(a) A facility may allow personal care staff to perform a health maintenance activity (HMA) for a resident, without being delegated, only if:      
        (1) the activity is performed for a person with a functional disability as defined in §553.3 of this chapter (relating to Definitions);       
        (2) a registered nurse (RN) acting on behalf of the facility conducts and documents an assessment in accordance with subsection (b) of this section, and determines, based on the assessment, that the activity qualifies as an HMA not requiring delegation; and       
        (3) the facility ensures and documents that all the conditions and requirements of subsection (c) of this section are met:                  (A) the resident, the resident's legally authorized representative, or other adult chosen by the resident, as applicable, is willing and able to direct personal care staff to perform the task without RN supervision; and                   (B) the resident, the resident's legally authorized representative, or other adult chosen by the resident, as applicable, is willing and able and has agreed in writing, to participate in directing the personal care staff's actions in carrying out the HMA;         
        (4) the activity addresses a condition that is stable and predictable, as defined in §553.3 of this chapter; and       
        (5) the activity is performed for a resident who could perform the task on his or her own but for a functional disability that prevents it.       
      (b) The RN conducting an assessment for purposes of subsection (a)(1) of this section must conduct it in accordance with Board of Nursing rules at 22 TAC §225.6 (relating to RN Assessment of the Client).      
        (1) The RN's assessment must consider each element listed in 22 TAC §225.6, and all relevant aspects of the resident's environment, to develop an overall understanding of the resident's health status.       
        (2) In assessing each element required by paragraph (1) of this subsection, the RN may consider strength in one element to compensate for or offset a weakness in another element, as long as the RN determines that all required conditions in subsection (c) of this section are met.       
        (3) The RN is not required to know the identity of the personal care staff member who will perform the activity or his or her specific qualifications. The RN is not required to determine the competency of the personal care staff who will perform the activity.       
        (4) The RN must reassess a resident's status in accordance with this subsection any time there is a change in the resident's condition that may affect the resident's physical or cognitive abilities, or the stability or predictability of the resident's condition and, at a minimum, must reassess the resident's status:                  (A) at least once annually; or                   (B) at least once every six months if the resident has been diagnosed with Alzheimer's disease or a related disorder or resides in an Alzheimer's disease certified facility or unit.         
      (c) To meet the condition of subsection (a)(2) of this section, the RN, in addition to conducting a resident assessment meeting the requirements of subsections (a)(1) and (b) of this section, must determine and document that all of the conditions listed in 22 TAC §225.8(a)(2) (relating to Health Maintenance Activities Not Requiring Delegation) exist.     
      (d) If the RN determines under subsection (a)(1) of this section that an activity does not qualify as an HMA not requiring delegation, personal care staff may perform that activity for the resident only if:      
        (1) the RN has determined in accordance with 22 Texas Administrative Code (TAC) Chapter 225 (relating to RN Delegation to Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions) that:                  (A) the activity can be delegated to a personal care staff member; and                   (B) the activity constitutes the medication administration;         
        (2) the RN has properly delegated the task to the personal care staff member in accordance with 22 TAC Chapter 225 and §553.261(a)(1)(A)(iii) of this chapter (relating to Coordination of Care); and       
        (3) the medication and medication administration requirements of §553.261(a) of this chapter are otherwise met.       
     Source Note:        The provisions of this §533.263 adopted to be effective August 31, 2021, 46 TexReg 5017