The status of Texas’s policies on Cleaning and Disinfection are as follows:

• Office of the Governor Greg Abbott
  • On May 5, 2020 at the Governor’s direction, the Texas Military Department activated 250 Texas National Guard personnel in support of nursing facilities, with additional activations to meet mission demand. These Guardsmen formed teams to disinfect COVID-19 contaminated care facilities. Teams are based across Texas and are serving the eight Emergency Medical Task Force regions https://gov.texas.gov/news/post/governor-abbott-expands-business-openings-in-texasannounces-surge-response-teams-to-combat-covid-19

Notable Groups: Office of the Governor Greg Abbott

The status of Texas’s policies on reporting, guidance, and mandated reporting are as follows:

• The Academy of Medicine, Engineering and Science of Texas (TAMEST)
  • Experts discuss what the science says about the spread of COVID-19 in Texas and steps officials and individuals can take to mitigate the outbreak in the state. The moderator was Peter J. Hotez, MD, PhD (NAM), Dean for the National School of Tropical Medicine, Baylor College of Medicine. Speakers included Rebecca Fischer, PhD, Assistant Professor of Epidemiology & Biostatistics, Texas A&M University, and Lauren Ancel Meyers, PhD, Professor of Integrative Biology, The University of Texas at Austin https://tamest.org/digital-conversations.
• Texas Department of Health and Human Services
  • Developed a nursing home COVID-19 response plan, which incorporates direction from state and federal agencies into an easy-to-use set of instructions for prevention of COVID-19 and actions to prioritize and initiate when there is a suspected or confirmed COVID-19 case. It includes an easy-to-remember acronym of S.P.I.C.E. (see page 18). This document is updated regularly as guidance changes https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providerportal/long-term-care/nf/covid-response-nursing-facilities.pdf
  • On July 27, 2020, the Texas Health and Human Services Commission began to electronically post to its website COVID-19 case counts and deaths by facility name for state-supported living centers, state hospitals, and state licensed nursing and assisted living facilities. They can be found in separate downloadable Excel files. The data is updated Monday through Friday by 3:00 PM Central Time, except state holidays. All data is provisional and subject to change. https://hhs.texas.gov/services/health/coronavirus-covid-19
• Texas Health and Human Services Commission (HHSC)
  • On September 9, 2020, the Texas HHSC released the Long-Term Care Regulatory Provider Letter outlining provider reporting requirements related to COVID-19 positive cases and deaths. The letter instructs all nursing, assisted living, and intermediate care facilities to report the first confirmed case of COVID-19 in staff or residents to the health authority with jurisdiction over the facility or directly to the Texas HHSC. Requirements include reporting:
    • The first confirmed case of COVID-19 in staff or residents after a facility has been without cases for 14 days or more
    • All suspected and confirmed COVID19 cases (including residents, staff, and previously treated cases) to the Centers for Disease Control and Prevention (via the National Healthcare Safety Network) on a weekly basis
    • Three or more residents/staff with new-onset respiratory symptoms occurring within 72 hours to residents, their representative, and families https://apps.hhs.texas.gov/providers/communications/2020/letters/PL2020-37.pdf

Notable Groups: Texas Department of Health and Human Services, Texas Department of Health and Human Services, The Academy of Medicine, Engineering and Science of Texas (TAMEST)

Texas’s testing policies are described below:

• Office of the Governor Greg Abbott
  • On April 27, 2020, Governor Abbott released the Texans Helping Texans: The Governor’s Report to Open Texas. A key component of this plan is preventing the spread of COVID-19 cases in long term care facilities. The Report outlines the expectation that any nursing home with one case of COVID-19 should receive immediate testing for all residents and staff to immediately quantify the extent of infection. On May 11, 2020, the Governor strengthened this effort by directing that Texas state agencies test 100 percent of residents and staff in Texas nursing homes
• Office of the Texas Governor Greg Abbott and the U.S. Department of Health and Human Services
  • • Federal support of Community Based Testing Sites in Dallas and Houston has been extended through July 31, 2020 https://gov.texas.gov/news/post/governor-abbott-announces-additional-extension-of-federallysupported-covid-19-testing-sites-in-texas
• Texas Division of Emergency Management and Omnicare
  • Omnicare, a CVS Health company, is partnering with the Texas Division of Emergency Management to provide COVID-19 point-of-care testing for assisted living facilities and nursing homes throughout the state. This partnership will provide on-site testing and results within 24 to 48 hours for facility staff in nursing facilities. https://hhs.texas.gov/about-hhs/communications-events/news/2020/07/clarification-aboutfree-covid-19-testing-initiative-nfs-alfs

Notable Groups: Office of the Governor Greg Abbott, Office of the Texas Governor Greg Abbott and the U.S. Department of Health and Human Services, Texas Division of Emergency Management and Omnicare

The status of Texas’s workforce and staffing are explained beneath:

• State of Texas Assistance Request (STAR), Texas Health and Human Services Commission (HHSC)
  • To ensure the safety of residents in facilities that have COVID-19-infected staff, Texas has contingency contracts to provide short-term staffing assistance to facilities that cannot maintain adequate staffing due to COVID-19. This assistance may be requested through a STAR (State of Texas Assistance Request) in coordination with HHSC or local emergency management
• Texas Department of Health and Human Services
  • Emergency Rule Enhancements for nursing facilities include that each facility must have a COVID-19 response plan that includes designated staff to work with cohorts of residents who have tested positive for COVID-19, and staff should not change designation from one day to another, unless required to maintain adequate staffing for a cohort https://hhs.texas.gov/about-hhs/communications-events/news/2020/08/hhsc-allow-limitedvisitation-nursing-facilities-long-term-care-facilities

Notable Groups: State of Texas Assistance Request (STAR), Texas Health and Human Services Commission (HHSC), Texas Department of Health and Human Services

Texas’s cohorting practices are as follows:

• Texas Health and Human Services Commission Regulatory Services
  • Created COVID-19 response plan for nursing facilities, which is updated regularly based on federal guidance and state COVID-19 response actions.
  • Nursing facilities have created plans for cohorting residents with symptoms of respiratory infection https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providerportal/long-term-care/nf/covid-response-nursing-facilities.pdf

Notable Groups: Texas Health and Human Services Commission Regulatory Services

Texas has established infection control “Strike Teams”, which are described in-depth beneath:

• Office of the Governor Greg Abbott
  • On April 27, 2020, Governor Abbott announced the formation of the Rapid Assessment Quick Response Force to provide rapid response to nursing facilities that can be deployed upon request by the Texas Health and Human Services Commission and Department of State Health Services through the Long-Term Care Regulatory and Emergency Medical Task Force. If needed, an additional team can be sent to assist the facility with immediate needs https://gov.texas.gov/uploads/files/organization/opentexas/OpenTexas-Report.pdf
• Office of the Texas Governor Greg Abbott and the U.S. Department of Defense
  • Governor Greg Abbott announced July 13, 2020 that the U.S. Department of Defense has activated additional U.S. Army Urban Augmentation Medical Task Forces (UAMTF) to assist the state’s efforts to combat COVID-19. At the Governor’s request and as part of a whole-of-nation approach, one UAMTF arrived in San Antonio on July 6, an additional task force arrived in Texas to support the Houston region July 13 and four UAMTFs, along with a U.S. Navy Acute Care Team and four U.S. Navy Rapid Rural Response teams, will be deployed to additional locations across Texas as identified by ongoing assessments. These teams consist of medical and support professionals which are being deployed to support medical needs in hospitals throughout the state https://gov.texas.gov/news/post/governor-abbott-announces-additional-department-ofdefense-resources-to-mitigate-covid-19

Notable Groups: Office of the Governor Greg Abbott, Office of the Texas Governor Greg Abbott and the U.S. Department of Defense

Texas has established a number of infection control surveys and other state survey activities within their state’s boundaries:

• State of Texas
  • Created a surveyor job aid tool to help ensure thorough reviews during a focused infection control survey or investigation. The job aid tool details questions the surveyor must ask and information that must be gathered. It includes the tag/regulatory reference for the requirements related to the questions or information, and space for the surveyor to document information.
• Texas Department of Health and Human Services
  • A Nursing Facility Infection Control webinar scheduled for September 18, 2020 for nursing facility surveyors and providers will offer an introduction to strategies and tools to assess and develop interventions to prevent infections in older adults and individuals with intellectual disabilities in Texas long term care settings https://apps.hhs.texas.gov/providers/training/jointtraining.cfm
  • Starting June 11, 2020, Special Infection Control Assessment (SICA) teams will be conducting on-site assessments at nursing facilities to identify infection control concerns and to provide immediate recommendations and guidance to facility leadership on infection control practices and mitigation strategies https://hhs.texas.gov/about-hhs/communications-events/news/2020/06/nf-special-infection-control-assessments
  • PPE training has been offered weekly via webinar starting July 24, 2020 through August 28, 2020. The training has been extended through September 25, 2020 https://apps.hhs.texas.gov/providers/training/jointtraining.cfm
  • The Texas Health and Humans Services Commission maintains a webpage of COVID-19 Provider Information which contains multiple helpful links including information about Special Issues in Skilled Nursing Facilities and Nursing Facilities during the COVID-19 pandemic, strategies to mitigate personnel shortages, Infection control guidance, proper N95 use, and helping residents with dementia prevent the spread of COVID-19, among other topics. https://hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-provider-information
• Texas Department of State Health Services
  • The Texas Department of State Health Services has created a robust contact tracing program and web-based application to find and follow up with people who have been in close contact with someone who has tested positive for COVID-19. This will also be helpful for tracking cases related to nursing facility outbreaks https://dshs.texas.gov/coronavirus/tracing.aspx
• Texas Health and Human Services Commission (HHSC)
  • The HHSC has published IL 20-41: Preadmission Screening and Resident Review (PASRR) Evaluations Using Telephone or Videoconferencing Interviews. Medicaid-certified nursing facilities must comply with these guidelines for PASRR Evaluations conducted by phone interviews or videoconferencing https://apps.hhs.texas.gov/providers/communications/2020/letters/IL2020-41.pdf

Notable Groups: State of Texas, Texas Department of Health and Human Services, Texas Department of State Health Services, Texas Health and Human Services Commission (HHSC)

The status of Texas’s nursing home (NH) communications during the Covid-19 pandemic:

• Office of the Governor Greg Abbott
  • The Governor’s Report to Open Texas includes a recommendation that nursing facilities immediately inform all those who have interacted with residents of facilities with positive patients to further limit the spread of the virus https://gov.texas.gov/uploads/files/organization/opentexas/OpenTexas-Report.pdf
• The National Forum of ESRD Networks
  • Released best practice and communication tool: “COVID-19 Communication between Skilled Nursing Facilities/Personal Care Homes and Dialysis Facilities” https://esrdnetworks.org/education/sharing-best-practices-in-the-kidney-community/covid-19-communication-between-snf-pch-dialysis-facilities-communication-06-19-2020/covid-19-communication-between-snf-pch-dialysis-facilities/view
• Texas Health and Human Services Commission
  • On August 26 and September 9, 2020, Senator Judith Zaffirini hosted two public Facebook Live discussions about long term care. The Texas Health and Human Services Commission compiled the questions from these discussions, provided responses and updated the information based on recently released visitation rules https://hhs.texas.gov/about-hhs/communications-events/news/2020/09/qa-previous-ltc-webinars-hosted-senator-zaffirini
  • The Texas Health and Human Services Commission sends communications to its regulated nursing homes through surveyor staff. State and regional levels speak with the nursing facilities in their regions daily
  • The Texas Health and Human Services Commission Regulatory Services hosts biweekly calls with long term care provider associations to communicate policy changes and answer questions
  • The agency has also produced over 100 guidance communications to providers, including letters, webinars, alerts, emergency rules, and temporary suspensions of regulatory requirements to give providers flexibility in responding to COVID-19
  • On June 30, 2020, Texas announced $9 million in federal funding for nursing facilities to implement infection control projects to protect residents and staff from the spread of COVID-19. Starting July 1, nursing facility providers in Texas are encouraged to submit applications to the Health and Human Services Commission to receive this federal funding https://gov.texas.gov/news/post/governor-abbott-hhsc-announce-9-million-for-nursing-facility-infection-control-projects-to-prevent-covid-19
• Texas Health and Human Services Commission (HHSC) Long-Term Care Regulatory Division (LTCR)
  • The Texas HHSC posted slides from a September 2, 2020, presentation that is loaded with helpful information for Texas nursing homes. The information is inclusive of: government text alerts, online training, N-95 mask availability, Relief Fund information, Doctors Without Borders assistance, testing, and more https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/nf/nf-covid-updates-qa-webinar-sept-2-2020.pdf

Notable Groups, Office of the Governor Greg Abbott, The National Forum of ESRD Networks, Texas Health and Human Services Commission, Texas Health and Human Services Commission (HHSC) Long-Term Care Regulatory Division (LTCR)

Texas’s ongoing actions to improve access to personal protective equipment (PPE):

• Office of the Governor Greg Abbott
  • On March 22, 2020, the Governor created the Supply Chain Strike Force to actively acquire personal protective equipment (PPE) supplies and initiate production of PPE. This includes a partnership between the Texas Military Department and Ameritech, which has led to the production and distribution of thousands of masks and PPE supplies to Texas facilities. Throughout the COVID-19 response, nursing facilities with outbreaks have been a prioritized group to receive PPE from the state https://gov.texas.gov/news/post/governor-abbott-issues-executive-order-increasing-hospital-capacity-announces-supply-chain-strike-force-for-covid-19-response
• Texas Department of Health and Human Services
  • Emergency Rule Enhancements for nursing facilities include that each facility must have plans for obtaining and maintaining a two-week supply of personal protective equipment and resident recovery plans for continuing care when a resident recovers from COVID-19 https://hhs.texas.gov/about-hhs/communications-events/news/2020/08/hhsc-allow-limited-visitation-nursing-facilities-long-term-care-facilities

Notable Groups: Office of the Governor Greg Abbott, Texas Department of Health and Human Services

Texas’s current actions to improving the utilization of personal protective equipment (PPE):

• Texas Health and Human Services Commission Regulatory Services
  • The Texas Health and Human Services Commission Regulatory Services and the Strike Force are trained to teach staff at facilities the “donning and doffing” of personal protective equipment (PPE)
  • The Texas Health and Human Services Commission is also offering webinars on best-practices of PPE use in infection control

Notable Groups: Texas Health and Human Services Commission Regulatory Services

Texas’s actions to house and shelter at-risk populations and infected patients:

• Texas Department of State Health Services
  • Contracts to staff and outfit alternate care sites are in place throughout the state, as well as to coordinate planning efforts with multiple jurisdictions that may have their own surge capacity plans. For instance, the City of Austin used models from the University of Texas to prepare to set up hospital-level care sites with select buildings https://www.austintexas.gov/news/surge-plan-developed-treat-covid-19-patients-if-hospitals-are-overwhelmed

Notable Groups: Texas Department of State Health Services

The state of Texas’s patient transfer routines below:

• Texas Health and Human Services Commission Regulatory Services
  • A patient/resident transfer assessment guidance and process flow assists with transfers of patients from hospitals to long term care facilities

Notable Groups: Texas Health and Human Services Commission Regulatory Services

Texas’s current resources during the Covid-19 pandemic:

• Office of the Governor Greg Abbott, University of Texas Southwestern Medical Center
  • Released a new Spanish-language public service announcement (PSA) on how Texans can protect themselves and others from COVID-19 https://gov.texas.gov/news/post/office-of-the-governor-ut-southwestern-medical-center-release-new-spanish-language-covid-19-psa
• Texas Health and Human Services Commission, Department of State Health Services
  • Provide targeted online resources for nursing facilities, including webinars, Centers for Disease Control and Prevention (CDC) resources, Centers for Medicare & Medicaid Services (CMS) resources, Occupational Safety and Health Administration guidance, mental health support lines for Texans, and provider letters
• Texas Health and Human Services Commission (HHSC) Long-Term Care Regulatory Division (LTCR)
  • The Texas HHSC posted slides from a September 2, 2020, presentation that is loaded with helpful information for Texas nursing homes. The information is inclusive of: government text alerts, online training, N-95 mask availability, Relief Fund information, Doctors Without Borders assistance, testing, and more https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/nf/nf-covid-updates-qa-webinar-sept-2-2020.pdf

Notable Groups: Office of the Governor Greg Abbott, University of Texas Southwestern Medical Center, Texas Health and Human Services Commission, Department of State Health Services, Texas Health and Human Services Commission (HHSC) Long-Term Care Regulatory Division (LTCR)

Texas’s ongoing actions to better check visitors for potential Covid-19 and other methods of screening said visitors for family meetings:

• State of Texas
  • All licensed long term care facilities must screen all individuals entering the facility, including staff and newly admitted residents
  • Based on federal guidance, Texas restricts non-essential visitors to nursing homes and encourages the use of alternate means of communication between residents and family members and friends
• Texas Department of Health and Human Services
  • On August 6, 2020 the Texas Health and Human Services Commission announced limited visitation at nursing facilities and long term care facilities. For the health and safety of residents and staff, public visitation is limited to outdoor visits only. Physical contact between residents and visitors is not permitted https://hhs.texas.gov/about-hhs/communications-events/news/2020/08/hhsc-allow-limited-visitation-nursing-facilities-long-term-care-facilities
  • Emergency Rule Enhancements for nursing facilities include that all nursing facilities must screen all residents, staff, and people who come to the facility in accordance with specified criteria, and each resident must be screened at least three times a day for signs or symptoms of COVID-19 https://hhs.texas.gov/about-hhs/communications-events/news/2020/08/hhsc-allow-limited-visitation-nursing-facilities-long-term-care-facilities
• Texas Health and Human Services Commission (HHSC)
  • On September 24, 2020, the Texas Health and Human Services Commission expanded visitation guidelines for eligible nursing, assisted living, and intermediate care facilities. Under the new rules, residents will be allowed to designate up to two essential family caregivers who will be provided necessary training to allow them to safely go inside a facility for a scheduled visit, including in the resident’s room, to help ensure their loved one’s physical, social and emotional needs are being met. Designated caregivers will not be required to maintain physical distancing, but only one caregiver can visit a resident at a time https://hhs.texas.gov/about-hhs/communications-events/news/2020/09/hhsc-expands-visitation-long-term-care-facilities

Notable Groups: State of Texas, Texas Department of Health and Human Services, Texas Health and Human Services Commission (HHSC)

Texas’s notable organizations that are confirmed nursing home assistance for the pandemic:

• Office of the Governor Greg Abbott
  • On May 5, 2020, at the Governor’s direction, the Texas Military Department activated 250 Texas National Guard personnel in support of nursing facilities, with additional activations to meet mission demand. These Guardsmen formed teams to disinfect COVID-19 contaminated care facilities. Teams are based across Texas and are serving the eight Emergency Medical Task Force regions https://gov.texas.gov/news/post/governor-abbott-expands-business-openings-in-texas-announces-surge-response-teams-to-combat-covid-19

Notable Groups: Office of the Governor Greg Abbott