Texas Register


  • CHAPTER 558. LICENSING STANDARDS FOR HOME AND COMMUNITY SUPPORT SERVICES AGENCIES  SUBCHAPTER I. RESPONSE TO COVID-19 AND PANDEMIC-LEVEL COMMUNICABLE DISEASE 26 TAC §558.960 HHSC is adopting an emergency rule to define criteria for screening staff, clients, and household members for COVID-19, to require that related documentation be made available to HHSC upon request, and to clarify that HCSSA staff must comply with a long-term care facility’s infection control protocols when entering to provide essential services.
  • Reminder~HHSC Provides Guidance for Revised HCSSA COVID-19 Response Emergency Rule (PL 2022-21) was released last week.  This letter provides guidance and describes the key changes in regulations adopted in emergency rule 26 TAC §558.960 (relating to HCSSA Response to COVID-19), which became effective on March 24, 2022.  Areas addressed are:  infection control, screening and non-essential visits.  To access, go to:  https://www.hhs.texas.gov/sites/default/files/documents/pl2022-21.pdf.

TITLE 26. HEALTH AND HUMAN SERVICES PART 1. HEALTH AND HUMAN SERVICES COMMISSION CHAPTER 556. NURSE AIDES 26 TAC §§556.2, 556.3, 556.5 – 556.13Texas Health and Human Services Commission (HHSC) proposes amendments to: §556.2 Definitions;

  • 556.3 Nurse Aide Training and Competency Evaluation Program (NATCEP) Requirements;
  • 556.5 Program Director, Program Instructor, Supplemental Trainers, and Skills Examiner Requirements;
  • 556.6 Competency Evaluation Requirements;
  • 556.7 Review and Reapproval of a Nurse Aide Training and Competency Evaluation Program (NATCEP);
  • 556.8 Withdrawal of Approval of a Nurse Aide Training and Competency Evaluation Program (NATCEP);
  • 556.9 Nurse Aide Registry and Renewal;
  • 556.10 Expiration of Active Status;
  • 556.11 Waiver, Reciprocity, and Exemption Requirements;
  • 556.12 Findings and Inquiries; and
  • 556.13 Alternate Licensing Requirements for Military Service Personnel.

To review, go to:  https://www.sos.state.tx.us/texreg/archive/April82022/Proposed%20Rules/26.HEALTH%20AND%20HUMAN%20SERVICES.html#67.

Please remember if you choose to hire a certified nurse aide you must comply with regulation.  It is the hospice’s choice to hire a C.N.A.  As outlined if federal rules 42 CFR 418.76 (a), the hospice has 3 options to choose from for the qualifications for a hospice aide.  (iii) is the option to hire a certified nurse aide.  You are told to comply with the state requirements.  Go to:  https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/subject-group-ECFR74797288a614803/section-418.76.


Federal News and Information


Hospices: Aggregate and Inpatient Caps under the Value-Based Insurance Design Model

Is your Medicare patient enrolled in a Medicare Advantage plan that’s participating in the Value Based Insurance Design (VBID) Model’s Hospice Benefit Component? If so, you can’t include your Medicare Advantage plan payments for these patients in calculating your aggregate and inpatient cap payments for January 1, 2021-December 31, 2024, the performance period of the Model component.  For more information, go to:

Value-Based Insurance Design Model: Medicare Advantage Organizations Pay for Hospice Care

Under the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model, participating Medicare Advantage Organizations (MAOs) retain responsibility for all Original Medicare services, including hospice care. MAOs must pay for:

  • Non-hospice care provided to a hospice enrollee during a hospice stay, such as the items, drugs, or services that are furnished to treat a condition unrelated to the terminal illness and related conditions
  • Other non-hospice care (items, drugs, or services) that are furnished after a hospice stay ends (in the event of a live discharge, including non-hospice care provided on the last day of the stay through the end of the calendar month that the hospice stay ends)

Information can be accessed above.


Centers for Medicare and Medicaid Services (CMS)

CMS To End COVID-19 Waivers for NFs, ICF/IIDs, Inpatient Hospices on May 7 or June 6, 2022 (QSO-22-15-NH & NLTC & LSC)

The Centers for Medicare & Medicaid Services has issued QSO-22-15-NH & NLTC & LSC (https://www.cms.gov/files/document/qso-22-15-nh-nltc-lsc.pdf). The memo will end COVID-19 emergency declaration blanket waivers for nursing facilities, skilled nursing facilities, ICF/IIDs, and inpatient hospices in two phases:

  • 30 days from April 7, 2022
  • 60 days from April 7, 2022

The following waivers will end May 7, 2022:

  • Resident Groups in SNF/NFs – 42 CFR §483.10(f)(5)
  • Physician Delegation of Tasks in SNFs – 42 CFR §483.30(e)(4)
  • Physician Visits in in SNF/NFs – 42 CFR §483.30(c)(3)
  • Physician Visits in Skilled Nursing Facilities/Nursing Facilities – 42 CFR §483.30
  • Quality Assurance and Performance Improvement (QAPI) in SNF/NFs – 42 CFR §483.75(b)–(d) and (e)(3)
  • Detailed Information Sharing for Discharge Planning in SNF/NFs – 42 CFR §483.21(c)(1)(viii)
  • Clinical Records in SNF/NFs – 42 CFR §483.10(g)(2)(ii)

The following waivers will end June 6, 2022:

  • Training and Certification of Nurse Aides for SNF/NFs (42 CFR §483.35(d)) – a SNF or NF may not employ anyone for longer than four months unless they met specific training and certification requirements.

PLEASE NOTE: Nurse aides will have until October 6, 2022 to successfully complete the required training and certification, regardless of the amount of time worked during the time the waiver was in effect. Nurse aides who want to use SNF/NF work training and experience gained during the COVID-19 public health emergency to count toward nurse aide certification must follow the process outlined in Provider Letter 2021-19 – Certification Process for Nurse Aides Training and Working Under a Waiver at: https://www.hhs.texas.gov/sites/default/files/documents/providers/communications/2021/letters/PL2021-19.pdf.

  • Physical Environment for SNF/NFs – 42 CFR §483.90
  • Facility and Medical Equipment Inspection, Testing & Maintenance (ITM) for Inpatient Hospice, ICF/IIDs and SNFs/NFs – 42 CFR §§418.110(c)(2)(iv), 483.470(j), and 483.90
  • Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM for Inpatient Hospice, ICF/IIDs and SNFs/NFs – 42 CFR §§ 418.110(d)(1)(i) and (e), 483.470(j)(1)(i) and (5)(v), and 483.90(a)(1)(i) and (b)
  • Outside Windows and Doors for Inpatient Hospice, ICF/IIDs and SFNs/NFs – 42 CFR §§418.110(d)(6), 483.470(e)(1)(i), and 483.90(a)(7)
  • Life Safety Code for Inpatient Hospice, ICF/IIDs, and SNFs/NFs – 42 CFR §§418.110(d), 483.470(j), and 483.90(a)
  • Paid Feeding Assistants for SNF/NFs – 42 CFR §§483.60(h)(1)(i) and 483.160(a)
  • In-Service Training for SNF/NFs – 42 CFR §483.95(g)(1)

Hospice Visits in the Last Days of Life

In February 2022, the National Quality Forum (NQF) endorsed the claims-based measure, Hospice Visits in the Last Days of Life, or HVLDL as NQF #3645. NQF is a not-for-profit, nonpartisan, membership-based organization that facilitates an evidence- and consensus-based approach to endorsing quality measures. HVLDL reflects the proportion of hospice patients who received in-person visits from a registered nurse or a medical social worker on at least 2 of the final 3 days of life. HVLDL is the re-specified measure replacing the HIS-based Hospice Visits When Death is Imminent (HVWDII). Public reporting for HVLDL will begin in May 2022 and will replace public reporting of HVWDII.  More information, including a link to the NQF website, can be found on the HQRP Quality Measure Development webpagehttps://www.cms.gov/medicare/hospice-quality-reporting-program/quality-measure-development.   The NQF can be accessed at: https://www.qualityforum.org/Home.aspx.


Texas News and Information

Supportive Palliative Care and Palliative Care Accreditation and Additional Information

Hospice providers who provide in-home supportive palliative care (SPC) must hold a license home health (LHH) category.  This must be done prior to seeking a palliative care accreditation with an accreditation company (AO).  Please note the following information:

  • State statute does not provide for provisional licensure, HCSSAs must have a license to provide any services to even one client in Texas.
  • Each of the AOs are required to be aware of changes in state licensing standards and interpretations posted on the Health and Human Services Commission (HHSC) website to ensure their standards and practices in the state are appropriate.
  • The accreditation process includes a review of service delivery in addition to the review of policies and procedures in accordance with the AO standards which must meet or exceed state licensing standards. Although the AO may have a procedure whereby it begins the accreditation process with a prospective agency to provide guidance and initial discussion, this is not dictated by HHSC.
  • The steps a hospice agency seeking to provide SPC to non-hospice elected clients may include reaching out to the desired AO for guidance and information prior to obtaining the LHH category, but no accreditation can be conveyed without appropriate licensure.

SPC – Additional Information:

If you are not operating as separate entities (hospice and supportive palliative care) you are required to use OASIS.


  • Obtain your LHH via TULIP
  • Notify your ACO or soon to be ACO of your LHH
  • Comply with 26 Texas Administrative Code Chapter 558 Subchapter D
  • Oasis as needed.


Disclaimer:  The Texas and New Mexico Hospice Organization publishes the Regulatory Update as an information only item.  TNMHO has no attorneys nor does it represent the state and federal governments.  All legal questions or concerns should be directed to your attorney or the governments involved.