TITLE 26. HEALTH AND HUMAN SERVICES
PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 745. LICENSING
SUBCHAPTER
J.
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §745.8301, concerning What words must I know to understand this subchapter, in Title 26, Texas Administrative Code, Chapter 745, Licensing.
The amendment to §745.8301 is adopted without changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3994). The rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to implement House Bill (HB) 1, 88th Legislature, Regular Session, 2023, which required Child Care Regulation (CCR) to collaborate with the Department of Family and Protective Services (DFPS) to develop and adopt a set of licensing and approval standards for kinship foster homes pursuant to the adoption of federal rules. The Administration for Children and Families amended 45 Code of Federal Regulations (CFR) Parts 1355 and 1356, with the amendments effective on November 27, 2023. These amendments allowed CCR to adopt a set of licensing or approval standards for all kinship foster homes that (1) were different from the standards used for non-kinship foster homes, and (2) allowed a child-placing agency (CPA) to issue a foster home verification to a kinship foster home that meets the new standards. The new standards reduce unnecessary and unreasonable burdens on kinship caregivers to encourage more kinship caregivers to pursue the verification process.
The amendment to §745.8301 also implements recommendations from the Texas HHSC & DFPS Independent Assessment of Residential Child Care Rules, Standards, and Requirements (SB 593) Report to streamline minimum standards and adopt separate verification standards for relative and kinship foster family homes.
The amendment to §745.8301(3) revises the definition of "kinship foster home" to be consistent with the term used in CCR and DFPS rules.
COMMENTS
The 21-day comment period ended August 1, 2025. During this period, HHSC did not receive any comments.
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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
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 17, 2025.
TRD-202503738
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
CHAPTER 749. MINIMUM STANDARDS FOR CHILD-PLACING AGENCIES
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §§749.4401, 749.4403, 749.4421, 749.4423, 749.4425, 749.4427, 749.4429, 749.4441, 749.4443, 749.4445, 479.4447, 479.4449, 749.4451, 749.4461, 749.4463, 749.4471, 749.4473, 749.4475, 749.4477, 749.4479, 749.4481, 749.4483, 749.4485, 749.4487, 749.4489, 749.4491, 749.4493, 749.4501, 749.4503, 749.4505, 749.4507, 749.4509, 749.4511, 749.4513, 749.4515, 749.4517, 749.4519, 749.4521, 749.4523, 749.4551, 749.4553, 749.4555, 749.4557, 749.4559, 749.4561, 749.4563, 749.4565, 749.4567, 749.4569, 749.4571, 749.4573, 749.4575, 749.4577, 749.4579, and 749.4581; and the repeal of §749.2472 in Texas Administrative Code, Title 26, Chapter 749, Minimum Standards for Child-Placing Agencies.
New §§749.4425, 749.4427, 749.4461, 749.4463, 749.4477, 749.4479, 749.4507, 749.4553, 749.4569, 749.4571, and 749.4577 are adopted with changes to the proposed text as published in the July 11, 2025, issue of the Texas Register (50 TexReg 3996). These rules will be republished. HHSC withdraws proposed new §749.4465.
New §§749.4401, 749.4403, 749.4421, 749.4423, 749.4429, 749.4441, 749.4443, 749.4445, 749.4447, 749.4449, 749.4451, 749.4471, 749.4473, 749.4475, 749.4481, 749.4483, 749.4485, 749.4487, 749.4489, 749.4491, 749.4493, 749.4501, 749.4503, 749.4505, 749.4509, 749.4511, 749.4513, 749.4515, 749.4517, 749.4519, 749.4521, 749.4523, 749.4551, 749.4555, 749.4557, 749.4559, 749.4561, 749.4563, 749.4565, 749.4567, 749.4573, 749.4575, 749.4579, and 749.4581; and the repeal of §749.2472 are adopted without changes to the proposed text as published in the July 11, 2025 issue of the Texas Register (50 TexReg 3996). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The new sections and repeals are necessary to implement House Bill (HB) 1, 88th Legislature, Regular Session, 2023, which required Child Care Regulation (CCR) to collaborate with the Department of Family and Protective Services (DFPS) to develop and adopt a set of licensing and approval standards for kinship foster homes pursuant to the adoption of federal rules. The Administration for Children and Families amended 45 Code of Federal Regulations (CFR) Parts 1355 and 1356, with the amendments effective on November 27, 2023. These amendments allow CCR to adopt a set of licensing or approval standards for all kinship foster homes that (1) were different from the standards used for non-kinship foster homes, and (2) allowed a child-placing agency (CPA) to issue a foster home verification to a kinship foster home that meets the new standards. The new standards reduce unnecessary and unreasonable burdens on kinship caregivers to encourage more kinship caregivers to pursue the verification process.
The new rules also implement recommendations from the Texas HHSC & DFPS Independent Assessment of Residential Child Care Rules, Standards, and Requirements (SB 593) Report to streamline minimum standards and adopt separate verification standards for relative and kinship foster family homes.
The repeal of §749.2472 and new rules Subchapter W of Chapter 749 establish a CPA's ability to issue a non-expiring foster home verification to a kinship foster home.
COMMENTS
The 21-day comment period ended on August 1, 2025. During this period, HHSC received one comment regarding the proposed rules from one commenter who is a member of the public. A summary of the comment relating to the rules and response from HHSC follows.
Comment: Regarding §749.4477 and §749.4571, the commenter stated that the allowances for sharing a sleeping space as detailed in §749.4571 seemed to conflict with the language in §749.4477 which prohibits co-sleeping with an infant. The commenter recommended updating the language in §749.4571 to add "with the exception of infants."
Response: HHSC agrees with this comment and revised §749.4477 and §749.4571. §749.4477 was revised to clarify that an infant may not co-sleep with any individual in any location, and §749.4571 was revised to explicitly say that child placement management staff may not approve an infant to share a sleeping surface.
HHSC also revised the proposed rules to remove references to tuberculosis (TB) testing to comply with HB 2789, SECTION 2, 89th Legislature, Regular Session, 2025. The documentation requirements for TB testing were removed from §749.4461, and the TB testing requirements were removed from §749.4465. The remaining requirements in §749.4465 were added to §749.4463, therefore HHSC withdraws proposed new §749.4465 Additionally, the section title for §749.4463 was revised to reflect the addition of immunization requirements to the rule.
HHSC revised the language in §749.4569 to clarify the rule is referring to an undue safety risk of indoor and outdoor space and equipment.
HHSC also made minor editorial changes to §§749.4425, 749.4427, 749.4479, 749.4507, 749.4553, and 749.4577 for consistency or to improve readability.
SUBCHAPTER
M.
DIVISION 3. VERIFICATION OF FOSTER HOME
26 TAC §749.2472STATUTORY AUTHORITY
The repealed section 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
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 17, 2025.
TRD-202503742
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
SUBCHAPTER
W.
DIVISION 1. DEFINITIONS AND SCOPE
26 TAC §749.4401, §749.4403STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
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 17, 2025.
TRD-202503743
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
DIVISION 2. PRE-VERIFICATION AND ONGOING TRAINING REQUIREMENTS
26 TAC §§749.4421, 749.4423, 749.4425, 749.4427, 749.4429STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§749.4425.
(a) One kinship foster parent must be certified in pediatric first aid and pediatric CPR before a child-placing agency (CPA) issues the kinship foster home verification. Other kinship caregivers, including a second kinship foster parent, must be certified in pediatric first aid and CPR within 90 days after the CPA verifies the home.
(b) Pediatric first aid must include training related to rescue breathing and choking.
(c) Pediatric CPR training must adhere to guidelines for CPR established by the American Heart Association.
§749.4427.
A kinship caregiver must complete the following applicable types of general training within the noted timeframes.
Figure: 26 TAC §749.4427 (.pdf)
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 17, 2025.
TRD-202503744
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
DIVISION 3. ADMISSION AND PLACEMENT
26 TAC §§749.4441, 749.4443, 749.4445, 749.4447, 749.4449, 749.4451STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
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 17, 2025.
TRD-202503745
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
DIVISION 4. MEDICAL AND DENTAL REQUIREMENTS
26 TAC §749.4461, §749.4463STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§749.4461.
(a) A child-placing agency (CPA) must verify that the following is documented either in the kinship foster child's health passport or in the kinship foster child's record:
(1) Each emergency medical and dental visit or hospitalization, including a discharge summary; and
(2) Applicable immunization requirements.
(b) A kinship foster home must maintain a daily medication log for each controlled substance and psychotropic prescription medication administered to a kinship foster child on a form provided by the CPA. The daily medication log must include:
(1) The name of the kinship foster child;
(2) The name of the controlled substance or psychotropic medication administered; and
(3) The date and time the medication was administered.
(c) If a kinship caregiver fails to administer any medication to a kinship foster child according to the medication label or subsequent signed orders, the kinship caregiver must document the following on a form provided by the CPA:
(1) The kinship foster child's name;
(2) The medication name;
(3) A description of the medication error; and
(4) How the kinship caregiver ensured the kinship foster child's safety.
§749.4463.
(a) A kinship foster child must receive timely routine and emergency medical and dental care.
(b) At the time of verification, a child-placing agency (CPA) must verify whether a kinship foster child who is at least three years old has had a medical examination within the past year and a dental examination within the past year. If the CPA determines that the child has not had one of these examinations during that time frame, the CPA must develop a plan for the child to receive the examination.
(c) All medications must be administered according to the instructions on the label or according to a prescribing health-care professional's subsequent signed order.
(d) All medications must be stored securely and in a way that makes them inaccessible to kinship foster children.
(e) Each kinship foster child that a child-placing agency admits must meet and continue to meet applicable immunization requirements as specified by the Texas Department of State Health Services.
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 17, 2025.
TRD-202503746
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
DIVISION 5. DAILY CARE, EDUCATION, AND DISCIPLINE
26 TAC §§749.4471, 749.4473, 749.4475, 749.4477, 749.4479, 749.4481, 749.4483, 749.4485, 749.4487, 749.4489, 749.4491, 749.4493STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§749.4477.
(a) A kinship caregiver must place an infant who is unable to turn over without assistance in a face-up sleeping position unless a healthcare professional orders otherwise. A child-placing agency (CPA) must keep any orders from a healthcare professional in the kinship foster child's record.
(b) An infant's head, face, or crib must not be covered at any time by any item, including a blanket, linen, or clothing.
(c) An infant must not co-sleep with any individual in any location.
(d) An infant must not sleep in a restrictive device, such as a car seat, swing, bouncy seat, or highchair. If an infant falls asleep in one of these devices, the kinship caregiver must move the infant to a crib as soon as possible.
(e) An infant who can roll over without assistance must not be swaddled.
(f) The CPA must notify the parent of each child in care of each kinship foster home verified by the CPA of any deficiencies cited in this section.
§749.4479.
A highchair, swing, stroller, infant carrier, rocker, bouncy seat, or similar type of equipment that a kinship foster home uses for an infant must have safety straps fastened when the equipment is in use with the infant.
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 17, 2025.
TRD-202503747
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
DIVISION 6. SCREENINGS AND VERIFICATIONS
26 TAC §§749.4501, 749.4503, 749.4505, 749.4507, 749.4509, 749.4511, 749.4513, 749.4515, 749.4517, 749.4519, 749.4521, 749.4523STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§749.4507.
(a) For a kinship foster home previously verified by another child-placing agency (CPA), the receiving CPA must conduct and complete a new home screening as required in this subchapter.
(b) If the kinship foster home is transferring from another CPA, the receiving CPA must request information about the home by submitting a written request to the agency that transferred the kinship foster home.
(c) If the kinship foster home is transferring from another CPA with a child in care, the receiving CPA may verify the kinship foster home prior to completion of the background check.
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 17, 2025.
TRD-202503748
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269
DIVISION 7. HEALTH AND SAFETY REQUIREMENTS, ENVIRONMENT, SPACE, AND EQUIPMENT
26 TAC §§749.4551, 749.4553, 749.4555, 749.4557, 749.4559, 749.4561, 749.4563, 749.4565, 749.4567, 749.4569, 749.4571, 749.4573, 749.4575, 749.4577, 749.4579, 749.4581STATUTORY AUTHORITY
The new sections 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 system and HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of HRC.
§749.4553.
(a) A kinship foster home must have either:
(1) A health inspection conducted by the local health authority; or
(2) A health and safety evaluation conducted by the child-placing agency's (CPA's) child placement staff using the Environmental Health Checklist for Kinship Foster Homes form.
(b) A kinship foster home must also have either:
(1) A fire inspection conducted by a state or local fire authority; or
(2) A fire safety evaluation developed and conducted by the CPA's child placement staff.
(c) A kinship foster home must correct any deficiencies documented during any inspection or evaluation and comply with any conditions or restrictions specified by the inspector or evaluator.
§749.4569.
(a) A kinship foster home must ensure that indoor and outdoor space and equipment does not pose an undue safety risk to kinship foster children.
(b) Kinship caregivers must provide adequate supervision to prevent access to space or equipment that poses a safety risk to a kinship foster child as needed based on the kinship foster child's developmental age, maturity, and service plan restrictions.
§749.4571.
(a) Unless approved to share by the child placement management staff (CPMS), each kinship foster child must have the child's own:
(1) Sleeping space; and
(2) Sleep surface, which may include a bed, mattress, air mattress, futon, or couch.
(b) Before approving a kinship foster child to share a sleeping space or sleeping surface, the CPMS must determine and document in the kinship foster child's service plan there is no known risk of harm to the kinship foster child by sharing a sleeping space or sleeping surface with the other individual after assessing:
(1) The relationship between the kinship foster child and the individual;
(2) The ages and developmental levels of the kinship foster child and the individual, noting that after the kinship foster child's 18th birthday, the kinship foster child may share a bedroom with another youth who is 16 years of age or older, provided the age difference does not exceed two years;
(3) The behaviors of the kinship foster child and the individual;
(4) Any history of possible sexual trauma or sexually inappropriate behaviors of the kinship foster child and the individual; and
(5) Any other identifiable factors that may affect the appropriateness of the individual and the kinship foster child sharing a bedroom.
(c) CPMS may not approve an infant to share a sleeping surface.
§749.4577.
(a) Kinship caregivers must utilize safe and reliable transportation for a kinship foster child.
(b) Special provisions must be made for transporting non-ambulatory and non-mobile children. When necessary, this may include locks for wheelchairs and hydraulic lifts.
(c) A kinship caregiver must secure each kinship foster child in an infant safety seat, rear-facing convertible child safety seat, forward-facing child safety seat, child booster seat, safety vest, harness, or a safety belt, as appropriate to the kinship foster child's age, height, and weight and according to the manufacturer's instructions.
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 17, 2025.
TRD-202503749
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: November 6, 2025
Proposal publication date: July 11, 2025
For further information, please call: (512) 438-3269