TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 306. BEHAVIORAL HEALTH DELIVERY SYSTEM

SUBCHAPTER C. TEXAS CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §306.101, relating to Purpose; §306.103, concerning Application; §306.105, concerning Definitions; §306.107, concerning Certification Eligibility; §306.109, concerning Application Process; and §306.111, concerning Certification Standards.

BACKGROUND AND PURPOSE

The purpose of the proposal is to add definitions for terms used in the subchapter and provide further clarification for certification requirements for Texas Certified Community Behavioral Health Clinics (T-CCBHCs).

SECTION-BY-SECTION SUMMARY

The proposed amendment to §306.101 updates language to improve reader understanding.

The proposed amendment to §306.103 updates language to improve reader understanding.

The proposed amendment to §306.105 adds definitions for outpatient mental health treatment services and outpatient substance use treatment services and clarifies language in other definitions. Definitions are in line with current processes and ensure integration of mental health and substance use treatment services consistent with the goals of the T-CCBHC initiative. The proposed amendment also updates other language to improve reader understanding.

The proposed amendment to §306.107 prohibits T-CCBHC applicants from denying or limiting services to people within the local service area based on a person's housing situation. This rule aligns with federal CCBHC criteria. The proposed amendment clarifies the services T-CCBHC applicants must deliver directly or through an agreement with another entity, including mental health rehabilitative services. The amendment adds the conditions that must exist for a T-CCBHC that is not an LMHA or LBHA to provide mobile crisis outreach services. These rules are needed to ensure the integration of mental health and substance use treatment services and that HHSC can adequately monitor provision of mobile crisis outreach services. The amendment adds the requirements for T-CCHBC applicants to be enrolled as a Medicaid provider. This rule aligns with federal CCBHC criteria. The proposed rule amendment clarifies the requirements of T-CCBHC governing boards and advisory committees. The proposed amendment also requires T-CCBHC applicants to be licensed as a Chemical Dependency Treatment Facility. This amendment is in line with Texas Administrative Code Title 26, Chapter 564. The proposed amendment updates rule language to improve reader understanding.

The proposed amendment to §306.109 clarifies that if T-CCBHC applicants do not meet all eligibility requirements listed on the application for certification, HHSC considers the applicant ineligible and denies the application. However, the proposed rule also allows the applicant to re-submit a new application to HHSC after the date HHSC denies the application. The proposed amendment requires an applicant to meet all eligibility requirements listed on the application. These rules support quality service delivery and administrative processes among T-CCBHC applicants for HHSC to successfully certify applicant organizations. The proposed amendment changes the time period for denial of an application by HHSC based on termination of an applicant's contract, license, or certification from three years to within four years. This is to align with the proposed amendment in §306.111 to increase certification approval as a T-CCBHC from three to four years. The proposed amendment also updates other language to improve reader understanding.

The proposed amendment to §306.111 requires T-CCBHCs to annually report its quality measures to HHSC to remain certified. This amendment is in line with current processes and derived from federal CCBHC criteria, from which T-CCBHC criteria are modeled. The proposed amendment also changes T-CCBHC certification approval from three years to four years. This amendment supports maintaining high quality reviews of applicants using existing staff resources. The proposed amendment updates other language to improve reader understanding.

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 create new regulations;

(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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because participation in the certification described in the proposed rule amendments is optional.

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

Trina Ita, Deputy Executive Commissioner of Behavioral Health Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be expanding provider organizations delivering and improving quality of integrated mental health, substance use disorder, and primary care screenings. There is no anticipated cost for compliance with the proposed rules since there is no requirement to alter current business practices, and there are no new fees imposed.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs because governmental and non-profit organizations have the option, but not requirement, to become T-CCBHCs. Thus, no organization is required to comply with the rule because the organization may choose not to become T-CCBHC certified. Individuals and for-profit organizations are not eligible for T-CCBHC certification.

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 24R095" 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 Health and Safety Code §531.001 which provides HHSC with authority to oversee community mental health services.

The amendments affect Texas Government Code §524.0151 and Texas Health and Safety Code §531.001.

§306.101. Purpose.

This [The purpose of this] subchapter explains [is to describe] the process and requirements for an applicant to be certified [by the Texas Health and Human Services Commission] as a Texas Certified Community Behavioral Health Clinic by the Texas Health and Human Services Commission.

§306.103. Application.

This [The provisions of this] subchapter applies to an applicant and a Texas Certified Community Behavioral Health Clinic as these terms are [apply to applicants] defined in §306.105 of this subchapter (relating to Definitions).

§306.105. Definitions.

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

(1) Applicant--An entity applying or reapplying for certification as a Texas Certified Community Behavioral Health Clinic (T-CCBHC).

(2) Application--A form that an applicant submits to the Texas Health and Human Services Commissionto apply for or renew the applicant's [form submitted by an applicant for T-CCBHC] certification as a T-CCBHC [and recertification].

(3) Community needs assessment--A method to identify the needs of the community and to describe how the applicant can meet those needs [systematic approach to identifying community needs and determining program capacity to address the needs of the population being served]. This [The needs] assessment is objective and includes feedback [input] from people receiving services, program staff, and other key community members [stakeholders].

(4) Crisis stabilization--Services to address a mental health or substance use crisis[, including suicide crisis response and services capable of addressing crises related to substance use].

(5) Family-centered--A way to plan, deliver, and evaluate services that involves participation between families, caregivers, and professionals [Developmentally appropriate and youth guided care that recognizes active participation between families and caregivers and professionals as a cornerstone to the planning, delivery, and evaluation of services].

(6) Governmental entity--A state agency or a political subdivision of Texas [the state], such as a city, county, hospital district, hospital authority, or state entity.

(7) HHSC--The Texas Health and Human Services Commission or its designee.

(8) LBHA--Local behavioral health authority. An entity designated [as the local behavioral health authority] by HHSC under Texas [in accordance with] Health and Safety Code [,] §533.0356(a) as the local behavioral health authority.

(9) LMHA--Local mental health authority. An entity designated [as the local mental health authority] by HHSC under Texas [in accordance with] Health and Safety Code [,] §533.035(a) as the local mental health authority.

(12) [(10)] Person--An individual receiving services under this subchapter.

(13) [(11)] Person-centered--Approaches that focus on a person's strengths and personal goals giving the person the chance to improve their quality of life, make choices, and have control. This method helps a person explore the person's preferences, needs, and wants while addressing medical and non-medical needs to support the person in reaching the person's full potential. [Care that is strengths-based, trauma informed, and focuses on individual capacities, preferences, and goals that gives the person the opportunity to optimize their self-defined quality of life, choice, control, and self-determination through meaningful exploration and discovery of unique preferences, needs, and wants while ensuring medical and non-medical needs are met via means that are exclusively for the benefit of the person and supports them to reach their full potential.]

(14) [(12)] T-CCBHC--Texas Certified Community Behavioral Health Clinic. An entity HHSC certifies under [certified in accordance with] this subchapter.

§306.107. Certification Eligibility.

An applicant must meet the criteria in this section for certification.

(1) Staffing requirements.

(A) Staffing plans must reflect the findings of theapplicant's community needs assessment.

(B) The applicant's staff [Staff] members must have [,] and be current [currently active] with [,] all necessary [state-required] licenses and accreditations required by the state to provide the [to deliver] required services.

(C) Staff members must be trained to serve the needs of the clinic's patients [patient population] as identified through the community needs assessment and in compliance with Section 223(a)(2)(A) of the Protecting Access to Medicare Act of 2014.

(D) Staff must be trained in a person-centered and family-centered approach.

(2) Availability and accessibility of services.

(A) An applicant may not refuse [The applicant cannot deny] or limit services if a person cannot [based on a person's inability to] pay for the services.

(3) Care coordination.

(A) An [The] applicant must coordinate care across settings and providers to make sure that [ensure seamless] transitions are seamless for a person receiving [for the person across the full spectrum of] health services [including acute, chronic, and behavioral health].

(B) A [The] T-CCBHC must have:

(i) a health information technology system that includes an electronic health record; and [must have]

(ii) a plan [in place] focusing on ways to improve care coordination using health information technology.

(4) Scope of services.

(A) An [The] applicant must directly provide [or, with HHSC approval, arrange for the provision of] the following services:

(i) crisis [mental health] services, including:

(I) 24-hour mobile crisis outreach services, except as required under subparagraph (D) of this paragraph;

(II) crisis intervention services; [,] and

(III) crisis stabilization services [safety monitoring];

(ii) mental health and substance use screening, assessment, and diagnosis, including risk assessment for possible harm to self or others;

(iii) person-centered treatment planning, and family-centered treatment planning, when appropriate [or similar processes, including risk assessment and crisis planning]; and

(iv) outpatient mental health treatment services and outpatient substance use treatment services. [;]

(B) An applicant must provide the following services either directly or by agreement with another entity:

(i) [(v)] outpatient [clinic] primary care screening and monitoring of [key] health indicators and health risks [risk];

(ii) [(vi)] mental health targeted case management as defined in 1 TAC [Texas Administrative Code, Title 1, Part 15,] §353.1403 (relating to Definitions);

(iv) [(viii)] peer specialist services, as defined in 1 TAC §354.3013 (relating to Services Provided), and family partner supports; and

(v) [(ix)] [intensive,] community-based mental health and substance use care for members of the armed forces and veterans.

(5) Quality and other reporting.

(A) A T-CCBHC must report encounter data, clinical outcomes data, quality data, and other data that HHSC may request [requests].

(B) A T-CCBHC must have health information technology systems that allow reporting on data and quality measures.

(6) Organizational authority.

(A) An [The] applicant must be:

(i) a non-profit or governmental entity; [or]

(ii) an entity operated under the authority of the Indian Health Service, an Indian tribe, or tribal organization, pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act and Education Act (25 U.S.C 5301, et seq.); [(25 U.S.C. 450 et seq.),] or

(iii) an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (25 U.S.C 1601, et seq.) [(25 U.S.C. 1601 et seq.)].

(B) An [The] applicant must operate [be operational] as an entity listed under subparagraph (A) of this paragraph for at least [a minimum of] two years in Texas before applying for T-CCBHC certification.

(C) An [The] applicant's T-CCBHC must have a governing board. [The governing board must:]

(i) The governing board must:

(I) [(i)] have [be comprised of] at least 51 percent of its members be [families, consumers, and] people with lived experience of a mental health or substance use need or family members of people receiving [in recovery from] behavioral health services [conditions]; or

(II) [(ii)] create [establish] an advisory committee that meets the requirements of subclause (I) [clause (i)] of this clause that gives feedback [subparagraph and provides meaningful input] to the governing board about the T-CCBHC's: [polices, processes, and services.]

§306.109. Application Process.

[(a)] To [An applicant must submit a completed HHSC application to] be considered for certification or recertification, an applicant must fill out and submit a complete application by using the application [using application information] and instructions [provided] on the HHSC website.

[(b) HHSC prioritizes review and approval of LMHA and LBHA T-CCBHC applications as appropriate.]

(1) [(c)] HHSC reviews an application based on the certification [in accordance with the T-CCBHC] eligibility requirements in §306.107 of this subchapter (relating to Certification Eligibility) and may deny an application for certification for good cause, including if:

(A) [(1)] the application is missing any required information; [the application is incomplete in any aspect;]

(B) [(2)] the applicant did not submit the application following HHSC's application instructions or published notice; [the application is not submitted in accordance with HHSC's application instructions or published notice;]

(C) [(3)] the application has [contains] false information;

(D) [(4)] HHSC, any other agency in Texas or in another state, or federal agency has terminated the applicant's contract, license [licensure], or certification for cause within [at any point in] the four [three] years before the date the applicant submitted [preceding] the application [submission date];

(E) [(5)] the applicant is excluded or debarred from contracting with the State of Texas or the federal government;

(F) [(6)] the applicant has an outstanding Medicaid program audit exception or other unresolved financial liability owed to the State of Texas; or

[(7) the applicant is ineligible to enroll as a Medicaid provider for reasons relating to criminal history records as set forth in state rules; or]

(G) [(8)] the applicant terminated a provider agreement in a "federal health care program," [federal health care program] as defined in 42 U.S.C §1320a-7b(f) [42 U.S.C, §1302a-7b(f)], while an adverse action or sanction was in effect.

(4) [(d)] If an applicant meets all eligibility requirements listed on the application, the [An] applicant must submit supporting documentation and participate in interviews, as requested by HHSC, [conducted interviews] to confirm the applicant meets each certification criterion in §306.107 of this subchapter.

(5) [(e)] The applicant must submit the [Applicants must submit appropriate documentation in response to no more than two requests from HHSC for supplemental] information to HHSC within a timeframe agreed on [upon] by the applicant and HHSC. The timeframe agreed on may not be more than [not to exceed] 60 calendar days after [from] the date HHSC requests the information [of HHSC's first request].

§306.111. Certification Standards.

(a) To keep [In order to maintain] certification, a T-CCBHC [T-CCBHCs] must work [coordinate] with other T-CCBHCs [that deliver services] in the same geographic service area to make sure they do [ensure services are] not duplicate services [duplicated] for people who receive [persons receiving] services from more than one T-CCBHC.

(b) A T-CCBHC must keep [certification does not replace Texas regulations regarding provision of services or contract requirements. T-CCBHCs must maintain] all required licenses during [throughout] the certification period. If any required licenses are revoked and [Any regulatory license revocations, of either facility or professional licenses, that result in] a T-CCBHC is [being] unable to operate in [within the State of] Texas, the certification will be void [preclude the T-CCBHC from continuing as certified].

(c) T-CCBHC certification is approved for four [three] years, subject to the limits [parameters] outlined in §306.109(1) [§306.109(c)] of this subchapter (relating to Application Process).

(d) A T-CCBHC [T-CCBHCs] may reapply for certification if eligible as outlined in [accordance with] §306.109 of this subchapter.

(e) To prevent a gap [ensure prevention of a lapse] in certification, a T-CCBHC [T-CCBHCs] must submit an application, as defined in §306.105(2) of this subchapter (relating to Definitions), to be considered for recertification. A T-CCBHC [Applications] must submit an application between [be submitted no earlier than] 180 calendar days and [before the expiration of certification, but not later than] 60 calendar days before the date the current [expiration of] certification expires.

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 November 17, 2025.

TRD-202504171

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: December 28, 2025

For further information, please call: (512) 458-0775