1. (a) In this section, unless the context clearly indicates otherwise, "emergency" means an incident likely to threaten the health, welfare, or safety of a facility's patients, facility staff, or the public, including a fire, equipment failure, power outage, flood, interruption in utility service, medical emergency, or natural or other disaster.

2. (b) In accordance with Texas Health and Safety Code §251.016 (relating to Emergency Preparedness and Contingency Operations Planning), a facility shall implement a written emergency preparedness and contingency operations plan that describes staff and patient actions to manage potential medical and nonmedical emergencies, including fire, equipment failure, power outages, medical emergencies, and natural or other disasters that are likely to threaten the health, welfare, or safety of the facility patients, staff, or public. The plan shall comply with the following requirements.

   1. (1) The facility shall update the plan at least annually.
   2. (2) The facility's leadership shall approve the plan each time the facility updates the plan.

   3. (3) The plan shall include:

      1. (A) procedures for notifying each of the following entities, as soon as practicable, regarding facility closure or reduction in hours of operation due to an emergency:

         1. (i) the Texas Health and Human Services Commission (HHSC);
         2. (ii) each hospital with which the facility has a transfer agreement in accordance with subsection (j) of this section;
         3. (iii) the trauma service area regional advisory council that serves the geographic area in which the facility is located; and
         4. (iv) each applicable local emergency management agency;
      2. (B) a documented patient communications plan that includes procedures for notifying a patient when that patient's scheduled dialysis treatment is interrupted;
      3. (C) a continuity of care plan for the provision of dialysis treatment to facility patients during an emergency that meets the requirements under subsection (d) of this section; and

      4. (D) a disaster preparedness plan for natural and other disasters that:

         1. (i) is specific to the facility based on an assessment of the probability and type of disaster in the region and the local resources available to the facility;
         2. (ii) incorporates the use of the HHSC-approved reporting system and participation in the End Stage Renal Disease (ESRD) Network disaster preparedness activities;
         3. (iii) includes procedures designed to minimize harm to patients and staff along with ensuring safe facility operations;
         4. (iv) along with in-service programs for patients and staff, includes provisions or procedures for responsibility of direction and control, communications, alerting and warning systems, evacuation, and closure;
         5. (v) requires each staff member employed by or under contract with the facility to be able to demonstrate their role or responsibility to implement the facility's disaster preparedness plan.
         6. (vi) designates a staff member in each facility to monitor and coordinate disaster preparedness activities;
         7. (vii) maintains in each facility documentation of the monitoring and coordination of disaster preparedness activities; and
         8. (viii) addresses the continuity of essential building systems, including emergency power and water, or a contract with another licensed ESRD facility to provide emergency contingency care to patients to meet the requirements of §507.501(i) of this chapter (relating to Fire Prevention, Protection, and Emergency Contingency Plan); and
   4. (4) except as provided by subsection (c) of this section, requires a facility to execute a contract with another ESRD facility located within a 100-mile radius of the facility stipulating that the other ESRD facility will provide dialysis treatment to facility patients who are unable to receive scheduled dialysis treatment due to the facility's closure or reduction in hours.

3. (c) A facility is not required to contract with another ESRD facility under subsection (b)(4) of this section if:

   1. (1) no other ESRD facility is located within a 100-mile radius of the facility; and
   2. (2) the facility obtains written approval from HHSC exempting the facility from that requirement.

4. (d) A facility shall develop a continuity of care plan for provision of dialysis treatment to facility patients during an emergency that:

   1. (1) includes procedures for distributing written materials to facility patients that specifically describe the facility's emergency preparedness and contingency operations plan;
   2. (2) includes detailed procedures on the facility's continency plans, based on the facility's patient population, including transportation options, for patients to access dialysis treatment at each ESRD facility with which the facility has an agreement or made advance preparations to ensure that the facility's patients have the option to receive dialysis treatment and procedures for notifying a patient when that patient's scheduled dialysis treatment is interrupted;
   3. (3) is approved by the facility's leadership; and
   4. (4) is provided by the facility to each patient before providing or scheduling dialysis treatment.

5. (e) On request, a facility shall provide the facility's emergency preparedness and contingency operations plan adopted under subsection (b) of this section to:

   1. (1) HHSC;
   2. (2) each hospital with which the facility has a transfer agreement in accordance with subsection (j) of this section;
   3. (3) the trauma service area regional advisory council that serves the geographic area in which the facility is located; and
   4. (4) each applicable local emergency management agency.
6. (f) A facility shall provide annual training to facility staff on the facility's emergency preparedness and contingency operations plan required by subsection (b) of this section.

7. (g) A facility shall annually contact a local and state disaster management representative, an emergency operations center in its local jurisdiction, and a trauma service area regional advisory council to:

   1. (1) request comments on whether the emergency preparedness and contingency plan adopted by the facility under subsection (b) of this section should be modified; and
   2. (2) ensure that local agencies, regional agencies, state agencies, and hospitals are aware of the facility, the facility's policy on provision of life saving treatment, the facility's patient population and potential transportation needs, and the anticipated number of patients affected.
8. (h) A facility shall have a functional plan to access emergency medical services.
9. (i) A facility shall have personnel qualified to operate emergency equipment and provide emergency care to patients on site and available during all treatment times. A charge nurse qualified to provide basic cardiopulmonary life support (BCLS) shall be on site and available to the treatment area whenever patients are present. All direct care staff members shall maintain current certification and competency in BCLS.

10. (j) A facility shall have a transfer agreement with one or more hospitals that provide acute dialysis service for provision of inpatient care and other hospital services to the facility's patients. The facility shall have documentation from the hospital to the effect that patients from the facility shall be accepted and treated in emergencies. There shall be reasonable assurances in the transfer agreement that:

    1. (1) whenever a transfer or referral is deemed medically appropriate by the attending physician, the hospital and facility shall coordinate the patient's transfer or referral to ensure timely acceptance and admission;
    2. (2) the interchange of medical and other information necessary or useful in the transferred patient's care and treatment shall occur within one business day; and
    3. (3) the facility shall ensure the security and accountability of the transferred patient's personal effects.
11. (k) A facility shall post a telephone number specific to the facility's equipment and locale to assist staff in contacting mechanical and technical support in the event of an emergency.
12. (l) The facility shall maintain information on the HHSC-approved reporting system and update online monthly.

Source Note:The provisions of this §507.46 adopted to be effective December 23, 2025, 50 TexReg 8289.