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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 26. HEALTH AND HUMAN SERVICES |
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PART 1. HEALTH AND HUMAN SERVICES COMMISSION |
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CHAPTER 554. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION |
| SUBCHAPTER A. BASIS AND SCOPE |
| § 554.1. Basis and Scope |
| SUBCHAPTER B. DEFINITIONS |
| § 554.101. Definitions |
| SUBCHAPTER C. NURSING FACILITY LICENSURE APPLICATION PROCESS |
| § 554.201. Criteria for Licensing |
| § 554.202. Building Approval |
| § 554.204. Application Requirements |
| § 554.205. Probationary License |
| § 554.206. Increase in Capacity |
| § 554.208. Renewal Procedures and Qualifications |
| § 554.209. Exclusion from Licensure |
| § 554.210. Change of Ownership and Notice of Changes |
| § 554.211. Relocation |
| § 554.212. Time Periods for Processing License Applications |
| § 554.214. Criteria for Denying a License or Renewal of a License |
| § 554.215. Opportunity to Show Compliance |
| § 554.216. License Fees |
| § 554.218. Method of Payment |
| § 554.219. Plan Review Fees |
| § 554.220. Expedited Life Safety Code and Physical Plant Inspection Fees |
| SUBCHAPTER D. FACILITY CONSTRUCTION |
| DIVISION 1. GENERAL PROVISIONS |
| § 554.300. General Requirements |
| § 554.301. Definitions |
| DIVISION 2. FACILITIES LICENSED BEFORE SEPTEMBER 11, 2003 |
| § 554.302. Applicable Codes and Standards |
| § 554.303. Emergency Power |
| § 554.304. Space and Equipment |
| § 554.305. Resident Rooms |
| § 554.306. Toilet Facilities |
| § 554.307. Resident Call System |
| § 554.308. Dining and Resident Activities |
| § 554.309. Other Environmental Conditions |
| § 554.310. Site and Grounds |
| § 554.311. Fire Service and Access |
| § 554.313. Interior Finishes--Walls, Ceilings, and Floors |
| § 554.314. Fire Alarms, Detection Systems, and Sprinkler Systems |
| § 554.315. Portable Fire Extinguishers |
| § 554.316. Subdivision of Building Spaces--Smoke Barriers |
| § 554.317. Elevators and Escalators |
| § 554.318. Other Rooms and Areas |
| § 554.319. Provisions for Persons with Disabilities |
| § 554.320. Lighting and Illumination |
| § 554.321. Heating, Ventilating, and Air-conditioning Systems (HVAC) |
| § 554.322. Plumbing |
| DIVISION 3. PROVISIONS APPLICABLE TO ALL FACILITIES |
| § 554.323. Housekeeping Services |
| § 554.324. Pest Control |
| § 554.325. Linen |
| § 554.326. Safety Operations |
| DIVISION 4. CONSTRUCTION AND INITIAL SURVEY |
| § 554.330. Construction Procedures and Initial Survey of Completed Construction |
| DIVISION 5. FACILITIES LICENSED ON OR AFTER SEPTEMBER 11, 2003 AND BEFORE APRIL 2, 2018 |
| § 554.331. Construction Standards |
| § 554.332. Location and Site |
| § 554.333. General Considerations |
| § 554.334. Architectural Space Planning and Utilization |
| § 554.335. Exit Provisions |
| § 554.336. Smoke Compartmentation (Subdivision of Building Spaces) |
| § 554.337. Fire Protection Systems |
| § 554.338. Hazardous Areas |
| § 554.339. Structural Requirements |
| § 554.340. Mechanical Requirements |
| § 554.341. Electrical Requirements |
| § 554.342. Miscellaneous Details |
| § 554.343. Elevators |
| DIVISION 6. PLAN REVIEW |
| § 554.344. Plan Review |
| DIVISION 7. SMALL HOUSE AND HOUSEHOLD FACILITIES |
| § 554.345. Small House and Household Facilities |
| DIVISION 8. BUILDING REHABILITATION |
| § 554.350. Building Rehabilitation |
| DIVISION 9. FACILITIES LICENSED ON OR AFTER APRIL 2, 2018 |
| § 554.351. Construction Standards for New Nursing Facilities |
| § 554.352. Location and Site for New Facilities |
| § 554.353. General Considerations for New Facilities |
| § 554.354. Architectural Space Planning and Utilization for New Facilities |
| § 554.355. Exit Provisions for New Facilities |
| § 554.356. Smoke Compartments (Subdivision of Building Spaces) for New Facilities |
| § 554.357. Fire Protection Systems for New Facilities |
| § 554.358. Hazardous Areas for New Facilities |
| § 554.359. Structural Requirements for New Facilities |
| § 554.360. Mechanical Requirements for New Facilities |
| § 554.361. Electrical Requirements for New Facilities |
| § 554.362. Miscellaneous Details for New Facilities |
| § 554.363. Elevators for New Facilities |
| SUBCHAPTER E. RESIDENT RIGHTS |
| § 554.401. Introduction |
| § 554.402. Exercise of Rights |
| § 554.403. Notice of Rights and Services |
| § 554.404. Protection of Resident Funds |
| § 554.405. Additional Requirements for Trust Funds in Medicaid-certified Facilities |
| § 554.406. Free Choice |
| § 554.407. Privacy and Confidentiality |
| § 554.408. Grievances |
| § 554.409. Examination of Survey Results |
| § 554.410. Refunds in Medicaid-certified Facilities |
| § 554.411. Work |
| § 554.412. Mail |
| § 554.413. Access and Visitation Rights |
| § 554.414. Telephone |
| § 554.415. Postmortem Procedures |
| § 554.416. Personal Property |
| § 554.417. Married Couples |
| § 554.419. Advance Directives |
| § 554.420. Documentation for the Delegation of Long-Term Care Resident's Rights |
| § 554.421. Refusal of Certain Transfers in Medicaid-certified Facilities |
| § 554.422. Authorized Electronic Monitoring (AEM) |
| § 554.423. Model Drug Testing Policy |
| § 554.424. Wheelchair Self-Release Seat Belts |
| SUBCHAPTER F. ADMISSION, TRANSFER, AND DISCHARGE RIGHTS IN MEDICAID-CERTIFIED FACILITIES |
| § 554.501. Admissions Policy for Medicaid-certified Facilities |
| § 554.502. Transfer and Discharge in Medicaid-certified Facilities |
| § 554.503. Notice of Bed-Hold Policy and Return To Medicaid-certified Facilities |
| § 554.504. Equal Access to Quality Care in Medicaid-certified Facilities |
| § 554.505. Discharge Planning in Medicaid-certified Facilities |
| SUBCHAPTER G. FREEDOM FROM ABUSE, NEGLECT, AND EXPLOITATION |
| § 554.601. Freedom from Abuse, Neglect, and Exploitation |
| § 554.602. Incidents of Abuse, Neglect, and Exploitation Reportable to the Texas Health and Human Services Commission and Law Enforcement Agencies by Facilities |
| § 554.604. Complaint Investigation |
| § 554.606. Reporting of Resident Death Information |
| SUBCHAPTER H. QUALITY OF LIFE |
| § 554.701. Quality of Life |
| § 554.702. Activities |
| § 554.703. Social Services General Requirements |
| § 554.704. Social Services Process |
| § 554.706. Resident Group and Family Council |
| SUBCHAPTER I. RESIDENT ASSESSMENT |
| § 554.801. Resident Assessment |
| § 554.802. Comprehensive Person-Centered Care Planning |
| § 554.803. Discharge Summary (Discharge Plan of Care) |
| § 554.804. Capacity Assessment for Self Care and Financial Management |
| § 554.805. Permanency Planning for a Resident Under 22 Years of Age |
| SUBCHAPTER J. QUALITY OF CARE |
| § 554.901. Quality of Care |
| § 554.904. Behavioral Health Services |
| § 554.910. Quality Assurance Early Warning System |
| § 554.911. Rapid Response Teams |
| SUBCHAPTER K. NURSING SERVICES |
| § 554.1001. Nursing Services |
| § 554.1002. Additional Nursing Services Staffing Requirements |
| § 554.1004. Director of Nursing Services |
| § 554.1006. Nursing Facility Restorative Nursing Care |
| § 554.1010. Nursing Practices |
| § 554.1011. Student Nurses |
| § 554.1012. Special Nurses and Sitters |
| SUBCHAPTER L. FOOD AND NUTRITION SERVICES |
| § 554.1101. Food and Nutrition Services |
| § 554.1102. Staffing |
| § 554.1104. Dietary Consultant Requirements |
| § 554.1107. Menus, Nutritional Adequacy, and Meal Service |
| § 554.1108. Food and Drink |
| § 554.1109. Food Intake |
| § 554.1110. Frequency of Meals |
| § 554.1111. Food Safety Requirements |
| § 554.1113. Paid Feeding Assistants |
| § 554.1115. Requirements for Training of Paid Feeding Assistants |
| § 554.1116. Therapeutic Diets |
| SUBCHAPTER M. PHYSICIAN SERVICES |
| § 554.1201. Physician Services |
| § 554.1202. Physician Visits |
| § 554.1203. Frequency of Physician Visits |
| § 554.1204. Availability of Physician for Emergency Care |
| § 554.1205. Physician Delegation of Tasks |
| § 554.1206. Physician Signatures |
| § 554.1207. Prescription of Psychoactive Medication |
| § 554.1208. Physicians' Reporting Communicable Diseases |
| § 554.1210. Certification and Recertification Requirements in Medicaid-Certified Facilities |
| SUBCHAPTER N. REHABILITATIVE SERVICES |
| § 554.1300. Purpose |
| § 554.1301. Provision of Rehabilitative Services |
| § 554.1302. Qualifications |
| § 554.1304. Rehabilitative Services in Medicaid-certified Facilities |
| § 554.1306. Fee-for-Service Payment for Rehabilitative Services |
| SUBCHAPTER O. DENTAL SERVICES |
| § 554.1401. Dental Services |
| § 554.1402. Medicaid-certified Nursing Facility Emergency Dental Services |
| SUBCHAPTER P. PHARMACY SERVICES |
| § 554.1501. Pharmacy Services |
| § 554.1502. Choice of Pharmacy Provider |
| § 554.1503. Additional Supervision and Consultation Requirements |
| § 554.1504. Drug Security |
| § 554.1506. Drug Orders |
| § 554.1507. Drug Release |
| § 554.1508. Drug Administration |
| § 554.1509. Controlled Substances |
| § 554.1510. Emergency Medication Kits |
| SUBCHAPTER Q. INFECTION CONTROL |
| § 554.1601. Infection Control |
| § 554.1602. Universal Precautions |
| SUBCHAPTER R. PHYSICAL PLANT AND ENVIRONMENT |
| § 554.1701. Physical Environment |
| SUBCHAPTER T. ADMINISTRATION |
| § 554.1901. Administration |
| § 554.1902. Governing Body |
| § 554.1905. Staff Qualifications |
| § 554.1906. Use of Outside Resources |
| § 554.1907. Medical Director |
| § 554.1908. Laboratory Services |
| § 554.1909. Radiology and Other Diagnostic Services |
| § 554.1910. Clinical Records |
| § 554.1911. Contents of the Clinical Record |
| § 554.1912. Additional Clinical Record Service Requirements |
| § 554.1914. Emergency Preparedness and Response |
| § 554.1915. Transfer Agreement |
| § 554.1916. Respite Care |
| § 554.1917. Quality Assessment and Assurance |
| § 554.1918. Disclosure of Ownership |
| § 554.1919. Right to Possession |
| § 554.1920. Operating Policies and Procedures |
| § 554.1921. General Requirements for a Nursing Facility |
| § 554.1922. Resident Care Policies |
| § 554.1923. Incident or Accident Reporting |
| § 554.1924. Financial Records |
| § 554.1925. Financial Condition |
| § 554.1926. Medicaid Hospice Services |
| § 554.1928. Volunteer Program |
| § 554.1929. Staff Development |
| § 554.1930. Blood and Blood Products |
| § 554.1931. Facility Assessment |
| § 554.1934. Educational Requirements for Persons under Age 22 |
| § 554.1935. Automated External Defibrillators |
| § 554.1936. Guardianship Orders for a Nursing Facility Resident |
| SUBCHAPTER U. INSPECTIONS, SURVEYS, AND VISITS |
| § 554.2002. Procedural Requirements--Licensure Inspections and Surveys |
| § 554.2004. Determinations and Actions Pursuant to Inspections |
| § 554.2006. Reporting Incidents and Complaints |
| § 554.2008. Investigations of Incidents and Complaints |
| § 554.2009. Hearings on Complaints of Resident Neglect and Abuse, and Misappropriation of Resident Property in Medicaid-Certified Facilities |
| § 554.2010. General Provisions |
| § 554.2011. Procedures for Inspection of Public Records |
| SUBCHAPTER V. ENFORCEMENT |
| DIVISION 1. ENFORCEMENT GENERALLY |
| § 554.2102. Enforcement Generally |
| DIVISION 2. LICENSING REMEDIES |
| § 554.2103. Warning Letter |
| § 554.2104. Suspension of a License |
| § 554.2106. Revocation of a License |
| § 554.2107. Revocation of a License by the HHSC Executive Commissioner |
| § 554.2108. Emergency Suspension and Closing Order |
| § 554.2110. Referral to the Attorney General |
| § 554.2111. Suspension of Admissions |
| § 554.2112. Administrative Penalties |
| § 554.2113. Criteria for the Executive Commissioner to Stay a License Revocation |
| § 554.2114. Right To Correct |
| § 554.2115. Amelioration of Violation |
| § 554.2116. Involuntary Appointment of a Trustee |
| § 554.2118. Appointment of a Trustee by Agreement |
| § 554.2119. Open Hearing |
| DIVISION 3. REMEDIES IN MEDICAID-CERTIFIED FACILITIES |
| § 554.2120. Definitions Pertaining to Medicaid Remedies |
| § 554.2121. General Provisions |
| § 554.2129. Interest on Civil Money Penalties |
| § 554.2144. Procedures Following Termination of the Provider Agreement |
| § 554.2146. Termination of Provider Agreement on the Basis of the Imposition of Enforcement Actions Three Times Within an Accountability Period |
| § 554.2147. Informal Dispute Resolution |
| § 554.2148. Arbitration |
| § 554.2149. Exclusions |
| § 554.2150. Fraud Referral |
| § 554.2151. Construction |
| SUBCHAPTER W. CERTIFICATION OF FACILITIES FOR CARE OF PERSONS WITH ALZHEIMER'S DISEASE AND RELATED DISORDERS |
| § 554.2204. Voluntary Certification of Facilities for Care of Persons with Alzheimer's Disease |
| § 554.2206. General Requirements for a Certified Facility |
| § 554.2208. Standards for Certified Alzheimer's Facilities |
| SUBCHAPTER X. REQUIREMENTS FOR MEDICAID-CERTIFIED FACILITIES |
| § 554.2301. Conditions for Participation as a Medicaid-Certified Facility |
| § 554.2302. Requirements for a Contracted Medicaid Facility |
| § 554.2304. Contract Requirements |
| § 554.2306. Effective Dates of Provider Contracts |
| § 554.2308. Change of Ownership |
| § 554.2310. Nursing Facility Ceases to Participate |
| § 554.2314. Financial Audits |
| § 554.2316. Collection of Applied Income |
| § 554.2318. Computation of Daily Reimbursement Rate for Recipients with Applied Income |
| § 554.2320. Medical Transportation |
| § 554.2322. Medicaid Bed Allocation Requirements |
| § 554.2326. Medicaid Swing Bed Program for Rural Hospitals |
| SUBCHAPTER Y. MEDICAL NECESSITY DETERMINATIONS |
| § 554.2401. General Qualifications for Medical Necessity Determinations |
| § 554.2403. Medical Necessity Determination |
| § 554.2405. Physicians' Certifications and Recertifications |
| § 554.2407. Denied Medical Necessity |
| § 554.2413. Determination of Payment Rate Based on the MDS Assessment Submission |
| SUBCHAPTER AA. VENDOR PAYMENT |
| § 554.2601. Vendor Payment (Items and Services Included) |
| § 554.2602. Additional Charges (Items and Services Excluded from Vendor Payment) |
| § 554.2603. Therapeutic Home Visits Away from the Facility |
| § 554.2604. Vendor Payment Information |
| § 554.2605. Effective Date of Vendor Coverage |
| § 554.2606. Supplementation of Vendor Payments |
| § 554.2607. Penalties for Supplementation |
| § 554.2608. Limitations on Provider Charges |
| § 554.2609. Payment of Claims |
| § 554.2610. Medicare Part A Skilled Nursing Facility Deductible and Coinsurance Payment |
| § 554.2611. Retroactive Vendor Payment |
| § 554.2612. Quality Incentive Payment |
| § 554.2613. Augmentative Communication Device Systems |
| § 554.2614. Customized Power Wheelchairs |
| § 554.2615. Resident Transaction Notices |
| SUBCHAPTER BB. NURSING FACILITY RESPONSIBILITIES RELATED TO PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) |
| DIVISION 1. GENERAL PROVISIONS |
| § 554.2701. Purpose |
| § 554.2702. Limitation on Charges for Nursing Facility Services |
| § 554.2703. Definitions |
| DIVISION 2. NURSING FACILITY RESPONSIBILITIES |
| § 554.2704. Nursing Facility Responsibilities Related to PASRR |
| § 554.2705. Nursing Facility Responsibilities Related to the Fair Hearing Process |
| § 554.2706. Nursing Facility Responsibilities Related to a Designated Resident |
| § 554.2707. Transition Activities Related to Designated Residents |
| § 554.2708. Educational and Informational Activities for Residents |
| § 554.2709. Incident and Complaint Reporting |
| DIVISION 3. NURSING FACILITY SPECIALIZED SERVICES FOR DESIGNATED RESIDENTS |
| § 554.2750. Nursing Facility Specialized Services for Designated Residents |
| § 554.2751. Requesting Authorization to Provide Therapy Services |
| § 554.2752. Qualifications of a Provider of Therapy Services |
| § 554.2753. Payment for Therapy Services |
| § 554.2754. Requesting Authorization to Provide Durable Medical Equipment and Customized Manual Wheelchairs |
| § 554.2755. Payment for Durable Medical Equipment and Customized Manual Wheelchairs |
| § 554.2756. Administrative Requirements for Durable Medical Equipment and Customized Manual Wheelchairs |