TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 303. PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC), Title 26, Part 1, Chapter 303, concerning Preadmission Screening and Resident Review (PASRR), amendments to §§303.101, 303.102, 303.201 - 303.204, 303.301 - 303.303, 303.401, 303.501, 303.502, 303.504, 303.601, 303.602, 303.701, 303.703, and 303.801. HHSC also proposes new §303.103, §303.603, and new Subchapter I, concerning MI Specialized Services, comprised of §§303.901 - 303.913, and the repeal of §303.103.

BACKGROUND AND PURPOSE

The purpose of the amendments, new sections, and repeal is to describe the new responsibilities of local intellectual and developmental disability authorities (LIDDAs) regarding intellectual and developmental disabilities (IDD) habilitative specialized services. The amendments, new sections, and repeal make the requirements in Chapter 303 consistent with new rules currently being developed for IDD habilitative specialized services in Chapter 368 (Intellectual and Developmental Disabilities (IDD) Habilitative Specialized Services).

HHSC is also clarifying definitions, updating TAC references, adopting person-first respectful language, incorporating the abbreviation for IDD habilitative specialized services (IHSS) and nursing facility (NF), revising certain responsibilities of the LIDDA, local mental health authority (LMHA), and local behavioral health authority (LBHA) related to PASRR, clarifying and updating training requirements, and revising requirements of a LIDDA regarding transition planning.

Finally, a new subchapter and related provisions are added to this chapter. The new subchapter and related provisions describe the requirements of a LIDDA, LMHA, and LBHA regarding specialized services for individuals with mental illness (MI) in accordance with 42 CFR §483.120 and the Performance Contracts with the LIDDAs, LMHAs, and LBHAs.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §303.101, Purpose, adds paragraph (3) which provides a third purpose of the chapter which is to describe the responsibilities of an LMHA and LBHA related to a resident with MI who is eligible for MI specialized services. The term "nursing facility" is replaced with its abbreviation "NF."

The proposed amendment to §303.102, Definitions, provides definitions of certain words and terms used in the chapter. HHSC replaced the term "person" with the term "individual" throughout the rules. The term "nursing facility" has been updated to the abbreviation "NF" and the term "IDD habilitative specialized services" has been replaced with the abbreviation "IHSS," throughout the rules. Formatting edits were also made throughout the rules for consistency. HHSC replaced the term "comprehensive care plan" with the term "NF comprehensive care plan." HHSC also added definitions for or revised the definitions of the following terms: actively involved person, acute care hospital, behavioral support, customized manual wheelchair (CMWC), day habilitation, developmental disability (DD), durable medical equipment (DME), employment assistance, intellectual and developmental disability (IDD), interdisciplinary team (IDT), IDD habilitative specialized services (IHSS), independent living skills training (ILST), implementation plan, licensed marriage and family therapist (LMFT), licensed professional counselor (LPC), MCO service coordinator, MI quarterly meeting, MI specialized services, NF comprehensive care plan, NF PASRR support activities, physician assistant, preadmission screening and resident review (PASRR), person-centered recovery plan (PCRP), PASRR level II evaluation (PE), physician, plan of care, qualified mental health professional-community services (QMHP-CS), resident, resident review, resident with MI, service provider agency, significant change in condition, service planning team (SPT), supported employment, therapy services, transition plan, and uniform assessment. This section has been renumbered to account for the additions and updates made to existing definitions.

Section 303.103, Fair Hearing Process, is deleted and replaced with a new §303.103, concerning fair hearing process for PASRR determination and specialized services. The new section permits an individual seeking admission to a NF, a resident, or an individual's or resident's LAR to request a fair hearing to appeal a PASRR level II evaluation (PE) that is negative for intellectual disability (ID), developmental disability (DD), or MI; a denial of a specialized service; or the reduction, suspension, or termination of an IHSS or MI specialized service. The new §303.103 also clarifies that the LIDDA, LMHA, LBHA, service provider agency, or NF, as applicable, must ensure the provision of the specialized service if the hearing officer reverses a denial, reduction, or termination of that specialized service.

The proposed amendments to §§303.201, Preadmission Process, 303.203, Admission Process for Exempted Hospital Discharge, 303.301, Referring Entity Responsibilities Related to the PASRR Process, 303.401, Reimbursement for a PE or Resident Review, and 303.701, Transition Planning for a Designated Resident, replace references to a nursing facility with the abbreviation "NF."

The proposed amendment to §303.202, Expedited Admission Process, clarifies the expedited admission process.

The proposed amendment §303.204, Resident Review Process, clarifies when a LIDDA, LMHA, or LBHA must conduct a resident review as a result of a change in condition of a resident with MI, ID, or DD.

The proposed amendment to §303.302, LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process, adds and revises responsibilities for the LIDDA, LMHA, or LBHA related to the PASRR process. If a PE or resident review is positive for MI, ID, or DD, new subsection (a)(3)(A) requires the LIDDA, LMHA, or LBHA to provide the individual seeking admission, resident, or LAR with a summary of the results of the PE or resident review. If a PE or resident review is negative for MI, ID, or DD, new subsection (a)(3)(B) requires the LIDDA, LMHA, or LBHA to provide the individual seeking admission, resident, or LAR notice of the right to a fair hearing. Amended subsection (c)(1) revises the responsibilities of the LIDDA, LMHA, or LBHA to require the LIDDA, LMHA, or LBHA to coordinate with the NF to schedule the interdisciplinary team (IDT) meeting, to confirm in the long-term care online portal participation in the IDT meeting and the specialized services recommended, and initiate and provide MI specialized services rather than both MI specialized services and IHSS. New subsection (d) requires the LIDDA, LMHA, or LBHA to develop a written policy to address challenges related to a designated resident's, resident with MI's, or LAR's participation in receiving IHSS or MI specialized services. New subsections (e) and (f) require the LIDDA, LMHA, or LBHA to inform a designated resident, resident with MI, or LAR orally and in writing of the processes for filing complaints. New subsection (g) states that the LIDDA is responsible for coordinating with the NF to schedule the IDT meeting for an individual seeking admission to a NF or a resident whose PE or resident review is positive for MI and ID or MI and DD.

The proposed amendment to §303.303, Qualifications and Requirements for Staff Person Conducting a PE or Resident Review, requires an LMHA or LBHA to ensure that the individual conducting a PE or resident review is either a qualified mental health professional--community services or is another type of health professional who has experience working directly with individuals with MI.

The proposed amendment to §303.401, Reimbursement for a PE or Resident Review, clarifies that a LIDDA's, LMHA's, or LBHA's payment for a PE or resident review includes assisting with the selection of another NF that will certify it can meet the needs of an individual seeking admission to a NF or resident with ID, DD, or MI when the original NF refuses to do so.

The proposed amendment to §303.501, Qualifications of a Habilitation Coordinator, changes a reference to intellectual and other developmental disabilities to the appropriate abbreviations for consistency with the other rules.

The proposed amendment to §303.502, Required Training for a Habilitation Coordinator, updates the required training for a habilitation coordinator to include training on other HHSC rules affecting the LIDDA and on community support services and removes the requirement for person-centered thinking training to be approved by HHSC.

The proposed amendment to §303.504, Documentation Maintained by a LIDDA in a Designated Resident's Record, updates the required documentation that must be maintained by a LIDDA in a designated resident's record to include the current plan of care and an implementation plan for each IHSS that appears on the plan of care. It also clarifies that the documentation of the designated resident's progress or lack of progress must reflect the designated resident's and LAR's perspectives.

The proposed amendment to §303.601, Habilitation Coordination for a Designated Resident, updates the requirements for habilitation coordination. The requirements for habilitation coordination include the following: determining the designated resident's preferences as well as needs; monitoring to determine if a specialized service agreed upon in an IDT or SPT meeting is requested within required timeframes in accordance with the IDD PASRR Handbook; sharing the habilitation service plan (HSP) with the members of the SPT within 10 days after the HSP is updated or renewed; determining the designated resident's progress or lack of progress toward achieving goals and outcomes identified in the HSP from the designated resident's and LAR's perspectives; coordinating with the NF in accessing medical, social, educational, and other appropriate services and supports that will help the designated resident achieve a quality of life acceptable to the designated resident and LAR on the resident's behalf; providing the designated resident and LAR an oral and written explanation of the designated resident's rights in accordance with the IDD PASRR Handbook; and informing the designated resident and LAR both orally and in writing of all the services available and requirements pertaining to the designated resident's participation.

For a designated resident who has a guardian, habilitation coordination also includes determining at least annually if the letters of guardianship are current. For a designated resident who does not have a guardian, if appropriate, habilitation coordination includes ensuring the SPT discusses whether the designated resident would benefit from a less restrictive alternative to guardianship or from guardianship and making appropriate referrals.

The proposed amendment to §303.601 also clarifies the habilitation coordinator's responsibilities regardless of whether the designated resident receives or refuses habilitation coordination. In both instances, the habilitation coordinator must address community living options with the designated resident and LAR and annually assess the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences.

Finally, the proposed amendment to §303.601 allows HHSC to waive the requirement that the habilitation coordinator meet face-to-face with the designated resident to provide habilitation coordination.

The proposed amendment to §303.602, Service Planning Team Responsibilities Related to Specialized Services, adds that the SPT must develop the plan of care regarding IHSS.

Proposed new §303.603, Habilitation Coordination for a Designated Resident Receiving IHSS, describes habilitation coordination for a designated resident receiving IHSS. The section requires the habilitation coordinator to facilitate the coordination of the designated resident's plan of care; assist a designated resident, LAR, or actively involved person in exercising the legal rights of the designated resident as a citizen and as a person with a disability; provide a designated resident, LAR, or family member with a written and oral explanation of the rights of a designated resident receiving IHSS; document the explanation of rights and ensure that the documentation is signed by the designated resident or LAR and the habilitation coordinator; immediately notify the NF and service provider agency if the habilitation coordinator becomes aware of an emergency that impacts the designated resident's health or safety; be objective in assisting a designated resident or LAR in selecting a service provider agency; ensure that a designated resident, LAR, and service provider agency are informed of the name of the designated resident's habilitation coordinator and how to contact the habilitation coordinator; and give the service provider agency a copy of the NF baseline care plan or NF comprehensive care plan. If the habilitation coordinator identifies a concern with the implementation of the plan of care, the habilitation coordinator must also ensure the concern is communicated to the service provider agency and attempts are made to resolve the concern.

The proposed amendment to §303.703, Requirements for Service Coordinators Conducting Transition Planning, revises the training requirements that a service coordinator must complete prior to providing service coordination for a designated resident. This training no longer needs to include the process for making a referral for relocation services and housing options. In addition, the training must include an overview of community living options rather than how to present community living options.

The proposed amendment to §303.801, LIDDA Compliance Review, revises the name of the section to "Compliance Review." The amendment clarifies that HHSC conducts compliance reviews of the LMHAs and LBHAs, in addition to the LIDDAs, to ensure compliance with the PASRR process.

Proposed new §303.901, Description of MI Specialized Services, describes MI specialized services, which are specialized services available to a resident with MI. The LMHA or LBHA staff must conduct a uniform assessment to determine which level of care the resident with MI will receive. MI specialized services include: crisis intervention services; day programs for acute needs; medication training and support services; psychiatric diagnostic interview examination; psychosocial rehabilitation services; routine case management; and skills training and development.

Proposed new §303.902, Eligibility Criteria, specifies that a resident with MI is eligible for MI specialized services funded by Medicaid if the resident with MI requires the provision of at least one MI specialized service.

Proposed new §303.903, MI Specialized Services Team, identifies the required members of the MI specialized services team. It also states that the MI specialized services team may include a concerned individual whose inclusion is requested by the resident with MI or the LAR.

Proposed new §303.904, Qualifications for Conducting the Uniform Assessment, requires the LMHA or LBHA staff person administering the uniform assessment to be certified in administering the uniform assessment.

Proposed new §303.905, Process for Service Initiation, describes the process for service initiation. Subsection (a) requires the LMHA or LBHA to comply with §303.302 of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process). Subsection (b) requires the LMHA or LBHA staff participating in the initial IDT meeting, in conjunction with the IDT, to review the MI specialized services recommended on the PE; explain the uniform assessment; ensure the resident with MI, or LAR on the resident with MI's behalf, understands the purpose of the uniform assessment; and have the resident with MI, or LAR on the resident with MI's behalf, agree or decline to receive a uniform assessment and MI specialized services. Subsection (c) requires the LMHA or LBHA, within 20 business days after the IDT meeting, to complete the uniform assessment; develop the PCRP; and for a resident with MI only, convene a meeting to discuss the results of the uniform assessment and PCRP and to determine the MI specialized services the resident with MI will receive. Subsection (d) requires the meeting convened in accordance with subsection (c)(3) to be attended by the QMHP-CS who completed the uniform assessment and PCRP; the resident with MI; the resident with MI's LAR, if any; and a NF staff person familiar with the resident with MI's needs. Subsection (e) requires the QMHP-CS to ensure the resident with MI participates in the meeting convened in accordance with subsection (c)(3) to the fullest extent possible and receives the support necessary to do so. Subsection (f) requires the LMHA or LBHA to provide a copy of the completed uniform assessment and PCRP to the NF for inclusion in the resident with MI's NF comprehensive care plan within 10 calendar days after the meeting convened in accordance with subsection (c)(3).

Proposed new §303.906, Person-Centered Recovery Plan, requires the QMHP-CS, in conjunction with the MI specialized services team, to develop, periodically review, and revise as needed the PCRP for each resident with MI.

Proposed new §303.907, Renewal and Revision of Person-Centered Recovery Plan, covers the renewal and revision of the PCRP. Subsection (a) requires the QMHP-CS to convene an MI quarterly meeting to review the PCRP to determine whether the MI specialized services previously identified remain relevant and determine whether the current uniform assessment accurately reflects the resident with MI's need for MI specialized services or if an updated uniform assessment is required. Subsection (b) requires the MI specialized services team to revise the PCRP in response to changes in the needs of the resident with MI. Any MI specialized services team member may ask the QMHP-CS to convene a meeting at any time to discuss whether a resident with MI's PCRP needs to be revised. Subsection (b) also requires the QMHP-CS to convene a meeting within seven calendar days after learning of the need to revise the resident with MI's PCRP. Subsection (c) requires the QMHP-CS to update the uniform assessment and provide it to the MI specialized services team within seven calendar days after the meeting, if the MI specialized services team agrees to add a new MI specialized service or determines an updated uniform assessment is required. Subsection (d) requires the QMHP-CS to document revisions on the PCRP within five calendar days after a team meeting and retain the revised PCRP documentation in the resident with MI's LMHA or LBHA record.

Proposed new §303.908, Service Delivery, describes the requirements for service delivery. Subsection (a) requires the LMHA or LBHA to begin delivering all MI specialized services in accordance with the PCRP within five calendar days after the MI specialized services team meeting. Subsection (b) requires the LMHA or LBHA to confirm that the resident with MI is a Medicaid recipient and receive authorization to deliver the MI specialized services. Subsection (c) requires the LMHA or LBHA to accurately and consistently document in observable, measurable terms a resident with MI's progress or lack of progress toward achieving an identified outcome from the resident with MI's or LAR's perspective. Subsection (d) requires the LMHA or LBHA to monitor a resident with MI's and LAR's satisfaction with MI specialized services. Subsection (e) requires the LMHA or LBHA to inform the NF of any significant changes to the resident with MI's behavioral or medical condition during the provision of MI specialized services.

Proposed new §303.909, Refusal of the Uniform Assessment or MI Specialized Services, outlines what steps an LMHA or LBHA must take when a resident with MI refuses a uniform assessment or MI specialized services. First, the LMHA or LBHA must ask the resident with MI or the LAR to sign the Refusal of PASRR MI Specialized Services form and inform the resident with MI of the need to conduct follow up visits every 30 days for 90 days after the initial IDT meeting. If the resident with MI or the LAR still refuses a uniform assessment or MI specialized services after 90 days, the LMHA or LBHA must inform the resident with MI that an annual IDT meeting is required and will be conducted, at which time a uniform assessment and MI specialized services will be offered again. A resident with MI or LAR may agree to receive a uniform assessment or MI specialized services at any time.

Proposed new §303.910, Suspension and Termination of MI Specialized Services, describes when an LMHA or LBHA suspends or terminates MI specialized services. Subsection (a) requires the LMHA or LBHA to suspend a resident with MI's MI specialized services when the resident with MI is admitted to an acute care hospital for fewer than 30 days and is returning to the same NF; the resident with MI loses Medicaid eligibility; or the resident with MI or LAR requests that MI specialized services be suspended when transferring from one NF to another NF without an intervening hospital stay. Subsection (b) permits an LMHA or LBHA to terminate one or more of a resident with MI's MI specialized services if the resident with MI loses Medicaid eligibility for more than 90 days or the resident with MI or LAR requests the MI specialized services be terminated.

Proposed new §303.911, Transition Planning for Residents with MI Only, specifies the process for transition planning for residents with MI only. Subsection (a) requires the QMHP-CS to facilitate the development of, revisions to, implementation of, and monitoring of a transition plan if a resident with MI only, or the LAR on the resident with MI's behalf, expresses an interest in moving to the community. Subsection (b) requires a transition plan to identify the services and supports a resident with MI needs to live in the community, including those essential supports that are critical to the resident with MI's health and safety.

Proposed new §303.912, Documentation, identifies the documentation that an LMHA or LBHA must maintain in the resident with MI's record. This documentation is: all assessments used for service planning; documentation related to the initiation and delivery of MI specialized services; documentation related to monitoring MI specialized services; documentation of all meetings; guardianship paperwork and consents, if applicable; and documentation of a resident with MI's refusal of MI specialized services, if applicable.

Proposed new §303.913, Quality Assurance, addresses quality assurance. Subsection (a) requires the LMHA or LBHA to allow access to the resident with MI or the resident with MI's record by advocacy agencies and HHSC staff. Subsection (b) requires the LMHA or LBHA to develop, update as necessary, and implement a written quality assurance process to evaluate and improve the quality of MI services delivered by the LMHA or LBHA.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules do not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not create new HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new rules;

(6) the proposed rules will expand existing rules;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The amendments, new sections, and repeal do not require small businesses, micro-businesses, or rural communities to change current business practices.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas, do not impose a cost on regulated persons, and are necessary to receive a source of federal funds or comply with federal law.

PUBLIC BENEFIT AND COSTS

Sonja Gaines, Deputy Executive Commissioner for IDD and Behavioral Health Services, has determined that for each year of the first five years the rules are in effect, the public benefit will be that service delivery provided by LIDDAs, LMHAs, and LBHAs will be improved by the clarification of existing rules regarding roles and responsibilities and training requirements. The additional public benefit of adding new §§303.901-303.913 will be that LMHAs and LBHAs will have specific requirements in rule for delivering services to individuals with MI residing in NFs.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. The proposal does not impose new costs or fees on those required to comply.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to HHSC IDD Services, Lisa Habbit, Mail Code 354, P.O. Box 149030, Austin, Texas 78714-9030, or by email to idd-bh_pasrrspa@hhsc.state.tx.us.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Commentson Proposed Rule 20R049" in the subject line.

SUBCHAPTER A. GENERAL PROVISIONS

26 TAC §§303.101 - 303.103

STATUTORY AUTHORITY

The amendments and new section are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments and new section implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.101.Purpose.

(a) The purpose of this chapter is to:

(1) describe the responsibilities of a LIDDA, LMHA, and LBHA related to PASRR, to ensure that:

(A) an individual seeking admission to a NF [nursing facility] or a resident of a NF [nursing facility] receives a PL1 to identify whether the individual or resident is suspected of having MI, ID, or DD; and

(B) an individual seeking admission to a NF [nursing facility] or resident suspected of having MI, ID, or DD receives a PE or resident review to confirm MI, ID, or DD and, if confirmed, to evaluate whether the individual or resident needs NF [nursing facility] care and needs specialized services; [and]

(2) describe the responsibilities of a LIDDA related to a designated resident who receives habilitative service planning and transition planning as described in Subchapters E, F, and G of this chapter (relating to Habilitation Coordination, Habilitative Service Planning for a Designated Resident, and Transition Planning); and[.]

(3) describe the responsibilities of an LMHA and LBHA related to a resident with MI who is eligible for MI specialized services as described in Subchapter I of this chapter (relating to MI Specialized Services).

(b) The rules regarding the responsibilities of a NF [ nursing facility] related to PASRR are in 40 TAC Chapter 19, Subchapter BB (relating to Nursing Facility Responsibilities Related to Preadmission Screening and Resident Review (PASRR)).

§303.102.Definitions.

The following words and terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise.

(1) Actively involved person--An individual who has significant, ongoing, and supportive involvement with a designated resident, as determined by the SPT based on the individual's:

(A) observed interactions with the designated resident;

(B) availability to the designated resident for assistance or support when needed; and

(C) knowledge of, sensitivity to, and advocacy for the designated resident's needs, preferences, values, and beliefs.

(2) [(1)] Acute care hospital--A health care facility in which an individual [a person] receives short-term treatment for a severe physical injury or episode of physical illness, an urgent medical condition, or recovery from surgery and:

(A) may include a long-term acute care hospital, an emergency room within an acute care hospital, or an inpatient rehabilitation hospital; and

(B) does not include a stand-alone psychiatric hospital or a psychiatric hospital within an acute care hospital.

(3) [(2)] Alternate placement assistance--Assistance provided to a resident to locate and secure services chosen by the resident or LAR that meets the resident's needs in a setting other than a NF [nursing facility]. Alternate placement assistance includes transition planning, pre-move site review, and post-move monitoring.

(4) [(3)] APRN--Advance practice registered nurse. An individual [A person] licensed to practice professional nursing as an advance practice registered nurse in accordance with Texas Occupations Code[,] Chapter 301.

[(4) Behavioral support--Specialized interventions by a qualified service provider to assist a person to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the person's inclusion in home and family life or community life.]

[(A) Behavioral support includes:]

[(i) assessing and analyzing assessment findings so that an appropriate behavior support plan may be designed;]

[(ii) developing an individualized behavior support plan consistent with the outcomes identified in the HSP;]

[(iii) training and consulting with family members or other providers and, as appropriate, the person; and]

[(iv) monitoring and evaluating the success of the behavior support plan and modifying the plan as necessary.]

[(B) A qualified service provider of behavioral support:]

[(i) is licensed as a psychologist in accordance with Texas Occupations Code, Chapter 501;]

[(ii) is licensed as a psychological associate in accordance with Texas Occupations Code, Chapter 501;]

[(iii) has been issued a provisional license to practice psychology in accordance with Texas Occupations Code, Chapter 501;]

[(iv) is a certified authorized provider as described in 40 TAC §5.161 (relating to Certified Authorized Provider);]

[(v) is an LCSW;]

(vi) is an LPC; or

[(vii) is licensed as a behavior analyst in accordance with Texas Occupations Code, Chapter 506.]

(5) Behavioral support--An IHSS that:

(A) is assistance provided for a designated resident to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the designated resident's interpersonal relationships across all service and social settings;

(B) is delivered in the NF or in a community setting;and

(C) consists of:

(i) assessing the behaviors to be targeted in an appropriate behavior support plan and analyzing those assessment findings;

(ii) developing an individualized behavior support plan that reduces or eliminates the target behaviors, assisting the designated resident in achieving the outcomes identified in the HSP;

(iii) training and consulting with the LAR, family members, NF staff, other support providers, and the designated resident about the purpose, objectives, and methods of the behavior support plan;

(iv) implementing the behavior support plan or revisions to the behavior support plan and documenting service delivery in accordance with the IDD Habilitative Specialized Services Billing Guidelines;

(v) monitoring and evaluating the success of the behavior support plan implementation;

(vi) revising the behavior support plan as necessary;and

(vii) participating in SPT and IDT meetings.

(6) [(5)] CMWC--Customized manual wheelchair. In accordance with 40 TAC §19.2703 (relating to Definitions) and consistent with the requirements of Texas Human Resources Code §32.0425, a wheelchair that consists of a manual mobility base and customized seating system and is adapted and fabricated to meet the individualized needs of a designated resident.

(7) [(6)] Collateral contact--A person who is knowledgeable about the individual seeking admission to a NF [a nursing facility] or the resident, such as family members, previous providers or caregivers, and who may support or corroborate information provided by the individual or resident.

(8) [(7)] Coma--A state of unconsciousness characterized by the inability to respond to sensory stimuli as documented by a physician.

[(8) Comprehensive care plan--A plan, defined in 40 TAC §19.2703.]

(9) Convalescent care--A type of care provided after an individual's release from an acute care hospital that is part of a medically prescribed period of recovery.

(10) Day habilitation--An IHSS that:

(A) is assistance provided for a designated resident to acquire, retain, or improve self-help, socialization, and adaptive skills necessary to successfully and actively participate in all service and social settings;

(B) is delivered in a setting other than the designated resident's NF;

(C) does not include services provided under the Day Activity and Health Services program;

(D) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 Code of Federal Regulations (CFR) §483.24; and

(E) consists of:

(i) individualized activities consistent with achieving the outcomes identified in a designated resident's HSP to attain, learn, maintain, or improve skills;

(ii) activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;

(iii) services in a group setting at a location other than a designated resident's NF for up to five days per week, six hours per day, on a regularly scheduled basis;

(iv) personal assistance for a designated resident who cannot manage personal care needs during the day habilitation activity;

(v) transportation between the NF and the day habilitation site, as well as during the day habilitation activity necessary for a designated resident's participation in day habilitation activities; and

(vi) participating in SPT and IDT meetings.

[(10) Day habilitation--Assistance to a person to acquire, retain, or improve self-help, socialization, and adaptive skills necessary to live successfully in the community and participate in home and community life. Day habilitation provides:]

[(A) individualized activities consistent with achieving the outcomes identified in the person's service plan;]

[(B) activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;]

[(C) services in a group setting, other than the person's residence, for typically up to five days a week, six hours per day on a regularly scheduled basis;]

[(D) personal assistance for a person who cannot manage personal care needs during the day habilitation activities; and]

[(E) transportation during the day habilitation activity necessary for a person's participation in the day habilitation activities.]

(11) DD--Developmental disability. A disability that meets the criteria described in the definition of "persons with related conditions" in 42 CFR [Code of Federal Regulations (CFR)] §435.1010.

(12) Delirium--A serious disturbance in an individual's mental abilities that results in a decreased awareness of the individual's environment and confused thinking.

(13) Designated resident--An individual:

(A) whose PE or resident review is positive for ID or DD;

(B) who is 21 years of age or older;

(C) who is a Medicaid recipient; and

(D) who is a resident or has transitioned to the community from a NF [nursing facility] within the previous 365 days.

(14) DME--Durable medical equipment. The items described in 40 TAC §19.2703(10). [Medical Equipment. In accordance with 40 TAC §19.2703, the following items, including any accessories and adaptations needed to operate or access the item:]

[(A) a gait trainer;]

[(B) a standing board;]

[(C) a special needs car seat or travel restraint;]

[(D) a specialized or treated pressure-reducing support surface mattress;]

[(E) a positioning wedge;]

[(F) a prosthetic device; and]

[(G) an orthotic device.]

(15) Emergency protective services--Services furnished by the Department of Family and Protective Services to an elderly or disabled individual who has been determined to be in a state of abuse, neglect, or exploitation.

(16) Employment assistance--An IHSS that:

(A) is assistance provided for a designated resident who requires intensive help locating competitive employment in the community; and

(B) consists of:

(i) identifying a designated resident's employment preferences, job skills, and requirements for a work setting and workconditions;

(ii) locating prospective employers offering employment compatible with a designated resident's identified preferences, skills, and requirements;

(iii) contacting prospective employers on a designated resident's behalf and negotiating the designated resident's employment;

(iv) transporting a designated resident between the NF and the site where employment assistance services are provided and as necessary to help the designated resident locate competitive employment in the community; and

(v) participating in SPT and IDT meetings.

[(16) Employment assistance--Assistance provided to a person to help the person locate competitive employment in the community, consisting of a service provider performing the following activities:]

[(A) identifying a person's employment preferences, job skills, and requirements for a work setting and work conditions;]

[(B) locating prospective employers offering employment compatible with a person's identified preferences, skills, and requirements;]

[(C) contacting a prospective employer on behalf of a person and negotiating the person's employment;]

[(D) transporting the person to help the person locate competitive employment in the community; and]

[(E) participating in SPT meetings.]

(17) Essential supports--Those supports identified in a transition plan that are critical to a designated resident's health and safety and that are directly related to a designated resident's successful transition to living in the community from residing in a NF [nursing facility].

(18) Exempted hospital discharge--A category of NF [nursing facility] admission that occurs when a physician has certified that an individual who is being discharged from an acute care hospital is likely to require less than 30 days of NF [nursing facility] services for the condition for which the individual was hospitalized.

(19) Expedited admission--A category of NF [nursing facility] admission that occurs when an individual meets the criteria for one of the following categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite, or coma.

(20) Habilitation coordination--Assistance for a designated resident residing in a NF [nursing facility] to access appropriate specialized services necessary to achieve a quality of life and level of community participation acceptable to the designated resident and LAR on the designated resident's behalf.

(21) Habilitation coordinator--An employee of a LIDDA who provides habilitation coordination.

(22) HHSC--The Texas Health and Human Services Commission.

(23) HSP--Habilitation service plan. A plan developed by the SPT while a designated resident is residing in a NF [nursing facility] that:

(A) is individualized and developed through a person-centered approach;

(B) identifies the designated resident's:

(i) strengths;

(ii) preferences;

(iii) desired outcomes; and

(iv) psychiatric, behavioral, nutritional management, and support needs as described in the NF comprehensive care plan or MDS assessment; and

(C) identifies the specialized services that will accomplish the desired outcomes of the designated resident, or the LAR's on behalf of the designated resident, including amount, frequency, and duration of each service.

(24) ID--Intellectual disability, as defined in 42 CFR §483.102(b)(3)(i).

(25) IDD--Intellectual and developmental disability.

[(25) IDD habilitative specialized services--The following specialized services available to a resident with ID or DD:]

[(A) habilitation coordination;]

[(B) day habilitation;]

[(C) independent living skills training;]

[(D) behavioral support;]

[(E) employment assistance; and]

[(F) supported employment.]

(26) IDT--Interdisciplinary team. A team consisting of:

(A) a resident with MI, ID, or DD;

(B) the resident's LAR, if any;

(C) an RN [a registered nurse] from the NF [nursing facility] with responsibility for the resident;

(D) a representative of:

(i) the LIDDA, if the resident has ID or DD;

(ii) the LMHA or LBHA, if the resident has MI; or

(iii) the LIDDA and the LMHA or LBHA, if the resident has MI and DD, or MI and ID; and

(E) others as follows:

(i) a concerned person whose inclusion is requested by the resident or LAR;

(ii) an individual [a person] specified by the resident, LAR, NF [nursing facility], LIDDA, LMHA, or LBHA, as applicable, who is professionally qualified, certified, or licensed with special training and experience in the diagnosis, management, needs, and treatment of people with MI, ID, or DD; and

(iii) a representative of the appropriate school district if the resident is school age and inclusion of the district representative is requested by the resident or LAR.

(27) IHSS--IDD habilitative specialized services. IHSS are:

(A) behavioral support;

(B) day habilitation;

(C) employment assistance;

(D) independent living skills training; and

(E) supported employment.

[(27) Independent living skills training--Individualized activities that are consistent with the HSP and provided in a person's residence and at community locations, such as libraries and stores. These activities include:]

[(A) habilitation and support activities that foster or facilitate improvement or maintenance of the person's ability to perform functional living skills and other daily living activities;]

[(B) activities for the person's family that help preserve the family unit and prevent or limit out-of-home placement of the person; and]

[(C) transportation to facilitate the person's employment opportunities and participation in community activities, and between the person's residence and day habilitation site.]

(28) ILST--Independent living skills training. An IHSS that:

(A) is assistance provided for a designated resident that is consistent with the designated resident's HSP;

(B) is provided in the designated resident's NF or in a community setting;

(C) includes expanded interactions, skills training activities, and programs of greater intensity or frequency beyond those a NF is required to provide by 42 CFR §483.24; and

(D) consists of:

(i) habilitation and support activities that foster improvement of or facilitate a designated resident's ability to attain, learn, maintain, or improve functional living skills and other daily living activities;

(ii) activities that help preserve the designated resident's bond with family members;

(iii) activities that foster inclusion in community activities generally attended by people without disabilities;

(iv) transportation to facilitate a designated resident's employment opportunities and participation in community activities, and between the designated resident's NF and a community setting; and

(v) participating in SPT and IDT meetings.

(29) Implementation plan--A plan for each IHSS on the designated resident's plan of care that includes:

(A) a list of the designated resident's outcomes identified in the HSP that will be addressed using IHSS;

(B) specific objectives to address the outcomes required by subparagraph (A) of this paragraph that are:

(i) observable, measurable, and outcome-oriented; and

(ii) derived from assessments;

(C) a target date for completion of each objective;

(D) the frequency, amount, and duration of IHSS needed to complete each objective; and

(E) the signature and date of the designated resident, LAR, and service provider agency.

(30) [(28)] LAR--Legally authorized representative. An individual [A person] authorized by law to act on behalf of an individual seeking admission to a NF [nursing facility] or resident with regard to a matter described by this chapter, and who may be the parent of a minor child, the legal guardian, or the surrogate decision maker.

(31) [(29)] LBHA--Local behavioral health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code[,] §533.0356.

(32) [(30)] LCSW--Licensed clinical social worker. An individual [A person] who is licensed as a licensed clinical social worker in accordance with Texas Occupations Code[,] Chapter 505.

(33) [(31)] Licensed psychologist--An individual [A person] who is licensed as a psychologist in accordance with Texas Occupations Code[,] Chapter 501.

(34) [(32)] LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code[,] §533A.035.

(35) [(33)] LMFT--Licensed marriage and family therapist. An individual [A person] who is licensed as a [licensed] marriage and family therapist in accordance with Texas Occupations Code[,] Chapter 502.

(36) [(34)] LMHA--Local mental health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code[,] §533.035.

(37) [(35)] LPC--Licensed professional counselor. An individual [A person] who is licensed as a [licensed] professional counselor in accordance with Texas Occupations Code[,] Chapter 503.

(38) [(36)] LTC online portal--Long term care online portal. A web-based application used by Medicaid providers to submit forms, screenings, evaluations, and other information.

(39) [(37)] MCO service coordinator--Managed [Medicaid managed] care organization service coordinator. The staff person assigned by a resident's Medicaid managed care organization to ensure access to and coordination of needed services.

(40) [(38)] MDS assessment--Minimum data set assessment. A standardized collection of demographic and clinical information that describes a resident's overall condition, which a licensed NF [nursing facility] in Texas is required to submit for a resident admitted into the facility.

(41) [(39)] MI--Mental illness. Serious mental illness, as defined in 42 CFR §483.102(b)(1).

(42) MI quarterly meeting--A quarterly meeting that is convened by the LMHA or LBHA for a resident with MI to develop, review, or revise the PCRP and the transition plan, if the resident is transitioning to the community.

(43) [(40)] MI specialized services--Specialized services for [available to] a resident with MI, if eligible, as described in the Texas Resilience and Recovery Utilization Management Guidelines, including:

(A) crisis intervention services;

(B) day programs for acute needs;

(C) medication training and support services;

(D) psychiatric diagnostic interview examination;

(E) psychosocial rehabilitation services;

(F) routine case management; and

(G) skills training and development

[(A) skills training;]

[(B) medication training;]

[(C) psychosocial rehabilitation;]

[(D) case management;]

[(E) psychiatric diagnostic interview exam; and]

[(F) supported housing, which includes alternate placement assistance and transitioning to the community].

(44) [(41)] NF--Nursing facility. [--]A Medicaid-certified facility that is licensed in accordance with the Texas Health and Safety Code[ ,] Chapter 242.

(45) NF comprehensive care plan--A comprehensive care plan, defined in 40 TAC §19.2703(3).

(46) [(42)] NF [Nursing facility] PASRR support activities--Actions a NF [Consistent with 40 TAC §19.2703, actions a nursing facility] takes in coordination with a LIDDA, LMHA, or LBHA to facilitate the successful provision of an IHSS [IDD habilitative specialized service] or MI specialized service, including:

(A) arranging transportation for a NF [nursing facility] resident to participate in an IHSS [IDD habilitative specialized service] or a MI specialized service outside the facility;

(B) sending a resident to a scheduled IHSS [IDD habilitative specialized service] or MI specialized service with food and medications required by the resident; and

(C) stating in the NF comprehensive care plan an agreement to avoid, when possible, scheduling NF [nursing facility] services at times that conflict with IHSS [IDD habilitative specialized services] or MI specialized services.

(47) [(43)] NF [Nursing facility] specialized services--The following specialized services available to a resident with ID or DD:

(A) therapy services;

(B) CMWC; and

(C) DME.

(48) [(44)] PA--Physician assistant [Assistant]. An individual [A person] who is licensed as a physician assistant in accordance with Texas Occupations Code[,] Chapter 204.

(49) [(45)] PASRR--Preadmission screening and resident review. A federal requirement in 42 CFR Part 483, Subpart C that requires states to prescreen all individuals seeking admission to a Medicaid-certified NF for ID, DD, and MI.

(50) PCRP--Person-centered recovery plan. For a resident with MI, the PCRP identifies the services and supports that are needed to:

(A) meet the resident with MI's needs;

(B) achieve the desired outcomes; and

(C) maximize the resident with MI's ability to live successfully in the most integrated setting possible.

(51) [(46)] PE--PASRR level II evaluation. A face-to-face evaluation:

(A) of an individual seeking admission to a NF [nursing facility] who is suspected of having MI, ID, or DD; and

(B) performed by a LIDDA, LMHA [LHMA], or LBHA to determine if the individual has MI, ID, or DD and, if so, to:

(i) assess the individual's need for care in a NF [nursing facility];

(ii) assess the individual's need for specialized services; and

(iii) identify alternate placement options.

(52) [(47)] Physician--An individual [A person] who is licensed to practice medicine [as a physician] in accordance with Texas Occupations Code[,] Chapter 155.

(53) [(48)] PL1--PASRR level I screening. The process of screening an individual seeking admission to a NF [nursing facility] to identify whether the individual is suspected of having MI, ID, or DD.

(54) Plan of care--A written plan that includes:

(A) the IHSS required by the NF baseline care plan or NF comprehensive care plan;

(B) the frequency, amount, and duration of each IHSS to be provided for the designated resident during a plan year; and

(C) the services and supports to be provided for the designated resident through resources other than PASRR.

(55) [(49)] Preadmission process--A category of NF [nursing facility] admission:

(A) from a community setting, such as a private home, an assisted living facility, a group home, a psychiatric hospital, or jail, but not an acute care hospital or another NF [nursing facility]; and

(B) that is not an expedited admission or an exempted hospital discharge.

(56) [(50)] QIDP--Qualified intellectual disability professional. An individual [A person] who meets the qualifications described in 42 CFR §483.430(a).

(57) [(51)] QMHP-CS--Qualified mental health professional-community services. An individual [A person] who meets the qualifications of a QMHP-CS as defined in §301.303 of this title [25 TAC §412.303] (relating [related] to Definitions).

(58) [(52)] Referring entity--The entity that refers an individual to a NF [nursing facility], such as a hospital, attending physician, LAR or other personal representative selected by the individual, a family member of the individual, or a representative from an emergency placement source, such as law enforcement.

(59) [(53)] Resident--An individual who resides in a NF [nursing facility and receives services provided by professional nursing personnel of the facility].

(60) [(54)] Resident review--A face-to-face evaluation of a resident performed by a LIDDA, LMHA, or LBHA:

(A) for a resident whose PE is positive for [with] MI, ID, or DD who experienced a significant change in condition [status], to:

(i) assess the resident's need for continued care in a NF [nursing facility];

(ii) assess the resident's need for specialized services; and

(iii) identify alternate placement options; and

(B) for a resident suspected of having MI, ID, or DD, to determine whether the resident has MI, ID, or DD and, if so:

(i) assess the resident's need for continued care in a NF [nursing facility];

(ii) assess the resident's need for specialized services; and

(iii) identify alternate placement options.

(61) Resident with MI--An individual:

(A) who is a resident of a NF;

(B) whose PE or resident review is positive for MI;

(C) who is at least 18 years of age; and

(D) who is a Medicaid recipient.

(62) [(55)] Respite--Services provided on a short-term basis to an individual [a person] because of the absence of or the need for relief by the individual's [person's] unpaid caregiver for a period not to exceed 14 days.

(63) [(56)] RN--Registered nurse. An individual [A person] licensed to practice professional nursing as a registered nurse in accordance with Texas Occupations Code[,] Chapter 301.

(64) [(57)] Service coordination--Assistance in accessing medical, social, educational, and other appropriate services and supports, including alternate placement assistance, that will help an individual to [a person] achieve a quality of life and community participation acceptable to the individual [person] and LAR on the individual's [person's] behalf.

(65) [(58)] Service coordinator--An employee of a LIDDA who provides service coordination.

(66) Service provider agency--An entity that has a contract with HHSC to provide IHSS for a designated resident.

(67) [(59)] Severe physical illness--An illness resulting in ventilator dependence or a diagnosis, such as chronic obstructive pulmonary disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, or congestive heart failure, that results in a level of impairment so severe that the individual could not be expected to benefit from specialized services.

(68) Significant change in condition--Consistent with 40 TAC §19.801(2)(C)(ii), when a resident experiences a major decline or improvement in the resident's status that:

(A) will not normally resolve itself without further intervention by NF staff or by implementing standard disease-related clinical interventions;

(B) has an impact on more than one area of the resident's health status; and

(C) requires review or revision of the NF comprehensive care plan, or both.

(69) [(60)] Specialized services--The following support services, other than NF [nursing facility] services, that are identified through the PE or resident review and may be provided to a resident who has a PE or resident review that is positive for MI, ID, or DD:

(A) NF [nursing facility] specialized services;

(B) IHSS [IDD habilitative specialized services]; and

(C) MI specialized services.

(70) [(61)] SPT--Service planning team. A team convened by a LIDDA staff person that develops, reviews, and revises the HSP and the transition plan for a designated resident.

(A) The team must include:

(i) the designated resident;

(ii) the designated resident's LAR, if any;

(iii) the habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the designated resident is transitioning to the community;

(iv) the MCO service coordinator, if the designated resident does not object;

(v) while the designated resident is in a NF [nursing facility]:

(I) a NF [nursing facility] staff person familiar with the designated resident's needs; and

(II) an individual [a person] providing a specialized service for [to] the designated resident or a representative of a provider agency that is providing specialized services for the designated resident;

(vi) if the designated resident is transitioning to the community:

(I) a representative from the community program provider, if one has been selected; and

(II) a relocation specialist; and

(vii) a representative from the LMHA or LBHA, if the designated resident's PE is positive for [resident has] MI.

(B) Other participants on the SPT may include:

(i) a concerned person whose inclusion is requested by the designated resident or the LAR; and

(ii) at the discretion of the LIDDA, an individual [a person] who is directly involved in the delivery of services for people with ID or DD.

(71) Supported employment--An IHSSthat:

(A) is assistance provided for a designated resident:

(i) who requires intensive, ongoing support to be self-employed, work from the designated resident's residence, or work in an integrated community setting at which people without disabilities are employed;and

(ii) to sustain competitive employment in an integrated community setting; and

(B) consists of:

(i) making employment adaptations, supervising, and providing training related to the designated resident's assessed needs;

(ii) transporting the designated resident between the NF and the site where the supported employment services are provided and as necessary to support the designated resident to be self-employed, work from the designated resident's residence, or work in an integrated community setting; and

(iii) participating in SPT and IDT meetings.

[(62) Supported employment--Assistance to sustain competitive employment for a person who, because of a disability, requires intensive, ongoing support to be self-employed, work from the person's residence, or perform in a work setting at which persons without disabilities are employed. Assistance consists of the following activities:]

[(A) making employment adaptations, supervising, and providing training related to the person's assessed needs;]

[(B) transporting the person to support the person to be self-employed, work from the person's residence, or perform in a work setting; and]

[(C) participating in SPT meetings.]

(72) [(63)] Surrogate decision maker--An actively involved family member of a resident who has been identified by an IDT in accordance with Texas Health and Safety Code[,] §313.004 and who is available and willing to consent to medical treatment on behalf of the resident.

(73) [(64)] Terminal illness--A medical prognosis that an individual's life expectancy is six months or less if the illness runs its normal course and that is documented by a physician's certification in the individual's medical record maintained by a NF [nursing facility].

(74) [(65)] Therapy services--In accordance with 40 TAC §19.2703(46) [§19.2703], assessment and treatment to help a designated resident learn, keep, or improve skills and functioning of daily living affected by a disabling condition. Therapy services are referred to as habilitative therapy services. Therapy services are limited to:

(A) physical therapy;

(B) occupational therapy; and

(C) speech therapy.

(75) [(66)] Transition plan--A plan developed by the SPT or MI quarterly meeting attendees that describes the activities, timetable, responsibilities, services, and essential supports involved in assisting a designated resident or resident with MI to transition from residing in a NF [nursing facility] to living in the community.

(76) Uniform assessment--The HHSC-approved uniform assessment tool for adult mental health services.

§303.103.Fair Hearing Process for PASRR Determination and Specialized Services.

(a) An individual seeking admission to a NF, a resident, or an individual's or resident's LAR may request a fair hearing in accordance with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing Rules) to appeal:

(1) a PE that is negative for ID, DD, or MI;

(2) a denial of a specialized service; or

(3) the reduction, suspension, or termination of an IHSS or MI specialized service.

(b) If the hearing officer reverses a denial, reduction, or termination of a specialized service, the LIDDA, the LMHA, the LBHA, the service provider agency, or the NF, as applicable, must ensure the provision of the specialized service.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101305

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


26 TAC §303.103

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The repeal implements Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.103.Fair Hearing Process.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101306

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER B. PASRR SCREENING AND EVALUATION PROCESS

26 TAC §§303.201 - 303.204

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.201.Preadmission Process.

(a) A referring entity must complete a PL1 when an individual is seeking admission into a NF [nursing facility] through the preadmission process, and:

(1) if the PL1 indicates the individual is suspected of having MI, ID, or DD:

(A) must notify the LIDDA, LMHA, or LBHA, as applicable; and

(B) must provide a copy of the PL1 to the LIDDA, LMHA, or LBHA, as applicable; and

(2) if the PL1 indicates the individual is not suspected of having MI, ID, or DD, must provide a copy of the completed PL1 to the NF [nursing facility].

(b) If a LIDDA, LMHA, or LBHA is provided a copy of a PL1 in accordance with subsection (a)(1)(B) of this section, the LIDDA, LMHA, or LBHA must:

(1) complete a PE in accordance with §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process);

(2) comply with §303.302(b) and (c) of this chapter; and

(3) make reasonable efforts to arrange for available community services and supports in the least restrictive setting to avoid NF [nursing facility] admission, if the individual seeking admission to a NF [nursing facility], or the individual's LAR on the individual's behalf, wants to remain in the community.

§303.202.Expedited Admission Process.

If the LTC online portal generates a notice to the LIDDA, LMHA, or LBHA that an individual suspected of having MI, ID, or DD is being admitted to a NF [nursing facility] through the expedited admission process [is suspected of having MI, ID, or DD], the LIDDA, LMHA, or LBHA, as applicable, must:

(1) complete a PE or resident review in accordance with §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process); and

(2) comply with §303.302(b) and (c) of this chapter.

§303.203.Admission Process for Exempted Hospital Discharge.

A LIDDA, LMHA, or LBHA must conduct a resident review in accordance with §303.204 of this subchapter (relating to Resident Review Process) for a resident of a NF [nursing facility] admitted through an exempted hospital discharge process if:

(1) the resident's stay in the NF [nursing facility] has exceeded 30 days; and

(2) the resident's PL1 indicates the resident is suspected of having MI, ID, or DD.

§303.204.Resident Review Process.

(a) The LTC online portal generates an automated notification to a LIDDA, LMHA, or LBHA that a resident review must be completed if:

(1) a resident with MI, ID, or DD experiences a significant change in condition as defined in §303.102 of this chapter (relating to Definitions) [status as determined by the MDS Significant Change in Status Assessment Form]; or

(2) a resident suspected of having MI, ID, or DD:

(A) was admitted as an exempted hospital discharge and has exceeded the allowed 30-day stay in the NF [nursing facility]; or

(B) is determined by a NF [nursing facility] or HHSC to need a resident review for any other reason.

(b) A LIDDA, LMHA, or LBHA that receives an automated notification in accordance with subsection (a) of this section must:

(1) complete a resident review in accordance with §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process); and

(2) comply with §303.302(b) and (c) of this chapter.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101307

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER C. RESPONSIBILITIES

26 TAC §§303.301 - 303.303

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.301.Referring Entity Responsibilities Related to the PASRR Process.

(a) A referring entity must:

(1) complete the PL1 for an individual seeking admission into a NF [nursing facility];

(2) contact a NF [nursing facility] selected by the individual or LAR to notify the NF [nursing facility] of the individual's interest in admission; and

(3) provide the completed PL1 as follows:

(A) to the NF [nursing facility] selected by the individual or LAR:

(i) for an individual who is being admitted through an expedited admission or an exempted hospital discharge; or

(ii) for an individual who is being admitted through a preadmission process and is not suspected of having MI, ID, or DD; and

(B) to the LIDDA, LMHA, or LBHA, as applicable, for an individual who is suspected of having MI, ID, or DD, and is being admitted through a preadmission process.

(b) If a referring entity is a family member, LAR, other personal representative selected by the individual, or a representative from an emergency placement source, the referring entity may request assistance from the NF [nursing facility], LIDDA, LMHA, or LBHA in completing the PL1.

§303.302.LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process.

(a) A LIDDA, LMHA, or LBHA, as applicable, must:

(1) enter in the LTC online portal the data from a PL1 completed by a referring entity in accordance with §303.201(a)(1) of this chapter (relating to Preadmission Process) for an individual who is suspected of having MI, ID, or DD and who is seeking admission to a NF [nursing facility] through the preadmission process; [and]

(2) complete a PE or resident review as follows:

(A) within 72 hours after receiving a copy of the PL1 from the referring entity in accordance with §303.201(a)(1)(B) of this chapter or notification from the LTC online portal in accordance with §303.202 or §303.204(a) of this chapter (relating to Expedited Admission Process and Resident Review Process, respectively):

(i) call the referring entity or NF [nursing facility] to schedule the PE or resident review; and

(ii) meet face-to-face with the individual or resident at the referring entity or NF [nursing facility] to gather information to complete the PE or resident review; and

(B) within seven days after receiving a copy of the PL1 from the referring entity or notification from the LTC online portal:

(i) complete the PE or resident review by:

(I) reviewing the individual's or resident's:

(-a-) medical records;

(-b-) relevant service records, including those available in online databases, such as the Client Assignment and Registration (CARE) system, Clinical Management for Behavioral Health Services (CMBHS), and LTC online portal; and

(-c-) previous PEs, service plans, and assessments from other LIDDAs, LMHAs, or LBHAs;

(II) meeting face-to-face with the individual's or resident's LAR or communicating with the LAR by telephone if the LAR is not able to meet face-to-face;

(III) communicating with a collateral contact as necessary;

(IV) providing information to the individual seeking admission or resident and the individual's or resident's LAR, if any, about community services, supports, and programs for which the individual or resident may be eligible; and

(V) obtaining additional information as needed; and

(ii) enter the data from the PE or resident review in the LTC online portal; and[.]

(3) within three business days after entering the data from the PE or resident review in the LTC online portal:

(A) if the PE or resident review is positive for MI, ID, or DD, provide the individual seeking admission or resident or the individual's or resident's LAR with a summary of the results of the PE or resident review, using HHSC forms; or

(B) if the PE or resident review is negative for MI, ID, or DD, provide the individual seeking admission or resident or the individual's or resident's LAR notice of the right to a fair hearing, using HHSC forms.

(b) If an individual seeking admission to a NF [nursing facility] or a resident has a PE or resident review that is positive for ID, DD, or MI and a NF [nursing facility] certifies in the LTC online portal that it cannot meet the needs of the individual or resident, then the LIDDA, LMHA, or LBHA, as applicable, must assist the individual, resident, or LAR in choosing another NF [nursing facility] that will certify it can meet the needs of the individual or resident.

(c) If an individual seeking admission to a NF [nursing facility] or a resident has a PE or resident review that is positive for ID, DD, or MI and a NF [nursing facility] certifies in the LTC online portal that it can meet the needs of the resident or certifies in the LTC online portal that it can meet the needs of the individual and admits the individual, the LIDDA, LMHA or LBHA, as applicable, must:

(1) coordinate with the NF [nursing facility] to schedule an IDT meeting to discuss specialized services; [:]

[(A) for a PE, within 14 days after admission; or]

[(B) for a resident review, within 14 days after the LTC online portal generated an automated notification to the LIDDA, LMHA, or LBHA;]

(2) participate in the resident's IDT meeting as scheduled by the NF [nursing facility] to, in collaboration with the other members of the IDT:

(A) identify which of the specialized services recommended for the resident that the resident, or LAR on the resident's behalf, wants to receive;

(B) identify the NF [nursing facility] PASRR support activities for the resident; and

(C) determine whether the resident is best served in a facility or community setting;

(3) within five business days after receiving notification from the LTC online portal that the NF [nursing facility] entered information from the IDT meeting, confirm the LIDDA's, LMHA's, or LBHA's participation in the meeting and the specialized services recommended [that the following information is] in the LTC online portal[, in accordance with HHSC instructions:]

[(A) the LIDDA, LMHA, or LBHA representative who participated in the IDT meeting; and]

[(B)[[all specialized services that were agreed to in the IDT meeting]; and

(4) if Medicaid or other funding is available:

(A) initiate [IDD habilitative specialized services or] MI specialized services within 20 business days after the date of the IDT meeting; and

(B) provide the [IDD habilitative specialized services or] MI specialized services agreed upon in the IDT meeting to the resident.

(d) The LIDDA, LMHA, or LBHA must develop a written policy that describes the process the LIDDA, LMHA, or LBHA will follow to address challenges related to the designated resident's, resident with MI's, or LAR's participation in receiving IHSS or MI specialized services.

(e) The LIDDA must ensure that a designated resident or LAR is informed orally and in writing of the processes for filing complaints as follows:

(1) the telephone number of the LIDDA to file a complaint;

(2) the telephone number of the IDD Ombudsman to file a complaint about the LIDDA;

(3) the telephone number of Complaint and Incident Intake to file a complaint about IHSS or the NF;

(4) the telephone number of DFPS Statewide Intake to report an allegation of abuse, neglect, or exploitation; and

(5) the telephone number of the Long-Term Care Ombudsman to file a complaint that relates to action, inaction, or a decision by any individual or entity who provides care or makes decisions related to a designated resident, that may adversely affect the health, safety, welfare, or rights of the designated resident.

(f) The LMHA or LBHA must ensure that a resident with MI or LAR is informed orally and in writing of the processes for filing complaints as follows:

(1) the telephone number of the LMHA or LBHA to file a complaint;

(2) the telephone number of the Ombudsman for Behavioral Health to file a complaint about MI specialized services or about an LMHA or LBHA;

(3) the telephone number of Complaint and Incident Intake to file a complaint about the NF;

(4) the telephone number of DFPS Statewide Intake to report an allegation of abuse, neglect, or exploitation; and

(5) the telephone number of the Long-Term Care Ombudsman to file a complaint that relates to action, inaction, or a decision by any individual or entity who provides care or makes decisions related to a resident with MI, that may adversely affect the health, safety, welfare, or rights of the resident with MI.

(g) If an individual seeking admission to a NF or a resident has a PE or resident review that is positive for MI and ID or MI and DD, the LIDDA is responsible for coordinating with the NF to schedule the IDT meeting to discuss specialized services.

§303.303.Qualifications and Requirements for Staff Person Conducting a PE or Resident Review.

(a) A LIDDA must ensure a PE or resident review is conducted by an individual [a person] who:

(1) is a QIDP; or

(2) has one of the following qualifications and at least one year of experience working directly with individuals [persons] with ID [intellectual disability] or DD [other developmental disabilities]:

(A) RN;

(B) LCSW;

(C) LPC;

(D) LMFT;

(E) Licensed Psychologist;

(F) APRN; or

(G) Physician.

(b) An LMHA or LBHA must ensure a PE or resident review is conducted by an individual [a person] who is a:

(1) QMHP-CS; or

(2) has one of the following qualifications and at least one year of experience working directly with individuals with MI:

(A) [(2)] RN;

(B) [(3)] LCSW;

(C) [(4)] LPC;

(D) [(5)] LMFT;

(E) [(6)] Licensed Psychologist;

(F) [(7)] APRN;

(G) [(8)] Physician; or

(H) [(9)] PA.

(c) A LIDDA, LMHA, and LBHA must:

(1) before a staff person conducts a PE or resident review, ensure the staff person:

(A) receives HHSC-developed training about how to conduct a PE and resident review; and

(B) demonstrates competency in completing a PE and resident review; and

(2) maintain documentation of the training received by a staff person who conducts a PE or resident review.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101308

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER D. VENDOR PAYMENT

26 TAC §303.401

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendment implements Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.401.Reimbursement for a PE or Resident Review.

(a) A LIDDA, LMHA, or LBHA must accept the reimbursement rate established by HHSC as payment in full for the following activities:

(1) completing a PE or resident review in accordance with §303.302(a)(2) of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process);

(2) assisting an individual who is seeking admission to a NF [nursing facility], or a resident with MI, ID, or DD, or the individual's or resident's LAR in choosing another NF [a nursing facility] that will certify it can meet the needs of the individual or resident as described in §303.302(b) of this chapter;

(3) participating in the resident's IDT meeting; and

(4) confirming in the LTC online portal the information required by §303.302(c)(3) of this chapter.

(b) The reimbursement rate for the activities described in subsection (a) of this section includes travel costs associated with the activities. HHSC does not pay any additional amounts for travel. A LIDDA, LMHA, or LBHA must not request reimbursement for travel time or travel costs associated with the activities described in subsection (a) of this section.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101309

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER E. HABILITATION COORDINATION

26 TAC §§303.501, 303.502, 303.504

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.501.Qualifications of a Habilitation Coordinator.

A habilitation coordinator must:

(1) be an employee of a LIDDA;

(2) have a bachelor's or advanced degree from an accredited college or university with a major in a social, behavioral, or human service field, such as psychology, social work, medicine, nursing, rehabilitation, counseling, sociology, human development, gerontology, educational psychology, education, or criminal justice; and

(3) have at least one year of experience working directly with individuals with ID or DD [intellectual or other developmental disabilities].

§303.502.Required Training for a Habilitation Coordinator.

(a) A LIDDA must ensure a habilitation coordinator completes the following training before providing habilitation coordination:

(1) training that addresses:

(A) appropriate LIDDA policies, procedures, and standards;

(B) this chapter, [and] other HHSC rules relating to the provision of specialized services, and other HHSC rules affecting the LIDDA;

(C) HHSC's IDD PASRR Handbook;

(D) developing and implementing an HSP;

(E) conducting assessments, service planning, coordination, and monitoring;

(F) providing crisis prevention and management;

(G) community support services;

(H) [(G)] presenting community living options using HHSC-developed materials and forms, and offering educational opportunities and informational activities about community living options;

(I) [(H)] arranging visits to community providers;

(J) [(I)] accessing specialized services for a designated resident;

(K) [(J)] the rights of an individual [a person] with an ID [intellectual disability], including the right to live in the least restrictive setting appropriate to the person's individual needs and abilities and in a variety of living situations, as described in the Persons with an Intellectual Disability Act, Texas Health and Safety Code[,] Chapter 592 and in an HHSC-developed rights handbook [the Your Rights in Local Authority Services booklet ]; and

(L) [(K)] advocacy for individuals with ID or DD;

(2) person-centered thinking training [approved by HHSC]; and

(3) all HHSC-developed training related to PASRR.

(b) A LIDDA must:

(1) ensure a habilitation coordinator demonstrates competency in providing habilitation coordination; and

(2) maintain documentation of the training received by habilitation coordinators.

§303.504.Documentation Maintained by a LIDDA in a Designated Resident's Record.

(a) A LIDDA must ensure a habilitation coordinator maintains the following documentation in a designated resident's record:

(1) all assessments used for service planning;

(2) all documentation of habilitation coordination contacts as described in §303.503(a) of this chapter (relating to Documenting Habilitation Coordination Contacts);

(3) documentation related to monitoring specialized services, including:

(A) the initiation and delivery of all specialized services provided for [to] the designated resident, including reasons for delays and all follow-up activities;

(B) the designated resident's and LAR's satisfaction with all specialized services; and

(C) the designated resident's progress or lack of progress toward achieving goals and outcomes identified in the HSP, including whether the designated resident is maintaining progress toward achieving goals and outcomes from the designated resident's and LAR's perspectives;

(4) the current NF comprehensive care plan;

(5) the current HSP;

(6) all documents and forms used to:

(A) identify the designated resident's need for specialized services; and

(B) conduct SPT meetings, including written reports from SPT members who are providers of specialized services and completed forms related to assessing for habilitative needs;

(7) the completed HHSC forms that document discussions with the designated resident and LAR about the range of community living options and alternative services and supports available; [services, supports, and alternatives; and]

(8) all pertinent information related to the designated resident, such as guardianship paperwork and consents;[.]

(9) the current plan of care; and

(10) an implementation plan for each IHSS that appears on the plan of care.

(b) For a designated resident who has refused habilitation coordination, a LIDDA must maintain the following documentation in a designated resident's record:

(1) all [the] completed Refusal of Habilitation Coordination forms [form];

(2) documentation of the specialized services discussed in the initial IDT and any SPT or IDT [annual] specialized services review meeting; and

(3) the completed HHSC forms that document discussions with the designated resident and LAR about the range of community living options and alternative services and supports available [services, supports, and alternatives].

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101310

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER F. HABILITATIVE SERVICE PLANNING FOR A DESIGNATED RESIDENT

26 TAC §§303.601 - 303.603

STATUTORY AUTHORITY

The amendments and new section are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments and new section implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.601.Habilitation Coordination for a Designated Resident.

(a) A LIDDA must assign a habilitation coordinator to each designated resident to attend the initial IDT and provide habilitation coordination while the designated resident is residing in the NF [nursing facility]. A designated resident may refuse habilitation coordination.

(b) Unless a designated resident has refused habilitation coordination, the assigned habilitation coordinator must:

(1) assess and reassess quarterly, and as needed, the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences and the specialized services that will address those needs and preferences;

(2) develop and revise, as needed, an individualized HSP in accordance with HHSC's rules and IDD PASRR Handbook, and using HHSC forms;

(3) assist the designated resident to access needed specialized services agreed upon in an IDT or SPT meeting, including:

(A) monitoring to determine if a specialized service agreed upon in an IDT or SPT meeting is requested within required timeframes in accordance with the IDD PASRR Handbook [20 business days after the IDT or SPT meeting] or documenting delays and the habilitation coordinator's follow-up activities; and

(B) ensuring the delivery of all specialized services agreed upon in an IDT or SPT meeting or documenting delays and the habilitation coordinator's follow-up activities;

(4) coordinate other habilitative programs and services that can address needs and achieve outcomes identified in the HSP;

(5) facilitate the coordination of the designated resident's HSP and NF [the] comprehensive care plan, including ensuring the HSP is shared with members of the SPT within 10 calendar days after the HSP is updated or renewed [and the nursing facility];

(6) monitor and provide follow-up activities that consist of:

(A) monitoring the initiation and delivery of all specialized services agreed upon in an IDT or SPT meeting and following up when delays occur;

(B) monitoring the designated resident's and LAR's satisfaction with all specialized services; [and]

(C) determining the designated resident's progress or lack of progress toward achieving goals and outcomes identified in the HSP; and

(D) determining the designated resident's progress or lack of progress toward achieving goals and outcomes identified in the HSP from the designated resident's and LAR's perspectives;

(7) unless waived by HHSC, meet face-to-face with the designated resident to provide habilitation coordination:

(A) at least monthly or more frequently if needed; or

(B) at least quarterly if the only specialized service the designated resident is receiving is habilitation coordination;

(8) convene and facilitate an SPT meeting at least quarterly, or more frequently if there is a change in service needs or [,] medical condition, or if requested by the designated resident or LAR;

(9) coordinate with the NF in accessing medical, social, educational, and other appropriate services and supports that will help the designated resident achieve a quality of life acceptable to the designated resident and LAR on the resident's behalf;

(10) initially and annually thereafter:

(A) provide the designated resident and LAR an oral and written explanation of the designated resident's rights in accordance with the IDD PASRR Handbook; and

(B) inform the designated resident and LAR both orally and in writing of all the services available and requirements pertaining to the designated resident's participation;

(11) for a designated resident who has a guardian, determine at least annually if the letters of guardianship are current; and

(12) if appropriate, for a designated resident who does not have a guardian, ensure the SPT discusses whether the designated resident would benefit from a less restrictive alternative to guardianship or from guardianship and make appropriate referrals.

(c) Regardless of whether the designated resident is receiving or has refused habilitation coordination, the habilitation coordinator must:

(1) [(9)] address community living options with the designated resident and LAR by:

(A) offering the educational opportunities and informational activities about community living options that are periodically scheduled by the LIDDA;

(B) providing information about the range of community living services, supports, and alternatives, identifying the services and supports the designated resident will need to live in the community, and identifying and addressing barriers to community living in accordance with HHSC's IDD PASRR Handbook and using HHSC materials at the following times:

(i) six months after the initial presentation of community living options during the PE described in §303.302(a)(2)(B)(i) of this Chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process) and at least every six months thereafter, but no more than 30 days before a scheduled quarterly SPT meeting;

(ii) when requested by the designated resident or LAR;

(iii) when the habilitation coordinator is notified or becomes aware that the designated resident, or the LAR on the designated resident's behalf, is interested in speaking with someone about transitioning to the community; and

(iv) when notified by HHSC that the designated resident's response in Section Q of the MDS Assessment indicates the resident is interested in speaking with someone about transitioning to the community; and

(C) arranging visits to community providers and addressing concerns about community living;

(10) coordinate with the nursing facility in accessing medical, social, educational, and other appropriate services and supports that will help the designated resident achieve a quality of life acceptable to the designated resident and LAR on the resident's behalf; and]

[(11) initially and annually thereafter, provide the designated resident and LAR an oral and written explanation of the designated resident's rights contained in the Your Rights in Local Authority Services booklet.]

(2) annually assess the designated resident's habilitative service needs by gathering information from the designated resident and other appropriate sources, such as the LAR, family members, social workers, and service providers, to determine the designated resident's habilitative needs and preferences.

§303.602.Service Planning Team Responsibilities Related to Specialized Services.

(a) The SPT for a designated resident must:

(1) meet at least quarterly, as convened by the habilitation coordinator;

(2) ensure that the designated resident, regardless of whether he or she has an LAR, participates in the SPT to the fullest extent possible and receives the support necessary to do so, including communication supports;

(3) develop an HSP for the designated resident;

(4) review and monitor identified risk factors, such as choking, falling, and skin breakdown, and report to the proper authority if they are not addressed;

(5) make timely referrals, service changes, and revisions to the HSP as needed; [and]

(6) considering the designated resident's preferences, monitor to determine if the designated resident is provided opportunities for engaging in integrated activities:

(A) with residents who do not have ID or DD; and

(B) in community settings with people who do not have a disability; and

(7) develop the plan of care for IHSS.

(b) Each member of the SPT for a designated resident must:

(1) consistent with the SPT member's role, assist the habilitation coordinator in ensuring the designated resident's needs are being met; and

(2) participate in an SPT meeting in person or by phone, except as described in subsections (c)(3) or (e) of this section;

(c) An SPT member who is a provider of a specialized service must:

(1) submit to the habilitation coordinator a copy of all assessments of the designated resident that were completed by the provider or provider agency;

(2) submit a written report describing the designated resident's progress or lack of progress to the habilitation coordinator at least five days before a quarterly SPT meeting; and

(3) actively participate in an SPT meeting, in person or by phone, unless the habilitation coordinator determines active participation by the provider is not necessary.

(d) If a habilitation coordinator determines active participation by a provider is not necessary as described in subsection (c)(3) of this section, the habilitation coordinator must:

(1) base the determination:

(A) on the information in the written report submitted in accordance with subsection (c)(2) of this section; and

(B) on the needs of the SPT; and

(2) document the reasons for exempting participation.

(e) A habilitation coordinator must facilitate a quarterly SPT meeting in person.

§303.603.Habilitation Coordination for a Designated Resident Receiving IHSS.

(a) The habilitation coordinator must:

(1) facilitate the coordination of the designated resident's plan of care, including ensuring the plan of care is shared with members of the SPT within 10 calendar days after the plan of care is developed, updated, or renewed;

(2) assist a designated resident, LAR, or actively involved person in exercising the legal rights of the designated resident as a citizen and as a person with a disability, including protection of rights and options to avoid unnecessary rights restrictions;

(3) provide a designated resident, LAR, or family member with a written and oral explanation of the rights of a designated resident receiving IHSS;

(4) document the explanation of rights required by paragraph (3) of this subsection and ensure that the documentation is signed by:

(A) the designated resident or LAR; and

(B) the habilitation coordinator;

(5) immediately notify the NF and service provider agency if the habilitation coordinator becomes aware of an emergency that impacts the designated resident's health or safety;

(6) be objective in assisting a designated resident or LAR in selecting a service provider agency;

(7) ensure that a designated resident, LAR, and service provider agency are informed of the name of the designated resident's habilitation coordinator and how to contact the habilitation coordinator; and

(8) give the service provider agency a copy of the NF baseline care plan or NF comprehensive care plan, whichever is most current.

(b) If the habilitation coordinator identifies a concern with the implementation of the plan of care, the habilitation coordinator must ensure the concern is communicated to the service provider agency and attempts are made to resolve the concern.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101311

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER G. TRANSITION PLANNING

26 TAC §303.701, §303.703

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendments implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.701.Transition Planning for a Designated Resident.

(a) A LIDDA must assign a service coordinator for [to] a designated resident if the designated resident, or the LAR on the designated resident's behalf, expresses an interest in moving to the community and has selected a community program.

(b) A service coordinator must facilitate the development, revisions, implementation, and monitoring of a transition plan in accordance with HHSC's IDD PASRR Handbook and using HHSC forms. A transition plan must identify the services and supports a designated resident needs to live in the community, including those essential supports that are critical to the designated resident's health and safety.

(c) The SPT for a designated resident must:

(1) meet as convened by the service coordinator;

(2) ensure that the designated resident, regardless of whether he or she has an LAR, participates in the SPT to the fullest extent possible and receives the support necessary to do so, including communication supports; and

(3) conduct transition planning activities and develop a transition plan for the designated resident.

(d) Consistent with an SPT member's role, each SPT member must:

(1) assist the service coordinator in developing, revising, implementing, and monitoring a designated resident's transition plan to ensure a successful transition to the community for the designated resident; and

(2) participate in an SPT meeting in person or by phone, except as described in subsections (e) or (g) of this section.

(e) An SPT member who is a provider of a specialized service must actively participate in an SPT meeting, in person or by phone, unless the service coordinator determines active participation by the provider is not necessary.

(f) If a service coordinator determines active participation by a provider is not necessary as described in subsection (e) of this section, the service coordinator must:

(1) base the determination on the needs of the SPT; and

(2) document the reasons for exempting participation.

(g) At an SPT meeting convened by a service coordinator, the service coordinator must facilitate the SPT meeting in person.

(h) For a designated resident who is transitioning to the community, a service coordinator must, in accordance with HHSC's IDD PASRR Handbook and using HHSC forms, conduct and document a pre-move site review of the designated resident's proposed residence in the community to determine whether all essential supports in the designated resident's transition plan are in place before the designated resident's transition to the community.

(i) If the SPT makes a recommendation that a designated resident continue to reside in a NF [nursing facility], the SPT must:

(1) document the reasons for the recommendation; and

(2) include in the designated resident's transition plan:

(A) the barriers to moving to a more integrated setting; and

(B) the steps the SPT will take to address those barriers.

§303.703.Requirements for Service Coordinators Conducting Transition Planning.

(a) A LIDDA must ensure that a service coordinator complies with 40 TAC Chapter 2, Subchapter L (relating to Service Coordination for Individuals with an Intellectual Disability), including documenting in the transition plan the frequency and duration of service coordination while the designated resident is in the NF [nursing facility].

(b) A LIDDA must ensure that a service coordinator who conducts transition planning completes the following training before providing service coordination for [to] a designated resident:

(1) training that addresses:

(A) this chapter;

(B) HHSC's IDD PASRR Handbook;

[(C) the process for making a referral for relocation services, the role of a relocation specialist, and housing options;]

(C) [(D)] the role of a relocation specialist and [the] MCO service coordinator for a NF [nursing facility] resident who wants to transition to the community;

(D) [(E)] services available through Texas Medicaid State Plan and all home and community-based [community based] services programs for individuals with ID or DD, including but not limited to, access to nursing, durable medical equipment and supplies, and transition assistance supports;

(E) [(F)] developing and implementing a transition plan for a designated resident;

(F) [(G)] an overview of [presenting] community living options, [using HHSC-developed materials and forms, and offering] educational opportunities, and informational activities about community living options; and

(G) [(H)] the rights of an individual [a person] with ID [an intellectual disability], including the right to live in the least restrictive setting appropriate to the person's individual needs and abilities and in a variety of living situations, as described in the Persons with an Intellectual Disability Act, Texas Health and Safety Code[,] Chapter 592 and an HHSC-developed rights handbook; [the Your Rights in Local Authority Services booklet; and]

(2) person-centered thinking training [approved by HHSC]; and

(3) all HHSC-developed training related to PASRR.

(c) A LIDDA must:

(1) ensure a service coordinator who conducts transition planning demonstrates competency in conducting transition planning; and

(2) maintain documentation of the training received by service coordinators who conduct transition planning.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101312

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER H. COMPLIANCE REVIEW

26 TAC §303.801

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The amendment implements Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.801.[LIDDA] Compliance Review.

(a) HHSC conducts a compliance review of each LIDDA, LMHA, and LBHA at least annually[,] to determine if the LIDDA, LMHA, and LBHA are [is] in compliance with the requirements for a LIDDA, LMHA, and LBHA described in this chapter.

(b) A LIDDA, LMHA, and LBHA must submit to HHSC a plan of correction in accordance with the performance contract for any item of non-compliance. HHSC may take action as specified in the performance contract if a LIDDA, LMHA, or LBHA fails to submit a plan of correction or implement an approved plan of correction.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101313

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


SUBCHAPTER I. MI SPECIALIZED SERVICES

26 TAC §§303.901 - 303.913

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code Chapter 531, Subchapter A-1, which provides for the consolidation of the health and human services system; Texas Government Code §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program.

The new sections implement Texas Government Code §531.0055 and §531.021 and Texas Human Resources Code §32.021.

§303.901.Description of MI Specialized Services.

(a) The LMHA or LBHA staff must conduct the uniform assessment to determine which level of care the resident with MI will receive.

(b) The following MI specialized services are available to a resident with MI.

(1) Crisis intervention services. Interventions provided in response to a crisis in order to reduce or manage symptoms of MI and to prevent admission of a resident with MI to a more restrictive environment.

(2) Day programs for acute needs. Short term, intensive treatment to a resident with MI who requires multidisciplinary treatment in order to stabilize acute psychiatric symptoms or prevent admission to a more restrictive setting.

(3) Medication training and support services. Education and guidance provided to a resident with MI and family members about the resident with MI's medications and their possible side effects as described in §306.315 of this title (relating to Medication Training and Support Services).

(4) Psychiatric diagnostic interview examination. An assessment of a resident with MI that includes relevant past and current medical and psychiatric information and a documented diagnosis by a licensed professional practicing within the scope of his or her license.

(5) Psychosocial rehabilitation services. Social, educational, vocational, behavioral, and cognitive interventions provided by members of a resident with MI's therapeutic team that address deficits in the resident with MI's ability to develop and maintain social relationships, occupational or educational achievement, independent living skills, or housing. Psychosocial rehabilitative services include the following component services:

(A) coordination services;

(B) crisis related services;

(C) employment related services;

(D) housing related services;

(E) independent living services; and

(F) medication related services.

(6) Routine case management. A primarily site-based service to assist a resident with MI or LAR in gaining and coordinating access to necessary care and services appropriate to the resident with MI's needs.

(7) Skills training and development. Training provided to a resident with MI that:

(A) addresses the severe and persistent MI and symptom-related problems that interfere with the resident with MI's functioning;

(B) provides opportunities for the resident with MI to acquire and improve skills needed to function as appropriately and independently as possible in the community; and

(C) facilitates the resident with MI's community integration and increases the resident with MI's community tenure.

§303.902.Eligibility Criteria.

A resident with MI is eligible for MI specialized services funded by Medicaid if the resident with MI requires the provision of at least one MI specialized service.

§303.903.MI Specialized Services Team.

(a) The MI specialized services team must include:

(1) the resident with MI;

(2) the resident with MI's LAR, if any;

(3) the QMHP-CS assigned to the resident with MI;

(4) a representative of the LMHA or LBHA providing the MI specialized services;

(5) the MCO service coordinator, if the resident with MI does not object;

(6) a NF staff person familiar with the resident with MI's needs; and

(7) if the resident with MI is transitioning to the community:

(A) a representative from the community program provider, if one has been selected; and

(B) a relocation specialist.

(b) The MI specialized services team may also include a concerned individual whose inclusion is requested by the resident with MI or the LAR.

§303.904.Qualifications for Conducting the Uniform Assessment.

The LMHA or LBHA staff person administering the uniform assessment must be certified in administering the uniform assessment.

§303.905.Process for Service Initiation.

(a) The LMHA or LBHA must comply with §303.302 of this chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related to the PASRR Process).

(b) At the initial IDT meeting, the LMHA or LBHA staff participating in the meeting, in conjunction with the IDT, must:

(1) review the MI specialized services recommended on the PE;

(2) explain the uniform assessment;

(3) ensure the resident with MI, or LAR on the resident with MI's behalf, understands the purpose of the uniform assessment; and

(4) have the resident with MI, or LAR on the resident with MI's behalf, agree or decline to receive the uniform assessment and MI specialized services.

(c) Within 20 business days after the IDT meeting, if the resident with MI or LAR agrees, the LMHA or LBHA must:

(1) complete the uniform assessment;

(2) develop the PCRP; and

(3) for a resident with MI only, convene a meeting to discuss the results of the uniform assessment and PCRP, and to determine the MI specialized services the resident with MI will receive.

(d) Attendees at the meeting convened in accordance with subsection (c)(3) of this section must include:

(1) the QMHP-CS who completed the uniform assessment and PCRP;

(2) the resident with MI;

(3) the resident with MI's LAR, if any; and

(4) a NF staff person familiar with the resident with MI's needs.

(e) At the meeting convened in accordance with subsection (c)(3) of this section, the QMHP-CS must ensure the resident with MI, regardless of whether he or she has an LAR, participates in the meeting to the fullest extent possible and receives the support necessary to do so, including communication supports.

(f) The LMHA or LBHA must provide a copy of the completed uniform assessment and PCRP to the NF for inclusion in the resident with MI's NF comprehensive care plan within 10 calendar days after the meeting convened in accordance with subsection (c)(3) of this section.

§303.906.Person-Centered Recovery Plan.

The QMHP-CS, in conjunction with the MI specialized services team, develops, periodically reviews, and revises as needed the PCRP for each resident with MI in accordance with §301.353(e)-(g) of this title (relating to Provider Responsibilities for Treatment Planning and Service Authorization).

§303.907.Renewal and Revision of Person-Centered Recovery Plan.

(a) At least quarterly, the QMHP-CS must convene an MI quarterly meeting to:

(1) review the PCRP to determine whether the MI specialized services previously identified remain relevant; and

(2) determine whether the current uniform assessment accurately reflects the resident with MI's need for MI specialized services in the identified frequency, amount, and duration, or if an updated uniform assessment is required.

(b) The MI specialized services team initiates revisions to the PCRP in response to changes to the needs of the resident with MI.

(1) Any MI specialized services team member may ask the QMHP-CS to convene a meeting at any time to discuss whether a resident with MI's PCRP needs to be revised to add a new MI specialized service or change the frequency, amount, or duration of an existing MI specialized service.

(2) The QMHP-CS must convene a meeting within seven calendar days after learning of the need to revise the resident with MI's PCRP.

(c) If the MI specialized services team agrees to add a new MI specialized service to the PCRP or determines an updated uniform assessment is required, a QMHP-CS must, within seven calendar days after the meeting is held, update the uniform assessment and provide it to the MI specialized services team.

(d) The QMHP-CS must:

(1) document revisions on the PCRP within five calendar days after a team meeting; and

(2) retain the revised PCRP documentation in the resident with MI's LMHA or LBHA record.

(e) Within ten calendar days after the PCRP is updated or renewed, the QMHP-CS must send each member of the MI specialized services team a copy of the revised PCRP.

(f) If the MI specialized services team determines a new MI specialized service is needed or determines a change in the frequency, amount, or duration of an existing service is needed, the PCRP must be revised before the LMHA or LBHA delivers a new or updated service.

§303.908.Service Delivery.

(a) The LMHA or LBHA must begin delivering all MI specialized services in accordance with the PCRP within five calendar days after the MI specialized services team meeting.

(b) Before delivering an MI specialized service, the LMHA or LBHA must:

(1) confirm that the resident with MI is a Medicaid recipient; and

(2) receive authorization to deliver the MI specialized services in accordance with §306.311 of this title (relating to Service Authorization and Recovery Plan).

(c) The LMHA or LBHA must ensure that a resident with MI's progress or lack of progress toward achieving an identified outcome from the resident with MI's or LAR's perspective is accurately and consistently documented in observable, measurable terms.

(d) The LMHA or LBHA must monitor a resident with MI's and LAR's satisfaction with MI specialized services.

(e) The LMHA or LBHA must inform the NF of any significant changes to the resident with MI's behavioral or medical condition during the provision of MI specialized services.

§303.909.Refusal of the Uniform Assessment or MI Specialized Services.

(a) When a resident with MI refuses the uniform assessment or MI specialized services, the LMHA or LBHA must:

(1) ask the resident with MI or the LAR to sign the Refusal of PASRR MI Specialized Services form and document on the form if the resident with MI or LAR refuses to sign;

(2) inform the resident with MI of the need to conduct follow-up visits every 30 days for 90 days after the initial IDT meeting; and

(3) if the resident with MI or the LAR continues to refuse the uniform assessment or MI specialized services after 90 days, inform the resident with MI and the LAR that an annual IDT meeting is required and will be conducted, at which time the uniform assessment and MI specialized services will be offered again.

(b) A resident with MI or LAR may agree to receive the uniform assessment or MI specialized services at any time.

§303.910.Suspension and Termination of MI Specialized Services.

(a) The LMHA or LBHA must suspend a resident with MI's MI specialized services when:

(1) the resident with MI is admitted to an acute care hospital for fewer than 30 days and is returning to the same NF;

(2) the resident with MI loses Medicaid eligibility; or

(3) the resident with MI or LAR requests that MI specialized services be suspended when transferring from one NF to another NF without an intervening hospital stay.

(b) The LMHA or LBHA may terminate one or more of a resident with MI's MI specialized services if:

(1) the resident with MI loses Medicaid eligibility for more than 90 days; or

(2) the resident with MI or LAR requests the MI specialized services be terminated.

§303.911.Transition Planning for Residents with MI Only.

(a) If a resident with MI only, or the LAR on the resident with MI's behalf, expresses an interest in moving to the community, the QMHP-CS must facilitate the development of, revisions to, implementation of, and monitoring of a transition plan.

(b) A transition plan must identify the services and supports a resident with MI needs to live in the community, including those essential supports that are critical to the resident with MI's health and safety.

§303.912.Documentation.

An LMHA or LBHA must maintain the following documentation in the resident with MI's record:

(1) all assessments used for service planning;

(2) documentation related to the initiation and delivery of MI specialized services, including reasons for delays and all follow-up activities;

(3) documentation related to monitoring MI specialized services, including:

(A) the resident with MI's or the LAR's satisfaction with MI specialized services; and

(B) progress or lack of progress toward achieving goals and outcomes identified in the PCRP;

(4) documentation of all meetings, including the required 30, 60, and 90 day follow-up meetings held after a resident with MI refuses MI specialized services;

(5) guardianship paperwork and consents, if applicable; and

(6) documentation of a resident with MI's refusal of MI specialized services, if applicable.

§303.913.Quality Assurance.

(a) The LMHA or LBHA must allow access to the resident with MI or the resident with MI's record by:

(1) advocacy agencies; and

(2) HHSC staff.

(b) The LMHA or LBHA must develop, update as necessary, and implement a written quality assurance process to evaluate and improve the quality of MI specialized services delivered by the LMHA or LBHA.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 25, 2021.

TRD-202101314

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-5018


CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) repeals §§553.61 - 553.64 and proposes new §§553.100, 553.101, 553.103, 553.104, 553.107, 553.110 - 553.113, 553.115 - 553.123, 553.125 - 553.149, 553.210 - 553.213, 553.215 - 553.223, 553.225 - 553.249, and 553.251, in Subchapter D, concerning Facility Construction, in Title 26, Texas Administrative Code (TAC), Chapter 553, Licensing Standards for Assisted Living Facilities.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill (S.B.) 1049, 85th Legislature, Regular Session, 2017, by amending the Licensing Standards for Assisted Living Facilities in Texas Administrative Code, Title 26, Chapter 553, to adopt the 2012 edition of National Fire Protection Association (NFPA) 101, Life Safety Code for assisted living facilities (ALF). Currently, ALFs in Texas must comply with the 2000 edition of the NFPA 101, which was adopted in January 2014.

The proposal repeals current 26 TAC §§553.61 - 553.64. The content currently in these sections is spread throughout the reorganized Subchapter D.

The proposal also reorganizes Subchapter D into divisions by facility size and type to provide consistency across divisions. HHSC licenses two types of facilities: Type A and Type B. Type A facilities may care for residents who are physically and mentally able to evacuate unassisted during an emergency. Type B residents may be incapable of following directions in an emergency and may require assistance from staff to evacuate. Both types of facilities are classified as either small or large, depending on the number of residents. A small facility has 16 or fewer residents, and a large facility has 17 or more residents.

SECTION-BY-SECTION SUMMARY

Proposed new §553.100 describes general requirements that apply to assisted living facilities.

Proposed new §553.101 defines words and terms used in this subchapter.

Proposed new §553.103 describes the site and location for all assisted living facilities.

Proposed new §553.104 describes safety operations for assisted living facilities.

Proposed new §553.107 describes building construction and rehabilitation.

Proposed new §553.110 describes general requirements for an existing small Type A assisted living facility.

Proposed new §553.111 describes construction requirements for an existing small Type A assisted living facility.

Proposed new §553.112 describes space planning and utilization requirements for an existing small Type A assisted living facility.

Proposed new §553.113 describes means of escape requirements for an existing small Type A assisted living facility.

Proposed new §553.115 describes fire protection systems requirements for an existing small Type A assisted living facility.

Proposed new §553.116 describes hazardous area requirements for an existing small Type A assisted living facility.

Proposed new §553.117 describes mechanical requirements for an existing small Type A assisted living facility.

Proposed new §553.118 describes electrical requirements for an existing small Type A assisted living facility.

Proposed new §553.119 describes miscellaneous requirements for an existing small Type A assisted living facility.

Proposed new §553.120 describes general requirements for an existing small Type B assisted living facility.

Proposed new §553.121describes construction requirements for an existing small Type B assisted living facility.

Proposed new §553.122 describes space planning and utilization requirements for an existing small Type B assisted living facility.

Proposed new §553.123 describes means of escape requirements for an existing small Type B assisted living facility.

Proposed new §553.125 describes fire protection systems requirements for an existing small Type B assisted living facility.

Proposed new §553.126 describes hazardous area requirements for an existing small Type B assisted living facility.

Proposed new §553.127 describes mechanical requirements for an existing small Type B assisted living facility.

Proposed new §553.128 describes electrical requirements for an existing small Type B assisted living facility.

Proposed new §553.129 describes miscellaneous requirements for an existing small Type B assisted living facility

Proposed new §553.130 describes general requirements for an existing large Type A assisted living facility.

Proposed new §553.131 describes construction requirements for an existing large Type A assisted living facility.

Proposed new §553.132 describes space planning and utilization requirements for an existing large Type A assisted living facility.

Proposed new §553.133 describes means of egress requirements for an existing large Type A assisted living facility.

Proposed new §553.134 describes smoke compartmentation for an existing large Type A assisted living facility.

Proposed new §553.135 describes fire protection systems requirements for an existing large Type A assisted living facility.

Proposed new §553.136 describes hazardous area requirements for an existing large Type A assisted living facility.

Proposed new §553.137 describes mechanical requirements for an existing large Type A assisted living facility.

Proposed new §553.138 describes electrical requirements for an existing large Type A assisted living facility.

Proposed new §553.139 describes miscellaneous requirements for an existing large Type A assisted living facility.

Proposed new §553.140 describes general requirements for an existing large Type B assisted living facility.

Proposed new §553.141 describes construction requirements for an existing large Type B assisted living facility.

Proposed new §553.142 describes space planning and utilization requirements for an existing large Type B assisted living facility.

Proposed new §553.143 describes means of egress requirements for an existing large Type B assisted living facility.

Proposed new §553.144 describes smoke compartmentation for an existing large Type B assisted living facility.

Proposed new §553.145 describes fire protection systems requirements for an existing large Type B assisted living facility.

Proposed new §553.146 describes hazardous area requirements for an existing large Type B assisted living facility.

Proposed new §553.147 describes mechanical requirements for an existing large Type B assisted living facility.

Proposed new §553.148 describes electrical requirements for an existing large Type B assisted living facility.

Proposed new §553.149 describes miscellaneous requirements for an existing large Type B assisted living facility.

Proposed new §553.210 describes general requirements for a new small Type A assisted living facility.

Proposed new §553.211 describes construction requirements for a new small Type A assisted living facility.

Proposed new §553.212 describes space planning and utilization requirements for a new small Type A assisted living facility.

Proposed new §553.213 describes means of escape requirements for a new small Type A assisted living facility.

Proposed new §553.215 describes fire protection systems requirements for a new small Type A assisted living facility.

Proposed new §553.216 describes Hazardous area requirements for a new small Type A assisted living facility.

Proposed new §553.217 describes mechanical requirements for a new small Type A assisted living facility.

Proposed new §553.218 describes electrical requirements for a new small Type A assisted living facility.

Proposed new §553.219 describes miscellaneous requirements for a new small Type A assisted living facility.

Proposed new §553.220 describes general requirements for a new small Type B assisted living facility.

Proposed new §553.221 describes construction requirements for a new small Type B assisted living facility.

Proposed new §553.222 describes space planning and utilization requirements for a new small Type B assisted living facility.

Proposed new §553.223 describes means of escape requirements for a new small Type B assisted living facility.

Proposed new §553.225 describes fire protection systems requirements for a new small Type B assisted living facility.

Proposed new §553.226 describes hazardous area requirements for a new small Type B assisted living facility.

Proposed new §553.227 describes mechanical requirements for a new small Type B assisted living facility.

Proposed new §553.228 describes electrical requirements for a new small Type B assisted living facility.

Proposed new §553.229 describes miscellaneous requirements for a new small Type B assisted living facility.

Proposed new §553.230 describes general requirements for a new large Type A assisted living facility.

Proposed new §553.231 describes construction requirements for a new large Type A assisted living facility.

Proposed new §553.232 describes space planning and utilization requirements for a new large Type A assisted living facility.

Proposed new §553.233 describes means of egress requirements for a new large Type A assisted living facility.

Proposed new §553.234 describes smoke compartmentation for a new large Type A assisted living facility.

Proposed new §553.235 describes fire protection systems requirements for a new large Type A assisted living facility.

Proposed new §553.236 describes hazardous area requirements for a new large Type A assisted living facility.

Proposed new §553.237 describes mechanical requirements for a new large Type A assisted living facility.

Proposed new §553.238 describes electrical requirements for a new large Type A assisted living facility.

Proposed new §553.239 describes miscellaneous requirements for a new large Type A assisted living facility.

Proposed new §553.240 describes general requirements for a new large Type B assisted living facility.

Proposed new §553.241 describes construction requirements for a new large Type B assisted living facility.

Proposed new §553.242 describes space planning and utilization requirements for a new large Type B assisted living facility.

Proposed new §553.243 describes means of egress requirements for a new large Type B assisted living facility.

Proposed new §553.244 describes smoke compartmentation for a new large Type B assisted living facility.

Proposed new §553.245 describes fire protection systems requirements for a new large Type B assisted living facility.

Proposed new §553.246 describes hazardous area requirements for a new large Type B assisted living facility.

Proposed new §553.247 describes mechanical requirements for a new large Type B assisted living facility.

Proposed new §553.248 describes electrical requirements for a new large Type B assisted living facility.

Proposed new §553.249 describes miscellaneous requirements for a new large Type B assisted living facility.

Proposed new §553.251 describes construction requirements for a certified Alzheimer's Disease assisted living facility

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rule will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new rules;

(6) the proposed rules will expand existing rules; and

(7) the proposed rules will not change the number of individuals subject to the rules.

HHSC has insufficient information to determine the proposed rules' effect on the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be an adverse economic effect on small businesses or micro-businesses, or rural communities.

Some existing facilities that have not previously been required to provide fire protection of their attic must now provide fire protection, which might include adding sprinklers to the attic. The cost for this is unknown but, depending on the size of the facility, the cost could be $10,000 or more. Smaller residential providers and many large Type A providers will need to meet these requirements, because large Type B facilities are already required to have sprinklers throughout.

The precise number of small businesses or micro-businesses subject to the rule is unknown. However, there are 792 small Type B facilities. All these facilities have sprinkler systems and are subject to the rule. There are 317 small Type A facilities and 150 large Type A facilities. Not all Type A facilities have sprinkler systems, but those that do are subject to the rule.

No alternative methods were considered as S.B. 1049 added §247.0273 to Texas Health and Safety Code, Chapter 247. Subsection (a) of §247.0273 says the executive commissioner shall specify an edition of the Life Safety Code of the National Fire Protection Association (NFPA) to be used in establishing the life safety requirements for an assisted living facility licensed under this chapter. Subsection (b) of §247.0273 says the rules adopted under Subsection (a) must specify an edition of the Life Safety Code of the NFPA issued on or after August 1, 2011. All editions of the Life Safety Code issued on or after August 1, 2011, contain the same attic fire protection requirements for existing assisted living facilities.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas, including residents of assisted living facilities, and the rules are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Rebekah Eaddy, Architectural Unit Manager, has determined that for each year of the first five years the rules are in effect, the public benefit will be protecting the health, safety, and welfare of the residents of Texas, including residents of assisted living facilities.

Trey Wood has also determined that for the first five years the rules are in effect, persons who are required to comply with the proposed rules may incur economic costs. The proposed rule requires additional facilities to provide fire protection in attics, which might include adding sprinklers. The estimated cost to person or provider is $10,000 or more. The proposed rule also allows existing facilities a three-year time period, after the effective adoption date of the rule, to install the required attic protection. HHSC does not have sufficient information to determine the costs to providers required to comply with the proposed rules.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to the Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4900 North Lamar Boulevard, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 18R038" in the subject line.

SUBCHAPTER D. FACILITY CONSTRUCTION

26 TAC §§553.61 - 553.64

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The repeals implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.61.Introduction and Application.

§553.62.General Requirements.

§553.63.Construction and Initial Survey of Completed Construction.

§553.64.Plans, Approvals, and Construction Procedures.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101363

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


SUBCHAPTER D. FACILITY CONSTRUCTION

DIVISION 1. GENERAL PROVISIONS

26 TAC §553.100, §553.101

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.100.General Requirements.

(a) A building or structure used as a licensed assisted living facility, whether new or existing, must comply with these standards.

(b) All assisted living facilities must comply with National Fire Protection Association Life Safety Code (NFPA 101) and any applicable Tentative Interim Amendment (TIA) issued by NFPA, except as otherwise stated in these standards.

(c) All assisted living facilities must comply with other chapters, sections, subsections, and paragraphs of NFPA 101, as they relate to: Chapter 18, New Health Care Occupancies; Chapter 19, Existing Health Care Occupancies; Chapter 32, New Residential Board and Care Occupancies; and Chapter 33, Existing Residential Board and Care Occupancies, including Chapter 1, Administration; Chapter 2, Referenced Publications; Chapter 3, Definitions; Chapter 4, General; Chapter 5, Performance-Based Option; Chapter 6, Classification of Occupancy and Hazard of Contents; Chapter 7, Means of Egress; Chapter 8, Features of Fire Protection; Chapter 9, Building Service and Fire Protection Equipment; Chapter 10, Interior Finish, Contents, and Furnishings; Chapter 11, Special Structures and High-Rise Buildings; and Chapter 43, Building Rehabilitation.

(d) An assisted living facility that wishes to be reclassified from a small facility to a large facility, from a Type A facility to a Type B facility, or both, must meet the requirements for a new facility of the type and size specified in this subchapter to be reclassified.

(e) The requirements of this subchapter apply to an assisted living facility as follows:

(1) All assisted living facilities must comply with Division 1 of this subchapter (relating to General Provisions) and Division 2 of this subchapter (relating to Provisions Applicable to All Facilities).

(2) An assisted living facility initially licensed before July 27, 2021, and continually operated under an assisted living license without interruption since then, is considered an existing assisted living facility and must comply with the following, as applicable:

(A) An existing small Type A assisted living facility must comply with Division 4 of this subchapter (relating to Existing Small Type A Assisted Living Facilities).

(B) An existing small Type B assisted living facility must comply with Division 5 of this subchapter (relating to Existing Small Type B Assisted Living Facilities).

(C) An existing large Type A assisted living facility must comply with Division 6 of this subchapter (relating to Existing Large Type A Assisted Living Facilities).

(D) An existing large Type B assisted living facility must comply with Division 7 of this subchapter (relating to Existing Large Type B Assisted Living Facilities).

(3) An assisted living facility initially licensed on or after July 27, 2021, or any new building or building addition to a currently licensed assisted living facility constructed on or after July 27, 2021, is considered a new assisted living facility and must comply with the following:

(A) A new small Type A assisted living facility must comply with Division 8 of this subchapter (relating to New Small Type A Assisted Living Facilities).

(B) A new small Type B assisted living facility must comply with Division 9 of this subchapter (relating to New Small Type B Assisted Living Facilities).

(C) A new large Type A assisted living facility must comply with Division 10 of this subchapter (relating to New Large Type A Assisted Living Facilities).

(D) A new large Type B assisted living facility must comply with Division 11 of this subchapter (relating to New Large Type B Assisted Living Facilities).

(f) An assisted living facility must comply with local codes and ordinances as follows:

(1) An assisted living facility located within the jurisdiction of a local organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure that adopts codes or ordinances governing building construction or fire safety (Authority Having Jurisdiction or AHJ) must comply with applicable local codes and ordinances adopted by the AHJ. The description of the occupancy may vary with local codes.

(2) An assisted living facility located where there is no local AHJ must propose a building code and a method of demonstrating compliance with this code that is acceptable to Texas Health and Human Services Commission (HHSC). An assisted living facility must submit a proposal in writing to and must receive approval from HHSC prior to construction start. The proposal must include the title and edition of the code and how the facility proposes to demonstrate compliance with the proposed code.

(3) An existing building, either occupied as an assisted living facility at the time of initial inspection by HHSC or converted to occupancy as an assisted living facility prior to the initial inspection by HHSC, must meet all local requirements pertaining to that building for that occupancy as administered by the local AHJ for the adopted code or ordinance.

(4) An assisted living facility must submit documentation from the local AHJ that local requirements are satisfied. For a Type B assisted living facility, this documentation must include an acknowledgement by the local AHJ that a resident of the facility might be incapable of self-preservation or be unable to evacuate the facility without physical assistance.

(g) When local laws, codes, or ordinances are more stringent than the standards for assisted living facilities set forth in this Subchapter D, an assisted living facility must comply with the more stringent requirements.

(h) An assisted living facility must ensure building rehabilitation on existing buildings is classified according to NFPA 101 and that any rehabilitation complies with NFPA 101 and §553.107 of this subchapter (relating to Building Rehabilitation).

(i) An assisted living facility must ensure buildings, or portions of buildings, are not occupied during construction, repair, alterations, or additions, except when required means of egress and required fire protection features are in place and continuously maintained for the portion occupied. Alternative life safety measures may be put in place if prior approval is obtained from HHSC.

(j) An assisted living facility must ensure no existing life safety feature is removed or reduced when the feature is a requirement for a new facility. Life safety features, and equipment not required by NFPA 101, that have been installed in existing buildings must continue to be maintained or be completely removed, if prior approval is obtained from HHSC.

(k) An assisted living facility must comply with the plan review and inspection requirements of the Texas Accessibility Standards (TAS) adopted by the Texas Department of Licensing and Regulation (TDLR) rules in Texas Administrative Code, Title 16, Chapter 68, and must provide documentation demonstrating it has registered the facility with TDLR and obtained a plan review from a Registered Accessibility Specialist.

(l) An assisted living facility must not segregate any area housing residents from other parts of the assisted living facility housing residents, except as permitted by §553.51 of this chapter (relating to Certification of a Facility or Unit for Persons with Alzheimer's Disease and Related Disorders).

§553.101.Definitions.

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. The definitions in §553.2 of this chapter (relating to Definitions) also apply to this subchapter.

(1) ASTM E84--Standard Test Method for Surface Burning Characteristics of Building Materials.

(2) Approved--Acceptable to the Texas Health and Human Services Commission.

(3) Authority having jurisdiction (AHJ)--An organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure.

(4) Auxiliary serving kitchen--An area that is not contiguous to a food preparation or serving area and that is for serving food but is not used for cooking or meal preparation.

(5) Bedroom usable floor space--The floor area of a resident bedroom that may be considered toward meeting minimum requirements for a resident bedroom floor area.

(6) Building rehabilitation--Any construction activity involving repair, modernization, reconfiguration, renovation, changes in occupancy or use, or installation of new fixed equipment, including:

(A) the replacement of finishes, such as new flooring or wall finishes or the painting of walls and ceilings;

(B) the construction, removal, or relocation of walls, partitions, floors, ceilings, doors, or windows;

(C) the replacement of doors, windows, or roofing;

(D) changes to the appearance of the exterior of a building, including new finish materials;

(E) the installation, repair, replacement, or extension of fire protection systems, including fire sprinkler systems, fire alarm system, and fire suppression systems, at cooking operations;

(F) the replacement of door hardware, plumbing fixtures, handrails in corridors, or grab rails in bathrooms and restrooms;

(G) the repair, replacement, or extension of required communication systems;

(H) the repair or replacement of emergency electrical system equipment and components, including generator sets, transfer switches, distribution panel boards, receptacles, switches, and light fixtures;

(I) the change of a wing or area to a Certified Alzheimer's Disease Assisted Living Facility or unit;

(J) the change of a Certified Alzheimer's Disease Assisted Living Facility or unit to ordinary resident-use;

(K) a change in the use of space, including the change of resident bedrooms to other uses, such as offices, storage, or living or dining spaces; and

(L) changes in locking arrangements, such as the installation of access control systems or the installation or removal of electronic locking devices, including electromagnetic locks, and other delayed-egress locking devices.

(7) Conversion--Change of occupancy from an existing residential or health care occupancy to a residential board and care occupancy, including an assisted living facility located in a building that had been used as a residence or a health care facility such as a hospital or a nursing home.

(8) Direct telephone--A telephone that automatically dials and connects to a fixed location when the caller takes the handset off-hook without requiring the caller to input a receiving telephone number. A direct telephone must ring at a location staffed 24-hours a day and may not be answered by an answering machine or voicemail system. A direct telephone may also function as a regular telephone when a receiving telephone number is entered.

(9) Factory Mutual (FM)--An organization that certifies products and services for compliance with loss prevention standards. Also known as FM Approvals.

(10) Flame spread index--The classification of the surface burning characteristics of an interior wall or ceiling finish based on the test results of ASTM E84, UL 723, or NFPA 255. Materials so classified have an index of Class A, Class B, or Class C.

(11) Living unit--A portion of a facility arranged as a separate unit providing one or more bedrooms, toilet and bathing facilities, and living or dining spaces, with or without facilities for cooking, exclusively for the use of the residents residing in the bedrooms.

(12) Neighborhood or household--A portion of a large facility arranged as a unit providing bedrooms, toilet and bathing facilities, resident living areas, and kitchen facilities serving up to 16 residents.

(13) NFPA--National Fire Protection Association.

(14) NFPA 10--Standard for Portable Fire Extinguishers, 2010 edition.

(15) NFPA 13--Standard for the Installation of Sprinkler Systems, 2010 edition.

(16) NFPA 13D--Standard for the Installation of Sprinkler Systems in One-and Two-Family Dwellings and Manufactured Homes, 2010 edition.

(17) NFPA 13R--Standard for the Installation of Sprinkler Systems in Residential Occupancies Up to and Including Four Stories in Height, 2010 edition.

(18) NFPA 25--Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2011 edition.

(19) NFPA 54--National Fuel Gas Code, 2012 edition.

(20) NFPA 55--Compressed Gases and Cryogenic Fluids Code, 2010 edition.

(21) NFPA 70--National Electrical Code, 2011 edition.

(22) NFPA 72--National Fire Alarm and Signaling Code, 2010 edition.

(23) NFPA 96--Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 2011 edition.

(24) NFPA 110--Standard for Emergency and Standby Power Systems, 2010 edition.

(25) NFPA 211--Standard for Chimneys, Fireplaces, Vents, and Solid Fuel-Burning Appliances, 2010 edition.

(26) NFPA 720--Standard for Installation of Carbon Monoxide (CO) Detection and Warning Equipment, 2012 edition.

(27) Special Waste from Health Care-Related Facilities--Special waste from health care-related facilities as defined in Texas Administrative Code, Title 25, Part 1, Chapter 1, Subchapter K (relating to Definition, Treatment, and Disposition of Special Waste from Health Care-Related Facilities).

(28) TCEQ--Texas Commission on Environmental Quality.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101364

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 2. PROVISIONS APPLICABLE TO ALL FACILITIES

26 TAC §553.103, §553.104

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.103.Site and Location for all Assisted Living Facilities.

(a) Firefighting unit. An assisted living facility must be served by a professional or volunteer firefighting unit and must have a water supply that meets the firefighting unit's requirements and approval.

(b) Correction of hazards. An assisted living facility must correct a site or building condition that HHSC staff identifies to be a fire, health, or physical hazard.

(c) Parking.

(1) An assisted living facility must provide or arrange for nearby parking spaces for the private vehicles of residents and visitors.

(2) An assisted living facility must provide a minimum of one parking space for every four residents in its licensed capacity, and for any fraction thereof, or per local requirements, whichever is more stringent.

(d) Ramps.

(1) An assisted living facility must ensure a ramp, walk, or step is of slip-resistive texture and is uniform, without irregularities.

(2) An assisted living facility must ensure a ramp does not exceed a slope of one foot in 12 feet.

(3) An assisted living facility must ensure any new ramp has a clear width of at least 36 inches.

(e) Site conditions. An assisted living facility must provide a guardrail, fence, or handrail where a grade makes an abrupt change in level.

(f) Outside grounds. An assisted living facility must ensure that each outside area, grounds, and any adjacent buildings are maintained in good condition and kept free of rubbish, garbage, and untended growth that may constitute a fire or health hazard.

(g) Drainage. An assisted living facility must ensure site grades provide for water drainage away from structures to prevent ponding or standing water at or near a building, unless the ponding or standing water is part of an engineered drainage system intended to hold water for a period of time.

§553.104.Safety Operations.

(a) Local fire marshal inspection.

(1) An assisted living facility must obtain an inspection by the local fire marshal on an annual basis and must correct any items cited by the local fire marshal.

(2) An assisted living facility must maintain documentation at the facility reflecting the outcome of the most recent annual inspection and correction of any cited items.

(b) Evacuation plan. An assisted living facility, other than a one-story small Type A or small Type B assisted living facility, must post an emergency evacuation floor plan in a location visible to residents.

(c) Fire safety plan. An assisted living facility must establish an evacuation plan for the protection of all persons in the facility in the event of fire.

(1) An assisted living facility must ensure the fire safety plan is in effect at all times.

(2) An assisted living facility must make written copies of the evacuation plan are available to all supervisory personnel.

(3) An assisted living facility must ensure the plan addresses:

(A) evacuation to an area of refuge;

(B) evacuation from the building when necessary; and

(C) special staff actions, including fire protection procedures necessary to ensure the safety of any resident.

(4) If the facility is a large Type B assisted living facility:

(A) An existing large Type B assisted living facility must ensure the plan includes the provisions described in 19.7.2, Procedure in Case of Fire, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(B) A new large Type B assisted living facility must ensure the plan includes the provisions described in 18.7.2, Procedure in Case of Fire, in NFPA 101, Chapter 18, New Health Care Occupancies.

(5) An assisted living facility must ensure the fire safety plan is reviewed at least annually and revised, as needed, to address the changing needs of residents.

(6) An assisted living facility must periodically instruct and inform all employees of their duties and responsibilities under the plan.

(7) An assisted living facility must keep a copy of the plan readily available at all times within the facility.

(8) An assisted living facility must ensure the plan reflects the current evacuation capabilities of the residents.

(d) Fire drills. An assisted living facility must conduct at least one quarterly fire drill on each shift with at least one drill each month. Each drill must meet these requirements:

(1) An assisted living facility must ensure staff take part in fire drills according to the assisted living facility's fire safety plan.

(2) An assisted living facility must inform residents of evacuation procedures and locations of exits.

(3) An assisted living facility must document every fire drill using the most current version of the required Texas Health and Human Services (HHSC) form titled "Fire Drill Report" available on the HHSC website.

(4) A large Type B assisted living facility must activate the fire alarm signal during a fire drill conducted between 6:00 a.m. and 9:00 p.m.

(5) An assisted living facility may announce a fire drill to residents in advance.

(e) Reporting fires.

(1) An assisted living facility must immediately report a fire causing injury or death to a resident.

(2) An assisted living facility must report a fire causing damage to the facility or facility equipment to HHSC within 72 hours after the fire is extinguished.

(3) After making a report by telephone or email, an assisted living facility must file a written report using the most current version of the required HHSC form titled "Fire Report for Long Term Care Facilities" available on the HHSC website.

(f) Smoking policies. An assisted living facility must establish and enforce policies regarding smoking, even if the policy is that smoking will not be permitted. The policy must also address the use of e-cigarettes and vaping devices. If smoking will be permitted, the smoking policies must:

(1) designate smoking areas for residents and staff; and

(2) provide ashtrays of noncombustible material and safe design in smoking areas.

(g) Fire alarm system. An assisted living facility must establish a program to inspect, test, and maintain the fire alarm system according to the requirements of NFPA 72, and according to the requirements of NFPA 720 where carbon monoxide detection is provided, and must execute the program at least once every six months.

(1) An assisted living facility must contract with a company that holds an Alarm Certificate of Registration from the State Fire Marshal's Office to execute the program.

(2) An assisted living facility must ensure a company that performs a service under the contract required under paragraph (1) of this subsection completes, signs, and dates an inspection form like the inspection and testing form in NFPA 72 for a service provided under the contract.

(3) If a task required by NFPA 72 or NFPA 720 must occur at intervals other than during the contracted visits in this subsection, an assisted living facility must ensure the task is performed and documented by a knowledgeable individual.

(4) An assisted living facility must ensure:

(A) a fire alarm system component that requires visual inspection is visually inspected in accordance with NFPA 72;

(B) a fire alarm system component that requires testing is tested in accordance with NFPA 72; and

(C) a fire alarm system component that requires maintenance is maintained in accordance with NFPA 72.

(5) An assisted living facility that provides carbon monoxide detection must ensure:

(A) a carbon monoxide detection component that requires visual inspection is visually inspected in accordance with NFPA 720;

(B) a carbon monoxide detection component that requires testing is tested in accordance with NFPA 720; and

(C) a carbon monoxide detection component that requires maintenance is maintained in accordance with NFPA 720.

(6) A large assisted living facility containing smoke compartments must ensure each required smoke damper is inspected and tested in accordance with NFPA 101.

(7) An assisted living facility must ensure smoke detector sensitivity is checked within one year after installation and every two years thereafter in accordance with test methods in NFPA 72.

(8) An assisted living facility must maintain onsite documentation of compliance with this subsection and must maintain record copies of documents regarding the installation of a fire alarm system, including as-built installation drawings, operation and maintenance manuals, the installation certificate for the system, and written sequences for its operation.

(9) An assisted living facility must make documentation described in paragraph (8) of this subsection available to HHSC on request.

(h) Fire sprinkler system. An assisted living facility that is equipped with a fire sprinkler system, including a fire sprinkler system meeting NFPA 13D, must establish a program to inspect, test, and maintain the fire sprinkler system according to the requirements of NFPA 25, and must execute the program at least once every six months.

(1) An assisted living facility must contract with a company that holds an appropriate Sprinkler Certificate of Registration from the State Fire Marshal's Office to execute the program.

(2) An assisted living facility must ensure a company that performs a service under the contract required under paragraph (1) of this subsection completes, signs, and dates an inspection form like the inspection and testing form in NFPA 25 for a service provided under the contract.

(3) If a task required by NFPA 25 must occur at intervals other than during the contracted visits in this subsection, an assisted living facility must ensure the task is performed and documented by knowledgeable individuals.

(4) An assisted living facility must ensure that a sprinkler system component that requires visual inspection is visually inspected in accordance with NFPA 25.

(5) An assisted living facility must ensure that a sprinkler system component that requires testing is tested in accordance with NFPA 25.

(6) An assisted living facility must ensure that a sprinkler system component that requires maintenance is maintained in accordance with NFPA 25.

(7) An assisted living facility must ensure that an individual sprinkler head is inspected and maintained in accordance with NFPA 25.

(8) An assisted living facility must maintain onsite documentation of compliance with this subsection and must maintain record copies of documents regarding the installation of a fire sprinkler system, including as-built installation drawings, hydraulic calculations, proof of adequate fire sprinkler water supply, and installation certificates for the system.

(9) An assisted living facility must make documentation described in paragraph (8) of this subsection available to HHSC on request.

(i) Portable fire extinguishers.

(1) An assisted living facility must ensure staff are appropriately trained in the use of each type of extinguisher in the facility.

(2) An assisted living facility must inspect and maintain portable fire extinguishers and:

(A) ensure that its staff perform regular monthly inspections or "quick checks" to ensure extinguishers are located in the designated place, extinguisher locations are not obstructed to access or visibility, and the pressure gauge reading or indicator on the extinguisher is in the operable range or position;

(B) ensure annual maintenance and inspection or "thorough checks" are performed according to NFPA 10 by an individual employed by a company holding an appropriate Extinguisher Certificate of Registration from the State Fire Marshal's Office to perform inspection, testing, and maintenance of portable fire extinguishers;

(C) maintain onsite, a record of all fire extinguisher inspections and maintenance performed; and

(D) replace unserviceable fire extinguishers.

(j) General facility condition and safety features.

(1) An assisted living facility must ensure staff utilize procedures to avoid cross-contamination between clean and soiled processes, including the handling of linens and cooking utensils.

(2) An assisted living facility must keep all buildings in good repair.

(A) An assisted living facility must maintain electrical, heating, and cooling systems so these systems operate in a safe manner. HHSC may require the facility to submit evidence to this effect, consisting of a report from the fire marshal, the city or county building official having jurisdiction over the location of the facility, a licensed electrician, or a registered professional engineer.

(B) An assisted living facility must ensure electrical appliances, devices, and lamps do not overload circuits or use extension cords of excessive length.

(3) An assisted living facility must keep all buildings free of accumulations of dirt, rubbish, dust, and hazards.

(4) An assisted living facility must maintain floors in good condition and clean floors regularly.

(5) An assisted living facility must structurally maintain walls and ceilings and must repair, repaint, or clean walls and ceilings whenever needed.

(6) An assisted living facility must keep storage areas and cellars organized and free from obstructions.

(7) An assisted living facility must not store any items in attic spaces.

(8) An assisted living facility must ensure all equipment requiring periodic maintenance, testing, and servicing is accessible.

(A) An assisted living facility must ensure equipment that is necessary to conduct maintenance, testing, and services, including ladders, specific tools, and keys, is readily available to staff or maintenance personnel on site.

(B) An assisted living facility must provide access panels, at least 20 inches wide by 20 inches long, for building maintenance and must ensure access panels are located for reasonable access to equipment and fire or smoke barrier walls installed in the attic or other concealed spaces.

(k) Waste and storage containers.

(1) An assisted living facility must provide metal waste baskets of substantial gauge or any UL- or FM-approved container in each area where smoking is permitted, if applicable, in accordance with the facility's smoking policies required in subsection (f) of this section.

(2) An assisted living facility must provide one or more garbage, waste, or trash containers made of metal or of any UL- or FM-approved material for use in kitchens, janitor closets, laundry rooms, mechanical or boiler rooms, general storage rooms, and similar places. The facility must use containers with close fitting covers. A facility may use disposable plastic liners in the containers for sanitation.

(3) An assisted living facility must ensure waste, including waste classified as Special Waste from Health Care-Related Facilities, trash, and garbage are disposed of from the premises at regular intervals according to state and local requirements. The facility may not permit or allow an accumulation of waste on the facility premises, either inside or outside of facility buildings.

(l) Pest control.

(1) An assisted living facility must have an ongoing and effective pest control program executed by facility staff or by contract with a licensed pest control company.

(2) An assisted living facility must ensure the chemicals used to control pests are the least toxic and least flammable chemicals that are effective.

(3) An assisted living facility must ensure each operable window is provided with an insect screen.

(m) Flammable or combustible liquids. An assisted living facility must not store flammable or combustible liquids, such as gasoline, oil-based paint, charcoal lighter fluid, or similar products in a building that houses residents.

(n) Storage of oxygen. An assisted living facility must ensure sanitary use and storage of oxygen for the safety of all residents.

(1) An assisted living facility must ensure oxygen cylinders in the possession and under the control of the facility are:

(A) identified by attached labels or stencils naming the contents;

(B) not stored with flammable or combustible materials;

(C) protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

(D) protected from tamper by unauthorized individuals;

(E) if not supported in a proper cart or stand, properly chained or supported;

(F) stored so the cylinders can be used in the order received from the supplier;

(G) if empty and full cylinders are stored in the same enclosure or room, stored so that empty cylinders are separated from full cylinders; and

(H) if empty, marked to avoid confusion and delay if a full cylinder is needed in a rapid manner.

(2) An assisted living facility must adopt, implement, and enforce procedures for resident use, storage, and handling of oxygen cylinders and liquid oxygen containers in the possession and under the control of residents, to ensure the safety of all residents.

(o) Gas pressure test.

(1) An assisted living facility must obtain an initial pressure test of facility gas lines from the gas meter or propane storage tank to all gas-fired appliances and equipment.

(2) An assisted living facility must obtain an additional gas pressure test when the facility performs major renovations or additions to the gas piping or gas-fired equipment that interrupt gas service or replace gas-fired equipment.

(p) Annual gas heating check.

(1) An assisted living facility must ensure all gas heating systems are checked at least once per year, prior to the heating season for proper operation and safety by persons who are licensed or approved by the State of Texas to inspect the equipment.

(2) An assisted living facility must maintain records of the testing of the gas heating system.

(3) An assisted living facility must correct unsatisfactory conditions.

(q) Emergency generator. A large assisted living facility that uses an emergency generator to provide power to emergency lighting systems must ensure the generator is tested and maintained according to Chapter 8, Routine Maintenance and Operational Testing, in NFPA 110. Routine maintenance and operational testing required by NFPA 110 includes the following procedures:

(1) a readily available record of inspections, test, exercising, operation, and repairs;

(2) monthly testing of cranking batteries;

(3) weekly inspection of the generator set and other components that make up the emergency power system;

(4) monthly exercise of the generator under load;

(5) monthly test of transfer switches; and

(6) a continuous operational test for at least 1-1/2 hours every three years.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101365

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 3. BUILDING REHABILITATION

26 TAC §553.107

STATUTORY AUTHORITY

The new section is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new section implements Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.107.Building Rehabilitation.

(a) Prior to the start of building rehabilitation, other than that classified as repair in subsection (b) of this section, a facility must notify the Texas Health and Human Services commission (HHSC) in Austin, Texas, in writing.

(b) Upon completion of building rehabilitation, other than that classified as repair or renovation in this section, a final construction inspection of the facility must be performed by HHSC prior to occupancy. The completed construction must have the written approval of the local authority having jurisdiction, including the fire marshal and building official. When construction or building rehabilitation does not alter the licensed capacity of a facility, based on submitted documentation and the scope of the performed building rehabilitation, HHSC may permit a facility to use the rehabilitated portion of a facility pending a final construction inspection or may determine a final construction inspection is not required.

(c) An assisted living facility undergoing any building rehabilitation must meet the requirements of this section.

(1) An assisted living facility must ensure the patching, restoration, or painting of materials, elements, equipment, or fixtures for maintaining such materials, elements, equipment, or fixtures in good or sound condition is classified as repair and must ensure the repair:

(A) meets the applicable requirements of §553.100(e) of this subchapter (relating to General Requirements);

(B) uses like materials, unless such materials are prohibited by NFPA 101, as modified by this subchapter; and

(C) does not make a building less conforming with NFPA 101, as modified by this subchapter, with the applicable sections of this subchapter, or with any alternative arrangements previously approved by HHSC, than it was before the repair was undertaken.

(2) An assisted living facility must ensure the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures that does not result in a reconfiguration of the building spaces within is classified as renovation and must ensure:

(A) any new work that is part of a renovation meets the applicable requirements of §553.100(e) of this subchapter;

(B) any new interior or exterior finishes meet the applicable requirements of §553.100(e)(3) of this subchapter; and

(C) does not make a building less conforming with NFPA 101, as modified by this subchapter, with the applicable sections of this subchapter, or with any alternative arrangements previously approved by HHSC, than it was before the renovation was undertaken.

(3) An assisted living facility must ensure the reconfiguration of any space; addition, relocation, or elimination of any door or window; addition or elimination of load-bearing elements; reconfiguration or extension of any system; or installation of any additional equipment, is classified as modification and must ensure:

(A) a newly constructed element, component, or system meets the applicable requirements of §553.100(e)(3) of this subchapter;

(B) all other work in a modification meets, at a minimum, the requirements for a renovation according to paragraph (2) of this subsection; and

(C) where the total rehabilitation work area classified as modification exceeds 50 percent of the total building area, the work is classified as reconstruction subject to paragraph (4) of this subsection.

(4) An assisted living facility must ensure the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress or fire protection systems are not in place or continuously maintained, is classified as reconstruction and must ensure:

(A) reconstruction of components of the means of egress meets the applicable requirements of §553.100(e) of this subchapter, except for the following components, which must meet the specific requirements of §553.100(e)(3) of this subchapter:

(i) illumination of means of egress;

(ii) emergency lighting of means of egress; and

(iii) marking of means of egress, including exit signs;

(B) if the total rehabilitation work area classified as reconstruction on any one floor exceeds 50 percent of the total area of the floor, all means of egress components identified in paragraph (4)(A)(i) - (iii) of this subsection and located on that floor meet the specific requirements of §553.100(e)(3) of this subchapter;

(C) if the total rehabilitation work area classified as reconstruction exceeds 50 percent of the total building area, all means of egress components identified in paragraph (4)(A)(i) - (iii) of this subsection and located in the building meet the specific requirements of §553.100(e)(3) of this subchapter; and

(D) all other work classified as reconstruction meets, at a minimum, the requirements for modification according to paragraph (3) of this subsection and renovation according to paragraph (2) of this subsection.

(5) An assisted living facility must ensure a change in the purpose or level of activity within a facility that involves a change in application of the requirements of this subchapter is classified as a change of use and meets the specific requirements of §553.100(e)(3) of this subchapter.

(6) An assisted living facility must ensure a change in the use of a structure or portion of a structure is classified as a change of occupancy and meets the specific requirements of §553.100(e)(3) of this subchapter.

(7) An assisted living facility must ensure an increase in the building area, aggregate floor area, building height, or number of stories of a structure is classified as an addition and meets the specific requirements of §553.100(e)(3) of this subchapter.

(d) An assisted living facility undergoing rehabilitation must comply with the requirements of NFPA 101, as modified by this subchapter in accordance with the requirements of NFPA 101, Chapter 43, Building Rehabilitation.

(e) An assisted living facility undergoing rehabilitation to an occupied building that involves means of escape, exit-ways, or exit doors must be accomplished without compromising the means of escape, means of egress, or exits or creating a dead-end situation at any time. HHSC may approve temporary exits or the facility must relocate residents until construction blocking the exit is completed. The facility must maintain other basic safety features including fire alarm systems, fire sprinkler systems, and emergency power at all times during construction.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101366

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 4. EXISTING SMALL TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.110 - 553.113. 553.115 - 553.119

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.110.General Requirements for an Existing Small Type A Assisted Living Facility.

An existing small Type A assisted living facility must comply with the requirements for a slow evacuation capability facility in 33.2, Small Facilities, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, where referenced by this division.

§553.111.Construction Requirements for an Existing Small Type A Assisted Living Facility.

(a) Structurally sound. An existing small Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads in accordance with applicable building codes.

(b) Separation of occupancies. An existing small Type A assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraph (2) of this subsection.

(1) An existing small Type A assisted living facility must be separated from other assisted living facilities, hospitals, or nursing facilities. After July 27, 2021, an existing small Type A assisted living facility must be separated from any new occupancy or new use subject to the Texas Health and Human Services commission (HHSC) licensing.

(2) An existing small Type A assisted living facility is not required to be separated from another occupancy not subject to HHSC licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of escape, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing small Type A assisted living facility.

(B) HHSC must be given unrestricted and unannounced access at any reasonable time to inspect the other occupancy type for compliance with the NFPA 101 requirements for an existing small Type A assisted living facility.

(c) Sheathing.

(1) Except as provided in paragraph (3) of this subsection, an existing small Type A assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating and ensure:

(A) interior wall and ceiling surfaces have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes; and

(B) columns, beams, girders, or trusses that are not enclosed within walls or ceilings are encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 19.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 19, Existing Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. An existing small Type A assisted living facility must ensure interior wall and ceiling finish materials meet the requirements of 33.2.3.3.2, Interior Wall and Ceiling Finish, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) Vertical openings. An existing small Type A assisted living facility must ensure vertical openings are protected according to the requirements of 33.2.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§553.112.Space Planning and Utilization Requirements for an Existing Small Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing small Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) An existing small Type A assisted living facility must ensure bedroom-usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC.

(3) An existing small Type A assisted living facility containing individual living units that include living space for the residents in addition to their bedrooms may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing small Type A assisted living facility may not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(5) of this section.

(4) An existing small Type A assisted living facility may house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing small Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by all residents occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by subsection (a)(2) of this section.

(4) An existing bedroom window not meeting these requirements may be continued in service subject to approval by HHSC.

(5) An existing small Type A assisted living facility that is not equipped with a fire sprinkler system meeting the requirements of §553.115 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility) must provide at least one window in each bedroom in the facility that, in addition to meeting the requirements of paragraphs (1) - (4) of this subsection, meets the following requirements:

(A) The bedroom window must meet the requirements of §553.113 of this division (relating to Means of Escape Requirements for an Existing Small Type A Assisted Living Facility) for use as a secondary means of escape from a resident sleeping room.

(B) The bedroom window must not be blocked by bars, shrubs, or any obstacle that could impede evacuation.

(C) The bedroom window must provide an operable section with a clear opening of not less than 5.7 square feet with a minimum width of 20 inches and a minimum height of 24 inches, subject to the following conditions:

(i) if the window meets only the minimum width of 20 inches, it must be at least 41.2 inches high; or

(ii) if the window meets only the minimum height of 24 inches, it must be at least 34.2 inches wide.

(6) An existing small Type A assisted living facility that is protected by an automatic sprinkler system meeting the requirements of §553.115 of this division must provide an operable window in a bedroom. The window opening size may be smaller than the minimum size listed in paragraph (5) of this subsection but must be operable according to the requirements of subsection (b)(2) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, an existing small Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing small Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing small Type A assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing small Type A assisted living facility must provide a staff area on each floor of an existing small Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) An existing small Type A assisted living facility that is not more than two-stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) An existing small Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.115 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing small Type A assisted living facility must ensure each resident bedroom is served by a separate, private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing small Type A assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) An existing small Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing small Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.117 of this division (relating to Mechanical Requirements for an Existing Small Type A Assisted Living Facility).

(g) Resident living areas.

(1) An existing small Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) An existing small Type A assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) An existing small Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) An existing small Type A assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(2) An existing small Type A assisted living facility must provide a dining area with appropriate furniture.

(A) An existing small Type A assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) An existing small Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) An existing small Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) An existing small Type A assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(3) An existing small Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) An existing small Type A assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.

(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing small Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) An existing small Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. An existing small Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

(1) An existing small Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) An existing small Type A assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:

(A) is equipped to store, refrigerate, prepare, and serve food;

(B) is equipped to clean and sterilize;

(C) provides for refuse storage and removal; and

(D) meets the requirements of the local fire, building, and health codes.

(3) An existing small Type A assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations as required in §553.116 of this division (relating to Hazardous Area Requirements for an Existing Small Type A Assisted Living Facility).

§553.113.Means of Escape Requirements for an Existing Small Type A Assisted Living Facility.

(a) The provisions of NFPA 101, Chapter 7, Means of Egress, do not apply to an existing small Type A assisted living facility unless explicitly referenced by this section or by NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing small Type A assisted living facility must meet the requirements of 33.2.2, Means of Escape, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, except as described in this section.

(c) An existing small Type A assisted living facility must ensure doors meet the requirements of 33.2.2.5, Doors, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, and the additional requirements of this section.

(1) A resident room door in an existing small Type A assisted living facility not protected throughout by an approved automatic fire sprinkler system complying with the requirements of §553.115 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility) must meet one of the following options. A resident room door is not otherwise required to meet the requirements for doors in 33.2.3.6, Construction of Corridor Walls, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(A) The door must be a solid core wood door at least 1-3/4 inches thick or have a 20-minute opening protection rating and must latch in its frame to resist the passage of smoke; or

(B) The door must be self-closing or automatic-closing and must latch in its frame to resist the passage of smoke.

(2) A resident room door in an existing small Type A assisted living facility protected throughout by an approved automatic fire sprinkler system complying with the requirements of §553.115 of this division must latch in its frame to resist the passage of smoke.

(3) In an existing small Type A assisted living facility comprised of buildings that contain living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(4) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) An existing small Type A assisted living facility providing a bedroom window used as a secondary means of escape must ensure the window meets the requirements for a bedroom window used as a secondary means of escape in §553.112 of this division (relating to Space Planning and Utilization Requirements for an Existing Small Type A Assisted Living Facility).

(e) An existing small Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs.

(1) An existing stair may be continued in service, subject to approval by HHSC.

(2) A stair used as means of escape must meet the requirements of 33.2.2.6, Stairs, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(3) Each stair must be arranged and located so that it is not necessary to go through another room, including a bedroom or bathroom, to reach the stair.

(4) Each stair must be provided with handrails.

(5) Each stair must be provided with normal lighting according to the requirements of §553.118 of this division (relating to Electrical Requirements for an Existing Small Type A Assisted Living Facility).

(6) A stair in an existing building that became an assisted living through conversion must meet the dimensional criteria for existing stairs in 7.2.2.2, Dimensional Criteria, in NFPA 101, Chapter 7, Means of Egress.

(7) An existing stair, previously approved by HHSC, may be rebuilt to the same dimensions but must meet all other requirements for stairs in NFPA 101.

§553.115.Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing small Type A assisted living facility must provide a manual fire alarm system meeting the requirements of section 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. An existing small Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing small Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) An existing small Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) An existing small Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, in lieu of the requirements in subparagraph (A) of this paragraph.

(3) Carbon monoxide detectors.

(A) An existing small Type A assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720, not later than July 27, 2021, where:

(i) the facility has a communicating attached garage; or

(ii) the facility contains a fuel-burning appliance or fuel-burning fireplace.

(B) An existing small Type A assisted living facility must install carbon monoxide detectors in the following locations required by subparagraph (A) of this paragraph:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within sleeping rooms containing fuel-burning appliance or fuel-burning fireplaces;

(iii) on every occupiable level, including basements and excluding attic and crawl spaces; and

(iv) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(C) Existing carbon monoxide detection equipment not meeting the requirements of this paragraph may be continued in service subject to approval by HHSC.

(4) Alarm control panel.

(A) An existing small Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing small Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(5) Fire alarm power source.

(A) An existing small Type A assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) An existing small Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(b) Fire sprinkler system.

(1) An existing small Type A assisted living facility may provide one of the following fire sprinkler systems according to the requirements of 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(A) A fire sprinkler system meeting the requirements of NFPA 13 in accordance with 33.2.3.5.3.3;

(B) A fire sprinkler system meeting the requirements of NFPA 13R in accordance with 33.2.3.5.3.4; or

(C) A fire sprinkler system meeting the requirements of NFPA 13D in accordance with 33.2.3.5.3.2.

(2) An existing small Type A assisted living facility must provide supervision of any fire sprinkler system where required by 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(c) Protection of attics. An existing small Type A assisted living facility equipped with a fire sprinkler system must ensure an attic is protected according to the requirements of 33.2.3.5.7, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, not later than July 27, 2021.

(d) Portable fire extinguishers. An existing small Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing small Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing small Type A assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing small Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(4) An existing small Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing small Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing small Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.116.Hazardous Area Requirements for an Existing Small Type A Assisted Living Facility.

(a) An existing small Type A assisted living facility must ensure any space where storage or an activity produces a greater potential for a fully involved fire than that found in a one- or two-family dwelling is protected according to the requirements of 33.2.3.2, Hazardous Areas, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing small Type A assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) An existing small Type A assisted living facility using commercial cooking equipment must protect the cooking operation according to the requirements of NFPA 96.

§553.117.Mechanical Requirements for an Existing Small Type A Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. An existing small Type A assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. An existing small Type A assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) An existing small Type A assisted living facility must provide at least one water closet and one lavatory for every six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) An existing small Type A assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) An existing small Type A assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) An existing small Type A assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, an existing small Type A assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) An existing small Type A assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. An existing small Type A assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. An existing small Type A assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Gas. An existing small Type A assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(d) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. An existing small Type A assisted living facility must ensure HVAC equipment meets the requirements of 33.2.5.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) Heating and cooling. An existing small Type A assisted living facility must provide heating and cooling for resident comfort.

(A) An existing small Type A assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) An existing small Type A assisted living facility constructed or licensed after August 1, 2004, must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain the temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) An existing small Type A assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) An existing small Type A assisted living facility must ensure a fuel burning heating device:

(i) not meeting the requirements of clauses (ii) - (v) of this subparagraph may be continued in service, subject to approval by HHSC;

(ii) must be connected to a chimney or vent;

(iii) must take air for combustion directly from outside;

(iv) must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(v) must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) An existing small Type A assisted living facility must ensure a working fireplace:

(i) not meeting the requirements of clauses (ii) - (vi) of this subparagraph may be continued in service, subject to approval by HHSC;

(ii) in a building containing a working fireplace is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers;

(iii) new installation is maintained and used according to NFPA 54 and NFPA 211;

(iv) the room where a working fireplace is located is provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720;

(v) a direct-vent gas fireplace, as defined in NFPA 54, meets the following requirements:

(I) not in a resident sleeping room;

(II) includes a sealed glass front with a wire mesh panel or screen; and

(III) the controls are locked or located in a restricted location;

(vi) a fireplace that burns solid fuels is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) An existing small Type A assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) An existing small Type A assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust.

(A) An existing small Type A assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control, unless otherwise permitted under subparagraph (B) of this paragraph.

(B) An existing small Type A assisted living facility may provide exhaust into an attic where permitted by the local building code.

§553.118.Electrical Requirements for an Existing Small Type A Assisted Living Facility.

(a) Electrical system. An existing small Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing small Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room;

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space as measured at 30 inches above the floor anywhere in the room; and

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. An existing small Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing small Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system, or intercom;

(B) if it is an existing communication system, be approved by HHSC to be continued in service;

(C) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) An existing small Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing small Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

§553.119.Miscellaneous Requirements for an Existing Small Type A Assisted Living Facility.

An existing small Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101367

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 5. EXISTING SMALL TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.120 - 553.123, 553.125 - 443.129

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.120.General Requirements for an Existing Small Type B Assisted Living Facility.

An existing small Type B assisted living facility must comply with the requirements for an impractical evacuation capability facility in 33.2, Small Facilities, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, where referenced by this division.

§553.121.Construction Requirements for an Existing Small Type B Assisted Living Facility.

(a) Structurally sound. An existing small Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads in accordance with applicable building codes.

(b) Separation of occupancies. An existing small Type B assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraph (2) of this subsection.

(1) An existing small Type B assisted living facility must be separated from other assisted living facilities, hospitals, or nursing facilities. After July 27, 2021, an existing small Type A assisted living facility must be separated from any new occupancy or new use subject to HHSC licensing.

(2) An existing small Type B assisted living facility is not required to be separated from another occupancy not subject to Texas Health and Human Services Commission (HHSC) licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of escape, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing small Type B assisted living facility.

(B) HHSC must be given unrestricted and unannounced access at any reasonable time to inspect the other occupancy type for compliance with the NFPA 101 requirements for an existing small Type B assisted living facility.

(c) Sheathing.

(1) Except as provided in paragraph (3) of this subsection, an existing small Type B assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 19.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 19, Existing Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. An existing small Type B assisted living facility must ensure interior wall and ceiling finish materials meet the requirements of 33.2.3.3.2, Interior Wall and Ceiling Finish, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) Vertical openings. An existing small Type B assisted living facility must ensure vertical openings are protected according to the requirements of 33.2.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§553.122.Space Planning and Utilization Requirements for an Existing Small Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing small Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) An existing small Type B assisted living facility must ensure bedroom-usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by the Texas Health and Human Services Commission (HHSC).

(3) An existing small Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing small Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(5) of this section.

(4) An existing small Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing small Type B assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by all residents occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by paragraph (a)(2) of this section.

(4) An existing bedroom window not meeting these requirements may be continued in service subject to approval by HHSC.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, an existing small Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing small Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing small Type B assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing small Type B assisted living facility must provide a staff area on each floor of an existing small Type B assisted living facility and in each separate building containing resident sleeping rooms. An existing small Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.125 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing small Type B assisted living facility must ensure each resident bedroom is served by a separate, private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing small Type B assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) An existing small Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing small Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.127 of this division (relating to Mechanical Requirements for an Existing Small Type B Assisted Living Facility).

(g) Resident living areas.

(1) An existing small Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) An existing small Type B assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) An existing small Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) An existing small Type B assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(2) An existing small Type B assisted living facility must provide a dining area with appropriate furniture.

(A) An existing small Type B assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) An existing small Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) An existing small Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) An existing small Type B assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(3) An existing small Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) An existing small Type B assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.

(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing small Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) An existing small Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. An existing small Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

(1) An existing small Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) An existing small Type B assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:

(A) is equipped to store, refrigerate, prepare, and serve food;

(B) is equipped to clean and sterilize;

(C) provides for refuse storage and removal; and

(D) meets the requirements of the local fire, building, and health codes.

(3) An existing small Type B assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations as required in §553.126 of this division (relating to Hazardous Area Requirements for an Existing Small Type B Assisted Living Facility).

§553.123.Means of Escape Requirements for an Existing Small Type B Assisted Living Facility.

(a) The provisions of NFPA 101, Chapter 7, Means of Egress, do not apply to an existing small Type B assisted living facility, unless explicitly referenced by this section or by NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing small Type B assisted living facility must meet the requirements of 33.2.2, Means of Escape, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, except as described in this section.

(c) An existing small Type B assisted living facility must ensure doors meet the requirements of 33.2.2.5, Doors, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, and the additional requirements of this section. A resident room door is not otherwise required to meet the requirements for doors in 33.2.3.6, Construction of Corridor Walls, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(1) A resident room door in an existing small Type B assisted living facility must latch in its frame to resist the passage of smoke.

(2) In an existing small Type B assisted living facility comprised of buildings that contain living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) An existing small Type B assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs.

(1) An existing stair may be continued in service, subject to approval by HHSC.

(2) A stair used as means of escape must meet the requirements of 33.2.2.6, Stairs, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(3) Each stair must be arranged and located so that it is not necessary to go through another room, including a bedroom or bathroom, to reach the stair.

(4) Each stair must be provided with handrails.

(5) Each stair must be provided with normal lighting according to the requirements of §553.128 of this division (relating to Electrical Requirements for an Existing Small Type B Assisted Living Facility).

(6) A stair in an existing building that became an assisted living through conversion must meet the dimensional criteria for existing stairs in 7.2.2.2, Dimensional Criteria, in NFPA 101, Chapter 7, Means of Egress.

(7) An existing stair, previously approved by HHSC, may be rebuilt to the same dimensions but must meet all other requirements for stairs in NFPA 101.

§553.125.Fire Protection Systems Requirements for an Existing Small Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing small Type B assisted living facility must provide a manual fire alarm system meeting the requirements of section 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. An existing small Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing small Type B assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) An existing small Type B assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) An existing small Type B assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, in lieu of the requirements in subparagraph (A) of this paragraph.

(3) Carbon monoxide detectors.

(A) An existing small Type B assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720, not later than July 27, 2021, where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) An existing small Type B assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph in the following locations:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within sleeping rooms containing fuel-burning appliance or fuel-burning fireplaces;

(iii) on every occupiable level, including basements and excluding attic and crawl spaces; and

(iv) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(C) Existing carbon monoxide detection equipment not meeting the requirements of this paragraph may be continued in service subject to approval by the Texas Health and Human Services Commission.

(4) Alarm control panel.

(A) An existing small Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing small Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(5) Fire alarm power source.

(A) An existing small Type B assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) An existing small Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(b) Fire sprinkler system.

(1) An existing small Type B assisted living facility must provide one of the following fire sprinkler systems according to the requirements of 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(A) A fire sprinkler system meeting the requirements of NFPA 13 in accordance with 33.2.3.5.3.3;

(B) A fire sprinkler system meeting the requirements of NFPA 13R in accordance with 33.2.3.5.3.4; or

(C) A fire sprinkler system meeting the requirements of NFPA 13D in accordance with 33.2.3.5.3.2.

(2) An existing small Type B assisted living facility must ensure a fire sprinkler system is supervised according to 9.7.2, Supervision, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(c) Protection of attics. An existing small Type B assisted living facility equipped with a fire sprinkler system must ensure an attic is protected according to the requirements of 33.2.3.5.7, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, not later than July 27, 2021.

(d) Portable fire extinguishers. An existing small Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing small Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing small Type B assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing small Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10; or

(B) Other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(4) An existing small Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing small Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing small Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.126.Hazardous Area Requirements for an Existing Small Type B Assisted Living Facility.

(a) An existing small Type B assisted living facility must ensure any space where storage or activity produces a greater potential for a fully involved fire than that found in a one- or two-family dwelling is protected according to the requirements of 33.2.3.2, Hazardous Areas, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing small Type B assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) An existing small Type B assisted living facility using commercial cooking equipment must protect the cooking operation according to the requirements of NFPA 96.

§553.127.Mechanical Requirements for an Existing Small Type B Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. An existing small Type B assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. An existing small Type B assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) An existing small Type B assisted living facility must provide at least one water closet and one lavatory for each six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) An existing small Type B assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) An existing small Type B assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) An existing small Type B assisted living facility must provide one tub or shower for every 10 residents, or for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, an existing small Type B assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) An existing small Type B assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. An existing small Type B assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. An existing small Type B assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Gas. An existing small Type B assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(d) Heating ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. An existing small Type A assisted living facility must ensure HVAC equipment meets the requirements of 33.2.5.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) Heating and cooling. An existing small Type B assisted living facility must provide heating and cooling for resident comfort.

(A) An existing small Type B assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort ranges of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) An existing small Type B assisted living facility constructed or licensed after August 1, 2004, must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) An existing small Type B assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) An existing small Type B assisted living facility must ensure a fuel burning heating device:

(i) not meeting the requirements of clauses (ii) - (v) of this subparagraph may be continued in service, subject to approval by the Texas Health and Human Services Commission (HHSC);

(ii) must be connected to a chimney or vent;

(iii) must take air for combustion directly from outside;

(iv) must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(v) must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) An existing small Type B assisted living facility must ensure a working fireplace:

(i) not meeting the requirements of clauses (ii) - (vi) of this subparagraph, is approved by HHSC;

(ii) is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers;

(iii) is installed, maintained, and used according to NFPA 54 and NFPA 211;

(iv) is provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720;

(v) may provide a direct-vent gas fireplace, as defined in NFPA 54, provided:

(I) it is not in a resident sleeping room;

(II) it has a sealed glass front with a wire mesh panel or screen; and

(III) the controls are locked or located in a restricted location;

(vi) that burns solid fuels is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) An existing small Type B assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) An existing small Type B assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust.

(A) An existing small Type B assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control, unless otherwise permitted under subparagraph (B) of this paragraph.

(B) An existing small Type B assisted living facility may provide exhaust into an attic where permitted by the local building code.

§553.128.Electrical Requirements for an Existing Small Type B Assisted Living Facility.

(a) Electrical system. An existing small Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing small Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room;

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room; and

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. An existing small Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing small Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system or intercom;

(B) if it is an existing communication system, be approved by the Texas Health and Human Services Commission to be continued in service;

(C) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) An existing small Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing small Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

§553.129.Miscellaneous Requirements for an Existing Small Type B Assisted Living Facility.

An existing small Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101368

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 6. EXISTING LARGE TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.130 - 553.139

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.130.General Requirements for an Existing Large Type A Assisted Living Facility.

(a) An existing large Type A assisted living facility must comply with the requirements for a slow evacuation capability facility in 33.3, Large Facilities, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, where referenced by this division, except as permitted by subsection (b) of this section.

(b) An existing large Type A assisted living facility campus comprised of multiple buildings providing sleeping rooms for no more than 16 residents in any one building may comply with other provision in NFPA 101, as follows.

(1) Each individual building providing sleeping rooms on the campus may comply with the requirements for a slow evacuation capability facility in 33.2, Small Facilities, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) Other buildings on the campus that are part of the existing large Type A assisted living facility may be permitted to comply with the requirements for other occupancies in NFPA 101, subject to approval by the Texas Health and Human Services Commission (HHSC).

(3) The provisions of this subsection do not apply where any building provides sleeping rooms for more than 16 residents.

§553.131.Construction Requirements for an Existing Large Type A Assisted Living Facility.

(a) Structurally sound. An existing large Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads in accordance with applicable building codes.

(b) Separation of occupancies. An existing large Type A assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraphs (1) or (2) of this subsection.

(1) An existing large Type A assisted living facility must be separated from other assisted living facilities, hospitals or nursing facilities. After July 27, 2021, an existing large Type A assisted living facility must be separated from any new occupancy or new use subject to HHSC licensing.

(2) An existing large Type A assisted living facility is not required to be separated from another occupancy not subject to HHSC licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of egress, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing large Type A assisted living facility.

(B) HHSC must be given unrestricted and unannounced access at any reasonable time to inspect the other occupancy type for compliance with the NFPA 101 requirements for an existing large Type A assisted living facility.

(c) Sheathing.

(1) Except as provided in paragraph (3) of this subsection, an existing large Type A assisted living facility must ensure all buildings used by residents are sheathed with materials providing the following fire resistance ratings.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for this minimum sheathing requirement under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 19.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 19, Existing Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. An existing large Type A assisted living facility must ensure interior wall and ceiling finish materials meet the requirements of 33.3.3.3.2, Interior Wall and Ceiling Finish, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) Vertical openings. An existing large Type A assisted living facility must ensure vertical openings are protected according to the requirements of 33.3.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§553.132.Space Planning and Utilization Requirements for an Existing Large Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing large Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) An existing large Type A assisted living facility must ensure bedroom usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by the Texas Health and Human Services Commission (HHSC).

(3) An existing large Type A assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing large Type A assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in paragraph (g)(6) of this section.

(4) An existing large Type A assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing large Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by a resident occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space according to the requirements of paragraph (a)(2) of this section.

(4) An existing bedroom window not meeting these requirements may be continued in service, subject to approval by HHSC.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, an existing large Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing large Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing large Type A assisted living facility must ensure a resident room is arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing large Type A assisted living facility must provide a staff area on each floor of an existing large Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) An existing large Type A assisted living facility that is not more than two stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) An existing large Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.135 of this division (relating to Fire Protection Systems Requirements for an Existing Large Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing large Type A assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing large Type A assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) An existing large Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing large Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.137 of this division (relating to Mechanical Requirements for an Existing Large Type A Assisted Living Facility).

(g) Resident living areas.

(1) An existing large Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) An existing large Type A assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) An existing large Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) An existing large Type A assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.132(g)(1)(C) (.pdf)

(2) An existing large Type A assisted living facility must provide a dining area with appropriate furniture.

(A) An existing large Type A assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) An existing large Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) An existing large Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) An existing large Type A assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.132(g)(2)(D) (.pdf)

(3) An existing large Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) For calculation purposes, where a means of egress passes through a living or dining area, an existing large Type A assisted living facility must deduct a pathway, equal to the minimum corridor width, according to §553.133 of this division (relating to Means of Egress Requirements for an Existing Large Type A Assisted Living Facility), from the measured area of the space.

(5) An existing large Type A assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.

(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing large Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) An existing large Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. An existing large Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

(1) An existing large Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) An existing large Type A assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.

(3) An existing large Type A assisted living facility that prepares food on-site must provide a kitchen or dietary area to meet the general food service needs of the residents and must include space for:

(A) storage, refrigeration, preparation, and serving food;

(B) dish and utensil cleaning, which includes:

(i) a three-compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(C) a food preparation sink;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area;

(F) refuse storage and removal;

(G) floor drains in the kitchen and dishwashing areas, unless the facility was licensed before January 6, 2014, and the facility can keep the floor clean; and

(H) a grease trap, if required by local authorities.

(4) An existing large Type A assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit measured throughout the room at five feet above the floor.

(5) An existing large Type A assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(6) An existing large Type A assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degreesFahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(7) An existing large Type A assisted living facility must maintain a separation between soiled and clean dish areas.

(8) An existing large Type A assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) An existing large Type A assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraph (2) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident-use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) An existing large Type A assisted living facility licensed before January 6, 2014, may provide a staff restroom that may be located outside the kitchen area.

(k) Kitchen janitorial facility.

(1) An existing large Type A assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area, except as described in paragraph (2) of this subsection.

(2) An existing large Type A assisted living facility licensed before January 6, 2014, must provide a janitorial facility for the kitchen. The janitorial facility may be located outside the kitchen if sanitary procedures are used to reduce the possibility of cross-contamination.

(3) An existing large Type A assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(4) An existing large Type A assisted living facility must provide floor drains in the kitchen and dishwashing areas unless the facility was licensed before January 6, 2014, and the facility can keep the floors clean.

(5) If required by local authorities, an existing large Type A assisted living facility must provide a grease trap.

(l) Finishes.

(1) An existing large Type A assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls and ceilings.

(2) An existing large Type A assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) An existing large Type A assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors.

(1) An existing large Type A assisted living facility must ensure a door between a kitchen and a dining area, serving area, or resident-use area, is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is located in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(2) Existing doors between kitchens and adjacent spaces that are not provided with vision panels may be continued in service, subject to approval by HHSC.

(n) Auxiliary serving kitchens.

(1) An existing large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) An existing large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this section.

(3) An existing large Type A assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) An existing large Type A assisted living facility must protect cooking facilities using commercial or residential cooking equipment for meal preparation as commercial cooking operations, according to the requirements for commercial cooking equipment in §553.136 of this division (relating to Hazardous Area Requirements for an Existing Large Type A Assisted Living Facility).

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.136 of this division:

(A) microwave ovens;

(B) hot plates; or

(C) toasters.

(p) Food storage areas.

(1) An existing large Type A assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) An existing large Type A assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving, so that food is not stored on the floor.

(A) An existing large Type A assisted living facility must ensure shelves are adjustable wire type shelving.

(B) An existing large Type A assisted living facility licensed before January 6, 2014, may use wood shelves provided the shelves are sealed and clean.

(3) An existing large Type A assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) An existing large Type A assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) An existing large Type A assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time, when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) An existing large Type A assisted living facility that co-mingles and processes laundry on-site in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating, and this separation must extend from the floor to the floor or roof above;

(B) is protected throughout by a fire sprinkler system;

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior that;

(I) must always operate when soiled linen is held in this area; and

(II) may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (1)(A) of this subsection;and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) An existing large Type A assisted living facility must ensure a laundry area for resident-use meets the following requirements.

(A) An existing large Type A assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident-use.

(B) When more than three washers and three dryers are provided in one laundry area for resident use, the area must be:

(i) protected throughout by a fire sprinkler system; or

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§553.133.Means of Egress Requirements for an Existing Large Type A Assisted Living Facility.

(a) An existing large Type A assisted living facility must meet the requirements of 33.3.2, Means of Egress, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, except as described in this section.

(b) The provisions of 33.3.2.11.2, Lockups, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, are not permitted.

(c) An existing large Type A assisted living facility must ensure doors meet the requirements of 33.3.2.2.2, Doors, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, and the additional requirements of this section.

(1) A resident room door in an existing large Type A assisted living facility must latch in its frame to resist the passage of smoke.

(2) In an existing large Type A assisted living facility comprised of buildings that contain living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) An existing large Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 33.3.2.2.3, Stairs, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) An existing large Type A assisted living facility must ensure means of egress are marked according to the requirements of 33.3.2.10, Marking of Means of Egress, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(f) An existing large Type A assisted living facility containing more than 25 sleeping rooms must provide emergency lighting, according to the requirements of 33.3.2.9, Emergency Lighting, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, unless each sleeping room has a direct exit to the outside at the finished ground level.

§553.134.Smoke Compartmentation for an Existing Large Type A Assisted Living Facility.

(a) An existing large Type A assisted living facility must meet the requirements of 33.3.3.6, Corridors and Separation of Sleeping Rooms, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing large Type A assisted living facility must meet the requirements of 33.3.3.7, Subdivision of Building Spaces, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§553.135.Fire Protection Systems Requirements for an Existing Large Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing large Type A assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. An existing large Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing large Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) - (D) of this paragraph.

(B) An existing large Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) An existing large Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, in lieu of the requirements found in subparagraphs (A) and (B) of this paragraph.

(D) An existing large Type A assisted living facility comprised of buildings containing living units with independent cooking must additionally have:

(i) a smoke detector installed all in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens and laundries within the living unit, that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(3) Carbon monoxide detectors.

(A) An existing large Type A assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720, not later than July 27, 2021, where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) An existing large Type A assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph in the following locations:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within any room containing a fuel-burning appliance or fuel-burning fireplace;

(iii) on every occupiable level of a sleeping room or sleeping room suite containing a fuel-burning appliance or fuel-burning fireplace;

(iv) centrally located within occupiable spaces served by the first supply air register from a fuel-burning HVAC system; and

(5) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(C) Existing carbon monoxide detection equipment not meeting the requirements of this paragraph may be continued in service, subject to approval by the Texas Health and Human Services Commission.

(4) Alarm control panel.

(A) An existing large Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing large Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) An existing large Type A assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(5) Fire alarm power source.

(A) An existing large Type A assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) An existing large Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(6) Emergency forces notification. An existing large Type A assisted living facility not equipped with a fire alarm system that automatically notifies emergency forces must immediately notify the fire department by telephone or other means.

(b) Fire sprinkler system.

(1) An existing large Type A assisted living facility may provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 33.3.3.5.1, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) An existing large Type A assisted living facility located in a building that is four or fewer stories in height may provide a fire sprinkler system meeting the requirements of NFPA 13R in accordance with 33.3.3.5.1.1, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(3) An existing large Type A assisted living facility located in a high-rise building must be protected throughout by an approved, supervised automatic fire sprinkler system meeting the requirements of NFPA 13 according to 33.3.3.5.3, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(c) Protection of attics. An existing large Type A assisted living facility equipped with a fire sprinkler system must ensure an attic is protected according to the requirements of 33.3.3.5.4, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, not later than July 27, 2021.

(d) Portable fire extinguishers. An existing large Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing large Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing large Type A assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing large Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen and walk-in mechanical room.

(4) An existing large Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing large Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing large Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.136.Hazardous Area Requirements for an Existing Large Type A Assisted Living Facility.

(a) An existing large Type A assisted living facility must meet the requirements of 33.3.3.2, Hazardous Areas, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing large Type A assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) An existing large Type A assisted living facility using commercial cooking equipment must protect cooking facilities, other than those in individual resident living units, in accordance with the requirements of NFPA 96.

§553.137.Mechanical Requirements for an Existing Large Type A Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. An existing large Type A assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. An existing large Type A assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) An existing large Type A assisted living facility must provide at least one water closet and one lavatory for every six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) An existing large Type A assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) An existing large Type A assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) An existing large Type A assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, an existing large Type A assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) An existing large Type A assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. An existing large Type A assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. An existing large Type A assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Public and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.132(j) of this division (relating to Space Planning and Utilization Requirements for an Existing Large Type A Assisted Living Facility), an existing large Type A assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by facility staff as follows:

(1) if licensed for 60 or fewer residents, a toilet for use by the public and by facility staff; or

(2) if licensed for more than 60 residents, a toilet for use by the public and a separate toilet for use by facility staff.

(d) Gas. An existing large Type A assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. An existing large Type A assisted living facility must ensure HVAC equipment meets the requirements of 33.3.6.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) Heating and cooling. An existing large Type A assisted living facility must provide heating and cooling for resident comfort.

(A) An existing large Type A assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) An existing large Type A assisted living facility constructed or licensed after August 1, 2004, must have a central air-conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) An existing large Type A assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) An existing large Type A assisted living facility must ensure a fuel burning heating device:

(i) installation not meeting the requirements of clauses (ii) - (v) of this subparagraph may be continued in service, subject to approved by the Texas Health and Human Services Commission (HHSC);

(ii) is connected to a chimney or vent;

(iii) takes air for combustion directly from outside;

(iv) is designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(v) has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) An existing large Type A assisted living facility must ensure a working fireplace:

(i) not meeting the requirements of clauses (ii) - (vi) of this subparagraph, is approved by HHSC;

(ii) in a building containing a working fireplace, is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers;

(iii) new installation is maintained and used according to NFPA 54 and NFPA 211;

(iv) location is provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720;

(v) a direct-vent gas fireplace, as defined in NFPA 54:

(I) is not in a resident sleeping room;

(II) includes a sealed glass front with a wire mesh panel or screen; and

(III) controls are locked or located in a restricted location;

(vi) the fireplace that burns solid fuels is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) An existing large Type A assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) An existing large Type A assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. An existing large Type A assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control.

§553.138.Electrical Requirements for an Existing Large Type A Assisted Living Facility.

(a) Electrical system. An existing large Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing large Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room;

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room; and

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. An existing large Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing large Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system orintercom;

(B) if it is an existing communication system, be approved by HHSC to be continued in service;

(C) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) An existing large Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing large Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

§553.139Miscellaneous Requirements for an Existing Large Type A Assisted Living Facility

An existing large Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101369

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 7. EXISTING LARGE TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.140 - 553.149

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.140.General Requirements for an Existing Large Type B Assisted Living Facility.

An existing large Type B assisted living facility must comply with the requirements for a limited care facility in NFPA 101, Chapter 19, Existing Health Care Occupancies, except as modified by this division.

§553.141.Construction Requirements for an Existing Large Type B Assisted Living Facility.

(a) Structurally sound. An existing large Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. An existing large Type B assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraphs (1) or (2) of this subsection.

(1) An existing large Type B assisted living facility is not required to be separated from a hospital or nursing facility unless the separation is required by NFPA 101 or the standards for licensing the hospital or nursing facility. After July 27, 2021, an existing large Type B assisted living facility must be separated from any new occupancy or new use subject to the Texas Health and Human Services Commission (HHSC) licensing.

(2) An existing large Type B assisted living facility is not required to be separated from another occupancy not subject to HHSC licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of egress, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing large Type B assisted living facility.

(B) HHSC must be given unrestricted and unannounced access at any reasonable time to inspect the other occupancy type for compliance with the NFPA 101 requirements for an existing large Type B assisted living facility.

(c) Construction type. An existing large Type B assisted living facility must ensure a building housing the facility meets the requirements of 19.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(d) Interior finish. An existing Large Type B assisted living facility must ensure interior wall, ceiling and floor finish materials meet the requirements of 19.3.3, Interior Finish, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(e) Vertical openings. An existing large Type B assisted living facility must ensure vertical openings are protected according to the requirements of 19.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

§553.142.Space Planning and Utilization Requirements for an Existing Large Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing large Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) An existing large Type B assisted living facility must ensure bedroom usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by the Texas Health and Human Services Commission (HHSC).

(3) An existing large Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing large Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in paragraph (g)(6) of this section.

(4) An existing large Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing large Type B assisted living facility must ensure each bedroom has at least one operable window, with outside exposure, that meets the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by a resident occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by paragraph (a)(2) of this section.

(4) An existing bedroom window that does not meet these requirements may be continued in service, subject to approval by HHSC.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, an existing large Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing large Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing large Type B assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing large Type B assisted living facility must provide a staff area on each floor of an existing large Type B assisted living facility and in each separate building containing resident sleeping rooms. An existing large Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.145 of this division (relating to Fire Protection Systems Requirements for an Existing Large Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing large Type B assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing large Type B assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) An existing large Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing large Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.147 of this division (relating to Mechanical Requirements for an Existing Large Type B Assisted Living Facility).

(g) Resident living areas.

(1) An existing large Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) An existing large Type B assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) An existing large Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) An existing large Type B assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.142(g)(1)(C) (.pdf)

(2) An existing large Type B assisted living facility must provide a dining area with appropriate furniture.

(A) An existing large Type B assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) An existing large Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) An existing large Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) An existing large Type B assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.142(g)(2)(D) (.pdf)

(3) An existing large Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) For calculation purposes, where a means of egress passes through a living or dining area, an existing large Type B assisted living facility must deduct a pathway, equal to the minimum corridor width, according to §553.143 of this division (relating to Means of Egress Requirements for an Existing Large Type B Assisted Living Facility), from the measured area of the space.

(5) An existing large Type B assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.

(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing large Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) An existing large Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. An existing large Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

(1) An existing large Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) An existing large Type B assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.

(3) An existing large Type B assisted living facility that prepares food on-site must provide a kitchen or dietary area to meet the general food service needs of the residents and must include space for:

(A) storage, refrigeration, preparation, and serving of food;

(B) dish and utensil cleaning, which includes:

(i) a three compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(C) a food preparation sink;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser, and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area;

(F) refuse storage and removal;

(G) floor drains in the kitchen and dishwashing areas, unless the facility was licensed before January 6, 2014, and the facility can keep the floor clean; and

(H) a grease trap, if required by local authorities.

(4) An existing large Type B assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit, measured throughout the room at five feet above the floor.

(5) An existing large Type B assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(6) An existing large Type B assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(7) An existing large Type B assisted living facility must maintain a separation between soiled and clean dish areas.

(8) An existing large Type B assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) An existing large Type B assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraphs (2) and (3) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident-use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) An existing large Type B assisted living facility licensed before January 6, 2014, may provide a staff restroom located outside the kitchen area.

(3) An existing large Type B assisted living facility must ensure a kitchen serving a neighborhood or household provides a restroom accessible to kitchen staff that is in close proximity to the kitchen.

(k) Kitchen janitorial facility.

(1) An existing large Type B assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area, except as described in paragraphs (2) and (3) of this subsection.

(2) An existing large Type B assisted living facility licensed before January 6, 2014, must provide a janitorial facility for the kitchen. The janitorial facility may be located outside the kitchen if sanitary procedures are used to reduce the possibility of cross-contamination.

(3) An existing large Type B assisted living facility must ensure a kitchen serving a neighborhood or household provides a janitorial facility exclusively for the kitchen that is close to the kitchen.

(4) An existing large Type B assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(5) An existing large Type B assisted living facility must provide floor drains in the kitchen and dishwashing areas, unless the facility was licensed before January 6, 2014, and the facility can keep the floors clean.

(6) If required by local authorities, an existing large Type B assisted living facility must provide a grease trap.

(l) Finishes.

(1) An existing large Type B assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls, and ceilings.

(2) An existing large Type B assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) An existing large Type B assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors.

(1) An existing large Type B assisted living facility must ensure a door between a kitchen and a dining, serving, or resident-use area is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(2) Existing doors between kitchens and adjacent spaces that are not provided with vision panels may be continued in service subject to approval by HHSC.

(n) Auxiliary serving kitchens.

(1) An existing large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) An existing large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this section.

(3) An existing large Type B assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) An existing large Type B assisted living facility must protect cooking facilities according to the requirements in §553.146 of this division (relating to Hazardous Area Requirements for an Existing Large Type B Assisted Living Facility) except as provided for in paragraph (3) of this subsection.

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.146 of this division.

(A) microwave ovens;

(B) hot plates; or

(C) toasters.

(3) A facility providing a kitchen serving a neighborhood or household may continue to operate the kitchen without modification subject to approval by HHSC.

(p) Food storage areas.

(1) An existing large Type B assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) An existing large Type B assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving so that food is not stored on the floor.

(A) An existing large Type B assisted living facility must ensure shelves are adjustable wire type shelving.

(B) An existing large Type B assisted living facility licensed before January 6, 2014, may use wood shelves provided the shelves are sealed and clean.

(3) An existing large Type B assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) An existing large Type B assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) An existing large Type B assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) An existing large Type B assisted living facility that co-mingles and processes laundry on-site in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating, which must extend from the floor to the floor or roof above:

(B) is protected throughout by a fire sprinkler system;

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior which;

(I) must always operate when soiled linen is held in this area; and

(II) may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section with;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (1)(A) of this subsection; and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) An existing large Type B assisted living facility must ensure a laundry area for resident-use meets the following requirements.

(A) An existing large Type B assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident-use.

(B) When more than three washers and three dryers are provided in one laundry area for resident-use, the area must be:

(i) protected throughout by a fire sprinkler system;and

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§553.143.Means of Egress Requirements for an Existing Large Type B Assisted Living Facility.

(a) An existing large Type B assisted living facility must meet the requirements of 19.2, Means of Egress, in NFPA 101, Chapter 19, Existing Health Care Occupancies, except as described in this section.

(b) An existing large Type B assisted living facility must ensure doors meet the requirements of 19.2.2.2, Doors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, and the additional requirements of this section.

(1) A resident room door in an existing large Type B assisted living facility must latch in its frame to resist the passage of smoke.

(2) In an existing large Type B assisted living facility comprised of buildings containing living units, with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(c) An existing large Type B assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 19.2.2.3, Stairs, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(d) An existing large Type B assisted living facility must ensure means of egress are marked according to the requirements of 19.2.10, Marking of Means of Egress, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(e) An existing large Type B assisted living facility must provide emergency lighting according to the requirements of 19.2.9, Emergency Lighting, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

§553.144.Smoke Compartmentation for an Existing Large Type B Assisted Living Facility.

(a) An existing large Type B assisted living facility must meet the requirements of 19.3.6, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(b) An existing large Type B assisted living facility must meet the requirements of 19.3.7, Subdivision of Building Spaces, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

§553.145.Fire Protection Systems Requirements for an Existing Large Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing large Type B assisted living facility must provide a fire alarm system meeting the requirements of 19.3.4, Detection, Alarm, and Communications Systems, in NFPA 101, Chapter 19, Existing Health Care Occupancies, as modified by this section.

(1) General. An existing large Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or FOR BOTH VISUALLY AND HEARING IMPAIRED a visual alarm at the site.

(2) Smoke detectors.

(A) An existing large Type B assisted living facility must install smoke detectors meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(B) An existing large Type B assisted living facility comprised of buildings containing living units with independent cooking must additionally have:

(i) a smoke detector installed in all resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, and laundries within the living unit that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(3) Carbon monoxide detectors.

(A) An existing large Type B assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720, not later than July 27, 2021, where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) An existing large Type B assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph in the following locations:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within any room containing a fuel-burning appliance or fuel-burning fireplace;

(iii) on every occupiable level of a sleeping room or sleeping room suite containing a fuel-burning appliance or fuel-burning fireplace;

(iv) centrally located within occupiable spaces served by the first supply air register from a fuel-burning HVAC system; and

(v) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(C) Existing carbon monoxide detection equipment not meeting the requirements of this paragraph may be continued in service, subject to approval by HHSC.

(4) Alarm control panel.

(A) An existing large Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing large Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) An existing large Type B assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(5) Fire alarm power source.

(A) An existing large Type B assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) An existing large Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(6) Emergency forces notification. An existing large Type B assisted living facility must ensure a fire alarm system automatically notifies emergency forces according to the requirements of 19.3.4.3.2, Emergency Forces Notification, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(b) Fire sprinkler system. An existing large Type B assisted living facility must provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 19.3.5.3, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(c) Portable Fire Extinguishers. An existing large Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing large Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing large Type B assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing large Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen, and walk-in mechanical room.

(4) An existing large Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing large Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing large Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.146.Hazardous Area Requirements for an Existing Large Type B Assisted Living Facility.

(a) An existing large Type B assisted living facility must meet the requirements of 19.3.2, Protection from Hazards, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(b) An existing large Type B assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) An existing large Type B assisted living facility must protect any cooking operation according to the requirements of 19.3.2.5, Cooking Facilities, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

§553.147.Mechanical Requirements for an Existing Large Type B Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. An existing large Type B assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. An existing large Type B assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) An existing large Type B assisted living facility must provide at least one water closet and one lavatory for each six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) An existing large Type B assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) An existing large Type B assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) An existing large Type B assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, an existing large Type B assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) An existing large Type B assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. An existing large Type B assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. An existing large Type B assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Public and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.142(j) of this division (relating to Space Planning and Utilization Requirements for an Existing Large Type B Assisted Living Facility), a new large Type B assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by facility staff, as follows:

(1) if licensed for 60 or fewer residents, a toilet for use by the public and by facility staff; or

(2) if licensed for more than 60 residents, a toilet for use by the public and a separate toilet for use by facility staff.

(d) Gas. An existing large Type B assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. An existing large Type B assisted living facility must ensure HVAC equipment meets the requirements of 19.5.2, Heating, Ventilating and Air-Conditioning, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(2) Heating and cooling. An existing large Type B assisted living facility must provide heating and cooling for resident comfort.

(A) An existing large Type B assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) An existing large Type B assisted living facility constructed or licensed after August 1, 2004, must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) An existing large Type B assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) An existing large Type B assisted living facility must ensure a fuel burning heating device:

(i) not meeting the requirements of clauses (ii) - (v) of this subparagraph may be continued in service, subject to approval by the Texas Health and Human Services Commission (HHSC);

(ii) must be connected to a chimney or vent;

(iii) must take air for combustion directly from outside;

(iv) must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(v) must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) An existing large Type B assisted living facility must ensure a working fireplace meets the following requirements.

(i) An existing fireplace not meeting the requirements of clauses (ii) - (vi) of this subparagraph may be continued in service, subject to approval by HHSC.

(ii) An existing large Type B assisted living facility must ensure a building containing a working fireplace is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers.

(iii) An existing large Type B assisted living facility must ensure any new fireplace is installed, maintained, and used according to NFPA 54 and NFPA 211.

(iv) An existing large Type B assisted living facility must ensure the room where a working fireplace is located is provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720.

(v) An existing large Type B assisted living facility may provide a direct-vent gas fireplace, as defined in NFPA 54, provided:

(I) the fireplace is not in a resident sleeping room;

(II) the fireplace includes a sealed glass front with a wire mesh panel or screen; and

(III) the controls for the fireplace are locked or located in a restricted location.

(vi) An existing large Type B assisted living facility may provide a fireplace that burns solid fuels, if it is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) An existing large Type B assisted living facility must be ventilated using windows or mechanical ventilation, or a combination of both.

(B) An existing large Type B assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. An existing large Type B assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control.

§553.148.Electrical Requirements for an Existing Large Type B Assisted Living Facility.

(a) Electrical system. An existing large Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing large Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room;

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room; and

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. An existing large Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing large Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system, orintercom;

(B) if it is an existing communication system, be approved by the Texas Health and Human Services Commission to be continued in service; and

(C) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) An existing large Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing large Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

§553.149.Miscellaneous Requirements for an Existing Large Type B Assisted Living Facility.

An existing large Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101370

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 8. NEW SMALL TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.210 - 553.213, 553.215 - 553.219

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.210.General Requirements for a New Small Type A Assisted Living Facility.

A new small Type A assisted living facility must comply with the requirements in 32.2, Small Facilities, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, where referenced by this division.

§553.211.Construction Requirements for a New Small Type A Assisted Living Facility.

(a) Structurally sound. A new small Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. A new small Type A assisted living facility must be separated from other occupancies including other assisted living facilities, hospitals, or nursing facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(c) Sheathing.

(1) Except as provided in paragraph (3) of this subsection a new small Type A assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating as follows.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 18.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 18, New Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. A new small Type A assisted living facility must ensure interior wall and ceiling finish materials meet the requirements of 32.2.3.3.2, Interior Wall and Ceiling Finish, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) Vertical openings. A new small Type A assisted living facility must ensure vertical openings are protected according to the requirements of 32.2.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§553.212.Space Planning and Utilization Requirements for a New Small Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) A new small Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) A new small Type A assisted living facility must ensure bedroom usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by the Texas Health and Human Services Commission.

(3) A new small Type A assisted living facility containing individual living units that include living space for the residents in addition to their bedrooms may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new small Type A assisted living facility may not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in paragraph (g)(5) of this section.

(4) A new small Type A assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new small Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by all residents occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space in paragraph (a)(3) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new small Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new small Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new small Type A assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new small Type A assisted living facility must provide a staff area on each floor of a new small Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) A new small Type A assisted living facility that is not more than two stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) A new small Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.215 of this division (relating to Fire Protection Systems Requirements for a New Small Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new small Type A assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new small Type A assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) A new small Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new small Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.217 of this division (relating to Mechanical Requirements for a New Small Type A Assisted Living Facility).

(g) Resident living areas.

(1) A new small Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) A new small Type A assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) A new small Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) A new small Type A assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(2) A new small Type A assisted living facility must provide a dining area with appropriate furniture.

(A) A new small Type A assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) A new small Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) A new small Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) A new small Type A assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(3) A new small Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) A new small Type A assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.

(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new small Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) A new small Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. A new small Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

(1) A new small Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) A new small Type A assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:

(A) is equipped to store, refrigerate, prepare and serve food;

(B) is equipped to clean and sterilize;

(C) provides for refuse storage and removal; and

(D) meets the requirements of the local fire, building, and health codes.

(3) A new small Type A assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations as required in §553.216 of this division (relating to Hazardous Area Requirements for a New Small Type A Assisted Living Facility).

§553.213.Means of Escape Requirements for a New Small Type A Assisted Living Facility.

(a) The provisions of NFPA 101, Chapter 7, Means of Egress, do not apply to a new small Type A assisted living facility, unless explicitly referenced by this section or by NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) A new small Type A assisted living facility must meet the requirements of 32.2.2, Means of Escape, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, except as described in this section.

(c) A new small Type A assisted living facility must ensure doors meet the requirements of 32.2.2.5, Doors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, and the additional requirements of this section. A resident room door is not otherwise required to meet the requirements for doors in 32.2.3.6, Construction of Corridor Walls, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(1) A resident room door in a new small Type A assisted living facility must latch in its frame to resist the passage of smoke.

(2) In a new small Type A assisted living facility comprised of buildings that contain living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) A new small Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs.

(1) A stair used as means of escape must meet the requirements of 32.2.2.6, Stairs, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Each stair must be arranged and located so that it is not necessary to go through another room, including a bedroom or bathroom, to reach the stair.

(3) Each stair must be provided with handrails.

(4) Each stair must be provided with normal lighting according to the requirements of §553.218 of this division (relating to Electrical Requirements for a New Small Type A Assisted Living Facility).

§553.215.Fire Protection Systems Requirements for a New Small Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new small Type A assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. A new small Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new small Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) A new small Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) A new small Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 18, New Health Care Occupancies, may install a smoke detection system meeting the requirements of 18.3.4.5.3, Nursing Homes, in NFPA 101, Chapter 18, New Health Care Occupancies, in lieu of the requirements found in subparagraph (A) of this paragraph.

(3) Carbon monoxide detectors.

(A) A new small Type A assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720, where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) A new small Type A assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph in the following locations:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within sleeping rooms containing fuel-burning appliance or fuel-burning fireplaces;

(iii) on every occupiable level, including basements and excluding attic and crawl spaces; and

(iv) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(4) Alarm control panel.

(A) A new small Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new small Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(5) Fire alarm power source.

(A) A new small Type A assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) A new small Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(b) Fire sprinkler system.

(1) A new small Type A assisted living facility must provide one of the following fire sprinkler systems according to the requirements of 32.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(A) A fire sprinkler system meeting the requirements of NFPA 13 in accordance with 32.2.3.5.3;

(B) A fire sprinkler system meeting the requirements of NFPA 13R in accordance with 32.2.3.5.3.1; or

(C) A fire sprinkler system meeting the requirements of NFPA 13D in accordance with 32.2.3.5.3.2.

(2) A new small Type A assisted living facility must provide electrical supervision of any fire sprinkler system according to the requirements of 32.2.3.5.4, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) Protection of attics. A new small Type A assisted living facility must ensure an attic is protected according to the requirements of 32.2.3.5.7, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) Portable fire extinguishers. A new small Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) A new small Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new small Type A assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new small Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(4) A new small Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) A new small Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new small Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.216.Hazardous Area Requirements for a New Small Type A Assisted Living Facility.

(a) A new small Type A assisted living facility must ensure any space where storage or an activity produces a greater potential for a fully involved fire than that found in a one- or two-family dwelling is protected according to the requirements of 32.2.3.2, Hazardous Areas, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) A new small Type A assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) A new small Type A assisted living facility using commercial cooking equipment must protect the cooking operation according to the requirements of NFPA 96.

§553.217.Mechanical Requirements for a New Small Type A Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. A new small Type A assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. A new small Type A assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) A new small Type A assisted living facility must provide at least one water closet and one lavatory for every six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) A new small Type A assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) A new small Type A assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) A new small Type A assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, a new small Type A assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) A new small Type A assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. A new small Type A assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. A new small Type A assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Gas. A new small Type A assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(d) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. A new small Type A assisted living facility must ensure HVAC equipment meets the requirements of 32.2.5.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Heating and cooling. A new small Type A assisted living facility must provide heating and cooling for resident comfort.

(A) A new small Type A assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) A new small Type A assisted living facility must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain the temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) A new small Type A assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) A new small Type A assisted living facility must ensure a fuel burning heating device:

(i) must be connected to a chimney or vent;

(ii) must take air for combustion directly from outside;

(iii) must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(iv) must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) A new small Type A assisted living facility must ensure a working fireplace:

(i) is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers;

(ii) is installed, maintained, and used according to NFPA 54 and NFPA 211;

(iii) electrically supervised carbon monoxide detection connected to the fire alarm system is provided in the room where the fireplace is located, according to NFPA 720;

(iv) may provide a direct-vent gas fireplace, as defined in NFPA 54, provided all the following requirements are met:

(I) the fireplace may not be in a resident sleepingroom;

(II) the fireplace must include a sealed glass front with a wire mesh panel or screen; and

(III) the controls for the fireplace must be locked or located in a restricted location;

(v) that burns solid fuels is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) A new small Type A assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) A new small Type A assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. A new small Type A assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control.

§553.218.Electrical Requirements for a New Small Type A Assisted Living Facility.

(a) Electrical system. A new small Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new small Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room;

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room; and

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. A new small Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new small Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system or intercom;

(B) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) A new small Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) A new small Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

§553.219.Miscellaneous Requirements for a New Small Type A Assisted Living Facility.

(a) A new small Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

(b) A new small Type A assisted living facility must ensure any new elevator, escalator, or conveyor meets the requirements of 32.2.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101371

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 9. NEW SMALL TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.220 - 553.223, 553.225 - 553.229

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.220.General Requirements for a New Small Type B Assisted Living Facility.

A new small Type B assisted living facility must comply with the requirements in 32.2, Small Facilities, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, where referenced by this division.

§553.221.Construction Requirements for a New Small Type B Assisted Living Facility.

(a) Structurally sound. A new small Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. A new small Type B assisted living facility must be separated from other occupancies, including other assisted living facilities, hospitals or nursing facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(c) Sheathing.

(1) Except as provided in paragraph (3) of this subsection, a new small Type B assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating as follows.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 18.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 18, New Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. A new small Type B assisted living facility must ensure interior wall and ceiling finish materials meet the requirements of 32.2.3.3.2, Interior Wall and Ceiling Finish, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) Vertical openings. A new small Type B assisted living facility must ensure vertical openings are protected according to the requirements of 32.2.3, Protection of Vertical Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§553.222.Space Planning and Utilization Requirements for a New Small Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) A new small Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) A new small Type B assisted living facility must ensure bedroom usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by the Texas Health and Human Services Commission.

(3) A new small Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new small Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in paragraph (g)(5) of this section.

(4) A new small Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new small Type B assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by a resident occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by paragraph (a)(3) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new small Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new small Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new small Type B assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new small Type B assisted living facility must provide a staff area on each floor of a new small Type B assisted living facility and in each separate building containing resident sleeping rooms. A new small Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.225 of this division (relating to Fire Protection Systems Requirements for a New Small Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new small Type B assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new small Type B assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) A new small Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new small Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.227 of this division (relating to Mechanical Requirements for a New Small Type B Assisted Living Facility).

(g) Resident living areas.

(1) A new small Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) A new small Type B assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) A new small Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) A new small Type B assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(2) A new small Type B assisted living facility must provide a dining area with appropriate furniture.

(A) A new small Type B assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) A new small Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) A new small Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) A new small Type B assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

(3) A new small Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) A new small Type B assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.

(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new small Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) A new small Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. A new small Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

(1) A new small Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) A new small Type B assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:

(A) is equipped to store, refrigerate, prepare, and serve food;

(B) is equipped to clean and sterilize;

(C) provides for refuse storage and removal; and

(D) meets the requirements of the local fire, building, and health codes.

(3) A new small Type B assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations, as required in §553.226 of this division (relating to Hazardous Area Requirements for a New Small Type B Assisted Living Facility).

§553.223.Means of Escape Requirements for a New Small Type B Assisted Living Facility.

(a) The provisions of NFPA 101, Chapter 7, Means of Egress, do not apply to a new small Type B assisted living facility unless explicitly referenced by this section or by NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) A new small Type B assisted living facility must meet the requirements of 32.2.2, Means of Escape, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, except as described in this section.

(c) A new small Type B assisted living facility must ensure doors meet the requirements of 32.2.2.5, Doors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, and the additional requirements of this section. A resident room door is not otherwise required to meet the requirements for doors in 32.2.3.6, Construction of Corridor Walls, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(1) A resident room door in a new small Type B assisted living facility must latch in its frame to resist the passage of smoke.

(2) In a new small Type B assisted living facility comprised of buildings that contain living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) A new small Type B assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs.

(1) A stair used as means of escape must meet the requirements of 32.2.2.6, Stairs, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Each stair must be arranged and located so that it is not necessary to go through another room, including a bedroom or bathroom, to reach the stair.

(3) Each stair must be provided with handrails.

(4) Each stair must be provided with normal lighting according to the requirements of §553.228 of this division (relating to Electrical Requirements for a New Small Type B Assisted Living Facility).

§553.225.Fire Protection Systems Requirements for a New Small Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new small Type B assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. A new small Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new small Type B assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) A new small Type B assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) A new small Type B assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 18, New Health Care Occupancies, may install a smoke detection system meeting the requirements of 18.3.4.5.3, Nursing Homes, in NFPA 101, Chapter 18, New Health Care Occupancies, in lieu of the requirements found in subparagraph (A) of this paragraph.

(3) Carbon monoxide detectors.

(A) A new small Type B assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720 where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) A new small Type B assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph in the following locations:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within sleeping rooms containing fuel-burning appliance or fuel-burning fireplaces;

(iii) on every occupiable level, including basements and excluding attic and crawl spaces; and

(iv) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(4) Alarm control panel.

(A) A new small Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new small Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(5) Fire alarm power source.

(A) A new small Type B assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) A new small Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(b) Fire sprinkler system.

(1) A new small Type B assisted living facility must provide one of the following fire sprinkler systems according to the requirements of 32.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(A) A fire sprinkler system meeting the requirements of NFPA 13 in accordance with 32.2.3.5.3;

(B) A fire sprinkler system meeting the requirements of NFPA 13R in accordance with 32.2.3.5.3.1; or

(C) A fire sprinkler system meeting the requirements of NFPA 13D in accordance with 32.2.3.5.3.2.

(2) A new small Type B assisted living facility must provide electrical supervision of any fire sprinkler system according to the requirements of 32.2.3.5.4, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) Protection of attics. A new small Type B assisted living facility must ensure an attic is protected according to the requirements of 32.2.3.5.7, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) Portable fire extinguishers. A new small Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) A new small Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new small Type B assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new small Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(4) A new small Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) A new small Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new small Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.226.Hazardous Area Requirements for a New Small Type B Assisted Living Facility.

(a) A new small Type B assisted living facility must ensure any space where storage or an activity produces a greater potential for a fully involved fire than that found in a one- or two-family dwelling is protected according to the requirements of 32.2.3.2, Hazardous Areas, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) A new small Type B assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) A new small Type B assisted living facility using commercial cooking equipment must protect the cooking operation according to the requirements of NFPA 96.

§553.227.Mechanical Requirements for a New Small Type B Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. A new small Type B assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. A new small Type B assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) A new small Type B assisted living facility must provide at least one water closet and one lavatory for each six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) A new small Type B assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) A new small Type B assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) A new small Type B assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, a new small Type B assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) A new small Type B assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. A new small Type B assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. A new small Type B assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Gas. A new small Type B assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(d) Heating, ventilation, and air conditioning (HVAC) and exhaust systems.

(1) General requirements. A new small Type B assisted living facility must ensure HVAC equipment meets the requirements of 32.2.5.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Heating and cooling. A new small Type B assisted living facility must provide heating and cooling for resident comfort.

(A) A new small Type B assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) A new small Type B assisted living facility must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain the temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) A new small Type B assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) A new small Type B assisted living facility must ensure a fuel burning heating device meets the following requirements:

(i) a fuel burning heating device must be connected to a chimney or vent;

(ii) a fuel burning heating device must take air for combustion directly from outside;

(iii) a fuel burning heating device must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(iv) a fuel burning heating device must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) A new small Type B assisted living facility must ensure a working fireplace meets the following requirements.

(i) A building containing a working fireplace is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers.

(ii) Any new fireplace is installed, maintained, and used according to NFPA 54 and NFPA 211.

(iii) The room where a working fireplace is located is provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720.

(iv) A facility may provide a direct-vent gas fireplace, as defined in NFPA 54, provided:

(I) the fireplace is not in a resident sleeping room;

(II) the fireplace includes a sealed glass front with a wire mesh panel or screen; and

(III) the controls for the fireplace are locked or located in a restricted location;

(v) A facility may provide a fireplace that burns solid fuels, if it is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) A new small Type B assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) A new small Type B assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. A new small Type B assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control.

§553.228.Electrical Requirements for a New Small Type B Assisted Living Facility.

(a) Electrical system. A new small Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new small Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room.

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room.

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. A new small Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new small Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system, or intercom;

(B) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) A new small Type B assisted living facility mayprovide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) A new small Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

§553.229.Miscellaneous Requirements for a New Small Type B Assisted Living Facility.

(a) A new small Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

(b) A new small Type B assisted living facility must ensure any new elevator, escalator, or conveyor meets the requirements of 32.2.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101372

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 10. NEW LARGE TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.230 - 553.239

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.230.General Requirements for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must comply with the requirements of 32.3, Large Facilities, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, as modified by this division, except as permitted by subsection (b) of this section.

(b) A new large Type A assisted living facility campus comprised of multiple buildings providing sleeping rooms for no more than 16 residents in any one building may comply with other provision in NFPA 101, as follows.

(1) Each individual building providing sleeping rooms on the campus may comply with the requirements in 32.2, Small Facilities, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Other buildings on the campus that are part of the new large Type A assisted living facility may be permitted to comply with the requirements for other occupancies in NFPA 101, subject to approval by HHSC.

(3) The provisions of this subsection do not apply where any building provides sleeping rooms for more than 16 residents.

§553.231.Construction Requirements for a New Large Type A Assisted Living Facility.

(a) Structurally sound. A new large Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. A new large Type A assisted living facility must be separated from other occupancies, including other assisted living facilities, hospitals or nursing facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(c) Construction type. A new large Type A assisted living facility must ensure a building housing the facility meets the requirements of 32.3.1.3, Minimum Construction Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) Interior finish. A new large Type A assisted living facility must ensure interior wall and ceiling finish materials meet the requirements of 32.3.3.3, Interior Finish, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) Vertical openings. A new large Type A assisted living facility must ensure vertical openings are protected according to the requirements of 32.3.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§553.232.Space Planning and Utilization Requirements for a New Large Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) A new large Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) A new large Type A assisted living facility must ensure bedroom usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted in paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC.

(3) A new large Type A assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new large Type A assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in paragraph (g)(6) of this section.

(4) A new large Type A assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new large Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by a resident occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space according to the requirements of paragraph (a)(3) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new large Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new large Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new large Type A assisted living facility must ensure a resident room is arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new large Type A assisted living facility must provide a staff area on each floor of a new large Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) A new large Type A assisted living facility that is not more than two stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) A new large Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.235 of this division (relating to Fire Protection Systems Requirements for a New Large Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new large Type A assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new large Type A assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) A new large Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new large Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.237 of this division (relating to Mechanical Requirements for a New Large Type A Assisted Living Facility).

(g) Resident living areas.

(1) A new large Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) A new large Type A assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) A new large Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) A new large Type A assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.232(g)(1)(C) (.pdf)

(2) A new large Type A assisted living facility must provide a dining area with appropriate furniture.

(A) A new large Type A assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) A new large Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) A new large Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) A new large Type A assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.232(g)(2)(D) (.pdf)

(3) A new large Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) For calculation purposes, where a means of egress passes through a living or dining area, a new large Type A assisted living facility must deduct a pathway, equal to the minimum corridor width according to §553.233 of this division (relating to Means of Egress Requirements for a New Large Type A Assisted Living Facility), from the measured area of the space.

(5) A new large Type A assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.

(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new large Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) A new large Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. A new large Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnisheslinen;

(7) soiled linen, if the facility furnishes linen;and

(8) lawn and maintenance equipment.

(i) General kitchen.

(1) A new large Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) A new large Type A assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.

(3) A new large Type A assisted living facility that prepares food on-site must provide a kitchen or dietary area to meet the general food service needs of the residents and must include space for the following:

(A) storage, refrigeration, preparation, and serving food;

(B) dish and utensil cleaning which includes:

(i) a three-compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(C) a food preparation sink;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area; and

(F) refuse storage and removal;

(G) floor drains in the kitchen and dishwashing areas, unless the facility was created through conversion and the facility can keep the floor clean; and

(H) a grease trap, if required by local authorities.

(4) A new large Type A assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit measured throughout the room at five feet above the floor.

(5) A new large Type A assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(6) A new large Type A assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(7) A new large Type A assisted living facility must maintain a separation between soiled and clean dish areas.

(8) A new large Type A assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) A new large Type A assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraph (2) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) A new large Type A assisted living facility created through conversion may provide a staff restroom that may be located outside the kitchen area.

(k) Kitchen janitorial facility.

(1) A new large Type A assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area except as described in paragraph (2) of this subsection.

(2) A new large Type A assisted living facility created through conversion must provide a janitorial facility for the kitchen. The janitorial facility may be located outside the kitchen if sanitary procedures are used to reduce the possibility of cross-contamination.

(3) A new large Type A assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(l) Finishes.

(1) A new large Type A assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls and ceilings.

(2) A new large Type A assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) A new large Type A assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors. A new large Type A assisted living facility must ensure a door between a kitchen and a dining area, serving area, or resident-use area, is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is located in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(n) Auxiliary serving kitchens.

(1) A new large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) A new large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this section.

(3) A new large Type A assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) A new large Type A assisted living facility must protect cooking facilities according to the requirements in §553.236 of this division (relating to Hazardous Area Requirements for a New Large Type A Assisted Living Facility).

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.236 of this division:

(A) microwave ovens;

(B) hot plates; or

(C) toasters.

(p) Food storage areas.

(1) A new large Type A assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) A new large Type A assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving, so that food is not stored on the floor, and must ensure shelves are adjustable wire type shelving.

(3) A new large Type A assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) A new large Type A assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) A new large Type A assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time, when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) A new large Type A assisted living facility that co-mingles and processes laundry on-site in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating. This separation must extend from the floor to the floor or roof above;

(B) is protected throughout by a fire sprinkler system;and

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior;

(I) the exhaust must always operate when soiled linen is held in this area; and

(II) the area may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (1)(A) of this subsection; and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) A new large Type A assisted living facility must ensure a laundry area for resident-use meets the following requirements.

(A) A new large Type A assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident-use.

(B) When more than three washers and three dryers are provided in one laundry area for resident-use, the area must be:

(i) protected throughout by a fire sprinkler system; and

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§553.233.Means of Egress Requirements for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must meet the requirements of 32.3.2, Means of Egress, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, except as described in this section.

(b) The provisions of 32.3.2.11.2, Lockups, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, are not permitted.

(c) A new large Type A assisted living facility must ensure doors meet the requirements of 32.3.2.2.2, Doors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, and the additional requirements of this section.

(1) A resident room door in a new large Type A assisted living facility must latch in its frame to resist the passage of smoke.

(2) In a new large Type A assisted living facility comprised of buildings that contain living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) A new large Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 32.3.2.2.3, Stairs, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) A new large Type A assisted living facility must ensure means of egress are marked according to the requirements of 32.3.2.10, Marking of Means of Egress, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(f) A new large Type A assisted living facility must provide emergency lighting according to the requirements of 32.3.2.9, Emergency Lighting, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, unless each sleeping room has a direct exit to the outside at the finished ground level.

§553.234.Smoke Compartmentation for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must meet the requirements of 32.3.3.6, Corridors and Separation of Sleeping Rooms, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) A new large Type A assisted living facility must meet the requirements of 32.3.3.7, Subdivision of Building Spaces, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§553.235.Fire Protection Systems Requirements for a New Large Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new large Type A assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. A new large Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new large Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) - (D) of this paragraph.

(B) A new large Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) A new large Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 18, New Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 18, New Health Care Occupancies, in lieu of the requirements found in subparagraphs (A) and (B) of this paragraph.

(D) A new large Type A assisted living facility comprised of buildings containing living units with independent cooking must additionally have:

(i) a smoke detector installed all in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens and laundries within the living unit, that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(E) A new large Type A assisted living facility is not required to install smoke alarms, as required by 32.3.4.7, Smoke Alarms, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, in addition to the smoke detectors required by subparagraphs (A) - (D) of this paragraph.

(3) Carbon monoxide detectors.

(A) A new large Type A assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720 where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) A new large Type A assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph in the following locations:

(i) outside each separate sleeping area near the sleepingrooms;

(ii) within any room containing a fuel-burning appliance or fuel-burning fireplace;

(iii) on every occupiable level of a sleeping room or sleeping room suite containing a fuel-burning appliance or fuel-burning fireplace;

(iv) centrally located within occupiable spaces served by the first supply air register from a fuel-burning HVAC system; and

(v) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(4) Alarm control panel.

(A) A new large Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new large Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) A new large Type A assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(5) Fire alarm power source.

(A) A new large Type A assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) A new large Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(6) Emergency forces notification. A new large Type A assisted living must ensure a fire alarm system provides emergency forces notification according to the requirements of 32.3.3.4.6, Emergency Forces Notification, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) Fire sprinkler system. A new large Type A assisted living facility must provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 32.3.3.5, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) Portable Fire Extinguishers. A new large Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of 32.3.3.5.7, Portable Fire Extinguishers, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, and the additional requirements of this subsection.

(1) A new large Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new large Type A assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new large Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen and walk-in mechanical room.

(4) A new large Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or is mounted in an approved cabinet.

(5) A new large Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new large Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.236.Hazardous Area Requirements for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must meet the requirements of 32.3.3.2, Protection from Hazards, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) A new large Type A assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) A new large Type A assisted living facility must protect cooking facilities, other than those in individual resident living units in accordance with the requirements of 32.3.3.8, Cooking Facilities, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§553.237.Mechanical Requirements for a New Large Type A Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. A new large Type A assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of TCEQ, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. A new large Type A assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) A new large Type A assisted living facility must provide at least one water closet and one lavatory for every six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) A new large Type A assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) A new large Type A assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) A new large Type A assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, a new large Type A assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) A new large Type A assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. A new large Type A assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. A new large Type A assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Public- and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.232(j) of this division (relating to Space Planning and Utilization Requirements for a New Large Type A Assisted Living Facility), an existing large Type A assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by facility staff as follows:

(1) if licensed for 60 or fewer residents, a new large Type A assisted living facility must provide a toilet for use by the public and by facility staff; or

(2) if licensed for more than 60 residents, a new large Type A assisted living facility must provide a toilet for use by the public and a separate toilet for use by facility staff.

(d) Gas. A new large Type A assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. A new large Type A assisted living facility must ensure HVAC equipment meets the requirements of 32.3.6.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Heating and cooling. A new large Type A assisted living facility must provide heating and cooling for resident comfort.

(A) A new large Type A assisted living facility must ensure air conditioning systems can maintain and does maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) A new large Type A assisted living facility must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) A new large Type A assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) A new large Type A assisted living facility must ensure a fuel burning heating device meets the following requirements:

(i) a fuel burning heating device must be connected to a chimney or vent;

(ii) a fuel burning heating device must take air for combustion directly from outside;

(iii) a fuel burning heating device must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(iv) a fuel burning heating device must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) A new large Type A assisted living facility must ensure a working fireplace meets the following requirements.

(i) A building containing a working fireplace is protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers.

(ii) Any new fireplace is installed, maintained, and used according to NFPA 54 and NFPA 211.

(iii) The room where a working fireplace is located is provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720.

(iv) A direct-vent gas fireplace, as defined in NFPA 54, provided:

(I) the fireplace is not in a resident sleeping room;

(II) the fireplace includes a sealed glass front with a wire mesh panel or screen; and

(III) the controls for the fireplace are locked or located in a restricted location.

(v) A new large Type A assisted living facility may provide a fireplace that burns solid fuels, if it is equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) A new large Type A assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) A new large Type A assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. A new large Type A assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with powered exhaust vented to the exterior for odor control.

§553.238.Electrical Requirements for a New Large Type A Assisted Living Facility.

(a) Electrical system. A new large Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new large Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room;

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room; and

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. A new large Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new large Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system or intercom;

(B) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) A new large Type A assisted living facility mayprovide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) A new large Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

(e) Generator.

(1) A new large Type A assisted living facility that provides a system to supply, distribute, and control electricity for emergency lighting and illumination of exit signs required by NFPA 101, such as a system that uses a generator set as an alternate source of power, must comply with the requirements of Article 700, Emergency Systems, in NFPA 70, Chapter 7, Special Conditions.

(A) The emergency system may not include any systems or equipment except:

(i) emergency lighting, as required by NFPA 101;

(ii) secondary power to ensure illumination of exit signs, as required by NFPA 101; and

(iii) secondary power for detection, alarm, and communications systems, as required by NFPA 72.

(B) A new large Type A assisted living facility must ensure wiring from an emergency source to emergency loads is kept entirely independent of all other wiring and equipment except as permitted by Article 700.10, Wiring, Emergency System, in NFPA 70. Two or more emergency circuits supplied from the same source may be routed in the same raceway, cable, box, or cabinet.

(C) A new large Type A assisted living facility must ensure that transfer equipment for an emergency system does not serve another facility, including a hospital, a nursing facility, or an independent living facility.

(2) A new large Type A assisted living facility that provides a system to supply, distribute, and control electricity for systems and equipment not identified in paragraph (1) of this subsection must comply with the requirements of Article 702, Optional Standby Systems, in NFPA 70.

(3) The alternate power source for the emergency system may supply other emergency loads, legally required standby loads, and optional standby system loads where the source has adequate capacity to ensure adequate power to the different circuits in the following priority:

(A) emergency circuits for the assisted living facility

(B) legally required standby circuits, if any; and

(C) optional standby circuits, if any.

§553.239.Miscellaneous Requirements for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

(b) A new large Type A assisted living facility must ensure an elevator, dumbwaiter, or vertical conveyor meets the requirements of 32.3.6.3, Elevators, Dumbwaiters, and Vertical Conveyors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101373

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 11. NEW LARGE TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.240 - 553.249

STATUTORY AUTHORITY

The new sections are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new sections implement Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.240.General Requirements for a New Large Type B Assisted Living Facility.

A new large Type B assisted living facility must comply with the requirements for a limited care facility in NFPA 101, Chapter 18, New Health Care Occupancies, as modified by this division.

§553.241.Construction Requirements for a New Large Type B Assisted Living Facility.

(a) Structurally sound. A new large Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies.

(1) A new large Type B assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(2) A large Type B assisted living facility is not required to be separated from a hospital or nursing facility unless the separation is required by NFPA 101 or the standards for licensing the hospital or nursing facility.

(c) Construction type. A new large Type B assisted living facility must ensure a building housing the facility meets the requirements of 18.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 18, New Health Care Occupancies.

(d) Interior finish. A new Large Type B assisted living facility must ensure interior wall, ceiling and floor finish materials meet the requirements of 18.3.3, Interior Finish, in NFPA 101, Chapter 18, New Health Care Occupancies.

(e) Vertical openings. A new large Type B assisted living facility must ensure vertical openings are protected according to the requirements of 18.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 18, New Health Care Occupancies.

§553.242.Space Planning and Utilization Requirements for a New Large Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) A new large Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below grade level.

(2) A new large Type B assisted living facility must ensure bedroom usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC.

(3) A new large Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new large Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in paragraph (g)(6) of this section.

(4) A new large Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new large Type B assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The window sill must be no higher than 44 inches above the floor.

(2) The window must be operable by a resident occupying the bedroom, from the inside, without the use of tools or special devices.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by paragraph (a)(3) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new large Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) an enclosed closet space and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new large Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new large Type B assisted living facility must ensure a resident room is arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new large Type B assisted living facility must provide a staff area on each floor of a new large Type B assisted living facility and in each separate building containing resident sleeping rooms. A new large Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.245 of this division (relating to Fire Protection Systems Requirements for a New Large Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new large Type B assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new large Type B assisted living facility that houses individuals of more than one gender must provide toilet rooms for each gender, or individual single-occupant toilet rooms for use by any gender.

(2) A new large Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new large Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.247 of this division (relating to Mechanical Requirements for a New Large Type B Assisted Living Facility).

(g) Resident living areas.

(1) A new large Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms.

(A) A new large Type B assisted living facility must provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space.

(B) A new large Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.

(C) A new large Type B assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.242(g)(1)(C) (.pdf)

(2) A new large Type B assisted living facility must provide a dining area with appropriate furniture.

(A) A new large Type B assisted living facility must provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of number of residents or other provisions of this section permitting a reduction in the total minimum dining space.

(B) A new large Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.

(C) A new large Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.

(D) A new large Type B assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

Figure: 26 TAC §553.242(g)(2)(D) (.pdf)

(3) A new large Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet.

(4) For calculation purposes, where a means of egress passes through a living or dining area, a new large Type B assisted living facility must deduct a pathway, equal to the minimum corridor width according to §553.243 of this division (relating to Means of Egress Requirements for a New Large Type B Assisted Living Facility), from the measured area of the space.

(5) A new large Type B assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.

(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new large Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.

(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.

(B) A new large Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.

(h) Storage areas. A new large Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

(1) A new large Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.

(2) A new large Type B assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.

(3) A new large Type B assisted living facility that prepares food on-site must provide a kitchen or dietary area to meet the general food service needs of the residents and must include space for the following:

(A) storage, refrigeration, preparation, and serving food;

(B) dish and utensil cleaning which includes:

(i) a three-compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(C) a food preparation sink;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser, and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area;

(F) refuse storage and removal;

(G) floor drains in the kitchen and dishwashing areas; and

(H) a grease trap, if required by local authorities.

(4) A new large Type B assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit measured throughout the room at five feet above the floor.

(5) A new large Type B assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(6) A new large Type B assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(7) A new large Type B assisted living facility must maintain a separation between soiled and clean dish areas.

(8) A new large Type B assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) A new large Type B assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraph (2) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) A new large Type B facility must ensure a kitchen serving a neighborhood or household provides a restroom accessible to kitchen staff located in close proximity to the kitchen.

(k) Kitchen janitorial facility.

(1) A new large Type B assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area except as described in paragraph (2) of this subsection.

(2) A new large Type B facility must ensure a kitchen serving a neighborhood or household provides a janitorial facility exclusively for the kitchen that is located in close proximity to the kitchen.

(3) A new large Type B assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(l) Finishes.

(1) A new large Type B assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls, and ceilings.

(2) A new large Type B assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) A new large Type B assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors. A new large Type B assisted living facility must ensure a door between a kitchen and a dining area, serving area, or resident-use area, is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is located in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(n) Auxiliary serving kitchens.

(1) A new large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) A new large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this subsection.

(3) A new large Type B assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) A new large Type B assisted living facility must protect cooking facilities according to the requirements in §553.246 of this division (relating to Hazardous Area Requirements for a new Large Type B Assisted Living Facility).

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.246 of this division:

(A) microwave ovens;

(B) hot plates; or

(C) toasters.

(p) Food storage areas.

(1) A new large Type B assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) A new large Type B assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving so that food is not stored on the floor and must ensure shelves are adjustable wire type shelving.

(3) A new large Type B assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) A new large Type B assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) A new large Type B assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) A new large Type B assisted living facility that co-mingles and processes laundry on-site in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating. This separation must extend from the floor to the floor or roof above;

(B) is protected throughout by a fire sprinkler system;

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior;

(I) The exhaust must always operate when soiled linen is held in this area; and

(II) The area may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (1)(A) of this subsection; and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) A new large Type B assisted living facility must ensure a laundry area for resident-use meets the following requirements.

(A) A new large Type B assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident-use.

(B) When more than three washers and three dryers are provided in one laundry area for resident-use, the area must be:

(i) protected throughout by a fire sprinkler system;and

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§553.243.Means of Egress Requirements for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must meet the requirements of 18.2, Means of Egress, in NFPA 101, Chapter 18, New Health Care Occupancies, except as described in this section.

(b) A new large Type B assisted living facility must ensure doors meet the requirements of 18.2.2.2, Doors, in NFPA 101, Chapter 18, New Health Care Occupancies, and the additional requirements of this section.

(1) A resident room door in a new large Type B assisted living facility must latch in its frame to resist the passage of smoke.

(2) In a new large Type B assisted living facility comprised of buildings containing living units with independent cooking within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(c) A new large Type B assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 18.2.2.3, Stairs, in NFPA 101, Chapter 18, New Health Care Occupancies.

(d) A new large Type A assisted living facility must ensure means of egress are marked according to the requirements of 18.2.10, Marking of Means of Egress, in NFPA 101, Chapter 18, New Health Care Occupancies.

(e) A new large Type B assisted living facility must provide emergency lighting according to the requirements of 18.2.9, Emergency Lighting, in NFPA 101, Chapter 18, New Health Care Occupancies.

§553.244.Smoke Compartmentation for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must meet the requirements of 18.3.6, Corridors, in NFPA 101, Chapter 18, New Health Care Occupancies.

(b) A new large Type B assisted living facility must meet the requirements of 18.3.7, Subdivision of Building Spaces, in NFPA 101, Chapter 18, New Health Care Occupancies.

§553.245.Fire Protection Systems Requirements for a New Large Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new large Type B assisted living facility must provide a fire alarm system meeting the requirements of 18.3.4, Detection, Alarm, and Communications Systems, in NFPA 101, Chapter 18, New Health Care Occupancies, as modified by this section.

(1) General. A new large Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new large Type B assisted living facility must install smoke detectors meeting the requirements of 18.3.4.5.1, Corridors, in NFPA 101, Chapter 18, New Health Care Occupancies.

(B) A new large Type B assisted living facility comprised of buildings containing living units with independent cooking within the living unit, must additionally have:

(i) a smoke detector installed in all resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens and laundries within the living unit, that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(3) Carbon monoxide detectors.

(A) A new large Type B assisted living facility must install carbon monoxide detectors meeting the requirements of NFPA 720 where the facility:

(i) has a communicating attached garage; or

(ii) contains a fuel-burning appliance or fuel-burning fireplace.

(B) A new large Type B assisted living facility must install carbon monoxide detectors required by subparagraph (A) of this paragraph:

(i) outside each separate sleeping area near the sleeping rooms;

(ii) within any room containing a fuel-burning appliance or fuel-burning fireplace;

(iii) on every occupiable level of a sleeping room or sleeping room suite containing a fuel-burning appliance or fuel-burning fireplace;

(iv) centrally located within occupiable spaces served by the first supply air register from a fuel-burning HVAC system; and

(v) centrally located within occupiable spaces adjacent to a communicating attached garage. A detector is not required in the garage itself.

(4) Alarm control panel.

(A) A new large Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new large Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) A new large Type B assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(5) Fire alarm power source.

(A) A new large Type B assisted living facility must ensure a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.

(B) A new large Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.

(6) Emergency forces notification. A new large Type B assisted living facility must ensure a fire alarm system automatically notifies emergency forces according to the requirements of 18.3.4.3.2, Emergency Forces Notification, in NFPA 101, Chapter 18, New Health Care Occupancies

(b) Fire sprinkler system. A new large Type B assisted living facility must provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 18.3.5.3, in NFPA 101, Chapter 18, New Health Care Occupancies.

(c) Portable Fire Extinguishers. A new large Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) A new large Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new large Type B assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet

(3) A new large Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen, and walk-in mechanical room.

(4) A new large Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) A new large Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new large Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit door opening and on the latch or knob side of the door.

§553.246.Hazardous Area Requirements for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must meet the requirements of 19.3.2, Protection from Hazards, in NFPA 101, Chapter 19, New Health Care Occupancies.

(b) A new large Type B assisted living facility must ensure flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar products are not stored in a building housing residents.

(c) A new large Type B assisted living facility must protect any cooking operation according to the requirements of 18.3.2.5, Cooking Facilities, in NFPA 101, Chapter 18, New Health Care Occupancies.

§553.247.Mechanical Requirements for a New Large Type B Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. A new large Type B assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of TCEQ, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. A new large Type B assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) A new large Type B assisted living facility must provide at least one water closet and one lavatory for each six residents and for each additional resident fewer than six. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) A new large Type B assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) A new large Type B assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) A new large Type B assisted living facility must provide one tub or shower for every 10 residents and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, a new large Type B assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) A new large Type B assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. A new large Type B assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. A new large Type B assisted living facility must supply towels, soap, and toilet tissue for individual resident-use.

(c) Public- and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.242(j) of this division (relating to Space Planning and Utilization Requirements for a New Large Type B Assisted Living Facility), a new large Type B assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by facility staff as follows:

(1) if licensed for 60 or fewer residents, a new large Type B assisted living facility must provide a toilet for use by the public and by facility staff; or

(2) if licensed for more than 60 residents, a new large Type B assisted living facility must provide a toilet for use by the public and a separate toilet for use by facility staff.

(d) Gas. A new large Type B assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. A new large Type B assisted living facility must ensure HVAC equipment meets the requirements of 18.5.2, Heating, Ventilating and Air-Conditioning, in NFPA 101, Chapter 18, New Health Care Occupancies.

(2) Heating and cooling. A new large Type B assisted living facility must provide heating and cooling for resident comfort.

(A) A new large Type B assisted living facility must ensure air conditioning systems can maintain and does maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) A new large Type B assisted living facility must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) A new large Type B assisted living facility may not use an open flame heating device in the facility, except as permitted by this section.

(D) A new large Type B assisted living facility must ensure any heating device, other than a central heating plant, meets the requirements of 18.5.2.2, in NFPA 101, Chapter 18, New Health Care Occupancies.

(E) A new large Type B assisted living facility must ensure a suspended unit heater meets the requirements of 18.5.2.3(1), in NFPA 101, Chapter 18, New Health Care Occupancies.

(F) A new large Type B assisted living facility must ensure a direct-vent gas fireplace, as defined in NFPA 54, meets the requirements of 18.5.2.3(2), in NFPA 101, Chapter 18, New Health Care Occupancies.

(G) A new large Type B assisted living facility must ensure a fuel-burning fireplace meets the requirements of 18.5.2.3(3), in NFPA 101, Chapter 18, New Health Care Occupancies.

(3) Ventilation.

(A) A new large Type B assisted living facility must be ventilated using mechanical ventilation.

(B) A new large Type B assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. A new large Type B assisted living facility must ensure bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with powered exhaust vented to the exterior for odor control.

§553.248.Electrical Requirements for a New Large Type B Assisted Living Facility.

(a) Electrical system. A new large Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new large Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels can be found in The Lighting Handbook, latest edition, published by the Illuminating Engineering Society, but must not be lower than:

(1) 10 footcandles in resident rooms during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room.

(2) 20 footcandles in each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator during the day--illumination requirements for these areas apply to lighting throughout the space, as measured at 30 inches above the floor anywhere in the room.

(3) 50 footcandles for each medication preparation or storage area, kitchen, and desk within a staff station--illumination requirements apply when the area is in use for a task it supports, as measured where the task is being performed.

(c) Telephone. A new large Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents for use in case of an emergency. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new large Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must:

(A) be a direct telephone, emergency call system, or intercom;

(B) include at least:

(i) one central notification station at a fixed location that receives all calls processed through the system; and

(ii) one permanently fixed call station or device in every resident living unit.

(2) A new large Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification; or

(B) additional call stations or devices in private or common resident areas.

(3) A new large Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands. However, a device may not be a substitute for a fixed call station in a resident living unit.

(e) Generator.

(1) A new large Type B assisted living facility that provides a system to supply, distribute, and control electricity for emergency lighting and illumination of exit signs required by NFPA 101, such as a system that uses a generator set as an alternate source of power, must comply with the requirements of Article 700, Emergency Systems, in NFPA 70, Chapter 7, Special Conditions.

(A) The emergency system may not include any systems or equipment except:

(i) emergency lighting, as required by NFPA 101;

(ii) secondary power to ensure illumination of exit signs, as required by NFPA 101; and

(iii) secondary power for detection, alarm, and communications systems, as required by NFPA 72.

(B) A new large Type B assisted living facility must ensure wiring from an emergency source to emergency loads is kept entirely independent of all other wiring and equipment except as permitted by Article 700.10, Wiring, Emergency System, in NFPA 70. Two or more emergency circuits supplied from the same source may be routed in the same raceway, cable, box, or cabinet.

(C) A new large Type B assisted living facility must ensure that transfer equipment for an emergency system does not serve another facility, including a hospital, a nursing facility or an independent living facility.

(2) A new large Type B assisted living facility that provides a system to supply, distribute, and control electricity for systems and equipment not identified in paragraph (1) of this subsection must comply with the requirements of Article 702, Optional Standby Systems, in NFPA 70.

(3) The alternate power source for the emergency system may supply other emergency loads, legally required standby loads, and optional standby system loads where the source has adequate capacity to ensure adequate power to the different circuits in the following priority:

(A) emergency circuits for the assisted living facility;

(B) legally required standby circuits, if any; and

(C) optional standby circuits, if any.

(4) A new large Type B assisted living facility is not required to comply with the requirements of Article 517, Health Care Facilities, in NFPA 70.

§553. 249.Miscellaneous Requirements for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located and the facility admits residents with mobility impairments.

(b) A new large Type B assisted living facility must ensure an elevator meets the requirements of 18.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 18, New Health Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101374

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


DIVISION 12. SPECIALIZED ASSISTED LIVING FACILITIES

26 TAC §553.251

STATUTORY AUTHORITY

The new section is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and is authorized to adopt rules governing the rights and duties of persons regulated by the health and human services system; and by Texas Health and Safety Code §247.025 and §247.026, which respectively require the Executive Commissioner to adopt rules necessary to implement Health and Safety Code, Chapter 247, relating to Assisted Living Facilities, and to prescribe by rule minimum standards to protect the health and safety of an assisted living facility resident.

The new section implements Texas Government Code §531.0055 and Texas Health and Safety Code, Chapter 247.

§553.251.Construction Requirements for a Certified Alzheimer's Disease Assisted Living Facility.

(a) An assisted living facility must ensure an Alzheimer's Disease unit, if segregated from other parts of the Type B facility with approved security devices, meets the requirements of this section within the Alzheimer's Disease unit.

(b) An Alzheimer's Disease certified assisted living facility must ensure resident living areas meet the requirements for resident living areas in Type B assisted living facilities, as specified in §553.100(e) of this subchapter (relating to General Requirements).

(c) An Alzheimer's Disease certified assisted living facility must ensure resident toilet and bathing facilities meet the requirements for resident-use plumbing fixtures in Type B assisted living facilities as specified by §553.100(e) of this subchapter.

(d) An Alzheimer's Disease certified assisted living facility must ensure a monitoring station is provided within the Alzheimer's Disease unit and must provide the following amenities at the monitoring station:

(1) a writing surface, such as a desk or counter;

(2) a chair;

(3) task illumination at the task surface;

(4) a telephone or intercom; and

(5) lockable storage for resident records.

(e) An Alzheimer's Disease certified assisted living facility must provide access to at least two approved exits or means of escape remote from each other according to the requirements of NFPA 101.

(f) An Alzheimer's Disease certified assisted living facility must provide an outdoor area of at least 800 square feet in at least one contiguous space.

(1) The outside area must be connected to, be part of, be controlled by, and be directly accessible from the facility.

(2) An assisted living facility must ensure the area is enclosed with walls or fencing that do not allow climbing or present a hazard and:

(A) the minimum distance of the enclosure fence from the building is eight feet if the fence is parallel to the building and there are no window openings;

(B) the minimum distance of the enclosure fence, parallel with building walls, from resident bedroom windows is 20 feet if the fencing is solid and 15 feet from bedroom windows if the fencing is open; or

(C) for unusual or unique site conditions, areas of enclosure may have alternate configurations with the prior approval of the Texas Health and Human Services Commission; and

(D) the minimum dimensions in subparagraphs (A) - (C) of this paragraph do not apply to:

(i) additional fencing erected along property lines; or

(ii) building setback lines for privacy or for meeting the requirements of local building authorities.

(3) An assisted living facility must provide access to at least two approved exits from the enclosed area that are remote from each other and meet the requirements of NFPA 101.

(4) Where a required exit discharges into the enclosed area, an assisted living facility must meet the following additional requirements:

(A) if only one exit is enclosed, a minimum of two gates must be remotely located from each other;

(B) if two or more exits are enclosed by the fencing and unrestricted entry access can be made at each door, a minimum of one gate is required;

(C) any gate must be located to provide a continuous path of travel from the building exit to a public way, including walkways of concrete, asphalt, or other approved materials; and

(D) if gates are locked, the gate nearest the exit from the building must be locked with an electronic lock that operates the same as electronic locks specified in subsection (h) of this section and meets the requirements of NFPA 70 for exterior exposure.

(i) Additional gates may be locked according to the requirements of subsection (h) of this section or be locked using keyed locks, provided all staff carry the keys at all times.

(ii) All gates may be locked using keyed locks, provided all staff carry the keys, and the outdoor area includes an area of refuge meeting the following requirements:

(I) the area extends beyond a line parallel to the building at a minimum distance of 30 feet from the building; and

(II) the area of refuge allows at least 15 square feet per person, including residents, staff, and visitors potentially present at the time of an emergency.

(g) Locking devices may be used on Alzheimer's Disease unit control doors provided the following requirements are met.

(1) The building must have an approved fire sprinkler system and an approved fire alarm system meeting the requirements of this subchapter.

(2) The locking device must be electronic and must be released when any of the following occurs:

(A) activation of the fire alarm or fire sprinkler system;

(B) power failure to the facility or to the locking device; and

(C) activating a switch or button located at the monitoring station and at the main staff station.

(3) A key pad, credential reader, or buttons may be located at the control doors for routine use by staff.

(4) Staff must be trained in all the methods of releasing the locking device.

(h) Locking devices may be used on Alzheimer's Disease unit exit doors provided the following requirements are met:

(1) the locking arrangement meets the requirements for Delayed Egress Locking Systems in NFPA 101; or

(2) the following criteria are met:

(A) the building must have an approved fire sprinkler system and an approved fire alarm system meeting the requirements of this subchapter;

(B) the locking device must be electro-magnetic; that is, no type of throw-bolt is to be used;

(C) the locking device must release when any of the following:

(i) activation of the fire alarm or fire sprinkler system;

(ii) power failure to the facility or to the locking device; or

(iii) activation of a switch or button located at the monitoring station and at the main staff station;

(D) a key pad, credential reader, or buttons may be located at the exit door for routine use by staff;

(E) a manual fire alarm pull must be located within five feet of each exit door with a sign stating, "Pull to release door in an emergency"; and

(F) staff must be trained in all the methods of releasing the door device.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 29, 2021.

TRD-202101375

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3161


CHAPTER 750. MINIMUM STANDARDS FOR INDEPENDENT FOSTER HOMES

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes the repeal of Title 26, Part 1, Chapter 750, regarding Minimum Standards for Independent Foster Homes. The repealed chapter is comprised of §§750.1, 750.3, 750.5, 750.41, 750.43, 750.61, 750.101, 750.103, 750.105, 750.107, 750.109, 750.111, 750.121, 750.123, 750.131, 750.133, 750.151, 750.153, 750.155, 750.157, 750.159, 750.161, 750.163, 750.165, 750.167, 750.169, 750.171, 750.181, 750.183, 750.185, 750.201, 750.231, 750.233, 750.235, 750.237, 750.239, 750.241, 750.243, 750.245, 750.301, 750.331, 750.333, 750.351, 750.353, 750.355, 750.371, 750.373, 750.401, 750.403, 750.451, 750.453, 750.455, 750.501, 750.503, 750.601, 750.701, 750.801, 750.901, 750.1001, 750.1003, 750.1004, 750.1005, 750.1007, 750.1009, 750.1101, and 750.1201.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement House Bill (H.B.) 7, 85th Legislature, Regular Session, 2017, as it applies to Title 26, Texas Administrative Code (TAC), Chapter 750, Minimum Standards for Independent Foster Homes. Prior to this bill, an independent foster home was identified in Chapter 42, Texas Human Resources Code, as a "foster group home" or "foster home." HHSC Child Care Regulation (CCR) directly licensed independent foster group homes. Even prior to this legislation, CCR did not license many independent foster homes. The majority of foster homes were verified by a child-placing agency. Now child-placing agencies verify and monitor all foster homes, as explained in Texas Human Resources Code §42.053 and 26 TAC Chapter 749, Minimum Standards for Child-Placing Agencies.

H.B. 7 required all independent foster homes to close or transition into being another type of regulated child care operation. The bill also removed all references to independent foster homes in Texas Human Resources Code and prohibited CCR from licensing any independent homes after August 31, 2017. The Minimum Standards for independent foster homes continued to serve a purpose only so long as an independent foster home existed. In 2020, the last remaining independent foster homes were closed. Accordingly, the minimum standards in Chapter 750 are no longer necessary.

SECTION-BY-SECTION SUMMARY

The proposed repeal of Title 26, Chapter 750 removes rules that are no longer necessary.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the chapter repeal will be in effect, there are no foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the repeals will be in effect:

(1) the proposed repeals will not create or eliminate a government program;

(2) implementation of the proposed repeals will not affect the number of HHSC employee positions;

(3) implementation of the proposed repeals will result in no assumed change in future legislative appropriations;

(4) the proposed repeals will not affect fees paid to HHSC;

(5) the proposed repeals will not create new rules;

(6) the proposed repeals will not expand existing rules;

(7) the proposed repeals will not change the number of individuals subject to the rules; and

(8) the proposed repeals will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities required to comply with the repealed rules. The proposed repeals do not impose any costs on these entities because there are no providers or businesses that are currently subject to the rules.

LOCAL EMPLOYMENT IMPACT

The proposed chapter repeal will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the repeals do not impose a cost on regulated persons and are necessary to implement legislation that does not specifically state that §2001.0045 applies.

PUBLIC BENEFIT AND COSTS

Jean Shaw, Associate Commissioner for Child Care Regulation, has determined that for each year of the first five years the proposed repeals are in effect, the public benefit will be compliance with statutory requirements.

Trey Wood has also determined that for the first five years the repeals are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because no persons are currently subject to the rules.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Questions about the content of this proposal may be directed to Ryan Malsbary by email at Ryan.Malsbary@hhsc.state.tx.us.

Written comments on the proposal may be submitted to Ryan Malsbary, Rules Writer, Child Care Regulation, Texas Health and Human Services Commission, E-550, P.O. Box 149030, Austin, Texas 78714-9030; or by email to CCLrules@hhsc.state.tx.us.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 21R036" in the subject line.

SUBCHAPTER A. PURPOSE AND SCOPE

26 TAC §§750.1, 750.3, 750.5

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.1.What is the purpose of this chapter?

§750.3.Who is responsible for complying with the rules of this chapter?

§750.5.How must I interpret the different terminology used in the requirements of Chapter 749 of this title (relating to Child-Placing Agencies)?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101267

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER B. DEFINITIONS AND SERVICES

DIVISION 1. DEFINITIONS

26 TAC §750.41, §750.43

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.41.What do certain pronouns mean in this chapter?

§750.43.What do certain words and terms mean in this chapter?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101268

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 2. SERVICES

26 TAC §750.61

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.61.What are the requirements regarding services?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101269

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER C. ORGANIZATION AND ADMINISTRATION

DIVISION 1. PERMIT HOLDER RESPONSIBILITIES

26 TAC §§750.101, 750.103, 750.105, 750.107, 750.109, 750.111

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.101.What are my responsibilities as the permit holder before I begin operating?

§750.103.What are my operational responsibilities as permit holder?

§750.105.What responsibilities do I have for personnel policies and procedures?

§750.107.What must my conflict of interest policies include?

§750.109.What are the rights and responsibilities of the foster home and Licensing?

§750.111.What must a policy for protecting children from vaccine-preventable diseases include?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101270

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 2. GOVERNING BODY

26 TAC §750.121, §750.123

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.121.What are the specific responsibilities of the governing body?

§750.123.After a permit has been issued, what subsequent information regarding my governing body must I provide to Licensing, and when must I provide it?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101271

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 3. FISCAL REQUIREMENTS

26 TAC §750.131, §750.133

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.131.What are my general fiscal requirements?

§750.133.What are my specific fiscal requirements?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101272

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 4. FOSTER HOME POLICIES

26 TAC §§750.151, 750.153, 750.155, 750.157, 750.159, 750.161, 750.163, 750.165, 750.167, 750.169, 750.171

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.151.What are the general requirements for my home's policies?

§750.153.What are the requirements for my admission policies?

§750.155.With whom must I share my admission policies?

§750.157.What child-care policies must I develop?

§750.159.What emergency behavior intervention policies must I develop if the use

§750.161.What policies must I develop on the discipline of children in foster care?

§750.163.What foster care policies must I develop?

§750.165.What additional policies must I develop if my home provides treatment services?

§750.167.What policies must I develop if I offer a transitional living program?

§750.169.What policies must I develop for babysitters, overnight care providers, and respite care providers?

§750.171.What policies must I develop if I use volunteers?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101273

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 5. CLIENTS AND APPEALS

26 TAC §§750.181, 750.183, 750.185

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.181.Who are my clients?

§750.183.What rights do my adult clients have?

§750.185.What must my appeal process include?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101274

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER D. REPORTS AND RECORD KEEPING

DIVISION 1. REPORTING SERIOUS INCIDENTS AND OTHER OCCURRENCES; OPERATIONS RECORDS; AND PERSONNEL RECORDS

26 TAC §750.201

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.201.What are the requirements for reports and record keeping?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101275

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 2. CLIENT RECORDS

26 TAC §§750.231, 750.233, 750.235, 750.237, 750.239, 750.241, 750.243, 750.245

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.231.What client records must I maintain?

§750.233.Where must I maintain active records for clients?

§750.235.What is an active record for a child?

§750.237.What information must an active child record include?

§750.239.How must I maintain an active child record?

§750.241.Where must I maintain archived client records?

§750.243.Who must consent to the release of a child's record?

§750.245.How long must I maintain client records?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101276

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER E. FOSTER HOME STAFF AND CAREGIVERS

DIVISION 1. GENERAL REQUIREMENTS

26 TAC §750.301

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.301.What are the general requirements for foster home staff and caregivers?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101277

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 2. EXECUTIVE DIRECTOR

26 TAC §750.331, §750.333

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.331.What qualifications must an executive director meet?

§750.333.What are the responsibilities of the executive director?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101278

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 3. TREATMENT DIRECTOR

26 TAC §§750.351, 750.353, 750.355

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.351.Must I have a treatment director?

§750.353.What qualifications must a treatment director have?

§750.355.If I provide more than one type of treatment service, can I have one treatment director?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101279

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


DIVISION 4. TREATMENT SERVICES PROVIDED BY NURSING PROFESSIONALS; CONTRACT STAFF AND VOLUNTEERS

26 TAC §750.371, §750.373

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.371.What are the requirements for treatment services provided by nursing professionals?

§750.373.What are the requirements for contract staff, volunteers, and student interns?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101280

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER F. TRAINING AND PROFESSIONAL DEVELOPMENT

26 TAC §750.401, §750.403

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.401.What are the requirements for training and professional development?

§750.403.What are the pre-service experience requirements for caregivers?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101281

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER G. CHILDREN'S RIGHTS

26 TAC §§750.451, 750.453, 750.455

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.451.What are the requirements regarding children's rights?

§750.453.What right does a child have regarding contact with a parent?

§750.455.What right to privacy does a child have with respect to his contact with others?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101282

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER H. ADMISSION

26 TAC §750.501, §750.503

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.501.What are the requirements for admission?

§750.503.Who must develop the admission assessment?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101283

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER I. SERVICE PLANNING, AND DISCHARGE

26 TAC §750.601

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.601.What are the requirements for service planning and discharge?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101284

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER J. MEDICAL AND DENTAL

26 TAC §750.701

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.701.What are the requirements for medical and dental care?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101285

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER K. DAILY CARE, PROBLEM MANAGEMENT

26 TAC §750.801

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.801.What are the requirements for daily care and problem management?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101286

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER L. EMERGENCY BEHAVIOR INTERVENTION

26 TAC §750.901

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.901.What are the requirements regarding emergency behavior intervention?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101287

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER M. CAPACITY AND CHILD/CAREGIVER RATIO; SUPERVISION; RESPITE CHILD-CARE SERVICES; AND FOSTER FAMILY RELATIONSHIPS

26 TAC §§750.1001, 750.1003 - 750.1005, 750.1007, 750.1009

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeals implement Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.1001.What are the requirements for capacity and child/caregiver ratios?

§750.1003.What are the requirements for supervision?

§750.1004.What are the requirements for normalcy?

§750.1005.What are the requirements for respite child-care services?

§750.1007.What are the requirements for foster family relationships?

§750.1009.When must you notify Licensing of changes that affect the foster home?

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101288

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER N. HEALTH AND SAFETY REQUIREMENTS, ENVIRONMENT, SPACE AND EQUIPMENT

26 TAC §750.1101

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.1101.What are the requirements for health and safety, environment, space, and equipment?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101289

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269


SUBCHAPTER O. ASSESSMENT SERVICES

26 TAC §750.1201

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies, and §531.02011, which transferred the regulatory functions of the Department of Family and Protective Services to HHSC. In addition, Texas Human Resources Code §42.042(a) requires HHSC to adopt rules to carry out the requirements of Chapter 42 of the Texas Human Resources Code. H.B. 7 removed all references to "foster group home" and "foster home" from Chapter 42 of Texas Human Resources Code, so that HHSC may no longer issue licenses to these types of operations.

The repeal implements Texas Government Code §531.0055 and Texas Human Resources Code §42.042.

§750.1201.What are the requirements to provide an assessment services program?

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on March 23, 2021.

TRD-202101290

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: May 9, 2021

For further information, please call: (512) 438-3269