HCSSA Pre-Survey Computer-Based Training

Module 4: Licensed Home Health Services

Health and Human Services Commission

Long-Term Care Regulation

Welcome to Module Four of the HCSSA Presurvey Computer-Based Training. This computer-based training (CBT) is designed to prepare HCSSA administrators, supervising nurses and their alternates for the initial HCSSA survey.

System requirements

Before beginning this course, ensure that your computer meets the following system requirements.

At the end of this course, you will need to verify that you've fulfilled the course requirements and obtain a learning certificate.

To access the course, your internet browser must be set to allow pop-ups.

Browser Requirements: Google Chrome, Firefox, Microsoft Edge or Safari

• You will not be able to receive credit for quizzes taken on Internet Explorer.

Printer: The ability to print hard copies of your learning certificate.

Navigation

To navigate through this course, use the buttons at the bottom left of the screen.

Click "next page" to proceed to the next page and click "previous page" to go back to the previous page.

You may also access content directly by using the page numbers at the top of the page.

In this training, be sure to click the text that appears in blue underlined text for important additional information.

This CBT is designed to provide an introduction to most HCSSA regulations and laws, but regulations and laws will not be covered in their entirety.

It is the full responsibility of each agency to remain in compliance with applicable federal, state, and local regulations and laws governing HCSSAs and the services they provide.

Agencies must be able to demonstrate compliance with applicable regulations and laws during the initial HCSSA survey and during any subsequent regulatory visits.

Successful completion of all required modules of the Presurvey CBT satisfies the Presurvey Conference licensure requirement at Texas Administrative Code (TAC), Title 26, Part 1, Chapter 558, §558.13. Please note that this training cannot be used to satisfy initial and continuing education requirements for administrators outlined in 26 TAC §558.259 and 26 TAC §558.260.

For policy/course content questions contact a HCSSA policy specialist at (512) 438-3161 or email LTCRPolicy@hhs.texas.gov.

For licensing/application questions contact a HCSSA licensing specialist at (512) 438-2630 or email LTC_HCSSA_Licensing@hhs.texas.gov.

On the HCSSA license application, HCSSA license applicants must designate appropriate service categories for the type of services they plan to offer.

This module covers Licensed Home Health Services (LHHS).

26 Texas Administrative Code, Chapter 558 defines home health service as "the provision of one or more of the following health services required by an individual in a residence or independent living environment:

• nursing, including blood pressure monitoring and diabetes treatment;
• physical, occupational, speech, or respiratory therapy;
• medical social service;
• intravenous therapy;
• dialysis;
• service provided by unlicensed personnel under the delegation or supervision of a licensed health professional;
• the furnishing of medical equipment and supplies, excluding drugs and medicines; or
• nutritional counseling.

Other modules in the presurvey CBT provide in-depth focus on other service categories.

In order to apply for an initial HCSSA license, license applicants must verify that certain personnel have completed this training.

• HCSSA license applicants planning to provide Personal Assistance Services (PAS) only must verify that their administrator and alternate administrator have successfully completed the training.
• HCSSA license applicants planning to offer any of the other service categories are required to verify that their administrator, alternate administrator, supervising nurse, and alternate supervising nurse have successfully completed this training.

Remember that each required participant must submit a signed certificate of completion.

The certificate of completion will be available after you complete the quiz for each module.

HHSC will not accept HCSSA license applications without these signed certificates for each required participant.

Agencies must keep copies of these signed certificates on file and available.

This module ends with a short quiz. Required participants must pass the quiz with a minimum score of 80%.

If a score of at least 80% is not earned, required participants must retake the course and quiz until they pass the quiz.

If you quit this module before completing the quiz, you must retake the module from its beginning.

Since HCSSA Presurvey CBT Module 4 focuses entirely on Licensed Home Health Services (LHHS), you will need to have access to all of the LHHS laws and regulations, which are listed below. Click on the titles and add the URLs to your computer's "favorites" list.

• Health and Safety Code, Title 2, Chapter 142
• Texas Administrative Code, Title 22, Part 11, Chapter 224
• Texas Administrative Code, Title 22, Part 11, Chapter 225
• Texas Administrative Code, Title 26, Part 1, Chapter 558
• Texas Administrative Code, Title 26, Part 1, Chapter 560
• Texas Administrative Code, Title 40, Part 1, Chapter 93

Refer to PL 19-02 on how to request a copy and print a copy of a rule or subchapter from the Texas Administrative Code (TAC).  

What will I learn in this module?

In this module, you will:

• identify regulations in Subchapter C that have special significance for the LHHS category;
• identify regulations in Subchapter D specific to the LHHS category; and
• identify regulations pertaining to the use of home health aides in the LHHS category.

Listed below are the main topics for Module 4 of the HCSSA Presurvey Training. You must complete all sections of this course, including the quiz.

• Selected Subchapter C Requirements
• Standards Specific to the LHHS Category
• Home Health Aides
• Quiz
  

When you're ready to begin this module, click "next page" to proceed.

This section of Module 4 will review some of the requirements in 26 TAC, Chapter 558, Subchapter C that are important to LHHS Agencies.

Remember:

• The regulations in 26 TAC, Chapter 558, establish minimum standards for acceptable quality of care. The LHHS is not limited to these minimum standards and may establish more stringent standards in its internal policies and procedures.
• Violating the minimum standards is a violation of law.
• 26 TAC, Chapter 558, Subchapter C, applies to ALL HCSSAs, including those operating under a licensed home health services (LHHS) category of service.

Under the LHHS category, the HCSSA must have a supervising nurse or alternate supervising nurse, unless the agency provides only:

• physical therapy;
• occupational therapy;
• speech therapy;
• respiratory therapy;
• medical social services; or
• nutritional counseling.

If the agency meets the above exception, a qualified licensed professional must supervise these services, as applicable.

Source: 26 TAC §558.243(c)

Under the LHHS category, the administrator and the alternative administrator of the HCSSA must:

• be a licensed physician, registered nurse, licensed social worker, licensed therapist, or licensed nursing facility administrator with at least one year of management or supervisory experience in a health-related setting; or
• possess a high school diploma or a general equivalency degree (GED) with at least two years of management or supervisory experience in a health-related setting.

This section of Module 4 will review some of the LHHS-specific requirements found in 26 TAC, Chapter 558, Subchapter D, §558.401.

An agency providing licensed home health services must meet the requirements specified in this section.

Clients must be accepted for services based on a reasonable expectation that medical, nursing, and social needs can be adequately met in the client's residence.

Care must be initiated within the time frame established in agency policy. The initiation of services must also be based on the client's health service needs.

The initial health assessment must be performed by an appropriate health care professional prior to the client's acceptance to allow agency staff to determine whether the agency has the ability to provide necessary services.

Source: 26 TAC §558.401(a)-(b)

Care Plan

For non-skilled services to be provided, an appropriate health care professional must prepare a care plan after consulting with the client and the client's family.

The care plan must include:

• services to be rendered;
• frequency of visits or hours of service;
• identified problems;
• method of intervention; and
• projected date of resolution.

Review of the Care Plan

A care plan for non-skilled services must be reviewed and updated at least annually (or more often, as necessary to meet the client's needs) by appropriate staff members who are involved in client care.

Source: 26 TAC §558.401(b)(2)(A)

Click on the +/- to learn more about each item related to skilled care. It is the responsibility of the license applicant to read this information in its entirety.

Source: 26 TAC §558.401(b)(2)(B)

Agency staff must perform at least one home health service, which may include:

• nursing, including blood pressure monitoring and diabetes treatment;
• physical, occupational, speech, or respiratory therapy;
• medical social service;
• intravenous therapy;
• dialysis;
• service provided by unlicensed personnel under the delegation or supervision of a licensed health professional;
• the furnishing of medical equipment and supplies, excluding drugs and medicines; or
• nutritional counseling.

When each type of service is provided, it must be provided and supervised by personnel qualified in that particular type of service. For instance, if medical social work is provided by the agency then it must be supervised and provided by a social worker licensed in the State of Texas to provide social work services.

All staff providing services, delegation, and supervision must be employed by, or be under contract with, the agency.

Source: 26 TAC §558.401(c)-(e); §558.2(52)

Unlicensed personnel employed by an agency to provide licensed home health services must:

• have demonstrated competency in the task assigned when competency cannot be determined through education and experience; and
• be at least 18 years of age, or if under 18 years of age, be a high school graduate or enrolled in a vocational education program.

Source: 26 TAC §558.401(g)

This section of Module 4 will review some of the requirements dealing with home health aides found in 26 TAC, Chapter 558, Subchapter G.

An agency is not required to employ home health aides. If the agency employs home health aides, it must comply with 26 TAC, Chapter 558, Subchapter G.

A home health aide is an individual working for an agency who meets at least one of the requirements for home health aides as defined in 26 TAC, Chapter 558, Subchapter G. These requirements are detailed on the following page.

A home health aide is not the same as a certified nursing assistant (CNA), but a home health aide may meet the requirements in Subchapter G by being a current CNA with no finding against the aide related to abuse, neglect, or misappropriation.

Assignment, delegation, and supervision of services provided by home health aides must be performed in accordance with the rules in 26 TAC, Chapter 558, governing the agency's license category.

Source: 26 TAC §558.401(f); §558.701(c)

A home health aide may be used by an agency providing licensed home health services if the aide meets one of the following requirements:

• has a minimum of one-year full-time experience in direct client care in an institutional setting (hospital or nursing facility);
• has one-year full-time experience within the last five years in direct client care in an agency setting;
• has satisfactorily completed a training and competency evaluation program that complies with the requirements of 26 TAC §558.701 (and has provided home health services in the previous 24 months);
• has submitted to the agency documentation from the director of programs or the dean of a school of nursing that states that the individual is a nursing student who has demonstrated competency in providing basic nursing skills in accordance with the school's curriculum; or
• is a certified nurse aide with no finding in the Nurse Aide Registry relating to client abuse or neglect or misappropriation of client property.

Source: 26 TAC §558.701

The training portion of a training and competency evaluation program for home health aides must be conducted by or under the general supervision of an RN who possesses a minimum of two years of nursing experience, at least one year of which must be in the provision of home health care. The training program may contain other aspects of learning, but must contain the following:

• A minimum of 75 hours as follows: An appropriate number of hours of classroom instruction; and a minimum of 16 hours of clinical experience, which will include in-home training and must be conducted in a home, a hospital, a nursing home, or a laboratory;
• Completion of at least 16 hours of classroom training before a home health aide begins clinical experience working directly with clients under the supervision of qualified instructors; and
• An assessment that the student knows how to read and write English and carry out directions.

Source: 26 TAC §558.701(d)

If licensed vocational nurse (LVN) instructors are used for the training portion of the program, the following qualifications and supervisory requirements apply:

• An LVN may provide the home health aide classroom training under the supervision of an RN who has two years of nursing experience, at least one year of which must be in the provision of home health care.
• LVNs, as well as RNs, may supervise home health aide candidates in the course of the clinical experience.
• An RN must maintain overall responsibility for the training and supervision of all home health aide training students.

Source: 26 TAC §558.701(d)

The classroom instruction and clinical experience content of the training portion of a training and competency evaluation program must include, but is not limited to the following:

• communication skills;
• observation, reporting, and documentation of a client's status and the care or service furnished;
• reading and recording temperature, pulse, and respiration;
• basic infection control procedures and instruction on universal precautions;
• basic elements of body functioning and changes in body function that must be reported to an aide's supervisor;
• maintenance of a clean, safe, and healthy environment;
• recognizing emergencies and knowledge of emergency procedures;
• the physical, emotional, and developmental needs of, and ways to work with, the populations served by the agency, including the need for respect for the client and his or her privacy and property;
• appropriate and safe techniques in personal hygiene and grooming;
• safe transfer techniques and ambulation;
• normal range of motion and positioning;
• adequate nutrition and fluid intake;
• any other delegated nursing task the agency may choose to have the home health aide perform; and
• the rights of the elderly.

Source: 26 TAC §558.701(e)

The competency evaluation program or the competency evaluation portion of a training and competency evaluation program has the following requirements:

• The competency evaluation must be performed by an RN;
• The competency evaluation must address each of the subjects listed on the previous page except communication skills and the rights of the elderly; 
• Some areas must be evaluated by observation of the home health aide's performance of the task with a client or person;
• Some areas may be evaluated through written examination, oral examination, or by observation of a home health aide with a client;
• A home health aide is not considered to have successfully completed a competency evaluation if the aide has an unsatisfactory rating in more than one of the areas listed except communication skills and rights of the elderly;
• If a home health aide receives an unsatisfactory rating, the aide must not perform that task without direct supervision by an RN or LVN until the aide receives training in the task for which he or she was evaluated as unsatisfactory and successfully completes a subsequent competency evaluation with a satisfactory rating on the task; and
• If an aide or home health aide fails to complete the competency evaluation satisfactorily, the individual must be advised of the areas in which he or she is inadequate.

Source: 26 TAC §558.701(f)

Congratulations!

You have reached the end of the HCSSA Presurvey CBT Module 4.

Please continue to next page and complete the quiz.

You must score 80% or higher to receive credit and print your certificate.  

If you would like to review any part of this module before taking the quiz, you may use the navigation buttons at the top of the page.

If you are ready to begin the quiz, click to below.

If your score is less than 80%, click the exit button and retake this module.

If your score is 80% or above, please enter the requested information below, print this certificate using the print button at bottom right, sign your certificate, and upload through TULIP to verify your successful completion. Submit one signed certificate for each required module.

Submit one certificate for each required module.