TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 500. COVID-19 EMERGENCY HEALTH CARE FACILITY LICENSING

SUBCHAPTER A. HOSPITALS

26 TAC §500.2

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26, Texas Administrative Code, Chapter 500, COVID-19 Emergency Health Care Facility Licensing, Subchapter A, Hospitals, new §500.2 Waiver of 36-Month Requirement in Response to COVID-19, concerning an emergency rule in response to COVID-19 to allow HHSC flexibility in implementation of an emergency rule adopted at 26 Texas Administrative Code, §500.1 related to off-site facility licensure. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for hospital off-site facilities in response to COVID-19.

To protect current and future patients in health care facilities and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC previously adopted an emergency rule to allow a currently licensed hospital to operate an off-site inpatient facility. To allow operation of additional off-site facilities, HHSC is adopting this emergency rule to allow licensed hospitals to request a waiver of the requirement that off-site facilities be open or licensed within the past 36 months, at the Commission's discretion.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §241.026. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of HHSC to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code §241.026 requires the Commission to develop, establish, and enforce standards for the construction, maintenance, and operation of licensed hospitals.

§500.2.Waiver of 36-Month Requirement in Response to COVID-19.

At its sole discretion, the Texas Health and Human Services Commission (HHSC) may waive the requirement that an off-site facility must have been licensed or open within the past 36 months under §500.1(b) of this title, if the hospital applying to use the off-site facility provides evidence satisfactory to HHSC that such waiver will not detrimentally affect the health or safety of patients, hospital staff, or the public.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 4, 2020.

TRD-202001353

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 4, 2020

Expiration date: August 1, 2020

For further information, please call: (512) 834-4591


SUBCHAPTER B. END STAGE RENAL DISEASE FACILITIES

26 TAC §500.20

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts on an emergency basis new §500.20, ESRD Off-Site Facilities in Response to COVID-19, in Texas Administrative Code (TAC), Title 26, Chapter 500, Subchapter B, concerning an emergency rule to allow end stage renal disease (ESRD) facilities to treat and train dialysis patients more effectively in response to COVID-19.

As authorized by Government Code §2001.034, the Executive Commissioner may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the new emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. HHSC accordingly finds that an imminent peril to the public health, safety, and welfare of the state exists and requires immediate adoption of this new rule to ensure that dialysis patients receive safe treatment.

To protect current and future patients in health care facilities and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to allow a currently licensed ESRD to operate an off-site outpatient facility without obtaining a new license at: (1) an ESRD that is no longer licensed that closed within the past 36 months; (2) a mobile, transportable, or relocatable medical unit; (3) a physician's office; or (4) an ambulatory surgical center or freestanding emergency medical care facility that is no longer licensed that closed within the past 36 months.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §251.003 and §251.014. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Health and Safety Code §251.003 requires HHSC to adopt rules for the issuance, renewal, denial, suspension, and revocation of a license to operate an ESRD. Health and Safety Code §251.014 requires these rules to include minimum standards to protect the health and safety of a patient of an ESRD. Government Code §531.0055 authorizes the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system.

§500.20.ESRD Off-Site Facilities in Response to COVID-19.

(a) An end stage renal disease (ESRD) facility licensed under Texas Health and Safety Code, Chapter 251 that meets the requirements of this emergency rule may use an off-site facility under its current license for added services or an increased number of stations to meet patient needs in response to COVID-19 for the duration this emergency rule is in effect or any extension of this emergency rule is in effect.

(b) The off-site facility must be:

(1) an ESRD facility no longer licensed under Texas Health and Safety Code, Chapter 251 that closed within the past 36 months, or a facility with a pending application for such a license that has passed its final architectural review inspection, which:

(A) shall be capable of meeting the current licensing requirements at 25 TAC §117.32(a) - (e) (relating to Water Treatment, Dialysate Concentrates, and Reuse); or

(B) shall provide integrated hemodialysis machines, which incorporate water treatment and dialysis preparation and delivery into one system;

(2) a mobile, transportable, or relocatable medical unit utilizing integrated dialysis systems and defined as any trailer or self-propelled unit:

(A) equipped with a chassis on wheels;

(B) without a permanent foundation; and

(C) intended for provision of medical services on a temporary basis;

(3) a physician's office built after January 1, 2015, that is currently in use, which shall be used only for home training of COVID-19-negative dialysis patients;

(4) a physician's office built after January 1, 2015, that has closed within the past 12 months, which shall be used only for home training of COVID-19-negative dialysis patients and complies with the following:

(A) the office shall be well maintained with all building systems in good working condition; and

(B) manual fire extinguishers shall be provided in accordance with NFPA 10: Standard for Portable Fire Extinguishers;

(5) an ambulatory surgical center no longer licensed under Texas Health and Safety Code, Chapter 243 that closed within the past 36 months and will be used for either home training or providing in-center dialysis treatment where both of the following are met:

(A) the ESRD facility shall only provide integrated hemodialysis machines; and

(B) the building layout shall provide a direct view of all patient stations from a nurse's station; or

(6) a freestanding emergency medical care facility no longer licensed under Texas Health and Safety Code, Chapter 254 that closed within the past 36 months and will be used for either for home training services or providing in-center dialysis treatment where both of the following are met:

(A) the ESRD facility shall only provide integrated hemodialysis machines; and

(B) the building layout shall provide a direct view of all patient stations from a nurse's station.

(c) Prior to receiving approval to use an off-site facility under this emergency rule, the ESRD facility must submit to INFOHFLC@hhsc.state.tx.us on a form provided by the Texas Health and Human Services Commission (HHSC):

(1) an application to use an off-site facility for the addition of services or increased number of stations; and

(2) water culture testing results that meet the requirements of 25 TAC §117.32(c)(4).

(d) HHSC has the discretion to approve or deny any application to use an off-site facility under this emergency rule. HHSC may require an inspection of the off-site facility or additional documentation prior to considering an application.

(e) In order to protect the health, safety, and welfare of patients and the public, HHSC may withdraw its approval for an ESRD to use the off-site facility under this emergency rule at any time. Any patients being treated in the off-site facility at the time approval is withdrawn shall be safely relocated as soon as practicable according to the ESRD's policies and procedures.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001350

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: (512) 438-3161


CHAPTER 510. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS

SUBCHAPTER C. OPERATIONAL REQUIREMENTS

26 TAC §510.48

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 510, Private Psychiatric Hospitals and Crisis Stabilization Units, new §510.48, concerning an emergency rule in response to COVID-19 in order to reduce the risk of transmission of COVID-19. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for Facility Response to COVID-19.

To protect patients and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to restrict entry into a facility and require screening of certain persons authorized to enter a facility.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §577.010. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code §577.010 authorizes the Executive Commissioner of HHSC to adopt rules governing rules and standards necessary and appropriate to ensure the proper care and treatment of patients in a private mental hospital or mental health facility.

§510.48.Emergency Rule for Facility Response to COVID-19.

(a) Based on state law and federal guidance, the Texas Health and Human Services Commission deems COVID-19 a health and safety risk to facility patients, staff, and the public and requires a facility to restrict entry to the facility.

(b) A facility must implement and enforce written policies and procedures in accordance with this section regarding the visitation rights of patients and setting forth any clinically necessary or reasonable restriction or limitation on such rights and the reasons for the clinical restriction or limitation.

(c) A facility must implement and enforce written policies and procedures regarding the entry of its workforce to protect the health and safety of patients, employees and staff, and the public.

(d) In this section:

(1) Providers of essential services include, but are not limited to, contract doctors, contract nurses, hospice workers, other contract healthcare providers, persons providing a survivor of sexual assault with services required by Health and Safety Code Chapter 323, a single designated caregiver acting on the patient's behalf, and individuals operating under the authority of a local intellectual and developmental disability authority (LIDDA) or a local mental health authority (LMHA) whose services are necessary to ensure resident health and safety.

(2) Persons with legal authority to enter include, but are not limited to, government personnel performing their official duties and an attorney or other legally authorized representative of a patient.

(3) Persons providing critical assistance include providers of essential services, persons with legal authority to enter, a clergy member authorized by the facility, one parent of a minor who is a patient, and family members and friends of a patient at the end of life, subject to the facility's policies and procedures.

(e) A facility must prohibit visitors, except as provided by subsection (f) of this section.

(f) A facility may allow entry of persons providing critical assistance, unless the person meets one or more of the following screening criteria:

(1) Fever or signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;

(2) Contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, someone who is under investigation for COVID-19, or someone who is ill with a respiratory illness; or

(3) International travel within the last 14 days to countries with ongoing community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html.

(g) A facility must not prohibit government personnel performing their official duty from entering the facility, unless the individual meets the above screening criteria.

(h) If this emergency rule is more restrictive than any minimum standard relating to a facility, this emergency rule will prevail so long as this emergency rule is in effect.

(i) If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this emergency rule or any minimum standard relating to a facility, the facility must comply with the executive order or other direction.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001352

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: (512) 834-4591


CHAPTER 550. LICENSING STANDARDS FOR PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS

SUBCHAPTER C. GENERAL PROVISIONS

DIVISION 1. OPERATIONS AND SAFETY PROVISIONS

26 TAC §550.212

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 550, Licensing Standards for Prescribed Pediatric Extended Care Centers, Subchapter C, General Provisions, Division 1, Operations and Safety Provisions, new §550.212, concerning an emergency rule in response to COVID-19 in order to reduce the risk of transmission of COVID-19. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for Prescribed Pediatric Extended Care Center Response to COVID-19.

To protect minors being served in a prescribed pediatric extended care center and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to restrict entry into a prescribed pediatric extended care center and require screening of certain persons authorized to enter a prescribed pediatric extended care center.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §248A.101. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of HHSC to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code §248A.101 authorizes the Executive Commissioner of HHSC to adopt rules to implement Health and Safety Code §248A, including rules prescribing minimum standards to protect the health and safety of minors being served in prescribed pediatric extended care centers.

§550.212.Emergency Rule for Prescribed Pediatric Extended Care Center Response to COVID-19.

(a) Based on state law and federal guidance, HHSC finds COVID-19 to be a health and safety risk and requires a prescribed pediatric extended care center to take the following measures. The screening required by this section does not apply to emergency services personnel entering the center in an emergency situation.

(b) In this section:

(1) Providers of essential services include, but are not limited to, contract doctors, contract nurses, therapists, dieticians, social workers, and home health workers whose services are necessary to ensure minors' health and safety.

(2) Persons with legal authority to enter include, but are not limited to, law enforcement officers, representatives of Disability Rights Texas, representatives of the long-term care ombudsman's office, and government personnel performing their official duties.

(c) A prescribed pediatric extended care center must take the temperature of every person upon arrival and may not allow a person with a fever to enter or remain in the center.

(d) A prescribed pediatric extended care center must prohibit visitors, except as provided in subsection (e) of this section.

(e) A prescribed pediatric extended care center may allow entry of persons providing critical assistance, unless the person meets one or more of the following screening criteria:

(1) Fever or signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;

(2) Contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, someone who is under investigation for COVID-19, or someone who is ill with a respiratory illness; or

(3) International travel within the last 14 days to countries with ongoing community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html.

(f) A facility must not prohibit government personnel performing their official duty from entering the facility, unless the individual meets the above screening criteria.

(g) If this emergency rule is more restrictive than any minimum standard relating to a prescribed pediatric extended care center, this emergency rule will prevail so long as this emergency rule is in effect.

(h) If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this emergency rule or any minimum standard relating to a prescribed pediatric extended care center, the prescribed pediatric extended care center must comply with the executive order or other direction.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001349

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: (512) 438-3161


CHAPTER 551. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS

SUBCHAPTER M. COVID-19 EMERGENCY RULE

26 TAC §551.401

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 551 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Condition, new §551.401, concerning an emergency rule in response to COVID-19 in order to reduce the risk of transmission of COVID-19. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for Intermediate Care Facility Response to COVID-19.

To protect residents of intermediate care facilities and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to restrict entry into an intermediate care facility and require screening of certain persons authorized to enter an intermediate care facility.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §252.001 and §252.008. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of HHSC to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code §252.008 authorizes the Executive Commissioner of HHSC to adopt rules administering and implementing Chapter 252 of the Health and Safety Code, concerning Intermediate Care Facilities for Individuals with an Intellectual Disability. Health and Safety Code §252.001 states that the purpose of Chapter 252 of the Health and Safety Code is to promote the public health, safety, and welfare by providing for the development, establishment, and enforcement of standards for the provision of services to individuals residing in intermediate care facilities for individuals with an intellectual disability.

§551.401Emergency Rule for Intermediate Care Facility Response to COVID-19.

(a) Based on state law and federal guidance, HHSC finds COVID-19 to be a health and safety risk and requires an intermediate care facility for individuals with an intellectual disability or related condition to take the following measures. The screening required by this section does not apply to emergency services personnel entering the facility in an emergency situation.

(b) In this section:

(1) Providers of essential services include, but are not limited to, contract doctors, contract nurses, hospice workers, and individuals operating under the authority of a local intellectual and developmental disability authority (LIDDA) or a local mental health authority (LMHA) whose services are necessary to ensure resident health and safety.

(2) Persons with legal authority to enter include, but are not limited to law enforcement officers, representatives of Disability Rights Texas, and government personnel performing their official duties.

(3) Persons providing critical assistance include providers of essential services, persons with legal authority to enter, and family members or friends of residents at the end of life.

(c) A facility must take the temperature of every person upon arrival and must not allow a person with a fever to enter or remain in the facility, except as a resident.

(d) A facility must prohibit all visitors, except as provided in subsection (e) of this section.

(e) A facility may allow entry of persons providing critical assistance, unless the facility believes the person may impede the health and safety of residents or the person meets one or more of the following screening criteria:

(1) Fever or signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;

(2) Contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, someone who is under investigation for COVID-19, or someone who is ill with a respiratory illness; or

(3) International travel within the last 14 days to countries with ongoing community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html.

(f) A facility must not prohibit government personnel performing their official duty from entering the facility, unless the individual meets the above screening criteria.

(g) If this emergency rule is more restrictive than any minimum standard relating to a facility, this emergency rule will prevail so long as this emergency rule is in effect.

(h) If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this emergency rule or any minimum standard relating to a facility, the facility must comply with the executive order or other direction.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001345

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: (512) 438-3161


CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES

SUBCHAPTER C. STANDARDS FOR LICENSURE

26 TAC §553.45

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 553 Licensing Standards for Assisted Living Facilities, new §553.45, concerning an emergency rule in response to COVID-19 in order to reduce the risk of transmission of COVID-19. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for Assisted Living Facility Response to COVID-19.

To protect residents of assisted living facilities and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to restrict entry into an assisted living facility and require screening of certain persons authorized to enter an assisted living facility.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §247.025 and §247.026. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of HHSC to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code §247.025, authorizes the Executive Commissioner of HHSC to adopt rules governing the implementation of Chapter 247 of the Health and Safety Code, concerning Assisted Living Facilities. Health and Safety Code, §247.026, authorizes the Executive Commissioner of HHSC to adopt rules governing minimum standards to protect the health and safety of an assisted living facility resident.

§553.45.Emergency Rule for Assisted Living Facility Response to COVID-19.

(a) Based on state law and federal guidance, HHSC finds COVID-19 to be a health and safety risk and requires an assisted living facility to take the following measures. The screening required by this section does not apply to emergency services personnel entering the facility in an emergency situation.

(b) In this section:

(1) Providers of essential services include, but are not limited to, contract doctors, contract nurses, and home health and hospice workers, whose services are necessary to ensure resident health and safety.

(2) Persons with legal authority to enter include, but are not limited to, law enforcement officers, representatives of Disability Rights Texas, representatives of the long-term care ombudsman's office, and government personnel performing their official duties.

(3) Persons providing critical assistance include providers of essential services, persons with legal authority to enter, and family members or friends of residents at the end of life.

(c) An assisted living facility must take the temperature of every person upon arrival and must not allow a person with a fever to enter or remain in the facility, except as a resident.

(d) An assisted living facility must prohibit visitors, except as provided in subsection (e) of this section.

(e) An assisted living facility may allow entry of persons providing critical assistance, unless the facility believes the person may impede the health and safety of residents or the person meets one or more of the following screening criteria:

(1) Fever or signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;

(2) Contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, someone who is under investigation for COVID-19, or someone who is ill with a respiratory illness; or

(3) International travel within the last 14 days to countries with ongoing community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html.

(f) A facility must not prohibit government personnel performing their official duty from entering the facility, unless the individual meets the above screening criteria.

(g) If this emergency rule is more restrictive than any minimum standard relating to an assisted living facility, this emergency rule will prevail so long as this emergency rule is in effect.

(h) If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this emergency rule or any minimum standard relating to an assisted living facility, the assisted living facility must comply with the executive order or other direction.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001343

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: (512) 438-3161


CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES

SUBCHAPTER D. ADDITIONAL STANDARDS SPECIFIC TO LICENSE CATEGORY AND SPECIFIC TO SPECIAL SERVICES

26 TAC §558.408

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 558 Licensing Standards for Home and Community Support Services Agencies, new §558.408, concerning an emergency rule in response to COVID-19 in order to reduce the risk of transmission of COVID-19. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for HCSSA Response to COVID-19.

To protect clients served by home and community support services agencies and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to require screening of staff, clients, and household members and offer alternative methods to provide non-essential services.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §142.012. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code §142.012, authorizes the Executive Commissioner of HHSC to adopt rules governing necessary to implement Chapter 142 of the Health and Safety Code, concerning, Home and Community Support Services. Health and Safety Code §142.012, authorizes the Executive Commissioner of HHSC to adopt rules governing minimum standards for home and commuity support services agencies that are necessary to protect the public.

§558.408.Emergency Rule for HCSSA Response to COVID-19.

(a) Based on state law and federal guidance, HHSC finds COVID-19 to be a health safety risk and requires a home and community support services agency to take the following measures. The screening required by this section does not apply to emergency services personnel entering an agency in an emergency situation.

(b) For the purposes of this section personal protective equipment means specialized clothing or equipment, worn by agency staff for protection against transmission of infectious diseases such as COVID-19, including masks, goggles, gloves, and disposable gowns.

(c) Agency staff have legal authority to enter a facility licensed under Health and Safety Code Chapters 242, 247, or 252, or Human Resources Code Chapter 103, to provide services to the facility's residents who are agency clients. Agency staff entering a licensed facility must follow the infection control protocols of the facility.

(d) An agency must screen its staff and must not allow staff to remain in the agency or make home visits if the person meets one or more of the following screening criteria:

(1) Fever or signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;

(2) Contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, someone who is under investigation for COVID-19, or someone who is ill with a respiratory illness; or

(3) International travel within the last 14 days to countries with ongoing community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html.

(e) The agency must determine if a home visit requires essential or non-essential services.

(1) If the visit requires non-essential services, the visit:

(A) must be conducted by phone or video conference, if possible; or

(B) must be rescheduled for a later date.

(2) If the visit requires essential services, staff must conduct the visit in person and screen the client and household members using the same criteria for staff that is described in subsection (d) of this section and proceed as described below:

(A) If the client or a member of the household meet one or more of the screening criteria, use appropriate personal protective equipment during the visit.

(B) If the client or a member of the household does not meet one or more of the screening criteria, conduct the visit as indicated for the type of service provided.

(3) An agency must document any missed visits in the plan of care, care plan, or individualized services plan and notify the attending physician, if applicable.

(f) A parent agency administrator or alternate administrator, or supervising nurse or alternate supervising nurse may make the monthly supervisory visit required for branch supervision by 26 TAC §558.321(d)(1) or as required for alternative delivery site by §558.322(c)(1) by virtual communication, such as video or telephone conferencing systems.

(g) A hospice RN may make the supervisory visit required in 26 TAC §558.842(d) by virtual communication, such as video or telephone conferencing systems.

(h) If this emergency rule is more restrictive than any minimum standard relating to a home and community support services agency, this emergency rule will prevail so long as this emergency rule is in effect.

(i) If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this emergency rule or any minimum standard relating to a home and community support services agency, the home and community support services agency must comply with the executive order or other direction.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001344

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: (512) 438-3161


SUBCHAPTER H. STANDARDS SPECIFIC TO AGENCIES LICENSED TO PROVIDE HOSPICE SERVICES

DIVISION 7. HOSPICE INPATIENT UNITS

26 TAC §558.872

The Executive Commissioner of the Health and Human Services Commission (HHSC) adopts on an emergency basis in Title 26 Texas Administrative Code, Chapter 558, Licensing Standards for Home and Community Support Services Agencies, new §558.872, concerning an emergency rule in response to COVID-19 in order to reduce the risk of transmission of COVID-19. As authorized by Government Code §2001.034 the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

BACKGROUND AND PURPOSE

The purpose of the emergency rulemaking is to support the Governor's March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this Emergency Rule for Hospice Inpatient Unit Response to COVID-19.

To protect clients and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting an emergency rule to restrict entry into an inpatient hospice unit and require screening of certain persons authorized to enter an inpatient hospice unit.

STATUTORY AUTHORITY

The emergency rulemaking is adopted under Government Code §2001.034 and §531.0055 and Health and Safety Code §142.012. Government Code §2001.034 authorizes the adoption of emergency rules without prior notice and hearing, if an agency finds that an imminent peril to the public health, safety, or welfare requires adoption of a rule on fewer than 30 days' notice. Government Code §531.0055 authorizes the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the health and human services system. Health and Safety Code, §142.012 authorizes the Executive Commissioner of HHSC to adopt rules necessary to implement Chapter 142 of the Health and Safety Code, concerning, Home and Community Support Services. Health and Safety Code §142.012 authorizes the Executive Commissioner of HHSC to adopt rules establishing minimum standards for home and community support services agencies that are necessary to protect the public.

§558.872.Emergency Rule for Hospice Inpatient Unit Response to COVID-19.

(a) Based on state law and federal guidance, HHSC finds COVID-19 to be a health and safety risk and requires a hospice inpatient unit to take the following measures. The screening required by this section does not apply to emergency services personnel entering the facility in an emergency situation.

(b) In this section:

(1) Providers of essential services include, but are not limited to, physicians, nurses, hospice aides, and spiritual counselors.

(2) Persons with legal authority to enter include, but are not limited to, law enforcement officers and government personnel performing their official duties.

(3) Persons providing critical assistance include providers of essential services, persons with legal authority to enter, and family members or friends of residents of clients at the end of life.

(c) A facility must take the temperature of every person upon arrival and must not allow a person with a fever to enter or remain in the facility, except as a client.

(d) A hospice inpatient unit must prohibit all visitors, except as provided in subsection (e) of this section.

(e) A hospice inpatient unit may allow entry of persons providing critical assistance, unless the person meets one or more of the following screening criteria:

(1) Fever or signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;

(2) Contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, someone who is under investigation for COVID-19, or someone who is ill with a respiratory illness; or

(3) International travel within the last 14 days to countries with ongoing community transmission. For updated information on affected countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html.

(f) A parent agency administrator or alternate administrator, or supervising nurse or alternate supervising nurse may make the monthly supervisory visit required for an alternative delivery site by §558.322(c)(1) of this chapter (relating to Standards for Alternate Delivery Sites) by virtual communication, such as video or telephone conferencing systems.

(g) A facility must not prohibit government personnel performing their official duty from entering the facility, unless the individual meets the above screening criteria.

(h) If this emergency rule is more restrictive than any minimum standard relating to a hospice inpatient unit, this emergency rule will prevail so long as this emergency rule is in effect.

(i) If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this emergency rule or any minimum standard relating to a hospice inpatient unit, the hospice inpatient unit must comply with the executive order or other direction.

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 3, 2020.

TRD-202001346

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: April 3, 2020

Expiration date: July 31, 2020

For further information, please call: