The Health and Human Services Commission (HHSC), on behalf of the Department of Aging and Disability Services (DADS), adopts amendments to §§97.2, 97.244, 97.256, 97.292, 97.295, 97.298, 97.299, 97.301, 97.403 - 97.405, and 97.602; new §97.259 and §97.260; and the repeal of §97.259, in Chapter 97, Licensing Standards for Home and Community Support Services Agencies. The amendments to §§97.2, 97.256, and 97.405 are adopted with changes to the proposed text published in the October 19, 2007, issue of the Texas Register (32 TexReg 7437). The amendments to §§97.244, 97.292, 97.295, 97.298, 97.299, 97.301, 97.403, 97.404, and 97.602; new §97.259 and §97.260; and the repeal of §97.259 are adopted without changes to the proposed text.

The amendments are adopted to clearly specify the requirements for licensed home and community support services agencies and hospice facilities to develop, maintain, and implement a comprehensive emergency preparedness and response plan. The adoption addresses the health and safety needs of clients who reside in a residence and clients admitted to or residing in a hospice facility during a disaster.

The adopted amendments on emergency planning conform with the recommendations of DADS' Emergency Task Force; the Governor's Task Force on Evacuation, Transportation, and Logistics; a written report from the United States Government Accountability Office on disaster preparedness for vulnerable populations; and current guidance from the Centers for Medicare and Medicaid Services on emergency preparedness. The recommendations were made in response to the lessons learned by federal, state, and local governments from the devastating hurricane season of 2005 in an effort to improve public health emergency preparedness and response.

The amendments are also adopted in response to Executive Order RP57, issued by the Governor of the State of Texas on March 21, 2006. This order directed coordination among DADS and other state entities to ensure the safe and efficient evacuation of Texans with special needs in the event of a disaster. This includes developing criteria for evacuation plans for all special needs facilities and ensuring that local jurisdictions approve evacuation plans maintained by special needs facilities.

The adoption of new §97.259 ensures that any initial training obtained prior to designation is obtained within the 12 months immediately preceding the date of designation to the position, allows a person to obtain the additional 16 hours of training prior to the date of designation, and adds that any of the additional 16 hours of initial training not on topics specified in this section may include other subjects related to the duties of an administrator.

The adoption of new §97.260 adds documentation requirements for continuing education and adds that any of the 12 hours of continuing education that are not on topics specified in this section may include other subjects related to the duties of an administrator.

Five minor editorial changes were made to the texts of §§97.2, 97.256, and 97.405 to clarify and improve the accuracy of the sections.

DADS received a written comment from the Coalition for Nurses in Advanced Practice (CNAP). A summary of the comment and the response follow.

Comment: Since the word "practitioner" is defined in the Texas State Board of Pharmacy Rules in 22 TAC §291.31 (relating to definitions) as including physicians and advanced practice nurses as practitioners who may prescribe medications, biologicals, and medical devices, CNAP recommended changing the word "physician" in §97.405(y)(1) to "practitioner." They also noted that "practitioner" is also defined in §97.2(76) of this chapter.

Response: The agency agrees that a physician's duties, including those referenced in §97.405(y)(1), may be delegated in accordance with applicable state law, including Chapter 157 of the Occupations Code. However, the agency prefers to make such a clarifying change when it can make similar changes to other sections in the chapter at the same time. Therefore, the agency declines to make the suggested change at this time.

The amendments are adopted under Texas Government Code, §531.0055, which provides that the HHSC executive commissioner shall adopt rules for the operation and provision of services by the health and human services agencies, including DADS; Texas Human Resources Code, §161.021, which provides that the Aging and Disability Services Council shall study and make recommendations to the HHSC executive commissioner and the DADS commissioner regarding rules governing the delivery of services to persons who are served or regulated by DADS; and Texas Health and Safety Code, Chapter 142, which provides the Aging and Disability Services Council with the authority to make recommendations regarding rules governing licensing and regulation of home and community support services agencies.