Survey Operations Resume as of June 15th, 2020

As of June 15, 2020, Survey Operations has begun to resume some normal survey activity, and Enforcement is also resuming enforcement processes and activities. This means we will be issuing various due process notice letters to individuals, agencies, and facilities that have been on hold due to COVID.
Please contact Enforcement Director Derek Jakovich by email at if you have questions.
In response to questions regarding what normal survey and enforcement activities are resuming as of June 15 and what programs are affected, HHSC replied as follows:
As of June 15, 2020 Survey Operations is resuming some survey activity such as complaints with lower priorities, and possibly some licensure and certification surveys. For Enforcement, due process notice letters such as denials, revocations, and imposition of administrative penalties will be issued and the opportunity to appeal will be provided. Of course, the COVID circumstances may affect these activities.
The notice applies to NF, ALF, DAHS, PPECC, HCSSA, and ICF/IID.

Providers Must Log Residents’ Leave

All community-based ICF/IID program providers must submit an absence request in the TMHP ICF/IID Online Portal for a resident away from the facility for one or more full days. See the TMHP ICF/IID Online Portal User Guide (PDF) starting on page 52 for more information. The program provider must submit a return request within three days after a resident returns to the facility. See page 58 of the Online Portal User Guide for an explanation.

Please ensure that information entered in the portal for absences is current. HHSC uses the information to determine how many residents are absent from their facilities and the length of those absences.


Very Important Information:  ICF License Renewals!!!

Regardless of whether HHSC sends advance notice that a license is expiring, providers are responsible for applying to renew their licenses in a timely manner. Furthermore, operating an ALF, DAHS facility, HCSSA, ICF/IID, NF, or PPECC without a license is a violation of state law.2.0Policy Details & Provider ResponsibilitiesSubject to certain narrow exceptions, state law requires a person to have a license if the person:•establishes or operates an ALF;1•operates a DAHS facility;2•engages in the business of providing home health, hospice, habilitation, or personal assistance services, or represents to the public 1Texas Health and Safety Code §247.021.2Human Resources Code, §103.0041.

PL 20-03 January 9, 2020
If a person is a provider of home health, hospice, habilitation, or personal assistance services for pay establishes, conducts, or maintains an ICF/IID or an NF owner or operates a PPECC, the expiration date of a license is printed on the license.
A provider must apply for a renewal license before its current license expires if the provider intends to engage in the activity that requires a license after the current license expires.
If a provider submits a sufficient application to renew its license, including applicable fees, to HHSC before its license expires, the license continues in effect and the provider may continue to operate while HHSC is processing the renewal application. If a provider does not submit a sufficient application to renew its license before it expires and continues to engage in the activity that requires a license after the license expires, the person is violating state law. HHSC may take enforcement action or pursue civil remedies against a person under those circumstances as per the statute and regulations applicable to that provider type. If a license expires without being renewed, the person who held the license must apply for an initial license as a new applicant. The person may not engage in the activity for which a license is required until HHSC issues a new initial license. The applicant must meet all requirements for an initial license, including any Life Safety Code or construction requirements. Any waivers, such as waivers of requirements related to room size in a facility, that were granted under the expired license will no longer be in effect.

Texas Health and Safety Code §142.002.4Texas Health and Safety Code §252.031.5Texas Health and Safety Code §242.031.6Texas Health and Safety Code §248A.051. 726 Texas Administrative Code (TAC) §553.15(a)(2) and (e) for ALF, 40 TAC §98.15(a)(2) and (e) for DAHS, 26 TAC §558.17(a) and (g)(2)and (3)for HCSSA, 26 TAC §551.15(d) for ICF/IID, 40 TAC §19.208(e) for NF, and 26 TAC §550.106(a) and (e) for PPECC.

PL 20-03 January 9, 2020
The Texas Unified Licensure Information Portal, which is the system HHSC uses for issuing and renewing licenses, has not been notifying providers that their licenses are about to expire. This PL is to remind providers that the expiration date of a license is printed on the license and, regardless of whether HHSC sends advance notice of an upcoming expiration, a provider must take necessary action to renew a license so the provider is operating in compliance with state law.
Contact Information
If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at or call (512) 438-3161.

Provider Joint Training Opportunities

Check out Joint Provider Trainings link from HHSC, for more info:



Survey Process for ICF Has Changed: Please Be Aware

You may check your SOMA (Surveyor’s Operational Manual for ICF in Appendix J) for these changes.

Look for our live training session coming in July 2020 on Appendix Q changes!

“Changes to Appendix Q-Immediate Jeopardy for ICF and What That Means For The Provider”

Webinar in July, 2020

Appendix Q of SOMA (Immediate Jeopardy) Changes

CMS clarifications letter

Online basic training for Core Appendix Q is available on the Integrated Surveyor Training
Website at the following link:
This basic training is intended to provide Regional Office and State Survey Agency surveyors, management staff, and
training coordinators, as well as providers, suppliers, and laboratories, and other stakeholders with
the ability to identify immediate jeopardy
NOTE: This is a required training for RO and SA staff involved in immediate jeopardy
determinations. All RO and SA surveyors, members of management, and training coordinators
are expected to take this training as soon as practicable, but not later than March 22, 2019.
Point of Contact:
For questions related to this information, please add in subject line
“Immediate Jeopardy Inquiry” and send your email to:  
Effective Date:
Immediately-This policy should be communicated to all survey and certification staff, their managers and the State
and Regional Office training coordinators within 30 days of this memorandum.


SOMA appendix Q Section  Immediate Jeopardy


II.  Proposed ICF/IID Rates: Below please find the link to information about the August 2, 2019 HHSC public hearing on the proposed ICF/IID rates.  The hearing will be at 3:00 p.m. and held in the HHSC public hearing room (first floor of HHSC).  Additional information about the hearing (specifically, needed member action) will be forthcoming.
Though the above link provides the proposed rates, below is a chart which reflects both the current and proposed ICF/IID rates.  Note that with the exception of LON 9, all LON categories and facility settings/sizes are proposed to receive an increase.  Also, at this time, the specifics regarding the impact of the increases on the rate categories (residential direct and indirect  & day habilitation direct and indirect) are not yet available.  According to HHSC the ‘specifics’ should be available on or after this Friday (July 19, 2019).

LON & Facility Size

Current Rates

Proposed Rates