The Texas Health and Human Services Commission (HHSC) proposes, on behalf of the Department of Aging and Disability Services (DADS), new Chapter 15, §§15.1 - 15.5, 15.101 - 15.122, 15.201 - 15.211, 15.301 - 15.311, 15.401 - 15.419, 15.501 - 15.511, 15.601 - 15.608, 15.701 - 15.708, 15.801 - 15.803, 15.901 - 15.906, 15.1001 - 15.1004, 15.1101, 15.1102, 15.1201 - 15.1224, 15.1301 - 15.1305, and 15.1401 - 15.1409, concerning Licensing Standards for Prescribed Pediatric Extended Care Centers.

BACKGROUND AND PURPOSE

The purpose of the proposal is to establish rules to license and regulate prescribed pediatric extended care center services in Texas in response to Senate Bill 492, 83rd Legislature, Regular Session, 2013, which enacted Texas Health and Safety Code (THSC) Chapter 248A. A prescribed pediatric extended care center provides services to medically dependent and technologically dependent individuals who are younger than age 21.

The proposal authorizes a licensed prescribed pediatric extended care center to provide a location where individuals with medically complex conditions may receive daily medical care in a non-residential setting. When prescribed by a physician, the individual can attend a prescribed pediatric extended care center up to a maximum of 12 hours per day to receive medical, nursing, psychosocial, therapeutic, and developmental services appropriate to the individual's medical condition and developmental status.

The proposal establishes licensing procedures and requirements, provides definitions for the program, establishes minimum standards designed to protect the health and safety of individuals served by a center, and establishes procedures for enforcement actions that DADS may take against a center.

The legislation mandates that prescribed pediatric extended care centers be licensed as of January 1, 2015.

SECTION-BY-SECTION SUMMARY

Proposed new §15.1 states the purpose of Chapter 15, which is to implement THSC 248A by adopting minimum standards that a person must meet to be licensed as a center. The new section also establishes that a person may not own or operate a center unless the person holds a license issued by DADS under THSC Chapter 248A and proposed new Chapter 15.

Proposed new §15.2 states that Chapter 15 establishes minimum standards for centers to promote the health, safety and welfare of minors served by a center. The section also explains that the standards are to ensure the provision of medical, nursing, psychosocial, therapeutic, and developmental services to a minor, and to meet the caregiver training needs of a minor's parent. The standards are the basis for inspection activities for licensure. The section also explains that the phrases "at a center" and "at the center" mean the premises of a center and vehicles used for transportation, if transportation is provided by the center.

Proposed new §15.3 establishes the applicability of the chapter, regardless of a center's funding sources. The section also provides that services provided by a center are not intended to supplant a minor's access to Medicaid private duty nursing and must not supplant services afforded to a minor by the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973.

Proposed new §15.4 establishes that compliance with THSC Chapter 248A and the minimum standards in Chapter 15 is required to maintain a prescribed pediatric extended care center license, and that Chapter 15 controls if there is a conflict with a local, county, or municipal ordinance.

Proposed new §15.5 defines certain terms used in Chapter 15. In particular, the term "minor" means an individual who is younger than 21 years of age who is medically dependent or technologically dependent, which is consistent with the terminology used in THSC 248A.

Proposed new §15.101 establishes some of the general eligibility criteria and operating requirements for a center.

Proposed new §15.102 describes the process and requirements to apply for a center license.

Proposed new §15.103 requires a center to obtain building approval from the local fire authority or the state fire marshal for a license, and to notify the local health authority for a license other than a renewal license.

Proposed new §15.104 describes some of the information that must be disclosed by an applicant for a center license and requires an applicant or license holder to provide additional information requested by DADS within 30 days after the request.

Proposed new §15.105 establishes the application procedures for an initial center license, including requirements for pre-licensing program training, a letter of credit, Life Safety Code and health inspections, and building approval. The section describes the criteria DADS considers for granting an initial license. The section describes the content of the license and prohibits the license from being transferred or assigned. The section allows an applicant to request an administrative hearing if its application is denied. The section provides that an initial license expires on the second anniversary after its effective date.

Proposed new §15.106 establishes the procedures to renew a center license, including providing that if a license holder does not timely submit a renewal application to DADS, DADS denies the renewal application. The section states that the license holder is not eligible to renew the license and must cease operation on the date the license expires. The section describes the criteria DADS considers for issuing a renewal license. In addition, the section describes the process for a center to show compliance before a renewal license is denied. The section also allows a license holder to request an administrative hearing if its application is denied. The section provides that a renewal license expires on the second anniversary after its effective date.

Proposed new §15.107 describes when a change of ownership occurs. The section also states that DADS may propose to take enforcement action against a center's license if any controlling person or any person required to submit background and qualification information fails to meet the criteria for a license.

Proposed new §15.108 establishes procedures for applying for a change of ownership license. The section provides that a license holder's license becomes invalid on the date DADS acknowledges a change of ownership and that the prospective new license holder must obtain a new license. The section also requires submission of a change of ownership application 30 days before the anticipated change of ownership.

Proposed new §15.109 establishes standards for a center to apply for a license with increased licensed capacity, including requirements for a letter of credit, Life Safety Code and health inspections, and building approval. The section describes the criteria DADS considers for granting an increased capacity license. The section allows an applicant to request an administrative hearing if the application is denied.

Proposed new §15.110 establishes the notification requirements if a center wants to decrease its licensed capacity.

Proposed new §15.111 establishes the procedures for a center to relocate its business operations to another location. The section prohibits a license holder from providing services at a new location without approval from DADS and requires the license holder to submit an application for an initial license. The section describes the requirements for obtaining the new license, including a letter of credit, Life Safety Code and health inspections, and building approval. The section describes the criteria DADS considers for granting the relocation license. The section allows an applicant to request an administrative hearing if the application is denied.

Proposed new §15.112 establishes the fees for a license and for a late fee. The section provides that, in general, the license fee is not refundable.

Proposed new §15.113 establishes the fees for DADS review of plans for new buildings, additions, conversion of buildings not previously licensed by DADS, and remodeling of licensed existing buildings.

Proposed new §15.114 establishes the time periods during which DADS processes a license application for an initial license, renewal of a license and a change of ownership. If an application is not processed within the required timeframe, the license holder may request a refund of the fee.

Proposed new §15.115 sets forth the reasons DADS may deny an initial or renewal application. The section allows an applicant to request an administrative hearing if its application is denied.

Proposed new §15.116 requires a center to display the license in a conspicuous location, readily visible to a person entering the center.

Proposed new §15.117 prohibits altering a center's license.

Proposed new §15.118 establishes procedures for reporting a change in a center's application information.

Proposed new §15.119 establishes procedures for notifying DADS of changes in a center's administrative and management staff.

Proposed new §15.120 establishes procedures for notifying DADS of a change in the center's telephone number and mailing address.

Proposed new §15.121 establishes procedures for notifying DADS of a change in a center's operating hours.

Proposed new §15.122 establishes procedures for notifying DADS of a change in a center's name that does not qualify as a change of ownership.

Proposed new §15.201 requires a center to adopt and enforce a written policy identifying the center's operating hours. The section prohibits a center from allowing services to be provided to a minor for more than 12 hours in any 24-hour period and from providing services overnight.

Proposed new §15.202 establishes standards for a center's voluntary suspension of operations for five or more consecutive days and when the center has at least 15 days advance notice of the suspension.

Proposed new §15.203 requires a center to have the financial ability to carry out its functions. The section also requires a center to make business records available to DADS and provides standards for making entries into records and maintaining records.

Proposed new §15.204 requires a center to adopt and enforce written policies ensuring accurate filing of bills and insurance claims and for preventing, detecting, and reporting fraud, waste, and abuse.

Proposed new §15.205 establishes standards to ensure a center implements safety provisions, including policies regarding fire drills, medical emergencies, transporting minors to an emergency medical facility, verifying and monitoring visitors, releasing minors, hand-rub dispensers, and weapons.

Proposed new §15.206 establishes standards for the development of policy regarding acceptable person-centered direction and guidance used at the center. The section allows timeout under certain conditions and prohibits negative discipline techniques. The section requires a center to establish a person-centered direction and guidance committee to review techniques and strategies used at the center.

Proposed new §15.207 establishes standards for the use of restraints in a center. Restraints are only permitted under certain conditions described in the section. The section lists the types of restraints that may be used and circumstances under which restraints are prohibited. The section requires monitoring and notification regarding the use of restraint. The section also sets forth additional requirements for restraint used in a behavioral emergency.

Proposed new §15.208 establishes standards for the use, maintenance, and cleaning of equipment, devices, and supplies that the center must keep on the premises to meet the needs of minors and for emergency purposes. The section also requires a center to ensure the availability of necessary consumable supplies and resources, including diapers.

Proposed new §15.209 establishes standards for emergency preparedness planning and implementation. A center is required to have an emergency preparedness and response plan that describes its approach to an emergency situation and includes provisions related to each of the eight core functions of emergency management. A center must train staff on the emergency response plan. A center must have a separate fire response emergency plan and must conduct fire prevention inspections on a monthly basis.

Proposed new §15.210 requires a center to ensure a sanitary environment by following accepted standards of practice and maintaining a safe physical environment free of hazards. The section establishes standards for sanitation, housekeeping, and the handling of linen.

Proposed new §15.211 requires a center to establish an infection prevention and control program. The section sets forth other requirements a center must meet to control communicable diseases and to control an identified public health disaster as defined in the rule. The section also establishes requirements related to vaccinations.

Proposed new §15.301 establishes that a center license holder is responsible for the operation of the center and for compliance with all enforcement orders issues by DADS. A center must designate an administrator and alternate administrator.

Proposed new §15.302 requires a center to prepare and maintain a current written description of the center's organizational structure and lines of authority that includes a description of the services provided by the center.

Proposed new §15.303 establishes the qualifications for a center administrator and alternate administrator.

Proposed new §15.304 establishes the responsibilities of a center administrator.

Proposed new §15.305 establishes the initial educational training requirements for an administrator and alternate administrator.

Proposed new §15.306 establishes the continuing educational training requirements for an administrator and alternate administrator.

Proposed new §15.307 establishes the qualifications for the medical director of a center.

Proposed new §15.308 establishes the responsibilities of the medical director of a center.

Proposed new §15.309 establishes the qualifications of the nursing director and alternate nursing director of a center. The section also sets forth the requirements related to staffing ratios for these positions.

Proposed new §15.310 establishes standards for quality of care, service delivery, supervision of nursing staff, and implementation of staffing policies by the nursing director of a center.

Proposed new §15.311 requires a center to adopt and enforce a written policy prohibiting the solicitation in accordance with Texas Occupations Code, Chapter 102.

Proposed new §15.401 requires a center to maintain sufficient registered and licensed vocational nurses on staff to ensure that the services are provided in accordance with the minor's plan of care.

Proposed new §15.402 establishes the minimum qualifications for a registered nurse providing services on behalf of a center.

Proposed new §15.403 establishes the responsibilities of a registered nurse providing services on behalf of a center.

Proposed new §15.404 establishes the qualifications for a licensed vocational nurse providing services on behalf of a center.

Proposed new §15.405 establishes the responsibilities of a licensed vocational nurse providing services on behalf of a center.

Proposed new §15.406 establishes the conditions under which a student nurse may provide care at a center.

Proposed new §15.407 requires a center to adopt and enforce a policy to ensure compliance with the rules of the Texas Board of Nursing at 22 TAC Chapters 221, 213 - 217 and 219 - 226, regarding nurse continuing education, licensure, and practice.

Proposed new §15.408 requires a center to adopt and enforce a policy that complies with rules of the Texas Board of Nursing at 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments).

Proposed new §15.409 establishes the qualifications for direct care staff providing services on behalf of a center.

Proposed new §15.410 establishes the nursing services staffing ratios required for a center. Nursing service staff includes registered nurses, licensed vocational nurses, and direct care staff. The staffing ratio is based on the number of minors on the center's actual census that are receiving nursing services from the center. The section also describes the documentation that must be maintained by a center to support compliance with the ratios.

Proposed new §15.411 establishes the qualifications for rehabilitative and ancillary professional staff providing services or supervising services on behalf of a center. In addition to valid licensure, one year of experience in pediatric care within a health care setting is required for many of the disciplines. The section also provides that a center must not include rehabilitative professionals in the staffing ratios.

Proposed new §15.412 requires a center to adopt and enforce a written policy to ensure that all professionals comply with the appropriate professional practice act relating to reporting and peer review.

Proposed new §15.413 sets forth provisions that must be contained in a contract between a center and an independent contractor who provides services at the center. A center is required to maintain a contract management system to ensure the services provided by a contractor are accurately documented and systematically organized. A center is not required to maintain a personnel record for a contractor but must have documentation to show that the contractor meets the qualifications for the duties performed.

Proposed new §15.414 establishes the qualifications for volunteers used by a center. The volunteers must be used in defined roles and supervised by designated center staff. A center must not include volunteers at the center's staffing ratios.

Proposed new §15.415 requires a center to adopt and enforce staffing policies that govern employees, volunteers and contractors. The section sets forth the areas that must be addressed in the staffing policies. The section requires a center to adopt and enforce written policies for parent orientation and training programs and sets forth the topics that must be addressed in the policies.

Proposed new §15.416 establishes the required elements for a center's staff development program. A center must document certain information relating to all staff development and maintain the documentation for two years. Documentation of training that is for individualized services to a specific minor must be maintained as part of the minor's medical record.

Proposed new §15.417 establishes the requirements for a center's personnel records for an employee or volunteer.

Proposed new §15.418 establishes standards for the background checks a center must perform for licensed and unlicensed staff. It also sets forth the actions a center must take in response to the results of the background checks.