Revision 07-3


§19.1 Basis and Scope


(a) Basis in legislation. The Nursing Facility Requirements for Licensure and Medicaid Certification specify requirements of federal and state laws and regulations governing licensed nursing facilities and the Title XIX Nursing Facilities vendor program administered by the Texas Department of Human Services (DHS) in cooperation with other federal and state agencies. If there is a conflict between material in these requirements and the laws or regulations governing the program, the latter are controlling. It is the intent of the Texas Legislature that rules adopted under §242 of the Health and Safety Code may be more stringent than the standards imposed by federal law for certification for participation in the state Medicaid program. The rules and standards may not be less stringent than the Medicaid certification standards imposed under the Omnibus Budget Reconciliation Act of 1987.
(b) Scope. The Nursing Facility Requirements for Licensure and Medicaid Certification contain the requirements that an institution must meet in order to be licensed as a nursing facility and also to qualify to participate in the Medicaid program. The requirements serve as a basis for survey activities for licensure and certification.

(1) Certain requirements are specific to Medicaid-certified facilities and are so designated. The Medicaid-specific requirements apply to all residents, including, but not limited to private pay, Medicaid applicants and recipients, VA patients, and Medicare recipients, who are admitted to and reside in a Medicaid-certified facility or a Medicaid-certified distinct part of a facility.
(2) Additional Requirements for facilities or distinct parts of facilities that are certified for Medicare-only participation are in Chapter 42, Code of Federal Regulations, §§483.5 - 483.75.
(3) These requirements do not apply to skilled nursing facilities (SNFs) licensed under the Health and Safety Code, Chapter 241, participating only in the Medicare program.
(4) Additional documents that a facility may need for reference include, but are not limited to:

(A) Medication Aide Rules (DHS);
(B) Nurse Aide Training Rules (DHS);
(C) Nurse Aide Training Manual (DHS);
(D) Occupational Safety and Health Administration (OSHA) rules and guidelines;
(E) rules and regulations for the Control of Communicable Diseases (TDH);
(F) Medical Waste Regulation in Texas (Publication RG-1, Texas Natural Resource Conservation Commission);
(G) Nurse Practice Act and Licensed Vocational Nurse Act;
(H) Food Establishment Rules (TDH);
(I) Centers for Disease Control:

(i) Handwashing Guidelines;
(ii) Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public Safety Workers;
(iii) Guidelines for Isolation Precautions in Hospitals and Infection Control in Hospital Personnel;
(iv) Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures; and
(v) Prevention and Control of Tuberculosis in Facilities Providing Long Term Care to the Elderly;

(J) §§96.1-96.9 of this title (relating to Certification of Long Term Care Facilities);
(K) Methicillin-Resistant Staphylococcus Aureus: A Protocol for Infection Control (TDH); and
(L) HIV/AIDS Model Workplace Guidelines (TDH).