TITLE 26. HEALTH AND HUMAN SERVICES
PART 1. HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 257. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §257.1, concerning Purpose and Application; §257.3, concerning Definitions; §257.5, concerning Client Eligibility; §257.7, concerning Client Rights; §257.9, concerning Client Confidentiality; §257.11, concerning Components of Case Management for Children and Pregnant Women Services; §257.15, concerning Provider Qualifications and Approval Process; §257.17, concerning Provider Responsibilities; §257.19, concerning Case Manager Qualifications; §257.21, concerning Case Manager Responsibilities; and §257.23, concerning Compliance with Utilization Reviews and Quality Assurance Reviews and Overpayments.
Sections 257.1, 257.3, 257.5, 257.7, 257.9, 257.11, 257.15, 257.17, 257.19, 257.21, and 257.23 are adopted without changes to the proposed text as published in the February 21, 2025, issue of the Texas Register (50 TexReg 939). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
Case Management for Children and Pregnant Women (CPW) services, administered by HHSC, provides Medicaid case management to assist eligible Medicaid clients in accessing necessary medical, social, educational, and other services related to health conditions and health risks. To be eligible for services, a client must be either a child with a health condition or health risk or a pregnant woman with a high-risk condition. The client must also be Medicaid-eligible in Texas, need case management for CPW services, and choose such services.
HHSC is repealing Chapter 27, Case Management for Children and Pregnant Women, in Title 25, Part 1, Texas Administrative Code (TAC), and adopting new Chapter 257, Case Management for Children and Pregnant Women, in 26 TAC, Part 1. The purpose for moving the CPW chapter from Title 25 to Title 26 is to conform administrative rules to current HHSC practices based on Senate Bill (S.B.) 200, 84th Legislature, Regular Session, 2015. S.B. 200 consolidated functions in the Texas Health and Human Services delivery system and transferred programs, including CPW, from the Department of State Health Services (DSHS) to HHSC. The repeal of the CPW rules in 25 TAC Chapter 27 is adopted elsewhere in this issue of the Texas Register .
In addition to relocating the CPW rules from DSHS to HHSC, the new sections are necessary to comply with amendments to the CPW rules in accordance with House Bill (H.B.) 133, 87th Legislature, Regular Session, 2021, that directs HHSC to deliver CPW services through managed care organizations. The adoption also makes amendments to the CPW rules to implement certain requirements of House Bill 1575, 88th Legislature, Regular Session, 2023. H.B. 1575 authorizes case management services to pregnant women with a high-risk condition to address nonmedical needs; adds two new provider types, doula and community health worker, as eligible to provide case management services; and establishes CPW provider qualifications for doulas and community health workers. The adoption also updates the CPW rules with appropriate references and terminology and includes organizational and minor editing changes for clarity.
COMMENTS
The 31-day comment period ended March 24, 2025.
During this period, HHSC did not receive any comments regarding the proposed rules.
SUBCHAPTER
A.
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules as necessary to carry out the commission's duties; and Human Resources Code §32.021 and Texas Government Code §531.021(a), which authorize HHSC to administer the federal medical assistance (Medicaid) program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 9, 2025.
TRD-202501592
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: May 29, 2025
Proposal publication date: February 21, 2025
For further information, please call: (737) 395-1786
SUBCHAPTER
B.
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules as necessary to carry out the commission's duties; and Human Resources Code §32.021 and Texas Government Code §531.021(a), which authorize HHSC to administer the federal medical assistance (Medicaid) program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 9, 2025.
TRD-202501593
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: May 29, 2025
Proposal publication date: February 21, 2025
For further information, please call: (737) 395-1786
SUBCHAPTER
C.
STATUTORY AUTHORITY
The new sections are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules as necessary to carry out the commission's duties; and Human Resources Code §32.021 and Texas Government Code §531.021(a), which authorize HHSC to administer the federal medical assistance (Medicaid) program.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on May 9, 2025.
TRD-202501594
Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: May 29, 2025
Proposal publication date: February 21, 2025
For further information, please call: (737) 395-1786