Texas Department of Aging and Disability Services
Licensing Standards for Medication Aides Handbook
Revision: 12-1

§95.101  Introduction

(a)
Purpose. The purpose of this chapter is to implement the provisions of the:
(1)
Health and Safety Code, Chapter 242, Subchapter N, concerning the administration of medications to facility residents;
(2)
Health and Safety Code, Chapter 142, Subchapter B, concerning the administration of medication by a home and community support services agency; and
(3)
Human Resource Code, 161.083, concerning the administration of medication to an inmate in a correctional facility.
(b)
Corrections medication aide permit requirements. Section 95.125 of this chapter (relating to Requirements for Corrections Medication Aides) applies to a corrections medication aide or an applicant for a corrections medication aide permit.
(c)
Definitions. The following words and terms, when used in this Chapter, have the following meanings, unless the context clearly indicates otherwise.
(1)
Abuse – The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.
(2)
BON – Texas Board of Nursing.
(3)
Correctional facility – a facility operated by or under contract with the Texas Department of Criminal Justice.
(4)
DADS – Department of Aging and Disability Services.
(5)
Examination – A written competency evaluation for medication aides administered by DADS.
(6)
Facility – An institution licensed under the Health and Safety Code, Chapter 242; a state supported living center as defined in the Health and Safety Code, 531.002(17); an intermediate care facility for persons with an intellectual disability operated by a community center established under Health and Safety Code, Chapter 534; or an assisted living facility licensed under the Health and Safety Code, Chapter 247.
(7)
Licensed nurse – A licensed vocational nurse or a licensed registered nurse.
(8)
Licensed vocational nurse – A person licensed by the BON , or who holds a license from another state recognized by the BON, to practice vocational nursing in Texas.
(9)
Medication aide – A person permitted by DADS to administer medications to facility residents, correctional facility inmates, or to persons served by home and community support services agencies.
(10)
Misappropriation of resident property – The deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent.
(11)
Neglect – The failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.
(12)
Non-licensed direct care staff – Employees of facilities other than Medicare-skilled nursing facilities or Medicaid nursing facilities who are primarily involved in the delivery of services to assist with residents' activities of daily living or active treatment programs.
(13)
Nurse aide – An individual who has completed a nurse aide training and competency evaluation program (NATCEP) approved by the state as meeting the requirements of 42 Code of Federal Regulations (CFR), §§483.151 - 483.154, or has been determined competent as provided in 42 CFR, §483.150(a) and (b), and is listed as certified on DADS nurse aide registry.
(14)
Registered nurse (RN) – A person licensed by the BON, or who holds a license from another state recognized by the BON , to practice professional nursing in Texas.
(15)
Registered pharmacist – An individual currently licensed by the Texas Board of Pharmacy to practice pharmacy.
(16)
TDCJ – Texas Department of Criminal Justice.
(17)
Training program – A program approved by DADS to instruct individuals to act as medication aides.

§95.103  Requirements for Administering Medications

(a)
General. A person may not administer medication to a resident in a facility or a correctional facility unless the person:
(1)
holds a current license under state law which authorizes the licensee to administer medication; or
(2)
if administering medication in a facility, holds a current permit issued under Health and Safety Code, Chapter 242, Subchapter N, or if administering medication in a correctional facility, holds a current permit issued under Human Resources Code, 161.083 or Health and Safety Code, Chapter 242, Subchapter N and acts under the authority of a person who holds a current license under state law which authorizes the licensee to administer medication.
(b)
Supervision and applicable law and rules. A permit holder must function under the direct supervision of a licensed nurse on duty or on call by the facility or correctional facility using the permit holder. A permit holder must:
(1)
function in accordance with applicable law and rules relating to administration of medication and operation of a facility or a correctional facility; and
(2)
comply with DADS rules applicable to personnel used in a facility or TDCJ rules applicable to personnel in a correctional facility.
(c)
Governmental employees. Governmental employees may receive a permit to administer medications under this chapter as authorized by Health and Safety Code, 242.610(f) or Human Resources Code, 161.083:
(1)
State supported living center employees and employees of an intermediate care facility for persons with an intellectual disability operated by a community center established under Health and Safety Code, Chapter 534 must comply with subsection (b) of this section and 95.105, 95.107, 95.109, 95.111, 95.113, 95.115, 95.117, 95.119, 95.121, and 95.123 of this chapter (relating to Allowable and Prohibited Practices of a Permit Holder; Training Requirements, Nursing Graduates, Reciprocity; Application Procedures; Examination; Determination of Eligibility; Permit Renewal; Changes; Training Program Requirements; Permitting of Persons with Criminal Backgrounds; and Violations, Complaints, and Disciplinary Actions).
(2)
Correctional facility employees and employees of medical services contractors for a correctional facility who administer medication as medication aides must comply with 95.125 of this chapter (relating to Requirements for Corrections Medication Aides).
(d)
Medication aides in nursing facilities. Persons employed as medication aides in a Medicare skilled nursing facility or a Medicaid nursing facility must comply with the requirements relating to nurse aides as set forth in the Omnibus Budget Reconciliation Act of 1987, Public Law 100-203, 4201-4214, December 22, 1987, as amended, and Chapter 94 of this title (relating to Nurse Aides).
(e)
Exemptions.
(1)
A person may administer medication to a resident in a facility without the license or permit as required in subsection (a) of this section, if the person is:
(A)
a graduate nurse holding a temporary permit issued by the BON;
(B)
a student enrolled in an accredited school of nursing or program for the education of registered nurses who is administering medications as part of the student's clinical experience;
(C)
a graduate vocational nurse holding a temporary permit issued by the BON;
(D)
a student enrolled in an accredited school of vocational nursing or program for the education of vocational nurses who is administering medications as part of the student's clinical experience; or
(E)
a trainee in a medication aide training program approved by DADS under this chapter who is administering medications as part of the trainee's clinical experience.
(2)
A student described in paragraph (1)(B), (D), or (E) of this subsection may administer medication only as part of the student's clinical experience
(3)
A person described in paragraph (1) of this subsection must act under the supervision of an individual as set forth in applicable law and rules.

§95.105  Allowable and Prohibited Practices of a Permit Holder

(a)
A permit holder under Health and Safety Code, Chapter 242, Subchapter N, may:
(1)
observe and report to the facility's charge licensed nurse reactions and side effects to medication shown by a resident;
(2)
take and record vital signs prior to the administration of medication which could affect or change the vital signs;
(3)
administer regularly prescribed medication which the permit holder has been trained to administer only after personally preparing (setting up) the medication to be administered. The medication aide must document the administered medication in the resident's clinical record;
(4)
administer oxygen per nasal canula or a non-sealing mask only in an emergency. Immediately after the emergency, the permit holder must verbally notify the licensed nurse on duty or on call and appropriately document the action and notification; and
(5)
apply specifically ordered ophthalmic, otic, nasal, vaginal, and rectal medication.
(b)
A permit holder under Health and Safety Code, Chapter 242, Subchapter N, may not:
(1)
administer medication by the injection route including:
(A)
intramuscular route;
(B)
intravenous route;
(C)
subcutaneous route;
(D)
intradermal route; and
(E)
hypodermoclysis route;
(2)
administer medication used for intermittent positive pressure breathing (IPPB) treatments or any form of medication inhalation treatments;
(3)
administer previously ordered pro re nata (PRN) medication unless authorization is obtained from the facility's licensed nurse on duty or on call. If authorization is obtained, permit holders must:
(A)
document, in the resident's records, symptoms indicating the need for the medication and the time the symptoms occurred;
(B)
document in the resident's records that the facility's licensed nurse was contacted, symptoms were described, and permission was granted to administer the medication, including the time of contact;
(C)
obtain permission to administer the medication each time the symptoms occur in the resident; and
(D)
ensure that the resident's record is co-signed by the licensed nurse who gave permission by the end of the nurse's shift, or if the nurse was on call, by the end of the nurse's next tour of duty;
(4)
administer the initial dose of a medication that has not been previously administered to a resident. Whether a medication has been previously administered must be determined by the resident's current clinical records;
(5)
calculate a resident's medication doses for administration, except that the permit holder may:
(A)
measure a prescribed amount of a liquid medication to be administered; and
(B)
break a tablet for administration to a resident, provided the licensed nurse on duty or on call has calculated the dosage. The resident's medication card or its equivalent must accurately document how the tablet must be altered prior to administration;
(6)
crush medication, unless authorization is obtained from the licensed nurse on duty or on call. The authorization to crush the specific medication must be documented on the resident's medication card or its equivalent;
(7)
administer medications or feedings by way of a tube inserted in a cavity of the body;
(8)
receive or assume responsibility for reducing to writing a verbal or telephone order from a physician, dentist, or podiatrist;
(9)
order a resident's medications from a pharmacy;
(10)
apply topical medications that involve the treatment of skin that is broken or blistered or when a specified aseptic technique is ordered by the attending physician;
(11)
steal, divert, or otherwise misuse medication;
(12)
violate any provision of the Health and Safety Code or this chapter;
(13)
fraudulently procure or attempt to procure a permit;
(14)
neglect to administer appropriate medications, as prescribed, in a responsible manner; or
(15)
administer medications if the person is unable to do so with reasonable skill and safety to residents by reason of drunkenness and/or excessive use of drugs, narcotics, chemicals, or any other type of material.

§95.107  Training Requirements; Nursing Graduates; Reciprocity

(a)
Each applicant for a permit issued under Health and Safety Code, Chapter 242, Subchapter N, must complete a training program unless the applicant meets the requirements of subsection (c) or (d) of this section.
(b)
Prior to application for a permit under Health and Safety Code, Chapter 242, Subchapter N, an applicant must:
(1)
be able to read, write, speak, and understand English;
(2)
be at least 18 years of age;
(3)
be free of communicable diseases and in suitable physical and emotional health to safely administer medications;
(4)
be a graduate of a high school or have a general equivalency diploma;
(5)
be currently employed in a facility as a nurse aide or nonlicensed direct care staff person on the first official day of an applicant's medication aide training program; and
(6)
have been employed in a facility for 90 days as a nonlicensed direct care staff person. This employment must have been completed within the 12-month period preceding the first official day of the applicant's medication aide training program. An applicant employed as a nurse aide in a Medicare-skilled nursing facility or a Medicaid nursing facility is exempt from the 90-day requirement.
(c)
A person who is attending or has attended an accredited school of nursing and who does not hold a license to practice professional or vocational nursing meets the training requirement for issuance of a permit under Health and Safety Code, Chapter 242, Subchapter N, if the person:
(1)
attended the nursing school no earlier than January I of the year immediately preceding the year of application for a permit under this chapter;
(2)
successfully completed courses at the nursing school that cover DADS curriculum for a medication aide training program;
(3)
submits a statement on the form provided by DADS that is signed by the nursing school's administrator or other authorized individual and certifies that the person completed the courses specified in paragraph (2) of this subsection. The administrator is responsible for determining that the courses he certifies cover DADS curriculum. The statement must be submitted with the person's application for a permit and permit application fee as provided in 95.109 of this chapter (relating to Application Procedures); and
(4)
complies with subsection (d)(5) and (6) of this section.
(d)
A person who is a graduate of an accredited school of nursing and who does not hold a license to practice professional or vocational nursing meets the training requirement for issuance of a permit under Health and Safety Code, Chapter 242, Subchapter N, provided the date of graduation from the nursing school was no earlier than January 1 of the year immediately preceding the year of application for a permit under this chapter.
(1)
The graduate must submit an official application form to DADS by the graduate. The applicant must meet the requirements of subsection (b)(l)-(4) of this section.
(2)
The application must be accompanied by the permit application fee as set out in 95.109(c) of this chapter.
(3)
The applicant must include an official transcript documenting graduation from an accredited school of nursing.
(4)
DADS acknowledges receipt of the application by sending the applicant a copy of this chapter and DADS open book examination.
(5)
The applicant must complete the open book examination and return it to DADS by the date given in the examination notice.
(6)
The applicant must complete DADS written examination. DADS denies the application of an applicant failing to schedule and take the examination by the date given in the examination notice.
(7)
An open-book or written examination may not be retaken if the applicant fails.
(8)
Upon successful completion of the two examinations, DADS evaluates all application documents submitted by the applicant.
(9)
DADS notifies the applicant in writing of the examination results.
(e)
A person who holds a valid license, registration, certificate, or permit as a medication aide issued by another state whose minimum standards or requirements are substantially equivalent to or exceed the requirements of Health and Safety Code, Chapter 242, Subchapter N, in effect at the time of application, may request a waiver of the training program requirement as follows:
(1)
The applicant must submit an official application form to DADS. The applicant must meet the requirements of subsection (b)(l)-(4) of this section.
(2)
The application must be accompanied by the permit application fee required in 95.109(c) of this chapter.
(3)
The application must include a current copy of the rules of the other state governing its licensing and regulation of medication aides, a copy of the legal authority (law, act, code, or other) for the state's licensing program, and a certified copy of the license or certificate for which the reciprocal permit is requested.
(4)
DADS acknowledges receipt of the application by sending the applicant a copy of this chapter and DADS open book examination.
(5)
DADS may contact the issuing agency to verify the applicant's status with the agency.
(6)
The applicant must complete DADS open-book examination and return it to DADS by the date given in the examination notice.
(7)
The applicant must complete DADS written examination. The site of the examination is determined by DADS. DADS denies the application of an applicant failing to schedule and take the examination by the date given in the examination notice.
(8)
An open-book or written examination may not be retaken if the applicant fails.
(9)
Upon successful completion of the two examinations, DADS evaluates all application documents submitted by the applicant.
(10)
DADS notifies the applicant in writing of the examination results.

§95.109  Application Procedures

(a)
An applicant for permit under Health and Safety Code, Chapter 242, Subchapter N, who complies with 95.107(a) of this chapter (relating to Training Requirements; Nursing Graduates; Reciprocity) must submit to DADS, no later than 30 days after enrollment in a training program, an application, including all required information and documentation on DADS forms.
(b)
DADS considers an application under subsection (a) of this section as officially submitted when DADS receives the permit application and examination fee.
(c)
Payment of fees must be by cashier's check or money order made payable to the Department of Aging and Disability Services. All fees are nonrefundable, except as provided by Government Code, Chapter 2005.
(1)
The fee schedule is as follows:
(A)
combined permit application and examination fee - $25;
(B)
renewal fee - $15;
(C)
late renewal fees for permit renewals made after the permit expires:
(i)
$22.50 for an expired permit renewed from one to 90 days after expiration;
(ii)
$30 for an expired permit renewed from 91 days to one year after expiration;
(iii)
$30 for a former permit holder who meets the criteria in 95.115(c)(5) of this chapter (relating to Permit Renewal); and
(D)
permit replacement fee - $5.
(2)
An initial or a renewal application is considered incomplete until the fee has been received and cleared through the appropriate financial institution.
(d)
All applicants must submit the following application materials.
(1)
The general statement enrollment form must contain:
(A)
specific information regarding personal data, certain misdemeanor and felony convictions, work experience, education, and training;
(B)
a statement that all the requirements in 95.107(b) of this chapter were met prior to the start of the program;
(C)
a statement that the applicant understands that application fees submitted in the permit process are nonrefundable;
(D)
a statement that the applicant understands materials submitted in the application process are nonreturnable;
(E)
a statement that the applicant understands that it is a misdemeanor to falsify any information submitted to DADS; and
(F)
the applicant's signature which has been dated and notarized.
(2)
A certified copy or a photocopy which has been notarized as a true and exact copy of an unaltered original of the applicant's high school graduation diploma or transcript or a general equivalency diploma, unless the applicant is applying under 95.107(d) of this chapter.
(e)
DADS sends notice listing the additional materials required to an applicant who does not complete the application. An application not completed by the day of the medication aide final exam must be voided.
(f)
DADS sends notice of application acceptance or ineligibility, disapproval, or deficiency in accordance with 95.127 of this chapter (relating to Application Processing).

§95.111  Examination

(a)
DADS gives a written examination to each applicant at a site determined by DADS.
(1)
The applicant must meet the requirements of §95.107 of this title (relating to Training Requirements; Nursing Graduates; Reciprocity) and §95.109 of this title (relating to Application Procedures) before taking the written examination.
(2)
The applicant is tested on the subjects taught in the training program curricula and clinical experience. The examination covers an applicant's knowledge of accurate and safe drug therapy that will be administered to a facility's residents.
(3)
The examination must be given after the applicant has successfully completed the training program or met the requirements of §95.107(c)-(e) of this title (relating to Training Requirements; Nursing Graduates; Reciprocity).
(4)
An applicant with a disability, including an applicant with dyslexia as defined in Texas Education Code §51.970 (relating to Instructional Material for Blind and Visually Impaired Students and Students with Dyslexia), may request a reasonable accommodation for the examination under the Americans with Disabilities Act.
(5)
Staff of a training program must notify DADS at least four weeks prior to its requested examination date.
(6)
DADS determines the passing grade on the examination.
(7)
If DADS grades or reviews the examination, DADS notifies the applicant of the results of the examination not later than the 30th day after the date the applicant took the examination.
(8)
If a testing service grades or reviews the examination:
(A)
DADS notifies the applicant of the results of the examination not later than the 14th day after the date DADS receives the results from the testing service; and
(B)
if notice of the examination results will be delayed for longer than 90 days after the examination date, DADS notifies the applicant of the reasons for the delay before the 90th day.
(9)
DADS may require a testing service to notify an applicant of the results of the applicant's examination.
(10)
DADS notifies in writing an applicant who fails the examination.
(A)
DADS may give an applicant under §95.107(a) of this title one subsequent examination, without additional payment of a fee, upon the applicant's written request to DADS.
(B)
A subsequent examination must be completed by the date given in the failure notification. The site of the examination is determined by DADS.
(C)
DADS gives no further examinations if the student fails the subsequent examination, unless the student enrolls in and successfully completes another training program.
(D)
If requested in writing by an applicant who fails the examination, DADS furnishes the applicant with an analysis of the applicant's performance on the examination.

(b)
An applicant who is unable to attend the applicant's scheduled examination due to unforeseen circumstances may be given an examination at another time without payment of an additional fee upon the applicant's written request to DADS. The examination must be completed within 45 days from the date of the originally scheduled examination. The rescheduled examination must be at a site determined by DADS.
(c)
An applicant whose application for a permit must be denied under §95.113 of this title (relating to Determination of Eligibility) is ineligible to take the examination.

§95.113  Determination of Eligibility

(a)
DADS approves or denies each application for a permit.
(b)
Notices of application approval, denial, or deficiency must be in accordance with 95.127 of this chapter (relating to Application Processing).
(c)
DADS denies an application for a permit if the person has:
(1)
not met the requirements in 95.107 of this chapter (relating to Training Requirements; Nursing Graduates; Reciprocity), or 95.125 of this chapter (relating to Requirements for Corrections Medication Aides);
(2)
failed to pass the examination prescribed by DADS, as referenced in 95.111 of this chapter (relating to Examination), or developed by TDCJ, as referenced in 95.125(g) of this chapter;
(3)
failed to or refused to properly complete or submit any application form or fee or deliberately presented false information on any form or document required by DADS;
(4)
violated or conspired to violate the Health and Safety Code, Chapter 242, Subchapter N, Human Resources Code, 161.083, or any provision of this chapter; or
(5)
been convicted of a felony or misdemeanor if the crime directly relates to the duties and responsibilities of a permit holder as set out in 95.121 of this chapter (relating to Permitting of Persons with Criminal Backgrounds).
(d)
If, after review, DADS determines that the application should not be approved, DADS gives the applicant written notice of the reason for the proposed decision and of the opportunity for a formal hearing in accordance with 95.123(c)(3) of this chapter (relating to Violations, Complaints, and Disciplinary Actions).

§95.115  Permit Renewal

(a)
General.
(1)
When issued, an initial permit is valid for 12 months from the date of issue.
(2)
A permit holder must renew the permit annually.
(3)
Each permit holder is responsible for renewing the permit before the expiration date. Failure to receive notification from DADS prior to the expiration date does not excuse the permit holder's failure to file for timely renewal.
(4)
A permit holder must complete a seven-clock-hour continuing education program approved by DADS prior to expiration of the permit in order to renew the permit. Continuing education hours are not required for the first renewal. After a permit is renewed for the first time, the permit holder must earn approved continuing education hours to have the permit renewed again.
(5)
DADS denies renewal of the permit of a permit holder who is in violation of Health and Safety Code, Chapter 242, Subchapter N, Human Resources Code, 161.083, or this chapter at the time of application for renewal.
(6)
A person whose permit has expired may not engage in activities that require a permit until the permit has been renewed.
(b)
Permit renewal procedures.
(1)
After receiving proof of the successful completion of the seven-clock-bour continuing education requirement, DADS sends to the permit holder, at the address listed in DADS records, notice of the expiration date of the permit and the amount of the renewal fee due and a renewal form that the permit holder must complete and return with the required renewal fee. If DADS does not receive proof of the successful completion of the continuing education requirement, DADS sends the permit holder a reminder notice about the required continuing education hours.
(2)
The renewal form includes the preferred mailing address of the permit holder and information on certain misdemeanor and felony convictions. It must be signed by the permit holder.
(3)
DADS issues a renewal permit to a permit holder who has met all requirements for renewal.
(4)
A person who is otherwise eligible to renew a permit may renew an unexpired permit by paying the required renewal fee to DADS before the expiration date of the permit.
(c)
Late renewal procedures.
(1)
A person whose permit has been expired for less than one year may renew the permit by submitting to DADS:
(A)
the permit renewal form;
(B)
all accrued renewal fees;
(C)
proof of having earned, during the expired period, seven hours in an approved continuing education program for each year, or part of a year, since the permit expired; and
(D)
proof of having earned, prior to expiration of the permit, seven hours in an approved continuing education program as required in subsection (a)(4) of this section.
(2)
A person whose permit has been expired for 90 days or less must pay DADS the late renewal fee stated in 95.109(c)(1)(C)(i) of this chapter (relating to Application Procedures) or 95.125(f)(3)(A) of this chapter (relating to Requirements for Corrections Medication Aides).
(3)
A person whose permit has been expired for more than 90 days but less than one year must pay DADS the late renewal fee stated in 95.109(c)(1)(C)(ii) or 95.125(f)(3)(B) of this chapter.
(4)
A person whose permit has been expired for one year or more may not renew the permit. The person may obtain a new permit by complying with the requirements and procedures, including the examination requirements, for obtaining an original permit.
(5)
A person who previously held a permit in Texas issued under Health and Safety Code, Chapter 242, Subchapter N, may obtain a new permit without reexamination if the person holds a facility medication aide permit from another state, practiced in that state for at least the two years preceding the application date, and pays to DADS the late renewal fee stated in 95.109(c)(1)(C)(iii) of this chapter.

§95.117  Changes

(a)
A permit holder must notify DADS within 30 days after changing his or her address or name.
(b)
DADS replaces a lost, damaged, or destroyed permit upon receipt of a completed duplicate permit request form and permit replacement fee as set out in 95.109(c) of this chapter (relating to Application Procedures) and 95.125(f) of this chapter (relating to Requirements for Corrections Medication Aides).

§95.119  Training Program Requirements

(a)
Application. An educational institution accredited by the Texas Workforce Commission or Texas Higher Education Coordinating Board that desires to offer a training program must file an application for approval on a DADS form. Programs sponsored by state agencies for the training and preparation of their own employees are exempt from the accreditation requirement. An approved institution may offer the training program and a continuing education program.
(1)
All signatures on DADS forms and supporting documentation must be originals.
(2)
The application must include:
(A)
the anticipated dates of the program;
(B)
the location(s) of the classroom course(s);
(C)
the name of the coordinator of the program;
(D)
a list of instructors and any other persons responsible for the conduct of the program. The list must include addresses and telephone numbers for each instructor; and
(E)
an outline of the program content and curriculum if the curriculum covers more than DADS established curricula.
(3)
DADS may conduct an inspection of the classroom site.
(4)
DADS sends notice of approval or proposed denial of the application to the program within 30 days of the receipt of a complete application. If DADS proposes to deny the application due to noncompliance with the requirements of Health and Safety Code, Chapter 242, Subchapter N, or this chapter, the reasons for denial are given in the notice.
(5)
An applicant may request in writing a hearing on a proposed denial within 10 days of receipt of the notice of the proposed denial. The hearing is conducted in accordance with 1 TAC Chapter 357, Subchapter I (relating to Hearings under the Administrative Procedure Act), Chapter 91 of this title (relating to Hearings under the Administrative Procedure Act), and Texas Government Code, Chapter 2001. If no request is made, the applicant has waived the opportunity for a hearing, and the proposed action may be taken.
(b)
Basic training program.
(1)
The program must include, but is not limited to, the following instruction and training:
(A)
procedures for preparation and administration of medications;
(B)
responsibility, control, accountability, storage, and safeguarding of medications;
(C)
use of reference material;
(D)
documentation of medications in resident's clinical records, including pro re nata (PRN) medications;
(E)
minimum licensing standards for facilities covering pharmaceutical service, nursing service, and clinical records;
(F)
federal and state certification standards for participation under Title XVIII (Medicare) and Title XIX (Medicaid) of the Social Security Act pertaining to pharmaceutical service, nursing service, and clinical records;
(G)
lines of authority in the facility, including facility personnel who are immediate supervisors;
(H)
responsibilities and liabilities associated with the administration and safeguarding of medications;
(I)
allowable and prohibited practices of permit holders in the administration of medication;
(J)
drug reactions and side effects of medications commonly administered to facility residents; and
(K)
rules covering the medication aide program.
(2)
The program must consist of 140 hours in the following sequence: 100 hours of classroom instruction and training, 20 hours of return skills demonstration laboratory, 10 hours of clinical experience including clinical observation and skills demonstration under the direct supervision of a licensed nurse in a facility, and 10 more hours in the return skills demonstration laboratory. A classroom or laboratory hour must include 50 clock minutes of actual classroom or laboratory time.
(A)
Class time must not exceed:
(i)
four hours in a 24-hour period for a facility training program; or
(ii)
eight hours in a 24-hour period for a correctional facility training program.
(B)
The completion date of the program must be:
(i)
a minimum of 60 days and a maximum of 180 days from the starting date of the facility training program; or
(ii)
a minimum of 30 days and a maximum of 180 days from the starting date of a correctional facility training program.
(3)
Each program must follow the curricula established by DADS.
(4)
At least seven days prior to the beginning of each program, the coordinator must notify DADS in writing of the dates and daily hours of the program, and the projected number of students.
(5)
A change in any information presented by the program in an approved application including, but not limited to, location, instructorship, and content must be approved by DADS prior to the program's effective date of the change.
(6)
The program instructors of the classroom hours must be a registered nurse and registered pharmacist.
(A)
The nurse instructor must have:
(i)
a minimum of two years of experience in caring for individuals in a long-term care setting or be an instructor in a school of nursing, for a facility training program; or
(ii)
a minimum of two years of experience employed in a correctional setting or be an instructor in a school of nursing, for a correctional facility program.
(B)
The pharmacist instructor must have a minimum of one year of experience and be currently employed as a consultant pharmacist in a facility.
(7)
The program coordinator must provide clearly defined and written policies regarding each student's clinical experience to the student, the administrator, and the director of nursing in the facility used for the clinical experience.
(A)
The clinical experience must be counted only when the student is performing functions involving medication administration and under the direct, contact supervision of a licensed nurse.
(B)
The program coordinator must be responsible for final evaluation of the student's clinical experience.
(8)
Each program must issue to each student, upon successful completion of the program, a certificate of completion, which must include the program's name, the student's name, the date of completion, and the signature of the program coordinator or administrative official.
(9)
Each program must inform DADS on the DADS class roster form of the final grade results for each student within 15 days after completion of the course.
(c)
Continuing education training program.
(1)
The program must consist of at least seven clock hours of classroom instruction.
(2)
The instructors must meet the requirements in subsection (b)(6) of this section.
(3)
Each program must follow the curricula established by DADS or the curriculum established by TDCJ for corrections medication aides, as applicable.
(4)
Within 15 days after completion of the course, each program must inform DADS on the DADS class roster form of the name of each permit holder who who has completed the course.
(d)
TDCJ must file with DADS an application for approval for a training program and curriculum for corrections medication aides that complies with Government Code, 501.1485 (relating to Corrections Medication Aides).
(e)
In developing a training program for corrections medication aides, TDCJ may modify, as appropriate, the content of the training program curriculum originally developed under Health and Safety Code, Chapter 242, to produce content suitable for administering medication in a correctional facility. The training program curriculum must be approved by DADS.
(f)
Subsection (c) of this section applies to a training program developed by the TDCJ.

§95.121  Permitting of Persons with Criminal Backgrounds

DADS may suspend or revoke an existing permit, disqualify a person from receiving a permit or deny to a person the opportunity to be examined for a permit because of a person's conviction of a felony or misdemeanor if the crime directly relates to the duties and responsibilities of a medication aide.

(1)
In considering whether a criminal conviction directly relates to the occupation of a medication aide, DADS considers:
(A)
the nature and seriousness of the crime;
(B)
the relationship of the crime to the purposes for requiring a permit to be a medication aide. The following felonies and misdemeanors relate to the permit of a medication aide because these criminal offenses indicate an inability or a tendency to be unable to perform as a medication aide:
(i)
the misdemeanor of knowingly or intentionally acting as a medication aide without a permit issued under the Health and Safety Code, Chapter 242;
(ii)
any conviction for an offense listed in §250.006 of the Health and Safety Code;
(iii)
any conviction, other than a Class C Misdemeanor, for an offense defined under Texas Penal Code, Chapter 22, as assault; sexual assault; intentional exposure of another to AIDS or HIV; aggravated assault or sexual assault; injury to a child, elderly person, or person with disabilities; or aiding suicide;
(iv)
any conviction, except Class C Misdemeanors, with a final disposition within the last ten years, for an offense defined in the Texas Penal Code as burglary under Chapter 30; theft under §31.03; sale or display of harmful material to minors; sexual performance by a child; and possession or promotion of child pornography;
(v)
any conviction for an offense defined in the Texas Penal Code as an attempt, solicitation, conspiracy, or organized criminal activity for any offense listed in clauses (ii)-(iv) of this subparagraph; and/or
(vi)
any conviction under United States statutes or jurisdiction other than Texas for any offense equivalent to those listed in clauses (ii)-(v) of this subparagraph.
(C)
the extent to which a permit might offer an opportunity to engage in further criminal activity of the same type as that in which the person previously had been involved; and
(D)
the relationship of the crime to the ability, capacity, or fitness required to perform the duties and discharge the responsibilities of a medication aide. In determining the present fitness of a person, DADS considers the evidence described in the Occupations Code, §53.023.
(2)
DADS gives written notice to the person that DADS proposes to deny the application or suspend or revoke the permit after a hearing in accordance with the provisions of §95.123(c)(3) of this title (relating to Violations, Complaints, and Disciplinary Actions). If DADS denies, suspends, or revokes an application or permit under this chapter, DADS gives the person written notice:
(A)
of the reasons for the decision;
(B)
that the person, after exhausting administrative appeals, may file an action in a district court of Travis County for review of the evidence presented to DADS and its decision; and
(C)
that the person must begin the judicial review by filing a petition with the court within 30 days after DADS' action is final and appealable.

§95.123  Violations, Complaints, and Disciplinary Actions

(a)
Filing of complaints. Any person may complain to DADS alleging that a person or program has violated the Health and Safety Code, Chapter 242, Subchapter N; Human Resources Code, 161.083; or this chapter.
(1)
Persons who want to file a complaint against a permit holder, training program, or another person, must notify DADS by calling 1-800-458-9858 or by writing the Medication Aide Permit Program, Department of Aging and Disability Services, P.O. Box 149030, Mail Code E-416, Austin, Texas 78714-9030.
(2)
Anonymous complaints may be investigated by DADS if the complainant provides sufficient information.
(b)
Investigation of complaints. If DADS initial investigation determines:
(1)
the complaint does not come within DADS jurisdictiion, DADS advises the complainant and, if possible, refers the complainant to the appropriate governmental agency for handling the complaint.
(2)
there are insufficient grounds to support the complaint, DADS dismisses the complaint and gives written notice of the dismissal to the permit holder or person against whom the complaint has been filed and the complainant; or
(3)
there are sufficient grounds to support the complaint, DADS may propose to deny, suspend, emergency suspend, revoke, or not renew a permit or to rescind program approval.
(c)
Disciplinary actions. DADS revokes, suspends, or refuses to renew a permit or reprimands a permit holder for a violation of Health and Safety Code, Chapter 242, Subchapter N; Human Resources Code, 161.083; or this chapter. In addition, DADS may suspend a permit in an emergency or rescind training program approval.
(1)
DADS may place on probation a person whose permit is suspended. DADS may require the person on probation:
(A)
to report regularly to DADS on matters that are the basis of the probation;
(B)
to limit practice to the areas prescribed by DADS; or
(C)
to continue or pursue professional education until the person attains a degree of skill satisfactory to DADS in those areas that are the basis of the probation.
(2)
Prior to institution of formal proceedings to revoke or suspend a permit or rescind program approval, DADS gives written notice to the permit holder or program of the facts or conduct alleged to warrant revocation, suspension, or rescission, and the permit holder or program must be given an opportunity, as described in the notice, to show compliance with all requirements of the Health and Safety Code, Chapter 242, Subchapter N; Human Resources Code, 161.083; or this chapter. When there is a finding of an alleged act of abuse, neglect, or misappropriation of resident property by a permit holder employed at a Medicaid-certified nursing facility or a Medicare-certified skilled nursing facility, DADS complies with the hearings process as provided in 42 Code of Federal Regulations 488.335.
(3)
If denial, revocation, or suspension of a permit or rescission of program approval is proposed, DADS gives written notice that the permit holder or program must request, in writing, a formal hearing within 30 days of receipt of the notice, or the right to a hearing is waived and the permit is denied, revoked, or suspended or the program approval is rescinded.
(4)
The formal hearing is conducted according to formal hearing procedures at 1 TAC Chapter 357, Subchapter I (relating to Hearings under the Administrative Procedure Act) and Chapter 91 of this title (relating to Hearings under the Administrative Procedure Act).
(5)
If an alleged act of abuse, neglect, or misappropriation by a medication aide who also is a certified nurse aide under the provisions of Chapter 94 of this title (relating to Nurse Aides) violates the rules in this chapter and Chapter 94, DADS complies with the formal hearing process described in paragraph (4) of this subsection. Through the formal hearing, determinations will be made on both the permit for medication aide practice and the certificate for nurse aide practice.
(d)
Suspension, revocation, or nonrenewal. If DADS suspends a permit, the suspension remains in effect until DADS determines that the reason for suspension no longer exists or DADS revokes or determines not to renew the permit. DADS investigates prior to making a determination, and:
(1)
during the time of suspension, the suspended permit holder must return his permit to DADS;
(2)
if a suspension overlaps a permit renewal date, the suspended permit holder may comply with the renewal procedures in 95.115 of this chapter (relating to Permit Renewal); however, DADS does not renew the permit until DADS determines that the reason for suspension no longer exists;
(3)
if DADS revokes or does not renew a permit, a person may reapply for a permit by complying with the requirements and procedures in this chapter at the time of reapplication. DADS may refuse to issue a permit if the reason for revocation or nonrenewal continues to exist; and
(4)
if a permit is revoked or not renewed, a permit holder must immediately return the permit to DADS.
(e)
Complaints of abuse and neglect by medication aides who are issued a permit under Health and Safety Code, Chapter 242, Subchapter N, and employed in a correctional facility, are investigated as described in 95.125(k) of this chapter (relating to Requirements for Corrections Medication Aides).

§95.125  Requirements for Corrections Medication Aides

(a)
Purpose. The purpose of this section is to provide the qualifications, conduct, and practice activities of a medication aide employed in a correctional facility or employed by a medical services contractor for a correctional facility.
(b)
Supervision and applicable law and rules. A permit holder must function under the direct supervision of a licensed nurse on duty or on call by the correctional facility using the permit holder. A permit holder must:
(1)
function in accordance with applicable law and rules relating to administration of medication and operation of a correctional facility; and
(2)
comply with TDCJ rules applicable to personnel used in a correctional institution.
(c)
Allowable and prohibited practices of a permit holder.
(1)
A permit holder may:
(A)
observe and report to the correctional facility's charge nurse reactions and side effects to medication shown by an inmate;
(B)
take and record vital signs prior to the administration of medication which could affect or change the vital signs;
(C)
administer regularly prescribed medication which the permit holder has been trained to administer only after personally preparing (setting up) the medication to be administered. The medication aide must document the administered medication in the inmate's clinical record;
(D)
administer oxygen per nasal canula or a non-sealing face mask only in an emergency. Immediately after the emergency, the permit holder must verbally notify the licensed nurse on duty or on call and appropriately document the action and notifications;
(E)
apply specifically ordered ophthalmic, otic, nasal, vaginal, and rectal medication;
(F)
administer previously ordered pro re nata (PRN) medication. A permit holder must document in the inmate's records, symptoms indicating the need for the medication, and the time the symptoms occurred;
(G)
administer the initial dose of a medication; and
(H)
order an inmate's medications from the correctional institution's pharmacy.
(2)
A permit holder may not:
(A)
administer medication by the injection route including:
(i)
intramuscular;
(ii)
intravenous;
(iii)
subcutaneous;
(iv)
intradermal; and
(v)
hypodermoclysis;
(B)
administer medication used for intermittent positive pressure breathing (IPPB) treatments or any form of medication inhalation treatments;
(C)
calculate an inmate's medication dose for administration except that the permit holder may:
(i)
measure a prescribed amount of a liquid medication to be administered; and
(ii)
break a tablet for administration to an inmate provided the licensed nurse on duty or on call has calculated the dosage. The inmate's medication card or its equivalent must accurately document how the tablet must be altered prior to administration;
(D)
crush medication unless authorization is obtained from the licensed nurse on duty or on call. The authorization to crush the specific medication must be documented on the inmate's medication card or its equivalent;
(E)
administer medications or feedings by way of a tube inserted in a cavity of the body;
(F)
receive or assume responsibility for reducing to writing a verbal or telephone order from a physician, dentist or podiatrist;
(G)
apply topical medications that involve the treatment of skin that is broken or blistered or when a specified aseptic technique is ordered by the attending licensed practitioner;
(H)
steal, divert, or otherwise misuse medications;
(I)
violate any provision of Human Resources Code, 161.083, or this chapter;
(J)
fraudulently procure or attempt to procure a permit;
(K)
neglect to administer appropriate medications, as prescribed, in a responsible manner; or
(L)
administer medications if the person is unable to do so with reasonable skill and safety to residents by reason of drunkenness and/or excessive use of drugs, narcotics, chemicals, or any other type of material.

(d)
Background and education requirements. Prior to applying for a corrections medication aide permit under Human Resources Code, 161.083, an applicant must be:
(1)
able to read, write, speak, and understand English;
(2)
at least 18 years of age;
(3)
free of communicable diseases and in suitable physical and emotional health to safely administer medications;
(4)
a graduate of a high school or have a general equivalency diploma; and
(5)
employed in a correctional facility or by a medical service contractor for a correctional facility on the first day of an applicant's medication aide training program.
(e)
Application. An applicant for a corrections medication aide permit under Human Resources Code, 161.083 must submit an official Corrections Medication Aide application form to DADS.
(1)
An applicant must submit the general statement enrollment form that contains:
(A)
specific information regarding personal data, certain misdemeanor and felony convictions, work experience, education, and training;
(B)
a statement that all the requirements in subsection (d) of this section were met prior to the start of the program;
(C)
a statement that the applicant understands that application fees submitted in the permit process are nonrefundable;
(D)
a statement that the applicant understands material submitted in the application process are nonreturnable;
(E)
a statement that the applicant understands that it is a misdemeanor to falsify any information submitted to DADS; and
(F)
the applicant's dated and notarized signature.
(2)
An applicant must submit a certified copy or a photocopy that has been notarized as a true and exact copy of an unaltered original of the applicant's high school graduation diploma or transcript.
(3)
DADS considers a corrections medication aide permit application as officially submitted when DADS receives the permit application.
(4)
DADS sends a notice listing the additional materials required to an applicant who does not complete the application. An application not completed by the day of the medication aide final exam is void.
(5)
DADS sends notice of application acceptance or ineligibility, disapproval, or deficiency in accordance with 95.127 of this chapter (relating to Application Processing).
(f)
Fees. The permit application and permit renewal fees for a corrections medication aide permit must be submitted by cashier's check or money order made payable to the Department of Aging and Disability Services. All fees are nonrefundable, except as provided by Government Code, Chapter 2005. The fee schedule is as follows:
(1)
permit application fee-$15;
(2)
renewal fee-$15;
(3)
late renewal fees for permit renewals made after the permit expires:
(A)
$22.50 for an expired permit renewed from one to 90 days after expiration;
(B)
$30 for an expired permit renewed from 91 days to one year after expiration; and
(4)
permit replacement fee-$5.
(g)
Examination procedures. TDCJ gives a written examination to each applicant at a site determined by TDCJ. An applicant with a disability, including an applicant with dyslexia as defined in Texas Education Code, 51.970 (relating to Instructional Material for Blind and Visually Impaired Students and Students with Dyslexia), may request a reasonable accommodation for the examination under the Americans with Disabilities Act.
(1)
The applicant must meet the requirements of the TDCJ training program described in 95.119 of this chapter (relating to Training Program Requirements) before taking the written examination.
(2)
The applicant must be tested on the subjects taught in the TDCJ training program curriculum and correctional facility clinical experience. The examination must test an applicant's knowledge of accurate and safe drug therapy administered to a correctional facility inmate.
(3)
The examination must be taken after the applicant has successfully completed the TDCJ training program.
(4)
TDCJ administers the examination and determines the passing grade.
(5)
TDCJ must inform DADS, on the DADS class roster form, of the final exam results for each applicant within 15 days after completion of the exam.
(6)
An applicant who is unable to attend the applicant's scheduled examination due to unforeseen circumstances must contact TDCJ to reschedule.
(7)
If an applicant fails the examination, TDCJ notifies DADS and the applicant in writing of the failure to pass the examination. The applicant may take one subsequent examination without having to re-enroll in the training program described in 95.119 of this chapter (relating to Training Program Requirements).
(8)
An applicant whose application for a permit is denied under 95.113 of this chapter (relating to Determination of Eligibility) is ineligible to take the examination.
(h)
Determination of eligibility. DADS determines eligibility for a corrections medication aide permit applicant according to 95.113 of this chapter and subsections (d), (e), (f) and (g) of this section.
(i)
Renewal. A permit must be renewed in accordance with 95.115 of this chapter.
(j)
Changes. Permit holders must report changes in accordance with 95.117 of this chapter (relating to Changes).
(k)
Violations, complaints, and disciplinary actions.
(1)
Complaints. Any person may complain to DADS alleging that a person or program has violated Human Resources Code, 161.083, or this chapter. DADS handles complaints in the manner set forth in 95.123 of this chapter (relating to Violations, Complaints, and Disciplinary Actions).
(2)
Investigations of abuse and neglect complaints. Allegations of abuse and neglect of inmates by corrections medication aides are investigated by the TDCJ Office of Inspector General. After an investigation, the TDCJ Office of Inspector General issues a report to DADS with findings of abuse or neglect against the corrections medication aide. After reviewing the report and findings, DADS determines whether to initiate a formal proceeding to revoke, suspend, or refuse to renew a corrections medication aide permit. If DADS determines a formal proceeding to revoke, suspend, or refuse to renew a corrections medication aide permit should be initiated, 95.123(c) and (d) of this chapter applies. If DADS determines that no formal proceeding to revoke, suspend, or refuse to renew a corrections medication aide permit should be initiated, DADS dismisses the complaint against the corrections medication aide and gives written notice of the dismissal to the corrections medication aide.
(l)
Section 95.121 of this chapter (relating to Permitting of Persons with Criminal Backgrounds) applies to corrections medication aide permit holders under this chapter.
(m)
Verification of corrections medication aide training.
(1)
A person employed as a medication aide in a correctional facility under a permit issued by DADS under Health and Safety Code, Chapter 242, Subchapter N, must submit to DADS a verification document issued by TDCJ. The verification document must certify that the person is employed as a medication aide in a correctional facility in good standing and received training equivalent to the TDCJ training described in 95.119 of this chapter. If the person fails to submit the verification by the person's first permit renewal date after January 1, 2012, the person must:
(A)
comply with subsections (e), (f), and (g) of this section to obtain a corrections medication aide permit; or
(B)
comply with this chapter to obtain a nursing facility permit under Health and Safety Code, Chapter 242, Subchapter N.
(2)
A medication aide who submits the verification described in paragraph (l) of this subsection must comply with the permit renewal procedures of 95.115 of this chapter and report any changes to his name and address as required by 95.117 of this chapter.

§95.127  Application Processing

(a)
Time periods. DADS complies with the following procedures in processing applications for a facility and corrections medication aide permit and renewal.
(1)
Ihe following periods of time must apply from the date of receipt of an application until the date of issuance of a written notice that the application is complete and accepted for filing or that the application is deficient and additional specific information is required. A written notice stating that the application has been approved may be sent in lieu of the notice of acceptance of a complete application. The time periods are as follows:
(A)
letter of acceptance of application for a permit – 14 workdays;
(B)
letter of application deficiency and/or ineligibility – 14 workdays;
(C)
acceptance of renewal permit – 20 workdays; and
(D)
letter of renewal of permit deficiency – 20 workdays.
(2)
The following periods of time must apply from the receipt of the last item necessary to complete the application until the date of issuance of written notice approving or denying the application. For the purpose of this section, an application is not considered complete until any required examination has been successfully completed by the applicant. The time periods for denial include notification of the proposed decision and of the opportunity, if required, to show compliance with law and of the opportunity for a formal hearing. The time periods are as follows:
(A)
issuance of initial permit – 90 workdays;
(B)
letter of denial for a permit or renewal permit – 90 workdays; and
(C)
issuance of renewal permit after receipt of documentation of all renewal requirements – 20 workdays.

(b)
Reimbursement of fees.
(1)
In the event an application is not processed in the time periods stated in subsection (a) of this section, the applicant has the right to request reimbursement of all fees paid in that particular application process. Application for reimbursement must be made to the program administrator for DADS Medication Aide Permit Program. If the program administrator does not agree that the time period has been violated or finds that good cause existed for exceeding the time period, the request must be denied.
(2)
Good cause for exceeding the time period exists if the number of applications for a permit and permit renewal exceeds by 15% or more the number of applications processed in the same calendar quarter the preceding year; another public or private entity relied upon by DADS in the application process caused the delay; or any other condition exists giving DADS good cause for exceeding the time period.
(c)
Appeal. If a request for reimbursement under subsection (b) of this section is denied by the program administrator, the applicant may appeal in writing to the Texas Health and Human Services Commission's hearings section to request a hearing on the reimbursement denial. The hearing will be held pursuant to applicable provisions of the procedures at 1 TAC Chapter 357, Subchapter I (relating to Hearings under the Administrative Procedure Act), and Chapter 91 of this title (relating to Hearings under the Administrative Procedure Act).

§95.128  Home Health Medication Aides

(a)
General.
(1)
A person may not administer medication to a client unless the person:
(A)
holds a current license under state law which authorizes the licensee to administer medication;
(B)
holds a current permit issued under this section and acts under the delegated authority of a registered nurse (RN) licensed by the Texas Board of Nursing which authorizes the licensee to administer medication;
(C)
administers a medication to a client of an agency in accordance with rules of the Texas Board of Nursing that permit delegation of the administration of medication to a person not holding a permit under this section; or
(D)
administers noninjectable medication under circumstances authorized by the memorandum of understanding between the Texas Board of Nursing and DADS.
(2)
An agency providing licensed and certified home health services, licensed home health services, hospice services, or personal assistance services may use a home health medication aide. If there is a direct conflict between the requirements of this chapter and federal regulations, the requirements that are more stringent apply to the licensed and certified home health services agency.
(3)
Exemptions are as follows.
(A)
A person may administer medication to a client of an agency without the license or permit as required in paragraph (1) of this subsection if the person is:
(i)
a graduate nurse holding a temporary permit issued by the Texas Board of Nursing;
(ii)
a student enrolled in an accredited school of nursing or program for the education of RNs who is administering medications as part of the student's clinical experience;
(iii)
a graduate vocational nurse holding a temporary permit issued by the Texas Board of Nursing;
(iv)
a student enrolled in an accredited school of vocational nursing or program for the education of vocational nurses who is administering medications as part of the student's clinical experience; or
(v)
a trainee in a medication aide training program approved by DADS under this chapter who is administering medications as part of the trainee's clinical experience.
(B)
Supervision of an exempt person described in subparagraph (A) of this paragraph is as follows.
(i)
A person described in:
(I)
subparagraph (A)(i) of this paragraph shall be supervised by an RN;
(II)
subparagraph (A)(ii) or (iv) of this paragraph shall be supervised by the student's instructor; or
(III)
subparagraph (A)(iii) of this paragraph shall be supervised by an RN or licensed vocational nurse.
(ii)
Supervision must be on-site.
(C)
An exempt person described in this subsection may not be used in a supervisory or charge position.

(b)
Required actions.
(1)
If home health medication aide services are provided, an agency employs a home health medication aide to provide home health medication aide services, and an RN shall be employed by or under contract with the agency to perform the initial assessment; prepare the client care plan; establish the medication list, medication administration record, and medication aide assignment sheet; and supervise the home health medication aide. The RN must be available to supervise the home health medication aide when services are provided.
(2)
The clinical records of a patient using a home health medication aide must include a statement signed by the client or family acknowledging receipt of the list of permitted and prohibited acts of a home health medication aide.
(3)
The RN must be knowledgeable of the rules of DADS governing home health medication aides and must assure that the home health medication aide is in compliance with the Health and Safety Code, Chapter 142, Subchapter B.
(4)
A permit holder must:
(A)
function under the supervision of an RN;
(B)
function in accordance with applicable law and this chapter relating to administration of medication and operation of the agency;
(C)
comply with DADS rules applicable to personnel used in an agency; and
(D)
comply with this section and §97.701 of this title (relating to Home Health Aides) if the person will be used as a home health aide and a home health medication aide.
(5)
The RN must make a supervisory visit while the medication aide is in the client's residence in accordance with §97.298 of this title (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel and Tasks Not Requiring Delegation).
(c)
Permitted actions. A permit holder is permitted to:
(1)
observe and report to the agency's RN and document in the clinical note reactions and side effects to medication shown by a client;
(2)
take and record vital signs prior to the administration of medication which could affect or change the vital signs;
(3)
administer regularly prescribed medication which the permit holder has been trained to administer only after personally preparing (setting up) the medication to be administered. The medication aide must document the administered medication in the client's clinical note;
(4)
administer oxygen per nasal cannula or a non-sealing face mask only in emergency. Immediately after the emergency, the permit holder must verbally notify the supervising RN and appropriately document the action and notification;
(5)
apply specifically ordered ophthalmic, otic, nasal, vaginal, topical, and rectal medication unless prohibited by subsection (d)(10) of this section; and
(6)
administer medications only from the manufacturer's original container or the original container in which the medication had been dispensed and labeled by the pharmacy with all information mandated by the Texas State Board of Pharmacy.
(d)
Prohibited actions. Permit holders must not:
(1)
administer a medication by any injectable route;
(2)
administer medication used for intermittent positive pressure breathing (IPPB) treatment or any form of medication inhalation treatments;
(3)
administer previously ordered pro re nata (PRN) medication unless authorization is obtained from the agency's RN. If authorization is obtained, the permit holder must:
(A)
document in the client's clinical notes symptoms indicating the need for medication and the time the symptoms occurred;
(B)
document in the client's clinical notes that the agency's RN was contacted, symptoms were described, and permission was granted to administer the medication and the time of contact;
(C)
obtain permission to administer the medication each time the symptoms occur in the client; and
(D)
insure that the client's clinical record is co-signed by the RN who gave permission within seven calendar days of incorporation of the notes into the clinical record;
(4)
administer the initial dose of a medication that has not been previously administered to a client. Whether a medication has been previously administered must be determined by the client's current clinical records;
(5)
calculate a client's medication doses for administration except that the permit holder may measure a prescribed amount of a liquid medication to be administered or break a scored tablet for administration to a client provided the RN has calculated the dosage. The client's medication administration record must accurately document how the tablet must be altered prior to administration;
(6)
crush medication unless authorization has been given in the original practitioner's order or obtained from the agency's RN. The authorization to crush the specific medication must be documented on the client's medication administration record;
(7)
administer medications or feedings by way of a tube inserted in a cavity of the body except as specified in §97.298 of this title;
(8)
receive or assume responsibility for reducing to writing a verbal or telephone order from a practitioner;
(9)
order a client's medication from a pharmacy;
(10)
apply topical medications that involve the treatment of skin that is broken or blistered when a specified aseptic technique is ordered by the attending practitioner;
(11)
administer medications from any container other than the manufacturer's original container or the original container in which the medication had been dispensed and labeled by the pharmacy with all information mandated by the Texas State Board of Pharmacy;
(12)
steal, divert, or otherwise misuse medications;
(13)
violate any provision of the statute or of this chapter;
(14)
fraudulently procure or attempt to procure a permit;
(15)
neglect to administer appropriate medications, as prescribed, in a responsible manner; or
(16)
administer medications if the person is unable to do so with reasonable skill and safety to clients by reasons of drunkenness, excessive use of drugs, narcotics, chemicals, or any other type of material.
(e)
Applicant qualifications. Each applicant for a permit issued under Health and Safety Code, Chapter 142, Subchapter B must complete a training program. Prior to enrollment in a training program and prior to application for a permit under this section, all persons:
(1)
must be able to read, write, speak, and understand English;
(2)
must be at least 18 years of age;
(3)
must be free of communicable diseases and in suitable physical and emotional health to safely administer medications;
(4)
must be a graduate of a high school or have an equivalent diploma or higher degree; and
(5)
must have satisfactorily completed a home health aide training and competency evaluation program or a competency evaluation program under §97.701 of this title.
(f)
Nursing graduates. A person who is a graduate of an accredited school of nursing and who does not hold a license to practice professional or vocational nursing meets the training requirements for issuance of a permit under this section if the date of graduation from the nursing school was no earlier than January 1 of the year immediately preceding the year of application for a permit under this section.
(1)
The applicant must submit a DADS application form to DADS. The applicant must meet the requirements of subsection (e)(1)-(4) of this section.
(2)
The application must be accompanied by the permit application fee.
(3)
The applicant must include an official transcript documenting graduation from an accredited school of nursing.
(4)
DADS acknowledges receipt of the application by sending the applicant a copy of this chapter and DADS open book examination.
(5)
The applicant must complete the open book examination and return it to DADS by the date given in the examination notice.
(6)
The applicant must complete DADS written examination. DADS determines the site of the examination. DADS denies the application of an applicant failing to schedule and take the examination by the date given in the examination notice.
(7)
An open book or written examination may not be retaken if the applicant fails.
(8)
Upon successful completion of the two examinations, DADS evaluates all application documents submitted by the applicant.
(9)
DADS notifies the applicant in writing of the examination results.
(g)
Nursing students. A person who is attending or has attended an accredited school of nursing and who does not hold a license to practice professional or vocational nursing meets the training requirements for issuance of a permit under this section if the person:
(1)
attended the nursing school no earlier than January 1 of the year immediately preceding the year of application for a permit under this section;
(2)
successfully completed courses at the nursing school that cover DADS curriculum for a home health medication aide training program;
(3)
submits a statement that is signed by the nursing school's administrator or other authorized individual and certifies that the person completed the courses specified under paragraph (2) of this subsection. The administrator is responsible for determining that the courses that he or she certifies cover DADS curriculum. The statement must be submitted with the person's application for a permit under this section; and
(4)
complies with subsection (f)(1)-(2) and (4)-(9) of this section.
(h)
Reciprocity. A person who holds a valid license, registration, certificate, or permit as a home health medication aide issued by another state whose minimum standards or requirements are substantially equivalent to or exceed the requirements of this section in effect at the time of application may request a waiver of the training program requirement as follows:
(1)
The applicant must submit a DADS application form to DADS. The applicant must meet the requirements of subsection (e)(1)-(4) of this section.
(2)
The application must be accompanied by the permit application fee.
(3)
The application must include a current copy of the rules of the other state governing its licensing and regulation of home health medication aides, a copy of the legal authority (law, act, code, section, or otherwise) for the state's licensing program, and a certified copy of the license or certificate by which the reciprocal permit is requested.
(4)
DADS acknowledges receipt of the application by sending the applicant a copy of this chapter and of DADS open book examination.
(5)
DADS may contact the issuing agency to verify the applicant's status with the agency.
(6)
The applicant must complete DADS open book examination and return it to DADS by the date given in the examination notice.
(7)
The applicant must complete DADS written examination. The site of the examination is determined by DADS. DADS denies the application of an applicant failing to schedule and take the examination by the date given in the examination notice.
(8)
An open book or written examination may not be retaken if the applicant fails.
(9)
Upon successful completion of the two examinations, DADS evaluates all application documents submitted by the applicant.
(10)
DADS notifies the applicant in writing of the examination results.
(i)
Application by trainees. An applicant under subsection (e) of this section must submit to DADS, no later than 30 calendar days after enrollment in a training program, an application, including all required information and documentation on DADS.
(1)
DADS considers an application as officially submitted when DADS receives the nonrefundable combined permit application and examination fee payable to the Department of Aging and Disability Services. The fee required by subsection (n) of this section must accompany the application form.
(2)
The general statement enrollment form must contain the following application material that is required of all applicants:
(A)
specific information regarding personal data, certain misdemeanor and felony convictions, work experience, education, and training;
(B)
a statement that all of the requirements in subsection (e) of this section were met prior to the start of the program;
(C)
a statement that the applicant understands that the application fee submitted in the permit process is nonrefundable;
(D)
a statement that the applicant understands that materials submitted in the application process are not returnable;
(E)
a statement that the applicant understands that it is a misdemeanor to falsify any information submitted to DADS; and
(F)
the applicant's signature that has been dated and notarized.
(3)
The applicant must submit a certified copy or a photocopy that has been notarized as a true and exact copy of an unaltered original of the applicant's high school graduation diploma or transcript or an equivalent GED diploma or higher degree unless the applicant is applying under subsection (f) of this section.
(4)
DADS sends a notice listing the additional materials required to an applicant who does not complete the application. An application not completed within 30 calendar days after the date of the notice will be void.
(5)
DADS send notice of application acceptance, disapproval, or deficiency in accordance with subsection (q) of this section.
(j)
Examination. DADS gives a written examination to each applicant at a site DADS determines.
(1)
No final examination may be given to an applicant until the applicant has met the requirements of subsections (e) and (i) of this section, and if applicable, subsections (f), (g), or (h) of this section.
(2)
An applicant with a disability, including an applicant with dyslexia as defined in Texas Education Code §51.970 (relating to Instructional Material for Blind and Visually Impaired Students and Students with Dyslexia), may request a reasonable accommodation for the examination under the Americans with Disabilities Act.
(3)
The applicant must be tested on the subjects taught in the training program curricula and clinical experience. The examination covers an applicant's knowledge of accurate and safe drug therapy to an agency's clients.
(4)
A training program must notify DADS at least four weeks prior to its requested examination date.
(5)
DADS determines the passing grade on the examination.
(6)
DADS notifies in writing an applicant who fails the examination.
(A)
DADS may give an applicant under subsection (e) of this section one subsequent examination, without additional payment of a fee, upon the applicant's written request to DADS.
(B)
A subsequent examination must be completed by the date given on the failure notification. DADS determines the site of the examination.
(C)
Another examination will not be permitted if the student fails the subsequent examination unless the student enrolls and successfully completes another training program.
(7)
An applicant who is unable to attend the applicant's scheduled examination due to unforeseen circumstances may be given an examination at another time without payment of an additional fee upon the applicant's written request to DADS. The examination must be completed within 45 calendar days from the date of the originally scheduled examination. DADS determines the site for the rescheduled examination.
(8)
An applicant whose application for a permit will be disapproved under subsection (k) of this section is ineligible to take the examination.
(k)
Determination of eligibility. DADS approves or disapproves all applications. DADS sends notices of application approval, disapproval, or deficiency in accordance with subsection (q) of this section.
(1)
DADS denies an application for a permit if the person has:
(A)
not met the requirements of subsections (e)-(i) of this section, if applicable;
(B)
failed to pass the examination prescribed by DADS as set out in subsection (j) of this section;
(C)
failed to or refused to properly complete or submit any application form, endorsement, or fee, or deliberately presented false information on any form or document required by DADS;
(D)
violated or conspired to violate the Health and Safety Code, Chapter 142, Subchapter B, or any provision of this chapter; or
(E)
been convicted of a felony or misdemeanor if the crime directly relates to the duties and responsibilities of a permit holder as set out in subsection (r) of this section.
(2)
If, after review, DADS determines that the application should not be approved, DADS gives the applicant written notice of the reason for the proposed decision and of the opportunity for a formal hearing in accordance with subsection (r) of this section.
(l)
Permit renewal. Home health medication aides must comply with the following permit renewal requirements.
(1)
When issued, a permit is valid for one year.
(2)
A permit holder must renew the permit annually.
(3)
The renewal date of a permit is the last day of the current permit.
(4)
Each permit holder is responsible for renewing the permit before the expiration date. Failure to receive notification from DADS before the expiration date of the permit does not excuse the permit holder's failure to file for timely renewal.
(5)
A permit holder must complete a seven clock-hour continuing education program approved by DADS prior to expiration of the permit in order to renew the permit. Continuing education hours are not required for the first renewal. After a permit is renewed for the first time, the permit holder must earn approved continuing education hours to have the permit renewed again.
(6)
DADS denies renewal of the permit of a permit holder who is in violation of the Health and Safety Code, Chapter 142, Subchapter B, or this chapter at the time of application for renewal.
(7)
Home health medication aide permit renewal procedures are as follows.
(A)
At least 30 calendar days before the expiration date of a permit, DADS sends to the permit holder at the address in DADS records notice of the expiration date of the permit and the amount of the renewal fee due and a renewal form that the permit holder must complete and return with the required renewal fee.
(B)
The renewal form must include the preferred mailing address of the permit holder and information on certain misdemeanor and felony convictions. It must be signed by the permit holder.
(C)
DADS issues a renewal permit to a permit holder who has met all requirements for renewal.
(D)
DADS does not renew a permit if the permit holder does not complete the required seven-hour continuing education requirement. Successful completion is determined by the student's instructor. An individual who does not meet the continuing education requirement must complete a new program, application, and examination in accordance with the requirements of this section.
(E)
DADS does not renew a permit if renewal is prohibited by the Texas Education Code, §57.491, concerning defaults on guaranteed student loans.
(F)
If a permit holder fails to timely renew his or her permit because the permit holder is or was on active duty with the armed forces of the United States of America serving outside the State of Texas, the permit holder may renew the permit pursuant to this subparagraph.
(i)
Renewal of the permit may be requested by the permit holder, the permit holder's spouse, or an individual having power of attorney from the permit holder. The renewal form must include a current address and telephone number for the individual requesting the renewal.
(ii)
Renewal may be requested before or after the expiration of the permit.
(iii)
A copy of the official orders or other official military documentation showing that the permit holder is or was on active military duty serving outside the State of Texas must be filed with DADS along with the renewal form.
(iv)
A copy of the power of attorney from the permit holder must be filed with DADS along with the renewal form if the individual having the power of attorney executes any of the documents required in this subparagraph.
(v)
A permit holder renewing under this subparagraph must pay the applicable renewal fee.
(vi)
A permit holder is not authorized to act as a home health medication aide after the expiration of the permit unless and until the permit holder actually renews the permit.
(vii)
A permit holder renewing under this subparagraph is not required to submit any continuing education hours.

(8)
A person whose permit has expired for not more than two years may renew the permit by submitting to DADS:
(A)
the permit renewal form;
(B)
all accrued renewal fees;
(C)
proof of having earned, during the expired period, seven hours in an approved continuing education program for each year or part of a year that the permit has been expired; and
(D)
proof of having earned, prior to expiration of the permit, seven hours in an approved continuing education program as required in paragraph (5) of this subsection.
(9)
A permit that is not renewed during the two years after expiration may not be renewed.
(10)
Notices of permit renewal approval, disapproval, or deficiency must be in accordance with subsection (q) of this section (relating to Processing Procedures).
(m)
Changes.
(1)
A permit holder must notify DADS within 30 calendar days after changing his or her address or name.
(2)
DADS replaces a lost, damaged, or destroyed permit upon receipt of a completed duplicate permit request form and permit replacement fee.
(n)
Fees.
(1)
The schedule of fees is:
(A)
combined permit application and examination fee--$25;
(B)
renewal fee--$15; and
(C)
permit replacement fee--$5.00.
(2)
All fees are nonrefundable.
(3)
An applicant or permit holder must pay the required fee by cashier's check or money order made payable to the Department of Aging and Disability Services. All fees are nonrefundable, except as provided by Government Code, Chapter 2005.
(o)
Training program requirements.
(1)
An educational institution accredited by the Texas Workforce Commission or Texas Higher Education Coordinating Board that desires to offer a training program must file an application for approval on a DADS form. Programs sponsored by state agencies for the training and preparation of its own employees are exempt from the accreditation requirement. An approved institution may offer the training program and a continuing education program.
(A)
All signatures on DADS forms and supporting documentation must be originals.
(B)
The application includes:
(i)
the anticipated dates of the program;
(ii)
the location(s) of the classroom course(s);
(iii)
the name of the coordinator of the program;
(iv)
a list of instructors and any other person responsible for the conduct of the program. The list must include addresses and telephone numbers for each instructor; and
(v)
an outline of the program content and curriculum if the curriculum covers more than DADS established curricula.
(C)
DADS may conduct an inspection of the classroom site.
(D)
DADS sends notice of approval or proposed disapproval of the application to the program within 30 calendar days of the receipt of a complete application. If the application is proposed to be disapproved due to noncompliance with the requirements of the Health and Safety Code, Chapter 142, Subchapter B, or of this chapter, the reasons for disapproval are given in the notice.
(E)
An applicant may request a hearing on a proposed disapproval in writing within ten calendar days of receipt of the notice of the proposed disapproval. The hearing must be in accordance with subsection (r) of this section and the Administrative Procedure Act, Texas Government Code, Chapter 2001. If no request is made, the applicant is deemed to have waived the opportunity for a hearing, and the proposed action may be taken.
(2)
The program includes, but is not limited to, the following instruction and training:
(A)
procedures for preparation and administration of medications;
(B)
responsibility, control, accountability, storage, and safeguarding of medications;
(C)
use of reference material;
(D)
documentation of medications in the client's clinical records, including PRN medications;
(E)
minimum licensing standards for agencies covering pharmaceutical service, nursing service, and clinical records;
(F)
federal and state certification standards for participation under the Social Security Act, Title XVIII (Medicare), pertaining to pharmaceutical service, nursing service, and clinical records;
(G)
lines of authority in the agency, including agency personnel who are immediate supervisors;
(H)
responsibilities and liabilities associated with the administration and safeguarding of medications;
(I)
allowable and prohibited practices of permit holders in the administration of medication;
(J)
drug reactions and side effects of medications commonly administered to home health clients;
(K)
instruction on universal precautions; and
(L)
the provisions of this chapter.
(3)
The program consists of 140 hours in the following order: 100 hours of classroom instruction and training, 20 hours of return skills demonstration laboratory, ten hours of clinical experience including clinical observation and skills demonstration under the supervision of a RN in an agency, and ten more hours in the return skills demonstration laboratory. A classroom or laboratory hour is 50 clock-minutes of actual classroom or laboratory time.
(A)
Class time will not exceed four hours in a 24-hour period.
(B)
The completion date of the program must be a minimum of 60 calendar days and a maximum of 180 calendar days from the starting date of the program.
(C)
Each program must follow the curricula established by DADS.
(4)
At least seven calendar days prior to the commencement of each program, the coordinator must notify DADS in writing of the starting date, the ending date, the daily hours of the program, and the projected number of students.
(5)
A change in any information presented by the program in an approved application including, but not limited to, location, instructorship, and content must be approved by DADS prior to the program's effective date of the change.
(6)
The program instructors of the classroom hours must be an RN and registered pharmacist.
(A)
The nurse instructor must have a minimum of two years of full-time experience in caring for the elderly, chronically ill, or pediatric clients or been employed full time for a minimum of two years as an RN with a home and community support services agency. An instructor in a school of nursing may request a waiver of the experience requirement.
(B)
The pharmacist instructor must have a minimum of one year of experience and be currently employed as a practicing pharmacist.
(7)
The coordinator must provide clearly defined and written policies regarding each student's clinical experience to the student, the administrator, and the supervising nurse of the agency used for the clinical experience.
(A)
The clinical experience must be counted only when the student is observing or involved in functions involving medication administration and under the direct, contact supervision of an RN.
(B)
The coordinator is responsible for final evaluation of the student's clinical experience.
(8)
Upon successful completion of the program, each program issues to each student a certificate of completion, including the program's name, the student's name, the date of completion, and the signature of the program coordinator.
(9)
Within 15 calendar days after completion of the course, each program must inform DADS on the DADS class roster form of the satisfactory completion for each student.
(p)
Continuing education. The continuing education training program is as follows.
(1)
The program must consist of at least seven clock hours of classroom instruction.
(2)
The instructor must meet the requirements in subsection (o)(6) of this section.
(3)
Each program must follow the curricula established by DADS.
(4)
Within 15 days after completion of the course, each program must inform DADS on the DADS class roster form of the name of each permit holder who has completed the course.
(q)
Processing procedures. DADS complies with the following procedures in processing applications of home health medication aide permits and renewal of permits.
(1)
The following periods of time apply from the date of receipt of an application until the date of issuance of a written notice that the application is complete and accepted for filing or that the application is deficient and additional specific information is required. A written notice stating that the application has been approved may be sent in lieu of the notice of acceptance of a complete application. The time periods are:
(A)
letter of acceptance of an application for a home health medication aide permit--14 working days; and
(B)
letter of application or renewal deficiency--14 working days.
(2)
The following periods of time shall apply from the receipt of the last item necessary to complete the application until the date of issuance of written notice approving or denying the application. The time periods for denial include notification of proposed decision and of the opportunity, if required, to show compliance with the law and of the opportunity for a formal hearing. An application is not considered complete until the required documentation and fee have been submitted by the applicant. The time periods are as follows:
(A)
the issuance of an initial permit--90 calendar days;
(B)
the letter of denial for a permit--90 calendar days; and
(C)
the issuance of a renewal permit--20 calendar days.
(3)
In the event an application is not processed in the time period stated in paragraphs (1) and (2) of this subsection, the applicant has the right to request reimbursement of all fees paid in that particular application process. Request for reimbursement is made to the director of the Home Health Medication Aide Permit Program. If the director of the Home Health Medication Aide Permit Program does not agree that the time period has been violated or finds that good cause existed for exceeding the time period, the request will be denied.
(4)
Good cause for exceeding the time period exists if the number of applications for initial home health medication aide permits and renewal permits exceeds by 15% or more the number of applications processed in the same calendar quarter of the preceding year; another public or private entity relied upon by DADS in the application process caused the delay; or any other condition exists giving DADS good cause for exceeding the time period.
(5)
If a request for reimbursement under paragraph (3) of this subsection is denied by the director of the Home Health Medication Aide Permit Program, the applicant may appeal to the commissioner of DADS for a timely resolution of any dispute arising from a violation of the time periods. The applicant must give written notice to the commissioner at the address of DADS that he or she requests full reimbursement of all fees paid because his or her application was not processed within the applicable time period. The director of the Home Health Medication Aide Permit Program must submit a written report of the facts related to the processing of the application and of any good cause for exceeding the applicable time period. The commissioner provides written notice of the commissioner's decision to the applicant and the director of the Home Health Medication Aide Permit Program. An appeal is decided in the applicant's favor if the applicable time period was exceeded and good cause was not established. If the appeal is decided in favor of the applicant, full reimbursement of all fees paid in that particular application process are made.
(r)
Denial, suspension, or revocation.
(1)
DADS may deny, suspend, emergency suspend, or revoke a permit or program approval if the permit holder or program fails to comply with any provision of the Health and Safety Code, Chapter 142, Subchapter B, or this chapter.
(2)
DADS may also take action under paragraph (1) of this subsection for fraud, misrepresentation, or concealment of material fact on any documents required to be submitted to DADS or required to be maintained or complied by the permit holder or program pursuant to this chapter.
(3)
DADS may suspend or revoke an existing permit or program approval or disqualify a person from receiving a permit or program approval because of a person's conviction of a felony or misdemeanor if the crime directly relates to the duties and responsibilities of a home health medication aide or training program. In determining whether a conviction directly relates, DADS considers the elements set forth in §97.601 of this title (relating to Enforcement Actions).
(4)
If DADS proposes to deny, suspend, or revoke a home health medication aide permit or to rescind a home health medication aide program approval, DADS notifies the permit holder or home health medication aide program by certified mail, return receipt requested, of the reasons for the proposed action and offers the permit holder or home health medication aide program an opportunity for a hearing.
(A)
The permit holder or home health medication aide program must request a hearing within 15 calendar days of receipt of the notice. Receipt of notice is presumed to occur on the tenth calendar day after the notice is mailed to the last address known to DADS unless another date is reflected on a United States Postal Service return receipt.
(B)
The request must be in writing and submitted to the Department of Aging and Disability Services, Medication Aide Program, Mail Code E-416, P.O. Box 149030, Austin, Texas 78714-9030.
(C)
If the permit holder or home health medication aide program does not request a hearing, in writing, within 15 calendar days of receipt of the notice, the permit holder or home health medication aide program is deemed to have waived the opportunity for a hearing and the proposed action is taken.
(5)
DADS may suspend a permit to be effective immediately when the health and safety of persons are threatened. DADS notifies the permit holder of the emergency action by certified mail, return receipt requested, or personal delivery of the notice and of the effective date of the suspension and the opportunity for the permit holder to request a hearing.
(6)
All hearings are conducted pursuant to Texas Government Code, Chapter 2001, and the formal hearing procedures at 1 TAC §§357.481-357.490.
(7)
If the permit holder or program fails to appear or be represented at the scheduled hearing, the permit holder or program has waived the right to a hearing and the proposed action is taken.
(8)
If DADS suspends a home health medication aide permit, the suspension remains in effect until DADS determines that the reason for suspension no longer exists, revokes the permit, or determines not to renew the permit. DADS investigates prior to making a determination.
(A)
During the time of suspension, the suspended permit holder must return his or her permit to DADS.
(B)
If a suspension overlaps a renewal date, the suspended permit holder may comply with the renewal procedures in this chapter; however, DADS does not renew the permit until DADS determines that the reason for suspension no longer exists.
(9)
If DADS revokes or does not renew a permit, a person may reapply for a permit by complying with the requirements and procedures in this chapter at the time of reapplication.
(A)
DADS may refuse to issue a permit if the reason for revocation or nonrenewal continues to exist.
(B)
When a permit is revoked or not renewed, a permit holder must immediately return the license or permit to DADS.