HHSC Executive Council – October 15, 2026

The Health and Human Services executive council met on October 15^th to take on multiple agenda items. The meeting agenda can be found here.The video archive can be found here. A list of the members can be found here.

This report is intended to give you an overview and highlight the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer. This report was written and reviewed by human authors.

 

Opening Remarks

• Dixon- Commenting on behalf of commissioner, finishing first year of Rural Texas Strong and working towards $281 M in grants by the end of this month
• Dixon- Recognizes Wood; posting weekly updates on website showing status of the awards; recently expanded inpatient psychiatric capacity
• Dixon- Sunrise Canyon doubled inpatient capacity thanks to a $60 M investment, expanding access to care in West Texas
• Dixon- Leadership announcements: Michelle Dionne-Vahalik was named deputy chief for regulatory services and Renee Blanch-Haley has been named deputy executive commissioner for long-term care regulation
• Dixon- We will now move to agency updates

 

Agency Updates

Imelda Garcia, Interim Commissioner, Texas Department of State Health Services

• Kicked off flu-season, looking at trends for respiratory viruses and covid-19; since it just kicked off flu trends are low but are increasing, most emergency visits have been related to covid-19 and the flu
• Respiratory dashboard is available on website and is updated weekly; respiratory surveillance report is used by Texas healthcare professionals
• October 15^th is global handwashing day; October is also breast cancer awareness month, reminds women to get mammograms
• Thanks stakeholders and practitioners for their reporting

 

Jennifer Sims, Deputy Commissioner of Operations, Texas Department of Family and Protective Services

• As of Nov. 1^st, transitioning community-based care contractors from a single contractor to two different contractors
• Texas Care and Family Network will handle Dallas while OCOK out of Ft. Worth will handle the 9 outlying counties
• C-mark update: estimated about 1.1 M checks and have done 2.2 M checks; working as designed, praises partnership
• T3C is about a year away from transitioning from current system of payments to new T3C model; providers have until September 1^st of 2027 to make the switch
• Providers should start transition process now; currently has 70% of kids in care already served through T3C
• Dixon- Echoes comments about C-mark

 

Eugenia Krieg, Chief of Staff, HHSC Office of Inspector General

• Here on behalf of Inspector General, Raymond Charles Winter who is attending a Texas fraud prevention meeting
• Updates on audits of Texas local mental and behavioral health authorities; as part of SB 26 passed under the 88^th legislative session, OIG is required to audit LMHA’s and LBHA’s at least once every 5 years
• By end of FY 2026, OIG completed 18 audits with 9 currently in progress; covered authorities serving 144 counties
• Released 4 audit reports in 2025, 5 in 2026 and 9 in 2026; expect to complete remaining audits by 2028
• Released a report summarizing results of 10 audits in July, available on reporttexasfraud.com

 

Dr. Ryan Van Ramshorst, Deputy Executive Commissioner, HHSC

• Serves as chief medical director for Medicaid Chip services; update regarding data on Private Duty Nursing Care Delivery Across Texas
• PDN is a type of skilled nursing care designed for children with special healthcare needs; service must be determined medically necessary to be covered
• PDN services may prevent prolonged hospitalization or need for institutionalization
• PDN is a state plan service and is available for anyone under 21 years of age in any Medicaid program
• Need for skilled nursing care may be identified by a primary care provider in consultation with family; nursing provider then goes to the child’s residence for a comprehensive assessment
• Service requires prior authorization as described in the Texas Medicaid procedures manual
• PDN is not intermittent, part-time care or childcare
• Efforts to improve access to PDN services; highlights roles of service coordinators
• Stakeholders requested data that shows how many hours Medicaid manage care organization’s (MCO) authorize for PDN services compared to the hours actually staffed
• Analyzed MCO’s self-reported data related to authorization, billing, and payment; reviewed data from FY 2023 and 2024
• Funnel diagram is representative of all units of PDN aggregated across STAR, STAR Kids and STAR health; key finding was that 69% were billed and 68% were billed of all authorized PDN services
• Data has limitations; data was self-reported and not fully validated; anticipates that data mark to be available next year
• Rate does not account for instances where child is hospitalized or caregiver declines services
• Trends: some variability across service delivery areas, rates seem to be lower in some rural areas, variability between MCO’s and plans that participate in STAR or STAR Kids
• Lower number of children in STAR program receiving PDN compared to STAR Kids
• Next steps: appreciates continued engagement, MCO’s have been partnering with PDN through alternative payment models
• Will continue to work with MCOs to understand what the data means

 

Stephanie Stephens, HHSC Chief Medicaid and CHIP Services Officer

• Will provide an update on provider revalidation
• Providers are enrolled in Medicaid and typically required to revalidate every 5 years; in June of this year, we began disenrolling providers who do not timely apply
• Since mid-June have disenrolled 17 K NPIs for not revalidating; 62% of those providers were inactive
• In the next 60 days, there are more than 16K due for revalidation and 34% are at risk of disenrollment; about half of those 34% are considered inactive
• Providers, please check your revalidation date and act accordingly; make sure to use accurate information and we will provide flexibility through 60-day extensions
• Extensive outreach through managed care organizations, sharing information about high billing providers
• Acknowledges the challenges in the enrollment/revalidation process due to timeliness and system issues; effort is underway to redesign the system
• Centers for Medicaid and Medicare services reached out to state and requested off cycle revalidations for high-risk providers; have submitted plan and is available on website
• Working through the data issues that may trigger revalidation requirements; providing CMS updates available on website

Rules Proposal

Kristi Kahr, Associate Commissioner, State Hospital

• THHSC is proposing new rules in Title 26, part 1, chapter 306, subchapter J concerning residential treatment facilities;
• Proposal project is to designate the Terrell Center for Youth as a residential treatment facility in accordance with HB 109 and SB 1 from 88^th legislative session
• HHSC must designate state facilities for use as residential treatments for adolescents with behavioral or mental health needs under HB 109; proposed rules govern admission, treatment, educational services and discharge or transfer of adolescents
• Rules also describe an MOU specifying rules and responsibilities of Texas Department of Family and Protective Services
• Public benefit will be an increase of placement options for adolescents

 

Tiffany Ford, Compliance Officer, Manufactured Foods Program, Texas Department of State Health Services

• Proposes an amendment in new rules in Texas Administrative Code, Title 25, part 1, chapter 229 concerning shrimp labeling
• Rule project was initiated to implement SB 823 from 89^th regular session which prohibits food suppliers from selling shrimp unless shrimp labels states whether it is imported
• Prohibits restaurants from labelling or representing imported shrimp as domestic shrimp

 

Briannah Halm, Milk Operations Manager, Consumer Protection Division, Texas Department of State Health Services

• Proposing an amendment to rules in Texas Administrative Code, Title 25 part 1, chapter 216, subchapter D
• Proposed amendments align bulk milk regulations with federal grade A pasteurized milk ordinance; updates terminology to improve clarity and removes duplicate or unnecessary provisions without creating new regulatory obligations
• Dixon- Notes that the past 3 proposals have been submitted to the Texas Registrar with an open comment public period
• Dixon- Agenda items in 3b are rule proposals submitted to Texas Registrar but not published; one rule in that category, first concerning Texas Radiation Advisory Board consolidation and industrial radiation machines

Joann Harthcock, Director of Radiation Section, Consumer Protection Division

• First proposal aims to improve public access by moving all advisory committee councils into a single chapter
• Relocating the current Texas Advisory board from Texas Administrative Code Title 25, Chapter 289 to 25 TAC chapter 3
• New rule is designed to align with Health and Human Services Advisory committee rule template
• TRAB will not be abolished as long as state law requires it; rule was presented to TRAB in 2026 and no comments were received from TRAB meeting; public comment will open from October 23^rd to November 23rd
• Second proposal is updating section 289.228, radiation safety requirements for industrial radiation machines; reorganizes requirements by machine type, removing minimum threat category and updating terminology
• Also clarifies requirement for training, documentation and operations procedure; including provisions addressing body scanners and bomb deductions
• Proposed rules provide transparency and compliance; presented the draft rule in April 2026 and was posted for public comment June; 4 comments were reviewed and incorporated
• Public comment will open from October 23^rd

Advisory Committee Reports

Dr. Jada Jackson, Chair of Texas Respite Advisory Committee

• TRAC assists HHSC in developing strategies to reduce barriers to Respite service access
• Presenting annual report recommendations; report was developed and approved through discussion of meetings held in accordance with Texas Open Meetings Act
• Report was submitted to agency as required by section 523.0225 of Texas Government Code; opinions are of TRAC members
• Defines respite as emergency care provided to a child or adult to offer temporary relief to family care givers
• Annual report examines current state of respite care in Texas, highlights 4 recommendations:
• 1) HHSC should request additional state general revenue for the agency’s respite related programs in the upcoming session
• 2) HHSC should adopt strategies to attract and retain respite workers and collaborate with Texas Workforce Commission to develop a career path model for individuals
• 3) HHSC should enhance the Take Time Texas website
• 4) HHSC should utilize technology to assist caregivers; consider a hybrid model that would be useful for areas where in-person care is limited
• Dixon- Idea of expanding access using technology is interesting; what specific services may be appropriate for telehealth?
  • Report envisions combining professionally guided virtual activities with flexible in-person support based on needs; cognitive stimulation and therapeutic activities
• No public comment

 

Meeting Adjourned