| (a) A person must be licensed to establish or operate
an assisted living facility in Texas.
(1) HHSC considers one or more facilities to be part
of the same establishment and, therefore, subject to licensure as
an assisted living facility, based on the following factors:
(A) common ownership;
(B) physical proximity;
(C) shared services, personnel, or equipment in any
part of the facilities' operations; and
(D) any public appearance of joint operations or of
a relationship between the facilities.
(2) The presence or absence of any one factor in paragraph
(1) of this subsection is not conclusive.
(b) To obtain a license, a person must follow the application
requirements in this subchapter and meet the criteria for a license.
(c) An applicant must affirmatively show that the applicant,
license holder, controlling person, and any person required to submit
background and qualification information meet the criteria and eligibility
for licensing, in accordance with this section, and:
(1) the building in which the facility is housed:
(A) meets local fire ordinances;
(B) is approved by the local fire authority;
(C) meets HHSC licensing standards in accordance with
Subchapter D of this chapter (relating to Facility Construction) based
on an on-site inspection by HHSC; and
(D) operation of the facility meets HHSC licensing
standards based on an on-site health inspection by HHSC, which must
include observation of the care of a resident; or
(2) the facility meets the standards for accreditation
based on an on-site accreditation survey by the accreditation commission.
(d) An applicant who chooses the option authorized
in subsection (c)(2) of this section must contact HHSC to determine
which accreditation commissions are available to meet the requirements
of that subsection. If a license holder uses an on-site accreditation
survey by an accreditation commission, as provided in this paragraph
and §553.33(i) of this subchapter (relating to Renewal Procedures
and Qualifications), the license holder must:
(1) provide written notification to HHSC within five
working days after the license holder receives a notice of change
in accreditation status from the accreditation commission; and
(2) include a copy of the notice of change with its
written notification to HHSC.
(e) HHSC issues a license to a facility meeting all
requirements of this chapter. The facility must not exceed the maximum
allowable number of residents specified on the license.
(f) HHSC denies an application for an initial license
or a renewal of a license if:
(1) the applicant, license holder, controlling person,
or any person required to submit background and qualification information
has been debarred or excluded from the Medicare or Medicaid programs
by the federal government or a state;
(2) a court has issued an injunction prohibiting the
applicant, license holder, controlling person, or any person required
to submit background and qualification information from operating
a facility; or
(3) during the five years preceding the date of the
application, a license to operate a health care facility, long-term
care facility, assisted living facility, or similar facility in any
state held by the applicant, license holder, controlling person, or
any person required to submit background and qualification information
has been revoked.
(g) A license holder or controlling person who operates
a nursing facility or an assisted living facility for which a trustee
was appointed and for which emergency assistance funds, other than
funds to pay the expenses of the trustee, were used is subject to
exclusion from eligibility for:
(1) the issuance of an initial license for a facility
for which the person has not previously held a license; and
(2) the renewal of the license of the facility for
which the trustee was appointed.
(h) HHSC may deny an application for an initial license
or refuse to renew a license if an applicant, license holder, controlling
person, or any person required to submit background and qualification
information:
(1) violates Texas Health and Safety Code, Chapter
247; a section, standard or order adopted under Chapter 247; or a
license issued under Chapter 247 in either a repeated or substantial
manner;
(2) commits an act described in §553.751(a)(2)
- (9) of this chapter (relating to Administrative Penalties);
(3) aids, abets, or permits a substantial violation
described in paragraphs (1) or (2) of this subsection about which
the person had or should have had knowledge;
(4) fails to provide the required information, facts,
or references;
(5) engages in the following:
(A) knowingly submits false or intentionally misleading
statements to HHSC;
(B) uses subterfuge or other evasive means of filing
an application for licensure;
(C) engages in subterfuge or other evasive means of
filing on behalf of another who is unqualified for licensure;
(D) knowingly conceals a material fact related to licensure;
or
(E) is responsible for fraud;
(6) fails to pay the following fees, taxes, and assessments
when due:
(A) license fees, as described in §553.47 of this
subchapter (relating to License Fees); or
(B) franchise taxes, if applicable;
(7) during the five years preceding the date of the
application, has a history in any state or other jurisdiction of any
of the following:
(A) operation of a facility that has been decertified
or has had its contract canceled under the Medicare or Medicaid program;
(B) federal or state long-term care facility, assisted
living facility, or similar facility sanctions or penalties, including
monetary penalties, involuntary downgrading of the status of a facility
license, proposals to decertify, directed plans of correction, or
the denial of payment for new Medicaid admissions;
(C) unsatisfied final judgments, excluding judgments
wholly unrelated to the provision of care rendered in long-term care
facilities;
(D) eviction involving any property or space used as
a facility; or
(E) suspension of a license to operate a health care
facility, long-term care facility, assisted living facility, or a
similar facility;
(8) violates Texas Health and Safety Code §247.021
by operating a facility without a license; or
(9) is subject to denial or refusal as described in
Chapter 560 of this title (relating to Denial or Refusal of License)
during the time frames described in that chapter.
(i) Without limitation, HHSC reviews all information
provided by an applicant, a license holder, a person with a disclosable
interest, or a manager when considering grounds for denial of an initial
license application or a renewal application in accordance with subsection
(h) of this section. HHSC may grant a license if HHSC finds the applicant,
license holder, person with a disclosable interest, affiliate, or
manager is able to comply with the rules in this chapter.
(j) HHSC reviews final actions when considering the
grounds for denial of an initial license application or renewal application
in accordance with subsections (f) and (h) of this section. An action
is final when routine administrative and judicial remedies are exhausted.
An applicant must disclose all actions, whether pending or final.
(k) If an applicant owns multiple facilities, HHSC
examines the overall record of compliance in all of the applicant's
facilities. An overall record poor enough to deny issuance of a new
license does not preclude the renewal of a license of a facility with
a satisfactory record.
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