26 TAC 564 requirements for outpatient SUD programs, in plain English

How the chapter is organized

HHSC moved these rules from 25 TAC chapters 441 and 448 to 26 TAC chapter 564 effective April 30, 2024 (Texas Register transfer notice). The numbers carried over, so 25 TAC 448.804 is now 564.804, and the text still mentions old numbers and "TCADA" in places; read those as the 564 sections and HHSC. Subchapter B applies to every provider; subchapters D through N apply to licensed treatment providers (564.3(b)).

The deadline cheat sheet

The clocks a surveyor can check with a calendar. "Service days" are days the client actually receives services (564.1), not calendar days; we count the admission day as day 1, the conservative reading.

Governing body, operational plan and policies

• Operational plan and policies (564.502). The program runs from a written operational plan and policies the governing body adopts, including client rights and abuse, neglect and exploitation (ANE). In practice: a governing body that actually meets, with minutes. Proof: minutes adopting the plan and manual, a dated annual review, and policies that match what staff do.
• Utilization review (564.504). A process that checks placement, the adequacy of services and length of stay. Proof: a UR policy, review records, and continued-stay justifications in the chart (which 564.804(i) also requires).
• Postings (564.506). The client bill of rights, HHSC's complaint information and the grievance procedure are posted in English and a second language. Proof: the posters on the wall, with HHSC's current address and phone number.

Writing the manual rule by rule is the job of our program policy and procedure manual ($4,500), which comes with a state-rule crosswalk mapping each 564 section to the policy that meets it.

Personnel, QCCs and training

Watch: in the July 10, 2026 Texas Register, HHSC proposed amending 564.603 to allow ANE training by live, instructor-led video after SB 437 (proposed rule). Until it's adopted, follow the current rule.

Client rights and grievances

• Bill of rights (564.701). Nineteen rights, including being told the rules, the proposed treatment, its risks and alternatives and the expected length of stay before admission; a treatment plan you help write; estimated charges in advance; and the right to complain directly to the state. Clients get a copy before admission with the agency's address and phone, and an explanation in plain words within 24 hours. Proof: a signed, dated copy in each chart (564.802(d)), using HHSC's contact details, not the old TCADA ones.
• Grievances (564.702). A copy of the procedure to the client and consenter within 24 hours; help writing a grievance; the right to complain to HHSC at any time; a written answer within 7 days; every grievance in a central file. Proof: signed receipt in the chart, central grievance log.
• Abuse, neglect and exploitation (564.703). Report allegations to HHSC immediately, a written incident report to the CEO within 24 hours, and the CEO's written report to HHSC within 2 business days. Proof: the ANE policy, training records and a segregated investigation file.
• Program rules (564.704). Clients are told the rules and consequences verbally and in writing at admission; consequences can't include physical discipline or denial of food, water, sleep or the bathroom. Proof: signed rules acknowledgment.
• No restraint or seclusion in outpatient programs (564.706(b)), except for court-committed clients.

Screening, consent and admission

• Screening (564.801). The client must meet current DSM criteria for a substance use disorder. Screening applies the placement criteria and reviews finances and insurance benefits. Proof: a dated screening signed by the supervising QCC with credentials.
• Admission authorization (564.802(a), 564.904(c)). A QCC authorizes each admission in writing and names the level of care, with a written justification for outpatient placement. Proof: an authorization dated on or before the first service.
• Consent to treatment (564.802(b)). Written consent before any treatment, signed and dated by the client, the consenter and the staff member, covering 16 listed elements: among them the condition, the recommended treatment, risks and alternatives, the primary counselor's name, the grievance procedure, the program rules and the estimated daily charges. Proof: a consent form built element by element from the rule.
• No turning clients away for prescribed medication (564.901(h)), including medications for opioid use disorder.

Our guide to starting an IOP in Texas covers the rest of the intake packet, including 42 CFR Part 2 consents.

Assessment, treatment plans and notes

The core of every chart review, and the part both surveyors and payer auditors read first:

• Assessment (564.803). A counselor or intern covers 11 areas, including medical history with TB, HIV and STD risk behaviors, and mental and emotional functioning. It ends in a problem, needs and strengths list and a DSM diagnostic impression. A possible mental health problem triggers a mental health assessment or referral. A QCC signs it within 3 service days. An outside evaluation counts only if done within 30 days before admission and updated with the client.
• Treatment plan (564.804(a)–(f)). Written with the client. Every problem from the assessment is on the plan, referred out, or deferred with a written reason. Objectives are measurable, time-specific and behavioral; strategies name the type and frequency of services. It includes individualized discharge criteria and a projected length of stay, names the primary counselor, and is signed within 5 service days.
• Reviews (564.804(g)–(k)). At the interval your policy sets, and at least by the midpoint of the projected stay: progress on each goal, revisions, and a justification for continued stay. A change in level of care (PHP to IOP, IOP to OP) needs a QCC-signed decision with rationale and effective date, a revised plan, and coordination with the receiving provider.
• Notes (564.804(l)). Every counseling, education and life skills service is documented within 72 hours with date, nature, duration, and signature and credentials. Group and education notes add the topic; individual notes add the goals addressed, clinical observations and new issues.

Payers read the same chart for medical necessity. Our sister product's chart audit checklist walks through a review, and Cima EHR for IOP and PHP programs keeps group notes, authorizations and continued-stay reviews in one place, so the dates are in front of staff.

Services, groups and required education topics

In the program we run, the health and tobacco topics sit on fixed days of a monthly group calendar, so every client meets them during a normal stay and the group note names the topic.

Discharge and follow-up

• Discharge plan (564.805(a)–(h)). Built with the client and updated as they progress; finished before a scheduled discharge; lists goals to sustain recovery, referrals and recovery maintenance services; signed by counselor, client and consenter; a copy to the client. Before referring, contact the receiving program and document when the client can get in.
• Discharge summary (564.805(i)). Within 30 days, QCC-signed, with admission and discharge dates, problems at admission, during treatment and at discharge, services provided, progress on goals, the reason for discharge, and referrals.
• Follow-up (564.805(j)). One contact between day 60 and day 90 after discharge, recording the client's status or why you couldn't reach them. A contact on day 45 doesn't count.

Records

• Entries (564.507). Complete, current, factual, dated and authenticated. Paper signatures show at least first initial, last name and credentials; electronic ones use a unique user ID and time stamp. Corrections are a single line, dated and initialed, never white-out. Only abbreviations on your approved list.
• The record (564.508). One record per client, protected from loss and tampering, locked when staff aren't present, retrievable at all times, with a reliable backup. Original records stay in Texas. Kept at least 6 years (adolescents: at least 5 years after age 18), with a log of destroyed records.
• Confidentiality (564.13, 564.508(f)). No disclosure without written consent except as the law allows; comply with 42 CFR Part 2, Texas Health and Safety Code chapter 611 and HIPAA.
• No falsifying or omitting significant information (564.20). Cloned notes and identical text across clients are what a surveyor looks for.

Choosing an EHR? Check that it can show who signed what and when, keep a correction trail, and export the whole record. See how Cima EHR protects records.

Safety, incidents and medications

• Emergencies (564.707). Written procedures for medical and psychiatric emergencies, with trained staff.
• Incidents (564.509). An internal report within 24 hours for events including medical or psychiatric emergencies, a suicide attempt or death of an active client, medication errors, rights violations or ANE allegations, a lost record or a release without consent. Reports go in a separate incident file.
• Medications (564.1001–564.1004), if you handle them: give exactly as prescribed, document each dose (including over-the-counter) with allergies, dose, route, time and the staff signature, and record missed doses and reactions. Count Schedule II–IV drugs daily.
• Searches (564.708). A non-routine search is documented with the reason, result and the signatures of the searcher and a witness.

Fire drills, environment-of-care checks and emergency plans come up again at accreditation. Comply keeps that recurring work on a schedule; see the behavioral health compliance calendar and fire drill requirements.

Adolescents and telehealth

• Adolescents (564.905). Ages 13–17 (exceptions justified and QCC-approved in writing); adults and adolescents kept separate; family involved or the reason documented; access to TEA-approved education within 3 school days when treatment is expected to last more than 14 days, if the law requires it. Adolescent day treatment provides at least 15 hours a week, including 1 hour of individual counseling; school time doesn't count. 16- and 17-year-olds may consent to their own treatment (564.1).
• Telehealth (564.911). Verify the client's identity at the start, record verbal consent for each electronic service, give written risks before starting, and use audio-only counseling only with an existing clinical relationship and a documented reason. HHSC's guidance letter GL 21-3004-A2 covers services by electronic means.

What 26 TAC 564 doesn't say

• No weekly hour minimums for adult IOP or PHP. The chapter asks for intensity sufficient to meet plan goals. Hour minimums (such as about 9 hours a week for adult IOP) come from payers and ASAM, not the license.
• No single plan review interval for outpatient. You set it in writing in your treatment planning policy, and the midpoint is the floor.
• No standalone suicide-screening instrument requirement. It falls under the assessment's mental and emotional functioning area and the mental health referral duty. Use a validated tool anyway.
• No published "most-cited deficiencies" list from HHSC that we've found. Audit against the deadline table above.
• Not mental health programs. The chapter covers substance use treatment. See licensing a mental health IOP or PHP in Texas.

Opening from scratch? The IOP / PHP Program Launch ($24,500) includes the license application, the manual and the 564 crosswalk. Or book a free 30-minute call.

Questions

Sources

• 26 TAC chapter 564 and its sections, for example 564.804, 564.507, 564.508, 564.901 (Cornell LII)
• Texas Register: transfer to 26 TAC 564, effective April 30, 2024
• HHSC: Chemical Dependency Treatment Facilities
• HHSC GL 21-3004-A2, services by electronic means
• Texas Register, July 10, 2026: proposed amendment to 564.603
• 42 CFR Part 2 (eCFR)

Cima Consulting isn't a law firm and doesn't give legal advice. This page paraphrases the rules; the official text controls.