TITLE 1. ADMINISTRATION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 354. MEDICAID HEALTH SERVICES

SUBCHAPTER A. PURCHASED HEALTH SERVICES

CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER H. BASE WAGE REQUIREMENTS FOR PERSONAL ATTENDANTS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Texas Administrative Code (TAC) Title 1, Part 15 Chapter 355, Subchapter H, §355.7051, concerning Base Wage for a Personal Attendant before September 1, 2025.

BACKGROUND AND PURPOSE

The purpose of the proposal is to repeal §355.7051. The proposed repeal is in accordance with 2026-27 General Appropriations Act (GAA) Senate Bill 1, 89th Legislature, Regular Session, 2025 (Article II, Health and Human Services Commission, Rider 23) (Rider 23). Rider 23 revised the personal attendant wage by providing appropriations to support a new average attendant base wage. Section 355.7052, Reimbursement Methodology for Determining Attendant Cost Component, was adopted and effective in September 2025 to outline new methodology for personal attendant wage rates and §355.7051 became obsolete effective September 1, 2025.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule 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 rule will be in effect:

(1) the proposed rule will not create or eliminate a government program;

(2) implementation of the proposed rule will not affect the number of HHSC employee positions;

(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;

(4) the proposed rule will not affect fees paid to HHSC;

(5) the proposed rule will not create a new regulation;

(6) the proposed rule will limit and repeal existing regulation;

(7) the proposed rule will not change the number of individuals subject to the rule; and

(8) the proposed rule will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. This rule does not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with this rule.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years the rules are in effect, the public will benefit from removing an obsolete TAC rule because it improves clarity, accuracy, and navigation of the TAC.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule does not include costs to persons required to comply.

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 rule, 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 26R085" in the subject line.

STATUTORY AUTHORITY

The repeal is 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 agencies; Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority; Texas Human Resources Code §32.021 and Texas Government Code §532.0051, which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §532.0057(a), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for Medicaid payments under Texas Human Resources Code Chapter 32.

The repeal affects Texas Government Code §524.0151, §524.0005, and Chapter 532 and Texas Human Resources Code Chapter 32.

§355.7051. Base Wage for a Personal Attendant before September 1, 2025.

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 August 11, 2026.

TRD-202603393

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 867-7817

CHAPTER 363. TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM

SUBCHAPTER F. PERSONAL CARE SERVICES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to Texas Administrative Code (TAC) Title 1, Part 15, Chapter 363, Subchapter F, §363.603, concerning Provider Participation Requirements.

BACKGROUND AND PURPOSE

The purpose of the proposal is to remove references to repealed §355.7051, Base Wage for a Personal Attendant before September 1, 2025, in §363.603. The proposed repeal of §355.7051 is published elsewhere in this issue of the Texas Register.

Additionally, the proposal updates TAC citations in the rule.

SECTION-BY-SECTION SUMMARY

The proposal amends §363.603 to reflect the discontinuation of the attendant base wage described in §355.7051 and updates references to TAC citations.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule 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 rule will be in effect:

(1) the proposed rule will not create or eliminate a government program;

(2) implementation of the proposed rule will not affect the number of HHSC employee positions;

(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;

(4) the proposed rule will not affect fees paid to HHSC;

(5) the proposed rule will not create a new regulation;

(6) the proposed rule will limit and repeal existing regulation;

(7) the proposed rule will not change the number of individuals subject to the rule; and

(8) the proposed rule will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. This rule does not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with this rule.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years the rule is in effect, the public will benefit from removing references to an obsolete TAC rule and updating references because it improves clarity, accuracy, and navigation of the TAC.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule does not include costs to persons required to comply.

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 rule, 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 26R085" in the subject line.

STATUTORY AUTHORITY

The amendment is 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 agencies; Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority; Texas Human Resources Code §32.021 and Texas Government Code §532.0051, which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §532.0057(a), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for Medicaid payments under Texas Human Resources Code Chapter 32.

The amendment affects Texas Government Code §524.0151, §524.0005, and Chapter 532 and Texas Human Resources Code Chapter 32.

§363.603. Provider Participation Requirements.

(a) Personal care services (PCS) must be provided by an individual who:

(1) is 18 years of age or older;

(2) is an attendant who:

(A) is an employee of a provider organization licensed as a home and community support services agency (HCSSA) per 26 TAC Chapter 558 [40 TAC Chapter 97] (relating to Licensing Standards for Home and Community Support Services Agencies); or

(B) if the recipient is receiving PCS through the consumer directed services (CDS) option described in 26 TAC Chapter 264 [40 TAC Chapter 41] (relating to Consumer Directed Services Option), is an employee of:

(i) the recipient; or

(ii) the recipient's responsible adult or legally authorized representative (LAR);

(3) has demonstrated the competence necessary, when competence cannot be demonstrated through education and experience, to perform the personal assistance tasks assigned by the provider organization supervisor or by the recipient or the recipient's responsible adult or LAR acting as employer through the CDS option described in 26 TAC Chapter 264 [40 TAC Chapter 41];

(4) is not the responsible adult of the recipient if the recipient is under the age of 18; and

(5) is not the legal spouse of the recipient.

(b) HHSC may establish rates of reimbursement based on the level of care required by the recipient and the qualifications of and tasks performed by the PCS attendant.

(c) An organization that employs attendants who provide PCS must meet the licensing standards set out in 26 TAC Chapter 558 [40 TAC Chapter 97] for one of the following license categories or special service types:

(1) Licensed Home Health Services, as set out in 26 TAC §558.401 [40 TAC §97.401] (relating to Standards Specific to Licensed Home Health Services);

(2) Licensed and Certified Home Health Services, as set out in 26 TAC §558.402 [40 TAC §97.402] (relating to Standards Specific to Licensed and Certified Home Health Services); or

(3) agencies licensed to provide personal assistance services, as set out in 26 TAC §558.404 [40 TAC §97.404] (relating to Standards Specific to Agencies Licensed to Provide Personal Assistance Services).

(d) An organization serving as a Financial Management Services Agency (FMSA) providing financial management services and other employer support services to a recipient receiving PCS through the CDS option must meet the FMSA contracting requirements specified in 26 TAC Chapters 264 and 52 [40 TAC Chapters 41 and 49] (relating to Consumer Directed Services Option and Contracting for Community Services, respectively).

(e) Provider organizations and FMSAs must successfully enroll as Texas Medicaid providers before [prior to] seeking authorization or payment for PCS.

(f) Any organization that employs attendants who provide PCS and any organization serving as an FMSA must comply with all documentation requirements as specified in PCS program policy.

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 August 11, 2026.

TRD-202603394

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 867-7817