(a) An agency must have a written emergency preparedness and response plan that comprehensively describes its approach to a disaster that could affect the need for its services or its ability to provide those services. The written plan must be based on a risk assessment that identifies the disasters from natural and man-made causes that are likely to occur in the agency's service area. Except for a freestanding hospice inpatient unit, HHSC does not require an agency to physically evacuate or transport a client.
(b) Agency personnel that must be involved with developing, maintaining, and implementing an agency's emergency preparedness and response plan include:
  (1) the administrator;
  (2) the supervising nurse, if the agency is required to employ or contract with a supervising nurse, as required by §558.243 of this subchapter (relating to Administrative and Supervisory Responsibilities);
  (3) the agency disaster coordinator; and
  (4) the alternate disaster coordinator.
(c) An agency's written emergency preparedness and response plan must:
  (1) designate, by title, an employee, and at least one alternate employee, to act as the agency's disaster coordinator;
  (2) include a continuity of operations business plan that addresses emergency financial needs, essential functions for client services, critical personnel, and how to return to normal operations as quickly as possible;
  (3) include how the agency will monitor disaster-related news and information, including after hours, weekends, and holidays, to receive warnings of imminent and occurring disasters;
  (4) include procedures to release client information in the event of a disaster, in accordance with the agency's written policy required by §558.301(a)(2) of this subchapter (relating to Client Records); and
  (5) describe the actions and responsibilities of agency staff in each phase of emergency planning, including mitigation, preparedness, response, and recovery.
(d) The response and recovery phases of the plan must describe:
  (1) the actions and responsibilities of agency staff when warning of an emergency is not provided;
  (2) who at the agency will initiate each phase;
  (3) a primary mode of communication and alternate communication or alert systems in the event of telephone or power failure; and
  (4) procedures for communicating with:
    (A) staff;
    (B) clients or persons responsible for a client's emergency response plan;
    (C) local, state, and federal emergency management agencies; and
    (D) other entities including HHSC and other health care providers and suppliers.
(e) An agency's emergency preparedness and response plan must include procedures to triage clients that allow the agency to:
  (1) readily access recorded information about an active client's triage category in the event of an emergency to implement the agency's response and recovery phases, as described in subsection (d) of this section; and
  (2) categorize clients into groups based on:
    (A) the services the agency provides to a client;
    (B) the client's need for continuity of the services the agency provides; and
    (C) the availability of someone to assume responsibility for a client's emergency response plan, if needed by the client.
(f) The agency's emergency preparedness and response plan must include procedures to identify a client who may need evacuation assistance from local or state jurisdictions because the client:
  (1) cannot provide or arrange for his or her transportation; or
  (2) has special health care needs requiring special transportation assistance.
(g) If the agency identifies a client who may need evacuation assistance, as described in subsection (f) of this section, agency personnel must provide the client with the amount of assistance the client requests to complete the registration process for evacuation assistance, if the client:
  (1) wants to register with the State of Texas Emergency Assistance Registry (STEAR), accessed by dialing 2-1-1; and
  (2) is not already registered, as reported by the client or legally authorized representative.
(h) An agency must provide and discuss the following information about emergency preparedness with each client:
  (1) the actions and responsibilities of agency staff during and immediately following an emergency;
  (2) the client's responsibilities in the agency's emergency preparedness and response plan;
  (3) materials that describe survival tips and plans for evacuation and sheltering in place; and
  (4) a list of community disaster resources that may assist a client during a disaster, including the STEAR, for which registration is available through 2-1-1 Texas, and other community disaster resources provided by local, state, and federal emergency management agencies. An agency's list of community disaster resources must include information on how to contact the resources directly or instructions to call 2-1-1 for more information about community disaster resources.
(i) An agency must orient and train employees, volunteers, and contractors about their responsibilities in the agency's emergency preparedness and response plan.
(j) An agency must complete an internal review of the plan at least annually, and after each actual emergency response, to evaluate its effectiveness and to update the plan as needed.
(k) As part of the annual internal review, an agency must test the response phase of its emergency preparedness and response plan in a planned drill, if not tested during an actual emergency response. Except for a freestanding hospice inpatient unit, a planned drill can be limited to the agency's procedures for communicating with staff.
(l) An agency must make a good faith effort to comply with the requirements of this section during a disaster. If the agency is unable to comply with any of the requirements of this section, it must document in the agency's records attempts of staff to follow procedures outlined in the agency's emergency preparedness and response plan.
(m) An agency is not required to continue to provide care to clients in emergency situations that are beyond the agency's control and that make it impossible to provide services, such as when roads are impassable or when a client relocates to a place unknown to the agency. An agency may establish links to local emergency operations centers to determine a mechanism by which to approach specific areas within a disaster area for the agency to reach its clients.
(n) If written records are damaged during a disaster, the agency must not reproduce or recreate client records, except from existing electronic records. Records reproduced from existing electronic records must include:
  (1) the date the record was reproduced;
  (2) the agency staff member who reproduced the record; and
  (3) how the original record was damaged.
(o) Notwithstanding the provisions specified in Division 2 of this subchapter (relating to Conditions of a License), no later than five working days after an agency temporarily relocates a place of business, or temporarily expands its service area resulting from the effects of an emergency or disaster, an agency must notify and provide the following information to the HHSC Home and Community Support Services Agencies licensing unit:
  (1) if temporarily relocating a place of business:
    (A) the license number for the place of business and the date of relocation;
    (B) the physical address and phone number of the location; and
    (C) the date the agency returns to a place of business after the relocation; or
  (2) if temporarily expanding the service area to provide services during a disaster:
    (A) the license number and revised boundaries of the service area;
    (B) the date the expansion begins; and
    (C) the date the expansion ends.
(p) An agency must provide the notice and information described in subsection (o) of this section by fax or email. If fax and email are unavailable, the agency may notify the HHSC licensing unit by telephone but must provide the notice and information in writing as soon as possible. If communication with the HHSC licensing unit is not possible, the agency must provide the notice and information by fax, email, or telephone to the designated survey office.
(q) Emergency Response System.
  (1) The agency administrator and alternate administrator must enroll in an emergency communication system in accordance with instructions from HHSC.
  (2) The agency must respond to requests for information received through the emergency communication system in the format established by HHSC.

Source Note: The provisions of this §558.256 adopted to be effective February 1, 2002, 26 TexReg 9159; amended to be effective May 1, 2008, 33 TexReg 1136; amended to be effective August 1, 2011, 36 TexReg 4673; transferred effective May 1, 2019, as published in the April 12, 2019, issue of the Texas Register, 44 TexReg 1893; amended to be effective April 25, 2021, 46 TexReg 2427; amended to be effective January 24, 2023, 48 TexReg 217