|(a) Administrative responsibilities.
(1) A license holder, or the license holder's designee,
must designate an individual who meets the qualifications and conditions
set out in §558.244 of this division (relating to Administrator
Qualifications and Conditions and Supervising Nurse Qualifications)
to serve as the administrator of the agency.
(2) A license holder, or the license holder's designee,
must designate in writing an alternate administrator who meets the
qualifications and conditions of an administrator to act in the absence
of the administrator.
(b) Administrator responsibilities.
(1) An administrator must be responsible for implementing
and supervising the administrative policies and operations of the
agency and for administratively supervising the provision of all services
to agency clients on a day-to-day basis. An administrator must:
(A) manage the daily operations of the agency;
(B) organize and direct the agency's ongoing functions;
(C) administratively supervise the provision of quality
care to agency clients;
(D) supervise to ensure implementation of agency policy
(E) ensure that the documentation of services provided
is accurate and timely;
(F) employ or contract with qualified personnel;
(G) ensure adequate staff education and evaluations,
according to requirements in §558.245(b) of this division (relating
to Staffing Policies);
(H) ensure the accuracy of public information materials
(I) implement an effective budgeting and accounting
system that promotes the health and safety of the agency's clients;
(J) supervise and evaluate client satisfaction survey
reports on all clients served.
(2) An administrator or alternate administrator must
be available to agency personnel, in person or by telephone, during
the agency's operating hours and in accordance with the rules in this
chapter, including §558.210 of this subchapter (relating to Agency
Operating Hours), §558.404(h)(2) of this chapter (relating to
Standards Specific to Agencies Licensed to Provide Personal Assistance
Services), §558.523 of this chapter (relating to Personnel Requirements
for a Survey), and §558.527 of this chapter (relating to Post-Survey
(3) An administrator must designate, in writing, an
agency employee who must provide HHSC surveyors entry to the agency
in accordance with §558.523(e) of this chapter (relating to Personnel
Requirements for a Survey), if the administrator and alternate administrator
are not available.
(c) Supervision of services.
(1) Except as provided in paragraph (3) of this subsection,
an agency licensed to provide licensed home health services, licensed
and certified home health services, or hospice services must directly
employ or contract with an individual who meets the qualifications
in §558.244 of this division to serve as the supervising nurse.
(2) An agency must designate, in writing, a similarly
qualified alternate to serve as supervising nurse in the absence of
the supervising nurse.
(A) The supervising nurse or alternate supervising
(i) always be available to agency personnel, in person
or by telephone;
(ii) participate in activities relevant to services
furnished, including the development of qualifications and assignment
of agency personnel;
(iii) ensure that a client's plan of care or care plan
is executed as written; and
(iv) ensure that an appropriate health care professional
performs a reassessment of a client's needs:
(I) when there is a significant health status change
in the client's condition;
(II) at the physician's request; or
(III) after hospital discharge.
(B) A supervising nurse may also be the administrator
of the agency, if the supervising nurse meets the qualifications and
conditions of an administrator described in §558.244(a) and (b)
of this division.
(3) An agency that provides only physical, occupational,
speech or respiratory therapy, medical social services, or nutritional
counseling is not required to employ or contract with a supervising
nurse. A qualified licensed professional must supervise these services,
(d) Supervision of branch offices and ADSs. An agency
must adopt and enforce a written policy relating to the supervision
of branch offices or ADSs, if established. This policy must be consistent
with the following:
(1) for a branch office, §558.27 of this chapter
(relating to Application and Issuance of an Initial Branch Office
License) and §558.321 of this chapter (relating to Standards
for Branch Offices); or
(2) for an ADS, §558.29 of this chapter (relating
to Application and Issuance of an Alternate Delivery Site License)
and §558.322 of this chapter (relating to Standards for Alternate
|Source Note: The provisions of this §558.243 adopted to be effective February 1, 2002, 26 TexReg 9159; amended to be effective December 1, 2006, 31 TexReg 7368; amended to be effective July 1, 2012, 37 TexReg 4613; transferred effective May 1, 2019, as published in the April 12, 2019, issue of the Texas Register, 44 TexReg 1893; amended to be effective April 25, 2021, 46 TexReg 2427