(a) The Texas Health and Human Services Commission (HHSC) may deny an initial license or refuse to renew a license if any person described in §551.11(d) of this subchapter (relating to Criteria for Licensing):      
        (1) is subject to denial or refusal as described in Chapter 560 of this title (relating to Denial or Refusal of License) during the time frames described in that chapter;       
        (2) substantially fails to comply with the requirements described in §551.42 of this chapter (relating to Standards for a Facility), including:                  (A) noncompliance that poses a serious threat to health and safety, as described in Appendix Q of the State Operations Manual, "Core Guidelines for Determining Immediate Jeopardy"; or                   (B) a failure to maintain compliance on a continuous basis, including decertification, contract termination, denial of certification, or license revocation;         
        (3) aids, abets, or permits a substantial violation described in paragraph (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 HHSC;                   (B) uses subterfuge or other evasive means of filing;                   (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; or                   (E) is responsible for fraud;         
        (6) fails to pay the following fees, taxes, and assessments when due:                  (A) licensing fees as described in §551.19 of this subchapter (relating to License Fees);                   (B) reimbursement of emergency assistance funds within one year after the date on which the funds were received by the trustee in accordance with the provisions of §551.238(e) of this chapter (relating to Involuntary Appointment of a Trustee);                   (C) administrative penalties within 60 days after the order assessing the penalties in accordance with §551.236 of this chapter (relating to Administrative Penalties); or                   (D) franchise taxes;         
        (7) has a history of any of the following actions during the five-year period preceding the date of the application:                  (A) operation of a facility that has been decertified or had its contract cancelled under the Medicare or Medicaid program in any state;                   (B) federal or state long term care facility sanctions or penalties, including vendor holds, monetary penalties, downgrading 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;                   (D) eviction involving any property or space used as a facility in any state; or                   (E) suspension of a license to operate a health care facility, long term care facility, assisted living facility, or a similar facility in any state.         
      (b) Concerning subsection (a)(7) of this section, HHSC may consider exculpatory information provided by any person described in §551.11(d) of this subchapter and grant a license if HHSC finds that person able to comply with the rules in this chapter.     
      (c) HHSC does not issue a license to an applicant to operate a new facility if the applicant has a history of any of the following actions during the five-year period preceding the date of the application:      
        (1) revocation of a license to operate a health care facility, long term care facility, assisted living facility, or similar facility in any state;       
        (2) debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state;       
        (3) a court injunction prohibiting any person described in §551.11(d) of this subchapter from operating a facility; or       
        (4) failure to comply with or breach of an administrative settlement agreement between the applicant and HHSC.       
      (d) Only final actions are considered for purposes of subsections (a)(7) and (c) of this section. An action is final when routine administrative and judicial remedies are exhausted. All actions, whether pending or final, must be disclosed.     
      (e) If an applicant for a new license owns multiple facilities, HHSC examines the overall record of compliance in all the applicant's facilities. Denial of a new license will not preclude the renewal of licenses for the applicant's other facilities with a history of compliance with licensing regulations.     
      (f) HHSC does not approve as meeting licensing standards new beds or the expansion of a facility serving persons with an intellectual disability or related conditions that participates in the medical assistance program under Title XIX of the Social Security Act, as provided by the Texas Health and Safety Code §533A.062 (relating to Plan on Long-term Care for Persons with an Intellectual Disability) , unless the new beds or the expansion was included in the plan as well as the applicant including the approval letter to be approved by HHSC in accordance with Texas Health and Safety Code §533A.062.     
      (g) If HHSC denies an application for a new license, the applicant may request an administrative hearing. If HHSC refuses to issue a renewal of a license, the licensee may request an informal reconsideration, as specified in §551.18 of this subchapter (relating to Informal Reconsideration) and an administrative hearing. An administrative hearing is held under HHSC's rules in 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act).     
     Source Note:        The provisions of this §551.17 adopted to be effective August 31, 1993, 18 TexReg 2557; transferred effective September 1, 1993, as published in the Texas Register September 3, 1993, 18 TexReg 5885; amended to be effective June 1, 1994, 19 TexReg 3260; amended to be effective November 15, 1994, 19 TexReg 7927; amended to be effective May 1, 1995, 20 TexReg 1659; amended to be effective May 1, 1998, 23 TexReg 4060; amended to be effective May 1, 2000, 25 TexReg 3557; amended to be effective September 1, 2009, 34 TexReg 5139; amended tobe effective September 1, 2010, 35 TexReg 7876; amended to be effective January 18, 2012, 37 TexReg 126; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1883; amended to be effective February 24, 2022, 47 TexReg 787