August 25th, 2021

Program Provider Response to COVID-19 and Visitation Expansion for HCS

(PL 2021-30)

HHSC published Provider Letter 2021-30 Program Provider Response to COVID-19 and Visitation Expansion for HCS. This letter replaces PL 2021-09.  This letter describes the actions a program provider must take to mitigate COVID-19 according to Executive Order GA-38(link is external) and CDC guidance and the criteria for expanded indoor and outdoor visitation as well as essential caregiver visits.

As part of the continued reopening of the State of Texas, the Texas Health and Human Services Commission (HHSC) has published new Home and Community-based Services (HCS) Program Provider Response to COVID-19 Emergency Rule1 and HCS Expansion of Reopening Visitation Rule2.

HCS Program Provider Response to COVID-19 Emergency Rule HHSC published new HCS Program Provider Response to COVID-19 – Mitigation Rules effective August 21, 2021. These new rules replace the previous COVID-19 mitigation rules. See the HCS Program Provider Response to COVID-19 Emergency Rule at 40 TAC 9.198 for the complete list of requirements. Notable updates include the following.

HHSC added the definition for a “fully vaccinated person,” which is a person who received the second dose in a two-dose series or a single dose of a one-dose COVID-19 vaccine and 14 days have passed since this dose was received

HCS Program Provider Response to COVID-19 Emergency Rule
Program providers are still required to implement personnel practices that safeguard individuals against the spread of COVID-19. Program providers must develop and implement an infection control policy that
:•ensures that they have processes in place to reduce the spread of communicable and infectious diseases;
•is updated to align with CDC guidance;
•may include the use of face masks; and
•is revised if a shortcoming is identified. These infection control policies should address the use of personal protective equipment (PPE). Program providers must have PPE available. If they are unable to obtain PPE, they will not be cited for not having certain supplies if they cannot obtain them for reasons outside of their control. Follow national guidelines for optimizing current supply or identify the next best option to care for the individuals
Program providers must ensure that all host homes, three-person, and four-person residences are equipped with soap, hand sanitizer, and any other disinfecting agents to maintain a healthful environment. Within residences, provider staff must ensure precautions such as, but not limited to:
•limiting physical contact, such as handshaking, hugging, etc. as recommended by the CDC;
•reinforcing strong hygiene practices for individuals and staff, such as proper handwashing, covering of coughs and sneezes, and the use of hand sanitizer;•practicing social distancing as defined by CDC; and

•regularly disinfecting all high-touch surfaces, such as counters, doorknobs, telephones, etc.

Face Coverings
HHSC removed the face mask and face-covering requirement when a staff member is providing care to a person with COVID-19 negative status.
However, if providing care to an individual with COVID-19, a program provider must still require staff to
:•wear appropriate PPE as defined by the CDC; and
•maintain physical distance according to CDC guidance as practicable.
A program provider may require the use of face masks as part of its infection control policy.
A program provider must screen individuals once a day in accordance with CDC guidance using the following criteria
:•a fever, defined as a temperature of 100.4 Fahrenheit or above;
•signs or symptoms of COVID-19, including chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea;
•any other signs and symptoms identified by the Centers for Disease Control and Prevention (CDC) in Symptoms of Coronavirus at; and
•contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, is under investigation for COVID-19, or is ill with a respiratory illness, regardless of whether the person is fully vaccinated, unless the visitor is seeking entry to provide critical assistance.
Day Habilitation and Outside Employment
HHSC removed the requirement found in previous COVID-19 emergency rules related to contracting with a day habilitation provider. Individuals receiving HCS or TxHmL services can choose to attend off-site day habilitation or outside employment.
Providers are responsible for ensuring the health and safety of the individuals in their care. In the context of deciding whether to attend outside day habilitation sites, the program provider fulfills this responsibility by participating in the informed decision-making process, which includes:
•providing a full list of available options and alternatives, including in-home day habilitation, if available;
•assessing the risks of attending day habilitation; and•providing training on hand hygiene, and physical distancing.
Program providers may use the CDC guidance for Interim Public Health Recommendations for Fully Vaccinated People for information regarding the use of face masks and physical distancing in a public setting.
Communal Dining and Activities
HHSC removed requirements related to meals and communal dining found in previous COVID-19 emergency rules. Program providers may use the CDC guidance for Communal Activities within a Healthcare Setting for information regarding group activities and communal dining……..
Some other Important information
Expanded Visitation
HHSC removed the requirement for certain program providers to complete an attestation form and use restrictive measures, such as plexiglass barriers.
A program provider must now offer a complete series of a one- or two-dose COVID-19 vaccine to individuals and staff and document each individual’s choice to vaccinate or not vaccinate.
A program provider must allow essential caregiver visits, end-of-life visits, indoor visits, and outdoor visits.
A program provider must also develop and enforce policies and procedures that ensure infection control practices for visitor, including whether the visitor and the individual must wear a face mask or face covering and whether the visitor should wear appropriate PPE.
The program provider must inform visitors of its infection control policies and procedures related to visitation.
While the program provider may ask about a visitor’s COVID-19 vaccination status and COVID-19 test results, it cannot require a visitor to provide documentation of a COVID-19 negative test or COVID-19 vaccination status as a condition of visitation or to enter the residence.
A visitor can be any age. However, essential caregivers must be 18 years of age or older.
As a reminder, an HCS provider is required to screen all visitors for signs or symptoms of COVID-19.
A visitor may not participate in a visit if the visitor has signs and symptoms of COVID-19 or active COVID-19 infection……
For more, please go to PL-2021-30
If you have any questions about this letter, please contact the LTCR Policyand Rules team by email at or call (512) 438-3161

(PL 2021-09) on Visitation Expansion

(This letter was published March 25th, 2021)

(PL 2021-09) on Visitation Expansion is no longer in place as of August 2021 It replaced the following Provider Letters:   PLs 2020-22 and 2020-40


September 21st, 2020



An ICF resident, as well as an individual living in an HCS group home, may have up to 2 Essential caregivers, as defined in the emergency rules, and they must have a negative COVID-19 test result from a test performed no more than 14 days before the first essential caregiver visit unless the facility chooses to perform a rapid test prior to entry into the facility.  Providers are still seeking clarification for some of the new COVID-19 emergency mitigation rules (including visitation rules) for persons receiving HH/CC services.  We plan to keep you updated!
Expanded ReopeningVisitation:
Phase 1 requirements all remain in place (except for compassionate care visits, which are being replaced with less restrictive essential caregiver visits.)
All facilities without an active facility acquired outbreak can move to visitation as outlined in the emergency rules(including those with isolation wings), but visitation is only allowed for residents/individuals,  who are NOT COVID positive and in areas away from COVID positive isolation areas.
Essential caregivers will be trained by the facility on PPE use and infection control, and they must meet the testing requirement.
Reopening is optional for facilities; those that do not feel they have the resources to re-open safely will not be mandated to open or allow for essential caregivers.
See the link below for more information on Visitation Rules for LTC Facilities, including ICF and HCS