Regulatory Changes on the Horizon Diana Martinez, TALA John Rickard, P3 Consulting

1. Regulatory Changes on the HorizonDiana Martinez, TALAJohn Rickard, P3 Consulting April 4, 2019

2. Disclaimer • The material we are covering today is anticipated. • We are providing an overview of what we anticipate HHSC will adopt. • In the case of the Life Safety Code changes, we are also covering some the differences between the 2000 and 2012 of NFPA 101. • Stay tuned to the TALA Eblast for additional information once adoption occurs.

3. Adoption of the 2012 Life Safety Code

4. Background 2000 NFPA 101 Life Safety Code contains concept of evacuation capability: • Prompt • Slow • Impractical

5. Background DHS/DADS/HHSC used these concepts to define levels for assisted living: • Promptbecame the short-lived Type E • Slow became Type A • Requires residents to evacuate to a central location on the floor of exit discharge within 13 minutes without continuous staff assistance • Must comply with NFPA 101 Chapter 32 Residential Board and Care Occupancies

6. Background Impractical became Type B • Large Type B must comply with NFPA 101 Chapter 18 Health Care Occupancies • Small (4-16 beds) must comply with NFPA 101 Chapter 32

7. Background The concept of evacuation capability was removed from NFPA 101 in 2003. • Allows aging-in-place • Eliminates requiring fire marshals to evaluate the residents

8. On the Horizon Texas state law passed last session requires HHSC to update assisted living standards to the 2012 or later edition of NFPA 101. • HHSC is in the process of updating to the 2012 edition. • The 2012 edition does not contain the concept of evacuation capability. • So . . . now what?

9. On the Horizon Our understanding is that HHSC will retain Type A and Type B with their current evacuation capability criteria.

10. Key Differences • The 2012 edition is generally less stringent and clearer than the 2000 edition. • The 2012 edition allows kitchens serving 30 or fewer residents to be open to the corridor, under certain conditions. • The 2012 edition allows gas fireplaces without requiring 1-hour rated separation from sleeping areas.

11. Key Differences • Reference codes in the 2012 edition are also generally less stringent and clearer than in the 2000 edition. • Smoke detection in NFPA 72 is clearer • NFPA 13 has a ceiling pocket exception

12. Effective Date • 2012 Life Safety Code rules will be effective early 2020 • Will be in a more organized structure  • Will be clearer, and sections will be formatted based on type and size of facility. 

13. Emergency Preparedness

14. Types of Emergencies • a fire or explosion • a power, telecommunication, or water outage; contamination of a water source; or significant interruption in the normal supply of any essential, such as food or water • a wildfire • a hazardous materials accident • an active or threatened terrorist or shooter, a detonated bomb or bomb threat, or a suspicious object or substance • a flood or a mudslide • a hurricane or other severe weather conditions • an epidemic or pandemic • a cyber-attack • a loss of all or a portion of the facility

15. Core Function One: Direction and Control (1) designate the emergency preparedness coordinator (EPC), who is the facility staff person with the responsibility and authority to manage the facility's response to an emergency situation (2) designate an alternate EPC, who is the facility staff person with the responsibility and authority to act as the EPC if the EPC is unable to serve in that capacity (3) assigns each staff member specific responsibilities and describes the facility’s system for ensuring that each staff member clearly understands the staff member’s own role and how to execute it, in the event of an emergency

16. Core Function Two: Warning (1) describes applicable procedures, methods, and responsibility for the facility, local EMC, and other outside organizations to notifying the EPC or alternate EPC, as applicable, of an emergency situation (2) identifies who, including during off hours, weekends, and holidays, the EPC will notify of an emergency situation, and the methods and procedures for notification

17. Core Function Two: Warning (3) addresses monitoring local news and weather reports regarding a disaster or potential disaster or emergency situation, taking into consideration factors, such as: (A) geographic-specific natural disasters; (B) whether a disaster is likely to be addressed or forecast in the reports; (C) the conditions, natural or otherwise, under which designated staff become responsible for monitoring news and weather reports for a disaster or emergency situation (4) delineates a procedure for keeping all persons present in the facility informed of the facility’s plan in response to a potential or occurrent emergency situation that could impact the area where the facility is located

18. Core Function Three: Communication (1) identifies the facility's primary mode of communication to be used during an emergency situation and the facility's supplemental or alternate mode of communication (2) requires posting the instruction to call 911 in the event of an emergency on or near each telephone in the facility, or if the facility is located in a community where a "911" emergency management system is unavailable, requires posting of the emergency contact number for the local fire department, ambulance, and police on or near each telephone in the facility (3) includes a list of contact information for the legally authorized representative and the designated emergency contact for each resident

19. Core Function Three: Communication (4) includes a list of contact information for each pre-arranged receiving facility (5) includes a list of contact information for home and community support services agencies and independent health care professionals that deliver health care services to residents in the facility, along with a list of residents under the care of each (6) includes a list of personal contact information for facility staff

20. Core Function Three: Communication (7) describes the procedure for notification as soon as practicable about facility actions affecting residents during a particular emergency situation, including an impending or actual evacuation, and for ongoing communication for the duration of the emergency situation or evacuation, to at least: (A) the facility staff (including off-duty staff); (B) the residents; (C) the legally authorized representative of a resident; (D) the designated emergency contact for a resident; (E) the home and community support services agency or independent health care professional that delivers health care services to a facility resident; and (F) the local EMC;

21. Core Function Three: Communication (8) includes a procedure for the facility to maintain communication, throughout the emergency situation, with at least: (A) the facility residents; (B) the facility staff involved in an emergency situation; (C) the receiving facility; (D) the driver of a vehicle transporting residents or staff, medication, records, food, water, equipment, or supplies during an evacuation, and the employer of the driver who is not a facility staff person, and (E) the local EMC

22. Core Function Three: Communication (9) provides a method for the facility to communicate information to the public about its status during an emergency situation (10) identifies the procedure for ensuring that the lists of contact information referenced in paragraphs (3) through (6) of this subsection are kept current at all times

23. Core Function Four: Sheltering in Place (1) describes the procedure for implementing a decision to shelter-in-place that includes: (A) the arrangements, staff responsibilities, and procedures for accessing and obtaining medication, records, equipment and supplies, water, and food, including food to accommodate an individual who has a medical need for a special diet; (B) facility arrangements and procedures for providing power, safe ambient temperatures in areas used by residents, in accordance with §92.62(i)(10) of this chapter (relating to general safety features), and telecommunication capabilities, if affected by the emergency situation; (C) if necessary, sheltering facility staff involved in responding to an emergency situation and, if and as necessary and appropriate, their family members. (2) includes a procedure for notifying the HHSC Regulatory Services regional office for the area in which the facility is located immediately after the EPC makes a decision to shelter-in-place.

24. Core Function Five: Evacuation (1) A facility may only evacuate to another facility that is licensed in Texas as an assisted living facility with the same evacuation capability as the evacuating facility, or greater. (2) A facility’s plan must contain a section for evacuation that: (A) describes the procedure for implementing a decision to evacuate some or all residents to one or more receiving facilities; (B) includes a current copy of an agreement with one or more receiving facilities that: (i) outlines arrangements for the receiving facility to receive an evacuating facility’s residents; and (ii) includes a process for ensuring that the evacuating facility notifies each receiving facility of the evacuation and verifies that it is available and ready to receive the evacuating residents; (C) identifies the procedure and the staff responsible, for notifying the local EMC regarding an evacuation of the facility

25. Core Function Five: Evacuation (D) includes the procedure and the staff responsible for: (i) notifying the HHSC Regulatory Services regional office for the area in which the facility is located immediately after the EPC makes a decision to evacuate (ii) ensuring that sufficient facility staff with qualifications necessary to meet resident needs accompany evacuating residents to a receiving facility and remain with the residents for the duration of the residents’ stay in the receiving facility providing any necessary care (iii) ensuring that residents and facility staff present in the building have been evacuated (iv) accounting for and tracking residents, facility staff, and transport vehicles’ locations during evacuation and after they have been evacuated, through the time of the residents and facility staff return to the evacuating facility; (v) accounting for residents absent from the facility at the time of the evacuation

26. Core Function Five: Evacuation (vi) overseeing the release of resident information to authorized persons in an emergency situation to promote continuity of a resident's care; (vii) contacting the local EMC to find out if it is safe to return to the geographical area after an evacuation; (viii) making or obtaining, as appropriate, a comprehensive determination of whether and when it is safe to re-enter and occupy each facility building after an evacuation; (ix) returning evacuated residents to the facility and notifying persons listed in subsection (g)(7) of this section who were not involved in the return of the residents; and (x) notifying the HHSC Regulatory Services regional office for the area in which the facility is located immediately after each instance when some or all residents have returned to the facility after an evacuation.

27. Core Function Six: Transportation (1) identifies current arrangements for a sufficient number of physically accessible, properly maintained, and fully fueled vehicles to be readily available to safely evacuate all residents (2) identifies facility staff designated to drive a facility owned, leased or rented vehicle during an evacuation, notification procedures to ensure their availability at the time of an evacuation, and methods for maintaining communication with vehicles, staff, and drivers transporting facility residents or staff during evacuation (3) includes procedures for safely transporting residents, facility staff, and any other individuals evacuating a facility (4) includes procedures for the safe and secure transport of, and staff’s timely access to for evacuating residents, oxygen, medications, records, food, water, equipment, and supplies needed during an evacuation

28. Core Function Seven: Health and Medical Needs (1) identifies special services used, specific to each resident, such as dialysis, oxygen, respirator care, or hospice services (2) identifies procedures to ensure that each resident's needs identified under paragraph (1) of this subsection are met during an emergency situation (3) identifies procedures to ensure that the facility notifies home and community support services agencies and independent health care professionals that deliver services to residents in the facility of an evacuation

29. Core Function Eight: Resource Mgmt (1) identifies a plan for identifying medications, records, food, water, equipment and supplies needed during an emergency situation (2) identifies facility staff who are assigned to access or obtain the items underparagraph (1) of this subsection and other necessary resources, and to ensure their delivery to the facility, as needed, or their transport in the event of an evacuation (3) describes the procedure to ensure medications are secure and maintained at the proper temperature throughout an emergency situation (4) describes procedures and safeguards to protect the confidentiality, security, and integrity of resident records throughout an emergency situation and the evacuation of residents

30. Surveys

31. Survey Delays Last legislative session (2017), HHSC sustained a cut in funding that resulted in a loss of 74 survey positions. • 66 of the positions have been back filled • Many still is training

32. Newly Implemented Projects • Expanded a pilot to allregions that streamlines the reports surveyors must write after conducting an investigation. The new template puts a lot of the required information into a readable, check-box format, which will greatly reduce the amount of information that must be written out in a narrative style. • Another initiative HHSC developed is a more risk-based approach for surveys. This means that HHSC is now able to conduct a scaled-back version of a survey for providers that have a strong regulatory history.

33. HHSC Response to Complaints and Self-Reports HHSC has revised their internal processes to change Priority 3 (30 days) and Priority 4 (45 days) complaints to the “next onsite visit” category for NFs and ALFs.

34. Reorganization of Chapter 92

35. Title 26, Chapter 553 Reorganization of Texas Administration Code Chapter 92 • The current ALF regulations reside in Chapter 92 • The regulations will move to Title 26, Chapter 553 • Chapter 553 will be reorganized so that it is easier to navigate • Project will be completed sometime in 2020

36. TULIP

37. Texas Unified Licensure Information Portal • TULIP is a new web-based portal that will allow LTC providers the ability to manage license applications / renewals / CHOWS /Self Reports • All forms online • Go live date was September 4th • HHSC has established a TULIP website • Provider Letter 18-15 New Web-based Licensure System - Texas Unified Licensure Information Portal (TULIP)

38. Contact Information Diana Martinez VP of Public Policy Texas Assisted Living Association 4505 Spicewood Springs Rd, Suite 250 Austin, TX 78759 512-914-3908 Diana.martinez@tala.org Twitter: @TALAPOLICY