reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1001 - Nursing Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility
				  must have sufficient staff with the appropriate competencies and skill sets to
				  provide nursing and related services to assure resident safety and attain or
				  maintain the highest practicable physical, mental, and psychosocial well-being
				  of each resident. This is determined by resident assessments and individual
				  comprehensive care plans and considering the number, acuity and diagnoses of
				  the facility's resident population in accordance with the facility assessment
				  required at § 554.1931 of this chapter (relating to Facility Assessment).
				  Staff who have been instructed and who have demonstrated competence in the care
				  of children must provide nursing services to children. Care and services are to
				  be provided as specified in § 554.901 of this chapter (relating to Quality
				  of Care).
(1) Sufficient staff.
(A) The facility must provide services by
				  sufficient numbers of each of the following types of personnel on a 24-hour
				  basis to provide nursing care to all residents in accordance with resident care
				  plans:
(i) licensed nurses, except when waived
				  under paragraph (5) of this subsection; and
(ii) other nursing personnel, including nurse
				  aides.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1002 - Additional Nursing Services Staffing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) The ratio of licensed nurses to residents
				  must be sufficient to meet the needs of the residents.
(1) At a minimum, the facility must maintain
				  a ratio (for every 24-hour period) of one licensed nursing staff person for
				  each 20 residents or a minimum of .4 licensed-care hours per resident day. To
				  determine licensed-care hours per resident day, multiply the number of licensed
				  nurses by the number of hours they work in a single day and divide the product
				  by the number of residents in the facility. Three nurses working eight-hour
				  shifts is 24 hours, divided by 60 residents, equals .4 licensed-care hours per
				  resident day.
(2) Licensed nurses
				  who may be counted in the ratio include, but are not limited to, director of
				  nursing, assistant directors of nursing, staff development coordinators, charge
				  nurses, and medication/treatment nurses. These licensed nurses may be counted
				  subject to the limitations of paragraphs (3) and (4) of this
				  subsection.
(3) Staff, who also
				  have administrative duties not related to nursing, may be counted in the ratio
				  only to the degree of hours spent in nursing-related duties.
(4) If a multi-level facility (nursing
				  facility or Medicare SNF) has one director of nursing over the entire facility,
				  he may not be counted in the nursing ratio. A director of nursing for a single
				  distinct part may be counted in the ratio for the distinct part.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1004 - Director of Nursing Services

Current through Reg. 49, No. 28; July 12, 2024
The director of nursing services must serve only one
					 facility in this capacity.
(1) If the
				  director of nursing services has other institutional responsibilities, a
				  qualified registered nurse must serve as an assistant so that there is the
				  equivalent of a full-time director of nursing services on duty.
(2) If a nursing facility, as a result of
				  waivered status, employs a licensed vocational nurse to supervise and direct
				  nursing services, the facility must have an agreement with a registered nurse
				  who must provide the vocational nurse at least four hours of consultation in
				  the facility per week. The registered nurse must not assume director of nursing
				  duties, but must act as a consultant to solve problems involving resident care,
				  conduct in-service training, and maintain proper clinical records.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1006 - Nursing Facility Restorative Nursing Care

Current through Reg. 49, No. 28; July 12, 2024
The facility must have a program of restorative nursing
					 care that is an integral part of nursing service and is directed toward helping
					 each resident to achieve and maintain an optimal level of self-care and
					 independence, as defined by the Comprehensive Assessment and Comprehensive Care
					 Plan. Nursing personnel must be trained in restorative nursing and must provide
					 restorative services daily for residents who require them. Nursing personnel
					 must routinely record these services in the resident's clinical
					 record.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1010 - Nursing Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) A licensed
				  nurse must practice within the constraints of applicable state laws and
				  regulations governing their practice, including the Nurse Practice Act, and
				  must follow the guidelines contained in the facility's written policies and
				  procedures.
(b) A nurse must enter,
				  or approve and sign, nurses' notes in the following instances:
(1) at least monthly; and
(2) at the time of any physical complaints,
				  accidents, incidents, and change in condition or diagnosis, and progress. All
				  of these situations must be promptly recorded as exceptions and included in the
				  clinical record.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1011 - Student Nurses

Current through Reg. 49, No. 28; July 12, 2024
If the facility has a contract or agreement with an
					 accredited school of nursing to use their facility for a portion of the student
					 nurses' clinical experience, those student nurses may provide care under the
					 following conditions.
(1) Student
				  nurses may be used in nursing facilities, provided the instructor gives class
				  supervision and assumes responsibility for all student nursing activities
				  occurring within the facility. These students cannot be counted in the
				  nurse-to-resident ratio required in the standards.
(2) The student nurse may administer
				  medications only when in the facility on assignment as a student of their
				  school of nursing.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter K - NURSING SERVICES › Section 554.1012 - Special Nurses and Sitters

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Facilities may develop their own policies regarding private duty aides and
				  sitters.
(b) The nursing facility
				  is responsible for meeting the needs of the residents regardless of the
				  presence of special nurses or sitters.
(c) In Medicaid-certified facilities, the
				  following apply.
(1) The facility is not
				  responsible for payment for a special nurse (registered nurse or licensed
				  vocational nurse) or sitter requested by the resident's physician or
				  family.
(2) The special nurse or
				  sitter must be hired as a separate agreement between the nurse or sitter and
				  resident, or the resident's family or legal representative, and paid directly
				  by them.
(3) The facility may
				  assist in the hiring of a special nurse or sitter but may not in any way enter
				  into the billing, collection, or fee-setting for the special duty nurse or
				  sitter. If it is determined by the auditing staff that the facility received
				  monetary benefits from an arrangement for special duty nurses or sitters, a
				  financial exception will be made and the facility will be asked to reimburse
				  the resident or the responsible party who paid the special duty nurses or
				  sitters. If the resident or family hires an individual to do the special duty
				  nursing, who was already on the facility's staff and a replacement for this
				  person was not hired, the facility will be determined to have received a
				  monetary benefit. See § 554.2606 of Title 40 (relating to Supplementation
				  of Vendor Payments).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1101 - Food and Nutrition Services

Current through Reg. 49, No. 28; July 12, 2024
The facility must provide each resident with a nourishing,
					 palatable, well-balanced diet that meets each resident's daily nutritional and
					 special dietary needs, taking into consideration the preferences of each
					 resident.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1102 - Staffing

Current through Reg. 49, No. 28; July 12, 2024
The facility must employ sufficient staff with the
					 appropriate competencies and skill sets to carry out the functions of the food
					 and nutrition services, taking into consideration resident assessments,
					 individual plans of care, and the number, acuity, and diagnoses of the
					 facility's resident population in accordance with the facility assessment
					 required at § 554.1931 of this chapter (relating to Facility Assessment).
					 This includes:
(1) a qualified
				  dietitian, either full-time, part-time, or on a consultant basis. A qualified
				  dietitian:
(A) holds a bachelors' or higher
				  degree granted by a regionally accredited college or university in the United
				  States, or an equivalent foreign degree, with completion of the academic
				  requirements of a program in nutrition or dietetics accredited by an
				  appropriate national accreditation organization recognized for this
				  purpose;
(B) has completed at least
				  900 hours of supervised dietetics practice under the supervision of a
				  registered dietitian or nutrition professional; and
(C) is licensed as a dietitian by the state
				  of Texas;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1104 - Dietary Consultant Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility must ensure a qualified
				  dietitian is available as frequently and for such time as is necessary to
				  assure each resident a diet that meets the daily nutritional and special
				  dietary needs of each resident, based upon the acuity and clinical needs of the
				  resident. The facility must ensure that monthly dietary consultant hours are
				  provided, at a minimum, as follows:
(1)
				  facility population: 60 residents or under - eight hours;
(2) facility population: each additional 30
				  residents or fraction thereof - additional four hours.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1107 - Menus, Nutritional Adequacy, and Meal Service

Current through Reg. 49, No. 28; July 12, 2024
(a) Menus must:
(1) meet the nutritional needs of residents
				  in accordance with established national guidelines;
(2) be prepared at least one week in
				  advance;
(3) be written for each
				  type of diet ordered in the facility, in accordance with the facility's diet
				  manual;
(4) be written or
				  completely evaluated for nutritional adequacy by the facility's qualified
				  dietitian;
(5) vary from week to
				  week, taking the general age-group of residents into consideration;
(6) be followed unless substitutions are
				  documented as required in subsection (d) of this section;
(7) reflect, based on a facility's reasonable
				  effort, the religious, cultural, and ethnic needs of the resident population,
				  as well as input received from residents and resident groups; and
(8) be updated periodically.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1108 - Food and Drink

Current through Reg. 49, No. 28; July 12, 2024
Each resident must receive and the facility must
					 provide:
(1) food prepared in
				  accordance with established professional food preparation practices and by
				  methods that conserve nutritive value, flavor, and appearance;
(2) adequate amounts of food and drink that
				  is palatable, attractive, and at a safe and appetizing temperature;
(3) food prepared in a form designed to meet
				  individual needs;
(4) appealing
				  options of similar nutritive value to a resident who chooses not to eat food
				  that is initially served or who requests a different meal choice;
(5) food that is prepared and served on
				  schedule;
(6) food that
				  accommodates resident allergies, intolerances, and preferences; and
(7) drinks, including water and other
				  liquids, consistent with a resident's needs and preferences, and sufficient to
				  maintain resident hydration.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1109 - Food Intake

Current through Reg. 49, No. 28; July 12, 2024
Food intake of a resident must be monitored and recorded as
					 follows.
(1) Deviations from normal
				  food and fluid intake must be recorded in the clinical records in accordance
				  with § 554.1911(b)(16)(E) of this chapter (relating to Contents of the
				  Clinical Record).
(2) In-between
				  meals and bedtime snacks, and supplementary feedings, either as a part of the
				  overall comprehensive care plan or as ordered by a physician, including
				  caloric-restricted diets, must be documented using the point, percentage, or
				  other system consistently facility-wide.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1110 - Frequency of Meals

Current through Reg. 49, No. 28; July 12, 2024
(a) Each
				  resident must receive and the facility must provide at least three meals daily,
				  at regular times comparable to normal mealtimes in the community or in
				  accordance with a resident's needs, preferences, requests, and comprehensive
				  care plan.
(b) There must be not
				  more than 14 hours between a substantial evening meal and breakfast the
				  following day, except when a nourishing snack is served at bedtime, up to 16
				  hours may elapse between a substantial evening meal and breakfast the following
				  day if a resident group agrees to this meal span.
(c) Suitable, nourishing alternative meals
				  and snacks must be provided to a resident who wants to eat at non-traditional
				  times or outside of scheduled meal service times, consistent with the
				  resident's plans of care.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1111 - Food Safety Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The facility must procure food from sources approved or considered satisfactory
				  by federal, state, and local authorities.
(1)
				  The facility may include food items obtained directly from local producers,
				  subject to applicable State and local laws or regulations.
(2) This section does not prohibit or prevent
				  a facility from using produce grown in facility gardens, subject to compliance
				  with applicable safe growing and food handling practices.
(3) This section does not preclude a resident
				  from consuming foods not procured by the facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1113 - Paid Feeding Assistants

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  State-approved training course. The facility may use a paid feeding assistant,
				  if the paid feeding assistant has successfully completed a state-approved
				  training course that meets the requirements of § 554.1115 of this
				  subchapter (relating to Requirements for Training of Paid Feeding Assistants)
				  before feeding a resident.
(b)
				  Supervision. A paid feeding assistant must work under the supervision of an RN
				  or an LVN. In an emergency, a paid feeding assistant must call a supervisory
				  nurse for help. A paid feeding assistant can only feed a resident in the dining
				  room.
(c) Resident selection
				  criteria.
(1) The facility must ensure that a
				  paid feeding assistant provides dining assistance only for a resident who has
				  no complicated feeding problems, which include difficulty swallowing, recurrent
				  lung aspirations, and tube or parenteral/IV feedings.
(2) The facility must base resident selection
				  on the interdisciplinary team's assessment and the resident's latest assessment
				  and comprehensive care plan. A resident's comprehensive care plan must reflect
				  the resident's appropriateness for a paid feeding assistant.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1115 - Requirements for Training of Paid Feeding Assistants

Current through Reg. 49, No. 28; July 12, 2024
(a) Minimum training course contents. A
				  state-approved training course for paid feeding assistants must include, at a
				  minimum, 16 hours of training in the following:
(1) feeding techniques;
(2) assistance with feeding and
				  hydration;
(3) communication and
				  interpersonal skills;
(4)
				  appropriate response to resident behavior;
(5) safety and emergency procedures,
				  including the Heimlich maneuver;
(6) infection control;
(7) resident rights; and
(8) recognizing changes in residents that are
				  inconsistent with their normal behavior and the importance of reporting those
				  changes to the supervisory nurse.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter L - DIETARY SERVICES › Section 554.1116 - Therapeutic Diets

Current through Reg. 49, No. 28; July 12, 2024
If a resident requires a therapeutic diet, the attending
					 physician must prescribe the therapeutic diet, unless the physician delegates
					 this task to a qualified dietitian, to the extent allowed by Texas
					 law.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1201 - Physician Services

Current through Reg. 49, No. 28; July 12, 2024
A physician must personally approve in writing a
					 recommendation that an individual be admitted to a facility. Each resident must
					 remain under the care of a physician. A physician, physician assistant, or
					 advanced practice registered nurse must provide orders for the resident's
					 immediate care and needs. The facility must ensure that:
(1) the medical care and other health care of
				  each resident is supervised by an attending physician. Any consultations must
				  be ordered by the attending physician;
(2) another physician supervises the medical
				  care and other health care of a resident when the resident's attending
				  physician is unavailable; and
(3)
				  if a child is admitted to the facility:
(A)
				  appropriate pediatric consultative services are utilized, in accordance with
				  the comprehensive assessment and comprehensive care plan; and
(B) a pediatrician or other physician with
				  training or expertise in the clinical care of children with complex medical
				  needs participates in all aspects of the medical care.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1202 - Physician Visits

Current through Reg. 49, No. 28; July 12, 2024
The physician must:
(1) review, revise, if necessary, and sign
				  orders relating to the resident's total program of care, including medications
				  and treatments, according to the visit schedule required by § 554.1203(2)
				  of this subchapter (relating to Frequency of Physician Visits);
(2) write, sign, and date progress notes at
				  each visit;
(3) sign and date all
				  orders, with the exception of influenza and pneumococcal vaccines, which may be
				  administered per physician's standing order after an assessment for
				  contraindications;
(4) write, sign,
				  and date a physician's discharge summary within 20 working days of being
				  notified by the facility of the discharge, except as specified in §
				  554.1912(e) of this chapter (relating to Additional Clinical Record Service
				  Requirements), if the resident has been temporarily discharged for 30 days or
				  less, and readmitted to the same facility; and
(5) provide documentation in the clinical
				  record as specified in § 554.1911 and § 554.1912 of this chapter
				  (relating to Contents of the Clinical Record and Additional Clinical Record
				  Service Requirements).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1203 - Frequency of Physician Visits

Current through Reg. 49, No. 28; July 12, 2024
Physician visits must conform to the following
					 schedule:
(1) Licensed-only facility.
				  Each resident must have a medical examination at least annually by the
				  resident's physician and as necessary to meet the needs of the resident.
				  Physician orders must be reviewed and revised as necessary at least once every
				  60 days, unless the resident's physician specifies, in writing in the
				  resident's clinical record, a different schedule for each review and
				  revision.
(2) Medicaid-certified
				  facilities and Medicare skilled nursing facilities.
(A) The resident must be seen by a physician
				  at least once every 30 days for the first 90 days after admission, and at least
				  once every 60 days thereafter.
(B)
				  A physician visit is considered timely if it occurs not later than ten days
				  after the date the visit was required.
(C) Except as provided in paragraph (3) of
				  this section and § 554.1205(c) of this subchapter (relating to Physician
				  Delegation of Tasks), all required visits must be made by the physician
				  personally.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1204 - Availability of Physician for Emergency Care

Current through Reg. 49, No. 28; July 12, 2024
The facility must provide or arrange for the provision of
					 physician services 24 hours a day, in case of an emergency.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1205 - Physician Delegation of Tasks

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  In a Medicare skilled nursing facility (SNF), except as specified in subsection
				  (b) of this section, a physician may delegate tasks to a physician assistant,
				  or an advanced practice registered nurse who:
(1) is acting within the scope of practice as
				  defined by state law; and
(2) is
				  under the supervision of the physician.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1206 - Physician Signatures

Current through Reg. 49, No. 28; July 12, 2024
Signature stamps and faxed signed documents are acceptable
					 if used as described in § 554.1912(f)(2) of Title 40 (relating to
					 Additional Clinical Record Service Requirements).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1207 - Prescription of Psychoactive Medication

Current through Reg. 49, No. 28; July 12, 2024
(a) In this section, the following words and
				  terms have the following meanings, unless the context clearly indicates
				  otherwise:
(1) Medication-related
				  emergency--A situation in which it is immediately necessary to administer
				  medication to a resident to prevent:
(A)
				  imminent probable death or substantial bodily harm (emotional or physical) to
				  the resident; or
(B) imminent
				  physical or emotional harm to another because of threats, attempts, or other
				  acts the resident overtly or continually makes or commits.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1208 - Physicians' Reporting Communicable Diseases

Current through Reg. 49, No. 28; July 12, 2024
The physician must report all reportable communicable
					 diseases immediately according to the requirements specified in §
					 554.1601(2)(D) of Title 40 (relating to Infection Control).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter M - PHYSICIAN SERVICES › Section 554.1210 - Certification and Recertification Requirements in Medicaid-Certified Facilities

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  recipient's physician must certify and recertify the recipient's need for
				  nursing facility care in accordance with this section.
(b) A recipient's physician must certify the
				  recipient's need for nursing facility care no later than 20 days after the
				  recipient's admission to the facility.
(c) A recipient's physician must recertify
				  the recipient's need for nursing facility care every 180 days that the
				  recipient remains in the nursing facility after the first
				  certification.
(d) A nursing
				  facility must:
(1) ensure that each
				  certification and recertification statement states: "I hereby certify that this
				  resident requires/continues to require nursing facility care for 180 days";
				  and
(2) keep the physician's
				  certification and recertification statements in the recipient's clinical
				  record.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter N - REHABILITATIVE SERVICES › Section 554.1300 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  contains the requirements a facility must comply with to provide rehabilitative
				  services to a resident.
(b)
				  Subchapter BB (relating to Nursing Facility Responsibilities Related to
				  Preadmission Screening and Resident Review (PASRR) contains the requirements a
				  facility must comply with to provide nursing facility specialized services to a
				  designated resident, as defined in § 554.2703 of this chapter (relating to
				  Definitions).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter N - REHABILITATIVE SERVICES › Section 554.1301 - Provision of Rehabilitative Services

Current through Reg. 49, No. 28; July 12, 2024
(a) If rehabilitative services are required
				  in a resident's comprehensive care plan, the facility must:
(1) provide the required services;
				  or
(2) obtain the required services
				  from an outside resource, in accordance with § 554.1906 of this chapter
				  (relating to Use of Outside Resources).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter N - REHABILITATIVE SERVICES › Section 554.1302 - Qualifications

Current through Reg. 49, No. 28; July 12, 2024
A facility must ensure that rehabilitative services are
					 provided by:
(1) an individual who:
(A) is a speech-language pathologist licensed
				  by the Texas Department of Licensing and Regulation; or
(B) meets the educational requirements and
				  has accumulated, or is in the process of accumulating, the supervised
				  professional experience required to be licensed as a speech-language
				  pathologist;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter N - REHABILITATIVE SERVICES › Section 554.1304 - Rehabilitative Services in Medicaid-Certified Facilities

Current through Reg. 49, No. 28; July 12, 2024
(a) Rehabilitative services covered by
				  Medicaid are physical therapy services, occupational therapy services, and
				  speech therapy services.
(b) A
				  facility must ensure that rehabilitative services covered by Medicaid are
				  provided to a resident to evaluate or treat a function that has been impaired
				  by illness or injury. Rehabilitative services must be provided with the
				  expectation that the resident's functioning will improve measurably in 30
				  days.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter N - REHABILITATIVE SERVICES › Section 554.1306 - Fee-for-Service Payment for Rehabilitative Services

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC pays a facility for rehabilitative
				  services provided to a Medicaid eligible resident based on fees determined in
				  accordance with 1 TAC §
										355.313(relating
				  to Reimbursement Methodology for Rehabilitative and Specialized
				  Services).
(b) A facility must
				  ensure that rehabilitative services provided to a resident eligible for
				  Medicaid are:
(1) ordered by the resident's
				  attending physician; and
(2) except
				  as provided in subsection (c)(1) of this section, pre-certified by
				  DADS.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter O - DENTAL SERVICES › Section 554.1401 - Dental Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  facility must assist a resident in obtaining routine and 24-hour emergency
				  dental care.
(1) At the time of admission,
				  the facility must obtain the name of the resident's preferred dentist and
				  record the name in the clinical record.
(2) At least annually, the facility must ask
				  each resident and resident representative if the resident desires a dental
				  examination at the resident's expense.
(3) The facility must make all reasonable
				  efforts to arrange for a dental examination for each resident who desires
				  one.
(4) The facility is not liable
				  for the cost of the resident's dental care.
(5) Licensed-only facilities must maintain a
				  list of local dentists for a resident who requires a dentist.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter O - DENTAL SERVICES › Section 554.1402 - Medicaid-Certified Nursing Facility Emergency Dental Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Emergency dental services. The Texas
				  Department of Human Services (DHS) will reimburse nursing facilities the cost
				  of emergency dental services provided to eligible Medicaid residents residing
				  in Medicaid-contracted facilities or distinct parts.
(1) Recipients must be 21 years of age or
				  older.
(2) Dental care for
				  recipients under the age of 21 is covered under the Early and Periodic
				  Screening, Diagnosis, and Treatment (EPSDT) program.
(3) Services reimbursed are subject to the
				  limitations specified in § 554.1401(b) of Title 40 (relating to Dental
				  Services).
(4) Emergency dental
				  services may be provided only if the attending physician orders a dental
				  consultation. See § 554.1201 of Title 40 (relating to Physician
				  Services).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1501 - Pharmacy Services

Current through Reg. 49, No. 28; July 12, 2024
A licensed-only facility must assist the resident in
					 obtaining routine drugs and biologicals and make emergency drugs readily
					 available, or obtain them under an agreement described in § 554.1906 of
					 this chapter (relating to Use of Outside Resources). A Medicaid-certified
					 facility must provide routine and emergency drugs and biologicals to its
					 residents, or obtain them under an agreement described in § 554.1906 of
					 this chapter.
(1) Methods and
				  procedures. The facility may permit unlicensed personnel to administer drugs,
				  but only under the general supervision of a licensed nurse. The unlicensed
				  individual must be a nursing student, a medication aide student, or a
				  medication aide with a current permit issued by HHSC.
(2) Accuracy in service delivery. A facility
				  must provide pharmaceutical services (including procedures that assure the
				  accurate acquiring, receiving, dispensing, and administering of all drugs and
				  biologicals) to meet the needs of each resident.
(3) Service consultation. The facility must
				  employ or obtain the services of a pharmacist, currently licensed by the Texas
				  State Board of Pharmacy and in good standing, who:
(A) provides consultation on all aspects of
				  the provision of pharmacy services in the facility;
(B) establishes a system of records of
				  receipt and disposition of all controlled drugs in sufficient detail to enable
				  an accurate reconciliation;
(C)
				  determines that drug records are in order and that an account of all controlled
				  drugs is maintained and periodically reconciled; and
(D) adheres to requirements in §
				  554.1503 of this subchapter (relating to Additional Supervision and
				  Consultation Requirements).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1502 - Choice of Pharmacy Provider

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Unless the facility is paying for the drugs and biologicals, the resident's
				  choice of pharmacy provider and any changes in his choice must be recorded on
				  appropriate forms maintained by the facility.
(b) A Medicaid-certified facility must have
				  written agreements with its provider pharmacies that define required services.
				  These agreements will not be considered to abridge the resident's freedom of
				  choice of pharmacy services when they require labeling, packaging, and a
				  drug-distribution system according to facility policy. The drug-distribution
				  system must be accessible to all pharmacies willing to meet the distribution
				  system requirements. The agreements must require the following:
(1) that the resident's pharmacy services be
				  provided by a pharmacy on a 24-hour basis for emergency medications;
				  and
(2) that the resident's
				  medications be delivered to the facility on a timely and reasonable
				  basis.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1503 - Additional Supervision and Consultation Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility must provide pharmaceutical
				  services under the responsibility and direction of the consultant pharmacist
				  and the director of nursing.
(b)
				  The facility must ensure that notes on the monthly visits by the consulting
				  pharmacist are entered in the resident's clinical record.
(c) The number of hours per month the
				  consultant pharmacist devotes to the pharmaceutical services for ordering,
				  storage, administration, disposal, recordkeeping (documentation) of drugs and
				  medications, and drug regimen review must be sufficient to meet the needs of
				  the residents.
(d) A record of
				  consultant pharmacist services, consultations, and recommendations for pharmacy
				  procedure must be maintained at the facility.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1504 - Drug Security

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  facility must establish procedures for storing and disposing of drugs and
				  biologicals in accordance with federal, state, and local laws.
(b) When not in use, a medication cart must
				  be secured in a designated area.
(c) Small multiple-dose drug containers which
				  are placed into another container must be labeled in a manner so that, if the
				  two containers become separated, the small drug container still has a strip
				  label attached containing the name of the resident and the prescription
				  number.
(d) Self-administered
				  medications may be kept in a locked cabinet in the resident's room. When
				  medications are self-administered, the facility remains responsible for
				  medication security, accurate information, and medication compliance.
(e) The facility must store each resident's
				  drugs in their original containers.
(f) The facility must store medications under
				  appropriate conditions of sanitation, temperature, light, moisture,
				  ventilation, segregation, and security.
(g) Medications of deceased residents,
				  medications that have passed the expiration date, and medications that have
				  been discontinued must be securely stored and reconciled. These medications
				  must be disposed of according to federal and state laws or rules on a quarterly
				  basis. Discontinued drugs may be reinstated if reordered prior to destruction.
				  These medications cannot be given to a family member or
				  representative.
(h) When the
				  directions for administration of a resident's medication have changed, but the
				  existing supply of medication can still be administered accurately, the
				  medication must not be destroyed. The facility must affix a change-of-direction
				  ancillary sticker or similar system and use the remaining medication. The
				  medication label must be updated at the time of next dispensing.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1506 - Drug Orders

Current through Reg. 49, No. 28; July 12, 2024
(a) All drugs must
				  be prescribed by the resident's physician or consulting physician, dentist,
				  podiatrist, or other individual allowed by law to prescribe. If drug orders are
				  verbal, they must be taken by a licensed nurse, pharmacist, physician assistant
				  or a physician, and immediately recorded and signed by the person receiving the
				  order. All drug orders must be counter-signed by the prescriber and returned to
				  the chart in a timely manner.
(b)
				  The facility may permit verbal orders for Schedule II drugs only in an
				  emergency.
(c) Medications must be
				  ordered and reordered on a timely basis so that no resident misses a
				  dose.
(d) The facility must have
				  written policies and procedures for stopping the administration of
				  drugs.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1507 - Drug Release

Current through Reg. 49, No. 28; July 12, 2024
(a) Medications
				  must be released to residents only on the written or verbal authorization of
				  the attending physician. When a resident is Transferred directly to another
				  nursing facility or discharged to home, the resident's medications must be
				  released to the new facility or to the resident or his family,
				  respectively.
(b) If a resident is
				  leaving the facility on a furlough, enough prescription drugs to last
				  throughout the furlough must be released. The facility must inventory Schedule
				  II, III, and IV drugs in and out. Nonschedule drugs should be listed by name.
				  The pharmacist must handle any division of the prescription, and all
				  information on the original prescription label must appear on the furlough
				  medication supply.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1508 - Drug Administration

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The facility must establish drug administration procedures to ensure that:
(1) drugs to be administered are checked
				  against the physician's orders;
(2)
				  the resident is identified before the administration of a drug;
(3) each resident has an individual
				  medication record, where the dose of drug administered is properly recorded by
				  the person who administered the drug;
(4) drugs and biologicals are prepared and
				  administered by the same person, except under unit-of-use package distribution
				  systems and as outlined in § 554.418 of Title 40 (relating to
				  Self-Administration of Drugs); and
(5) drugs prescribed for one resident must
				  not be administered to any other person.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1509 - Controlled Substances

Current through Reg. 49, No. 28; July 12, 2024
The facility must adhere to the following procedures
					 governing the use of drugs covered by the Controlled Substances Act:
(1) a separate record must be maintained for
				  each drug covered by Schedules II, III, and IV of the Controlled Substances
				  Act, Health and Safety Code, Chapter 481;
(2) the record for each drug must contain the
				  prescription number, name, and strength of drug, date received by the facility,
				  date and time administered, name of resident, dose, physician's name, signature
				  of person administering dose, and original amount dispensed with the balance
				  verifiable by drug inventory at every shift change; and
(3) Schedule V drugs are exempt from the
				  requirements in paragraphs (1) and (2) of this section.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter P - PHARMACY SERVICES › Section 554.1510 - Emergency Medication Kits

Current through Reg. 49, No. 28; July 12, 2024
Stocks of inventoried emergency medications may be kept in
					 facilities.
(1) Emergency medication
				  kits must be maintained in compliance with 22 TAC §
										291.121(b)
				  (relating to Remote Pharmacy Services), with the exception of emergency
				  medication kits in veterans homes, as defined by Natural Resources Code, §
										164.002. In veterans
				  homes, a United States Department of Veterans Affairs pharmacy or another
				  federally operated pharmacy may maintain emergency medication kits.
(2) Facilities must have contracts with the
				  pharmacy that provides the emergency medication kit. The contract must outline
				  the services to be provided by the pharmacy and the responsibilities and
				  accountabilities of each party in fulfilling the terms of the contract in
				  compliance with federal and state laws and regulations.