Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 18.
NURSING FACILITY ADMINISTRATORS
The Texas Department of Human Services (DHS) proposes to repeal §§18.1
- 18.20, concerning licensure of nursing facility administrators; and proposes
new Subchapter A, concerning general information, §§18.1 - 18.4;
Subchapter B, concerning requirements for licensure, §§18.11 - 18.16;
Subchapter C, concerning licenses, §§18.31 - 18.41; and Subchapter
D, concerning referrals, complaint procedures, and sanctions, §§18.51
- 18.57, in its Nursing Facility Administrators chapter. The purpose of the
repeals and new sections is to reorganize the chapter and rewrite the rules
in plain English. The rules cover the requirements, application procedures,
types of licenses, fees, complaint procedures, violations, and sanctions governing
the licensing of nursing facility administrators in the state of Texas. Policies
contained in the new rules are substantially the same as current policy, with
two exceptions. New §18.13 allows DHS to accept alternate education,
training, and experience in lieu of current academic requirements. New §18.35
allows administrators to receive continuing education credit for a DHS-sponsored
event or upper-division course taken at a post-secondary institution of higher
education that meets DHS's continuing education requirements.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections.
Bettye Mitchell, Deputy Commissioner for Long Term Care, 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 is to have
rules governing nursing facility administrators that are easier for the public
to navigate and understand. New policies in §18.13 and §18.35 will
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. There is no adverse economic effect on small or micro
businesses as a result of enforcing or administering the sections, because
the new rules contain substantially the same polices as are currently in place.
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 the recognition of experience, training, and qualifications
of persons wanting to practice in Texas but who cannot meet the current educational
requirements. There is no anticipated economic cost to persons who are required
to comply with the proposed sections. There is no anticipated effect on local
employment in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Amy Harper
at (512) 231-5819 in DHS's Credentialing Department. Written comments on the
proposal may be submitted to Supervisor, Rules and Handbooks Unit-045, 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 Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
These rules are promulgated by DHS. This state agency is currently scheduled
to be merged into a successor agency, the Texas Health and Human Services
Commission (HHSC) and one of its subordinate departments, the Texas Department
of Aging and Disability Services, sometime in 2004. This change is mandated
by legislation passed by the 78th Legislature.
At the time of that transition, HHSC will have complete authority for these
and all related rules. This may result in these rules being changed from one
chapter of the Texas Administrative Code to another or variations in the rules
adoption process.
40 TAC §§18.1 - 18.20
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections 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 repeals are proposed under the Health and Safety
Code, Chapter 242, Subchapter I, consisting of §§242.301 - 242.322,
as added by Acts 1997, 75th Legislature, Chapter 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 Legislature, Chapter 1280, §1.01.
§18.1.Introduction.
§18.2.The Nursing Facility Administrators Advisory Committee.
§18.3.Application and Licensure Fees.
§18.4.Applicant Requirements for Examination and Licensure.
§18.5.Academic Requirements for Examination and Licensure.
§18.6.Administrator-In-Training (AIT) Internship Requirements.
§18.7.Successful Completion of Examination.
§18.8.Provisional Licensure.
§18.9.Licensure Renewal and Inactive Status.
§18.10.Continuing Education Requirements.
§18.11.Complaint Procedures.
§18.12.Referrals.
§18.13.Schedule of Sanctions.
§18.14.Violations by an Unlicensed Person.
§18.15.Default Orders.
§18.16.Licensure of Individuals with Criminal Backgrounds.
§18.17.Formal Hearing Procedures.
§18.18.Informal Reconsideration.
§18.19.Standards of Conduct.
§18.20.Administrative Penalties.
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 December 22, 2003.
TRD-200308831
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
Subchapter A. GENERAL INFORMATION
40 TAC §§18.1 - 18.4
The new sections are proposed under the Health and Safety
Code, Chapter 242, Subchapter I, consisting of §§242.301 - 242.322,
as added by Acts 1997, 75th Legislature, Chapter 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 Legislature, Chapter 1280, §1.01.
§18.1.Purpose.
This chapter implements the provisions of the Texas Health and Safety
Code, Chapter 242, Subchapter I, Nursing Facility Administration, for the
purpose of licensing nursing facility administrators in the state of Texas.
§18.2.Definitions.
The words and terms in this chapter have the following meanings, unless
the context clearly indicates otherwise:
(1)
Abuse--Any act, failure to act, or incitement to act done
willfully, knowingly, or recklessly through words or physical action that
causes or could cause mental or physical injury or harm or death to a resident.
Includes verbal, sexual, mental/psychological, or physical abuse; corporal
punishment; involuntary seclusion; or any other actions within this definition.
(2)
Administrative law judge (ALJ)--A State Office of Administrative
Hearings (SOAH) attorney who conducts formal hearings for the Texas Department
of Human Services (DHS).
(3)
Administrator--A licensed nursing facility administrator.
(4)
Administrator-in-training (AIT)--A person undergoing a
minimum 1,000-hour internship under a DHS-approved certified preceptor.
(5)
Applicant--A person applying for a Texas nursing facility
administrator license.
(6)
Application--The notarized DHS application for licensure
as a nursing facility administrator, as well as all required forms, fees,
and supporting documentation.
(7)
Complaint--An allegation that a licensed nursing facility
administrator violated one or more of the licensure rules or statutory requirements.
(8)
Contested case--A proceeding in accordance with the Administrative
Procedure Act pertaining to DHS's rule enforcement and licensing activities
that results in the determination of a party's legal rights, duties, or privileges
as determined by an administrative law judge.
(9)
Credentialing Department--The section of DHS's Long Term
Care Regulatory division that is responsible for the licensing of nursing
facility administrators.
(10)
Deficiency--Violation of a federal participation requirement
in a nursing facility.
(11)
Domains of the NAB--The five domains of the National Association
of Boards of Examiners of Long Term Care Administrators, Inc. (NAB) are resident
care and quality of life; human resources; finance; physical environment and
atmosphere; and leadership and management.
(12)
Equivalent--A level of achievement that is equal in amount
and quality to completion of an educational or training program.
(13)
Formal hearing--A hearing held by SOAH to adjudicate a
sanction taken by DHS against a licensed administrator.
(14)
Good standing--The licensure status of a nursing facility
administrator who is in compliance with the rules in this chapter and/or,
if applicable, the terms of any sanction imposed by DHS.
(15)
Informal review--The opportunity for a licensee to dispute
the allegations made by DHS. The informal review includes the opportunity
to show compliance.
(16)
Internship--The 1,000-hour training period in a nursing
facility for an AIT.
(17)
License--A nursing facility administrator license or provisional
license.
(18)
Licensee--A person licensed by DHS as a nursing facility
administrator.
(19)
Long Term Care Regulatory--The division of DHS responsible
for long term care regulation, including surveying nursing facilities to determine
compliance with licensure and certification and licensing nursing facility
administrators.
(20)
Misappropriation of resident property--The taking, secretion,
misapplication, deprivation, transfer, or attempted transfer to any person
not entitled to receive any property, real or personal, or anything of value
belonging to or under the legal control of a resident without the effective
consent of the resident or other appropriate legal authority, or taking of
any action contrary to any duty imposed by federal or state law prescribing
conduct relating to the custody or disposition of property of a resident.
(21)
NAB--Acronym for the National Association of Boards of
Examiners of Long Term Care Administrators, Inc., which is composed of state
boards or agencies responsible for the licensure of nursing facility administrators.
(22)
NAB examination--The national examination developed by
NAB that applicants must pass in combination with the state licensure examination
to be issued a license to practice nursing facility administration in Texas.
(23)
NCERS--Acronym for the National Continuing Education Review
Service, the part of NAB that approves and monitors continuing education activities
for nursing facility administrators.
(24)
Neglect--A deprivation of life's necessities of food,
water, or shelter; or a failure of an individual to provide services, treatment,
or care to a resident that causes or could cause mental or physical injury,
harm, or death to the resident.
(25)
Nursing facility--An institution or facility licensed
by DHS as a nursing home, nursing facility, or skilled nursing facility.
(26)
Nursing facility administrator--A person who is licensed
to engage in the practice of nursing facility administration, regardless of
whether the person has ownership interest in the facility.
(27)
Nursing Facility Administrators Advisory Committee (NFAAC)--The
nine-member governor-appointed advisory committee that makes recommendations
to DHS about the practice and regulation of nursing facility administration.
(28)
Opportunity to show compliance--An informal meeting between
DHS and a licensee that allows the licensee an opportunity to show compliance
with the requirements of law for the retention of the license. The opportunity
to show compliance is part of an informal review.
(29)
Preceptor--A licensed nursing facility administrator certified
by DHS to provide supervision to an AIT.
(30)
Referral--A recommendation made by Long Term Care Regulatory
to investigate an administrator's compliance with licensure requirements when
deficiencies and/or substandard quality of care deficiencies are found in
a nursing facility, as required by Title 42 Code of Federal Regulations.
(31)
Sanctions--Any adverse licensure actions DHS imposes against
a licensee, including letter of reprimand, and suspension, revocation, and
denial of license.
(32)
State examination--The state licensure examination that
applicants must pass, in combination with the NAB examination, to be issued
a license to practice nursing facility administration in Texas. This examination
covers the nursing facility requirements found in Chapter 19 of this title
(relating to Nursing Facility Requirements for Licensure and Medicaid Certification).
(33)
Substandard quality of care--Any deficiency in Resident
Behavior and Facility Practices, Quality of Life, or Quality of Care that
is immediate jeopardy to resident health or safety; or a pattern of widespread
actual harm that is not immediate jeopardy; or a widespread potential for
more than minimal harm that is not immediate jeopardy, with no actual harm.
(34)
Survey--A resident-focused complaint/incident investigation
or annual licensure and/or certification inspection of a nursing facility
by DHS.
(35)
Sylvan Prometric--The testing agency that administers
the NAB and state examinations to applicants seeking licensure as nursing
facility administrators.
(36)
Texas Department of Human Services (DHS)--The licensing
authority for nursing facility administrators.
§18.3.Nursing Facility Administrators Advisory Committee.
(a)
The governor-appointed Nursing Facility Administrators
Advisory Committee (NFAAC) advises the Texas Department of Human Services
on:
(1)
the licensing of nursing facility administrators;
(2)
minimum standards of conduct for the practice of nursing
facility administration;
(3)
rule changes;
(4)
administrator complaints and referrals; and
(5)
sanctions for rule violations.
(b)
NFAAC members serve staggered terms of six years.
(c)
The nine-member advisory committee is made up of:
(1)
three licensed nursing facility administrators, one of
whom represents a not-for-profit nursing facility;
(2)
three licensed healthcare professionals with geriatric
experience and not employed by a nursing facility, consisting of:
(A)
a licensed physician;
(B)
a registered nurse; and
(C)
a licensed social worker; and
(3)
three public members who have working experience with the
chronically ill and infirm.
§18.4.Schedule of Fees.
The Texas Department of Human Services charges the following administrative
and licensure fees:
(1)
application fee--$100;
(2)
state examination fee--$135;
(3)
state reexamination fee--$135;
(4)
National Association of Boards of Examiners of Long Term
Care Administrators, Inc. (NAB) examination fee--$260;
(5)
NAB reexamination fee--$260;
(6)
initial licensure fee--$250;
(7)
renewal fee--$250 every two years when the license is renewed
on or before the date the license expires;
(8)
late renewal fees for license renewals made after the license
expires:
(A)
$375 for an expired license renewed during the first 90
days after the license expires; and
(B)
$500 for an expired license renewed between 91 and 365
days after the license expires;
(9)
formal inactive status fee--$250;
(10)
reinstatement of licensure fee--$500; and
(11)
duplicate license fee--$25.
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 December 22, 2003.
TRD-200308832
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§18.11 - 18.16
The new sections are proposed under the Health and Safety
Code, Chapter 242, Subchapter I, consisting of §§242.301 - 242.322,
as added by Acts 1997, 75th Legislature, Chapter 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 Legislature, Chapter 1280, §1.01.
§18.11.Academic Requirements.
(a)
Applicants seeking licensure must meet the following academic
requirements:
(1)
a baccalaureate degree in any subject from a university
or health science center accredited by an association recognized by the Texas
Higher Education Coordinating Board; and
(2)
completion of a minimum of 15 semester credit hours in
long term care administration, or its equivalent, that includes courses in
the following domains of the National Association of Boards of Examiners of
Long Term Care Administrators, Inc.:
(A)
resident care and quality of life;
(B)
human resources;
(C)
finance;
(D)
physical environment and atmosphere; and
(E)
leadership and management.
(b)
The Texas Department of Human Services accepts foreign
university degrees and coursework that is counted as transfer credit by accredited
universities recognized by the American Association of Collegiate Registrars
and Admissions Officers.
§18.12.Internship Requirements.
An administrator-in-training (AIT) must meet the following requirements:
(1)
Before starting the internship, the AIT must provide the
Texas Department of Human Services (DHS) written notice of:
(A)
the name and license number of the DHS-approved preceptor
providing training; and
(B)
the name and address of the nursing facility where the
internship will be completed.
(2)
The nursing facility must have a minimum of 60 beds.
(3)
The internship must be a minimum of 1,000 hours of training.
(4)
The AIT can train no more than 40 hours a week.
(5)
Upon completing the internship, the AIT must submit to
DHS:
(A)
a complete and notarized AIT Final Report and Preceptor
Performance Report; or
(B)
official transcript from a university accredited by an
association recognized by the Texas Higher Education Coordinating Board that
reflects completion of the internship.
§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, 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 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.
§18.14.Preceptor Requirements.
(a)
A licensee seeking to sponsor an administrator-in-training
(AIT) must:
(1)
be licensed or registered as a nursing facility administrator
for a minimum of five years, with the two most recent years in Texas;
(2)
be in good standing; and
(3)
have completed the Texas Department of Human Services (DHS)
preceptor training to become a certified preceptor.
(b)
A preceptor must submit a complete and notarized AIT Performance
Report to DHS at the end of the internship.
(c)
A preceptor must obtain DHS approval for sponsoring more
than one AIT at the same time.
(d)
DHS may consider any imposed sanction against a preceptor
as grounds for refusing to allow the preceptor to sponsor an AIT.
(e)
DHS may refuse to allow a preceptor to provide training
to an AIT if the preceptor did not provide adequate training to previous AITs.
(f)
DHS waives 20 of the 40 hours of continuing education required
for license renewal for a preceptor who sponsors an AIT.
(g)
A preceptor certificate is valid for two years from the
date the licensee completes DHS's preceptor training, providing the licensee
remains in good standing.
§18.15.Application Requirements.
(a)
Applicants seeking licensure must submit the following
to the Texas Department of Human Services (DHS):
(1)
a complete and notarized Nursing Facility Administrator's
Application for Licensure form;
(2)
$100 application fee;
(3)
a Texas Department of Public Safety (DPS) Texas Criminal
Conviction report and fingerprint card;
(4)
an official transcript reflecting a baccalaureate degree
from a university or health science center accredited by an association recognized
by the Texas Higher Education Coordinating Board;
(5)
if not a part of the transcript reflecting a baccalaureate
degree, another transcript reflecting 15 semester credit hours in long term
care administration or its equivalent that include the five domains of the
NAB as listed in §18.11 of this chapter (relating to Academic Requirements);
and
(6)
proof of completing the minimum applicable internship that
meets the internship requirements in §18.12 of this chapter (relating
to Internship Requirements).
(b)
An application is valid for one year from the date the
application fee is received.
(c)
Applicants not meeting the requirements for licensure and
examination within one year after DHS receives their application must resubmit
the following to DHS:
(1)
a notarized Nursing Facility Administrator's Application
for Licensure form;
(2)
$100 application fee; and
(3)
a DPS Texas Criminal Conviction report and fingerprint
card.
(d)
DHS is not responsible for applications, forms, notices,
and correspondence unless they are received by DHS.
(e)
DHS is not responsible for mail it sends to a licensee
or applicant if the licensee's or applicant's last known address was not reported
in writing to DHS.
§18.16.Examinations.
(a)
Applicants seeking licensure as nursing facility administrators
from the Texas Department of Human Services (DHS) must pass the following
examinations:
(1)
state examination on the nursing facility requirements
found in Chapter 19 of this title (relating to Nursing Facility Requirements
for Licensure and Medicaid Certification); and
(2)
National Association of Boards of Examiners of Long Term
Care Administrators, Inc. (NAB) examination.
(b)
Applicants register for examination(s) at a designated
NAB website by:
(1)
submitting an application for approval to test; and
(2)
paying the $135 state examination and $260 NAB examination
fees on-line.
(c)
DHS sends e-mails notifying applicants of their eligibility
to take the test.
(d)
Applicants must not take any examination without DHS approval.
(e)
Applicants complete the on-line state and NAB examinations
at a Sylvan Prometric-testing site.
(f)
DHS notifies applicants of test scores within two weeks
after receiving examination results from the testing agency.
(g)
An applicant who fails an examination and wants to retest
must pay NAB reexamination fees of:
(1)
$135 for the state examination; and/or
(2)
$260 for the NAB examination.
(h)
Applicants failing the state or NAB examination(s) three
consecutive times must complete another minimum 1,000-hour administrator-in-training
internship before retesting.
(i)
Applicants previously licensed as nursing facility administrators
by passing the comprehensive examination and who have an expired licensed
for 12 months or longer or voluntarily surrendered their license must pass
the NAB and state examinations to obtain a new license.
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 December 22, 2003.
TRD-200308833
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§18.31 - 18.41
The new sections are proposed under the Health and Safety
Code, Chapter 242, Subchapter I, consisting of §§242.301 - 242.322,
as added by Acts 1997, 75th Legislature, Chapter 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 Legislature, Chapter 1280, §1.01.
§18.31.Initial License.
(a)
The Texas Department of Human Services (DHS) issues a license
certificate to applicants who:
(1)
receive passing scores on the state and NAB examinations;
and
(2)
submit the $250 initial license fee to DHS.
(b)
A license expires two years from the date issued.
(c)
Licensees must keep DHS informed of their current home
address and employment address. If employed by a nursing facility, a licensee
must submit a Data Change Request form to DHS within 30 days of a change.
(d)
Licensees who do not notify DHS of a change in address
or employment within the required 30 days may be subject to an administrative
penalty as listed in §18.57 of this chapter (relating to Schedule of
Sanctions).
(e)
DHS reserves the right to determine whether a criminal
conviction or a sanction taken against an applicant in Texas or another state
is a basis for pending or denying an initial license.
§18.32.Provisional License.
(a)
The Texas Department of Human Services (DHS) issues a provisional
license to applicants currently licensed or registered as nursing facility
administrators in another state who submit the following to DHS:
(1)
complete and notarized Provisional Licensure Questionnaire
and Nursing Facility Administrator License Application forms;
(2)
the $100 application fee; and
(3)
proof of the following:
(A)
a license and good standing status in another state with
licensing requirements substantially equivalent to the Texas licensure requirements;
(B)
employment for at least two years as an administrator of
record of a nursing facility;
(C)
a passing score on the National Association of Boards of
Examiners of Long Term Care Administrators, Inc., examination; and
(D)
sponsorship by an administrator licensed by DHS and who
is in good standing. Sponsorship is waived in cases of demonstrated hardship.
(b)
A provisional license expires 180 days from the date of
issue.
(c)
DHS issues a license certificate to a provisional license
holder:
(1)
who passes the state examination; and
(2)
pays DHS the $250 initial licensure fee.
(d)
DHS reserves the right to determine whether a criminal
conviction or a sanction taken against an applicant in Texas or another state
is a basis for pending or denying a provisional license.
(e)
DHS does not issue a license to an applicant who has had
a license revoked in Texas or any other state.
§18.33.Duplicate License.
The Texas Department of Human Services replaces lost, damaged, or destroyed
license certificates to licensees who submit a notarized Duplicate License
Request form and $25 duplicate license fee to DHS.
§18.34.License Renewal.
(a)
The Texas Department of Human Services (DHS) notifies licensees
of their license expiration date and renewal requirements at least 31 days
before the license expires.
(b)
Failure to receive a renewal notice does not release the
licensee from the responsibility of renewing the license on time.
(c)
Licensees seeking renewal must submit the following to
DHS on or before the date the license expires:
(1)
a complete and notarized License Renewal form;
(2)
the $250 renewal fee; and
(3)
proof of completion of 40 clock hours of continuing education.
(d)
DHS uses the postmark date to determine if a renewal application
is on time. If there is no postmark or the postmark is not legible, DHS uses
the stamp-in date.
(e)
DHS issues a two-year license renewal card to eligible
licensees who meet the requirements in subsection (c) of this section.
§18.35.Continuing Education Requirements for License Renewal.
(a)
The 40 clock hours of continuing education required for
license renewal must:
(1)
be completed during the previous two-year licensure period;
(2)
include one or more of the five domains of the National
Association of Boards of Examiners of Long Term Care Administrators, Inc.
(NAB) listed in §18.11 of this chapter (relating to Academic Requirements);
(3)
include at least six clock hours in ethics; and
(4)
be:
(A)
approved by the National Continuing Education Review Service;
(B)
a Texas Department of Human Services (DHS)-sponsored event;
or
(C)
an upper-division semester credit course taken or taught
at a post-secondary institution of higher education accredited by an association
recognized by the Texas Higher Education Coordinating Board.
(b)
DHS accepts no more than six hours of NAB-approved self-study
courses toward the required 40 hours of continuing education.
(c)
DHS waives, at a maximum, 20 of the 40 hours of continuing
education to a licensee who completes one three-semester hour upper-division
course taken at a post-secondary institution of higher education.
(d)
DHS approves continuing education hours once per licensure
renewal period for the same course, seminar, workshop, or program.
(e)
DHS waives 20 of the required 40 hours of continuing education
for preceptors who sponsor an administrator-in-training.
(f)
DHS may perform an audit of continuing education courses,
seminars, or workshops that the licensee has reported by requesting certificates
of attendance.
§18.36.Late Renewals.
(a)
A person whose license has expired has up to one year from
the expiration date to renew a license by:
(1)
completing 40 clock hours of continuing education as listed
in §18.35 of this chapter (relating to Continuing Education Requirements
for License Renewal); and
(2)
submitting the following fee to the Texas Department of
Human Services (DHS):
(A)
a $375 renewal fee for a license that has been expired
for 90 days or less; or
(B)
a $500 renewal fee for a license that has been expired
for 91 days to 365 days.
(b)
A person whose license has been expired for more than one
year must meet the licensure and examination requirements for an initial license.
(c)
A person must retake the National Association of Boards
of Examiners of Long Term Care Administrators, Inc. (NAB) exam if the applicant
last took and passed the NAB exam five years before the application date.
(d)
A person who does not renew a license on or before the
date the license expires must return the license to DHS.
(e)
A person who fails to renew a license before the expiration
date must not practice in the field of nursing facility administration until
the license is renewed.
(f)
DHS imposes one or more sanctions listed in §18.57
of this chapter (relating to Schedule of Sanctions) against a person who practices
with an expired license.
§18.37.Denial of License Renewal.
(a)
The Texas Department of Human Services (DHS) reserves the
right to determine if any of the following may result in denial of an application
for license renewal:
(1)
a sanction taken against a licensee; or
(2)
a conviction for a crime listed in §18.41 of this
chapter (relating to Licensure of Persons with Criminal Backgrounds).
(b)
DHS will not renew a license if:
(1)
a person's license was revoked in another jurisdiction;
(2)
a licensee defaulted on a guaranteed student loan as addressed
in the Education Code, §57.491; or
(3)
the licensee did not comply with the terms of a sanction
or settlement agreement.
§18.38.Inactive Status.
(a)
A licensee may place a license in a formal inactive status
with the Texas Department of Human Services (DHS) for up to two renewal periods.
(b)
To place a license in a formal inactive status, the licensee
submits the following to DHS on or before the date the license expires:
(1)
the Inactive Status Application form; and
(2)
the $250 inactive status fee.
(c)
Licensees must renew the inactive license on or before
the date that the second inactive status expires by submitting to DHS:
(1)
the $250 renewal fee; and
(2)
proof of completing 40 clock hours of continuing education
as listed in §18.35 of this chapter (relating to Continuing Education
Requirements for License Renewal).
§18.39.Voluntary Surrender of a License.
(a)
A licensee may voluntarily surrender a license by returning
the license certificate to the Texas Department of Human Services.
(b)
A licensee who voluntarily surrenders a license while under
investigation for a violation of licensure requirements may still receive:
(1)
a written reprimand; and/or
(2)
an administrative penalty.
(c)
A licensee who voluntarily surrenders a license in lieu
of a proposed sanction, other than license revocation, may not reapply for
licensure until two years after the surrender date.
(d)
A licensee who voluntarily surrenders a license in lieu
of a proposed license revocation is disqualified from licensure in Texas.
§18.40.Reinstatement.
Applicants who previously were licensed and in good standing in Texas
may obtain a new license without reexamination if they:
(1)
are licensed in good standing in another state;
(2)
practiced in that state for at least the preceding two
years before the date of their current licensure application; and
(3)
pay the Texas Department of Human Services a $500 reactivation
fee.
§18.41.Licensure of Persons with Criminal Backgrounds.
(a)
The Texas Department of Human Services (DHS) considers
applicant's or licensee's conviction(s) for crimes as a potential basis for:
(1)
denying an initial or renewal application for licensure;
and
(2)
imposing a sanction listed in §18.57 of this chapter
(relating to Schedule of Sanctions).
(b)
DHS considers the following when determining if a criminal
conviction directly relates to the duties and responsibilities of a nursing
facility administrator:
(1)
the nature and seriousness of the crime;
(2)
the extent to which a license may offer an individual an
opportunity to engage in the same type of criminal activity; and
(3)
the relationship of the crime to the ability or fitness
required to perform the duties of nursing facility administrator.
(c)
DHS believes that the following crimes relate to nursing
facility administration and reflect an inability or tendency of an individual
to inadequately perform as an administrator:
(1)
intentionally acting as a nursing facility administrator
without a license; and
(2)
attempting or conspiring to commit any offense under the
following chapters of the Texas Penal Code:
(A)
Title 5 (offenses against persons), including homicide,
kidnapping, unlawful restraint, and sexual and assault offenses;
(B)
Title 7 (offenses against property), including arson, criminal
mischief, robbery, burglary, criminal trespass, theft, fraud, computer crimes,
telecommunications crimes, money laundering, and insurance fraud;
(C)
Title 9 (offenses against public order and decency), including
disorderly conduct and public indecency; and
(D)
Title 10 (offenses against public health, safety, and morals),
including weapons, gambling, conduct affecting public health, intoxication,
and alcoholic beverage offenses.
(d)
DHS may consider other crimes and pertinent information
as a potential basis for denying an initial or renewal application.
(e)
Convictions under federal law or another state or nation
for offenses containing elements similar to offenses listed in subsection
(c) of this section may be a basis for DHS imposing sanctions.
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 December 22, 2003.
TRD-200308834
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§18.51 - 18.57
The new sections are proposed under the Health and Safety
Code, Chapter 242, Subchapter I, consisting of §§242.301 - 242.322,
as added by Acts 1997, 75th Legislature, Chapter 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 Legislature, Chapter 1280, §1.01.
§18.51.Referral and Complaint Procedures.
(a)
The Texas Department of Human Services (DHS), Credentialing
Department, receives and investigates:
(1)
referrals from Long Term Care Regulatory regional staff
to determine an administrator's compliance with licensure requirements when
survey findings cite deficiencies and/or substandard quality of care; and
(2)
complaints alleging an administrator violated one or more
of the licensure rules.
(b)
Persons wanting to file a complaint against a licensee
may contact the Credentialing Department's Complaint Investigations Unit:
(1)
by calling (512) 231-5800; or
(2)
by writing the Texas Department of Human Services, Credentialing
Department, Mail Code Y-978, ATTN: NFA Complaint Investigations, P.O. Box
149030, Austin, TX 78714-9030.
(c)
DHS sends a Nursing Facility Administrator Complaint form
to persons wanting to file a complaint. The complainant should complete, sign,
and return the form to DHS.
(d)
Once a referral or complaint is received, the Credentialing
Department notifies the licensee and, if applicable, the person filing the
complaint of the:
(1)
alleged rule violation;
(2)
assigned case number; and
(3)
investigator contact information.
(e)
DHS investigates referrals and complaints by first determining
if a complaint is within Credentialing's authority to investigate, then by:
(1)
reviewing pertinent documentation maintained by the facility,
including financial and resident medical records;
(2)
gathering additional evidence, including licensee and witness
statements;
(3)
determining licensee culpability for survey or investigative
findings; and
(4)
utilizing the services of a private investigator when special
circumstances exist.
(f)
DHS protects copies of documents or records for privacy
and confidentiality in accordance with applicable state and federal laws.
(g)
DHS prioritizes complaints as follows:
(1)
Priority one complaints allege physical abuse, sexual abuse,
neglect, serious injury, death, or immediate jeopardy to resident health or
safety. Investigations are initiated within 24 hours of receipt or by the
next working day.
(2)
Priority two complaints allege all other types of misconduct
by the licensee. Investigations are initiated within 30 days of receipt.
(h)
After the investigation is complete, a final report with
supporting documentation is given to the Nursing Facility Administrators Advisory
Committee (NFAAC) for review and consideration.
(i)
After considering the NFAAC's recommendation, DHS evaluates
the evidence and makes a decision to either:
(1)
impose a sanction;
(2)
collect additional information; or
(3)
dismiss the case.
(j)
DHS notifies the licensee and, if applicable, the person
filing a complaint of the status and final outcome of a complaint or referral.
§18.52.Informal Reviews.
(a)
Before the Texas Department of Human Services (DHS) initiates
proceedings for a sanction, DHS gives a licensee:
(1)
a description of the alleged rule violation(s) warranting
the proposed action;
(2)
an opportunity to demonstrate compliance with all requirements
of the law for retention of the license; and
(3)
the option to accept the sanction.
(b)
A licensee's request for an informal review must:
(1)
be received by DHS within 10 calendar days after the licensee
receives DHS's notice letter; and
(2)
contain documentation that refutes the allegations.
(c)
DHS conducts the informal review:
(1)
by telephone;
(2)
in person; or
(3)
by reviewing the licensee's written response and supporting
evidence.
(d)
DHS provides the licensee with official notice of the outcome
of the informal review.
§18.53.Formal Hearings.
(a)
The Texas Department of Human Services (DHS) gives licensees
a formal hearing notice when the following occurs:
(1)
a licensee does not respond to DHS's notice letter regarding
the informal review; or
(2)
after the informal review, DHS upholds or modifies the
proposed sanction in a manner that is unsatisfactory to the licensee.
(b)
The formal hearing notice to the licensee includes:
(1)
DHS's decision to continue with sanctions;
(2)
an offer for the licensee to accept the sanction as proposed;
and
(3)
notice to request a formal hearing no later than 20 days
after receiving DHS's notice letter.
(c)
DHS imposes sanctions against a licensee when:
(1)
a licensee accepts DHS's decision to impose the sanction;
or
(2)
after the formal hearing before the administrative law
judge upholds DHS's proposed sanction; or
(3)
the licensee does not respond to DHS's formal hearing notice.
(d)
When an administrative penalty is proposed, DHS schedules
a formal hearing with the State Office of Administrative Hearings if the licensee
does not respond to DHS's formal hearing notice.
§18.54.Rule or Statutory Violations.
The Texas Department of Human Services initiates sanctions listed in §18.57
of this chapter (relating to Schedule of Sanctions) against licensees for
the following statutory violations:
(1)
the licensee willfully or repeatedly violated a provision
of Texas Health and Safety Code, Chapter 242, or a rule in this chapter;
(2)
the licensee willfully or repeatedly acted in a manner
inconsistent with the health and safety of the residents of a facility of
which the licensee is an administrator;
(3)
the licensee obtained or attempted to obtain a license
through misrepresentation or deceit or by making a material misstatement of
fact on a license application;
(4)
the licensee's use of alcohol or drugs creates a hazard
to the residents of a facility;
(5)
a judgment of a court of competent jurisdiction finds that
the licensee is mentally incapacitated;
(6)
the licensee has been convicted in a court of competent
jurisdiction of a misdemeanor or felony involving moral turpitude; or
(7)
the licensee has been negligent or incompetent in the licensee's
duties as a nursing facility administrator.
§18.55.Violations of Standards of Conduct.
(a)
The Texas Department of Human Services (DHS) initiates
sanctions listed in §18.57 of this chapter (relating to Schedule of Sanctions)
against licensees for violations of the following nursing facility administrator
Standards of Conduct:
(1)
A licensee must employ sufficient staff to adequately meet
the needs of facility residents as determined by care outcomes.
(2)
A licensee must ensure that sufficient resources are present
to provide adequate nutrition, medications, and treatments to facility residents
in accordance with physician orders as determined by care outcomes.
(3)
A licensee must promote and protect the rights of facility
residents and ensure that employees, contractors, and others respect the rights
of residents.
(4)
A licensee must ensure that residents remain free of chemical
and physical restraints unless required by a physician's order to protect
a resident's health and safety.
(5)
A licensee must report and direct facility staff to report
to the appropriate government agency any suspected case of abuse, neglect,
or misappropriation of resident property as defined in §18.2 of this
chapter (relating to Definitions).
(6)
A licensee must ensure that the nursing facility is physically
maintained in a manner that protects the health and safety of residents and
the public.
(7)
A licensee must notify and direct employees to notify an
appropriate government agency of any suspected cases of criminal activity
as defined by state and federal laws.
(8)
A licensee must post in the facility where employed the
notice provided by DHS that gives the Credentialing Department's address and
telephone number for reporting complaints against an administrator. The notice
must be posted in a conspicuous place and in clearly legible type.
(9)
A licensee must not knowingly or through negligence commit,
direct, or allow actions that result or could result in inadequate care, harm,
or injury to a resident.
(10)
A licensee must not knowingly or through negligence allow
nursing facility employees to harm facility residents by coercion, threat,
intimidation, solicitation, harassment, theft of personal property, or cruelty.
(11)
A licensee must not knowingly or through negligence allow
or direct employees to contradict or alter in any manner the orders of a physician
regarding a resident's medical or therapeutic care.
(12)
A licensee must not knowingly commit or through negligence
allow another individual to commit an act of abuse, neglect, or misappropriation
of resident property as defined in §18.2 of this chapter.
(13)
A licensee must not permit another individual to use his
or her license or allow a facility to falsely post his or her license.
(14)
A licensee must not advertise or knowingly participate
in the advertisement of nursing facility services in a manner that is fraudulent,
false, deceptive, or misleading in form or content.
(15)
A licensee must not knowingly allow, aid, or abet a violation
by another licensed nursing facility administrator of the Texas Health and
Safety Code, Chapter 242, Subchapter I, or the agency's rules adopted under
that subchapter and must report such violations to DHS.
(16)
A licensee must not make or allow employees, contractors,
or volunteers to make misrepresentations or fraudulent statements about the
operation of a nursing facility.
(17)
A licensee must not allow or direct facility employees,
contractors, or others in a manner that results in the harassment or intimidation
of any person for purposes of coercing that person to use the services or
equipment of a particular health agency or facility.
(18)
A licensee must not falsely bill for goods or services
or allow another person to bill for goods or services other than those that
have actually been rendered.
(19)
A licensee must not make or file false reports or allow
an employee, contractor, or volunteer to make or file a report that the licensee
knows to be false.
(20)
A licensee must not intentionally fail to file a report
or record required by state or federal law, impede or obstruct such filings,
or induce another person to impede or obstruct such filings.
(21)
A licensee must not use or knowingly allow employees or
others to use alcohol, narcotics, or other drugs in a manner that interferes
with the performance of the administrator's or other person's duties.
(22)
A licensee must not knowingly or through negligence violate
any confidentiality provisions as prescribed by state or federal law concerning
a resident.
(23)
A licensee must not interfere or impede an investigation
by withholding or misrepresenting fact to DHS representatives, or by using
threats or harassment against any person involved or participating in the
investigation.
(24)
A licensee must not display a license issued by DHS that
is reproduced, altered, expired, suspended, or revoked.
(25)
A licensee must not and must not, knowingly or through
negligence, allow employees or other individuals to mismanage a resident's
personal funds deposited with the facility.
(26)
A licensee must not bribe, attempt to bribe, harass, or
intimidate employees of DHS, other government agencies, or their representatives
concerning the administration of the nursing facility.
(b)
Negligence, as referenced in the Standards of Conduct in
subsection (a) of this section, means the failure of a licensee to use such
care as a reasonably prudent and careful licensee would use in similar circumstances,
or failure to act as a reasonably prudent licensee would in similar circumstances.
§18.56.Violations by Unlicensed Persons.
(a)
Persons with an expired license must not engage in activities
that require a license.
(b)
A person practicing as a licensed nursing facility administrator
after license expiration:
(1)
commits an offense punishable as a Class B misdemeanor;
(2)
is subject to local criminal prosecution; and
(3)
may be referred to the Office of Attorney General for civil
penalties not to exceed $1,000 per violation per day for each day the violation
continues.
(c)
Licensees whose license expires before an investigation
is complete, may still receive:
(1)
a written reprimand; or
(2)
an administrative penalty.
(d)
Licensees allowing a license to expire instead of accepting
a proposed license revocation are disqualified from licensure in Texas.
(e)
All persons with expired licenses must return the license
certificate to the Texas Department of Human Services.
§18.57.Schedule of Sanctions.
(a)
The Texas Department of Human Services (DHS) initiates
one or more of the following sanctions against licensees for violations listed
in §18.54 and §18.55 of this chapter (relating to Rule or Statutory
Violations; and Violations of Standards of Conduct):
(1)
revocation of license;
(2)
license suspension;
(3)
denial of application for license renewal;
(4)
assessment of an administrative penalty;
(5)
written letter of reprimand;
(6)
requiring a licensee to participate in continuing education;
(7)
probation; or
(8)
referral to the Office of Attorney General for civil penalties
not to exceed $1,000 per violation per day for each day the violation continues.
(b)
If a sanction is probated, DHS may require the licensee
to:
(1)
report regularly to DHS on matters that are the basis of
the probation;
(2)
limit practice to the areas prescribed by DHS;
(3)
practice under the direct supervision or guidance of a
DHS-certified preceptor as specified in §18.14 of this chapter (relating
to Preceptor Requirements); and/or
(4)
complete prescribed continuing education until the licensee
attains a degree of skill satisfactory to DHS in those areas that are the
basis of the probation.
(c)
Administrative penalties may not exceed $1,000 per violation
per day for each day the violation continues.
(d)
The amount the administrative penalty is assessed is based
on:
(1)
the seriousness of the violation, including:
(A)
the nature, circumstances, extent, and gravity of prohibited
acts; and
(B)
the hazard or potential hazard created to the health, safety,
or economic welfare of the public;
(2)
economic harm to property or environment;
(3)
history of previous violations;
(4)
amount necessary to deter future violations;
(5)
efforts to correct the violations;
(6)
the severity level of the violation:
(A)
Level I--$500 to $1,000 for violations that have or had
an adverse impact on resident health and/or safety that includes serious harm,
permanent injury, or death to a resident;
(B)
Level II--$250 to $500 for violations that have or had
a potential or adverse impact on the health and/or safety of a resident, but
less impact than Level I; or
(C)
Level III--$250 or less for violations having minimal or
no significant impact on resident health and/or safety; and
(7)
any other matter that justice may require.
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 December 22, 2003.
TRD-200308835
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
The Texas Department of Human Services (DHS) proposes to amend §19.301,
concerning applicable codes and standards; §19.334, concerning architectural
space planning and utilization; §19.340, concerning mechanical requirements; §19.341,
concerning electrical requirements; §19.602, concerning incidents of
abuse and neglect reportable to DHS and law enforcement agencies by facilities; §19.1103,
concerning sufficient staffing; and §19.1929, concerning staff development,
in its Nursing Facility Requirements for Licensure and Medicaid Certification
chapter.
The purpose of the amendments is to implement changes mandated by the 78th
Legislature, and to revise or correct references to the Life Safety Code (LSC)
of the National Fire Protection Association (NFPA) and the Penal Code. The
amendment to §19.301 revises the reference to the LSC of the NFPA and
corrects the address for NFPA. The amendment to §19.334 deletes the requirement
that beds must have casters, and corrects the NFPA reference for the storage
and use of oxygen. The amendment to §19.340 adds the requirement for
nursing facilities constructed or licensed after January 1, 2004, to have
a central air conditioning system, or a substantially similar air conditioning
system, that is capable of maintaining a temperature suitable for resident
comfort within areas used by residents. The amendment to §19.341 corrects
a reference to the LSC. The amendment to §19.602 corrects a reference
to the Penal Code. The amendment to §19.1103 corrects a licensing rule
reference. The amendment to §19.1929 adds the requirement for nursing
staff to receive at least one hour of training each year in caring for people
who have dementia as required by the Health and Safety Code, §242.037.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections.
Bettye M. Mitchell, Deputy Commissioner for Long Term Care, 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 is (1) to
foster appropriate nursing care of individuals who have dementia by ensuring
that nursing staff is knowledgeable of the disease process as well as what
constitutes appropriate care; (2) ensure a comfortable environment by maintaining
facility temperature at a level that is suitable for resident comfort; (3)
enhance a facility's ability to provide a safe environment for residents as
they are less likely to sustain injuries from a bed without casters because
it is lower to the floor; (4) enhance the public's ability to locate desired
information referenced in the rules; (5) ensure the accuracy of information
available to the public; and (6) have rules that comply with current state
law.
There is no adverse economic effect on small or micro businesses, or on
businesses of any size, as a result of enforcing or administering the sections.
The required one hour of dementia training for nursing staff should not generate
additional costs, because nursing facilities will be able to cover the additional
topic within the same number of required in-service hours that they are required
to provide now. The requirement for facilities licensed or constructed after
January 1, 2004, to have a central air conditioning unit or a substantially
similar air conditioning system has no effect on currently licensed facilities,
and this requirement for new facilities would normally be incorporated in
the cost of starting a business. Removing the requirement for facilities to
have beds with casters has no adverse economic effect because facilities will
no longer have to purchase beds with casters to be in compliance. There is
no anticipated economic cost to persons who are required to comply with the
proposed sections. There is no anticipated effect on local employment in geographic
areas affected by these sections.
Questions about the content of this proposal may be directed to Marcia
Bowen at (512) 438-3529 in DHS's Long Term Care-Regulatory Policy section.
Written comments on the proposal may be submitted to Supervisor, Rules and
Handbooks Unit-040, 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 Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
These rules are promulgated by DHS. This state agency is currently scheduled
to be merged into a successor agency, the Texas Health and Human Services
Commission (HHSC) and one of its subordinate departments, the Texas Department
of Aging and Disability Services, sometime in 2004. This change is mandated
by legislation passed by the 78th Legislature.
At the time of that transition, HHSC will have complete authority for these
and all related rules. This may result in these rules being changed from one
chapter of the Texas Administrative Code to another or variations in the rules
adoption process.
Subchapter D. FACILITY CONSTRUCTION
40 TAC §§19.301, 19.334, 19.340, 19.341
The amendments are proposed under the Health and Safety Code,
Chapter 242, which authorizes DHS to license and regulate convalescent and
nursing homes and related institutions.
The amendments implement the Health and Safety Code, §§242.001
- 242.852.
§19.301.Applicable Codes and Standards.
(a)
The facility must meet the applicable provisions of the
2000
[
(b) - (c)
(No change.)
§19.334.Architectural Space Planning and Utilization.
(a)
Resident bedrooms. Each resident bedroom must meet the
following requirements:
(1) - (9)
(No change.)
[(10)
All beds must have castors with wheel-locking
devices.]
(10)
[
(11)
[
(12)
[
(13)
[
(b) - (o)
(No change.)
(p)
Oxygen. The storage and use of oxygen and equipment must
meet applicable NFPA standards for oxygen, including NFPA
99
[
§19.340.Mechanical Requirements.
The design of the mechanical systems must be done by or under the direction
of a registered professional (mechanical) engineer approved by the Texas State
Board of Registration for Professional Engineers to operate in Texas, and
the parts of the plans and specifications covering mechanical design must
bear the legible seal of the engineer. Building services pertaining to utilities;
heating, ventilating, and air-conditioning systems; vertical conveyors; and
chutes must be in accordance with the Life Safety Code. Required plumbing
fixtures must be in accordance with the Life Safety Code and §19.334
of this title (relating to Architectural Space Planning and Utilization) in
specific use areas.
(1)
(No change.)
(2)
Heating, ventilating, and air-conditioning systems.
(A) - (C)
(No change.)
(D)
The heating system must be designed, installed, and functioning
to be able to maintain a temperature of at least 75 degrees Fahrenheit for
all areas occupied by residents. For all other occupied areas, the indoor
design temperature must be at least 72 degrees Fahrenheit. The cooling system
must be designed, installed, and functioning to be able to maintain a temperature
of not more than 78 degrees Fahrenheit.
A facility constructed or licensed
after January 1, 2004, must have a central air conditioning system, or a substantially
similar air conditioning system, that is capable of maintaining a temperature
suitable for resident comfort within areas used by residents.
Occupied
areas generating high heat, such as kitchens, must be provided with a sufficient
cool air supply to maintain a temperature not exceeding 85 degrees Fahrenheit
at the five-foot level. Supply air volume must be approximately equal to the
air volume exhausted to the exterior for these areas.
(E) - (P)
(No change.)
(3) - (4)
(No change.)
§19.341.Electrical Requirements.
(a)
The design of the electrical systems must be done by or
under the direction of a registered professional electrical engineer approved
by the Texas State Board of Registration for Professional Engineers to operate
in Texas, and the parts of the plans and specifications covering electrical
design must bear the legible seal of the engineer. Requirements pertaining
to utilities, heating, ventilating, and air-conditioning systems, vertical
conveyors, and chutes must be in accordance with the Life Safety Code, Chapter
9
[
(b) - (d)
(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 December 22, 2003.
TRD-200308836
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §19.602
The amendment is proposed under the Health and Safety Code,
Chapter 242, which authorizes DHS to license and regulate convalescent and
nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001
- 242.852.
§19.602.Incidents of Abuse and Neglect Reportable to the Texas Department of Human Services (DHS) and Law Enforcement Agencies by Facilities.
(a) - (d)
(No change.)
(e)
A local or state law enforcement agency must be notified
of reports described in subsection (a) of this section, which allege that:
(1) - (4)
(No change.)
(5)
a resident has suffered bodily injury, as that term is
defined in the Penal Code,
§1.07
[
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 December 22, 2003.
TRD-200308837
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §19.1103
The amendment is proposed under the Health and Safety Code,
Chapter 242, which authorizes DHS to license and regulate convalescent and
nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001
- 242.852.
§19.1103.Sufficient Staffing.
The facility must employ sufficient dietary support personnel who are
competent to carry out the functions of the dietary service. [
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 December 22, 2003.
TRD-200308838
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §19.1929
The amendment is proposed under the Health and Safety Code,
Chapter 242, which authorizes DHS to license and regulate convalescent and
nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001
- 242.852.
§19.1929.Staff Development.
Each facility must implement and maintain programs of orientation,
training, and continuing in-service education to develop the skills of its
staff, as described in §19.1903 of this title (relating to Required Training
of Nurse Aides).
(1)
(No change.)
(2)
Each registered nurse, licensed vocational
nurse, and nurse aide (nurse assistant) who provides nursing services must
receive at least one hour of training each year in caring for people who have
dementia.
(3)
[
(A)
communication techniques and skills useful when providing
geriatric care, such as skills for communicating with the hearing impaired,
visually impaired and cognitively impaired; therapeutic touch; and recognizing
communication that indicates psychological abuse;
(B)
assessment and nursing interventions related to the common
physical and psychological changes of aging for each body system;
(C)
geriatric pharmacology, including treatment for pain management
and sleep disorders;
(D)
common emergencies of geriatric residents and how to prevent
them, for example, falls, choking on food or medicines, injuries from restraint
use; recognizing sudden changes in physical condition, such as stroke, heart
attack, acute abdomen, and acute glaucoma; and obtaining emergency treatment;
(E)
common mental disorders with related nursing implications;
and
(F)
ethical and legal issues regarding advance directives,
abuse and neglect, guardianship, and confidentiality.
(4)
[
(A)
Facility staff must be trained in the use of pediatric
equipment and supplies, including emergency equipment and supplies.
(B)
Facility staff should receive annual continuing education
dealing with pediatric issues, including child growth and development and
pediatric assessment.
(5)
[
(A)
licensed personnel--two hours per quarter; and
(B)
nurse aides--12 hours annually. For the purpose of this
paragraph, a medication aide is considered a nurse aide and must receive the
same continuing in-service education. This in-service education does not qualify
as continuing education units required for renewal of a medication aide permit.
(6)
[
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 December 22, 2003.
TRD-200308839
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §20.110, §20.112
The Texas Department of Human Services (DHS) proposes to
amend §20.110, concerning informal reviews and formal appeals, and §20.112,
concerning attendant compensation rate enhancement, in its Cost Determination
Process chapter.
The purpose of the amendment to §20.110 is to modify the amount of
time a provider is allowed to submit a request for an informal review. The
amendment grants providers an additional 15 calendar day extension beyond
the 30 calendar day deadline to submit required information related to the
provider's request for an informal review.
The purpose of the amendment to §20.112 is to lower the spending requirement
for participating providers by amending the calculation used to determine
the adjusted attendant compensation per unit of service. Beginning September
1, 2003, the attendant compensation spending per unit of service has been
multiplied by 1.10 to determine the adjusted attendant compensation per unit
of service.
The Texas Health and Human Services Commission (HHSC) is proposing related
policy in its Chapter 355 in this issue of the
Texas
Register
.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections.
Bettye M. Mitchell, Deputy Commissioner for Long Term Care, 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 §20.110 is that providers
will be allowed additional time, if it proves necessary, to collect the necessary
information and evidence to support an efficient resolution of matters in
dispute. The public benefit anticipated as a result of enforcing §20.112
is that participating providers will be allowed more flexibility in spending
in other cost areas of the total reimbursement rate.
There is no adverse economic effect on small or micro businesses as a result
of enforcing or administering the sections, because the proposal increases
flexibility for providers and does not add any new requirements for businesses.
There is no anticipated economic cost to persons who are required to comply
with the proposed sections. There is no anticipated effect on local employment
in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Carolyn
Pratt at (512) 685-3127 in HHSC's Rate Analysis Department. Written comments
on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-010,
Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
. For further information regarding the proposal or to make the proposal
available for public review, contact local offices of DHS or Carolyn Pratt
at (512) 685-3127 in HHSC's Rate Analysis Department.
Under §2007.003(b) of the Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
These rules are promulgated by DHS. This state agency is currently scheduled
to be merged into a successor agency, the Texas Health and Human Services
Commission (HHSC) and one of its subordinate departments, the Texas Department
of Aging and Disability Services, sometime in 2004. This change is mandated
by legislation passed by the 78th Legislature.
At the time of that transition, HHSC will have complete authority for these
and all related rules. This may result in these rules being changed from one
chapter of the Texas Administrative Code to another or variations in the rules
adoption process.
The amendments are proposed under the Human Resources Code, Chapter
22, which authorizes DHS to administer public assistance programs.
The amendments implement the Human Resources Code, §§22.0001
- 22.038.
§20.110.Informal Reviews and Formal Appeals.
(a) - (b)
(No change.)
(c)
Informal review.
(1)
An interested party who disputes an action or determination
under this chapter may request an informal review under this section. The
purpose of an informal review is to provide for the informal and efficient
resolution of the matters in dispute. An informal review is not a formal administrative
hearing, but is a prerequisite to obtaining a formal administrative hearing
and is conducted according to the following procedures:
(A)
Texas Health and Human Services Commission
(HHSC)
Rate Analysis must receive a written request for an informal review
by hand delivery,
United States (
U.S.
)
mail, or special
mail delivery no later than 30 calendar days from the date on the written
notification of the adjustments. If the 30th calendar day is a weekend day,
national holiday, or state holiday, then the first business day following
the 30th calendar day is the final day the receipt of the written request
will be accepted.
HHSC Rate Analysis will extend this deadline if it
receives a written request for the extension by hand delivery, U.S. mail,
or special mail delivery no later than 30 calendar days from the date of the
written notice of adjustments. The extension gives the requester a total of
45 calendar days from the date of the written notice of adjustment to file
a request for an informal review. If the 45th calendar day is a weekend day,
national holiday, or state holiday, then the 45th day is considered the next
business day following the 45th calendar day.
A request for an informal
review
or extension
that is not received by the stated deadline
will not be accepted.
(B) - (C)
(No change.)
(2)
(No change.)
(d) - (e)
(No change.)
§20.112.Attendant Compensation Rate Enhancement.
(a) - (r)
(No change.)
(s)
Spending requirements for participating contracts. DHS
or its designee will determine from the Attendant Compensation Report, as
specified in subsection (h) of this section and other appropriate data sources,
the amount of attendant compensation spending per unit of service delivered.
The provider's compliance with the spending requirement is determined based
on the total attendant compensation spending as reported on the Attendant
Compensation Report for each participating contract if the provider requested
participation individually for each contract. A participating contract that
has been terminated in accordance with subsection (v) of this section or that
has undergone a contract assignment in accordance with subsection (w) of this
section will be considered to have participated on an individual basis for
compliance with the spending requirement for the owner prior to the termination
or contract assignment. If the provider specified that he wished to have all
participating contracts be considered as a group for purposes related to the
attendant compensation rate enhancement, as specified in subsection (f) of
this section, compliance with the spending requirement is based on the total
attendant compensation as reported on the single aggregate Attendant Compensation
Report described in subsection (h) of this section. Compliance with the spending
requirement is determined separately for each program specified in subsection
(a) of this section, except for providers delivering services to both RC and
CBA AL/RC clients in the same facility whose compliance is determined by combining
both programs. DHS or its designee will calculate recoupment, if any, as follows.
(1)
For the rate year beginning September 1, 2000, the attendant
compensation spending per unit of service
is
[
(2) - (3)
(No change.)
(t) - (dd)
(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 December 22, 2003.
TRD-200308851
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
Subchapter D. GENERAL REQUIREMENTS FOR FACILITY CONSTRUCTION
40 TAC §§90.61, 90.65, 90.68, 90.74
The Texas Department of Human Services (DHS) proposes to
amend §90.61, concerning introduction, application, and general requirements
for facilities for persons with mental retardation or related conditions; §90.65,
concerning fire alarms, detection systems, and sprinkler systems; §90.68,
concerning architectural space planning; and §90.74, concerning safety
operations, in its Intermediate Care Facilities for Persons with Mental Retardation
or Related Conditions chapter. The purpose of the amendments is to update
references to the National Fire Protection Association (NFPA) Life Safety
Code from the 1985 edition to the 2000 edition, which reflects the recent
adoption of the latter edition by the Centers for Medicare and Medicaid Services
(CMS) and by the State Fire Marshal's office. The amendments update fire safety
requirements for resident safety in facilities. The amendment to §90.68
also corrects the reference to the requirement for dishes and utensils sanitation.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections.
Bettye M. Mitchell, Deputy Commissioner for Long Term Care, 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 is that residents
within the facilities should be safer due to updated code requirements, and
facility owners will have clear and concise guidance concerning the NFPA requirements.
The updated reference to the correct sanitation requirements will ensure the
accuracy of information provided to the public. There is no adverse economic
effect on small or micro businesses as a result of enforcing or administering
the sections, because the 2000 edition of the code allows facilities to continue
to operate at their current location without making any significant changes
that are different from changes that would have been required under the 1985
code. There is no anticipated economic cost to persons who are required to
comply with the proposed sections. There is no anticipated effect on local
employment in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Jeanoyce
Wilson at (512) 438-2353 in DHS's Long Term Care-Regulatory Section. Written
comments on the proposal may be submitted to Supervisor, Rules and Handbooks
Unit-041, 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 Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
These rules are promulgated by DHS. This state agency is currently scheduled
to be merged into a successor agency, the Texas Health and Human Services
Commission (HHSC) and one of its subordinate departments, the Texas Department
of Aging and Disability Services, sometime in 2004. This change is mandated
by legislation passed by the 78th Legislature.
At the time of that transition, HHSC will have complete authority for these
and all related rules. This may result in these rules being changed from one
chapter of the Texas Administrative Code to another or variations in the rules
adoption process.
The amendments are proposed under the Health and Safety Code,
Chapter 252, which authorizes DHS to license and regulate intermediate care
facilities for persons with mental retardation or related conditions.
The amendments implement the Health and Safety Code, §§252.001
- 252.209.
§90.61.Introduction, Application, and General Requirements for Facilities for Persons with Mental Retardation or Related Conditions.
(a)
(No change.)
(b)
Purpose.
(1)
The concept of requirements for fire safety with regard
to the residents is based on evacuation capability as published by National
Fire Protection Association (NFPA) in NFPA 101 Life Safety Code. These standards
are written with the premise that the residents will be capable of self-evacuation
without continuous staff assistance. Residents that are not normally capable
of self-evacuation nor capable of negotiating stairs unassisted shall not
be housed above or below the floor of exit discharge unless the facility meets
the construction requirements of NFPA 101, Chapter
18
[
(A) - (C)
(No change.)
(2)
The method of determining the evacuation capability of
residents under NFPA 101,
Chapter 32 or 33
[
(A) - (C)
(No change.)
(3)
(No change.)
(c)
(No change.)
(d)
Construction.
(1)
New construction is any construction work
that
[
(2)
An existing facility is one
that
[
(3) - (9)
(No change.)
(e)
Applicable codes and standards. Facilities must meet the
requirements of NFPA 101,
2000
[
(1) - (6)
(No change.)
(f)
(No change.)
§90.65.Fire Alarms, Detection Systems, and Sprinkler Systems.
(a)
General. Fire alarms, detection systems, and sprinkler
systems shall be as required by National Fire Protection Association (NFPA)
101 Life Safety Code, NFPA
72 National Fire Alarm Code
[
(1) - (5)
(No change.)
(b)
Fire alarm and smoke detection and sprinkler systems for
small facilities.
(1)
A manual alarm initiating system shall be provided and
shall be supplemented by an automatic smoke detection and alarm initiation
system in accordance with NFPA 101, Chapter
9
[
(2) - (6)
(No change.)
(7)
Facilities classified as "impractical evacuation capability
,
"[
(c)
(No change.)
§90.68.Architectural Space Planning.
(a)
Large facilities.
(1) - (5)
(No change.)
(6)
Kitchens (main/dietary).
(A) - (C)
(No change.)
(D)
Kitchens shall be provided with facilities for washing
and sanitizing dishes and cooking utensils. Such facilities will be provided
for the number of meals served and the method of serving (permanent or disposable
dishes, etc.). The kitchen shall contain a compartmented sink large enough
to immerse pots and pans. Separation of soiled and clean dish areas shall
be maintained, including air flow.
(i)
A mechanical dishwasher must be used to sanitize dishes
and utensils and must meet requirements specified under 25 TAC
§229.165
[
(ii)
Dishes and utensils will be manually sanitized in accordance
with 25 TAC
§229.165
[
(E) - (J)
(No change.)
(7) - (9)
(No change.)
(b)
Small facilities.
(1)
Bedrooms.
(A) - (F)
(No change.)
(G)
Each small facility shall have at least two remotely located
means of escape that do not involve windows. The arrangement shall be such
that there is a primary means of escape from each sleeping room that provides
a path of travel to the outside without traversing any corridor or other space
exposed to unprotected vertical openings or common living spaces, such as
living rooms and kitchens. Exceptions are as follows:
(i)
A second means of escape or alternate protection is not
required:
(I)
(No change.)
(II)
if the building is protected with an approved sprinkler
system meeting National Fire Protection Association (NFPA) 13 Standard for
the
Installation of Sprinkler Systems
, NFPA 13R Standard for the
Installation of Sprinkler Systems in Residential Occupancies up to and Including
Four Stories in Height,
or NFPA 13D Standard for
the
Installation
of Sprinkler Systems in One- and Two-family Dwellings and
Manufactured
[
(ii)
(No change.)
(2) - (8)
(No change.)
§90.74.Safety Operations.
(a)
(No change.)
(b)
Fire and evacuation drills.
(1) - (2)
(No change.)
(3)
Any direct care staff, including relief staff, must participate
in the initial fire drill within ten days of their employment at the facility.
An exception is that facilities meeting NFPA 101, Chapter
18
[
(4) - (5)
(No change.)
(c)
(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 December 22, 2003.
TRD-200308840
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
The Texas Department of Human Services (DHS) proposes to repeal Chapter
93, concerning its Employee Misconduct Registry (EMR), consisting of §§93.1
- 93.6. DHS proposes new Chapter 93, consisting of Subchapter A, Introduction, §§93.1
- 93.4; Subchapter B, EMR Use Requirements, §§93.11 - 93.13; Subchapter
C, Process for Facility Referrals, §§93.21 - 93.23; Subchapter D,
Process for Agency Referrals, §§93.31 - 93.34; Subchapter E, Determination
of Reportable Conduct, Informal Review, and Formal Hearing for Facility Referrals, §§93.41
- 93.48; and Subchapter F, Recordable Information in the EMR, §§93.61
- 93.63.
The purpose of the repeals and new sections is to reorganize the rules
in Chapter 93 and to rewrite them in plain English question-and-answer format.
The new sections expand the definitions section, explain the requirements
for use of the EMR, separate the process for facility and agency referrals,
define the process once reportable conduct occurs, and provide a list of recordable
information in the EMR. In addition, the new sections implement the Health
and Safety Code, §253.008, by requiring persons exempt from licensing
under the Health and Safety Code, §142.003(a)(19), to use the EMR. The
new sections also implement the Health and Safety Code, §253.009(a),
by requiring persons exempt from licensing under the Health and Safety Code, §142.003(a)(19),
to notify their employees as required by that section.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections.
Bettye M. Mitchell, Deputy Commissioner for Long Term Care, 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 is to have
rules that facilities, agencies, and the public can more easily access and
understand. The public will also benefit by having rules that comply with
current laws. There is no adverse economic effect on small or micro businesses
as a result of enforcing or administering the sections, because the proposal
does not add any new requirements that would have a negative economic impact
on businesses. There is no anticipated economic cost to persons who are required
to comply with the proposed sections. There is no anticipated effect on local
employment in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Lynette
Sanders at (512) 231-5810 in DHS's Long Term Care-Credentialing section. Written
comments on the proposal may be submitted to Supervisor, Rules and Handbooks
Unit-044, 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 Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
These rules are promulgated by DHS. This state agency is currently scheduled
to be merged into a successor agency, the Texas Health and Human Services
Commission (HHSC) and one of its subordinate departments, the Texas Department
of Aging and Disability Services, sometime in 2004. This change is mandated
by legislation passed by the 78th Legislature.
At the time of that transition, HHSC will have complete authority for these
and all related rules. This may result in these rules being changed from one
chapter of the Texas Administrative Code to another or variations in the rules
adoption process.
40 TAC §§93.1 - 93.6
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections 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 repeals are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The repeals implement the Health and Safety Code, §§253.001 -
253.010.
§93.1.Purpose.
§93.2.Definitions.
§93.3.Texas Department of Human Services' (DHS's) Requirements for Facilities.
§93.4.Employee Misconduct Registry Requirements.
§93.5.Texas Department of Protective and Regulatory Services' (PRS's) Requirements for Agencies.
§93.6.Facility and Agency Responsibilities.
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 December 22, 2003.
TRD-200308841
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
Subchapter A. INTRODUCTION
40 TAC §§93.1 - 93.4
The new sections are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The new sections implement the Health and Safety Code, §§253.001
- 253.010.
§93.1.What is the purpose of this chapter?
This chapter implements the Health and Safety Code, Chapter 253, Employee
Misconduct Registry, to track findings of reportable conduct by unlicensed
employees of Texas Department of Human Services-regulated facilities and agencies,
and persons exempt from licensing under the Health and Safety Code, §142.003(a)(19).
§93.2.What do certain words and terms in this chapter mean?
The following words and terms in this chapter have the following meanings,
unless the context clearly indicates otherwise:
(1)
Administrative law judge (ALJ)--A State Office of Administrative
Hearings (SOAH) attorney who conducts formal hearings for the Texas Department
of Human Services (DHS).
(2)
Agency--An entity that is licensed by DHS under the Health
and Safety Code, Chapter 142, Home and Community Support Services, or persons
exempt from licensing under the Health and Safety Code, §142.003(a)(19),
which include Home and Community-Based Services Program providers at the Texas
Department of Mental Health and Mental Retardation.
(3)
Commissioner--The commissioner of DHS.
(4)
Employee--
(A)
a person who works for an agency or facility;
(B)
a person who provides personal services to a client, resident,
or consumer of the agency or facility;
(C)
a person who performs services at an agency or facility
and is not licensed or certified to perform those services; and
(D)
a person who is not a certified nurse aide working at a
nursing facility.
(5)
EMR--Employee Misconduct Registry.
(6)
Facility--A facility licensed by DHS or an adult foster
care provider that contracts with DHS.
(7)
Formal hearing--A hearing held by SOAH to determine whether
an employee has committed reportable conduct in a DHS-regulated long term
care facility.
(8)
Informal review (IR)--An opportunity for an employee to
dispute the finding(s) of reportable conduct by providing testimony and supporting
documentation to an impartial DHS staff person.
(9)
Reportable conduct--
(A)
abuse or neglect that causes or may cause death or harm
to a client, resident, or consumer of a facility or agency;
(B)
sexual abuse of a client, resident, or consumer of a facility
or agency;
(C)
financial exploitation of a client, resident, or consumer
of a facility or agency in the amount of $25 or more; or
(D)
emotional, verbal, or psychological abuse that causes harm
to a client, resident, or consumer of a facility or agency.
(10)
State Office of Administrative Hearings (SOAH)--A state
agency responsible for conducting formal hearings for other state agencies,
including DHS.
(11)
Texas Department of Human Services (DHS)--The licensing
authority of long term care facilities and agencies in Texas.
§93.3.What is the EMR?
The EMR is a tool to track findings of reportable conduct by unlicensed
employees of DHS-regulated long term care facilities; agencies licensed under
the Health and Safety Code, Chapter 142; and persons exempt from licensing
under the Health and Safety Code, §142.003(a)(19).
§93.4.To whom does the EMR apply?
The EMR applies to employees of DHS-regulated long term care facilities;
agencies licensed under the Health and Safety Code, Chapter 142; and persons
exempt from licensing under the Health and Safety Code, §142.003(a)(19),
including:
(1)
nursing facilities;
(2)
intermediate care facilities for persons with mental retardation
or related conditions;
(3)
assisted living facilities;
(4)
adult foster care facilities;
(5)
adult day care facilities;
(6)
home and community support services agencies, which include
hospice and home health agencies; and
(7)
persons exempt from licensing under the Health and Safety
Code, §142.003(a)(19), which include Home and Community-Based Services
Program providers at the Texas Department of Mental Health and Mental Retardation.
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 December 22, 2003.
TRD-200308842
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§93.11 - 93.13
The new sections are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The new sections implement the Health and Safety Code, §§253.001
- 253.010.
§93.11.What are facilities and agencies required to do before hiring a new employee?
Facilities and agencies must check the EMR and the Nurse Aide Registry
(maintained under the Omnibus Budget Reconciliation Act of 1987) to see if
the person is listed as unemployable.
§93.12.Can facilities and agencies employ a person who is listed on the EMR or the Nurse Aide Registry as unemployable?
No.
§93.13.What information are facilities and agencies required to provide to employees?
Facilities and agencies must provide information about the EMR to all
employees. The information must:
(1)
be in writing; and
(2)
state that persons listed on the EMR are not employable.
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 December 22, 2003.
TRD-200308843
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§93.21 - 93.23
The new sections are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The new sections implement the Health and Safety Code, §§253.001
- 253.010.
§93.21.How does the process begin for a facility employee referred to the EMR?
DHS requires facilities to make an incident report for any allegation
of reportable conduct of an employee against a resident of the facility.
§93.22.Who is responsible for the investigation and provision of due process to facility employees referred to the EMR?
DHS is responsible for the investigation and provision of due process
to facility employees, as provided in Subchapter E of this chapter (relating
to Determination of Reportable Conduct, Informal Review, and Formal Hearing
for Facility Referrals).
§93.23.What happens when DHS receives a report that a facility employee has committed reportable conduct?
The following actions occur:
(1)
The local DHS regional office investigates the report to
determine whether the employee committed reportable conduct. The standards
that apply to these investigations are the standards that apply to the type
of facility where the investigation takes place.
(2)
If DHS determines reportable conduct, the DHS surveyor
makes the appropriate referral(s) to the EMR.
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 December 22, 2003.
TRD-200308844
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§93.31 - 93.34
The new sections are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The new sections implement the Health and Safety Code, §§253.001
- 253.010.
§93.31.How does the process begin for an agency employee referred to the EMR?
The Texas Department of Protective and Regulatory Services and DHS
require agencies to make an incident report for any allegation of reportable
conduct of an employee against a client of the agency.
§93.32.Who is responsible for the investigation and due process of agency employees referred to the EMR?
The Texas Department of Protective and Regulatory Services is responsible
for the investigation and due process of agency employees.
§93.33.What happens when the Texas Department of Protective and Regulatory Services receives a report that an agency employee has committed reportable conduct?
The Texas Department of Protective and Regulatory Services:
(1)
investigates the report to determine whether the employee
committed reportable conduct;
(2)
notifies the employee and completes all due process procedures;
and
(3)
forwards substantiated findings of reportable conduct to
DHS state office after completion of all due process procedures.
§93.34.What happens when DHS receives a notice of substantiated findings of reportable conduct from the Texas Department of Protective and Regulatory Services?
DHS records the reportable conduct in the EMR, as required by the Health
and Safety Code, §253.007.
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 December 22, 2003.
TRD-200308845
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§93.41 - 93.48
The new sections are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The new sections implement the Health and Safety Code, §§253.001
- 253.010.
§93.41.What happens once reportable conduct is determined and the facility employee is referred to the EMR?
DHS staff send the employee a written notice that includes:
(1)
a brief summary of the findings and facts on which the
findings are based;
(2)
the employee's right to an informal review (IR) to dispute
the findings; and
(3)
notice that the request for an IR must be made no later
than 10 days after the day the employee receives the written notice. This
written notice to the employee provides the address and contact information
for the local DHS regional office.
§93.42.How does a facility employee dispute DHS's finding of reportable conduct?
An employee may dispute these findings by responding to the notice
letter within the required time frame to request an informal review.
§93.43.What happens when a facility employee requests an informal review?
(a)
If the employee requests an informal review (IR), DHS sets
a date to allow the employee to dispute the findings by providing testimony,
in person or by telephone, to an impartial Long Term Care Regulatory staff
person at the local DHS regional office.
(b)
If the IR is conducted and the findings are not upheld,
DHS dismisses the referral.
(c)
If the IR is conducted and the findings are upheld, DHS
sends a second written notice of findings to the employee and the referral
process continues.
§93.44.What happens if the facility employee does not respond to the notice letter and does not request an informal review?
DHS sends a second written notice of findings to the employee and the
referral process continues.
§93.45.Is the facility employee offered any further opportunities to dispute the finding(s) of reportable conduct?
After the informal review process is completed, DHS staff review the
referral and supporting documentation and send the employee a third written
notice that includes:
(1)
a brief summary of the findings;
(2)
the employee's right to a formal hearing on the reportable
conduct; and
(3)
notice that the request for hearing must be made in writing
no later than 30 days after the day the employee receives the written notice.
This written notice to the employee provides the address and contact information
for the DHS Hearings Division.
§93.46.What happens if the facility employee does not respond to the notice letter and does not request a formal hearing?
The reportable conduct is recorded in the EMR.
§93.47.What happens when a facility employee requests a formal hearing?
DHS handles the request in accordance with its formal hearing procedures
in Chapter 79 of this title (relating to Legal Services). The employee is
granted a formal hearing on the incident of reportable conduct before an administrative
law judge at the State Office of Administrative Hearings.
§93.48.What happens if the administrative law judge finds that the facility employee committed reportable conduct?
An order is issued approving the findings and directing DHS to record
the act of reportable conduct in the EMR. DHS gives final notice of the order
to the employee.
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 December 22, 2003.
TRD-200308846
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §§93.61 - 93.63
The new sections are proposed under the Health and Safety
Code, Chapter 253, which authorizes DHS to administer the employee misconduct
registry.
The new sections implement the Health and Safety Code, §§253.001
- 253.010.
§93.61.What must occur before DHS may record an employee's name in the EMR?
Before DHS records an employee's name in the EMR, all due process procedures
must be completed and the finding(s) of reportable conduct must be substantiated.
§93.62.What information is recorded in the EMR?
DHS records the following information in the EMR:
(1)
the employee's name;
(2)
the employee's address;
(3)
the employee's social security number;
(4)
the name of the facility, agency, or person exempt from
licensure under the Health and Safety Code, §142.003(a)(19);
(5)
the address of the facility, agency, or person exempt from
licensure under the Health and Safety Code, §142.003(a)(19);
(6)
the date of the act of reportable conduct; and
(7)
a description of the act of reportable conduct.
§93.63.Is it possible to remove an employee's name from the EMR once it is listed?
Yes, if the employee requests that the referral be reconsidered, and
DHS determines that the employee does not meet the requirements to be listed
on the EMR.
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 December 22, 2003.
TRD-200308847
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
The Texas Department of Human Services (DHS) proposes to amend §97.249,
concerning reportable conduct; §97.282, concerning client conduct and
responsibility and client rights; and §97.403, concerning standards specific
to agencies licensed to provide hospice services, in its Licensing Standards
for Home and Community Support Services Agencies chapter.
The purpose of the amendments to §97.249 and §97.282 is to provide
the new telephone number for reporting general complaints and complaints of
abuse, exploitation, or neglect involving an employee of a home and community
support services agency to DHS. In addition, §97.249(3) is amended to
remove "upon discovery" from the sentence instructing an agency when it must
report information concerning employee abuse.
The purpose of the amendment to §97.403 is to require a hospice employee
providing medical social services to be a licensed social worker in the state
of Texas, and to update code references in the construction standards for
freestanding hospices.
Gordon Taylor, Chief Financial Officer, has determined that, for the first
five-year period the proposed sections are in effect, there are no fiscal
implications for state or local government as a result of enforcing or administering
the sections.
Bettye M. Mitchell, Deputy Commissioner for Long Term Care, has determined
that, for each year of the first five years the sections are in effect, the
public benefits anticipated as a result of enforcing the amendments to §97.249
and §97.282 is that the public will have the correct toll-free number
for reporting complaints. The public benefits anticipated as a result of enforcing
the amendment to §97.403 are as follows: (1) There will be more social
workers who meet the qualifications for providing medical social services
in a hospice, which will give hospices more staffing sources for this required
service; and (2) the higher standards for construction in inpatient hospice
agencies will result in improved public safety, helping to ensure the best
possible service for clients. There is no adverse economic effect on small
or micro businesses as a result of enforcing or administering the amendments
to §97.249 and §97.282, because the amendments do not add any new
requirements for businesses. There is little, if any, adverse economic effect
on small, micro, or other businesses as a result of enforcing or administering
the amendment to §97.403. The freestanding hospices in Texas that provide
inpatient care directly currently meet the existing health care occupancy
chapter of the 2000 Life Safety Code with rare, if any, exceptions. There
is no anticipated economic cost to persons who are required to comply with
the proposed sections. There is no anticipated effect on local employment
in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Linda Kotek
at (512) 438-3158 in DHS's Long Term Care-Policy section. Written comments
on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-046,
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 Government Code, DHS has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
DHS is not required to complete a takings impact assessment regarding these
rules.
These rules are promulgated by DHS. This state agency is currently scheduled
to be merged into a successor agency, the Texas Health and Human Services
Commission (HHSC) and one of its subordinate departments, the Texas Department
of Aging and Disability Services, sometime in 2004. This change is mandated
by legislation passed by the 78th Legislature.
At the time of that transition, HHSC will have complete authority for these
and all related rules. This may result in these rules being changed from one
chapter of the Texas Administrative Code to another or variations in the rules
adoption process.
Subchapter C. MINIMUM STANDARDS FOR ALL HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
3.
AGENCY ADMINISTRATION
40 TAC §97.249
The amendment is proposed under the Health and Safety Code,
Chapter 142, which provides DHS with the authority to adopt rules for the
licensing and regulation of home and community support services agencies.
The amendment implements the Health and Safety Code, §§142.001
- 142.030.
§97.249.Reportable Conduct.
An agency must adopt and enforce a written policy relating to reporting
acts of abuse, neglect, or exploitation of clients and reportable conduct
by an employee(s) of the agency.
(1) - (2)
(No change.)
(3)
An agency that has cause to believe that an employee has
abused, exploited, or neglected a client of the agency must report the information
[
(A)
the Texas Department of Human Services at
1-800-458-9858
[
(B)
(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 December 22, 2003.
TRD-200308848
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §97.282
The amendment is proposed under the Health and Safety Code,
Chapter 142, which provides DHS with the authority to adopt rules for the
licensing and regulation of home and community support services agencies.
The amendment implements the Health and Safety Code, §§142.001
- 142.030.
§97.282.Client Conduct and Responsibility and Client Rights.
An agency must adopt and enforce a written policy governing client
conduct and responsibility and client rights in accordance with this section.
(1) - (10)
(No change.)
(11)
The client has the right to voice grievances regarding
treatment or care that is or fails to be furnished, or regarding the lack
of respect for property by anyone who is furnishing services on behalf of
the agency and must not be subjected to discrimination or reprisal for doing
so.
(A)
(No change.)
(B)
At the time of admission, an agency must provide each person
who receives home health, hospice, or personal assistance services with a
written statement that informs the client that a complaint against the agency
may be directed to the director, Texas Department of Human Services (DHS),
P.O. Box 149030, Austin, Texas 78714-9030, toll free
1-800-458-9858
[
(12)
(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 December 22, 2003.
TRD-200308849
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
40 TAC §97.403
The amendment is proposed under the Health and Safety Code,
Chapter 142, which provides DHS with the authority to adopt rules for the
licensing and regulation of home and community support services agencies.
The amendment implements the Health and Safety Code, §§142.001
- 142.030.
§97.403.Standards Specific to Agencies Licensed to Provide Hospice Services.
(a) - (n)
(No change.)
(o)
Medical social services must be provided by a social worker
who is licensed in the state of Texas to provide social work services
[
(p) - (v)
(No change.)
(w)
A freestanding hospice that provides inpatient care directly
must comply with the following standards in addition to the standards in subsections
(a) - (v) of this section.
(1)
The hospice
[
[
(A)
Each client must receive treatments, medications,
and diet as prescribed, and must be kept comfortable, clean, well groomed,
and protected from accident, injury, and infection.
(B)
Each shift must include a registered nurse that provides
and supervises direct client care.
(2) - (3)
(No change.)
(4)
Except as provided in this subsection, the hospice must
meet National Fire Protection Association 101,
Life Safety Code, 2000
[
(A)
(No change.)
(B)
Any existing facility of two or more stories that is not
of fire-resistive construction and is participating on the basis of a waiver
of construction type or height, may not house blind, nonambulatory, or physically
disabled clients above the street-level floor unless the facility is one of
the following construction types (as defined in the NFPA 101):
(i) - (iv)
(No change.)
(v)
a facility that
achieves a passing score on
the Fire Safety Evaluation System (FSES) for Health Care Occupancies, [
(5) - (12)
(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 December 22, 2003.
TRD-200308850
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734
Chapter 801.
LOCAL WORKFORCE DEVELOPMENT BOARDS
Subchapter C. BOARD CONTRACTING GUIDELINES
Chapter 18.
NURSING FACILITY ADMINISTRATORS
Subchapter B. REQUIREMENTS FOR LICENSURE
Subchapter C. LICENSES
Subchapter D. REFERRALS, COMPLAINT PROCEDURES, AND SANCTIONS
Chapter 19.
NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
1985
] edition of the Life Safety Code of the National
Fire Protection Association (NFPA). The Life Safety Code is available for
inspection at the Office of the Federal Register Information Center, Washington,
D.C. Copies may be obtained from the NFPA,
1
Batterymarch Park,
Quincy, Massachusetts
02169
[
02200
]. The New Health
Care Occupancies chapter of the Life Safety Code is applicable to new construction,
conversions of existing unlicensed buildings, remodeling, and additions. The
Existing Health Care Occupancies chapter of the Life Safety Code is applicable
to existing nursing homes. Life safety features and equipment that have been
installed in existing buildings which are now in excess of that required by
the Life Safety Code must continue to be maintained or may be completely removed
if prior approval is obtained from the Texas Department of Human Services
(DHS).
(11)
] Each room must open onto
an exit corridor and must be arranged for convenient resident access to dining,
living, and bathing areas.
(12)
] Visual privacy (such as cubicle
curtains) must be available for each resident in multi-bed rooms. Design for
privacy must not restrict resident access to entry, lavatory, or toilet, nor
may it restrict bed evacuation or obstruct sprinkler flow coverage.
(13)
] At least one noncombustible
wastebasket must be provided in each bedroom.
(14)
] See the requirements in §19.341(d)(4)
of this title (relating to Electrical Requirements) for nurse call systems.
56F
].
7
], Building Service and Fire Protection Equipment.
Subchapter G. RESIDENT BEHAVIOR AND FACILITY PRACTICE
§1.01
],
because of conduct alleged in the report of abuse or neglect or other complaint.
Subchapter L. DIETARY SERVICES
See also §19.1929(2)(C)
of this title (relating to Staff Development).
]
Subchapter T. ADMINISTRATION
(2)
] Nursing staff, licensed nurses,
and nurse aides must receive annual in-service training which includes components,
appropriate to their job responsibilities, from one or more of the following
categories:
(3)
] Facilities with pediatric residents
must comply with the following:
(4)
] Minimum continuing in-service
education requirements are listed in subparagraphs (A) - (B) of this paragraph.
Attendance at relevant outside training may be used to satisfy the in-service
education requirement. The facility must keep in-service records for each
employee listed. The minimum requirements are:
(5)
] A rural hospital participating
in the Medicaid Swing Bed Program as specified in §19.2326 of this title
(relating to Medicaid Swing Bed Program for Rural Hospitals) is not required
to meet the requirements of this section, if the swing beds are used for no
more than one 30-day length of stay per year, per resident.
Chapter 20.
COST DETERMINATION PROCESS
will be
]
multiplied by 1.09 to determine the adjusted attendant compensation per unit
of service. For the rate
years
[
year
] beginning September
1, 2001, and
September 1, 2002
[
thereafter
], the attendant
compensation spending per unit of service
is
[
will be
]
multiplied by 1.07 to determine the adjusted attendant compensation per unit
of service.
For the rate year beginning September 1, 2003, and thereafter,
the attendant compensation spending per unit of service is multiplied by 1.10
to determine the adjusted attendant compensation per unit of service.
Chapter 90.
INTERMEDIATE CARE FACILITIES FOR PERSONS WITH MENTAL RETARDATION OR RELATED CONDITIONS
12
] titled "New Health Care Occupancies"
or Chapter 19 titled "Existing
Health Care Occupancies"
for large facilities, or the "impractical"
requirements for small facilities as found in NFPA 101, Chapter
32
[
21
] titled "
New
Residential Board and Care Occupancies[
.
]"
or Chapter 33 titled "Existing Residential Board and Care Occupancies."
Examples of residents who may not be capable of self-evacuation are
as follows:
Chapter 21
],
is by rating each resident and each staff member to determine an evacuation
difficulty score (E-score). If the E-score is 1.5 or less, the evacuation
capability of the facility is prompt, greater than 1.5 to five is slow, greater
than five is impractical. The worksheets to be completed are located in
NFPA 101A, Guide on Alternative Approaches to Life Safety, 2001 edition, Chapter
6
[
NFPA 101, 1985 Edition, Appendix F
]. Intermediate Care
Facilities for Persons with Mental Retardation
(ICF-MR)
[
(ICFs-MR)
] with 16 beds or less must meet the evacuation requirement
for their designated
Chapter 32 or 33
[
Chapter 21
] rating.
The ratings and their requirements follow:
which
] began on or after
March 11, 2003
[
October 3,
1988
]. The provisions of NFPA 101, Chapter
18
[
12
]
are applicable for large facilities, and Chapter
32
[
21
]
for small facilities.
which
] was operating with a license as a facility for persons with mental
retardation and related conditions before
September 11, 2003
[
October 3, 1988
], and has not subsequently become unlicensed. The provisions
of NFPA 101, Chapter
19
[
13 titled "Existing Health Care Occupancies,"
] are applicable for large facilities, and Chapter
33
[
21
] for small facilities.
1985
] edition, and any
other codes and standards of NFPA listed in this section, except as may be
otherwise approved or required by DHS.
72A
Standard for the Installation, Maintenance and Use of Local Protective Signaling
Systems
], NFPA 13 Standard for the Installation of Sprinkler Systems,
NFPA 13R Standard for the Installation of Sprinkler Systems in Residential
Occupancies up to and Including Four Stories in Height,
or NFPA
13D
[
13-D
] Standard for the Installation of Sprinkler Systems
in One- and Two-Family Dwellings and
Manufactured
[
Mobile
] Homes, as specified in NFPA 101, Chapter
32
[
21
]
titled "
New
Residential Board and Care Occupancies"
and Chapter
33 titled "Existing Residential Board and Care Occupancies,"
and as
modified in this section.
7, Section
7-6
], titled "Building Service and Fire Protection Equipment
,
[
.
]"
Section 9-6, titled "Fire Detection, Alarm, and Communications
Systems."
,
] must be protected by a sprinkler system in compliance
with NFPA 13
, NFPA 13R,
[
;
] or NFPA 13D with additional
requirements for coverage in all dwelling areas and all closets as specified
by NFPA 101,
Chapters 32 and 33
[
Chapter 21
].
§229.166(a)(4)
] (
relating to Equipment, Utensils,
and Linens);
[
Cleaning, Sanitization, and Storage of Equipment
and Utensils),
] or
§229.166(a)(3)(E)
] prior
to placement in the dishwasher.
Mobile
] Homes [
standards
].
12
] titled "New Health Care Occupancies" or Chapter
19
[
13
] titled "Existing
Health
Care Occupancies," or meeting
the impractical evacuation category of Chapter
32
[
21
]
titled "
New
Residential Board and Care
Occupancies
,"
and Chapter 33 titled "Existing Residential Board and Care Occupancies"
are
not required to conduct fire drills within ten days of employment.
Chapter 93.
EMPLOYEE MISCONDUCT REGISTRY
Chapter 93.
EMPLOYEE MISCONDUCT REGISTRY (EMR)
Subchapter B. EMR USE REQUIREMENTS
Subchapter C. PROCESS FOR FACILITY REFERRALS
Subchapter D. PROCESS FOR AGENCY REFERRALS
Subchapter E. DETERMINATION OF REPORTABLE CONDUCT, INFORMAL REVIEW, AND FORMAL HEARING FOR FACILITY REFERRALS
Subchapter F. RECORDABLE INFORMATION IN THE EMR
Chapter 97.
LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
upon discovery
] to:
1-800-228-1570
]; and
4.
PROVISION AND COORDINATION OF TREATMENT AND SERVICES
1-800-228-1570
]. The statement also may inform each client that a complaint
against the agency may be directed to the administrator of the agency. Information
about complaints directed to the administrator also must include the timeframe
for the agency's review and resolution.
Subchapter D. ADDITIONAL STANDARDS SPECIFIC TO LICENSE CATEGORY AND SPECIFIC TO SPECIAL SERVICES
with a bachelor's degree in social work from an accredited college or university
] and must be under the direction of a physician.
A freestanding hospice that
provides inpatient care directly
] must have on-site 24-hour nursing
service provided by registered nurses and licensed vocational nurses[
.
]
(A)
]
[
The facility must provide 24-hour nursing
services that are
] sufficient
in number
to meet total nursing
needs and [
which are
] in accordance with the client's plan of care.
Code for Safety to Life from Fire in Buildings and Structures,
1994
] Edition (NFPA 101), Chapter
18
[
12
] (concerning
new health care occupancies) and Chapter
19
[
13
] (concerning
existing health care occupancies), published by the National Fire Protection
Association (NFPA). All documents published by the NFPA as referenced in this
subsection may be obtained by writing the National Fire Protection Association,
[
Post Office Box 9101,
]
1
Batterymarch Park, Quincy,
Massachusetts 02169, or calling 1-800-344-3555.
National Fire Codes, Volume 10,
] NFPA 101A, Guide on Alternative Approaches
to Life Safety, Chapter
4, Fire Safety Evaluation System for Health Care
Occupancies, 2001
[
3, 1995
] Edition published by the NFPA.
Part 20.
TEXAS WORKFORCE COMMISSION