Current through Reg. 50, No. 13; March 28, 2025
(a) A person must
be licensed to establish or operate an assisted living facility in Texas.
(1) HHSC considers one or more facilities to
be part of the same establishment and, therefore, subject to licensure as an
assisted living facility, based on the following factors:
(C) shared services, personnel, or equipment
in any part of the facilities' operations; and
(D) any public appearance of joint operations
or of a relationship between the facilities.
(2) The presence or absence of any one factor
in paragraph (1) of this subsection is not conclusive.
(b) To obtain a license, a person must follow
the application requirements in this subchapter and meet the criteria for a
license.
(c) An applicant must
affirmatively show that the applicant, license holder, controlling person, and
any person required to submit background and qualification information meet the
criteria and eligibility for licensing, in accordance with this section; and
(1) the building in which the facility is
housed:
(A) meets local fire
ordinances;
(B) is approved by the
local fire authority;
(C) meets
HHSC licensing standards in accordance with Subchapter D of this chapter
(relating to Facility Construction) based on an on-site inspection by HHSC or
the standards for accreditation based on an on-site accreditation survey by an
accreditation commission; and
(D)
if located in a county of more than 3.3 million residents for initial license
applications submitted or issued on or after December 6, 2022, is not located
in a 100-year floodplain; and
(2) operation of the facility meets HHSC
licensing standards based on an on-site health inspection by HHSC, which must
include observation of the care of a resident; or
(3) the facility meets the standards for
accreditation based on an on-site accreditation survey by the accreditation
commission.
(d) An
applicant who chooses the option authorized in subsection (c)(3) of this
section must contact HHSC to determine which accreditation commissions are
available to meet the requirements of that subsection. If a license holder uses
an on-site accreditation survey by an accreditation commission, as provided in
this subsection and §
553.33(i) of
this subchapter (relating to Renewal Procedures and Qualifications), the
license holder must:
(1) provide written
notification to HHSC by submitting an updated application in the licensing
system within five working days after the license holder receives a notice of
change in accreditation status from the accreditation commission; and
(2) include a copy of the notice of change
with its written notification to HHSC.
(e) HHSC issues a license to a facility
meeting all requirements of this chapter. The facility must not exceed the
maximum allowable number of residents specified on the license.
(f) HHSC denies an application for an initial
license or a renewal of a license if:
(1) the
applicant, license holder, controlling person, or any person required to be
disclosed on the application for licensure has been debarred or excluded from
the Medicare or Medicaid programs by the federal government or a
state;
(2) a court has issued an
injunction prohibiting the applicant, license holder, controlling person, or
any person required to be disclosed on the application for licensure from
operating a facility; or
(3) during
the five years preceding the date of the application, a license to operate a
health care facility, long-term care facility, assisted living facility, or
similar facility in any state held by the applicant, license holder,
controlling person, or any person required to be disclosed on the application
for licensure has been revoked.
(g) A license holder or controlling person
who operates a nursing facility or an assisted living facility for which a
trustee was appointed and for which emergency assistance funds, other than
funds to pay the expenses of the trustee, were used is subject to exclusion
from eligibility for:
(1) the issuance of an
initial license for a facility for which the person has not previously held a
license; and
(2) the renewal of the
license of the facility for which the trustee was appointed.
(h) HHSC may deny an application
for an initial license or refuse to renew a license if an applicant, license
holder, controlling person, or any person required to be disclosed on the
application for licensure:
(1) violates Texas
Health and Safety Code, Chapter 247; a section, standard, or order adopted
under Chapter 247; or a license issued under Chapter 247 in either a repeated
or substantial manner;
(2) commits
an act described in §
553.751(a)(2) -
(9) of this chapter (relating to
Administrative Penalties);
(3)
aids, abets, or permits a substantial violation described in paragraph (1) or
(2) of this subsection about which the person had or should have had
knowledge;
(4) fails to provide the
required information, facts, or references;
(5) engages in the following:
(A) knowingly submits false or intentionally
misleading statements to HHSC;
(B)
uses subterfuge or other evasive means of filing an application for
licensure;
(C) engages in
subterfuge or other evasive means of filing on behalf of another who is
unqualified for licensure;
(D)
knowingly conceals a material fact related to licensure; or
(E) is responsible for fraud;
(6) fails to pay the following
fees, taxes, and assessments when due:
(A)
license fees, as described in §
553.47 of this subchapter
(relating to License Fees); or
(B)
franchise taxes, if applicable;
(7) during the five years preceding the date
of the application, has a history in any state or other jurisdiction of any of
the following:
(A) operation of a facility
that has been decertified or has had its contract canceled under the Medicare
or Medicaid program;
(B) federal or
state long-term care facility, assisted living facility, or similar facility
sanctions or penalties, including monetary penalties, involuntary downgrading
of the status of a facility license, proposals to decertify, directed plans of
correction, or the denial of payment for new Medicaid admissions;
(C) unsatisfied final judgments, excluding
judgments wholly unrelated to the provision of care rendered in long-term care
facilities;
(D) eviction involving
any property or space used as a facility; or
(E) suspension of a license to operate a
health care facility, long-term care facility, assisted living facility, or a
similar facility;
(8)
violates Texas Health and Safety Code §
247.021 by
operating a facility without a license; or
(9) is subject to denial or refusal as
described in Chapter 560 of this title (relating to Denial or Refusal of
License) during the time frames described in that chapter.
(i) Without limitation, HHSC reviews all
information provided by an applicant, a license holder, a person required to be
disclosed on the application for licensure, or a manager when considering
grounds for denial of an initial license application or a renewal application
in accordance with subsection (h) of this section. HHSC may grant a license if
HHSC finds the applicant, license holder, person required to be disclosed on
the application for licensure, affiliate, or manager is able to comply with the
rules in this chapter.
(j) HHSC
reviews final actions when considering the grounds for denial of an initial
license application or renewal application in accordance with subsections (f)
and (h) of this section. An action is final when routine administrative and
judicial remedies are exhausted. An applicant must disclose all actions,
whether pending or final.
(k) If an
applicant owns multiple facilities, HHSC examines the overall record of
compliance in all of the applicant's facilities. An overall record poor enough
to deny issuance of a new license does not preclude the renewal of a license of
a facility with a satisfactory record.
