1. Emergency License Suspension, Closure and Systems Improvement Agreements
Presenters:
Mary T. Henderson, TX LTC, Derek Jakovich, TX LTC and Ramiro Cantu, WA-NLTC

2. Texas Emergency Suspension and Closure Process
Immediate Jeopardy (IJ) Determination is made according to the HHSC Long-Term Care Regulatory (LTCR) IJ procedure described in Internal Memorandum
(Please see attachments below)
After the IJ Determination, LTCR survey operations staff in the Region and State Office staff must determine whether the facility is operating in violation of the standards prescribed by Health and Safety Code Chapter 242 and Texas Administrative Code Chapter 19 and the violation(s) create an immediate threat (IT) to the health and safety of the resident(s).
A Plan of Removal (POR) submitted after an IJ Determination is evaluated by the Region in consultation with the State Office staff. An unacceptable POR is an important factor to consider when considering possible emergency action.

3. HHSC Long-Term Care Regulatory * Internal Memorandum (IM)
11/13/2018

4. HHSC Long-Term Care Regulatory * Internal Memorandum (IM)
11/13/2018

5. HHSC Long-Term Care Regulatory * Internal Memorandum (IM)
11/13/2018

6. HHSC Long-Term Care Regulatory * Internal Memorandum (IM)
11/13/2018

7. Applicable Legal Authority (Texas Health & Safety Code)
Sec   EMERGENCY SUSPENSION OR CLOSING ORDER.  (a)  The department shall suspend an institution's license or order an immediate closing of part of the institution if:
(1)  the department finds the institution is operating in violation of the standards prescribed by this chapter;  and
(2)  the violation creates an immediate threat to the health and safety of a resident.
(b)  The executive commissioner by rule shall provide for the placement of residents during the institution's suspension or closing to ensure their health and safety.
(c)  An order suspending a license or closing a part of an institution under this section is immediately effective on the date on which the license holder receives written notice or a later date specified in the order.
(d)  An order suspending a license or ordering an immediate closing of a part of an institution is valid for 10 days after the effective date of the order.
(e)  A court having jurisdiction of a judicial review of the matter may not order arbitration, whether on motion of any party or on the court's own motion, to resolve a dispute involving an emergency suspension or closing order under this section or the conduct with respect to which the emergency suspension or closing order is sought

8. Immediate Threat Determination
A conference call(s) is held with the appropriate Regional and State Office staff to evaluate the facts and applicable statute and rule violations that support the proposed emergency suspension and closure order. The LTCR Associate Commissioner, Deputy Executive Commissioner for Regulatory Services (DEC), and Legal are consulted during and/or after the conference call.
If approval is given to proceed, the Region will prepare the Referral Memo; copy of Memo template attached.
State Office Enforcement staff prepare the Referral Addendum with Supporting documents; copy of Addendum template attached.
Regional Staff work on identifying capacity for placement of residents.
Legal in State Office prepares the Cover Letter and Order; copy of Order template attached.

9. Notification and Order Process
The LTCR Associate Commissioner and DEC will notify the HHSC Chief Policy Officer and Executive Commissioner regarding the possible emergency suspension and closing order, and conduct the briefing, including the supporting documentation. Meeting is called with the Executive Commissioner, Deputy Executive Commissioner, Associate Commissioner, Legal, Communications Director, and Governmental Relations.
Once all documents are reviewed and approved, the Executive Commissioner will execute the Order.
Legal will provide executed copies of the Cover Letter and Order to the Region and State Office staff.
The Regional staff will hand-deliver the Cover Letter and Order to the facility; State Office staff will also fax the Cover Letter & Order to the facility. 
HHSC also considers seeking a TRO to prevent the facility from reopening if the facility may reopen and the health and safety risk remain.

10. Service of Order & Monitoring
Importance of serving the Order on the appropriate legal and responsible entity
Monitoring the Placement of Residents and Facility Closure

11. Texas Health and Human Services Commission     TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEMORANDUM

12. NF –Template Suspension and Closure Cover Letter

13. ORDER OF EMERGENCY SUSPENSION OF LICENSE AND CLOSURE

14. Addendum: Information from State Office
11/13/2018

15. Thank you Mary T. Henderson
Associate Commissioner LTC Regulatory Services
Derek Jakovich, Director LTC Enforcement