This chapter governs HHSC-funded providers delivering substance use prevention, intervention, and treatment services in Texas. It sets requirements for prevention program design (using SAMHSA's Strategic Prevention Framework and CSAP strategies), staff credentialing (certified or associate prevention specialists), service delivery models (universal, selective, indicated, and community coalition programs), and written policies and procedures. Providers must use HHSC-approved evidence-based curricula and comply with applicable state and federal laws. The chapter does not license or set operating standards for residential, inpatient, or other clinical facility types.
View official source§321.1 Purpose This subchapter explains to HHSC-funded providers which substance use prevention approaches to use. It sets requirements for provider staff. It also explains policies and procedures for the program. Source Note: The provisions of this §321.1 adopted to be effective April 16, 2026, 51 TexReg 2399. §321.3 Application This subchapter applies to a provider who receives funding from HHSC to deliver substance use prevention services. Source Note: The provisions of this §321.3 adopted to be effective April 16, 2026, 51 TexReg 2399. §321.5 Definitions The words and terms below have the assigned meanings when used in this subchapter, unless the context indicates otherwise. (1) ACE--Adverse childhood experiences. Childhood events that may be traumatic. (2) Alternatives--A primary prevention strategy that is defined in 45 CFR §96.125(b)(3). (3) Behavioral health--Refers to the topics of mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms. (4) Behavioral health promotion--The advancement of mental health, resilience, and well-being. (5) CFR--Code of Federal Regulations. (6) CLAS--Culturally and linguistically appropriate services. National standards for a set of 15 action steps. These standards aim to improve behavioral health quality and outcomes. (7) Community-based process--A primary prevention strategy that is defined in 45 CFR §96.125(b)(5). (8) CSAP--Center for Substance Abuse Prevention. A center under the Substance Abuse Mental Health Services Administration (SAMHSA). (9) CSAP strategies--The evidence-based primary prevention strategies that are used by SAMHSA and defined in 45 CFR §96.125(b). (10) Education--A primary prevention strategy that is defined in 45 CFR §96.125(b)(2). (11) Environmental--A primary prevention strategy that is defined in 45 CFR §96.125(b)(6). (12) Evidence-based--Models, curricula, and other interventions proven to be effective through research. (13) HHSC--Texas Health and Human Services Commission or its designee. (14) Individual--A person who receives services under this subchapter. (15) Information dissemination--A primary prevention strategy that is defined in 45 CFR §96.125(b)(1). (16) NMDOH--Non-medical drivers of health. The conditions where people live, learn, work, and play that affect a wide range of health outcomes. (17) Prevention strategies--Proactive approaches that help individuals and communities promote healthy behaviors and lifestyles, including strategies defined in 45 CFR §96.125(b). (18) Primary prevention--Activities that target individuals who do not need treatment for substance use disorder, which is defined in 45 CFR §96.121. These activities may include education, mentoring, and other activities that reduce the risk of substance use. (19) Problem identification and referral--A primary prevention strategy that is defined in 45 CFR §96.125(b)(4). (20) Protective factors--Elements that reduce the impact of risk factors. These elements build resilience and decrease the likelihood of developing behaviors that could lead to substance use and misuse. (21) Provider--A person or entity that contracts with HHSC to provide substance use prevention services. (22) Risk factors--Biological, psychological, family, community, or environmental influences that precede and are associated with a higher likelihood of negative outcomes. (23) SAMHSA--Substance Abuse and Mental Health Services Administration. An agency within the U.S. Department of Health and Human Services. (24) Socio-ecological model--A framework that explains the different factors that affect health behavior and how to organize health intervention strategies. (25) Strategic prevention framework--A framework created by SAMHSA used in prevention planning to address substance use and mental health issues. Source Note: The provisions of this §321.5 adopted to be effective April 16, 2026, 51 TexReg 2399. §321.7 General Program Requirements (a) A provider must: (1) promote behavioral health; (2) focus on preventing and delaying first use of substances; (3) attempt to reduce long-term consequences of substance misuse; (4) provide services using the socio-ecological model and SAMHSA's Strategic Prevention Framework; (5) incorporate CSAP strategies that apply to the program, including Alternatives, Community-based Process, Information Dissemination, Education, Environmental, and Problem Identification, and Referral; (6) follow CLAS; and (7) offer services that help fill gaps in line with the current Statewide Behavioral Health Coordinating Council's Behavioral Health Strategic Plan required by Texas Government Code §547.0156. (b) A provider must use prevention strategies that: (1) focus on risk factors that lead to substance use and misuse, including: (A) ACEs; (B) NMDOH; (C) unequal access to healthcare and behavioral health services; or (D) other youth, family, and community risk factors; and (2) promote behavioral health and help build protective factors. (c) Before providing substance use prevention education services, the provider must complete memorandums of understanding or community agreements with public schools and agencies, businesses, or community partners to ensure programs operate efficiently. (d) A provider must operate a program according to written policies and procedures to support implementation. (e) The policies and procedures must: (1) follow the rules in this subchapter; (2) meet any of HHSC's contractual and financial requirements; and (3) follow all relevant state and federal laws or rules. (f) The provider must: (1) keep a copy of the policies and procedures; (2) provide a copy of the policies and procedures to staff; and (3) provide a copy of the policies and procedures to HHSC, if requested. (g) A screening tool is not required for referral to services. If a tool is used, it must be HHSC-approved and not be used for purposes of diagnosis or treatment. Source Note: The provisions of this §321.7 adopted to be effective April 16, 2026, 51 TexReg 2399. §321.9 Program Staffing (a) A provider must keep sufficient staff to effectively operate the prevention program and provide services as required by §321.11 of this subchapter (relating to Program Service Delivery). (b) A provider must ensure that every staff member providing primary prevention services obtains a prevention designation. (c) The designations must: (1) be a certified prevention specialist or associate prevention specialist; and (2) come from an organization that is a member of the International Certification and Reciprocity Consortium. Source Note: The provisions of this §321.9 adopted to be effective April 16, 2026, 51 TexReg 2399. §321.11 Program Service Delivery (a) A provider must deliver a prevention program that: (1) directs prevention activities at individuals that are not in treatment for substance use; (2) carries out activities appropriate for individuals that are not in treatment for substance use; and (3) provides services: (A) in different settings for the general population; (B) to populations at high risk for substance use; and (C) to communities with less access to services. (b) A provider who delivers a universal prevention program must: (1) use a proactive process that addresses the health and wellness of the general population; (2) build protective factors; (3) deter the onset of alcohol, tobacco, and other drug misuse; (4) create places in the community that promote healthy living; and (5) target populations not based on risk level of substance misuse. (c) A provider who delivers a selective prevention program must: (1) use a process that addresses and promotes the health and wellness of individuals, families, and communities by enhancing protective factors; (2) use relevant CSAP strategies to prevent risk factors; (3) focus on individuals or groups who are determined to be at risk for misusing substances; and (4) focus on individuals who are determined to be at a higher-than-average risk of developing a substance use disorder. (d) A provider who delivers an indicated prevention program must: (1) focus on individuals who show early signs of and behaviors related to substance use; (2) serve individuals who are not in substance use treatment; and (3) focus on youth who show early warning signs of substance use. (e) A provider who delivers a community coalition partnership program must: (1) recruit partners involved in the community; and (2) implement evidence-based strategies that: (A) focus on changing community policies and social norms; and (B) increase protective factors in the community. (f) Prevention resource centers must: (1) provide information about substance use to the general community within the HHSC service region where the Prevention Resource Center is located; (2) educate the community on how to promote behavioral health to prevent substance use; (3) support programs in the community that focus on substance use and tobacco prevention and control, including HHSC-funded organizations; (4) connect people to resources related to substance use; and (5) conduct tobacco-specific prevention and compliance strategies as required under 42 United States Code §300x-26 and 45 CFR §96.130. (g) A provider must use and follow an evidence-based curriculum approved by HHSC. (h) HHSC must approve any changes a provider wants to make to the approved evidence-based curriculum. Source Note: The provisions of this §321.11 adopted to be effective April 16, 2026, 51 TexReg 2399. §321.51 Purpose The purpose of this subchapter is to describe department-funded substance abuse intervention services programs. In general, interventions services are designed to address specific problems that, if left unresolved, can lead to substance abuse or dependence. Intervention services are designed to be flexible and responsive to changing community needs and budgetary constraints. Source Note: The provisions of this §321.51 adopted to be effective September 2, 2012, 37 TexReg 6600; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1240. §321.53 Application This subchapter applies to providers of department-funded substance abuse intervention services. Source Note: The provisions of this §321.53 adopted to be effective September 2, 2012, 37 TexReg 6600; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1240. §321.55 Definitions The following words and phrases when used in this subchapter shall have the following meanings unless the context clearly indicates otherwise. (1) Behavioral health services--Services that consist of mental health services and services for the prevention, intervention, and treatment of substance abuse. (2) Brief interventions--Practices designed to initiate resolution of a problem and motivate a person receiving services from a program provider to begin to do something about his or her substance abuse. Brief interventions are described in "Brief Interventions and Brief Therapies for Substance Abuse" (Treatment Improvement Protocol 34), published by the United States Department of Health and Human Services Center for Substance Abuse Treatment. (3) Case management--Services that assist and support persons receiving services from a program provider in developing skills to gain access to and obtain services from needed medical, social, educational and other service providers essential to meeting basic human needs. This function consists of assessment of needs, appropriate referrals, follow-up on referrals, and a plan of action with clear goals. (4) Colonias--A residential area along the Texas-Mexico border that lacks basic living needs, such as potable water and sewer systems, electricity, paved roads, and safe and sanitary housing. Colonias, while frequently found in unincorporated areas of the counties, are also found within city limits. (5) Contract--A written agreement between the department and a program provider providing intervention services. (6) Department--The Department of State Health Services. (7) Indicated target population--Indicated services include youth who are showing early warning signs of substance use, such as experimenting, or abuse and/or exhibiting other problem behaviors. This service targets youth in difficult situations resulting in problem behaviors that, if not addressed, may lead to substance use or abuse. (8) Outreach--The provision of health- and substance abuse-related information, activities, and services to a specified group that has traditionally been underserved. Outreach is a strategy for taking services and activities where the group resides and works. (9) Program provider--A person or entity that contracts with the department to provide substance abuse intervention services. (10) Referral--The process of identifying appropriate services and providing the information and assistance needed to obtain access to them. (11) Rural border--The area that extends 62 miles north of the Texas-Mexico border and encompasses 32 counties as described in the United States-Mexico La Paz agreement of 1983. (12) Screening--The process through which the program provider, person receiving services from the program provider, and available family determine the most appropriate initial course of action given the needs and characteristics of the person receiving services from the program provider and the available resources within the community. Screening includes determining whether a person receiving services from a program provider is appropriate and eligible for admission to a particular treatment service type. (13) Selective target population--The target population for selective prevention services is those individuals whose risk of developing a substance use or abuse disorder is significantly higher than average. These services target individuals or subgroups of the general population who are determined to be at risk for substance abuse, such as children of substance abusers. (14) Service coordination--Administrative, clinical, and evaluative activities that bring the person receiving services from the program provider, treatment services, community agencies, and other resources together to focus on issues and needs identified in the plan for treatment of the person receiving services. Service coordination, which includes case management and advocacy for the person receiving services, establishes a framework of action for the person receiving services to achieve specified goals. It involves collaboration with the person receiving services, and family and/or significant others; coordination of treatment and referral services, liaison activities with community resources and managed care systems, advocacy for the person receiving services, and ongoing evaluation of treatment progress and needs of the person receiving services. (15) State of Texas required training program--The State of Texas required training program on human immunodeficiency virus (HIV) antibody testing and counseling which is used as a tool to guide the discussion with a person receiving services from a program provider about his/her risk(s) as it relates to HIV, sexually transmitted disease (STD), hepatitis C virus (HCV), his/her most recent risk, and the development of incremental steps to reduce the person's risk for acquiring or transmitting HIV/STD/HCV. This State of Texas training program is required for all program providers performing HIV testing/counseling. Source Note: The provisions of this §321.55 adopted to be effective September 2, 2012, 37 TexReg 6600; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1240. §321.101 Purpose The purpose of this subchapter is to describe department-funded substance abuse treatment programs and program providers. Source Note: The provisions of this §321.101 adopted to be effective September 2, 2012, 37 TexReg 6600; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1240. §321.103 Application This subchapter applies to providers of department-funded substance abuse treatment services. Source Note: The provisions of this §321.103 adopted to be effective September 2, 2012, 37 TexReg 6600; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1240. §321.105 Definitions The following words and phrases when used in this subchapter shall have the following meanings unless the context clearly indicates otherwise. (1) Contract--A written agreement between the department and a program provider to provide substance abuse treatment services. (2) Case management--Services that assist and support persons receiving services from a program provider in developing skills to gain access to and obtain services from needed medical, social, educational and other service providers essential to meeting basic human needs. This function consists of assessment of needs, appropriate referrals, follow-up on referrals, and a plan of action with clear goals. (3) Department--The Department of State Health Services. (4) Medication-assisted therapies--Medications used in any treatment for addictions that includes a medication approved by the U.S. Food and Drug Administration for addiction detoxification or maintenance treatment. (5) Program provider--A person or entity that contracts with the department to provide substance abuse treatment services. (6) Substance use disorder--A broad term that includes substance abuse, substance dependence, substance withdrawal, substance intoxication, and other related disorders as described in the Diagnostic and Statistical Manual of Mental Disorders. Source Note: The provisions of this §321.105 adopted to be effective September 2, 2012, 37 TexReg 6600; transferred effective March 15, 2020, as published in the February 21, 2020 issue of the Texas Register, 45 TexReg 1240.