PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 742. MINIMUM STANDARDS FOR LISTED FAMILY HOMES
SUBCHAPTER E. BASIC CARE REQUIREMENTS
The Texas Health and Human Services Commission (HHSC) adopts new §742.508, concerning What are the requirements when an infant is engaged in tummy time, in Texas Administrative Code, Title 26, Part 1, Chapter 742, Minimum Standards for Listed Family Homes, Subchapter E, Basic Care Requirements.
New §742.508 is adopted without changes to the proposed text as published in the March 18, 2022, issue of the Texas Register (47 TexReg 1442). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The new rule is necessary to implement the portion of Senate Bill 225, 87th Legislature, Regular Session, 2021, that amended Chapter 42, Texas Human Resources Code by adding Section 42.04291. This new section requires the HHSC Executive Commissioner to establish standards for listed family homes and registered and licensed child-care homes for the visual and auditory supervision of an infant engaged in time on the infant's stomach while awake (that is, tummy time). To meet this legislative requirement, HHSC Child Care Regulation proposed a new rule for listed family homes that specifies supervision requirements for when an infant is engaged in tummy time activities.
COMMENTS
The 31-day comment period ended April 18, 2022. During this period, HHSC received three comments regarding the proposed rule from a parent-advocate. A summary of the comments relating to the rule and HHSC's responses follows.
Comment: One commenter requested that HHSC revise the rule to require a maximum distance the caregiver can be from an infant who is positioned in tummy time.
Response: HHSC disagrees with the comment and declines to revise the rule. This additional requirement could restrict the caregiver's ability to meet the needs of other children because there is a great deal of variability in the layout of child-care homes and the caregiver must move around frequently to meet the needs of other children in care (for example, diapering, administering first aid, preparing food and bottles, etc.). It would also be difficult to enforce. HHSC believes that the proposed requirements that the caregiver be able to see and hear an infant positioned for tummy time activities, and intervene as necessary to ensure the safety of the infant, sufficiently address any risk to the infant engaged in tummy time activities.
Comment: One commenter requested that HHSC revise the rule to require the caregiver be in the same room with an infant who is positioned in tummy time.
Response: HHSC disagrees with the comment and declines to revise the rule. HHSC believes that the proposed requirements that a caregiver be able to see and hear an infant positioned for tummy time activities, and intervene as necessary to ensure the safety of the infant, sufficiently address any risk to the infant engaged in tummy time activities. Because there is a great deal of variability in the layout of child-care homes and the caregiver must move around frequently to meet the needs of other children in care, this additional requirement could restrict the caregiver's ability to meet the needs of other children (for example, diapering, administering first aid, preparing food and bottles, etc.). It would also be difficult to enforce. In response to the comment, HHSC will add additional guidance to the Helpful Information box that follows the rule in the minimum standards courtesy publication, further clarifying that the caregiver must remove the infant from tummy time when the caregiver must step away from the room and the caregiver will not be able to see and hear the infant.
Comment: One commenter requested that HHSC revise the rule to require a time limit for tummy time as recommended by pediatricians. For example, two minutes maximum for a child three months of age with no signs of distress.
Response: HHSC disagrees with the comment and declines to revise the rule. The American Academy of Pediatrics (AAP) recommends an infant be placed on the tummy 2-3 times each day for a short period of time (3-5) minutes, increasing the amount of time as the baby shows enjoyment of the activity. While this information is included in the Helpful Information box that follows the rule in the courtesy publication of the minimum standards, the AAP recommendation may not be appropriate for all infants and would be difficult to enforce. Additionally, the rule contains requirements for (1) repositioning the infant to maintain the infant's comfort and safety; and (2) moving the infant to a safe sleeping space if the infant falls asleep while positioned on the infant's stomach. Each of these components of the rule serve as a preventative measure to ensure an infant is not left in tummy time for too long. In response to the comment, HHSC will add a link in the Helpful Information box to the AAP website that offers information and resources about tummy time.
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Texas Human Resources Code Chapter 42.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 24, 2022.
TRD-202202012
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 13, 2022
Proposal publication date: March 18, 2022
For further information, please call: (512) 438-3269
SUBCHAPTER H. BASIC CARE REQUIREMENTS FOR INFANTS
The Texas Health and Human Services Commission (HHSC) adopts new §747.2318, concerning What are the requirements when an infant is engaged in tummy time, in Texas Administrative Code, Title 26, Part 1, Chapter 747, Minimum Standards for Child-Care Homes, Subchapter H, Basic Care Requirements for Infants.
New §747.2318 is adopted without changes to the proposed text as published in the March 18, 2022, issue of the Texas Register (47 TexReg 1443). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The new rule is necessary to implement the portion of Senate Bill 225, 87th Legislature, Regular Session, 2021, that amended Chapter 42, Texas Human Resources Code by adding Section 42.04291. This new section requires the HHSC Executive Commissioner to establish standards for listed family homes and registered and licensed child-care homes for the visual and auditory supervision of an infant engaged in time on the infant's stomach while awake (that is, tummy time). To meet this legislative requirement, HHSC Child Care Regulation proposed a new rule for licensed and registered child-care homes that specifies supervision requirements for when an infant is engaged in tummy time activities.
COMMENTS
The 31-day comment period ended April 18, 2022. During this period, HHSC received four comments regarding the proposed rule from a registered child-care home provider and a parent-advocate. A summary of the comments relating to the rule and HHSC's responses follows.
Comment: One commenter stated that she does not place the infants in her care in tummy time because a child will develop the muscles needed to hold its head up while on a caregiver's shoulder. She further stated the proposed rule is unenforceable and HHSC should focus instead on better education for caregivers regarding early childhood development.
Response: HHSC disagrees with the comment and declines to revise the rule. The rule is legislatively mandated. The proposed rule does not require a caregiver to utilize tummy time but will help ensure the safety of an infant engaged in these activities. With regard to enforcement, HHSC is accustomed to monitoring and enforcing supervision rules in child-care homes and will monitor and enforce the proposed rule as it does other supervision rules. Lastly, while the proposal did not include child development training, HHSC agrees that training in early childhood development is a critical component of caring for infants in a child-care setting. HHSC does not provide training for caregivers but does share training resources to aid caregivers in obtaining training from various sources. HHSC also requires the primary caregiver in a licensed child-care home or registered child-care home to obtain 30 hours of annual training in various topics, including child development.
Comment: One commenter requested that HHSC revise the rule to require a maximum distance the caregiver can be from an infant who is positioned in tummy time.
Response: HHSC disagrees with the comment and declines to revise the rule. This additional requirement could restrict the caregiver's ability to meet the needs of other children because there is a great deal of variability in the layout of child-care homes and the caregiver must move around frequently to meet the needs of other children in care (for example, diapering, administering first aid, preparing food and bottles, etc.). It would also be difficult to enforce. HHSC believes that the proposed requirements that the caregiver be able to see and hear an infant positioned for tummy time activities, and intervene as necessary to ensure the safety of the infant, sufficiently address any risk to the infant engaged in tummy time activities.
Comment: One commenter requested that HHSC revise the rule to require the caregiver be in the same room with an infant who is positioned in tummy time.
Response: HHSC disagrees with the comment and declines to revise the rule. HHSC believes that the proposed requirements that a caregiver be able to see and hear an infant positioned for tummy time activities and intervene as necessary to ensure the safety of the infant, sufficiently address any risk to the infant engaged in tummy time activities. Because there is a great deal of variability in the layout of child-care homes and the caregiver must move around frequently to meet the needs of other children in care, this additional requirement could restrict the caregiver's ability to meet the needs of other children (for example, diapering, administering first aid, preparing food and bottles, etc.). It would also be difficult to enforce. In response to the comment, HHSC will add additional guidance to the Helpful Information box that follows the rule in the minimum standards courtesy publication further clarifying that the caregiver must remove the infant from tummy time when the caregiver must step away from the room and the caregiver will not be able to see and hear the infant.
Comment: One commenter requested that HHSC revise the rule to require a time limit for tummy time as recommended by pediatricians. For example, two minutes maximum for a child three months of age with no signs of distress.
Response: HHSC disagrees with the comment and declines to revise the rule. The American Academy of Pediatrics (AAP) recommends an infant be placed on the tummy 2-3 times each day for a short period of time (3-5) minutes, increasing the amount of time as the baby shows enjoyment of the activity. While this information is included in the Helpful Information box that follows the rule in the courtesy publication of the minimum standards, the AAP recommendation may not be appropriate for all infants and would be difficult to enforce. Additionally, the rule contains requirements for (1) repositioning the infant to maintain the infant's comfort and safety; and (2) moving the infant to a safe sleeping space if the infant falls asleep while positioned on the infant's stomach. Each of these components of the rule serve as a preventative measure to ensure an infant is not left in tummy time for too long. In response to the comment, HHSC will add a link in the Helpful Information box to the AAP website that offers information and resources about tummy time.
STATUTORY AUTHORITY
The new section is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and Texas Government Code §531.02011, which transferred the regulatory functions of the Texas Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Texas Human Resources Code Chapter 42.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 24, 2022.
TRD-202202013
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: June 13, 2022
Proposal publication date: March 18, 2022
For further information, please call: (512) 438-3269