Federal and state agency rules lay out how federal and state laws will be implemented. They provide detail and specifics and create a process for stakeholders to review and provide input (data, views, arguments orally or in writing) to agencies as they create rules. 

HHSC is the state agency responsible for the majority of programs and policies affecting THOT’s core mission.  

Texas rules are processed by the Secretary of State and published in the Texas Register. 

The standard rules process:

  1. Agency creates a proposed rule and published it in the Texas Register for at least 30 days. 
  2. The Agency reviews comments received and may make non-signficant changes to the rule before submitting to the Texas Register as an Adopted Rule.
  3. If the agency makes substantive changes to the rule, it must republish as proposed to allow for another round of stakeholder input.
  4. The Rule is effective 20 days after submission to the Texas Register. 

Archived rules can be found here:

State Plan & Amendments

Some Medicaid policies and programs also need to be approved by CMS through an amendment to the State Medicaid plan.  State Plan Amendments are tracked by HHSC at this website:


HHSC also reviews rules through public meetings. For hospital-related rules, meetings include those at:

The Hospital Payment and Advisory Committee – where comments can be shared and proceedings can be viewed online or via archive.

The Medical Care Advisory Committee – which makes recommendations to the state Medicaid director on proposed rules and policies. Comments can be shared and proceedings can be viewed online or via archive.

The HHSC Executive Council- which discusses agency rules and policies and accepts stakeholder feedback. Proceedings can be viewed online or via archive.

Check out more committees