TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 505. HOSPITAL LICENSING

SUBCHAPTER B. HOSPITAL LICENSE

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §505.27, concerning Mobile Stroke Units.

BACKGROUND AND PURPOSE

The proposal is necessary to comply with House Bill (HB) 4743, 89th Legislature, Regular Session, 2025. HB 4743 amended Texas Health and Safety Code (THSC) §241.023 to allow a general or special hospital license to include a mobile stroke unit (MSU).

The proposed rule outlines requirements for MSUs to exist as a part of a licensed hospital and specifies which existing licensing rules do not apply to MSUs. The proposed rule improves consistency between hospital licensing rules and THSC §241.023.

SECTION-BY-SECTION SUMMARY

Proposed new §505.27 outlines requirements for MSUs that: (1) allows HHSC to include an MSU in a hospital's license; (2) specifies the guidelines for a hospital to apply to add an MSU to its license; (3) provides requirements to apply for a renewal license; (4) outlines necessary actions if a hospital or MSU no longer meet the requirements; (5) exempts MSUs from certain existing licensing rules; and (6) allows HHSC to conduct inspections for MSUs.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rule will be in effect:

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

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

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

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

(5) the proposed rule will create a new regulation;

(6) the proposed rule will not expand, limit, or repeal existing regulations;

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

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

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

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities.

The rule does not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rule.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule is necessary to protect the health, safety, and welfare of the residents of Texas, is necessary to implement legislation that does not specifically state that §2001.0045 applies to the rule, and the rule does not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rule is in effect, the public benefit will be increased access to care for the public because of allowing a general or special hospital license to include a mobile stroke unit.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule is codifying current practices as required by statute.

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 26R049" in the subject line.

STATUTORY AUTHORITY

The 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 THSC §241.026, which requires HHSC to develop, establish, and enforce standards for the construction, maintenance, and operation of licensed hospitals.

The new section implements Texas Government Code §524.0151 and THSC §241.026.

§505.27. Mobile Stroke Units.

(a) In this section, a mobile stroke unit (MSU) means a specialized vehicle authorized by the Texas Department of State Health Services (DSHS) for an emergency medical services (EMS) provider licensed under Title 25 Texas Administrative Code (TAC) §157.11 (relating to Requirements for an Emergency Medical Services (EMS) Provider License), that is:

(1) equipped with a computed tomography (CT) scanner; and

(2) staffed by personnel capable of diagnosing and treating a stroke patient on-site as authorized by the EMS provider's medical director.

(b) The Texas Health and Human Services Commission (HHSC) includes an MSU in a hospital's license under Texas Health and Safety Code §241.023(c-1)(2) if:

(1) the hospital has a Level I, II, or III stroke designation from DSHS under 25 TAC §157.133 (relating to Requirements for Stroke Facility Designation);

(2) the MSU is accredited by a health care accreditation organization approved by the Centers for Medicare & Medicaid Services; and

(3) the hospital submits an application as specified in subsection (c) of this section.

(1) a completed application form for adding an MSU to a hospital license as provided on the HHSC website;

(2) a current copy of the EMS provider license for the MSU the hospital is seeking to add to its hospital license;

(3) a current copy of the hospital's stroke designation certificate;

(4) a current copy of the MSU's letter or certificate of accreditation from an approved health care accreditation organization; and

(5) any additional information requested by HHSC.

(d) For renewal of a hospital license that includes an MSU, a hospital shall submit a license renewal application to HHSC and include:

(1) a current copy of the EMS provider license for the MSU the hospital is seeking to keep under its hospital license;

(2) a current copy of the hospital's stroke designation certificate;

(3) a current copy of the MSU's letter or certificate of accreditation from an approved healthcare accreditation organization; and

(4) any additional information requested by HHSC.

(e) The hospital shall immediately notify HHSC in writing if:

(1) the hospital loses its Level I, II, or III stroke designation from DSHS under 25 TAC §157.133; or

(2) the MSU is no longer accredited by a health care accreditation organization approved by the Centers for Medicare & Medicaid Services.

(f) If the hospital or MSU no longer meets a requirement in paragraph (b)(1) or (b)(2) of this section, or both:

(1) the hospital shall provide documentation of unmet requirements to DSHS and HHSC within 30 days and include:

(A) a plan for selling, transferring, or decommissioning the MSU; or

(B) a statement of intent to reapply for licensure of the MSU and a plan to remedy noncompliance;

(2) HHSC removes the MSU from the hospital's license; and

(3) the MSU may not operate under the hospital's license.

(g) The MSU is exempt from the following requirements:

(1) hospital license display under §505.21(d) of this chapter (relating to General); and

(2) CT room requirements under §505.163(l) of this chapter (relating to Spatial Requirements for New Construction).

(h) HHSC may inspect an MSU as specified in §505.102 of this chapter (relating to Inspections), including before adding an MSU to a hospital license.

(i) To the extent this section may conflict with a requirement in §505.21(c) of this subchapter, this section prevails.

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 July 8, 2026.

TRD-202602791

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: August 23, 2026

For further information, please call: (512) 834-4591

CHAPTER 509. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES

SUBCHAPTER C. OPERATIONAL REQUIREMENTS

26 TAC §509.45

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §509.45, concerning Medical Staff.

BACKGROUND AND PURPOSE

In a freestanding emergency medical care (FEMC) facility licensed by HHSC, a physician must have at least one year of experience in emergency services, and current certification in advanced cardiac life support (ACLS), pediatric advanced life support (PALS), and advanced trauma life support (ATLS) to have medical staff privileges in the facility.

HHSC proposes to amend §509.45 to allow an FEMC facility to give medical staff privileges to physicians who are currently board certified in emergency medicine from the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM) with the required experience and without requiring current certification in ACLS, PALS, and ATLS. The proposal is in response to requests from providers, and because HHSC determined that emergency medicine board certification from the ABEM or AOBEM ensures a physician has the required knowledge and skills related to emergency life support without having additional life support certifications.

The proposed amendment addresses concerns from providers and physicians that additional certifications for board certified emergency room physicians creates an additional regulatory hardship for FEMC facilities.

Additionally, the proposed amendment contains requirements for a physician with an expired ABEM or AOBEM board certification to be granted medical staff privileges in an FEMC facility.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §509.45 adds new subsection (e) to move the current requirements in subsection (d)(5) for a physician to have medical staff privileges in an FEMC facility.

The proposed amendment adds new subsection (f) to allow an FEMC facility to grant medical staff privileges to a physician with at least one year of experience in emergency services and current board certified in emergency medicine from the ABEM or AOBEM without having the certifications required in proposed subsection (e).

The proposed amendment adds new subsection (g) that contains the requirements for a physician with an expired ABEM or AOBEM board certification and at least one year of experience in emergency services to be granted medical staff privileges in an FEMC facility.

The proposed amendment in subsection (a), subsection (c)(4) and (5), and subsection (d) makes minor edits to improve the clarity and meaning of these rules.

FISCAL NOTE

Victoria Grady, HHSC Deputy Chief, Finance, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rule will be in effect

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

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

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

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

(5) the proposed rule will create new regulations;

(6) the proposed rule will limit existing regulations;

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

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

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

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

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule is necessary to protect the health, safety, and welfare of the residents of Texas; does not impose a cost on regulated persons; and is amended to reduce the burden or responsibilities imposed on regulated persons by the rule.

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rule is in effect, the public will benefit from a rule that allows more physicians with the requisite knowledge and skills to be granted privileges in a FEMC facility. The FEMC facilities will benefit from a rule that increases the number of physicians who qualify for medical staff privileges.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because there are no requirements to alter current business practices and there are no new fees or costs.

TAKINGS IMPACT ASSESSMENT

PUBLIC COMMENT

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 health and human services by the health and human services system, and Texas Health and Safety Code (HSC) §254.101, which authorizes HHSC to adopt rules regarding freestanding emergency medical care facilities.

The amendment implements Texas Government Code §524.0151 and HSC §254.101.

§509.45. Medical Staff.

(a) The medical staff shall periodically conduct appraisals of its medical staff members according to medical staff bylaws.

(b) The medical staff shall examine credentials of candidates for medical staff membership and make recommendations to the governing body on the appointment of the candidate.

(c) The medical staff shall be well-organized and accountable to the governing body for the quality of the medical care provided to patients.

(1) The medical staff shall be organized in a manner approved by the governing body.

(2) If the medical staff has an executive committee, the members of the committee shall be doctors of medicine or osteopathy.

(3) The facility shall maintain records of medical staff meetings.

(4) The governing body shall assign responsibility for the organization and conduct of the medical staff only to an individual physician.

(5) Each medical staff member shall sign a statement signifying the member [~~they~~] will abide by medical staff and facility policies.

(d) The medical staff shall adopt, implement, and enforce written bylaws, rules, and regulations that outline the responsibilities of the medical staff [~~to carry out its responsibilities~~]. The bylaws shall:

(1) be approved by the governing body;

(2) include a statement of the duties and privileges of each category of medical staff (e.g., active, courtesy, consultant);

(3) describe the organization of the medical staff;

(4) describe the qualifications a candidate must meet for the medical staff to recommend the governing body appoint the candidate; and

(5) include criteria for determining the privileges to be granted and a procedure for applying the criteria to individuals requesting privileges. [To be privileged, a physician must have at least one year of experience in emergency services, and current certification in advanced cardiac life support, pediatric advanced life support, and advanced trauma life support.]

(e) To have medical staff privileges, a physician must have at least one year of experience in emergency services, and current certification in:

(1) advanced cardiac life support;

(2) pediatric advanced life support; and

(3) advanced trauma life support.

(f) A physician with at least one year of experience in emergency services and current board certification in emergency medicine from the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM) may be granted privileges without having the certifications required in subsection (e) of this section.

(g) If a physician with at least one year of experience in emergency services has an expired board certification in emergency medicine from the ABEM or AOBEM, the physician shall not be granted privileges until the physician has:

(1) current board certification in emergency medicine from the ABEM or AOBEM; or

(2) the current certifications listed in subsection (e) of this section.