(a) As defined by Texas Health and Safety Code §241.401, and when used in this subchapter, the following words and terms have the following meanings.
  (1) "Acute hospital care at home waiver program" means:
    (A) the program established by the Centers for Medicare and Medicaid Services under United States Code Title 42 Section 1320b-5 that waives the requirements of 42 CFR Sections 482.23(b) and (b)(1); and
    (B) a successor program to the program described by subparagraph (A) of this paragraph that is established by the United States Congress or the Centers for Medicare & Medicaid Services.
  (2) "Hospital at home program" means a program operated by a hospital to provide in a home setting health care services that are considered to be acute hospital care for purposes of the acute hospital care at home waiver program.
(b) Notwithstanding hospital functions and services requirements in §133.41 of this subchapter (relating to Hospital Functions and Services) and hospital physical plant and construction requirements in Subchapter I of this chapter (relating to Physical Plant and Construction Requirements), a hospital may operate a hospital at home program and treat an eligible patient at that patient's home if the hospital:
  (1) obtains approval from the Centers for Medicare & Medicaid Services (CMS) to participate in the acute hospital care at home waiver program; and
  (2) receives written approval from the Texas Health and Human Services Commission (HHSC) to operate a hospital at home program.
(c) To apply for HHSC approval to operate a hospital at home program, an applicant shall submit the following to HHSC:
  (1) a complete application to operate the program as indicated on the HHSC website;
  (2) a nonrefundable application fee of $350;
  (3) a copy of the CMS approval to participate in the acute hospital care at home waiver program; and
  (4) any additional information requested by HHSC.
(d) A hospital shall reapply for HHSC approval to operate the hospital's hospital at home program when applying to renew the hospital's license under §133.23 of this chapter (relating to Application and Issuance of Renewal License).
(e) A hospital shall pay a nonrefundable renewal application fee of $390 per 10 beds the hospital designates for the hospital at home program in the renewal application. This fee is in addition to the hospital's license renewal fee.
(f) When a hospital increases the number of beds designated for its hospital at home program between license renewal periods, the hospital shall notify HHSC and pay a nonrefundable fee of $390 per block of 10 beds the hospital adds to their program.
(g) A hospital that is approved by HHSC to operate a hospital at home program shall:
  (1) maintain CMS approval to participate in the acute hospital care at home waiver program;
  (2) comply with the CMS acute hospital care at home waiver program requirements and all other applicable statutes and regulations;
  (3) develop, implement, and enforce policies and procedures to ensure:
    (A) the patient's health and safety;
    (B) the safety of hospital staff entering the patient's home; and
    (C) the safety of the patient's home;
  (4) ensure the hospital's policies and procedures adopted under paragraph (3) of this subsection at a minimum:
    (A) require the patient's home to:
      (i) be located at a physical address;
      (ii) allow hospital staff entry into the home as needed;
      (iii) have animals separated securely away from the patient care area while hospital staff is on site, except for service animals as allowed by the Americans with Disabilities Act of 1990; and
      (iv) maintain a safe route from the entrance and exit to the patient area within in the home;
    (B) require the patient's home maintain electricity, water, and wastewater service and identify how the hospital addresses any disruptions in these services in an emergency; and
    (C) require the patient maintain access to telephone service;
  (5) obtain a patient's written and informed consent to participate before the patient participates in the hospital's hospital at home program, including notice that HHSC may request to accompany hospital staff when entering the patient's home to ensure a hospital's compliance with this rule; and
  (6) notify HHSC in writing no later than five business days if the hospital:
    (A) chooses to no longer operate a hospital at home program; or
    (B) loses CMS approval to participate in the acute hospital care at home waiver program.
(h) At any time, HHSC may withdraw its approval for a hospital to operate a hospital at home program if HHSC finds a threat to patient health or safety. Any patient being treated under the hospital at home program at the time HHSC withdraws its approval shall be safely relocated as soon as practicable and according to the hospital's policies and procedures.
(i) To the extent this section may conflict with a requirement in §133.21(c)(4)(B) or (C) of this chapter (relating to General), this section controls.

Source Note: The provisions of this §133.54 adopted to be effective January 25, 2024, 49 TexReg 247