TITLE 25. HEALTH SERVICES
PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 13. HEALTH PLANNING AND RESOURCE DEVELOPMENT
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts amendments to §13.11, concerning Purpose and Scope; §13.13, concerning Definitions; §13.18, concerning Noncompliance with Reporting Requirements; §13.19, concerning Confidential Data; §13.51, concerning Purpose and Scope; and §13.85, concerning Award Criteria and Selection for Funding.
Sections 13.11, 13.19, 13.51, and 13.85 are adopted without changes to the proposed text as published in the July 24, 2026, issue of the Texas Register (51 TexReg 4800). These rules will not be republished.
Sections 13.13 and 13.18 are adopted with changes to the proposed text as published in the July 24, 2026, issue of the Texas Register (51 TexReg 4800). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to comply with House Bill (HB) 3801, 89th Legislature, Regular Session, 2025, that repealed Texas Health and Safety Code Chapter 104 and abolished the Statewide Health Coordinating Council (SHCC) and the nursing advisory committee (NAC) for the SHCC effective September 1, 2025. The proposed amendments remove references to those topics from Title 25 of the Texas Administrative Code (TAC) Chapter 13.
COMMENTS
The 31-day comment period ended August 24, 2026. During this period, DSHS did not receive any comments regarding the proposed rules.
Minor editorial changes were made to §13.13(17)(C) to remove a redundant word and §13.18(a)(1) to correct spelling.
SUBCHAPTER
B.
STATUTORY AUTHORITY
The amendments are adopted under 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 systems and Texas Health and Safety Code §1001.075, which authorizes the executive commissioner of HHSC to adopt rules for the administration of Texas Health and Safety Code Chapter 1001, HSC §105.005, and Acts 2025, 89th Leg., R.S., Ch. 636 (H.B. 3801), Secs. 11(2), 11(3) eff. September 1, 2025.
§13.13.
The following terms in this subchapter have the following meanings, unless the context clearly indicates otherwise.
(1) Chapter 311--Relates to the powers and duties of hospitals found within Texas Health and Safety Code (HSC) Title 4.
(2) Charity care--The unreimbursed cost to a hospital of:
(A) providing, funding, or otherwise financially supporting health care services on an inpatient or outpatient basis to a person classified by the hospital as financially or medically indigent; and/or
(B) providing, funding, or otherwise financially supporting health care services provided to financially indigent persons through other nonprofit or public outpatient clinics, hospitals, or health care organizations.
(3) Community benefits--The unreimbursed cost to a hospital of providing charity care, government-sponsored indigent health care, donations, education, government-sponsored program services, research, and subsidized health services. Community benefits do not include the cost to the hospital of paying any taxes or other governmental assessments.
(4) Department--The Texas Department of State Health Services.
(5) Donations--The unreimbursed costs of providing cash and in-kind services and gifts, including facilities, equipment, personnel, and programs, to other nonprofit or public outpatient clinics, hospitals, or health care organizations.
(6) Education-related cost--The unreimbursed cost to a hospital of providing, funding, or otherwise financially supporting educational benefits, services, and programs, including:
(A) education of medical professionals and health care providers;
(B) scholarships and funding to medical schools, colleges, and universities for health professions education;
(C) education of patients concerning diseases and home care in response to community needs; and
(D) community health education through informational programs, publications, and outreach activities in response to community needs.
(7) Financially indigent--An uninsured or underinsured person who is accepted for care with no obligation or a discounted obligation to pay for the services rendered based on the hospital's eligibility system.
(8) Government-sponsored indigent health care--The unreimbursed cost to a hospital of providing health care services to recipients of Medicaid and other federal, state, or local indigent health care programs, eligibility for which is based on financial need.
(9) Government-sponsored program unreimbursed costs--The unreimbursed cost to the hospital of providing health care services to the beneficiaries of Medicare, the Civilian Health and Medical Program of the Uniformed Services, and other federal, state, or local government health care programs.
(10) Health care facility--Regardless of ownership, a public or private hospital, skilled nursing facility, intermediate care facility, ambulatory surgical facility, family planning clinic that performs ambulatory surgical procedures, rural health initiative clinic, urban health initiative clinic, kidney disease treatment facility, inpatient rehabilitation facility, and other facilities as defined by federal law. This definition does not include an office of physicians or practitioners of the healing arts, singly or in groups, in the conduct of their profession.
(11) Health care organization--A nonprofit or public organization that provides, funds, or otherwise financially supports health care services provided to financially indigent persons.
(12) Hospital--A general or special hospital licensed under HSC Chapter 241; a private mental hospital licensed under HSC Chapter 577; and a treatment facility licensed under HSC Chapter 464.
(13) Hospital eligibility system--The financial criteria and procedure used by a hospital to determine if a patient is eligible for charity care. The system shall include income levels and means testing indexed to the federal poverty guidelines; provided, however, that a hospital may not establish an eligibility system that sets the income level eligible for charity care lower than that required by counties under HSC §61.023 or higher, in the case of the financially indigent, than 200% of the federal poverty guidelines. A hospital may determine that a person is financially or medically indigent pursuant to the hospital's eligibility system after health care services are provided.
(14) Hospital system--A system of local nonprofit hospitals under the common governance of a single corporate parent that are located within a radius of not more than 125 linear miles of the corporate parent.
(15) Medically indigent--A person whose medical or hospital bills after payment by third-party payors exceed a specified percentage of the patient's annual gross income, determined in accordance with the hospital's eligibility system, and the person is financially unable to pay the remaining bill.
(16) Net patient revenue--An accounting term calculated in accordance with generally accepted accounting principles for hospitals.
(17) Nonprofit hospital--
(A) A hospital that is organized as a nonprofit corporation or a charitable trust under the laws of this state or any other state or country and is:
(i) eligible for tax-exempt bond financing; or
(ii) exempt from state franchise, sales, ad valorem, or other state or local taxes.
(B) A "nonprofit hospital" shall not include a hospital that:
(i) is exempt from state franchise, sales, ad valorem, or other state or local taxes;
(ii) does not receive payment for providing health care services to any inpatients or outpatients from any source, including the patient or any person legally obligated to support the patient, third-party payers, Medicare, Medicaid, or any other federal, state, or local indigent care program; payment for providing health care services does not include charitable donations, legacies, bequests, or grants or payments for research; and
(iii) does not discriminate on the basis of inability to pay, race, color, creed, religion, or sex in its provision of services.
(C) A "nonprofit hospital" does not include a hospital that is located in a county with a population under 50,000 where the entire county or the population of the entire county has been designated as a health professional shortage area. A "nonprofit hospital" includes a hospital that is located in a county with a population under 50,000 where only a subpopulation, partial geographic area or a facility is designated as a health professional shortage area.
(18) Patient data--Information derived from individual, acute care, inpatient, and outpatient discharge abstract records.
(19) Subsidized health services--Services provided by a hospital in response to community needs for which the reimbursement is less than the hospital's cost for providing the services and which must be subsidized by other hospital or nonprofit supporting entity revenue sources. Subsidized health services include emergency and trauma care, neonatal intensive care, freestanding community clinics, and collaborative efforts with local government or private agencies in preventive medicine.
(20) Survey--The annual data collection conducted by the department to implement the provisions of Texas Health and Safety Code Chapter 311.
(21) Tax-exempt benefits--All of the following, calculated in accordance with standard accounting principles for hospitals for tax purposes using the applicable statutes, rules, and regulations regarding the calculation of these taxes:
(A) the dollar amount of federal, state, and local taxes, including income, franchise, ad valorem, and sales taxes, foregone by a nonprofit hospital and its nonprofit supporting entities;
(B) the dollar amount of contributions received by a nonprofit hospital and its nonprofit supporting entities; and
(C) the value of tax-exempt bond financing received by a nonprofit hospital and its nonprofit supporting entities.
(22) Unreimbursed costs--The costs a hospital incurs for providing services after subtracting payments received from any source for such services, including: third-party insurance payments; Medicare payments; Medicaid payments; Medicare education reimbursements; state reimbursements for education; payments from drug companies to pursue research; grant funds for research; and disproportionate share payments. For purposes of this definition, the term "costs" shall be calculated by applying the cost to charge ratios derived in accordance with generally accepted accounting principles for hospitals to billed charges. The calculation of the cost to charge ratios shall be based on the most recently completed and audited prior fiscal year of the hospital or hospital system. For purposes of this definition, charitable contributions and grants to a hospital, including transfers from endowment or other funds controlled by the hospital or its nonprofit supporting entities, shall not be subtracted from the costs of providing services for purposes of determining the unreimbursed costs of charity care and government-sponsored indigent health care.
§13.18.
(a) Reporting of data through the online survey form for the Annual Survey of Hospitals (ASH).
(1) A hospital that does not complete and submit the online survey form to the department within the 60-day reporting period and according to §13.15 of this subchapter (relating to Survey Forms and Methods of Reporting Data), will be notified of noncompliance in writing by certified mail with return receipt.
(2) If the entity does not send the requested data within 30 days of receiving the certified mail, the commissioner may notify the attorney general in writing that the entity is in noncompliance, providing a copy of the notification to the entity.
(b) Report of the Community Benefit Plan (CBP). A nonprofit hospital or hospital system that does not submit a CBP report, as described in Texas Health and Safety Code §311.046, to the department by April 30 of each year, may be assessed a civil penalty up to $1,000 each day for which the report is delinquent. The department notifies the entity of noncompliance by certified mail, with return receipt. No penalty may be assessed against a hospital until 10 business days after the written notification to the hospital of its failure to file a report. The commissioner notifies the attorney general in writing of noncompliant entities, providing a copy of the notification to the entity.
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 October 14, 2026.
TRD-202604367
Cynthia Hernandez
General Counsel
Department of State Health Services
Effective date: November 3, 2026
Proposal publication date: July 24, 2026
For further information, please call: (512) 696-3881
SUBCHAPTER
E.
STATUTORY AUTHORITY
The amendment is adopted under 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 systems and Texas Health and Safety Code §1001.075, which authorizes the executive commissioner of HHSC to adopt rules for the administration of Texas Health and Safety Code Chapter 1001, HSC §105.005, and Acts 2025, 89th Leg., R.S., Ch. 636 (H.B. 3801), Secs. 11(2), 11(3) eff. September 1, 2025.
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 October 14, 2026.
TRD-202604368
Cynthia Hernandez
General Counsel
Department of State Health Services
Effective date: November 3, 2026
Proposal publication date: July 24, 2026
For further information, please call: (512) 696-3881
SUBCHAPTER
G.
STATUTORY AUTHORITY
The amendment is adopted under 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 systems and Texas Health and Safety Code §1001.075, which authorizes the executive commissioner of HHSC to adopt rules for the administration of Texas Health and Safety Code Chapter 1001, HSC §105.005, and Acts 2025, 89th Leg., R.S., Ch. 636 (H.B. 3801), Secs. 11(2), 11(3) eff. September 1, 2025.
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 October 14, 2026.
TRD-202604369
Cynthia Hernandez
General Counsel
Department of State Health Services
Effective date: November 3, 2026
Proposal publication date: July 24, 2026
For further information, please call: (512) 696-3881
PART 6. STATEWIDE HEALTH COORDINATING COUNCIL
CHAPTER 571. HEALTH PLANNING AND RESOURCE DEVELOPMENT
SUBCHAPTER
A.
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Texas Department of State Health Services (DSHS), adopts the repeal of §571.1, concerning General Provisions, and §571.2, concerning State Health Plan and Plan Implementation.
Sections 571.1 and 571.2 are adopted without changes to the proposed text as published in the July 24, 2026, issue of the Texas Register (51 TexReg 4805). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The repeal is necessary to provide consistency with amendments to the Texas Health and Safety Code (HSC) that resulted from the passage of House Bill (HB) 3801, 89th Legislature, Regular Session, 2025. HB 3801 repealed HSC Chapter 104 and abolished the Statewide Health Coordinating Council (SHCC). The repeal removes references to those topics in Title 25 of the Texas Administrative Code (TAC) Part 6, Statewide Health Coordinating Council, consisting of Chapter 571, Subchapter A, §571.1 and §571.2.
COMMENTS
The 31-day comment period ended on August 24, 2026. During this period, DSHS did not receive any comments regarding the proposed rules.
STATUTORY AUTHORITY
The repeals are adopted under 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 systems and Texas Health and Safety Code §1001.075, which authorizes the executive commissioner of HHSC to adopt rules for the administration of Texas Health and Safety Code Chapter 1001 and Acts 2025, 89th Leg., R.S., Ch. 636 (H.B. 3801), Sec. 11(1), eff. September 1, 2025.
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 October 14, 2026.
TRD-202604370
Cynthia Hernandez
General Counsel
Statewide Health Coordinating Council
Effective date: November 3, 2026
Proposal publication date: July 24, 2026
For further information, please call: (512) 696-3881