TITLE 1. ADMINISTRATION

DIVISION 1. COMMITTEES

1 TAC §351.851

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §351.851, concerning Interested Parties Advisory Group.

BACKGROUND AND PURPOSE

The purpose of the proposal is to comply with 42 Code of Federal Regulations (42 CFR) §447.203(b)(6), which requires HHSC to "establish an advisory group for interested parties to advise and consult on provider rates with respect to service categories under the Medicaid State Plan, 1915(c) waiver, and demonstration programs, as applicable, where payments are made to direct care workers specified in §441.311(e)(1)(ii) for the self-directed or agency-directed services found at §440.180(b)(2) through (4), and (6)."

New §351.851 establishes the Interested Parties Advisory Group (IPAG) to advise and consult with HHSC on current and proposed payment rates, Home and Community Based Services (HCBS) payment adequacy data as required by 42 CFR §441.311(e), and access to care metrics described in 42 CFR §441.311(d)(2), associated with services found in 42 CFR §440.180(b)(2) through (4), and (6).

The IPAG is intended to advise the executive commissioner and HHSC on certain current and proposed Medicaid provider payment rates to ensure the relevant Medicaid payment rates are sufficient to ensure Medicaid beneficiaries access to personal care, home health aide, homemaker, and habilitation services.

SECTION-BY-SECTION SUMMARY

Proposed new §351.851(a) provides the statutory authority for the IPAG.

Proposed new §351.851(b) describes the purpose of the IPAG.

Proposed new §351.851(c) lists the tasks performed by IPAG.

Proposed new §351.851(d) explains the reporting requirements.

Proposed new §351.851(e) describes the meeting requirements.

Proposed new §351.851(f) lists the membership composition and appointment terms.

Proposed new §351.851(g) describes how the chair and vice chair are selected and the terms of office.

Proposed new §351.851(h) explains the required training.

Proposed new §351.851(i) provides the travel reimbursement policy.

Proposed new §351.851(j) provides the abolishment date.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rule 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 rule will be in effect:

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

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

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

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

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

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

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

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

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

Trey Wood, Chief Financial Officer, has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities.

The rule does not apply to small or micro-businesses, or rural communities.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons and is necessary to receive a source of federal funds or comply with federal law.

PUBLIC BENEFIT AND COSTS

Victoria Grady, Director of Provider Finance, has determined that for each year of the first five years the rule is in effect, the public benefit will by allowing interested parties to provide advice on provider rates.

Trey Wood, Chief Financial Officer, 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 any costs can be absorbed by HHSC to establish the Interested Parties Advisory Group.

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 25R053" in the subject line.

STATUTORY AUTHORITY

The new section 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; 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; and Texas Government Code §523.0203, which provides that the executive commissioner of HHSC shall establish and maintain advisory committees and adopt rules governing such advisory committees in compliance with Texas Government Code, Chapter 2110.

The new section affects Texas Government Code §§524.0151, 524.0005, 532.0051, 532.0057(a), 523.0203, and Chapter 2110. It also affects Texas Human Resources Code Chapter 32.

§351.851. Interested Party Advisory Group.

(a) Statutory authority. Interested Party Advisory Group (IPAG) is established under 42 CFR 447.203(b)(6) and is subject to §351.801 of this division (relating to Authority and General Provisions).

(b) Purpose. The IPAG advises the executive commissioner and Health and Human Services Commission (HHSC) on certain current and proposed Medicaid provider payment rates to ensure the relevant Medicaid payment rates are sufficient to ensure Medicaid beneficiaries access to personal care, home health aide, homemaker, and habilitation services.

(c) Tasks. The IPAG performs the following tasks:

(1) advises and consults with HHSC on current and proposed payment rates with respect to service categories under the Medicaid State plan, 1915(c) waiver, and demonstration programs, as applicable, where payments are made to the direct care workers based on current and proposed payment rates, Home and Community-Based Services (HCBS) payment adequacy data, and access to care metrics; and

(2) adopts bylaws to guide how the IPAG operates.

(d) Reporting requirements. HHSC will publish IPAG's recommendations within one month of the group's recommendation to the agency.

(e) Meetings.

(1) Open meetings. In accordance with the statute, the IPAG complies with the requirements for open meetings under Texas Government Code, Chapter 551, as if it were a governmental body.

(2) Frequency. The IPAG will meet at least every two years and no more than once annually.

(3) Quorum. A majority of all voting members constitutes a quorum for the purpose of transacting official business.

(f) Membership.

(1) The IPAG is composed of 12 members appointed by the executive commissioner. In selecting voting members to serve on the IPAG, HHSC considers the applicants' qualifications, background, interest in serving, and geographic location.

(A) Eleven voting members representing the following categories. The categories in clauses (i) through (iii) of this subparagraph must have at least one voting member each on the IPAG.

(i) Direct care workers.

(ii) Medicaid beneficiaries.

(iii) Medicaid beneficiaries' authorized representatives.

(iv) Other interested parties impacted by the service rates in question outlined in subsection (c)(1) of this section which may consist of:

(I) a rural Medicaid contracted provider who is contracted to provide HCBS services outlined in subsection (c)(1) of this section and who employs direct care workers;

(II) an urban Medicaid contracted provider who is contracted to provide HCBS services outlined in subsection (c)(1) of this section and who employs direct care workers;

(III) a provider who provides 1915(c) waiver services;

(IV) a provider who provides HCBS state plan services;

(V) an association or associations representing Medicaid providers who provide services outlined in subsection (c)(1) of this section;

(VI) an association or associations representing Medicaid beneficiaries who receive services outlined in subsection (c)(1) of this section; and

(VII) other disciplines with expertise in Medicaid finance, delivery, or access to care.

(B) One non-voting, ex officio member representing HHSC, who serves at the pleasure of the executive commissioner.

(2) Voting members are appointed for staggered terms so the terms of an equal or almost equal number of members expire on December 31 of each even-numbered year. Regardless of the term limit, a member serves until their replacement is appointed. This ensures there is membership representation to conduct IPAG business.

(A) If a vacancy occurs, the executive commissioner appoints a person to serve the unexpired portion of that term.

(B) Except as may be necessary to stagger terms, the term of each member is four years. A member may not serve more than two full terms.

(g) Officers. The IPAG selects a chair and a vice chair from among its members.

(1) The chair serves until January 1 of each even-numbered year. The vice chair serves until January 1 of each odd-numbered year.

(2) A member may serve as chair or vice chair for up to two terms in a row.

(h) Required training. Each member must complete training on relevant laws and rules, including this section and §351.801 of this division and Social Security Act §§1902, 1905, and 1915, 42 CFR §§440.1-440.395 and §§441.300-441.595; Texas Government Code Chapters 551, 552, and 2110; the HHS Ethics Policy; the Advisory Committee Member Code of Conduct; and other relevant HHS policies. Training will be provided by HHSC.

(i) Travel reimbursement. Unless allowed by the current General Appropriations Act, members are not paid to participate in the IPAG or reimbursed for travel to and from meetings.

(j) Abolishment date. The IPAG is required by federal regulation and will continue if the federal law requiring it remains in effect.

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 October 14, 2025.

TRD-202503701

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: November 30, 2025

For further information, please call: (512) 730-7475

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