1. (a) This section applies only to an end stage renal disease (ESRD) facility located in a county for which:

   1. (1) the governor declared a state of disaster due to a pandemic or epidemic pursuant to Texas Government Code Chapter 418 (relating to Emergency Management);
   2. (2) the commissioner of the Texas Department of State Health Services determined that a public health disaster exists, pursuant to Texas Health and Safety Code Chapter 81 (relating to Communicable Diseases; Public Health Disasters; Public Health Emergencies); and
   3. (3) the Texas Health and Human Services Commission (HHSC) designated this section as applicable, pursuant to paragraphs (1) and (2) of this subsection.
2. (b) An ESRD facility licensed under Texas Health and Safety Code Chapter 251 (relating to End Stage Renal Disease Facilities) that meets the requirements of this section may apply to HHSC to temporarily use an off-site facility under its current license for added services or an increased number of stations to meet patient needs for the public health disaster's duration.

3. (c) The ESRD facility may only use the off-site facility after HHSC approves the off-site facility and when the off-site facility is:

   1. (1) an ESRD facility no longer licensed under Texas Health and Safety Code Chapter 251 that closed within the past 36 months, or a facility with a pending application for such a license that has passed its final architectural review inspection that:

      1. (A) can meet the current licensing requirements at §507.33 of this chapter (relating to Water Treatment) and §507.34 of this chapter (relating to Dialysate); or
      2. (B) shall provide integrated hemodialysis machines, which incorporate water treatment and dialysis preparation and delivery into one system;

   2. (2) a mobile, transportable, or relocatable medical unit using integrated dialysis systems, defined as any trailer or self-propelled unit:

      1. (A) equipped with a chassis on wheels;
      2. (B) without a permanent foundation; and
      3. (C) intended for provision of medical services on a temporary basis;
   3. (3) a physician's office built after January 1, 2015, that is currently in use, which a facility may use for home training of dialysis patients;

   4. (4) a physician's office built after January 1, 2015, that has closed within the past 12 months, which a facility may use for home training of dialysis patients and:

      1. (A) is well maintained with all building systems in good working condition; and
      2. (B) has manual fire extinguishers in accordance with the latest National Fire Protection Association (NFPA) code and standard;

   5. (5) an ambulatory surgical center no longer licensed under Texas Health and Safety Code Chapter 243 (relating to Ambulatory Surgical Centers) that closed within the past 36 months, which an ESRD facility may use for either home training or providing in-center dialysis treatment where:

      1. (A) the ESRD facility only provides integrated hemodialysis machines; and
      2. (B) the building layout provides a direct view of all patient stations from a nurse's station;

   6. (6) a freestanding emergency medical care facility no longer licensed under Texas Health and Safety Code Chapter 254 (relating to Freestanding Emergency Medical Care Facilities) that closed within the past 36 months, which an ESRD facility may use for either home training services or providing in-center dialysis treatment where:

      1. (A) the ESRD facility only provides integrated hemodialysis machines; and
      2. (B) the building layout provides a direct view of all patient stations from a nurse's station;
   7. (7) a hospital or portion of a hospital currently licensed under Texas Health and Safety Code Chapter 241 (relating to Hospitals); or
   8. (8) a building or structure of opportunity temporarily converted for health care use, including an alternate care site, that is created or maintained by the ESRD facility in partnership with or under the supervision of the health authority, local health department, public health district, or public health consortium that has jurisdiction over the site location.

4. (d) To request approval for an off-site facility under this section, the ESRD facility must submit in accordance with HHSC instructions:

   1. (1) an application to use an off-site facility for the addition of services or increased number of stations; and
   2. (2) water culture testing results that meet the requirements of §507.33 of this chapter (relating to Water Treatment).
5. (e) HHSC may approve or deny an ESRD facility application to use an off-site facility under this section. HHSC may require an off-site facility inspection or additional documentation before considering an application.
6. (f) To protect the health, safety, and welfare of patients and the public, HHSC may withdraw its approval for an ESRD facility to use the off-site facility under this section at any time. The facility shall safely relocate any patients being treated in the off-site facility at the time HHSC withdraws its approval as soon as practicable according to the ESRD facility's policies and procedures.

Source Note:The provisions of this §507.24 adopted to be effective December 23, 2025, 50 TexReg 8289.