the ratio of service providers to individuals is maintained in accordance with §260.507 of this title (relating to Staffing Ratios), §262.917 of this title (relating to Staffing Ratios for Off-Site Individualized Skills and Socialization), and §263.2017 of this title (relating to Staffing Ratios for Off-Site Individualized Skills and Socialization), during the provision of off-site individualized skills and socialization, including during transportation; and
(3) sufficient staff are on duty at all times during the provision of on-site individualized skills and socialization to ensure:
(A) the health and safety of the individuals;
(B) supervision is provided in accordance with the needs of an individual; and
(C) individualized skills and socialization services or similar services are provided in accordance with an individual's individual plan of care (IPC), individual program plan (IPP), person-directed plan (PDP), and implementation plan, as applicable.
(c) Staff responsibilities.
(1) The administrator:
(A) manages the individualized skills and socialization services and the on-site individualized skills and socialization location;
(B) ensures staff are trained;
(C) supervises staff; and
(D) maintains all records.
(2) A service provider:
(A) delivers individualized skills and socialization services;
(B) assists with recreational activities; [and ]
(C) provides protective supervision through observation and monitoring; and
(D) is trained on the needs of the individual.
(d) An individualized skills and socialization provider must make both on-site and off-site individualized skills and socialization services available to an individual who receives Home and Community-based Services (HCS), Texas Home Living (TxHmL), or Deaf Blind with Multiple Disabilities (DBMD) services, unless the individualized skills and socialization provider provides off-site individualized skills and socialization services only.
(e) An individualized skills and socialization provider must ensure that on-site individualized skills and socialization services :
(1) are [is] provided in a building or a portion of a building that is owned or leased by an individualized skills and socialization provider; and
(2) promote an individual's development of skills and behavior that support the individual's independence and personal choice;
(3) [(2)] are [is] not provided in:
(A) a prohibited setting for an individual, as set forth in the rules governing Home and Community-based Services (HCBS) waiver programs; or
(B) the residence of an individual or another person [the HCS Program].
(f) An individualized skills and socialization provider must ensure that off-site individualized skills and socialization services :
(1) include activities that:
(A) integrate the individual into the community; and
(B) promote the individual's development of skills and behavior that support the individual's independence and personal choice;
(2) [(1)] are provided in a community setting chosen by the individual from among available community setting options;
(3) [(2)] include [includes ] transportation necessary for the individual's participation in off-site individualized skills and socialization; and
(4) [(3)] are [is] not provided in:
(A) a building in which on-site individualized skills and socialization are provided;
(B) a prohibited setting for an individual, as set forth in the rules governing Home and Community-based Services (HCBS) waiver programs [the HCS Program], unless:
(i) provided in an event open to the public; or
(ii) the activity is a volunteer activity performed by an individual in such a setting; or
(C) the residence of an individual or another person, unless the activity is a volunteer activity performed by an individual in the residence.
(g) An individualized skills and socialization provider must:
(1) provide services [individualized skills and socialization]:
(A) that promote autonomy and positive social interaction;
(B) in accordance with:
(i) the individuals IPC, IPP, PDP, or implementation plan as applicable; and
(ii) the individuals identified health and safety needs, physicians' orders, and goals, as documented and agreed upon by the individual or the individual's legally authorized representative (LAR); and
(2) develop and implement written policies and procedures for consistent and effective monitoring and documentation of an individual's progress towards person-centered objectives related to skill development and socialization, in accordance with the individuals IPC, IPP, PDP, or implementation plan as applicable.
[(1) in the Deaf Blind with Multiple Disabilities (DBMD) program, in accordance with an individual's individual plan of care (IPC) and individual program plan (IPP); and]
[(2) in the Texas Home Living (TxHmL) program and Home and Community-based Services (HCS) program, in accordance with an individual's person-directed plan (PDP), IPC, and implementation plan.]
(h) An individualized skills and socialization provider must not require an individual to take a skills test or meet other requirements to receive off-site individualized skills and socialization services.
(i) If an individual does not want to participate in a scheduled on-site or off-site individualized skills and socialization activity, or the individual's LAR does not want the individual to participate in a scheduled on-site or off-site individualized skills and socialization [an] activity, [the individual scheduled for on-site individualized skills and socialization or off-site individualized skills and socialization, or the legally authorized representative (LAR) does not want the individual to participate in such activity,] the individualized skills and socialization provider must document the decision not to participate in the individual's record.
(j) If an individualized skills and socialization provider becomes aware that a modification or restriction to the services provided is needed based on a specific assessed need of an individual, the individualized skills and socialization provider must:
(1) inform the individual's program provider of the needed modification or restriction;
(2) obtain updated documentation from the program provider outlining the modification or restriction on the individual's person-centered service plan, which includes:
(A) for HCS and TxHmL, the individual's PDP; or
(B) for DBMD, the individual's IPP;
(3) ensure the updated person-centered service plan is received from the program provider and maintained in the individual's record, and that any updates are included on the individual information document as described in §559.225(f) of this division (relating to General Requirements) prior to the implementation of the modification or restriction;
(4) inform service providers of updates to an individual's person-centered service plan; and
(5) ensure the implementation of modifications or restrictions is in accordance with the individual's updated person-centered service plan.
(k) [(j)] An individualized skills and socialization provider must provide on-site and off-site individualized skills and socialization services in-person.
(l) [(k)] Training.
(1) Initial training.
(A) An individualized skills and socialization provider must:
(i) provide service providers with training on fire, disaster, and their responsibilities under the emergency response plan developed in accordance with §559.229 of this division [ subchapter] (relating to Environment and Emergency Response Plan) within three workdays after the start of employment and document the training in the individualized skills and socialization provider's records; and
(ii) provide service providers with a minimum of eight hours of training during the first three months after the start of employment and document the training in the records of the individualized skills and socialization provider.
(B) The training provided in accordance with subparagraph (A)(ii) of this paragraph must include:
(i) any nationally or locally recognized adult CPR course or certification;
(ii) first aid;
(iii) infection control;
(iv) overview of the population served by the individualized skills and socialization provider; and
(v) identification and reporting of abuse, neglect, or exploitation.
(2) Ongoing training.
[(A)]
In addition to initial training requirements described in subsection (l)(1)(A) of this section, at least annually, an [An] individualized skills and socialization provider must:
(A) [(i)] ensure that service providers maintain current certification in CPR;
(B) [(ii)] retrain service providers [train] on their responsibilities under the emergency response plan developed in accordance with §559.229 of this division and when the service provider's responsibilities under the plan change;
(C) [(iii)] conduct training for service providers [train] on infection control policies and procedures developed in accordance with subsection (o) [ (n)] of this section; and
(D) [(iv)] conduct training for service providers [train] on the identification and reporting of abuse, neglect, or exploitation.
(m) [(l)] Medications.
(1) Administration.
(A) If individuals [an individual] cannot or choose [chooses] not to self-administer his or her medications, an individualized skills and socialization provider must provide assistance with such medications and the performance of related tasks if:
(i) a registered nurse has assessed the need for assistance and related tasks and delegated such to the individualized skills and socialization provider in accordance with state law and rules; or
(ii) a physician has delegated the assistance and related tasks as a medical act to the individualized skills and socialization provider under Texas Occupations Code Chapter 157, as documented by the physician.
(B) An individualized skills and socialization provider must record an individual's medications, including over-the-counter medications, on the individual's medication profile record and ensure that medication labels are:[.]
(i) original and current;
(ii) easily readable;
(iii) affixed to the corresponding prescription bottle, container, or packaging; and
(iv) include the appropriate accessory and cautionary instructions and prescription expiration date when applicable.
(C) An individualized skills and socialization provider must ensure that information on the medication profile record:
(i) reflects current prescription orders as verified by the pharmacy or ordering healthcare provider; and
(ii) includes [The recorded information must be obtained from the prescription label and must include] the medication name, strength, dosage, doses received, directions for use, route of administration, prescription number, pharmacy name, and the date each medication was issued by the pharmacy.
(2) General.
(A) An individualized skills and socialization provider must immediately report to an individual's program provider any unusual reactions to a medication or treatment.
(B) When an individualized skills and socialization provider supervises or administers medications, the individualized skills and socialization provider must:
(i) maintain accurate, current, and accessible documentation of medication administration for each individual; and
(ii) document the date and time each medication was taken in accordance with recorded information on the individual's medication profile record.
(C) In the event of a medication error, or if an individual does not receive or take the medication or treatment as prescribed, the individualized skills and socialization provider must:
(i) document the date and time the medication dose should have been administered or provided to the individual; and
(ii) the name and strength of any medication missed [document in writing if an individual does not receive or take the medication and treatment as prescribed. The documentation must include the date and time the dose should have been taken, and the name and strength of medication missed].
(3) Storage.
(A) An individualized skills and socialization provider must provide a locked area for all medications, which may include:
(i) a central storage area; or
(ii) a medication cart that, when not in use, is secured in the area designated for its storage.
(B) An individualized skills and socialization provider must store an individual's medication separately from other individuals' medications within the storage area.
(C) An individualized skills and socialization provider must store medication requiring refrigeration in a locked refrigerator that is used only for medication storage or in a separate, permanently attached, locked medication storage box in a refrigerator.
(D) An individualized skills and socialization provider must store poisonous substances and medications labeled for "external use only" separately within the locked area.
(E) An individualized skills and socialization provider must store drugs covered by Schedule II of the Controlled Substances Act of 1970 in a locked, permanently attached cabinet, box, or drawer that is separate from the locked storage area for other medications.
(F) An individualized skills and socialization provider must store medications in accordance with manufacturer's instructions, under sanitary conditions, and with consideration of requirements pertaining to temperature, light, moisture, ventilation, segregation, and security.
(n) [(m)] Accident, injury, or acute illness.
(1) An individualized skills and socialization provider must stock and maintain in a single location in the on-site individualized skills and socialization location first aid supplies to treat burns, cuts, and poisoning.
(2) An individualized skills and socialization provider delivering off-site individualized skills and socialization must ensure first aid supplies to treat burns, cuts, and poisoning are immediately available at all times during service provision.
(3) In the event of accident or injury to an individual requiring emergency care, or in the event of death of an individual, an individualized skills and socialization provider must:
(A) arrange for emergency care or transfer to an appropriate place for treatment, including:
(i) a physician's office;
(ii) a clinic; or
(iii) a hospital;
(B) immediately notify an individual's program provider with which the individualized skills and socialization provider contracts to provide services to the individual; and
(C) describe and document the accident, injury, or illness on a separate report containing a statement of final disposition and maintain the report on file.
(o) [(n)] An individualized skills and socialization provider must develop [create] and enforce written policies and procedures for infection control, including spread of disease to ensure staff compliance with state law, the Occupational Safety and Health Administration, and the Centers for Disease Control and Prevention.
§559.228.
(a) An individualized skills and socialization provider must:
(1) provide each individual referenced in Texas Human Resources Code (HRC) §103.011 and the individual's legally authorized representative (LAR), as appropriate, with a written list of the individual's rights, as outlined under HRC §102.004 (relating to List of Rights); and
(2) comply with all applicable provisions of HRC Chapter 102 (relating to Rights of the Elderly).
(b) An individualized skills and socialization provider must ensure that individuals are informed of their rights and responsibilities and of grievance procedures in a language they comprehend:
(1) through the individual's preferred mode of communication; and
(2) in a manner accessible to the individual.
(c) An individualized skills and socialization provider must develop and implement written policies and procedures that protect and promote the rights of all individuals receiving services and ensure individuals can exercise their rights without interference, coercion, discrimination, or retaliation from the provider.
(d) An individualized skills and socialization provider must ensure that any deviation from the requirements of this section is based on an assessed need and documented in accordance with the requirements outlined in §559.227(j) of this division (relating to Program Requirements) prior to implementation. This includes an individual's right to:
(1) control and support personal schedules and activities;
(2) access personal food items at any time;
(3) receive visitors of the individual's choosing at any time; and
(4) physically access the building.
(e) An individualized skills and socialization provider must develop and implement policies and procedures for ensuring individuals:
(1) receive support and assistance from the individualized skills and socialization provider in addressing concerns with the program provider regarding the individual plan of care (IPC), individual program plan (IPP), person-directed plan (PDP), or implementation plan when the individual dislikes or disagrees with the services being rendered;
(2) live free from abuse, neglect, or exploitation;
(3) receive services in a safe and clean environment;
(4) receive services in accordance with the individuals IPC, IPP, PDP, and implementation plan, as applicable, through service providers who are responsive to the needs of the individual;
(5) have privacy during treatment and care of personal needs; and
(6) participate in social, recreational, and group activities.
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 July 3, 2025.
TRD-202502248
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (512) 438-3161
DIVISION 4. SURVEYS, INVESTIGATIONS, AND ENFORCEMENT
26 TAC §559.239STATUTORY AUTHORITY
The repeal is authorized by Texas Government Code §531.0055, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and §531.033, which provides the executive commissioner of HHSC with broad rule-making authority; and Texas Human Resources Code §32.021, which provides that HHSC adopt rules necessary for the proper and efficient operation of the Medicaid program; and §103.004, which requires the executive commissioner of HHSC to adopt rules and set standards implementing Chapter 103.
The repeal implements Texas Government Code §§531.0055, 531.021, and 531.033, and Texas Human Resources Code §§32.021, 103.004, and 103.005.
§559.239.
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 July 3, 2025.
TRD-202502249
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (512) 438-3161
STATUTORY AUTHORITY
The amendments and new sections are authorized by Texas Government Code §531.0055, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and §531.033, which provides the executive commissioner of HHSC with broad rule-making authority; and Texas Human Resources Code §32.021, which provides that HHSC adopt rules necessary for the proper and efficient operation of the Medicaid program; and §103.004, which requires the executive commissioner of HHSC to adopt rules and set standards implementing Chapter 103.
The amendments and new sections implement Texas Government Code §§531.0055, 531.021, and 531.033, and Texas Human Resources Code §§32.021, 103.004, and 103.005.
§559.241. , or Incidents] to HHSC.
(a) Any individualized skills and socialization provider [staff] who has reasonable cause to believe that an individual is being or has been subjected to [is in a state of] abuse, neglect, or exploitation must report the abuse, neglect, or exploitation to the Texas Health and Human Services (HHSC) Complaint and Incident Intake Section through the online licensure portal or by telephone to 1-800-458-9858 within one hour after suspecting or learning of the alleged abuse, neglect, or exploitation.
(b) In addition to the reporting requirements described in subsection (a) of this section, an individualized skills and socialization provider must report the death of an individual when the death occurs while the individual is receiving services from an individualized skills and socialization provider to the HHSC Complaint and Incident Intake Section within one hour after learning of the [individual's] death.
(c) The following information must be reported to HHSC when making a report described in subsections (a) or (b) of this section:
(1) name, age, and address of the individual;
(2) name and address of the person responsible for the care of the individual, if available;
(3) nature and extent of the individual's condition;
(4) basis of the reporter's knowledge; and
(5) any other relevant information.
(d) Within five working days after making a report described in subsections (a) or (b) of this section, the individualized skills and socialization provider must conduct [ensure] an investigation of the incident [is conducted] and send a written investigation report on Form 3613-A, Provider Investigation Report, [or a form containing, at a minimum, the information required by Form 3613-A,] to HHSC [HHSC's] Complaint and Incident Intake.
(e) An individualized skills and socialization provider may not retaliate against an individual, legally authorized representative, or service provider for filing a complaint or presenting a grievance or for providing, in good faith, information to HHSC relating to abuse, neglect, or exploitation.
§559.243.
[(a) A complaint is any allegation received by the Texas Health and Human Services Commission (HHSC) regarding abuse, neglect, or exploitation of an individual or a violation of state standards.]
(a) [(b)] HHSC must give the individualized skills and socialization provider notification of the complaint received and a summary of the complaint, without identifying the source of the complaint.
(b) [(c)] HHSC investigates complaints of abuse, neglect, or exploitation when the alleged victim is an individual receiving services from an individualized skills and socialization provider and:
(1) the act occurs at the on-site individualized skills and socialization location;
(2) the act occurs during the provision of off-site individualized skills and socialization services;
(3) the individualized skills and socialization provider is responsible for the supervision of the individual at the time the act occurs; or
(4) the alleged perpetrator is affiliated with the individualized skills and socialization provider.
[(d) Complaints of abuse, neglect, or exploitation not meeting the criteria in subsection (a) of this section must be referred to the Texas Department of Family and Protective Services.]
(c) [(e)] Complaint investigations must include a visit to the individualized skills and socialization provider and consultation with persons thought to have knowledge of the circumstances. If the individualized skills and socialization provider fails to admit HHSC staff for a complaint investigation, HHSC will seek a district [probate or county] court order for admission. Investigators may request from [ of] the court that a peace officer accompany them.
[(f) In cases concluded to be physical abuse, the written report of the investigation by HHSC must be submitted to the appropriate law enforcement agency.]
[(g) In cases concluded to be abuse, neglect, or exploitation of an individual with a guardian, the written report of the investigation by HHSC must be submitted to the probate or county court that oversees the guardianship.]
§559.253.
(a) The Texas Health and Human Services Commission (HHSC) may impose an administrative penalty if an individualized skills and socialization provider:
(1) fails to comply with Texas Human Resources Code (HRC) Chapter 103 or a rule, standard, or order adopted under HRC Chapter 103;
(2) makes a false statement of a material fact that the provider knows or should know is false:
(A) on an application for a license or a renewal of a license or in an attachment to the application; or
(B) with respect to a matter under investigation by HHSC;
(3) refuses to allow an HHSC representative to inspect:
(A) a book, record, or file required to be maintained by the provider; or
(B) any portion of the premises of the on-site location, or for off-site only providers, the designated place of business where records are kept;
(4) willfully interferes with the work of an HHSC representative who is preserving evidence of a violation of:
(A) HRC Chapter 103;
(B) a rule, standard, or order adopted under HRC Chapter 103; or
(C) a term of a license issued under this chapter;
(5) willfully interferes with the work of an HHSC representative or the enforcement of this chapter;
(6) fails to pay a penalty assessed under HRC Chapter 103, or a rule adopted under this chapter within 30 calendar days after the date the assessment of the penalty becomes final;
(7) fails to notify HHSC of a change of ownership in accordance with §559.211 of this subchapter (relating to Change of Ownership and Notice of Changes); or
(8) fails to submit an approved plan of correction to HHSC within 10 calendar days after receiving the final notification of assessed penalties.
(b) The range of the administrative penalty that may be imposed against the individualized skills and socialization provider each day for a violation described in subsection (a)(1) of this section is based on the scope and severity of the violation and whether it is an initial or repeated violation, as set forth in the following figure.
Figure: 26 TAC §559.253(b) (.pdf)
(c) HHSC imposes administrative penalties in accordance with the schedule of appropriate and graduated penalties established in this section. When determining the amount of an administrative penalty, HHSC considers:
(1) the seriousness of the violation, including the nature, circumstances, extent, and gravity of the situation, and the hazard or potential hazard created by the situation to the health or safety of the public;
(2) the history of previous violations by a facility;
(3) the amount necessary to deter future violations;
(4) the facility's efforts to correct the violation; and
(5) any other matter that justice may require.
(d) If HHSC determines a violation is non-substantial, HHSC allows the individualized skills and socialization provider one opportunity to correct the violation to avoid an administrative penalty.
(e) If HHSC determines a violation is substantial as defined in §559.203 of this subchapter (relating to Definitions), HHSC does not allow the individualized skills and socialization provider an opportunity to correct the violation before HHSC imposes an administrative penalty.
(f) If HHSC imposes an administrative penalty for a violation as described in subsection (a) of this section, the administrative penalty begins accruing:
(1) for a substantial violation, on the date HHSC identifies the violation; or
(2) for a violation that is non-substantial, on the date of the exit conference of the post 45-day follow-up survey.
(g) An administrative penalty accrues each day until the individualized skills and socialization provider completes corrective action for that violation, as determined by HHSC.
(h) If an individualized skills and socialization provider demonstrates the corrective action is complete on the same day an administrative penalty begins accruing, HHSC imposes an administrative penalty for one day.
(i) For an administrative penalty imposed in accordance with subsection (a)(2) of this section:
(1) HHSC imposes the penalty no more than once per survey;
(2) HHSC does not allow the individualized skills and socialization provider an opportunity to correct the action before imposing the penalty; and
(3) the amount of the penalty is $500.
(j) If HHSC imposes an administrative penalty against the individualized skills and socialization provider in accordance with subsection (a)(2)- (8) of this section, HHSC does not, at the same time, impose a closing order or licensure suspension from the program provider for the same violation, action, or failure to act.
§559.255.
(a) The Texas Health and Human Services Commission (HHSC) may conduct an unannounced survey or investigation in accordance with §559.231 of this division (relating to Surveys and Visits) to assess the health and safety of individuals receiving services from an individualized skills and socialization provider and make a determination regarding the provider's compliance with licensing and program requirements under this subchapter.
(b) During a survey or investigation, if HHSC determines there is an immediate threat to the health and safety of individuals due to an individualized skills and socialization provider's non-compliance with one or more regulatory requirements identified under this subchapter, HHSC notifies the individualized skills and socialization provider orally and in writing of the determination. In accordance with HHSC instructions and the requirements of this subchapter, the individualized skills and socialization provider must develop and document a plan of removal and submit the written plan to HHSC. The plan must include:
(1) a separate plan of removal for each identified area of non-compliance;
(2) a description of:
(A) immediate actions the individualized skills and socialization provider will take to ensure there is no longer a threat of harm to individuals receiving services;
(B) how the provider will identify all affected individuals;
(C) how the provider will monitor and document progress on:
(i) each action identified on the plan of removal; and
(ii) the effectiveness of the plan;
(D) actions the provider will take to ensure each identified non-compliance will not reoccur; and
(E) specific dates and times by which the individualized skills and socialization provider will complete each corrective action identified in this paragraph.
(c) HHSC notifies an individualized skills and socialization provider if a plan of removal is approved or not approved, and HHSC conducts daily visits and monitoring of the provider until HHSC determines threat of immediate harm no longer exists.
(d) If HHSC does not approve an individualized skills and socialization provider's plan of removal, the provider must resubmit a revised plan of removal to HHSC.
(e) If an individualized skills and socialization provider fails to submit a plan of removal as required, or does not implement an approved plan of removal, HHSC may deny or revoke the individualized skills and socialization provider's license.
(f) If HHSC determines the individualized skills and socialization provider complies with the regulatory requirements as indicated under this subchapter, HHSC:
(1) sends the individualized skills and socialization provider a final survey report stating that the individualized skills and socialization provider complies with the regulatory requirements;
(2) does not require any action by the individualized skills and socialization provider; and
(3) issues a license to the individualized skills and socialization provider as described in §559.205 of this subchapter (relating to Criteria for Licensing) if the survey is an initial or a re-licensing survey.
(g) If HHSC determines from an initial licensure survey, re-licensure survey, intermittent survey, or investigation that the individualized skills and socialization provider is not in compliance with a regulatory requirement:
(1) HHSC provides a final statement of violations in accordance with §559.233 of this division (relating to Determinations and Actions Pursuant to Surveys).
(2) HHSC may recommend with the final statement of violations the assessment of an administrative penalty for each violation and the amount of the administrative penalty, in which case HHSC provides:
(A) written notice to the individualized skills and socialization provider, indicating the amount of the recommended administrative penalty; and
(B) a statement of whether the violation is subject to correction in accordance with subsection (b) of this section and, if the violation is subject to correction:
(i) a statement of the date on which the individualized skills and socialization provider must file with HHSC a plan of correction for approval by HHSC;
(ii) the date on which the individualized skills and socialization provider must complete the plan of correction to avoid assessment of the administrative penalty; and
(iii) a statement that the license holder has a right to an administrative hearing on the occurrence of the violation, the amount of the penalty, or both.
(3) Within 20 calendar days after the date on which the individualized skills and socialization provider receives a written notice of the final statement of violations, the provider may:
(A) agree to the final statement of violations in writing, including the recommended administrative penalty; or
(B) submit a written request for an administrative hearing to HHSC.
(h) After HHSC receives the plan of correction as required by §559.233(f) of this division, HHSC notifies the individualized skills and socialization provider whether the plan is approved or not approved.
(1) If HHSC does not approve a plan of correction, the individualized skills and socialization provider must submit a revised plan of correction within five business days after the date of the HHSC notice that the plan of correction was not approved. After HHSC receives the revised plan of correction, HHSC notifies the individualized skills and socialization provider whether the revised plan is approved or not approved.
(2) If HHSC approves a plan of correction, HHSC notifies the individualized skills and socialization provider in writing that the plan of correction has been approved, and HHSC takes the following actions to determine if the individualized skills and socialization provider has completed the corrective action as outlined on the approved plan of correction:
(A) HHSC may request that the individualized skills and socialization provider submit evidence of corrective action; and
(B) HHSC may conduct:
(i) for a substantial violation, a follow-up survey after the date specified in the plan of correction for correcting the violation but within 45 calendar days after the survey exit conference; or
(ii) for a violation that is non-substantial, an off-site desk review or a post 45-day follow-up survey based on HHSC discretion.
(i) If an individualized skills and socialization provider does not submit a plan of correction as required by §559.233(f) of this division or a revised plan of correction required by subsection (h) of this section, or if HHSC notifies the individualized skills and socialization provider that a revised plan of correction is not approved, HHSC may impose administrative penalties in accordance with §559.253 of this division (relating to Administrative Penalties).
(j) If an individualized skills and socialization provider corrects a violation, the individualized skills and socialization provider must maintain the correction until the first anniversary of the date the correction was made.
(k) If an individualized skills and socialization provider fails to maintain a correction in accordance with subsection (j) of this section, HHSC may assess an administrative penalty equal to three times the amount of the original penalty assessed, but not collected. HHSC does not provide the individualized skills and socialization provider an opportunity to correct the subsequent violation.
(l) If HHSC determines from a follow-up survey described in subsection (h)(2)(B)(i) of this section that the individual skills and socialization provider has completed a corrective action for a substantial violation, the administrative penalty associated with the substantial violation stops accruing on the date the corrective action was completed, as determined by HHSC.
(m) If HHSC determines from a follow-up survey described in subsection (h)(2)(B)(i) of this section that the individualized skills and socialization provider has not completed the corrective action for a substantial violation, HHSC may:
(1) continue to impose an administrative penalty and conduct a second follow-up survey to determine if the individualized skills and socialization provider completed the corrective action;
(2) impose a license suspension or closing order against the individualized skills and socialization provider; or
(3) deny or revoke the license of the individualized skills and socialization provider.
(n) If HHSC determines from a follow-up survey or off-site desk review described in subsection (h)(2)(B)(ii) of this section that the individualized skills and socialization provider has completed the corrective action for a violation that is non-substantial, HHSC does not impose an administrative penalty for the non-substantial violation.
(o) If HHSC determines from a follow-up survey or off-site desk review described in subsection (h)(2)(B)(ii) of this section that the individualized skills and socialization provider has not completed the corrective action for a violation that is non-substantial, HHSC:
(1) imposes an administrative penalty for the non-substantial violation in accordance with §559.253 of this division;
(2) notifies the individualized skills and socialization provider of the administrative penalty; and
(3) conducts a survey:
(A) after the date of the post 45-day exit conference of the follow-up survey; or
(B) after the date of the exit conference of the post 45-day follow-up survey if the program provider has submitted evidence of corrective action to HHSC during the 30-day period.
(p) If an individualized skills and socialization provider cannot resolve a dispute regarding a violation of regulations, the individualized skills and socialization provider is entitled to an informal dispute resolution (IDR) as outlined in §559.233(g) of this division.
(q) If HHSC determines that the individualized skills and socialization provider committed any of the actions described in §559.253(a) of this division, HHSC may:
(1) impose an administrative penalty against the individualized skills and socialization provider as described in §559.253 of this division;
(2) impose a non-emergency license suspension against the individualized skills and socialization provider as described in §559.247 of this division (relating to Nonemergency Suspension); or
(3) deny or revoke the license of the individualized skills and socialization provider as described in §559.215 of this subchapter (relating to Criteria for Denying a License or Renewal of a License) and §559.249 of this division (relating to Revocation).
(r) HHSC does not cite an individualized skills and socialization provider for violation of a regulatory requirement based solely on the action or inaction of a person who is not an employee, contractor, or volunteer of the individualized skills and socialization provider. HHSC may cite the individualized skills and socialization provider for violation of a regulatory requirement based on the individualized skills and socialization provider's response to the action or inaction of such a person.
§559.257.
(a) An administrative hearing is held in accordance with Chapter 110 of this title (relating to Hearings Under the Administrative Procedure Act), Texas Government Code Chapter 2001, Subchapter I (relating to Administrative Procedure), and Texas Administrative Code, Title 1, Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act).
(b) An administrative law judge sets a hearing date and gives notice of the hearing if an individualized skills and socialization provider is assessed an administrative penalty and requests a hearing.
(c) The requested hearing is held before an administrative law judge who makes findings of fact and conclusions of law regarding the occurrence of a violation under Texas Human Resources Code Chapter 103, a rule adopted under this chapter, or a term of a license issued under this chapter.
(d) Based on the findings of fact and conclusions of law and the recommendation of the administrative law judge, the executive commissioner or designee, by order, finds:
(1) a violation has occurred and assesses an administrative penalty; or
(2) a violation has not occurred.
(e) The executive commissioner or designee provides notice of the findings made under subsection (d) of this section to the individualized skills and socialization provider charged with a violation. If the executive commissioner finds that a violation has occurred, the executive commissioner or designee provides written notice to the provider of:
(1) the findings;
(2) the amount of the administrative penalty;
(3) the rate of interest payable on the penalty and the date on which interest begins to accrue; and
(4) the provider's right to judicial review of the order of the executive commissioner.
(f) Not later than the 30th day after the date on which the order of the executive commissioner or designee is final, the individualized skills and socialization provider assessed an administrative penalty must:
(1) pay the full amount of the penalty; or
(2) file a petition for judicial review contesting the occurrence of the violation, the amount of the penalty, or both.
(g) Notwithstanding subsection (e) of this section, HHSC may permit the individualized skills and socialization provider to pay an administrative penalty in installments.
(h) If an individualized skills and socialization provider does not pay an administrative penalty within the period provided by subsection (f) or (g) of this section or in accordance with the installment plan permitted by HHSC:
(1) the penalty is subject to interest; and
(2) HHSC may refer the matter to the attorney general for collection of the penalty and interest.
(i) Interest accrues:
(1) at a rate equal to the rate charged on loans to depository institutions by the New York Federal Reserve Bank; and
(2) for the period beginning on the day after the date on which the penalty becomes due and ending on the date the penalty is paid.
(j) Accrued interest on the amount remitted by the executive commissioner or designee must be paid:
(1) at a rate equal to the rate charged on loans to depository institutions by the New York Federal Reserve Bank; and
(2) for the period beginning on the date the penalty is paid and ending on the date the penalty is remitted to the individualized skills and socialization provider.
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 July 3, 2025.
TRD-202502250
Karen Ray
Chief Counsel
Health and Human Services Commission
Earliest possible date of adoption: August 24, 2025
For further information, please call: (512) 438-3161