Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 18.
NURSING FACILITY ADMINISTRATORS
The Texas Department of Human Services (DHS) adopts the repeals of §§18.1-18.20;
and adopts new §§18.1-18.4, 18.11-18.16, 18.31-18.41, and 18.51-18.57
in its Nursing Facility Administrators chapter. New §18.13 is adopted
with changes to the proposed text published in the January 9, 2004, issue
of the
Texas Register
(29 TexReg 322). The
repeals of §§18.1-18.20; and new §§18.1-18.4, §18.11, §18.12, §§18.14-
18.16, §§18.31-18.41, and §§18.51-18.57 are adopted without
changes to the proposed text.
DHS is adopting the repeals and new sections as part of an agency-wide
initiative to reorganize and rewrite its rules in plain English to make them
easier for the public to navigate and understand. During the course of rewriting
the rules, DHS, with input from the Nursing Facility Administrators Advisory
Committee (NFAAC), determined that the alternate education and training requirements
needed to be updated to make the rules more consistent with statutory requirements
specified in Texas Health and Safety Code, §242.306(d). Therefore, the
requirements in new §18.13 allow DHS to accept alternate standards of
demonstrated education, training, and experience for applicants who do not
meet the academic and/or internship requirements for licensure in §18.11
and §18.12. New §18.35 is being adopted to assist licensees in obtaining
quality continuing education. It allows administrators to receive continuing
education credit for a DHS-sponsored event or upper-division course taken
at an accredited post-secondary institution of higher education that meets
DHS's continuing education requirements.
DHS received written comments from two staff members of the Department
of Health Services Research at Texas State University. A summary of the comments
and DHS's responses follow.
Comment: The new policies in §18.13 will not help ensure that nursing
facility administrators licensed in the state of Texas have the necessary
licensure qualifications and expertise to provide greater protection for the
health and safety of residents of nursing facilities that DHS regulates. It
appears that the proposed relaxation of requirements for alternative education
for licensure is not equivalent to the minimal requirements stated in §18.11
(Academic Requirements) and §18.12 (Internship Requirements). The generic
knowledge base of health administration, health services administration or
nursing, unless supported by specific nursing facility based information,
is in no way equivalent to the knowledge bases required of nursing facility
administrators. Alternative education should exceed the minimal requirements
of an academic program. The best benchmark to guide the determination of equivalency
in preparation in this nation is to use the guidelines of the National Association
of Boards of Examiners of Long Term Care Administrators, Inc. (NAB) Domains
of Practice. What curriculums in the listed disciplines have been reviewed?
What courses within these curriculums have been reviewed to identify content
comparable in scope and depth to the NAB Domains of Practice?
Response: DHS agrees with this comment and changed the proposed rule. Because
of the concerns that have been raised, the proposed language for §18.13
has been modified to stipulate that a masters or baccalaureate degree in health
administration, health services administration, health care administration,
or nursing must encompass the five domains of the NAB.
Before developing the current proposed alternative educational requirements
for licensure specified in §18.13, DHS reviewed the academic requirements
for licensure of other states across the nation. The minimum academic requirements
for the majority of states reviewed specifically require a licensure applicant
to have a baccalaureate or masters degree in health care or health care services
administration.
According to the United States (U.S.) Department of Labor, Bureau of Labor
Statistics,
Occupational Outlook Handbook, 2002-03
Edition
, all states and the District of Columbia require nursing home
administrators to have a baccalaureate degree and to complete a state-approved
training program. A baccalaureate degree is the standard credential for employment
as an administrator or department head in nursing homes or small hospitals,
whereas a masters degree is generally required for employment with larger
hospitals or as a regional VP with multi-facility nursing home corporations.
The federal regulation, as specified at 42 United States Code §1396g,
states: (c) It shall be the function and duty of such agency or board to-
(1) develop, impose, and enforce standards which must be met by individuals
in order to receive a license as a nursing home administrator, which standards
shall be designed to insure that nursing home administrators will be individuals
who are of good character and are otherwise suitable, and who, by training
or experience in the field of institutional administration, are qualified
to serve as nursing home administrators. DHS's proposed alternative education
requirements comply with specifications established within federal law.
Currently, there are in excess of 100 reputable undergraduate and graduate
health services administration degree programs in the U.S. that are certified
and accredited by the Accrediting Commission on Education for Health Services
Administration (ACEHS), which is recognized by the U.S. Department of Education.
Universities accredited by ACEHS include Texas (San Marcos), Indiana, New
York, and California State universities, as well as Tulane, Johns Hopkins,
Yale, Cornell, and Duke universities. ACEHS criteria for certification and
accreditation address the five domains of the NAB, specifically resident care
and quality of life, human resources, physical environment and atmosphere,
finance, and leadership and management by focusing on:
(1) financial management, leadership, interpersonal and communications
skills in managing human resources and health professionals in diverse organizational
environments;
(2) managing information resources and collecting, analyzing and using
business and health information in decision making;
(3) legal and ethical analysis applied to business and clinical decision-making;
(4) organizational and governmental health policy formulation, implementation,
and effect;
(5) assessment and understanding of the health status of populations, determinants
of health and illness, and managing health risks and behaviors in diverse
populations;
(6) the development, organization, financing, performance, and change of
health systems in diverse communities drawing broadly on the social and behavioral
sciences; and
(7) business and health outcomes measurement, process/outcome relationships,
and methods for process improvement in health organizations.
In developing the proposed alternative education requirements at §18.13,
DHS researched other states' alternate licensure requirements and numerous
university curricula by reviewing the states' licensure statutes and rules,
educational curriculum from higher education institutions, occupational information
and statistics from the U.S. Department of Labor, and accreditation and certification
information from ACEHS. DHS also gleaned information from other long term
care and nursing educational, employment, and professional associations and
organizations such as the NAB.
Comment: How does management experience qualify an individual to manage
a nursing home?
Response: In §18.13 (Alternate Education, Training, and Experience),
DHS defined management experience as full-time employment as a department
head or licensed professional supervising two or more employees in a nursing
home or skilled hospital unit. An individual who has a masters degree in health
administration, health services administration, health care administration,
or nursing with one year of management experience as defined above, would
still have to complete a 500-hour AIT internship. An individual with a baccalaureate
degree in health administration, health services administration, health care
administration, or nursing with three years of management experience would
also still be required to complete a 500-hour AIT internship before being
able to sit for the licensure examinations. DHS believes that combination
of training and experience will qualify an individual to manage a nursing
home.
Comment: Reducing the internship requirement from the traditional 1,000-hour
requirement to a cursory 500-hour substitute is a travesty of the requirement
of equality in training. The entire proposal of alternative training and experience
appears to serve a vested interest proposed by individuals who want to let
their buddies sneak through the doors of alternate education and become legitimate
nursing facility administrators.
Response: DHS disagrees with this comment and did not change the proposed
rule at §18.13. DHS's proposed Chapter 18 rules provide alternate education
and training requirements for licensure pursuant to federal and state law
for the licensing of nursing facility administrators. Further, many states
allow credit towards the AIT internship based on an individual's academic
preparation and past work experience or history. In addition, Texas Health
and Safety Code, Chapter 242, specifies at §242.306(d) that an applicant
who has not completed the course of instruction and training described by
subsection (c) must present evidence satisfactory to the department of having
completed sufficient education, training, and experience in the fields described
in subsection (c) to enable the applicant to engage in the practice of nursing
facility administration. For example, DHS determined that in many states,
because of a registered nurse's (RN's) typical role of supervising nursing
services and staff in a nursing facility, hospital, or other healthcare facility,
a baccalaureate or masters degree in nursing with completion of a 500-hour
AIT internship is acceptable training preparation. By still requiring completion
of a 500-hour AIT internship, an RN will be able to concentrate on the laws
governing the operation of nursing facilities and elements of nursing facility
administration. In addition, emphasis during the 500-hour AIT internship can
be focused on the domains of the NAB other than resident care/quality of life
and human resources, which include finance, physical environment and atmosphere,
and leadership and management. The alternate training and experience proposal
offers an alternate route for qualified individuals with demonstrated academic
training and experience to gain entry into the profession.
Comment: The language in the TDHS document states the flexibility provided
in new §18.13 and §18.35 may help increase the availability of licensed
nursing facility administrators in the state of Texas by allowing recognition
of experience, training and qualifications of persons wanting to practice
in Texas but who cannot meet the current educational requirements. What does
"cannot meet" really mean?
Response: "Cannot meet" means that, under the present rules, individuals
who currently have a masters or baccalaureate degree in health administration,
health services administration, health care administration, or nursing cannot
gain entry into the profession without completing an additional 15 academic
credit hours in long term care administration or an equivalent that encompasses
the NAB domains.
Comment: Workgroups, which often consist of stakeholders, usually play
a role in rule development and are involved with the deliberations of a committee
prior to the writing of rules. Why was this process not used with regard to
rules pertaining to nursing facility administrators? It appears that the publication
of rules in the
Texas Register
without soliciting
input from stakeholders is a strategy to minimize discussion because relatively
few individuals read the
Texas Register
on
a daily basis.
Response: DHS's Credentialing Department has involved outside work groups
when drafting previous rule revisions to the Nursing Facility Administrators
licensure rules. In fact, the Nursing Facility Administrators Advisory Committee
(NFAAC) chair has appointed subcommittees and enlisted assistance from providers
and advocates such as the Texas Health Care Association (THCA), the Texas
Association for Homes and Services for the Aging (TAHSA), and other stakeholders
when proposing significant changes to the licensure requirements. However,
the original purpose of the current rule revisions was to convert the licensure
rules to plain English. During the course of this process, DHS, with input
from the NFAAC, determined that modifications should be made to the alternate
education and training requirements. Because the proposed modifications were
not outside the current national standards for licensure, but were reflective
of the national minimum standards for licensure, the NFAAC did not appoint
a subcommittee to look further into this matter. The NFAAC approved the rules
for submittal as proposed rules in October 2003.
40 TAC §§18.1 - 18.20
The repeals are adopted under the Health and Safety Code,
Chapter 242, Subchapter I, consisting of §§242.301 to 242.322, as
added by Acts 1997, 75th Leg., ch. 1280, §1.01, which authorizes DHS
to license and regulate nursing facility administrators.
The repeals implement the Health and Safety Code, §§242.301-242.322,
as added by Acts 1997, 75th Leg., ch. 1280, §1.01.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on April 16, 2004.
TRD-200402536
Carey Smith
Deputy Commissioner, Legal Services
Texas Department of Human Services
Effective date: June 1, 2004
Proposal publication date: January 9, 2004
For further information, please call: (512) 438-3734
Subchapter A. GENERAL INFORMATION
40 TAC §§18.1 - 18.4
The new sections are adopted under the Health and Safety Code,
Chapter 242, Subchapter I, consisting of §§242.301 to 242.322, as
added by Acts 1997, 75th Leg., ch. 1280, §1.01, which authorizes DHS
to license and regulate nursing facility administrators.
The new sections implement the Health and Safety Code, §§242.301-242.322,
as added by Acts 1997, 75th Leg., ch. 1280, §1.01.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on April 16, 2004.
TRD-200402537
Carey Smith
Deputy Commissioner, Legal Services
Texas Department of Human Services
Effective date: June 1, 2004
Proposal publication date: January 9, 2004
For further information, please call: (512) 438-3734
40 TAC §§18.11 - 18.16
The new sections are adopted under the Health and Safety Code,
Chapter 242, Subchapter I, consisting of §§242.301 to 242.322, as
added by Acts 1997, 75th Leg., ch. 1280, §1.01, which authorizes DHS
to license and regulate nursing facility administrators.
The new sections implement the Health and Safety Code, §§242.301-242.322,
as added by Acts 1997, 75th Leg., ch. 1280, §1.01.
§18.13.Alternate Education, Training, and Experience.
(a)
Applicants not meeting the academic and/or internship requirements
for licensure in §18.11 and §18.12 of this chapter (relating to
Academic Requirements; and Internship Requirements), are eligible for licensure
if they present evidence satisfactory to the Texas Department of Human Services
of the following alternate education and experience:
(1)
a master's degree in health administration, health services
administration, health care administration, or nursing, which includes coursework
that encompasses the five domains of the National Association of Boards of
Examiners of Long Term Care Administrators, Inc. (NAB), with one year of management
experience and completion of a 500-hour internship; or
(2)
a baccalaureate degree in health administration, health
services administration, health care administration, or nursing, which includes
coursework that encompasses the five domains of the NAB, with three years
of management experience and completion of a 500-hour internship.
(b)
Management experience is defined as full-time employment
as a department head or licensed professional supervising two or more employees
in a nursing home or skilled nursing hospital unit.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on April 16, 2004.
TRD-200402538
Carey Smith
Deputy Commissioner, Legal Services
Texas Department of Human Services
Effective date: June 1, 2004
Proposal publication date: January 9, 2004
For further information, please call: (512) 438-3734
Chapter 18.
NURSING FACILITY ADMINISTRATORS
Subchapter B. REQUIREMENTS FOR LICENSURE
Subchapter C. LICENSES