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 that is experiencing a documented, significant staffing shortage may temporarily adopt the accommodations under this section to meet patient needs for the duration of the public health disaster.

3. (c) Subject to HHSC approval, an ESRD facility may request a temporary exemption from staffing requirements:

   1. (1) for nursing services, as specified in §507.48 of this subchapter (relating to Nursing Services);
   2. (2) for nutrition services, as specified in §507.49 of this subchapter (relating to Nutrition Services);
   3. (3) for social services, as specified §507.51 of this subchapter (relating to Social Services); and
   4. (4) for staffing levels of direct care staff, as specified in §507.60 of this subchapter (relating to Staffing Table).
4. (d) Notwithstanding §507.43(e) of this subchapter (relating to Quality Assessment and Performance Improvement), core staff members shall actively participate in quality assessment and performance improvement (QAPI) activities and attend meetings every other month.
5. (e) Notwithstanding §507.47 of this subchapter (relating to Medication Storage and Administration), all verbal or telephone physician orders shall be documented and authenticated or countersigned by the physician not more than 30 calendar days from the date the order was given.
6. (f) Notwithstanding §507.53 of this subchapter (relating to Home Dialysis Service), the staffing level for home dialysis patients, including all modalities, shall be one full-time equivalent registered nurse per 25 patients, or portion thereof.

7. (g) Notwithstanding §507.54(d)(2) of this subchapter (relating to Staff Qualifications), each registered nurse who is assigned charge nurse responsibilities shall have at least 12 months of clinical experience and have three months of experience in hemodialysis after completion of the facility's training program. In addition:

   1. (1) the registered nurse shall be able to demonstrate competency for the required level of responsibility and the facility shall maintain documentation of that competency;
   2. (2) the registered nurse shall be certified by the facility's medical director and governing body;
   3. (3) the hemodialysis experience shall be within the last 24 months; and
   4. (4) a registered nurse who holds a current certification from a nationally recognized board in nephrology nursing or hemodialysis may substitute the certification for the three months experience in dialysis obtained within the last 24 months.
8. (h) Notwithstanding §507.54(d)(4) of this subchapter, if patient self-care training is provided, a registered nurse who has at least 12 months of clinical experience and three months of experience in the specific modality shall be responsible for training the patient or family in that modality. When other personnel assist in the training, supervision by the qualified registered nurse shall be demonstrated.
9. (i) Notwithstanding the deadline provision of §507.56(a) of this subchapter (relating to Incident Reports), a facility shall report an incident listed in §507.56(a)(1) - (5) of this subchapter to HHSC within 20 business days of the incident.
10. (j) Notwithstanding §507.72(i) of this chapter (relating to Training Curricula and Instructors), for individuals with no previous experience in direct patient care, a minimum of 80 clock hours of classroom education and 200 clock hours of supervised clinical training shall be required for dialysis technicians. Training programs for dialysis technician trainees who have confirmed previous direct patient care experience may be shortened to a total of 40 clock hours of combined classroom education and clinical training if they demonstrate competency with the required knowledge and skills and there has not been more than a year of time elapsed since they provided patient care in a licensed ESRD facility setting.

Source Note:The provisions of this §507.58 adopted to be effective December 23, 2025, 50 TexReg 8289.