TITLE 1. ADMINISTRATION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER J. PURCHASED HEALTH SERVICES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §355.8443, concerning Reimbursement Methodology for School Health and Related Services (SHARS), and §355.8600, concerning Reimbursement Methodology for Ambulance Services.

Section 355.8443 and §355.8600 are adopted without changes to the proposed text as published in the February 13, 2026, issue of the Texas Register (51 TexReg 787). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The amendments are necessary to align the rules with current updated practices and reduce administrative burdens by modernizing the informal review process for cost reports.

COMMENTS

The 21-day comment period ended March 6, 2026.

During this period, HHSC received comments regarding the proposed rules from two commenters. HHSC received comments from the Texas Association of School Boards (TASB) and one individual that commented. All comments pertained to §355.8443. A summary of the comments and HHSC responses follows.

Comment: Two commenters stated concerns about cost report preparation and timelines for school districts to complete the cost reporting process. Commenters request at least a 90-day period between the cost report opening and the submission deadline, with advance written notice to school districts. One commenter requests that a 90-day period be established in the rule or a formal policy.

Response: HHSC declines to revise the rule in response to this comment. HHSC declines to include a fixed 90-day preparation period in rule, as the amended rule is intended to provide school districts flexibility in the cost reporting process by removing set deadlines and due dates. However, advance notice of due dates is necessary and will be provided through the State of Texas Electronic Provider System (STEPS) and email.

Comment: One commenter requests that HHSC establish clear procedures for system outages or technical issues. Additionally, the commenter requests automatic extensions if the cost report system is unavailable for an extended period, particularly near the submission deadline.

Response: HHSC declines to revise the rule in response to this comment. HHSC declines to process automatic extensions; however, under 1 TAC §355.105(c)(3), providers may submit requests for extensions which may be granted by HHSC for good cause. Additionally, with the new cost reporting system, a ticketing process is built in to address any system outages or other technical issues, and extensions can be easily requested within the new system in response to system outages or other issues.

Comment: One commenter requests that school districts receive confirmation that includes date, time, and verification of when a cost report is successfully submitted and accepted.

Response: HHSC declines to revise the rule in response to this comment. HHSC agrees that status updates should be included in the cost reporting process, however this will not be detailed in the rule text. With the new cost reporting system, status updates occur in real time, and notifications are provided within the system and sent via email.

Comment: One commenter requested that if a cost report due date falls on a weekend or state holiday, the deadline be moved to the next business day.

Response: HHSC declines to revise the rule in response to this comment. HHSC declines to amend the due date for SHARS cost reporting at this time. The rule provides that HHSC has flexibility to choose the due date for the report. This flexibility enables HHSC to choose a business day for the deadline. HHSC will continue to communicate due dates and reminders to the Primary Entity Contact in the new cost reporting system, via email, and through established communication channels.

Comment: Two commenters requested to formalize structured stakeholder engagement by creating a new advisory group or adding SHARS into an existing advisory body. Suggesting this approach would allow for identification of potential implementation challenges, clarify guidance, and support smoother program transitions.

Response: HHSC declines to revise the rule in response to this comment. The creation of an advisory committee is outside the scope of this rule proposal.

Comment: One commenter is concerned about communication to school districts, stating that many districts were unaware of this proposed rule change until it was placed on the Executive Council agenda and/or published in the Texas Register. The commenter stated that most school districts do not routinely monitor the Texas Register and rely on direct communication from HHSC about SHARS program changes. The commenter requests that HHSC communicate SHARS rule changes and reporting requirements directly to participating districts via established communication channels and the STEPS system. The commenter requests that HHSC provide direct email communication to district SHARS contacts on rule amendments, reporting timelines, and program updates.

Response: The notification process for rule making is outside the scope of the rule proposal. In addition to the Executive Council agenda and publication in the Texas Register, a GovDelivery notice was sent on December 2, 2025, with details on the transition to the new cost reporting system (STEPS) and announcing pending updates to the SHARS rule.

Comment: One commenter recommended that HHSC expand SHARS training opportunities, provide training in advance of major program changes, and provide refresher training and updated guidance when there are program or system changes.

Response: HHSC declines to revise the rule in response to this comment. Training programs are outside the scope of the rule proposal. However, with the implementation of STEPS, new training will be accessible and updated annually.