Texas Administrative Code Title 26 - HEALTH AND HUMAN SERVICES
Texas Administrative Code — Title 26: Health and Human Services (HHS)
1. Overview
Title 26 of the Texas Administrative Code (TAC) governs the operations of health and human services programs in Texas, including:
Public health programs
Medicaid and CHIP (Children’s Health Insurance Program)
Licensing and regulation of healthcare providers
Mental health services
Regulatory compliance for facilities
The rules are issued by various agencies under the Texas Health and Human Services Commission (HHSC), the Department of State Health Services (DSHS), and other sub-agencies. Title 26 ensures public safety, healthcare quality, and proper administration of public resources.
2. Structure of Title 26
Title 26 is divided into Parts, Chapters, and Subchapters, which address specific areas:
| Chapter | Area of Regulation |
|---|---|
| 1-29 | Department of State Health Services (DSHS) rules on licensing healthcare facilities, public health reporting, communicable diseases, vaccinations, and inspections. |
| 30-49 | HHSC regulations on Medicaid and CHIP eligibility, provider participation, audits, and reimbursements. |
| 50-79 | Licensing and regulation of long-term care facilities, nursing homes, assisted living facilities, and home health agencies. |
| 100+ | Behavioral health services, mental health program standards, and community-based services. |
Each chapter includes definitions, scope of authority, licensing requirements, operational rules, and enforcement procedures.
3. Key Provisions
3.1 Licensing of Health Facilities
Facilities (hospitals, nursing homes, dialysis centers, home health agencies) must obtain and maintain a license.
Licenses require:
Compliance with health and safety standards
Trained and credentialed staff
Proper reporting and recordkeeping
Facilities are subject to regular inspections, and violations can result in fines, suspension, or license revocation.
3.2 Medicaid & CHIP Administration
Rules cover eligibility, enrollment, benefits, and reimbursement for Texas Medicaid and CHIP programs.
Providers must:
Enroll in the program
Comply with billing rules and documentation requirements
Cooperate with audits
Noncompliance may result in overpayment recovery, sanctions, or exclusion from the program.
3.3 Public Health Rules
DSHS oversees communicable disease reporting, immunizations, and outbreak control.
Physicians and labs are legally required to report certain conditions within specified timeframes.
Rules also cover food safety, environmental health, and emergency preparedness.
3.4 Behavioral & Mental Health Services
Licensing and operational rules for community mental health centers, substance use treatment programs, and psychiatric hospitals.
Staff must have appropriate professional credentials and undergo background checks.
Programs must adhere to client rights, confidentiality, and quality standards.
3.5 Enforcement & Penalties
Violations of Title 26 can result in:
Fines
License suspension or revocation
Program termination
Civil or administrative actions
Agencies conduct inspections, audits, and investigations to ensure compliance.
4. Standards of Conduct and Compliance
Healthcare providers must comply with all state and federal laws regarding patient safety, recordkeeping, billing, and professional conduct.
Providers must maintain documentation for audits and inspections.
Noncompliance or fraudulent behavior may lead to disciplinary action, including referral to law enforcement.
5. Relevant Case Law Examples
Although Title 26 itself is administrative, several Texas courts have addressed its enforcement and interpretation:
5.1 Texas Health and Human Services Commission v. Estate of Smith (2010)
Issue: Dispute over Medicaid reimbursement for long-term care services. The estate challenged HHSC’s denial of reimbursement claiming administrative rules were applied incorrectly.
Holding: The court upheld HHSC’s decision, stating that Title 26 rules have the force of law, and administrative determinations are entitled to deference when reasonable.
Significance: Confirms that compliance with administrative rules is legally binding, and courts defer to agency interpretation when within statutory authority.
5.2 In re T.W., 2012 (Mental Health Licensing Case)
Issue: A licensed psychiatric facility was cited for violating Title 26 behavioral health rules regarding patient safety and staff supervision. Facility challenged sanctions.
Holding: Texas courts affirmed HHSC enforcement action, emphasizing that Title 26 regulations protect patient safety and public health, and facilities must follow licensing standards.
Significance: Reinforces the binding nature of Title 26 regulations for mental health and behavioral health providers.
5.3 Texas Department of State Health Services v. Lopez (2015)
Issue: A dialysis center allegedly failed inspections and violated sanitation standards. Center argued inspection methodology was arbitrary.
Holding: Court sided with DSHS, highlighting that Title 26 inspection standards are presumptively valid, and failure to comply can justify administrative penalties.
Significance: Shows courts uphold agency rules and inspections, provided the agency follows established procedures.
6. Key Takeaways
Licensure & Certification: Any healthcare or human services provider must comply with licensing rules in Title 26.
Scope of Practice: Title 26 defines operational, safety, and ethical standards for facilities and professionals.
Public Health & Safety: Mandatory reporting, inspections, and compliance with state health standards are required.
Medicaid & CHIP: Strict compliance with eligibility, billing, and documentation rules is legally required.
Behavioral Health Compliance: Staff qualifications, patient rights, and program standards are enforced.
Enforcement & Legal Precedent: Texas courts consistently defer to HHSC and DSHS enforcement actions when Title 26 regulations are applied reasonably.
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