TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 275. CONSUMER MANAGED PERSONAL ATTENDANT SERVICES (CMPAS) PROGRAM

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to Texas Administrative Code (TAC) Title 26, Part 1, Chapter 275, Subchapter C, §275.53, concerning Provider Qualifications and Responsibilities in All CMPAS Service Delivery Options, and Subchapter D, Division 2, §275.129, concerning Individual Responsibilities in the Block Grant Option.

BACKGROUND AND PURPOSE

The purpose of the proposal is to remove references to repealed 1 TAC §355.7051, Base Wage for a Personal Attendant before September 1, 2025, in §275.53 and §275.129. The proposed repeal of 1 TAC §355.7051 is published elsewhere in this issue of the Texas Register .

Additionally, the proposal updates TAC citations in the rules.

SECTION-BY-SECTION SUMMARY

The proposal amends §275.53 and §275.129 to remove references to 1 TAC §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 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 not create a new regulation;

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

(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

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

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 do 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 a reference 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 rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules do 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.

SUBCHAPTER C. SERVICE DELIVERY IN ALL CMPAS OPTIONS

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.

§ 275.53. Provider Qualifications and Responsibilities in All CMPAS Service Delivery Options.

To participate as a provider in the CMPAS Program, the provider must:

(1) maintain a license from HHSC under 26 TAC Chapter 558 (relating to Licensing Standards for Home and Community Support Services Agencies) in one or more of the following categories of licensure:

(A) personal assistance services;

(B) licensed home health services; or

(C) licensed and certified home health services;

(2) comply with the requirements of 26 TAC Chapter 558;

(3) comply with Chapter 52 [ 49 ] of this title (relating to Contracting for Community Services);

(4) obtain required training to function as an FMSA for those individuals who choose the CDS option for CMPAS services;

(5) comply with the requirements described in this chapter;

(6) have contract compliance monitored by an HHSC contract manager;

(7) be able to provide services under all three service delivery options; and

(8) provide case management services, including:

(A) determining applicant eligibility and co-payment amount;

(B) preparing individual registration data entry forms;

(C) assessing and reassessing individual needs using the HHSC Assessment Questionnaire and Task/Hour Guide; and

(D) developing a service plan.

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-202603395

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

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

SUBCHAPTER D. SERVICE DELIVERY OPTIONS

CHAPTER 350. EARLY CHILDHOOD INTERVENTION SERVICES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code (TAC), Title 26, Chapter 350, concerning Early Childhood Intervention Services, amendments to §§350.103, 350.105, 350.203, 350.204, 350.207, 350.211, 350.213, 350.215, 350.217 - 350.219, 350.221, 350.223, 350.227, 350.229, 350.231, 350.233, 350.235, 350.237, 350.239, 350.307, 350.309 - 350.311, 350.313, 350.314, 350.405, 350.409, 350.417, 350.505, 350.704, 350.705, 350.809, 350.813, 350.815, 350.825, 350.1009, 350.1017, 350.1105, 350.1203, 350.1205, 350.1209, 350.1211, 350.1213, 350.1217, 350.1407, 350.1409, 350.1417, 350.1419, 350.1421, 350.1423, 350.1425, 350.1427, 350.1429, 350.1431, 350.1435, 350.1437, and 350.1439; and new §§350.816, 350.1020, and 350.1216.

BACKGROUND AND PURPOSE

The purpose of the proposal is to update rules as they relate to Early Childhood Intervention (ECI) to increase administrative efficiencies and improve processes for ECI subrecipients. The proposal aligns rules with the Code of Federal Regulations, Title 34, Subtitle B, Chapter III, Part 303.

The proposal is necessary to align with House Bill 5629, 89th Legislature, Regular Session, 2025, which amended Texas Occupations Code §55.004 and §55.0041 to require state agencies that issue a license to issue a license to an applicant who is a military service member, military veteran, or military spouse who holds a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency. As the authority for the Early Intervention Specialist (EIS) credentialing process, HHSC ECI must implement applicable policies and procedures for the EIS credential.

The proposal also clarifies requirements related to eligibility for children who are deaf or hard of hearing, deaf-blind, or visually impaired and requirements for when a child transitions from ECI to early childhood special education.

The proposal also contains non-substantive changes to improve readability, consistency, and understanding.

The proposal simplifies the rules and reduces unnecessary administrative work related to services for children who are deaf or hard of hearing, deaf-blind, or visually impaired, where possible.

SECTION-BY-SECTION SUMMARY

The proposal revises terminology by replacing "contractor" with "subrecipient" to align with ECI contracts, "early childhood intervention" with "ECI," and the "Texas Health and Human Services Commission" with "HHSC" throughout the rules. The proposal also makes non-substantive terminology and grammatical revisions to improve clarity and readability.

Subchapter A, General Rules

The proposed amendment to §350.103, Definitions, adds or revises the following definitions: Children's Health Insurance Program (CHIP); comprehensive needs assessment; co-visits; DFPS; ECI program; ECI services; early childhood special education; group services; IFSP team; interdisciplinary team; limited personally identifiable information; participating agency; subrecipient; targeted case management. The definitions have also been renumbered.

The proposed amendment to §350.105, Safety Regulations, makes non-substantive terminology and grammatical revisions to promote consistency and clarity.

Subchapter B, Procedural Safeguards and Due Process Procedures

The proposed amendment to §350.203, Responsibilities, adds a citation to the Code of Federal Regulations (CFR), removes a redundant citation to the CFR, and revises the title of the Early Childhood Intervention Parent Handbook.

The proposed amendment to §350.204, Prior Written Notice, updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.207, Parental Consent, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.211, Parent, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.213, Surrogate Parents, removes subsection (c)(5) which explains the reasoning for the rule requirements under (c)(1) through (c)(4), updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.215, Early Childhood Intervention (ECI) Procedures for Filing Complaints, updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.217, Procedures for Investigation and Resolution of Complaints, updates formatting and makes non-substantive edits to improve readability and clarity. The proposed amendment also updates a TAC reference and adds a reference to CFR.

The proposed amendment to §350.218, Mediation, updates formatting and makes non-substantive edits to improve readability and clarity and updates TAC references.

The proposed amendment to §350.219, Confidentiality Notice to Parents, revises the title of the Early Childhood Intervention Parent Handbook and makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.221, Access Rights, updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.223, Fees for Records, makes non-substantive edits to improve readability and clarity and adds a citation to the CFR.

The proposed amendment to §350.227, Opportunity for a Hearing, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.229, Minimum Requirements for Conducting a Hearing, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.231, Results of Hearing, makes non-substantive terminology and grammatical revisions to improve consistency and clarity and adds a citation to the CFR.

The proposed amendment to §350.233, Release of Personally Identifiable Information, updates formatting and makes non-substantive edits to improve readability and clarity. The proposed amendment also adds the United States Department of Education to the list of federal or state oversight entities that an ECI subrecipient can disclose personally identifiable information to without prior written parental consent, adds a citation to the Uninterrupted Scholars Act, and updates a TAC reference.

The proposed amendment to §350.235, Safeguards, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.237, Record Retention Period, updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.239, Destruction of Information, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

Subchapter C, Staff Qualifications

The proposed amendment to §350.307, Personnel Grievances, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.309, Minimum Requirements for All Direct Service Staff, corrects the alphabetization for definitions, updates formatting, and makes non-substantive edits to improve readability and clarity. The proposed amendment also updates a citation to §350.313.

The proposed amendment to §350.310, Criminal Background Checks, updates formatting, adds a TAC reference, and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.311, Licensed Professional, updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.313, Early Intervention Specialist, adds a pathway for professionals who are military service members, military spouses, and military veterans who hold a current out of state license in good standing with a similar scope of practice as an EIS, to obtain the EIS credential. The proposed amendment also updates formatting, makes non-substantive edits to improve readability and clarity and updates cross-references.

The proposed amendment to §350.314, EIS Code of Ethics, adds language to codify a code of ethics standard that an EIS must report child abuse, neglect, or exploitation as directed by Texas Family Code §261.101. The proposed amendment also revises the rule to align with language in Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), and Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.). The proposed amendment also makes non-substantive edits to improve readability and clarity.

Subchapter D, Case Management For Infants and Toddlers With Developmental Disabilities

The proposed amendment to §350.405, Case Management Services, updates cross-references.

The proposed amendment to §350.409, Conditions for Case Management Provider Agency Participation, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.417, Due Process, makes non-substantive terminology and grammatical revisions to improve consistency and clarity and updates a TAC citation.

Subchapter E, Specialized Rehabilitative Services

The proposed amendment to §350.505, Conditions for Provider Agency Participation, makes non-substantive terminology revisions to improve consistency and clarity.

Subchapter G, Referral, Pre-Enrollment, and Developmental Screening

The proposed amendment to §350.704, Referral Requirements, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.705, Child Referred before Birth, makes a non-substantive terminology revision.

Subchapter H, Eligibility, Evaluation, and Assessment

The proposed amendment to §350.809, Initial Eligibility Criteria, adds deaf-blindness as an eligibility category for a child to be eligible for ECI to align with Texas Education Agency (TEA) rules in 19 TAC §89.1040, concerning Eligibility Criteria. The proposed amendment also updates formatting, makes non-substantive edits to improve readability and clarity, and updates cross-references.

The proposed amendment to §350.813, Deaf or Hard of Hearing, reorganizes the rule language to enhance clarity and better aligns with TEA eligibility rules. The proposed amendment also adds a requirement for ECI subrecipients to refer a child who is suspected of being deaf or hard of hearing directly to the Local Educational Agency (LEA). The proposed amendment also makes non-substantive edits to improve readability and clarity and adds a citation to the CFR.

The proposed amendment to §350.815, Visual Impairment, reorganizes the rule language to enhance clarity and better align with TEA eligibility rules. The proposed amendment also adds a requirement for ECI subrecipients to refer a child who is suspected of being blind or visually impaired directly to the LEA. The proposed amendment also makes non-substantive edits to improve readability and clarity and adds a citation to the CFR.

Proposed new §350.816, Deaf-blindness, adds requirements for a child to meet initial eligibility criteria with documentation that they are deaf-blind. Effective May 18, 2025, TEA added 19 TAC §231.710, which established certification requirements for teachers of students who are deaf-blind. HHSC ECI added deaf-blindness to the initial eligibility criteria to ensure children who are deaf-blind have access to appropriate services.

The proposed amendment to §350.825, Eligibility Statement, adds deaf-blindness as an eligibility category on the eligibility statement to align with the amendment to §350.809.

Subchapter J, Individualized Family Service Plan (IFSP)

The proposed amendment to §350.1009, Participants in Initial and Annual Individualized Family Service Plan Meetings, reorganizes the rule and adds a requirement that a certified teacher of the deaf-blind and a certified orientation and mobility specialist is present at the initial and annual IFSP meetings for children who are deaf-blind. The proposed amendment also indicates that if a certified teacher of students who are deaf-blind is not available, a certified teacher of students who are deaf or hard of hearing and a certified teacher of students with visual impairments must be present. The proposed amendment also adds language to clarify what an ECI subrecipient must do if the LEA has not completed evaluations and assessments within 45 days after ECI receives a referral for a child who is deaf or hard of hearing, has a visual impairment, or is deaf-blind. The proposed amendment changes the number of days for when a request for another IFSP meeting may be made from five to ten. The proposed amendment also makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.1017, Periodic Reviews, updates formatting and makes non-substantive edits to improve readability and clarity.

Proposed new §350.1020, Re-Establishing IFSP Services, codifies internal procedures regarding ECI subrecipients re-establishing IFSP services after a child's IFSP services have been suspended or discontinued, or the child has been disenrolled or discharged. The proposed new rule promotes clarity and supports ECI subrecipients by providing the appropriate steps for re-establishing IFSP services.

Subchapter K, Service Delivery

The proposed amendment to §350.1105, Capacity to Provide Early Childhood Intervention Services, makes non-substantive edits to improve readability and clarity and updates a citation to §350.103.

Subchapter L, Transition

The proposed amendment to §350.1203, Definitions, adds a definition for "SEA notification" to align with 34 CFR §303.3(b)(1). The proposed amendment also updates the definition of "LEA notification" to clarify that the LEA treats the notification as a referral for services and removes the definition of "LEA notification opt-out" because the term is not used in rule. The proposed amendment also moves the definition of "limited personally identifiable information" from this rule because it was added to §350.103.

The proposed amendment to §350.1205, Transition Education and Information for the Family, clarifies that the family's right to opt out of the LEA notification also applies to the State Educational Agency (SEA) notification. The proposed amendment also makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.1209, State Education Agency Notification, updates the title of the rule to "State Educational Agency Notification." The proposed amendment also adds language to clarify requirements for allowing families to opt out of the TEA notification. The proposed amendment makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.1211, Local Education Agency Notification of Potential Eligibility for Early Childhood Special Education Services, updates the title of the rule to "Local Educational Agency Notification of Potential Eligibility for Early Childhood Special Education Services." The proposed amendment clarifies the requirement for the LEA notification to include all required elements designated by HHSC ECI. The proposed amendment also includes revisions to require the subrecipient, with written parental consent, to provide the date the child enrolled for part C services to the LEA. The proposed amendment also clarifies the requirements for an ECI subrecipient when a referral is received for a child fewer than 45 days before the child's third birthday.

The proposed amendment to §350.1213, The Family's Right to Opt Out of the Local Education Agency Notification, updates the title to "The Family's Right to Opt Out of the Local Educational Agency and State Educational Agency Notification." The proposed amendment updates references from "SEA" to "TEA." The proposed amendment also clarifies that if the family opts out of the LEA notification, the family is also opting out of the TEA notification. The proposed amendment also updates formatting and makes non-substantive edits to improve readability and clarity.

Proposed new §350.1216, Early Childhood Intervention Referrals to the Local Education Agency, adds clarification about requirements for an ECI subrecipient related to referring a child to the LEA.

The proposed amendment to §350.1217, Local Education Agency Transition Conference, updates the title of the rule to "Local Educational Agency Transition Conference." The proposed amendment also clarifies that the ECI subrecipient, with parental approval, must convene the LEA transition conference for each child enrolled in ECI who may be eligible for ECSE. The proposed amendment outlines the minimum requirements for the LEA transition conference and the timeline and documentation requirements for the LEA transition conference. The proposed amendment also outlines requirements for the ECI subrecipient when the LEA is unable to attend the conference and adds requirements surrounding obtaining parental approval and written consent.

Subchapter N, Family Cost Share System

The proposed amendment to §350.1407, Family Cost Share System Administration, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1409, Parent Rights Related to the Family Cost Share System, makes non-substantive edits to improve readability and clarity and updates TAC citations.

The proposed amendment to §350.1417, Family Cost Share Agreement, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1419, Private Insurance, clarifies the requirement that if a parent does not provide consent to bill and release personally identifiable information to private insurance, the ECI subrecipient must bill the family up to the family's maximum charge. The proposed amendment also updates formatting and makes non-substantive edits to improve readability and clarity.

The proposed amendment to §350.1421, Insurance Premiums, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1423, Co-pays, Co-Insurance, and Deductibles, makes a non-substantive terminology revision.

The proposed amendment to §350.1425, Public Benefits and Insurance, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1427, Maximum Charge, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1429, Family Size and Adjusted Income makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1431, Texas Health and Human Services Commission Early Childhood Intervention Sliding Fee Scale, removes a reference to a fixed percentage that is no longer applicable. The proposed amendment also updates formatting.

The proposed amendment to §350.1435, Suspension of Services for Nonpayment, adds a reference to new §350.1020 and makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1437, Conditions for Provider Agency Participation, makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

The proposed amendment to §350.1439, Program Fiscal and Recordkeeping Policies makes non-substantive terminology and grammatical revisions to improve consistency and clarity.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, 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 a new regulation;

(6) the proposed rules will expand 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

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

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; do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; to receive a source of federal funds or comply with federal law; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Crystal Starkey, Deputy Executive Commissioner for Family Health Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be improved ECI services for infants and toddlers with developmental delays or disabilities because the proposal will enhance administrative efficiencies and improve clarity of processes and procedures, reducing confusion and challenges for ECI subrecipients. Additionally, the proposal adds a new credentialing pathway for early intervention specialists, which reduces barriers for ECI subrecipients when recruiting and hiring these professionals.

Victoria Grady 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 there are no changes in how required persons comply with the rules.

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 26R022" in the subject line.

SUBCHAPTER A. GENERAL RULES

STATUTORY AUTHORITY

The amendments 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.103. Definitions.

The following terms in this chapter [ words and terms, when used in this chapter, will ] have the following meanings, unless the context clearly indicates otherwise.

(1) Assessment--As defined in 34 CFR §303.321(a)(2)(ii), the ongoing procedures used by appropriate qualified personnel to assess the child's individual strengths and needs and determine the appropriate services to meet those needs throughout the period of a child's eligibility for ECI services.

(3) [ (2) ] Child--An infant or toddler under the age of three.

(4) [ (3) ] Child find--As described in 34 CFR §§303.115, 303.302, and 303.303, activities and strategies designed to locate and identify, as early as possible, infants and toddlers with developmental delay.

(6) [ (5) ] Complaint--A formal written allegation submitted to HHSC stating that a requirement of IDEA Part C or an applicable federal or state regulation has been violated.

(7) [ (6) ] Comprehensive needs assessment--The process for identifying a child's unique strengths and needs, and the family's resources, concerns, and priorities , in order to develop an IFSP. The comprehensive needs assessment:

(A) is conducted by an interdisciplinary team as defined in paragraph (31) [ (29) ] of this section; and

(B) gathers information across developmental domains regarding the child's abilities to participate in the everyday routines and activities of the family.

(8) [ (7) ] Consent--As defined in 34 CFR §303.7 and meeting all requirements in 34 CFR §303.420.

(9) [ (8) ] Co-visits--When two or more ECI professionals provide [ deliver ] different types of services to a [ the ] child at [ during ] the same [ period of ] time. A co-visit may only be used if it benefits the child more than separate services. [ Co-visits are provided when a child will receive greater benefit from services being provided at the same time, rather than individually. ]

(10) [ (9) ] Days--Calendar days.

(11) [ (10) ] Developmental delay--As defined in Texas Human Resources Code §73.001(3) and determined to be significant in compliance with the criteria and procedures in Subchapter H of this chapter (relating to Eligibility, Evaluation, and Assessment).

(12) [ (11) ] Developmental screenings--General screenings provided by the ECI program to assess the child's need for further evaluation.

(13) [ (12) ] DFPS--Department of Family and Protective Services. [ The state agency that provides family reunification services for families. These services are provided to families and children to protect the children from abuse and neglect and help the family reduce the risk of abuse and neglect. ]

(14) [ (13) ] ECI--Early Childhood Intervention.

(15) [ (14) ] ECI professional--An individual employed by or under the direction of an ECI program who meets the requirements of qualified personnel as defined in 34 CFR §303.13(c) and §303.31, and who is knowledgeable in child development and developmentally appropriate behavior, possesses the requisite education and experience, and demonstrates competence to provide ECI services.

(16) [ (15) ] ECI program-- A program that:

(A) meets [ In addition to ] the definition of early intervention service program [ as defined ] in 34 CFR §303.11 ; and [ , ]

(B) is [ a program ] operated by a subrecipient [ of HHSC ECI with the express purpose of implementing a system ] to provide ECI services to children with developmental delays and the children's [ their ] families.

(17) [ (16) ] ECI services--Individualized IDEA Part C services that:

(A) the IFSP team determines are [ determined by the IFSP team to be ] necessary to support the family's ability to enhance the [ their ] child's development ; and [ . ]

(B) meet the definitions in: [ ECI services are further defined in ]

(i) 34 CFR §303.13 ; [ and ]

(ii) 34 CFR §303.16 ; and

(iii) §350.1105 of this chapter (relating to Capacity to Provide Early Childhood Intervention Services).

(18) [ (17) ] ECSE--Early Childhood Special Education. The state and federally mandated program for young children with disabilities ages three to five , not in kindergarten, under IDEA Part B, Section 619.

(19) [ (18) ] EIS--Early intervention specialist. A credentialed professional who meets specific educational requirements established by HHSC ECI in §350.313(a) of this chapter (relating to Early Intervention Specialist) and has specialized knowledge in early childhood cognitive, physical, communication, social-emotional, and adaptive development.

(20) [ (19) ] Evaluation--The procedures used by qualified personnel to determine a child's initial and continuing eligibility for ECI services that comply with the requirements described in 34 CFR §303.21 and §303.321.

(21) [ (20) ] Face-to-face--The delivery of ECI services in-person or via telehealth.

(22) [ (21) ] FERPA--Family Educational Rights and Privacy Act of 1974, 20 U.S.C. [ USC ] §1232g, as amended, and implementing regulations at 34 CFR Part 99. Federal law that outlines privacy protection for parents and children enrolled in the ECI program. FERPA includes rights to confidentiality and restrictions on disclosure of personally identifiable information, and the right to inspect records.

(23) [ (22) ] Group services--ECI services provided by an ECI professional to no more than four children at the same time . A parent or routine caregiver must be present during group services. Group services support [ to no more than four children and their parent or parents or routine caregivers per ECI professional to meet ] the developmental needs of each child [ the individual infant or toddler ].

(24) [ (23) ] HHSC--Texas Health and Human Services Commission.

(A) HHSC has the final authority and responsibility for the administration, supervision, and monitoring of programs and activities under this system.

(B) HHSC has the final authority for the obligation and expenditure of funds and compliance with all applicable laws and rules.

(25) [ (24) ] HHSC ECI--Texas Health and Human Services Commission Early Childhood Intervention. The entity designated as the lead agency, as defined by 34 CFR §303.22. HHSC ECI is responsible for maintaining and implementing the statewide IDEA Part C system.

(26) [ (25) ] IDEA Part C--The Individuals with Disabilities Education Act, Part C, as amended in 2004.

(27) [ (26) ] IFSP--Individualized Family Service Plan as defined in 34 CFR §303.20. A written plan of care for providing ECI services and other medical, health, and social services to an eligible child and the child's family when necessary to enhance the child's development. The IFSP is considered complete when the parent has signed the IFSP and received a copy.

(28) [ (27) ] IFSP services--The individualized ECI services listed in the IFSP that have been determined by the IFSP team to be necessary to enhance an eligible child's development.

(29) [ (28) ] IFSP services pages--The standardized form designated by HHSC ECI that constitutes the required final pages of the IFSP used to record ECI services planned for the child.

(30) [ (29) ] IFSP team--An interdisciplinary team that meets the requirements in 34 CFR §303.24(b) and works collaboratively to develop, review, modify, and approve the IFSP. The IFSP team includes, at a minimum, the child's parent and at least two ECI professionals from different disciplines or professions.

(A) At least one of the ECI professionals must be the family's assigned service coordinator.

(B) At least one of the ECI professionals must be a Licensed Practitioner of the Healing Arts (LPHA). [ an LPHA. ]

(C) At least one ECI professional must have been involved in conducting the evaluation. This may be the LPHA or another professional.

(D) If the LPHA attending the IFSP meeting did not conduct the evaluation, the subrecipient must ensure that the most recent observations and conclusions of the LPHA who conducted the evaluation were communicated to the LPHA attending the initial IFSP meeting and incorporated into the IFSP.

(E) Other team members may participate by other means acceptable to the team.

(31) [ (30) ] Interdisciplinary team-- A [ In addition to the definition of multidisciplinary team as defined in 34 CFR §303.24, a ] team that includes the child's parent and [ consists of ] at least two ECI professionals from different disciplines that meets the requirements of 34 CFR §303.24. [ and the child's parent. ]

(A) One of the ECI professionals must be an LPHA.

(B) The team may include a teacher for the deaf and hard of hearing, a teacher for students with visual impairments, and a certified orientation and mobility specialist from the child's LEA, as appropriate.

(C) Professionals on the team shall share a common perspective regarding infant and toddler development and developmental delay.

(D) Professionals on the team must work collaboratively to:

(i) conduct the evaluation and assessment;

(ii) develop the IFSP; and

(iii) provide ECI services.

(32) [ (31) ] LEA--Local educational agency as defined in 34 CFR §303.23.

(34) [ (32) ] LPHA--Licensed practitioner of the healing arts. A licensed physician, registered nurse, licensed physical therapist, licensed occupational therapist, licensed speech language pathologist, licensed professional counselor, licensed clinical social worker, licensed psychologist, licensed dietitian, licensed audiologist, licensed physician assistant, licensed marriage and family therapist, licensed intern in speech language pathology, licensed behavior analyst, or advanced practice registered nurse who is an employee or a subcontractor of an ECI subrecipient. LPHA responsibilities are further described in §350.312 of this chapter (relating to Licensed Practitioner of the Healing Arts).

(35) [ (33) ] Medicaid--The medical assistance entitlement program administered by HHSC.

(36) [ (34) ] MOU--Memorandum of understanding. A written document evidencing the understanding or agreement of two or more parties regarding the subject matter of the agreement.

(37) [ (35) ] Native language--As defined in 34 CFR §303.25.

(A) When used with respect to an individual who is limited English proficient (as that term is defined in IDEA Part B, Section 602(18)), native language means:

(i) the language normally used by that individual, or, in the case of a child, the language normally used by the parents of the child; and

(ii) for evaluations and assessments conducted pursuant to 34 CFR §303.321(a)(5) and (a)(6), the language normally used by the child, if determined developmentally appropriate for the child by qualified personnel conducting the evaluation or assessment.

(B) When used with respect to an individual who is deaf or hard of hearing, blind or visually impaired, or for an individual with no written language, "native language" means the mode of communication that is normally used by the individual (such as sign language, braille, or oral communication).

(38) [ (36) ] Natural environments--As defined in 34 CFR §303.26, settings that are natural or typical for a same-aged infant or toddler without a disability. A natural environment may include the home or community settings, include the daily activities of the child and family or caregiver, and must be consistent with the provisions of 34 CFR §303.126.

(39) [ (37) ] Parent--As defined in 20 U.S.C. [ USC ] §1401(23) and 34 CFR §303.27.

(41) [ (38) ] Personally identifiable information--As defined in 34 CFR §99.3 and 34 CFR §303.29.

(42) [ (39) ] Pre-enrollment--All family-related activities from the time the referral is received up until the time the parent signs the initial IFSP.

(43) [ (40) ] Primary referral sources--As defined in 34 CFR §303.303(c).

(44) [ (41) ] Public agency--HHSC and any other state agency or political subdivision of the state that is responsible for providing ECI services to eligible children under IDEA Part C.

(45) [ (42) ] Qualifying medical diagnosis--A diagnosed medical condition that has a high probability of developmental delay as determined by HHSC, as described in §350.811 of this chapter (relating to Qualifying Medical Diagnosis).

(46) [ (43) ] Referral date--The date the child's name and sufficient information to contact the family was obtained by the subrecipient.

(47) [ (44) ] Routine caregiver--An adult who:

(A) has written authorization from the parent to participate in ECI services with the child, even in the absence of the parent;

(B) participates in the child's daily routines;

(C) knows the child's likes, dislikes, strengths, and needs; and

(D) may be the child's relative, child care [ childcare ] provider, or other person who regularly cares for the child.

(48) [ (45) ] SEA--State educational agency as defined by 34 CFR §303.3(b).

(49) [ (46) ] Service coordinator--An employee or subcontractor of an ECI subrecipient who:

(A) meets all applicable requirements in Subchapter C of this chapter (relating to Staff Qualifications);

(B) is assigned to be the single contact point for the family;

(C) is responsible for providing case management services as described in §350.405 of this chapter (relating to Case Management Services); and

(D) is from the profession most relevant to the child's or family's needs or is otherwise qualified to carry out all applicable responsibilities.

(50) [ (47) ] SRS--Specialized rehabilitative services. Rehabilitative services outlined in §350.501 of this chapter (relating to Specialized Rehabilitative Services) that promote age-appropriate development by correcting deficits and teaching compensatory skills for deficits that directly result from medical, developmental, or other health-related conditions.

(51) [ (48) ] SST--Specialized skills training. As defined by 34 CFR 303.13(b)(14). SST seeks to reduce the child's functional limitations across developmental domains, including strengthening the child's cognitive skills, positive behaviors, and social interactions.

(52) [ (49) ] Subrecipient--A local private or public agency that is approved to contract with HHSC [ with proper legal status ] and is governed by a board of directors or governing authority that accepts funds from HHSC to administer an ECI program.

(53) [ (50) ] Surrogate parent--A person assigned to act as a surrogate for the parent in compliance with IDEA Part C and this chapter.

(54) [ (51) ] TAC--Texas Administrative Code. A compilation of all state agency rules in Texas.

(55) [ (52) ] TCM--Targeted case management. Case management activities that meet criteria in §350.405(c) of this chapter [ subchapter ] and are reimbursable by Medicaid when provided to Medicaid-enrolled children who are eligible for ECI.

(56) [ (53) ] TEA--Texas Education Agency. The state agency that oversees primary and secondary public education. It is headed by the commissioner of education.

(57) [ (54) ] Telehealth services--Health care services, other than telemedicine medical services, delivered by a health professional licensed, certified, or otherwise entitled to practice in Texas and acting within the scope of the health professional's license, certification, or entitlement to a patient who is located at a different physical location than the health professional using synchronous audio-visual telecommunications or information technology.

(58) [ (55) ] U.S.C. [ USC ]--United States Code. The official codification of the general and permanent federal statutes of the United States.

§ 350.105. Safety Regulations.

(a) The subrecipient [ contractor ] must develop and implement written policies [ policy ] and procedures to address accessibility and safety regulations for all buildings and offices where ECI programs are housed.

(1) Buildings must be physically accessible to persons with disabilities.

(2) Buildings must be inspected annually by a local or state fire authority. A safety and sanitation inspection must be completed annually. If the fire or safety and sanitation inspection indicates that hazards exist, these hazards must be corrected.

(3) Buildings must comply with all requirements of any applicable licensing or regulatory body for these types of activities carried on in the building.

(b) If the subrecipient [ contractor ] provides ECI [ early childhood intervention ] services in settings other than the child's home, the subrecipient [ contractor ] must develop and implement written policies [ policy ] and procedures that address accessibility and safety issues.

(c) The subrecipient must ensure that the transportation services system for children and families complies with all local and state legal requirements. [ The contractor's system for transportation services for children and families must meet all local and state legal requirements. ]

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-202603381

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER B. PROCEDURAL SAFEGUARDS AND DUE PROCESS PROCEDURES

STATUTORY AUTHORITY

The amendments 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.203. Responsibilities.

(a) The subrecipient must: [ contractor shall be responsible for: ]

(1) establish or adopt procedural safeguards that meet the requirements of 34 CFR §303.400; [ establishing or adopting procedural safeguards that meet the requirements of the federal and state regulations listed in §350.101 of this chapter (relating to Purpose) and that also meet additional requirements of this subchapter; ]

(2) implement [ implementing ] the procedural safeguards; and

(3) provide [ providing ] oral and written explanation to the parent regarding procedural safeguards during the pre-enrollment process and at other times when parental consent is required.

(b) The subrecipient [ contractor ] must make reasonable effort to provide , at no cost to the family:

(1) appropriate interpreter or translation services in the child's native language ; [ as defined in 34 CFR §303.25 ] or

(2) other communication assistance necessary for a parent or child with limited English proficiency or communication impairments to participate in ECI services. [ early childhood intervention services. Interpreter, translation, and communication assistance services are provided at no cost to the family. ]

(c) The subrecipient [ contractor ] must provide the family a copy of the Early Childhood Intervention Parent Handbook. [ with the Early Childhood Intervention Parent Handbook. ] The subrecipient [ contractor ] must document that the subrecipient explained the following to the family: [ the following were explained: ]

(1) the family's rights;

(2) the ECI [ the early childhood intervention ] process; and

(3) ECI [ early childhood intervention ] services.

§ 350.204. Prior Written Notice.

(a) The subrecipient must provide prior written notice to the parent in [ In ] accordance with 34 CFR §303.421[ , prior written notice is required ] to inform the parent of :

(1) any actions the subrecipient [ contractor ] proposes to take or not take ; [ , ]

(2) the reason for taking or not taking the action ; [ , ] and

(3) [ to remind the parent about ] the parent's rights regarding these actions.

(b) Actions referenced under subsection (a) of this section [ These actions ] include the needs assessment and identification of the child and family's needs , evaluation, IFSP meetings, and the provision of ECI [ early childhood intervention ] services. Through prior written notice, the subrecipient [ contractor ]:

(1) provides the parent with sufficient notice of meetings to allow the parent time to prepare for the meeting and to invite other persons [ individuals ] if desired; [ they choose; ]

(2) keeps the parent informed about any action the subrecipient [ contractor ] is proposing to take or not take; and

(3) provides the parent with sufficient notice of actions the subrecipient [ contractor ] will take unless the parent exercises the parent's [ his or her ] due process rights.

§ 350.207. Parental Consent.

(a) Written parental consent provides documentation that the parent has been informed of and agrees, in writing, to the proposed action. Consent is voluntary and can be withdrawn by the parent at any time. Any action for which the parent has withdrawn consent must be stopped immediately.

(b) In addition to the requirements in 34 CFR §303.420, written parental consent must be obtained before:

(1) beginning any screening, except when performing a developmental screening on a child in the conservatorship of DFPS; [ the Texas Department of Family and Protective Services; ]

(2) conducting any evaluation or assessment procedures;

(3) providing ECI [ early childhood intervention ] services listed in the IFSP [ Individualized Family Service Plan (IFSP) ];

(4) changing the type, intensity, or frequency of ECI [ early childhood intervention ] services;

(5) contacting medical professionals and other outside sources to coordinate and gather information about the child and family;

(6) reporting personally identifiable information, including disposition of referral, electronically to statewide databases unless release is authorized without consent in FERPA [ the Family Education Rights and Privacy Act ]; or

(7) releasing personally identifiable information except as allowed by §350.241 of this subchapter [ chapter ] (relating to Release of Records).

(c) As required by 34 CFR §303.420(b), the subrecipient [ contractor ] must adopt procedures designed to inform the parent of the nature of the recommended assessment or evaluation procedures and the recommended ECI [ early childhood intervention ] services that the parent has refused. The procedures may include:

(1) providing the parent relevant literature or other materials; and

(2) offering the parent peer counseling to enhance the parent's [ their ] understanding of the value of ECI [ early childhood intervention ] and the inability to participate in the IDEA [ Individuals with Disabilities Education Act, ] Part C programs without consent.

(d) If [ a specific assessment or service is determined necessary by ] the IFSP team determined a specific assessment or service is necessary , the subrecipient must [ contractor may ] not limit or deny that assessment or service because the parent has refused consent for another service or assessment.

§ 350.211. Parent.

If [ When situations arise in which ] more than one person meets the definition of parent under[ , as defined in ] 20 U.S.C. [ USC ] §1401 and in 34 CFR §303.27, the subrecipient [ contractor ] must have a method to resolve [ of resolving ] conflicts . This method must give priority [ in a manner that gives proper deference ] to the opinions and decisions of the person or persons with the strongest [ individual or individuals who has the best ] legal right to act as the child's parent. Any written [ Written ] rules or policies developed by the subrecipient [ contractor ] must not violate other state or federal laws.

(1) The biological or adoptive parent of a child [ , unless such parent does not have legal authority to make health, educational or early childhood intervention services decisions for the child, ] has priority to act as the parent for the purposes of this chapter , unless the biological or adoptive parent's legal authority to make decisions regarding health, education, or ECI services for the child has been removed .

(2) If a judicial decree or order identifies a specific person or persons to act as the child's parent to make health, educational, or ECI services, the subrecipient must recognize [ early childhood intervention service decisions on behalf of a child, then the contractor acknowledges ] that person or persons as [ to be ] the "parent."

(A) No [ The exception to this rule is that no ] state agency, [ no ] HHSC ECI subrecipient [ contractor ] or provider, [ and no ] public agency that provides any paid services to a child , or any family member of that child may serve [ act ] as the parent for the purposes of ECI.

(B) A person [ Notwithstanding the preceding exception, an individual ] who is a biological or adoptive parent or family member of the child , and who has also been identified by a judicial decree to act as the "parent" of the child , may act as the parent for purposes of ECI, even if that person receives paid services from a state agency, HHSC ECI subrecipient or provider, or public agency. [ is not disqualified to act as parent. ]

§ 350.213. Surrogate Parents.

(a) The subrecipient must [ contractor shall ] ensure that the rights of children eligible under this chapter are protected if:

(1) no parent can be identified; or

(2) the subrecipient, [ contractor, ] after reasonable efforts, cannot discover the whereabouts of a parent.

(b) The subrecipient [ contractor ] must determine the need for and assign a surrogate parent for the child consistent with 34 CFR §303.422 and existing state laws and regulations. This must include a method for:

(1) determining whether a child needs a surrogate parent;

(2) assigning a surrogate parent within the required 30-day timeframe; and

(3) providing training to ensure that the surrogate parent [ fully ] understands the [ their ] role and responsibilities for representing [ to represent ] the best interest of the child.

(c) The subrecipient must use the following criteria [ Criteria ] for selecting surrogates . [ are as follows. ]

(1) A person selected as surrogate must have no interest that conflicts with the interests of the child represented.

(2) A person assigned as a surrogate parent must not be : [ an employee of any state agency or a person or an employee of a person providing early childhood intervention services to the child or any family member of the child. ]

(3) A person who qualifies to be a surrogate parent is not an employee solely because he or she is paid to serve as a surrogate parent.

(4) A person selected as a surrogate parent must have knowledge and skills that ensure adequate representation of the interests of the child.

(d) A surrogate parent may represent a child in all matters related to:

(1) the evaluation and assessment of the child for ECI services ;

(2) development and implementation of the child's IFSPs, including annual evaluations and periodic reviews;

(3) the ongoing provision of ECI [ early childhood intervention ] services to the child; and

(4) any other rights established under this chapter.

§ 350.215. Early Childhood Intervention (ECI) Procedures for Filing Complaints.

(a) A person [ An individual ] or organization may submit [ file ] a written, signed complaint to HHSC, [ with the Texas Health and Human Services Commission (HHSC) ] alleging that a requirement of IDEA [ the Individuals with Disabilities Education Act, ] Part C , or applicable federal or [ and ] state regulation [ regulations ] has been violated. The complaint must state [ be in writing, be signed, and include ] the nature of the violation and include a statement of the facts supporting the allegation. [ on which the complaint is based. ]

(b) A person or organization may submit a written, signed complaint [ may be filed ] directly to [ with ] HHSC without first filing the complaint with the subrecipient [ having been filed with the contractor ] or local program.

(c) HHSC must receive the complaint [ The alleged violation must have occurred not more than ] one year of [ before ] the date of the alleged violation [ that the complaint is received by the public agency ] unless a longer period is reasonable because the alleged violation continues for that child or other children.

(d) Procedures for receipt of a complaint are as follows.

(1) All complaints received by HHSC related to ECI [ concerning early childhood intervention ] services must [ shall ] be forwarded to the HHSC Director of ECI .

(2) The HHSC Director of ECI must [ who will ] log and assign each complaint [ all complaints ], monitor [ the ] resolution [ of those complaints ], and retain copies [ maintain a copy ] of all complaints for seven years. [ a seven-year period. ]

(3) [ (2) ] A complaint must [ should ] be clearly distinguished from :

(A) a request for an administrative hearing under §100.693 of this title (relating to Administrative Hearings Concerning Individual Child Rights); [ 40 TAC Chapter 101, Subchapter E, Division 3 (relating to Division for Early Childhood Intervention Services) ] and

(B) [ from ] a request for a hearing under §350.227 of this subchapter [ chapter ] (relating to Opportunity for a Hearing) regarding [ concerning the ] requirements of FERPA. [ the Federal Education Rights and Privacy Act. ]

§ 350.217. Procedures for Investigation and Resolution of Complaints.

(a) After receiving [ receipt of ] the complaint, the HHSC [ Texas Health and Human Services Commission (HHSC) ] Director of ECI [ Early Childhood Intervention (ECI) ] assigns [ will assign ] a staff person to conduct an individual investigation, on-site if necessary, to make a recommendation to the HHSC Director of ECI for resolution of the complaint. The child's and family's confidentiality must be [ is ] protected during the complaint resolution process.

(1) The complainant has [ will have ] the opportunity to submit additional information, either orally or in writing, about the allegations in the complaint.

(2) All relevant information is [ will be ] reviewed and an independent determination made as to whether a violation of the requirements of IDEA [ the Individuals with Disabilities Education Act ] occurred.

(b) The HHSC Director of ECI resolves [ will resolve ] the complaint within 60 days of receiving the complaint. [ the receipt date. ]

(c) The HHSC Director of ECI may extend the 60-day timeframe [ An extension of the time limit under subsection (b) of this section shall be granted ] only if exceptional circumstances exist with respect to a particular complaint , and all parties agree .

(d) Complainants shall be informed in writing of the final decision of the HHSC Director of ECI. The HHSC Director of ECI's written decision to the complainant must [ will ] address each allegation in the complaint and contain:

(1) findings of fact and conclusions; and

(2) reasons for the final decision.

(e) To ensure effective implementation of the HHSC Director of ECI's final decision and to achieve compliance with any corrective actions, the HHSC Director of ECI assigns [ will assign ] a staff person to provide technical assistance and appropriate follow-up to the parties involved in the complaint as necessary.

(f) As required by 34 CFR §303.432, when a [ In resolving a ] complaint results in a determination that the ECI subrecipient did not provide [ in which there is a finding of failure to provide ] appropriate services, the HHSC Director of ECI corrects [ will remediate ] the denial of those services . Correction may include [ , including , ] as appropriate : [ , ]

(1) compensatory services or [ the awarding of ] monetary reimbursement ; [ or ]

(2) other corrective actions that address [ action appropriate to ] the needs of the child and the child's family; or

(3) services provided to all ECI-eligible children and families of those children in the future. [ and appropriate future provision of services for all infants and toddlers with disabilities and their families. ]

(g) When a complaint is filed, the HHSC Director of ECI will offer mediation services as an alternative to proceeding with the complaint investigation. Mediation may be used when both parties agree to it. A parent's right to a due process hearing or complaint investigation will not be denied or delayed because the parent chose to participate in mediation. The complaint investigation will continue and be resolved within 60 days even if mediation is used as the resolution process.

(h) If HHSC ECI receives a written complaint [ is received ] that is also the subject of a request for an administrative hearing under §100.693 of this title (relating to Administrative Hearings Concerning Individual Child Rights) [ 40 TAC Chapter 101, Subchapter E, Division 3 (relating to Division for Early Childhood Intervention Services) ] or a request for a hearing under §350.227 of this subchapter [ chapter ] (relating to Opportunity for a Hearing) concerning the requirements of FERPA [ the Federal Education Rights and Privacy Act ], or if the complaint contains multiple issues, including [ of which ] one or more that are part of those hearings, the part of the complaint that is being addressed in those hearings is set aside until the conclusion of the hearings. However, any issue in the complaint that is not a part of such action must be resolved within the 60-day timeline using the complaint procedures.

§ 350.218. Mediation.

(a) A [ At any time, a ] party or all parties to a dispute about the provision of appropriate ECI services, about [ involving a matter with respect to the provision of appropriate early childhood intervention services or ] a potential or actual violation of IDEA [ the Individuals with Disabilities Education Act, ] Part C or other applicable federal or Texas statutes , [ or ] regulations , or rules , may request mediation at any time. The party or parties must make the request in writing and send the request to the HHSC Director of ECI. The request for mediation must meet the following requirements. [ of that dispute by sending the request in writing to the Texas Health and Human Services Commission (HHSC) Director of Early Childhood Intervention (ECI). A request for mediation must: ]

(1) The request must be signed by the party making the request. [ be in writing and signed by the requesting party; ]

(2) The request must describe the dispute to be mediated and provide enough detail to show that the dispute involves: [ state the dispute to be mediated with some detail showing it is a matter with respect to the provision of appropriate early childhood intervention services to a particular child or children, or that it is a matter with respect to a potential or actual violation of the Individuals with Disabilities Education Act, Part C or other applicable federal or Texas statutes or regulations or rules; ]

(3) The request must identify the opposing party or parties. If the opposing party or parties have agreed to mediation, the request must include the opposing party's or parties' signatures. [ name the opposing party or parties and, if they have agreed to mediation, contain their signatures; ]

(4) The request must provide contact information for all parties, as known by the party making the request. [ give contact information for all parties to the extent known by the requestor; and ]

(5) The request must show that a copy of the request [ for mediation ] has also been sent to all other parties , or that attempts have been made to send it [ do so ], if possible.

(b) If the request for mediation is also a complaint pursuant to §350.215 of this subchapter (relating to Early Childhood Intervention (ECI) Procedures for Filing Complaints), it will be handled both as a complaint and as a request for mediation under subsection (c) of this section. If the request for mediation is also a request for a due process hearing, it will be handled both as a request for a due process hearing and a request for mediation under subsection (c) of this section. If the request for mediation does not clearly designate itself as a complaint or request for a due process hearing, or if it does not comply with the filing requirements for those procedures, it will be handled only as a request for mediation under this section.

(c) If the parties to a request for a due process hearing under §100.693 of this title [ as described in 40 TAC §101.1107 ] (relating to Administrative Hearings Concerning Individual Child Rights) reach an agreement [ agree ] to mediate the dispute according to §100.597 of this title [ in accordance with 40 TAC §101.947 ] (relating to Mediation Procedures), mediation [ those ] procedures in §100.597 of this title [ shall ] apply . Mediation must [ , but the mediation shall ] also comply with [ the ] requirements in [ of federal regulation ] 34 CFR §303.431.

(d) If the parties to a complaint filed with HHSC under §350.215 of this subchapter agree to mediate the dispute in accordance with §350.217 of this subchapter (relating to Procedures for Investigation and Resolution of Complaints), the procedures in this section apply except for those in subsections (b) and (c) of this section.

(e) If not all parties have agreed to mediation, HHSC will make reasonable efforts to contact the other parties and give them the opportunity to agree to or to decline mediation. If neither HHSC nor the requesting party is able to obtain agreement to mediate by all parties within a reasonable time, HHSC may notify the requesting party and treat the original request for mediation as having been declined by the other party or parties.

(f) The parties may agree to mediate some or all of the disputes listed [ described ] in the [ request for ] mediation request. The parties [ , and they ] may also change which [ amend the ] disputes will [ to ] be mediated by agreeing to the change in writing.

(g) If HHSC is not a party to the dispute being mediated, HHSC will not be a party to any mediation resolution agreement and will not sign it, but HHSC may assist in the enforcement of it if requested.

§ 350.219. Confidentiality Notice to Parents.

During pre-enrollment, the subrecipient [ contractor ] must give the family a copy of the HHSC Early Childhood Intervention [ ECI ] Parent Handbook publication, which contains notice that fully informs the parent about the parent's [ their ] confidentiality rights as specified in 34 CFR §303.402. The subrecipient [ contractor ] must explain the contents of the HHSC Early Childhood Intervention [ ECI ] Parent Handbook when initially providing the publication to the family and annually thereafter.

§ 350.221. Access Rights.

(a) The subrecipient must give the child's parent the opportunity to inspect and review any records related to evaluations, assessments, eligibility determination, development and implementation of the IFSP, individual complaints regarding the child, and any other records under this chapter concerning the child and the child's family.

(1) Records described in this section are subject to FERPA. [ The parent of a child eligible under this chapter must be afforded the opportunity to inspect and review any records relating to evaluations and assessments, eligibility determination, development and implementation of the IFSP, individual complaints dealing with the child, and any other area under this chapter involving records about the child and the child's family. The records are covered by FERPA. ]

(2) Any participating agency, institution, or program that [ which ] collects, maintains, or uses personally identifiable information to determine eligibility for or provide ECI services must follow the requirements of this section. [ from which information is obtained for the purpose of determining eligibility for or providing early childhood intervention services will be subject to these provisions. ]

(3) The subrecipient must respond to a parent's request to inspect and review records without unnecessary delay and must do so before any meeting regarding an IFSP or hearing related to identification, evaluation, or placement of the child. In all cases, the subrecipient must comply within 10 days after the request is made. [ The contractor shall comply with a request without unnecessary delay and before any meeting regarding an IFSP or hearing relating to the identification, evaluation, or placement of the child, and in no case, more than 10 days after the request has been made. ]

(b) The right to inspect and review records under this section includes the parent's right to:

(1) receive a response from the subrecipient [ participating contractor ] to reasonable requests for explanations and interpretations of the records;

(2) request that the subrecipient [ contractor ] provide copies of the records containing the information if failure to provide those copies would [ effectively ] prevent the parent from exercising the right to inspect and review the records; and

(3) have the parent's representative inspect and review the records.

(c) The subrecipient [ contractor ] may assume [ presume ] that the parent has authority to inspect and review records relating to the parent's [ his or her ] child unless the subrecipient [ agency ] has been advised that the parent does not have the authority under applicable state law governing such matters as guardianship, separation, and divorce.

(d) If a [ any ] record contains [ includes ] information about [ on ] more than one child, the parent of those children [ shall ] have the right to :

(1) inspect and review only the information relating to the parent's [ their ] child ; and [ or ]

(2) [ to ] be informed about [ of ] that specific information.

(e) The subrecipient [ contractor ] must, on request, provide the parent a list of the types and locations of service records collected, maintained, or used by the subrecipient. [ contractor. ]

§ 350.223. Fees for Records.

(a) The subrecipient [ contractor ] must provide the parent [ make available to parents ] an initial copy of the child's ECI [ early childhood intervention ] services record at no cost to the parent [ parents ].

(b) The subrecipient [ contractor ] may charge a fee for copies of records that [ which ] are made for the parent under this section if the fee does not [ effectively ] prevent the parent from exercising the [ their ] right to inspect and review those records.

(c) The subrecipient [ contractor ] may not charge a fee to search for or to retrieve information under this section.

(d) The subrecipient [ contractor ] must provide copies of the child's ECI records, as defined by 34 CFR §303.403, to the parent [ to parents ] according to 34 CFR §303.405 and §303.409.

§ 350.227. Opportunity for a Hearing.

The subrecipient must [ contractor shall ], on request, provide the parent an opportunity for a hearing to challenge information in the child's ECI [ early childhood intervention ] records to ensure that it is not inaccurate, misleading, or otherwise in violation of the privacy or other rights of the child. The subrecipient must ensure the hearing is [ This hearing must be ] conducted in accordance with FERPA.

§ 350.229. Minimum Requirements for Conducting a Hearing.

When conducting a hearing, the subrecipient must ensure the following FERPA requirements, at minimum, are met. [ The hearing must meet at a minimum the following FERPA requirements. ]

(1) The subrecipient [ contractor ] must hold the hearing within 30 days after receiving [ it has received ] the request for the hearing from the parent.

(2) The subrecipient [ contractor ] must give the parent notice of the date, time, and place, reasonably in advance of the hearing.

(3) The hearing may be conducted by any person, [ individual ] including an official of the subrecipient, [ contractor, ] who does not have a direct interest in the outcome of the hearing.

(4) The subrecipient [ contractor ] must give the parent a full and fair opportunity to present evidence relevant to the issues under FERPA, including[ , but not limited to, ] FERPA regulations at 34 CFR §99.21. The parent may, at the parent's [ their ] own expense, be assisted or represented by one or more persons [ individuals ] of the parent's [ his or her ] own choice, including an attorney.

(5) The subrecipient [ contractor ] must make a [ its ] decision in writing within 30 days.

(6) The decision must be based solely on the evidence presented at the hearing[ , ] and must include a summary of the evidence and the reasons for the decision.

§ 350.231. Results of Hearing.

(a) If the subrecipient [ , as a result of the hearing, the contractor ] decides , as a result of the hearing, that the information is inaccurate, misleading, or otherwise in violation of the privacy or other rights of the child or family, the subrecipient [ it ] must amend the information accordingly and so inform the parent in writing.

(b) If the subrecipient [ , as a result of the hearing, the contractor ] decides , as a result of the hearing, that the information is accurate and not misleading or otherwise in violation of the privacy or other rights of the child or family, the subrecipient [ it ] must inform the parent of the right to add a statement, in writing, about the parent's reasons for disagreeing with the subrecipient's decision. The subrecipient must maintain any statement placed in the record in accordance with 34 CFR §99.21 and all applicable requirements. [ the right to place in the record it maintains on the child or family, a statement commenting on the information or setting forth any reasons for disagreeing with the decision of the contractor. ]

(c) The subrecipient must ensure that any [ Any ] explanation placed in the records of the child or family under this section must:

(1) be maintained by the subrecipient [ contractor ] as part of the records of the child or family as long as the record or contested portion is maintained; and

(2) be disclosed along with the contested portion of the records of the child or family if the subrecipient is disclosing those records to any party. [ if the records of the child or family or the contested portion is disclosed by the contractor to any party, the explanation must also be disclosed to the party. ]

§ 350.233. Release of Personally Identifiable Information.

(a) Unless authorized to do so under 34 CFR §99.31 or the Uninterrupted Scholars Act (20 U.S.C. 1232g(b)(1)(L)) [ (Public Law 112-278) ], the subrecipient must obtain parental consent [ must be obtained ] before personally identifiable information is:

(1) disclosed to anyone who is not an official or employee of HHSC ECI or an ECI participating agency that collects or uses the information; or [ other than officials or employees of Early Childhood Intervention (ECI) participating agencies collecting or using the information; or ]

(2) used for any purpose other than meeting a requirement under this chapter.

(b) The subrecipient [ A contractor ] may request that the parent provide a release to share information with others for legitimate purposes. When requesting this release, the subrecipient must: [ However, when such a release is sought: ]

(1) inform the parent [ must be informed ] of the [ their ] right to refuse to sign the release;

(2) ensure the release form clearly lists which agencies and providers the subrecipient may send the information to and specifies the type of information that might be given to each; [ must list the agencies and providers to whom information may be given and specify the type of information that might be given to each; ]

(3) provide the parent [ must be given ] the opportunity to limit the information provided under the release and to limit the agencies, providers, and persons with whom the subrecipient may share information, and the subrecipient must ensure the [ information may be shared. The ] release form provides [ must provide ] ample space for the parent to express in writing such limitations;

(4) allow the parent to revoke the release [ must be revocable ] at any time;

(5) provide a time limit for the consent to release information form [ must have a time limit ]:

(A) not to exceed seven years after the child exits services or other applicable record retention period, as described in §350.237 of this subchapter (relating to Record Retention Period) for billing records; or

(B) not to exceed one year for all other consents to release information; and

(6) not release the information if the parent refuses to consent to the release of all or some personally identifiable information[ , the program will not release the information ].

(c) The subrecipient [ contractor ] may disclose personally identifiable information without prior written parental consent if the disclosure meets one or more of the following conditions:

(1) the disclosure is to another HHSC ECI subrecipient [ Texas Health and Human Services Commission (HHSC) ECI contractor ] during a transfer of services;

(2) the disclosure is restricted to limited personally identifiable information, [ limited personal identification, ] as defined in §350.103 [ §350.1203 ] of this chapter (relating to Definitions), being sent to the LEA [ Local Education Agency (LEA) ] for child find purposes or a child's transition from ECI to ECSE , unless the parent opted-out of the notification in accordance with §350.1213 of this chapter (relating to The Family's Right to Opt Out of the Local Educational Agency and State Educational Agency Notification); [ LEA Notification Opt Out); ]

(3) the disclosure is to DFPS [ the Texas Department of Family and Protective Services ] for the purpose of reporting or cooperating in the investigation of suspected child abuse or neglect;

(4) the disclosure is in response to a court order or subpoena;

(5) the disclosure is to a federal or state oversight entity, including:

(B) [ (A) ] United States Department of Health and Human Services, or its designee;

(C) [ (B) ] Comptroller General of the United States, or its designee;

(D) [ (C) ] Office of the State Auditor of Texas, or its designee;

(E) [ (D) ] Office of the Texas Comptroller of Public Accounts, or its designee;

(F) [ (E) ] Medicaid Fraud Control Unit of the Texas Attorney General's Office, or its designee;

(G) [ (F) ] HHSC, including:

(i) Office of Inspector General;

(ii) Medicaid and CHIP Services [ Managed Care Organization Program ] personnel from HHSC, or designee;

(iii) any other state or federal entity identified by HHSC, or any other entity engaged by HHSC; and

(iv) any independent verification and validation contractor, audit firm, or quality assurance contractor acting on behalf of HHSC;

(H) [ (G) ] state or federal law enforcement agency; or

(I) [ (H) ] State of Texas Legislature general or special investigating committee or its designee; or

(6) the disclosure meets the requirements of the Uninterrupted Scholars Act (20 U.S.C. 1232g(b)(1)(L)) , which provides that:

(A) the disclosure is to a caseworker or other representative of a State or local child welfare agency or tribal organization authorized to access the child's case plan;

(B) the child is in foster care and the child welfare agency or organization is legally responsible, in accordance with State or tribal law, for the care and protection of the student; and

(C) the disclosure must pertain to addressing the educational needs of the child.

§ 350.235. Safeguards.

(a) The subrecipient [ contractor ] must protect the confidentiality of personally identifiable information at all stages of record collection, storage, disclosure, and destruction [ stages ].

(b) The subrecipient must designate one [ One ] official to [ for each contractor shall ] assume responsibility for ensuring the confidentiality of any personally identifiable information.

(c) The subrecipient must ensure that all [ All ] persons who collect or use [ collecting or using ] personally identifiable information [ must ] receive training or instruction about [ regarding ] the state's policies and procedures.

(d) The subrecipient [ Each contractor ] must maintain, for public inspection, a current listing of the names and positions of those employees within the agency who may have access to personally identifiable information.

§ 350.237. Record Retention Period.

(a) The subrecipient [ contractor ] must retain records for seven years after the child has been dismissed from services unless a longer period is required by state or federal law.

(b) The subrecipient [ A contractor ] must allow HHSC and any authorized federal or state agency, or agency representatives, [ all appropriate federal and state agencies or their representatives ] to inspect, monitor, or evaluate all client records, books, and supporting documents related [ pertaining ] to the services provided. [ The contractor and the subcontractors must make these documents available at reasonable times and for reasonable periods. Upon request, the contractor must submit copies of their records, at no cost, to HHSC ECI, the Texas Attorney General's Office, and representatives of the United States Department of Health and Human Services. ]

(c) The subrecipient [ contractor ] must maintain [ keep ] financial documents, [ and ] supporting documents, statistical records, and any other records relevant [ pertinent ] to [ the ] services for which a claim is [ was ] submitted to HHSC ECI or its agent.

(1) The subrecipient must retain all such records for at least [ The records and documents must be kept for a minimum of ] seven years after the end of the contract period , or for at least seven years after the end of the federal fiscal year in which services were provided if the subrecipient agreement or contract does not specify a [ a contractor agreement/contract has no specific ] termination date . [ in effect. ]

(2) If any litigation, claim, negotiations, open records request, administrative review, or audit involving these records begins before the seven year period ends, [ expires, ] the subrecipient must retain all [ contractor must keep the ] records and documents for at least [ not less than ] seven years or until matters [ all litigation, claims, negotiations, open records request, administrative review, or audit finds ] are resolved , whichever period is longer .

(3) A [ The ] case is considered resolved when a final order is issued in litigation, or HHSC ECI and the subrecipient [ contractor ] enter into a written agreement.

(4) For purposes of [ In ] this section, "contract period" [ contract period ] means the time span from the beginning date to [ through ] the ending date specified in the original agreement or contract; any extension is [ agreement/contract; extensions are ] considered a separate contract period. [ periods. ]

§ 350.239. Destruction of Information.

(a) "Destroy," [ "Destruction," ] as used in this section, means to physically destroy or remove [ physical destruction or removal of ] personal identifiers from information so that the information is no longer personally identifiable.

(b) The subrecipient [ contractor ] must inform the parent when personally identifiable information collected, maintained, or used under this chapter is no longer needed to provide services to the child and family.

(c) The subrecipient must destroy information [ must be destroyed ] upon request of the parent; however, the subrecipient may maintain a permanent record of the child's name, address, telephone [ phone ] number, service dates, delivered ECI [ early childhood intervention ] services, and years completed and dismissed , [ may be maintained ] without time limitation.

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-202603382

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER C. STAFF QUALIFICATIONS

STATUTORY AUTHORITY

The amendments 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.307. Personnel Grievances.

(a) The subrecipient must develop and maintain a procedure for reviewing [ Each contractor must maintain a procedure for local review of ] personnel grievances.

(b) The subrecipient [ contractor ] must inform staff of personnel grievance procedures.

§ 350.309. Minimum Requirements for All Direct Service Staff.

(a) The following terms in this section have the following meanings, unless the context clearly indicates otherwise. [ For the purposes of this section, the following terms are defined as follows. ]

(1) Consultation--Evaluation and development of staff knowledge, skills, and abilities in the context of case-specific problem solving.

(2) [ (3) ] Observation--Watching staff interactions with children and families and providing guidance and feedback about the interaction.

(b) The subrecipient must comply with HHSC ECI requirements related to health regulations for all direct service staff. The subrecipient must comply with 2 CFR Part 3485 and Texas Health and Safety Code Chapter 81.

(c) The subrecipient must comply with HHSC ECI requirements related to initial training requirements for direct service staff. Before providing services, all staff must:

(1) with the exception of teachers of the deaf or hard of hearing, teachers of students with visual impairment, and certified orientation and mobility specialists, complete orientation training as required by HHSC ECI;

(2) hold current certification in first-aid and cardiopulmonary resuscitation for children and infants; and

(3) complete universal precautions training that aligns with recommendations from the Centers for Disease Control and Prevention.

(d) The subrecipient must comply with HHSC ECI requirements related to continuing education requirements for direct service staff. All staff providing ECI services to children and families must maintain current certification in first aid and cardiopulmonary resuscitation for children and infants.

(e) With the exception of teachers of the deaf or hard of hearing, teachers of students with visual impairments, and certified orientation and mobility specialists, the subrecipient must verify that all newly employed staff:

(1) are qualified in terms of education and experience for their assigned scopes of responsibilities;

(2) are competent to perform the job-related activities before providing ECI services; and

(3) complete orientation training as required by HHSC ECI before providing ECI services.

(f) The subrecipient must comply with HHSC ECI requirements related to supervision of direct service staff.

(1) The [ A ] subrecipient must implement a system of supervision and oversight that consists of consultation, record review, and observation from a qualified supervisor.

(2) The subrecipient must ensure supervisors meet minimum qualifications. Supervisor qualifications are further described in §350.313(e) [ §350.313(d) ] and §350.315(e) of this subchapter (relating to Early Intervention Specialist and Service Coordinator, respectively).

(g) The subrecipient must follow all training requirements mandated by HHSC ECI.

§ 350.310. Criminal Background Checks.

(a) The subrecipient [ contractor ] must conduct [ complete ] a fingerprint-based criminal background check on every new hire, volunteer, or other person who will work [ be working ] under the authority [ auspices ] of the subrecipient [ contractor ] before [ the person has ] direct contact with children or families occurs. This requirement includes [ , including ] employees or subcontractors who previously completed [ have had ] a fingerprint-based check for [ as a requirement of their ] professional licensure.

(b) The subrecipient [ contractor ] must complete a fingerprint-based criminal background check renewal for [ on ] any employee, subcontractor, volunteer, or [ any ] other person [ who will be ] working under the authority [ auspices ] of the subrecipient [ contractor ] who has direct contact with children or families[ , ] at least once every 24 months, unless the subrecipient [ contractor ] uses Federal Bureau of Investigations (FBI) Rap Back service and receives notifications of [ and gets alerts of any ] new arrests and convictions.

(1) For any person working under the authority of the subrecipient that is [ Employees who are ] covered by the FBI Rap Back service , the subrecipient must complete a fingerprint-based criminal background check [ checks ] at least once every five years.

(2) The subrecipient must complete a [ Employees deemed "unfingerprintable" by the Texas Department of Public Safety or other fingerprinting entity must have a ] name-based background check [ completed ] every 24 months for any employee, volunteer, or other person deemed unable to be fingerprinted by the Texas Department of Public Safety or another fingerprinting entity .

(3) If the subrecipient [ If at any time a contractor ] has reason to suspect that an employee , subcontractor, volunteer, or other person with direct contact with children and families has been convicted of a crime listed [ specified ] in §745.661 of this title (relating to What types of criminal convictions may affect a subject's ability to be present at an operation?), the subrecipient [ contractor ] must immediately complete a fingerprint-based criminal background check renewal for the person [ on the employee ] in question.

(c) The subrecipient [ contractor ] must verify [ ensure ] that every LPHA who provides [ all therapists providing ] Medicaid services for [ Early Childhood Intervention ] children enrolled in ECI is properly [ are correctly ] enrolled with the Texas Medicaid Program. This requirement includes disclosing all criminal convictions and arrests as required by 1 TAC §371.1005 (relating to Disclosure Requirements). The HHSC [ Texas Health and Human Services Commission (HHSC) ] Office of Inspector General may recommend denial of [ an ] enrollment or re-enrollment based on criminal history, as specified in [ accordance with ] 1 TAC §371.1011 (relating to Recommendation Criteria).

(d) HHSC Child Care Regulation [ Licensing ] maintains three charts of criminal history requirements for persons [ people ] who regularly enter licensed child care facilities.

(1) The three charts set forth in §745.661 of this title are published on the HHSC website:

(A) Licensed or Certified Child Care Operations: Criminal History Requirements;

(B) Foster or Adoptive Placements: Criminal History Requirements; and

(C) Registered Child Care Homes and Listed Family Homes: Criminal History Requirements.

(2) The subrecipient [ contractor ] must review the [ each employee's ] criminal background check of each employee to verify [ to ensure ] that staff members who regularly enter regulated child care facilities or foster homes to provide ECI [ early childhood intervention ] services do not have any criminal convictions that would result in a prohibition from [ an absolute bar to ] entering those facilities or homes [ them ] in accordance [ compliance ] with §745.661 of this title.

(e) If a criminal background check reveals criminal convictions that are not on the HHSC Child Care Regulation [ Licensing ] charts of criminal history requirements or would result in the person [ individual ] being eligible for an [ a ] HHSC Child Care Regulation [ Licensing ] risk assessment, the program director may conduct a risk assessment. The risk assessment process must include, at a minimum, consideration of:

(1) the number of convictions;

(2) the nature and seriousness of the crime;

(3) the age of the person [ individual ] at the time the crime was committed;

(4) the relationship of the crime to the person's [ individual's ] fitness or capacity to serve in the role of an ECI [ early childhood intervention ] professional;

(5) the amount of time that has elapsed since the person's last conviction; and

(6) any relevant information the person [ individual ] provides or otherwise demonstrates.

§ 350.311. Licensed Professionals.

(a) The subrecipient [ contractor ] must comply with HHSC ECI requirements related to minimum qualifications for a licensed professional. [ professionals. ]

(b) The subrecipient [ contractor ] must verify and document that a licensed professional: [ professionals ]

(1) holds [ hold ] a current license issued by the State of Texas in good standing in the licensed professional's [ his or her ] discipline ; and

(2) practices [ practice ] within the scope of the licensed professional's [ his or her ] specific state licensure laws and regulations.

(c) [ (b) ] A licensed professional must comply with the established licensing board requirements for the licensed professional's discipline for continuing education , providing and receiving supervision , and conduct.

§ 350.313. Early Intervention Specialist.

(a) The subrecipient must comply with HHSC ECI requirements related to minimum qualifications for an EIS.

(b) [ (1) ] A person [ An individual ] who meets one of the following criteria is eligible for EIS credentialing.

(1) [ (A) ] Was [ Be ] registered as an EIS before September 1, 2011.

(3) [ (B) ] Has [ Hold ] a bachelor's or graduate degree from an accredited university with:

(A) [ (i) ] academic transcripts reflecting the successful completion of required coursework for an EIS, designated by HHSC ECI; or

(B) [ (ii) ] documentation reflecting at least three years of experience providing special instruction, as defined in 34 CFR §303.13(b)(14), to infants and toddlers with developmental delays or disabilities and the infants' and toddlers' families while employed by an IDEA Part C Program in the United States or a United States territory within the past 10 years. [ three years of experience within the last ten years working for an IDEA Part C program in the United States or a United States territory providing special instruction, as defined in 34 CFR §303.13(b)(14), or SST, as defined in §350.501(a)(4) of this chapter (relating to Specialized Rehabilitative Services), to infants and toddlers with developmental delays or disabilities and their families. ]

(4) [ (C) ] If a person [ an individual ] lacks some of the required coursework referenced in paragraph (3) [ (1)(B)(i) ] of this subsection, the person [ they ] may complete applicable contact hours of continuing education:

(A) [ (i) ] up to the maximum amount set by HHSC ECI; and

(B) [ (ii) ] that meets HHSC ECI requirements.

(c) [ (b) ] The subrecipient must comply with HHSC ECI requirements related to initial credentialing for an EIS.

(1) Before the subrecipient can create an employee record for an EIS on the EIS Registry, the EIS [ An EIS ] must read and sign the EIS code of ethics [ prior to the creation of an employee record on the EIS Registry ].

(2) An EIS must complete the current orientation to ECI training, as designated by HHSC ECI, and develop an Individualized Professional Development Plan (IPDP) [ IPDP ] with the [ their ] supervisor within 30 days after the EIS's hire date.

(3) An EIS must complete the EIS IPDP no more than one year after the [ their ] hire date.

(d) [ (c) ] The subrecipient must comply with HHSC ECI requirements related to the biennial renewal of the EIS credential. Every two years after obtaining the EIS credential, an EIS must complete a minimum of:

(1) [ (A) ] 20 contact hours of continuing professional education (CPE) that has been approved by the [ their ] supervisor; and

(2) [ (B) ] three contact hours of CPE in ethics that has been approved by the [ their ] supervisor.

(e) [ (d) ] The subrecipient must comply with HHSC ECI requirements related to supervision of an EIS.

(1) The subrecipient must provide supervision for an EIS as defined in §350.309(f) of this subchapter (relating to Minimum Requirements for All Direct Service Staff) as required by HHSC ECI.

(2) An EIS supervisor must:

(A) have two years of experience providing ECI services, or two years of experience supervising staff who provide ECI services to children and families; and

(B) meet the minimum requirements in subsection (b) [ (a) ] of this section.

(f) [ (e) ] Requirements for EIS active status, EIS past due status, and EIS inactive status are as follows.

(1) Only an EIS with active status is allowed to provide ECI services to children and families.

(2) An EIS on past due status or inactive status may not perform any ECI services.

(A) An EIS goes on past due status when:

(i) the EIS fails to complete initial credentialing or renewal activities by the designated due date; or

(ii) the EIS transfers from another ECI program and the EIS's supervisor does not approve the EIS's [ fails to complete the ] orientation to ECI within 30 days after the EIS's [ their ] hire date[ , unless the EIS has documentation that they have completed the current orientation module ].

(B) An EIS goes on inactive status when :

(i) the EIS is no longer employed by a subrecipient ; or

(ii) [ has ] the EIS credential is removed from the EIS's [ their ] record in the Texas Kids Intervention Database System.

(C) If, due to exceptional circumstances, an EIS is unable to submit documentation of completion of credentialing activities by the designated due date, the EIS's supervisor must contact the HHSC ECI EIS credentialing specialist as soon as the supervisor [ he or she ] is aware the due date will not be met. The credentialing specialist and the credentialing specialist's [ his or her ] supervisor will work with the EIS [ EIS's ] supervisor and the EIS to determine an appropriate course of action.

(g) [ (f) ] Requirements for reinstating EIS active status are as follows.

(1) If an [ An ] EIS is [ who has been ] on short-term past due or [ status or short-term ] inactive status , the EIS must submit the training in subsection (d) of this section for each [ must submit the required contact hours of continuing professional education and ethics training for their ] missed renewal date. [ dates. ]

(2) If an [ An ] EIS is [ who has been ] on long-term past due or [ status or long-term ] inactive status , the EIS must complete all initial credentialing activities in subsection (c) [ (b) ] of this section.

(3) EIS active status is considered reinstated after the information is entered into the EIS Registry and is approved by HHSC ECI.

(h) [ (g) ] The subrecipient must comply with HHSC ECI requirements related to ethics for an EIS.

(1) The subrecipient must establish and maintain disciplinary procedures that apply to all EISs upon violations of standards of conduct in §350.314 of this subchapter (relating to EIS Code of Ethics).

(2) An EIS who violates any of the standards of conduct is subject to the subrecipient's disciplinary procedures.

(3) The subrecipient must complete an EIS Code of Ethics Incident Report in the EIS Registry when an EIS violates any of the standards of conduct.

(i) [ (h) ] Subrecipients must contact HHSC ECI when hiring a new EIS to verify if an EIS Code of Ethics Incident Report has been recorded in the EIS Registry.

§ 350.314. EIS Code of Ethics.

An EIS must observe and comply with the following standards of conduct.

(1) An EIS must comply with the policies and procedures established by [ of ] both the subrecipient [ contractor ] and HHSC ECI.

(2) An EIS must provide services [ operate ] only within the limits of the EIS's [ boundaries provided by their ] education, training, and credentials.

(3) An EIS must take measures to avoid imposing or inflicting harm.

(4) An EIS must :

(A) truthfully represent the EIS's [ their ] services, professional credentials, and qualifications ; and [ . The EIS must ]

(B) notify [ inform ] families about [ of ] the scope and any limitations of [ their ] credentials held by the EIS .

(5) An EIS must strive to maintain and improve [ their ] professional knowledge, skills, and abilities.

(6) An EIS must maintain the confidentiality of families served by the subrecipient's [ contractor's ] ECI program in accordance with the policies and procedures of HHSC ECI.

(7) An EIS must establish professional boundaries and avoid establishing dual relationships or conflicts of interest with families. An EIS must immediately report any [ Any ] prior relationships with a family member [ must be reported ] to the EIS's supervisor [ immediately ].

(8) An EIS must not engage in sexual or intimate relationships with any family member of a child enrolled in the ECI program that employs the EIS [ Sexual or intimate relationships between an EIS and family members of a child enrolled in the contractor's ECI program that employs the EIS are prohibited ] during the child's enrollment and for three years after the enrollment ends [ child is no longer enrolled ].

(9) An EIS must not enter into a financial relationship with any family member of a child enrolled in the ECI program that employs the EIS during the child's enrollment. [ Financial relationships between the EIS and family members of a child enrolled in the contractor's ECI program that employs the EIS are prohibited during the child's enrollment. ]

(10) An EIS must not use the [ exploit their ] position of trust and influence with a family to gain personal benefit [ by benefiting ] from relationships established as an EIS.

(11) An EIS must not provide direct service while impaired, including impairments that are due to the use of medication, illicit drugs, or alcohol.

(12) An EIS must not falsify documentation.

(13) An EIS must not deny services within the EIS's credentialed scope based on discrimination under Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), or Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.). [ refuse to provide services for which they are credentialed on the basis of a child's or family's gender, race, ethnicity, color, religion, national origin, sexual orientation, political affiliation, socioeconomic status, or disability. ]

(14) An EIS must make reasonable efforts to ensure that families receive appropriate services when the EIS is unavailable or anticipates discontinued employment with the subrecipient [ contractor ].

(15) An EIS has a professional obligation to report unethical behavior demonstrated by colleagues throughout the ECI system to the EIS's [ their ] program director and to the appropriate board or state agency.

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-202603383

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER D. CASE MANAGEMENT FOR INFANTS AND TODDLERS WITH DEVELOPMENTAL DISABILITIES

STATUTORY AUTHORITY

The amendments 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.405. Case Management Services.

(a) Case management services may be provided via telehealth with the prior written consent of the parent. If the parent declines to consent to telehealth services, case management must still be provided.

(b) All case management activities must be documented in the child's record. Case management activities include:

(1) coordinating the performance of evaluations and assessments;

(2) facilitating and participating in the development, review, and evaluation of the IFSP in accordance with Subchapter J of this chapter (relating to Individualized Family Service Plan);

(3) supporting families to meet their needs by:

(A) assisting families with identifying unmet needs;

(B) assisting families with identifying available providers of services and supports;

(C) making appropriate referrals and facilitating applications for services and supports; and

(D) assisting with initial and ongoing contact to obtain services from medical, social, and educational providers to address identified needs and achieve goals specified in the IFSP;

(4) following up with families and providers of services and supports to assist the child with timely access to services, and discussing the status of referrals to determine whether the services have met the child's identified needs, and whether ongoing assistance to ensure continued access will be necessary;

(5) monitoring and assessment of the delivery and effectiveness of services at least every six months after the IFSP is developed. This process must:

(A) be individualized and clearly related to the needs of the child and family;

(B) collect information from family members, ECI professionals, and other entities and individuals who provide services or supports to the child and family to assess whether:

(i) services are being provided in accordance with the child's IFSP;

(ii) services are adequate to meet the child's and family's needs;

(iii) all ECI professionals are effectively collaborating to address the child's and family's needs; and

(iv) parents and routine caregivers are able to use the interventions being presented;

(6) adjusting the IFSP if new needs, ineffectiveness, or barriers to services are identified;

(7) assisting the parent or routine caregiver in advocating for the child;

(8) coordinating with medical and other health providers to ensure services are effective in meeting the child's and family's needs; and

(9) facilitating the child's transition to ECSE or other appropriate community services and supports.

(c) TCM is case management that meets the following criteria.

(1) The contact occurs with the parent or routine caregiver.

(2) The contact occurs face-to-face or by telephone.

(3) Contacts made in one day total at least eight minutes in duration.

(4) The desired outcome of the contact is of direct benefit to a child who is eligible for ECI services.

(5) The [ During the contact the ] service coordinator performs a case management activity as described in subsection (b) [ (a) ] of this section.

(d) TCM must be offered to all families and documented in a child's record, regardless of the child's Medicaid enrollment.

(e) Case management activities not defined as TCM occur when the service coordinator performs a case management activity as defined in subsection (b) [ (a) ] of this section; and

(1) the contact is with individuals other than a parent or routine caregiver;

(2) the desired outcome of the contact is not of direct benefit to a child who is eligible for ECI services;

(3) the contact is less than eight minutes in duration; or

(4) the contact does not occur face-to-face or by telephone.

§ 350.409. Conditions for Case Management Provider Agency Participation.

In order to be reimbursed for services specified in §350.405 of this subchapter (relating to Case Management Services), a provider must:

(1) be a subrecipient of HHSC ECI [ an Early Childhood Intervention contractor of the Texas Health and Human Services Commission ];

(2) comply with all applicable federal and state laws and regulations governing the services provided;

(3) ensure that services are provided by qualified staff as specified in Subchapter C of this chapter (relating to Staff Qualifications); and

(4) be responsible for the service coordinator's compliance with this subchapter.

§ 350.417. Due Process.

(a) A Medicaid-eligible person who is denied eligibility for case management, whose request for case management is not processed promptly, or whose case management is terminated, suspended, or reduced, has the right to a fair hearing as described in [ Medicaid-eligible individuals. Any Medicaid-eligible individual whose request for eligibility for case management is denied or is not acted upon with reasonable promptness, or whose case management has been terminated, suspended, or reduced is entitled to a fair hearing in accordance with ] 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules).

(b) [ All individuals. ] If an ECI subrecipient [ Early Childhood Intervention contractor ] denies, involuntarily reduces, or ends [ terminates ] case management , an affected person may file a complaint, [ for an individual, the individual has all rights to file complaints, ] request mediation, or request a hearing . These actions must follow the requirements of [ in accordance with ] Subchapter B of this chapter (relating to Procedural Safeguards and Due Process Procedures) and §100.693 of this title (relating to Administrative Hearings Concerning Individual Child Rights). [ in accordance with 40 TAC Chapter 101, Subchapter E, Division 3 (relating to Division for Early Childhood Intervention Services). ]

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-202603384

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER E. SPECIALIZED REHABILITATIVE SERVICES

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 system, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendment affects Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.505. Conditions for Provider Agency Participation.

(1) comply with applicable federal and state laws and regulations governing the services provided;

(2) ensure that services are provided by an ECI [ Early Childhood Intervention (ECI) ] professional as defined in §350.103 of this chapter (relating to Definitions); and

(3) be responsible for the ECI professional's compliance with this subchapter.

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-202603385

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER G. REFERRAL, PRE-ENROLLMENT, AND DEVELOPMENTAL SCREENING

STATUTORY AUTHORITY

The amendments 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.704. Referral Requirements.

(a) The subrecipient must:

(1) accept referrals for children younger than 36 months of age;

(2) document in the child's ECI record the referral date, source, and reason for referral; and

(3) contact the family in a timely manner after receiving the referral.

(b) The subrecipient must follow all requirements described in this chapter when a referral is received 45 days or more before the child's third birthday.

(c) When a referral is received less than 45 days before the child's third birthday, the subrecipient is not required to conduct pre-enrollment procedures, an evaluation, an assessment, or an initial IFSP meeting. With written parental consent, if the referral information indicates the toddler is potentially eligible for ECSE services:

(1) the subrecipient must refer the child to [ notify ] the LEA; and

(2) HHSC must coordinate [ coordinates ] the notification to TEA [ the SEA ].

§ 350.705. Child Referred before Birth.

Information received regarding an unborn child becomes a referral the day the subrecipient [ contractor ] is notified of the child's birth.

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-202603386

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER H. ELIGIBILITY, EVALUATION, AND ASSESSMENT

STATUTORY AUTHORITY

The amendments and new section 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments and new section affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.809. Initial Eligibility Criteria.

(b) [ (a) A child must be younger than 36 months of age and meet initial eligibility criteria to receive ECI services. ] Initial eligibility is established by:

(1) documentation confirming that the child has a medically diagnosed condition that is highly likely to result in a developmental delay; [ of a medically diagnosed condition that has a high probability of resulting in developmental delay; ]

(2) meeting the TEA criteria provided in 19 TAC §89.1040 (relating to Eligibility Criteria) for: [ definition of deaf or hard of hearing or criteria for a visual impairment provided in 19 TAC §89.1040 (relating to Eligibility Criteria); or ]

(3) a developmental delay that the subrecipient has [ , which must be ] evaluated as described in 34 CFR §303.321 and [ the delay is ] determined based on:

(A) an evaluation using a standardized tool designated by HHSC ECI that indicates a delay of at least 25 percent in one or more of the following developmental areas:

(i) communication;

(ii) cognitive;

(iii) gross motor;

(iv) fine motor;

(v) social emotional; or

(vi) adaptive;

(B) an evaluation using a standardized tool designated by HHSC ECI that indicates a delay of at least 33 percent if the child's only delay is in expressive communication; or

(C) a qualitative determination of delay, as defined in §350.821 of this subchapter (relating to Qualitative Determination of Developmental Delay).

(c) [ (b) ] A child must meet the same eligibility standards in subsection (b)(3)(A) or (b)(3)(B) [ (a)(3)(A) or (a)(3)(B) ] of this section on the designated supplemental protocol [ tool ] to qualify for a qualitative determination of delay unless the child has an adjusted age or chronological age of under three months.

§ 350.813. Deaf or Hard of Hearing.

(a) The interdisciplinary team must [ may ] not determine that a child who [ ineligible if the child ] is suspected to be deaf or hard of hearing is not eligible for ECI until all evaluations and assessments required in §350.809 of this subchapter (relating to Initial Eligibility Criteria) and this section are complete and have been [ completed and ] reviewed by the interdisciplinary team.

(b) During each child's evaluation to determine eligibility, the [ The ] interdisciplinary team must identify whether the child has a [ determine any ] need for [ further ] hearing testing by analyzing risk factors and evaluation results . [ during every evaluation to determine eligibility. ]

(1) Evaluation results must include the items listed in §350.809 of this subchapter. [ (relating to Initial Eligibility Criteria). ]

(2) The interdisciplinary team may use a [ A ] hearing screening tool [ may be used ] when an evaluation tool is not administered for a child who is eligible based on a medical diagnosis or a child who meets the criteria of having a visual impairment as defined by 19 TAC §89.1040 (relating to Eligibility Criteria).

(c) If the interdisciplinary team determines the child needs [ The subrecipient must refer the child to a licensed audiologist if the child has been identified as having a need for further ] hearing testing and the child has not had a hearing test within the past six months , the subrecipient must refer the child to a licensed audiologist and help the family get a hearing test. [ prior to identifying the need. ]

(1) The [ If necessary to access a licensed audiologist, the ] subrecipient may refer the child to the child's primary health care provider to help access a licensed audiologist .

(2) The referral must be made:

(A) within five business [ working ] days; and

(B) with written parental consent.

(e) [ (d) ] A child is eligible for ECI under the criteria of deaf or hard of hearing if the child's record [ If the subrecipient receives a hearing test that ] indicates the child is experiencing a developmental delay because of hearing loss or impairment, or the child [ deaf or hard of hearing or receives documentation that the child ] has a physical or mental [ medical ] condition that has a high probability of resulting in a developmental delay and sensory impairment, in accordance with 34 CFR §303.21. [ the subrecipient mustenroll the child and make a referral to the LEA. ]

(g) [ (e) ] The subrecipient must also refer any child who uses amplification to the LEA.

(h) [ (f) ] The certified teacher of the deaf and hard of hearing [ Certified Teacher of the Deaf and Hard of Hearing ] from the LEA participates in the service planning process as part of the interdisciplinary team and, with written parental consent, completes any necessary evaluations.

§ 350.815. Visual Impairment.

(a) The interdisciplinary team must [ may ] not determine a child who is suspected to be blind or visually impaired is not eligible for ECI [ ineligible if the child is suspected to be blind or visually impaired ] until all evaluations and assessments required in §350.809 of this subchapter (relating to Initial Eligibility Criteria) and this section are complete [ have been completed ] and have been reviewed by the interdisciplinary team.

(b) During each child's evaluation to determine eligibility, the [ The ] interdisciplinary team must identify whether the child has a [ determine any ] need for further vision testing by analyzing risk factors and evaluation [ results during every evaluation to determine eligibility ].

(1) Evaluation results must include the items listed in §350.809 of this subchapter. [ (relating to Initial Eligibility Criteria). ]

(2) The interdisciplinary team may use a [ A ] vision screening tool [ may be used ] when an evaluation tool is not administered for a child who is eligible based on a qualifying medical diagnosis or because the child meets the definition of deaf or hard of hearing in 19 TAC §89.1040 (relating to Eligibility Criteria).

(c) If the interdisciplinary team determines the child needs [ The subrecipient must refer the child to an ophthalmologist or optometrist if the child has been identified as having a need for further ] vision testing and the child has not had a vision test within the past six months , the subrecipient must refer the child to an ophthalmologist or optometrist and help the family receive the vision test. [ prior to identifying the need. ]

(1) The subrecipient [ If necessary to access an ophthalmologist or optometrist, the subrecipient ] may refer the child to the child's primary health care provider to help access an ophthalmologist or optometrist .

(2) The referral must be made:

(A) within five business [ working ] days; and

(B) with written parental consent.

(e) [ (d) ] A child is eligible for ECI under the criteria for visual impairment if the child's record indicates the child is experiencing a developmental delay because of vision loss or impairment, or [ If the subrecipient receives a vision test that indicates the child is blind or visually impaired or receives documentation that ] the child has a physical or mental condition that has a high probability of resulting in a developmental delay and a sensory impairment, in accordance with 34 CFR §303.21. [ the subrecipient must enroll the child and make a referral to the LEA. With written parental consent consistent with §350.207 of this chapter (relating to Parental Consent), the subrecipient must also refer the child to the local office of the Health and Human Services Blind Children's Vocational Discovery and Development Program. ]

(g) [ (e) ] The certified teacher of students with visual impairments and the certified orientation and mobility specialist from the LEA participate in the service planning process as part of the interdisciplinary team and, with written parental consent, complete any necessary evaluations.

§ 350.825. Eligibility Statement.

(a) The interdisciplinary team must document eligibility decisions regarding a child on an eligibility statement containing the elements required by HHSC ECI.

(b) The eligibility statement must document the eligibility criteria that applies to the child. Only one of the following eligibility types may be listed on the eligibility statement:

(1) a qualifying medical diagnosis;

(2) meeting the criteria for deaf or hard of hearing , deaf-blindness, or a visual impairment as defined by the TEA; or

(3) completion of the elements required by HHSC ECI for a determination of developmental delay.

(c) The eligibility statement must be:

(1) completed for every child evaluated;

(2) maintained in the child's record; and

(3) updated when eligibility is re-determined.

(d) The eligibility statement is valid:

(1) for 12 months if the child is younger than 21 months of age when eligibility is determined;

(2) until the child's third birthday for a child whose eligibility was determined at 21 months of age or older; or

(3) for six months from the initial eligibility determination if eligibility was based on a qualitative determination of developmental delay.

(e) If new information about additional qualifying criteria is discovered, the new information is documented in the child's record. The eligibility statement does not need to be changed or updated until eligibility is re-determined.

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-202603387

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER J. INDIVIDUALIZED FAMILY SERVICE PLAN (IFSP)

STATUTORY AUTHORITY

The amendments and new section 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments and new section affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.1009. Participants in Initial and Annual Individualized Family Service Plan Meetings.

(a) The initial IFSP meeting and each annual meeting to evaluate the IFSP must be conducted by the IFSP team as defined in §350.103 of this chapter (relating to Definitions) and 34 CFR §303.343(a).

(b) With parental consent, the subrecipient must also invite to the initial IFSP meeting and annual meetings to evaluate the IFSP:

(1) Early Head Start or Migrant Head Start staff members, if the family is jointly served by either of these programs; and

(2) representatives from other agencies serving or providing case management to the child or family, including Medicaid managed care programs.

(c) If a child:

(1) is documented to be deaf or hard of hearing as described in §350.809(b)(2) [ §350.809(2) ] of this chapter (relating to Initial Eligibility Criteria), the IFSP team for an initial IFSP meeting and annual IFSP evaluation meetings must include a certified teacher of the deaf and hard of hearing; [ or ]

(2) has a documented visual impairment as described in §350.809(b)(2) [ §350.809(2) ] of this chapter [ (relating to Initial Eligibility Criteria) ], the IFSP team for an initial IFSP meeting and annual IFSP evaluation meetings must include a certified teacher of students with visual impairments and a certified orientation and mobility specialist ; or [ . ]

(e) [ (d) ] Unless there is documentation that the LEA has waived notice, the subrecipient must:

(1) provide the certified teacher and certified orientation and mobility specialist, if applicable, required in subsection (c) of this section at least a 10-day written notice before :

(A) the initial IFSP meeting ; [ , ]

(B) any annual meetings to evaluate the IFSP ; [ , ] or

(C) any review and evaluation when issues will be addressed that are related to or affected by the child being deaf, hard of hearing, deaf-blind, or having a visual impairment; [ or visually impaired; ] and

(2) keep documentation of the notice in the child's record.

(f) [ (e) ] The IFSP team cannot plan deaf and hard of hearing or vision services or make any changes that affect those services if the certified teacher or certified orientation and mobility specialist required in subsection (c) of this section is not in attendance.

(g) [ (f) ] The certified teacher and the certified orientation and mobility specialist required in subsection (c) of this section are [ is ] not required to attend an IFSP review when the following criteria are met, but the subrecipient must obtain the teacher's input.

(1) The IFSP review does not affect the child's vision or hearing services.

(2) Changes made during the IFSP review are not affected by the child's hearing or visual status.

(i) [ (h) ] The certified teacher of the deaf and hard of hearing , [ and ] the certified teacher of the students with visual impairments , the certified teacher of students who are deaf-blind, and the certified orientation and mobility specialist required in subsection (c) of this section may submit a request within 10 [ five ] days of the IFSP meeting to have another IFSP meeting if the teacher disagrees with any portion of the IFSP.

§ 350.1017. Periodic Reviews.

(a) The IFSP team must complete each periodic review in a meeting or by another means that is acceptable to the parents and other participants: [ Each periodic review must be conducted by individuals who meet the requirements in 34 CFR §303.343(b) and be completed in compliance with 34 CFR §303.342(b). The periodic review may be carried out by a meeting or by another means that is acceptable to the parents and other participants. ]

(b) The child's record must contain documentation that includes all required elements designated by HHSC ECI.

(1) Participation in the periodic review may be accomplished by a team member attending the meeting face-to-face or by telephone or by providing input and information in advance of the meeting.

(2) If a team member participates by means other than a face-to-face meeting, the team member must :

(A) provide [ give ] the service coordinator the [ his or her ] most recent observations and conclusions about the child ; [ , ] and

(B) [ the team member must ] document how and when the information was shared.

(3) If the team member is an LPHA who is not providing ongoing services to the child, the team member [ he or she ] must have assessed the child face-to-face within the previous 45 days.

(c) The IFSP team must conduct a periodic review [ A periodic review is required ] at least every six months.

(d) The IFSP team must conduct a periodic review at any time [ Additional periodic reviews of the IFSP are conducted more frequently than six-month intervals ] if requested by the parent or other IFSP team members.

(e) The periodic review of the IFSP consists of the following actions, which must be documented in the child's ECI record and be provided to the parent:

(1) a review of the child's progress toward meeting each goal on the IFSP and the child's functional abilities related to the goal;

(2) a review of the current developmental needs of the child ; [ and the needs of the family related to their ability to meet the developmental concerns and priorities; ]

(4) [ (3) ] a review of the case management needs of the child and the family;

(5) [ (4) ] the development of new goals or the modification of existing goals, as appropriate, that must be dated and attached to the IFSP; and

(6) [ (5) ] the reasons for any modification to the planned services [ plan ] or the rationale for not changing the planned services [ plan ].

(f) If the IFSP team adds transition steps and transition services as part of the periodic review, the team must follow the requirements in §350.1207(d) of this chapter (relating to Transition Planning).

(g) If the IFSP team determines that changes to the type, intensity, or frequency of services are required:

(1) the IFSP team must complete [ completes ] the IFSP services pages and provide [ provides ] a signed copy to the parent;

(2) the IFSP team must document the rationale for:

(A) a change in intensity or frequency of a service;

(B) the addition of a new service; or

(C) the discontinuation of a service; and

(3) the subrecipient must continue to provide planned ECI services not affected by the change while the IFSP team finalizes revisions to [ develops ] the IFSP [ revision ] and gathers required signatures.

(h) If services remain the same, the documentation must describe the rationale for making no changes and for recommending continued services.

(i) If new goals are developed, the documentation must be provided to the parent.

(j) A change of service coordinator does not require a periodic review.

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-202603388

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER K. SERVICE DELIVERY

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 system, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendment affects Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.1105. Capacity to Provide Early Childhood Intervention Services.

The subrecipient [ contractor ] must have the capacity to provide all ECI [ early childhood intervention ] services in 34 CFR §303.13 and additional ECI [ early childhood intervention ] services described in this chapter. These services are as follows. [ the following: ]

(1) Assistive Technology Device and Service--As defined in 34 CFR §303.13(b)(1).

(2) Audiology Services--As defined in 34 CFR §303.13(b)(2), plus services provided by LEA [ local educational agency ] personnel, including sign language and cued language services as defined in 34 CFR §303.13(b)(12).

(3) Behavioral Intervention--Services delivered through a structured plan to strengthen developmental skills while specifically addressing severely challenging behaviors as determined by the IFSP [ Individualized Family Service Plan (IFSP) ] team. The behavior plan is developed by the IFSP team [ (that includes the plan supervisor) ] to:

(A) identify goals;

(B) conduct a functional assessment to determine the motivation for the behavior;

(C) develop a hypothesis;

(D) design support plans; and

(E) implement, monitor, and evaluate outcomes.

(4) Counseling--As family training, counseling, and home visits are defined in 34 CFR §303.13(b)(3). Counseling is provided when the nature and quality of the parent-child relationship interferes significantly with the ECI-enrolled [ Early Childhood Intervention ] child's development. Counseling focuses on the parent-child relationship or other critical care-giving relationships and helps the child meet developmental outcomes.

(5) Family Education and Training--As family training, counseling, and home visits are defined in 34 CFR §303.13(b)(3). Family education and training is provided when the family needs information about general parenting techniques or environmental concerns. Information provided follows a specific scope and sequence. Information may be based on general child care, developmental education, or other specific curriculum. Family Education and Training can be provided to parents in group settings without the children present.

(6) Health Services--As defined in 34 CFR §303.16.

(7) Medical Services--As defined in 34 CFR §303.13(b)(5).

(8) Nursing Services--As defined in 34 CFR §303.13(b)(6).

(9) Nutrition Services--As defined in 34 CFR §303.13(b)(7).

(10) Occupational Therapy--As defined in 34 CFR §303.13(b)(8).

(11) Physical Therapy--As defined in 34 CFR §303.13(b)(9).

(12) Psychological Services--As defined in 34 CFR §303.13(b)(10).

(13) Service Coordination--As defined in 34 CFR §303.13(b)(11) and includes all requirements in 34 CFR §303.34.

(14) Social Work Services--As defined in 34 CFR §303.13(b)(13).

(15) Sign Language and Cued Language--As defined in 34 CFR §303.13(b)(12).

(16) Specialized Skills Training--As defined in §350.103 of this chapter (relating to Definitions) [ Subchapter E of this chapter (relating to Specialized Rehabilitative Services) ] plus the provision of special instruction as defined in 34 CFR §303.13(b)(14).

(17) Speech-Language Pathology Services--As defined in 34 CFR §303.13(b)(15) and can include sign language and cued language services as defined in 34 CFR §303.13(b)(12).

(18) Targeted Case Management--As defined in Subchapter D of this chapter (relating to Case Management for Infants and Toddlers with Developmental Disabilities).

(19) Transportation and Related Costs--As defined in 34 CFR §303.13(b)(16).

(20) Vision Services--As defined in 34 CFR §303.13(b)(17) plus services provided by LEA [ local educational agency ] personnel.

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-202603389

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER L. TRANSITION

STATUTORY AUTHORITY

The amendments and new section 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments and new section affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.1203. Definitions.

The following terms in this subchapter [ words and terms, when used in this subchapter, will ] have the following meanings, unless the context clearly indicates otherwise.

(1) Community transition meeting--A meeting held to discuss how the subrecipient will assist the family with transitioning from ECI services to community services, activities, places, or programs that the family would like the child to participate in after exiting ECI services.

(2) LEA notification--A notification sent to the LEA of a child who is potentially eligible for ECSE services. The LEA treats this notification as a referral for ECSE services.

(3) [ (4) ] LEA transition conference--A meeting to discuss ECSE services and eligibility determination for children who are potentially eligible for ECSE services.

(5) [ (6) ] Transition planning--The process of identifying and documenting appropriate steps and transition services to support the child and family to smoothly and effectively transition from ECI services to ECSE services or other community services, activities, places, or programs that the family would like the child to participate in after exiting ECI services.

§ 350.1205. Transition Education and Information for the Family.

(a) At the first meeting with the family after a child is referred to ECI, the subrecipient [ the referral, the contractor ] must explain to the family :

(1) circumstances that would cause the child to no longer meet the eligibility requirements for early intervention services; and

(2) the ECI [ Early Childhood Intervention ] transition process.

(b) The subrecipient [ contractor ] must provide the enrolled family with an overview of transition concepts and activities, including:

(1) ways to plan ahead and help the child adjust to and function in new settings;

(2) future placement options for the child such as ECSE services through the LEA, [ Local Education Agency (LEA) special education services, ] community child care settings, private therapy, and home care;

(3) referral and contact information for [ relevant advocacy groups, ] local resources, parent support organizations, Medicaid programs, including waiver programs offering long-term services and supports if the child has a condition that would make them eligible for waiver programs, and other governmental agencies; and

(4) requirements for the LEA notification and SEA notification of potential eligibility for ECSE and the family's right to opt out of these notifications. [ LEA Notification requirements and the LEA Notification Opt Out option. ]

(c) The subrecipient [ contractor ] must document the transition conversation with the family in a progress note.

§ 350.1209. State Educational [ Education ] Agency Notification.

HHSC ECI must coordinate [ coordinates ] the SEA notification for [ of ] children potentially eligible for ECSE[ , ] in compliance with 34 CFR §303.209(b).

(1) HHSC must notify TEA [ will send notification ] of children who are potentially eligible for ECSE : [ services to the SEA ]

(A) at least 90 days before the [ each ] child's third birthday ; [ , ] or

(B) as soon as possible for children who are determined eligible for ECI services more than 45 but less than 90 days before the child's third birthday.

(2) With written parental consent, HHSC ECI will refer the child directly to TEA if: [ If a referral is received for a child fewer ]

(A) the child is referred less than 45 days before the child's third birthday ; and

(B) the child may be potentially eligible for ECSE services . [ , HHSC will, with written parental consent, refer the child directly to the SEA. ]

§ 350.1211. Local Educational [ Education ] Agency Notification of Potential Eligibility for Early Childhood Special Education Services.

(a) The IFSP team must determine [ determines ] if a child who is 24 months [ two years ] old or older receiving ECI services is potentially eligible for ECSE.

(b) If the IFSP team determines the child is potentially eligible for ECSE, the subrecipient must send a notification of potential eligibility for ECSE [ provide notification ] to the LEA as soon as possible, unless the parent opts out of the disclosure as described in §350.1213 of this subchapter (relating to The Family's Right to Opt Out of the Local Educational [ Education ] Agency and State Educational Agency Notification).

(1) The notification must include all required elements designated by HHSC ECI, which includes sharing the child's limited personally identifiable information. [ Written parental consent is not required for the subrecipient to send the LEA Notification. ]

(2) The subrecipient does not need to obtain written parental consent to send the notification with [ Written parental consent is required before sending information other than the child's ] limited personally identifiable information to the LEA.

(c) With parental consent, the subrecipient must provide the date the child enrolled for IDEA Part C services. The subrecipient may provide this date with the notification of potential eligibility or when the subrecipient provides other information to the LEA as described in §350.1216 of this subchapter (relating to Early Childhood Intervention Referrals to the Local Educational Agency). [ For a child whose parent has not opted out of the disclosure as described in §350.1213 of this subchapter: ]

(d) If the subrecipient determines a child is eligible for ECI services less than 90 days and more than 45 days before the child's third birthday, the subrecipient must determine as soon as possible whether the child is potentially eligible for ECSE services and notify the LEA in accordance with subsection (b) of this section .

(e) If the subrecipient receives a referral for a child fewer than 45 days before the child's third birthday , the subrecipient must determine whether the child is [ and the child may be ] potentially eligible for ECSE based on information included in the child's referral. [ : ]

(1) The subrecipient is not required to conduct pre-enrollment procedures, an evaluation, an assessment, or an initial IFSP meeting. [ the subrecipient must, with written parental consent, refer the child directly to the LEA; and ]

(2) If the child is potentially eligible for ECSE based on information included in the child's referral, the subrecipient must, with written parental consent, refer the child directly to the LEA. [ the subrecipient is not required to conduct pre-enrollment procedures, an evaluation, an assessment, or an initial IFSP meeting. ]

§ 350.1213. The Family's Right to Opt Out of the Local Educational [ Education ] Agency and State Educational Agency Notification.

(a) The parent may choose not to allow [ the subrecipient to ]:

(1) the subrecipient to send the child's limited personally identifiable information in a notification of potential eligibility to the LEA; and

(2) HHSC ECI to send the child's limited personally identifiable information in a notification of potential eligibility to TEA. [ notify the LEA of their child's potential eligibility for ECSE services. ]

(b) The subrecipient must explain the LEA notification and TEA notification before the parent signs the initial IFSP and annually as part of the annual meeting to review the IFSP. The subrecipient must also explain :

(1) the parent's right to opt out of the LEA notification to the parent and the consequences of opting out; and [ inform the parent of the LEA Notification requirements before the parent signs the initial IFSP and annually as part of the annual meeting to review the IFSP; and ]

(2) that by opting out of the LEA notification, HHSC ECI will not send the notification to TEA. [ explain the option to opt out of the LEA Notification to the parent and the consequences of this option. ]

(c) The parent must inform the subrecipient of the [ their ] decision to opt out of the LEA and TEA notification [ Notification ] in writing before the scheduled LEA notification date.

(d) The subrecipient must provide the parent with written communication regarding the LEA notification at least 10 days before the date the subrecipient is scheduled to send the notification. The written communication must include [ Notification that includes ] the following information:

(1) what information will be disclosed to the LEA and TEA ;

(2) the scheduled LEA notification [ Notification ] date;

(3) a clear statement that the parent must inform the subrecipient of the [ their ] decision to opt out of the LEA notification and TEA notification [ Notification ] in writing before the scheduled LEA notification date; and

(4) an explanation that the child's limited personally identifiable information will be sent to the LEA and TEA [ for LEA Notification ], unless the parent has opted out [ informs the subrecipient of their decision to opt out of the LEA Notification before the scheduled notification date ].

(e) [ (f) ] If the parent opts out of the LEA notification [ Notification ] at any time before the scheduled notification date, the subrecipient must:

(1) not send the notification of potential eligibility and the child's limited personally identifiable information to the LEA;

(2) inform the parent that even if the parent [ he or she ] opts out of the LEA notification, the parent [ Notification, he or she ] can later request that the notification of potential eligibility with the child's limited personally identifiable information be sent to the LEA and TEA ; and

(3) document in the child's record:

(A) the date the written communication regarding the LEA notification and TEA notification [ Notification ] was provided to the parent; and

(B) the parent's written request to opt out of LEA notification [ Notification ].

(f) [ (g) ] If the subrecipient determines a child is eligible for ECI more than 45 days but less than 90 days before the child's third birthday and the IFSP team determines the child is potentially eligible for ECSE [ special education ] services, the subrecipient must:

(1) immediately inform the parent of the LEA notification and TEA notification [ Notification ] requirements;

(2) explain the option to opt out of the LEA notification and TEA notification [ Notification ] to the parent and the consequences of this option; and

(3) comply with all other requirements in this section related to the family's right to opt out of the LEA notification and TEA notification [ Notification ].

§ 350.1217. Local Educational [ Education ] Agency Transition Conference.

(a) With parental approval, the subrecipient must convene the LEA transition conference for each child enrolled in ECI who may be eligible for ECSE. Parental approval is an affirmative response that the parent may give to the subrecipient verbally. [ If the parent gives approval to convene the LEA transition conference, the subrecipient must: ]

(b) The subrecipient must ensure the LEA transition conference meets the requirements in 34 CFR §303.342(d) and (e) and §303.343(a), which require: [ conduct the LEA transition conference, even if the representatives for the LEA that serves the area where the child resides do not attend, and provide the parent information about ECSE and related services, including a description of the: ]

(1) face-to-face attendance of the parent and service coordinator; and [ eligibility definitions; ]

(2) attendance of at least one other ECI professional who is a member of the IFSP team who may participate through other means as permitted in 34 CFR §303.343(a)(2). [ timelines; ]

(c) The subrecipient must: [ is not required to conduct the LEA transition conference for children referred to the subrecipient's ECI program less than 90 days before the child's third birthday. ]

(d) The subrecipient may encourage the LEA representative to participate in the meeting by telephone if unable to attend the meeting face-to-face. [ The 14-day timeline for inviting the LEA representative may be changed by written local agreement between the LEA and the subrecipient. ]

(e) If the LEA representative cannot attend the transition conference, the subrecipient must still conduct the conference and provide information about ECSE and related services to the parent, including a description of the: [ parent gives approval to have an LEA transition conference, but does not give written consent to release records to the LEA, then the subrecipient may release only limited personally identifiable information to the LEA. With written parental consent, the subrecipient may release other personally identifiable information to the LEA. ]

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-202603391

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

SUBCHAPTER N. FAMILY COST SHARE SYSTEM

STATUTORY AUTHORITY

The amendments 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, and Texas Occupations Code §55.004 and §55.0041, which requires state agencies that issue professional licenses or credentials to also offer them to military service members, military veterans, and military spouses who hold a current out-of-state license in good standing that is similar in scope of practice to the license issued by the state agency.

The amendments affect Texas Government Code §524.0151, Texas Occupations Code §55.004 and §55.0041, and Texas Human Resources Code Chapter 73.

§ 350.1407. Family Cost Share System Administration.

(a) The subrecipient [ contractor ] must administer the family cost share system in compliance with the requirements in this title, HHSC policy concerning ECI, and the contract.

(b) In compliance with 34 CFR §303.510(a) and (b) and §303.203(b)(1), IDEA Part C funding is the payor of last resort for ECI [ early childhood intervention ] services. The subrecipient [ contractor ] must:

(1) establish third-party billing systems, determine client eligibility for all third-party reimbursement sources, and complete and submit reimbursement requests to corresponding third-party sources, including private insurance, Medicaid programs, CHIP, and TRICARE;

(2) coordinate funding sources for services required under IDEA Part C; and

(3) use other funding for which the clients are eligible before billing services to the HHSC contract, which includes distribution of IDEA Part C funds.

§ 350.1409. Parent Rights Related to the Family Cost Share System.

(a) The parent has the right to:

(1) receive certain ECI [ early childhood intervention ] services at no cost in accordance with 34 CFR §303.521(b);

(2) refuse any ECI [ early childhood intervention ] services the parent does [ they do ] not wish to receive;

(3) receive information about any method the subrecipient [ contractor ] may use to verify the family's allowable deductions;

(4) receive information about how the subrecipient determines the family's [ contractor's process for determining their ] maximum charge before signing the family cost share agreement;

(5) provide written consent before [ not have their ] personally identifiable information is released for billing purposes [ without prior written consent ]; and

(6) not have [ their ] private insurance billed without prior written consent.

(b) If the family has an inability to pay, all IDEA Part C services are provided with no out-of-pocket charge to the parent. The family's inability to pay for ECI [ early childhood intervention ] services will not result in the delay or denial of ECI [ early childhood intervention ] services to the child or the family.

(c) If the parent disagrees with the subrecipient's [ contractor's ] determination of the family's ability to pay, the calculated adjusted income, or the assigned maximum charge, the parent can:

(1) request a review by the subrecipient's program director or other manager [ contractor manager or program director ];

(2) file an informal or formal complaint with the subrecipient [ contractor ];

(3) contact the HHSC Office of the Ombudsman for help resolving a problem or concern with the subrecipient [ contractor ];

(4) file a formal complaint with HHSC, in compliance with §350.215 of this chapter (relating to Early Childhood Intervention (ECI) Procedures for Filing Complaints) and 34 CFR §303.434;

(5) participate in mediation, in compliance with §350.218 of this chapter (relating to Mediation) and 34 CFR §303.431; and

(6) participate in a due process hearing, in compliance with §350.227 of this chapter (relating to Opportunity for a Hearing), §350.229 of this chapter (relating to Minimum Requirements for Conducting a Hearing), and 34 CFR §303.436 or §303.441, whichever is applicable.

(d) The subrecipient [ contractor ] must provide the parent a copy of the ECI Family Cost Share publication before the subrecipient [ contractor ] initially bills the child's third-party payor to pay for ECI [ early childhood intervention ] services.

(e) The ECI Family Cost Share publication:

(1) explains the family cost share process;

(2) describes the parent's procedural safeguards and related due process rights;

(3) notifies the parent that:

(A) parental consent must be obtained before the subrecipient [ contractor ] releases personally identifiable information to third-party payors;

(B) if the parent does not consent to the use of public or private insurance under 34 CFR §303.520(a)(2), the subrecipient [ contractor ] must still offer the [ make available those Part C ] services on the IFSP that [ to which ] the parent has consented to ;

(C) the parent has the right to withdraw [ their ] consent at any time;

(D) by using the parent's public insurance to pay for ECI services, the parent may incur potential costs for co-pays ; [ as a result of using their public insurance and potential costs such as co-pays, co-insurance, or deductibles as a result of using their private insurance to pay for early childhood intervention services; and ]

(F) [ (E) ] if the child has private insurance in addition to Medicaid, the private insurance is the primary payor and must be billed before filing a claim with Medicaid.

§ 350.1417. Family Cost Share Agreement.

(a) The parent must sign a family cost share agreement. The parent's signature acknowledges the [ their ] assigned maximum charge and provides written attestation that:

(1) information regarding third-party coverage, family size, gross income, and allowable deductions is true and accurate; or

(2) the parent chooses not to provide information regarding:

(A) third-party coverage;

(B) gross income and family size; or

(C) allowable deductions.

(b) The subrecipient [ contractor ] must not initiate IFSP services subject to out-of-pocket payment until the parent signs the family cost share agreement.

(c) At the annual meeting to evaluate the IFSP, the subrecipient [ contractor ] must review the family cost share agreement, obtain current public and private insurance information, and re-calculate the family's assigned maximum charge. The parent must update and sign the [ their ] family cost share agreement if family size, gross income, deductions, or third-party coverage is modified.

(d) The parent must report changes to family size, gross income, deductions, and third-party coverage as soon as possible. When the parent reports a change, the subrecipient [ contractor ] must review the family cost share agreement, obtain current public or private insurance information, and re-calculate the family's assigned maximum charge. The parent must update and sign the [ their ] family cost share agreement.

(e) When the parent signs an updated family cost share agreement, the new maximum charge takes effect the beginning of the following month.

(f) If the child is in the conservatorship of the state, the subrecipient [ contractor ] assigns the family a maximum charge of $0.

(1) The foster parent must sign the family cost share agreement acknowledging the $0 maximum charge and attesting to the child's third-party status and foster care status.

(2) The foster parent is not required to attest to family size, gross income, or allowable deductions.

§ 350.1419. Private Insurance.

(a) The subrecipient [ contractor ] must obtain written parental consent to bill and to release personally identifiable information to private insurance.

(b) The subrecipient [ contractor ] must obtain written parental consent when :

(1) initially seeking to use [ their ] private insurance ; and

(2) each time there is an increase (in frequency, length, duration, or intensity) in the provision of services in the IFSP that requires the subrecipient [ contractor ] to obtain written parental consent.

(d) [ (c) ] If private insurance denies payment of a [ the ] claim, the subrecipient [ contractor ] must bill the family up to the family's [ their ] maximum charge, based on the family's [ their ] placement on the sliding fee scale.

(e) [ (d) ] The subrecipient [ contractor ] must adjust the amount billed to the family if the subrecipient [ contractor ] or parent successfully disputes a denied claim.

(f) [ (e) ] The subrecipient [ contractor ] must not deny or delay a child's services if:

(1) the family does not have private insurance; or

(2) the parent does not give consent to bill or to release personally identifiable information to the [ their ] private insurance. [ If the parent does not give consent, the contractor bills the family up to their maximum charge, based on their placement on the sliding fee scale. ]

(g) [ (f) ] The subrecipient must not charge a [ A ] family with private insurance [ will not be charged ] disproportionately more than a family without private insurance.

(h) [ (g) ] If a child has only private insurance, and the subrecipient has confirmed that the private insurance plan does not pay for certain ECI services, the subrecipient is not required to bill the private insurance plan for those services. [ is covered by private insurance only, once the contractor has verified that the private insurance plan will not pay for certain Early Childhood Intervention (ECI) services for a child, the contractor is not required to continue to bill the private insurance plan for those services for that child. The contractor must continue to bill for any services that the private insurance company does cover. The contractor must verify coverage for ECI services with the private insurance plan at least annually. ]

§ 350.1421. Insurance Premiums.

The policyholder is responsible for paying health care premiums based on the [ their ] individual policy. When [ The contractor includes insurance premiums when ] calculating the family's allowable deductions, the subrecipient includes insurance premiums, but insurance premiums do not count toward meeting the maximum charge. Neither HHSC nor the subrecipient [ contractor ] pays the family's private insurance premium.

§ 350.1423. Co-pays, Co-Insurance, and Deductibles.

(a) The subrecipient [ contractor ] collects co-pays, co-insurance, and deductibles as set by the family's insurance plan, up to the family's maximum charge. The maximum charge includes and is not in addition to co-pays, co-insurance, and deductibles.

(b) HHSC absorbs any additional costs that exceed the family's maximum charge, including costs for services not covered by insurance, co-pays, co-insurance, and deductibles.

§ 350.1425. Public Benefits and Insurance.

(a) Medicaid, CHIP, [ Children's Health Insurance Program (CHIP), ] and TRICARE are public insurance programs.

(b) The subrecipient [ contractor ] must assist the parent to:

(1) identify and access other available funding sources to pay for a child's ECI [ early childhood intervention ] services; and

(2) enroll a potentially eligible child in Medicaid or CHIP.

(c) The subrecipient [ contractor ] must not require a parent to enroll in public benefits or insurance programs as a condition of receiving ECI [ early childhood intervention ] services.

(d) If the child is not already receiving public insurance, the subrecipient [ contractor ] must obtain written parental consent before billing. The subrecipient [ contractor ] must waive the maximum charge while eligibility is being determined, not to exceed 90 days.

(e) The subrecipient [ contractor ] must obtain written parental consent to release personally identifiable information to Medicaid, CHIP, and TRICARE. If the parent does not give consent to release personally identifiable information, the subrecipient [ contractor ] bills the parent up to the family's [ their ] maximum charge, based on the family's [ their ] placement on the sliding fee scale.

(f) The subrecipient [ contractor ] must not bill the parent if the child is enrolled in Medicaid and the parent gives consent to release personally identifiable information to Medicaid.

(g) If the child is in foster care or kinship care, the subrecipient [ contractor ] must obtain consent to release personally identifiable information to bill Medicaid.

(h) If the child has private insurance in addition to Medicaid, the private insurance is the primary payor. The subrecipient [ contractor ] must bill the private insurance every time before filing a claim with Medicaid for all services other than targeted case management or SST [ specialized skills training ].

(i) If the child has CHIP or TRICARE and the parent gives consent to release personally identifiable information, the subrecipient [ contractor ] must bill the family for services not paid for by CHIP or TRICARE and for any co-pays, up to the family's maximum charge, based on the family's [ their ] placement on the sliding fee scale.

(j) If the child becomes ineligible for Medicaid, CHIP, or TRICARE, the subrecipient [ contractor ] bills the parent up to the family's [ their ] maximum charge, based on the family's [ their ] placement on the sliding fee scale.

(k) The subrecipient [ contractor ] must not deny or delay a child's services if:

(1) the family does not have public insurance; or

(2) the parent does not give consent to release personally identifiable information to the [ their ] public insurance. If the parent does not give consent, the subrecipient [ contractor ] bills the family up to the family's [ their ] maximum charge, based on the family's [ their ] placement on the sliding fee scale.

(l) A family with public insurance must [ will ] not be charged disproportionately more than a family without public or private insurance.

§ 350.1427. Maximum Charge.

(a) Before initiating ECI [ early childhood intervention ] services, the subrecipient [ contractor ] determines the family's ability or inability to pay and calculates the family's [ their ] out-of-pocket maximum charge.

(b) The family's maximum charge is the total amount of money billed to the family for services delivered in one calendar month. The maximum charge includes payments for services not covered by insurance, co-pays, co-insurance, and deductibles.

(c) The family's assigned maximum charge does not increase if the family has more than one child receiving IFSP services , subject to the Family Cost Share out-of-pocket payment .

§ 350.1429. Family Size and Adjusted Income.

(a) The family size equals:

(1) the total number of persons [ people ] living in the home, including the child's parent(s) and the child; and

(2) other persons [ individuals ] who are financial dependents of the parent.

(b) The family's annual gross income equals the total of all income received by the family. The gross income includes all income classified as taxable income by the Internal Revenue Service before federal allowable deductions are applied. If the parent does not attest to the family's annual gross income, the subrecipient [ contractor ] must bill the family the full cost of services.

(c) The family's allowable deductions are limited to the family's expenses in the following categories:

(1) child care [ childcare ] and respite;

(2) costs and fees associated with the adoption of a child;

(3) court-ordered child support payments paid by the parent in the home for financially dependent children who were not included in the family size calculation; and

(4) medical or dental expenses that are to primarily alleviate or prevent a physical or mental illness or defect. Allowable deductions for medical and dental expenses are limited to the cost of:

(A) diagnosis, cure, alleviation, treatment, or prevention of disease;

(B) treatment of any affected body part or function;

(C) medical services legally delivered by physicians, surgeons, dentists, and other medical practitioners;

(D) medications, medical supplies, and diagnostic devices;

(E) medical and dental health care premiums;

(F) transportation to receive medical or dental care; and

(G) medical or dental debt that the family is paying on an established payment plan.

(d) The subrecipient [ contractor ] calculates the allowable deductions using the actual amounts the family paid over the previous 12 months and are expected to continue during the IFSP period and projections for new expenses expected to occur during the IFSP period. If the parent does not attest to the family's allowable deductions, the subrecipient [ contractor ] determines the maximum charge based on the family's gross income. The subrecipient [ contractor ] may implement written local policies requiring verification of allowable deductions in addition to the family's required written attestation.

(e) The family's annual adjusted income equals the family's annual gross income minus the family's allowable deductions.

§ 350.1431. Texas Health and Human Services Commission Early Childhood Intervention Sliding Fee Scale.

(a) The subrecipient must provide the family with a copy of the HHSC ECI sliding fee scale. Based on family size and income, placement on the HHSC ECI sliding fee scale determines the family's maximum charge for services received in one calendar month.

(b) [ (1) ] The HHSC ECI sliding fee scale assigns a set dollar amount as the maximum charge for adjusted income ranges less than or equal to 1000 percent of the federal poverty level.

(c) [ (b) ] The family's maximum charge shall be pursuant to Figure: 26 TAC §350.1431(c) [ §350.1431(b) ] identified in this subsection. If the parent refuses to attest in writing that information about their third-party coverage, family size, and gross income is true and accurate, then the family monthly maximum payment equals the full cost of services.

Figure: 26 TAC §350.1431(c) (.pdf)

[ Figure: 26 TAC §350.1431(b) ]

§ 350.1435. Suspension of Services for Nonpayment.

(a) The subrecipient [ contractor ] must suspend IFSP [ Individualized Family Service Plan (IFSP) ] services subject to an out-of-pocket payment as identified in §350.1413 of this subchapter (relating to Individualized Family Service Plan [ IFSP ] Services Subject to Out-of-Pocket Payment [ from the Family ]) when the balance remains delinquent for 90 days. If the parent uses [ their ] public or private insurance, the 90-day time period begins the date the subrecipient [ contractor ] receives notice that the claims are denied for reimbursement and all appeals are exhausted.

(b) Before suspending IFSP services, the subrecipient [ contractor ] must inform the parent that:

(1) the parent [ he or she ] has the option to request a:

(A) review of the family cost share agreement, as described in §350.1417 of this subchapter (relating to Family Cost Share Agreement); or

(B) reconsideration and adjustment of the family cost share obligation, as described in §350.1437 of this subchapter (relating to Extraordinary Circumstances);

(2) IFSP services subject to an out-of-pocket payment will be suspended when a balance is delinquent for 90 days; and

(3) the subrecipient [ contractor ] cannot guarantee the same schedule or the same individual service provider if IFSP services are later reinstated.

(c) Respite vouchers will be denied during a suspension period.

(d) A notation must be made on the family cost share agreement that IFSP services subject to an out-of-pocket payment have been suspended due to non-payment.

(e) The subrecipient [ contractor ] must reinstate suspended IFSP services when the family's account is paid in full or the family negotiates an acceptable payment plan with the subrecipient, as required in §350.1020 of this chapter (relating to Re-Establishing IFSP Services). [ contractor. The IFSP team must reassess the appropriateness of the IFSP before reinstating IFSP services if IFSP services are suspended for more than six months. ] The subrecipient [ contractor ] must document the reinstatement of IFSP services date on [ the IFSP and ] the family cost share agreement.

(f) The subrecipient [ contractor ] must maintain written local policy for collecting delinquent family cost share accounts. Documentation must reflect all reasonable attempts to collect unpaid balances. Reasonable attempts include multiple attempts at written notification, telephone [ phone ] notification, and e-mail.

§ 350.1437. Extraordinary Circumstances.

(a) The subrecipient [ contractor ] must develop a local process to reconsider and adjust the current or overdue family cost share obligation based on extraordinary circumstances.

(b) Only the program director or designated administrator has authority to reconsider and adjust the family cost share obligation. The reconsideration may include an assessment of the parent's ability to pay the family cost share obligation in any particular month or months [ month(s) ].

(c) Extraordinary circumstances that require a reconsideration of the family cost share obligation are:

(1) increase or decrease in income;

(2) unexpected short-term medical expenses;

(3) unanticipated child care [ childcare ] or respite expenses;

(4) change in family size;

(5) catastrophic loss such as fire, flood, or tornado;

(6) short-term financial hardship such as major repair to the family home or car; or

(7) other extenuating circumstances for which the family requests reconsideration.

(d) The parent must attest in writing that information regarding extraordinary circumstances is true and accurate. The subrecipient [ contractor ] may implement written local policy requiring verification of extraordinary circumstances from families, or the subrecipient [ contractor ] may rely solely on the family's required written attestation. The subrecipient [ contractor ] must deny a request for reconsideration if the parent refuses to provide written attestation that the information related to extraordinary circumstances is true and accurate.

(e) The family's last signed IFSP and family cost share agreement remain in effect during the reconsideration process.

§ 350.1439. Program Fiscal and Recordkeeping Policies.

(a) The subrecipient [ contractor ] must:

(1) use revenue received from the family cost share system only for ECI [ early childhood intervention ] services within the HHSC ECI system;

(2) not supplant any other local fund sources; and

(3) report fees collected to HHSC ECI as program income.

(b) The family cost share agreement and any financial records related to income, deductions, and payment history must [ shall ] be kept separate from the child's other educational records, and these records must not be forwarded to a school district or other non-ECI service provider(s) at any time unless requested by the family. All financial records must be maintained in a manner consistent with FERPA [ the Family Educational Rights and Privacy Act ].

(c) If a family transfers between HHSC ECI subrecipients, the transferring subrecipient must send [ contractors, ] the family cost share agreement, other financial records, and the IFSP [ are transferred ] to the receiving subrecipient [ HHSC ECI contractor ].

(d) The family cost share agreement and financial records are subject to subpoena.

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-202603392

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 424-6580

CHAPTER 742. MINIMUM STANDARDS FOR LISTED FAMILY HOMES

SUBCHAPTER D. NOTIFICATIONS AND LIABILITY INSURANCE [ REQUIREMENTS ]

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §742.403, concerning What are the liability insurance requirements; and §742.407, concerning When must I notify parents that I do not carry liability insurance.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill 2789, Section 4, 89th Legislature, Regular Session, 2025.

Section 4 amended Texas Human Resources Code (HRC) §42.0495 by reducing the liability insurance coverage requirement for a listed family home from $300,000 to $100,000 for each occurrence of negligence and removing the requirement that a listed family home annually file with HHSC proof of liability insurance coverage.

The proposed amendments in Chapter 742 update liability insurance requirements for listed family homes. The proposed amendments update the requirements for a listed family home to provide notice that the home does not carry liability insurance coverage or has stopped carrying the insurance. The proposed amendments remove a grandfather clause for homes that received a permit before April 25, 2021, related to parental notification of the home's inability to obtain liability insurance.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using rule titles written as a question. The proposed amendments replace pronouns with what the pronouns mean to increase clarity.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

The proposal also changes the title of Subchapter D to "Notifications and Liability Insurance."

SECTION-BY-SECTION SUMMARY

The proposed amendment to §742.403 changes the title of the rule to "Liability Insurance Requirements." The proposed amendment removes paragraphs (1) and (2) to remove the requirements for a listed family home to have at least $300,000 of liability insurance coverage and to provide proof of insurance coverage to CCR each year. The proposed amendment adds new rule language that requires a listed family home to have liability insurance coverage of at least $100,000 for each occurrence of negligence. These changes implement HRC §42.0495. The proposed amendment replaces the rule removed from paragraph (1)(B) with new rule language. The proposed new language clarifies that liability insurance must cover injury to a child while the child is on the premises of the listed family home or in the care of the home when off the premises. The proposed amendment makes clarifying edits to explain when the listed family home is not required to maintain liability insurance.

The proposed amendment to §742.407 changes the rule title to "Lack of Liability Insurance Notification Requirements." The proposed amendment in subsection (a) updates and clarifies the requirement for a listed family home that does not carry liability insurance coverage to give written notice to a child's parent before admitting the child into care. The proposed amendment in subsection (a) removes the Texas Administrative Code (TAC) reference to §742.403 and the title of §742.403. These changes reduce the need for HHSC to amend rules when TAC references or the titles of rules change. The proposed amendment removes subsection (b) to remove an obsolete grandfather clause for a listed family home issued a permit before April 25, 2021. The proposed amendment in subsection (c), renumbered as subsection (b), updates the requirement and clarifies that if a listed family home previously carried liability insurance, and stops carrying the insurance, then the home must give written notice to the parent of each child that the home does not carry the insurance. The proposed amendment in renumbered subsection (b) clarifies that "within 30 days" means within 30 days after the date the home stops carrying the insurance. The proposed amendment in subsection (d), renumbered as subsection (c), updates a website, removes a form number, and makes the rule easier to read and understand.

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 not create a new regulation;

(6) the proposed rules will limit and 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

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 do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; are amended to decrease a person's cost for compliance with the rules; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public will benefit from rules that (1) reduce the amount of liability insurance a child care operation must carry, which may increase the number of child care operations able to obtain liability insurance; and (2) comply with state law.

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 rules do not require a child care operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

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 26R009" in the subject line.

STATUTORY AUTHORITY

The amendments 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, and Texas Government Code §524.0005, which provides the executive commissioner of HHSC with broad rulemaking authority. In addition, HRC §42.042(a) requires HHSC to adopt rules to carry out the requirements of HRC Chapter 42.

The amendments implement Texas Government Code §524.0151 and HRC §§42.042(a) and 42.0495.

§ 742.403. Liability Insurance Requirements. [ What are the liability insurance requirements? ]

A listed family home must have liability insurance coverage of at least $100,000 for each occurrence of negligence, unless the listed family home has [ Unless you have ] an acceptable reason not to maintain liability [ have the ] insurance as provided by Texas Human Resources Code (HRC) §42.0495. Liability insurance must cover injury to a child while on the premises or in the care of the listed family home. [ , you must: ]

§ 742.407. Lack of Liability Insurance Notification Requirements. [ When must I notify parents that I do not carry liability insurance? ]

(a) If a listed family home does [ you do ] not carry liability insurance coverage [ that meets the requirements of §742.403 of this subchapter (relating to What are the liability insurance requirements?) ], the home [ then you ] must give written notice to [ notify ] a child's parent [ in writing that you do not carry liability insurance ] before admitting the [ you admit a ] child into [ your ] care.

(b) [ (c) ] If a listed family home [ you ] previously carried [ the ] liability insurance and stops [ you subsequently stop ] carrying the [ liability ] insurance, then the home [ you ] must give written notice to [ notify ] the parent of each child in [ your ] care that the home does [ you do ] not carry the insurance[ , in writing, ] within 30 days after the date the home stops [ you stop ] carrying the insurance [ it ].

(c) [ (d) ] A listed family home [ You ] may use the [ use Form 2962, Attachment A, ] Parental Notification of Lack of Required Liability Insurance form [ , located ] on the Child Care Regulation Provider [ Licensing's provider ] website . A listed family home [ to notify parents. Regardless of whether you use this form, you ] must keep proof that the home [ be able to demonstrate that you ] provided written notice to the parent of each child in [ your ] care , even if the home uses a different form or method to provide the written notice .

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 14, 2026.

TRD-202603504

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: September 27, 2026

For further information, please call: (512) 438-3269

CHAPTER 744. MINIMUM STANDARDS FOR SCHOOL-AGE AND BEFORE OR AFTER-SCHOOL PROGRAMS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§744.203, 744.501, 744.603, 744.901, and 744.1103; and the repeal of §744.625.

BACKGROUND AND PURPOSE

The purpose of the proposal is to (1) implement House Bill (HB) 2789, Sections 2 and 3, 89th Legislature, Regular Session, 2025; and (2) partially implement HB 163, 89th Legislature, Regular Session, 2025.

HB 2789, Section 2 amended Texas Human Resources Code (HRC) §42.043(b) to remove the requirement for a child in care to have a tuberculosis (TB) test. HB 2789, Section 3 amended HRC §42.049(a) to reduce the liability insurance coverage requirement for a licensed or registered child care operation from $300,000 to $100,000 for each occurrence of negligence.

HB 163 repealed statutory provisions in Texas Health and Safety Code §773.0145(a) and (b), regarding possession and administration of unassigned epinephrine in a child-care facility as defined by Texas Human Resources Code (HRC) §42.002.

Therefore, the proposed amendments and repeal in Chapter 744 (1) remove requirements related to TB testing; (2) update liability insurance requirements; and (3) remove the requirement for a child care operation to have operational policies and procedures for maintaining and administering unassigned epinephrine auto-injectors.

TB-related rules are also being removed because the Texas Department of State Health Services no longer recommends universal TB screening for settings with populations at low risk of TB such as schools and child care operations.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using rule titles written as a question. The proposed amendments remove cross references and the titles of other rules cross-referenced. These changes avoid the need for HHSC to amend rules when Texas Administrative Code references or the titles of these rules change.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules. The proposed amendments replace pronouns with what the pronouns mean to improve clarity.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §744.203, What are the liability insurance requirements, changes the rule title to "Liability Insurance Requirements." The proposed amendment reduces the required amount of liability insurance coverage for a child care operation from $300,000 to $100,000 for each occurrence of negligence. The proposed amendment makes clarifying edits to explain when the operation is not required to maintain liability insurance and when proof of coverage must be provided to CCR.

The proposed amendment to §744.501, What written operational policies must I have, changes the rule title to "Operational Policies and Procedures Requirements." The proposed amendment removes policy requirements related to unassigned epinephrine auto-injectors and renumbers paragraphs.

The proposed amendment to §744.603, What records must I have for children in my care and how long must I keep them, changes the rule title to "Children's Records." The proposed amendment removes requirements for a child care operation to maintain TB screening and testing records for children and renumbers paragraphs.

The proposed repeal of §744.625, Must children in my care have a tuberculosis (TB) examination, removes the requirement for children in care to have a TB test.

The proposed amendment to §744.901, What information must I maintain in my personnel records, changes the rule title to "Personnel Records." The proposed amendment removes paragraph (3) to remove the requirement for a child care operation to maintain documentation that an employee, caregiver, substitute, or volunteer is free of active TB. The proposed amendment renumbers paragraphs (4) - (11) as paragraphs (3) - (10) because of the removal of paragraph (3). The proposed amendment removes form numbers to avoid a need to amend the rules if the form numbers change. The proposed amendment removes duplicative content that exists in another rule.

The proposed amendment to §744.1103, What minimum qualifications must each of my employees meet, changes the rule title to "Employee Minimum Qualifications." The proposed amendment removes paragraph (2) to remove the requirement for an employee to have a current record of a TB examination that shows that the employee is free of contagious TB. The proposed amendment renumbers paragraphs (3) and (4) as paragraphs (2) and (3) because of the removal of paragraph (2). The proposed amendment removes form numbers and a reference to Subchapter F in Chapter 745 to avoid a need to amend the rule if these change.

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 not create a new regulation;

(6) the proposed rules will limit and 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

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 do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; are amended to decrease a person's cost for compliance with the rules; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public will benefit from rules that (1) reduce the amount of liability insurance an operation must carry, which may increase the number of child care operations able to obtain liability insurance; (2) reduce a child care operation's administrative duties by removing requirements related to TB testing; and (3) comply with state law.

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 rules do not require an operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

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 26R009" in the subject line.

SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION

SUBCHAPTER C. RECORD KEEPING

SUBCHAPTER D. PERSONNEL

CHAPTER 745. LICENSING

SUBCHAPTER D. APPLICATION PROCESS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §745.249, concerning What are the liability insurance requirements for a licensed operation, registered child-care home, or listed family home; and §745.347, concerning How long is an initial license valid; and the repeal of §745.349, concerning What if I am not able to care for children during the initial period.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill 2789, Sections 3, 4, and 5, 89th Legislature, Regular Session, 2025.

Sections 3 and 4 amended Texas Human Resources Code (HRC) §42.049(a) to reduce the liability insurance coverage requirement for a licensed or registered child care operation from $300,000 to $100,000 for each occurrence of negligence, and HRC §42.0495 to (1) reduce the liability insurance coverage requirement for a listed family home from $300,000 to $100,000 for each occurrence of negligence; and (2) remove the requirement that a listed family home annually file with HHSC proof of liability insurance coverage. Section 5 amended HRC §42.051(b) to increase the period of validity of an initial license from 6 months to 12 months.

The proposed amendments in Chapter 745 update (1) liability insurance requirements at the time of application for licensed operations, registered child care homes, and listed family homes; and (2) the period of initial license validity from 6 to 12 months.

The proposed repeal of §745.349 removes a rule related to actions HHSC may take when an operation does not have children in care during the initial license period.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using rule titles written as a question. The proposed amendments replace pronouns with what the pronouns mean to improve clarity.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §745.249 changes the rule title to "Liability Insurance Requirements." The proposed amendment reduces the amount of required liability insurance coverage for a licensed operation, registered child care home, or listed family home from $300,000 to $100,000 for each occurrence of negligence. The proposed amendment removes the requirement for an operation to provide proof of coverage to CCR each year because that requirement exists elsewhere in minimum standard rules. The proposed amendment clarifies that liability insurance must cover injury to a child while the child is on the premises of the operation or home or in the care of the operation or home when off the premises. The proposed amendment makes clarifying edits to explain when the listed family home is not required to maintain liability insurance. The proposed amendment changes the spelling of "child-care" to "child care" because of a program initiative.

The proposed amendment to §745.347 changes the rule title to "Initial License Duration." The proposed amendment changes the period of validity of an initial license from six to 12 months. The proposed amendment changes "a maximum of one year" to "a maximum of 18 months" in the rule that allows CCR to renew an initial license for up to an additional six months, as provided by HRC §42.051(b). This change is needed because an initial license period is increasing from six to 12 months. The proposed amendment makes editorial changes to replace the terms "we" and "you" to stop using these pronouns in the rule and to improve the readability of the rule.

The proposed repeal of §745.349 removes licensure actions CCR may take if unable to determine compliance during the initial license period because an operation does not have children in care. The rule is no longer necessary due to the increase of an initial license period from six months to 12 months and the continued option for CCR to renew an initial license for an additional six months.

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 not create a new regulation;

(6) the proposed rules will expand, limit, and 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

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 do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; are amended to decrease a person's cost for compliance with the rules; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rules are in effect, the public will benefit from rules that (1) reduce the amount of liability insurance an operation must carry, which may increase the number of child care operations able to obtain liability insurance; and (2) comply with state law.

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 proposed rules do not require an operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

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 26R009" in the subject line.

CHAPTER 746. MINIMUM STANDARDS FOR CHILD CARE [ CHILD-CARE ] CENTERS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§746.203, 746.501, 746.603, 746.629, 746.901, and 746.1105; and the repeal of §746.627.

BACKGROUND AND PURPOSE

The purpose of the proposal is to (1) implement House Bill (HB) 2789, Sections 2, 3, and 9, 89th Legislature, Regular Session, 2025; and (2) partially implement Section 27 of Senate Bill (SB) 1619, 89th Legislature, Regular Session, 2025.

HB 2789, Section 2 amended Texas Human Resources Code (HRC) §42.043(b) to remove the requirement for a child in care to have a tuberculosis (TB) test. Section 3 amended HRC §42.049(a) to reduce the liability insurance coverage requirement for a licensed or registered child care operation from $300,000 to $100,000 for each occurrence of negligence. Section 9 repealed HRC §42.0431(b) to remove requirements for a licensed child care center and licensed child care home to maintain screening records for vision, hearing, and any other special senses or communication disorders for children attending the facility and for HHSC to inspect those records in accordance with protocol agreements between HHSC and the Texas Department of State Health Services.

SB 1619, Section 27 amended HRC §42.067(a) by adding the term "epinephrine delivery system" to expand the allowable epinephrine devices to include epinephrine nasal spray in addition to an epinephrine auto-injector.

The proposed amendments and repeal in Chapter 746 (1) remove requirements related to TB testing in child care centers; (2) update liability insurance requirements for child care centers; (3) update and remove requirements related to vision and hearing screening records in child care centers; and (4) update epinephrine terminology and policy requirements in child care centers.

TB-related rules are also being removed because the Texas Department of State Health Services no longer recommends universal TB screening for settings with populations at low risk of TB such as schools and child care operations.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using rule titles written as a question. The proposed amendments remove cross references to other rules and the titles of rules cross-referenced. These changes avoid the need for HHSC to amend rules when Texas Administrative Code (TAC) references or rule titles change. The proposal changes the spelling of "child-care" to "child care" in the title of Chapter 746, the title of Division 2 in Subchapter D, and throughout the proposed amendments because of a program initiative.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules. The proposed amendments replace pronouns with what the pronouns mean to improve clarity.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §746.203, What are the liability insurance requirements, changes the rule title to "Liability Insurance Requirements." The proposed amendment reduces the amount of required liability insurance coverage for a child care center from $300,000 to $100,000 for each occurrence of negligence. The proposed amendment makes clarifying edits to explain when the operation is not required to maintain liability insurance and when proof of coverage must be provided to CCR.

The proposed amendment to §746.501, What written operational policies must I have, changes the rule title to "Operational Policies and Procedures Requirements." The proposed amendment removes the requirement to have a policy for TB screening and testing, and renumbers paragraphs. The proposed amendment adds a statutory reference to HRC §42.0431 in the requirement for a child care center to have policies for hearing and vision screening. The proposed amendment updates the policy requirement, statutory and rule references, and terminology if the operation maintains and administers an unassigned epinephrine delivery system. The proposed amendment updates language related to gang-free zones to align with statutory requirements in the Texas Penal Code.

The proposed amendment to §746.603, What records must I have for children in my care and how long must I keep them, changes the rule title to "Children's Records." The proposed amendment removes requirements for a child care center to maintain records of TB screening and testing and vision and hearing screening results, and renumbers paragraphs. The proposed amendment updates and clarifies the record retention periods.

The proposed repeal of §746.627, Must children in my care have a tuberculosis (TB) examination, removes the requirement for children in care to have a TB examination.

The proposed amendment to §746.629, Must children in my care have vision and hearing screening, changes the rule title to "Vision and Hearing Screening Requirements." The proposed amendment clarifies for a child care center that 25 TAC Chapter 37, Subchapter C, are the state rules that implement Texas Health and Safety Code, Chapter 36. The proposed amendment updates the website that may be accessed for specific information on vision and hearing screening. The proposed amendment removes the requirements in subsection (b) for a child care center to maintain vision and hearing screening records for each child in care. The proposed amendment updates the formatting of the rule because of the removal of subsection (b).

The proposed amendment to §746.901, What information must I maintain in my personnel records, changes the rule title to "Personnel Records." The proposed amendment removes paragraph (3) to remove the requirement for a child care center to maintain documentation that an employee, caregiver, substitute, or volunteer is free of active TB. The proposed amendment renumbers paragraphs (4) - (11) as paragraphs (3) - (10) because of the removal of paragraph (3). The proposed amendment removes form numbers to avoid amending the rules if the form numbers change. The proposed amendment removes duplicative content that exists in another rule.

The proposed amendment to §746.1105, What minimum qualifications must each of my child-care center employees meet, changes the rule title to "Employee Minimum Qualifications." The proposed amendment removes paragraph (2) to remove the requirement for an employee to have a current record of a TB examination that shows that the employee is free of contagious TB. The proposed amendment renumbers paragraphs (3) and (4) as paragraphs (2) and (3) because of the removal of paragraph (2). The proposed amendment removes form numbers and a reference to Subchapter F in Chapter 745 to avoid a need to amend the rule if these change.

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 not create a new regulation;

(6) the proposed rules will limit and 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

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 do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; are amended to decrease a person's cost for compliance with the rules; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public will benefit from rules that (1) reduce the amount of liability insurance an operation must carry, which may increase the number of child care operations able to obtain liability insurance; (2) reduce a child care operation's administrative duties by removing requirements related to TB testing and vision and hearing screenings; and (3) comply with state law.

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 rules do not require an operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

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 26R009" in the subject line.

SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION

SUBCHAPTER C. RECORD KEEPING

CHAPTER 746. MINIMUM STANDARDS FOR CHILD-CARE CENTERS

SUBCHAPTER C. RECORD KEEPING

CHAPTER 746. MINIMUM STANDARDS FOR CHILD CARE [ CHILD-CARE ] CENTERS

SUBCHAPTER C. RECORD KEEPING

SUBCHAPTER D. PERSONNEL

CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE [ CHILD-CARE ] HOMES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§747.209, 747.213, 747.603, 747.633, 747.901, 747.905, 747.909, 747.1007, 747.1107, 747.1207, and 747.1401; and the repeal of §747.629 and §747.631.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill 2789, Sections 2, 3, and 9, 89th Legislature, Regular Session, 2025.

Section 2 amended Texas Human Resources Code (HRC) §42.043(b) to remove the requirement for a child in care to have a tuberculosis (TB) test. Section 3 amended HRC §42.049(a) to reduce the liability insurance coverage requirement for a licensed or registered child care operation from $300,000 to $100,000 for each occurrence of negligence. Section 9 repealed HRC §42.0431(b) to remove requirements for a licensed child care center and licensed child care home to maintain screening records for vision, hearing, and any other special senses or communication disorders for children attending the facility and for HHSC to inspect those records in accordance with protocol agreements between HHSC and the Texas Department of State Health Services.

The proposed amendments and repeals in Chapter 747 (1) remove requirements related to TB testing in child care homes; (2) update liability insurance requirements for child care homes, including removing a grandfather clause related to parental notification of a child care home's inability to obtain liability insurance; and (3) update and remove requirements related to vision and hearing screening records in licensed child care homes.

TB-related rules are also being removed because the Texas Department of State Health Services no longer recommends universal TB screening for settings with populations at low risk of TB such as schools and child care operations.

The proposed amendments change the title of each rule because HHSC Child Care Regulation (CCR) plans to stop using rule titles written as a question. The proposed amendments remove cross references to other rules and the titles of rules cross-referenced. These changes avoid the need for HHSC to amend rules when Texas Administrative Code references or rule titles change. The proposal changes the spelling of "child-care" to "child care" in the title of Chapter 747, the title of Division 1 and Division 2 in Subchapter D, and throughout the proposed amendments because of a program initiative.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules. The proposed amendments replace pronouns with what the pronouns mean to improve clarity.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §747.209, What are the liability insurance requirements, changes the rule title to "Liability Insurance Requirements." The proposed amendment reduces the amount of required liability insurance coverage for a child care home from $300,000 to $100,000 for each occurrence of negligence. The proposed amendment makes clarifying edits to explain when the operation is not required to maintain liability insurance and when proof of coverage must be provided to CCR.

The proposed amendment to §747.213, When must I notify parents that I do not carry liability insurance, changes the rule title to "Lack of Liability Insurance Notification Requirements." The proposed amendment removes subsection (b) to remove a grandfather clause that required a child care home issued a permit before April 25, 2021 to notify parents of children in care by May 25, 2021 if the home did not carry liability insurance. The proposed amendment renumbers paragraphs (c) and (d) to (b) and (c) because of the removal of subsection (b). The proposed amendment updates the name and removes the form number for the Parental Notification of Lack of Required Liability Insurance form.

The proposed amendment to §747.603, What records must I have for children in my care and how long must I keep them, changes the rule title to "Children's Records." The proposed amendment removes requirements for a child care home to maintain records of TB screening and testing and vision and hearing screening results. The proposed amendment makes clarifying edits to describe how long different types of records must be kept by the child care home.

The proposed repeal of §747.629, Must children in my care have a tuberculosis (TB) examination, removes the requirement for children in care to have a TB examination.

The proposed repeal of §747.631, Must children in my registered child-care home have vision and hearing screening, removes an obsolete rule explaining that children in a registered child care home are not required to have a vision and hearing screening. The rule is obsolete because the proposed amendment to §747.633 clarifies that the vision and hearing screening requirement applies only to licensed child care homes.

The proposed amendment to §747.633, Must children in my licensed child-care home have vision and hearing screening, changes the rule title to "Vision and Hearing Screening Requirements for Licensed Child Care Homes." The proposed amendment removes subsection (b) to remove the requirement for a licensed child care home to maintain vision and hearing screening records for each child in care. The proposed amendment updates the formatting of the rule because of the removal of subsection (b).

The proposed amendment to §747.901, What information must I maintain in my personnel records, changes the rule title to "Personnel Records." The proposed amendment removes paragraph (3) to remove the requirement for a child care home to maintain documentation that an assistant caregiver or substitute caregiver is free of active TB. The proposed amendment renumbers paragraphs (4) - (10) as paragraphs (3) - (9) because of the removal of paragraph (3). The proposed amendment removes form numbers to avoid a need to amend the rules if the form numbers change. The proposed amendment removes duplicative content that exists in another rule.

The proposed amendment to §747.905, What records must I keep for my household members who are not counted in the child/caregiver ratio, changes the rule title to "Required Records for Household Members Not Counted in the Child to Caregiver Ratio." The proposed amendment removes paragraph (1) to remove the requirement for a child care home to maintain documentation that a household member who is not counted in the child to caregiver ratio is free of active TB. The proposed amendment renumbers paragraphs (2) and (3) as paragraphs (1) and (2) because of the removal of paragraph (1). The proposed amendment updates the requirement for each child care home to maintain proof the home requested a background check by adding "as required by Chapter 745 of this title" to replace "a DFPS Background Check."

The proposed amendment to §747.909, What records must I maintain on myself, changes the rule title to "Required Records for Primary Caregiver." The proposed amendment removes paragraph (1) to remove the requirement for the primary caregiver to have documentation that shows that the primary caregiver is free of contagious TB. The proposed amendment renumbers paragraphs (2) and (3) as paragraphs (1) and (2) because of the removal of paragraph (1).

The proposed amendment to §747.1007, What qualifications must I meet to be the primary caregiver of a registered child care home, changes the rule title to "Registered Child Care Home Primary Caregiver Qualifications." The proposed amendment removes paragraph (6) to remove the requirement for the primary caregiver of a registered child care home to have a current record of a TB examination that shows the primary caregiver is free of contagious TB. The proposed amendment renumbers paragraph (7) as paragraph (6) because of the removal of paragraph (6).

The proposed amendment to §747.1107, What qualifications must I meet to be the primary caregiver of a licensed child care home, changes the rule title to "Licensed Child Care Home Primary Caregiver Qualifications." The proposed amendment removes paragraph (6) to remove the requirement for the primary caregiver of a licensed child care home to have a current record of a TB examination that shows the primary caregiver is free of contagious TB. The proposed amendment deletes Figure 26 TAC §747.1107(8) and moves the education and experience requirements the figure contains for the primary caregiver in a licensed child care home to renumbered paragraph (7).

The proposed amendment to §747.1207, What minimum qualifications must an assistant caregiver meet, changes the rule title to "Assistant Caregiver Minimum Qualifications." The proposed amendment removes paragraph (5) to remove the requirement for an assistant caregiver to have a current record of a TB examination that shows that the caregiver is free of contagious TB. The proposed amendment renumbers paragraphs (6) and (7) as paragraphs (5) and (6) because of the removal of paragraph (5); and removes form numbers in renumbered paragraphs (5) and (6).

The proposed amendment to §747.1401, Must members of my household meet specific qualifications, changes the rule title to "Household Members Minimum Qualifications." The proposed amendment removes the requirement in subsection (a)(1) for household members of a child care home to have a current record of a TB examination that shows the primary caregiver is free of contagious TB. The proposed amendment reorganizes subsection (a) to include the requirement removed from subsection (a)(2), for the household member to complete orientation to the child care home.

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 not create a new regulation;

(6) the proposed rules will limit and 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

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 do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; are amended to decrease a person's cost for compliance with the rules; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public will benefit from rules that (1) reduce the amount of liability insurance an operation must carry, which may increase the number of child care operations able to obtain liability insurance; (2) reduce a child care operation's administrative duties by removing requirements related to TB testing and vision and hearing screenings; and (3) comply with state law.

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 proposed rules do not require an operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

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 26R009" in the subject line.

SUBCHAPTER B. ADMINISTRATION AND COMMUNICATION

SUBCHAPTER C. RECORD KEEPING

CHAPTER 747. MINIMUM STANDARDS FOR CHILD-CARE HOMES

SUBCHAPTER C. RECORD KEEPING

CHAPTER 747. MINIMUM STANDARDS FOR CHILD CARE [ CHILD-CARE ] HOMES

SUBCHAPTER C. RECORD KEEPING

SUBCHAPTER D. PERSONNEL

CHAPTER 748. MINIMUM STANDARDS FOR GENERAL RESIDENTIAL OPERATIONS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §748.158 and §748.4751; and the repeal of §§748.1583, 748.1943, and 748.1945.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill 2789, Sections 2, and 3, 89th Legislature, Regular Session, 2025.

Section 2 amended Texas Human Resources Code (HRC) §42.043(b) to remove the requirement for a child in care to have a tuberculosis (TB) test. Section 3 amended HRC §42.049(a) to reduce the liability insurance coverage requirement for a licensed or registered child care operation from $300,000 to $100,000 for each occurrence of negligence.

The proposed amendments and repeals in Chapter 748 (1) remove requirements related to TB testing for all individuals who live, work, or volunteer at a General Residential Operation (GRO); and (2) update liability insurance requirements for GROs.

TB-related rules are also being removed because the Texas Department of State Health Services no longer recommends universal TB screening for settings with populations at low risk of TB such as schools and child care operations.

The proposed amendments change the title of the amended rules because HHSC Child Care Regulation (CCR) plans to stop using rule titles written as a question. The proposed amendments replace pronouns with what the pronouns mean to improve clarity.

The proposed amendments have been written in plain language to improve understanding and effectiveness of the rules.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §748.158, What are the liability insurance requirements, changes the rule title to "Liability Insurance Requirements." The proposed amendment reduces the amount of required liability insurance coverage for a GRO from $300,000 to $100,000 for each occurrence of negligence. The proposed amendment makes clarifying edits to explain when an operation is not required to maintain liability insurance. The proposed amendment changes "Licensing" to "Child Care Regulation" and clarifies the timeframe each year for an operation to provide proof of coverage as "no later than" the anniversary date of the issuance of the operation's permit.

The proposed repeal of §748.1583, Who must have a tuberculosis (TB) examination, removes the TB screening and documentation requirements of TB screening for all persons over the age of one year old who live, work, or volunteer at a GRO.

The proposed repeal of §748.1943, Must adult residents have a tuberculosis (TB) examination, removes the requirement for adult residents of a GRO to have a TB examination.

The proposed repeal of §748.1945, What must I do if an adult resident has a positive tuberculosis test result, removes the requirement related to action a GRO must take if an adult resident has a positive TB test result. The rule is obsolete because of the proposed repeal of §748.1943.

The proposed amendment to §748.4751, Are there additional medical requirements when I admit a child for trafficking victim services, changes the rule title to "Additional Medical Requirements for Trafficking Victim Services." The proposed amendment removes paragraph (1)(B)(v) to remove the requirement that a child receiving trafficking victim services be screened for tuberculosis. The proposed amendment reorganizes paragraph (1)(B) to renumber the remaining medical tests for screening as paragraph (1)(B)(i) - (v).

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 not create a new regulation;

(6) the proposed rules will limit and 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 impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

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 do not impose a cost on regulated persons; are amended to reduce the burden or responsibilities imposed on regulated persons by the rules; are amended to decrease a person's cost for compliance with the rules; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rachel Ashworth-Mazerolle, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the rule is in effect, the public benefit will be rules that (1) reduce the amount of liability insurance an operation must carry, which may increase the number of child care operations able to obtain liability insurance; (2) reduce a child care operation's administrative duties by removing requirements related to TB testing; and (3) comply with state law.

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 proposed rules do not require an operation to purchase equipment, supplies, or hire additional personnel to comply with the rules.

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 26R009" in the subject line.

SUBCHAPTER C. ORGANIZATION AND ADMINISTRATION

SUBCHAPTER J. CHILD CARE

SUBCHAPTER K. OPERATIONS THAT PROVIDE CARE FOR CHILDREN AND ADULTS

SUBCHAPTER V. ADDITIONAL REQUIREMENTS FOR OPERATIONS THAT PROVIDE TRAFFICKING VICTIM SERVICES