Duplication of regulations and other issues with the survey process in nursing homes drew legislators’ scrutiny in a hearing of the House Human Services Committee on December 13.

The hearing covered a charge from Speaker Joe Straus (R-San Antonio) directing the committee to “examine the survey process for nursing facilities to determine any duplication of government regulations. Consider recommendations to reduce duplication while ensuring patient safety is preserved.”

Julie Sulik, who is Vice-Chair of the THCA Nurse Council, told the committee that the long term care industry is “one of the most highly regulated industries in our country.”

“The regulatory environment we are forced to operate under is often the reason many highly competent, compassionate nurses–as well as other healthcare professionals– leave our industry,” Sulik testified. “I am hopeful through this process and the efforts of this committee a positive change will be made at HHSC and for nursing facilities all across the State of Texas while ensuring the primary goal for everyone–patient safety is preserved.”

Sulik made several recommendations for the committee’s consideration. Those included:

Discretion should be given to HHSC to investigate less serious complaints at the next regular onsite survey for those less serious incidents deemed necessary for an onsite investigation or when the report submitted by the provider regarding the incident does not satisfy necessary requirements for self-reports.

Eliminate any dual enforcement where CMS imposes a remedy by prohibiting the agency from issuing a licensure remedy for the same facts as identified on the CMS 2567.

Direct HHSC to develop guidance on writing an acceptable Plan of Removal and provide joint training to surveyors and providers.

Require the surveyor to stay at the facility until a Plan of Removal has been approved and a timeframe has been established for the surveyor to return to the facility to validate the completion of the Plan of Removal and lift the Immediate Jeopardy.

Direct HHSC to develop measurable criteria to evaluate the skills and competencies of regulatory staff on an ongoing basis and require surveyors to attend joint training opportunities annually.

The committee will issue a report on the charge before the next Legislative session, which begins in January, 2019.


Two more legislators received recognition in December for their stands in support of improved long term care funding.

Rep. J.D. Sheffield (R-Gatesville) accepted the award as Legislator of the Year for his efforts to pass House Bill 2766 during the 2017 Legislative Session. That bill, which passed the House but died in the Senate, would have increased Medicaid funding for nursing facilities without costing the state budget.

THCA President and CEO Kevin Warren presented the award to Sheffield, who is a physician, at an event in Gatesville.

“Rep. Sheffield has the bedside manner of a country doctor, but there is no more ferocious advocate for vulnerable Texas seniors in Austin,” Warren said. “Rep. Sheffield cares about the quality of long term care in Texas because he understands how important long term care is to so many Texans.”

In accepting the award, Sheffield said “there is no higher calling than to fight for those who cannot fight for themselves.”

“I will continue to fight with you for legislation to improve Texas nursing homes and medical care to our seniors in a responsible way that doesn’t increase costs to the taxpayer or the state, and we will win this fight,” he said.

Rep. John Zerwas (R-Richmond) was honored as a Champion of Long Term Care. As a doctor and the chair of the powerful House Appropriations Committee, Zerwas worked to convince legislators that Sheffield’s bill was important for helping the state meet its health care needs.

Zerwas thanked THCA for the award and said “our elderly are among the most vulnerable in our society and we must ensure quality care for them.”

Rep. Sheffield (left) and Rep. Zerwas (right) receive their awards.


Are you registered to vote? What about your family members? Or your staff? Or your colleagues?

In Texas, most key races are decided in the party primaries. Those will be held on March 6. To vote in the primary for either party, you must be registered to vote by February 5.

You can see if you are registered at

Texas does not allow on-line voter registration. You must fill out an application and mail it in or give it to a volunteer deputy registrar from your county.

If you would like registration applications, please contact Scot Kibbe, THCA Director of Government Relations, at

Information is also available at

The voice of long term care needs to be heard at the ballot box. Please register to vote and encourage others to do the same and then vote for candidates who support quality care.