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Presented by: Yolanda Chavez, RN, BSN Policy Rules and Curriculum Development Unit

DADS REGULATORY UPDATE March 2013. Presented by: Yolanda Chavez, RN, BSN Policy Rules and Curriculum Development Unit DADS Regulatory Services. Objectives. At the end of this presentation participants will be able to: locate the basic regulations that affect hospices ;

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Presented by: Yolanda Chavez, RN, BSN Policy Rules and Curriculum Development Unit

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  1. DADS REGULATORY UPDATE March 2013 Presented by: Yolanda Chavez, RN, BSN Policy Rules and Curriculum Development Unit DADS Regulatory Services

  2. Objectives At the end of this presentation participants will be able to: • locate the basic regulations that affect hospices; • recognize the form that must be sent to DADS Licensing when a hospice has certain changes of information; and • list at least three recent DADS Provider Letters, Alerts & Bulletins.

  3. Reason for the Changes Senate Bill 223 and House Bill 1720, 82ndLegislature, Regular Session, 2011 Require an initial survey before an initial license is renewed Ensure timely and up-to-date HCSSA licensure information is maintained Assess fee(s) for reporting change in application information after DADS issues a HCSSA license Provide a DADS representative with a reasonable and safe workspace to conduct a survey

  4. Timeline 82nd Legislature, passes Senate Bill 223 and House Bill 1720 (June 2011) Worked with DADS internal and external stakeholder proposed rules (November 2011- June 2012) Proposed rules presented at DADS Council (March 2012) Proposed rules published in Texas Register for public comment (April 13, 2012) The adopted rules were published in the June 22, 2012 issue of the Texas Register with an effective date of July 1, 2012.

  5. DADS Provider News, Alerts & Bulletins • The adopted rules can be reviewed in the Texas Register at: http://www.sos.state.tx.us/texreg/archive/index.shtml • Agencies are expected to be in compliance with all new rules

  6. List of Adopted Rules

  7. List of Adopted Rules

  8. §97.2 Definitions Amended: (4) Administrator: The person who is responsible for implementing and supervising the administrative policies and operations of a home and community support services agency and for administratively supervising the provision of all services to agency clients on a day-to-day basis.

  9. §97.2 Definitions Added new: (54) Joint training--Training provided by DADS at least semi-annually for home and community support services agencies and DADS surveyors on subjects that address the 10 most commonly cited violations of federal or state law by home and community support services agencies as published in DADS annual reports.

  10. §97.2 Definitions Added new: (65) Operating hours--The days of the week and the hours of day an agency place of business is open as identified in an agency's written policy as required by §97.210 of this chapter (relating to Agency Operating Hours).

  11. §97.3 License Fees§97.15 Issuance of an Initial License Amended: • §97.3 License Fees: • clarifies the rule; • deletes outdated provisions pertaining to one-year renewal license fees; and • updates a cross-reference in the rule. • §97.15 Issuance of an Initial License; • clarifies and corrects the enforcement actions DADS may take against the holder of an initial license; and • makes several technical corrections.

  12. §97.17 Application Procedures for a Renewal License§97.19 Issuance of a Renewal License Amendment: • §97.17 Application Procedures for a Renewal License: • deletes outdated provisions pertaining to renewing a one-year license; • adds notice of administrative penalties DADS may assess; and • updates a reference to §97.3 (Licensing Fee). • §97.19 Issuance of a Renewal License: • deletes an outdated cross-reference to §97.17 and adds a reference to §97.503, which specifies when a HCSSA is exempt from an initial and routine survey by DADS; and • specifies that DADS may not renew an initial license unless DADS conducts an initial survey of a HCSSA that is not exempt from an initial survey.

  13. §97.21 Denial of an Application or License Amendment: • §97.21 Denial of an Application or License: • provides notice to a HCSSA that DADS may deny an application for an initial license or for renewal of a license if certain persons associated with a HCSSA violate: • Texas Occupations Code, §102.001 (relating to Soliciting Patients; Offense), or • Texas Occupations Code, §102.006 (relating to Failure to Disclose; Offense); and • deletes and replaces an outdated reference to rules relating to an administrative hearing.

  14. §97.208 Reporting Changes in Application Information and Fees New Section: §97.208 Reporting Changes in Application Information and Fees: “(a) If certain information provided on an initial or renewal application changes after DADS issues the license, an agency must report the change to DADS. The agency must use Home and Community Support Services Agency License Application, (DADS Form 2021), to report the change. To avoid a late fee, a change must be reported within the time frame specified for the type of change.”

  15. §97.208 Reporting Changes in Application Information and Fees New Section: §97.208 Reporting Changes in Application Information and Fees: What form must be submitted to DADS when a change in application information occurs?

  16. §97.208 Reporting Changes in Application Information and Fees Answer: Home and Community Support Services Agency License Application (DADS Form 2021) *Read instructions on page 20 carefully to ensure pages are completed correctly

  17. §97.208 Reporting Changes in Application Information and Fees Planning and Preparation • SECTION §97.17(g) “DADS sends written notice and the renewal application at least 120 days before the expiration date of the license to an agency.” • If an agency plans to change agency information that must be reported to DADS (§97.208), the agency can do this on the renewal application. • The agency must be within the time frame required by the regulations and no application change fee is incurred($30). • Avoid fee(s) by planning ahead if possible

  18. §97.208 Reporting Changes in Application Information and Fees New Section:

  19. §97.208 Reporting Changes in Application Information and Fees New Section:

  20. §97.208 Reporting Changes in Application Information and Fees New Section: Failure to Report Information Within Time Requirement: • If DADS determines, based on review of the agency’s renewal application, that an agency did not report a change in application information as required by the regulations, DADS notifies the agency in writing of the fee amount due for payment. • Within 30 days of receipt, the agency must pay the appropriate fee. • If the agency is assessed a late fee, the agency must pay a $30 fee(if applicable) for reporting a change and a $100 late fee charge. • Failure to pay the fee within 30 days after DADS provides written notice of the fee amount due may result in a suspension, revocation, or denial of a license.

  21. §97.208 Reporting Changes in Application Information and Fees New Section: Failure to Report Information Within Time Requirement:

  22. §97.213 Agency Relocation Amendment: • §97.213 Agency Relocation: • Updates the requirement that a HCSSA must submit written notice to DADS to report a change in physical location; • specifies when a change in physical location requires DADS review and approval; • specifies that a HCSSA is exempt from the requirement when a temporary relocation results from an emergency or disaster; and • allows an agency to request an exemption from the 30-day time frame requirement.

  23. §97.214 Notification Procedures for a Change in Agency Contact Information and Operation Hours§97.215 Notification Procedures for a Change in Agency Name Amendment: • §97.214 Notification Procedures for an Change in Agency Contact Information and Operation Hours: • Updates the requirement that a HCSSA must submit written notice to DADS to report a change in contact information and HCSSA operating hours. • §97.215 Notification Procedures for an Agency Name Change • Updates the requirement that a HCSSA must submit written notice to DADS to report a change in the HCSSA’s name.

  24. §97.218 Agency Organizational Changes New Section: • §97.218 Agency Organizational Changes • Requires a HCSSA to submit written notice to DADS to report a change in management personnel. • Requires a fee to report changes in the administrator, chief financial officer and controlling person. • Requires a late fee for untimely reporting of changes in management personnel. • Specifies that a change in management personnel requires DADS evaluation and approval.

  25. §97.219 Procedures for Adding or Deleting a Category License Amendment: • §97.219 Procedures for Adding or Deleting a Category to the License • Requires a HCSSA to submit written notice to DADS to request to add or delete a category of service on the HCSSA license; and • specifies the requirements a HCSSA must meet to add a category of service.

  26. §97.220 Service Areas Amendment: • §97.220 Service Areas • Amends the requirements for a HCSSA to submit written notice to DADS to expand or reduce its service area; • clarifies the exemption from the 30-day time frame requirement for an emergency situation that would affect client health and safety; and • specifies that a HCSSA is exempt from the requirements of the section when a temporary services area expansion occurs due to an emergency disaster.

  27. §97.243 Administrative and Supervisory Responsibilities§ 97.255 Prohibition of Solicitation of Patients Amendment: • §97.243 Administrative and Supervisory Responsibilities • Specifies the responsibilities of an HCSSA administrator based on the new statutory definition of a “HCSSA administrator”; and • clarifies the duties and responsibilities of a HCSSA administrator. • §97.255 Prohibition of Solicitation of Patients • Specifies that DADS may take enforcement action against a HCSSA if the agency violates Texas Occupations Code, §102.001(relating to Soliciting Patients) and §102.006 (relating to Failure to Disclose).

  28. §97.259 Initial Education training in Administration of Agencies Amendment: • §97.259 Initial Educational Training in Administration of Agencies • Allows an administrator to use DADS joint training if it meets the requirements for the 24 hours of educational training required in the rule; and • clarifies that initial educational training may be completed before designation as an administrator and alternate administrator.

  29. §97.507 Agency Cooperation with a Survey Amendment: • §97.507 Agency Cooperation with a Survey • Specifies that a HCSSA must not refuse to allow a DADS representative to inspect a book, record or file required to be maintained by or on behalf of the HCSSA • Must provide a representative with a reasonable and safe workspace at the agency • Specifies what a HCSSA must do if notified by DADS that a workspace requirement is not met and actions DADS may take for a HCSSA’s willful refusal to provide a reasonable and safe workspace

  30. §97.521 Requirements for an Initial Survey Amendment: • §97.521 Requirements for an Initial Survey • Clarifies that a HCSSA must submit a written request to DADS for an initial licensure survey; • adds a reference to §97.15, which specifies the enforcement actions DADS may take against an initial license; and • specifies when a HCSSA is exempt from the requirement to submit a written request to DADS for an initial licensure survey.

  31. §97.601 Enforcement Actions Amendment: • §97.601 Enforcement Actions • Adds the correct references to violations of the Texas Occupations Code for which DADS may take enforcement action against a HCSSA; • updates references to the rules for requesting an administrative hearing; and • specifies that a HCSSA must continue to submit a renewal application until an enforcement action proposed by DADS is completed.

  32. §97.601 Enforcement Actions DADS may take the following enforcement actions against an agency: (1) license suspension; (2) immediate license suspension; (3) license revocation; (4) immediate license revocation; (5) administrative penalties; and (6) denial of license application.

  33. §97.602 Administrative Penalties Amendment: • §97.602 Administrative Penalties • Provides that DADS may assess an administrative penalty against a person who violates Texas Occupations Code, §102.001 or §102.006, if the violation is related to providing HCSSA services; and • updates the rule cites and subject matter descriptions listed in the SeverityLevel A and B Violations penalty tables.

  34. Proposed Hospice Rule Project Rules to Conform with Centers (CMS) Conditions of Participation, passed in December, 2008

  35. Conformance with CMS Conditions of Participation • Rule project in response to the Centers for Medicare and Medicaid Services' revised hospice conditions of participation (CoPs) at 42 Code of Federal Regulations, Part 418, effective December 2, 2008. • The rule proposal includes repealing §97.403, Standards Specific to Agencies Licensed to Provide Hospice Services, from Chapter 97, Subchapter D, and replacing it with a new Subchapter H to better organize the information in the proposed new rule sections. The rule sections in new Subchapter H are based on the federal hospice CoPs and on Texas state laws regulating services provided by hospice licensed staff and hospice aides.

  36. Hospice Rule Project Timeline Hospice conditions of participation at 42 Code of Federal Regulations, Part 418, effective December 2, 2008. Worked with DADS internal and external stakeholders on proposed rules (August 2009- September 2012) Proposed rules presented at DADS Council (December 2012) Rules proposed in Texas Register (Spring 2013) Rules adopted/ effective date (Summer 2013)

  37. DADS Provider News, Alerts & Bulletins • The adopted rules are available on the handbooks page of the DADS website at http://www.dads.state.tx.us/handbooks. • The adopted rules are available on the Texas Administrative Code website at http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=97.

  38. Who to Contact:Policy & Rule Interpretations DADS Regulatory Services: 512 – 438 - 3161 Dana Hornsby (Policy) E-mail: dana.hornsby@dads.state.tx.us Yolanda Chavez, BSN, RN (Policy) E-mail: yolanda.chavez@dads.state.tx.us Gilbert Estrada (Policy) E-mail: gilbert.estrada@dads.state.tx.us

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