TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 321. SUBSTANCE USE SERVICES

SUBCHAPTER A. PREVENTION

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of §321.1, concerning Purpose; §321.3, concerning Application; §321.5, concerning Definitions; and §321.7, concerning Program Description, and new §321.1, concerning Purpose; §321.3, concerning Application; §321.5, concerning Definitions; §321.7, concerning General Program Requirements; §321.9, concerning Program Staffing; and §321.11, concerning Program Service Delivery.

BACKGROUND AND PURPOSE

The purpose of the proposal is to replace the current rules in Title 26, Texas Administrative Code Chapter 321, Subchapter A relating to Substance Use Prevention, with new rules that clarify provider requirements related to training, staffing, written policies and procedures, screening tools, and other requirements that inform substance use prevention service delivery.

SECTION-BY-SECTION SUMMARY

The proposed repeal of §321.1 deletes the rule as no longer necessary, because the content of the rule is outdated.

Proposed new §321.1 describes the requirements for substance use prevention services providers to implement the primary prevention strategies.

The proposed repeal of §321.3 deletes the rule as no longer necessary, because the content of the rule is outdated.

Proposed new §321.3 clarifies that the rules apply to HHSC providers delivering substance use prevention services.

The proposed repeal of §321.5 deletes the rule as no longer necessary, because proposed new §321.5 contains the definitions used in the proposed new rules.

Proposed new §321.5 contains key terms and their definitions needed to align with the proposed new rules.

The proposed repeal of §321.7 deletes the rule because the content of the rule has been added to proposed new rule §321.11.

Proposed new §321.7 describes provider requirements and the prevention strategies that providers must implement. The proposed new rules clarify provider responsibilities when implementing substance use services including the need for formal agreements, operating in accordance with required policies and procedures, and the ability to screen for additional services.

Proposed new §321.9 sets standards for providers regarding sufficient staffing levels and certification requirements for staff.

Proposed new §321.11 describes prevention program service delivery requirements for each of the five prevention program types: universal prevention programs, selective prevention programs, indicated prevention programs, community coalition partnership programs, and prevention resource centers.

FISCAL NOTE

Trey Wood, HHSC 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 create new regulations;

(6) the proposed rules will repeal existing regulations;

(7) the proposed rules will not change 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 the rules do not apply to small or micro-businesses, or rural communities.

LOCAL EMPLOYMENT IMPACT

The proposed rules 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 and do not impose a cost on regulated persons.

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 clarification of HHSC-funded provider requirements. Additionally, program recipients may experience an increase in quality and consistency of 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 the new rules incorporate and clarify existing program requirements.

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, including information related to the cost, benefit, or effect of the proposed rules, as well as any applicable data, research, or analysis, 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 24R089" in the subject line.

26 TAC §§321.1, 321.3, 321.5, 321.7

STATUTORY AUTHORITY

The repeals sections 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 §1001.073, which provides that HHSC the responsibility for administering, coordinating, and contracting for the delivery of substance use prevention services, §1001.075, which provides that the executive commissioner of HHSC may adopt rules reasonably necessary for the administration of substance use prevention services, §461A.052, which provides that HHSC shall plan, develop, coordinate, evaluate, and implement programs for the prevention of substance use, and §461A.051, which provides that the executive commissioner of HHSC shall adopt rules governing the functions of the agency in relation to substance use services.

The new sections and repeals affect Texas Government Code §524.0151 and Texas Health and Safety Code §1001.073, §1001.75, §461A.051, and §461A.052.

§321.1. Purpose.

§321.3. Application.

§321.5. Definitions.

§321.7. Program Description.

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 October 15, 2025.

TRD-202503730

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: November 30, 2025

For further information, please call: (512) 902-8075

26 TAC §§321.1, 321.3, 321.5, 321.7, 321.9, 321.11

STATUTORY AUTHORITY

The new sections 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 §1001.073, which provides that HHSC the responsibility for administering, coordinating, and contracting for the delivery of substance use prevention services, §1001.075, which provides that the executive commissioner of HHSC may adopt rules reasonably necessary for the administration of substance use prevention services, §461A.052, which provides that HHSC shall plan, develop, coordinate, evaluate, and implement programs for the prevention of substance use, and §461A.051, which provides that the executive commissioner of HHSC shall adopt rules governing the functions of the agency in relation to substance use services.

The new sections and repeals affect Texas Government Code §524.0151 and Texas Health and Safety Code §1001.073, §1001.75, §461A.051, and §461A.052.

§321.1. Purpose.

This subchapter explains to HHSC-funded providers which substance use prevention approaches to use. It sets requirements for provider staff. It also explains policies and procedures for the program.

§321.3. Application.

This subchapter applies to a provider who receives funding from HHSC to deliver substance use prevention services.

§321.5. Definitions.

The words and terms below have the assigned meanings when used in this subchapter, unless the context indicates otherwise.

(1) ACE--Adverse childhood experiences. Childhood events that may be traumatic.

(2) Alternatives--A primary prevention strategy that is defined in 45 CFR §96.125(b)(3).

(3) Behavioral health--Refers to the topics of mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms.

(4) Behavioral health promotion--The advancement of mental health, resilience, and well-being.

(5) CFR--Code of Federal Regulations.

(6) CLAS--Culturally and linguistically appropriate services. National standards for a set of 15 action steps. These standards aim to improve behavioral health quality and outcomes.

(7) Community-based process--A primary prevention strategy that is defined in 45 CFR §96.125(b)(5).

(8) CSAP--Center for Substance Abuse Prevention. A center under the Substance Abuse Mental Health Services Administration (SAMHSA).

(9) CSAP strategies--The evidence-based primary prevention strategies that are used by SAMHSA and defined in 45 CFR §96.125(b).

(10) Education--A primary prevention strategy that is defined in 45 CFR §96.125(b)(2).

(11) Environmental--A primary prevention strategy that is defined in 45 CFR §96.125(b)(6).

(12) Evidence-based--Models, curricula, and other interventions proven to be effective through research.

(13) HHSC--Texas Health and Human Services Commission or its designee.

(14) Individual--A person who receives services under this subchapter.

(15) Information dissemination--A primary prevention strategy that is defined in 45 CFR §96.125(b)(1).

(16) NMDOH--Non-medical drivers of health. The conditions where people live, learn, work, and play that affect a wide range of health outcomes. NMDOH can be divided into five domains:

(A) economic stability;

(B) education access and quality;

(D) neighborhood and built environment; and

(E) social and community context.

(17) Prevention strategies--Proactive approaches that help individuals and communities promote healthy behaviors and lifestyles, including strategies defined in 45 CFR §96.125(b).

(18) Primary prevention--Activities that target individuals who do not need treatment for substance use disorder, which is defined in 45 CFR §96.121. These activities may include education, mentoring, and other activities that reduce the risk of substance use.

(19) Problem identification and referral--A primary prevention strategy that is defined in 45 CFR §96.125(b)(4).

(20) Protective factors--Elements that reduce the impact of risk factors. These elements build resilience and decrease the likelihood of developing behaviors that could lead to substance use and misuse.

(21) Provider--A person or entity that contracts with HHSC to provide substance use prevention services.

(22) Risk factors--Biological, psychological, family, community, or cultural influences that precede and are associated with a higher likelihood of negative outcomes.

(23) SAMHSA--Substance Abuse and Mental Health Services Administration. An agency within the U.S. Department of Health and Human Services.

(24) Socio-ecological model--A framework that explains the different factors that affect health behavior and how to organize health intervention strategies.

(25) Strategic prevention framework--A framework created by SAMHSA used in prevention planning to address substance use and mental health issues.

§321.7. General Program Requirements.

(a) A provider must:

(1) promote behavioral health;

(2) attempt to reduce substance use and misuse;

(3) focus on preventing:

(A) for all ages, prescription drug misuse, marijuana, cannabinoids, tobacco, and other nicotine product use; and

(B) underage alcohol use;

(4) provide services using the socio-ecological model and SAMHSA's Strategic Prevention Framework;

(5) incorporate CSAP strategies that apply to the program, including Alternatives, Community-based Process, Information Dissemination, Education, Environmental, and Problem Identification, and Referral;

(6) follow CLAS; and

(7) offer services that help fill gaps in line with the current Statewide Behavioral Health Coordinating Council's Behavioral Health Strategic Plan required by Texas Government Code §547.0156.

(b) A provider must use prevention strategies that:

(1) focus on risk factors that lead to substance use and misuse, including:

(A) ACEs;

(B) NMDOH;

(D) other youth, family, and community risk factors; and

(2) promote behavioral health and help build protective factors.

(c) Before providing substance use prevention education services, the provider must complete memorandums of understanding or community agreements with public schools and agencies, businesses, or community partners to ensure programs operate efficiently.

(d) A provider must operate a program according to written policies and procedures to support implementation.

(e) The policies and procedures must:

(1) follow the rules in this subchapter;

(2) meet any of HHSC's contractual and financial requirements; and

(3) follow all relevant state and federal laws or rules.

(f) The provider must:

(1) keep a copy of the policies and procedures;

(2) provide a copy of the policies and procedures to staff; and

(3) provide a copy of the policies and procedures to HHSC, if requested.

(g) A screening tool is not required for referral to services. If a tool is used, it must be HHSC-approved and not be used for purposes of diagnosis or treatment.

§321.9. Program Staffing.

(a) A provider must keep sufficient staff to effectively operate the prevention program and provide services as required by §321.11 of this subchapter (relating to Program Service Delivery).

(b) A provider must ensure that every staff member providing primary prevention services obtains a prevention designation.

(1) be a certified prevention specialist or associate prevention specialist; and

(2) come from an organization that is a member of the International Certification and Reciprocity Consortium.

§321.11. Program Service Delivery.

(a) A provider must deliver a prevention program that:

(1) directs prevention activities at individuals that are not in treatment for substance use;

(2) carries out activities appropriate for individuals that are not in treatment for substance use; and

(3) provides services:

(A) in different settings for the general population;

(B) to populations at high risk for substance use; and

(b) A provider who delivers a universal prevention program must:

(1) use a proactive process that addresses the health and wellness of the general population;

(2) build protective factors;

(3) deter the onset of alcohol, tobacco, and other drug misuse;

(4) create places in the community that promote healthy living; and

(5) target populations not based on risk level of substance misuse.

(1) use a process that addresses and promotes the health and wellness of individuals, families, and communities by enhancing protective factors;

(2) use relevant CSAP strategies to prevent risk factors;

(3) focus on individuals or groups who are determined to be at risk for misusing substances; and

(4) focus on individuals who are determined to be at a higher-than-average risk of developing a substance use disorder.

(d) A provider who delivers an indicated prevention program must:

(1) focus on individuals who show early signs of and behaviors related to substance use;

(2) serve individuals who are not in substance use treatment; and

(3) focus on youth who show early warning signs of substance use.

(e) A provider who delivers a community coalition partnership program must:

(1) recruit partners involved in the community; and

(2) implement evidence-based strategies that:

(A) focus on changing community policies and social norms; and

(B) increase protective factors in the community.

(f) Prevention resource centers must:

(1) provide information about substance use to the general community within the HHSC service region where the Prevention Resource Center is located;

(2) educate the community on how to promote behavioral health to prevent substance use;

(3) support programs in the community that focus on substance use and tobacco prevention and control, including HHSC-funded organizations;

(4) connect people to resources related to substance use; and

(5) conduct tobacco-specific prevention and compliance strategies as required under 42 United States Code §300x-26 and 45 CFR §96.130.

(g) A provider must use and follow an evidence-based curriculum approved by HHSC.

(h) HHSC must approve any changes a provider wants to make to the approved evidence-based curriculum.