TITLE 40.SOCIAL SERVICES AND ASSISTANCE

Part 1. TEXAS DEPARTMENT OF HUMAN SERVICES

Chapter 15. MEDICAID ELIGIBILITY

The Texas Department of Human Services (DHS) proposes amendments to §15.435, concerning liquid resources, §15.605, concerning medical effective date, and §15.610, concerning Medicaid coverage, in its Medicaid Eligibility chapter. The purpose of the amendments is to simplify the medical effective date policy for clients in institutional settings, clarify that parents of a deceased child of any age can file for benefits on his behalf, and address the treatment of funds in the "Texas Tomorrow" program as a resource.

The medical effective date is currently the first day on which all eligibility criteria are met. The proposed medical effective date for an individual filing a Medicaid application in the month of facility entry would be the first day of that month if all eligibility criteria are met during that month.

The current rule language on parental rights to apply for Medicaid benefits for a deceased child caused confusion because it seems to limit the right to file only to parents of minor children. The amendment will ensure that parents of a deceased child of any age can file for Medicaid benefits on his behalf.

The "Texas Tomorrow" program allows parent/grandparents to purchase a prepaid college education for a child/grandchild. If the funds can be withdrawn from the program, they are a countable resource to the purchaser. If the right to withdraw funds has been irrevocably waived, the funds are not countable and there is no transfer of assets.

Eric M. Bost, commissioner, has determined that for the first five-year period the proposed sections will be in effect there will be no fiscal implications for state or local governments as a result of enforcing or administering the sections.

Mr. Bost also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the sections will be that policy will be applied correctly and consistently statewide. There will be no effect on large, small, or micro businesses as a result of enforcing or administering the sections because it applies only to the client's financial eligibility for Medicaid benefits, not to the operation of business. There is no anticipated economic cost to persons who are required to comply with the proposed amendments.

Questions about the content of this proposal may be directed to Judy Coker at (512) 438-3227 in DHS's Long Term Care section. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-132, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

Subchapter D. RESOURCES

40 TAC §15.435

The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department 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 the Human Resources Code, §§22.001 - 22.030 and §§32.001 - 32.042.

§15.435.Liquid Resources.

(a)-(t)

(No change.)

(u)

"Texas Tomorrow" funds which can be withdrawn with approval of the Texas Prepaid Higher Education Tuition Board are a countable resource to the purchaser. If the purchaser irrevocably waives any right to revoke the contract and receive a refund of monies invested, the funds are no longer a countable resource. Irrevocably waiving the right to withdraw "Texas Tomorrow" funds is not a transfer of assets.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 4, 2000.

TRD-200000810

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


Subchapter G. APPLICATION FOR MEDICAID

40 TAC §15.605, §15.610

The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department 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 the Human Resources Code, §§22.001 - 22.030 and §§32.001 - 32.042.

§15.605.Medical Effective Date.

The effective date for medical assistance is

(1)

(No change.)

(2)

the first day of the month of nursing facility, intermediate care facility for the mentally retarded (ICF/MR) facility, or state school entry if the applicant filed a Medicaid application during that month and met all eligibility criteria.

(3)

[ (2) ] the earliest date in the month of application on which the applicant met all eligibility criteria;

(4)

[ (3) ] the date on which the applicant subsequently met all eligibility criteria, if not eligible in the month of application; or

(5)

[ (4) ] the day after the effective date of denial (under Type Program 13), for individuals transferred from SSI assistance to MAO (excluding qualified Medicare beneficiaries).

§15.610.Medicaid Coverage.

(a)-(c)

(No change.)

(d)

SSI-MAO eligibility requirements.

(1)-(3)

(No change.)

(4)

Prior coverage for deceased individuals.

(A)-(B)

(No change.)

(C)

If a bona fide agent was not appointed during the individual's lifetime, then only the individual's spouse, children, sibling or half-sibling, parent[ (in the case of a minor child) ], or court-appointed estate representative may file for benefits on behalf of the deceased individual.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 4, 2000.

TRD-200000811

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


Chapter 79. LEGAL SERVICES

Subchapter T. ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS

40 TAC §79.1906

The Texas Department of Human Services (DHS) proposes an amendment to §79.1906 to eliminate duplicative advance notice of hearing, in its Legal Services chapter. The purpose of the amendment is to delete the requirement of "certified mail, return-receipt requested" for simplification and as a cost savings for DHS. It will retain the requirement of notice by first-class mail.

Eric M. Bost, commissioner, has determined that for the first five- year period the section is in effect there will be fiscal implications for state government as a result of enforcing or administering the section. The effect on state government for the first five-year period the sections will be in effect is an estimated reduction in cost of $6,072 in fiscal year (FY) 2000; $18,215 in FY 2001; $18,215 in FY 2002; $18,215 in FY 2003; and $18,215 in FY 2004. There will be no fiscal implications for local government as a result of enforcing or administering the section.

Mr. Bost also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be a cost savings for DHS and, therefore, more efficient use of state resources. There will be no effect on large, small, or micro businesses, because the change is internal to DHS. There is no anticipated economic cost to persons who are required to comply with the proposed section.

Questions about the content of this proposal may be directed to Barbara Stegall at (512) 438-4878 in DHS's Hearings Department. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-131, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 31, which authorizes the department to administer public and financial assistance programs.

The amendment implements the Human Resources Code, §§22.001 - 22.030 and §§31.001 - 31.0325.

§79.1906.Advance Notice of Hearing.

(a)

The hearing officer sends the household member an advance notice of the hearing in sufficient time to allow receipt at least 30 calendar days before the scheduled hearing date. The notice is sent first class [ and certified mail, return-receipt requested, ] and marked "return service requested" to the address where the household member last received benefits. Delivery is not restricted to the addressee. The notice specifies the charges against the household member and a summary of the evidence (including how and where it may be examined). If the notice is returned showing a new address, it will be resent and the normal due process rules will be reapplied.

(b)

Advance notice requirements are met when the notice is mailed to the most current mailing address available to any division within the department whether or not the [ certified or ] first class mail is returned. The hearing will be conducted.

(1)-(2)

(No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 4, 2000.

TRD-200000778

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


Chapter 97. HOME AND COMMUNITY SUPPORT SERVICES AGENCIES

The Texas Department of Human Services (DHS) proposes the repeal of §97.13, concerning change of ownership or services; proposes amendments to §97.1, concerning purpose; §97.2, concerning definitions; §97.3, concerning licensing fees; §97.11, concerning application and issuance of initial license; §97.12, concerning issuance and renewal of license; §97.14, concerning application and issuance of a branch office license; §97.15, concerning application and issuance of an alternate delivery site license; §97.16, concerning time periods for processing and issuing a license; §97.21, concerning licensure requirements and standards for agencies providing licensed home health, licensed and certified home health, or hospice services; §97.51, concerning survey procedures; and §97.52, concerning enforcement action; and proposes new §97.13, concerning change of ownership or services, in its Home and Community Support Services Agencies chapter. The purpose of the repeal, amendments, and new section is to implement recent legislation from the 76th Legislative Session, which amended Health and Safety Code, Chapter 142, relating to licensing and regulation of home and community support services agencies (HCSSA).

In addition, the sections concerning license application processes have been amended and the sections on change of ownership/services have been rewritten to address licensure problems that have been identified by DHS. The timelines for applying for a license have been changed to expedite the application process. The definition of change of ownership has been amended. The application procedures for change of ownership include new time periods for applying for a license and include a late fee for not complying with the time periods. The time periods for notifying DHS of specific service changes have been changed to reflect more realistic expectations. Also, a process for informal reconsideration of proposed enforcement actions has been added to the enforcement section in compliance with Government Code, §2001.054.

House Bill (HB) 2914, 76th Legislature, requires agencies to provide a written statement describing the agencies policy for drug testing of employees who have direct contact with clients to certain individuals. Senate Bill (SB) 94, 76th Legislature, requires DHS to adopt minimum standards for acceptable quality of care; adds the concept of a controlling person and adds a definition for controlling person; amends the requirements for disposal of special or medical waste; adds requirements regarding the reporting of abuse, neglect, and exploitation; and adds requirements prohibiting retaliation. HB 2037 establishes a late renewal fee for licenses that have been expired for 90 days or less. Senate Bill 1260 requires additional language relating to advance directives policy. The policy must include a clear and precise statement of any procedure the agency is unwilling to provide or withhold. This statement must be shared with clients. Failure to comply will result in an administrative penalty.

In addition, DHS has made technical changes to the sections which facilitate the transfer from the Texas Department of Health to DHS.

Eric M. Bost, commissioner, has determined that for the first five- year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the sections.

Mr. Bost also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the sections will be stronger HCSSA rules, particularly the sections which require agencies to provide a written statement describing the agency's policy for drug testing of employees who have direct contact with clients to certain individuals; require agencies to dispose of special or medical waste generated in the home in the same manner as they do at the agency; require agencies to report abuse, exploitation, and neglect; prohibits retaliation against a person for filing a complaint or presenting a grievance; and require agencies to inform residents of policies regarding advance directives and establishes a $500 administrative penalty for failure to do so. Also the sections on application procedures and change of ownership have been strengthened to expedite the application process for licensing of HCSSAs. There will be some effect on large, small, or micro businesses, because HCSSAs will be required to dispose of special or medical waste generated in a client's home in the same manner as they do at the agency, as required by statute. Cost will vary depending on the current method of disposal and on the number of clients served. The rules establish a renewal fee for licenses that have been expired for 90 days or less. The fee is one and one-half times the normal renewal license fee. If an agency renews its license 90 days or less after the expiration date of the license, the agency will incur the higher fee. The rules relating to change of ownership include a $250 late fee for applications submitted postmarked 29 days or less prior to the date of the change of ownership and prior to the expiration date, unless there is a valid emergency. There is no anticipated economic cost to persons who are required to comply with the proposed sections.

Questions about the content of this proposal may be directed to Linda Kotek at (512) 438-3158 in DHS's Long Term Care Section. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-100, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register.

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

Subchapter A. GENERAL PROVISIONS

40 TAC §§97.1 - 97.3

The amendments are proposed under the Health and Safety Code, Chapter 142, which provides the department with the authority to adopt rules for the licensing and regulation of home and community support services agencies.

The amendments implement the Health and Safety Code, Chapter 142.001 - 142.030.

§97.1. Purpose.

(a)

(No change.)

(b)

These sections provide minimum standards for acceptable quality of care, which include the following components:

(1)

client independence and self-determination;

(2)

humane treatment;

(3)

continuity of care;

(4)

coordination of services;

(5)

professionalism of service providers;

(6)

quality of life; and

(7)

client satisfaction with services. [ home and community support services which may include licensed home health services, licensed and certified home health services, home dialysis designation, hospice services or personal assistance services, procedures for granting, denying, suspending, and revoking a license, requirements for permitting home health medication aides, approving home health medication aide programs, home health aide training programs, and criminal history checks. ]

(c)

(No change.)

§97.2.Definitions.

The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise.

(1)-(21)

(No change.)

(22)

Controlling person - A person with the ability, acting alone or in concert with others, to directly or indirectly, influence, direct, or cause the direction of the management, expenditure of money, or policies of an agency or other person.

(A)

A controlling person includes:

(i)

a management company, landlord, or other business entity that operates or contracts with others for the operation of an agency;

(ii)

any person who is a controlling person of a management company or other business entity that operates an agency or that contracts with another person for the operation of an agency;

(iii)

any other individual who, because of a personal, familial, or other relationship with the owner, manager, landlord, tenant, or provider of an agency, is in a position of actual control or authority with respect to the agency, without regard to whether the individual is formally named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the agency.

(B)

A controlling person, as described by subparagraph (A)(iii) of this paragraph, does not include an employee, lender, secured creditor, or landlord, or other person who does not exercise formal or actual influence or control over the operation of an agency.

(23)

[ (22) ] Counselor--An individual qualified under Medicare standards to provide counseling services, including bereavement, dietary, spiritual, and other counseling services to both the client and the family.

(24)

[ (23) ] Department--The Texas Department of Human Services (DHS) [ Health ].

(25)

[ (24) ] Dialysis treatment record--For home dialysis designation, a dated and signed written notation by the person providing dialysis treatment which contains a description of signs and symptoms, machine parameters and pressure settings, type of dialyzer and dialysate, actual pre- and post-treatment weight, medications administered as part of the treatment, and the client's response to treatment.

(26)

[ (25) ] Dietitian--A person who is currently licensed under the laws of this state to use the title of licensed dietitian or provisional licensed dietitian, or who is a registered dietitian.

(27)

[ (26) ] Director--The director of the Home and Community Support Services Agencies [ Health Facility Licensing Division ] of the Texas Department of Human Services [ Health ] or his or her designee.

(28)

[ (27) ] End stage renal disease (ESRD)--For home dialysis designation, the stage of renal impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplantation to maintain life.

(29)

[ (28) ] Freestanding hospice--An agency that provides hospice services to clients of the agency who are residing at the agency's physical location including inpatient and respite care.

(30)

[ (29) ] Functional need--Needs of the individual which require services without regard to diagnosis or label.

(31)

[ (30) ] Health assessment--A determination of a client's physical and mental status through inventory of systems.

(32)

[ (31) ] Home and community support services agency--A person who provides home health, hospice, or personal assistance services for pay or other consideration in a client's residence, an independent living environment, or another appropriate location.

(33)

[ (32) ] Home health medication aide--A person permitted under the Health and Safety Code, Chapter 142, Subchapter B.

(34)

[ (33) ] Home health service--The provision of one or more of the following health services required by an individual in a residence or independent living environment:

(A)

nursing;

(B)

physical, occupational, speech, or respiratory therapy;

(C)

medical social service;

(D)

intravenous therapy;

(E)

dialysis;

(F)

service provided by unlicensed personnel under the delegation of a licensed health professional;

(G)

the furnishing of medical equipment and supplies, excluding drugs and medicines; or

(H)

nutritional counseling.

(35)

[ (34) ] Hospice--A person licensed under this chapter to provide hospice services, including a person who owns or operates a residential unit or an inpatient unit.

(36)

[ (35) ] Hospice services--Services, including services provided by unlicensed personnel under the delegation of a registered nurse or physical therapist, provided to a client or a client's family as part of a coordinated program consistent with the standards and rules adopted under this chapter. These services include palliative care for terminally ill clients and support services for clients and their families that:

(A)

are available 24 hours a day, seven days a week, during the last stages of illness, during death, and during bereavement;

(B)

are provided by a medically directed interdisciplinary team; and

(C)

may be provided in a residence, nursing facility, residential unit, independent living environment, or inpatient unit according to need. These services do not include inpatient care normally provided in a licensed hospital to a terminally ill person who has not elected to be a hospice client.

(37)

[ (36) ] Independent living environment--A client's individual residence, which may include a group home or foster home, or other settings where a client participates in activities, including school, work, or church.

(38)

[ (37) ] Individual/family choice and control--Individuals and families who express preferences and make choices about how their support service needs are met.

(39)

[ (38) ] Inpatient unit--A facility that provides a continuum of medical or nursing care and other hospice services to clients admitted into the unit and that is in compliance with the conditions of participation for inpatient units adopted under Social Security Act, Title XVIII (42 United States Code §1395 et seq.) and standards adopted under this chapter.

(40)

[ (39) ] Interdisciplinary team--

(A)

for home dialysis designation, the physician, the registered nurse, the dietitian, and the qualified social worker responsible for planning the care delivered to the home staff-assisted dialysis patient; or

(B)

a group of individuals who work together in a coordinated manner to provide hospice services and must include a physician, registered nurse, social worker, and counselor.

(41)

[ (40) ] Licensed vocational nurse--A person who is currently licensed under Texas Civil Statutes, Article 4528c, as a licensed vocational nurse.

(42)

[ (41) ] Long-term program--For home dialysis designation, the written documentation of the selection of a suitable treatment modality and dialysis setting which has been selected by the client and the interdisciplinary team.

(43)

[ (42) ] Manager--A person having a contractual relationship to provide management services to a home and community support services agency for the overall operation of a home and community support services agency including administration, staffing, or delivery of services. Examples of contracts for services that will not be considered to be contracts for management services shall include contracts solely for maintenance, laundry, or food services.

(44)

[ (43) ] Medication administration record--A record used to document the administration of a client's medications.

(45)

[ (44) ] Medication list--A list of a client's medications that includes the recommended dosage and the frequency and method of administration. The medication list is used to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindications. The medication list does not include a medication profile.

(46)

[ (45) ] Notarized copy--A sworn affidavit stating that attached copies are true and correct copies of the original documents.

(47)

[ (46) ] Nursing facility--An institution licensed as a nursing home under the Health and Safety Code, Chapter 242.

(48)

[ (47) ] Nutritional counseling--Advising and assisting individuals or families on appropriate nutritional intake by integrating information from the nutrition assessment with information on food and other sources of nutrients and meal preparation consistent with cultural background and socioeconomic status, with the goal being health promotion, disease prevention, and nutrition education. Nutritional counseling may include, but is not limited to, the following:

(A)

dialogue with the client to discuss current eating habits, exercise habits, food budget and problems with food preparation;

(B)

discussion of dietary needs to help the client understand why certain foods should be included or excluded from the client's diet and to help with adjustment to the new or revised or existing diet plan;

(C)

a personalized written diet plan as ordered by the client's physician or practitioner, to include instructions for implementation;

(D)

providing the client with motivation to help him or her understand and appreciate the importance of the diet plan in getting and staying healthy; or

(E)

working with the client or the client's family members by recommending ideas for meal planning, food budget planning, and appropriate food gifts.

(49)

[ (48) ] Occupational therapist--A person who is currently licensed under the Occupational Therapy Practice Act, Texas Civil Statutes, Article 8851, as an occupational therapist.

(50)

[ (49) ] Owner--One of the following persons which will hold or does hold a license issued under the statute in the person's name or the person's assumed name:

(A)

a corporation;

(B)

a limited liability company;

(C)

an individual;

(D)

a partnership if a partnership name is stated in a written partnership agreement or an assumed name certificate;

(E)

all partners in a partnership if a partnership name is not stated in a written partnership agreement or an assumed name certificate; or

(F)

all co-owners under any other business arrangement.

(51)

[ (50) ] Palliative care--Intervention services that focus primarily on the reduction or abatement of physical, psychosocial, and spiritual symptoms of a terminal illness.

(52)

[ (51) ] Parent agency--The agency that develops and maintains administrative controls and provides supervision of branch offices and alternate delivery sites.

(53)

[ (52) ] Parent company--A person, other than an individual, who has a direct 100% ownership interest in the owner of an agency.

(54)

[ (53) ] Person--An individual, corporation, or association.

(55)

[ (54) ] Personal assistance services--Routine ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services. The term includes health-related services performed under circumstances that are defined as not constituting the practice of professional nursing by the Board of Nurse Examiners through a memorandum of understanding with DHS [ the department ] in accordance with Health and Safety Code, §167 142.016, and health-related tasks provided by unlicensed personnel under the delegation of a registered nurse or physician.

(56)

[ (55) ] Physical therapist--A person who is currently licensed under Texas Civil Statutes, Article 4512e, as a physical therapist.

(57)

[ (56) ] Physician--A person who is currently licensed under the laws of a state within the United States and in which the person practices medicine and who holds a doctor of medicine or doctor of osteopathy degree.

(58)

[ (57) ] Physician assistant--A person who is licensed under the Physician Assistant Licensing Act, Texas Civil Statutes, Article 4495-1, as a physician assistant.

(59)

[ (58) ] Physician delegated tasks--Tasks performed in accordance with the Medical Practice Act, Texas Civil Statutes, Article 4495d, §3.06, including orders signed by a physician which specify the delegated task(s), the individual to whom the task(s) is delegated, and the client's name.

(60)

[ (59) ] Place of business--An office of a home and community support services agency that maintains client records or directs home health, hospice, or personal assistance services. The term does not include an administrative support site.

(61)

[ (60) ] Plan of care--The written orders of a practitioner for a client who requires skilled services.

(62)

[ (61) ] Practitioner--A person who is currently licensed in a state in which the person practices as a physician, dentist, podiatrist, or a physician assistant, or a person who is a registered nurse registered with the Board of Nurse Examiners for the State of Texas as an advanced practice nurse.

(63)

[ (62) ] Presurvey conference--A conference held with department staff and the applicant or his or her representatives to review licensure standards and survey documents and provide consultation prior to the on-site licensure survey.

(64)

[ (63) ] Progress note--A dated and signed written notation by agency personnel summarizing facts about care and the client's response during a given period of time.

(65)

[ (64) ] Psychoactive treatment--The provision of a skilled nursing visit to a client with a psychiatric diagnosis under the direction of a physician that includes one or more of the following:

(A)

assessment of alterations in mental status or evidence of suicide ideations or tendencies;

(B)

teaching coping mechanisms or skills;

(C)

counseling activities; or

(D)

evaluation of the plan of care.

(66)

[ (65) ] Registered nurse (RN)--A person who is currently licensed under the Nursing Practice Act, Texas Civil Statutes, Article 4513 et seq. as a registered nurse.

(67)

[ (66) ] Registered nurse delegation--Delegation by a registered nurse in accordance with 22 TAC §§218.1-218.11 (Delegation of Selected Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel).

(68)

[ (67) ] Residence--A place where a person resides and includes a home, a nursing facility, a convalescent home, an independent living environment, or a residential unit. A residence includes a group or a foster home.

(69)

[ (68) ] Residential unit--A facility that provides living quarters and hospice services to clients admitted into the unit and that is in compliance with standards adopted under the Texas Special Care Facility Licensing Act, Health and Safety Code, Chapter 248.

(70)

[ (69) ] Respiratory therapist--A person who is currently licensed under Texas Civil Statutes, Article 4512l, as a respiratory care practitioner.

(71)

[ (70) ] Respite services--Support options that are provided temporarily for the purpose of relief for a primary caregiver in providing care to individuals of all ages with disabilities or at risk of abuse or neglect. Respite services may be provided under home health, hospice, or personal assistance services depending on the needs of the client.

(72)

[ (71) ] Sections--Chapter 97 of this title (Home and Community Support Services Agency).

(73)

[ (72) ] Service area--The geographic area(s) established by an agency in which all or some of the agency's services are available.

(74)

[ (73) ] Skilled services--Services in accordance with a plan of care that require the skills of a:

(A)

registered nurse;

(B)

licensed vocational nurse;

(C)

physical, occupational, or respiratory therapist;

(D)

speech-language pathologist;

(E)

audiologist;

(F)

social worker; or

(G)

dietitian.

(75)

[ (74) ] Social worker--A person who is currently licensed as a social worker under Human Resource Code, Chapter 50.

(76)

[ (75) ] Speech-language pathologist--A person who is currently licensed under the Texas Civil Statutes, Article 4512j, as a speech-language pathologist.

(77)

[ (76) ] Statute--The Health and Safety Code, Chapter 142.

(78)

[ (77) ] Supervising nurse--The person responsible for supervising skilled services provided by an agency and who has the qualifications described in §97.21(b)(3)(C) of this title (relating to Licensure Requirements and Standards for Agencies Providing Licensed Home Health, Licensed and Certified Home Health, or Hospice Services). This person may also be known as the director of nursing or similar title.

(79)

[ (78) ] Supervision--Authoritative procedural guidance by a qualified person for the accomplishment of a function or activity with initial direction and periodic inspection of the actual act of accomplishing the function or activity.

(80)

[ (79) ] Support services--Social, spiritual, and emotional care provided to a client and a client's family by a hospice.

(81)

[ (80) ] Survey--An inspection or investigation conducted by a representative of the department to determine if a licensee is in compliance with the statute and this chapter. A survey may be conducted onsite, by mail, by telephone or by electronic communication methods.

(82)

[ (81) ] Terminal illness--An illness for which there is a limited prognosis if the illness runs its usual course.

(83)

[ (82) ] Unlicensed person--An individual who is not licensed as a health care professional. The term includes, but is not limited to, home health aides, medication aides permitted by the department, and other individuals providing personal care or assistance in health services.

(84)

[ (83) ] Volunteer--An individual who provides assistance to a home and community support services agency without compensation other than reimbursement for actual expenses. A volunteer must [ shall ] meet the same requirements and standards in this chapter as apply to an employee of the agency doing the same activities unless the volunteer is exempt under this chapter from certain requirements or standards.

§97.3.Licensing Fees.

(a)

The schedule of fees for licensure of an agency authorized to provide one or more services is as follows:

(1)

initial (includes change of ownership) license fee--$875;

(2)

(No change.)

(3)

initial (includes change of ownership) branch office license fee--$875;

(4)

(No change.)

(5)

initial (includes change of ownership) alternate delivery site license fee--$500; and

(6)

(No change.)

(b)

If an applicant for an initial license, based on a change of ownership, makes late application for a license to the Texas Department of Human Services (DHS) in accordance with §97.13(b)(2)(C)(iii) of this title (relating to Change of Ownership and Services), the applicant shall submit the appropriate initial license fee as set out in subsection (a) of this section plus an additional late fee of $250.

(c)

[ (b) ] DHS [ The Texas Department of Health ] will not consider an application as officially submitted until the applicant pays the licensing fee. The fee must accompany the application form.

(d)

[ (c) ] Fees paid to DHS [ the department ] are not refundable, except as provided by §97.16 of this title (relating to Time Periods for Processing and Issuing a License) .

(e)

[ (d) ] Any remittance submitted to DHS [ the department ] in payment of a required fee must be in the form of a certified check, money order, or personal check made out to the Texas Department of Human Services [ Health ].

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 7, 2000.

TRD-200000934

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


Subchapter B. APPLICATION AND ISSUANCE OF A LICENSE

40 TAC §§97.11 - 97.16

The new section and amendments are proposed under the Health and Safety Code, Chapter 142, which authorizes the department to adopt rules for the licensing and regulation of home and community support services agencies.

The new section and amendments implement the Health and Safety Code, Chapter 142.001 - 142.030.

§97.11.Application and Issuance of Initial License.

(a)

All first-time applications for a license are applications for an initial license. An application for a license when there is a change of ownership is considered to be a first-time application for an initial license.

(b)

Upon written request, the Texas Department of Human Services (DHS) [ Health (department) ] will furnish a person with an application packet for an agency license.

(c)

If the applicant is an individual, the applicant must [ shall ] be at least 18 years of age.

(d)

The applicant must [ shall ] retain a copy of all documentation that is submitted to DHS [ the department ].

(e)-(f)

(No change.)

(g)

The applicant must [ shall ] apply for a license in accordance with this subsection.

(1)

(No change.)

(2)

All applications for a license must be made on forms prescribed by and available from DHS.

(A)

The application must be completed in accordance with DHS instructions, and it must contain original signatures and be notarized.

(B)

The address provided on the application must be the address from which the agency will be operating and providing services.

(C)

The address for the agency's place of business to be licensed must be located in the State of Texas.

[ (2)

The applicant for a license shall submit the information listed in subparagraphs (A)-(T) of this paragraph to the department within six months from the date the department mails the application packet to the applicant. If the department does not receive the information listed in subparagraphs (A)-(T) of this paragraph within six months from the mailing date, the applicant must request a new application packet. The following documents must be submitted with the original application form and shall be originals or notarized copies: ]

[ (A)

an accurate and complete application form which contains original signatures. The address provided on the application must be the address from which the agency will be operating and providing services. The address for its place of business to be licensed by the department must be located in the State of Texas; ]

(3)

The following items must accompany the application form and must be originals or notarized copies:

(A)

[ (B) ] a description of the agency's service area. The service area must [ shall ] be established in accordance with

(i)

§97.21(a)(7) [ §97.21(a)(6) ] of this title (relating to Licensure Requirements and Standards for Agencies Providing Licensed Home Health, Licensed and Certified Home Health, or Hospice Services) for agencies providing licensed home health, licensed and certified home health, or hospice services; or

(ii)

§97.26(b) of this title (relating to Standards for Personal Assistance Services) for agencies with the category of personal assistance services;

(B)

[ (C) ] a nonrefundable license fee;

(C)

[ (D) ] the name of the applicant and identifying information relating to the owner(s), administrator, and chief financial officer (if applicable) on a form provided by the department to enable DHS [ the department ] to conduct criminal background checks;

(D)

the name of any controlling person and documentation relating to any controlling person, if requested by DHS and relevant to the controlling person's compliance with any applicable licensing standard;

(E)-(J)

(No change.)

(K)

for a parent agency:

(i)-(ii)

(No change.)

(iii)

its organizational structure, a list of management personnel (including names and titles), and a job description of each administrative and supervisory position. The job description must contain at a minimum the job title, qualifications including required education and training, and job responsibilities ; [ . ]

(iv)

[ The applicant must submit ] a plan to provide annual continuing education and training for management personnel;

(v)

[ (iv) ] the resume or curriculum vitae of the agency administrator. The resume or curriculum vitae must [ shall ] reflect that the administrator has the qualifications described in:

(I)

§97.21(b)(3)(B) of this title for agencies providing licensed home health, licensed and certified home health, or hospice services; or

(II)

§97.26(g) of this title for agencies providing personal assistance services; and

(vi)

[ (v) ] the resume or curriculum vitae of the agency supervising nurse (if applicable). The resume or curriculum vitae must [ shall ] reflect that the supervising nurse has the qualifications described in §97.21(b)(3)(C) of this title;

(L)-(S)

(No change.)

(T)

notice that the agency has attended a presurvey conference at the office designated by DHS [ the department ], or that the designated survey office has waived the presurvey conference. [ The application is not considered complete and correct unless the department has received this notice. ]

(i)

(No change.)

(ii)

The administrator and supervising nurse (if applicable) must [ shall ] attend the presurvey conference.

(iii)

The designated survey office must [ shall ] verify compliance with the applicable provisions of this chapter and recommend that the agency be issued an initial license or that the application be denied pursuant to §97.52 of this title (relating to Enforcement Action) ; and [ . ]

(U)

information relating to compliance by the applicant or a controlling person with respect to the applicant with regulatory requirements in any other state in which the applicant or controlling person operates or operated a home and community support services agency.

(V)

any other document or information that DHS requests that is relevant to the application process.

(4)

[ (3) ] Upon DHS's [ the department's ] receipt of the application form, the required information described in paragraph (3) [ (2) ] of this subsection, and the fee from an applicant, DHS will [ the department shall ] review the material to determine whether it is complete and correct.

(A)

DHS will review the materials [ The time periods for reviewing the material shall be ] in accordance with time periods established in §97.16 of this title (relating to Time Periods for Processing and Issuing a License).

(B)

If an agency receives a notice from DHS [ the department ] that some or all of the information required under paragraphs (2) and (3) [ paragraph (2) ] of this subsection is deficient, the agency must [ shall ] submit the required information no later than 30 calendar days [ six months ] from the date of the notice.

(i)

An agency which fails to submit the required information within 30 calendar days [ six months ] from the notice date is considered to have withdrawn its application for an initial agency license. The license fee will not be refunded.

(ii)

An agency which has withdrawn its application must reapply for a license in accordance with this section, if it wishes to continue the application process. A new license fee is required.

(C)

Information received by the department relating to the competence and financial resources of the applicant is confidential and may not be disclosed to the public.

(5)

[ (4) ] Once DHS [ the department ] has determined that the application form, the information described in paragraph (3) [ (2) ] of this subsection required to accompany the application form, and the license fee are complete and correct, and that the applicant meets the requirements for the license, DHS will [ the department shall ] issue the initial license. The initial license is valid for one year from the date of issuance. [ shall expire ]:

[ (A)

on the last day of the preceding month of the next year if issued on the first day of a month; or]

[ (B)

on the last day of the month of issuance of the next year if issued on the second or any subsequent day of a month.]

(6)

[ (5) ] DHS will [ The department shall ] mail the initial license certificate to the licensee. The license certificate will designate the category(ies) of service the agency is authorized to provide at or from the designated place of business.

(h)

(No change.)

(i)

The agency must [ shall ] admit at least one client and initiate services during the initial license period.

(1)

Upon admitting the first client, the agency must [ shall ] inform the designated survey office of the admission and the name of the client and request that an initial survey be conducted.

(2)

The agency is not required to admit a client(s) under each category authorized under the license in order to be surveyed by DHS [ the department ].

(j)

A DHS [ department ] surveyor will [ shall ] conduct an onsite survey of the agency after the issuance of the initial license.

(1)

Upon receiving an agency request for an initial survey, the designated survey office will [ shall ] schedule the survey of the agency and will [ shall ] inform the agency of the survey date and time.

(2)

An initial survey will [ shall ] not be required if the agency has received notification of accreditation from [ by ] the Community Health Accreditation Program or the Joint Commission on Accreditation for Healthcare Organizations since the issuance of the initial license.

(3)

(No change.)

(4)

At the time of the initial survey, the agency must [ shall ]:

(A)-(B)

(No change.)

(5)

DHS [ The department ] will not renew the license unless the designated survey office has conducted an initial survey of the agency.

(6)

By applying for or holding a license, an agency consents to entry and survey by DHS [ the department ] or a representative of DHS [ the department ] to verify compliance with the statute or this chapter. The agency must [ shall ] provide a DHS [ department ] representative entry to the agency and access to documents in accordance with §97.51(a) of this title (relating to Survey Procedures).

(k)

A person who has requested the category of licensed and certified home health services on the initial license application must [ shall ] also make application for certification by the United States Department of Health and Human Services (USDHHS) as a Medicare certified agency under the Social Security Act, Title XVIII.

(1)

Pending approval by the USDHHS Health Care Financing Administration (HCFA), the person:

(A)

(No change.)

(B)

must [ shall ] comply with the Medicare conditions of participation for home health agencies in 42 Code of Federal Regulations, Part 484, as if the person were duly certified.

(2)

Upon becoming certified by HCFA to participate in the Medicare program during the initial licensing period, DHS will [ the department shall ] send notice to the agency that the category of licensed and certified home health services has been added to the license. The agency must [ shall ] submit a written request for deletion or retention of the licensed home health services category.

(3)

If HCFA denies certification to the person or if the person withdraws application for participation in the Medicare program, the person will retain the category of licensed home health services. An agency's retention of the licensed home health services category does not preclude DHS [ the department ] from taking enforcement action, as appropriate, under §97.52 of this title (relating to Enforcement Action) .

(l)

Continuing compliance with the minimum standards and the provisions of this chapter for the services authorized to be provided under the license is required during the initial licensing period in order for a first renewal license to be issued.

(1)

An agency authorized under the license to provide licensed home health, licensed and certified home health, or hospice services must [ shall ] comply with §97.21 of this title.

(2)

An agency authorized under the license to provide licensed home health services must [ shall ] comply with §97.22 of this title (relating to Standards for Licensed Home Health Services).

(3)

An agency authorized under the license to provide licensed and certified home health services must [ shall ] comply with §97.23 of this title (relating to Standards for Licensed and Certified Home Health Services).

(4)

An agency authorized under the license to provide home dialysis must [ shall ] comply with §97.24 of this title (relating to Standards for Home Dialysis Designation).

(5)

An agency authorized under the license to provide hospice services must [ shall ] comply with §97.25 of this title (relating to Standards for Hospice Services).

(6)

An agency which holds a license with the category of personal assistance services must [ shall ] comply with §97.26 of this title (relating to Standards for Personal Assistance Services).

(m)

If DHS [ the department ] determines that compliance with the minimum standards and the provisions of this chapter is not substantiated after the issuance of the initial license, the department may propose to revoke the initial license and deny the first renewal license and must [ shall ] notify the applicant of a license revocation and denial as provided in §97.52 of this title (relating to Enforcement Action) .

(n)

If an applicant decides not to continue the application process for an initial license, the application may be withdrawn. If a license has been issued, the applicant must [ shall ] cease providing services and return the license to the department with its written request to withdraw. DHS will [ The department shall ] acknowledge receipt of the request to withdraw. The license fee will not be refunded.

(o)

(No change.)

§97.12.Issuance and Renewal of License.

(a)

Eligibility for license renewal.

(1)

An agency must [ shall ] renew a license annually. The Texas Department of Human Services (DHS) will [ Health (department) shall ] issue a renewal license to an agency which meets the minimum standards for a license.

(2)

The renewal license is valid for one year [ shall expire 12 months ] from the date of issuance. For each annual license period, the agency must [ shall ] provide services to one or more clients and document the provision of services. The agency must show proof that services have been provided under the license within the previous 12 months. Such documentation must [ shall ] be available for review by a DHS [ department ] surveyor.

(3)-(5)

(No change.)

(6)

An agency license will not be renewed with the category of licensed and certified home health services if the agency withdraws from or is terminated (voluntarily or involuntarily) from participation in the Medicare program. However, if continued compliance with the requirements for licensed home health services is demonstrated, the license will [ shall ] be renewed with the category of licensed home health services.

(7)-(9)

(No change.)

(b)

Renewal application.

(1)

DHS [ The department ] will send notice of expiration to an agency at least 60 calendar days before the expiration date of the license. If the agency has not received notice of expiration from DHS [ the department ] 45 calendar days prior to the expiration date, it is the duty of the agency to notify DHS [ the department ] and request a renewal application for a license.

(2)

The agency must [ shall ] submit to DHS [ the department ] postmarked at least 30 days prior to the expiration date of the license:

(A)

a complete and correct application renewal form which includes updated information as required by §97.11(g)(3)(C)-(J)) [ §97.11(g)(2)(D)-(J) ], §97.11(g)(3)(K)(iii)-(vi) [ §97.11(g)(2)(K)(iii)-(v) ], and §97.11(g)(3)(R) and (S) [ §97.11(g)(2)(R) and (S) ] of this title;

(B)

a description of the agency's service area. The service area must [ shall ] be established in accordance with §97.21(a)(7) of this title (relating to Licensure Requirements and Standards for Agencies Providing Licensed Home Health, Licensed and Certified Home Health, or Hospice Services) for agencies providing licensed home health, licensed and certified home health, or hospice services; or §97.26(b) of this title (relating to Standards for Personal Assistance Services) for agencies with the category of personal assistance services;

(C)-(E)

(No change.)

(F)

if certified by or contracting with another state agency to deliver services for which a license is required under this chapter, documentation from the certifying state agency(ies) confirming the certification or contract; [ and ]

(G)

if an applicant is a corporation, a current letter from the state comptroller's office stating the corporation is in good standing or a notarized certification that the tax owed to the state under the Tax Code, Chapter 171, is not delinquent or that the corporation is exempt from the payment of the tax and is not subject to the Tax Code, Chapter 171 ; and [ . ]

(H)

information relating to compliance by the license holder or a controlling person with respect to the license holder with regulatory requirements in any other state in which the license holder or controlling person operates or operated a home and community support services agency.

(I)

any other document or information that DHS requests that is relevant to the application process.

(3)

All documents submitted with the renewal application must [ shall ] be notarized copies or originals. The time periods for processing an application must [ shall ] be in accordance with §97.16 of this title (relating to Time Periods for Processing and Issuing a License).

(c)

Timely application required. [ An agency which fails to make timely and sufficient application for renewal of its license shall not provide home health, hospice, or personal assistance services after the expiration date of the license. ] If an agency fails to make timely and sufficient application for renewal of a license at least 30 days prior to the expiration date of the license, the agency must cease operation upon expiration of the license. [ In order to resume operations, the agency must apply for an initial license in accordance with §97.11 of this title. ]

(1)

An agency whose license has been expired for 90 days or less may renew the license by paying the DHS renewal fee that is 1 and 1/2 times the normally required renewal fee established in §97.3 of this title (relating to Licensing Fees).

(2)

An agency whose license has been expired for more than 90 days must apply for an initial license in accordance with §97.11 of this title (relating to Application and Issuance of Initial License.

(d)

Active military duty exception. If a licensee fails to timely renew his or her license on or after August 1, 1990, because the licensee is or was on active duty with the armed forces of the United States of America serving outside the State of Texas, the licensee may renew the license pursuant to this subsection.

(1)

Renewal of the license may be requested by the licensee, the licensee's spouse, or an individual having power of attorney from the licensee. The renewal form must [ shall ] include a current address and telephone number for the individual requesting the renewal.

(2)

(No change.)

(3)

A copy of the official orders or other official military documentation showing that the licensee is or was on active military duty serving outside the State of Texas must [ shall ] be filed with DHS [ the department ] along with the renewal form.

(4)

A copy of the power of attorney from the licensee must [ shall ] be filed with DHS [ the department ] along with the renewal form if the individual having the power of attorney executes any of the documents required in this section.

(5)

A licensee renewing under this subsection must [ shall ] pay the applicable renewal fee.

(6)-(7)

(No change.)

(e)

Withdrawal of application. If an agency decides not to continue the application process for the renewal of a license, the application may be withdrawn. If a license has been issued, the applicant must [ shall ] return the license to the department with its written request to withdraw and cease providing services. DHS will [ The department shall ] acknowledge receipt of the request to withdraw.

§97.13.Change of Ownership or Services.

(a)

Change of ownership.

(1)

A license may not be transferred.

(2)

A change of ownership occurs when there is:

(A)

a change of 50% or more in the ownership of the business organization or sole proprietorship that is licensed to operate the agency; or

(B)

a change in the federal tax payer identification number.

(3)

A change of ownership for a parent agency is a change of ownership for the parent agency's branch office(s) or alternate delivery site(s) and requires the submittal of a new initial application(s) and fee(s) for the branch office(s) or alternate delivery site(s).

(4)

A change of ownership does not include when the licensee is a business entity who is simply amending its official documents to revise its name.

(b)

Agency procedures for change of ownership.

(1)

An application for a change of ownership must be requested at least 60 calendar days prior to the effective date of the change of ownership.

(2)

To avoid a gap in the license period, the prospective new owner must submit to the Texas Department of Human Services (DHS) a complete application for a license, along with the appropriate license fee at least 30 days before the anticipated date of sale or other transfer of ownership and prior to expiration date of the license.

(A)

The application must be completed, as applicable, in accordance with §97.11 of this title (relating to Application and Issuance of Initial License), §97.14 of this title (relating to Application and Issuance of a Branch Office License) or §97.15 of this title (relating to Application and Issuance of an Alternate Delivery Site License). In addition, the application packet must include:

(i)

the effective date of the change of ownership;

(ii)

a notarized affidavit signed by the previous owner acknowledging agreement with the change of ownership;

(iii)

if the applicant is a corporation, a copy of the applicant's articles of incorporation; and

(iv)

if the applicant is a business entity other than a corporation, a copy of the sales agreement.

(B)

The applicant must meet all requirements for a license.

(C)

If the applicant has submitted a timely and sufficient application packet and license fee for a license and otherwise meets all requirements for a license, DHS will issue the applicant a license effective on the date of the transfer of ownership. DHS considers an applicant to have filed a timely and sufficient application for a license if the applicant submits:

(i)

a complete application packet and license fee to DHS, and the application packet and license fee are received by DHS postmarked at least 30 calendar days before the anticipated date of sale or other transfer of ownership and prior to the expiration date of the license;

(ii)

an incomplete application packet and license fee to DHS with a letter explaining the circumstances which prevented the inclusion of the missing information, and the application packet, license fee, and letter are received by DHS postmarked at least 30 calendar days before the anticipated date of sale or other transfer of ownership and prior to the expiration date of the license, and the explanation is found to be acceptable to DHS. The missing information must be submitted to DHS within 30 calendar days from the date of the letter;

(iii)

a complete application packet and license fee to DHS, and the application packet and license fee are received by DHS postmarked 29 calendar days or less before the anticipated date of sale or other transfer of ownership and prior to the expiration date of the license, and the applicant pays a late fee as set out in §97.3(b) of this title (relating to Licensing Fees); or

(iv)

a complete application packet and license fee to DHS, and the application packet and license fee are received by DHS by the date of sale or other transfer of ownership and prior to the expiration date of the license, and the applicant proves to DHS's satisfaction that the health and safety of the agency's clients required an emergency change of ownership.

(3)

If an application and license fee are timely filed, but DHS determines that the application is incomplete and a letter explaining the circumstances which prevented the inclusion of the missing information was not filed with the application, the application is considered to be timely filed but insufficient.

(A)

DHS will provide the applicant with written notification of the missing information required to complete the application and may assess a late fee as set out in §97.3(b) of this title (relating to Licensing Fees) for failure to comply with paragraph (2) of this section.

(B)

The applicant must submit the required information and late fee, if assessed, no later than 30 calendar days from the date of the notice.

(i)

An applicant which fails to submit the required information within 30 calendar days from the notice date is considered to have withdrawn the application for an initial agency license. The license fee will not be refunded.

(ii)

An applicant which has withdrawn the application must reapply for a license in accordance with this section, if wishing to continue the application process. A new license fee is required.

(4)

Failure to comply with the application procedures set out in this section may result in an enforcement action(s) under §97.52 of this title (relating to Enforcement Action).

(5)

The initial license issued to the new owner is valid for one year from the date of issuance.

(6)

The previous owner's license is void on the effective date of the new initial license and must be surrendered to DHS.

(7)

DHS may deny issuance of a license for any of the reasons specified in §97.52(a) of this title (relating to Enforcement Action).

(8)

DHS may waive the on-site survey required by §97.11(i) of this title (relating to Application and Issuance of Initial License).

(c)

Federal law or regulations.The requirements of this section are in addition to any applicable federal law or regulation relating to change of ownership or control.

(d)

Notification procedures for agency name change.

(1)

If an agency changes the agency's name (legal entity or doing business as), but does not undergo a change of ownership as defined in subsection (a)(2) of this section, the agency must provide:

(A)

written notification to DHS within five business days prior the effective date of change;

(B)

a copy of a certificate of amendment from the Secretary of State's office or other governmental authority(ies), e.g., an assumed name certificate, reflecting the name change to DHS within 30 days of receipt of the certificate; and

(C)

a copy of the agency's current federal tax payer identification number.

(2)

On receipt and verification of the certificate of amendment and the current federal tax payor identification number, DHS will provide the agency with a notification of change in the agency's new name.

(e)

Service change/agency closure procedures.

(1)

An agency must provide written notification to DHS within five calendar days of the agency's receipt of notice of change in state or federal certification or accreditation status. The licensee must include a copy of the notice of change with its written notice to DHS.

(2)

An agency must notify DHS in writing within five calendar days prior to the cessation of operation of the agency, branch office, or alternate delivery site.

(A)

The agency must include in the written notice the reason for closure, the location of the client records, and the name and address of the client record custodian.

(B)

If the agency closes with an active client roster, the agency must transfer a copy of the active client record with the client to the receiving agency in order to assure continuity of care and services to the client.

(C)

The agency must mail or return the initial license or renewal license to DHS at the end of the day services were terminated.

(D)

Continuing to operate after the closure date specified in the notice may result in enforcement action.

(f)

Procedures for adding or deleting a category to the license.To add or delete a category to the license, the agency must provide written notification to DHS at least 30 calendar days prior to the addition or deletion of the category.

(1)

DHS will approve or disapprove the addition of a category.

(A)

At the discretion of DHS, an agency must attend a presurvey conference at the designated survey office prior to DHS approving the addition of a category.

(B)

If disapproved, DHS will inform the agency of the reason for disapproval.

(2)

At the discretion of DHS, an on-site survey may be conducted following the approval of a category.

(3)

DHS's receipt of an agency request to delete a category from the license does not preclude DHS from taking enforcement action as appropriate in accordance with §97.52 of this title (relating to Enforcement Action).

§97.14.Application and Issuance of a Branch Office License.

(a)

The Texas Department of Human Services (DHS) [ Health (department) ] may issue a branch office license to a person who holds a current agency license to provide home health or personal assistance services. A person who holds a current agency license is eligible to apply for a branch office license:

(1)-(2)

(No change.)

(b)

Upon written request, DHS will [ the department shall ] furnish a license holder with an application for a branch office license.

(c)

The parent agency applicant must [ shall ] submit to DHS [ the department ]:

(1)-(5)

(No change.)

(d)

The applicant must [ shall ] retain a copy of all documentation that is submitted to DHS [ the department ].

(e)

DHS will [ The department shall ] review the application and accompanying material to determine whether it is complete and correct.

(1)

The time frames for review will [ shall ] be in accordance with §97.16 of this title (relating to Time Periods for Processing and Issuing a License).

(2)

An agency which fails to respond to the department's notice of an incomplete application for a branch office license described in §97.16(b) of this title within 30 calendar days [ six months ] from the date of the notice is considered to have withdrawn the application for a branch office license. The branch office license fee will not be refunded.

(3)

(No change.)

(f)

DHS will [ The department shall ] notify the designated survey office of the agency's request to establish a branch office.

(g)

The designated survey office will conduct a review of the applicant's request to establish a branch office. The survey office will recommend to approve or disapprove the branch office request. At the discretion of DHS [ the department ], the designated survey office may conduct an onsite survey of the branch office prior to recommending approval or disapproval of the branch office request.

(h)

DHS [ The department ] may propose denial of the application according to §97.52 of this title (relating to Enforcement Action) after consideration of the designated survey office's recommendation.

(i)

Upon approval of the branch office license application, DHS [ the department ] will issue the branch office a license, which will [ shall ] expire on the same expiration date as the parent agency's license and will [ shall ] be renewed with the parent agency's license.

(j)

At the discretion of DHS [ the department ], an onsite survey of the branch office may be conducted after issuance of the license to determine compliance with the statute and this chapter.

(k)

DHS [ The department ] will mail the branch office license to the licensee. The branch office license must [ shall ] be posted in a conspicuous place on the licensed branch office premises.

(l)

The branch office must [ shall ] comply with §97.27 of this title (relating to Standards for Branch Offices and the standards relating to the category(ies) authorized under the license.

§97.15.Application and Issuance of an Alternate Delivery Site License.

(a)

The Texas Department of Human Services (DHS) [ department ] may issue an alternate delivery site license to a person who holds a current agency license to provide hospice services. A person who holds a current agency license to provide hospice services is eligible to apply for an alternate delivery site license:

(1)-(2)

(No change.)

(b)

Upon written request, DHS will [ the department shall ] furnish a hospice license holder with an application for an alternate delivery site license.

(c)

The hospice must [ shall ] submit to DHS [ the department ]:

(1)-(5)

(No change.)

(d)

The hospice must [ shall ] retain a copy of all documentation that is submitted to DHS [ the department ].

(e)

DHS will [ The department shall ] review the application and accompanying material to determine whether it is complete and correct.

(1)

The time frames for review will [ shall ] be in accordance with §97.16 of this title (relating to Time Periods for Processing and Issuing a License).

(2)

An agency which fails to respond to DHS's [ the department's ] notice of an incomplete application for an alternate delivery site license described in §97.16(b) of this title within 30 calendar days [ six months ] from the date of the notice is considered to have withdrawn the application for an alternate delivery site license. The alternate delivery site license fee will not be refunded.

(3)

(No change.)

(f)

DHS will [ The department shall ] notify the designated survey office of the hospice's request to establish an alternate delivery site.

(g)

The designated survey office will [ shall ] conduct a review of the hospice's request to establish an alternate delivery site. The survey office will recommend to approve or disapprove the alternate delivery site request. At the discretion of DHS [ the department ], the designated survey office may conduct an onsite survey of the alternate delivery site prior to recommending approval or disapproval of the alternate delivery site request.

(h)

DHS [ The department ] may propose denial of the application according to §97.52 of this title after consideration of the designated survey office's recommendation.

(i)

Upon approval of the alternate delivery site application, the department will issue the alternate delivery site a license, which will [ shall ] expire on the same expiration date as the hospice's license, and will [ shall ] be renewed with the hospice's license. The alternate delivery site license must [ shall ] be posted in a conspicuous place on the licensed alternate delivery site premises.

(j)

The alternate delivery site must [ shall ] comply with §97.25 of this title (relating to Standards for Hospice Services) and §97.28 of this title. The designated survey office will conduct an on-site survey after a license has been issued to verify compliance with §97.25 of this title (relating to Standards for Hospice Services) and §97.28 of this title (relating to Standards for Alternate Delivery Sites) .

(k)

If the designated survey office recommends that the licensed alternate delivery site seek a license as a hospice, a written report supporting the recommendation must [ shall ] be submitted to DHS [ the department ] for review.

§97.16.Time Periods for Processing and Issuing a License.

(a)

General.

(1)

The date a license application is received is the date the application reaches the Home and Community Support Services Agency Division [ Health Facility Licensing Division (division) ], Texas Department of Human Services (DHS) [ Health (department) ].

(2)

An application for an initial license is complete when DHS [ the department ] has received, reviewed, and found acceptable the information described in §97.11 of this title (relating to Application and Issuance of Initial License).

(3)

An application for a renewal license is complete when DHS [ the department ] has received, reviewed and found acceptable the information described in §97.12 of this title (relating to Issuance and Renewal of License).

(4)

An application for a change of ownership license is complete when DHS [ the department ] has received, reviewed, and found acceptable the information described in §97.13 of this title (relating to Change of Ownership or Services).

(b)

Time periods. An application from an agency for an initial license, renewal license, or change of ownership license will [ shall ] be processed in accordance with the following time periods.

(1)

The first time period begins on the date the division receives the application and ends on the date the license is issued, or if the application is received incomplete, the period ends on the date the facility is issued a written notice that the application is incomplete. The written notice must [ shall ] describe the specific information that is required before the application is considered complete. The first time period is 45 days.

(2)

(No change.)

(c)

Reimbursement of fees.

(1)

In the event the application is not processed in the time periods stated in subsection (b) of this section, the applicant has the right to request that DHS [ the department ] reimburse in full the fee paid in that particular application process. If DHS [ the department ] does not agree that the established periods have been violated or finds that good cause existed for exceeding the established periods, the request will be denied.

(2)

(No change.)

(d)

Appeal. If the request for reimbursement as authorized by subsection (c) of this section is denied, the applicant may then appeal to the commissioner of DHS [ health ] for a resolution of the dispute. The applicant must [ shall ] give written notice to the commissioner requesting reimbursement of the fee paid because the application was not processed within the established time period. DHS will [ The department shall ] submit a written report of the facts related to the processing of the application and good cause for exceeding the established time periods. The commissioner will make the final decision and provide written notification of the decision to the applicant and the director.

[ (e)

Hearings. If a hearing is proposed during the processing of the application, the time periods in §1.34 of this title (relating to Time Periods for Conducting Contested Case Hearing) are applicable.]

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 7, 2000.

TRD-200000936

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


40 TAC §97.13

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeal is proposed under the Health and Safety Code, Chapter 142, which authorizes the department to adopt rules for the licensing and regulation of home and community support services agencies.

The repeal implements the Health and Safety Code, Chapter 142.001 - 142.030.

§97.13.Change of Ownership or Services.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 7, 2000.

TRD-200000935

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


Subchapter C. SERVICE STANDARDS

40 TAC §97.21

The amendment is proposed under the Health and Safety Code, Chapter 142, which authorizes the department to adopt rules for the licensing and regulation of home and community support services agencies.

The amendment implements the Health and Safety Code, Chapter 142.001 - 142.030.

§97.21.Licensure Requirements and Standards for Agencies Providing Licensed Home Health, Licensed and Certified Home Health, or Hospice Services.

(a)

Conditions of license. An agency licensed to provide licensed home health, licensed and certified home health, or hospice services must [ shall ] comply with the requirements in this section.

(1)

A license must [ shall ] be displayed in a conspicuous place in the designated place of business.

(2)

A license may not be transferred from one location to another without prior approval from the Texas Department of Human Services (DHS) [ Health (department) ]. If an agency is considering relocation, the agency must [ shall ] notify the department 30 calendar days prior to the intended relocation. DHS [ The department ] will provide written notification to the agency amending the annual license to reflect the new location.

(3)

The relocation of a branch office or alternate delivery site to a different parent agency requires [ shall require ] submission of a new application for the branch office or alternate delivery site and compliance [ shall comply ] with §97.14 of this title (relating to Application and Issuance of a Branch Office License) and §97.15 of this title (relating to Application and Issuance of an Alternate Delivery Site License) as appropriate.

(4)

An agency must [ shall ] notify DHS [ the department ] in writing of any change in its telephone number within 30 calendar days after the change.

(5)

An agency must [ shall ] notify DHS [ the department ] in writing of any change in the agency administrator or chief financial officer within 15 calendar days after the change.

(6)

A license may [ shall ] not be materially altered.

(7)

An agency must [ shall ] provide services only within its service area.

(A)

The agency must [ shall ] maintain adequate staff to provide services and to supervise the provision of services within the service area.

(B)

An agency may expand its service area at any time during the licensure period. To expand its service area, an agency must submit to DHS [ the department ] a written notice for the expansion which includes revised boundaries of the agency's original service area, the effective date of the expansion, and an updated list of management and supervisory personnel (including names), if changes are made. The notice must be submitted either before or within 30 calendar days after the effective date of the expansion.

(C)

An agency may reduce its service area at any time during the licensure period by sending DHS [ the department ] written notification of the reduction, revised boundaries of the agency's original service area, and the effective date of the reduction.

(D)

A branch office or alternate delivery site must [ shall ] be located within the parent agency's service area.

(8)

(No change.)

(b)

Agency responsibilities.

(1)

General.

(A)

An agency must [ shall ] adopt, implement, and enforce the provisions of the Human Resources Code, Chapter 102 (Rights of the Elderly).

(B)

An agency must [ shall ] investigate complaints made by a client or the client's family or guardian or the client's health care provider regarding treatment or care that is (or fails to be) furnished or regarding the lack of respect for the client's property by anyone furnishing services on behalf of the agency and must document the receipt of the complaint and the disposition of the complaint. The investigation and documentation must be completed within 30 calendar days after the agency receives the complaint, unless the agency has and documents reasonable cause for a delay.

(C)

An agency that generates special or medical waste while providing home health services must dispose of the waste according to [ shall meet ] the requirements [ set forth by the department ] in 25 TAC §§1.131-1.137 [ of this title ] (relating to Definition, Treatment, and Disposition of Special Waste from Health Care-Related Facilities). [ This requirement does not apply to disposition of special waste in a client's place of residence, but would apply to any special waste disposed of from an agency's office location. ] An agency must provide both verbal and written instructions to the agency's clients regarding the proper procedure for disposing of sharps. For purposes of this subparagraph, sharps include hypodermic needles, hypodermic syringes with attached needles, scalpel blades, razor blades, disposable razors, disposable scissors used in medical procedures, and intravenous stylets and rigid introducers.

(D)

An agency that provides laboratory services must [ shall ] meet the Clinical Laboratory Improvement Amendments of 1988, 42 United States Code, §263a, Certification of Laboratories (CLIA 1988). CLIA 1988 applies to all agencies with laboratories that examine human specimens for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings.

(E)

An agency must [ shall ] comply with the Nursing Practice Act, Texas Civil Statutes, Articles 4525a and 4525b, concerning professional nurse reporting and peer review.

(F)

An agency must [ shall ] comply with 22 TAC §§240.11-240.13, concerning licensed vocational nurse peer review and reporting.

(G)

(No change.)

(H)

An agency must provide a written statement describing the agency's policy for the drug testing of employees who have direct contact with clients to the following persons:

(i)

each person applying for services from the agency; and

(ii)

any person requesting the information.

(2)

Reports of abuse, exploitation and neglect.

(A)

In this paragraph, "abuse," "exploitation," and "neglect" have the meanings assigned by §48.002, Human Resources Code.

(B)

An agency that has cause to believe that a client has been abused, exploited or neglected by an employee of the agency must report the information to:

(i)

DHS at 1-800-228-1570; and

(ii)

the Texas Department of Protective and Regulatory Services at 1-800-252-5400.

(3)

Retaliation prohibited.

(A)

An agency may not retaliate against a person for filing a complaint, presenting a grievance, or providing in good faith information relating to home health, hospice or personal assistance services provided by the agency.

(B)

An agency is not prohibited from terminating an employee for a reason other than retaliation.

(4)

[ (2) ] Provision of services.

(A)

An agency must [ shall ] conduct an ongoing, comprehensive, integrated, self-assessment of the quality and appropriateness of care provided, including services provided under arrangement. The findings are to be used by the agency to correct identified problems and to revise policies, if necessary. The agency staff responsible for the quality assurance program must [ shall ]:

(i)

ensure that all service providers involved in the care of a client (e.g., contracted health care professional or another agency) are engaged in an effective interchange, reporting, and coordination of care regarding the client. The agency must [ shall ] document the steps taken to meet this standard;

(ii)

implement and report on activities and mechanisms for monitoring the quality of care;

(iii)

identify and, when possible, resolve problems; and

(iv)

make suggestions for improving care.

(B)

If an agency utilizes independent contractors, there must [ shall ] be a written agreement between such independent contractors (i.e., per hour, per visit) and the agency. The agreement must [ shall ] be enforced by the agency and clearly designate:

(i)

that clients are accepted for care only by the licensed agency;

(ii)

the services to be provided;

(iii)

the necessity to conform to all applicable agency policies, including personnel qualifications;

(iv)

the plan of care or care plan to be carried out;

(v)

the manner in which services will be coordinated and evaluated by the licensed agency in accordance with subparagraph (A) of this paragraph;

(vi)

the procedures for submitting information and documentation regarding the client's needs and services, including clinical and progress notes, if required; the scheduling of visits; and periodic client evaluation or supervision; and

(vii)

the procedures for determining charges and reimbursement.

(C)

Services provided by an agency under arrangement with another agency or organization shall be subject to a written agreement conforming with the requirements specified in subparagraph (B) of this paragraph.

(D)

The agency must [ shall ] provide for back-up services when an employee or contractor is not able to deliver the services.

(E)

A person who is not licensed to provide hospice services may not use the word "hospice" in a title or description of a facility, organization, program, service provider or services or use any other words, letters, abbreviations, or insignia indicating or implying that the person holds a license to provide hospice services.

(F)

The agency must [ shall ] have a written contingency plan which is implemented in the event of dissolution to assure continuity of client care. The plan must be consistent with subparagraph (I) of this paragraph and include provisions for notifying the client of the agency's dissolution and for documenting the notification, and procedures for carrying out the notification.

(G)

The agency and the client or his family must [ shall ] have a written agreement for services. The agency must [ shall ] obtain an acknowledgment of receipt of the agreement. The agency must [ shall ] comply with the terms of the agreement. The agreement must [ shall ] include, but may not be limited to, the following:

(i)

notification of the Human Resources Code, Chapter 102 (Rights of the Elderly);

(ii)

documentation concerning notification to the client of the availability of durable power of attorney for health care, advance directive or do-not-resuscitate (DNR) [ DNR ] orders in accordance with the applicable law;

(iii)

services to be provided;

(iv)

supervision by the agency of services provided; and

(v)

agency charges for services rendered if the charges will be paid in full or in part by the client or the client's family, or on request.

(H)

An agency must [ shall ] maintain a current list of clients which includes the services being delivered by the agency and establish a record for each client which is maintained in accordance with and contains the information described in paragraph (6)(I) [ (4)(I) ] of this subsection.

(I)

Except in an emergency [ situation ], an agency intending to transfer or discharge a client must [ shall ] notify the client or the client's parent, family, spouse, significant other, or legal representative; and the client's attending physician not later than five days before the date on which the client will be transferred or discharged.

(J)

An agency may transfer or discharge a client without five days notice:

(i)

upon the client's request;

(ii)

if the client's medical needs require transfer (e.g., a medical emergency);

(iii)

in the event of a natural disaster where if not transferred, the client's health and safety is at risk;

(iv)

for the protection of staff or a client after the agency has made a documented reasonable effort to notify the client, the client's family and physician, and appropriate state or local authorities of the agency's concerns for staff or client safety, and in accordance with agency policy;

(v)

according to physician orders; or

(vi)

if the client fails to pay for services, except as prohibited by federal law.

(5)

[ (3) ] Staffing.

(A)

A personnel record must [ shall ] be maintained on each employee and volunteer. All information must [ shall ] be kept current. A personnel record must [ shall ] include, but not be limited to, the following:

(i)

job description. In lieu of the job description and qualifications for employment, the personnel record may include a statement signed by the employee that the employee has read the job description and qualifications for the position accepted;

(ii)

qualifications;

(iii)

application for employment or volunteer agreement;

(iv)

verification of license, permits, reference(s), job experience, and educational requirements as appropriate; and

(v)

performance evaluations and disciplinary actions.

(B)

The agency must [ shall ] appoint an administrator who shall administratively supervise the provision of all services.

(i)

The administrator must [ shall ]:

(I)

be a physician, registered nurse, social worker, or nursing home administrator;

(II)

have a baccalaureate or postgraduate degree in administration in a health or human services field and at least one year of full-time administrative experience as the administrator of an agency or licensed health care facility; or

(III)

have training and experience in health service administration and at least one year of full-time supervisory or administrative experience in home health care, hospice, or related health programs.

(ii)

The administrator must [ shall ] not have been employed in the last one year as an administrator with another agency at the time the agency was cited with violations of the statute or this chapter which resulted in enforcement action taken against the agency. For purposes of this clause only, the term "enforcement action" means license revocation, suspension, emergency suspension, or denial of a license or injunction action but does not include administrative or civil penalties. If DHS [ the department ] prevails in one enforcement action (e.g., injunctive action) against the agency but also proceeds with another enforcement action (e.g., revocation) based on some or all of the same violations, but DHS [ the department ] does not prevail in the second action (e.g., the agency prevails), the prohibition in this clause does not apply.

(iii)

The administrator must [ shall ] not have been convicted of a felony or misdemeanor listed in §97.52(a)(2)(B) of this title (relating to Enforcement Action).

(iv)

The administrator must [ shall ] be able to read, write and comprehend English.

(v)

The administrator must [ shall ]:

(I)

organize and direct the agency's ongoing functions;

(II)

assure documentation of services provided is accurate and timely;

(III)

employ qualified personnel and ensure adequate staff education and evaluations;

(IV)

ensure the accuracy of public information materials and activities;

(V)

implement an effective budgeting and accounting system; and

(VI)

authorize in writing an assistant administrator or other individual to act in his or her absence. The administrator, assistant administrator, or other designee shall be available during the agency's usual working hours. The administrator's designee shall be able to read, write, and comprehend English and have at least six months of full-time supervisory or administrative experience in home health, hospice, or related health programs.

(C)

An agency with a license to provide licensed home health, licensed and certified home health, or hospice services must [ shall ] appoint a supervising nurse. The supervising nurse must [ shall ] designate an alternate to serve as supervising nurse in his or her absence, provided the alternate meets the qualifications of this subparagraph. The supervising nurse may also be the administrator of the agency if the supervising nurse meets the qualifications of an administrator described in subparagraph (B) of this paragraph. The supervising nurse or designee must [ shall ]:

(i)

be a registered nurse;

(ii)

have at least one year experience in nursing obtained within the last 24 months;

(iii)

be available at all times during operating hours;

(iv)

be able to read, write, and comprehend English;

(v)

participate in activities relevant to professional services furnished including the development of qualifications and assignment of agency personnel;

(vi)

assure a client's plan of care is executed as written;

(vii)

assure a reassessment of a client's needs is performed by the appropriate health care professional:

(I)

when there is a significant health status change in the client's condition;

(II)

at the physician's request; or

(III)

after hospitalization; and

(viii)

if the agency holds the home dialysis designation, have the qualifications described in §97.24(r)(1)(A) of this title (relating to Standards for Home Dialysis Designation).

(D)

An agency which only provides physical, occupational, speech, or respiratory therapy; medical social services; or nutritional counseling is not required to comply with subparagraph (C) of this paragraph. Supervision of these services shall be provided by the applicable licensed professional (e.g., a physical therapist supervising physical therapy services).

(6)

[ (4) ] Client record. An agency must [ shall ] establish and maintain a client record system to assure that the care and services provided to each client is completely and accurately documented, readily available, and systematically organized to facilitate the compilation and retrieval of information.

(A)

For each client an agency may keep a single file or separate files for each category provided to the client and the client's family.

(B)

The agency must [ shall ] have written procedures which are adopted, implemented, and enforced regarding the removal of records and the release of information. An agency may [ shall ] not release any portion of a client record to anyone other than the client except as allowed by law.

(C)

All information regarding the client's care and services must [ shall ] be centralized in the client's record and be protected against loss or damage.

(D)

The agency must [ shall ] establish an area for active client record storage at the agency's place of business. The active client record must [ shall ] be stored at the place of business (e.g., parent agency location, branch office, or alternate delivery site) from which services are actually provided. Active client records may [ shall ] not be stored at an administrative support site or records storage facility.

(E)

The agency must [ shall ] ensure that each client's record is treated with confidentiality, safeguarded against loss and unofficial use, and is maintained according to professional standards of practice.

(F)

The clinical record must [ shall ] be an original, a microfilmed copy, an optical disc imaging system, or a certified copy. An original record includes manually signed paper records or electronically signed computer records. Computerized records must [ shall ] meet all requirements of paper records including protection from unofficial use and retention for the period specified in subparagraph (J) of this paragraph. Systems must [ shall ] assure that entries regarding the delivery of care or services may not be altered without evidence and explanation of such alteration.

(G)

Each entry to the client record must [ shall ] be accurate, signed, and dated with the date of entry by the individual making the entry. Correction fluid or tape must [ shall ] not be used in the record. Corrections must [ shall ] be made by striking through the error with a single line and must [ shall ] include the date the correction was made and the initials of the person making the correction.

(H)

Inactive client records may be preserved on microfilm, optical disc or other electronic means and may be stored at the parent agency location, branch office, alternate delivery site, administrative support site, or records storage facility. Security must [ shall ] be maintained and the record must be readily retrievable by the agency.

(I)

Each client record must [ shall ] include:

(i)

appropriate identifying information;

(ii)

name of the client's practitioner;

(iii)

initial assessment;

(iv)

care plan or plan of care. The plan of care must [ shall ] include, as applicable, medication, dietary, treatment, and activities orders;

(v)

clinical and progress notes, if applicable. Such notes are to be written the day service is rendered and incorporated into the client record on a timely basis;

(vi)

medication list and medication administration record, if applicable;

(vii)

records of supervisory visits;

(viii)

documentation to show that effective interchange, reporting, and coordination of care occurs as described by the agency policy required in subsection (c)(23) of this section;

(ix)

acknowledgment of the client's receipt of a copy of the Human Resources Code, Chapter 102, Rights of the Elderly;

(x)

acknowledgment of the client's receipt of the agency's policy relating to the reporting of abuse, neglect or exploitation of a client;

(xi)

client agreement to and acknowledgment of services by home health medication aides, if home health medication aides are used; and

(xii)

discharge summary, including the reason for discharge or transfer and the agency's documented notice to the client, the client's physician, and other individuals as required in paragraph (4)(I) [ (2)(I) ] of this subsection.

(J)

An agency must [ shall ] retain original client records for a minimum of five years after the discharge of the client. The agency may not destroy client records that relate to any matter that is involved in litigation if the agency knows the litigation has not been finally resolved.

(K)

If an agency closes, there must [ shall ] be an arrangement for the preservation of inactive records to insure compliance with this subsection. The agency must [ shall ] send DHS [ the department ] written notification of the reason for closure, the location of the client records and the name and address of the client record custodian. If an agency closes with an active client roster, a copy of the active client record must [ shall ] be transferred with the client to the receiving agency in order to assure continuity of care and services to the client.

(7)

[ (5) ] Financial solvency. An agency must [ shall ] have the financial ability to carry out its functions.

(A)

An agency may [ shall ] not intentionally or knowingly pay employees with checks from accounts with insufficient funds.

(B)

An agency must [ shall ] have sufficient funds to meet its payroll.

(C)

The agency must [ shall ] make available to the department upon request financial records relating to its ability to carry out its functions. If there is a question relating to the accuracy of the records or financial ability, the department or its designee may conduct a more extensive review of the records. Any financial review by DHS will [ the department shall ] be conducted by an individual who has the financial qualifications to review such records.

(D)

An agency must [ shall ] maintain business records in their original state. Each entry must [ shall ] be accurate and dated with the date of entry. Correction fluid or tape may [ shall ] not be used in the record. Corrections must [ shall ] be made in accordance with standard accounting practices.

(8)

[ (6) ] Administration of medication. Administration of medication must be ordered by the client's practitioner. A current medication list and medication administration records may be incorporated into one document. Notation must [ will ] be made in clinical notes of medications not given and the reason. Any untoward action must [ will ] be reported to a supervisor and documented in the client record.

(c)

Policies required. An agency must [ shall ] develop, adopt, implement, and enforce a written policy(ies):

(1)-(4)

(No change.)

(5)

for publicly known natural disaster preparedness for clients receiving services. The written policy must [ shall ] include a plan for the reasonable mechanism for triaging clients, the notification of appropriate personnel and clients in the event of a disaster if possible, the identification of appropriate community resources, and the identification of possible evacuation procedures. The plan need not require that the agency actually evacuate, transport, or triage the clients;

(6)-(7)

(No change.)

(8)

on pronouncement of death if that function is carried out by an agency registered nurse. The policy must [ shall ] be in compliance with the Health and Safety Code, §671.001;

(9)-(18)

(No change.)

(19)

to ensure a quality assurance program which provides for accountability and desired client outcomes. The policy must [ shall ] meet the minimum requirements in subsection (b)(4)(A) [ (b)(2)(A) ] of this section;

(20)-(21)

(No change.)

(22)

addressing compliance with out-of-hospital do-not-resuscitate orders and advance directives. The policy must [ shall ]:

(A)

be in compliance with the Advance Directives Act, Health and Safety Code, Chapter 166. In accordance with Health and Safety Code, §142.0145, DHS will assess an administrative penalty of $500 against an agency that violates Health and Safety Code, §166.004, relating to requirements for the provision of a written statement relating to advance directives. DHS will provide notice of administrative penalty and opportunity for a hearing in accordance with §97.52(b)(5) of this title (relating to Enforcement Action); [ be consistent with the Health and Safety Code, Chapter 674, concerning out-of-hospital do-not-resuscitate; the Natural Death Act, Health and Safety Code, Chapter 672; and Civil Practice and Remedies Code, Chapter 135, concerning durable power of attorney for health care; ] and

(B)

address the provision of information regarding advance directives to its clients and assure its clients are allowed, but not required, to formulate such directives to the extent permitted by law;

(23)-(33)

(No change.)

(34)

relating to the supervision of branch offices or alternate delivery sites, if established. This policy must [ shall ] be consistent with:

(A)

for a branch office, §97.14 of this title (relating to Application and Issuance of a Branch Office License) and §97.27 of this title (relating to Standards for Branch Offices); or

(B)

(No change.)

(35)

relating to the agency's procedures for investigating complaints. Such procedures must [ shall ] require the agency to initiate a complaint investigation within ten days of the agency's receipt of the complaint and to document all components of the investigation;

(36)-(38)

(No change.)

(d)

Medicare certification optional.

(1)

An agency which makes application for participation in the Medicare program must [ shall ] comply with the regulations in the Medicare Conditions of Participation for Home Health Agencies, 42 Code of Federal Regulations, Part 484, pending approval of certification granted by the Health Care Financing Administration (HCFA).

(2)

Upon DHS's [ the department's ] receipt of written approval from HCFA, DHS [ the department ] will amend the licensing status of the agency to include the licensed and certified home health services category.

(e)

Psychoactive services. An agency that provides skilled nursing psychoactive treatments must [ shall ] comply with the requirements of this subsection.

(1)

Skilled nursing psychoactive treatments must [ shall ] be under the direction of a physician. Psychoactive treatments may only be provided by a physician or a registered nurse.

(2)

A registered nurse providing skilled nursing psychoactive treatments must [ shall ] have one of the following qualifications:

(A)-(D)

(No change.)

(3)

An agency must [ shall ] have written documentation that a registered nurse providing skilled nursing psychoactive treatments is qualified under paragraph (2) of this subsection.

(4)

The initial assessment of a client receiving skilled nursing psychoactive treatments must [ shall ] include:

(A)-(E)

(No change.)

(f)

Home intravenous therapy. An agency furnishing intravenous therapy directly or under arrangement must [ shall ] comply with the following standards of care.

(1)

A physician's order must [ shall ] be written specifically for intravenous therapy.

(2)

Intravenous therapy must [ shall ] be provided by a licensed nurse.

(3)

To insure that prescribed care is administered safely, the licensed nurse must [ shall ] have the knowledge and documented competency to interpret and implement the written order.

(4)

Responsibilities of the licensed nurse must [ shall ] be clearly delineated in written policies and procedures.

(5)

A registered nurse must [ shall ] be available 24 hours per day.

(6)

The client and caregiver must [ shall ] be assessed for the ability to safely administer the prescribed intravenous therapy as per agency written criteria.

(7)

(No change.)

(8)

Actions must [ shall ] be implemented prior to and during all intravenous therapy to minimize the risk of anaphylaxis or other adverse reactions as stated in the agency's written policy.

(9)

An ongoing assessment of client and caregiver compliance in performing therapy related procedures must [ shall ] be done at periodic intervals.

(10)

Written policies and procedures regarding the agency's provision of intravenous therapy must [ shall ] include, but are not limited to, addressing initiation, medication administration, monitoring, and discontinuation.

(11)

Care coordination must [ shall ] be provided in order to assure continuity of care.

(12)

The client and caregiver must [ shall ] be provided with 24-hour access to appropriate health care professionals employed by or contracted with the agency.

(g)

Possession of sterile water or saline, certain vaccines or tuberculin, and certain dangerous drugs.

(1)

(No change.)

(2)

Possession of certain vaccines or tuberculin.

(A)

(No change.)

(B)

An agency that purchases, stores, or transports a vaccine or tuberculin under this section must [ shall ] ensure that any standing order for the vaccine or tuberculin:

(i)-(v)

(No change.)

(3)

Possession of certain dangerous drugs.

(A)-(C)

(No change.)

(D)

If an agency or the agency's authorized employee administers a drug listed in subparagraph (A) of this paragraph pursuant to a physician's oral order, the agency shall ensure the physician promptly sends a signed copy of the order to the agency, and the agency must [ shall ]:

(i)-(ii)

(No change.)

(E)

A pharmacist that dispenses a sealed portable container under this subsection must [ will ] ensure that the container:

(i)-(iii)

(No change.)

(F)

If an agency or the agency's authorized employee purchases, stores, or transports a sealed portable container under this subsection, the agency must [ shall ] deliver the container to the dispensing pharmacy for verification of drug quality, quantity, integrity, and expiration dates not later than the earlier of:

(i)-(ii)

(No change.)

(G)

A pharmacy that dispenses a sealed portable container under this subsection is required to take reasonable precautionary measures to ensure that the agency receiving the container complies with subparagraph (F) of this paragraph. On receipt of a container under subparagraph (F) of this paragraph, the pharmacy must [ will ] perform an inventory of the drugs used from the container and will restock and reseal the container before delivering the container to the agency for reuse.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 7, 2000.

TRD-200000937

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108


Subchapter D. ENFORCEMENT

40 TAC §97.51, §97.52

The amendments are proposed under the Health and Safety Code, Chapter 142, which authorizes the department to adopt rules for the licensing and regulation of home and community support services agencies.

The amendments implement the Health and Safety Code, Chapter 142.001 - 142.030.

§97.51.Survey Procedures.

(a)

An on-site survey will [ shall ] determine if the requirements of the statute and the rules are being met.

(1)

The Texas Department of Human Services (DHS) [ Health (department) ] or its authorized representative(s) (surveyor) may enter the premises of a license applicant or license holder at reasonable times during business hours to conduct an on-site survey incidental to the issuance of a license, and at other times as it considers necessary to ensure compliance with the statute or the rules adopted under the statute, an order of the commissioner of health (commissioner), a court order granting injunctive relief, or other enforcement action. A standard-by-standard evaluation is required before the first renewal license is issued unless waived in accordance with §97.13(b)(8) [ §97.13(a)(1)(B) ] of this title (relating to Change of Ownership or Services).

(2)

At the discretion of DHS [ the department ], an on-site survey may be conducted for renewal of a license or issuance of a branch office or alternate delivery site license.

(3)

If there is a question relating to the accuracy of an agency's financial records relating to the operation of the agency or the agency's financial ability to carry out its functions, DHS [ the department ] or its designee may conduct an extensive review of the records. Any financial review by DHS will [ the department shall ] be conducted by an individual who has the financial qualifications to review such records.

(4)

The agency administrator, supervising nurse, or other authorized representative from the agency must [ shall ] be present at the time of a survey by DHS [ the department ].

(5)

DHS [ The department ] or a representative of DHS [ the department ] is entitled to access to all books, records, or other documents maintained by or on behalf of the agency to the extent necessary to ensure compliance with the statute, this chapter, an order of the commissioner, a court order granting injunctive relief, or other enforcement action. DHS will [ The department shall ] maintain the confidentiality of agency records as applicable under federal or state law. Ensuring compliance includes permitting photocopying by a DHS [ department ] surveyor or providing photocopies to a DHS [ department ] surveyor of any records or other information by or on behalf of DHS [ the department ] as necessary to determine or verify compliance with the statute or this chapter.

(6)

By applying for or holding a license, the agency consents to entry and survey of the agency by DHS [ the department ] or a representative of DHS [ the department ] in accordance with the statute and this chapter.

(b)

Except for a survey conducted for the purposes of issuing a first renewal license, a survey conducted by DHS will [ the department shall ] be unannounced.

(c)

Except for the investigation of complaints, an agency licensed by DHS [ the department ] is not subject to additional surveys relating to home health, hospice, or personal assistance services while the agency maintains accreditation for the applicable services from the Joint Commission on Accreditation of Healthcare Organizations, the Community Health Accreditation Program or certification as a home and community-based services or home and community-based services-OBRA agency by the Texas Department of Mental Health and Mental Retardation (TXMHMR). An initial survey after issuance of an initial license will [ shall ] be done by DHS [ the department ]:

(1)-(2)

(No change.)

(d)

A DHS [ The department's ] surveyor will [ shall ] hold a conference with the person who is in charge of an agency prior to commencing the on-site survey for the purpose of explaining the nature and scope of the survey. The surveyor [ department's representative ] will [ shall ] hold an exit conference with the person who is in charge of the agency when the survey is completed, and [ the department's representative ] will [ shall ] identify any records that were duplicated. Any original agency records that are removed from an agency must [ shall ] be removed only with the consent of the agency.

(e)

A DHS [ The department's ] authorized representative will [ shall ] hold an exit conference and fully inform the person who is in charge of the agency of the preliminary findings of the survey and will [ shall ] give the person a reasonable opportunity to submit additional facts or other information to DHS's [ the department's ] authorized representative in response to those findings. The response will [ shall ] be made a part of the survey for all purposes and must be received by DHS [ the department ] within ten calendar days of receipt of the preliminary findings of the survey by the agency.

(f)

After a survey of an agency, DHS will [ the department shall ] provide the person in charge of the agency specific and timely written notice of the findings of the survey including:

(1)-(5)

(No change.)

(g)

The surveyor will [ shall ]:

(1)-(7)

(No change.)

(8)

obtain within ten calendar days of the survey written comments, if any, by the person in charge of the agency. Additional facts, written comments or other information provided by the agency in response to the findings will [ shall ] be made a part of the record of the survey for all purposes; and

(9)

(No change.)

(h)

The agency must [ shall ]:

(1)

submit an acceptable written plan of correction for each deficiency no later than ten days from its receipt of a statement of deficiencies. A plan of correction date must [ shall ] not exceed 45 days from the date the deficiency was cited; and

(2)

(No change.)

(i)

If Medicare certification is denied by the Health Care Financing Administration (HCFA) or the agency withdraws from the Medicare program, the agency's license will revert to the category of and be governed by the standards for licensed home health services. The effective date of the change will [ shall ] be the date indicated on the final termination letter issued to the agency by HCFA. This change does not preclude DHS [ the department ] from taking enforcement action, if appropriate, under §97.52 of this title.

(j)

If deficiencies are cited and the plan of correction is not acceptable, DHS will [ the department shall ] notify the agency in writing and request that the plan of correction be resubmitted no later than 30 calendar days of the agency's receipt of DHS's [ the department's ] written notice. Upon resubmission of an acceptable plan of correction, DHS will send written notice [ will be sent by the department ] to the agency acknowledging same.

(k)

DHS [ The department ] will provide upon completion of the review and processing of the survey:

(1)

information on the identity, including the signature, of each department representative conducting, reviewing, or approving the results of the survey and the date on which the DHS [ department ] representative acted on the matter; and

(2)

if requested by the agency, copies of all documents relating to the survey maintained by DHS [ the department ] or provided by DHS [ the department ] to any other state or federal agency that are not confidential under state law.

(l)

DHS will [ The department shall ] verify the correction of deficiencies by mail or by an on-site survey within 90 days of DHS's [ the department's ] receipt of an acceptable plan of correction.

(m)

Acceptance of a plan of correction does not preclude DHS [ the department ] from taking enforcement action as appropriate under §97.52 of this title.

(n)

Except as provided by subsection (b) of this section, an on-site survey will [ must ] be conducted within 18 months after a survey for an initial license. After that time, an on-site survey will [ must ] be conducted at least every 36 months.

(o)

If a person is renewing or applying for a license to provide more than one category under the statute or for a branch office or alternate delivery site license, the required surveys for each of the services or location(s) the license holder or applicant seeks to provide will [ shall ] be completed during the same survey visit.

§97.52.Enforcement Action.

(a)

License denial, suspension or revocation.

(1)

The Texas Department of Human Services (DHS) [ Health (department)] may deny, suspend, suspend on an emergency basis, or revoke a license issued to an applicant or agency if the applicant or agency:

(A)-(B)

(No change.)

(C)

has a provider agreement under the Social Security Act, Title XVIII, which has been terminated by the certifying body, Health Care Financing Administration, or if the agency withdraws its certification or its request for certification. An agency providing licensed and certified home health services that submits a request for a hearing as provided by this section is governed by the requirements of the statute and the rules relating to an agency providing licensed only home health services until suspension or revocation is finally determined by DHS [ the department ] or, if the license is suspended or revoked, until the last day for seeking review of the DHS [ department ] order or a later date fixed by order of the reviewing court;

(D)

commits fraud, misrepresentation, or concealment of a material fact on any documents required to be submitted to DHS [ the department ] or required to be maintained by the agency pursuant to this chapter;

(E)-(J)

(No change.)

(2)

DHS [ The department ] may suspend or revoke an existing valid license or disqualify a person from receiving a license because of a person's conviction of a felony or misdemeanor if the crime directly relates to the duties and responsibilities of a licensed agency.

(A)

In determining whether a criminal conviction directly relates, the department will [ shall ] consider the provisions of Texas Civil Statutes, Article 6252-13c.

(B)

The following felonies and misdemeanors directly relate because these criminal offenses indicate an inability or a tendency for the person to be unable to own or operate an agency. These offenses also relate to the holding of a home health medication aide permit or an entity approved under §97.62(o) of this title (relating to Home Health Medication Aides), to conduct a home health medication aide training program:

(i)-(xx)

(No change.)

(xxi)

other misdemeanors and felonies which indicate an inability or tendency for the person to be unable to own or operate an agency, hold a permit, or receive program approval under §97.62(o) of this title (relating to Home Health Medication Aides), if action by DHS [ the department ] will promote the intent of the statute, this chapter, or Texas Civil Statutes, Article 6252-13c.

(C)

Upon a licensee's felony conviction, felony probation revocation, revocation of parole, or revocation of mandatory supervision, the license will [ shall ] be revoked.

(3)

Before the institution of proceedings to revoke or suspend a license or deny an application for the renewal of a license, DHS will give the license holder:

(A)

notice by personal service or by registered or certified mail of the facts or conduct alleged to warrant the proposed action; and

(B)

an opportunity to show compliance with all requirements of law for the retention of the license by sending the director of Long Term Care-Regulatory a written request for an informal reconsideration. The request must:

(i)

be postmarked within 10 days of the date of DHS's notice and be received in the state office of the director of Long Term Care- Regulatory within 10 days of the date of the postmark; and

(ii)

contain specific documentation refuting DHS's allegations.

(4)

If the agency requests an informal reconsideration under paragraph (3)(B) of this subsection, DHS's review will be limited to a review of documentation submitted by the license holder and information DHS used as the basis for its proposed action and will not be conducted as an adversary hearing. DHS will give the license holder a written affirmation or a reversal of the proposed action, as appropriate.

(5)

[ (3) ] If DHS [ the department ] proposes to deny, suspend, or revoke a license, DHS will [ the department shall ] notify the agency by certified mail, return receipt requested, or personal delivery of the reasons for the proposed action and offer the agency an opportunity for a hearing. If a notice served by mail is returned undeliverable or DHS [ the department ] is unable to execute personal delivery of the notice, DHS [ the department ] will [ may ] publish the notice in a newspaper of general circulation serving the county in which the agency is located based upon the last address provided by the agency. Publication of the notice will [ shall ] be for seven consecutive calendar days. An agency which fails to claim a notice sent by certified mail or refuses to accept the notice does not make the notice null and void.

(A)

The agency must request a hearing within 15 [ 20 ] calendar days of receipt of the notice. The request must be in accordance with Chapter 79, Subchapter Q of this title (relating to Formal Hearings). Receipt of the notice is presumed to occur on the tenth day after the notice is mailed to the last address known to DHS [ the department ] unless another date is reflected on a United States Postal Service return receipt.

[ (B)

The request for a hearing must be in writing and submitted to the Director, Health Facility Licensing Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756.]

(B)

[ (C) ] A hearing will [ shall ] be conducted pursuant to the Administrative Procedure Act, Texas Government Code, Chapter 2001, and DHS's [ the department's ] formal hearing procedures in Chapter 79, Subchapter Q (of this title (relating to Formal Hearings) [ Chapter 1 of this title (relating to the Texas Board of Health) ].

(C)

[ (D) ] If the agency does not request a hearing in writing within 15 [ 20 ] calendar days of receipt of the notice, the agency is deemed to have waived the opportunity for a hearing and the proposed action will [ shall ] be taken.

(D)

[ (E) ] If the agency fails to appear or be represented at the scheduled hearing, the agency has waived the right to a hearing and the proposed action will [ shall ] be taken.

(E)

The denial, suspension, or revocation of a license will take effect when the deadline for appeal of the denial, suspension, or revocation passes, unless the agency appeals the enforcement action. If the agency appeals the enforcement action, the status of the license holder is preserved until final disposition of the contested matter.

(6)

[ (4) ] DHS [ The department ] may suspend or revoke a license to be effective immediately when the health and safety of persons are threatened. DHS will [ The department ] shall] immediately give the chief executive officer of the agency adequate notice of the action taken, the legal grounds for the action, and the procedure governing appeal of the action. DHS will [ The department shall ] also notify the agency of the emergency action including the legal grounds for the action and the procedure governing appeal of the action by certified mail, return receipt requested, or personal delivery of the notice and of the date of a hearing, which will [ shall ] be not later than seven calendar days after the effective date of the suspension or revocation. The effective date of the emergency action will [ shall ] be stated in the notice. The hearing will [ shall ] be conducted pursuant to the Administrative Procedure Act, Texas Government Code, Chapter 2001, and DHS's [ the department's ] formal hearing procedures in Chapter 79, Subchapter Q (of this title (relating to Formal Hearings [ Chapter 1 of this title (relating to the Texas Board of Health) ].

(7)

[ (5) ] If an agency has had enforcement action taken by DHS [ the department ] against the agency, the agency, its owner(s), or its affiliate(s) may not apply for an agency license for one year following the effective date of the enforcement action. For purposes of this paragraph only, the term "enforcement action" means license revocation, suspension, emergency suspension, or denial or injunctive action but does not include administrative penalties or civil penalties. If DHS [ the department ] prevails in one enforcement action (e.g., injunctive action) against the agency but also proceeds with another enforcement action (e.g., revocation) based on some or all of the same violations, but DHS [ the department ] does not prevail in the second enforcement action (e.g., the agency prevails), the prohibition in this paragraph does not apply.

(8)

[ (6) ] If DHS [ the department ] suspends a license, the suspension will [ shall ] remain in effect until DHS [ the department ] determines that the reason for suspension no longer exists. An authorized representative of DHS will [ the department shall ] conduct a survey of the agency prior to making a determination.

(A)

During the time of suspension, the suspended license holder must [ shall ] return the license to DHS [ the department ].

(B)

If a suspension overlaps a renewal date, the suspended license holder must [ shall ] comply with the renewal procedures in this chapter; however, DHS [ the department ] may not renew the license until DHS [ the department ] determines that the reason for suspension no longer exists.

(C)

If suspension is for more than one year, the suspended license holder may apply to DHS [ the department ] for cancellation of the suspension only after one year following the initial date of the suspension.

(9)

[ (7) ] If DHS [ the department ] revokes or does not renew a license and the one-year period described in paragraph (7) [ (5) ] of this subsection has passed, a person may reapply for a license by complying with the requirements and procedures in this chapter at the time of reapplication. DHS [ The department ] may refuse to issue a license if the reason for revocation or nonrenewal continues to exist.

(10)

[ (8) ] Upon revocation or nonrenewal, a license holder must [ shall ] return the license to DHS [ the department ].

(b)

Administrative penalties.

(1)

General. DHS [ The department ] may assess an administrative penalty against a person who violates the statute or this chapter. A person under this subsection includes:

(A)-(E)

(No change.)

(2)

Assessment of a penalty.

(A)

Notwithstanding any other provision of the statute, DHS [ the department ] may not assess an administrative penalty against an agency:

(i)-(ii)

(No change.)

(B)

The assessment of an administrative penalty will [ shall ] be in accordance with the schedule of appropriate and graduated penalties described in paragraph (4) of this subsection. The schedule of appropriate and graduated penalties for each violation is based on the following criteria:

(i)-(vi)

(No change.)

(C)

In determining which violation(s) warrants a penalty(ies), DHS [ the department ] will consider:

(i)-(ii)

(No change.)

(D)

(No change.)

(E)

The assessment of an administrative penalty does not preclude DHS [ the department ] from suspending, revoking, or denying a license in accordance with subsection (a) of this section.

(3)

Correction period.

(A)

Following the first day of a violation, DHS will give an agency [ shall be given ] a reasonable period of time to correct the violation. The period of time must be reflected in and implemented through an accepted plan of correction. A reasonable period of time for purposes of this subsection will [ shall ] be as follows.

(i)-(ii)

(No change.)

(iii)

An agency may request an extension in writing. An agency may receive an extension upon DHS's approval [ of the department ]. An extension is only appropriate if the agency has made a good faith effort to correct the violation within the required time period but has not been able to correct due to circumstances beyond their control and if there is no serious harm or threat to clients.

(B)

If an agency corrects the violation within the time periods described in subparagraph (A) of this paragraph, DHS [ the department ] may assess an administrative penalty only for one level II violation that occurred before the day on which the agency received written notice of the violation (e.g., statement of deficiencies). No administrative penalty would be assessed for a level I violation.

(C)

A penalty(ies) assessed under this subsection may be a severity level I penalty(ies) or a severity level II penalty(ies) or a combination of a severity level I penalty(ies) and severity level II penalty(ies). If an agency does not correct the violation within the time periods described in subparagraph (A) of this paragraph, DHS [ the department ] may assess an administrative penalty for:

(i)-(ii)

(No change.)

(4)

Schedule of penalties.

(A)

Minimum and maximum amount. An administrative penalty may [ shall ] not be less than $100 or more than $1,000 for each violation.

(B)

Subject matter considered. If two or more of the rules listed in subparagraphs (C) and (D) of this paragraph relate to the same or similar subject matter, only one administrative penalty may [ shall ] be assessed at the higher severity level violation.

(C)

Severity level I. A severity level I violation is a violation that has or has had minor or no client health or safety significance.

(i)

The penalty for a severity level I violation will be [ is ] assessed only if the violation is of a continuing nature or the violation was not corrected in accordance with the accepted plan of correction. DHS [ The department ] is not required to provide the agency an opportunity to correct subsequent violations under this subsection.

(ii)-(iii)

(No change.)

(D)

Severity level II.

(i)

The penalty for a severity level II violation will [ shall ] be assessed according to following schedule:

(I)

for a violation that results in serious harm to or death of a client, the penalty will [ shall ] be $1,000;

(II)

for a violation that constitutes an actual serious threat to the health or safety of a client, the penalty will [ shall ] be $500 to $1,000; or

(III)

for a violation that substantially limits the agency's capacity to provide care, the penalty will [ shall ] be $500 to $750.

(ii)

DHS [ The department ] may assess a separate level II administrative penalty for a violation of each of the rules listed in the following table.

Figure: 40 TAC §97.52(b)(4)(D)(ii)

(5)

Notice of violation. After investigation of a possible violation and the facts surrounding that possible violation and the after the agency's receipt of the statement of deficiencies, if DHS [ the department ] determines that a violation has occurred, DHS [ the department ] will give further written notice (e.g., a notice of violation letter) to the person alleged to have committed the violation.

(A)

The notice will [ shall ] include:

(i)-(iii)

(No change.)

(B)

Not later than the 20th calendar day after the date on which the notice is received, the person notified may accept the determination of DHS [ the department ] made under this subsection, including the proposed penalty amount, or may make a written request for a hearing on that determination. A person's acceptance of DHS's [ the department's ] determination means that the person has sent and DHS [ the department ] has received a written acceptance notice accompanied by remittance of the proposed penalty.

(C)

If the person notified of the violation accepts the determination of DHS [ the department ] or if the person fails to respond in a timely manner to the notice, the commissioner or the commissioner's designee shall issue an order approving the determination and ordering that the person pay the proposed penalty.

(D)

If the person requests a hearing, procedures will [ shall ] be in accordance with the statute, §142.0172-142.0173 and DHS's [ the department's ] formal hearing procedures in Chapter 79, Subchapter Q (of this title (relating to Formal Hearings [ Chapter 1 of this title (relating to the Texas Board of Health) ].

(c)

Court action.

(1)

(No change.)

(2)

If a person violates the licensing requirements of the statute, DHS [ the department ] may petition the district court to restrain the person from continuing the violation.

(d)

Surrender or expiration of license.

(1)

After a survey in which deficiencies were cited by the surveyor, an agency may surrender its license before expiration or allow its license to expire in lieu of DHS [ the department ] proceeding with enforcement action.

(2)

An agency may surrender before the expiration date by returning its original license to DHS [ the department ].

(3)

(No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 7, 2000.

TRD-200000938

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: March 19, 2000

For further information, please call: (512) 438-3108