ADOPTED RULES
An agency may take final action on a section 30 days after a proposal has been 
published in the Texas Register. The section becomes effective 20 days after the 
agency files the correct document with the Texas Register, unless a later date 
is specified or unless a federal statute or regulation requires implementation 
of the action on shorter notice.
If an agency adopts the section without any changes to the proposed text, only 
the preamble of the notice and statement of legal authority will be published. 
If an agency adopts the section with changes to the proposed text, the proposal 
will be republished with the changes.

TITLE 22. EXAMINING BOARDS
PART XIII. Texas Board of Nursing Facility Administrators 
CHAPTER 241. Nursing Facility Administrators
22 TAC sec.sec.241.10, 241.11, 241.13, 241.18
The Texas Board of Nursing Facility Administrators (board) adopts amendments to 
sec.sec.241.10, 241.11, and 241.13; and new sec.241.18, concerning the 
regulation of nursing facility administrators. Section 241.10 and sec.241.13 are 
adopted without changes, and therefore will not be republished. Section 241.11 
and sec.241.18 are adopted with changes to the proposed text as published in the 
August 13, 1996, issue of the Texas Register (21 TexReg 7631). The proposed 
amendment to sec.241.2, which was simultaneously proposed, is withdrawn from 
consideration for permanent adoption. 
The sections provide for protection of health, safety, and welfare of the 
citizens of Texas from the unskilled or unprincipled practitioners in the field 
of nursing facility administration, by providing policies and procedures of the 
board; continuing education requirements; adverse licensing actions; complaint 
procedures; and informal disposition of complaints. 
The amendments update language to bring the sections into compliance with the 
statutory amendments passed during the 74th Texas Legislature. The amendment to 
sec.241.10 changes the time period for completion of continuing education for 
license renewal to biennially. The amendment to sec.241.11 establishes 
procedures for suspension of license for failure to pay child support. The 
amendment to sec.241.13 requires licensees to respond in writing to notification 
from the board of a complaint. New sec.241.18 establishes procedures for 
informal disposition of complaints. 
A summary of the comments received and the board's responses are as follows.
COMMENT: Concerning sec.241.2, the board had previously considered reducing fees 
for license renewals. 
RESPONSE: The board chose to withdraw the amendment from consideration for 
permanent adoption and may revisit this issue in the future at a more 
appropriate time. 
COMMENT: Concerning sec.241.11(e)(2), a commenter stated that the wording "to 
others concerned with the license" is vague and does not limit the board's 
obligation to provide notice. The rule does not specify whom the "others" might 
include or how the board will determine who is concerned with the license. The 
board should not assume responsibility for determining who all the concerned 
parties are and affirmatively notifying them. Concerned parties have access to 
the information through open records. The commenter recommended rewording the 
last sentence of paragraph (2) to read "The board will provide notice to the 
licensee and the licensee's employer and will make information regarding 
suspending a license available as required by law." 
RESPONSE: The board disagrees and feels that the language as written 
sufficiently states statutory requirements. 
COMMENT: Concerning sec.241.11(e)(6), a commenter stated that the appropriate 
trigger for the license holder to cease acting as a nursing facility 
administrator is the demand from the board for surrender of the license. The 
phrase "of the board" is confusing because there is no discernable difference 
between a "license holder" and a "license holder of the board." The commenter's 
recommendation was to replace the term "the issuance of a court or attorney 
general's order suspending the license " with " the demand by the Board for 
surrender of the license," and striking the term "of the board" at the end of 
the sentence.
RESPONSE: The board disagrees and feels the language as stated complies with 
statutory requirements. 
COMMENT: Concerning sec.241.11(e)(8), staff corrected the cross-reference to 
sec.241.2 by adding the term "of this title" after reference to the section 
number. 
COMMENT: Concerning sec.241.18(d), a commenter stated that 10 days notice may 
not give the license holder adequate time to review and prepare for the 
settlement conference. In addition, many documents arrive at nursing facilities 
by certified mail and are routinely signed for by staff other than the 
administrator. Additional time would allow the staff time to contact the 
administrator if out of town when the certified letter arrives. The commenter 
recommended that 20 days be substituted for 10, with the 20 days beginning on 
the date of receipt or personal delivery. The commenter recommended adding the 
following language: "If the license holder fails to respond timely to 
notification from the board or fails to appear at the settlement conference and 
shows good cause for the failure to respond or appear, the settlement conference 
may be rescheduled."  
RESPONSE: The board considered these comments and amended the wording as 
suggested. 
COMMENT: Concerning sec.241.18(g), a commenter recommended changing the word 
"complainant" to "complaints". 
RESPONSE: The board agrees and has amended this section to reflect the wording 
change. 
COMMENT: Concerning to sec.241.18(l), a commenter recommended a wording change 
to substitute "shall" for "may." 
RESPONSE: The board disagrees and feels that access to the investigative file is 
subject to the provisions of the Public Information Act and the Administrative 
Procedure Act which may allow limited access in certain circumstances. 
COMMENT: Concerning sec.241.18(p), a commenter stated that when the 
investigation is closed on the basis of lack of jurisdiction or non-violation of 
the act established, the complaint should have no current or future negative 
impact on the license holder and no record of the complaint should be maintained 
by the board in a record associated with the license holder. The commenter 
recommended the board add a sentence to sec.241.18(p) which reads, "An 
investigation closed because the board lacks jurisdiction or because the board 
members conclude that a violation of the Act or Chapter 241 has not been 
established shall be deleted from the record of the license holder."
RESPONSE: The board disagrees because the Act requires the board to retain an 
information file on all complaints. 
COMMENT: Concerning sec.241.18(q), a commenter requested clarification about 
what appeared to be a duplicate sentence. 
RESPONSE: The board has clarified the language by deleting the duplicate 
sentence. 
COMMENT: Concerning sec.241.18(t), a commenter suggested that notification of 
the date, time, and place of the board meeting should be by certified mail.  
RESPONSE: The board considered this comment and amended the wording as suggested 
and included wording relating to 20 days as amended in sec.241.18(d).
COMMENT: Concerning sec.241.18(u), a commenter recommended the following 
wording: "The board may change the terms of a proposal order only if the 
licensee or applicant is present at the board meeting and agrees to the terms 
proposed by the board." 
RESPONSE: The board disagrees and feels that the language is sufficiently clear 
as written. 
COMMENT: Concerning sec.241.18(x)(2), a commenter pointed out a typo of the word 
"advised". 
RESPONSE: The board has corrected this typographical error. 
The Texas Health Care Association (THCA) provided comments on the proposed 
rules. The THCA was generally in favor of the rules as proposed; however they 
made suggestions and recommendations as summarized in the summary of comments.  
The amendments and new section are adopted under the Texas Nursing Facility 
Administrators Act, Texas Civil Statutes, Article 4512q (Act), Family Code, 
Chapter 232 as added by Acts 1995, 74th Legislature, Chapter 751, sec.85 (HB 
433), which requires the board to establish procedures for suspension and 
reinstatement of a license for non-payment of child support; and the 
Administrative Procedure Act, Government Code, sec.2001.056 which requires the 
board to establish procedures for informal hearings.  

sec.241.11. Adverse Licensure Actions.
(a)-(d) (No changes.) 
(e) Suspension of license for failure to pay child support.
(1) On receipt of a final court or attorney's general's order suspending a 
license due to failure to pay child support, the executive secretary shall 
immediately determine if the board has issued a license to the obligator named 
on the order, and, if a license has been issued: 
(A) record the suspension of the license in the board's records;
(B) report the suspension as appropriate; and 
(C) demand surrender of the suspended license. 
(2) The board shall implement the terms of a final court or attorney general's 
order suspending a license without additional review or hearing. The board will 
provide notice as appropriate to the licensee or to others concerned with the 
license. 
(3) The board may not modify, remand, reverse, vacate, or stay a court or 
attorney general's order suspending a license issued under the Family Code, 
Chapter 232 as added by Acts 1995, 74th Legislature, Chapter 751, sec.85 and may 
not review, vacate, or reconsider the terms of an order.
(4) A licensee who is the subject of a final court or attorney general's order 
suspending his or her license is not entitled to a refund for any fee paid to 
the board. 
(5) If a suspension overlaps a license renewal period, an individual with a 
license suspended under this section shall comply with the normal renewal 
procedures in the Act and this chapter; however, the license will not be renewed 
until paragraphs (7) and (8) of this subsection are met.
(6) An individual who continues to act as a licensed nursing facility 
administrator after the issuance of a court or attorney general's order 
suspending the license is liable for the same civil and criminal penalties 
provided for engaging in the prohibited activity without a license or while a 
license is suspended as any license holder of the board. 
(7) On receipt of a court or attorney general's order vacating or staying an 
order suspending a license, the executive secretary or executive secretary's 
designee shall promptly issue the affected license to the individual if the 
individual is otherwise qualified for the license.
(8) The individual must pay a reinstatement fee set out in sec.241.2 of this 
title (relating to Fees) prior to issuance of the license under paragraph (7) of 
this subsection. 
(9) A party may appear in person or be represented by counsel or other 
authorized representative.  

sec.241.18. Informal Disposition. 
(a) Informal disposition of any complaint or contested case involving a licensee 
or an applicant for licensure may be made through an informal settlement 
conference held to determine whether an agreed settlement order may be approved. 
(b) If the executive secretary or the Complaints Committee of the Texas Board of 
Nursing Facility Administrators (board) determines that the public interest 
might be served by attempting to resolve a complaint or contested case with an 
agreed order in lieu of a formal hearing, the provisions of this chapter shall 
apply. A licensee or applicant may request an informal settlement conference; 
however, the decision to hold a conference shall be made by the executive 
secretary or the Complaints Committee. 
(c) An informal settlement conference shall be voluntary and shall not be a 
prerequisite to a formal hearing. 
(d) The executive secretary shall decide upon the time, date, and place of the 
settlement conference, and provide written notice to the licensee or applicant 
of the same. Notice shall be provided no less than 20 calendar days from the 
postmark date prior to the date of the conference by certified mail, return 
receipt requested, to the last known address of the licensee or applicant or by 
personal delivery. The 20 days shall begin on the date of mailing or personal 
delivery. The licensee or applicant may waive the 20-day notice requirement. 
(e) A copy of the board's rules concerning informal disposition shall be 
enclosed with the notice of the settlement conference. The notice shall inform 
the licensee or applicant of the following: 
(1) the nature of the alleged violation; 
(2) that the licensee or applicant may be represented by legal counsel; 
(3) that the licensee or applicant may offer the testimony of witnesses and 
present other evidence as may be appropriate; 
(4) that board members may be present; 
(5) that the board's legal counsel or a representative of the Office of the 
Attorney General will be present; 
(6) that the licensee's or applicant's attendance and participation is 
voluntary; 
(7) that the complainant and any client involved in the alleged violations may 
be present; and 
(8) that the settlement conference will be canceled if the licensee or applicant 
notifies the executive secretary that he or she or his or her legal counsel will 
not attend. 
(f) The notice of the settlement conference shall be sent by certified mail, 
return receipt requested, to the complainant at his or her last known address or 
personally delivered to the complainant. The complainant shall be informed that 
he or she may appear and testify or may submit a written statement for 
consideration at the settlement conference. The complainant shall be notified if 
the conference is canceled. 
(g) Members of the complaints committee may be present at a settlement 
conference. 
(h) The settlement conference shall be informal and shall not follow the 
procedures established in this section for contested cases and formal hearings. 
(i) The licensee or applicant, the licensee's or applicant's attorney, the board 
members, the board's legal counsel, the executive secretary, and the board may 
question witnesses, make relevant statements, present statements of persons not 
in attendance and present such other evidence as may be appropriate.
(j) The board's legal counsel or an attorney from the Office of the Attorney 
General shall attend each settlement conference. The board members or executive 
secretary may call upon the attorney at any time for assistance in the 
settlement conference. 
(k) The licensee shall be afforded the opportunity to make statements that are 
material and relevant. 
(l) Access to the board's investigative file may be prohibited or limited in 
accordance with the Public Information Act (Open Records Act) Government Code, 
Chapter 552; and the Administrative Procedure Act (APA), Government Code, 
Chapter 2001. 
(m) At the discretion of the executive secretary or the board members, a tape 
recording may be made of some or all of the settlement conference.
(n) The board members or the executive secretary shall exclude from the 
settlement conference all persons except witnesses during their testimony, the 
licensee or applicant, the licensee's or applicant's attorney, and the board 
staff. 
(o) The complainant shall not be considered a party in the settlement conference 
but shall be given the opportunity to be heard if the complainant attends. Any 
written statement submitted by the complainant shall be reviewed at the 
conference. 
(p) At the conclusion of the settlement conference, the board members or 
executive secretary may make recommendations for informal disposition of the 
complaint or contested case. The recommendations may include any disciplinary 
action authorized by the Texas Nursing Facility Administrators Licensure Act 
(Act). The board members may also conclude that the board lacks jurisdiction, 
conclude that a violation of the Act or this chapter has not been established, 
order that the investigation be closed, or refer the matter for further 
investigation.
(q) The licensee or applicant may either accept or reject the settlement 
recommendations at the conference. If the recommendations are accepted, an 
agreed settlement order shall be prepared by the board office or the board's 
legal counsel and forwarded to the licensee or applicant. The order shall 
contain agreed findings of fact and conclusions of law. The licensee or 
applicant shall execute the order and return the signed order to the board 
office within ten days of his or her receipt of the order. If the licensee or 
applicant fails to return the signed order within the stated time period, the 
inaction shall constitute rejection of the settlement recommendations.
(r) If the licensee or applicant rejects the proposed settlement, the matter 
shall be referred to the executive secretary for appropriate action.
(s) If the licensee or applicant signs and accepts the recommendations, the 
agreed order shall be submitted to the entire board for its approval. Placement 
of the agreed order on the board agenda shall constitute only a recommendation 
for approval by the board. 
(t) The identity of the licensee or applicant shall not be made available to the 
board until after the board has reviewed and accepted the agreed order unless 
the licensee or applicant chooses to attend the board meeting. The licensee or 
applicant shall be notified of the date, time, and place of the board meeting at 
which the proposed agreed order will be considered by certified mail. Notice 
shall be provided no less than 20 calendar days from the postmark date prior to 
the board meeting. Attendance by the licensee or applicant shall be voluntary. 
(u) Upon an affirmative majority vote, the board shall enter an agreed order 
approving the accepted settlement recommendations. The board may not change the 
terms of a proposed order and shall only approve or disapprove an agreed order 
if the licensee or applicant is present at the board meeting and agrees to other 
terms proposed by the board. 
(v) If the board does not approve a proposed agreed order, the licensee or 
applicant and the complainant shall be so informed. The matter shall be referred 
to the executive secretary for other appropriate action.
(w) A proposed agreed order is not effective until the full board has approved 
the agreed order. The order shall then be effective in accordance with the APA. 
(x) A licensee's opportunity for an informal conference under this section shall 
satisfy the requirement of the APA, Government Code, sec.2001.054(c).
(1) If the executive secretary and Complaints Committee determines that an 
informal conference will not be held, the executive secretary shall give written 
notice to the licensee or applicant of the facts or conduct alleged to warrant 
the intended disciplinary action and the licensee or applicant shall be given 
the opportunity to show, in writing and as described in the notice, compliance 
with all requirements of the Act and this section. 
(2) The complainant shall be sent a copy of the written notice. The complainant 
shall be advised that he or she may also submit a written statement to the board 
office. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on February 13, 1997.
TRD-9702104
Michael O. Sims
Chair
Texas Board of Nursing Facility Administrators
Effective date: March 6, 1997
Proposal publication date: August 13, 1996
For further information, please call: (512) 458-7236