(a) DADS may deny an initial license or refuse to renew a license if any person described in §19.201(e) of this subchapter (relating to Criteria for Licensing):
  (1) 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;
  (2) does not have a satisfactory history of compliance with state and federal nursing home regulations. In determining whether there is a history of satisfactory compliance with federal or state regulations, DADS at a minimum may consider:
    (A) whether any violation resulted in significant harm or a serious and immediate threat to the health, safety, or welfare of any resident;
    (B) whether the person promptly investigated the circumstances surrounding any violation and took steps to correct and prevent a recurrence of a violation;
    (C) the history of surveys and complaint investigation findings and any resulting enforcement actions;
    (D) a repeated failure to comply with regulation;
    (E) an inability to attain compliance with cited deficiencies within an acceptable period of time as specified in the plan of correction or credible allegation of compliance, whichever is appropriate;
    (F) the number of violations relative to the number of facilities the applicant or any other person named in §19.201(e) of this subchapter has been affiliated with at any time; and
    (G) any exculpatory information deemed relevant by DADS;
  (3) has committed any act described in §19.2112(a)(2) - (7) of this chapter (relating to Administrative Penalties);
  (4) violated Chapter 242 of the Texas Health and Safety Code in either a repeated or substantial manner;
  (5) aids, abets, or permits a substantial violation described in paragraph (4) of this subsection about which the person had or should have had knowledge;
  (6) fails to provide the required information and facts and/or references;
  (7) fails to pay the following fees, taxes, and assessments when due:
    (A) licensing fees as described in §19.216 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 §19.2116(e) and (f) of this chapter (relating to Involuntary Appointment of a Trustee); or
    (C) franchise taxes;
  (8) has a history of any of the following actions at any time preceding the date of the application:
    (A) operation of a facility that has been decertified or had its contract canceled under the Medicare or Medicaid program in any state or both;
    (B) federal or state nursing facility sanctions or penalties, including, but not limited to, 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;
    (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;
    (F) revocation of a license to operate a health care facility, long-term care facility, assisted living facility, or similar facility in any state;
    (G) surrender of a license in lieu of revocation or while a revocation hearing is pending; or
    (H) expiration of a license while a revocation action is pending and the license is surrendered without an appeal of the revocation or an appeal is withdrawn;
  (9) fails to meet minimum standards of financial condition as described in §19.201(d)(1)(A) of this subchapter and §19.1925(a) of this chapter (relating to Financial Condition); or
  (10) fails to notify DADS of a significant adverse change in financial condition as required under §19.1925 of this chapter.
(b) DADS:
  (1) denies a license to an applicant to operate a facility if the applicant has on the date of the application:
    (A) a debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state; or
    (B) a court injunction prohibiting the applicant or manager from operating a facility; or
  (2) may deny a license to an applicant to operate a new facility if the applicant has a history of any of the following actions at any time preceding the date of the application:
    (A) revocation of a license to operate a health care facility, long-term care facility, assisted living facility, or similar facility in any state;
    (B) surrender of a license in lieu of revocation or while a revocation hearing is pending;
    (C) expiration of a license while a revocation action is pending and the license is surrendered without an appeal of the revocation or an appeal is withdrawn;
    (D) debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state; or
    (E) a court injunction prohibiting the applicant or manager from operating a facility.
(c) Only final actions are considered for purposes of subsections (a)(8) and (b) of this section. An action is final when routine administrative and judicial remedies are exhausted. All actions, whether pending or final, must be disclosed.
(d) If an applicant for a new license owns multiple facilities, DADS examines the overall record of compliance in all of the applicant's facilities. Denial of an application for a new license will not preclude the renewal of licenses for the applicant's other facilities with satisfactory records.
(e) If DADS denies a license or refuses to issue a renewal of a license, the applicant or license holder may request an administrative hearing. Administrative hearings are held under the Health and Human Services Commission's hearing procedures in 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act), and Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act).

Source Note: The provisions of this §554.214 adopted to be effective May 1, 1995, 20 TexReg 2054; amended to be effective March 1, 1998, 23 TexReg 1314; amended to be effective October 1, 1999, 24 TexReg 8314; amended to be effective April 1, 2001, 26 TexReg 1547; amended to be effective September 1, 2007, 32 TexReg 4231; amended to be effective May 4, 2008, 33 TexReg 3446; amended to be effective September 1, 2009, 34 TexReg 5138; amended to be effective January 18, 2012, 37 TexReg 125; amended to be effective December 2, 2012, 37 TexReg 9525;transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871