Relating to dispute resolution for and enforcement actions against certain long-term care facilities.

Contracts

• Legal Retainers: Update engagement letters with outside regulatory counsel. Because IDR decisions are now binding on HHSC, the IDR stage is effectively your final trial on the merits. Authorize counsel to engage fully at the IDR stage rather than preserving resources for a formal administrative hearing.
• Management Agreements: Amend third-party management contracts to prohibit the automatic payment of state administrative penalties without a mandatory cross-check against federal CMS penalties.

Hiring/Training

• Administrator & DON Training: Clinical leadership must be trained to identify the specific federal F-Tag that corresponds to any state regulatory citation immediately upon receipt of the CMS-2567.
• IDR Preparation: Staff must be retrained to treat the IDR packet as a final legal pleading. The "wait and see" approach to IDR is now obsolete.

Reporting & Record-Keeping

• Penalty Cross-Walk Log: Implement a mandatory log linking State Regulatory Tags to Federal F-Tags. To utilize the penalty shield, you must document that the state violation arises out of the "same act or failure to act" as the federal violation.
• Retaliation Documentation: Maintain a "Protected Activity Log." Record the exact date and time of any appeal or complaint filed against HHSC. If an adverse survey occurs shortly after, this log establishes the timeline necessary to claim statutory protection against regulatory retaliation.

Fees & Costs

• Penalty Reduction: Expect a decrease in total administrative penalty expenditures due to the prohibition on "stacking" state and federal fines.
• Legal Spend Shift: Budget for higher legal costs during the initial IDR phase, offset by reduced litigation costs for formal administrative hearings.