Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 565 - HOME AND COMMUNITY-BASED (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) CERTIFICATION STANDARDS › Subchapter E - CERTIFICATION STANDARDS: SERVICE DELIVERY › Section 565.13 - Nursing

Current through Reg. 49, No. 28; July 12, 2024
(a) A program provider
				  must:
(1) ensure that nursing is provided in
				  accordance with the individual's person-directed plan (PDP); individual plan of
				  care (IPC); implementation plan; Texas Occupations Code Chapter 301 (Nursing
				  Practice Act); 22 Texas Administrative Code (TAC) Chapter 217 (relating to
				  Licensure, Peer Assistance and Practice); 22 TAC Chapter 224 (relating to
				  Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed
				  Personnel for Clients with Acute Conditions or in Acute Care Environments); 22
				  TAC Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks
				  Not Requiring Delegation in Independent Living Environments for Clients with
				  Stable and Predictable Conditions); and Appendix C of the HCS Program waiver
				  application approved by the Centers for Medicare and Medicaid Services (CMS)
				  and found on the Texas Health and Human Services Commission (HHSC) website, and
				  consists of performing health care activities and monitoring the individual's
				  health conditions;
(2) this
				  includes:
(A) administering
				  medication;
(B) monitoring the
				  individual's use of medications;
(C) monitoring health risks, data, and
				  information, including ensuring that an unlicensed service provider is
				  performing only those nursing tasks identified from a nursing
				  assessment;
(D) assisting the
				  individual to secure emergency medical services;
(E) making referrals for appropriate medical
				  services;
(F) performing health
				  care procedures ordered or prescribed by a physician or medical practitioner
				  and required by standards of professional practice or law to be performed by a
				  registered nurse (RN) or licensed vocational nurse (LVN);
(G) delegating nursing tasks to an unlicensed
				  service provider and supervising the performance of those tasks in accordance
				  with state law and rules;
(H)
				  teaching an unlicensed service provider about the specific health needs of an
				  individual;
(I) performing an
				  assessment of an individual's health condition;
(J) ensuring a registered nurse (RN):
(i) performs a nursing assessment for each
				  individual:
(I) before an unlicensed service
				  provider performs a nursing task for the individual, unless a physician has
				  delegated the task as a medical act under Texas Occupations Code Chapter 157,
				  as documented by the physician; and
(II) as determined necessary by an RN,
				  including if the individual's health needs change;
(ii) documents information from performance
				  of a nursing assessment;
(iii) if
				  an individual is receiving a service through the consumer directed services
				  (CDS) option, provides a copy of the documentation described in clause (ii) of
				  this subparagraph to the individual's service coordinator;
(iv) develops the nursing service portion of
				  an individual's implementation plan, which includes developing a plan and
				  schedule for monitoring and supervising delegated nursing tasks; and
(v) makes and documents decisions related to
				  the delegation of a nursing task to an unlicensed service provider;
				  and
(K) in accordance
				  with Texas Human Resources Code Chapter 161:
(i) allowing an unlicensed service provider
				  to provide administration of medication to an individual without the delegation
				  or oversight of an RN if:
(I) an RN has
				  performed a nursing assessment and based on the results of the assessment,
				  determined that the individual's health permits the administration of
				  medication by an unlicensed service provider;
(II) the medication is:
(-a-) an oral medication;
(-b-) a topical medication; or
(-c-) a metered dose
				  inhaler;
(III) the
				  medication is administered to the individual for a predictable or stable
				  condition; and
(IV) the unlicensed
				  service provider has been:
(-a-) trained by
				  an RN or a licensed vocational nurse (LVN) under the direction of an RN
				  regarding the proper administration of medication; or
(-b-) determined to be competent by an RN or
				  LVN under the direction of an RN regarding proper administration of medication,
				  including through a demonstration of proper technique by the unlicensed service
				  provider; and
(ii) ensuring that an RN or LVN under the
				  supervision of an RN reviews the administration of medication to an individual
				  by an unlicensed service provider at least annually and after any significant
				  change in the individual's condition.