HHS Tropical Weather-related News and Information

Hurricane Harvey Information

Expedited Reciprocity for Certified Nurse Aides Impacted by Hurricane Harvey

Posted: Oct. 3, 2017

HHSC Long-term Care Regulatory is allowing certified nurse aides (CNAs) from out-of-state to begin working immediately if they submit a reciprocity application within one business day of beginning work in Texas (or within one day of release of this notice if the CNA has already begun working in Texas). HHSC is expediting the review and processing these applications within 1 business day. The nurse aide should be current as a nurse aide on his or her state registry. To apply for CNA reciprocity, please send the following information via fax to the Licensing and Credentialing Section at (512) 438-2052:

  • A statement indicating that the CNA needs expedited consideration because of the effects of Hurricane Harvey;
  • Picture identification showing the nurse aide's birth date and correct spelling of the nurse aide's name;
  • Legible copy of the nurse aide's social security card;
  • Criminal history result for all the last names the nurse aide has ever had from the Texas Department of Public Safety; and
  • Form for employment verification (FORM 5506) if a nurse aide does not have an expiration date in their active state.

**Note: This waiver request does not impact the existing emergency criminal history check requirements spelled out in §250.003(b) of the Health and Safety Code. All providers hiring an individual during an emergency are still required to request a criminal history check within 24 hours of the individual starting work. The individual must be employed only on a temporary or interim basis until the facility receives the employee’s criminal history results.

If you have any questions about applying for CNA reciprocity, please email credential@dads.state.tx.us. If you have questions about this alert or about regulatory requirements for CNAs, please contact the Policy, Rules and Training Section at 512-438-3161.

Guidance for Returning to Evacuated ICF/IID Facilities or Discharging/Transferring Residents

Posted: Oct. 2, 2017

Based on CMS guidance, HHS is issuing the following notice to intermediate care facilities for people with an intellectual disability or related conditions (ICFs/IID) that were impacted by Hurricane Harvey. Evacuated ICFs, which have not already done so, must determine whether residents will be able to return to the evacuated facility or will be discharged or transferred to a new facility.

Facilities that are unable to return must notify their HHSC Regulatory Regional Office as soon as possible.

According to CMS guidance, facilities that are unable to repatriate must discharge or transfer residents and ensure they are safely admitted to another facility. With the exception of the notice timeframes spelled out in rule, all state and federal discharge/transfer requirements remain in effect. Meaning, discharge/transfer notifications must still be provided to residents and their representatives. Additionally, discharging facilities must complete required discharge/transfer paperwork, including a post discharge plan of care and a summary of the client’s developmental, behavioral, social, health and nutritional status. If some documentation is not immediately available due to the effects of the storm, discharging facilities must make any required documents available to the receiving facility as soon as practicable.

Throughout the discharge or transfer process and upon admission to the receiving facility, residents should be offered choices about where they receive their long-term care services. Discharging facilities should discuss long-term care goals and preferences with evacuated residents that are being discharged or transferred. If the resident or the resident’s representative indicates a desire to move to another facility or alternative care setting, the discharging facility should assist the resident to make preparations to move to a setting which meets the resident’s choice and needs.

Guidance for Repatriating Evacuated Facilities or Discharging Residents

Posted: Sept. 20, 2017

Clarification: The following alert applies only to nursing facilities.

Based on CMS guidance under the 1135 waiver, facilities should determine by the 15th day of evacuation (or as soon as practicable) whether or not residents will be able to return to the evacuated facility within 30 days from the date of the evacuation. Nonetheless, evacuating facilities must ensure displaced residents are returned or admitted to a new facility 30 days post-evacuation.

Facilities that have made the determination that they will not repatriate by the 30th day after evacuation must notify their HHSC Regulatory Regional Office.

According to CMS guidance, facilities that cannot repatriate residents within 30 days must discharge residents and ensure they are safely admitted to another facility. All state and federal discharge requirements remain in effect. Meaning, discharge notifications must still be provided to residents and their representatives prior to a discharge taking place. Additionally, discharging facilities must complete required discharge paperwork, including discharge assessments and discharge summaries. If some documentation is not immediately available due to the effects of the storm, discharging facilities must make any required documents available to the receiving facility as soon as practicable.

Throughout the discharge process and upon admission to the receiving facility, residents should be offered choices about where they receive their long-term care services. As part of the comprehensive assessment completed by the receiving facility, discharge planning must be conducted. Receiving facilities should discuss long-term care goals and preferences with evacuated residents that are being admitted. If the resident or the resident’s representative indicates a desire to move to another facility or alternative care setting, the admitting facility must assist the resident to make preparations to move to a setting which meets the resident’s choice and needs.

Service Area Expansion and Relocation Notification Exemptions for HCSSAs Impacted by Hurricane Harvey

Posted: Sept. 13, 2017

Under normal circumstances, a Home and Community Support Services Agency (HCSSA) must notify HHS Long-Term Care (LTC) Regulatory 30 days in advance if it wishes to change its physical location or expand its service area. In accordance with the rules at 40 Texas Administrative Code, §97.213 and §97.220, HCSSAs located in disaster-impacted counties will be exempted from the 30 day advance notice requirements if they notify HHS LTC Regulatory as soon as possible after relocating or expanding service area. HCSSAs should provide written notice to the LTC Regulatory Licensing section at Heidi.lopez@hhsc.state.tx.us if they wish to use the emergency process. As soon as possible after providing the notification, HCSSAs must send in their form 2021 application noting the relocation or service area expansion. The $30 change of information fee will be waived for all providers located in counties impacted by the disaster. The instructions on how to report a change of information are outlined on the HHS HCSSA licensing webpage.

Regulatory Reminder for Long-term Care Providers

Posted: Sept. 6, 2017

The Texas Health and Human Services system is issuing this reminder to long-term care providers that regulatory staff continues to be available to evaluate and address regulatory challenges related to Hurricane Harvey.

Texas Home Living (TxHmL) and Home and Community-based Services (HCS) waiver providers affected by the hurricane should contact Will Medina at: William.Medina@hhsc.state.tx.us. Mr. Medina and his staff will work with providers to identify potential solutions to their challenges and to obtain waivers of existing standards as necessary. HCS and TxHmL providers requesting waivers or other accommodations should provide the following:

  • Provider Name

  • Provider Contract Number

  • Contact person and his or her contact information (including a contact phone number) for any follow-up questions

  • Brief summary of situation (i.e., why the waiver is needed.)

  • Specific type of relief you are seeking (i.e., the regulatory requirements the requestor is seeking to have waived).

  • CARE Identification Number of all Individuals that would be impacted by the waiver request

  • If relocating individuals, the address of the current residence and the receiving residence

Any Nursing Facilities, Assisted Living Facilities, Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions, and Home and Community Support Services Agencies needing to request a waiver of a state long-term care regulatory requirement not addressed here should contact the Director for Regulatory Policy, Rule and Curriculum Development at calvin.green@hhsc.state.tx.us. If you have a request for a waiver of federal requirements not addressed here, please email the CMS Dallas Region VI office at RODALDSC@cms.hhs.gov and cc Calvin Green at calvin.green@hhsc.state.tx.us with the following information:

  • Full provider address (including county/city/town/state)

  • CCN (Medicare provider number)

  • Contact person and his or her contact information (including a contact phone number) for follow-up questions should the Region need additional clarification

  • Brief summary of situation (i.e., why the waiver is needed.)

  • Specific type of relief you are seeking (i.e., the regulatory requirements the requestor is seeking to have waived.)

Note: At this time, no specific form is required to submit waiver information, but providers should be prepared to discuss the scope of the issue, the assistance being requested, and your plan to ensure that a requested waiver would not jeopardize the health and safety of individuals receiving services.

Facility Fire Watch Notice

Posted: Sep. 1, 2017

Texas Health and Human Services has been informed that multiple long-term care facilities are currently experiencing water outages as a result of Hurricane Harvey. Facilities should be aware that lack of water will render the facility’s emergency fire suppression system inoperable. As such, long-term care facilities facing water outages must comply with sprinkler impairment procedures as outlined in National Fire Protection Association (NFPA) 101, Life Safety Code, and the NFPA Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.

Each long-term care facility experiencing a water outage must provide and implement a fire watch to ensure the health and safety of all residents until the sprinkler system has been returned to service.

This notice applies to the following facility types:

  • Assisted Living Facilities (ALF)

  • Nursing Facilities (NF)

  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID)

Texas Administrative Code and Federal Regulations supporting these expectations are as follows:

  • ALF: 40 Texas Administrative Code Chapter 92.62 (f)(2)

  • NF: 40 Texas Administrative Code Chapter 19 §19.326(c) and Code of Federal Regulations §483.90(a)(8)

  • ICF-IID: 40 Texas Administrative Code Chapter 90.74 and Code of Federal Regulations §483.470(j)

  • If you have questions regarding this alert, please contact a policy specialist in the Policy, Rules and Curriculum section at 512-438-3161.

Waivers of Regulatory Requirements for Weather-Impacted Long-Term Care Providers

Posted Aug. 31, 2017

The Health and Human Services Commission and Centers for Medicare and Medicaid Services (CMS) are waiving certain regulatory requirements in response to Harvey. Read the full document in PDF format.

Hurricane Harvey Expected to Hit Texas Coast Aug. 25

Posted Aug. 24, 2017

The National Hurricane Center is predicting that Hurricane Harvey will hit the Texas coast on Friday, August 25. This storm is likely to produce hurricane force winds and rain, storm surge flooding, as well as prolonged heavy rainfall and flooding across parts of Texas into next week.

Assisted living facilities, day activity health services facilities, Home and Community-based Services (HCS) providers, home and community support service agencies, intermediate care facilities for individuals with an intellectual disability or related conditions, in-patient hospice facilities, nursing facilities, and Texas Home Living (TxHmL) providers should review their emergency preparedness and response plans in anticipation of severe weather.

In consideration of a possible facility evacuation, plans must address:

  • evacuation procedures;

  • procedures for receiving evacuees from other providers, if applicable; and

  • resources available in the event of an emergency.

Facilities and home health, personal assistance services, and hospice agencies should contact their local DADS Regulatory Services Regional Office (RO) if their operations are impacted by severe weather.

TxHmL or HCS waiver providers that are impacted should contact Will Medina at: William.Medina@hhsc.state.tx.us.

In addition to contacting the RO, all requests to exceed licensed capacity due to an emergency must be approved by the director of survey operations. If your facility is projected to exceed its licensed capacity because it is accepting residents who have been evacuated from another facility, please email Linda Lothringer at linda.lothringer@hhsc.state.tx.us.

Please refer to Provider Letter 15-15 for additional important Regulatory information regarding emergency preparedness.

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Last updated: 10/3/2017 at 12:51 PM