SECTION 260.351. Residential Services

(a) General.

(1) A program provider may provide residential services as:

(A) licensed assisted living, either 18-hour or 24-hour; or

(B) licensed home health assisted living, either 18-hour or 24-hour.

(2) A program provider must:

(A) provide personal assistance with ADLs and IADLs;

(B) provide assistance with housekeeping;

(C) provide therapeutic social and recreational activities;

(D) provide on-site response staff to meet scheduled or unpredictable needs;

(E) provide supervision of an individual's safety and security; and

(F) provide, make arrangements for, transportation other than medical transportation.

(3) An individual receiving either licensed assisted living or licensed home health assisted living must not receive:

(A) in-home respite;

(B) out-of-home respite;

(C) transportation provided as a residential habilitation activity;

(D) chore services;

(E) CFC PAS/HAB; or

(F) nursing services except those required for program eligibility.

(4) A program provider must ensure that an individual transitioning from institutional services to either licensed assisted living or licensed home health assisted living does not receive TAS.

(5) If an individual is absent from the individual's residence for six or more hours in a day, the program provider may bill for 18-hour licensed assisted living or 18-hour licensed home health assisted living and must not bill for 24-hour licensed assisted living or 24-hour licensed home health assisted living.

(6) If an individual's IPC includes day habilitation, the program provider may bill for 18-hour licensed assisted living or 18-hour licensed home health assisted living for a day on which the individual participates in day habilitation, but must not bill for 24-hour licensed assisted living or 24-hour licensed home health assisted living.

(7) A program provider must maintain documentation of the daily census using the HHSC Daily Census Documentation form or a form developed by the program provider that documents the information on the HHSC Daily Census Documentation form.

(8) A program provider must ensure that an individual's record includes the individual's progress or lack of progress in achieving the following outcomes for residential services:

(A) the ability to effectively communicate the individual's wants and needs to a residential services service provider;

(B) the ability to actively participate in activities of daily living to the extent of the individual's ability;

(C) the ability to implement the individual's choices;

(D) the ability to access and participate in community activities; and

(E) the ability to move safely and efficiently within home and community settings.

(b) Licensed assisted living.

(1) A program provider must provide licensed assisted living to no more than six persons in an ALF owned by the program provider.

(2) A program provider must not bill HHSC for the cost of a minor home modification for an individual who is receiving licensed assisted living.

(3) A program provider must not charge an individual or LAR a pet deposit for a service animal, including a guide dog, signal dog, or other animal individually trained to provide assistance to an individual who is receiving licensed assisted living.

(4) A program provider must maintain a ledger in accordance with generally accepted accounting principles with amounts paid for room and board by an individual who is receiving licensed assisted living.

(5) A program provider must provide a receipt for amounts paid for room and board by an individual who is receiving licensed assisted living.

(c) Licensed home health assisted living.

(1) A program provider must not allow more than three persons to reside in a residence in which the program provider provides licensed home health assisted living.

(2) A program provider must ensure that a residence in which licensed home health assisted living is provided:

(A) is accessible to and usable by the individuals receiving services in the residence;

(B) is maintained in good repair;

(C) has at least two means of egress from:

(i) the living areas; and

(ii) the individuals' bedrooms;

(D) has working smoke alarms installed to detect smoke in the kitchen, living areas, and the individuals' bedrooms;

(E) has a universal, fully-charged, and unexpired fire extinguisher easily accessible:

(i) from the kitchen;

(ii) from the laundry area;

(iii) from the vicinity of a hot water heater or furnace;

(iv) from each bedroom area; and

(v) on each floor of a multi-level residence;

(F) has a first aid kit that complies with American Red Cross recommendations with contents that are not out-of-date;

(G) has water temperature that does not exceed 110 degrees Fahrenheit from faucets used by an individual who cannot self-regulate the water temperature from a faucet the individual uses;

(H) has a locked container that can be used to store the medications for the individual as required by paragraph (3) of this subsection;

(I) has a place to store flammable or poisonous substances in a manner that makes them inaccessible to the individuals; and

(J) has a working carbon monoxide detector installed in each individual's bedroom.

(3) A program provider must ensure:

(A) an individual's prescribed medication is stored in a locked container and in the original container labeled with:

(i) individual's name;

(ii) date dispensed;

(iii) instructions;

(iv) name of medication with dosage; and

(v) physician's name;

(B) a medication requiring refrigeration is kept separate from food in a clearly labeled, designated locked container;

(C) a medication that is no longer needed by the individual or that is past its expiration date is disposed of according to federal and state laws and regulations;

(D) a medication prescribed for one individual is not given to another individual; and

(E) an individual takes prescribed medications according to the physician's instructions and over-the-counter medications according to the package directions.

(4) A program provider must conduct a home inspection and document the results of the inspection to determine compliance with the requirements in paragraph (2) of this subsection for a residence:

(A) before providing services and annually thereafter for a residence not used to provide licensed home health assisted living services before September 1, 2014; or

(B) before September 30, 2014 and annually thereafter for a residence used to provide licensed home health assisted living before September 1, 2014.

(5) A program provider must ensure correction of any noncompliance found during the home inspection and document the correction.

(6) A program provider must:

(A) develop and implement a written emergency response plan for the residence that describes the actions a program provider will take in the event of an emergency, such as a fire or other man-made or natural disaster, including evacuation or sheltering-in-place of the individual, as appropriate; and

(B) ensure that:

(i) the emergency response plan takes into account the abilities of the individual to follow the plan;

(ii) the individual receives instruction concerning the emergency response plan:

(I) within 48 hours after the individual moves into the residence and annually thereafter; and

(II) if the individual's ability to follow the emergency response plan changes;

(iii) the individual's service providers demonstrate competence in implementing the emergency response plan at the time job duties are assumed and annually thereafter;

(iv) the emergency response plan is reviewed and revised by the program provider when necessary and at least annually; and

(v) a copy of the current emergency response plan is:

(I) maintained in the residence; and

(II) accessible to service providers.

(7) A program provider must ensure:

(A) an individual successfully participates in a fire drill within 48 hours after the individual moves into the residence;

(B) all individuals in the residence successfully participate in a fire drill at least every 90 calendar days, with at least two drills per year conducted when at least one individual is sleeping; and

(C) an individual successfully participates in a fire drill within 48 hours after a change occurs in the individual's condition that may negatively affect the individual's ability to participate in a fire drill.

(8) A program provider must ensure:

(A) the residence has furnishings that are safe for the individual in all common areas;

(B) a bedroom in the residence:

(i) has at least:

(I) 80 square feet of floor space for a single occupancy room; and

(II) 60 square feet of floor space per individual in a double occupancy room;

(ii) was built as a bedroom when the residence was built, or was remodeled under a permit that meets local building codes;

(iii) is finished with walls or partitions of standard construction that go from floor to ceiling;

(iv) is adequately ventilated and lighted;

(v) has at least one window that will open freely and remain open from the inside without special tools;

(vi) has no more than two beds in any room;

(vii) has adequate drawer and closet space; and

(viii) provides comfortable sleeping arrangements for the individual;

(C) the residence has a common telephone or other communication system usable by the individual and for which:

(i) an individual has an opportunity to have input on residence procedures concerning:

(I) time limits on calls; and

(II) privacy during an individual's use of the phone; and

(ii) a program provider does not charge an individual for local calls; and

(D) bathrooms have adequate supplies of towels, washcloths, soap, and toilet tissue at all times.

(9) A program provider must ensure that an individual living in a residence where the individual receives licensed home health assisted living has a written "lease," as defined in Texas Property Code Chapter 92, with the owner of the residence or with an individual who leases from the owner of the residence. The lease must provide the same responsibilities and protections against eviction that tenants have under state law governing residential tenancies, including Texas Property Code Chapters 24, 91, and 92 and the Texas Rules of Civil Procedure Rule 510.

Source Note: The provisions of this §260.351 adopted to be effective February 26, 2023, 48 TexReg 896