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

2. 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. March 2013 2

3.  Senate Bill 223 and House Bill 1720, 82 nd Legislature, 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 March 2013 3

4. 82 nd 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. March 2013 4

5. 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 March 2013 5

6. §97.2 Definitions §97.21 Denial of an Application or a License §97.3 License Fees §97.208 Reporting Changes in Application Information and Fees §97.15 Issuance of an Initial License §97.213 Agency Relocation §97.17 Application Procedures for a Renewal License §97.214 Notification Procedures for a Change in Agency Contact Information and Operation Hours §97.19 Issuance of a Renewal License §97.215 Notification Procedures an Agency Name Change March 2013 6

7. §97.216 Change in Agency Certification Status §97.259 Initial Education training in Administration of Agencies §97.218 Agency Organizational Changes §97.507 Agency Cooperation with a Survey §97.219 Procedures for Adding or Deleting a Category License §97.521 Requirements for an Initial Survey §97.220 Service Areas§97.601 Enforcement Actions §97.243 Administrative and Supervisory Responsibilities §97.602 Administrative Penalties §97.255 Prohibition of Solicitation of Patients March 2013 7

8. 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. March 2013 8

9. 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. March 2013 9

10. 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). March 2013 10

11. 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. March 2013 11

12. 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. March 2013 12

13. 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. March 2013 13

14. 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.” March 2013 14

15. 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 ? March 2013 15

16. Answer : Home and Community Support Services Agency License Application (DADS Form 2021) *Read instructions on page 20 carefully to ensure pages are completed correctly March 2013 16

17. March 2013 17

18. 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 March 2013 18

19. New Section: March 2013 19 Changes in agency information that must be reported on DADS Form 2021: $30 Fee 1. Agency’s location ( § 97.213) $ 2. * Agency’s contact information and operating hours ( § 97.214) N/A 3. Agency’s name change ( § 97.215) $ 4. * Agency’s organizational management personnel ( § 97.218) $ 5. Adding or deleting a category of service to the license ( § 97.219) $ 6. Expanding or deleting a service area to the license ( § 97.220) $ *no fee for reporting a change in contact information and operating hours *no fee for reporting a change in alternate administrator

20. New Section: March 2013 20 Changes in agency information that must be reported on DADS Form 2021: Time Requirement No Later Than: $30 Fee 1. Agency’s location (§97.213)*30 days before relocation$ 2. *Agency’s contact information and operating hours (§97.214) 7 days after a changeN/A 3. Agency’s name change (§97.215) 7 days after a change$ 4. *Agency’s organizational management personnel (§97.218) 7 days after a change$ 5.Adding or deleting a category of service to the license (§97.219) 30 days before adding 30 days before deleting $ 6. Expanding or deleting a service area to the license (§97.220) *30 days before expansion 10 days after reduction$

21. 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. March 2013 21

22. New Section: Failure to Report Information Within Time Requirement: March 2013 22 Changes in agency information that must be reported on DADS Form 2021: Time Requirement No Later Than: Fee: $30Late Fee: $100Total Due 1. Agency’s location (§97.213)*30 days before relocation$Yes$130 2. *Agency’s contact information and operating hours (§97.214) 7 days after a changeN/AYes$100 3. Agency’s name change (§97.215) 7 days after a change$Yes$130 4. Agency’s organizational management personnel (§97.218) 7 days after a change$Yes$130 5.Adding or deleting a category of service to the license (§97.219) 30 days before adding 30 days before deleting $Yes$130 6. Expanding or deleting a service area to the license (§97.220) *30 days before expansion 10 days after reduction $Yes$130

23. 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. March 2013 23

24. 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. March 2013 24

25. 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. March 2013 25

26. 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. March 2013 26

27. 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. March 2013 27

28. 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). March 2013 28

29. 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. March 2013 29

30. 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 March 2013 30

31. 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. March 2013 31

32. 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. March 2013 32

33. 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. March 2013 33

34. 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 Severity Level A and B Violations penalty tables. March 2013 34

35. Rules to Conform with Centers (CMS) Conditions of Participation, passed in December, 2008 March 2013 35

36. 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. March 2013 36

37. 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) March 2013 37

38. 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.ViewTA C?tac_view=4&ti=40&pt=1&ch=97. March 2013 38

39. 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 March 2013 39