TITLE 26. HEALTH AND HUMAN SERVICES
PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 358. CHILDREN'S AUTISM PROGRAM
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §§358.101, 358.105, 358.307, 358.311, 358.313, 358.315, 358.605, 358.607 - 358.609; the repeal of §§358.309, 358.507, and 358.515; and new §§358.107, 358.109, 358.201, and 358.309.
Sections 358.105 and 358.311 are adopted with changes to the proposed text as published in the May 1, 2026, issue of the Texas Register (51 TexReg 2869). These rules will be republished.
Sections 358.101, 358.107, 358.109, 358.201, 358.307, 358.309, 358.313, 358.315, 358.507, 358.515, 358.605, and 358.607 - 358.609 are adopted without changes to the proposed text as published in the May 1, 2026, issue of the Texas Register (51 TexReg 2869). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments, new sections, and repeals update the Children's Autism Program rules in Title 26 Texas Administrative Code (TAC) Chapter 358, including definitions and contractor qualifications. The updates also replace references to the former Texas Department of Assistive and Rehabilitative Services with HHSC.
The adopted rules change the program eligibility requirement based on age. This change aligns with the other program within the Children's Autism and Blindness Services section, the Blind Children's Program.
Additionally, the Children's Autism Program rules were in two titles in TAC. The adopted rules consolidate program rules into 26 TAC Chapter 358. The repealed rules in 1 TAC Chapter 392, Subchapter C, Autism Program, are published elsewhere in this issue of the Texas Register.
COMMENTS
The 31-day comment period ended June 1, 2026.
HHSC received comments regarding the proposed rules from five commenters. HHSC received comments from Texas Nurse Practitioners, Texas Academy of Physician Assistants, Families for Effective Autism Treatment - Houston, Texas Council of Community Centers, and Texas Association for Behavior Analysis Public Policy Group. A summary of comments relating to the rules and HHSC's responses follows.
Comment: A commenter suggested the proposed definition of "qualified professional" in §358.105(24) should include advanced practice registered nurses, such as nurse practitioners (NPs). The commenter indicated the proposed rule limited qualified professionals to "a physician or psychologist" and the restriction is inconsistent with NPs' scope of practice under Texas law and authority under other HHSC programs.
Response: HHSC agrees and revises the rule as suggested. HHSC also adds a definition for "nurse practitioner" in §358.105(20) and renumbers the section accordingly.
Comment: A commenter suggested the proposed definition of "qualified professional" in §358.105(24) should include physicians assistants (PAs). The commenter indicated PAs are authorized to perform medical acts, including diagnosis, within their scope of practice. The commenter further indicated the proposed rule created an internal inconsistency within HHSC's regulatory framework.
Response: HHSC agrees and revises the rule as suggested. HHSC also adds a definition for "physician assistant" in §358.105(24) and renumbers the section accordingly.
Comment: Multiple commenters expressed support and enthusiasm for expansion of services to children and adults through age 21. The commenters further expressed continuing support for flexibility in the use of authorized service hours and limitations and appreciate tailoring the services to the child rather than arbitrary limits. The commenters also encouraged HHSC to carefully consider how requirements related to parent participation and client attendance are implemented.
Response: HHSC acknowledges support for expanded eligibility and changes to use of service hours. The Children's Autism Program's policy and process continue to include reviewing and approving exceptions to participation requirement. No changes were made in response to the comment.
A minor editorial change was made to §358.105 for consistency across HHSC rules.
A minor editorial change was made to §358.105(4) to correct formatting.
A minor editorial change was made to §358.311(a)(1)(B) to correct a typo.
SUBCHAPTER
A.
STATUTORY AUTHORITY
The amendments and 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 Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code §117.082 requires HHSC to adopt rules for the children's autism program.
§358.105.
The following terms in this chapter have the following meanings, unless the context clearly indicates otherwise.
(1) Adjusted gross income--The total income of the family after subtracting allowable deductions. Adjusted gross income is used to calculate a family's monthly cost share for a child to participate in the Children's Autism Program.
(2) Allowable deductions--Expenses that may be subtracted from total income. Allowable deductions are limited to:
(A) the actual medical or dental expenses of the family that are mainly for helping or preventing a physical or mental condition, paid within the last 12 months, and expected to continue during the eligibility period. Expenses must be limited to the cost of:
(i) diagnosis, cure, alleviation, treatment, or prevention of disease;
(ii) treatment of any affected body part or function;
(iii) legal medical services delivered by physicians, surgeons, dentists, and other medical practitioners;
(iv) medication, medical supplies, and diagnostic devices;
(v) premiums paid for insurance that covers the expenses of medical or dental care;
(vi) transportation to receive medical or dental care; and
(vii) medical or dental debt that is being paid on an established payment plan;
(B) child-care and respite expenses for a family member;
(C) costs and fees associated with the adoption of a child who will be counted as a family member; and
(D) court-ordered child support payments paid for a child who is not counted as a family member.
(3) ABA--Applied behavior analysis. The design, implementation, and evaluation of systematic environmental changes to produce socially significant change in human behavior through skill acquisition and the reduction of problematic behavior. Applied behavior analysis includes direct observation and measurement of behavior and the identification of functional relations between behavior and the environment. Contextual factors, establishing operations, antecedent stimuli, positive reinforcers, and other consequences are used to produce the desired behavior change.
(4) ASD--Autism spectrum disorder. A disorder found in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) related to autism or a diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified, made under a previous DSM, used to meet the eligibility criteria for a documented diagnosis in §358.307(a) of this chapter (relating to Eligibility).
(5) BCaBA--Board Certified Assistant Behavior Analyst. A person who meets the requirements in and holds the appropriate license under Texas Occupations Code Chapter 506, the Behavior Analyst Licensing Act.
(6) BCBA--Board Certified Behavior Analyst. A person who meets the requirements in and holds the appropriate license under Texas Occupations Code Chapter 506.
(7) BCBA-D--Board Certified Behavior Analyst-Doctoral. A person who meets the requirements in and holds the appropriate license under Texas Occupations Code Chapter 506.
(8) Child--An individual diagnosed with ASD who is younger than 22 years of age.
(9) Contractor--A local community agency or organization under contract with HHSC to provide services under this chapter.
(10) Cost share--The amount of money a family must pay each month for a child to participate in the Children's Autism Program, as described in Subchapter F of this chapter (relating to Cost Share).
(11) Dependent--A person in the household of a child who receives services who is 19 years of age or older, a parent, a guardian, a stepparent, a grandparent, a brother, a sister, a stepbrother, a stepsister, or an in-law. Dependents may not have gross income more than the income requirement set by the Internal Revenue Service (IRS) for the relevant year. More than half of the person's support must be provided by the parent during the calendar year.
(12) Direct services--Direct services happen when a staff member provides services to a child or the family. Direct services include parent or family training, in person and virtual ABA sessions, and meetings related to the service plan. Direct services do not include casual or accidental physical contact with, talking to, or meeting at an educational presentation or seminar with a child who is in the Children's Autism Program or with the child's family.
(13) Family--If living in the same home, means:
(A) the parent;
(B) the child;
(C) other children younger than 19 years old; and
(D) other dependents.
(14) Fiscal year--The state fiscal year. Begins on September 1 and ends on August 31 of the following year.
(15) Focused ABA services--ABA services provided to a child by an HHSC contractor to treat one or more skill deficits or behaviors.
(16) Gross income--All income received by the family for determination of the family's cost share, from whatever source, that is considered income by the Internal Revenue Service before federal allowable deductions are applied.
(17) HHSC--The Texas Health and Human Services Commission.
(18) Individualized Education Program (IEP)--A written document that is developed for each public school child who is eligible for special education.
(19) Interest list--A list, maintained by a contractor, of families who have indicated an interest in receiving services, and who meet the eligibility criteria.
(20) Nurse practitioner--A person licensed to practice nursing under Texas Occupations Code Chapter 301.
(21) Parent--Means:
(A) a child's natural or adoptive parent; or
(B) a child's guardian.
(22) Parent training--A Focused ABA service that a contractor provides to a parent in the native language of a parent with limited English proficiency, when possible.
(23) Physician--A person licensed to practice medicine under Texas Occupations Code Chapter 155.
(24) Physician assistant--A person licensed to practice medicine under Texas Occupations Code Chapter 204.
(25) Psychologist--A person licensed to practice psychology under Texas Occupations Code Chapter 501.
(26) Qualified professional--A physician, psychologist, nurse practitioner, or physician assistant who has training and experience in diagnosing and treating neurodevelopmental disorders.
(27) RBT--Registered Behavior Technician. A paraprofessional who provides direct support to individuals, under the supervision of a BCBA or BCaBA. A RBT implements behavior intervention plans, collects data, and assists individuals to develop or improve skills and manage challenging behaviors. This term also includes a Board Certified Autism Technician.
(28) Staff member--Means a person working for a contractor as:
(A) an RBT;
(B) a BCaBA;
(C) a BCBA; or
(D) a BCBA-D.
(29) Texas resident--A person who lives in Texas.
(30) Third-party payer--A company, organization, insurer, or government agency, except for HHSC, that pays for health care services a child receives in the Children's Autism Program.
(31) Transition plan--A written document that lists the steps and services needed to help the child and family move from the Children's Autism Program to local education agency special education services or other community activities, places, or programs chosen by the family after leaving the Children's Autism Program.
(32) Treatment plan--A written plan of care that describes how services will be provided to a child and the child's family to enhance the child's development, that includes treatment goals.
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 August 5, 2026.
TRD-202603308
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 25, 2026
Proposal publication date: May 1, 2026
For further information, please call: (512) 815-6272
SUBCHAPTER
B.
STATUTORY AUTHORITY
The new 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 Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code §117.082 requires HHSC to adopt rules for the children's autism program.
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 August 5, 2026.
TRD-202603309
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 25, 2026
Proposal publication date: May 1, 2026
For further information, please call: (512) 815-6272
SUBCHAPTER
C.
STATUTORY AUTHORITY
The repeal 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 Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code §117.082 requires HHSC to adopt rules for the children's autism program.
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 August 5, 2026.
TRD-202603310
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 25, 2026
Proposal publication date: May 1, 2026
For further information, please call: (512) 815-6272
26 TAC §§358.307, 358.309, 358.311, 358.313, 358.315
STATUTORY AUTHORITY
The amendments and new section 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 Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code §117.082 requires HHSC to adopt rules for the children's autism program.
§358.311.
(a) A contractor must:
(1) develop a written treatment plan with the family for each child served, which must include;
(A) goals that are clear, specific, and can be measured and will direct the treatment process and show progress; and
(B) plans that help the child use skills and behaviors learned during services in other places, such as home or school; and
(2) provide and keep records of parent training as a part of the Focused ABA services.
(b) A contractor must provide parent training. A contractor may provide this training in either individual or group format. If provided in a group of other parents and children, a contractor may provide parent training in a home, school, or clinic setting.
(c) Parent training must include:
(1) providing education to the parent about ABA;
(2) the contractor working with the parent to find ways to help the child practice skills at home so learned skills can carry over to other places, including school settings; and
(3) teaching the parent how to review data, make decisions about the program, and plan for new goals.
(d) Documentation of parent training must include:
(1) the name of the child;
(2) the names of those who participated in the training;
(3) any training information the contractor discussed and shared with each parent who participated in the training; and
(4) the location where the contractor provided the training.
(e) A contractor must:
(1) provide ongoing analysis and evaluation of each child's progress;
(2) collect data on operationally defined target behaviors at baseline, during treatment, and after treatment for every behavior listed in the child's treatment plan;
(3) document efforts to coordinate services with the school setting the child attends to promote the child's use of learned skills in that setting so learned skills can carry over to other places;
(4) develop a written transition plan with the child and family before each child exits the Children's Autism Program;
(5) maintain an updated transition plan in the child's record and include in the transition plan:
(A) timelines for completing each of the steps and transition services documented in the plan to support the family's exit from the Children's Autism Program; and
(B) the family's choice for the child to:
(i) transition to local education agency special education services or other community activities, places, or programs the family would like the child to participate in after exiting the Children's Autism Program; or
(ii) remain in the home; and
(6) maintain documentation in the child's record of all services provided to the child that includes:
(A) the child's name;
(B) the date of service;
(C) the start and end time of service;
(D) the location of service;
(E) the names of those present during the time of service;
(F) the contractor's signature;
(G) a description of the service and goals addressed; and
(H) progress toward goals.
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 August 5, 2026.
TRD-202603311
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 25, 2026
Proposal publication date: May 1, 2026
For further information, please call: (512) 815-6272
SUBCHAPTER
E.
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 system and Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code §117.082 requires HHSC to adopt rules for the children's autism program.
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 August 5, 2026.
TRD-202603312
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 25, 2026
Proposal publication date: May 1, 2026
For further information, please call: (512) 815-6272
SUBCHAPTER
F.
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 system and Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, Texas Human Resources Code §117.082 requires HHSC to adopt rules for the children's autism program.
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 August 5, 2026.
TRD-202603313
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: August 25, 2026
Proposal publication date: May 1, 2026
For further information, please call: (512) 815-6272