Part I.
Texas Department of Human Services
Chapter 18.
Nursing Facility Administrators
The Texas Department of Human Services (DHS) adopts the repeal of
§§18.2-18.5, 18.7, and 18.8 and new §§18.2-18.5, 18.7,
and 18.8. Sections 18.3, 18.4, 18.5, and 18.8 are adopted with changes to
the proposed text. The repeal of §§18.2-18.5, 18.7 and 18.8 and
new §18.2, and §18.7 are adopted without changes to the proposed
text published in the October 30, 1998, issue of the
Texas Register
(23 TexReg 11095), and the text will not be republished.
Justification for the repeals and new sections is to establish the organization,
terms, and functions of the Nursing Facility Administrators Advisory Committee,
alter the academic requirements for licensure by replacing the current 200-clock
hour nursing facility administrator's course with 15 academic credit hours
in long-term care administration which encompasses all domains of the National
Association of Boards of Examiners of Long Term Care Administrators, Inc.
(NAB), and place a limit on the number of times an applicant may fail the
national and state licensure examinations before being required to obtain
additional training. In addition, the provisional license fee has been reduced
in order to promote uniform and consistent program fees.
The new sections will function by assuring that applicants seeking licensure
as nursing facility administrators receive adequate preparatory training before
obtaining a license to practice as a nursing facility administrator. This
will improve the quality of care provided to nursing facility residents. The
Nursing Facility Administrators Advisory Committee (NFAAC) and the Subcommittee
on Education for the NFAAC, which includes representatives from academic,
professional, and provider groups, participated in the revisions to these
sections. The following responses to public comments are also incorporated
by reference into the basis for these rules.
The department received three comments during the comment period regarding
adoption of the new sections. The commenters were McLennan Community College,
Texas Health Care Association (THCA), and one licensed nursing facility administrator.
A summary of the comments and the department's responses follow.
Comment: Regarding §18.2(a)(1), given the new emphasis on the educational
requirements, consideration should be given to including an individual from
the educational community on the Nursing Facility Administrator Advisory Committee
(NFAAC).
Response: Health and Safety Code, Chapter 242, Section 242.303, specifies
the composition of the NFAAC. Members of the NFAAC are appointed by the governor.
Any change in membership composition will require an amendment to the statute.
Comment: Regarding §18.4(b), does this mean that all documentation
has to be received at least 30 days prior to testing? Students acting responsibly
by sending in documentation well in advance may be denied the opportunity
to test due to slow processing by DPS or the delay on the part of a college
or university in providing a transcript at the end of an academic semester.
Response: Yes, all documentation will have to be received at least 30 days
before an applicant can take the National Association of Boards of Examiners
of Long Term Care Administrators, Inc. (NAB) and state examination on the
Nursing Facility Requirements for Licensure and Medicaid Certification in
order to ensure the application packet is complete and all supporting documentation
is correct. This includes the completed "Texas Criminal Conviction" report
that is done by Texas Department of Public Safety (DPS) with accompanying
fingerprint card as well as a college transcript that reflects completion
of the minimum requirements of a bachelor's degree and completion of 15 academic
credit hours in long term care administration or its equivalent, or (until
January 1, 2000) the 200- clock hour nursing facility administrator's course
or its equivalent that is approved by the Credentialing Department.
Comment: Regarding §18.4(e)(3), will the NFAAC require transcripts
from all colleges or universities the applicant has attended or only the final
transcript from the degree-granting institution? Will the NFAAC accept proof
other than transcripts, that the applicant has received a Bachelor's degree
(i.e., institutions are no longer in existence).
Response: The department requires an applicant to provide a transcript
from only the degree-awarding institution or other documentation that is acceptable
to the department which reflects attainment of a bachelor's degree. In addition,
an applicant must provide a transcript which reflects completion of 15 academic
credit hours in long-term care administration or its equivalent or (until
January 1, 2000) the 200-clock hour nursing facility administrator's course
or its equivalent that is approved by the Credentialing Department. The department
will consider other proof of attainment of a Bachelor's degree; however, each
case will be determined on its own merits.
Comment: Regarding §18.4(e)(4), the courses should specifically focus
on long- term care administration because acceptance of generic courses (such
as general personnel management or business law) would miss specific competencies
related to long- term care administration. Courses should focus on long-term
care administration and be so identified by either course title or prefix.
Response: The department does not concur with the comments and recommends
adoption of the language as proposed. The department believes that previously
completed courses that are equivalent to courses offered in long-term care
administration programs should be recognized.
Comment: Regarding §18.4(e)(4), what criteria will be used by the
Credentialing Department to determine approval of the long-term care administration
courses? Who will do the actual review for approval, what is the process by
which the approval will be granted, what will disqualify a course from approval,
and how long will approval be valid?
Response: For accredited colleges or universities that plan to begin offering
a long- term care administration program consisting of 15 academic credit
hours, in consultation with the NFAAC or the NFAAC Subcommittee on Education,
the department will review the course descriptions, course syllabi, and request
a list of textbooks, and the curriculum vitae of instructors. The department
will inform the college or university of program or course approval or disapproval.
Program or course approval will continue as long as the program or course
remains consistent with the National Association of Boards of Examiners of
Long Term Care Administrators, Inc. (NAB) requirements.
Comment: Regarding §18.4(e)(4), the reference to the "five domains
of the NAB" could limit the ability of programs to respond to changing needs
in the LTC industry. Delete the word "five" to allow flexibility to respond
to change without the need to go through the rule revision process.
Response: The department concurs with the comments and has revised the
proposed language at §18.4(e)(4).
Comment: Regarding §18.4(e)(4), the timetable of September 1, 1999,
for implementation of 15 academic credit hours in long-term care administration
may be unrealistic for colleges and universities to meet.
Response: The department concurs with the comments and has revised the
proposed language to extend until January 1, 2000, the timeframe for colleges
and universities to convert from the 200-clock hour course to 15 academic
credit hours.
Comment: Regarding §18.4(e)(4), if an applicant successfully passes
the American College of Health Care Administrators (ACHCA) professional certification
exam, will this be used for equivalency purposes for endorsement regarding
the 15 academic credit hours required under the proposed rules? Many other
states offer reciprocity based on this exam.
Response: Yes, the department will waive the 15 academic credit hours in
long-term care administration if an applicant successfully passes the ACHCA
professional certification exam. The department recommends adoption of the
language as proposed because the department will have the authority to grant
waivers as indicated in the proposed rules at §18.5(e).
Comment: Regarding §18.4(e)(5), what will be the requirements for
the college- based internship programs? Traditionally, colleges were viewed
as filling the role of the preceptor for students enrolled in their programs.
Therefore, the individual administrators did not have to independently be
certified preceptors.
Response: The department recommends adoption of the language as proposed.
Under the previous Texas Board of Nursing Facility Administrators, colleges
and universities were allowed to fill the role of preceptor for students enrolled
in their programs, even if this entailed only one monitoring visit to the
facility in the fall and spring semesters. The department and NFAAC are committed
to enhancing the "hands-on" training provided to the administrator-in-training
(AIT). Therefore,it is recommended that the AIT complete the 1,000 hour training
under the daily supervision of a preceptor who is certified by the department.
Colleges and universities will be able to continue monitoring AIT performance
and maintain the required documentation regarding the AIT internship. Since
the on-sight administrator is ultimately responsible for the training, it
is critical that the administrator be a certified preceptor.
Comment: Regarding §18.5, add language to this section that states
"this does not apply to currently licensed administrators."
Response: The department does not concur and recommends adoption of the
language as proposed in §18.5, "Academic Requirements for Examination
and Licensure". A currently licensed administrator has already satisfied the
academic requirements necessary to attain a license.
Comment: Regarding §18.5(b), clarification is needed on when this
section will be effective. Add "after September 1, 1999" after "An applicant"
so the proposed language will state: An applicant, after September 1, 1999,
shall complete a minimum of 15 academic credit hours in long term care administration."
Response: The department concurs with the comments regarding the need to
include an effective date in the proposed rules for clarification purposes.
However, to allow colleges and universities ample time to complete the necessary
process required by the Texas Higher Education Coordination Board to modify
the long-term care administration course from 200-clock hours to 15 academic
credit hours, the department is extending the date of implementation to January
1, 2000.
Comment: Regarding §18.5(e), any evidence submitted by an applicant
for purposes of waiving academic or AIT internship requirements should be
left to the educational institution. Since the NFAAC will hold colleges and
universities responsible for offering courses that meet the criteria of the
NAB, it is those academic institutions that should be responsible for determining
if a student has met their learning requirements. The credibility of the institution
is on the line when it comes to the competency of students.
Response: The department does not concur and recommends adoption of the
language as proposed. The department is the licensing authority for nursing
facility administrators and is ultimately accountable to ensure that minimal
academic and experiential competencies are gained by an individual who seeks
to become a nursing facility administrator.
Comment: Regarding §18.5(g), the same failure-retest requirements
should be established for the state portion of the licensing exam.
Response: The department concurs with the comments and has made the suggested
change at §18.5(g).
Comment: Regarding §18.5(h), it is unclear as to the group of previously
licensed nursing facility administrators that are referenced in this section.
Clarification in needed in this item.
Response: The department concurs and has revised the proposed language
at §18.5(h) to require an applicant who has failed the state examination
to repeat the 1,000 hour AIT internship before being allowed to retest.
Comment: Regarding §18.8(a)(1), define substantially equivalent.
Response: §18.8(a)(1) allows the department to grant a provisional
license to an individual that is licensed as a nursing facility administrator
by another state or other jurisdiction, which has equivalent or substantially
equivalent requirements to Texas licensure requirements. The department's
determination of whether the requirements of another jurisdiction are substantially
equivalent to the requirements established in this chapter must be determined
on a case-by-case basis after consideration is given to the documentation
submitted by the applicant and other jurisdiction. Therefore, the department
recommends adoption of the rules as proposed.
Comment: Regarding §18.8(a)(2), delete this section as it requires
a person that is seeking a provisional license to have a bachelor's degree.
Without this change, it would be impossible for a person who does not have
a bachelor's degree, but has many years of experience as a licensed nursing
facility administrator in a state to become licensed in Texas.
Response: The department does not concur and recommends adoption of the
language as proposed. With the recommendation of the Nursing Facility Administrators
Advisory Committee (NFAAC), the department has established minimal educational
and experiential qualifications for individuals seeking to practice in the
field of nursing facility administration. A minimum of a bachelor's degree
in any subject, is required for both initial and provisional licensure applicants.
Comment: Regarding §18.8(a)(4), clarification is needed that the person
is employed as a licensed administrator of record in a licensed nursing facility.
Also, change the time period from two years to one year, which is closer to
the 1,000 hour requirement.
Response: The department concurs with the comments and has revised the
proposed language at §18.8 (a)(4).
Comment: Regarding §18.8(a)(5), this section is too vague; delete
§18.8(a)(5).
Response: The department does not concur and recommends adoption of the
language as proposed.
In addition, the department added §18.3(b) to inform applicants that
effective January 1, 2000, NAB will offer year round computerized testing
which will alter the current process of DHS administering the NAB exam.
40 TAC §§18.2-18.5, 18.7, 18.8
The repeals are adopted under the Texas Health and Safety
Code, Chapter 242, Subchapter I, (Nursing Facility Administration, §§242.301,
added by Acts 1997, 75th Legislature, Chapter 1280, §1.01), which authorizes
the department to license nursing facility administrators.
The repeals implement the Texas Health and Safety Code, Chapter 242.302,
as added by Acts 1997, 75th Legislature, Chapter 1280, §1.01.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April
9, 1999.
TRD-9902134
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 1999
Proposal publication date: October 30, 1998
For further information, please call: (512) 438-3765
The new sections are adopted under the
Texas Health and Safety Code, Chapter 242, Subchapter I, (Nursing Facility
Administration, §§242.301, added by Acts 1997, 75th Legislature,
Chapter 1280, §1.01), which authorizes the department to license nursing
facility administrators.
The new sections implement the Texas Health and Safety Code, Chapter 242.302,
as added by Acts 1997, 75th Legislature, Chapter 1280, §1.01.
§18.3.Application and Licensure Fees.
(a)
The Texas Department of Human Services (DHS) shall charge
the following fees for a license, license renewal, examination, and administrative
fees. The fees shall be as follows:
(1)
Application Fee - $100;
(2)
National Association of Boards of Examiners of Long
Term Care Administrators, Inc. (NAB) Examination Fee - $125;
(3)
NAB Re-examination Fee - $125;
(4)
Initial Licensure Fee - $250;
(5)
State Examination Fee - $150;
(6)
Exam Re-test Fee - $50 per examination;
(7)
Licensure Renewal Fee - $250 (biennially);
(8)
Formal Inactive Status Fee - $250;
(9)
Late Renewal Fee - an additional $75 for renewals
made within 90 days of the license expiration date and an additional $150
for renewals made between 91 and 365 days of the license expiration date;
(10)
Duplicate License Fee - $25; and
(11)
Provisional License Fee - $100.
(b)
Effective January 1, 2000, DHS shall not administer the
NAB examination. NAB shall offer computer-based testing, and fees shall be
paid in advance by the applicant directly to NAB.
§18.4.Applicant Requirements for Examination and Licensure.
(a)
An applicant seeking licensure as a nursing facility administrator
shall submit the required documentation of credentials on official Texas Department
of Human Services (DHS) forms.
(b)
DHS shall not consider an application as officially submitted
until the applicant pays the required fee and accurately completes required
forms. An applicant shall not take the National Association of Boards of Examiners
of Long Term Care Administrators, Inc. (NAB) examination or the state examination
on the Nursing Facility Requirements for Licensure and Medicaid Certification
unless completed application form(s) and fees are received at least 30 calendar
days prior to the date of the examination.
(c)
An application that is submitted to DHS is valid for only
one year after the date of receipt. An applicant that fails to meet all requirements
for licensure, including successfully passing the NAB examination and state
examination on the Nursing Facility Requirements for Licensure and Medicaid
Certification during a one-year period, shall be required to submit another
application and application fee to DHS.
(d)
DHS shall not be responsible for lost, misrouted, or undelivered
applications, forms, or correspondence.
(e)
An applicant shall submit the following documentation and
evidence to DHS:
(1)
a completed application that is sworn and notarized before
a public notary which contains specific information regarding U.S. citizenship
or legal resident status, personal data, employment history, and licensure
in other states;
(2)
a statement that the applicant has read and agrees
to abide by the rules set forth in the Nursing Facility Administrators Licensure
Rules Handbook;
(3)
an official college transcript that provides evidence
of the minimum education requirements of a Bachelor's degree;
(4)
proof of completion of a minimum of 15 academic credit
hours in long-term care administration or its equivalent which encompasses
all domains of the NAB that is approved by the Credentialing Department, or
proof of completion of a 200-clock hour nursing facility administrator's course
or its equivalent which encompasses all domains of the NAB through January
1, 2000, that is approved by the Credentialing Department;
(5)
proof of completion of 1,000 hours in an Administrator-In-Training
Internship with a DHS-approved preceptor in a licensed nursing facility with
a minimum of 60 beds; and
(6)
a completed "Texas Criminal Conviction" report that
is performed by the Texas Department of Public Safety with accompanying fingerprint
card.
(f)
An applicant may submit a curriculum vitae, resume, and/or
other documentation of credentials to DHS in addition to the completed application.
(g)
DHS shall review any adverse disciplinary action implemented
by a state licensing board or authority in the health care profession and/or
official court and hearing findings to determine applicant eligibility for
licensure.
(h)
DHS shall not issue a license to an applicant that has
had a nursing facility administrator's license revoked by this or another
nursing facility administrator licensure authority, board, or its equivalent.
§18.5.Academic Requirements for Examination and Licensure.
(a)
An applicant seeking licensure as an administrator shall
have a minimum of a Bachelor's degree in any subject from an accredited college
approved by an accrediting association recognized by the Texas Higher Education
Coordinating Board.
(b)
An applicant shall complete a minimum of 15 academic credit
hours in long term care administration or its equivalent, which encompasses
all domains of the National Association of Boards of Examiners of Long Term
Care Administrators, Inc. (NAB), that is approved by the Credentialing Department
or a 200-clock hour nursing facility administrator's course or its equivalent
through January 1, 2000, which encompasses all domains of the NAB, that is
approved by the Credentialing Department.
(c)
An applicant shall complete a minimum of 1,000 hours in
an Administrator-in-Training (AIT) Internship with a DHS-approved preceptor
in a licensed nursing facility with a minimum of 60 beds.
(d)
Degrees and coursework received at foreign universities
shall be accepted by DHS only if such coursework is counted as transfer credit
by accredited universities as reported by the American Association of Collegiate
Registrars and Admissions Officers. Degrees or coursework that can not be
documented because the foreign university refuses to issue a transcript, degree,
or other evidence which indicates the attainment of the minimum educational
requirements by the foreign applicant shall result in the forfeiture of the
original application. The applicant shall submit a new application to DHS
with the proper transcripts or transcript evaluation.
(e)
DHS staff shall review any evidence submitted by an applicant
for purposes of waiving academic or AIT internship requirements to determine
compliance with subsections (a), (b), and (c) of this section.
(f)
DHS shall provide an applicant prior notice of eligibility
to take the NAB examination and state examination on the Nursing Facility
Requirements for Licensure and Medicaid Certification. Applicants shall not
be allowed to take the examination(s) unless prior notice of eligibility is
provided by DHS.
(g)
An applicant who fails the NAB examination or the state
examination on the Nursing Facility Requirements for Licensure and Medicaid
Certification three times shall be required to repeat the 1,000 hours AIT
Internship before being allowed to re-test.
(h)
An applicant previously licensed as a nursing facility
administrator by passing the comprehensive examination who allows a license
to expire or voluntarily surrenders a license shall be required to successfully
pass the NAB examination and state examination on the Nursing Facility Requirements
for Licensure and Medicaid Certification in order to obtain a current license.
§18.8.Provisional Licensure.
(a)
The Texas Department of Human Services (DHS) shall grant
a provisional license to an individual that provides evidence of the following:
(1)
licensure or registration as a nursing facility administrator
by another state or other jurisdiction that has equivalent or substantially
equivalent requirements for licensure or registration to the requirements
established in this chapter; and
(2)
a Bachelor's degree in any subject from an accredited
college approved by an accrediting association recognized by the Texas Higher
Education Coordinating Board; and
(3)
a passing score on the National Association of Boards
of Examiners of Long Term Care Administrators, Inc. (NAB) examination; and
(4)
employment as the licensed nursing facility administrator
of record of a licensed nursing facility for a period of one year; or
(5)
employment in an equivalent administrative capacity
in a licensed nursing facility or health care setting for a period of one
year; or
(6)
completion of a 1,000 hour Administrator-in-Training
(AIT) program.
(b)
An individual that provides proof of completion of the
requirements established in subsection (a)(1)-(6) of this section before taking
the state examination on the Nursing Facility Requirements for Licensure and
Medicaid Certification shall be granted a provisional license.
(c)
DHS shall grant a license to a provisional license holder
that passes the state examination on the Nursing Facility Requirements for
Licensure and Medicaid Certification.
(d)
A provisional license that is granted by DHS shall expire
180 days from the date of issuance. DHS may extend the expiration date of
a provisional license at its discretion.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April
9, 1999.
TRD-9902135
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 1999
Proposal publication date: October 30, 1998
For further information, please call: (512) 438-3765
Subchapter D. Fiscal Monitoring
40 TAC §45.401, §45.403
The Texas Department of Human Services (DHS) adopts amendments
to §45.401 and §45.403, without changes to the proposed text published
in the January 22, 1999, issue of the
Texas Register
(24 TexReg 373).
The justification for the amendments is to delete the failure to use an
unapproved substitute form as an administrative error.
Repealing this particular provision will focus the administrative sanctions
on the collection of the required data, rather than on the process of obtaining
DHS approval for a substitute form. If the provider fails to obtain DHS approval
for the substitute form, but collects all of the required data on the substitute
form, no administrative error will be cited.
No comments were received regarding adoption of the amendments.
The amendments are adopted under the Human Resources Code, Title
2, Chapters 22 and 32, which provides the department with the authority to
administer public and medical assistance programs and under Texas Government
Code §531.021, which provides the Health and Human Services Commission
with the authority to administer federal medical assistance funds.
The amendments implement §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April
9, 1999.
TRD-9902136
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 1999
Proposal publication date: January 22, 1999
For further information, please call: (512) 438-3765
Subchapter H. Administrative and Financial Errors
40 TAC §46.8002
The Texas Department of Human Services (DHS) adopts an amendment
to §46.8002, without changes to the proposed text published in the January
22,1999, issue of the
Texas Register
(24 TexReg
374).
The justification for the amendment is to delete the failure to use an
unapproved substitute form as an administrative error.
Repealing this particular provision will focus the administrative sanctions
on the collection of the required data, rather than on the process of obtaining
DHS approval for a substitute form. If the provider fails to obtain DHS approval
for the substitute form, but collects all of the required data on the substitute
form, no administrative error will be cited.
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Human Resources Code, Title
2, Chapters 22 and 32, which provides the department with the authority to
administer public and medical assistance programs and under Texas Government
Code §531.021, which provides the Health and Human Services Commission
with the authority to administer federal medical assistance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April
9, 1999.
TRD-9902137
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 1999
Proposal publication date: January 22, 1999
For further information, please call: (512) 438-3765
Subchapter C. Claims Payment
40 TAC §47.3906
The Texas Department of Human Services (DHS) adopts an amendment
to §47.3906, without changes to the proposed text published in the January
22,1999, issue of the
Texas Register
(24 TexReg
375).
The justification for the amendment is to delete the failure to use an
unapproved substitute form as an administrative error.
Repealing this particular provision will focus the administrative sanctions
on the collection of the required data, rather than on the process of obtaining
DHS approval for a substitute form. If the provider fails to obtain DHS approval
for the substitute form, but collects all of the required data on the substitute
form, no administrative error will be cited.
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Human Resources Code, Title
2, Chapters 22 and 32, which provides the department with the authority to
administer public and medical assistance programs and under Texas Government
Code §531.021, which provides the Health and Human Services Commission
with the authority to administer federal medical assistance funds.
The amendment implements §§22.001-22.030 and 32.001-32.042 of
the Human Resources Code.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April
9, 1999.
TRD-9902138
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 1999
Proposal publication date: January 22, 1999
For further information, please call: (512) 438-3765
Subchapter J. 1915(c) Medicaid Home and Community-based Waiver Services for Aged and Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care
Chapter 45.
Community Living Assistance and Support Services
Chapter 46.
Licensed Personal Care Facilities Contracting with the Texas Department of Human Services to Provide Residential Care Services
Chapter 47.
Primary Home Care
Chapter 48.
Community Care for Aged and Disabled