A person must be licensed to establish or operate an assisted living facility in Texas.
1. An assisted living facility is an establishment that:
A. furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment;
i. personal care services;
ii. administration of medication by a person licensed or otherwise authorized in this state to administer the medication; or
iii. services described in clauses (i) and (ii) of this subparagraph; and
C. may provide assistance with or supervision of the administration of medication.
2. An assisted living facility may provide skilled nursing services for the following limited purposes:
A. coordinate resident care with an outside home and community support services agency or health care professional;
B. provide or delegate personal care services and medication administration,
as described in this chapter;
C. assess residents to determine the care required; and 20
D. deliver, for a period not to exceed 30 days, temporary skilled nursing
services for a minor illness, injury or emergency.
3. DADS considers one or more facilities to be part of the same establishment and, therefore, subject to licensure as an assisted living facility, based on the following factors:
A. common ownership;
B. physical proximity;
C. shared services, personnel, or equipment in any part of the facilities’ operations; and
D. any public appearance of joint operations or of a relationship between the facilities.
4. The presence or absence of any one factor in paragraph (3) of this subsection is not conclusive.
b. To obtain a license, a person must follow the application requirements in this subchapter and meet the criteria for a license.
c. An applicant must affirmatively show that the applicant, license holder, controlling person, and any person required to submit background and qualification information meet the criteria and eligibility for licensing, in accordance with this section, and:
1. the building in which the facility is housed:
A. meets local fire ordinances;
B. is approved by the local fire authority; and
C. meets DADS licensing standards in accordance with Subchapter D of this chapter (relating to Facility Construction) based on an on-site inspection by DADS; and
D. operation of the facility meets DADS licensing standards based on an onsite health inspection by DADS, which must include observation of the care of a resident; or
2. the facility meets the standards for accreditation based on an on-site accreditation
a survey by the accreditation commission.
d. An applicant who chooses the option authorized in subsection (c)(2) of this section mus contact DADS to determine which accreditation commissions are available to meet the requirements of that subsection.
e. DADS issues a license to a facility meeting all requirements of this chapter. The facility must not exceed the maximum allowable number of residents specified on the license.
f. DADS denies an application for an initial license or a renewal of a license if:
1. the applicant, license holder, controlling person, or any person required to submit background and qualification information has been debarred or excluded from the Medicare or Medicaid programs by the federal government or a state;
2. a court has issued an injunction prohibiting the applicant, license holder, controlling person, or any person required to submit background and qualification information from operating a facility; or
3. during the five years preceding the date of the application, a license to operate a health care facility, long-term care facility, assisted living facility, or similar facility in any state held by the applicant, license holder, controlling person, or
21any person required to submit background and qualification information has been revoked.
g. A license holder or controlling person who operates a nursing facility or an assisted living facility for which a trustee was appointed and for which emergency assistance funds, other than funds to pay the expenses of the trustee, were used is subject to exclusion from
1. the issuance of an initial license for a facility for which the person has not previously held a license; and
2. the renewal of the license of the facility for which the trustee was appointed.
h. DADS may deny an application for an initial license or refuse to renew a license if an applicant, license holder, controlling person, or any person required to submit background and qualification information:
1. violates Texas Health and Safety Code, Chapter 247; a section, standard or order adopted under Chapter 247; or a license issued under Chapter 247 in either a repeated or substantial manner;
2. commits an act described in §92.551(a)(2)-(7) of this chapter (relating to Administrative Penalties);
3. aids abet or permit a substantial violation described in paragraphs (1)-(2) of this subsection about which the person had or should have had knowledge;
4. fails to provide the required information, facts, or references;
5. provides the following false or fraudulent information:
A. knowingly submits false or intentionally misleading statements to DADS;
B. uses subterfuge or other evasive means of filing an application for licensure;
C. engages in subterfuge or other evasive means of filing on behalf of another who is unqualified for licensure;
D. knowingly conceals a material fact related to licensure; or
E. is responsible for fraud;
6. fails to pay the following fees, taxes, and assessments when due:
A. license fees as described in §92.4 of this chapter (relating to License Fees); or
B. franchise taxes, if applicable;
7. during the five years preceding the date of the application has a history in any
state or other jurisdiction of any of the following:
A. operation of a facility that has been decertified or has had its contract
canceled under the Medicare or Medicaid program;
B. federal or state long-term care facility assisted living facility, or similar facility sanctions or penalties, including monetary penalties, the involuntary downgrading of the status of a facility license, proposals to decertify, directed plans of correction, or the denial of payment for new Medicaid admissions;
C. unsatisfied final judgments, excluding judgments wholly unrelated to the provision of care rendered in long-term care facilities; 22
D. eviction involving any property or space used as a facility; or
E. suspension of a license to operate a health care facility, long-term care the facility, assisted living facility, or a similar facility;
8. violates Texas Health and Safety Code, §247.021 by operating a facility without a license; or
9. is subject to denial or refusal as described in Chapter 99 of this title (relating to
Denial or Refusal of License) during the time frames described in that chapter.
i. DADS reviews all information provided by an applicant, a license holder, a person with a disclosable interest, or a manager when considering grounds for denial of an initial license application or a renewal application in accordance with subsection (h)(8) of this
section. DADS may grant a license if DADS finds the applicant, license holder, person with a disclosable interest, affiliate, or manager is able to comply with the rules in this chapter.
j. DADS reviews final actions when considering the grounds for denial of an initial license application or renewal application in accordance with subsections (f) and (h)(8) of this section. An action is final when routine administrative and judicial remedies are
exhausted. An applicant must disclose all actions, whether pending or final.
k. If an applicant owns multiple facilities, DADS examines the overall record of compliance in all of the applicant’s facilities. An overall record poor enough to deny issuance of a new license does not preclude the renewal of a license of a facility with a satisfactory